Physician & professional Medicaid rates by code
7,838 physician & professional codes with published Medicaid rates in five or more states. Each page compares every state's rate, unit and managed-care rule.
| Code | Service | States | Median rate |
|---|---|---|---|
| 0001A | Physician and practitioner services (fee schedule) | 8 | $38.47 |
| 0002A | Physician and practitioner services (fee schedule) | 7 | $40.00 |
| 0002M | Physician and practitioner services (fee schedule) | 6 | $478.23 |
| 0003A | Physician and practitioner services (fee schedule) | 5 | $40.00 |
| 0003M | Physician and practitioner services (fee schedule) | 7 | $453.06 |
| 0004A | Physician and practitioner services (fee schedule) | 5 | $40.00 |
| 0004M | Physician and practitioner services (fee schedule) | 9 | $79.00 |
| 0006M | Physician and practitioner services (fee schedule) | 9 | $150.00 |
| 0007M | Physician and practitioner services (fee schedule) | 9 | $375.00 |
| 00100 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00102 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00103 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00104 | Physician and practitioner services (fee schedule) | 37 | $4.00 |
| 0011A | Physician and practitioner services (fee schedule) | 8 | $40.00 |
| 0011M | Physician and practitioner services (fee schedule) | 7 | $684.00 |
| 00120 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00124 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00126 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 0012A | Physician and practitioner services (fee schedule) | 7 | $40.00 |
| 0012M | Physician and practitioner services (fee schedule) | 9 | $684.00 |
| 0013A | Physician and practitioner services (fee schedule) | 5 | $40.00 |
| 0013M | Physician and practitioner services (fee schedule) | 9 | $684.00 |
| 00140 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00142 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00144 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00145 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00147 | Physician and practitioner services (fee schedule) | 35 | $6.00 |
| 00148 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 0015M | Physician and practitioner services (fee schedule) | 7 | $1,174.83 |
| 00160 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00162 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 00164 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 0016M | Physician and practitioner services (fee schedule) | 9 | $3,140.67 |
| 00170 | Physician and practitioner services (fee schedule) | 38 | $5.00 |
| 00172 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00174 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00176 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 00190 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00192 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 0020M | Physician and practitioner services (fee schedule) | 7 | $2,250.00 |
| 00210 | Physician and practitioner services (fee schedule) | 36 | $11.00 |
| 00211 | Physician and practitioner services (fee schedule) | 35 | $10.00 |
| 00212 | Physician and practitioner services (fee schedule) | 35 | $5.00 |
| 00214 | Physician and practitioner services (fee schedule) | 36 | $9.00 |
| 00215 | Physician and practitioner services (fee schedule) | 36 | $9.00 |
| 00216 | Physician and practitioner services (fee schedule) | 36 | $15.00 |
| 00218 | Physician and practitioner services (fee schedule) | 36 | $13.00 |
| 00220 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 00222 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00300 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 0031A | Physician and practitioner services (fee schedule) | 8 | $39.99 |
| 00320 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00322 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 00326 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 0034A | Physician and practitioner services (fee schedule) | 6 | $40.00 |
| 00350 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 00352 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00400 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 00402 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00404 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00406 | Physician and practitioner services (fee schedule) | 36 | $13.00 |
| 00410 | Physician and practitioner services (fee schedule) | 37 | $4.00 |
| 00450 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00454 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 00470 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00472 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 00474 | Physician and practitioner services (fee schedule) | 36 | $13.00 |
| 00500 | Physician and practitioner services (fee schedule) | 36 | $15.00 |
| 0051A | Physician and practitioner services (fee schedule) | 5 | $40.00 |
| 00520 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00522 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00524 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00528 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 00529 | Physician and practitioner services (fee schedule) | 35 | $11.00 |
| 00530 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00532 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00534 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 00537 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 00539 | Physician and practitioner services (fee schedule) | 36 | $18.00 |
| 00540 | Physician and practitioner services (fee schedule) | 36 | $12.00 |
| 00541 | Physician and practitioner services (fee schedule) | 36 | $15.00 |
| 00542 | Physician and practitioner services (fee schedule) | 36 | $15.00 |
| 00546 | Physician and practitioner services (fee schedule) | 36 | $15.00 |
| 00548 | Physician and practitioner services (fee schedule) | 36 | $17.00 |
| 00550 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 00560 | Physician and practitioner services (fee schedule) | 36 | $15.00 |
| 00561 | Physician and practitioner services (fee schedule) | 36 | $25.00 |
| 00562 | Physician and practitioner services (fee schedule) | 36 | $20.00 |
| 00563 | Physician and practitioner services (fee schedule) | 36 | $25.00 |
| 00566 | Physician and practitioner services (fee schedule) | 36 | $25.00 |
| 00567 | Physician and practitioner services (fee schedule) | 34 | $18.00 |
| 00580 | Physician and practitioner services (fee schedule) | 36 | $20.00 |
| 00600 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 00604 | Physician and practitioner services (fee schedule) | 36 | $13.00 |
| 00620 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 00625 | Physician and practitioner services (fee schedule) | 35 | $13.00 |
| 00626 | Physician and practitioner services (fee schedule) | 35 | $15.00 |
| 00630 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 00632 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 00635 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00640 | Physician and practitioner services (fee schedule) | 35 | $3.00 |
| 0064A | Physician and practitioner services (fee schedule) | 6 | $40.00 |
| 00670 | Physician and practitioner services (fee schedule) | 36 | $13.00 |
| 00700 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00702 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 0071A | Physician and practitioner services (fee schedule) | 5 | $40.00 |
| 0072A | Physician and practitioner services (fee schedule) | 6 | $40.00 |
| 00730 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00731 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00732 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 0073A | Physician and practitioner services (fee schedule) | 5 | $40.00 |
| 0074A | Physician and practitioner services (fee schedule) | 5 | $40.00 |
| 00750 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00752 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00754 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 00756 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 0075T | Physician and practitioner services (fee schedule) | 5 | $795.03 |
| 00770 | Physician and practitioner services (fee schedule) | 36 | $15.00 |
| 00790 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 00792 | Physician and practitioner services (fee schedule) | 36 | $13.00 |
| 00794 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 00796 | Physician and practitioner services (fee schedule) | 36 | $30.00 |
| 00797 | Physician and practitioner services (fee schedule) | 35 | $11.00 |
| 00800 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00802 | Physician and practitioner services (fee schedule) | 35 | $5.00 |
| 00811 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00812 | Physician and practitioner services (fee schedule) | 36 | $3.50 |
| 00813 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00820 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00830 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00832 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00834 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00836 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00840 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00842 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00844 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 00846 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 00848 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 00851 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00860 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00862 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 00864 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 00865 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 00866 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 00868 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 00870 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00872 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 00873 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00880 | Physician and practitioner services (fee schedule) | 36 | $15.00 |
| 00882 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 00902 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00904 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 00906 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00908 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00910 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 00912 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00914 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00916 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00918 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00920 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 00921 | Physician and practitioner services (fee schedule) | 34 | $3.00 |
| 00922 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00924 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00926 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00928 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00930 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00932 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00934 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00936 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 00938 | Physician and practitioner services (fee schedule) | 28 | $4.00 |
| 00940 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 00942 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00944 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 00948 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 00950 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 00952 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 0101T | Physician and practitioner services (fee schedule) | 8 | $130.54 |
| 0102T | Physician and practitioner services (fee schedule) | 8 | $1,584.14 |
| 01112 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01120 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 01130 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01140 | Physician and practitioner services (fee schedule) | 36 | $15.00 |
| 01150 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 01160 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01170 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 01173 | Physician and practitioner services (fee schedule) | 36 | $12.00 |
| 01200 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01202 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01210 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 01212 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 01214 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 01215 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 01220 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01230 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 01232 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01234 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 01250 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01260 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01270 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 01272 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01274 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 01320 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01340 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01360 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01380 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01382 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01390 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01392 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01400 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01402 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 01404 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01420 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01430 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01432 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 01440 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 01442 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 01444 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 01462 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01464 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01470 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01472 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01474 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01480 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01482 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01484 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01486 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 01490 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01500 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 01502 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 01520 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01522 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01610 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01620 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01622 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01630 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01634 | Physician and practitioner services (fee schedule) | 36 | $9.00 |
| 01636 | Physician and practitioner services (fee schedule) | 36 | $15.00 |
| 01638 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 01650 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 01652 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 01654 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 01656 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 01670 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01680 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01710 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01712 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01714 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01716 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01730 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01732 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01740 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01742 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01744 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01756 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 01758 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01760 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 01770 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 01772 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 01780 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01782 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01810 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01820 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01829 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01830 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01832 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 01840 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 01842 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 01844 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 0184T | Physician and practitioner services (fee schedule) | 5 | $835.25 |
| 01850 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01852 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01860 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01916 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01920 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 01922 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 01924 | Physician and practitioner services (fee schedule) | 36 | $6.00 |
| 01925 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 01926 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 01930 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01931 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 01932 | Physician and practitioner services (fee schedule) | 36 | $7.00 |
| 01933 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 01935 | Anesthesia base units (per procedure) | 6 | $16.13 |
| 01936 | Anesthesia base units (per procedure) | 6 | $16.13 |
| 01937 | Anesthesia base units (per procedure) | 35 | $4.00 |
| 01938 | Anesthesia base units (per procedure) | 35 | $4.00 |
| 01939 | Anesthesia base units (per procedure) | 34 | $4.00 |
| 01940 | Anesthesia base units (per procedure) | 35 | $4.00 |
| 01941 | Anesthesia base units (per procedure) | 35 | $5.00 |
| 01942 | Anesthesia base units (per procedure) | 35 | $5.00 |
| 01951 | Physician and practitioner services (fee schedule) | 36 | $3.00 |
| 01952 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01953 | Physician and practitioner services (fee schedule) | 32 | $10.79 |
| 01958 | Physician and practitioner services (fee schedule) | 33 | $5.00 |
| 01960 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01961 | Physician and practitioner services (fee schedule) | 37 | $7.00 |
| 01962 | Physician and practitioner services (fee schedule) | 36 | $8.00 |
| 01963 | Physician and practitioner services (fee schedule) | 36 | $10.00 |
| 01965 | Physician and practitioner services (fee schedule) | 36 | $4.00 |
| 01966 | Physician and practitioner services (fee schedule) | 35 | $4.00 |
| 01967 | Physician and practitioner services (fee schedule) | 37 | $10.84 |
| 01968 | Physician and practitioner services (fee schedule) | 36 | $6.87 |
| 01969 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01990 | Physician and practitioner services (fee schedule) | 24 | $7.00 |
| 01991 | Physician and practitioner services (fee schedule) | 35 | $3.00 |
| 01992 | Physician and practitioner services (fee schedule) | 35 | $5.00 |
| 01996 | Physician and practitioner services (fee schedule) | 38 | $26.28 |
| 01999 | Physician and practitioner services (fee schedule) | 11 | $22.80 |
| 0202U | Physician and practitioner services (fee schedule) | 23 | $375.10 |
| 0213T | Physician and practitioner services (fee schedule) | 5 | $125.46 |
| 0214T | Physician and practitioner services (fee schedule) | 5 | $69.86 |
| 0215T | Physician and practitioner services (fee schedule) | 5 | $71.16 |
| 0216T | Physician and practitioner services (fee schedule) | 5 | $106.19 |
| 0217T | Physician and practitioner services (fee schedule) | 5 | $59.41 |
| 0218T | Physician and practitioner services (fee schedule) | 5 | $60.30 |
| 0223U | Physician and practitioner services (fee schedule) | 17 | $375.10 |
| 0255U | Physician and practitioner services (fee schedule) | 6 | $30.02 |
| 0402T | Physician and practitioner services (fee schedule) | 11 | $422.81 |
| 0403T | Physician and practitioner services (fee schedule) | 8 | $26.23 |
| 0408U | Physician and practitioner services (fee schedule) | 9 | $14.13 |
| 0460U | Physician and practitioner services (fee schedule) | 6 | $871.23 |
| 0461U | Physician and practitioner services (fee schedule) | 6 | $871.23 |
| 0463U | Physician and practitioner services (fee schedule) | 6 | $684.00 |
| 0466U | Physician and practitioner services (fee schedule) | 6 | $328.16 |
| 0470U | Physician and practitioner services (fee schedule) | 6 | $568.02 |
| 0472U | Physician and practitioner services (fee schedule) | 6 | $26.51 |
| 0478U | Physician and practitioner services (fee schedule) | 7 | $552.99 |
| 0479T | Physician and practitioner services (fee schedule) | 8 | $216.36 |
| 0480T | Physician and practitioner services (fee schedule) | 7 | $64.83 |
| 0485U | Physician and practitioner services (fee schedule) | 8 | $3,649.48 |
| 0486U | Physician and practitioner services (fee schedule) | 7 | $1,644.25 |
| 0489U | Physician and practitioner services (fee schedule) | 8 | $1,095.94 |
| 0496U | Physician and practitioner services (fee schedule) | 7 | $485.86 |
| 0501U | Physician and practitioner services (fee schedule) | 7 | $192.00 |
| 0509T | Physician and practitioner services (fee schedule) | 7 | $43.74 |
| 0510U | Physician and practitioner services (fee schedule) | 7 | $473.91 |
| 0515T | Physician and practitioner services (fee schedule) | 7 | $11,483.76 |
| 0516T | Physician and practitioner services (fee schedule) | 7 | $4,995.58 |
| 0517T | Physician and practitioner services (fee schedule) | 7 | $4,995.58 |
| 0518T | Physician and practitioner services (fee schedule) | 7 | $1,987.59 |
| 0520T | Physician and practitioner services (fee schedule) | 7 | $4,970.91 |
| 0524T | Physician and practitioner services (fee schedule) | 9 | $1,578.49 |
| 0526T | Physician and practitioner services (fee schedule) | 9 | $4,265.23 |
| 0531T | Physician and practitioner services (fee schedule) | 9 | $1,987.59 |
| 0532T | Physician and practitioner services (fee schedule) | 9 | $1,987.59 |
| 0583T | Physician and practitioner services (fee schedule) | 8 | $176.54 |
| 0600T | Physician and practitioner services (fee schedule) | 8 | $4,440.03 |
| 0601T | Physician and practitioner services (fee schedule) | 8 | $4,423.45 |
| 0627T | Physician and practitioner services (fee schedule) | 8 | $6,283.03 |
| 0629T | Physician and practitioner services (fee schedule) | 8 | $6,404.70 |
| 0689T | Physician and practitioner services (fee schedule) | 9 | $27.10 |
| 0817T | Physician and practitioner services (fee schedule) | 8 | $8,801.13 |
| 0818T | Physician and practitioner services (fee schedule) | 8 | $1,473.41 |
| 0819T | Physician and practitioner services (fee schedule) | 8 | $1,473.41 |
| 0861T | Physician and practitioner services (fee schedule) | 6 | $1,538.71 |
| 0862T | Physician and practitioner services (fee schedule) | 6 | $830.01 |
| 0863T | Physician and practitioner services (fee schedule) | 6 | $830.01 |
| 0950T | Physician and practitioner services (fee schedule) | 6 | $4,306.16 |
| 0958T | Physician and practitioner services (fee schedule) | 6 | $1,209.73 |
| 0959T | Physician and practitioner services (fee schedule) | 6 | $545.74 |
| 0962T | Physician and practitioner services (fee schedule) | 6 | $54.09 |
| 0964T | Physician and practitioner services (fee schedule) | 6 | $1,088.84 |
| 0965T | Physician and practitioner services (fee schedule) | 6 | $1,088.84 |
| 0966T | Physician and practitioner services (fee schedule) | 6 | $1,088.84 |
| 0970T | Physician and practitioner services (fee schedule) | 6 | $1,312.87 |
| 0971T | Physician and practitioner services (fee schedule) | 6 | $1,312.87 |
| 0973T | Physician and practitioner services (fee schedule) | 6 | $164.01 |
| 0975T | Physician and practitioner services (fee schedule) | 6 | $164.01 |
| 0977T | Physician and practitioner services (fee schedule) | 6 | $366.15 |
| 0989T | Physician and practitioner services (fee schedule) | 6 | $1,473.41 |
| 10004 | Physician and practitioner services (fee schedule) | 44 | $38.68 |
| 10005 | Physician and practitioner services (fee schedule) | 45 | $83.72 |
| 10006 | Physician and practitioner services (fee schedule) | 45 | $45.25 |
| 10007 | Physician and practitioner services (fee schedule) | 45 | $180.37 |
| 10008 | Physician and practitioner services (fee schedule) | 45 | $83.93 |
| 10009 | Physician and practitioner services (fee schedule) | 45 | $263.06 |
| 10010 | Physician and practitioner services (fee schedule) | 45 | $139.41 |
| 10011 | Physician and practitioner services (fee schedule) | 22 | $114.47 |
| 10012 | Physician and practitioner services (fee schedule) | 21 | $131.31 |
| 10021 | Physician and practitioner services (fee schedule) | 45 | $68.56 |
| 10030 | Physician and practitioner services (fee schedule) | 45 | $326.39 |
| 10035 | Physician and practitioner services (fee schedule) | 44 | $215.39 |
| 10036 | Physician and practitioner services (fee schedule) | 44 | $178.44 |
| 10040 | Physician and practitioner services (fee schedule) | 41 | $72.21 |
| 10060 | Physician and practitioner services (fee schedule) | 45 | $87.02 |
| 10061 | Physician and practitioner services (fee schedule) | 45 | $150.46 |
| 10080 | Physician and practitioner services (fee schedule) | 45 | $115.26 |
| 10081 | Physician and practitioner services (fee schedule) | 45 | $187.27 |
| 10120 | Physician and practitioner services (fee schedule) | 45 | $96.39 |
| 10121 | Physician and practitioner services (fee schedule) | 45 | $165.54 |
| 10140 | Physician and practitioner services (fee schedule) | 45 | $106.13 |
| 10160 | Physician and practitioner services (fee schedule) | 45 | $83.69 |
| 10180 | Physician and practitioner services (fee schedule) | 45 | $165.58 |
| 1025T | Physician and practitioner services (fee schedule) | 7 | $69.88 |
| 11000 | Physician and practitioner services (fee schedule) | 45 | $36.55 |
| 11001 | Physician and practitioner services (fee schedule) | 45 | $16.93 |
| 11004 | Physician and practitioner services (fee schedule) | 45 | $436.33 |
| 11005 | Physician and practitioner services (fee schedule) | 45 | $581.92 |
| 11006 | Physician and practitioner services (fee schedule) | 45 | $540.51 |
| 11008 | Physician and practitioner services (fee schedule) | 45 | $208.64 |
| 11010 | Physician and practitioner services (fee schedule) | 45 | $275.93 |
| 11011 | Physician and practitioner services (fee schedule) | 45 | $303.31 |
| 11012 | Physician and practitioner services (fee schedule) | 45 | $414.55 |
| 11042 | Physician and practitioner services (fee schedule) | 45 | $78.71 |
| 11043 | Physician and practitioner services (fee schedule) | 45 | $164.23 |
| 11044 | Physician and practitioner services (fee schedule) | 45 | $218.19 |
| 11045 | Physician and practitioner services (fee schedule) | 44 | $25.95 |
| 11046 | Physician and practitioner services (fee schedule) | 44 | $48.58 |
| 11047 | Physician and practitioner services (fee schedule) | 44 | $83.90 |
| 11055 | Physician and practitioner services (fee schedule) | 45 | $30.69 |
| 11056 | Physician and practitioner services (fee schedule) | 45 | $35.45 |
| 11057 | Physician and practitioner services (fee schedule) | 45 | $41.79 |
| 11102 | Physician and practitioner services (fee schedule) | 45 | $66.99 |
| 11103 | Physician and practitioner services (fee schedule) | 45 | $33.33 |
| 11104 | Physician and practitioner services (fee schedule) | 45 | $81.27 |
| 11105 | Physician and practitioner services (fee schedule) | 45 | $40.62 |
| 11106 | Physician and practitioner services (fee schedule) | 45 | $96.49 |
| 11107 | Physician and practitioner services (fee schedule) | 45 | $47.42 |
| 11200 | Physician and practitioner services (fee schedule) | 44 | $61.93 |
| 11201 | Physician and practitioner services (fee schedule) | 43 | $14.62 |
| 11300 | Physician and practitioner services (fee schedule) | 45 | $44.47 |
| 11301 | Physician and practitioner services (fee schedule) | 45 | $60.30 |
| 11302 | Physician and practitioner services (fee schedule) | 45 | $73.01 |
| 11303 | Physician and practitioner services (fee schedule) | 45 | $89.89 |
| 11305 | Physician and practitioner services (fee schedule) | 45 | $47.91 |
| 11306 | Physician and practitioner services (fee schedule) | 45 | $72.18 |
| 11307 | Physician and practitioner services (fee schedule) | 45 | $82.08 |
| 11308 | Physician and practitioner services (fee schedule) | 45 | $94.92 |
| 11310 | Physician and practitioner services (fee schedule) | 45 | $56.43 |
| 11311 | Physician and practitioner services (fee schedule) | 45 | $72.37 |
| 11312 | Physician and practitioner services (fee schedule) | 45 | $83.40 |
| 11313 | Physician and practitioner services (fee schedule) | 45 | $109.12 |
| 11400 | Physician and practitioner services (fee schedule) | 45 | $81.58 |
| 11401 | Physician and practitioner services (fee schedule) | 45 | $98.83 |
| 11402 | Physician and practitioner services (fee schedule) | 45 | $114.92 |
| 11403 | Physician and practitioner services (fee schedule) | 45 | $134.93 |
| 11404 | Physician and practitioner services (fee schedule) | 45 | $155.21 |
| 11406 | Physician and practitioner services (fee schedule) | 45 | $225.00 |
| 11420 | Physician and practitioner services (fee schedule) | 45 | $79.66 |
| 11421 | Physician and practitioner services (fee schedule) | 45 | $105.40 |
| 11422 | Physician and practitioner services (fee schedule) | 45 | $121.51 |
| 11423 | Physician and practitioner services (fee schedule) | 45 | $144.69 |
| 11424 | Physician and practitioner services (fee schedule) | 45 | $166.41 |
| 11426 | Physician and practitioner services (fee schedule) | 45 | $240.13 |
| 11440 | Physician and practitioner services (fee schedule) | 45 | $94.60 |
| 11441 | Physician and practitioner services (fee schedule) | 45 | $117.20 |
| 11442 | Physician and practitioner services (fee schedule) | 45 | $131.28 |
| 11443 | Physician and practitioner services (fee schedule) | 45 | $163.78 |
| 11444 | Physician and practitioner services (fee schedule) | 45 | $206.75 |
| 11446 | Physician and practitioner services (fee schedule) | 45 | $276.90 |
| 11450 | Physician and practitioner services (fee schedule) | 44 | $265.82 |
| 11451 | Physician and practitioner services (fee schedule) | 44 | $338.47 |
| 11462 | Physician and practitioner services (fee schedule) | 44 | $261.85 |
| 11463 | Physician and practitioner services (fee schedule) | 44 | $333.36 |
| 11470 | Physician and practitioner services (fee schedule) | 44 | $284.59 |
| 11471 | Physician and practitioner services (fee schedule) | 45 | $340.24 |
| 11600 | Physician and practitioner services (fee schedule) | 45 | $125.49 |
| 11601 | Physician and practitioner services (fee schedule) | 45 | $144.84 |
| 11602 | Physician and practitioner services (fee schedule) | 45 | $159.77 |
| 11603 | Physician and practitioner services (fee schedule) | 45 | $177.02 |
| 11604 | Physician and practitioner services (fee schedule) | 45 | $198.30 |
| 11606 | Physician and practitioner services (fee schedule) | 45 | $290.31 |
| 11620 | Physician and practitioner services (fee schedule) | 45 | $123.86 |
| 11621 | Physician and practitioner services (fee schedule) | 45 | $145.69 |
| 11622 | Physician and practitioner services (fee schedule) | 45 | $168.72 |
| 11623 | Physician and practitioner services (fee schedule) | 45 | $200.95 |
| 11624 | Physician and practitioner services (fee schedule) | 45 | $231.35 |
| 11626 | Physician and practitioner services (fee schedule) | 45 | $288.34 |
| 11640 | Physician and practitioner services (fee schedule) | 45 | $129.44 |
| 11641 | Physician and practitioner services (fee schedule) | 45 | $163.78 |
| 11642 | Physician and practitioner services (fee schedule) | 45 | $192.41 |
| 11643 | Physician and practitioner services (fee schedule) | 45 | $231.17 |
| 11644 | Physician and practitioner services (fee schedule) | 45 | $281.90 |
| 11646 | Physician and practitioner services (fee schedule) | 45 | $373.92 |
| 11719 | Physician and practitioner services (fee schedule) | 39 | $9.61 |
| 11720 | Physician and practitioner services (fee schedule) | 45 | $20.48 |
| 11721 | Physician and practitioner services (fee schedule) | 45 | $30.70 |
| 11730 | Physician and practitioner services (fee schedule) | 45 | $69.87 |
| 11732 | Physician and practitioner services (fee schedule) | 45 | $23.34 |
| 11740 | Physician and practitioner services (fee schedule) | 45 | $34.44 |
| 11750 | Physician and practitioner services (fee schedule) | 45 | $119.03 |
| 11755 | Physician and practitioner services (fee schedule) | 45 | $80.21 |
| 11760 | Physician and practitioner services (fee schedule) | 45 | $114.55 |
| 11762 | Physician and practitioner services (fee schedule) | 45 | $187.65 |
| 11765 | Physician and practitioner services (fee schedule) | 45 | $98.08 |
| 11770 | Physician and practitioner services (fee schedule) | 45 | $192.96 |
| 11771 | Physician and practitioner services (fee schedule) | 45 | $396.93 |
| 11772 | Physician and practitioner services (fee schedule) | 45 | $519.41 |
| 11900 | Physician and practitioner services (fee schedule) | 43 | $32.68 |
| 11901 | Physician and practitioner services (fee schedule) | 43 | $43.88 |
| 11920 | Physician and practitioner services (fee schedule) | 37 | $125.75 |
| 11921 | Physician and practitioner services (fee schedule) | 37 | $143.88 |
| 11922 | Physician and practitioner services (fee schedule) | 28 | $42.94 |
| 11950 | Physician and practitioner services (fee schedule) | 25 | $59.24 |
| 11951 | Physician and practitioner services (fee schedule) | 25 | $74.76 |
| 11952 | Physician and practitioner services (fee schedule) | 24 | $101.68 |
| 11954 | Physician and practitioner services (fee schedule) | 26 | $110.21 |
| 11960 | Physician and practitioner services (fee schedule) | 45 | $737.49 |
| 11970 | Physician and practitioner services (fee schedule) | 45 | $448.21 |
| 11971 | Physician and practitioner services (fee schedule) | 45 | $363.32 |
| 11976 | Physician and practitioner services (fee schedule) | 45 | $101.99 |
| 11980 | Physician and practitioner services (fee schedule) | 43 | $72.81 |
| 11981 | Physician and practitioner services (fee schedule) | 45 | $80.88 |
| 11982 | Physician and practitioner services (fee schedule) | 45 | $89.45 |
| 11983 | Physician and practitioner services (fee schedule) | 45 | $117.79 |
| 12001 | Physician and practitioner services (fee schedule) | 45 | $69.99 |
| 12002 | Physician and practitioner services (fee schedule) | 45 | $83.90 |
| 12004 | Physician and practitioner services (fee schedule) | 45 | $103.31 |
| 12005 | Physician and practitioner services (fee schedule) | 45 | $125.75 |
| 12006 | Physician and practitioner services (fee schedule) | 45 | $160.79 |
| 12007 | Physician and practitioner services (fee schedule) | 44 | $175.03 |
| 12011 | Physician and practitioner services (fee schedule) | 45 | $77.80 |
| 12013 | Physician and practitioner services (fee schedule) | 45 | $89.14 |
| 12014 | Physician and practitioner services (fee schedule) | 45 | $108.17 |
| 12015 | Physician and practitioner services (fee schedule) | 45 | $138.14 |
| 12016 | Physician and practitioner services (fee schedule) | 45 | $171.93 |
| 12017 | Physician and practitioner services (fee schedule) | 45 | $133.68 |
| 12018 | Physician and practitioner services (fee schedule) | 44 | $152.18 |
| 12020 | Physician and practitioner services (fee schedule) | 44 | $189.54 |
| 12021 | Physician and practitioner services (fee schedule) | 43 | $124.88 |
| 12031 | Physician and practitioner services (fee schedule) | 45 | $155.65 |
| 12032 | Physician and practitioner services (fee schedule) | 45 | $191.27 |
| 12034 | Physician and practitioner services (fee schedule) | 45 | $208.33 |
| 12035 | Physician and practitioner services (fee schedule) | 45 | $242.46 |
| 12036 | Physician and practitioner services (fee schedule) | 45 | $273.02 |
| 12037 | Physician and practitioner services (fee schedule) | 45 | $306.05 |
| 12041 | Physician and practitioner services (fee schedule) | 45 | $152.15 |
| 12042 | Physician and practitioner services (fee schedule) | 45 | $188.67 |
| 12044 | Physician and practitioner services (fee schedule) | 45 | $216.70 |
| 12045 | Physician and practitioner services (fee schedule) | 45 | $247.94 |
| 12046 | Physician and practitioner services (fee schedule) | 45 | $306.38 |
| 12047 | Physician and practitioner services (fee schedule) | 44 | $320.43 |
| 12051 | Physician and practitioner services (fee schedule) | 45 | $162.33 |
| 12052 | Physician and practitioner services (fee schedule) | 45 | $198.94 |
| 12053 | Physician and practitioner services (fee schedule) | 45 | $196.04 |
| 12054 | Physician and practitioner services (fee schedule) | 45 | $206.14 |
| 12055 | Physician and practitioner services (fee schedule) | 45 | $286.89 |
| 12056 | Physician and practitioner services (fee schedule) | 45 | $388.43 |
| 12057 | Physician and practitioner services (fee schedule) | 44 | $388.77 |
| 13100 | Physician and practitioner services (fee schedule) | 45 | $215.56 |
| 13101 | Physician and practitioner services (fee schedule) | 45 | $249.98 |
| 13102 | Physician and practitioner services (fee schedule) | 44 | $74.47 |
| 13120 | Physician and practitioner services (fee schedule) | 45 | $223.86 |
| 13121 | Physician and practitioner services (fee schedule) | 45 | $264.78 |
| 13122 | Physician and practitioner services (fee schedule) | 44 | $80.96 |
| 13131 | Physician and practitioner services (fee schedule) | 45 | $243.46 |
| 13132 | Physician and practitioner services (fee schedule) | 45 | $324.85 |
| 13133 | Physician and practitioner services (fee schedule) | 44 | $115.73 |
| 13151 | Physician and practitioner services (fee schedule) | 45 | $278.96 |
| 13152 | Physician and practitioner services (fee schedule) | 45 | $337.30 |
| 13153 | Physician and practitioner services (fee schedule) | 44 | $128.40 |
| 13160 | Physician and practitioner services (fee schedule) | 45 | $583.96 |
| 14000 | Physician and practitioner services (fee schedule) | 45 | $425.57 |
| 14001 | Physician and practitioner services (fee schedule) | 45 | $530.28 |
| 14020 | Physician and practitioner services (fee schedule) | 45 | $464.32 |
| 14021 | Physician and practitioner services (fee schedule) | 45 | $596.91 |
| 14040 | Physician and practitioner services (fee schedule) | 45 | $524.36 |
| 14041 | Physician and practitioner services (fee schedule) | 45 | $672.17 |
| 14060 | Physician and practitioner services (fee schedule) | 45 | $551.28 |
| 14061 | Physician and practitioner services (fee schedule) | 45 | $724.81 |
| 14301 | Physician and practitioner services (fee schedule) | 45 | $731.15 |
| 14302 | Physician and practitioner services (fee schedule) | 44 | $160.32 |
| 14350 | Physician and practitioner services (fee schedule) | 45 | $505.42 |
| 15002 | Physician and practitioner services (fee schedule) | 45 | $222.05 |
| 15003 | Physician and practitioner services (fee schedule) | 44 | $48.23 |
| 15004 | Physician and practitioner services (fee schedule) | 45 | $268.62 |
| 15005 | Physician and practitioner services (fee schedule) | 44 | $84.78 |
| 15011 | Physician and practitioner services (fee schedule) | 15 | $119.30 |
| 15012 | Physician and practitioner services (fee schedule) | 16 | $112.28 |
| 15013 | Physician and practitioner services (fee schedule) | 16 | $67.20 |
| 15014 | Physician and practitioner services (fee schedule) | 16 | $58.06 |
| 15015 | Physician and practitioner services (fee schedule) | 16 | $530.33 |
| 15016 | Physician and practitioner services (fee schedule) | 16 | $87.50 |
| 15017 | Physician and practitioner services (fee schedule) | 16 | $565.18 |
| 15018 | Physician and practitioner services (fee schedule) | 15 | $107.96 |
| 15040 | Physician and practitioner services (fee schedule) | 42 | $182.71 |
| 15050 | Physician and practitioner services (fee schedule) | 45 | $371.24 |
| 15100 | Physician and practitioner services (fee schedule) | 45 | $588.31 |
| 15101 | Physician and practitioner services (fee schedule) | 44 | $122.81 |
| 15110 | Physician and practitioner services (fee schedule) | 45 | $604.27 |
| 15111 | Physician and practitioner services (fee schedule) | 45 | $92.34 |
| 15115 | Physician and practitioner services (fee schedule) | 45 | $624.35 |
| 15116 | Physician and practitioner services (fee schedule) | 45 | $124.64 |
| 15120 | Physician and practitioner services (fee schedule) | 45 | $603.90 |
| 15121 | Physician and practitioner services (fee schedule) | 44 | $149.65 |
| 15130 | Physician and practitioner services (fee schedule) | 45 | $527.77 |
| 15131 | Physician and practitioner services (fee schedule) | 45 | $75.64 |
| 15135 | Physician and practitioner services (fee schedule) | 45 | $668.28 |
| 15136 | Physician and practitioner services (fee schedule) | 45 | $74.35 |
| 15150 | Physician and practitioner services (fee schedule) | 44 | $539.06 |
| 15151 | Physician and practitioner services (fee schedule) | 44 | $96.35 |
| 15152 | Physician and practitioner services (fee schedule) | 44 | $119.99 |
| 15155 | Physician and practitioner services (fee schedule) | 44 | $570.87 |
| 15156 | Physician and practitioner services (fee schedule) | 44 | $130.42 |
| 15157 | Physician and practitioner services (fee schedule) | 44 | $143.86 |
| 15200 | Physician and practitioner services (fee schedule) | 45 | $558.49 |
| 15201 | Physician and practitioner services (fee schedule) | 44 | $89.60 |
| 15220 | Physician and practitioner services (fee schedule) | 45 | $514.75 |
| 15221 | Physician and practitioner services (fee schedule) | 44 | $89.87 |
| 15240 | Physician and practitioner services (fee schedule) | 45 | $651.42 |
| 15241 | Physician and practitioner services (fee schedule) | 44 | $121.92 |
| 15260 | Physician and practitioner services (fee schedule) | 45 | $693.00 |
| 15261 | Physician and practitioner services (fee schedule) | 44 | $141.22 |
| 15271 | Physician and practitioner services (fee schedule) | 45 | $98.04 |
| 15272 | Physician and practitioner services (fee schedule) | 44 | $17.86 |
| 15273 | Physician and practitioner services (fee schedule) | 45 | $205.33 |
| 15274 | Physician and practitioner services (fee schedule) | 44 | $52.97 |
| 15275 | Physician and practitioner services (fee schedule) | 45 | $104.93 |
| 15276 | Physician and practitioner services (fee schedule) | 44 | $23.91 |
| 15277 | Physician and practitioner services (fee schedule) | 45 | $231.57 |
| 15278 | Physician and practitioner services (fee schedule) | 45 | $64.54 |
| 15570 | Physician and practitioner services (fee schedule) | 45 | $610.39 |
| 15572 | Physician and practitioner services (fee schedule) | 45 | $628.90 |
| 15574 | Physician and practitioner services (fee schedule) | 45 | $639.90 |
| 15576 | Physician and practitioner services (fee schedule) | 45 | $545.07 |
| 15600 | Physician and practitioner services (fee schedule) | 45 | $218.07 |
| 15610 | Physician and practitioner services (fee schedule) | 45 | $233.35 |
| 15620 | Physician and practitioner services (fee schedule) | 45 | $298.32 |
| 15630 | Physician and practitioner services (fee schedule) | 45 | $316.47 |
| 15650 | Physician and practitioner services (fee schedule) | 45 | $343.04 |
| 15730 | Physician and practitioner services (fee schedule) | 45 | $970.63 |
| 15731 | Physician and practitioner services (fee schedule) | 45 | $798.99 |
| 15733 | Physician and practitioner services (fee schedule) | 45 | $801.14 |
| 15734 | Physician and practitioner services (fee schedule) | 44 | $1,075.97 |
| 15736 | Physician and practitioner services (fee schedule) | 43 | $943.57 |
| 15738 | Physician and practitioner services (fee schedule) | 44 | $915.60 |
| 15740 | Physician and practitioner services (fee schedule) | 45 | $691.23 |
| 15750 | Physician and practitioner services (fee schedule) | 44 | $679.66 |
| 15756 | Physician and practitioner services (fee schedule) | 45 | $1,677.65 |
| 15757 | Physician and practitioner services (fee schedule) | 45 | $1,664.70 |
| 15758 | Physician and practitioner services (fee schedule) | 45 | $1,660.66 |
| 15760 | Physician and practitioner services (fee schedule) | 45 | $580.11 |
| 15769 | Physician and practitioner services (fee schedule) | 45 | $385.35 |
| 15770 | Physician and practitioner services (fee schedule) | 44 | $482.94 |
| 15771 | Physician and practitioner services (fee schedule) | 40 | $452.48 |
| 15772 | Physician and practitioner services (fee schedule) | 40 | $140.74 |
| 15773 | Physician and practitioner services (fee schedule) | 38 | $439.15 |
| 15774 | Physician and practitioner services (fee schedule) | 38 | $131.87 |
| 15775 | Physician and practitioner services (fee schedule) | 7 | $256.45 |
| 15776 | Physician and practitioner services (fee schedule) | 9 | $347.19 |
| 15777 | Physician and practitioner services (fee schedule) | 43 | $173.53 |
| 15778 | Physician and practitioner services (fee schedule) | 38 | $287.83 |
| 15780 | Physician and practitioner services (fee schedule) | 29 | $528.03 |
| 15781 | Physician and practitioner services (fee schedule) | 31 | $331.85 |
| 15782 | Physician and practitioner services (fee schedule) | 30 | $312.70 |
| 15783 | Physician and practitioner services (fee schedule) | 23 | $269.18 |
| 15786 | Physician and practitioner services (fee schedule) | 31 | $113.39 |
| 15787 | Physician and practitioner services (fee schedule) | 31 | $21.39 |
| 15788 | Physician and practitioner services (fee schedule) | 25 | $183.56 |
| 15789 | Physician and practitioner services (fee schedule) | 25 | $315.07 |
| 15792 | Physician and practitioner services (fee schedule) | 26 | $190.16 |
| 15793 | Physician and practitioner services (fee schedule) | 25 | $280.27 |
| 15819 | Physician and practitioner services (fee schedule) | 5 | $603.61 |
| 15820 | Physician and practitioner services (fee schedule) | 37 | $452.59 |
| 15821 | Physician and practitioner services (fee schedule) | 36 | $482.76 |
| 15822 | Physician and practitioner services (fee schedule) | 39 | $360.84 |
| 15823 | Physician and practitioner services (fee schedule) | 43 | $485.78 |
| 15824 | Physician and practitioner services (fee schedule) | 11 | $347.74 |
| 15825 | Physician and practitioner services (fee schedule) | 11 | $502.07 |
| 15826 | Physician and practitioner services (fee schedule) | 11 | $300.76 |
| 15828 | Physician and practitioner services (fee schedule) | 11 | $821.68 |
| 15829 | Physician and practitioner services (fee schedule) | 11 | $895.01 |
| 15830 | Physician and practitioner services (fee schedule) | 42 | $840.90 |
| 15832 | Physician and practitioner services (fee schedule) | 26 | $658.28 |
| 15833 | Physician and practitioner services (fee schedule) | 27 | $620.59 |
| 15834 | Physician and practitioner services (fee schedule) | 27 | $631.24 |
| 15835 | Physician and practitioner services (fee schedule) | 26 | $655.27 |
| 15836 | Physician and practitioner services (fee schedule) | 27 | $545.65 |
| 15837 | Physician and practitioner services (fee schedule) | 25 | $548.24 |
| 15838 | Physician and practitioner services (fee schedule) | 26 | $435.93 |
| 15839 | Physician and practitioner services (fee schedule) | 31 | $572.08 |
| 15840 | Physician and practitioner services (fee schedule) | 44 | $771.57 |
| 15841 | Physician and practitioner services (fee schedule) | 44 | $1,207.30 |
| 15842 | Physician and practitioner services (fee schedule) | 43 | $1,898.51 |
| 15845 | Physician and practitioner services (fee schedule) | 44 | $775.79 |
| 15847 | Physician and practitioner services (fee schedule) | 28 | $315.58 |
| 15851 | Physician and practitioner services (fee schedule) | 43 | $47.29 |
| 15852 | Physician and practitioner services (fee schedule) | 44 | $35.16 |
| 15853 | Physician and practitioner services (fee schedule) | 40 | $9.45 |
| 15854 | Physician and practitioner services (fee schedule) | 40 | $12.62 |
| 15860 | Physician and practitioner services (fee schedule) | 42 | $83.62 |
| 15876 | Physician and practitioner services (fee schedule) | 12 | $289.93 |
| 15877 | Physician and practitioner services (fee schedule) | 9 | $499.59 |
| 15878 | Physician and practitioner services (fee schedule) | 10 | $368.61 |
| 15879 | Physician and practitioner services (fee schedule) | 9 | $464.77 |
| 15920 | Physician and practitioner services (fee schedule) | 45 | $479.86 |
| 15922 | Physician and practitioner services (fee schedule) | 45 | $536.47 |
| 15931 | Physician and practitioner services (fee schedule) | 45 | $523.70 |
| 15933 | Physician and practitioner services (fee schedule) | 45 | $650.06 |
| 15934 | Physician and practitioner services (fee schedule) | 45 | $710.52 |
| 15935 | Physician and practitioner services (fee schedule) | 44 | $778.07 |
| 15936 | Physician and practitioner services (fee schedule) | 45 | $674.49 |
| 15937 | Physician and practitioner services (fee schedule) | 45 | $782.35 |
| 15940 | Physician and practitioner services (fee schedule) | 45 | $520.48 |
| 15941 | Physician and practitioner services (fee schedule) | 45 | $684.89 |
| 15944 | Physician and practitioner services (fee schedule) | 45 | $681.74 |
| 15945 | Physician and practitioner services (fee schedule) | 44 | $743.04 |
| 15946 | Physician and practitioner services (fee schedule) | 44 | $1,160.75 |
| 15950 | Physician and practitioner services (fee schedule) | 45 | $461.05 |
| 15951 | Physician and practitioner services (fee schedule) | 45 | $640.59 |
| 15952 | Physician and practitioner services (fee schedule) | 45 | $625.40 |
| 15953 | Physician and practitioner services (fee schedule) | 44 | $724.32 |
| 15956 | Physician and practitioner services (fee schedule) | 44 | $873.73 |
| 15958 | Physician and practitioner services (fee schedule) | 44 | $891.10 |
| 15999 | Physician and practitioner services (fee schedule) | 8 | $371.87 |
| 16000 | Physician and practitioner services (fee schedule) | 44 | $47.04 |
| 16020 | Physician and practitioner services (fee schedule) | 45 | $53.97 |
| 16025 | Physician and practitioner services (fee schedule) | 45 | $101.99 |
| 16030 | Physician and practitioner services (fee schedule) | 45 | $126.76 |
| 16035 | Physician and practitioner services (fee schedule) | 45 | $156.22 |
| 16036 | Physician and practitioner services (fee schedule) | 45 | $63.66 |
| 17000 | Physician and practitioner services (fee schedule) | 45 | $49.91 |
| 17003 | Physician and practitioner services (fee schedule) | 45 | $5.09 |
| 17004 | Physician and practitioner services (fee schedule) | 45 | $121.75 |
| 17106 | Physician and practitioner services (fee schedule) | 45 | $238.21 |
| 17107 | Physician and practitioner services (fee schedule) | 45 | $353.91 |
| 17108 | Physician and practitioner services (fee schedule) | 45 | $506.02 |
| 17110 | Physician and practitioner services (fee schedule) | 45 | $72.30 |
| 17111 | Physician and practitioner services (fee schedule) | 45 | $86.13 |
| 17250 | Physician and practitioner services (fee schedule) | 45 | $39.12 |
| 17260 | Physician and practitioner services (fee schedule) | 45 | $64.90 |
| 17261 | Physician and practitioner services (fee schedule) | 45 | $90.51 |
| 17262 | Physician and practitioner services (fee schedule) | 45 | $113.24 |
| 17263 | Physician and practitioner services (fee schedule) | 45 | $126.88 |
| 17264 | Physician and practitioner services (fee schedule) | 44 | $134.87 |
| 17266 | Physician and practitioner services (fee schedule) | 44 | $155.74 |
| 17270 | Physician and practitioner services (fee schedule) | 45 | $94.23 |
| 17271 | Physician and practitioner services (fee schedule) | 45 | $108.60 |
| 17272 | Physician and practitioner services (fee schedule) | 45 | $123.83 |
| 17273 | Physician and practitioner services (fee schedule) | 45 | $139.75 |
| 17274 | Physician and practitioner services (fee schedule) | 45 | $170.38 |
| 17276 | Physician and practitioner services (fee schedule) | 45 | $196.29 |
| 17280 | Physician and practitioner services (fee schedule) | 45 | $90.14 |
| 17281 | Physician and practitioner services (fee schedule) | 45 | $121.10 |
| 17282 | Physician and practitioner services (fee schedule) | 45 | $144.56 |
| 17283 | Physician and practitioner services (fee schedule) | 44 | $162.49 |
| 17284 | Physician and practitioner services (fee schedule) | 44 | $198.00 |
| 17286 | Physician and practitioner services (fee schedule) | 44 | $263.17 |
| 17311 | Physician and practitioner services (fee schedule) | 45 | $451.74 |
| 17312 | Physician and practitioner services (fee schedule) | 45 | $273.83 |
| 17313 | Physician and practitioner services (fee schedule) | 45 | $419.44 |
| 17314 | Physician and practitioner services (fee schedule) | 45 | $256.32 |
| 17315 | Physician and practitioner services (fee schedule) | 44 | $54.84 |
| 17340 | Physician and practitioner services (fee schedule) | 38 | $38.26 |
| 17360 | Physician and practitioner services (fee schedule) | 26 | $68.41 |
| 17380 | Physician and practitioner services (fee schedule) | 14 | $57.31 |
| 17999 | Physician and practitioner services (fee schedule) | 11 | $100.00 |
| 19000 | Physician and practitioner services (fee schedule) | 45 | $46.07 |
| 19001 | Physician and practitioner services (fee schedule) | 45 | $19.89 |
| 19020 | Physician and practitioner services (fee schedule) | 45 | $281.90 |
| 19030 | Physician and practitioner services (fee schedule) | 44 | $93.13 |
| 19081 | Physician and practitioner services (fee schedule) | 45 | $256.92 |
| 19082 | Physician and practitioner services (fee schedule) | 45 | $221.99 |
| 19083 | Physician and practitioner services (fee schedule) | 45 | $255.76 |
| 19084 | Physician and practitioner services (fee schedule) | 45 | $227.91 |
| 19085 | Physician and practitioner services (fee schedule) | 45 | $389.36 |
| 19086 | Physician and practitioner services (fee schedule) | 45 | $340.24 |
| 19100 | Physician and practitioner services (fee schedule) | 45 | $94.31 |
| 19101 | Physician and practitioner services (fee schedule) | 45 | $230.57 |
| 19105 | Physician and practitioner services (fee schedule) | 36 | $1,364.73 |
| 19110 | Physician and practitioner services (fee schedule) | 45 | $317.17 |
| 19112 | Physician and practitioner services (fee schedule) | 45 | $286.75 |
| 19120 | Physician and practitioner services (fee schedule) | 44 | $360.69 |
| 19125 | Physician and practitioner services (fee schedule) | 45 | $392.07 |
| 19126 | Physician and practitioner services (fee schedule) | 45 | $123.11 |
| 19281 | Physician and practitioner services (fee schedule) | 45 | $141.63 |
| 19282 | Physician and practitioner services (fee schedule) | 45 | $93.22 |
| 19283 | Physician and practitioner services (fee schedule) | 45 | $152.28 |
| 19284 | Physician and practitioner services (fee schedule) | 45 | $111.45 |
| 19285 | Physician and practitioner services (fee schedule) | 45 | $212.45 |
| 19286 | Physician and practitioner services (fee schedule) | 45 | $172.81 |
| 19287 | Physician and practitioner services (fee schedule) | 45 | $366.22 |
| 19288 | Physician and practitioner services (fee schedule) | 45 | $281.12 |
| 19294 | Physician and practitioner services (fee schedule) | 39 | $130.71 |
| 19296 | Physician and practitioner services (fee schedule) | 41 | $2,546.63 |
| 19297 | Physician and practitioner services (fee schedule) | 42 | $71.01 |
| 19298 | Physician and practitioner services (fee schedule) | 41 | $542.94 |
| 19300 | Physician and practitioner services (fee schedule) | 40 | $385.58 |
| 19301 | Physician and practitioner services (fee schedule) | 44 | $476.51 |
| 19302 | Physician and practitioner services (fee schedule) | 45 | $635.62 |
| 19303 | Physician and practitioner services (fee schedule) | 45 | $683.16 |
| 19305 | Physician and practitioner services (fee schedule) | 45 | $798.77 |
| 19306 | Physician and practitioner services (fee schedule) | 45 | $830.89 |
| 19307 | Physician and practitioner services (fee schedule) | 45 | $835.45 |
| 19316 | Physician and practitioner services (fee schedule) | 41 | $591.22 |
| 19318 | Physician and practitioner services (fee schedule) | 44 | $794.72 |
| 19325 | Physician and practitioner services (fee schedule) | 42 | $466.87 |
| 19328 | Physician and practitioner services (fee schedule) | 44 | $375.85 |
| 19330 | Physician and practitioner services (fee schedule) | 42 | $456.37 |
| 19340 | Physician and practitioner services (fee schedule) | 44 | $553.73 |
| 19342 | Physician and practitioner services (fee schedule) | 44 | $590.69 |
| 19350 | Physician and practitioner services (fee schedule) | 45 | $592.80 |
| 19355 | Physician and practitioner services (fee schedule) | 33 | $486.98 |
| 19357 | Physician and practitioner services (fee schedule) | 44 | $898.85 |
| 19361 | Physician and practitioner services (fee schedule) | 44 | $1,130.53 |
| 19364 | Physician and practitioner services (fee schedule) | 44 | $1,879.16 |
| 19367 | Physician and practitioner services (fee schedule) | 44 | $1,299.11 |
| 19368 | Physician and practitioner services (fee schedule) | 44 | $1,504.90 |
| 19369 | Physician and practitioner services (fee schedule) | 45 | $1,392.93 |
| 19370 | Physician and practitioner services (fee schedule) | 44 | $494.15 |
| 19371 | Physician and practitioner services (fee schedule) | 44 | $530.53 |
| 19380 | Physician and practitioner services (fee schedule) | 44 | $581.95 |
| 19396 | Physician and practitioner services (fee schedule) | 28 | $137.15 |
| 19499 | Physician and practitioner services (fee schedule) | 9 | $127.70 |
| 20100 | Physician and practitioner services (fee schedule) | 44 | $439.41 |
| 20101 | Physician and practitioner services (fee schedule) | 45 | $207.49 |
| 20102 | Physician and practitioner services (fee schedule) | 45 | $250.61 |
| 20103 | Physician and practitioner services (fee schedule) | 44 | $334.67 |
| 20150 | Physician and practitioner services (fee schedule) | 44 | $724.78 |
| 20200 | Physician and practitioner services (fee schedule) | 45 | $108.90 |
| 20205 | Physician and practitioner services (fee schedule) | 45 | $163.10 |
| 20206 | Physician and practitioner services (fee schedule) | 45 | $96.90 |
| 20220 | Physician and practitioner services (fee schedule) | 45 | $116.60 |
| 20225 | Physician and practitioner services (fee schedule) | 45 | $232.60 |
| 20240 | Physician and practitioner services (fee schedule) | 45 | $123.11 |
| 20245 | Physician and practitioner services (fee schedule) | 45 | $269.34 |
| 20250 | Physician and practitioner services (fee schedule) | 45 | $302.71 |
| 20251 | Physician and practitioner services (fee schedule) | 44 | $328.99 |
| 20500 | Physician and practitioner services (fee schedule) | 45 | $88.58 |
| 20501 | Physician and practitioner services (fee schedule) | 45 | $86.78 |
| 20520 | Physician and practitioner services (fee schedule) | 45 | $137.05 |
| 20525 | Physician and practitioner services (fee schedule) | 45 | $254.78 |
| 20526 | Physician and practitioner services (fee schedule) | 44 | $54.24 |
| 20527 | Physician and practitioner services (fee schedule) | 42 | $61.73 |
| 20550 | Physician and practitioner services (fee schedule) | 45 | $41.52 |
| 20551 | Physician and practitioner services (fee schedule) | 45 | $41.10 |
| 20552 | Physician and practitioner services (fee schedule) | 45 | $37.18 |
| 20553 | Physician and practitioner services (fee schedule) | 45 | $42.49 |
| 20555 | Physician and practitioner services (fee schedule) | 44 | $234.14 |
| 20560 | Physician and practitioner services (fee schedule) | 17 | $16.98 |
| 20561 | Physician and practitioner services (fee schedule) | 18 | $23.74 |
| 20600 | Physician and practitioner services (fee schedule) | 45 | $35.52 |
| 20604 | Physician and practitioner services (fee schedule) | 45 | $49.77 |
| 20605 | Physician and practitioner services (fee schedule) | 45 | $37.97 |
| 20606 | Physician and practitioner services (fee schedule) | 45 | $55.11 |
| 20610 | Physician and practitioner services (fee schedule) | 45 | $46.38 |
| 20611 | Physician and practitioner services (fee schedule) | 45 | $62.95 |
| 20612 | Physician and practitioner services (fee schedule) | 44 | $43.45 |
| 20615 | Physician and practitioner services (fee schedule) | 45 | $152.66 |
| 20650 | Physician and practitioner services (fee schedule) | 45 | $153.67 |
| 20660 | Physician and practitioner services (fee schedule) | 45 | $167.06 |
| 20661 | Physician and practitioner services (fee schedule) | 45 | $401.64 |
| 20662 | Physician and practitioner services (fee schedule) | 45 | $388.62 |
| 20663 | Physician and practitioner services (fee schedule) | 45 | $341.43 |
| 20664 | Physician and practitioner services (fee schedule) | 44 | $695.26 |
| 20665 | Physician and practitioner services (fee schedule) | 44 | $86.86 |
| 20670 | Physician and practitioner services (fee schedule) | 45 | $164.69 |
| 20680 | Physician and practitioner services (fee schedule) | 45 | $382.22 |
| 20690 | Physician and practitioner services (fee schedule) | 45 | $428.14 |
| 20692 | Physician and practitioner services (fee schedule) | 45 | $755.43 |
| 20693 | Physician and practitioner services (fee schedule) | 45 | $349.53 |
| 20694 | Physician and practitioner services (fee schedule) | 45 | $310.06 |
| 20696 | Physician and practitioner services (fee schedule) | 40 | $839.81 |
| 20697 | Physician and practitioner services (fee schedule) | 41 | $1,206.61 |
| 20700 | Physician and practitioner services (fee schedule) | 41 | $67.45 |
| 20701 | Physician and practitioner services (fee schedule) | 41 | $51.32 |
| 20702 | Physician and practitioner services (fee schedule) | 40 | $115.01 |
| 20703 | Physician and practitioner services (fee schedule) | 40 | $84.18 |
| 20704 | Physician and practitioner services (fee schedule) | 40 | $119.42 |
| 20705 | Physician and practitioner services (fee schedule) | 40 | $99.03 |
| 20802 | Physician and practitioner services (fee schedule) | 42 | $1,942.29 |
| 20805 | Physician and practitioner services (fee schedule) | 44 | $2,294.08 |
| 20808 | Physician and practitioner services (fee schedule) | 42 | $2,751.13 |
| 20816 | Physician and practitioner services (fee schedule) | 43 | $1,522.23 |
| 20822 | Physician and practitioner services (fee schedule) | 44 | $1,324.65 |
| 20824 | Physician and practitioner services (fee schedule) | 44 | $1,528.83 |
| 20827 | Physician and practitioner services (fee schedule) | 44 | $1,359.49 |
| 20838 | Physician and practitioner services (fee schedule) | 43 | $1,988.20 |
| 20900 | Physician and practitioner services (fee schedule) | 44 | $213.42 |
| 20902 | Physician and practitioner services (fee schedule) | 44 | $239.81 |
| 20910 | Physician and practitioner services (fee schedule) | 45 | $364.03 |
| 20912 | Physician and practitioner services (fee schedule) | 45 | $360.23 |
| 20920 | Physician and practitioner services (fee schedule) | 45 | $286.55 |
| 20922 | Physician and practitioner services (fee schedule) | 44 | $413.44 |
| 20924 | Physician and practitioner services (fee schedule) | 44 | $370.41 |
| 20930 | Physician and practitioner services (fee schedule) | 21 | $124.66 |
| 20931 | Physician and practitioner services (fee schedule) | 43 | $85.07 |
| 20932 | Physician and practitioner services (fee schedule) | 42 | $558.50 |
| 20933 | Physician and practitioner services (fee schedule) | 42 | $512.77 |
| 20934 | Physician and practitioner services (fee schedule) | 42 | $568.45 |
| 20936 | Physician and practitioner services (fee schedule) | 22 | $161.55 |
| 20937 | Physician and practitioner services (fee schedule) | 43 | $125.55 |
| 20938 | Physician and practitioner services (fee schedule) | 43 | $138.98 |
| 20939 | Physician and practitioner services (fee schedule) | 39 | $53.54 |
| 20950 | Physician and practitioner services (fee schedule) | 43 | $92.56 |
| 20955 | Physician and practitioner services (fee schedule) | 44 | $1,896.72 |
| 20956 | Physician and practitioner services (fee schedule) | 45 | $1,875.64 |
| 20957 | Physician and practitioner services (fee schedule) | 45 | $1,934.07 |
| 20962 | Physician and practitioner services (fee schedule) | 43 | $2,011.76 |
| 20969 | Physician and practitioner services (fee schedule) | 44 | $2,015.00 |
| 20970 | Physician and practitioner services (fee schedule) | 43 | $2,113.75 |
| 20972 | Physician and practitioner services (fee schedule) | 43 | $2,101.10 |
| 20973 | Physician and practitioner services (fee schedule) | 42 | $2,171.31 |
| 20974 | Physician and practitioner services (fee schedule) | 42 | $62.73 |
| 20975 | Physician and practitioner services (fee schedule) | 41 | $138.57 |
| 20979 | Physician and practitioner services (fee schedule) | 38 | $32.54 |
| 20982 | Physician and practitioner services (fee schedule) | 44 | $1,659.43 |
| 20983 | Physician and practitioner services (fee schedule) | 39 | $2,553.19 |
| 20985 | Physician and practitioner services (fee schedule) | 37 | $105.96 |
| 20999 | Physician and practitioner services (fee schedule) | 8 | $178.73 |
| 21010 | Physician and practitioner services (fee schedule) | 42 | $560.82 |
| 21011 | Physician and practitioner services (fee schedule) | 45 | $239.24 |
| 21012 | Physician and practitioner services (fee schedule) | 45 | $251.98 |
| 21013 | Physician and practitioner services (fee schedule) | 45 | $360.11 |
| 21014 | Physician and practitioner services (fee schedule) | 45 | $376.05 |
| 21015 | Physician and practitioner services (fee schedule) | 44 | $509.98 |
| 21016 | Physician and practitioner services (fee schedule) | 45 | $715.45 |
| 21025 | Physician and practitioner services (fee schedule) | 45 | $569.01 |
| 21026 | Physician and practitioner services (fee schedule) | 44 | $390.13 |
| 21029 | Physician and practitioner services (fee schedule) | 44 | $541.93 |
| 21030 | Physician and practitioner services (fee schedule) | 45 | $348.77 |
| 21031 | Physician and practitioner services (fee schedule) | 43 | $252.59 |
| 21032 | Physician and practitioner services (fee schedule) | 43 | $254.04 |
| 21034 | Physician and practitioner services (fee schedule) | 44 | $857.95 |
| 21040 | Physician and practitioner services (fee schedule) | 45 | $310.42 |
| 21044 | Physician and practitioner services (fee schedule) | 44 | $646.47 |
| 21045 | Physician and practitioner services (fee schedule) | 44 | $892.21 |
| 21046 | Physician and practitioner services (fee schedule) | 45 | $748.47 |
| 21047 | Physician and practitioner services (fee schedule) | 45 | $875.31 |
| 21048 | Physician and practitioner services (fee schedule) | 45 | $752.15 |
| 21049 | Physician and practitioner services (fee schedule) | 45 | $823.38 |
| 21050 | Physician and practitioner services (fee schedule) | 42 | $657.97 |
| 21060 | Physician and practitioner services (fee schedule) | 42 | $595.07 |
| 21070 | Physician and practitioner services (fee schedule) | 44 | $465.60 |
| 21073 | Physician and practitioner services (fee schedule) | 36 | $242.71 |
| 21076 | Physician and practitioner services (fee schedule) | 38 | $655.65 |
| 21077 | Physician and practitioner services (fee schedule) | 35 | $1,616.42 |
| 21079 | Physician and practitioner services (fee schedule) | 39 | $1,177.12 |
| 21080 | Physician and practitioner services (fee schedule) | 39 | $1,298.07 |
| 21081 | Physician and practitioner services (fee schedule) | 38 | $1,185.97 |
| 21082 | Physician and practitioner services (fee schedule) | 38 | $1,076.24 |
| 21083 | Physician and practitioner services (fee schedule) | 38 | $1,031.53 |
| 21084 | Physician and practitioner services (fee schedule) | 38 | $1,141.49 |
| 21085 | Physician and practitioner services (fee schedule) | 40 | $472.38 |
| 21086 | Physician and practitioner services (fee schedule) | 39 | $1,192.25 |
| 21087 | Physician and practitioner services (fee schedule) | 38 | $1,205.93 |
| 21088 | Physician and practitioner services (fee schedule) | 19 | $1,094.62 |
| 21100 | Physician and practitioner services (fee schedule) | 44 | $338.72 |
| 21110 | Physician and practitioner services (fee schedule) | 43 | $579.74 |
| 21116 | Physician and practitioner services (fee schedule) | 45 | $63.99 |
| 21120 | Physician and practitioner services (fee schedule) | 42 | $476.44 |
| 21121 | Physician and practitioner services (fee schedule) | 43 | $471.42 |
| 21122 | Physician and practitioner services (fee schedule) | 42 | $563.61 |
| 21123 | Physician and practitioner services (fee schedule) | 42 | $644.31 |
| 21125 | Physician and practitioner services (fee schedule) | 43 | $685.43 |
| 21127 | Physician and practitioner services (fee schedule) | 44 | $852.84 |
| 21137 | Physician and practitioner services (fee schedule) | 39 | $565.77 |
| 21138 | Physician and practitioner services (fee schedule) | 41 | $684.23 |
| 21139 | Physician and practitioner services (fee schedule) | 38 | $817.89 |
| 21141 | Physician and practitioner services (fee schedule) | 45 | $989.23 |
| 21142 | Physician and practitioner services (fee schedule) | 45 | $1,008.46 |
| 21143 | Physician and practitioner services (fee schedule) | 45 | $1,061.70 |
| 21145 | Physician and practitioner services (fee schedule) | 45 | $1,138.34 |
| 21146 | Physician and practitioner services (fee schedule) | 45 | $1,214.33 |
| 21147 | Physician and practitioner services (fee schedule) | 44 | $1,263.47 |
| 21150 | Physician and practitioner services (fee schedule) | 42 | $1,237.37 |
| 21151 | Physician and practitioner services (fee schedule) | 42 | $1,366.95 |
| 21154 | Physician and practitioner services (fee schedule) | 43 | $1,485.34 |
| 21155 | Physician and practitioner services (fee schedule) | 43 | $1,603.88 |
| 21159 | Physician and practitioner services (fee schedule) | 43 | $1,914.64 |
| 21160 | Physician and practitioner services (fee schedule) | 42 | $2,082.88 |
| 21172 | Physician and practitioner services (fee schedule) | 44 | $1,564.76 |
| 21175 | Physician and practitioner services (fee schedule) | 45 | $1,626.28 |
| 21179 | Physician and practitioner services (fee schedule) | 43 | $1,117.95 |
| 21180 | Physician and practitioner services (fee schedule) | 43 | $1,250.01 |
| 21181 | Physician and practitioner services (fee schedule) | 43 | $556.32 |
| 21182 | Physician and practitioner services (fee schedule) | 42 | $1,533.93 |
| 21183 | Physician and practitioner services (fee schedule) | 42 | $1,696.09 |
| 21184 | Physician and practitioner services (fee schedule) | 41 | $1,808.68 |
| 21188 | Physician and practitioner services (fee schedule) | 44 | $1,195.26 |
| 21193 | Physician and practitioner services (fee schedule) | 44 | $920.34 |
| 21194 | Physician and practitioner services (fee schedule) | 43 | $1,068.91 |
| 21195 | Physician and practitioner services (fee schedule) | 43 | $1,011.53 |
| 21196 | Physician and practitioner services (fee schedule) | 45 | $1,083.54 |
| 21198 | Physician and practitioner services (fee schedule) | 43 | $803.87 |
| 21199 | Physician and practitioner services (fee schedule) | 42 | $759.33 |
| 21206 | Physician and practitioner services (fee schedule) | 43 | $756.66 |
| 21208 | Physician and practitioner services (fee schedule) | 44 | $738.95 |
| 21209 | Physician and practitioner services (fee schedule) | 42 | $526.81 |
| 21210 | Physician and practitioner services (fee schedule) | 45 | $748.26 |
| 21215 | Physician and practitioner services (fee schedule) | 44 | $772.32 |
| 21230 | Physician and practitioner services (fee schedule) | 44 | $591.98 |
| 21235 | Physician and practitioner services (fee schedule) | 45 | $501.66 |
| 21240 | Physician and practitioner services (fee schedule) | 43 | $811.88 |
| 21242 | Physician and practitioner services (fee schedule) | 42 | $748.41 |
| 21243 | Physician and practitioner services (fee schedule) | 43 | $1,166.34 |
| 21244 | Physician and practitioner services (fee schedule) | 43 | $758.40 |
| 21245 | Physician and practitioner services (fee schedule) | 40 | $822.35 |
| 21246 | Physician and practitioner services (fee schedule) | 40 | $670.85 |
| 21247 | Physician and practitioner services (fee schedule) | 44 | $1,224.51 |
| 21248 | Physician and practitioner services (fee schedule) | 39 | $773.44 |
| 21249 | Physician and practitioner services (fee schedule) | 38 | $1,058.92 |
| 21255 | Physician and practitioner services (fee schedule) | 42 | $1,039.72 |
| 21256 | Physician and practitioner services (fee schedule) | 43 | $924.21 |
| 21260 | Physician and practitioner services (fee schedule) | 43 | $1,023.40 |
| 21261 | Physician and practitioner services (fee schedule) | 41 | $1,692.15 |
| 21263 | Physician and practitioner services (fee schedule) | 43 | $1,633.76 |
| 21267 | Physician and practitioner services (fee schedule) | 43 | $1,190.06 |
| 21268 | Physician and practitioner services (fee schedule) | 42 | $1,452.21 |
| 21270 | Physician and practitioner services (fee schedule) | 43 | $697.55 |
| 21275 | Physician and practitioner services (fee schedule) | 43 | $617.68 |
| 21280 | Physician and practitioner services (fee schedule) | 41 | $417.76 |
| 21282 | Physician and practitioner services (fee schedule) | 42 | $303.68 |
| 21295 | Physician and practitioner services (fee schedule) | 40 | $148.30 |
| 21296 | Physician and practitioner services (fee schedule) | 39 | $289.62 |
| 21299 | Physician and practitioner services (fee schedule) | 7 | $25.00 |
| 21310 | Physician and practitioner services (fee schedule) | 5 | $46.31 |
| 21315 | Physician and practitioner services (fee schedule) | 45 | $106.59 |
| 21320 | Physician and practitioner services (fee schedule) | 45 | $143.13 |
| 21325 | Physician and practitioner services (fee schedule) | 45 | $335.30 |
| 21330 | Physician and practitioner services (fee schedule) | 45 | $409.68 |
| 21335 | Physician and practitioner services (fee schedule) | 45 | $556.17 |
| 21336 | Physician and practitioner services (fee schedule) | 45 | $457.66 |
| 21337 | Physician and practitioner services (fee schedule) | 44 | $265.53 |
| 21338 | Physician and practitioner services (fee schedule) | 45 | $501.49 |
| 21339 | Physician and practitioner services (fee schedule) | 45 | $544.48 |
| 21340 | Physician and practitioner services (fee schedule) | 43 | $568.10 |
| 21343 | Physician and practitioner services (fee schedule) | 45 | $789.26 |
| 21344 | Physician and practitioner services (fee schedule) | 45 | $1,018.76 |
| 21345 | Physician and practitioner services (fee schedule) | 45 | $561.19 |
| 21346 | Physician and practitioner services (fee schedule) | 43 | $731.14 |
| 21347 | Physician and practitioner services (fee schedule) | 45 | $776.14 |
| 21348 | Physician and practitioner services (fee schedule) | 45 | $810.42 |
| 21355 | Physician and practitioner services (fee schedule) | 45 | $300.26 |
| 21356 | Physician and practitioner services (fee schedule) | 44 | $378.91 |
| 21360 | Physician and practitioner services (fee schedule) | 44 | $398.77 |
| 21365 | Physician and practitioner services (fee schedule) | 44 | $816.85 |
| 21366 | Physician and practitioner services (fee schedule) | 44 | $923.79 |
| 21385 | Physician and practitioner services (fee schedule) | 44 | $563.60 |
| 21386 | Physician and practitioner services (fee schedule) | 44 | $541.17 |
| 21387 | Physician and practitioner services (fee schedule) | 45 | $579.42 |
| 21390 | Physician and practitioner services (fee schedule) | 44 | $612.48 |
| 21395 | Physician and practitioner services (fee schedule) | 44 | $750.96 |
| 21400 | Physician and practitioner services (fee schedule) | 44 | $151.13 |
| 21401 | Physician and practitioner services (fee schedule) | 45 | $302.22 |
| 21406 | Physician and practitioner services (fee schedule) | 44 | $443.26 |
| 21407 | Physician and practitioner services (fee schedule) | 44 | $484.83 |
| 21408 | Physician and practitioner services (fee schedule) | 44 | $667.06 |
| 21421 | Physician and practitioner services (fee schedule) | 45 | $446.22 |
| 21422 | Physician and practitioner services (fee schedule) | 45 | $500.24 |
| 21423 | Physician and practitioner services (fee schedule) | 45 | $596.34 |
| 21431 | Physician and practitioner services (fee schedule) | 44 | $515.47 |
| 21432 | Physician and practitioner services (fee schedule) | 44 | $546.12 |
| 21433 | Physician and practitioner services (fee schedule) | 44 | $1,240.97 |
| 21435 | Physician and practitioner services (fee schedule) | 45 | $1,012.07 |
| 21436 | Physician and practitioner services (fee schedule) | 44 | $1,440.48 |
| 21440 | Physician and practitioner services (fee schedule) | 44 | $507.07 |
| 21445 | Physician and practitioner services (fee schedule) | 44 | $510.79 |
| 21450 | Physician and practitioner services (fee schedule) | 43 | $398.44 |
| 21451 | Physician and practitioner services (fee schedule) | 45 | $526.91 |
| 21452 | Physician and practitioner services (fee schedule) | 45 | $415.66 |
| 21453 | Physician and practitioner services (fee schedule) | 45 | $751.87 |
| 21454 | Physician and practitioner services (fee schedule) | 45 | $397.79 |
| 21461 | Physician and practitioner services (fee schedule) | 44 | $969.59 |
| 21462 | Physician and practitioner services (fee schedule) | 44 | $1,009.20 |
| 21465 | Physician and practitioner services (fee schedule) | 44 | $613.94 |
| 21470 | Physician and practitioner services (fee schedule) | 44 | $893.23 |
| 21480 | Physician and practitioner services (fee schedule) | 44 | $47.90 |
| 21485 | Physician and practitioner services (fee schedule) | 43 | $599.81 |
| 21490 | Physician and practitioner services (fee schedule) | 42 | $586.04 |
| 21495 | Physician and practitioner services (fee schedule) | 5 | $449.50 |
| 21497 | Physician and practitioner services (fee schedule) | 38 | $484.03 |
| 21499 | Physician and practitioner services (fee schedule) | 9 | $241.98 |
| 21501 | Physician and practitioner services (fee schedule) | 45 | $297.50 |
| 21502 | Physician and practitioner services (fee schedule) | 45 | $380.40 |
| 21510 | Physician and practitioner services (fee schedule) | 45 | $360.64 |
| 21550 | Physician and practitioner services (fee schedule) | 45 | $159.18 |
| 21552 | Physician and practitioner services (fee schedule) | 45 | $333.81 |
| 21554 | Physician and practitioner services (fee schedule) | 45 | $535.14 |
| 21555 | Physician and practitioner services (fee schedule) | 45 | $286.04 |
| 21556 | Physician and practitioner services (fee schedule) | 45 | $356.97 |
| 21557 | Physician and practitioner services (fee schedule) | 44 | $667.91 |
| 21558 | Physician and practitioner services (fee schedule) | 45 | $949.98 |
| 21600 | Physician and practitioner services (fee schedule) | 45 | $427.16 |
| 21601 | Physician and practitioner services (fee schedule) | 45 | $879.69 |
| 21602 | Physician and practitioner services (fee schedule) | 45 | $1,218.87 |
| 21603 | Physician and practitioner services (fee schedule) | 45 | $1,330.73 |
| 21610 | Physician and practitioner services (fee schedule) | 44 | $846.61 |
| 21615 | Physician and practitioner services (fee schedule) | 44 | $471.35 |
| 21616 | Physician and practitioner services (fee schedule) | 44 | $556.82 |
| 21620 | Physician and practitioner services (fee schedule) | 45 | $390.85 |
| 21627 | Physician and practitioner services (fee schedule) | 45 | $432.00 |
| 21630 | Physician and practitioner services (fee schedule) | 44 | $932.20 |
| 21632 | Physician and practitioner services (fee schedule) | 7 | $1,080.78 |
| 21685 | Physician and practitioner services (fee schedule) | 42 | $695.36 |
| 21700 | Physician and practitioner services (fee schedule) | 45 | $283.56 |
| 21705 | Physician and practitioner services (fee schedule) | 45 | $414.14 |
| 21720 | Physician and practitioner services (fee schedule) | 45 | $402.72 |
| 21725 | Physician and practitioner services (fee schedule) | 45 | $400.83 |
| 21740 | Physician and practitioner services (fee schedule) | 45 | $769.70 |
| 21742 | Physician and practitioner services (fee schedule) | 31 | $669.16 |
| 21743 | Physician and practitioner services (fee schedule) | 32 | $769.42 |
| 21750 | Physician and practitioner services (fee schedule) | 45 | $524.18 |
| 21811 | Physician and practitioner services (fee schedule) | 39 | $448.68 |
| 21812 | Physician and practitioner services (fee schedule) | 40 | $542.15 |
| 21813 | Physician and practitioner services (fee schedule) | 40 | $739.12 |
| 21820 | Physician and practitioner services (fee schedule) | 44 | $121.67 |
| 21825 | Physician and practitioner services (fee schedule) | 45 | $413.51 |
| 21899 | Physician and practitioner services (fee schedule) | 8 | $162.93 |
| 21920 | Physician and practitioner services (fee schedule) | 45 | $147.30 |
| 21925 | Physician and practitioner services (fee schedule) | 45 | $334.30 |
| 21930 | Physician and practitioner services (fee schedule) | 45 | $344.85 |
| 21931 | Physician and practitioner services (fee schedule) | 45 | $354.62 |
| 21932 | Physician and practitioner services (fee schedule) | 45 | $488.30 |
| 21933 | Physician and practitioner services (fee schedule) | 45 | $544.48 |
| 21935 | Physician and practitioner services (fee schedule) | 45 | $759.50 |
| 21936 | Physician and practitioner services (fee schedule) | 45 | $1,017.26 |
| 22010 | Physician and practitioner services (fee schedule) | 45 | $728.71 |
| 22015 | Physician and practitioner services (fee schedule) | 45 | $714.52 |
| 22100 | Physician and practitioner services (fee schedule) | 44 | $654.55 |
| 22101 | Physician and practitioner services (fee schedule) | 44 | $621.59 |
| 22102 | Physician and practitioner services (fee schedule) | 44 | $551.57 |
| 22103 | Physician and practitioner services (fee schedule) | 45 | $99.19 |
| 22110 | Physician and practitioner services (fee schedule) | 45 | $736.53 |
| 22112 | Physician and practitioner services (fee schedule) | 45 | $796.82 |
| 22114 | Physician and practitioner services (fee schedule) | 45 | $796.82 |
| 22116 | Physician and practitioner services (fee schedule) | 45 | $104.23 |
| 22206 | Physician and practitioner services (fee schedule) | 44 | $1,729.45 |
| 22207 | Physician and practitioner services (fee schedule) | 44 | $1,694.72 |
| 22208 | Physician and practitioner services (fee schedule) | 44 | $407.63 |
| 22210 | Physician and practitioner services (fee schedule) | 45 | $1,289.96 |
| 22212 | Physician and practitioner services (fee schedule) | 45 | $1,122.78 |
| 22214 | Physician and practitioner services (fee schedule) | 45 | $1,073.18 |
| 22216 | Physician and practitioner services (fee schedule) | 45 | $263.11 |
| 22220 | Physician and practitioner services (fee schedule) | 45 | $1,161.60 |
| 22222 | Physician and practitioner services (fee schedule) | 45 | $1,240.31 |
| 22224 | Physician and practitioner services (fee schedule) | 45 | $1,151.30 |
| 22226 | Physician and practitioner services (fee schedule) | 45 | $265.81 |
| 22310 | Physician and practitioner services (fee schedule) | 45 | $242.23 |
| 22315 | Physician and practitioner services (fee schedule) | 45 | $660.40 |
| 22318 | Physician and practitioner services (fee schedule) | 45 | $1,223.13 |
| 22319 | Physician and practitioner services (fee schedule) | 44 | $1,343.30 |
| 22325 | Physician and practitioner services (fee schedule) | 44 | $1,061.60 |
| 22326 | Physician and practitioner services (fee schedule) | 45 | $1,092.39 |
| 22327 | Physician and practitioner services (fee schedule) | 44 | $1,146.96 |
| 22328 | Physician and practitioner services (fee schedule) | 45 | $208.49 |
| 22505 | Physician and practitioner services (fee schedule) | 44 | $117.37 |
| 22510 | Physician and practitioner services (fee schedule) | 43 | $1,036.76 |
| 22511 | Physician and practitioner services (fee schedule) | 43 | $814.19 |
| 22512 | Physician and practitioner services (fee schedule) | 43 | $392.72 |
| 22513 | Physician and practitioner services (fee schedule) | 43 | $3,188.22 |
| 22514 | Physician and practitioner services (fee schedule) | 43 | $2,538.66 |
| 22515 | Physician and practitioner services (fee schedule) | 43 | $1,663.97 |
| 22526 | Physician and practitioner services (fee schedule) | 22 | $1,010.03 |
| 22527 | Physician and practitioner services (fee schedule) | 21 | $868.10 |
| 22532 | Physician and practitioner services (fee schedule) | 44 | $1,305.29 |
| 22533 | Physician and practitioner services (fee schedule) | 44 | $1,197.27 |
| 22534 | Physician and practitioner services (fee schedule) | 45 | $251.72 |
| 22548 | Physician and practitioner services (fee schedule) | 44 | $1,455.20 |
| 22551 | Physician and practitioner services (fee schedule) | 45 | $1,248.20 |
| 22552 | Physician and practitioner services (fee schedule) | 45 | $276.06 |
| 22554 | Physician and practitioner services (fee schedule) | 44 | $971.33 |
| 22556 | Physician and practitioner services (fee schedule) | 44 | $1,260.49 |
| 22558 | Physician and practitioner services (fee schedule) | 44 | $1,152.07 |
| 22585 | Physician and practitioner services (fee schedule) | 45 | $235.77 |
| 22586 | Physician and practitioner services (fee schedule) | 43 | $1,318.87 |
| 22590 | Physician and practitioner services (fee schedule) | 44 | $1,182.43 |
| 22595 | Physician and practitioner services (fee schedule) | 44 | $1,156.13 |
| 22600 | Physician and practitioner services (fee schedule) | 44 | $989.22 |
| 22610 | Physician and practitioner services (fee schedule) | 44 | $975.81 |
| 22612 | Physician and practitioner services (fee schedule) | 44 | $1,173.23 |
| 22614 | Physician and practitioner services (fee schedule) | 44 | $293.26 |
| 22630 | Physician and practitioner services (fee schedule) | 44 | $1,162.62 |
| 22632 | Physician and practitioner services (fee schedule) | 43 | $237.56 |
| 22633 | Physician and practitioner services (fee schedule) | 45 | $1,322.23 |
| 22634 | Physician and practitioner services (fee schedule) | 44 | $333.63 |
| 22800 | Physician and practitioner services (fee schedule) | 45 | $1,032.35 |
| 22802 | Physician and practitioner services (fee schedule) | 44 | $1,570.28 |
| 22804 | Physician and practitioner services (fee schedule) | 44 | $1,822.62 |
| 22808 | Physician and practitioner services (fee schedule) | 44 | $1,347.56 |
| 22810 | Physician and practitioner services (fee schedule) | 44 | $1,417.64 |
| 22812 | Physician and practitioner services (fee schedule) | 45 | $1,551.95 |
| 22818 | Physician and practitioner services (fee schedule) | 44 | $1,578.60 |
| 22819 | Physician and practitioner services (fee schedule) | 44 | $1,742.78 |
| 22830 | Physician and practitioner services (fee schedule) | 45 | $624.47 |
| 22836 | Physician and practitioner services (fee schedule) | 29 | $1,376.86 |
| 22837 | Physician and practitioner services (fee schedule) | 28 | $1,429.41 |
| 22838 | Physician and practitioner services (fee schedule) | 28 | $1,448.30 |
| 22840 | Physician and practitioner services (fee schedule) | 44 | $541.51 |
| 22841 | Physician and practitioner services (fee schedule) | 21 | $436.98 |
| 22842 | Physician and practitioner services (fee schedule) | 45 | $553.15 |
| 22843 | Physician and practitioner services (fee schedule) | 44 | $588.55 |
| 22844 | Physician and practitioner services (fee schedule) | 45 | $714.88 |
| 22845 | Physician and practitioner services (fee schedule) | 45 | $526.46 |
| 22846 | Physician and practitioner services (fee schedule) | 45 | $540.17 |
| 22847 | Physician and practitioner services (fee schedule) | 45 | $578.33 |
| 22848 | Physician and practitioner services (fee schedule) | 45 | $270.66 |
| 22849 | Physician and practitioner services (fee schedule) | 45 | $957.34 |
| 22850 | Physician and practitioner services (fee schedule) | 45 | $545.91 |
| 22852 | Physician and practitioner services (fee schedule) | 45 | $534.44 |
| 22853 | Physician and practitioner services (fee schedule) | 45 | $194.73 |
| 22854 | Physician and practitioner services (fee schedule) | 44 | $257.91 |
| 22855 | Physician and practitioner services (fee schedule) | 45 | $807.73 |
| 22856 | Physician and practitioner services (fee schedule) | 43 | $1,168.55 |
| 22857 | Physician and practitioner services (fee schedule) | 36 | $1,185.58 |
| 22858 | Physician and practitioner services (fee schedule) | 40 | $374.96 |
| 22859 | Physician and practitioner services (fee schedule) | 44 | $257.04 |
| 22860 | Physician and practitioner services (fee schedule) | 22 | $283.62 |
| 22861 | Physician and practitioner services (fee schedule) | 36 | $1,550.74 |
| 22862 | Physician and practitioner services (fee schedule) | 27 | $1,486.67 |
| 22864 | Physician and practitioner services (fee schedule) | 39 | $1,458.95 |
| 22865 | Physician and practitioner services (fee schedule) | 32 | $1,469.81 |
| 22867 | Physician and practitioner services (fee schedule) | 31 | $853.52 |
| 22868 | Physician and practitioner services (fee schedule) | 31 | $197.79 |
| 22869 | Physician and practitioner services (fee schedule) | 30 | $390.37 |
| 22870 | Physician and practitioner services (fee schedule) | 29 | $98.32 |
| 22899 | Physician and practitioner services (fee schedule) | 9 | $555.11 |
| 22900 | Physician and practitioner services (fee schedule) | 45 | $385.55 |
| 22901 | Physician and practitioner services (fee schedule) | 45 | $467.75 |
| 22902 | Physician and practitioner services (fee schedule) | 45 | $300.31 |
| 22903 | Physician and practitioner services (fee schedule) | 45 | $329.53 |
| 22904 | Physician and practitioner services (fee schedule) | 44 | $717.84 |
| 22905 | Physician and practitioner services (fee schedule) | 45 | $908.90 |
| 22999 | Physician and practitioner services (fee schedule) | 6 | $402.97 |
| 23000 | Physician and practitioner services (fee schedule) | 45 | $329.51 |
| 23020 | Physician and practitioner services (fee schedule) | 44 | $504.02 |
| 23030 | Physician and practitioner services (fee schedule) | 45 | $251.40 |
| 23031 | Physician and practitioner services (fee schedule) | 44 | $230.46 |
| 23035 | Physician and practitioner services (fee schedule) | 45 | $497.71 |
| 23040 | Physician and practitioner services (fee schedule) | 45 | $531.65 |
| 23044 | Physician and practitioner services (fee schedule) | 45 | $432.03 |
| 23065 | Physician and practitioner services (fee schedule) | 45 | $147.61 |
| 23066 | Physician and practitioner services (fee schedule) | 45 | $364.70 |
| 23071 | Physician and practitioner services (fee schedule) | 44 | $308.77 |
| 23073 | Physician and practitioner services (fee schedule) | 44 | $506.59 |
| 23075 | Physician and practitioner services (fee schedule) | 45 | $323.50 |
| 23076 | Physician and practitioner services (fee schedule) | 45 | $420.56 |
| 23077 | Physician and practitioner services (fee schedule) | 44 | $821.30 |
| 23078 | Physician and practitioner services (fee schedule) | 45 | $969.90 |
| 23100 | Physician and practitioner services (fee schedule) | 45 | $387.88 |
| 23101 | Physician and practitioner services (fee schedule) | 45 | $359.08 |
| 23105 | Physician and practitioner services (fee schedule) | 45 | $505.66 |
| 23106 | Physician and practitioner services (fee schedule) | 45 | $398.43 |
| 23107 | Physician and practitioner services (fee schedule) | 44 | $504.21 |
| 23120 | Physician and practitioner services (fee schedule) | 44 | $426.93 |
| 23125 | Physician and practitioner services (fee schedule) | 44 | $524.01 |
| 23130 | Physician and practitioner services (fee schedule) | 44 | $473.64 |
| 23140 | Physician and practitioner services (fee schedule) | 45 | $424.35 |
| 23145 | Physician and practitioner services (fee schedule) | 44 | $506.34 |
| 23146 | Physician and practitioner services (fee schedule) | 45 | $470.38 |
| 23150 | Physician and practitioner services (fee schedule) | 44 | $483.35 |
| 23155 | Physician and practitioner services (fee schedule) | 44 | $578.81 |
| 23156 | Physician and practitioner services (fee schedule) | 45 | $499.80 |
| 23170 | Physician and practitioner services (fee schedule) | 45 | $431.31 |
| 23172 | Physician and practitioner services (fee schedule) | 45 | $424.47 |
| 23174 | Physician and practitioner services (fee schedule) | 44 | $539.33 |
| 23180 | Physician and practitioner services (fee schedule) | 44 | $516.88 |
| 23182 | Physician and practitioner services (fee schedule) | 44 | $488.81 |
| 23184 | Physician and practitioner services (fee schedule) | 44 | $545.57 |
| 23190 | Physician and practitioner services (fee schedule) | 44 | $414.82 |
| 23195 | Physician and practitioner services (fee schedule) | 44 | $555.89 |
| 23200 | Physician and practitioner services (fee schedule) | 44 | $961.32 |
| 23210 | Physician and practitioner services (fee schedule) | 44 | $1,145.71 |
| 23220 | Physician and practitioner services (fee schedule) | 44 | $1,252.83 |
| 23330 | Physician and practitioner services (fee schedule) | 45 | $156.92 |
| 23333 | Physician and practitioner services (fee schedule) | 44 | $363.08 |
| 23334 | Physician and practitioner services (fee schedule) | 45 | $793.04 |
| 23335 | Physician and practitioner services (fee schedule) | 45 | $953.55 |
| 23350 | Physician and practitioner services (fee schedule) | 44 | $101.60 |
| 23395 | Physician and practitioner services (fee schedule) | 43 | $929.89 |
| 23397 | Physician and practitioner services (fee schedule) | 45 | $834.86 |
| 23400 | Physician and practitioner services (fee schedule) | 44 | $712.28 |
| 23405 | Physician and practitioner services (fee schedule) | 45 | $455.76 |
| 23406 | Physician and practitioner services (fee schedule) | 45 | $550.41 |
| 23410 | Physician and practitioner services (fee schedule) | 44 | $625.28 |
| 23412 | Physician and practitioner services (fee schedule) | 44 | $662.58 |
| 23415 | Physician and practitioner services (fee schedule) | 44 | $531.39 |
| 23420 | Physician and practitioner services (fee schedule) | 44 | $732.15 |
| 23430 | Physician and practitioner services (fee schedule) | 44 | $541.17 |
| 23440 | Physician and practitioner services (fee schedule) | 44 | $549.51 |
| 23450 | Physician and practitioner services (fee schedule) | 44 | $699.90 |
| 23455 | Physician and practitioner services (fee schedule) | 44 | $736.87 |
| 23460 | Physician and practitioner services (fee schedule) | 44 | $813.04 |
| 23462 | Physician and practitioner services (fee schedule) | 44 | $797.15 |
| 23465 | Physician and practitioner services (fee schedule) | 44 | $824.80 |
| 23466 | Physician and practitioner services (fee schedule) | 44 | $825.34 |
| 23470 | Physician and practitioner services (fee schedule) | 45 | $871.91 |
| 23472 | Physician and practitioner services (fee schedule) | 44 | $1,060.97 |
| 23473 | Physician and practitioner services (fee schedule) | 45 | $1,197.09 |
| 23474 | Physician and practitioner services (fee schedule) | 45 | $1,293.88 |
| 23480 | Physician and practitioner services (fee schedule) | 45 | $602.21 |
| 23485 | Physician and practitioner services (fee schedule) | 44 | $705.75 |
| 23490 | Physician and practitioner services (fee schedule) | 43 | $622.67 |
| 23491 | Physician and practitioner services (fee schedule) | 43 | $752.16 |
| 23500 | Physician and practitioner services (fee schedule) | 45 | $183.69 |
| 23505 | Physician and practitioner services (fee schedule) | 45 | $275.97 |
| 23515 | Physician and practitioner services (fee schedule) | 45 | $494.53 |
| 23520 | Physician and practitioner services (fee schedule) | 44 | $186.28 |
| 23525 | Physician and practitioner services (fee schedule) | 45 | $298.69 |
| 23530 | Physician and practitioner services (fee schedule) | 45 | $433.44 |
| 23532 | Physician and practitioner services (fee schedule) | 45 | $471.25 |
| 23540 | Physician and practitioner services (fee schedule) | 44 | $190.24 |
| 23545 | Physician and practitioner services (fee schedule) | 45 | $287.41 |
| 23550 | Physician and practitioner services (fee schedule) | 45 | $436.60 |
| 23552 | Physician and practitioner services (fee schedule) | 44 | $481.07 |
| 23570 | Physician and practitioner services (fee schedule) | 45 | $185.23 |
| 23575 | Physician and practitioner services (fee schedule) | 45 | $309.85 |
| 23585 | Physician and practitioner services (fee schedule) | 45 | $646.08 |
| 23600 | Physician and practitioner services (fee schedule) | 45 | $258.15 |
| 23605 | Physician and practitioner services (fee schedule) | 45 | $374.70 |
| 23615 | Physician and practitioner services (fee schedule) | 44 | $637.59 |
| 23616 | Physician and practitioner services (fee schedule) | 44 | $945.75 |
| 23620 | Physician and practitioner services (fee schedule) | 45 | $211.19 |
| 23625 | Physician and practitioner services (fee schedule) | 45 | $308.18 |
| 23630 | Physician and practitioner services (fee schedule) | 45 | $534.41 |
| 23650 | Physician and practitioner services (fee schedule) | 45 | $266.92 |
| 23655 | Physician and practitioner services (fee schedule) | 45 | $309.27 |
| 23660 | Physician and practitioner services (fee schedule) | 45 | $446.55 |
| 23665 | Physician and practitioner services (fee schedule) | 45 | $333.51 |
| 23670 | Physician and practitioner services (fee schedule) | 44 | $602.17 |
| 23675 | Physician and practitioner services (fee schedule) | 45 | $416.46 |
| 23680 | Physician and practitioner services (fee schedule) | 44 | $668.20 |
| 23700 | Physician and practitioner services (fee schedule) | 45 | $149.65 |
| 23800 | Physician and practitioner services (fee schedule) | 43 | $759.38 |
| 23802 | Physician and practitioner services (fee schedule) | 44 | $890.28 |
| 23900 | Physician and practitioner services (fee schedule) | 45 | $980.95 |
| 23920 | Physician and practitioner services (fee schedule) | 44 | $822.73 |
| 23921 | Physician and practitioner services (fee schedule) | 44 | $360.96 |
| 23929 | Physician and practitioner services (fee schedule) | 6 | $181.91 |
| 23930 | Physician and practitioner services (fee schedule) | 44 | $218.59 |
| 23931 | Physician and practitioner services (fee schedule) | 45 | $168.08 |
| 23935 | Physician and practitioner services (fee schedule) | 45 | $401.83 |
| 24000 | Physician and practitioner services (fee schedule) | 45 | $366.30 |
| 24006 | Physician and practitioner services (fee schedule) | 45 | $516.68 |
| 24065 | Physician and practitioner services (fee schedule) | 45 | $167.13 |
| 24066 | Physician and practitioner services (fee schedule) | 45 | $387.79 |
| 24071 | Physician and practitioner services (fee schedule) | 44 | $298.78 |
| 24073 | Physician and practitioner services (fee schedule) | 44 | $505.85 |
| 24075 | Physician and practitioner services (fee schedule) | 45 | $309.75 |
| 24076 | Physician and practitioner services (fee schedule) | 45 | $405.24 |
| 24077 | Physician and practitioner services (fee schedule) | 45 | $751.30 |
| 24079 | Physician and practitioner services (fee schedule) | 44 | $920.43 |
| 24100 | Physician and practitioner services (fee schedule) | 45 | $322.91 |
| 24101 | Physician and practitioner services (fee schedule) | 45 | $391.48 |
| 24102 | Physician and practitioner services (fee schedule) | 45 | $467.80 |
| 24105 | Physician and practitioner services (fee schedule) | 45 | $279.83 |
| 24110 | Physician and practitioner services (fee schedule) | 44 | $460.62 |
| 24115 | Physician and practitioner services (fee schedule) | 44 | $535.59 |
| 24116 | Physician and practitioner services (fee schedule) | 44 | $630.84 |
| 24120 | Physician and practitioner services (fee schedule) | 45 | $411.16 |
| 24125 | Physician and practitioner services (fee schedule) | 44 | $448.81 |
| 24126 | Physician and practitioner services (fee schedule) | 45 | $480.32 |
| 24130 | Physician and practitioner services (fee schedule) | 44 | $396.14 |
| 24134 | Physician and practitioner services (fee schedule) | 44 | $560.31 |
| 24136 | Physician and practitioner services (fee schedule) | 44 | $483.20 |
| 24138 | Physician and practitioner services (fee schedule) | 44 | $506.12 |
| 24140 | Physician and practitioner services (fee schedule) | 44 | $525.31 |
| 24145 | Physician and practitioner services (fee schedule) | 44 | $449.89 |
| 24147 | Physician and practitioner services (fee schedule) | 44 | $476.85 |
| 24149 | Physician and practitioner services (fee schedule) | 44 | $854.98 |
| 24150 | Physician and practitioner services (fee schedule) | 44 | $984.34 |
| 24152 | Physician and practitioner services (fee schedule) | 44 | $861.76 |
| 24155 | Physician and practitioner services (fee schedule) | 44 | $622.48 |
| 24160 | Physician and practitioner services (fee schedule) | 45 | $831.31 |
| 24164 | Physician and practitioner services (fee schedule) | 45 | $530.71 |
| 24200 | Physician and practitioner services (fee schedule) | 45 | $146.35 |
| 24201 | Physician and practitioner services (fee schedule) | 45 | $367.96 |
| 24220 | Physician and practitioner services (fee schedule) | 44 | $117.74 |
| 24300 | Physician and practitioner services (fee schedule) | 45 | $341.38 |
| 24301 | Physician and practitioner services (fee schedule) | 44 | $550.88 |
| 24305 | Physician and practitioner services (fee schedule) | 45 | $427.46 |
| 24310 | Physician and practitioner services (fee schedule) | 45 | $349.63 |
| 24320 | Physician and practitioner services (fee schedule) | 44 | $573.56 |
| 24330 | Physician and practitioner services (fee schedule) | 45 | $533.89 |
| 24331 | Physician and practitioner services (fee schedule) | 44 | $581.06 |
| 24332 | Physician and practitioner services (fee schedule) | 45 | $458.76 |
| 24340 | Physician and practitioner services (fee schedule) | 44 | $455.63 |
| 24341 | Physician and practitioner services (fee schedule) | 44 | $520.77 |
| 24342 | Physician and practitioner services (fee schedule) | 44 | $575.32 |
| 24343 | Physician and practitioner services (fee schedule) | 44 | $516.74 |
| 24344 | Physician and practitioner services (fee schedule) | 44 | $797.51 |
| 24345 | Physician and practitioner services (fee schedule) | 44 | $514.38 |
| 24346 | Physician and practitioner services (fee schedule) | 45 | $795.28 |
| 24357 | Physician and practitioner services (fee schedule) | 44 | $317.10 |
| 24358 | Physician and practitioner services (fee schedule) | 44 | $392.23 |
| 24359 | Physician and practitioner services (fee schedule) | 44 | $487.09 |
| 24360 | Physician and practitioner services (fee schedule) | 44 | $677.21 |
| 24361 | Physician and practitioner services (fee schedule) | 44 | $752.11 |
| 24362 | Physician and practitioner services (fee schedule) | 44 | $788.33 |
| 24363 | Physician and practitioner services (fee schedule) | 43 | $1,093.36 |
| 24365 | Physician and practitioner services (fee schedule) | 44 | $467.77 |
| 24366 | Physician and practitioner services (fee schedule) | 44 | $514.51 |
| 24370 | Physician and practitioner services (fee schedule) | 45 | $1,129.37 |
| 24371 | Physician and practitioner services (fee schedule) | 45 | $1,302.49 |
| 24400 | Physician and practitioner services (fee schedule) | 44 | $602.08 |
| 24410 | Physician and practitioner services (fee schedule) | 44 | $770.22 |
| 24420 | Physician and practitioner services (fee schedule) | 44 | $768.17 |
| 24430 | Physician and practitioner services (fee schedule) | 44 | $767.43 |
| 24435 | Physician and practitioner services (fee schedule) | 44 | $804.85 |
| 24470 | Physician and practitioner services (fee schedule) | 44 | $477.36 |
| 24495 | Physician and practitioner services (fee schedule) | 45 | $607.12 |
| 24498 | Physician and practitioner services (fee schedule) | 43 | $644.53 |
| 24500 | Physician and practitioner services (fee schedule) | 45 | $277.91 |
| 24505 | Physician and practitioner services (fee schedule) | 45 | $396.31 |
| 24515 | Physician and practitioner services (fee schedule) | 44 | $640.12 |
| 24516 | Physician and practitioner services (fee schedule) | 44 | $624.77 |
| 24530 | Physician and practitioner services (fee schedule) | 45 | $299.79 |
| 24535 | Physician and practitioner services (fee schedule) | 44 | $483.04 |
| 24538 | Physician and practitioner services (fee schedule) | 44 | $606.24 |
| 24545 | Physician and practitioner services (fee schedule) | 44 | $672.99 |
| 24546 | Physician and practitioner services (fee schedule) | 44 | $749.29 |
| 24560 | Physician and practitioner services (fee schedule) | 44 | $261.81 |
| 24565 | Physician and practitioner services (fee schedule) | 44 | $414.12 |
| 24566 | Physician and practitioner services (fee schedule) | 44 | $539.07 |
| 24575 | Physician and practitioner services (fee schedule) | 44 | $552.95 |
| 24576 | Physician and practitioner services (fee schedule) | 44 | $274.91 |
| 24577 | Physician and practitioner services (fee schedule) | 44 | $428.50 |
| 24579 | Physician and practitioner services (fee schedule) | 44 | $612.72 |
| 24582 | Physician and practitioner services (fee schedule) | 44 | $613.49 |
| 24586 | Physician and practitioner services (fee schedule) | 44 | $811.41 |
| 24587 | Physician and practitioner services (fee schedule) | 44 | $806.70 |
| 24600 | Physician and practitioner services (fee schedule) | 44 | $311.96 |
| 24605 | Physician and practitioner services (fee schedule) | 44 | $371.09 |
| 24615 | Physician and practitioner services (fee schedule) | 44 | $532.11 |
| 24620 | Physician and practitioner services (fee schedule) | 44 | $445.00 |
| 24635 | Physician and practitioner services (fee schedule) | 44 | $533.62 |
| 24640 | Physician and practitioner services (fee schedule) | 44 | $79.51 |
| 24650 | Physician and practitioner services (fee schedule) | 44 | $208.43 |
| 24655 | Physician and practitioner services (fee schedule) | 44 | $356.60 |
| 24665 | Physician and practitioner services (fee schedule) | 44 | $476.04 |
| 24666 | Physician and practitioner services (fee schedule) | 44 | $547.37 |
| 24670 | Physician and practitioner services (fee schedule) | 44 | $228.24 |
| 24675 | Physician and practitioner services (fee schedule) | 44 | $360.53 |
| 24685 | Physician and practitioner services (fee schedule) | 44 | $498.03 |
| 24800 | Physician and practitioner services (fee schedule) | 44 | $622.33 |
| 24802 | Physician and practitioner services (fee schedule) | 44 | $745.82 |
| 24900 | Physician and practitioner services (fee schedule) | 44 | $540.44 |
| 24920 | Physician and practitioner services (fee schedule) | 44 | $538.10 |
| 24925 | Physician and practitioner services (fee schedule) | 44 | $413.31 |
| 24930 | Physician and practitioner services (fee schedule) | 44 | $565.49 |
| 24931 | Physician and practitioner services (fee schedule) | 44 | $651.24 |
| 24935 | Physician and practitioner services (fee schedule) | 43 | $843.56 |
| 24940 | Physician and practitioner services (fee schedule) | 35 | $561.19 |
| 24999 | Physician and practitioner services (fee schedule) | 6 | $76.74 |
| 25000 | Physician and practitioner services (fee schedule) | 44 | $277.76 |
| 25001 | Physician and practitioner services (fee schedule) | 44 | $269.85 |
| 25020 | Physician and practitioner services (fee schedule) | 44 | $544.45 |
| 25023 | Physician and practitioner services (fee schedule) | 44 | $978.35 |
| 25024 | Physician and practitioner services (fee schedule) | 44 | $585.37 |
| 25025 | Physician and practitioner services (fee schedule) | 44 | $893.45 |
| 25028 | Physician and practitioner services (fee schedule) | 45 | $483.26 |
| 25031 | Physician and practitioner services (fee schedule) | 44 | $288.04 |
| 25035 | Physician and practitioner services (fee schedule) | 44 | $466.72 |
| 25040 | Physician and practitioner services (fee schedule) | 44 | $429.04 |
| 25065 | Physician and practitioner services (fee schedule) | 43 | $152.92 |
| 25066 | Physician and practitioner services (fee schedule) | 44 | $285.80 |
| 25071 | Physician and practitioner services (fee schedule) | 44 | $310.65 |
| 25073 | Physician and practitioner services (fee schedule) | 44 | $388.44 |
| 25075 | Physician and practitioner services (fee schedule) | 44 | $327.82 |
| 25076 | Physician and practitioner services (fee schedule) | 44 | $400.52 |
| 25077 | Physician and practitioner services (fee schedule) | 44 | $652.00 |
| 25078 | Physician and practitioner services (fee schedule) | 43 | $791.38 |
| 25085 | Physician and practitioner services (fee schedule) | 44 | $345.30 |
| 25100 | Physician and practitioner services (fee schedule) | 44 | $282.27 |
| 25101 | Physician and practitioner services (fee schedule) | 44 | $320.06 |
| 25105 | Physician and practitioner services (fee schedule) | 44 | $378.79 |
| 25107 | Physician and practitioner services (fee schedule) | 44 | $457.28 |
| 25109 | Physician and practitioner services (fee schedule) | 43 | $410.59 |
| 25110 | Physician and practitioner services (fee schedule) | 44 | $278.40 |
| 25111 | Physician and practitioner services (fee schedule) | 43 | $255.51 |
| 25112 | Physician and practitioner services (fee schedule) | 43 | $308.00 |
| 25115 | Physician and practitioner services (fee schedule) | 44 | $589.77 |
| 25116 | Physician and practitioner services (fee schedule) | 44 | $475.78 |
| 25118 | Physician and practitioner services (fee schedule) | 44 | $306.79 |
| 25119 | Physician and practitioner services (fee schedule) | 44 | $388.46 |
| 25120 | Physician and practitioner services (fee schedule) | 44 | $394.40 |
| 25125 | Physician and practitioner services (fee schedule) | 44 | $466.62 |
| 25126 | Physician and practitioner services (fee schedule) | 44 | $464.83 |
| 25130 | Physician and practitioner services (fee schedule) | 44 | $345.04 |
| 25135 | Physician and practitioner services (fee schedule) | 44 | $423.96 |
| 25136 | Physician and practitioner services (fee schedule) | 44 | $378.69 |
| 25145 | Physician and practitioner services (fee schedule) | 44 | $407.58 |
| 25150 | Physician and practitioner services (fee schedule) | 44 | $433.35 |
| 25151 | Physician and practitioner services (fee schedule) | 44 | $447.90 |
| 25170 | Physician and practitioner services (fee schedule) | 44 | $958.36 |
| 25210 | Physician and practitioner services (fee schedule) | 44 | $379.53 |
| 25215 | Physician and practitioner services (fee schedule) | 44 | $467.76 |
| 25230 | Physician and practitioner services (fee schedule) | 43 | $333.20 |
| 25240 | Physician and practitioner services (fee schedule) | 44 | $337.65 |
| 25246 | Physician and practitioner services (fee schedule) | 44 | $110.07 |
| 25248 | Physician and practitioner services (fee schedule) | 44 | $332.01 |
| 25250 | Physician and practitioner services (fee schedule) | 43 | $399.53 |
| 25251 | Physician and practitioner services (fee schedule) | 43 | $527.07 |
| 25259 | Physician and practitioner services (fee schedule) | 42 | $342.27 |
| 25260 | Physician and practitioner services (fee schedule) | 44 | $490.92 |
| 25263 | Physician and practitioner services (fee schedule) | 44 | $487.20 |
| 25265 | Physician and practitioner services (fee schedule) | 43 | $567.59 |
| 25270 | Physician and practitioner services (fee schedule) | 44 | $389.43 |
| 25272 | Physician and practitioner services (fee schedule) | 44 | $438.90 |
| 25274 | Physician and practitioner services (fee schedule) | 44 | $511.58 |
| 25275 | Physician and practitioner services (fee schedule) | 44 | $500.21 |
| 25280 | Physician and practitioner services (fee schedule) | 44 | $435.12 |
| 25290 | Physician and practitioner services (fee schedule) | 44 | $349.45 |
| 25295 | Physician and practitioner services (fee schedule) | 44 | $415.78 |
| 25300 | Physician and practitioner services (fee schedule) | 43 | $517.87 |
| 25301 | Physician and practitioner services (fee schedule) | 44 | $472.88 |
| 25310 | Physician and practitioner services (fee schedule) | 44 | $504.95 |
| 25312 | Physician and practitioner services (fee schedule) | 44 | $540.15 |
| 25315 | Physician and practitioner services (fee schedule) | 44 | $574.84 |
| 25316 | Physician and practitioner services (fee schedule) | 43 | $683.34 |
| 25320 | Physician and practitioner services (fee schedule) | 44 | $707.27 |
| 25332 | Physician and practitioner services (fee schedule) | 44 | $625.19 |
| 25335 | Physician and practitioner services (fee schedule) | 44 | $707.97 |
| 25337 | Physician and practitioner services (fee schedule) | 44 | $679.38 |
| 25350 | Physician and practitioner services (fee schedule) | 44 | $515.72 |
| 25355 | Physician and practitioner services (fee schedule) | 44 | $578.14 |
| 25360 | Physician and practitioner services (fee schedule) | 44 | $496.58 |
| 25365 | Physician and practitioner services (fee schedule) | 44 | $681.92 |
| 25370 | Physician and practitioner services (fee schedule) | 44 | $748.93 |
| 25375 | Physician and practitioner services (fee schedule) | 44 | $702.40 |
| 25390 | Physician and practitioner services (fee schedule) | 44 | $582.68 |
| 25391 | Physician and practitioner services (fee schedule) | 44 | $747.32 |
| 25392 | Physician and practitioner services (fee schedule) | 44 | $769.22 |
| 25393 | Physician and practitioner services (fee schedule) | 44 | $860.30 |
| 25394 | Physician and practitioner services (fee schedule) | 43 | $572.02 |
| 25400 | Physician and practitioner services (fee schedule) | 44 | $608.45 |
| 25405 | Physician and practitioner services (fee schedule) | 44 | $778.09 |
| 25415 | Physician and practitioner services (fee schedule) | 44 | $726.36 |
| 25420 | Physician and practitioner services (fee schedule) | 44 | $864.65 |
| 25425 | Physician and practitioner services (fee schedule) | 44 | $720.56 |
| 25426 | Physician and practitioner services (fee schedule) | 44 | $806.68 |
| 25430 | Physician and practitioner services (fee schedule) | 43 | $548.57 |
| 25431 | Physician and practitioner services (fee schedule) | 43 | $574.61 |
| 25440 | Physician and practitioner services (fee schedule) | 44 | $569.69 |
| 25441 | Physician and practitioner services (fee schedule) | 44 | $687.19 |
| 25442 | Physician and practitioner services (fee schedule) | 44 | $581.27 |
| 25443 | Physician and practitioner services (fee schedule) | 44 | $576.01 |
| 25444 | Physician and practitioner services (fee schedule) | 44 | $625.70 |
| 25445 | Physician and practitioner services (fee schedule) | 44 | $547.85 |
| 25446 | Physician and practitioner services (fee schedule) | 44 | $870.53 |
| 25447 | Physician and practitioner services (fee schedule) | 45 | $586.06 |
| 25448 | Physician and practitioner services (fee schedule) | 37 | $663.43 |
| 25449 | Physician and practitioner services (fee schedule) | 44 | $731.71 |
| 25450 | Physician and practitioner services (fee schedule) | 44 | $474.03 |
| 25455 | Physician and practitioner services (fee schedule) | 44 | $550.44 |
| 25490 | Physician and practitioner services (fee schedule) | 43 | $546.84 |
| 25491 | Physician and practitioner services (fee schedule) | 43 | $560.22 |
| 25492 | Physician and practitioner services (fee schedule) | 43 | $689.90 |
| 25500 | Physician and practitioner services (fee schedule) | 44 | $224.02 |
| 25505 | Physician and practitioner services (fee schedule) | 44 | $403.14 |
| 25515 | Physician and practitioner services (fee schedule) | 44 | $497.16 |
| 25520 | Physician and practitioner services (fee schedule) | 44 | $461.38 |
| 25525 | Physician and practitioner services (fee schedule) | 44 | $603.81 |
| 25526 | Physician and practitioner services (fee schedule) | 44 | $721.73 |
| 25530 | Physician and practitioner services (fee schedule) | 44 | $214.69 |
| 25535 | Physician and practitioner services (fee schedule) | 44 | $390.35 |
| 25545 | Physician and practitioner services (fee schedule) | 44 | $477.90 |
| 25560 | Physician and practitioner services (fee schedule) | 44 | $225.55 |
| 25565 | Physician and practitioner services (fee schedule) | 44 | $421.22 |
| 25574 | Physician and practitioner services (fee schedule) | 44 | $502.61 |
| 25575 | Physician and practitioner services (fee schedule) | 44 | $653.24 |
| 25600 | Physician and practitioner services (fee schedule) | 44 | $261.03 |
| 25605 | Physician and practitioner services (fee schedule) | 44 | $437.18 |
| 25606 | Physician and practitioner services (fee schedule) | 44 | $511.24 |
| 25607 | Physician and practitioner services (fee schedule) | 44 | $540.86 |
| 25608 | Physician and practitioner services (fee schedule) | 44 | $613.04 |
| 25609 | Physician and practitioner services (fee schedule) | 44 | $769.98 |
| 25622 | Physician and practitioner services (fee schedule) | 44 | $242.50 |
| 25624 | Physician and practitioner services (fee schedule) | 44 | $375.10 |
| 25628 | Physician and practitioner services (fee schedule) | 44 | $525.33 |
| 25630 | Physician and practitioner services (fee schedule) | 44 | $249.47 |
| 25635 | Physician and practitioner services (fee schedule) | 44 | $357.14 |
| 25645 | Physician and practitioner services (fee schedule) | 44 | $427.89 |
| 25650 | Physician and practitioner services (fee schedule) | 44 | $266.93 |
| 25651 | Physician and practitioner services (fee schedule) | 43 | $374.99 |
| 25652 | Physician and practitioner services (fee schedule) | 43 | $467.56 |
| 25660 | Physician and practitioner services (fee schedule) | 44 | $332.69 |
| 25670 | Physician and practitioner services (fee schedule) | 44 | $445.84 |
| 25671 | Physician and practitioner services (fee schedule) | 43 | $413.78 |
| 25675 | Physician and practitioner services (fee schedule) | 44 | $367.59 |
| 25676 | Physician and practitioner services (fee schedule) | 44 | $466.96 |
| 25680 | Physician and practitioner services (fee schedule) | 44 | $393.01 |
| 25685 | Physician and practitioner services (fee schedule) | 44 | $550.98 |
| 25690 | Physician and practitioner services (fee schedule) | 44 | $378.49 |
| 25695 | Physician and practitioner services (fee schedule) | 44 | $462.59 |
| 25800 | Physician and practitioner services (fee schedule) | 44 | $550.08 |
| 25805 | Physician and practitioner services (fee schedule) | 44 | $639.12 |
| 25810 | Physician and practitioner services (fee schedule) | 44 | $641.91 |
| 25820 | Physician and practitioner services (fee schedule) | 44 | $486.00 |
| 25825 | Physician and practitioner services (fee schedule) | 44 | $593.14 |
| 25830 | Physician and practitioner services (fee schedule) | 44 | $733.31 |
| 25900 | Physician and practitioner services (fee schedule) | 44 | $543.34 |
| 25905 | Physician and practitioner services (fee schedule) | 44 | $525.97 |
| 25907 | Physician and practitioner services (fee schedule) | 44 | $465.01 |
| 25909 | Physician and practitioner services (fee schedule) | 44 | $514.95 |
| 25915 | Physician and practitioner services (fee schedule) | 43 | $879.05 |
| 25920 | Physician and practitioner services (fee schedule) | 44 | $550.99 |
| 25922 | Physician and practitioner services (fee schedule) | 44 | $457.10 |
| 25924 | Physician and practitioner services (fee schedule) | 44 | $514.80 |
| 25927 | Physician and practitioner services (fee schedule) | 44 | $638.74 |
| 25929 | Physician and practitioner services (fee schedule) | 44 | $430.78 |
| 25931 | Physician and practitioner services (fee schedule) | 44 | $599.57 |
| 25999 | Physician and practitioner services (fee schedule) | 7 | $134.99 |
| 26010 | Physician and practitioner services (fee schedule) | 44 | $148.31 |
| 26011 | Physician and practitioner services (fee schedule) | 44 | $193.11 |
| 26020 | Physician and practitioner services (fee schedule) | 44 | $406.26 |
| 26025 | Physician and practitioner services (fee schedule) | 44 | $329.70 |
| 26030 | Physician and practitioner services (fee schedule) | 44 | $377.20 |
| 26034 | Physician and practitioner services (fee schedule) | 44 | $425.85 |
| 26035 | Physician and practitioner services (fee schedule) | 43 | $643.24 |
| 26037 | Physician and practitioner services (fee schedule) | 44 | $426.99 |
| 26040 | Physician and practitioner services (fee schedule) | 44 | $251.91 |
| 26045 | Physician and practitioner services (fee schedule) | 44 | $376.79 |
| 26055 | Physician and practitioner services (fee schedule) | 44 | $283.78 |
| 26060 | Physician and practitioner services (fee schedule) | 44 | $196.16 |
| 26070 | Physician and practitioner services (fee schedule) | 44 | $249.38 |
| 26075 | Physician and practitioner services (fee schedule) | 44 | $263.46 |
| 26080 | Physician and practitioner services (fee schedule) | 44 | $312.33 |
| 26100 | Physician and practitioner services (fee schedule) | 44 | $271.92 |
| 26105 | Physician and practitioner services (fee schedule) | 44 | $273.24 |
| 26110 | Physician and practitioner services (fee schedule) | 44 | $255.82 |
| 26111 | Physician and practitioner services (fee schedule) | 44 | $308.51 |
| 26113 | Physician and practitioner services (fee schedule) | 44 | $394.55 |
| 26115 | Physician and practitioner services (fee schedule) | 44 | $319.52 |
| 26116 | Physician and practitioner services (fee schedule) | 44 | $401.53 |
| 26117 | Physician and practitioner services (fee schedule) | 44 | $561.31 |
| 26118 | Physician and practitioner services (fee schedule) | 43 | $706.28 |
| 26121 | Physician and practitioner services (fee schedule) | 44 | $477.99 |
| 26123 | Physician and practitioner services (fee schedule) | 44 | $639.28 |
| 26125 | Physician and practitioner services (fee schedule) | 43 | $202.65 |
| 26130 | Physician and practitioner services (fee schedule) | 44 | $373.04 |
| 26135 | Physician and practitioner services (fee schedule) | 44 | $411.39 |
| 26140 | Physician and practitioner services (fee schedule) | 44 | $390.35 |
| 26145 | Physician and practitioner services (fee schedule) | 44 | $397.87 |
| 26160 | Physician and practitioner services (fee schedule) | 44 | $298.98 |
| 26170 | Physician and practitioner services (fee schedule) | 44 | $317.25 |
| 26180 | Physician and practitioner services (fee schedule) | 44 | $344.69 |
| 26185 | Physician and practitioner services (fee schedule) | 44 | $379.16 |
| 26200 | Physician and practitioner services (fee schedule) | 44 | $343.49 |
| 26205 | Physician and practitioner services (fee schedule) | 44 | $463.43 |
| 26210 | Physician and practitioner services (fee schedule) | 44 | $347.56 |
| 26215 | Physician and practitioner services (fee schedule) | 44 | $436.84 |
| 26230 | Physician and practitioner services (fee schedule) | 44 | $382.92 |
| 26235 | Physician and practitioner services (fee schedule) | 44 | $372.61 |
| 26236 | Physician and practitioner services (fee schedule) | 44 | $341.04 |
| 26250 | Physician and practitioner services (fee schedule) | 44 | $729.68 |
| 26260 | Physician and practitioner services (fee schedule) | 44 | $538.36 |
| 26262 | Physician and practitioner services (fee schedule) | 44 | $432.40 |
| 26320 | Physician and practitioner services (fee schedule) | 44 | $272.71 |
| 26340 | Physician and practitioner services (fee schedule) | 42 | $283.00 |
| 26341 | Physician and practitioner services (fee schedule) | 40 | $80.32 |
| 26350 | Physician and practitioner services (fee schedule) | 44 | $588.84 |
| 26352 | Physician and practitioner services (fee schedule) | 44 | $614.97 |
| 26356 | Physician and practitioner services (fee schedule) | 44 | $623.85 |
| 26357 | Physician and practitioner services (fee schedule) | 44 | $666.35 |
| 26358 | Physician and practitioner services (fee schedule) | 44 | $729.80 |
| 26370 | Physician and practitioner services (fee schedule) | 44 | $612.76 |
| 26372 | Physician and practitioner services (fee schedule) | 44 | $674.09 |
| 26373 | Physician and practitioner services (fee schedule) | 44 | $662.41 |
| 26390 | Physician and practitioner services (fee schedule) | 44 | $646.53 |
| 26392 | Physician and practitioner services (fee schedule) | 44 | $739.22 |
| 26410 | Physician and practitioner services (fee schedule) | 44 | $474.82 |
| 26412 | Physician and practitioner services (fee schedule) | 44 | $559.61 |
| 26415 | Physician and practitioner services (fee schedule) | 43 | $635.79 |
| 26416 | Physician and practitioner services (fee schedule) | 43 | $713.43 |
| 26418 | Physician and practitioner services (fee schedule) | 44 | $493.26 |
| 26420 | Physician and practitioner services (fee schedule) | 43 | $569.94 |
| 26426 | Physician and practitioner services (fee schedule) | 44 | $405.74 |
| 26428 | Physician and practitioner services (fee schedule) | 44 | $623.64 |
| 26432 | Physician and practitioner services (fee schedule) | 44 | $430.62 |
| 26433 | Physician and practitioner services (fee schedule) | 44 | $452.01 |
| 26434 | Physician and practitioner services (fee schedule) | 44 | $528.69 |
| 26437 | Physician and practitioner services (fee schedule) | 44 | $517.36 |
| 26440 | Physician and practitioner services (fee schedule) | 44 | $504.93 |
| 26442 | Physician and practitioner services (fee schedule) | 44 | $754.71 |
| 26445 | Physician and practitioner services (fee schedule) | 44 | $477.82 |
| 26449 | Physician and practitioner services (fee schedule) | 44 | $538.79 |
| 26450 | Physician and practitioner services (fee schedule) | 44 | $360.69 |
| 26455 | Physician and practitioner services (fee schedule) | 44 | $359.25 |
| 26460 | Physician and practitioner services (fee schedule) | 44 | $355.54 |
| 26471 | Physician and practitioner services (fee schedule) | 44 | $505.83 |
| 26474 | Physician and practitioner services (fee schedule) | 44 | $449.82 |
| 26476 | Physician and practitioner services (fee schedule) | 44 | $508.47 |
| 26477 | Physician and practitioner services (fee schedule) | 44 | $470.69 |
| 26478 | Physician and practitioner services (fee schedule) | 43 | $506.29 |
| 26479 | Physician and practitioner services (fee schedule) | 44 | $486.35 |
| 26480 | Physician and practitioner services (fee schedule) | 44 | $556.87 |
| 26483 | Physician and practitioner services (fee schedule) | 44 | $656.01 |
| 26485 | Physician and practitioner services (fee schedule) | 44 | $633.92 |
| 26489 | Physician and practitioner services (fee schedule) | 44 | $737.45 |
| 26490 | Physician and practitioner services (fee schedule) | 44 | $651.47 |
| 26492 | Physician and practitioner services (fee schedule) | 44 | $648.29 |
| 26494 | Physician and practitioner services (fee schedule) | 44 | $619.64 |
| 26496 | Physician and practitioner services (fee schedule) | 44 | $692.48 |
| 26497 | Physician and practitioner services (fee schedule) | 44 | $664.81 |
| 26498 | Physician and practitioner services (fee schedule) | 44 | $847.97 |
| 26499 | Physician and practitioner services (fee schedule) | 42 | $616.50 |
| 26500 | Physician and practitioner services (fee schedule) | 44 | $526.81 |
| 26502 | Physician and practitioner services (fee schedule) | 44 | $547.06 |
| 26508 | Physician and practitioner services (fee schedule) | 44 | $504.51 |
| 26510 | Physician and practitioner services (fee schedule) | 43 | $473.43 |
| 26516 | Physician and practitioner services (fee schedule) | 44 | $563.55 |
| 26517 | Physician and practitioner services (fee schedule) | 44 | $633.06 |
| 26518 | Physician and practitioner services (fee schedule) | 44 | $611.42 |
| 26520 | Physician and practitioner services (fee schedule) | 44 | $537.94 |
| 26525 | Physician and practitioner services (fee schedule) | 44 | $531.84 |
| 26530 | Physician and practitioner services (fee schedule) | 44 | $408.97 |
| 26531 | Physician and practitioner services (fee schedule) | 44 | $462.05 |
| 26535 | Physician and practitioner services (fee schedule) | 44 | $343.00 |
| 26536 | Physician and practitioner services (fee schedule) | 44 | $572.22 |
| 26540 | Physician and practitioner services (fee schedule) | 44 | $533.64 |
| 26541 | Physician and practitioner services (fee schedule) | 44 | $609.03 |
| 26542 | Physician and practitioner services (fee schedule) | 44 | $554.47 |
| 26545 | Physician and practitioner services (fee schedule) | 44 | $555.81 |
| 26546 | Physician and practitioner services (fee schedule) | 44 | $717.42 |
| 26548 | Physician and practitioner services (fee schedule) | 44 | $608.09 |
| 26550 | Physician and practitioner services (fee schedule) | 44 | $1,215.85 |
| 26551 | Physician and practitioner services (fee schedule) | 43 | $2,379.70 |
| 26553 | Physician and practitioner services (fee schedule) | 43 | $2,333.88 |
| 26554 | Physician and practitioner services (fee schedule) | 43 | $2,736.54 |
| 26555 | Physician and practitioner services (fee schedule) | 43 | $958.18 |
| 26556 | Physician and practitioner services (fee schedule) | 43 | $2,450.36 |
| 26560 | Physician and practitioner services (fee schedule) | 44 | $488.01 |
| 26561 | Physician and practitioner services (fee schedule) | 44 | $717.12 |
| 26562 | Physician and practitioner services (fee schedule) | 44 | $954.36 |
| 26565 | Physician and practitioner services (fee schedule) | 44 | $530.63 |
| 26567 | Physician and practitioner services (fee schedule) | 44 | $549.78 |
| 26568 | Physician and practitioner services (fee schedule) | 43 | $708.65 |
| 26580 | Physician and practitioner services (fee schedule) | 41 | $1,134.94 |
| 26587 | Physician and practitioner services (fee schedule) | 43 | $765.89 |
| 26590 | Physician and practitioner services (fee schedule) | 44 | $1,032.92 |
| 26591 | Physician and practitioner services (fee schedule) | 44 | $385.76 |
| 26593 | Physician and practitioner services (fee schedule) | 43 | $480.12 |
| 26596 | Physician and practitioner services (fee schedule) | 43 | $609.33 |
| 26600 | Physician and practitioner services (fee schedule) | 44 | $232.19 |
| 26605 | Physician and practitioner services (fee schedule) | 44 | $255.09 |
| 26607 | Physician and practitioner services (fee schedule) | 44 | $399.27 |
| 26608 | Physician and practitioner services (fee schedule) | 44 | $370.63 |
| 26615 | Physician and practitioner services (fee schedule) | 44 | $430.03 |
| 26641 | Physician and practitioner services (fee schedule) | 44 | $316.83 |
| 26645 | Physician and practitioner services (fee schedule) | 44 | $335.20 |
| 26650 | Physician and practitioner services (fee schedule) | 44 | $377.92 |
| 26665 | Physician and practitioner services (fee schedule) | 44 | $465.64 |
| 26670 | Physician and practitioner services (fee schedule) | 44 | $279.03 |
| 26675 | Physician and practitioner services (fee schedule) | 44 | $353.80 |
| 26676 | Physician and practitioner services (fee schedule) | 44 | $391.43 |
| 26685 | Physician and practitioner services (fee schedule) | 44 | $431.58 |
| 26686 | Physician and practitioner services (fee schedule) | 44 | $471.24 |
| 26700 | Physician and practitioner services (fee schedule) | 44 | $271.58 |
| 26705 | Physician and practitioner services (fee schedule) | 44 | $329.11 |
| 26706 | Physician and practitioner services (fee schedule) | 44 | $334.50 |
| 26715 | Physician and practitioner services (fee schedule) | 44 | $432.01 |
| 26720 | Physician and practitioner services (fee schedule) | 44 | $159.42 |
| 26725 | Physician and practitioner services (fee schedule) | 44 | $267.65 |
| 26727 | Physician and practitioner services (fee schedule) | 44 | $358.68 |
| 26735 | Physician and practitioner services (fee schedule) | 44 | $442.99 |
| 26740 | Physician and practitioner services (fee schedule) | 44 | $183.50 |
| 26742 | Physician and practitioner services (fee schedule) | 44 | $292.26 |
| 26746 | Physician and practitioner services (fee schedule) | 44 | $519.72 |
| 26750 | Physician and practitioner services (fee schedule) | 44 | $152.23 |
| 26755 | Physician and practitioner services (fee schedule) | 44 | $252.94 |
| 26756 | Physician and practitioner services (fee schedule) | 44 | $327.49 |
| 26765 | Physician and practitioner services (fee schedule) | 44 | $369.36 |
| 26770 | Physician and practitioner services (fee schedule) | 44 | $234.72 |
| 26775 | Physician and practitioner services (fee schedule) | 44 | $302.77 |
| 26776 | Physician and practitioner services (fee schedule) | 44 | $341.58 |
| 26785 | Physician and practitioner services (fee schedule) | 44 | $397.54 |
| 26820 | Physician and practitioner services (fee schedule) | 44 | $609.44 |
| 26841 | Physician and practitioner services (fee schedule) | 44 | $575.64 |
| 26842 | Physician and practitioner services (fee schedule) | 44 | $620.92 |
| 26843 | Physician and practitioner services (fee schedule) | 44 | $573.90 |
| 26844 | Physician and practitioner services (fee schedule) | 44 | $603.70 |
| 26850 | Physician and practitioner services (fee schedule) | 44 | $554.99 |
| 26852 | Physician and practitioner services (fee schedule) | 44 | $594.02 |
| 26860 | Physician and practitioner services (fee schedule) | 44 | $476.57 |
| 26861 | Physician and practitioner services (fee schedule) | 44 | $79.54 |
| 26862 | Physician and practitioner services (fee schedule) | 44 | $547.60 |
| 26863 | Physician and practitioner services (fee schedule) | 44 | $158.81 |
| 26910 | Physician and practitioner services (fee schedule) | 44 | $588.39 |
| 26951 | Physician and practitioner services (fee schedule) | 44 | $535.84 |
| 26952 | Physician and practitioner services (fee schedule) | 44 | $531.34 |
| 26989 | Physician and practitioner services (fee schedule) | 7 | $40.48 |
| 26990 | Physician and practitioner services (fee schedule) | 44 | $520.27 |
| 26991 | Physician and practitioner services (fee schedule) | 44 | $460.25 |
| 26992 | Physician and practitioner services (fee schedule) | 44 | $743.99 |
| 27000 | Physician and practitioner services (fee schedule) | 44 | $299.22 |
| 27001 | Physician and practitioner services (fee schedule) | 44 | $392.52 |
| 27003 | Physician and practitioner services (fee schedule) | 44 | $447.64 |
| 27005 | Physician and practitioner services (fee schedule) | 44 | $528.35 |
| 27006 | Physician and practitioner services (fee schedule) | 44 | $527.33 |
| 27025 | Physician and practitioner services (fee schedule) | 44 | $680.35 |
| 27027 | Physician and practitioner services (fee schedule) | 44 | $653.16 |
| 27030 | Physician and practitioner services (fee schedule) | 44 | $693.07 |
| 27033 | Physician and practitioner services (fee schedule) | 44 | $710.25 |
| 27035 | Physician and practitioner services (fee schedule) | 43 | $809.83 |
| 27036 | Physician and practitioner services (fee schedule) | 44 | $735.05 |
| 27040 | Physician and practitioner services (fee schedule) | 44 | $192.48 |
| 27041 | Physician and practitioner services (fee schedule) | 44 | $516.31 |
| 27043 | Physician and practitioner services (fee schedule) | 44 | $354.94 |
| 27045 | Physician and practitioner services (fee schedule) | 44 | $539.23 |
| 27047 | Physician and practitioner services (fee schedule) | 44 | $364.28 |
| 27048 | Physician and practitioner services (fee schedule) | 44 | $421.96 |
| 27049 | Physician and practitioner services (fee schedule) | 44 | $886.64 |
| 27050 | Physician and practitioner services (fee schedule) | 44 | $319.48 |
| 27052 | Physician and practitioner services (fee schedule) | 44 | $436.03 |
| 27054 | Physician and practitioner services (fee schedule) | 44 | $530.02 |
| 27057 | Physician and practitioner services (fee schedule) | 44 | $727.93 |
| 27059 | Physician and practitioner services (fee schedule) | 44 | $1,218.18 |
| 27060 | Physician and practitioner services (fee schedule) | 44 | $355.80 |
| 27062 | Physician and practitioner services (fee schedule) | 44 | $345.26 |
| 27065 | Physician and practitioner services (fee schedule) | 44 | $402.50 |
| 27066 | Physician and practitioner services (fee schedule) | 44 | $594.47 |
| 27067 | Physician and practitioner services (fee schedule) | 44 | $746.84 |
| 27070 | Physician and practitioner services (fee schedule) | 44 | $610.62 |
| 27071 | Physician and practitioner services (fee schedule) | 44 | $690.77 |
| 27075 | Physician and practitioner services (fee schedule) | 44 | $1,381.50 |
| 27076 | Physician and practitioner services (fee schedule) | 44 | $1,576.58 |
| 27077 | Physician and practitioner services (fee schedule) | 44 | $1,791.38 |
| 27078 | Physician and practitioner services (fee schedule) | 44 | $1,294.02 |
| 27080 | Physician and practitioner services (fee schedule) | 43 | $386.36 |
| 27086 | Physician and practitioner services (fee schedule) | 44 | $167.24 |
| 27087 | Physician and practitioner services (fee schedule) | 44 | $463.18 |
| 27090 | Physician and practitioner services (fee schedule) | 44 | $605.69 |
| 27091 | Physician and practitioner services (fee schedule) | 44 | $1,164.97 |
| 27093 | Physician and practitioner services (fee schedule) | 44 | $136.15 |
| 27095 | Physician and practitioner services (fee schedule) | 44 | $173.22 |
| 27096 | Physician and practitioner services (fee schedule) | 44 | $130.78 |
| 27097 | Physician and practitioner services (fee schedule) | 44 | $493.51 |
| 27098 | Physician and practitioner services (fee schedule) | 44 | $497.03 |
| 27100 | Physician and practitioner services (fee schedule) | 44 | $581.68 |
| 27105 | Physician and practitioner services (fee schedule) | 43 | $627.79 |
| 27110 | Physician and practitioner services (fee schedule) | 44 | $698.97 |
| 27111 | Physician and practitioner services (fee schedule) | 44 | $659.49 |
| 27120 | Physician and practitioner services (fee schedule) | 44 | $939.14 |
| 27122 | Physician and practitioner services (fee schedule) | 44 | $831.57 |
| 27125 | Physician and practitioner services (fee schedule) | 44 | $852.14 |
| 27130 | Physician and practitioner services (fee schedule) | 44 | $997.84 |
| 27132 | Physician and practitioner services (fee schedule) | 43 | $1,250.46 |
| 27134 | Physician and practitioner services (fee schedule) | 44 | $1,378.90 |
| 27137 | Physician and practitioner services (fee schedule) | 44 | $1,091.96 |
| 27138 | Physician and practitioner services (fee schedule) | 43 | $1,129.56 |
| 27140 | Physician and practitioner services (fee schedule) | 44 | $664.06 |
| 27146 | Physician and practitioner services (fee schedule) | 44 | $927.96 |
| 27147 | Physician and practitioner services (fee schedule) | 44 | $1,051.96 |
| 27151 | Physician and practitioner services (fee schedule) | 44 | $1,138.84 |
| 27156 | Physician and practitioner services (fee schedule) | 44 | $1,215.31 |
| 27158 | Physician and practitioner services (fee schedule) | 44 | $998.31 |
| 27161 | Physician and practitioner services (fee schedule) | 44 | $882.57 |
| 27165 | Physician and practitioner services (fee schedule) | 44 | $1,000.43 |
| 27170 | Physician and practitioner services (fee schedule) | 44 | $874.59 |
| 27175 | Physician and practitioner services (fee schedule) | 44 | $488.72 |
| 27176 | Physician and practitioner services (fee schedule) | 44 | $668.51 |
| 27177 | Physician and practitioner services (fee schedule) | 44 | $814.05 |
| 27178 | Physician and practitioner services (fee schedule) | 44 | $670.92 |
| 27179 | Physician and practitioner services (fee schedule) | 44 | $713.85 |
| 27181 | Physician and practitioner services (fee schedule) | 44 | $820.89 |
| 27185 | Physician and practitioner services (fee schedule) | 44 | $533.38 |
| 27187 | Physician and practitioner services (fee schedule) | 43 | $748.83 |
| 27197 | Physician and practitioner services (fee schedule) | 44 | $101.41 |
| 27198 | Physician and practitioner services (fee schedule) | 44 | $237.10 |
| 27200 | Physician and practitioner services (fee schedule) | 43 | $146.28 |
| 27202 | Physician and practitioner services (fee schedule) | 43 | $399.86 |
| 27215 | Physician and practitioner services (fee schedule) | 43 | $482.56 |
| 27216 | Physician and practitioner services (fee schedule) | 42 | $642.10 |
| 27217 | Physician and practitioner services (fee schedule) | 43 | $643.28 |
| 27218 | Physician and practitioner services (fee schedule) | 43 | $869.07 |
| 27220 | Physician and practitioner services (fee schedule) | 44 | $352.31 |
| 27222 | Physician and practitioner services (fee schedule) | 44 | $727.83 |
| 27226 | Physician and practitioner services (fee schedule) | 44 | $782.39 |
| 27227 | Physician and practitioner services (fee schedule) | 44 | $1,176.97 |
| 27228 | Physician and practitioner services (fee schedule) | 44 | $1,334.98 |
| 27230 | Physician and practitioner services (fee schedule) | 44 | $390.09 |
| 27232 | Physician and practitioner services (fee schedule) | 44 | $570.92 |
| 27235 | Physician and practitioner services (fee schedule) | 44 | $697.35 |
| 27236 | Physician and practitioner services (fee schedule) | 44 | $897.54 |
| 27238 | Physician and practitioner services (fee schedule) | 44 | $361.59 |
| 27240 | Physician and practitioner services (fee schedule) | 44 | $724.02 |
| 27244 | Physician and practitioner services (fee schedule) | 44 | $906.31 |
| 27245 | Physician and practitioner services (fee schedule) | 44 | $921.87 |
| 27246 | Physician and practitioner services (fee schedule) | 44 | $316.87 |
| 27248 | Physician and practitioner services (fee schedule) | 44 | $563.74 |
| 27250 | Physician and practitioner services (fee schedule) | 44 | $157.16 |
| 27252 | Physician and practitioner services (fee schedule) | 44 | $564.56 |
| 27253 | Physician and practitioner services (fee schedule) | 44 | $697.24 |
| 27254 | Physician and practitioner services (fee schedule) | 44 | $917.72 |
| 27256 | Physician and practitioner services (fee schedule) | 44 | $250.20 |
| 27257 | Physician and practitioner services (fee schedule) | 44 | $275.82 |
| 27258 | Physician and practitioner services (fee schedule) | 44 | $817.26 |
| 27259 | Physician and practitioner services (fee schedule) | 44 | $1,111.24 |
| 27265 | Physician and practitioner services (fee schedule) | 43 | $342.38 |
| 27266 | Physician and practitioner services (fee schedule) | 44 | $442.43 |
| 27267 | Physician and practitioner services (fee schedule) | 44 | $325.97 |
| 27268 | Physician and practitioner services (fee schedule) | 44 | $383.61 |
| 27269 | Physician and practitioner services (fee schedule) | 44 | $877.84 |
| 27275 | Physician and practitioner services (fee schedule) | 44 | $145.60 |
| 27278 | Physician and practitioner services (fee schedule) | 35 | $7,397.86 |
| 27279 | Physician and practitioner services (fee schedule) | 42 | $546.20 |
| 27280 | Physician and practitioner services (fee schedule) | 44 | $944.48 |
| 27282 | Physician and practitioner services (fee schedule) | 44 | $634.41 |
| 27284 | Physician and practitioner services (fee schedule) | 44 | $1,065.61 |
| 27286 | Physician and practitioner services (fee schedule) | 44 | $1,092.57 |
| 27290 | Physician and practitioner services (fee schedule) | 44 | $1,190.63 |
| 27295 | Physician and practitioner services (fee schedule) | 44 | $937.97 |
| 27299 | Physician and practitioner services (fee schedule) | 9 | $530.14 |
| 27301 | Physician and practitioner services (fee schedule) | 44 | $470.60 |
| 27303 | Physician and practitioner services (fee schedule) | 44 | $473.33 |
| 27305 | Physician and practitioner services (fee schedule) | 44 | $362.76 |
| 27306 | Physician and practitioner services (fee schedule) | 44 | $269.08 |
| 27307 | Physician and practitioner services (fee schedule) | 44 | $312.84 |
| 27310 | Physician and practitioner services (fee schedule) | 44 | $540.17 |
| 27323 | Physician and practitioner services (fee schedule) | 44 | $173.29 |
| 27324 | Physician and practitioner services (fee schedule) | 44 | $314.90 |
| 27325 | Physician and practitioner services (fee schedule) | 43 | $396.53 |
| 27326 | Physician and practitioner services (fee schedule) | 44 | $384.52 |
| 27327 | Physician and practitioner services (fee schedule) | 44 | $315.57 |
| 27328 | Physician and practitioner services (fee schedule) | 44 | $460.97 |
| 27329 | Physician and practitioner services (fee schedule) | 44 | $751.05 |
| 27330 | Physician and practitioner services (fee schedule) | 44 | $335.83 |
| 27331 | Physician and practitioner services (fee schedule) | 44 | $367.86 |
| 27332 | Physician and practitioner services (fee schedule) | 44 | $494.09 |
| 27333 | Physician and practitioner services (fee schedule) | 44 | $448.84 |
| 27334 | Physician and practitioner services (fee schedule) | 44 | $523.13 |
| 27335 | Physician and practitioner services (fee schedule) | 44 | $578.97 |
| 27337 | Physician and practitioner services (fee schedule) | 44 | $308.79 |
| 27339 | Physician and practitioner services (fee schedule) | 44 | $550.74 |
| 27340 | Physician and practitioner services (fee schedule) | 44 | $292.77 |
| 27345 | Physician and practitioner services (fee schedule) | 44 | $370.45 |
| 27347 | Physician and practitioner services (fee schedule) | 44 | $371.76 |
| 27350 | Physician and practitioner services (fee schedule) | 44 | $496.47 |
| 27355 | Physician and practitioner services (fee schedule) | 44 | $452.52 |
| 27356 | Physician and practitioner services (fee schedule) | 44 | $555.34 |
| 27357 | Physician and practitioner services (fee schedule) | 44 | $597.39 |
| 27358 | Physician and practitioner services (fee schedule) | 44 | $214.69 |
| 27360 | Physician and practitioner services (fee schedule) | 44 | $646.03 |
| 27364 | Physician and practitioner services (fee schedule) | 44 | $1,117.99 |
| 27365 | Physician and practitioner services (fee schedule) | 44 | $1,324.64 |
| 27369 | Physician and practitioner services (fee schedule) | 44 | $108.41 |
| 27372 | Physician and practitioner services (fee schedule) | 44 | $368.87 |
| 27380 | Physician and practitioner services (fee schedule) | 44 | $468.83 |
| 27381 | Physician and practitioner services (fee schedule) | 44 | $620.12 |
| 27385 | Physician and practitioner services (fee schedule) | 44 | $469.93 |
| 27386 | Physician and practitioner services (fee schedule) | 44 | $644.60 |
| 27390 | Physician and practitioner services (fee schedule) | 44 | $337.67 |
| 27391 | Physician and practitioner services (fee schedule) | 44 | $439.37 |
| 27392 | Physician and practitioner services (fee schedule) | 44 | $527.68 |
| 27393 | Physician and practitioner services (fee schedule) | 44 | $368.45 |
| 27394 | Physician and practitioner services (fee schedule) | 44 | $485.08 |
| 27395 | Physician and practitioner services (fee schedule) | 44 | $645.13 |
| 27396 | Physician and practitioner services (fee schedule) | 44 | $461.04 |
| 27397 | Physician and practitioner services (fee schedule) | 44 | $669.57 |
| 27400 | Physician and practitioner services (fee schedule) | 44 | $504.48 |
| 27403 | Physician and practitioner services (fee schedule) | 44 | $491.00 |
| 27405 | Physician and practitioner services (fee schedule) | 44 | $511.83 |
| 27407 | Physician and practitioner services (fee schedule) | 44 | $572.18 |
| 27409 | Physician and practitioner services (fee schedule) | 44 | $713.66 |
| 27412 | Physician and practitioner services (fee schedule) | 37 | $1,179.03 |
| 27415 | Physician and practitioner services (fee schedule) | 40 | $1,000.03 |
| 27416 | Physician and practitioner services (fee schedule) | 42 | $710.90 |
| 27418 | Physician and practitioner services (fee schedule) | 44 | $628.61 |
| 27420 | Physician and practitioner services (fee schedule) | 44 | $566.42 |
| 27422 | Physician and practitioner services (fee schedule) | 44 | $562.50 |
| 27424 | Physician and practitioner services (fee schedule) | 44 | $567.27 |
| 27425 | Physician and practitioner services (fee schedule) | 44 | $358.78 |
| 27427 | Physician and practitioner services (fee schedule) | 44 | $530.00 |
| 27428 | Physician and practitioner services (fee schedule) | 44 | $808.13 |
| 27429 | Physician and practitioner services (fee schedule) | 43 | $904.05 |
| 27430 | Physician and practitioner services (fee schedule) | 44 | $550.36 |
| 27435 | Physician and practitioner services (fee schedule) | 44 | $581.90 |
| 27437 | Physician and practitioner services (fee schedule) | 43 | $516.12 |
| 27438 | Physician and practitioner services (fee schedule) | 43 | $633.79 |
| 27440 | Physician and practitioner services (fee schedule) | 44 | $593.98 |
| 27441 | Physician and practitioner services (fee schedule) | 44 | $601.83 |
| 27442 | Physician and practitioner services (fee schedule) | 44 | $656.82 |
| 27443 | Physician and practitioner services (fee schedule) | 44 | $622.22 |
| 27445 | Physician and practitioner services (fee schedule) | 12 | $976.32 |
| 27446 | Physician and practitioner services (fee schedule) | 44 | $878.69 |
| 27447 | Physician and practitioner services (fee schedule) | 44 | $1,011.53 |
| 27448 | Physician and practitioner services (fee schedule) | 44 | $607.32 |
| 27450 | Physician and practitioner services (fee schedule) | 44 | $757.14 |
| 27454 | Physician and practitioner services (fee schedule) | 44 | $938.09 |
| 27455 | Physician and practitioner services (fee schedule) | 44 | $716.71 |
| 27457 | Physician and practitioner services (fee schedule) | 44 | $718.02 |
| 27458 | Physician and practitioner services (fee schedule) | 28 | $1,326.67 |
| 27465 | Physician and practitioner services (fee schedule) | 44 | $914.99 |
| 27466 | Physician and practitioner services (fee schedule) | 44 | $953.04 |
| 27468 | Physician and practitioner services (fee schedule) | 13 | $1,085.58 |
| 27470 | Physician and practitioner services (fee schedule) | 44 | $870.71 |
| 27472 | Physician and practitioner services (fee schedule) | 44 | $937.85 |
| 27475 | Physician and practitioner services (fee schedule) | 44 | $510.66 |
| 27477 | Physician and practitioner services (fee schedule) | 44 | $580.97 |
| 27479 | Physician and practitioner services (fee schedule) | 44 | $693.80 |
| 27485 | Physician and practitioner services (fee schedule) | 44 | $515.55 |
| 27486 | Physician and practitioner services (fee schedule) | 44 | $1,032.99 |
| 27487 | Physician and practitioner services (fee schedule) | 44 | $1,305.64 |
| 27488 | Physician and practitioner services (fee schedule) | 44 | $883.10 |
| 27495 | Physician and practitioner services (fee schedule) | 42 | $851.94 |
| 27496 | Physician and practitioner services (fee schedule) | 44 | $419.64 |
| 27497 | Physician and practitioner services (fee schedule) | 44 | $438.26 |
| 27498 | Physician and practitioner services (fee schedule) | 44 | $489.58 |
| 27499 | Physician and practitioner services (fee schedule) | 43 | $482.18 |
| 27500 | Physician and practitioner services (fee schedule) | 44 | $404.94 |
| 27501 | Physician and practitioner services (fee schedule) | 44 | $411.36 |
| 27502 | Physician and practitioner services (fee schedule) | 44 | $604.03 |
| 27503 | Physician and practitioner services (fee schedule) | 44 | $604.18 |
| 27506 | Physician and practitioner services (fee schedule) | 44 | $961.92 |
| 27507 | Physician and practitioner services (fee schedule) | 44 | $726.33 |
| 27508 | Physician and practitioner services (fee schedule) | 44 | $422.76 |
| 27509 | Physician and practitioner services (fee schedule) | 44 | $516.29 |
| 27510 | Physician and practitioner services (fee schedule) | 44 | $534.27 |
| 27511 | Physician and practitioner services (fee schedule) | 44 | $745.82 |
| 27513 | Physician and practitioner services (fee schedule) | 44 | $920.25 |
| 27514 | Physician and practitioner services (fee schedule) | 44 | $735.62 |
| 27516 | Physician and practitioner services (fee schedule) | 43 | $418.57 |
| 27517 | Physician and practitioner services (fee schedule) | 43 | $527.30 |
| 27519 | Physician and practitioner services (fee schedule) | 44 | $689.43 |
| 27520 | Physician and practitioner services (fee schedule) | 44 | $257.57 |
| 27524 | Physician and practitioner services (fee schedule) | 44 | $573.38 |
| 27530 | Physician and practitioner services (fee schedule) | 44 | $260.87 |
| 27532 | Physician and practitioner services (fee schedule) | 44 | $476.69 |
| 27535 | Physician and practitioner services (fee schedule) | 44 | $666.97 |
| 27536 | Physician and practitioner services (fee schedule) | 44 | $854.12 |
| 27538 | Physician and practitioner services (fee schedule) | 44 | $387.19 |
| 27540 | Physician and practitioner services (fee schedule) | 44 | $637.57 |
| 27550 | Physician and practitioner services (fee schedule) | 44 | $410.26 |
| 27552 | Physician and practitioner services (fee schedule) | 44 | $475.06 |
| 27556 | Physician and practitioner services (fee schedule) | 44 | $659.03 |
| 27557 | Physician and practitioner services (fee schedule) | 44 | $792.93 |
| 27558 | Physician and practitioner services (fee schedule) | 44 | $867.68 |
| 27560 | Physician and practitioner services (fee schedule) | 44 | $300.70 |
| 27562 | Physician and practitioner services (fee schedule) | 44 | $376.22 |
| 27566 | Physician and practitioner services (fee schedule) | 44 | $654.76 |
| 27570 | Physician and practitioner services (fee schedule) | 44 | $122.04 |
| 27580 | Physician and practitioner services (fee schedule) | 44 | $1,077.50 |
| 27590 | Physician and practitioner services (fee schedule) | 44 | $595.12 |
| 27591 | Physician and practitioner services (fee schedule) | 43 | $700.59 |
| 27592 | Physician and practitioner services (fee schedule) | 44 | $504.63 |
| 27594 | Physician and practitioner services (fee schedule) | 44 | $374.89 |
| 27596 | Physician and practitioner services (fee schedule) | 44 | $537.76 |
| 27598 | Physician and practitioner services (fee schedule) | 44 | $511.08 |
| 27599 | Physician and practitioner services (fee schedule) | 8 | $403.55 |
| 27600 | Physician and practitioner services (fee schedule) | 44 | $300.85 |
| 27601 | Physician and practitioner services (fee schedule) | 44 | $336.11 |
| 27602 | Physician and practitioner services (fee schedule) | 44 | $350.35 |
| 27603 | Physician and practitioner services (fee schedule) | 45 | $353.72 |
| 27604 | Physician and practitioner services (fee schedule) | 44 | $312.75 |
| 27605 | Physician and practitioner services (fee schedule) | 45 | $192.24 |
| 27606 | Physician and practitioner services (fee schedule) | 45 | $217.00 |
| 27607 | Physician and practitioner services (fee schedule) | 45 | $451.18 |
| 27610 | Physician and practitioner services (fee schedule) | 45 | $493.52 |
| 27612 | Physician and practitioner services (fee schedule) | 44 | $436.21 |
| 27613 | Physician and practitioner services (fee schedule) | 45 | $165.88 |
| 27614 | Physician and practitioner services (fee schedule) | 45 | $389.15 |
| 27615 | Physician and practitioner services (fee schedule) | 44 | $758.20 |
| 27616 | Physician and practitioner services (fee schedule) | 44 | $931.98 |
| 27618 | Physician and practitioner services (fee schedule) | 45 | $321.64 |
| 27619 | Physician and practitioner services (fee schedule) | 45 | $371.38 |
| 27620 | Physician and practitioner services (fee schedule) | 45 | $354.61 |
| 27625 | Physician and practitioner services (fee schedule) | 45 | $454.41 |
| 27626 | Physician and practitioner services (fee schedule) | 44 | $476.26 |
| 27630 | Physician and practitioner services (fee schedule) | 45 | $358.69 |
| 27632 | Physician and practitioner services (fee schedule) | 44 | $306.99 |
| 27634 | Physician and practitioner services (fee schedule) | 44 | $497.47 |
| 27635 | Physician and practitioner services (fee schedule) | 45 | $450.54 |
| 27637 | Physician and practitioner services (fee schedule) | 44 | $560.07 |
| 27638 | Physician and practitioner services (fee schedule) | 44 | $568.71 |
| 27640 | Physician and practitioner services (fee schedule) | 44 | $636.91 |
| 27641 | Physician and practitioner services (fee schedule) | 44 | $510.48 |
| 27645 | Physician and practitioner services (fee schedule) | 44 | $1,145.71 |
| 27646 | Physician and practitioner services (fee schedule) | 44 | $983.81 |
| 27647 | Physician and practitioner services (fee schedule) | 44 | $717.81 |
| 27648 | Physician and practitioner services (fee schedule) | 44 | $138.89 |
| 27650 | Physician and practitioner services (fee schedule) | 44 | $503.75 |
| 27652 | Physician and practitioner services (fee schedule) | 44 | $533.04 |
| 27654 | Physician and practitioner services (fee schedule) | 44 | $555.72 |
| 27656 | Physician and practitioner services (fee schedule) | 44 | $320.03 |
| 27658 | Physician and practitioner services (fee schedule) | 44 | $280.85 |
| 27659 | Physician and practitioner services (fee schedule) | 44 | $366.91 |
| 27664 | Physician and practitioner services (fee schedule) | 44 | $276.13 |
| 27665 | Physician and practitioner services (fee schedule) | 43 | $310.69 |
| 27675 | Physician and practitioner services (fee schedule) | 44 | $376.84 |
| 27676 | Physician and practitioner services (fee schedule) | 44 | $458.30 |
| 27680 | Physician and practitioner services (fee schedule) | 44 | $334.81 |
| 27681 | Physician and practitioner services (fee schedule) | 44 | $393.45 |
| 27685 | Physician and practitioner services (fee schedule) | 44 | $419.16 |
| 27686 | Physician and practitioner services (fee schedule) | 44 | $408.64 |
| 27687 | Physician and practitioner services (fee schedule) | 44 | $345.54 |
| 27690 | Physician and practitioner services (fee schedule) | 44 | $484.72 |
| 27691 | Physician and practitioner services (fee schedule) | 44 | $555.44 |
| 27692 | Physician and practitioner services (fee schedule) | 44 | $77.15 |
| 27695 | Physician and practitioner services (fee schedule) | 44 | $388.40 |
| 27696 | Physician and practitioner services (fee schedule) | 44 | $441.68 |
| 27698 | Physician and practitioner services (fee schedule) | 44 | $502.06 |
| 27700 | Physician and practitioner services (fee schedule) | 44 | $533.60 |
| 27702 | Physician and practitioner services (fee schedule) | 44 | $736.60 |
| 27703 | Physician and practitioner services (fee schedule) | 43 | $846.18 |
| 27704 | Physician and practitioner services (fee schedule) | 44 | $430.59 |
| 27705 | Physician and practitioner services (fee schedule) | 44 | $567.14 |
| 27707 | Physician and practitioner services (fee schedule) | 44 | $315.84 |
| 27709 | Physician and practitioner services (fee schedule) | 44 | $774.80 |
| 27712 | Physician and practitioner services (fee schedule) | 44 | $796.10 |
| 27713 | Physician and practitioner services (fee schedule) | 29 | $1,332.50 |
| 27715 | Physician and practitioner services (fee schedule) | 44 | $892.50 |
| 27720 | Physician and practitioner services (fee schedule) | 44 | $650.62 |
| 27722 | Physician and practitioner services (fee schedule) | 44 | $653.93 |
| 27724 | Physician and practitioner services (fee schedule) | 44 | $888.37 |
| 27725 | Physician and practitioner services (fee schedule) | 43 | $885.58 |
| 27726 | Physician and practitioner services (fee schedule) | 43 | $691.61 |
| 27727 | Physician and practitioner services (fee schedule) | 43 | $755.38 |
| 27730 | Physician and practitioner services (fee schedule) | 44 | $445.43 |
| 27732 | Physician and practitioner services (fee schedule) | 44 | $346.26 |
| 27734 | Physician and practitioner services (fee schedule) | 44 | $506.56 |
| 27740 | Physician and practitioner services (fee schedule) | 44 | $531.77 |
| 27742 | Physician and practitioner services (fee schedule) | 44 | $586.47 |
| 27745 | Physician and practitioner services (fee schedule) | 42 | $552.44 |
| 27750 | Physician and practitioner services (fee schedule) | 44 | $280.32 |
| 27752 | Physician and practitioner services (fee schedule) | 44 | $435.54 |
| 27756 | Physician and practitioner services (fee schedule) | 44 | $439.84 |
| 27758 | Physician and practitioner services (fee schedule) | 44 | $673.02 |
| 27759 | Physician and practitioner services (fee schedule) | 44 | $764.04 |
| 27760 | Physician and practitioner services (fee schedule) | 44 | $264.42 |
| 27762 | Physician and practitioner services (fee schedule) | 44 | $396.55 |
| 27766 | Physician and practitioner services (fee schedule) | 44 | $468.71 |
| 27767 | Physician and practitioner services (fee schedule) | 44 | $234.35 |
| 27768 | Physician and practitioner services (fee schedule) | 44 | $345.50 |
| 27769 | Physician and practitioner services (fee schedule) | 44 | $528.87 |
| 27780 | Physician and practitioner services (fee schedule) | 44 | $238.02 |
| 27781 | Physician and practitioner services (fee schedule) | 44 | $340.45 |
| 27784 | Physician and practitioner services (fee schedule) | 44 | $531.92 |
| 27786 | Physician and practitioner services (fee schedule) | 45 | $249.61 |
| 27788 | Physician and practitioner services (fee schedule) | 45 | $337.93 |
| 27792 | Physician and practitioner services (fee schedule) | 44 | $503.24 |
| 27808 | Physician and practitioner services (fee schedule) | 44 | $267.14 |
| 27810 | Physician and practitioner services (fee schedule) | 44 | $381.51 |
| 27814 | Physician and practitioner services (fee schedule) | 44 | $584.07 |
| 27816 | Physician and practitioner services (fee schedule) | 44 | $265.90 |
| 27818 | Physician and practitioner services (fee schedule) | 45 | $404.14 |
| 27822 | Physician and practitioner services (fee schedule) | 44 | $660.03 |
| 27823 | Physician and practitioner services (fee schedule) | 44 | $746.67 |
| 27824 | Physician and practitioner services (fee schedule) | 44 | $257.25 |
| 27825 | Physician and practitioner services (fee schedule) | 44 | $418.15 |
| 27826 | Physician and practitioner services (fee schedule) | 44 | $647.25 |
| 27827 | Physician and practitioner services (fee schedule) | 44 | $825.77 |
| 27828 | Physician and practitioner services (fee schedule) | 44 | $961.06 |
| 27829 | Physician and practitioner services (fee schedule) | 44 | $528.60 |
| 27830 | Physician and practitioner services (fee schedule) | 44 | $294.77 |
| 27831 | Physician and practitioner services (fee schedule) | 44 | $314.98 |
| 27832 | Physician and practitioner services (fee schedule) | 44 | $517.59 |
| 27840 | Physician and practitioner services (fee schedule) | 44 | $316.33 |
| 27842 | Physician and practitioner services (fee schedule) | 45 | $375.81 |
| 27846 | Physician and practitioner services (fee schedule) | 44 | $538.99 |
| 27848 | Physician and practitioner services (fee schedule) | 44 | $613.10 |
| 27860 | Physician and practitioner services (fee schedule) | 45 | $128.29 |
| 27870 | Physician and practitioner services (fee schedule) | 44 | $752.53 |
| 27871 | Physician and practitioner services (fee schedule) | 44 | $517.23 |
| 27880 | Physician and practitioner services (fee schedule) | 44 | $643.45 |
| 27881 | Physician and practitioner services (fee schedule) | 43 | $646.37 |
| 27882 | Physician and practitioner services (fee schedule) | 44 | $465.40 |
| 27884 | Physician and practitioner services (fee schedule) | 44 | $434.58 |
| 27886 | Physician and practitioner services (fee schedule) | 44 | $490.19 |
| 27888 | Physician and practitioner services (fee schedule) | 44 | $462.22 |
| 27889 | Physician and practitioner services (fee schedule) | 44 | $510.95 |
| 27892 | Physician and practitioner services (fee schedule) | 44 | $412.39 |
| 27893 | Physician and practitioner services (fee schedule) | 44 | $460.52 |
| 27894 | Physician and practitioner services (fee schedule) | 44 | $598.27 |
| 27899 | Physician and practitioner services (fee schedule) | 7 | $325.00 |
| 28001 | Physician and practitioner services (fee schedule) | 44 | $124.21 |
| 28002 | Physician and practitioner services (fee schedule) | 44 | $189.86 |
| 28003 | Physician and practitioner services (fee schedule) | 44 | $299.83 |
| 28005 | Physician and practitioner services (fee schedule) | 45 | $449.56 |
| 28008 | Physician and practitioner services (fee schedule) | 45 | $274.06 |
| 28010 | Physician and practitioner services (fee schedule) | 45 | $179.48 |
| 28011 | Physician and practitioner services (fee schedule) | 45 | $235.83 |
| 28020 | Physician and practitioner services (fee schedule) | 45 | $363.29 |
| 28022 | Physician and practitioner services (fee schedule) | 44 | $310.35 |
| 28024 | Physician and practitioner services (fee schedule) | 44 | $295.70 |
| 28035 | Physician and practitioner services (fee schedule) | 44 | $368.79 |
| 28039 | Physician and practitioner services (fee schedule) | 44 | $324.10 |
| 28041 | Physician and practitioner services (fee schedule) | 44 | $339.08 |
| 28043 | Physician and practitioner services (fee schedule) | 44 | $255.84 |
| 28045 | Physician and practitioner services (fee schedule) | 44 | $329.41 |
| 28046 | Physician and practitioner services (fee schedule) | 44 | $537.49 |
| 28047 | Physician and practitioner services (fee schedule) | 43 | $744.50 |
| 28050 | Physician and practitioner services (fee schedule) | 44 | $275.90 |
| 28052 | Physician and practitioner services (fee schedule) | 44 | $243.77 |
| 28054 | Physician and practitioner services (fee schedule) | 44 | $235.78 |
| 28055 | Physician and practitioner services (fee schedule) | 44 | $306.40 |
| 28060 | Physician and practitioner services (fee schedule) | 44 | $355.64 |
| 28062 | Physician and practitioner services (fee schedule) | 44 | $420.84 |
| 28070 | Physician and practitioner services (fee schedule) | 44 | $345.58 |
| 28072 | Physician and practitioner services (fee schedule) | 44 | $321.99 |
| 28080 | Physician and practitioner services (fee schedule) | 44 | $351.41 |
| 28086 | Physician and practitioner services (fee schedule) | 44 | $324.99 |
| 28088 | Physician and practitioner services (fee schedule) | 44 | $295.76 |
| 28090 | Physician and practitioner services (fee schedule) | 44 | $313.97 |
| 28092 | Physician and practitioner services (fee schedule) | 44 | $269.99 |
| 28100 | Physician and practitioner services (fee schedule) | 44 | $385.23 |
| 28102 | Physician and practitioner services (fee schedule) | 44 | $462.79 |
| 28103 | Physician and practitioner services (fee schedule) | 44 | $313.77 |
| 28104 | Physician and practitioner services (fee schedule) | 44 | $329.61 |
| 28106 | Physician and practitioner services (fee schedule) | 44 | $339.65 |
| 28107 | Physician and practitioner services (fee schedule) | 44 | $332.09 |
| 28108 | Physician and practitioner services (fee schedule) | 43 | $284.68 |
| 28110 | Physician and practitioner services (fee schedule) | 44 | $295.23 |
| 28111 | Physician and practitioner services (fee schedule) | 44 | $321.07 |
| 28112 | Physician and practitioner services (fee schedule) | 44 | $311.54 |
| 28113 | Physician and practitioner services (fee schedule) | 44 | $373.01 |
| 28114 | Physician and practitioner services (fee schedule) | 44 | $700.45 |
| 28116 | Physician and practitioner services (fee schedule) | 44 | $469.42 |
| 28118 | Physician and practitioner services (fee schedule) | 44 | $392.57 |
| 28119 | Physician and practitioner services (fee schedule) | 44 | $356.32 |
| 28120 | Physician and practitioner services (fee schedule) | 44 | $445.54 |
| 28122 | Physician and practitioner services (fee schedule) | 44 | $383.18 |
| 28124 | Physician and practitioner services (fee schedule) | 44 | $316.22 |
| 28126 | Physician and practitioner services (fee schedule) | 44 | $246.64 |
| 28130 | Physician and practitioner services (fee schedule) | 44 | $482.98 |
| 28140 | Physician and practitioner services (fee schedule) | 44 | $385.42 |
| 28150 | Physician and practitioner services (fee schedule) | 44 | $274.14 |
| 28153 | Physician and practitioner services (fee schedule) | 44 | $252.15 |
| 28160 | Physician and practitioner services (fee schedule) | 44 | $256.60 |
| 28171 | Physician and practitioner services (fee schedule) | 43 | $698.07 |
| 28173 | Physician and practitioner services (fee schedule) | 44 | $523.36 |
| 28175 | Physician and practitioner services (fee schedule) | 44 | $374.22 |
| 28190 | Physician and practitioner services (fee schedule) | 44 | $150.52 |
| 28192 | Physician and practitioner services (fee schedule) | 44 | $309.60 |
| 28193 | Physician and practitioner services (fee schedule) | 44 | $347.58 |
| 28200 | Physician and practitioner services (fee schedule) | 44 | $324.78 |
| 28202 | Physician and practitioner services (fee schedule) | 44 | $403.05 |
| 28208 | Physician and practitioner services (fee schedule) | 44 | $298.48 |
| 28210 | Physician and practitioner services (fee schedule) | 44 | $384.80 |
| 28220 | Physician and practitioner services (fee schedule) | 44 | $299.35 |
| 28222 | Physician and practitioner services (fee schedule) | 44 | $367.65 |
| 28225 | Physician and practitioner services (fee schedule) | 44 | $251.04 |
| 28226 | Physician and practitioner services (fee schedule) | 44 | $363.61 |
| 28230 | Physician and practitioner services (fee schedule) | 44 | $271.84 |
| 28232 | Physician and practitioner services (fee schedule) | 44 | $236.06 |
| 28234 | Physician and practitioner services (fee schedule) | 45 | $251.41 |
| 28238 | Physician and practitioner services (fee schedule) | 44 | $442.60 |
| 28240 | Physician and practitioner services (fee schedule) | 44 | $277.86 |
| 28250 | Physician and practitioner services (fee schedule) | 44 | $370.35 |
| 28260 | Physician and practitioner services (fee schedule) | 44 | $467.31 |
| 28261 | Physician and practitioner services (fee schedule) | 44 | $726.76 |
| 28262 | Physician and practitioner services (fee schedule) | 44 | $948.25 |
| 28264 | Physician and practitioner services (fee schedule) | 44 | $628.41 |
| 28270 | Physician and practitioner services (fee schedule) | 44 | $327.24 |
| 28272 | Physician and practitioner services (fee schedule) | 44 | $244.70 |
| 28280 | Physician and practitioner services (fee schedule) | 44 | $316.77 |
| 28285 | Physician and practitioner services (fee schedule) | 43 | $337.69 |
| 28286 | Physician and practitioner services (fee schedule) | 44 | $286.43 |
| 28288 | Physician and practitioner services (fee schedule) | 44 | $374.19 |
| 28289 | Physician and practitioner services (fee schedule) | 43 | $422.43 |
| 28291 | Physician and practitioner services (fee schedule) | 40 | $465.82 |
| 28292 | Physician and practitioner services (fee schedule) | 43 | $453.90 |
| 28295 | Physician and practitioner services (fee schedule) | 41 | $614.53 |
| 28296 | Physician and practitioner services (fee schedule) | 43 | $547.82 |
| 28297 | Physician and practitioner services (fee schedule) | 43 | $600.60 |
| 28298 | Physician and practitioner services (fee schedule) | 43 | $500.68 |
| 28299 | Physician and practitioner services (fee schedule) | 43 | $584.24 |
| 28300 | Physician and practitioner services (fee schedule) | 44 | $497.00 |
| 28302 | Physician and practitioner services (fee schedule) | 44 | $532.61 |
| 28304 | Physician and practitioner services (fee schedule) | 44 | $523.82 |
| 28305 | Physician and practitioner services (fee schedule) | 44 | $522.88 |
| 28306 | Physician and practitioner services (fee schedule) | 44 | $376.94 |
| 28307 | Physician and practitioner services (fee schedule) | 44 | $503.40 |
| 28308 | Physician and practitioner services (fee schedule) | 44 | $354.10 |
| 28309 | Physician and practitioner services (fee schedule) | 43 | $674.97 |
| 28310 | Physician and practitioner services (fee schedule) | 44 | $342.22 |
| 28312 | Physician and practitioner services (fee schedule) | 44 | $332.56 |
| 28313 | Physician and practitioner services (fee schedule) | 43 | $358.69 |
| 28315 | Physician and practitioner services (fee schedule) | 44 | $304.99 |
| 28320 | Physician and practitioner services (fee schedule) | 44 | $475.68 |
| 28322 | Physician and practitioner services (fee schedule) | 44 | $481.19 |
| 28340 | Physician and practitioner services (fee schedule) | 44 | $425.63 |
| 28341 | Physician and practitioner services (fee schedule) | 44 | $493.28 |
| 28344 | Physician and practitioner services (fee schedule) | 44 | $288.69 |
| 28345 | Physician and practitioner services (fee schedule) | 44 | $380.80 |
| 28360 | Physician and practitioner services (fee schedule) | 42 | $770.29 |
| 28400 | Physician and practitioner services (fee schedule) | 44 | $199.28 |
| 28405 | Physician and practitioner services (fee schedule) | 44 | $340.57 |
| 28406 | Physician and practitioner services (fee schedule) | 44 | $444.94 |
| 28415 | Physician and practitioner services (fee schedule) | 44 | $849.56 |
| 28420 | Physician and practitioner services (fee schedule) | 44 | $946.78 |
| 28430 | Physician and practitioner services (fee schedule) | 44 | $187.51 |
| 28435 | Physician and practitioner services (fee schedule) | 44 | $283.42 |
| 28436 | Physician and practitioner services (fee schedule) | 44 | $389.68 |
| 28445 | Physician and practitioner services (fee schedule) | 44 | $757.57 |
| 28446 | Physician and practitioner services (fee schedule) | 41 | $867.46 |
| 28450 | Physician and practitioner services (fee schedule) | 44 | $168.40 |
| 28455 | Physician and practitioner services (fee schedule) | 44 | $204.86 |
| 28456 | Physician and practitioner services (fee schedule) | 44 | $289.74 |
| 28465 | Physician and practitioner services (fee schedule) | 44 | $500.34 |
| 28470 | Physician and practitioner services (fee schedule) | 44 | $175.44 |
| 28475 | Physician and practitioner services (fee schedule) | 44 | $197.42 |
| 28476 | Physician and practitioner services (fee schedule) | 44 | $297.97 |
| 28485 | Physician and practitioner services (fee schedule) | 44 | $439.89 |
| 28490 | Physician and practitioner services (fee schedule) | 44 | $106.40 |
| 28495 | Physician and practitioner services (fee schedule) | 44 | $130.05 |
| 28496 | Physician and practitioner services (fee schedule) | 44 | $280.68 |
| 28505 | Physician and practitioner services (fee schedule) | 44 | $425.58 |
| 28510 | Physician and practitioner services (fee schedule) | 44 | $95.64 |
| 28515 | Physician and practitioner services (fee schedule) | 44 | $117.57 |
| 28525 | Physician and practitioner services (fee schedule) | 44 | $364.57 |
| 28530 | Physician and practitioner services (fee schedule) | 43 | $91.20 |
| 28531 | Physician and practitioner services (fee schedule) | 42 | $198.17 |
| 28540 | Physician and practitioner services (fee schedule) | 44 | $149.11 |
| 28545 | Physician and practitioner services (fee schedule) | 44 | $227.00 |
| 28546 | Physician and practitioner services (fee schedule) | 44 | $357.18 |
| 28555 | Physician and practitioner services (fee schedule) | 44 | $529.66 |
| 28570 | Physician and practitioner services (fee schedule) | 44 | $170.16 |
| 28575 | Physician and practitioner services (fee schedule) | 44 | $281.75 |
| 28576 | Physician and practitioner services (fee schedule) | 44 | $290.93 |
| 28585 | Physician and practitioner services (fee schedule) | 44 | $576.29 |
| 28600 | Physician and practitioner services (fee schedule) | 44 | $145.53 |
| 28605 | Physician and practitioner services (fee schedule) | 44 | $257.98 |
| 28606 | Physician and practitioner services (fee schedule) | 44 | $313.95 |
| 28615 | Physician and practitioner services (fee schedule) | 44 | $613.75 |
| 28630 | Physician and practitioner services (fee schedule) | 43 | $112.80 |
| 28635 | Physician and practitioner services (fee schedule) | 44 | $120.05 |
| 28636 | Physician and practitioner services (fee schedule) | 44 | $218.93 |
| 28645 | Physician and practitioner services (fee schedule) | 44 | $415.52 |
| 28660 | Physician and practitioner services (fee schedule) | 43 | $95.21 |
| 28665 | Physician and practitioner services (fee schedule) | 44 | $114.49 |
| 28666 | Physician and practitioner services (fee schedule) | 44 | $141.70 |
| 28675 | Physician and practitioner services (fee schedule) | 44 | $365.11 |
| 28705 | Physician and practitioner services (fee schedule) | 44 | $900.97 |
| 28715 | Physician and practitioner services (fee schedule) | 44 | $721.48 |
| 28725 | Physician and practitioner services (fee schedule) | 44 | $596.69 |
| 28730 | Physician and practitioner services (fee schedule) | 44 | $557.68 |
| 28735 | Physician and practitioner services (fee schedule) | 42 | $588.35 |
| 28737 | Physician and practitioner services (fee schedule) | 44 | $518.44 |
| 28740 | Physician and practitioner services (fee schedule) | 44 | $498.80 |
| 28750 | Physician and practitioner services (fee schedule) | 44 | $523.57 |
| 28755 | Physician and practitioner services (fee schedule) | 44 | $348.39 |
| 28760 | Physician and practitioner services (fee schedule) | 44 | $464.52 |
| 28800 | Physician and practitioner services (fee schedule) | 44 | $420.36 |
| 28805 | Physician and practitioner services (fee schedule) | 44 | $527.44 |
| 28810 | Physician and practitioner services (fee schedule) | 44 | $333.84 |
| 28820 | Physician and practitioner services (fee schedule) | 44 | $210.32 |
| 28825 | Physician and practitioner services (fee schedule) | 44 | $197.55 |
| 28890 | Physician and practitioner services (fee schedule) | 32 | $241.74 |
| 28899 | Physician and practitioner services (fee schedule) | 8 | $148.27 |
| 29000 | Physician and practitioner services (fee schedule) | 44 | $204.70 |
| 29010 | Physician and practitioner services (fee schedule) | 44 | $161.78 |
| 29015 | Physician and practitioner services (fee schedule) | 44 | $184.30 |
| 29035 | Physician and practitioner services (fee schedule) | 44 | $155.53 |
| 29040 | Physician and practitioner services (fee schedule) | 44 | $177.63 |
| 29044 | Physician and practitioner services (fee schedule) | 44 | $182.32 |
| 29046 | Physician and practitioner services (fee schedule) | 44 | $191.81 |
| 29049 | Physician and practitioner services (fee schedule) | 44 | $72.77 |
| 29055 | Physician and practitioner services (fee schedule) | 44 | $147.26 |
| 29058 | Physician and practitioner services (fee schedule) | 44 | $90.45 |
| 29065 | Physician and practitioner services (fee schedule) | 44 | $72.30 |
| 29075 | Physician and practitioner services (fee schedule) | 44 | $65.44 |
| 29085 | Physician and practitioner services (fee schedule) | 44 | $68.93 |
| 29086 | Physician and practitioner services (fee schedule) | 42 | $52.21 |
| 29105 | Physician and practitioner services (fee schedule) | 44 | $54.76 |
| 29125 | Physician and practitioner services (fee schedule) | 45 | $42.49 |
| 29126 | Physician and practitioner services (fee schedule) | 45 | $52.24 |
| 29130 | Physician and practitioner services (fee schedule) | 43 | $28.17 |
| 29131 | Physician and practitioner services (fee schedule) | 44 | $36.57 |
| 29200 | Physician and practitioner services (fee schedule) | 44 | $23.52 |
| 29240 | Physician and practitioner services (fee schedule) | 44 | $21.95 |
| 29260 | Physician and practitioner services (fee schedule) | 44 | $21.50 |
| 29280 | Physician and practitioner services (fee schedule) | 42 | $21.76 |
| 29305 | Physician and practitioner services (fee schedule) | 45 | $167.54 |
| 29325 | Physician and practitioner services (fee schedule) | 45 | $182.05 |
| 29345 | Physician and practitioner services (fee schedule) | 44 | $101.29 |
| 29355 | Physician and practitioner services (fee schedule) | 45 | $106.14 |
| 29358 | Physician and practitioner services (fee schedule) | 45 | $110.09 |
| 29365 | Physician and practitioner services (fee schedule) | 45 | $88.80 |
| 29405 | Physician and practitioner services (fee schedule) | 45 | $59.54 |
| 29425 | Physician and practitioner services (fee schedule) | 45 | $59.71 |
| 29435 | Physician and practitioner services (fee schedule) | 45 | $87.87 |
| 29440 | Physician and practitioner services (fee schedule) | 45 | $28.12 |
| 29445 | Physician and practitioner services (fee schedule) | 45 | $101.47 |
| 29450 | Physician and practitioner services (fee schedule) | 44 | $96.86 |
| 29505 | Physician and practitioner services (fee schedule) | 44 | $57.97 |
| 29515 | Physician and practitioner services (fee schedule) | 45 | $51.34 |
| 29520 | Physician and practitioner services (fee schedule) | 44 | $27.06 |
| 29530 | Physician and practitioner services (fee schedule) | 44 | $22.70 |
| 29540 | Physician and practitioner services (fee schedule) | 44 | $20.71 |
| 29550 | Physician and practitioner services (fee schedule) | 44 | $15.87 |
| 29580 | Physician and practitioner services (fee schedule) | 44 | $38.76 |
| 29581 | Physician and practitioner services (fee schedule) | 44 | $54.58 |
| 29584 | Physician and practitioner services (fee schedule) | 43 | $48.28 |
| 29700 | Physician and practitioner services (fee schedule) | 42 | $36.22 |
| 29705 | Physician and practitioner services (fee schedule) | 42 | $43.89 |
| 29710 | Physician and practitioner services (fee schedule) | 42 | $80.24 |
| 29720 | Physician and practitioner services (fee schedule) | 43 | $56.81 |
| 29730 | Physician and practitioner services (fee schedule) | 43 | $41.21 |
| 29740 | Physician and practitioner services (fee schedule) | 44 | $71.14 |
| 29750 | Physician and practitioner services (fee schedule) | 43 | $69.66 |
| 29799 | Physician and practitioner services (fee schedule) | 7 | $20.00 |
| 29800 | Physician and practitioner services (fee schedule) | 42 | $407.51 |
| 29804 | Physician and practitioner services (fee schedule) | 41 | $467.81 |
| 29805 | Physician and practitioner services (fee schedule) | 44 | $354.72 |
| 29806 | Physician and practitioner services (fee schedule) | 44 | $782.25 |
| 29807 | Physician and practitioner services (fee schedule) | 44 | $763.86 |
| 29819 | Physician and practitioner services (fee schedule) | 44 | $459.36 |
| 29820 | Physician and practitioner services (fee schedule) | 44 | $409.95 |
| 29821 | Physician and practitioner services (fee schedule) | 44 | $454.78 |
| 29822 | Physician and practitioner services (fee schedule) | 44 | $420.71 |
| 29823 | Physician and practitioner services (fee schedule) | 44 | $454.52 |
| 29824 | Physician and practitioner services (fee schedule) | 44 | $501.18 |
| 29825 | Physician and practitioner services (fee schedule) | 44 | $446.80 |
| 29826 | Physician and practitioner services (fee schedule) | 44 | $147.45 |
| 29827 | Physician and practitioner services (fee schedule) | 44 | $778.16 |
| 29828 | Physician and practitioner services (fee schedule) | 44 | $666.89 |
| 29830 | Physician and practitioner services (fee schedule) | 44 | $364.33 |
| 29834 | Physician and practitioner services (fee schedule) | 44 | $377.51 |
| 29835 | Physician and practitioner services (fee schedule) | 44 | $386.23 |
| 29836 | Physician and practitioner services (fee schedule) | 44 | $439.25 |
| 29837 | Physician and practitioner services (fee schedule) | 44 | $400.70 |
| 29838 | Physician and practitioner services (fee schedule) | 44 | $456.92 |
| 29840 | Physician and practitioner services (fee schedule) | 44 | $354.68 |
| 29843 | Physician and practitioner services (fee schedule) | 44 | $364.49 |
| 29844 | Physician and practitioner services (fee schedule) | 44 | $377.32 |
| 29845 | Physician and practitioner services (fee schedule) | 44 | $443.97 |
| 29846 | Physician and practitioner services (fee schedule) | 44 | $400.45 |
| 29847 | Physician and practitioner services (fee schedule) | 44 | $418.56 |
| 29848 | Physician and practitioner services (fee schedule) | 44 | $387.23 |
| 29850 | Physician and practitioner services (fee schedule) | 44 | $496.10 |
| 29851 | Physician and practitioner services (fee schedule) | 44 | $690.35 |
| 29855 | Physician and practitioner services (fee schedule) | 44 | $589.19 |
| 29856 | Physician and practitioner services (fee schedule) | 44 | $739.07 |
| 29860 | Physician and practitioner services (fee schedule) | 44 | $459.68 |
| 29861 | Physician and practitioner services (fee schedule) | 44 | $532.23 |
| 29862 | Physician and practitioner services (fee schedule) | 44 | $601.28 |
| 29863 | Physician and practitioner services (fee schedule) | 44 | $587.45 |
| 29866 | Physician and practitioner services (fee schedule) | 40 | $788.26 |
| 29867 | Physician and practitioner services (fee schedule) | 40 | $958.19 |
| 29868 | Physician and practitioner services (fee schedule) | 40 | $1,277.75 |
| 29870 | Physician and practitioner services (fee schedule) | 44 | $394.20 |
| 29871 | Physician and practitioner services (fee schedule) | 44 | $400.50 |
| 29873 | Physician and practitioner services (fee schedule) | 44 | $412.51 |
| 29874 | Physician and practitioner services (fee schedule) | 44 | $431.96 |
| 29875 | Physician and practitioner services (fee schedule) | 44 | $397.76 |
| 29876 | Physician and practitioner services (fee schedule) | 44 | $521.24 |
| 29877 | Physician and practitioner services (fee schedule) | 44 | $479.88 |
| 29879 | Physician and practitioner services (fee schedule) | 44 | $512.24 |
| 29880 | Physician and practitioner services (fee schedule) | 44 | $465.53 |
| 29881 | Physician and practitioner services (fee schedule) | 44 | $451.90 |
| 29882 | Physician and practitioner services (fee schedule) | 44 | $549.84 |
| 29883 | Physician and practitioner services (fee schedule) | 44 | $636.72 |
| 29884 | Physician and practitioner services (fee schedule) | 44 | $471.74 |
| 29885 | Physician and practitioner services (fee schedule) | 44 | $567.20 |
| 29886 | Physician and practitioner services (fee schedule) | 44 | $497.85 |
| 29887 | Physician and practitioner services (fee schedule) | 44 | $573.97 |
| 29888 | Physician and practitioner services (fee schedule) | 44 | $732.07 |
| 29889 | Physician and practitioner services (fee schedule) | 44 | $886.64 |
| 29891 | Physician and practitioner services (fee schedule) | 44 | $510.73 |
| 29892 | Physician and practitioner services (fee schedule) | 44 | $505.08 |
| 29893 | Physician and practitioner services (fee schedule) | 44 | $419.54 |
| 29894 | Physician and practitioner services (fee schedule) | 44 | $406.62 |
| 29895 | Physician and practitioner services (fee schedule) | 44 | $371.13 |
| 29897 | Physician and practitioner services (fee schedule) | 44 | $401.53 |
| 29898 | Physician and practitioner services (fee schedule) | 44 | $440.84 |
| 29899 | Physician and practitioner services (fee schedule) | 44 | $740.47 |
| 29900 | Physician and practitioner services (fee schedule) | 44 | $388.72 |
| 29901 | Physician and practitioner services (fee schedule) | 44 | $410.53 |
| 29902 | Physician and practitioner services (fee schedule) | 44 | $432.91 |
| 29904 | Physician and practitioner services (fee schedule) | 44 | $457.59 |
| 29905 | Physician and practitioner services (fee schedule) | 44 | $409.79 |
| 29906 | Physician and practitioner services (fee schedule) | 44 | $506.13 |
| 29907 | Physician and practitioner services (fee schedule) | 43 | $637.74 |
| 29914 | Physician and practitioner services (fee schedule) | 43 | $745.68 |
| 29915 | Physician and practitioner services (fee schedule) | 43 | $762.66 |
| 29916 | Physician and practitioner services (fee schedule) | 44 | $755.51 |
| 29999 | Physician and practitioner services (fee schedule) | 8 | $270.71 |
| 30000 | Physician and practitioner services (fee schedule) | 45 | $114.37 |
| 30020 | Physician and practitioner services (fee schedule) | 45 | $123.20 |
| 30100 | Physician and practitioner services (fee schedule) | 45 | $70.30 |
| 30110 | Physician and practitioner services (fee schedule) | 44 | $130.90 |
| 30115 | Physician and practitioner services (fee schedule) | 44 | $342.81 |
| 30117 | Physician and practitioner services (fee schedule) | 45 | $386.66 |
| 30118 | Physician and practitioner services (fee schedule) | 45 | $509.22 |
| 30120 | Physician and practitioner services (fee schedule) | 40 | $379.81 |
| 30124 | Physician and practitioner services (fee schedule) | 45 | $217.43 |
| 30125 | Physician and practitioner services (fee schedule) | 45 | $454.08 |
| 30130 | Physician and practitioner services (fee schedule) | 45 | $301.03 |
| 30140 | Physician and practitioner services (fee schedule) | 45 | $234.85 |
| 30150 | Physician and practitioner services (fee schedule) | 45 | $569.39 |
| 30160 | Physician and practitioner services (fee schedule) | 45 | $582.72 |
| 30200 | Physician and practitioner services (fee schedule) | 44 | $59.80 |
| 30210 | Physician and practitioner services (fee schedule) | 43 | $83.62 |
| 30220 | Physician and practitioner services (fee schedule) | 43 | $133.10 |
| 30300 | Physician and practitioner services (fee schedule) | 45 | $109.64 |
| 30310 | Physician and practitioner services (fee schedule) | 45 | $152.36 |
| 30320 | Physician and practitioner services (fee schedule) | 45 | $352.51 |
| 30400 | Physician and practitioner services (fee schedule) | 41 | $903.12 |
| 30410 | Physician and practitioner services (fee schedule) | 41 | $1,015.56 |
| 30420 | Physician and practitioner services (fee schedule) | 42 | $1,049.59 |
| 30430 | Physician and practitioner services (fee schedule) | 40 | $790.50 |
| 30435 | Physician and practitioner services (fee schedule) | 38 | $985.51 |
| 30450 | Physician and practitioner services (fee schedule) | 40 | $1,260.64 |
| 30460 | Physician and practitioner services (fee schedule) | 44 | $603.09 |
| 30462 | Physician and practitioner services (fee schedule) | 44 | $1,148.44 |
| 30465 | Physician and practitioner services (fee schedule) | 45 | $738.56 |
| 30468 | Physician and practitioner services (fee schedule) | 38 | $1,487.56 |
| 30469 | Physician and practitioner services (fee schedule) | 34 | $156.96 |
| 30520 | Physician and practitioner services (fee schedule) | 45 | $493.44 |
| 30540 | Physician and practitioner services (fee schedule) | 45 | $510.24 |
| 30545 | Physician and practitioner services (fee schedule) | 45 | $701.44 |
| 30560 | Physician and practitioner services (fee schedule) | 45 | $144.11 |
| 30580 | Physician and practitioner services (fee schedule) | 45 | $428.85 |
| 30600 | Physician and practitioner services (fee schedule) | 45 | $374.14 |
| 30620 | Physician and practitioner services (fee schedule) | 45 | $495.00 |
| 30630 | Physician and practitioner services (fee schedule) | 45 | $485.82 |
| 30801 | Physician and practitioner services (fee schedule) | 45 | $127.52 |
| 30802 | Physician and practitioner services (fee schedule) | 45 | $174.59 |
| 30901 | Physician and practitioner services (fee schedule) | 45 | $70.78 |
| 30903 | Physician and practitioner services (fee schedule) | 44 | $103.30 |
| 30905 | Physician and practitioner services (fee schedule) | 45 | $132.40 |
| 30906 | Physician and practitioner services (fee schedule) | 45 | $144.09 |
| 30915 | Physician and practitioner services (fee schedule) | 45 | $432.78 |
| 30920 | Physician and practitioner services (fee schedule) | 45 | $630.50 |
| 30930 | Physician and practitioner services (fee schedule) | 45 | $87.19 |
| 30999 | Physician and practitioner services (fee schedule) | 9 | $150.00 |
| 31000 | Physician and practitioner services (fee schedule) | 45 | $89.90 |
| 31002 | Physician and practitioner services (fee schedule) | 45 | $133.92 |
| 31020 | Physician and practitioner services (fee schedule) | 44 | $302.61 |
| 31030 | Physician and practitioner services (fee schedule) | 44 | $494.14 |
| 31032 | Physician and practitioner services (fee schedule) | 44 | $446.54 |
| 31040 | Physician and practitioner services (fee schedule) | 43 | $574.65 |
| 31050 | Physician and practitioner services (fee schedule) | 45 | $381.71 |
| 31051 | Physician and practitioner services (fee schedule) | 45 | $507.69 |
| 31070 | Physician and practitioner services (fee schedule) | 44 | $350.96 |
| 31075 | Physician and practitioner services (fee schedule) | 44 | $599.86 |
| 31080 | Physician and practitioner services (fee schedule) | 44 | $775.33 |
| 31081 | Physician and practitioner services (fee schedule) | 44 | $827.96 |
| 31084 | Physician and practitioner services (fee schedule) | 44 | $867.03 |
| 31085 | Physician and practitioner services (fee schedule) | 44 | $891.80 |
| 31086 | Physician and practitioner services (fee schedule) | 44 | $833.57 |
| 31087 | Physician and practitioner services (fee schedule) | 44 | $801.19 |
| 31090 | Physician and practitioner services (fee schedule) | 45 | $809.32 |
| 31200 | Physician and practitioner services (fee schedule) | 45 | $454.77 |
| 31201 | Physician and practitioner services (fee schedule) | 45 | $566.58 |
| 31205 | Physician and practitioner services (fee schedule) | 44 | $629.97 |
| 31225 | Physician and practitioner services (fee schedule) | 44 | $1,269.09 |
| 31230 | Physician and practitioner services (fee schedule) | 44 | $1,390.89 |
| 31231 | Physician and practitioner services (fee schedule) | 45 | $91.89 |
| 31233 | Physician and practitioner services (fee schedule) | 44 | $167.85 |
| 31235 | Physician and practitioner services (fee schedule) | 44 | $195.76 |
| 31237 | Physician and practitioner services (fee schedule) | 44 | $172.95 |
| 31238 | Physician and practitioner services (fee schedule) | 44 | $178.21 |
| 31239 | Physician and practitioner services (fee schedule) | 44 | $464.43 |
| 31240 | Physician and practitioner services (fee schedule) | 44 | $128.05 |
| 31241 | Physician and practitioner services (fee schedule) | 44 | $325.48 |
| 31242 | Physician and practitioner services (fee schedule) | 30 | $1,400.42 |
| 31243 | Physician and practitioner services (fee schedule) | 30 | $1,359.39 |
| 31253 | Physician and practitioner services (fee schedule) | 44 | $366.45 |
| 31254 | Physician and practitioner services (fee schedule) | 45 | $256.98 |
| 31255 | Physician and practitioner services (fee schedule) | 44 | $274.45 |
| 31256 | Physician and practitioner services (fee schedule) | 44 | $147.80 |
| 31257 | Physician and practitioner services (fee schedule) | 44 | $326.88 |
| 31259 | Physician and practitioner services (fee schedule) | 44 | $345.95 |
| 31267 | Physician and practitioner services (fee schedule) | 44 | $216.43 |
| 31276 | Physician and practitioner services (fee schedule) | 44 | $307.60 |
| 31287 | Physician and practitioner services (fee schedule) | 44 | $171.83 |
| 31288 | Physician and practitioner services (fee schedule) | 44 | $198.85 |
| 31290 | Physician and practitioner services (fee schedule) | 44 | $861.41 |
| 31291 | Physician and practitioner services (fee schedule) | 44 | $917.69 |
| 31292 | Physician and practitioner services (fee schedule) | 44 | $739.26 |
| 31293 | Physician and practitioner services (fee schedule) | 44 | $803.85 |
| 31294 | Physician and practitioner services (fee schedule) | 44 | $927.05 |
| 31295 | Physician and practitioner services (fee schedule) | 41 | $1,006.00 |
| 31296 | Physician and practitioner services (fee schedule) | 41 | $967.70 |
| 31297 | Physician and practitioner services (fee schedule) | 41 | $1,044.09 |
| 31298 | Physician and practitioner services (fee schedule) | 43 | $1,980.62 |
| 31299 | Physician and practitioner services (fee schedule) | 6 | $118.90 |
| 31300 | Physician and practitioner services (fee schedule) | 44 | $885.26 |
| 31360 | Physician and practitioner services (fee schedule) | 45 | $1,359.17 |
| 31365 | Physician and practitioner services (fee schedule) | 44 | $1,685.78 |
| 31367 | Physician and practitioner services (fee schedule) | 45 | $1,419.26 |
| 31368 | Physician and practitioner services (fee schedule) | 45 | $1,695.52 |
| 31370 | Physician and practitioner services (fee schedule) | 45 | $1,409.78 |
| 31375 | Physician and practitioner services (fee schedule) | 45 | $1,273.85 |
| 31380 | Physician and practitioner services (fee schedule) | 45 | $1,263.08 |
| 31382 | Physician and practitioner services (fee schedule) | 45 | $1,375.26 |
| 31390 | Physician and practitioner services (fee schedule) | 45 | $1,853.34 |
| 31395 | Physician and practitioner services (fee schedule) | 45 | $2,017.12 |
| 31400 | Physician and practitioner services (fee schedule) | 45 | $726.32 |
| 31420 | Physician and practitioner services (fee schedule) | 45 | $594.10 |
| 31500 | Physician and practitioner services (fee schedule) | 45 | $103.61 |
| 31502 | Physician and practitioner services (fee schedule) | 43 | $27.32 |
| 31505 | Physician and practitioner services (fee schedule) | 44 | $53.67 |
| 31510 | Physician and practitioner services (fee schedule) | 44 | $109.55 |
| 31511 | Physician and practitioner services (fee schedule) | 44 | $132.10 |
| 31512 | Physician and practitioner services (fee schedule) | 44 | $126.06 |
| 31513 | Physician and practitioner services (fee schedule) | 42 | $100.83 |
| 31515 | Physician and practitioner services (fee schedule) | 45 | $117.96 |
| 31520 | Physician and practitioner services (fee schedule) | 45 | $115.95 |
| 31525 | Physician and practitioner services (fee schedule) | 45 | $160.18 |
| 31526 | Physician and practitioner services (fee schedule) | 45 | $121.20 |
| 31527 | Physician and practitioner services (fee schedule) | 43 | $148.36 |
| 31528 | Physician and practitioner services (fee schedule) | 45 | $110.91 |
| 31529 | Physician and practitioner services (fee schedule) | 43 | $119.50 |
| 31530 | Physician and practitioner services (fee schedule) | 45 | $158.14 |
| 31531 | Physician and practitioner services (fee schedule) | 45 | $164.47 |
| 31535 | Physician and practitioner services (fee schedule) | 44 | $151.93 |
| 31536 | Physician and practitioner services (fee schedule) | 45 | $169.46 |
| 31540 | Physician and practitioner services (fee schedule) | 45 | $187.72 |
| 31541 | Physician and practitioner services (fee schedule) | 45 | $210.39 |
| 31545 | Physician and practitioner services (fee schedule) | 44 | $265.65 |
| 31546 | Physician and practitioner services (fee schedule) | 44 | $407.60 |
| 31551 | Physician and practitioner services (fee schedule) | 45 | $1,139.06 |
| 31552 | Physician and practitioner services (fee schedule) | 44 | $1,115.26 |
| 31553 | Physician and practitioner services (fee schedule) | 45 | $1,242.13 |
| 31554 | Physician and practitioner services (fee schedule) | 45 | $1,273.91 |
| 31560 | Physician and practitioner services (fee schedule) | 45 | $235.37 |
| 31561 | Physician and practitioner services (fee schedule) | 45 | $257.19 |
| 31570 | Physician and practitioner services (fee schedule) | 45 | $243.81 |
| 31571 | Physician and practitioner services (fee schedule) | 45 | $188.49 |
| 31572 | Physician and practitioner services (fee schedule) | 44 | $288.26 |
| 31573 | Physician and practitioner services (fee schedule) | 43 | $168.94 |
| 31574 | Physician and practitioner services (fee schedule) | 43 | $479.14 |
| 31575 | Physician and practitioner services (fee schedule) | 45 | $80.26 |
| 31576 | Physician and practitioner services (fee schedule) | 44 | $165.57 |
| 31577 | Physician and practitioner services (fee schedule) | 44 | $162.46 |
| 31578 | Physician and practitioner services (fee schedule) | 44 | $191.20 |
| 31579 | Physician and practitioner services (fee schedule) | 45 | $132.00 |
| 31580 | Physician and practitioner services (fee schedule) | 44 | $885.98 |
| 31584 | Physician and practitioner services (fee schedule) | 44 | $1,041.00 |
| 31587 | Physician and practitioner services (fee schedule) | 44 | $845.62 |
| 31590 | Physician and practitioner services (fee schedule) | 42 | $679.19 |
| 31591 | Physician and practitioner services (fee schedule) | 43 | $822.82 |
| 31592 | Physician and practitioner services (fee schedule) | 43 | $1,313.45 |
| 31599 | Physician and practitioner services (fee schedule) | 7 | $460.85 |
| 31600 | Physician and practitioner services (fee schedule) | 45 | $236.69 |
| 31601 | Physician and practitioner services (fee schedule) | 45 | $277.43 |
| 31603 | Physician and practitioner services (fee schedule) | 45 | $220.85 |
| 31605 | Physician and practitioner services (fee schedule) | 45 | $229.65 |
| 31610 | Physician and practitioner services (fee schedule) | 45 | $628.78 |
| 31611 | Physician and practitioner services (fee schedule) | 43 | $381.86 |
| 31612 | Physician and practitioner services (fee schedule) | 45 | $53.54 |
| 31613 | Physician and practitioner services (fee schedule) | 45 | $317.02 |
| 31614 | Physician and practitioner services (fee schedule) | 44 | $520.54 |
| 31615 | Physician and practitioner services (fee schedule) | 44 | $118.81 |
| 31622 | Physician and practitioner services (fee schedule) | 45 | $186.18 |
| 31623 | Physician and practitioner services (fee schedule) | 45 | $181.17 |
| 31624 | Physician and practitioner services (fee schedule) | 45 | $182.54 |
| 31625 | Physician and practitioner services (fee schedule) | 45 | $201.41 |
| 31626 | Physician and practitioner services (fee schedule) | 42 | $315.47 |
| 31627 | Physician and practitioner services (fee schedule) | 39 | $615.76 |
| 31628 | Physician and practitioner services (fee schedule) | 45 | $213.94 |
| 31629 | Physician and practitioner services (fee schedule) | 45 | $235.03 |
| 31630 | Physician and practitioner services (fee schedule) | 45 | $159.24 |
| 31631 | Physician and practitioner services (fee schedule) | 45 | $181.75 |
| 31632 | Physician and practitioner services (fee schedule) | 43 | $51.29 |
| 31633 | Physician and practitioner services (fee schedule) | 44 | $62.17 |
| 31634 | Physician and practitioner services (fee schedule) | 42 | $585.97 |
| 31635 | Physician and practitioner services (fee schedule) | 45 | $213.48 |
| 31636 | Physician and practitioner services (fee schedule) | 44 | $171.77 |
| 31637 | Physician and practitioner services (fee schedule) | 44 | $58.77 |
| 31638 | Physician and practitioner services (fee schedule) | 44 | $194.36 |
| 31640 | Physician and practitioner services (fee schedule) | 45 | $192.11 |
| 31641 | Physician and practitioner services (fee schedule) | 45 | $202.26 |
| 31643 | Physician and practitioner services (fee schedule) | 45 | $135.36 |
| 31645 | Physician and practitioner services (fee schedule) | 45 | $196.60 |
| 31646 | Physician and practitioner services (fee schedule) | 45 | $111.69 |
| 31647 | Physician and practitioner services (fee schedule) | 38 | $155.38 |
| 31648 | Physician and practitioner services (fee schedule) | 38 | $152.64 |
| 31649 | Physician and practitioner services (fee schedule) | 38 | $58.51 |
| 31651 | Physician and practitioner services (fee schedule) | 36 | $64.04 |
| 31652 | Physician and practitioner services (fee schedule) | 45 | $634.28 |
| 31653 | Physician and practitioner services (fee schedule) | 45 | $661.16 |
| 31654 | Physician and practitioner services (fee schedule) | 44 | $75.23 |
| 31660 | Physician and practitioner services (fee schedule) | 29 | $146.53 |
| 31661 | Physician and practitioner services (fee schedule) | 29 | $154.45 |
| 31717 | Physician and practitioner services (fee schedule) | 45 | $117.63 |
| 31720 | Physician and practitioner services (fee schedule) | 45 | $39.18 |
| 31725 | Physician and practitioner services (fee schedule) | 45 | $63.12 |
| 31730 | Physician and practitioner services (fee schedule) | 43 | $185.04 |
| 31750 | Physician and practitioner services (fee schedule) | 44 | $872.12 |
| 31755 | Physician and practitioner services (fee schedule) | 44 | $1,106.49 |
| 31760 | Physician and practitioner services (fee schedule) | 45 | $1,002.33 |
| 31766 | Physician and practitioner services (fee schedule) | 44 | $1,299.59 |
| 31770 | Physician and practitioner services (fee schedule) | 45 | $981.30 |
| 31775 | Physician and practitioner services (fee schedule) | 45 | $1,035.97 |
| 31780 | Physician and practitioner services (fee schedule) | 45 | $833.20 |
| 31781 | Physician and practitioner services (fee schedule) | 45 | $1,047.56 |
| 31785 | Physician and practitioner services (fee schedule) | 44 | $782.33 |
| 31786 | Physician and practitioner services (fee schedule) | 45 | $1,072.57 |
| 31800 | Physician and practitioner services (fee schedule) | 45 | $514.03 |
| 31805 | Physician and practitioner services (fee schedule) | 45 | $627.58 |
| 31820 | Physician and practitioner services (fee schedule) | 45 | $301.37 |
| 31825 | Physician and practitioner services (fee schedule) | 45 | $419.44 |
| 31830 | Physician and practitioner services (fee schedule) | 45 | $330.17 |
| 31899 | Physician and practitioner services (fee schedule) | 6 | $111.04 |
| 32035 | Physician and practitioner services (fee schedule) | 45 | $529.48 |
| 32036 | Physician and practitioner services (fee schedule) | 44 | $572.91 |
| 32096 | Physician and practitioner services (fee schedule) | 44 | $594.91 |
| 32097 | Physician and practitioner services (fee schedule) | 45 | $600.10 |
| 32098 | Physician and practitioner services (fee schedule) | 45 | $563.07 |
| 32100 | Physician and practitioner services (fee schedule) | 45 | $641.30 |
| 32110 | Physician and practitioner services (fee schedule) | 45 | $1,003.86 |
| 32120 | Physician and practitioner services (fee schedule) | 45 | $662.27 |
| 32124 | Physician and practitioner services (fee schedule) | 44 | $681.54 |
| 32140 | Physician and practitioner services (fee schedule) | 45 | $742.94 |
| 32141 | Physician and practitioner services (fee schedule) | 45 | $1,035.29 |
| 32150 | Physician and practitioner services (fee schedule) | 45 | $734.19 |
| 32151 | Physician and practitioner services (fee schedule) | 45 | $716.63 |
| 32160 | Physician and practitioner services (fee schedule) | 45 | $583.68 |
| 32200 | Physician and practitioner services (fee schedule) | 45 | $808.05 |
| 32215 | Physician and practitioner services (fee schedule) | 45 | $583.17 |
| 32220 | Physician and practitioner services (fee schedule) | 45 | $1,157.84 |
| 32225 | Physician and practitioner services (fee schedule) | 45 | $744.76 |
| 32310 | Physician and practitioner services (fee schedule) | 45 | $693.04 |
| 32320 | Physician and practitioner services (fee schedule) | 45 | $1,166.34 |
| 32400 | Physician and practitioner services (fee schedule) | 45 | $92.30 |
| 32408 | Physician and practitioner services (fee schedule) | 45 | $523.87 |
| 32440 | Physician and practitioner services (fee schedule) | 44 | $1,158.91 |
| 32442 | Physician and practitioner services (fee schedule) | 44 | $1,913.12 |
| 32445 | Physician and practitioner services (fee schedule) | 44 | $2,337.88 |
| 32480 | Physician and practitioner services (fee schedule) | 44 | $1,096.17 |
| 32482 | Physician and practitioner services (fee schedule) | 44 | $1,154.38 |
| 32484 | Physician and practitioner services (fee schedule) | 44 | $1,072.45 |
| 32486 | Physician and practitioner services (fee schedule) | 44 | $1,546.15 |
| 32488 | Physician and practitioner services (fee schedule) | 44 | $1,603.59 |
| 32491 | Physician and practitioner services (fee schedule) | 36 | $1,094.93 |
| 32501 | Physician and practitioner services (fee schedule) | 45 | $189.08 |
| 32503 | Physician and practitioner services (fee schedule) | 44 | $1,314.33 |
| 32504 | Physician and practitioner services (fee schedule) | 44 | $1,492.50 |
| 32505 | Physician and practitioner services (fee schedule) | 45 | $697.57 |
| 32506 | Physician and practitioner services (fee schedule) | 45 | $109.88 |
| 32507 | Physician and practitioner services (fee schedule) | 44 | $109.83 |
| 32540 | Physician and practitioner services (fee schedule) | 44 | $1,154.64 |
| 32550 | Physician and practitioner services (fee schedule) | 44 | $448.18 |
| 32551 | Physician and practitioner services (fee schedule) | 44 | $123.50 |
| 32552 | Physician and practitioner services (fee schedule) | 43 | $133.43 |
| 32553 | Physician and practitioner services (fee schedule) | 43 | $310.96 |
| 32554 | Physician and practitioner services (fee schedule) | 44 | $165.83 |
| 32555 | Physician and practitioner services (fee schedule) | 44 | $198.22 |
| 32556 | Physician and practitioner services (fee schedule) | 44 | $439.13 |
| 32557 | Physician and practitioner services (fee schedule) | 44 | $384.69 |
| 32560 | Physician and practitioner services (fee schedule) | 44 | $179.33 |
| 32561 | Physician and practitioner services (fee schedule) | 44 | $63.45 |
| 32562 | Physician and practitioner services (fee schedule) | 44 | $57.09 |
| 32601 | Physician and practitioner services (fee schedule) | 44 | $242.15 |
| 32604 | Physician and practitioner services (fee schedule) | 44 | $363.64 |
| 32606 | Physician and practitioner services (fee schedule) | 44 | $359.86 |
| 32607 | Physician and practitioner services (fee schedule) | 44 | $228.99 |
| 32608 | Physician and practitioner services (fee schedule) | 44 | $279.16 |
| 32609 | Physician and practitioner services (fee schedule) | 44 | $190.01 |
| 32650 | Physician and practitioner services (fee schedule) | 44 | $511.76 |
| 32651 | Physician and practitioner services (fee schedule) | 44 | $799.45 |
| 32652 | Physician and practitioner services (fee schedule) | 44 | $1,183.29 |
| 32653 | Physician and practitioner services (fee schedule) | 44 | $773.85 |
| 32654 | Physician and practitioner services (fee schedule) | 44 | $830.11 |
| 32655 | Physician and practitioner services (fee schedule) | 44 | $723.56 |
| 32656 | Physician and practitioner services (fee schedule) | 44 | $611.22 |
| 32658 | Physician and practitioner services (fee schedule) | 44 | $554.46 |
| 32659 | Physician and practitioner services (fee schedule) | 44 | $567.52 |
| 32661 | Physician and practitioner services (fee schedule) | 44 | $604.72 |
| 32662 | Physician and practitioner services (fee schedule) | 44 | $689.38 |
| 32663 | Physician and practitioner services (fee schedule) | 44 | $1,029.43 |
| 32664 | Physician and practitioner services (fee schedule) | 44 | $654.29 |
| 32665 | Physician and practitioner services (fee schedule) | 44 | $901.04 |
| 32666 | Physician and practitioner services (fee schedule) | 44 | $657.41 |
| 32667 | Physician and practitioner services (fee schedule) | 43 | $110.88 |
| 32668 | Physician and practitioner services (fee schedule) | 44 | $110.64 |
| 32669 | Physician and practitioner services (fee schedule) | 44 | $989.79 |
| 32670 | Physician and practitioner services (fee schedule) | 44 | $1,170.48 |
| 32671 | Physician and practitioner services (fee schedule) | 44 | $1,293.77 |
| 32672 | Physician and practitioner services (fee schedule) | 44 | $1,113.29 |
| 32673 | Physician and practitioner services (fee schedule) | 44 | $899.64 |
| 32674 | Physician and practitioner services (fee schedule) | 44 | $151.89 |
| 32701 | Physician and practitioner services (fee schedule) | 40 | $163.65 |
| 32800 | Physician and practitioner services (fee schedule) | 43 | $713.33 |
| 32810 | Physician and practitioner services (fee schedule) | 44 | $680.28 |
| 32815 | Physician and practitioner services (fee schedule) | 44 | $1,861.14 |
| 32820 | Physician and practitioner services (fee schedule) | 43 | $1,024.32 |
| 32850 | Physician and practitioner services (fee schedule) | 8 | $903.46 |
| 32851 | Physician and practitioner services (fee schedule) | 41 | $2,230.90 |
| 32852 | Physician and practitioner services (fee schedule) | 42 | $2,388.87 |
| 32853 | Physician and practitioner services (fee schedule) | 42 | $3,053.23 |
| 32854 | Physician and practitioner services (fee schedule) | 42 | $3,237.64 |
| 32855 | Physician and practitioner services (fee schedule) | 16 | $193.10 |
| 32856 | Physician and practitioner services (fee schedule) | 17 | $202.68 |
| 32900 | Physician and practitioner services (fee schedule) | 44 | $984.05 |
| 32905 | Physician and practitioner services (fee schedule) | 44 | $985.98 |
| 32906 | Physician and practitioner services (fee schedule) | 44 | $1,210.20 |
| 32940 | Physician and practitioner services (fee schedule) | 44 | $888.58 |
| 32960 | Physician and practitioner services (fee schedule) | 44 | $86.88 |
| 32994 | Physician and practitioner services (fee schedule) | 37 | $2,430.67 |
| 32997 | Physician and practitioner services (fee schedule) | 43 | $250.85 |
| 32998 | Physician and practitioner services (fee schedule) | 36 | $1,935.12 |
| 32999 | Physician and practitioner services (fee schedule) | 8 | $429.94 |
| 33016 | Physician and practitioner services (fee schedule) | 44 | $173.72 |
| 33017 | Physician and practitioner services (fee schedule) | 44 | $182.36 |
| 33018 | Physician and practitioner services (fee schedule) | 44 | $211.68 |
| 33019 | Physician and practitioner services (fee schedule) | 44 | $155.21 |
| 33020 | Physician and practitioner services (fee schedule) | 44 | $627.55 |
| 33025 | Physician and practitioner services (fee schedule) | 44 | $605.90 |
| 33030 | Physician and practitioner services (fee schedule) | 44 | $1,349.19 |
| 33031 | Physician and practitioner services (fee schedule) | 44 | $1,570.24 |
| 33050 | Physician and practitioner services (fee schedule) | 44 | $754.37 |
| 33120 | Physician and practitioner services (fee schedule) | 44 | $1,518.25 |
| 33130 | Physician and practitioner services (fee schedule) | 43 | $1,018.82 |
| 33140 | Physician and practitioner services (fee schedule) | 40 | $1,116.42 |
| 33141 | Physician and practitioner services (fee schedule) | 40 | $106.65 |
| 33202 | Physician and practitioner services (fee schedule) | 44 | $602.17 |
| 33203 | Physician and practitioner services (fee schedule) | 42 | $599.40 |
| 33206 | Physician and practitioner services (fee schedule) | 44 | $351.00 |
| 33207 | Physician and practitioner services (fee schedule) | 44 | $381.73 |
| 33208 | Physician and practitioner services (fee schedule) | 44 | $394.56 |
| 33210 | Physician and practitioner services (fee schedule) | 44 | $130.40 |
| 33211 | Physician and practitioner services (fee schedule) | 44 | $134.34 |
| 33212 | Physician and practitioner services (fee schedule) | 44 | $254.83 |
| 33213 | Physician and practitioner services (fee schedule) | 44 | $270.11 |
| 33214 | Physician and practitioner services (fee schedule) | 44 | $365.62 |
| 33215 | Physician and practitioner services (fee schedule) | 44 | $231.83 |
| 33216 | Physician and practitioner services (fee schedule) | 44 | $292.13 |
| 33217 | Physician and practitioner services (fee schedule) | 44 | $290.69 |
| 33218 | Physician and practitioner services (fee schedule) | 44 | $288.29 |
| 33220 | Physician and practitioner services (fee schedule) | 44 | $292.90 |
| 33221 | Physician and practitioner services (fee schedule) | 44 | $264.54 |
| 33222 | Physician and practitioner services (fee schedule) | 44 | $274.31 |
| 33223 | Physician and practitioner services (fee schedule) | 44 | $317.56 |
| 33224 | Physician and practitioner services (fee schedule) | 44 | $370.95 |
| 33225 | Physician and practitioner services (fee schedule) | 44 | $333.34 |
| 33226 | Physician and practitioner services (fee schedule) | 44 | $356.38 |
| 33227 | Physician and practitioner services (fee schedule) | 44 | $250.04 |
| 33228 | Physician and practitioner services (fee schedule) | 44 | $262.54 |
| 33229 | Physician and practitioner services (fee schedule) | 44 | $269.01 |
| 33230 | Physician and practitioner services (fee schedule) | 44 | $282.36 |
| 33231 | Physician and practitioner services (fee schedule) | 44 | $293.82 |
| 33233 | Physician and practitioner services (fee schedule) | 44 | $174.89 |
| 33234 | Physician and practitioner services (fee schedule) | 44 | $368.76 |
| 33235 | Physician and practitioner services (fee schedule) | 44 | $469.73 |
| 33236 | Physician and practitioner services (fee schedule) | 44 | $609.85 |
| 33237 | Physician and practitioner services (fee schedule) | 44 | $663.39 |
| 33238 | Physician and practitioner services (fee schedule) | 44 | $742.97 |
| 33240 | Physician and practitioner services (fee schedule) | 44 | $287.26 |
| 33241 | Physician and practitioner services (fee schedule) | 44 | $164.54 |
| 33243 | Physician and practitioner services (fee schedule) | 44 | $1,002.61 |
| 33244 | Physician and practitioner services (fee schedule) | 44 | $623.11 |
| 33249 | Physician and practitioner services (fee schedule) | 44 | $697.34 |
| 33250 | Physician and practitioner services (fee schedule) | 44 | $1,063.12 |
| 33251 | Physician and practitioner services (fee schedule) | 44 | $1,192.25 |
| 33254 | Physician and practitioner services (fee schedule) | 44 | $1,006.97 |
| 33255 | Physician and practitioner services (fee schedule) | 44 | $1,208.16 |
| 33256 | Physician and practitioner services (fee schedule) | 44 | $1,423.33 |
| 33257 | Physician and practitioner services (fee schedule) | 44 | $446.82 |
| 33258 | Physician and practitioner services (fee schedule) | 43 | $494.86 |
| 33259 | Physician and practitioner services (fee schedule) | 44 | $646.56 |
| 33261 | Physician and practitioner services (fee schedule) | 43 | $1,205.41 |
| 33262 | Physician and practitioner services (fee schedule) | 44 | $268.57 |
| 33263 | Physician and practitioner services (fee schedule) | 43 | $273.99 |
| 33264 | Physician and practitioner services (fee schedule) | 44 | $290.16 |
| 33265 | Physician and practitioner services (fee schedule) | 43 | $1,006.61 |
| 33266 | Physician and practitioner services (fee schedule) | 43 | $1,353.93 |
| 33267 | Physician and practitioner services (fee schedule) | 35 | $825.25 |
| 33268 | Physician and practitioner services (fee schedule) | 35 | $102.86 |
| 33269 | Physician and practitioner services (fee schedule) | 35 | $661.94 |
| 33270 | Physician and practitioner services (fee schedule) | 43 | $428.79 |
| 33271 | Physician and practitioner services (fee schedule) | 43 | $351.85 |
| 33272 | Physician and practitioner services (fee schedule) | 43 | $278.81 |
| 33273 | Physician and practitioner services (fee schedule) | 43 | $306.06 |
| 33274 | Physician and practitioner services (fee schedule) | 32 | $366.62 |
| 33275 | Physician and practitioner services (fee schedule) | 33 | $391.70 |
| 33276 | Physician and practitioner services (fee schedule) | 36 | $429.24 |
| 33277 | Physician and practitioner services (fee schedule) | 36 | $219.37 |
| 33278 | Physician and practitioner services (fee schedule) | 36 | $423.55 |
| 33279 | Physician and practitioner services (fee schedule) | 36 | $258.98 |
| 33280 | Physician and practitioner services (fee schedule) | 36 | $157.21 |
| 33281 | Physician and practitioner services (fee schedule) | 36 | $282.40 |
| 33285 | Physician and practitioner services (fee schedule) | 44 | $1,435.19 |
| 33286 | Physician and practitioner services (fee schedule) | 44 | $85.34 |
| 33287 | Physician and practitioner services (fee schedule) | 35 | $284.00 |
| 33288 | Physician and practitioner services (fee schedule) | 35 | $381.74 |
| 33289 | Physician and practitioner services (fee schedule) | 27 | $246.24 |
| 33300 | Physician and practitioner services (fee schedule) | 44 | $1,685.17 |
| 33305 | Physician and practitioner services (fee schedule) | 44 | $2,683.91 |
| 33310 | Physician and practitioner services (fee schedule) | 44 | $880.74 |
| 33315 | Physician and practitioner services (fee schedule) | 44 | $1,353.93 |
| 33320 | Physician and practitioner services (fee schedule) | 44 | $813.30 |
| 33321 | Physician and practitioner services (fee schedule) | 44 | $938.54 |
| 33322 | Physician and practitioner services (fee schedule) | 44 | $1,103.90 |
| 33330 | Physician and practitioner services (fee schedule) | 44 | $1,068.51 |
| 33335 | Physician and practitioner services (fee schedule) | 44 | $1,377.93 |
| 33340 | Physician and practitioner services (fee schedule) | 34 | $545.96 |
| 33361 | Physician and practitioner services (fee schedule) | 44 | $901.54 |
| 33362 | Physician and practitioner services (fee schedule) | 44 | $984.17 |
| 33363 | Physician and practitioner services (fee schedule) | 44 | $1,020.57 |
| 33364 | Physician and practitioner services (fee schedule) | 44 | $1,065.90 |
| 33365 | Physician and practitioner services (fee schedule) | 44 | $1,083.39 |
| 33366 | Physician and practitioner services (fee schedule) | 44 | $1,196.32 |
| 33367 | Physician and practitioner services (fee schedule) | 44 | $458.22 |
| 33368 | Physician and practitioner services (fee schedule) | 44 | $555.33 |
| 33369 | Physician and practitioner services (fee schedule) | 44 | $733.47 |
| 33370 | Physician and practitioner services (fee schedule) | 33 | $104.94 |
| 33390 | Physician and practitioner services (fee schedule) | 44 | $1,482.15 |
| 33391 | Physician and practitioner services (fee schedule) | 44 | $1,735.65 |
| 33404 | Physician and practitioner services (fee schedule) | 44 | $1,383.98 |
| 33405 | Physician and practitioner services (fee schedule) | 44 | $1,706.62 |
| 33406 | Physician and practitioner services (fee schedule) | 44 | $2,082.48 |
| 33410 | Physician and practitioner services (fee schedule) | 43 | $1,853.82 |
| 33411 | Physician and practitioner services (fee schedule) | 43 | $2,348.01 |
| 33412 | Physician and practitioner services (fee schedule) | 44 | $2,258.27 |
| 33413 | Physician and practitioner services (fee schedule) | 44 | $2,338.81 |
| 33414 | Physician and practitioner services (fee schedule) | 44 | $1,554.38 |
| 33415 | Physician and practitioner services (fee schedule) | 44 | $1,520.76 |
| 33416 | Physician and practitioner services (fee schedule) | 44 | $1,521.78 |
| 33417 | Physician and practitioner services (fee schedule) | 43 | $1,237.96 |
| 33418 | Physician and practitioner services (fee schedule) | 39 | $1,352.71 |
| 33419 | Physician and practitioner services (fee schedule) | 39 | $327.02 |
| 33420 | Physician and practitioner services (fee schedule) | 44 | $1,087.06 |
| 33422 | Physician and practitioner services (fee schedule) | 44 | $1,298.93 |
| 33425 | Physician and practitioner services (fee schedule) | 44 | $1,931.15 |
| 33426 | Physician and practitioner services (fee schedule) | 44 | $1,754.01 |
| 33427 | Physician and practitioner services (fee schedule) | 44 | $1,872.82 |
| 33430 | Physician and practitioner services (fee schedule) | 44 | $2,040.78 |
| 33440 | Physician and practitioner services (fee schedule) | 43 | $2,665.41 |
| 33460 | Physician and practitioner services (fee schedule) | 44 | $1,696.36 |
| 33463 | Physician and practitioner services (fee schedule) | 44 | $2,229.91 |
| 33464 | Physician and practitioner services (fee schedule) | 44 | $1,779.73 |
| 33465 | Physician and practitioner services (fee schedule) | 44 | $1,978.54 |
| 33468 | Physician and practitioner services (fee schedule) | 44 | $1,792.92 |
| 33470 | Physician and practitioner services (fee schedule) | 5 | $926.26 |
| 33471 | Physician and practitioner services (fee schedule) | 6 | $1,183.27 |
| 33474 | Physician and practitioner services (fee schedule) | 44 | $1,557.11 |
| 33475 | Physician and practitioner services (fee schedule) | 44 | $1,698.06 |
| 33476 | Physician and practitioner services (fee schedule) | 43 | $1,166.34 |
| 33477 | Physician and practitioner services (fee schedule) | 44 | $972.12 |
| 33478 | Physician and practitioner services (fee schedule) | 44 | $1,203.69 |
| 33496 | Physician and practitioner services (fee schedule) | 43 | $1,316.24 |
| 33500 | Physician and practitioner services (fee schedule) | 43 | $1,200.30 |
| 33501 | Physician and practitioner services (fee schedule) | 43 | $847.64 |
| 33502 | Physician and practitioner services (fee schedule) | 43 | $953.88 |
| 33503 | Physician and practitioner services (fee schedule) | 44 | $1,035.00 |
| 33504 | Physician and practitioner services (fee schedule) | 44 | $1,149.57 |
| 33505 | Physician and practitioner services (fee schedule) | 43 | $1,473.61 |
| 33506 | Physician and practitioner services (fee schedule) | 43 | $1,480.79 |
| 33507 | Physician and practitioner services (fee schedule) | 44 | $1,248.88 |
| 33508 | Physician and practitioner services (fee schedule) | 44 | $11.70 |
| 33509 | Physician and practitioner services (fee schedule) | 44 | $134.19 |
| 33510 | Physician and practitioner services (fee schedule) | 44 | $1,517.71 |
| 33511 | Physician and practitioner services (fee schedule) | 44 | $1,650.11 |
| 33512 | Physician and practitioner services (fee schedule) | 44 | $1,789.14 |
| 33513 | Physician and practitioner services (fee schedule) | 44 | $1,929.51 |
| 33514 | Physician and practitioner services (fee schedule) | 44 | $2,024.85 |
| 33516 | Physician and practitioner services (fee schedule) | 44 | $2,125.20 |
| 33517 | Physician and practitioner services (fee schedule) | 44 | $144.71 |
| 33518 | Physician and practitioner services (fee schedule) | 44 | $293.10 |
| 33519 | Physician and practitioner services (fee schedule) | 44 | $400.73 |
| 33521 | Physician and practitioner services (fee schedule) | 44 | $503.89 |
| 33522 | Physician and practitioner services (fee schedule) | 44 | $565.37 |
| 33523 | Physician and practitioner services (fee schedule) | 44 | $645.79 |
| 33530 | Physician and practitioner services (fee schedule) | 43 | $371.21 |
| 33533 | Physician and practitioner services (fee schedule) | 44 | $1,483.37 |
| 33534 | Physician and practitioner services (fee schedule) | 44 | $1,730.89 |
| 33535 | Physician and practitioner services (fee schedule) | 44 | $1,847.82 |
| 33536 | Physician and practitioner services (fee schedule) | 44 | $2,069.30 |
| 33542 | Physician and practitioner services (fee schedule) | 44 | $1,858.11 |
| 33545 | Physician and practitioner services (fee schedule) | 44 | $2,233.28 |
| 33548 | Physician and practitioner services (fee schedule) | 40 | $2,090.95 |
| 33572 | Physician and practitioner services (fee schedule) | 44 | $179.31 |
| 33600 | Physician and practitioner services (fee schedule) | 43 | $1,273.65 |
| 33602 | Physician and practitioner services (fee schedule) | 43 | $1,238.24 |
| 33606 | Physician and practitioner services (fee schedule) | 42 | $1,355.16 |
| 33608 | Physician and practitioner services (fee schedule) | 43 | $1,418.09 |
| 33610 | Physician and practitioner services (fee schedule) | 43 | $1,313.45 |
| 33611 | Physician and practitioner services (fee schedule) | 43 | $1,416.89 |
| 33612 | Physician and practitioner services (fee schedule) | 43 | $1,453.44 |
| 33615 | Physician and practitioner services (fee schedule) | 44 | $1,514.01 |
| 33617 | Physician and practitioner services (fee schedule) | 44 | $1,636.19 |
| 33619 | Physician and practitioner services (fee schedule) | 44 | $2,049.87 |
| 33620 | Physician and practitioner services (fee schedule) | 42 | $1,224.66 |
| 33621 | Physician and practitioner services (fee schedule) | 41 | $688.79 |
| 33622 | Physician and practitioner services (fee schedule) | 42 | $2,542.30 |
| 33641 | Physician and practitioner services (fee schedule) | 44 | $1,274.33 |
| 33645 | Physician and practitioner services (fee schedule) | 44 | $1,261.28 |
| 33647 | Physician and practitioner services (fee schedule) | 44 | $1,371.16 |
| 33660 | Physician and practitioner services (fee schedule) | 44 | $1,370.18 |
| 33665 | Physician and practitioner services (fee schedule) | 44 | $1,441.41 |
| 33670 | Physician and practitioner services (fee schedule) | 44 | $1,470.29 |
| 33675 | Physician and practitioner services (fee schedule) | 43 | $1,431.20 |
| 33676 | Physician and practitioner services (fee schedule) | 43 | $1,467.74 |
| 33677 | Physician and practitioner services (fee schedule) | 43 | $1,522.71 |
| 33681 | Physician and practitioner services (fee schedule) | 44 | $1,431.69 |
| 33684 | Physician and practitioner services (fee schedule) | 44 | $1,472.80 |
| 33688 | Physician and practitioner services (fee schedule) | 44 | $1,408.49 |
| 33690 | Physician and practitioner services (fee schedule) | 44 | $908.68 |
| 33692 | Physician and practitioner services (fee schedule) | 44 | $1,407.60 |
| 33694 | Physician and practitioner services (fee schedule) | 44 | $1,468.73 |
| 33697 | Physician and practitioner services (fee schedule) | 44 | $1,609.00 |
| 33702 | Physician and practitioner services (fee schedule) | 44 | $1,213.77 |
| 33710 | Physician and practitioner services (fee schedule) | 43 | $1,487.44 |
| 33720 | Physician and practitioner services (fee schedule) | 44 | $1,184.55 |
| 33724 | Physician and practitioner services (fee schedule) | 44 | $1,124.18 |
| 33726 | Physician and practitioner services (fee schedule) | 44 | $1,472.00 |
| 33730 | Physician and practitioner services (fee schedule) | 44 | $1,504.39 |
| 33732 | Physician and practitioner services (fee schedule) | 44 | $1,256.92 |
| 33735 | Physician and practitioner services (fee schedule) | 44 | $974.96 |
| 33736 | Physician and practitioner services (fee schedule) | 44 | $1,071.19 |
| 33737 | Physician and practitioner services (fee schedule) | 7 | $1,145.31 |
| 33741 | Physician and practitioner services (fee schedule) | 44 | $552.71 |
| 33745 | Physician and practitioner services (fee schedule) | 44 | $773.20 |
| 33746 | Physician and practitioner services (fee schedule) | 42 | $297.60 |
| 33750 | Physician and practitioner services (fee schedule) | 44 | $965.14 |
| 33755 | Physician and practitioner services (fee schedule) | 42 | $1,003.70 |
| 33762 | Physician and practitioner services (fee schedule) | 43 | $1,010.97 |
| 33764 | Physician and practitioner services (fee schedule) | 44 | $995.57 |
| 33766 | Physician and practitioner services (fee schedule) | 44 | $1,048.41 |
| 33767 | Physician and practitioner services (fee schedule) | 44 | $1,115.51 |
| 33768 | Physician and practitioner services (fee schedule) | 44 | $293.86 |
| 33770 | Physician and practitioner services (fee schedule) | 44 | $1,583.85 |
| 33771 | Physician and practitioner services (fee schedule) | 44 | $1,558.72 |
| 33774 | Physician and practitioner services (fee schedule) | 44 | $1,377.02 |
| 33775 | Physician and practitioner services (fee schedule) | 44 | $1,463.63 |
| 33776 | Physician and practitioner services (fee schedule) | 44 | $1,495.48 |
| 33777 | Physician and practitioner services (fee schedule) | 44 | $1,485.53 |
| 33778 | Physician and practitioner services (fee schedule) | 44 | $1,706.26 |
| 33779 | Physician and practitioner services (fee schedule) | 44 | $1,796.77 |
| 33780 | Physician and practitioner services (fee schedule) | 44 | $1,822.09 |
| 33781 | Physician and practitioner services (fee schedule) | 44 | $1,790.02 |
| 33782 | Physician and practitioner services (fee schedule) | 42 | $2,274.27 |
| 33783 | Physician and practitioner services (fee schedule) | 41 | $2,477.26 |
| 33786 | Physician and practitioner services (fee schedule) | 44 | $1,727.40 |
| 33788 | Physician and practitioner services (fee schedule) | 43 | $1,201.80 |
| 33800 | Physician and practitioner services (fee schedule) | 44 | $750.59 |
| 33802 | Physician and practitioner services (fee schedule) | 44 | $823.83 |
| 33803 | Physician and practitioner services (fee schedule) | 42 | $874.44 |
| 33813 | Physician and practitioner services (fee schedule) | 7 | $1,068.94 |
| 33814 | Physician and practitioner services (fee schedule) | 44 | $1,168.15 |
| 33820 | Physician and practitioner services (fee schedule) | 44 | $768.51 |
| 33822 | Physician and practitioner services (fee schedule) | 44 | $799.34 |
| 33824 | Physician and practitioner services (fee schedule) | 44 | $909.73 |
| 33840 | Physician and practitioner services (fee schedule) | 44 | $959.39 |
| 33845 | Physician and practitioner services (fee schedule) | 44 | $1,033.56 |
| 33851 | Physician and practitioner services (fee schedule) | 44 | $971.75 |
| 33852 | Physician and practitioner services (fee schedule) | 44 | $1,058.79 |
| 33853 | Physician and practitioner services (fee schedule) | 44 | $1,448.41 |
| 33858 | Physician and practitioner services (fee schedule) | 44 | $2,568.93 |
| 33859 | Physician and practitioner services (fee schedule) | 44 | $1,906.43 |
| 33863 | Physician and practitioner services (fee schedule) | 44 | $2,259.88 |
| 33864 | Physician and practitioner services (fee schedule) | 44 | $2,295.72 |
| 33866 | Physician and practitioner services (fee schedule) | 42 | $704.91 |
| 33871 | Physician and practitioner services (fee schedule) | 44 | $2,536.33 |
| 33875 | Physician and practitioner services (fee schedule) | 43 | $1,971.56 |
| 33877 | Physician and practitioner services (fee schedule) | 43 | $2,560.56 |
| 33880 | Physician and practitioner services (fee schedule) | 44 | $1,111.76 |
| 33881 | Physician and practitioner services (fee schedule) | 44 | $946.83 |
| 33882 | Physician and practitioner services (fee schedule) | 36 | $1,362.29 |
| 33883 | Physician and practitioner services (fee schedule) | 44 | $815.88 |
| 33884 | Physician and practitioner services (fee schedule) | 10 | $334.45 |
| 33886 | Physician and practitioner services (fee schedule) | 44 | $751.28 |
| 33889 | Physician and practitioner services (fee schedule) | 10 | $666.64 |
| 33891 | Physician and practitioner services (fee schedule) | 10 | $850.09 |
| 33894 | Physician and practitioner services (fee schedule) | 44 | $730.82 |
| 33895 | Physician and practitioner services (fee schedule) | 44 | $581.73 |
| 33897 | Physician and practitioner services (fee schedule) | 44 | $432.34 |
| 33900 | Physician and practitioner services (fee schedule) | 41 | $432.01 |
| 33901 | Physician and practitioner services (fee schedule) | 42 | $559.01 |
| 33902 | Physician and practitioner services (fee schedule) | 42 | $539.82 |
| 33903 | Physician and practitioner services (fee schedule) | 42 | $636.53 |
| 33904 | Physician and practitioner services (fee schedule) | 41 | $217.04 |
| 33910 | Physician and practitioner services (fee schedule) | 44 | $1,671.10 |
| 33915 | Physician and practitioner services (fee schedule) | 43 | $984.18 |
| 33916 | Physician and practitioner services (fee schedule) | 44 | $2,736.01 |
| 33917 | Physician and practitioner services (fee schedule) | 44 | $1,159.08 |
| 33920 | Physician and practitioner services (fee schedule) | 44 | $1,421.03 |
| 33922 | Physician and practitioner services (fee schedule) | 43 | $1,081.49 |
| 33924 | Physician and practitioner services (fee schedule) | 44 | $222.13 |
| 33925 | Physician and practitioner services (fee schedule) | 43 | $1,243.26 |
| 33926 | Physician and practitioner services (fee schedule) | 44 | $1,737.23 |
| 33927 | Physician and practitioner services (fee schedule) | 28 | $2,004.58 |
| 33928 | Physician and practitioner services (fee schedule) | 9 | $1,718.76 |
| 33929 | Physician and practitioner services (fee schedule) | 9 | $1,133.48 |
| 33930 | Physician and practitioner services (fee schedule) | 10 | $992.67 |
| 33933 | Physician and practitioner services (fee schedule) | 11 | $274.79 |
| 33935 | Physician and practitioner services (fee schedule) | 40 | $3,141.74 |
| 33940 | Physician and practitioner services (fee schedule) | 12 | $1,361.22 |
| 33944 | Physician and practitioner services (fee schedule) | 17 | $206.82 |
| 33945 | Physician and practitioner services (fee schedule) | 42 | $3,351.61 |
| 33946 | Physician and practitioner services (fee schedule) | 44 | $240.71 |
| 33947 | Physician and practitioner services (fee schedule) | 44 | $264.45 |
| 33948 | Physician and practitioner services (fee schedule) | 44 | $186.81 |
| 33949 | Physician and practitioner services (fee schedule) | 44 | $180.46 |
| 33951 | Physician and practitioner services (fee schedule) | 44 | $327.25 |
| 33952 | Physician and practitioner services (fee schedule) | 44 | $315.03 |
| 33953 | Physician and practitioner services (fee schedule) | 44 | $364.53 |
| 33954 | Physician and practitioner services (fee schedule) | 44 | $352.17 |
| 33955 | Physician and practitioner services (fee schedule) | 44 | $644.19 |
| 33956 | Physician and practitioner services (fee schedule) | 44 | $640.92 |
| 33957 | Physician and practitioner services (fee schedule) | 44 | $145.21 |
| 33958 | Physician and practitioner services (fee schedule) | 44 | $146.40 |
| 33959 | Physician and practitioner services (fee schedule) | 44 | $183.22 |
| 33962 | Physician and practitioner services (fee schedule) | 44 | $183.22 |
| 33963 | Physician and practitioner services (fee schedule) | 44 | $364.69 |
| 33964 | Physician and practitioner services (fee schedule) | 44 | $384.47 |
| 33965 | Physician and practitioner services (fee schedule) | 44 | $145.21 |
| 33966 | Physician and practitioner services (fee schedule) | 44 | $185.61 |
| 33967 | Physician and practitioner services (fee schedule) | 44 | $196.43 |
| 33968 | Physician and practitioner services (fee schedule) | 43 | $26.42 |
| 33969 | Physician and practitioner services (fee schedule) | 44 | $212.35 |
| 33970 | Physician and practitioner services (fee schedule) | 43 | $251.12 |
| 33971 | Physician and practitioner services (fee schedule) | 43 | $522.14 |
| 33973 | Physician and practitioner services (fee schedule) | 43 | $390.48 |
| 33974 | Physician and practitioner services (fee schedule) | 42 | $685.67 |
| 33975 | Physician and practitioner services (fee schedule) | 43 | $916.21 |
| 33976 | Physician and practitioner services (fee schedule) | 43 | $1,125.59 |
| 33977 | Physician and practitioner services (fee schedule) | 43 | $869.19 |
| 33978 | Physician and practitioner services (fee schedule) | 43 | $1,009.20 |
| 33979 | Physician and practitioner services (fee schedule) | 43 | $1,375.49 |
| 33980 | Physician and practitioner services (fee schedule) | 39 | $1,271.97 |
| 33981 | Physician and practitioner services (fee schedule) | 37 | $648.86 |
| 33982 | Physician and practitioner services (fee schedule) | 36 | $1,503.73 |
| 33983 | Physician and practitioner services (fee schedule) | 36 | $1,701.65 |
| 33984 | Physician and practitioner services (fee schedule) | 44 | $221.61 |
| 33985 | Physician and practitioner services (fee schedule) | 44 | $400.24 |
| 33986 | Physician and practitioner services (fee schedule) | 44 | $409.70 |
| 33987 | Physician and practitioner services (fee schedule) | 44 | $161.97 |
| 33988 | Physician and practitioner services (fee schedule) | 44 | $588.04 |
| 33989 | Physician and practitioner services (fee schedule) | 43 | $380.52 |
| 33990 | Physician and practitioner services (fee schedule) | 43 | $264.40 |
| 33991 | Physician and practitioner services (fee schedule) | 42 | $354.92 |
| 33992 | Physician and practitioner services (fee schedule) | 43 | $139.31 |
| 33993 | Physician and practitioner services (fee schedule) | 42 | $119.56 |
| 33995 | Physician and practitioner services (fee schedule) | 42 | $266.19 |
| 33997 | Physician and practitioner services (fee schedule) | 42 | $118.85 |
| 33999 | Physician and practitioner services (fee schedule) | 7 | $1,071.99 |
| 34001 | Physician and practitioner services (fee schedule) | 44 | $647.94 |
| 34051 | Physician and practitioner services (fee schedule) | 44 | $720.03 |
| 34101 | Physician and practitioner services (fee schedule) | 44 | $460.38 |
| 34111 | Physician and practitioner services (fee schedule) | 44 | $447.25 |
| 34151 | Physician and practitioner services (fee schedule) | 44 | $975.94 |
| 34201 | Physician and practitioner services (fee schedule) | 44 | $712.27 |
| 34203 | Physician and practitioner services (fee schedule) | 44 | $670.98 |
| 34401 | Physician and practitioner services (fee schedule) | 44 | $937.19 |
| 34421 | Physician and practitioner services (fee schedule) | 44 | $512.90 |
| 34451 | Physician and practitioner services (fee schedule) | 44 | $1,004.61 |
| 34471 | Physician and practitioner services (fee schedule) | 44 | $756.62 |
| 34490 | Physician and practitioner services (fee schedule) | 44 | $453.69 |
| 34501 | Physician and practitioner services (fee schedule) | 44 | $634.84 |
| 34502 | Physician and practitioner services (fee schedule) | 43 | $1,188.27 |
| 34510 | Physician and practitioner services (fee schedule) | 44 | $720.11 |
| 34520 | Physician and practitioner services (fee schedule) | 44 | $698.64 |
| 34530 | Physician and practitioner services (fee schedule) | 44 | $696.55 |
| 34701 | Physician and practitioner services (fee schedule) | 44 | $916.72 |
| 34702 | Physician and practitioner services (fee schedule) | 44 | $1,338.65 |
| 34703 | Physician and practitioner services (fee schedule) | 44 | $1,044.31 |
| 34704 | Physician and practitioner services (fee schedule) | 44 | $1,719.43 |
| 34705 | Physician and practitioner services (fee schedule) | 44 | $1,159.31 |
| 34706 | Physician and practitioner services (fee schedule) | 44 | $1,727.83 |
| 34707 | Physician and practitioner services (fee schedule) | 44 | $886.30 |
| 34708 | Physician and practitioner services (fee schedule) | 44 | $1,378.84 |
| 34709 | Physician and practitioner services (fee schedule) | 44 | $244.06 |
| 34710 | Physician and practitioner services (fee schedule) | 44 | $606.42 |
| 34711 | Physician and practitioner services (fee schedule) | 44 | $217.63 |
| 34712 | Physician and practitioner services (fee schedule) | 44 | $503.01 |
| 34713 | Physician and practitioner services (fee schedule) | 44 | $93.30 |
| 34714 | Physician and practitioner services (fee schedule) | 44 | $205.65 |
| 34715 | Physician and practitioner services (fee schedule) | 44 | $226.92 |
| 34716 | Physician and practitioner services (fee schedule) | 44 | $284.01 |
| 34717 | Physician and practitioner services (fee schedule) | 42 | $338.37 |
| 34718 | Physician and practitioner services (fee schedule) | 42 | $945.99 |
| 34808 | Physician and practitioner services (fee schedule) | 44 | $154.90 |
| 34812 | Physician and practitioner services (fee schedule) | 44 | $160.77 |
| 34813 | Physician and practitioner services (fee schedule) | 44 | $180.33 |
| 34820 | Physician and practitioner services (fee schedule) | 44 | $260.94 |
| 34830 | Physician and practitioner services (fee schedule) | 44 | $1,316.89 |
| 34831 | Physician and practitioner services (fee schedule) | 44 | $1,384.11 |
| 34832 | Physician and practitioner services (fee schedule) | 44 | $1,415.16 |
| 34833 | Physician and practitioner services (fee schedule) | 43 | $304.94 |
| 34834 | Physician and practitioner services (fee schedule) | 43 | $100.98 |
| 34841 | Physician and practitioner services (fee schedule) | 26 | $1,138.11 |
| 34842 | Physician and practitioner services (fee schedule) | 27 | $1,213.36 |
| 34843 | Physician and practitioner services (fee schedule) | 26 | $1,315.25 |
| 34844 | Physician and practitioner services (fee schedule) | 26 | $1,457.75 |
| 34845 | Physician and practitioner services (fee schedule) | 27 | $1,359.92 |
| 34846 | Physician and practitioner services (fee schedule) | 27 | $1,495.92 |
| 34847 | Physician and practitioner services (fee schedule) | 27 | $1,574.22 |
| 34848 | Physician and practitioner services (fee schedule) | 26 | $1,637.58 |
| 35001 | Physician and practitioner services (fee schedule) | 44 | $853.62 |
| 35002 | Physician and practitioner services (fee schedule) | 43 | $888.17 |
| 35005 | Physician and practitioner services (fee schedule) | 44 | $768.45 |
| 35011 | Physician and practitioner services (fee schedule) | 43 | $757.88 |
| 35013 | Physician and practitioner services (fee schedule) | 43 | $909.93 |
| 35021 | Physician and practitioner services (fee schedule) | 44 | $962.52 |
| 35022 | Physician and practitioner services (fee schedule) | 44 | $1,083.82 |
| 35045 | Physician and practitioner services (fee schedule) | 43 | $684.85 |
| 35081 | Physician and practitioner services (fee schedule) | 44 | $1,219.65 |
| 35082 | Physician and practitioner services (fee schedule) | 44 | $1,547.85 |
| 35091 | Physician and practitioner services (fee schedule) | 44 | $1,334.30 |
| 35092 | Physician and practitioner services (fee schedule) | 44 | $1,822.51 |
| 35102 | Physician and practitioner services (fee schedule) | 44 | $1,354.82 |
| 35103 | Physician and practitioner services (fee schedule) | 44 | $1,624.05 |
| 35111 | Physician and practitioner services (fee schedule) | 44 | $947.98 |
| 35112 | Physician and practitioner services (fee schedule) | 44 | $1,142.76 |
| 35121 | Physician and practitioner services (fee schedule) | 44 | $1,188.31 |
| 35122 | Physician and practitioner services (fee schedule) | 44 | $1,461.01 |
| 35131 | Physician and practitioner services (fee schedule) | 44 | $975.37 |
| 35132 | Physician and practitioner services (fee schedule) | 44 | $1,160.90 |
| 35141 | Physician and practitioner services (fee schedule) | 44 | $824.12 |
| 35142 | Physician and practitioner services (fee schedule) | 44 | $936.70 |
| 35151 | Physician and practitioner services (fee schedule) | 44 | $892.93 |
| 35152 | Physician and practitioner services (fee schedule) | 44 | $977.38 |
| 35180 | Physician and practitioner services (fee schedule) | 44 | $596.96 |
| 35182 | Physician and practitioner services (fee schedule) | 43 | $1,220.40 |
| 35184 | Physician and practitioner services (fee schedule) | 43 | $681.19 |
| 35188 | Physician and practitioner services (fee schedule) | 44 | $823.20 |
| 35189 | Physician and practitioner services (fee schedule) | 43 | $1,052.86 |
| 35190 | Physician and practitioner services (fee schedule) | 44 | $578.60 |
| 35201 | Physician and practitioner services (fee schedule) | 44 | $659.41 |
| 35206 | Physician and practitioner services (fee schedule) | 44 | $570.23 |
| 35207 | Physician and practitioner services (fee schedule) | 44 | $558.92 |
| 35211 | Physician and practitioner services (fee schedule) | 44 | $1,049.34 |
| 35216 | Physician and practitioner services (fee schedule) | 44 | $1,426.06 |
| 35221 | Physician and practitioner services (fee schedule) | 44 | $1,041.85 |
| 35226 | Physician and practitioner services (fee schedule) | 44 | $590.58 |
| 35231 | Physician and practitioner services (fee schedule) | 44 | $846.54 |
| 35236 | Physician and practitioner services (fee schedule) | 44 | $712.42 |
| 35241 | Physician and practitioner services (fee schedule) | 44 | $1,093.35 |
| 35246 | Physician and practitioner services (fee schedule) | 44 | $1,156.15 |
| 35251 | Physician and practitioner services (fee schedule) | 44 | $1,201.04 |
| 35256 | Physician and practitioner services (fee schedule) | 44 | $722.26 |
| 35261 | Physician and practitioner services (fee schedule) | 44 | $709.42 |
| 35266 | Physician and practitioner services (fee schedule) | 44 | $612.08 |
| 35271 | Physician and practitioner services (fee schedule) | 44 | $1,036.47 |
| 35276 | Physician and practitioner services (fee schedule) | 44 | $1,065.58 |
| 35281 | Physician and practitioner services (fee schedule) | 44 | $1,152.88 |
| 35286 | Physician and practitioner services (fee schedule) | 44 | $663.46 |
| 35301 | Physician and practitioner services (fee schedule) | 44 | $835.11 |
| 35302 | Physician and practitioner services (fee schedule) | 44 | $789.30 |
| 35303 | Physician and practitioner services (fee schedule) | 44 | $870.20 |
| 35304 | Physician and practitioner services (fee schedule) | 44 | $897.72 |
| 35305 | Physician and practitioner services (fee schedule) | 44 | $859.73 |
| 35306 | Physician and practitioner services (fee schedule) | 44 | $327.06 |
| 35311 | Physician and practitioner services (fee schedule) | 44 | $1,138.73 |
| 35321 | Physician and practitioner services (fee schedule) | 44 | $700.28 |
| 35331 | Physician and practitioner services (fee schedule) | 44 | $1,063.26 |
| 35341 | Physician and practitioner services (fee schedule) | 44 | $972.49 |
| 35351 | Physician and practitioner services (fee schedule) | 44 | $979.96 |
| 35355 | Physician and practitioner services (fee schedule) | 44 | $800.16 |
| 35361 | Physician and practitioner services (fee schedule) | 44 | $1,166.98 |
| 35363 | Physician and practitioner services (fee schedule) | 44 | $1,221.58 |
| 35371 | Physician and practitioner services (fee schedule) | 44 | $638.64 |
| 35372 | Physician and practitioner services (fee schedule) | 44 | $730.53 |
| 35390 | Physician and practitioner services (fee schedule) | 43 | $122.92 |
| 35400 | Physician and practitioner services (fee schedule) | 43 | $112.45 |
| 35500 | Physician and practitioner services (fee schedule) | 41 | $223.14 |
| 35501 | Physician and practitioner services (fee schedule) | 44 | $1,048.18 |
| 35506 | Physician and practitioner services (fee schedule) | 44 | $985.42 |
| 35508 | Physician and practitioner services (fee schedule) | 44 | $1,002.73 |
| 35509 | Physician and practitioner services (fee schedule) | 44 | $1,057.97 |
| 35510 | Physician and practitioner services (fee schedule) | 43 | $943.87 |
| 35511 | Physician and practitioner services (fee schedule) | 44 | $826.84 |
| 35512 | Physician and practitioner services (fee schedule) | 44 | $889.41 |
| 35515 | Physician and practitioner services (fee schedule) | 44 | $936.54 |
| 35516 | Physician and practitioner services (fee schedule) | 44 | $897.97 |
| 35518 | Physician and practitioner services (fee schedule) | 44 | $890.51 |
| 35521 | Physician and practitioner services (fee schedule) | 44 | $917.82 |
| 35522 | Physician and practitioner services (fee schedule) | 44 | $863.08 |
| 35523 | Physician and practitioner services (fee schedule) | 43 | $895.78 |
| 35525 | Physician and practitioner services (fee schedule) | 44 | $822.13 |
| 35526 | Physician and practitioner services (fee schedule) | 44 | $1,228.88 |
| 35531 | Physician and practitioner services (fee schedule) | 44 | $1,365.31 |
| 35533 | Physician and practitioner services (fee schedule) | 44 | $1,160.59 |
| 35535 | Physician and practitioner services (fee schedule) | 43 | $1,459.59 |
| 35536 | Physician and practitioner services (fee schedule) | 44 | $1,269.88 |
| 35537 | Physician and practitioner services (fee schedule) | 44 | $1,534.78 |
| 35538 | Physician and practitioner services (fee schedule) | 44 | $1,718.71 |
| 35539 | Physician and practitioner services (fee schedule) | 44 | $1,613.53 |
| 35540 | Physician and practitioner services (fee schedule) | 44 | $1,861.12 |
| 35556 | Physician and practitioner services (fee schedule) | 44 | $982.56 |
| 35558 | Physician and practitioner services (fee schedule) | 44 | $872.22 |
| 35560 | Physician and practitioner services (fee schedule) | 44 | $1,245.87 |
| 35563 | Physician and practitioner services (fee schedule) | 44 | $930.32 |
| 35565 | Physician and practitioner services (fee schedule) | 44 | $941.75 |
| 35566 | Physician and practitioner services (fee schedule) | 44 | $1,169.35 |
| 35570 | Physician and practitioner services (fee schedule) | 43 | $1,130.97 |
| 35571 | Physician and practitioner services (fee schedule) | 44 | $969.22 |
| 35572 | Physician and practitioner services (fee schedule) | 44 | $250.21 |
| 35583 | Physician and practitioner services (fee schedule) | 44 | $1,054.17 |
| 35585 | Physician and practitioner services (fee schedule) | 44 | $1,221.16 |
| 35587 | Physician and practitioner services (fee schedule) | 44 | $992.77 |
| 35600 | Physician and practitioner services (fee schedule) | 44 | $145.68 |
| 35601 | Physician and practitioner services (fee schedule) | 44 | $988.24 |
| 35602 | Physician and practitioner services (fee schedule) | 36 | $887.51 |
| 35606 | Physician and practitioner services (fee schedule) | 44 | $903.97 |
| 35612 | Physician and practitioner services (fee schedule) | 44 | $767.75 |
| 35616 | Physician and practitioner services (fee schedule) | 44 | $859.44 |
| 35621 | Physician and practitioner services (fee schedule) | 44 | $850.93 |
| 35623 | Physician and practitioner services (fee schedule) | 44 | $919.45 |
| 35626 | Physician and practitioner services (fee schedule) | 44 | $1,187.03 |
| 35631 | Physician and practitioner services (fee schedule) | 44 | $1,295.03 |
| 35632 | Physician and practitioner services (fee schedule) | 44 | $1,395.38 |
| 35633 | Physician and practitioner services (fee schedule) | 44 | $1,528.64 |
| 35634 | Physician and practitioner services (fee schedule) | 44 | $1,365.72 |
| 35636 | Physician and practitioner services (fee schedule) | 44 | $1,121.09 |
| 35637 | Physician and practitioner services (fee schedule) | 44 | $1,169.52 |
| 35638 | Physician and practitioner services (fee schedule) | 44 | $1,224.58 |
| 35642 | Physician and practitioner services (fee schedule) | 44 | $774.01 |
| 35645 | Physician and practitioner services (fee schedule) | 44 | $740.60 |
| 35646 | Physician and practitioner services (fee schedule) | 44 | $1,297.25 |
| 35647 | Physician and practitioner services (fee schedule) | 43 | $1,147.08 |
| 35650 | Physician and practitioner services (fee schedule) | 44 | $797.57 |
| 35654 | Physician and practitioner services (fee schedule) | 44 | $1,042.58 |
| 35656 | Physician and practitioner services (fee schedule) | 44 | $825.08 |
| 35661 | Physician and practitioner services (fee schedule) | 44 | $819.94 |
| 35663 | Physician and practitioner services (fee schedule) | 44 | $891.16 |
| 35665 | Physician and practitioner services (fee schedule) | 43 | $897.23 |
| 35666 | Physician and practitioner services (fee schedule) | 44 | $956.31 |
| 35671 | Physician and practitioner services (fee schedule) | 44 | $868.92 |
| 35681 | Physician and practitioner services (fee schedule) | 43 | $62.22 |
| 35682 | Physician and practitioner services (fee schedule) | 44 | $274.29 |
| 35683 | Physician and practitioner services (fee schedule) | 43 | $317.00 |
| 35685 | Physician and practitioner services (fee schedule) | 43 | $151.19 |
| 35686 | Physician and practitioner services (fee schedule) | 43 | $124.80 |
| 35691 | Physician and practitioner services (fee schedule) | 44 | $739.51 |
| 35693 | Physician and practitioner services (fee schedule) | 44 | $650.54 |
| 35694 | Physician and practitioner services (fee schedule) | 44 | $765.61 |
| 35695 | Physician and practitioner services (fee schedule) | 44 | $785.21 |
| 35697 | Physician and practitioner services (fee schedule) | 44 | $112.55 |
| 35700 | Physician and practitioner services (fee schedule) | 43 | $115.53 |
| 35701 | Physician and practitioner services (fee schedule) | 44 | $326.02 |
| 35702 | Physician and practitioner services (fee schedule) | 43 | $311.27 |
| 35703 | Physician and practitioner services (fee schedule) | 43 | $324.56 |
| 35800 | Physician and practitioner services (fee schedule) | 43 | $483.85 |
| 35820 | Physician and practitioner services (fee schedule) | 44 | $1,387.39 |
| 35840 | Physician and practitioner services (fee schedule) | 44 | $805.06 |
| 35860 | Physician and practitioner services (fee schedule) | 44 | $553.58 |
| 35870 | Physician and practitioner services (fee schedule) | 44 | $949.98 |
| 35875 | Physician and practitioner services (fee schedule) | 44 | $455.67 |
| 35876 | Physician and practitioner services (fee schedule) | 44 | $666.65 |
| 35879 | Physician and practitioner services (fee schedule) | 44 | $680.44 |
| 35881 | Physician and practitioner services (fee schedule) | 44 | $774.59 |
| 35883 | Physician and practitioner services (fee schedule) | 43 | $842.70 |
| 35884 | Physician and practitioner services (fee schedule) | 43 | $876.73 |
| 35901 | Physician and practitioner services (fee schedule) | 44 | $376.34 |
| 35903 | Physician and practitioner services (fee schedule) | 44 | $434.46 |
| 35905 | Physician and practitioner services (fee schedule) | 44 | $1,162.91 |
| 35907 | Physician and practitioner services (fee schedule) | 44 | $1,324.78 |
| 36000 | Physician and practitioner services (fee schedule) | 36 | $17.66 |
| 36002 | Physician and practitioner services (fee schedule) | 43 | $105.41 |
| 36005 | Physician and practitioner services (fee schedule) | 44 | $157.87 |
| 36010 | Physician and practitioner services (fee schedule) | 44 | $163.91 |
| 36011 | Physician and practitioner services (fee schedule) | 44 | $293.87 |
| 36012 | Physician and practitioner services (fee schedule) | 44 | $307.24 |
| 36013 | Physician and practitioner services (fee schedule) | 44 | $366.17 |
| 36014 | Physician and practitioner services (fee schedule) | 44 | $357.23 |
| 36015 | Physician and practitioner services (fee schedule) | 44 | $312.52 |
| 36100 | Physician and practitioner services (fee schedule) | 44 | $229.12 |
| 36140 | Physician and practitioner services (fee schedule) | 44 | $108.85 |
| 36160 | Physician and practitioner services (fee schedule) | 44 | $214.30 |
| 36200 | Physician and practitioner services (fee schedule) | 44 | $206.47 |
| 36215 | Physician and practitioner services (fee schedule) | 44 | $407.94 |
| 36216 | Physician and practitioner services (fee schedule) | 44 | $561.45 |
| 36217 | Physician and practitioner services (fee schedule) | 44 | $804.07 |
| 36218 | Physician and practitioner services (fee schedule) | 44 | $115.95 |
| 36221 | Physician and practitioner services (fee schedule) | 44 | $530.91 |
| 36222 | Physician and practitioner services (fee schedule) | 44 | $514.52 |
| 36223 | Physician and practitioner services (fee schedule) | 44 | $902.57 |
| 36224 | Physician and practitioner services (fee schedule) | 44 | $1,044.22 |
| 36225 | Physician and practitioner services (fee schedule) | 44 | $762.91 |
| 36226 | Physician and practitioner services (fee schedule) | 44 | $1,041.03 |
| 36227 | Physician and practitioner services (fee schedule) | 44 | $132.77 |
| 36228 | Physician and practitioner services (fee schedule) | 44 | $552.98 |
| 36245 | Physician and practitioner services (fee schedule) | 44 | $478.67 |
| 36246 | Physician and practitioner services (fee schedule) | 44 | $466.28 |
| 36247 | Physician and practitioner services (fee schedule) | 44 | $704.37 |
| 36248 | Physician and practitioner services (fee schedule) | 44 | $73.49 |
| 36251 | Physician and practitioner services (fee schedule) | 44 | $757.22 |
| 36252 | Physician and practitioner services (fee schedule) | 43 | $856.69 |
| 36253 | Physician and practitioner services (fee schedule) | 44 | $1,177.94 |
| 36254 | Physician and practitioner services (fee schedule) | 44 | $1,184.84 |
| 36260 | Physician and practitioner services (fee schedule) | 44 | $503.69 |
| 36261 | Physician and practitioner services (fee schedule) | 43 | $291.26 |
| 36262 | Physician and practitioner services (fee schedule) | 43 | $227.19 |
| 36299 | Physician and practitioner services (fee schedule) | 6 | $83.15 |
| 36400 | Physician and practitioner services (fee schedule) | 41 | $18.04 |
| 36405 | Physician and practitioner services (fee schedule) | 41 | $17.97 |
| 36406 | Physician and practitioner services (fee schedule) | 41 | $14.31 |
| 36410 | Physician and practitioner services (fee schedule) | 38 | $13.12 |
| 36415 | Physician and practitioner services (fee schedule) | 38 | $7.47 |
| 36416 | Physician and practitioner services (fee schedule) | 24 | $3.22 |
| 36420 | Physician and practitioner services (fee schedule) | 43 | $39.52 |
| 36425 | Physician and practitioner services (fee schedule) | 43 | $29.16 |
| 36430 | Physician and practitioner services (fee schedule) | 44 | $32.13 |
| 36440 | Physician and practitioner services (fee schedule) | 43 | $38.57 |
| 36450 | Physician and practitioner services (fee schedule) | 44 | $120.61 |
| 36455 | Physician and practitioner services (fee schedule) | 43 | $98.67 |
| 36456 | Physician and practitioner services (fee schedule) | 39 | $75.26 |
| 36460 | Physician and practitioner services (fee schedule) | 44 | $254.58 |
| 36465 | Physician and practitioner services (fee schedule) | 39 | $857.95 |
| 36466 | Physician and practitioner services (fee schedule) | 39 | $912.23 |
| 36468 | Physician and practitioner services (fee schedule) | 17 | $32.85 |
| 36470 | Physician and practitioner services (fee schedule) | 41 | $75.25 |
| 36471 | Physician and practitioner services (fee schedule) | 41 | $107.87 |
| 36473 | Physician and practitioner services (fee schedule) | 36 | $649.04 |
| 36474 | Physician and practitioner services (fee schedule) | 36 | $136.99 |
| 36475 | Physician and practitioner services (fee schedule) | 44 | $690.91 |
| 36476 | Physician and practitioner services (fee schedule) | 44 | $184.75 |
| 36478 | Physician and practitioner services (fee schedule) | 44 | $688.45 |
| 36479 | Physician and practitioner services (fee schedule) | 44 | $209.54 |
| 36481 | Physician and practitioner services (fee schedule) | 44 | $507.65 |
| 36482 | Physician and practitioner services (fee schedule) | 33 | $1,239.64 |
| 36483 | Physician and practitioner services (fee schedule) | 33 | $98.63 |
| 36500 | Physician and practitioner services (fee schedule) | 44 | $129.03 |
| 36510 | Physician and practitioner services (fee schedule) | 44 | $56.76 |
| 36511 | Physician and practitioner services (fee schedule) | 43 | $76.06 |
| 36512 | Physician and practitioner services (fee schedule) | 43 | $74.23 |
| 36513 | Physician and practitioner services (fee schedule) | 43 | $75.89 |
| 36522 | Physician and practitioner services (fee schedule) | 42 | $417.43 |
| 36555 | Physician and practitioner services (fee schedule) | 44 | $146.72 |
| 36556 | Physician and practitioner services (fee schedule) | 44 | $159.45 |
| 36557 | Physician and practitioner services (fee schedule) | 44 | $501.41 |
| 36558 | Physician and practitioner services (fee schedule) | 44 | $447.94 |
| 36560 | Physician and practitioner services (fee schedule) | 44 | $741.18 |
| 36561 | Physician and practitioner services (fee schedule) | 44 | $591.00 |
| 36563 | Physician and practitioner services (fee schedule) | 44 | $758.60 |
| 36565 | Physician and practitioner services (fee schedule) | 44 | $533.33 |
| 36566 | Physician and practitioner services (fee schedule) | 44 | $878.12 |
| 36568 | Physician and practitioner services (fee schedule) | 44 | $72.55 |
| 36569 | Physician and practitioner services (fee schedule) | 44 | $73.98 |
| 36570 | Physician and practitioner services (fee schedule) | 44 | $863.56 |
| 36571 | Physician and practitioner services (fee schedule) | 44 | $488.47 |
| 36572 | Physician and practitioner services (fee schedule) | 44 | $232.90 |
| 36573 | Physician and practitioner services (fee schedule) | 44 | $236.30 |
| 36575 | Physician and practitioner services (fee schedule) | 44 | $83.90 |
| 36576 | Physician and practitioner services (fee schedule) | 44 | $217.44 |
| 36578 | Physician and practitioner services (fee schedule) | 44 | $254.15 |
| 36580 | Physician and practitioner services (fee schedule) | 44 | $125.73 |
| 36581 | Physician and practitioner services (fee schedule) | 44 | $351.14 |
| 36582 | Physician and practitioner services (fee schedule) | 44 | $495.24 |
| 36583 | Physician and practitioner services (fee schedule) | 44 | $586.56 |
| 36584 | Physician and practitioner services (fee schedule) | 44 | $197.29 |
| 36585 | Physician and practitioner services (fee schedule) | 43 | $853.49 |
| 36589 | Physician and practitioner services (fee schedule) | 44 | $128.24 |
| 36590 | Physician and practitioner services (fee schedule) | 44 | $170.48 |
| 36591 | Physician and practitioner services (fee schedule) | 36 | $20.44 |
| 36592 | Physician and practitioner services (fee schedule) | 35 | $22.40 |
| 36593 | Physician and practitioner services (fee schedule) | 44 | $29.32 |
| 36595 | Physician and practitioner services (fee schedule) | 43 | $390.19 |
| 36596 | Physician and practitioner services (fee schedule) | 44 | $82.64 |
| 36597 | Physician and practitioner services (fee schedule) | 44 | $73.40 |
| 36598 | Physician and practitioner services (fee schedule) | 43 | $89.79 |
| 36600 | Physician and practitioner services (fee schedule) | 42 | $17.87 |
| 36620 | Physician and practitioner services (fee schedule) | 45 | $38.66 |
| 36625 | Physician and practitioner services (fee schedule) | 44 | $82.05 |
| 36640 | Physician and practitioner services (fee schedule) | 44 | $89.04 |
| 36660 | Physician and practitioner services (fee schedule) | 44 | $49.86 |
| 36680 | Physician and practitioner services (fee schedule) | 44 | $48.93 |
| 36800 | Physician and practitioner services (fee schedule) | 44 | $96.62 |
| 36810 | Physician and practitioner services (fee schedule) | 44 | $159.44 |
| 36815 | Physician and practitioner services (fee schedule) | 44 | $109.32 |
| 36818 | Physician and practitioner services (fee schedule) | 44 | $530.62 |
| 36819 | Physician and practitioner services (fee schedule) | 44 | $561.55 |
| 36820 | Physician and practitioner services (fee schedule) | 43 | $555.63 |
| 36821 | Physician and practitioner services (fee schedule) | 44 | $469.77 |
| 36823 | Physician and practitioner services (fee schedule) | 39 | $1,021.20 |
| 36825 | Physician and practitioner services (fee schedule) | 44 | $561.11 |
| 36830 | Physician and practitioner services (fee schedule) | 44 | $509.49 |
| 36831 | Physician and practitioner services (fee schedule) | 44 | $383.17 |
| 36832 | Physician and practitioner services (fee schedule) | 44 | $535.07 |
| 36833 | Physician and practitioner services (fee schedule) | 44 | $559.26 |
| 36835 | Physician and practitioner services (fee schedule) | 43 | $381.44 |
| 36836 | Physician and practitioner services (fee schedule) | 39 | $4,094.62 |
| 36837 | Physician and practitioner services (fee schedule) | 39 | $4,874.66 |
| 36838 | Physician and practitioner services (fee schedule) | 43 | $867.08 |
| 36860 | Physician and practitioner services (fee schedule) | 43 | $128.03 |
| 36861 | Physician and practitioner services (fee schedule) | 43 | $109.20 |
| 36901 | Physician and practitioner services (fee schedule) | 44 | $414.12 |
| 36902 | Physician and practitioner services (fee schedule) | 44 | $768.98 |
| 36903 | Physician and practitioner services (fee schedule) | 44 | $3,071.14 |
| 36904 | Physician and practitioner services (fee schedule) | 44 | $1,125.31 |
| 36905 | Physician and practitioner services (fee schedule) | 44 | $1,276.93 |
| 36906 | Physician and practitioner services (fee schedule) | 44 | $3,268.88 |
| 36907 | Physician and practitioner services (fee schedule) | 44 | $369.75 |
| 36908 | Physician and practitioner services (fee schedule) | 44 | $895.59 |
| 36909 | Physician and practitioner services (fee schedule) | 44 | $1,165.96 |
| 37140 | Physician and practitioner services (fee schedule) | 44 | $1,600.92 |
| 37145 | Physician and practitioner services (fee schedule) | 44 | $1,352.10 |
| 37160 | Physician and practitioner services (fee schedule) | 44 | $1,388.41 |
| 37180 | Physician and practitioner services (fee schedule) | 44 | $1,345.16 |
| 37181 | Physician and practitioner services (fee schedule) | 44 | $1,463.84 |
| 37182 | Physician and practitioner services (fee schedule) | 44 | $618.12 |
| 37183 | Physician and practitioner services (fee schedule) | 44 | $401.57 |
| 37184 | Physician and practitioner services (fee schedule) | 44 | $1,084.91 |
| 37185 | Physician and practitioner services (fee schedule) | 44 | $307.90 |
| 37186 | Physician and practitioner services (fee schedule) | 43 | $738.05 |
| 37187 | Physician and practitioner services (fee schedule) | 44 | $1,062.73 |
| 37188 | Physician and practitioner services (fee schedule) | 44 | $993.97 |
| 37191 | Physician and practitioner services (fee schedule) | 44 | $1,173.87 |
| 37192 | Physician and practitioner services (fee schedule) | 44 | $780.30 |
| 37193 | Physician and practitioner services (fee schedule) | 44 | $847.57 |
| 37195 | Physician and practitioner services (fee schedule) | 40 | $247.66 |
| 37197 | Physician and practitioner services (fee schedule) | 43 | $323.21 |
| 37200 | Physician and practitioner services (fee schedule) | 44 | $167.67 |
| 37211 | Physician and practitioner services (fee schedule) | 44 | $281.04 |
| 37212 | Physician and practitioner services (fee schedule) | 44 | $252.63 |
| 37213 | Physician and practitioner services (fee schedule) | 44 | $173.73 |
| 37214 | Physician and practitioner services (fee schedule) | 44 | $92.60 |
| 37215 | Physician and practitioner services (fee schedule) | 44 | $777.43 |
| 37216 | Physician and practitioner services (fee schedule) | 38 | $718.77 |
| 37217 | Physician and practitioner services (fee schedule) | 44 | $814.20 |
| 37218 | Physician and practitioner services (fee schedule) | 43 | $621.80 |
| 37220 | Physician and practitioner services (fee schedule) | 11 | $1,506.76 |
| 37221 | Physician and practitioner services (fee schedule) | 10 | $1,306.17 |
| 37222 | Physician and practitioner services (fee schedule) | 12 | $344.76 |
| 37223 | Physician and practitioner services (fee schedule) | 10 | $518.50 |
| 37224 | Physician and practitioner services (fee schedule) | 10 | $1,904.91 |
| 37225 | Physician and practitioner services (fee schedule) | 11 | $5,202.74 |
| 37226 | Physician and practitioner services (fee schedule) | 11 | $4,815.08 |
| 37227 | Physician and practitioner services (fee schedule) | 11 | $6,644.75 |
| 37228 | Physician and practitioner services (fee schedule) | 10 | $2,698.36 |
| 37229 | Physician and practitioner services (fee schedule) | 11 | $6,343.63 |
| 37230 | Physician and practitioner services (fee schedule) | 11 | $5,317.97 |
| 37231 | Physician and practitioner services (fee schedule) | 11 | $8,346.33 |
| 37232 | Physician and practitioner services (fee schedule) | 11 | $494.80 |
| 37233 | Physician and practitioner services (fee schedule) | 11 | $749.19 |
| 37234 | Physician and practitioner services (fee schedule) | 11 | $2,162.16 |
| 37235 | Physician and practitioner services (fee schedule) | 11 | $2,860.56 |
| 37236 | Physician and practitioner services (fee schedule) | 44 | $1,460.80 |
| 37237 | Physician and practitioner services (fee schedule) | 44 | $700.89 |
| 37238 | Physician and practitioner services (fee schedule) | 44 | $1,841.85 |
| 37239 | Physician and practitioner services (fee schedule) | 44 | $933.23 |
| 37241 | Physician and practitioner services (fee schedule) | 44 | $2,404.76 |
| 37242 | Physician and practitioner services (fee schedule) | 44 | $3,770.26 |
| 37243 | Physician and practitioner services (fee schedule) | 44 | $4,571.65 |
| 37244 | Physician and practitioner services (fee schedule) | 44 | $2,528.96 |
| 37246 | Physician and practitioner services (fee schedule) | 43 | $914.66 |
| 37247 | Physician and practitioner services (fee schedule) | 43 | $336.08 |
| 37248 | Physician and practitioner services (fee schedule) | 44 | $802.10 |
| 37249 | Physician and practitioner services (fee schedule) | 44 | $279.55 |
| 37252 | Physician and practitioner services (fee schedule) | 43 | $571.05 |
| 37253 | Physician and practitioner services (fee schedule) | 43 | $111.14 |
| 37254 | Physician and practitioner services (fee schedule) | 39 | $1,280.67 |
| 37255 | Physician and practitioner services (fee schedule) | 39 | $314.59 |
| 37256 | Physician and practitioner services (fee schedule) | 39 | $1,500.67 |
| 37257 | Physician and practitioner services (fee schedule) | 39 | $356.94 |
| 37258 | Physician and practitioner services (fee schedule) | 39 | $2,203.40 |
| 37259 | Physician and practitioner services (fee schedule) | 39 | $745.45 |
| 37260 | Physician and practitioner services (fee schedule) | 39 | $5,220.96 |
| 37261 | Physician and practitioner services (fee schedule) | 39 | $2,081.54 |
| 37262 | Physician and practitioner services (fee schedule) | 31 | $1,792.75 |
| 37263 | Physician and practitioner services (fee schedule) | 39 | $3,462.53 |
| 37264 | Physician and practitioner services (fee schedule) | 39 | $1,392.38 |
| 37265 | Physician and practitioner services (fee schedule) | 39 | $4,354.36 |
| 37266 | Physician and practitioner services (fee schedule) | 39 | $1,556.60 |
| 37267 | Physician and practitioner services (fee schedule) | 39 | $3,321.52 |
| 37268 | Physician and practitioner services (fee schedule) | 39 | $2,142.78 |
| 37269 | Physician and practitioner services (fee schedule) | 39 | $7,367.67 |
| 37270 | Physician and practitioner services (fee schedule) | 38 | $2,196.77 |
| 37271 | Physician and practitioner services (fee schedule) | 39 | $6,735.91 |
| 37272 | Physician and practitioner services (fee schedule) | 39 | $1,490.36 |
| 37273 | Physician and practitioner services (fee schedule) | 39 | $8,435.87 |
| 37274 | Physician and practitioner services (fee schedule) | 39 | $1,585.79 |
| 37275 | Physician and practitioner services (fee schedule) | 39 | $6,363.08 |
| 37276 | Physician and practitioner services (fee schedule) | 39 | $2,205.62 |
| 37277 | Physician and practitioner services (fee schedule) | 39 | $9,834.00 |
| 37278 | Physician and practitioner services (fee schedule) | 39 | $2,470.59 |
| 37279 | Physician and practitioner services (fee schedule) | 31 | $2,437.78 |
| 37280 | Physician and practitioner services (fee schedule) | 39 | $1,666.67 |
| 37281 | Physician and practitioner services (fee schedule) | 39 | $454.70 |
| 37282 | Physician and practitioner services (fee schedule) | 39 | $3,773.12 |
| 37283 | Physician and practitioner services (fee schedule) | 39 | $532.43 |
| 37284 | Physician and practitioner services (fee schedule) | 39 | $3,484.76 |
| 37285 | Physician and practitioner services (fee schedule) | 39 | $1,726.39 |
| 37286 | Physician and practitioner services (fee schedule) | 39 | $6,418.08 |
| 37287 | Physician and practitioner services (fee schedule) | 39 | $3,059.29 |
| 37288 | Physician and practitioner services (fee schedule) | 39 | $4,823.90 |
| 37289 | Physician and practitioner services (fee schedule) | 39 | $568.47 |
| 37290 | Physician and practitioner services (fee schedule) | 39 | $6,589.05 |
| 37291 | Physician and practitioner services (fee schedule) | 39 | $662.78 |
| 37292 | Physician and practitioner services (fee schedule) | 38 | $6,428.79 |
| 37293 | Physician and practitioner services (fee schedule) | 39 | $2,171.06 |
| 37294 | Physician and practitioner services (fee schedule) | 39 | $9,409.47 |
| 37295 | Physician and practitioner services (fee schedule) | 39 | $3,714.92 |
| 37296 | Physician and practitioner services (fee schedule) | 39 | $1,934.25 |
| 37297 | Physician and practitioner services (fee schedule) | 39 | $528.24 |
| 37298 | Physician and practitioner services (fee schedule) | 39 | $2,174.94 |
| 37299 | Physician and practitioner services (fee schedule) | 39 | $572.97 |
| 37500 | Physician and practitioner services (fee schedule) | 12 | $530.49 |
| 37501 | Physician and practitioner services (fee schedule) | 5 | $437.90 |
| 37565 | Physician and practitioner services (fee schedule) | 43 | $507.59 |
| 37600 | Physician and practitioner services (fee schedule) | 43 | $501.24 |
| 37605 | Physician and practitioner services (fee schedule) | 44 | $510.96 |
| 37606 | Physician and practitioner services (fee schedule) | 44 | $478.89 |
| 37607 | Physician and practitioner services (fee schedule) | 44 | $274.72 |
| 37609 | Physician and practitioner services (fee schedule) | 44 | $186.05 |
| 37615 | Physician and practitioner services (fee schedule) | 44 | $364.09 |
| 37616 | Physician and practitioner services (fee schedule) | 43 | $832.83 |
| 37617 | Physician and practitioner services (fee schedule) | 44 | $903.13 |
| 37618 | Physician and practitioner services (fee schedule) | 44 | $286.98 |
| 37619 | Physician and practitioner services (fee schedule) | 44 | $1,231.18 |
| 37650 | Physician and practitioner services (fee schedule) | 44 | $334.17 |
| 37660 | Physician and practitioner services (fee schedule) | 44 | $908.48 |
| 37700 | Physician and practitioner services (fee schedule) | 44 | $195.71 |
| 37718 | Physician and practitioner services (fee schedule) | 44 | $296.98 |
| 37722 | Physician and practitioner services (fee schedule) | 44 | $350.21 |
| 37735 | Physician and practitioner services (fee schedule) | 44 | $453.09 |
| 37760 | Physician and practitioner services (fee schedule) | 44 | $453.64 |
| 37761 | Physician and practitioner services (fee schedule) | 43 | $379.54 |
| 37765 | Physician and practitioner services (fee schedule) | 42 | $317.28 |
| 37766 | Physician and practitioner services (fee schedule) | 42 | $385.95 |
| 37780 | Physician and practitioner services (fee schedule) | 44 | $174.96 |
| 37785 | Physician and practitioner services (fee schedule) | 44 | $231.77 |
| 37788 | Physician and practitioner services (fee schedule) | 34 | $922.35 |
| 37790 | Physician and practitioner services (fee schedule) | 37 | $378.81 |
| 37799 | Physician and practitioner services (fee schedule) | 8 | $498.37 |
| 38100 | Physician and practitioner services (fee schedule) | 44 | $809.32 |
| 38101 | Physician and practitioner services (fee schedule) | 44 | $805.84 |
| 38102 | Physician and practitioner services (fee schedule) | 43 | $189.62 |
| 38115 | Physician and practitioner services (fee schedule) | 44 | $893.89 |
| 38120 | Physician and practitioner services (fee schedule) | 43 | $777.56 |
| 38129 | Physician and practitioner services (fee schedule) | 7 | $130.00 |
| 38200 | Physician and practitioner services (fee schedule) | 44 | $94.56 |
| 38204 | Physician and practitioner services (fee schedule) | 12 | $70.98 |
| 38205 | Physician and practitioner services (fee schedule) | 36 | $61.14 |
| 38206 | Physician and practitioner services (fee schedule) | 40 | $58.34 |
| 38220 | Physician and practitioner services (fee schedule) | 44 | $117.64 |
| 38221 | Physician and practitioner services (fee schedule) | 44 | $128.92 |
| 38222 | Physician and practitioner services (fee schedule) | 44 | $117.94 |
| 38225 | Physician and practitioner services (fee schedule) | 16 | $72.48 |
| 38226 | Physician and practitioner services (fee schedule) | 15 | $29.22 |
| 38227 | Physician and practitioner services (fee schedule) | 15 | $29.51 |
| 38228 | Physician and practitioner services (fee schedule) | 35 | $203.42 |
| 38230 | Physician and practitioner services (fee schedule) | 42 | $165.84 |
| 38232 | Physician and practitioner services (fee schedule) | 42 | $136.32 |
| 38240 | Physician and practitioner services (fee schedule) | 43 | $161.32 |
| 38241 | Physician and practitioner services (fee schedule) | 43 | $122.59 |
| 38242 | Physician and practitioner services (fee schedule) | 42 | $83.13 |
| 38243 | Physician and practitioner services (fee schedule) | 40 | $88.66 |
| 38300 | Physician and practitioner services (fee schedule) | 44 | $198.92 |
| 38305 | Physician and practitioner services (fee schedule) | 44 | $361.20 |
| 38308 | Physician and practitioner services (fee schedule) | 44 | $321.72 |
| 38380 | Physician and practitioner services (fee schedule) | 44 | $409.19 |
| 38381 | Physician and practitioner services (fee schedule) | 44 | $610.71 |
| 38382 | Physician and practitioner services (fee schedule) | 44 | $509.19 |
| 38500 | Physician and practitioner services (fee schedule) | 44 | $231.62 |
| 38505 | Physician and practitioner services (fee schedule) | 44 | $100.54 |
| 38510 | Physician and practitioner services (fee schedule) | 44 | $360.36 |
| 38520 | Physician and practitioner services (fee schedule) | 44 | $344.19 |
| 38525 | Physician and practitioner services (fee schedule) | 44 | $335.39 |
| 38530 | Physician and practitioner services (fee schedule) | 44 | $382.34 |
| 38531 | Physician and practitioner services (fee schedule) | 44 | $351.58 |
| 38542 | Physician and practitioner services (fee schedule) | 43 | $363.07 |
| 38550 | Physician and practitioner services (fee schedule) | 44 | $393.28 |
| 38555 | Physician and practitioner services (fee schedule) | 44 | $741.52 |
| 38562 | Physician and practitioner services (fee schedule) | 43 | $528.18 |
| 38564 | Physician and practitioner services (fee schedule) | 43 | $520.25 |
| 38570 | Physician and practitioner services (fee schedule) | 44 | $382.59 |
| 38571 | Physician and practitioner services (fee schedule) | 44 | $508.30 |
| 38572 | Physician and practitioner services (fee schedule) | 44 | $663.71 |
| 38573 | Physician and practitioner services (fee schedule) | 44 | $912.99 |
| 38589 | Physician and practitioner services (fee schedule) | 7 | $130.00 |
| 38700 | Physician and practitioner services (fee schedule) | 44 | $578.66 |
| 38720 | Physician and practitioner services (fee schedule) | 44 | $955.89 |
| 38724 | Physician and practitioner services (fee schedule) | 44 | $1,007.62 |
| 38740 | Physician and practitioner services (fee schedule) | 44 | $490.56 |
| 38745 | Physician and practitioner services (fee schedule) | 44 | $636.90 |
| 38746 | Physician and practitioner services (fee schedule) | 44 | $165.89 |
| 38747 | Physician and practitioner services (fee schedule) | 44 | $189.05 |
| 38760 | Physician and practitioner services (fee schedule) | 44 | $569.87 |
| 38765 | Physician and practitioner services (fee schedule) | 44 | $934.93 |
| 38770 | Physician and practitioner services (fee schedule) | 44 | $633.61 |
| 38780 | Physician and practitioner services (fee schedule) | 44 | $792.31 |
| 38790 | Physician and practitioner services (fee schedule) | 44 | $67.10 |
| 38792 | Physician and practitioner services (fee schedule) | 43 | $42.87 |
| 38794 | Physician and practitioner services (fee schedule) | 41 | $212.65 |
| 38900 | Physician and practitioner services (fee schedule) | 44 | $109.15 |
| 38999 | Physician and practitioner services (fee schedule) | 8 | $224.22 |
| 39000 | Physician and practitioner services (fee schedule) | 44 | $377.77 |
| 39010 | Physician and practitioner services (fee schedule) | 44 | $607.64 |
| 39200 | Physician and practitioner services (fee schedule) | 44 | $663.20 |
| 39220 | Physician and practitioner services (fee schedule) | 44 | $851.53 |
| 39401 | Physician and practitioner services (fee schedule) | 44 | $245.00 |
| 39402 | Physician and practitioner services (fee schedule) | 44 | $317.94 |
| 39501 | Physician and practitioner services (fee schedule) | 44 | $636.17 |
| 39503 | Physician and practitioner services (fee schedule) | 44 | $4,013.26 |
| 39540 | Physician and practitioner services (fee schedule) | 44 | $653.54 |
| 39541 | Physician and practitioner services (fee schedule) | 44 | $694.01 |
| 39545 | Physician and practitioner services (fee schedule) | 44 | $679.21 |
| 39560 | Physician and practitioner services (fee schedule) | 44 | $597.00 |
| 39561 | Physician and practitioner services (fee schedule) | 44 | $906.10 |
| 40490 | Physician and practitioner services (fee schedule) | 45 | $64.83 |
| 40500 | Physician and practitioner services (fee schedule) | 45 | $354.78 |
| 40510 | Physician and practitioner services (fee schedule) | 45 | $336.05 |
| 40520 | Physician and practitioner services (fee schedule) | 45 | $338.15 |
| 40525 | Physician and practitioner services (fee schedule) | 44 | $437.92 |
| 40527 | Physician and practitioner services (fee schedule) | 45 | $500.64 |
| 40530 | Physician and practitioner services (fee schedule) | 45 | $377.95 |
| 40650 | Physician and practitioner services (fee schedule) | 45 | $304.69 |
| 40652 | Physician and practitioner services (fee schedule) | 45 | $342.39 |
| 40654 | Physician and practitioner services (fee schedule) | 45 | $393.20 |
| 40700 | Physician and practitioner services (fee schedule) | 45 | $723.30 |
| 40701 | Physician and practitioner services (fee schedule) | 45 | $897.27 |
| 40702 | Physician and practitioner services (fee schedule) | 45 | $719.85 |
| 40720 | Physician and practitioner services (fee schedule) | 44 | $758.21 |
| 40761 | Physician and practitioner services (fee schedule) | 45 | $780.35 |
| 40799 | Physician and practitioner services (fee schedule) | 6 | $103.08 |
| 40800 | Physician and practitioner services (fee schedule) | 45 | $100.41 |
| 40801 | Physician and practitioner services (fee schedule) | 45 | $178.95 |
| 40804 | Physician and practitioner services (fee schedule) | 45 | $100.12 |
| 40805 | Physician and practitioner services (fee schedule) | 44 | $184.58 |
| 40806 | Physician and practitioner services (fee schedule) | 42 | $40.97 |
| 40808 | Physician and practitioner services (fee schedule) | 45 | $93.93 |
| 40810 | Physician and practitioner services (fee schedule) | 44 | $116.62 |
| 40812 | Physician and practitioner services (fee schedule) | 45 | $166.77 |
| 40814 | Physician and practitioner services (fee schedule) | 45 | $240.85 |
| 40816 | Physician and practitioner services (fee schedule) | 45 | $260.50 |
| 40818 | Physician and practitioner services (fee schedule) | 43 | $232.38 |
| 40819 | Physician and practitioner services (fee schedule) | 43 | $182.43 |
| 40820 | Physician and practitioner services (fee schedule) | 45 | $160.10 |
| 40830 | Physician and practitioner services (fee schedule) | 45 | $134.28 |
| 40831 | Physician and practitioner services (fee schedule) | 45 | $167.53 |
| 40840 | Physician and practitioner services (fee schedule) | 43 | $490.96 |
| 40842 | Physician and practitioner services (fee schedule) | 41 | $518.62 |
| 40843 | Physician and practitioner services (fee schedule) | 41 | $677.82 |
| 40844 | Physician and practitioner services (fee schedule) | 41 | $893.79 |
| 40845 | Physician and practitioner services (fee schedule) | 42 | $994.44 |
| 40899 | Physician and practitioner services (fee schedule) | 7 | $78.87 |
| 41000 | Physician and practitioner services (fee schedule) | 45 | $98.66 |
| 41005 | Physician and practitioner services (fee schedule) | 45 | $107.95 |
| 41006 | Physician and practitioner services (fee schedule) | 45 | $213.96 |
| 41007 | Physician and practitioner services (fee schedule) | 45 | $210.59 |
| 41008 | Physician and practitioner services (fee schedule) | 45 | $240.23 |
| 41009 | Physician and practitioner services (fee schedule) | 45 | $266.41 |
| 41010 | Physician and practitioner services (fee schedule) | 45 | $117.22 |
| 41015 | Physician and practitioner services (fee schedule) | 45 | $251.83 |
| 41016 | Physician and practitioner services (fee schedule) | 45 | $291.50 |
| 41017 | Physician and practitioner services (fee schedule) | 45 | $305.44 |
| 41018 | Physician and practitioner services (fee schedule) | 45 | $329.54 |
| 41019 | Physician and practitioner services (fee schedule) | 44 | $338.04 |
| 41100 | Physician and practitioner services (fee schedule) | 45 | $103.74 |
| 41105 | Physician and practitioner services (fee schedule) | 44 | $103.91 |
| 41108 | Physician and practitioner services (fee schedule) | 45 | $95.35 |
| 41110 | Physician and practitioner services (fee schedule) | 45 | $121.85 |
| 41112 | Physician and practitioner services (fee schedule) | 45 | $225.14 |
| 41113 | Physician and practitioner services (fee schedule) | 44 | $243.86 |
| 41114 | Physician and practitioner services (fee schedule) | 44 | $461.26 |
| 41115 | Physician and practitioner services (fee schedule) | 45 | $150.89 |
| 41116 | Physician and practitioner services (fee schedule) | 45 | $202.17 |
| 41120 | Physician and practitioner services (fee schedule) | 44 | $745.82 |
| 41130 | Physician and practitioner services (fee schedule) | 45 | $884.59 |
| 41135 | Physician and practitioner services (fee schedule) | 45 | $1,419.83 |
| 41140 | Physician and practitioner services (fee schedule) | 45 | $1,498.88 |
| 41145 | Physician and practitioner services (fee schedule) | 45 | $1,799.00 |
| 41150 | Physician and practitioner services (fee schedule) | 45 | $1,457.85 |
| 41153 | Physician and practitioner services (fee schedule) | 45 | $1,639.57 |
| 41155 | Physician and practitioner services (fee schedule) | 45 | $2,040.33 |
| 41250 | Physician and practitioner services (fee schedule) | 45 | $144.39 |
| 41251 | Physician and practitioner services (fee schedule) | 45 | $186.32 |
| 41252 | Physician and practitioner services (fee schedule) | 45 | $197.17 |
| 41510 | Physician and practitioner services (fee schedule) | 43 | $346.98 |
| 41512 | Physician and practitioner services (fee schedule) | 35 | $495.05 |
| 41520 | Physician and practitioner services (fee schedule) | 44 | $240.18 |
| 41530 | Physician and practitioner services (fee schedule) | 34 | $451.03 |
| 41599 | Physician and practitioner services (fee schedule) | 7 | $30.00 |
| 41800 | Physician and practitioner services (fee schedule) | 45 | $158.86 |
| 41805 | Physician and practitioner services (fee schedule) | 45 | $175.13 |
| 41806 | Physician and practitioner services (fee schedule) | 45 | $227.43 |
| 41820 | Physician and practitioner services (fee schedule) | 32 | $119.88 |
| 41821 | Physician and practitioner services (fee schedule) | 28 | $39.06 |
| 41822 | Physician and practitioner services (fee schedule) | 43 | $194.39 |
| 41823 | Physician and practitioner services (fee schedule) | 43 | $310.04 |
| 41825 | Physician and practitioner services (fee schedule) | 44 | $114.74 |
| 41826 | Physician and practitioner services (fee schedule) | 44 | $177.72 |
| 41827 | Physician and practitioner services (fee schedule) | 45 | $267.52 |
| 41828 | Physician and practitioner services (fee schedule) | 41 | $225.45 |
| 41830 | Physician and practitioner services (fee schedule) | 43 | $304.16 |
| 41850 | Physician and practitioner services (fee schedule) | 30 | $33.01 |
| 41870 | Physician and practitioner services (fee schedule) | 25 | $226.78 |
| 41872 | Physician and practitioner services (fee schedule) | 40 | $278.74 |
| 41874 | Physician and practitioner services (fee schedule) | 41 | $246.44 |
| 41899 | Physician and practitioner services (fee schedule) | 9 | $35.12 |
| 42000 | Physician and practitioner services (fee schedule) | 45 | $93.98 |
| 42100 | Physician and practitioner services (fee schedule) | 45 | $98.23 |
| 42104 | Physician and practitioner services (fee schedule) | 45 | $124.24 |
| 42106 | Physician and practitioner services (fee schedule) | 45 | $158.83 |
| 42107 | Physician and practitioner services (fee schedule) | 44 | $301.77 |
| 42120 | Physician and practitioner services (fee schedule) | 44 | $693.74 |
| 42140 | Physician and practitioner services (fee schedule) | 45 | $149.42 |
| 42145 | Physician and practitioner services (fee schedule) | 45 | $518.03 |
| 42160 | Physician and practitioner services (fee schedule) | 45 | $133.49 |
| 42180 | Physician and practitioner services (fee schedule) | 45 | $168.03 |
| 42182 | Physician and practitioner services (fee schedule) | 45 | $226.19 |
| 42200 | Physician and practitioner services (fee schedule) | 45 | $675.92 |
| 42205 | Physician and practitioner services (fee schedule) | 45 | $694.73 |
| 42210 | Physician and practitioner services (fee schedule) | 44 | $795.71 |
| 42215 | Physician and practitioner services (fee schedule) | 45 | $526.93 |
| 42220 | Physician and practitioner services (fee schedule) | 44 | $429.91 |
| 42225 | Physician and practitioner services (fee schedule) | 44 | $741.75 |
| 42226 | Physician and practitioner services (fee schedule) | 45 | $678.77 |
| 42227 | Physician and practitioner services (fee schedule) | 45 | $620.15 |
| 42235 | Physician and practitioner services (fee schedule) | 45 | $536.43 |
| 42260 | Physician and practitioner services (fee schedule) | 45 | $539.86 |
| 42280 | Physician and practitioner services (fee schedule) | 42 | $105.83 |
| 42281 | Physician and practitioner services (fee schedule) | 43 | $133.10 |
| 42299 | Physician and practitioner services (fee schedule) | 5 | $29.81 |
| 42300 | Physician and practitioner services (fee schedule) | 45 | $136.75 |
| 42305 | Physician and practitioner services (fee schedule) | 45 | $308.44 |
| 42310 | Physician and practitioner services (fee schedule) | 45 | $116.72 |
| 42320 | Physician and practitioner services (fee schedule) | 45 | $163.65 |
| 42330 | Physician and practitioner services (fee schedule) | 45 | $151.18 |
| 42335 | Physician and practitioner services (fee schedule) | 45 | $249.12 |
| 42340 | Physician and practitioner services (fee schedule) | 45 | $332.06 |
| 42400 | Physician and practitioner services (fee schedule) | 45 | $58.02 |
| 42405 | Physician and practitioner services (fee schedule) | 45 | $195.79 |
| 42408 | Physician and practitioner services (fee schedule) | 45 | $288.88 |
| 42409 | Physician and practitioner services (fee schedule) | 45 | $217.76 |
| 42410 | Physician and practitioner services (fee schedule) | 44 | $457.35 |
| 42415 | Physician and practitioner services (fee schedule) | 44 | $803.17 |
| 42420 | Physician and practitioner services (fee schedule) | 44 | $888.29 |
| 42425 | Physician and practitioner services (fee schedule) | 44 | $631.35 |
| 42426 | Physician and practitioner services (fee schedule) | 45 | $998.28 |
| 42440 | Physician and practitioner services (fee schedule) | 44 | $334.87 |
| 42450 | Physician and practitioner services (fee schedule) | 45 | $312.22 |
| 42500 | Physician and practitioner services (fee schedule) | 44 | $306.33 |
| 42505 | Physician and practitioner services (fee schedule) | 44 | $407.38 |
| 42507 | Physician and practitioner services (fee schedule) | 43 | $361.93 |
| 42509 | Physician and practitioner services (fee schedule) | 42 | $612.89 |
| 42510 | Physician and practitioner services (fee schedule) | 43 | $451.84 |
| 42550 | Physician and practitioner services (fee schedule) | 45 | $59.71 |
| 42600 | Physician and practitioner services (fee schedule) | 45 | $336.12 |
| 42650 | Physician and practitioner services (fee schedule) | 45 | $50.96 |
| 42660 | Physician and practitioner services (fee schedule) | 45 | $67.59 |
| 42665 | Physician and practitioner services (fee schedule) | 45 | $196.82 |
| 42699 | Physician and practitioner services (fee schedule) | 7 | $132.98 |
| 42700 | Physician and practitioner services (fee schedule) | 45 | $121.83 |
| 42720 | Physician and practitioner services (fee schedule) | 45 | $302.79 |
| 42725 | Physician and practitioner services (fee schedule) | 44 | $566.01 |
| 42800 | Physician and practitioner services (fee schedule) | 45 | $107.43 |
| 42804 | Physician and practitioner services (fee schedule) | 45 | $101.85 |
| 42806 | Physician and practitioner services (fee schedule) | 45 | $129.10 |
| 42808 | Physician and practitioner services (fee schedule) | 45 | $158.09 |
| 42809 | Physician and practitioner services (fee schedule) | 45 | $124.91 |
| 42810 | Physician and practitioner services (fee schedule) | 45 | $251.80 |
| 42815 | Physician and practitioner services (fee schedule) | 44 | $407.42 |
| 42820 | Physician and practitioner services (fee schedule) | 44 | $218.18 |
| 42821 | Physician and practitioner services (fee schedule) | 44 | $233.56 |
| 42825 | Physician and practitioner services (fee schedule) | 44 | $202.91 |
| 42826 | Physician and practitioner services (fee schedule) | 44 | $199.76 |
| 42830 | Physician and practitioner services (fee schedule) | 44 | $160.52 |
| 42831 | Physician and practitioner services (fee schedule) | 44 | $172.62 |
| 42835 | Physician and practitioner services (fee schedule) | 44 | $147.88 |
| 42836 | Physician and practitioner services (fee schedule) | 44 | $183.54 |
| 42842 | Physician and practitioner services (fee schedule) | 45 | $725.40 |
| 42844 | Physician and practitioner services (fee schedule) | 44 | $933.53 |
| 42845 | Physician and practitioner services (fee schedule) | 45 | $1,473.83 |
| 42860 | Physician and practitioner services (fee schedule) | 45 | $147.36 |
| 42870 | Physician and practitioner services (fee schedule) | 45 | $438.18 |
| 42890 | Physician and practitioner services (fee schedule) | 45 | $932.72 |
| 42892 | Physician and practitioner services (fee schedule) | 44 | $1,252.14 |
| 42894 | Physician and practitioner services (fee schedule) | 44 | $1,589.61 |
| 42900 | Physician and practitioner services (fee schedule) | 45 | $256.08 |
| 42950 | Physician and practitioner services (fee schedule) | 44 | $581.03 |
| 42953 | Physician and practitioner services (fee schedule) | 44 | $710.53 |
| 42955 | Physician and practitioner services (fee schedule) | 44 | $533.39 |
| 42960 | Physician and practitioner services (fee schedule) | 45 | $118.19 |
| 42961 | Physician and practitioner services (fee schedule) | 45 | $298.31 |
| 42962 | Physician and practitioner services (fee schedule) | 45 | $373.34 |
| 42970 | Physician and practitioner services (fee schedule) | 45 | $286.78 |
| 42971 | Physician and practitioner services (fee schedule) | 45 | $319.96 |
| 42972 | Physician and practitioner services (fee schedule) | 45 | $356.53 |
| 42975 | Physician and practitioner services (fee schedule) | 37 | $84.72 |
| 42999 | Physician and practitioner services (fee schedule) | 8 | $27.63 |
| 43020 | Physician and practitioner services (fee schedule) | 44 | $425.34 |
| 43030 | Physician and practitioner services (fee schedule) | 44 | $389.83 |
| 43045 | Physician and practitioner services (fee schedule) | 44 | $962.61 |
| 43100 | Physician and practitioner services (fee schedule) | 45 | $466.12 |
| 43101 | Physician and practitioner services (fee schedule) | 45 | $746.69 |
| 43107 | Physician and practitioner services (fee schedule) | 44 | $1,975.56 |
| 43108 | Physician and practitioner services (fee schedule) | 44 | $2,964.99 |
| 43112 | Physician and practitioner services (fee schedule) | 44 | $2,193.82 |
| 43113 | Physician and practitioner services (fee schedule) | 43 | $2,966.86 |
| 43116 | Physician and practitioner services (fee schedule) | 44 | $3,342.91 |
| 43117 | Physician and practitioner services (fee schedule) | 44 | $2,057.97 |
| 43118 | Physician and practitioner services (fee schedule) | 44 | $2,559.34 |
| 43121 | Physician and practitioner services (fee schedule) | 44 | $1,980.36 |
| 43122 | Physician and practitioner services (fee schedule) | 44 | $1,752.01 |
| 43123 | Physician and practitioner services (fee schedule) | 44 | $2,992.15 |
| 43124 | Physician and practitioner services (fee schedule) | 43 | $2,671.07 |
| 43130 | Physician and practitioner services (fee schedule) | 44 | $591.77 |
| 43135 | Physician and practitioner services (fee schedule) | 44 | $1,003.71 |
| 43180 | Physician and practitioner services (fee schedule) | 45 | $414.93 |
| 43191 | Physician and practitioner services (fee schedule) | 45 | $108.00 |
| 43192 | Physician and practitioner services (fee schedule) | 45 | $121.10 |
| 43193 | Physician and practitioner services (fee schedule) | 45 | $126.57 |
| 43194 | Physician and practitioner services (fee schedule) | 45 | $132.01 |
| 43195 | Physician and practitioner services (fee schedule) | 45 | $136.40 |
| 43196 | Physician and practitioner services (fee schedule) | 45 | $147.02 |
| 43197 | Physician and practitioner services (fee schedule) | 45 | $99.17 |
| 43198 | Physician and practitioner services (fee schedule) | 45 | $114.67 |
| 43200 | Physician and practitioner services (fee schedule) | 45 | $166.04 |
| 43201 | Physician and practitioner services (fee schedule) | 45 | $177.43 |
| 43202 | Physician and practitioner services (fee schedule) | 45 | $218.40 |
| 43204 | Physician and practitioner services (fee schedule) | 45 | $123.96 |
| 43205 | Physician and practitioner services (fee schedule) | 45 | $126.56 |
| 43206 | Physician and practitioner services (fee schedule) | 26 | $235.05 |
| 43210 | Physician and practitioner services (fee schedule) | 37 | $328.70 |
| 43211 | Physician and practitioner services (fee schedule) | 45 | $177.53 |
| 43212 | Physician and practitioner services (fee schedule) | 45 | $145.44 |
| 43213 | Physician and practitioner services (fee schedule) | 45 | $345.25 |
| 43214 | Physician and practitioner services (fee schedule) | 45 | $145.83 |
| 43215 | Physician and practitioner services (fee schedule) | 45 | $223.38 |
| 43216 | Physician and practitioner services (fee schedule) | 45 | $211.66 |
| 43217 | Physician and practitioner services (fee schedule) | 45 | $248.98 |
| 43220 | Physician and practitioner services (fee schedule) | 45 | $178.70 |
| 43226 | Physician and practitioner services (fee schedule) | 45 | $199.13 |
| 43227 | Physician and practitioner services (fee schedule) | 45 | $344.98 |
| 43229 | Physician and practitioner services (fee schedule) | 45 | $364.21 |
| 43231 | Physician and practitioner services (fee schedule) | 45 | $123.87 |
| 43232 | Physician and practitioner services (fee schedule) | 45 | $159.53 |
| 43233 | Physician and practitioner services (fee schedule) | 45 | $176.79 |
| 43235 | Physician and practitioner services (fee schedule) | 45 | $205.76 |
| 43236 | Physician and practitioner services (fee schedule) | 45 | $208.44 |
| 43237 | Physician and practitioner services (fee schedule) | 45 | $150.46 |
| 43238 | Physician and practitioner services (fee schedule) | 44 | $182.23 |
| 43239 | Physician and practitioner services (fee schedule) | 45 | $231.22 |
| 43240 | Physician and practitioner services (fee schedule) | 45 | $302.65 |
| 43241 | Physician and practitioner services (fee schedule) | 44 | $114.83 |
| 43242 | Physician and practitioner services (fee schedule) | 45 | $205.79 |
| 43243 | Physician and practitioner services (fee schedule) | 45 | $192.62 |
| 43244 | Physician and practitioner services (fee schedule) | 45 | $192.85 |
| 43245 | Physician and practitioner services (fee schedule) | 45 | $286.71 |
| 43246 | Physician and practitioner services (fee schedule) | 45 | $158.92 |
| 43247 | Physician and practitioner services (fee schedule) | 45 | $197.93 |
| 43248 | Physician and practitioner services (fee schedule) | 45 | $209.03 |
| 43249 | Physician and practitioner services (fee schedule) | 45 | $192.43 |
| 43250 | Physician and practitioner services (fee schedule) | 45 | $260.88 |
| 43251 | Physician and practitioner services (fee schedule) | 44 | $231.90 |
| 43252 | Physician and practitioner services (fee schedule) | 30 | $239.10 |
| 43253 | Physician and practitioner services (fee schedule) | 45 | $197.69 |
| 43254 | Physician and practitioner services (fee schedule) | 45 | $201.41 |
| 43255 | Physician and practitioner services (fee schedule) | 45 | $287.79 |
| 43257 | Physician and practitioner services (fee schedule) | 35 | $198.86 |
| 43259 | Physician and practitioner services (fee schedule) | 45 | $178.52 |
| 43260 | Physician and practitioner services (fee schedule) | 45 | $251.56 |
| 43261 | Physician and practitioner services (fee schedule) | 45 | $264.80 |
| 43262 | Physician and practitioner services (fee schedule) | 45 | $278.96 |
| 43263 | Physician and practitioner services (fee schedule) | 45 | $273.71 |
| 43264 | Physician and practitioner services (fee schedule) | 45 | $286.40 |
| 43265 | Physician and practitioner services (fee schedule) | 43 | $340.90 |
| 43266 | Physician and practitioner services (fee schedule) | 45 | $165.13 |
| 43270 | Physician and practitioner services (fee schedule) | 45 | $375.36 |
| 43273 | Physician and practitioner services (fee schedule) | 45 | $88.93 |
| 43274 | Physician and practitioner services (fee schedule) | 45 | $345.79 |
| 43275 | Physician and practitioner services (fee schedule) | 45 | $282.20 |
| 43276 | Physician and practitioner services (fee schedule) | 45 | $360.40 |
| 43277 | Physician and practitioner services (fee schedule) | 45 | $283.66 |
| 43278 | Physician and practitioner services (fee schedule) | 45 | $323.62 |
| 43279 | Physician and practitioner services (fee schedule) | 45 | $933.10 |
| 43280 | Physician and practitioner services (fee schedule) | 44 | $791.30 |
| 43281 | Physician and practitioner services (fee schedule) | 45 | $1,067.26 |
| 43282 | Physician and practitioner services (fee schedule) | 45 | $1,201.94 |
| 43283 | Physician and practitioner services (fee schedule) | 44 | $111.64 |
| 43284 | Physician and practitioner services (fee schedule) | 29 | $524.67 |
| 43285 | Physician and practitioner services (fee schedule) | 31 | $530.77 |
| 43286 | Physician and practitioner services (fee schedule) | 45 | $2,357.10 |
| 43287 | Physician and practitioner services (fee schedule) | 45 | $2,739.30 |
| 43288 | Physician and practitioner services (fee schedule) | 45 | $2,771.95 |
| 43289 | Physician and practitioner services (fee schedule) | 9 | $329.00 |
| 43290 | Physician and practitioner services (fee schedule) | 27 | $396.47 |
| 43291 | Physician and practitioner services (fee schedule) | 30 | $240.23 |
| 43300 | Physician and practitioner services (fee schedule) | 44 | $466.49 |
| 43305 | Physician and practitioner services (fee schedule) | 45 | $795.47 |
| 43310 | Physician and practitioner services (fee schedule) | 44 | $1,089.24 |
| 43312 | Physician and practitioner services (fee schedule) | 44 | $1,172.00 |
| 43313 | Physician and practitioner services (fee schedule) | 44 | $2,032.52 |
| 43314 | Physician and practitioner services (fee schedule) | 44 | $2,221.28 |
| 43320 | Physician and practitioner services (fee schedule) | 44 | $968.36 |
| 43325 | Physician and practitioner services (fee schedule) | 44 | $963.96 |
| 43327 | Physician and practitioner services (fee schedule) | 45 | $615.40 |
| 43328 | Physician and practitioner services (fee schedule) | 45 | $830.73 |
| 43330 | Physician and practitioner services (fee schedule) | 44 | $934.10 |
| 43331 | Physician and practitioner services (fee schedule) | 44 | $976.94 |
| 43332 | Physician and practitioner services (fee schedule) | 45 | $838.28 |
| 43333 | Physician and practitioner services (fee schedule) | 45 | $916.44 |
| 43334 | Physician and practitioner services (fee schedule) | 45 | $912.33 |
| 43335 | Physician and practitioner services (fee schedule) | 45 | $979.47 |
| 43336 | Physician and practitioner services (fee schedule) | 45 | $1,067.14 |
| 43337 | Physician and practitioner services (fee schedule) | 45 | $1,134.57 |
| 43338 | Physician and practitioner services (fee schedule) | 45 | $81.51 |
| 43340 | Physician and practitioner services (fee schedule) | 44 | $969.10 |
| 43341 | Physician and practitioner services (fee schedule) | 44 | $1,003.25 |
| 43351 | Physician and practitioner services (fee schedule) | 45 | $892.83 |
| 43352 | Physician and practitioner services (fee schedule) | 45 | $763.23 |
| 43360 | Physician and practitioner services (fee schedule) | 44 | $1,620.99 |
| 43361 | Physician and practitioner services (fee schedule) | 44 | $1,907.54 |
| 43400 | Physician and practitioner services (fee schedule) | 45 | $981.34 |
| 43405 | Physician and practitioner services (fee schedule) | 43 | $1,038.71 |
| 43410 | Physician and practitioner services (fee schedule) | 43 | $690.78 |
| 43415 | Physician and practitioner services (fee schedule) | 44 | $1,643.54 |
| 43420 | Physician and practitioner services (fee schedule) | 45 | $703.28 |
| 43425 | Physician and practitioner services (fee schedule) | 44 | $996.55 |
| 43450 | Physician and practitioner services (fee schedule) | 45 | $93.48 |
| 43453 | Physician and practitioner services (fee schedule) | 45 | $127.87 |
| 43460 | Physician and practitioner services (fee schedule) | 44 | $157.27 |
| 43496 | Physician and practitioner services (fee schedule) | 33 | $1,054.64 |
| 43497 | Physician and practitioner services (fee schedule) | 40 | $618.58 |
| 43499 | Physician and practitioner services (fee schedule) | 9 | $400.67 |
| 43500 | Physician and practitioner services (fee schedule) | 45 | $555.59 |
| 43501 | Physician and practitioner services (fee schedule) | 45 | $929.15 |
| 43502 | Physician and practitioner services (fee schedule) | 45 | $983.14 |
| 43510 | Physician and practitioner services (fee schedule) | 44 | $645.50 |
| 43520 | Physician and practitioner services (fee schedule) | 45 | $502.64 |
| 43605 | Physician and practitioner services (fee schedule) | 45 | $557.05 |
| 43610 | Physician and practitioner services (fee schedule) | 45 | $682.71 |
| 43611 | Physician and practitioner services (fee schedule) | 45 | $843.04 |
| 43620 | Physician and practitioner services (fee schedule) | 44 | $1,323.18 |
| 43621 | Physician and practitioner services (fee schedule) | 44 | $1,565.25 |
| 43622 | Physician and practitioner services (fee schedule) | 44 | $1,526.49 |
| 43631 | Physician and practitioner services (fee schedule) | 44 | $1,038.77 |
| 43632 | Physician and practitioner services (fee schedule) | 44 | $1,401.38 |
| 43633 | Physician and practitioner services (fee schedule) | 44 | $1,325.64 |
| 43634 | Physician and practitioner services (fee schedule) | 43 | $1,348.97 |
| 43635 | Physician and practitioner services (fee schedule) | 45 | $87.38 |
| 43640 | Physician and practitioner services (fee schedule) | 44 | $837.71 |
| 43641 | Physician and practitioner services (fee schedule) | 44 | $835.73 |
| 43644 | Physician and practitioner services (fee schedule) | 43 | $1,209.75 |
| 43645 | Physician and practitioner services (fee schedule) | 40 | $1,309.18 |
| 43647 | Physician and practitioner services (fee schedule) | 23 | $509.07 |
| 43648 | Physician and practitioner services (fee schedule) | 23 | $446.91 |
| 43651 | Physician and practitioner services (fee schedule) | 44 | $485.88 |
| 43652 | Physician and practitioner services (fee schedule) | 44 | $556.48 |
| 43653 | Physician and practitioner services (fee schedule) | 44 | $435.30 |
| 43659 | Physician and practitioner services (fee schedule) | 11 | $592.63 |
| 43752 | Physician and practitioner services (fee schedule) | 40 | $30.44 |
| 43753 | Physician and practitioner services (fee schedule) | 45 | $16.31 |
| 43754 | Physician and practitioner services (fee schedule) | 45 | $49.22 |
| 43755 | Physician and practitioner services (fee schedule) | 45 | $104.74 |
| 43756 | Physician and practitioner services (fee schedule) | 45 | $141.36 |
| 43757 | Physician and practitioner services (fee schedule) | 45 | $190.10 |
| 43761 | Physician and practitioner services (fee schedule) | 45 | $92.12 |
| 43762 | Physician and practitioner services (fee schedule) | 45 | $142.27 |
| 43763 | Physician and practitioner services (fee schedule) | 45 | $193.55 |
| 43770 | Physician and practitioner services (fee schedule) | 42 | $781.66 |
| 43771 | Physician and practitioner services (fee schedule) | 42 | $874.22 |
| 43772 | Physician and practitioner services (fee schedule) | 41 | $663.34 |
| 43773 | Physician and practitioner services (fee schedule) | 42 | $874.22 |
| 43774 | Physician and practitioner services (fee schedule) | 42 | $667.12 |
| 43775 | Physician and practitioner services (fee schedule) | 43 | $772.92 |
| 43800 | Physician and practitioner services (fee schedule) | 44 | $656.51 |
| 43810 | Physician and practitioner services (fee schedule) | 45 | $662.29 |
| 43820 | Physician and practitioner services (fee schedule) | 44 | $936.15 |
| 43825 | Physician and practitioner services (fee schedule) | 45 | $902.56 |
| 43830 | Physician and practitioner services (fee schedule) | 45 | $494.83 |
| 43831 | Physician and practitioner services (fee schedule) | 45 | $432.61 |
| 43832 | Physician and practitioner services (fee schedule) | 45 | $719.51 |
| 43840 | Physician and practitioner services (fee schedule) | 44 | $940.34 |
| 43842 | Physician and practitioner services (fee schedule) | 37 | $817.50 |
| 43843 | Physician and practitioner services (fee schedule) | 38 | $903.11 |
| 43845 | Physician and practitioner services (fee schedule) | 34 | $1,378.06 |
| 43846 | Physician and practitioner services (fee schedule) | 42 | $1,144.77 |
| 43847 | Physician and practitioner services (fee schedule) | 40 | $1,228.02 |
| 43848 | Physician and practitioner services (fee schedule) | 40 | $1,335.42 |
| 43850 | Physician and practitioner services (fee schedule) | 5 | $718.70 |
| 43855 | Physician and practitioner services (fee schedule) | 5 | $819.39 |
| 43860 | Physician and practitioner services (fee schedule) | 44 | $1,127.14 |
| 43865 | Physician and practitioner services (fee schedule) | 44 | $1,176.05 |
| 43870 | Physician and practitioner services (fee schedule) | 44 | $490.07 |
| 43880 | Physician and practitioner services (fee schedule) | 45 | $1,106.21 |
| 43881 | Physician and practitioner services (fee schedule) | 20 | $540.73 |
| 43882 | Physician and practitioner services (fee schedule) | 20 | $579.43 |
| 43886 | Physician and practitioner services (fee schedule) | 38 | $273.64 |
| 43887 | Physician and practitioner services (fee schedule) | 37 | $241.34 |
| 43888 | Physician and practitioner services (fee schedule) | 37 | $329.34 |
| 43889 | Physician and practitioner services (fee schedule) | 22 | $553.13 |
| 43999 | Physician and practitioner services (fee schedule) | 8 | $108.27 |
| 44005 | Physician and practitioner services (fee schedule) | 45 | $768.06 |
| 44010 | Physician and practitioner services (fee schedule) | 44 | $580.25 |
| 44015 | Physician and practitioner services (fee schedule) | 45 | $108.35 |
| 44020 | Physician and practitioner services (fee schedule) | 45 | $679.05 |
| 44021 | Physician and practitioner services (fee schedule) | 44 | $673.82 |
| 44025 | Physician and practitioner services (fee schedule) | 44 | $697.80 |
| 44050 | Physician and practitioner services (fee schedule) | 45 | $652.88 |
| 44055 | Physician and practitioner services (fee schedule) | 44 | $1,026.27 |
| 44100 | Physician and practitioner services (fee schedule) | 45 | $82.32 |
| 44110 | Physician and practitioner services (fee schedule) | 45 | $586.82 |
| 44111 | Physician and practitioner services (fee schedule) | 45 | $704.24 |
| 44120 | Physician and practitioner services (fee schedule) | 44 | $861.81 |
| 44121 | Physician and practitioner services (fee schedule) | 44 | $181.56 |
| 44125 | Physician and practitioner services (fee schedule) | 44 | $852.63 |
| 44126 | Physician and practitioner services (fee schedule) | 45 | $1,760.01 |
| 44127 | Physician and practitioner services (fee schedule) | 45 | $2,033.63 |
| 44128 | Physician and practitioner services (fee schedule) | 45 | $173.98 |
| 44130 | Physician and practitioner services (fee schedule) | 45 | $900.30 |
| 44132 | Physician and practitioner services (fee schedule) | 9 | $464.63 |
| 44133 | Physician and practitioner services (fee schedule) | 10 | $849.02 |
| 44135 | Physician and practitioner services (fee schedule) | 19 | $1,149.06 |
| 44136 | Physician and practitioner services (fee schedule) | 14 | $987.03 |
| 44137 | Physician and practitioner services (fee schedule) | 15 | $784.34 |
| 44139 | Physician and practitioner services (fee schedule) | 45 | $90.71 |
| 44140 | Physician and practitioner services (fee schedule) | 44 | $970.69 |
| 44141 | Physician and practitioner services (fee schedule) | 44 | $1,242.82 |
| 44143 | Physician and practitioner services (fee schedule) | 44 | $1,149.37 |
| 44144 | Physician and practitioner services (fee schedule) | 44 | $1,234.12 |
| 44145 | Physician and practitioner services (fee schedule) | 44 | $1,183.95 |
| 44146 | Physician and practitioner services (fee schedule) | 44 | $1,428.61 |
| 44147 | Physician and practitioner services (fee schedule) | 44 | $1,313.07 |
| 44150 | Physician and practitioner services (fee schedule) | 44 | $1,297.17 |
| 44151 | Physician and practitioner services (fee schedule) | 44 | $1,433.38 |
| 44155 | Physician and practitioner services (fee schedule) | 44 | $1,457.15 |
| 44156 | Physician and practitioner services (fee schedule) | 44 | $1,584.30 |
| 44157 | Physician and practitioner services (fee schedule) | 45 | $1,524.96 |
| 44158 | Physician and practitioner services (fee schedule) | 45 | $1,563.87 |
| 44160 | Physician and practitioner services (fee schedule) | 43 | $900.11 |
| 44180 | Physician and practitioner services (fee schedule) | 44 | $653.22 |
| 44186 | Physician and practitioner services (fee schedule) | 45 | $459.70 |
| 44187 | Physician and practitioner services (fee schedule) | 45 | $777.93 |
| 44188 | Physician and practitioner services (fee schedule) | 45 | $832.04 |
| 44202 | Physician and practitioner services (fee schedule) | 45 | $1,003.41 |
| 44203 | Physician and practitioner services (fee schedule) | 45 | $180.47 |
| 44204 | Physician and practitioner services (fee schedule) | 45 | $1,099.09 |
| 44205 | Physician and practitioner services (fee schedule) | 45 | $953.62 |
| 44206 | Physician and practitioner services (fee schedule) | 44 | $1,249.77 |
| 44207 | Physician and practitioner services (fee schedule) | 44 | $1,291.79 |
| 44208 | Physician and practitioner services (fee schedule) | 44 | $1,411.89 |
| 44210 | Physician and practitioner services (fee schedule) | 44 | $1,278.02 |
| 44211 | Physician and practitioner services (fee schedule) | 44 | $1,523.65 |
| 44212 | Physician and practitioner services (fee schedule) | 44 | $1,464.28 |
| 44213 | Physician and practitioner services (fee schedule) | 45 | $129.99 |
| 44227 | Physician and practitioner services (fee schedule) | 45 | $1,145.29 |
| 44238 | Physician and practitioner services (fee schedule) | 11 | $645.00 |
| 44300 | Physician and practitioner services (fee schedule) | 45 | $583.17 |
| 44310 | Physician and practitioner services (fee schedule) | 44 | $735.22 |
| 44312 | Physician and practitioner services (fee schedule) | 45 | $430.58 |
| 44314 | Physician and practitioner services (fee schedule) | 45 | $679.18 |
| 44316 | Physician and practitioner services (fee schedule) | 44 | $980.49 |
| 44320 | Physician and practitioner services (fee schedule) | 45 | $826.43 |
| 44322 | Physician and practitioner services (fee schedule) | 44 | $715.23 |
| 44340 | Physician and practitioner services (fee schedule) | 45 | $437.74 |
| 44345 | Physician and practitioner services (fee schedule) | 44 | $721.74 |
| 44346 | Physician and practitioner services (fee schedule) | 45 | $808.37 |
| 44360 | Physician and practitioner services (fee schedule) | 45 | $113.87 |
| 44361 | Physician and practitioner services (fee schedule) | 45 | $125.56 |
| 44363 | Physician and practitioner services (fee schedule) | 45 | $156.01 |
| 44364 | Physician and practitioner services (fee schedule) | 45 | $161.61 |
| 44365 | Physician and practitioner services (fee schedule) | 44 | $145.09 |
| 44366 | Physician and practitioner services (fee schedule) | 45 | $187.71 |
| 44369 | Physician and practitioner services (fee schedule) | 44 | $192.46 |
| 44370 | Physician and practitioner services (fee schedule) | 45 | $194.93 |
| 44372 | Physician and practitioner services (fee schedule) | 45 | $195.59 |
| 44373 | Physician and practitioner services (fee schedule) | 45 | $151.78 |
| 44376 | Physician and practitioner services (fee schedule) | 45 | $222.62 |
| 44377 | Physician and practitioner services (fee schedule) | 44 | $233.69 |
| 44378 | Physician and practitioner services (fee schedule) | 45 | $300.24 |
| 44379 | Physician and practitioner services (fee schedule) | 44 | $306.56 |
| 44380 | Physician and practitioner services (fee schedule) | 45 | $101.58 |
| 44381 | Physician and practitioner services (fee schedule) | 37 | $552.61 |
| 44382 | Physician and practitioner services (fee schedule) | 45 | $122.95 |
| 44384 | Physician and practitioner services (fee schedule) | 35 | $114.86 |
| 44385 | Physician and practitioner services (fee schedule) | 44 | $129.74 |
| 44386 | Physician and practitioner services (fee schedule) | 45 | $127.38 |
| 44388 | Physician and practitioner services (fee schedule) | 45 | $166.05 |
| 44389 | Physician and practitioner services (fee schedule) | 45 | $210.07 |
| 44390 | Physician and practitioner services (fee schedule) | 45 | $232.57 |
| 44391 | Physician and practitioner services (fee schedule) | 44 | $272.12 |
| 44392 | Physician and practitioner services (fee schedule) | 45 | $239.44 |
| 44394 | Physician and practitioner services (fee schedule) | 45 | $285.40 |
| 44401 | Physician and practitioner services (fee schedule) | 38 | $1,265.63 |
| 44402 | Physician and practitioner services (fee schedule) | 38 | $199.24 |
| 44403 | Physician and practitioner services (fee schedule) | 38 | $216.51 |
| 44404 | Physician and practitioner services (fee schedule) | 38 | $292.14 |
| 44405 | Physician and practitioner services (fee schedule) | 38 | $328.39 |
| 44406 | Physician and practitioner services (fee schedule) | 38 | $169.53 |
| 44407 | Physician and practitioner services (fee schedule) | 38 | $196.42 |
| 44408 | Physician and practitioner services (fee schedule) | 39 | $168.89 |
| 44500 | Physician and practitioner services (fee schedule) | 44 | $15.14 |
| 44602 | Physician and practitioner services (fee schedule) | 44 | $982.05 |
| 44603 | Physician and practitioner services (fee schedule) | 44 | $1,106.53 |
| 44604 | Physician and practitioner services (fee schedule) | 44 | $759.27 |
| 44605 | Physician and practitioner services (fee schedule) | 44 | $894.38 |
| 44615 | Physician and practitioner services (fee schedule) | 44 | $731.87 |
| 44620 | Physician and practitioner services (fee schedule) | 45 | $590.24 |
| 44625 | Physician and practitioner services (fee schedule) | 45 | $726.47 |
| 44626 | Physician and practitioner services (fee schedule) | 45 | $1,126.37 |
| 44640 | Physician and practitioner services (fee schedule) | 45 | $951.33 |
| 44650 | Physician and practitioner services (fee schedule) | 45 | $979.58 |
| 44660 | Physician and practitioner services (fee schedule) | 45 | $864.52 |
| 44661 | Physician and practitioner services (fee schedule) | 44 | $1,048.50 |
| 44680 | Physician and practitioner services (fee schedule) | 44 | $760.09 |
| 44700 | Physician and practitioner services (fee schedule) | 44 | $733.18 |
| 44701 | Physician and practitioner services (fee schedule) | 43 | $118.46 |
| 44705 | Physician and practitioner services (fee schedule) | 13 | $61.67 |
| 44715 | Physician and practitioner services (fee schedule) | 12 | $296.14 |
| 44720 | Physician and practitioner services (fee schedule) | 26 | $190.15 |
| 44721 | Physician and practitioner services (fee schedule) | 26 | $266.18 |
| 44799 | Physician and practitioner services (fee schedule) | 7 | $61.07 |
| 44800 | Physician and practitioner services (fee schedule) | 45 | $545.41 |
| 44820 | Physician and practitioner services (fee schedule) | 45 | $585.48 |
| 44850 | Physician and practitioner services (fee schedule) | 45 | $522.16 |
| 44899 | Physician and practitioner services (fee schedule) | 6 | $142.14 |
| 44900 | Physician and practitioner services (fee schedule) | 45 | $518.71 |
| 44950 | Physician and practitioner services (fee schedule) | 45 | $461.90 |
| 44955 | Physician and practitioner services (fee schedule) | 44 | $63.50 |
| 44960 | Physician and practitioner services (fee schedule) | 44 | $617.49 |
| 44970 | Physician and practitioner services (fee schedule) | 44 | $448.05 |
| 44979 | Physician and practitioner services (fee schedule) | 7 | $349.95 |
| 45000 | Physician and practitioner services (fee schedule) | 45 | $321.08 |
| 45005 | Physician and practitioner services (fee schedule) | 45 | $178.46 |
| 45020 | Physician and practitioner services (fee schedule) | 45 | $400.35 |
| 45100 | Physician and practitioner services (fee schedule) | 45 | $228.88 |
| 45108 | Physician and practitioner services (fee schedule) | 45 | $289.90 |
| 45110 | Physician and practitioner services (fee schedule) | 44 | $1,313.96 |
| 45111 | Physician and practitioner services (fee schedule) | 44 | $797.99 |
| 45112 | Physician and practitioner services (fee schedule) | 44 | $1,297.34 |
| 45113 | Physician and practitioner services (fee schedule) | 44 | $1,366.60 |
| 45114 | Physician and practitioner services (fee schedule) | 44 | $1,276.53 |
| 45116 | Physician and practitioner services (fee schedule) | 44 | $1,076.16 |
| 45119 | Physician and practitioner services (fee schedule) | 44 | $1,367.25 |
| 45120 | Physician and practitioner services (fee schedule) | 44 | $1,167.83 |
| 45121 | Physician and practitioner services (fee schedule) | 45 | $1,236.07 |
| 45123 | Physician and practitioner services (fee schedule) | 44 | $802.10 |
| 45126 | Physician and practitioner services (fee schedule) | 43 | $1,930.88 |
| 45130 | Physician and practitioner services (fee schedule) | 45 | $742.45 |
| 45135 | Physician and practitioner services (fee schedule) | 44 | $946.69 |
| 45136 | Physician and practitioner services (fee schedule) | 45 | $1,271.58 |
| 45150 | Physician and practitioner services (fee schedule) | 44 | $319.13 |
| 45160 | Physician and practitioner services (fee schedule) | 44 | $739.11 |
| 45171 | Physician and practitioner services (fee schedule) | 45 | $431.15 |
| 45172 | Physician and practitioner services (fee schedule) | 45 | $580.46 |
| 45190 | Physician and practitioner services (fee schedule) | 45 | $511.25 |
| 45300 | Physician and practitioner services (fee schedule) | 45 | $57.09 |
| 45303 | Physician and practitioner services (fee schedule) | 45 | $97.46 |
| 45305 | Physician and practitioner services (fee schedule) | 45 | $76.05 |
| 45307 | Physician and practitioner services (fee schedule) | 45 | $110.03 |
| 45308 | Physician and practitioner services (fee schedule) | 45 | $98.29 |
| 45309 | Physician and practitioner services (fee schedule) | 45 | $98.29 |
| 45315 | Physician and practitioner services (fee schedule) | 45 | $117.97 |
| 45317 | Physician and practitioner services (fee schedule) | 45 | $125.66 |
| 45320 | Physician and practitioner services (fee schedule) | 45 | $126.01 |
| 45321 | Physician and practitioner services (fee schedule) | 45 | $82.16 |
| 45327 | Physician and practitioner services (fee schedule) | 45 | $86.40 |
| 45330 | Physician and practitioner services (fee schedule) | 45 | $64.08 |
| 45331 | Physician and practitioner services (fee schedule) | 45 | $96.77 |
| 45332 | Physician and practitioner services (fee schedule) | 45 | $117.32 |
| 45333 | Physician and practitioner services (fee schedule) | 45 | $116.19 |
| 45334 | Physician and practitioner services (fee schedule) | 45 | $171.09 |
| 45335 | Physician and practitioner services (fee schedule) | 45 | $139.93 |
| 45337 | Physician and practitioner services (fee schedule) | 45 | $99.91 |
| 45338 | Physician and practitioner services (fee schedule) | 45 | $143.34 |
| 45340 | Physician and practitioner services (fee schedule) | 45 | $234.34 |
| 45341 | Physician and practitioner services (fee schedule) | 45 | $107.98 |
| 45342 | Physician and practitioner services (fee schedule) | 45 | $147.39 |
| 45346 | Physician and practitioner services (fee schedule) | 40 | $1,222.69 |
| 45347 | Physician and practitioner services (fee schedule) | 40 | $117.63 |
| 45349 | Physician and practitioner services (fee schedule) | 38 | $144.00 |
| 45350 | Physician and practitioner services (fee schedule) | 38 | $396.25 |
| 45378 | Physician and practitioner services (fee schedule) | 45 | $227.27 |
| 45379 | Physician and practitioner services (fee schedule) | 45 | $322.32 |
| 45380 | Physician and practitioner services (fee schedule) | 45 | $306.08 |
| 45381 | Physician and practitioner services (fee schedule) | 45 | $312.68 |
| 45382 | Physician and practitioner services (fee schedule) | 45 | $405.37 |
| 45384 | Physician and practitioner services (fee schedule) | 45 | $340.83 |
| 45385 | Physician and practitioner services (fee schedule) | 45 | $336.48 |
| 45386 | Physician and practitioner services (fee schedule) | 45 | $482.73 |
| 45388 | Physician and practitioner services (fee schedule) | 40 | $1,203.61 |
| 45389 | Physician and practitioner services (fee schedule) | 40 | $223.01 |
| 45390 | Physician and practitioner services (fee schedule) | 41 | $236.71 |
| 45391 | Physician and practitioner services (fee schedule) | 44 | $202.70 |
| 45392 | Physician and practitioner services (fee schedule) | 43 | $239.21 |
| 45393 | Physician and practitioner services (fee schedule) | 40 | $188.56 |
| 45395 | Physician and practitioner services (fee schedule) | 45 | $1,348.53 |
| 45397 | Physician and practitioner services (fee schedule) | 45 | $1,510.31 |
| 45398 | Physician and practitioner services (fee schedule) | 42 | $421.29 |
| 45399 | Physician and practitioner services (fee schedule) | 8 | $48.37 |
| 45400 | Physician and practitioner services (fee schedule) | 45 | $812.30 |
| 45402 | Physician and practitioner services (fee schedule) | 45 | $1,083.24 |
| 45499 | Physician and practitioner services (fee schedule) | 9 | $298.71 |
| 45500 | Physician and practitioner services (fee schedule) | 45 | $419.19 |
| 45505 | Physician and practitioner services (fee schedule) | 45 | $437.15 |
| 45520 | Physician and practitioner services (fee schedule) | 44 | $41.89 |
| 45540 | Physician and practitioner services (fee schedule) | 45 | $720.66 |
| 45541 | Physician and practitioner services (fee schedule) | 44 | $652.09 |
| 45550 | Physician and practitioner services (fee schedule) | 44 | $980.55 |
| 45560 | Physician and practitioner services (fee schedule) | 44 | $467.18 |
| 45562 | Physician and practitioner services (fee schedule) | 45 | $797.94 |
| 45563 | Physician and practitioner services (fee schedule) | 44 | $1,146.40 |
| 45800 | Physician and practitioner services (fee schedule) | 45 | $843.94 |
| 45805 | Physician and practitioner services (fee schedule) | 44 | $988.19 |
| 45820 | Physician and practitioner services (fee schedule) | 44 | $859.39 |
| 45825 | Physician and practitioner services (fee schedule) | 44 | $1,036.23 |
| 45900 | Physician and practitioner services (fee schedule) | 44 | $155.95 |
| 45905 | Physician and practitioner services (fee schedule) | 45 | $132.51 |
| 45910 | Physician and practitioner services (fee schedule) | 45 | $148.20 |
| 45915 | Physician and practitioner services (fee schedule) | 45 | $223.43 |
| 45990 | Physician and practitioner services (fee schedule) | 44 | $79.10 |
| 45999 | Physician and practitioner services (fee schedule) | 6 | $191.16 |
| 46020 | Physician and practitioner services (fee schedule) | 44 | $108.25 |
| 46030 | Physician and practitioner services (fee schedule) | 44 | $80.85 |
| 46040 | Physician and practitioner services (fee schedule) | 45 | $376.74 |
| 46045 | Physician and practitioner services (fee schedule) | 45 | $326.77 |
| 46050 | Physician and practitioner services (fee schedule) | 45 | $106.58 |
| 46060 | Physician and practitioner services (fee schedule) | 45 | $382.38 |
| 46070 | Physician and practitioner services (fee schedule) | 45 | $189.16 |
| 46080 | Physician and practitioner services (fee schedule) | 45 | $147.49 |
| 46083 | Physician and practitioner services (fee schedule) | 45 | $112.22 |
| 46200 | Physician and practitioner services (fee schedule) | 45 | $300.39 |
| 46220 | Physician and practitioner services (fee schedule) | 45 | $130.46 |
| 46221 | Physician and practitioner services (fee schedule) | 45 | $180.17 |
| 46230 | Physician and practitioner services (fee schedule) | 45 | $174.71 |
| 46250 | Physician and practitioner services (fee schedule) | 45 | $301.87 |
| 46255 | Physician and practitioner services (fee schedule) | 45 | $351.76 |
| 46257 | Physician and practitioner services (fee schedule) | 45 | $333.07 |
| 46258 | Physician and practitioner services (fee schedule) | 45 | $375.20 |
| 46260 | Physician and practitioner services (fee schedule) | 45 | $382.97 |
| 46261 | Physician and practitioner services (fee schedule) | 45 | $416.52 |
| 46262 | Physician and practitioner services (fee schedule) | 45 | $457.20 |
| 46270 | Physician and practitioner services (fee schedule) | 45 | $353.59 |
| 46275 | Physician and practitioner services (fee schedule) | 45 | $402.14 |
| 46280 | Physician and practitioner services (fee schedule) | 45 | $383.06 |
| 46285 | Physician and practitioner services (fee schedule) | 45 | $357.05 |
| 46288 | Physician and practitioner services (fee schedule) | 45 | $429.66 |
| 46320 | Physician and practitioner services (fee schedule) | 45 | $127.56 |
| 46500 | Physician and practitioner services (fee schedule) | 44 | $175.37 |
| 46505 | Physician and practitioner services (fee schedule) | 42 | $216.04 |
| 46600 | Physician and practitioner services (fee schedule) | 45 | $43.19 |
| 46601 | Physician and practitioner services (fee schedule) | 34 | $106.28 |
| 46604 | Physician and practitioner services (fee schedule) | 45 | $327.58 |
| 46606 | Physician and practitioner services (fee schedule) | 45 | $144.22 |
| 46607 | Physician and practitioner services (fee schedule) | 35 | $148.62 |
| 46608 | Physician and practitioner services (fee schedule) | 45 | $107.97 |
| 46610 | Physician and practitioner services (fee schedule) | 45 | $90.84 |
| 46611 | Physician and practitioner services (fee schedule) | 45 | $115.36 |
| 46612 | Physician and practitioner services (fee schedule) | 45 | $152.64 |
| 46614 | Physician and practitioner services (fee schedule) | 44 | $110.91 |
| 46615 | Physician and practitioner services (fee schedule) | 45 | $126.29 |
| 46700 | Physician and practitioner services (fee schedule) | 45 | $476.83 |
| 46705 | Physician and practitioner services (fee schedule) | 45 | $400.90 |
| 46706 | Physician and practitioner services (fee schedule) | 42 | $127.74 |
| 46707 | Physician and practitioner services (fee schedule) | 43 | $380.75 |
| 46710 | Physician and practitioner services (fee schedule) | 44 | $776.55 |
| 46712 | Physician and practitioner services (fee schedule) | 45 | $1,518.87 |
| 46715 | Physician and practitioner services (fee schedule) | 45 | $412.03 |
| 46716 | Physician and practitioner services (fee schedule) | 44 | $872.18 |
| 46730 | Physician and practitioner services (fee schedule) | 45 | $1,358.58 |
| 46735 | Physician and practitioner services (fee schedule) | 44 | $1,543.96 |
| 46740 | Physician and practitioner services (fee schedule) | 44 | $1,474.19 |
| 46742 | Physician and practitioner services (fee schedule) | 43 | $1,693.35 |
| 46744 | Physician and practitioner services (fee schedule) | 44 | $2,356.88 |
| 46746 | Physician and practitioner services (fee schedule) | 42 | $2,591.19 |
| 46748 | Physician and practitioner services (fee schedule) | 44 | $2,803.44 |
| 46750 | Physician and practitioner services (fee schedule) | 45 | $496.84 |
| 46751 | Physician and practitioner services (fee schedule) | 45 | $454.21 |
| 46753 | Physician and practitioner services (fee schedule) | 45 | $445.54 |
| 46754 | Physician and practitioner services (fee schedule) | 43 | $207.75 |
| 46760 | Physician and practitioner services (fee schedule) | 44 | $738.41 |
| 46761 | Physician and practitioner services (fee schedule) | 44 | $614.72 |
| 46900 | Physician and practitioner services (fee schedule) | 45 | $141.76 |
| 46910 | Physician and practitioner services (fee schedule) | 45 | $137.29 |
| 46916 | Physician and practitioner services (fee schedule) | 45 | $146.61 |
| 46917 | Physician and practitioner services (fee schedule) | 45 | $141.67 |
| 46922 | Physician and practitioner services (fee schedule) | 45 | $140.05 |
| 46924 | Physician and practitioner services (fee schedule) | 45 | $255.45 |
| 46930 | Physician and practitioner services (fee schedule) | 45 | $140.97 |
| 46940 | Physician and practitioner services (fee schedule) | 45 | $144.99 |
| 46942 | Physician and practitioner services (fee schedule) | 45 | $128.18 |
| 46945 | Physician and practitioner services (fee schedule) | 45 | $240.83 |
| 46946 | Physician and practitioner services (fee schedule) | 45 | $259.29 |
| 46947 | Physician and practitioner services (fee schedule) | 43 | $295.10 |
| 46948 | Physician and practitioner services (fee schedule) | 38 | $360.56 |
| 46999 | Physician and practitioner services (fee schedule) | 7 | $25.00 |
| 47000 | Physician and practitioner services (fee schedule) | 45 | $109.78 |
| 47001 | Physician and practitioner services (fee schedule) | 44 | $77.67 |
| 47010 | Physician and practitioner services (fee schedule) | 45 | $829.57 |
| 47015 | Physician and practitioner services (fee schedule) | 44 | $805.15 |
| 47100 | Physician and practitioner services (fee schedule) | 45 | $579.30 |
| 47120 | Physician and practitioner services (fee schedule) | 45 | $1,599.64 |
| 47122 | Physician and practitioner services (fee schedule) | 44 | $2,258.36 |
| 47125 | Physician and practitioner services (fee schedule) | 44 | $2,032.20 |
| 47130 | Physician and practitioner services (fee schedule) | 44 | $2,266.78 |
| 47133 | Physician and practitioner services (fee schedule) | 12 | $1,559.38 |
| 47135 | Physician and practitioner services (fee schedule) | 43 | $3,918.90 |
| 47140 | Physician and practitioner services (fee schedule) | 34 | $2,301.85 |
| 47141 | Physician and practitioner services (fee schedule) | 34 | $2,661.77 |
| 47142 | Physician and practitioner services (fee schedule) | 34 | $2,988.28 |
| 47143 | Physician and practitioner services (fee schedule) | 22 | $263.38 |
| 47144 | Physician and practitioner services (fee schedule) | 19 | $356.62 |
| 47145 | Physician and practitioner services (fee schedule) | 16 | $345.39 |
| 47146 | Physician and practitioner services (fee schedule) | 30 | $224.59 |
| 47147 | Physician and practitioner services (fee schedule) | 30 | $262.06 |
| 47300 | Physician and practitioner services (fee schedule) | 45 | $752.08 |
| 47350 | Physician and practitioner services (fee schedule) | 44 | $939.87 |
| 47360 | Physician and practitioner services (fee schedule) | 44 | $1,294.52 |
| 47361 | Physician and practitioner services (fee schedule) | 44 | $2,075.13 |
| 47362 | Physician and practitioner services (fee schedule) | 44 | $991.11 |
| 47370 | Physician and practitioner services (fee schedule) | 43 | $895.69 |
| 47371 | Physician and practitioner services (fee schedule) | 43 | $866.13 |
| 47379 | Physician and practitioner services (fee schedule) | 9 | $724.83 |
| 47380 | Physician and practitioner services (fee schedule) | 45 | $998.69 |
| 47381 | Physician and practitioner services (fee schedule) | 45 | $1,019.46 |
| 47382 | Physician and practitioner services (fee schedule) | 44 | $686.53 |
| 47383 | Physician and practitioner services (fee schedule) | 43 | $1,115.59 |
| 47384 | Physician and practitioner services (fee schedule) | 20 | $318.01 |
| 47399 | Physician and practitioner services (fee schedule) | 5 | $348.98 |
| 47400 | Physician and practitioner services (fee schedule) | 44 | $1,426.15 |
| 47420 | Physician and practitioner services (fee schedule) | 45 | $918.42 |
| 47425 | Physician and practitioner services (fee schedule) | 44 | $946.22 |
| 47460 | Physician and practitioner services (fee schedule) | 45 | $886.70 |
| 47480 | Physician and practitioner services (fee schedule) | 43 | $594.36 |
| 47490 | Physician and practitioner services (fee schedule) | 45 | $264.83 |
| 47531 | Physician and practitioner services (fee schedule) | 45 | $242.24 |
| 47532 | Physician and practitioner services (fee schedule) | 45 | $482.29 |
| 47533 | Physician and practitioner services (fee schedule) | 45 | $589.37 |
| 47534 | Physician and practitioner services (fee schedule) | 45 | $776.81 |
| 47535 | Physician and practitioner services (fee schedule) | 45 | $507.69 |
| 47536 | Physician and practitioner services (fee schedule) | 45 | $363.32 |
| 47537 | Physician and practitioner services (fee schedule) | 45 | $248.20 |
| 47538 | Physician and practitioner services (fee schedule) | 45 | $1,874.03 |
| 47539 | Physician and practitioner services (fee schedule) | 45 | $2,112.18 |
| 47540 | Physician and practitioner services (fee schedule) | 45 | $2,108.18 |
| 47541 | Physician and practitioner services (fee schedule) | 45 | $591.79 |
| 47542 | Physician and practitioner services (fee schedule) | 45 | $285.86 |
| 47543 | Physician and practitioner services (fee schedule) | 45 | $249.61 |
| 47544 | Physician and practitioner services (fee schedule) | 45 | $477.43 |
| 47550 | Physician and practitioner services (fee schedule) | 45 | $118.33 |
| 47552 | Physician and practitioner services (fee schedule) | 45 | $218.45 |
| 47553 | Physician and practitioner services (fee schedule) | 45 | $221.86 |
| 47554 | Physician and practitioner services (fee schedule) | 45 | $341.66 |
| 47555 | Physician and practitioner services (fee schedule) | 45 | $260.17 |
| 47556 | Physician and practitioner services (fee schedule) | 45 | $295.14 |
| 47562 | Physician and practitioner services (fee schedule) | 44 | $518.59 |
| 47563 | Physician and practitioner services (fee schedule) | 44 | $540.06 |
| 47564 | Physician and practitioner services (fee schedule) | 44 | $782.36 |
| 47570 | Physician and practitioner services (fee schedule) | 45 | $572.58 |
| 47579 | Physician and practitioner services (fee schedule) | 7 | $130.00 |
| 47600 | Physician and practitioner services (fee schedule) | 45 | $747.13 |
| 47605 | Physician and practitioner services (fee schedule) | 45 | $739.99 |
| 47610 | Physician and practitioner services (fee schedule) | 45 | $872.79 |
| 47612 | Physician and practitioner services (fee schedule) | 44 | $917.49 |
| 47620 | Physician and practitioner services (fee schedule) | 44 | $967.91 |
| 47700 | Physician and practitioner services (fee schedule) | 44 | $745.66 |
| 47701 | Physician and practitioner services (fee schedule) | 45 | $1,268.66 |
| 47711 | Physician and practitioner services (fee schedule) | 44 | $1,071.38 |
| 47712 | Physician and practitioner services (fee schedule) | 44 | $1,365.88 |
| 47715 | Physician and practitioner services (fee schedule) | 45 | $913.11 |
| 47720 | Physician and practitioner services (fee schedule) | 44 | $789.16 |
| 47721 | Physician and practitioner services (fee schedule) | 44 | $945.76 |
| 47740 | Physician and practitioner services (fee schedule) | 44 | $900.32 |
| 47741 | Physician and practitioner services (fee schedule) | 44 | $1,023.74 |
| 47760 | Physician and practitioner services (fee schedule) | 44 | $1,493.42 |
| 47765 | Physician and practitioner services (fee schedule) | 44 | $2,001.90 |
| 47780 | Physician and practitioner services (fee schedule) | 44 | $1,704.05 |
| 47785 | Physician and practitioner services (fee schedule) | 44 | $2,226.37 |
| 47800 | Physician and practitioner services (fee schedule) | 44 | $1,105.56 |
| 47801 | Physician and practitioner services (fee schedule) | 45 | $762.99 |
| 47802 | Physician and practitioner services (fee schedule) | 5 | $974.26 |
| 47900 | Physician and practitioner services (fee schedule) | 44 | $970.19 |
| 47999 | Physician and practitioner services (fee schedule) | 7 | $630.22 |
| 48000 | Physician and practitioner services (fee schedule) | 45 | $1,294.92 |
| 48001 | Physician and practitioner services (fee schedule) | 45 | $1,462.75 |
| 48020 | Physician and practitioner services (fee schedule) | 45 | $775.50 |
| 48100 | Physician and practitioner services (fee schedule) | 45 | $591.53 |
| 48102 | Physician and practitioner services (fee schedule) | 45 | $264.73 |
| 48105 | Physician and practitioner services (fee schedule) | 45 | $1,987.77 |
| 48120 | Physician and practitioner services (fee schedule) | 45 | $779.09 |
| 48140 | Physician and practitioner services (fee schedule) | 44 | $1,112.43 |
| 48145 | Physician and practitioner services (fee schedule) | 44 | $1,182.39 |
| 48146 | Physician and practitioner services (fee schedule) | 44 | $1,320.75 |
| 48148 | Physician and practitioner services (fee schedule) | 44 | $872.78 |
| 48150 | Physician and practitioner services (fee schedule) | 44 | $2,221.41 |
| 48152 | Physician and practitioner services (fee schedule) | 44 | $2,028.83 |
| 48153 | Physician and practitioner services (fee schedule) | 44 | $2,215.28 |
| 48154 | Physician and practitioner services (fee schedule) | 43 | $2,008.36 |
| 48155 | Physician and practitioner services (fee schedule) | 43 | $1,325.69 |
| 48160 | Physician and practitioner services (fee schedule) | 16 | $1,751.47 |
| 48400 | Physician and practitioner services (fee schedule) | 43 | $81.41 |
| 48500 | Physician and practitioner services (fee schedule) | 44 | $787.24 |
| 48510 | Physician and practitioner services (fee schedule) | 45 | $766.18 |
| 48520 | Physician and practitioner services (fee schedule) | 44 | $794.61 |
| 48540 | Physician and practitioner services (fee schedule) | 44 | $923.89 |
| 48545 | Physician and practitioner services (fee schedule) | 44 | $932.96 |
| 48547 | Physician and practitioner services (fee schedule) | 44 | $1,241.62 |
| 48548 | Physician and practitioner services (fee schedule) | 44 | $1,156.56 |
| 48550 | Physician and practitioner services (fee schedule) | 8 | $945.06 |
| 48551 | Physician and practitioner services (fee schedule) | 18 | $207.77 |
| 48552 | Physician and practitioner services (fee schedule) | 26 | $166.47 |
| 48554 | Physician and practitioner services (fee schedule) | 37 | $1,797.66 |
| 48556 | Physician and practitioner services (fee schedule) | 34 | $879.54 |
| 48999 | Physician and practitioner services (fee schedule) | 6 | $222.84 |
| 49000 | Physician and practitioner services (fee schedule) | 45 | $566.49 |
| 49002 | Physician and practitioner services (fee schedule) | 44 | $744.97 |
| 49010 | Physician and practitioner services (fee schedule) | 45 | $672.29 |
| 49013 | Physician and practitioner services (fee schedule) | 42 | $347.27 |
| 49014 | Physician and practitioner services (fee schedule) | 42 | $283.03 |
| 49020 | Physician and practitioner services (fee schedule) | 45 | $1,143.06 |
| 49040 | Physician and practitioner services (fee schedule) | 45 | $709.31 |
| 49060 | Physician and practitioner services (fee schedule) | 45 | $796.96 |
| 49062 | Physician and practitioner services (fee schedule) | 44 | $561.28 |
| 49082 | Physician and practitioner services (fee schedule) | 45 | $127.59 |
| 49083 | Physician and practitioner services (fee schedule) | 45 | $185.24 |
| 49084 | Physician and practitioner services (fee schedule) | 45 | $79.98 |
| 49180 | Physician and practitioner services (fee schedule) | 45 | $115.41 |
| 49185 | Physician and practitioner services (fee schedule) | 42 | $451.57 |
| 49186 | Physician and practitioner services (fee schedule) | 43 | $975.10 |
| 49187 | Physician and practitioner services (fee schedule) | 43 | $1,237.62 |
| 49188 | Physician and practitioner services (fee schedule) | 43 | $1,482.47 |
| 49189 | Physician and practitioner services (fee schedule) | 43 | $1,718.50 |
| 49190 | Physician and practitioner services (fee schedule) | 43 | $2,113.05 |
| 49203 | Physician and practitioner services (fee schedule) | 6 | $919.56 |
| 49204 | Physician and practitioner services (fee schedule) | 6 | $1,169.10 |
| 49205 | Physician and practitioner services (fee schedule) | 6 | $1,341.24 |
| 49215 | Physician and practitioner services (fee schedule) | 45 | $1,482.30 |
| 49250 | Physician and practitioner services (fee schedule) | 45 | $443.73 |
| 49255 | Physician and practitioner services (fee schedule) | 45 | $583.17 |
| 49320 | Physician and practitioner services (fee schedule) | 44 | $258.43 |
| 49321 | Physician and practitioner services (fee schedule) | 44 | $259.60 |
| 49322 | Physician and practitioner services (fee schedule) | 44 | $283.77 |
| 49323 | Physician and practitioner services (fee schedule) | 44 | $468.49 |
| 49324 | Physician and practitioner services (fee schedule) | 44 | $284.58 |
| 49325 | Physician and practitioner services (fee schedule) | 44 | $303.06 |
| 49326 | Physician and practitioner services (fee schedule) | 44 | $133.49 |
| 49327 | Physician and practitioner services (fee schedule) | 44 | $93.47 |
| 49329 | Physician and practitioner services (fee schedule) | 8 | $282.04 |
| 49400 | Physician and practitioner services (fee schedule) | 44 | $94.32 |
| 49402 | Physician and practitioner services (fee schedule) | 45 | $621.89 |
| 49405 | Physician and practitioner services (fee schedule) | 45 | $224.33 |
| 49406 | Physician and practitioner services (fee schedule) | 45 | $224.70 |
| 49407 | Physician and practitioner services (fee schedule) | 45 | $296.40 |
| 49411 | Physician and practitioner services (fee schedule) | 42 | $264.68 |
| 49412 | Physician and practitioner services (fee schedule) | 43 | $57.41 |
| 49418 | Physician and practitioner services (fee schedule) | 45 | $599.17 |
| 49419 | Physician and practitioner services (fee schedule) | 45 | $313.28 |
| 49421 | Physician and practitioner services (fee schedule) | 45 | $198.09 |
| 49422 | Physician and practitioner services (fee schedule) | 45 | $178.25 |
| 49423 | Physician and practitioner services (fee schedule) | 45 | $80.38 |
| 49424 | Physician and practitioner services (fee schedule) | 45 | $41.63 |
| 49425 | Physician and practitioner services (fee schedule) | 45 | $570.59 |
| 49426 | Physician and practitioner services (fee schedule) | 44 | $501.90 |
| 49427 | Physician and practitioner services (fee schedule) | 44 | $31.75 |
| 49428 | Physician and practitioner services (fee schedule) | 44 | $319.38 |
| 49429 | Physician and practitioner services (fee schedule) | 44 | $344.43 |
| 49435 | Physician and practitioner services (fee schedule) | 43 | $81.74 |
| 49436 | Physician and practitioner services (fee schedule) | 44 | $170.85 |
| 49440 | Physician and practitioner services (fee schedule) | 45 | $374.54 |
| 49441 | Physician and practitioner services (fee schedule) | 45 | $433.14 |
| 49442 | Physician and practitioner services (fee schedule) | 45 | $472.86 |
| 49446 | Physician and practitioner services (fee schedule) | 45 | $403.62 |
| 49450 | Physician and practitioner services (fee schedule) | 44 | $361.66 |
| 49451 | Physician and practitioner services (fee schedule) | 44 | $352.27 |
| 49452 | Physician and practitioner services (fee schedule) | 44 | $468.64 |
| 49460 | Physician and practitioner services (fee schedule) | 45 | $455.18 |
| 49465 | Physician and practitioner services (fee schedule) | 44 | $84.01 |
| 49491 | Physician and practitioner services (fee schedule) | 45 | $562.91 |
| 49492 | Physician and practitioner services (fee schedule) | 45 | $707.15 |
| 49495 | Physician and practitioner services (fee schedule) | 45 | $310.61 |
| 49496 | Physician and practitioner services (fee schedule) | 45 | $437.25 |
| 49500 | Physician and practitioner services (fee schedule) | 44 | $311.27 |
| 49501 | Physician and practitioner services (fee schedule) | 44 | $427.81 |
| 49505 | Physician and practitioner services (fee schedule) | 44 | $381.04 |
| 49507 | Physician and practitioner services (fee schedule) | 44 | $442.01 |
| 49520 | Physician and practitioner services (fee schedule) | 44 | $471.07 |
| 49521 | Physician and practitioner services (fee schedule) | 44 | $525.06 |
| 49525 | Physician and practitioner services (fee schedule) | 44 | $428.78 |
| 49540 | Physician and practitioner services (fee schedule) | 44 | $479.17 |
| 49550 | Physician and practitioner services (fee schedule) | 44 | $409.26 |
| 49553 | Physician and practitioner services (fee schedule) | 44 | $447.53 |
| 49555 | Physician and practitioner services (fee schedule) | 44 | $448.60 |
| 49557 | Physician and practitioner services (fee schedule) | 44 | $514.03 |
| 49560 | Physician and practitioner services (fee schedule) | 6 | $513.50 |
| 49561 | Physician and practitioner services (fee schedule) | 5 | $514.92 |
| 49565 | Physician and practitioner services (fee schedule) | 5 | $538.16 |
| 49566 | Physician and practitioner services (fee schedule) | 5 | $572.50 |
| 49568 | Physician and practitioner services (fee schedule) | 5 | $241.25 |
| 49570 | Physician and practitioner services (fee schedule) | 6 | $319.51 |
| 49572 | Physician and practitioner services (fee schedule) | 6 | $351.31 |
| 49580 | Physician and practitioner services (fee schedule) | 6 | $284.93 |
| 49582 | Physician and practitioner services (fee schedule) | 6 | $359.37 |
| 49585 | Physician and practitioner services (fee schedule) | 5 | $317.04 |
| 49587 | Physician and practitioner services (fee schedule) | 6 | $366.15 |
| 49591 | Physician and practitioner services (fee schedule) | 45 | $246.61 |
| 49592 | Physician and practitioner services (fee schedule) | 45 | $339.98 |
| 49593 | Physician and practitioner services (fee schedule) | 45 | $408.25 |
| 49594 | Physician and practitioner services (fee schedule) | 45 | $529.80 |
| 49595 | Physician and practitioner services (fee schedule) | 45 | $548.33 |
| 49596 | Physician and practitioner services (fee schedule) | 45 | $727.12 |
| 49600 | Physician and practitioner services (fee schedule) | 44 | $524.00 |
| 49605 | Physician and practitioner services (fee schedule) | 44 | $3,390.88 |
| 49606 | Physician and practitioner services (fee schedule) | 44 | $821.00 |
| 49610 | Physician and practitioner services (fee schedule) | 44 | $501.48 |
| 49611 | Physician and practitioner services (fee schedule) | 44 | $451.77 |
| 49613 | Physician and practitioner services (fee schedule) | 45 | $302.00 |
| 49614 | Physician and practitioner services (fee schedule) | 45 | $407.40 |
| 49615 | Physician and practitioner services (fee schedule) | 45 | $453.86 |
| 49616 | Physician and practitioner services (fee schedule) | 45 | $608.56 |
| 49617 | Physician and practitioner services (fee schedule) | 45 | $628.94 |
| 49618 | Physician and practitioner services (fee schedule) | 45 | $879.54 |
| 49621 | Physician and practitioner services (fee schedule) | 44 | $537.80 |
| 49622 | Physician and practitioner services (fee schedule) | 44 | $664.76 |
| 49623 | Physician and practitioner services (fee schedule) | 45 | $142.48 |
| 49650 | Physician and practitioner services (fee schedule) | 44 | $330.19 |
| 49651 | Physician and practitioner services (fee schedule) | 44 | $424.62 |
| 49659 | Physician and practitioner services (fee schedule) | 9 | $167.22 |
| 49900 | Physician and practitioner services (fee schedule) | 45 | $582.43 |
| 49904 | Physician and practitioner services (fee schedule) | 44 | $1,033.45 |
| 49905 | Physician and practitioner services (fee schedule) | 45 | $254.80 |
| 49906 | Physician and practitioner services (fee schedule) | 30 | $1,204.37 |
| 49999 | Physician and practitioner services (fee schedule) | 9 | $76.34 |
| 50010 | Physician and practitioner services (fee schedule) | 45 | $535.55 |
| 50020 | Physician and practitioner services (fee schedule) | 44 | $736.45 |
| 50040 | Physician and practitioner services (fee schedule) | 44 | $674.51 |
| 50045 | Physician and practitioner services (fee schedule) | 45 | $677.84 |
| 50060 | Physician and practitioner services (fee schedule) | 45 | $823.40 |
| 50065 | Physician and practitioner services (fee schedule) | 45 | $897.91 |
| 50070 | Physician and practitioner services (fee schedule) | 45 | $864.92 |
| 50075 | Physician and practitioner services (fee schedule) | 45 | $1,047.91 |
| 50080 | Physician and practitioner services (fee schedule) | 45 | $558.94 |
| 50081 | Physician and practitioner services (fee schedule) | 45 | $851.84 |
| 50100 | Physician and practitioner services (fee schedule) | 44 | $776.71 |
| 50120 | Physician and practitioner services (fee schedule) | 45 | $692.56 |
| 50125 | Physician and practitioner services (fee schedule) | 44 | $716.23 |
| 50130 | Physician and practitioner services (fee schedule) | 44 | $770.55 |
| 50135 | Physician and practitioner services (fee schedule) | 5 | $954.40 |
| 50200 | Physician and practitioner services (fee schedule) | 45 | $152.52 |
| 50205 | Physician and practitioner services (fee schedule) | 45 | $554.61 |
| 50220 | Physician and practitioner services (fee schedule) | 45 | $811.17 |
| 50225 | Physician and practitioner services (fee schedule) | 44 | $898.86 |
| 50230 | Physician and practitioner services (fee schedule) | 44 | $985.53 |
| 50234 | Physician and practitioner services (fee schedule) | 45 | $935.98 |
| 50236 | Physician and practitioner services (fee schedule) | 43 | $1,060.06 |
| 50240 | Physician and practitioner services (fee schedule) | 44 | $966.55 |
| 50250 | Physician and practitioner services (fee schedule) | 43 | $862.75 |
| 50280 | Physician and practitioner services (fee schedule) | 45 | $690.58 |
| 50290 | Physician and practitioner services (fee schedule) | 45 | $658.85 |
| 50300 | Physician and practitioner services (fee schedule) | 24 | $590.08 |
| 50320 | Physician and practitioner services (fee schedule) | 40 | $1,143.79 |
| 50323 | Physician and practitioner services (fee schedule) | 24 | $159.91 |
| 50325 | Physician and practitioner services (fee schedule) | 22 | $127.40 |
| 50327 | Physician and practitioner services (fee schedule) | 30 | $150.95 |
| 50328 | Physician and practitioner services (fee schedule) | 30 | $131.83 |
| 50329 | Physician and practitioner services (fee schedule) | 29 | $126.12 |
| 50340 | Physician and practitioner services (fee schedule) | 43 | $730.04 |
| 50360 | Physician and practitioner services (fee schedule) | 44 | $1,775.34 |
| 50365 | Physician and practitioner services (fee schedule) | 44 | $2,099.67 |
| 50370 | Physician and practitioner services (fee schedule) | 44 | $903.61 |
| 50380 | Physician and practitioner services (fee schedule) | 41 | $1,511.95 |
| 50382 | Physician and practitioner services (fee schedule) | 44 | $630.77 |
| 50384 | Physician and practitioner services (fee schedule) | 44 | $593.57 |
| 50385 | Physician and practitioner services (fee schedule) | 44 | $659.00 |
| 50386 | Physician and practitioner services (fee schedule) | 43 | $504.24 |
| 50387 | Physician and practitioner services (fee schedule) | 44 | $334.32 |
| 50389 | Physician and practitioner services (fee schedule) | 44 | $277.70 |
| 50390 | Physician and practitioner services (fee schedule) | 45 | $73.69 |
| 50391 | Physician and practitioner services (fee schedule) | 44 | $94.88 |
| 50396 | Physician and practitioner services (fee schedule) | 45 | $82.06 |
| 50400 | Physician and practitioner services (fee schedule) | 45 | $843.57 |
| 50405 | Physician and practitioner services (fee schedule) | 45 | $1,017.70 |
| 50430 | Physician and practitioner services (fee schedule) | 44 | $373.99 |
| 50431 | Physician and practitioner services (fee schedule) | 44 | $124.32 |
| 50432 | Physician and practitioner services (fee schedule) | 44 | $534.15 |
| 50433 | Physician and practitioner services (fee schedule) | 44 | $666.61 |
| 50434 | Physician and practitioner services (fee schedule) | 44 | $535.65 |
| 50435 | Physician and practitioner services (fee schedule) | 44 | $343.13 |
| 50436 | Physician and practitioner services (fee schedule) | 44 | $117.51 |
| 50437 | Physician and practitioner services (fee schedule) | 44 | $193.51 |
| 50500 | Physician and practitioner services (fee schedule) | 44 | $920.06 |
| 50520 | Physician and practitioner services (fee schedule) | 45 | $820.18 |
| 50525 | Physician and practitioner services (fee schedule) | 44 | $1,047.79 |
| 50526 | Physician and practitioner services (fee schedule) | 44 | $1,136.09 |
| 50540 | Physician and practitioner services (fee schedule) | 44 | $854.13 |
| 50541 | Physician and practitioner services (fee schedule) | 44 | $665.37 |
| 50542 | Physician and practitioner services (fee schedule) | 43 | $825.28 |
| 50543 | Physician and practitioner services (fee schedule) | 45 | $1,038.55 |
| 50544 | Physician and practitioner services (fee schedule) | 44 | $903.46 |
| 50545 | Physician and practitioner services (fee schedule) | 44 | $965.89 |
| 50546 | Physician and practitioner services (fee schedule) | 45 | $868.86 |
| 50547 | Physician and practitioner services (fee schedule) | 41 | $1,133.87 |
| 50548 | Physician and practitioner services (fee schedule) | 45 | $962.32 |
| 50549 | Physician and practitioner services (fee schedule) | 6 | $367.56 |
| 50551 | Physician and practitioner services (fee schedule) | 45 | $263.76 |
| 50553 | Physician and practitioner services (fee schedule) | 45 | $281.58 |
| 50555 | Physician and practitioner services (fee schedule) | 45 | $321.59 |
| 50557 | Physician and practitioner services (fee schedule) | 45 | $325.74 |
| 50561 | Physician and practitioner services (fee schedule) | 45 | $368.71 |
| 50562 | Physician and practitioner services (fee schedule) | 43 | $415.04 |
| 50570 | Physician and practitioner services (fee schedule) | 45 | $347.12 |
| 50572 | Physician and practitioner services (fee schedule) | 45 | $382.38 |
| 50574 | Physician and practitioner services (fee schedule) | 44 | $414.42 |
| 50575 | Physician and practitioner services (fee schedule) | 44 | $560.71 |
| 50576 | Physician and practitioner services (fee schedule) | 45 | $405.74 |
| 50580 | Physician and practitioner services (fee schedule) | 45 | $436.88 |
| 50590 | Physician and practitioner services (fee schedule) | 45 | $577.02 |
| 50592 | Physician and practitioner services (fee schedule) | 44 | $1,240.44 |
| 50593 | Physician and practitioner services (fee schedule) | 42 | $1,264.43 |
| 50600 | Physician and practitioner services (fee schedule) | 45 | $681.66 |
| 50605 | Physician and practitioner services (fee schedule) | 45 | $731.92 |
| 50606 | Physician and practitioner services (fee schedule) | 44 | $290.88 |
| 50610 | Physician and practitioner services (fee schedule) | 44 | $700.79 |
| 50620 | Physician and practitioner services (fee schedule) | 44 | $667.27 |
| 50630 | Physician and practitioner services (fee schedule) | 45 | $653.24 |
| 50650 | Physician and practitioner services (fee schedule) | 44 | $752.17 |
| 50660 | Physician and practitioner services (fee schedule) | 44 | $831.40 |
| 50684 | Physician and practitioner services (fee schedule) | 45 | $81.79 |
| 50686 | Physician and practitioner services (fee schedule) | 44 | $96.22 |
| 50688 | Physician and practitioner services (fee schedule) | 44 | $60.12 |
| 50690 | Physician and practitioner services (fee schedule) | 45 | $73.48 |
| 50693 | Physician and practitioner services (fee schedule) | 44 | $586.43 |
| 50694 | Physician and practitioner services (fee schedule) | 44 | $657.91 |
| 50695 | Physician and practitioner services (fee schedule) | 44 | $790.06 |
| 50700 | Physician and practitioner services (fee schedule) | 44 | $677.54 |
| 50705 | Physician and practitioner services (fee schedule) | 42 | $1,076.83 |
| 50706 | Physician and practitioner services (fee schedule) | 44 | $492.21 |
| 50715 | Physician and practitioner services (fee schedule) | 45 | $881.44 |
| 50722 | Physician and practitioner services (fee schedule) | 44 | $741.99 |
| 50725 | Physician and practitioner services (fee schedule) | 44 | $821.30 |
| 50727 | Physician and practitioner services (fee schedule) | 44 | $383.55 |
| 50728 | Physician and practitioner services (fee schedule) | 45 | $518.37 |
| 50740 | Physician and practitioner services (fee schedule) | 44 | $897.39 |
| 50750 | Physician and practitioner services (fee schedule) | 44 | $888.71 |
| 50760 | Physician and practitioner services (fee schedule) | 44 | $868.64 |
| 50770 | Physician and practitioner services (fee schedule) | 44 | $858.41 |
| 50780 | Physician and practitioner services (fee schedule) | 45 | $852.14 |
| 50782 | Physician and practitioner services (fee schedule) | 44 | $801.39 |
| 50783 | Physician and practitioner services (fee schedule) | 44 | $869.35 |
| 50785 | Physician and practitioner services (fee schedule) | 44 | $925.70 |
| 50800 | Physician and practitioner services (fee schedule) | 44 | $701.80 |
| 50810 | Physician and practitioner services (fee schedule) | 44 | $1,014.02 |
| 50815 | Physician and practitioner services (fee schedule) | 44 | $913.15 |
| 50820 | Physician and practitioner services (fee schedule) | 45 | $959.28 |
| 50825 | Physician and practitioner services (fee schedule) | 44 | $1,192.85 |
| 50830 | Physician and practitioner services (fee schedule) | 43 | $1,294.67 |
| 50840 | Physician and practitioner services (fee schedule) | 44 | $897.86 |
| 50845 | Physician and practitioner services (fee schedule) | 43 | $939.38 |
| 50860 | Physician and practitioner services (fee schedule) | 45 | $690.30 |
| 50900 | Physician and practitioner services (fee schedule) | 44 | $631.57 |
| 50920 | Physician and practitioner services (fee schedule) | 45 | $645.58 |
| 50930 | Physician and practitioner services (fee schedule) | 44 | $802.35 |
| 50940 | Physician and practitioner services (fee schedule) | 44 | $660.25 |
| 50945 | Physician and practitioner services (fee schedule) | 44 | $703.21 |
| 50947 | Physician and practitioner services (fee schedule) | 44 | $1,028.54 |
| 50948 | Physician and practitioner services (fee schedule) | 44 | $944.46 |
| 50949 | Physician and practitioner services (fee schedule) | 7 | $842.49 |
| 50951 | Physician and practitioner services (fee schedule) | 45 | $276.07 |
| 50953 | Physician and practitioner services (fee schedule) | 45 | $294.26 |
| 50955 | Physician and practitioner services (fee schedule) | 45 | $325.00 |
| 50957 | Physician and practitioner services (fee schedule) | 45 | $323.63 |
| 50961 | Physician and practitioner services (fee schedule) | 45 | $297.93 |
| 50970 | Physician and practitioner services (fee schedule) | 45 | $277.58 |
| 50972 | Physician and practitioner services (fee schedule) | 44 | $254.06 |
| 50974 | Physician and practitioner services (fee schedule) | 45 | $340.55 |
| 50976 | Physician and practitioner services (fee schedule) | 45 | $335.50 |
| 50980 | Physician and practitioner services (fee schedule) | 45 | $266.72 |
| 51020 | Physician and practitioner services (fee schedule) | 43 | $371.96 |
| 51030 | Physician and practitioner services (fee schedule) | 6 | $421.57 |
| 51040 | Physician and practitioner services (fee schedule) | 44 | $229.53 |
| 51045 | Physician and practitioner services (fee schedule) | 45 | $369.73 |
| 51050 | Physician and practitioner services (fee schedule) | 44 | $364.04 |
| 51060 | Physician and practitioner services (fee schedule) | 44 | $452.57 |
| 51065 | Physician and practitioner services (fee schedule) | 45 | $446.70 |
| 51080 | Physician and practitioner services (fee schedule) | 44 | $307.35 |
| 51100 | Physician and practitioner services (fee schedule) | 45 | $45.29 |
| 51101 | Physician and practitioner services (fee schedule) | 45 | $88.22 |
| 51102 | Physician and practitioner services (fee schedule) | 45 | $168.78 |
| 51500 | Physician and practitioner services (fee schedule) | 44 | $476.96 |
| 51520 | Physician and practitioner services (fee schedule) | 44 | $450.91 |
| 51525 | Physician and practitioner services (fee schedule) | 44 | $642.70 |
| 51530 | Physician and practitioner services (fee schedule) | 45 | $565.77 |
| 51535 | Physician and practitioner services (fee schedule) | 44 | $572.48 |
| 51550 | Physician and practitioner services (fee schedule) | 45 | $703.28 |
| 51555 | Physician and practitioner services (fee schedule) | 44 | $916.32 |
| 51565 | Physician and practitioner services (fee schedule) | 45 | $933.27 |
| 51570 | Physician and practitioner services (fee schedule) | 44 | $1,064.84 |
| 51575 | Physician and practitioner services (fee schedule) | 44 | $1,301.82 |
| 51580 | Physician and practitioner services (fee schedule) | 44 | $1,371.67 |
| 51585 | Physician and practitioner services (fee schedule) | 44 | $1,511.73 |
| 51590 | Physician and practitioner services (fee schedule) | 44 | $1,401.51 |
| 51595 | Physician and practitioner services (fee schedule) | 44 | $1,575.92 |
| 51596 | Physician and practitioner services (fee schedule) | 44 | $1,701.66 |
| 51597 | Physician and practitioner services (fee schedule) | 44 | $1,703.20 |
| 51600 | Physician and practitioner services (fee schedule) | 45 | $108.08 |
| 51605 | Physician and practitioner services (fee schedule) | 44 | $30.19 |
| 51610 | Physician and practitioner services (fee schedule) | 45 | $67.52 |
| 51700 | Physician and practitioner services (fee schedule) | 45 | $52.70 |
| 51701 | Physician and practitioner services (fee schedule) | 44 | $32.72 |
| 51702 | Physician and practitioner services (fee schedule) | 44 | $46.53 |
| 51703 | Physician and practitioner services (fee schedule) | 45 | $99.14 |
| 51705 | Physician and practitioner services (fee schedule) | 44 | $58.72 |
| 51710 | Physician and practitioner services (fee schedule) | 45 | $89.67 |
| 51715 | Physician and practitioner services (fee schedule) | 44 | $225.17 |
| 51720 | Physician and practitioner services (fee schedule) | 44 | $68.61 |
| 51721 | Physician and practitioner services (fee schedule) | 24 | $325.25 |
| 51725 | Physician and practitioner services (fee schedule) | 45 | $96.32 |
| 51726 | Physician and practitioner services (fee schedule) | 45 | $145.21 |
| 51727 | Physician and practitioner services (fee schedule) | 45 | $173.81 |
| 51728 | Physician and practitioner services (fee schedule) | 45 | $177.28 |
| 51729 | Physician and practitioner services (fee schedule) | 45 | $178.83 |
| 51736 | Physician and practitioner services (fee schedule) | 45 | $8.58 |
| 51741 | Physician and practitioner services (fee schedule) | 45 | $8.74 |
| 51784 | Physician and practitioner services (fee schedule) | 45 | $48.44 |
| 51785 | Physician and practitioner services (fee schedule) | 45 | $191.69 |
| 51792 | Physician and practitioner services (fee schedule) | 44 | $148.26 |
| 51797 | Physician and practitioner services (fee schedule) | 45 | $85.41 |
| 51798 | Physician and practitioner services (fee schedule) | 44 | $10.64 |
| 51800 | Physician and practitioner services (fee schedule) | 45 | $755.53 |
| 51820 | Physician and practitioner services (fee schedule) | 44 | $793.04 |
| 51840 | Physician and practitioner services (fee schedule) | 45 | $522.29 |
| 51841 | Physician and practitioner services (fee schedule) | 45 | $598.60 |
| 51845 | Physician and practitioner services (fee schedule) | 45 | $437.94 |
| 51860 | Physician and practitioner services (fee schedule) | 44 | $550.22 |
| 51865 | Physician and practitioner services (fee schedule) | 45 | $655.14 |
| 51880 | Physician and practitioner services (fee schedule) | 44 | $346.56 |
| 51900 | Physician and practitioner services (fee schedule) | 44 | $617.99 |
| 51920 | Physician and practitioner services (fee schedule) | 44 | $562.62 |
| 51925 | Physician and practitioner services (fee schedule) | 44 | $755.72 |
| 51940 | Physician and practitioner services (fee schedule) | 44 | $1,178.61 |
| 51960 | Physician and practitioner services (fee schedule) | 44 | $1,056.08 |
| 51980 | Physician and practitioner services (fee schedule) | 45 | $522.33 |
| 51990 | Physician and practitioner services (fee schedule) | 44 | $544.54 |
| 51992 | Physician and practitioner services (fee schedule) | 44 | $597.60 |
| 51999 | Physician and practitioner services (fee schedule) | 7 | $589.67 |
| 52000 | Physician and practitioner services (fee schedule) | 45 | $131.44 |
| 52001 | Physician and practitioner services (fee schedule) | 45 | $262.73 |
| 52005 | Physician and practitioner services (fee schedule) | 45 | $178.92 |
| 52007 | Physician and practitioner services (fee schedule) | 45 | $275.20 |
| 52010 | Physician and practitioner services (fee schedule) | 45 | $232.81 |
| 52204 | Physician and practitioner services (fee schedule) | 45 | $226.63 |
| 52214 | Physician and practitioner services (fee schedule) | 45 | $190.77 |
| 52224 | Physician and practitioner services (fee schedule) | 45 | $417.45 |
| 52234 | Physician and practitioner services (fee schedule) | 45 | $194.24 |
| 52235 | Physician and practitioner services (fee schedule) | 45 | $232.03 |
| 52240 | Physician and practitioner services (fee schedule) | 45 | $314.61 |
| 52250 | Physician and practitioner services (fee schedule) | 44 | $186.57 |
| 52260 | Physician and practitioner services (fee schedule) | 45 | $157.96 |
| 52265 | Physician and practitioner services (fee schedule) | 45 | $193.74 |
| 52270 | Physician and practitioner services (fee schedule) | 45 | $218.36 |
| 52275 | Physician and practitioner services (fee schedule) | 45 | $271.19 |
| 52276 | Physician and practitioner services (fee schedule) | 44 | $204.46 |
| 52277 | Physician and practitioner services (fee schedule) | 44 | $251.43 |
| 52281 | Physician and practitioner services (fee schedule) | 44 | $161.83 |
| 52282 | Physician and practitioner services (fee schedule) | 44 | $265.19 |
| 52283 | Physician and practitioner services (fee schedule) | 44 | $203.05 |
| 52284 | Physician and practitioner services (fee schedule) | 29 | $1,879.57 |
| 52285 | Physician and practitioner services (fee schedule) | 44 | $191.69 |
| 52287 | Physician and practitioner services (fee schedule) | 44 | $214.53 |
| 52290 | Physician and practitioner services (fee schedule) | 44 | $184.37 |
| 52300 | Physician and practitioner services (fee schedule) | 44 | $215.97 |
| 52301 | Physician and practitioner services (fee schedule) | 44 | $224.95 |
| 52305 | Physician and practitioner services (fee schedule) | 44 | $221.03 |
| 52310 | Physician and practitioner services (fee schedule) | 44 | $196.01 |
| 52315 | Physician and practitioner services (fee schedule) | 44 | $288.17 |
| 52317 | Physician and practitioner services (fee schedule) | 44 | $417.91 |
| 52318 | Physician and practitioner services (fee schedule) | 44 | $365.42 |
| 52320 | Physician and practitioner services (fee schedule) | 44 | $189.27 |
| 52325 | Physician and practitioner services (fee schedule) | 44 | $248.30 |
| 52327 | Physician and practitioner services (fee schedule) | 44 | $219.85 |
| 52330 | Physician and practitioner services (fee schedule) | 44 | $344.89 |
| 52332 | Physician and practitioner services (fee schedule) | 44 | $243.54 |
| 52334 | Physician and practitioner services (fee schedule) | 44 | $152.34 |
| 52341 | Physician and practitioner services (fee schedule) | 44 | $221.64 |
| 52342 | Physician and practitioner services (fee schedule) | 44 | $240.51 |
| 52343 | Physician and practitioner services (fee schedule) | 44 | $266.98 |
| 52344 | Physician and practitioner services (fee schedule) | 44 | $286.23 |
| 52345 | Physician and practitioner services (fee schedule) | 44 | $305.43 |
| 52346 | Physician and practitioner services (fee schedule) | 43 | $339.12 |
| 52351 | Physician and practitioner services (fee schedule) | 44 | $234.98 |
| 52352 | Physician and practitioner services (fee schedule) | 44 | $281.01 |
| 52353 | Physician and practitioner services (fee schedule) | 44 | $311.58 |
| 52354 | Physician and practitioner services (fee schedule) | 44 | $316.36 |
| 52355 | Physician and practitioner services (fee schedule) | 44 | $359.99 |
| 52356 | Physician and practitioner services (fee schedule) | 44 | $312.97 |
| 52400 | Physician and practitioner services (fee schedule) | 44 | $381.98 |
| 52402 | Physician and practitioner services (fee schedule) | 42 | $203.15 |
| 52441 | Physician and practitioner services (fee schedule) | 44 | $795.31 |
| 52442 | Physician and practitioner services (fee schedule) | 44 | $549.16 |
| 52443 | Physician and practitioner services (fee schedule) | 22 | $2,357.44 |
| 52450 | Physician and practitioner services (fee schedule) | 43 | $374.04 |
| 52500 | Physician and practitioner services (fee schedule) | 44 | $342.66 |
| 52597 | Physician and practitioner services (fee schedule) | 25 | $433.47 |
| 52601 | Physician and practitioner services (fee schedule) | 44 | $539.97 |
| 52630 | Physician and practitioner services (fee schedule) | 44 | $338.58 |
| 52640 | Physician and practitioner services (fee schedule) | 44 | $263.06 |
| 52647 | Physician and practitioner services (fee schedule) | 11 | $651.79 |
| 52648 | Physician and practitioner services (fee schedule) | 44 | $551.88 |
| 52649 | Physician and practitioner services (fee schedule) | 44 | $596.41 |
| 52700 | Physician and practitioner services (fee schedule) | 44 | $334.01 |
| 53000 | Physician and practitioner services (fee schedule) | 44 | $116.91 |
| 53010 | Physician and practitioner services (fee schedule) | 44 | $232.39 |
| 53020 | Physician and practitioner services (fee schedule) | 44 | $74.33 |
| 53025 | Physician and practitioner services (fee schedule) | 44 | $53.19 |
| 53040 | Physician and practitioner services (fee schedule) | 44 | $291.69 |
| 53060 | Physician and practitioner services (fee schedule) | 44 | $140.58 |
| 53080 | Physician and practitioner services (fee schedule) | 44 | $315.83 |
| 53085 | Physician and practitioner services (fee schedule) | 43 | $480.87 |
| 53200 | Physician and practitioner services (fee schedule) | 44 | $120.36 |
| 53210 | Physician and practitioner services (fee schedule) | 44 | $540.57 |
| 53215 | Physician and practitioner services (fee schedule) | 44 | $674.59 |
| 53220 | Physician and practitioner services (fee schedule) | 44 | $344.30 |
| 53230 | Physician and practitioner services (fee schedule) | 44 | $458.50 |
| 53235 | Physician and practitioner services (fee schedule) | 44 | $467.05 |
| 53240 | Physician and practitioner services (fee schedule) | 44 | $317.92 |
| 53250 | Physician and practitioner services (fee schedule) | 44 | $297.95 |
| 53260 | Physician and practitioner services (fee schedule) | 44 | $148.13 |
| 53265 | Physician and practitioner services (fee schedule) | 44 | $156.42 |
| 53270 | Physician and practitioner services (fee schedule) | 44 | $149.15 |
| 53275 | Physician and practitioner services (fee schedule) | 44 | $197.97 |
| 53400 | Physician and practitioner services (fee schedule) | 44 | $573.98 |
| 53405 | Physician and practitioner services (fee schedule) | 44 | $637.70 |
| 53410 | Physician and practitioner services (fee schedule) | 44 | $708.85 |
| 53415 | Physician and practitioner services (fee schedule) | 44 | $835.01 |
| 53420 | Physician and practitioner services (fee schedule) | 44 | $644.98 |
| 53425 | Physician and practitioner services (fee schedule) | 44 | $679.76 |
| 53430 | Physician and practitioner services (fee schedule) | 44 | $690.40 |
| 53431 | Physician and practitioner services (fee schedule) | 44 | $834.09 |
| 53440 | Physician and practitioner services (fee schedule) | 44 | $579.75 |
| 53442 | Physician and practitioner services (fee schedule) | 43 | $513.62 |
| 53444 | Physician and practitioner services (fee schedule) | 43 | $578.88 |
| 53445 | Physician and practitioner services (fee schedule) | 43 | $581.22 |
| 53446 | Physician and practitioner services (fee schedule) | 44 | $498.82 |
| 53447 | Physician and practitioner services (fee schedule) | 44 | $593.62 |
| 53448 | Physician and practitioner services (fee schedule) | 44 | $929.63 |
| 53449 | Physician and practitioner services (fee schedule) | 40 | $454.49 |
| 53450 | Physician and practitioner services (fee schedule) | 44 | $304.55 |
| 53451 | Physician and practitioner services (fee schedule) | 5 | $189.52 |
| 53452 | Physician and practitioner services (fee schedule) | 5 | $154.91 |
| 53453 | Physician and practitioner services (fee schedule) | 5 | $35.00 |
| 53454 | Physician and practitioner services (fee schedule) | 6 | $40.08 |
| 53460 | Physician and practitioner services (fee schedule) | 44 | $339.20 |
| 53500 | Physician and practitioner services (fee schedule) | 44 | $536.35 |
| 53502 | Physician and practitioner services (fee schedule) | 43 | $360.28 |
| 53505 | Physician and practitioner services (fee schedule) | 44 | $363.23 |
| 53510 | Physician and practitioner services (fee schedule) | 44 | $467.91 |
| 53515 | Physician and practitioner services (fee schedule) | 44 | $583.68 |
| 53520 | Physician and practitioner services (fee schedule) | 44 | $413.34 |
| 53600 | Physician and practitioner services (fee schedule) | 44 | $60.18 |
| 53601 | Physician and practitioner services (fee schedule) | 44 | $56.13 |
| 53605 | Physician and practitioner services (fee schedule) | 44 | $47.98 |
| 53620 | Physician and practitioner services (fee schedule) | 44 | $101.43 |
| 53621 | Physician and practitioner services (fee schedule) | 44 | $79.53 |
| 53660 | Physician and practitioner services (fee schedule) | 44 | $46.76 |
| 53661 | Physician and practitioner services (fee schedule) | 44 | $45.75 |
| 53665 | Physician and practitioner services (fee schedule) | 44 | $29.06 |
| 53850 | Physician and practitioner services (fee schedule) | 44 | $942.72 |
| 53852 | Physician and practitioner services (fee schedule) | 43 | $890.55 |
| 53854 | Physician and practitioner services (fee schedule) | 34 | $1,224.89 |
| 53855 | Physician and practitioner services (fee schedule) | 39 | $392.09 |
| 53860 | Physician and practitioner services (fee schedule) | 33 | $1,091.13 |
| 53865 | Physician and practitioner services (fee schedule) | 25 | $1,968.33 |
| 53866 | Physician and practitioner services (fee schedule) | 24 | $98.69 |
| 53899 | Physician and practitioner services (fee schedule) | 6 | $54.77 |
| 54000 | Physician and practitioner services (fee schedule) | 43 | $113.02 |
| 54001 | Physician and practitioner services (fee schedule) | 44 | $138.30 |
| 54015 | Physician and practitioner services (fee schedule) | 44 | $224.95 |
| 54050 | Physician and practitioner services (fee schedule) | 45 | $97.84 |
| 54055 | Physician and practitioner services (fee schedule) | 44 | $94.49 |
| 54056 | Physician and practitioner services (fee schedule) | 45 | $97.77 |
| 54057 | Physician and practitioner services (fee schedule) | 44 | $96.57 |
| 54060 | Physician and practitioner services (fee schedule) | 44 | $131.58 |
| 54065 | Physician and practitioner services (fee schedule) | 44 | $163.16 |
| 54100 | Physician and practitioner services (fee schedule) | 44 | $127.98 |
| 54105 | Physician and practitioner services (fee schedule) | 44 | $196.07 |
| 54110 | Physician and practitioner services (fee schedule) | 44 | $461.25 |
| 54111 | Physician and practitioner services (fee schedule) | 43 | $586.26 |
| 54112 | Physician and practitioner services (fee schedule) | 44 | $692.64 |
| 54115 | Physician and practitioner services (fee schedule) | 42 | $345.14 |
| 54120 | Physician and practitioner services (fee schedule) | 44 | $465.60 |
| 54125 | Physician and practitioner services (fee schedule) | 44 | $603.43 |
| 54130 | Physician and practitioner services (fee schedule) | 44 | $869.54 |
| 54135 | Physician and practitioner services (fee schedule) | 44 | $1,122.10 |
| 54150 | Physician and practitioner services (fee schedule) | 41 | $102.67 |
| 54160 | Physician and practitioner services (fee schedule) | 40 | $147.52 |
| 54161 | Physician and practitioner services (fee schedule) | 44 | $155.82 |
| 54162 | Physician and practitioner services (fee schedule) | 44 | $189.80 |
| 54163 | Physician and practitioner services (fee schedule) | 44 | $173.09 |
| 54164 | Physician and practitioner services (fee schedule) | 43 | $152.00 |
| 54200 | Physician and practitioner services (fee schedule) | 44 | $80.49 |
| 54205 | Physician and practitioner services (fee schedule) | 43 | $393.77 |
| 54220 | Physician and practitioner services (fee schedule) | 44 | $141.72 |
| 54230 | Physician and practitioner services (fee schedule) | 39 | $72.99 |
| 54231 | Physician and practitioner services (fee schedule) | 37 | $103.62 |
| 54235 | Physician and practitioner services (fee schedule) | 36 | $61.81 |
| 54240 | Physician and practitioner services (fee schedule) | 33 | $52.36 |
| 54250 | Physician and practitioner services (fee schedule) | 31 | $85.44 |
| 54300 | Physician and practitioner services (fee schedule) | 44 | $477.06 |
| 54304 | Physician and practitioner services (fee schedule) | 44 | $570.21 |
| 54308 | Physician and practitioner services (fee schedule) | 44 | $527.66 |
| 54312 | Physician and practitioner services (fee schedule) | 44 | $611.69 |
| 54316 | Physician and practitioner services (fee schedule) | 44 | $726.34 |
| 54318 | Physician and practitioner services (fee schedule) | 44 | $531.23 |
| 54322 | Physician and practitioner services (fee schedule) | 44 | $582.67 |
| 54324 | Physician and practitioner services (fee schedule) | 44 | $707.57 |
| 54326 | Physician and practitioner services (fee schedule) | 44 | $689.43 |
| 54328 | Physician and practitioner services (fee schedule) | 44 | $716.69 |
| 54332 | Physician and practitioner services (fee schedule) | 44 | $737.55 |
| 54336 | Physician and practitioner services (fee schedule) | 44 | $908.28 |
| 54340 | Physician and practitioner services (fee schedule) | 44 | $426.35 |
| 54344 | Physician and practitioner services (fee schedule) | 44 | $706.01 |
| 54348 | Physician and practitioner services (fee schedule) | 44 | $754.49 |
| 54352 | Physician and practitioner services (fee schedule) | 43 | $1,031.94 |
| 54360 | Physician and practitioner services (fee schedule) | 44 | $534.29 |
| 54380 | Physician and practitioner services (fee schedule) | 44 | $587.81 |
| 54385 | Physician and practitioner services (fee schedule) | 43 | $680.20 |
| 54390 | Physician and practitioner services (fee schedule) | 44 | $903.98 |
| 54400 | Physician and practitioner services (fee schedule) | 25 | $383.50 |
| 54401 | Physician and practitioner services (fee schedule) | 23 | $490.03 |
| 54405 | Physician and practitioner services (fee schedule) | 25 | $537.55 |
| 54406 | Physician and practitioner services (fee schedule) | 34 | $532.48 |
| 54408 | Physician and practitioner services (fee schedule) | 26 | $554.22 |
| 54410 | Physician and practitioner services (fee schedule) | 27 | $656.06 |
| 54411 | Physician and practitioner services (fee schedule) | 26 | $713.18 |
| 54415 | Physician and practitioner services (fee schedule) | 34 | $391.84 |
| 54416 | Physician and practitioner services (fee schedule) | 29 | $505.72 |
| 54417 | Physician and practitioner services (fee schedule) | 30 | $626.33 |
| 54420 | Physician and practitioner services (fee schedule) | 44 | $539.10 |
| 54430 | Physician and practitioner services (fee schedule) | 44 | $487.56 |
| 54435 | Physician and practitioner services (fee schedule) | 44 | $330.14 |
| 54437 | Physician and practitioner services (fee schedule) | 44 | $522.66 |
| 54438 | Physician and practitioner services (fee schedule) | 5 | $1,147.21 |
| 54440 | Physician and practitioner services (fee schedule) | 38 | $467.25 |
| 54450 | Physician and practitioner services (fee schedule) | 43 | $52.80 |
| 54500 | Physician and practitioner services (fee schedule) | 44 | $56.45 |
| 54505 | Physician and practitioner services (fee schedule) | 44 | $159.89 |
| 54512 | Physician and practitioner services (fee schedule) | 44 | $411.38 |
| 54520 | Physician and practitioner services (fee schedule) | 44 | $262.81 |
| 54522 | Physician and practitioner services (fee schedule) | 44 | $436.14 |
| 54530 | Physician and practitioner services (fee schedule) | 44 | $402.04 |
| 54535 | Physician and practitioner services (fee schedule) | 44 | $558.63 |
| 54550 | Physician and practitioner services (fee schedule) | 44 | $368.20 |
| 54560 | Physician and practitioner services (fee schedule) | 44 | $506.74 |
| 54600 | Physician and practitioner services (fee schedule) | 44 | $352.53 |
| 54620 | Physician and practitioner services (fee schedule) | 44 | $235.23 |
| 54640 | Physician and practitioner services (fee schedule) | 44 | $349.28 |
| 54650 | Physician and practitioner services (fee schedule) | 44 | $531.11 |
| 54660 | Physician and practitioner services (fee schedule) | 34 | $279.33 |
| 54670 | Physician and practitioner services (fee schedule) | 44 | $313.29 |
| 54680 | Physician and practitioner services (fee schedule) | 43 | $574.68 |
| 54690 | Physician and practitioner services (fee schedule) | 44 | $481.86 |
| 54692 | Physician and practitioner services (fee schedule) | 44 | $580.62 |
| 54699 | Physician and practitioner services (fee schedule) | 5 | $35.00 |
| 54700 | Physician and practitioner services (fee schedule) | 44 | $165.08 |
| 54800 | Physician and practitioner services (fee schedule) | 44 | $96.79 |
| 54830 | Physician and practitioner services (fee schedule) | 44 | $287.61 |
| 54840 | Physician and practitioner services (fee schedule) | 44 | $257.54 |
| 54860 | Physician and practitioner services (fee schedule) | 44 | $329.26 |
| 54861 | Physician and practitioner services (fee schedule) | 44 | $447.74 |
| 54865 | Physician and practitioner services (fee schedule) | 44 | $272.68 |
| 54900 | Physician and practitioner services (fee schedule) | 27 | $588.78 |
| 54901 | Physician and practitioner services (fee schedule) | 28 | $781.52 |
| 55000 | Physician and practitioner services (fee schedule) | 44 | $84.09 |
| 55040 | Physician and practitioner services (fee schedule) | 44 | $269.51 |
| 55041 | Physician and practitioner services (fee schedule) | 44 | $404.91 |
| 55060 | Physician and practitioner services (fee schedule) | 44 | $292.69 |
| 55100 | Physician and practitioner services (fee schedule) | 44 | $162.73 |
| 55110 | Physician and practitioner services (fee schedule) | 43 | $302.42 |
| 55120 | Physician and practitioner services (fee schedule) | 44 | $265.72 |
| 55150 | Physician and practitioner services (fee schedule) | 44 | $366.48 |
| 55175 | Physician and practitioner services (fee schedule) | 43 | $289.88 |
| 55180 | Physician and practitioner services (fee schedule) | 43 | $526.00 |
| 55200 | Physician and practitioner services (fee schedule) | 38 | $253.55 |
| 55250 | Physician and practitioner services (fee schedule) | 44 | $262.43 |
| 55300 | Physician and practitioner services (fee schedule) | 35 | $135.34 |
| 55400 | Physician and practitioner services (fee schedule) | 14 | $352.93 |
| 55500 | Physician and practitioner services (fee schedule) | 44 | $307.58 |
| 55520 | Physician and practitioner services (fee schedule) | 44 | $323.05 |
| 55530 | Physician and practitioner services (fee schedule) | 44 | $279.88 |
| 55535 | Physician and practitioner services (fee schedule) | 44 | $320.06 |
| 55540 | Physician and practitioner services (fee schedule) | 44 | $416.53 |
| 55550 | Physician and practitioner services (fee schedule) | 44 | $319.26 |
| 55559 | Physician and practitioner services (fee schedule) | 8 | $177.98 |
| 55600 | Physician and practitioner services (fee schedule) | 43 | $327.36 |
| 55605 | Physician and practitioner services (fee schedule) | 42 | $399.00 |
| 55650 | Physician and practitioner services (fee schedule) | 44 | $536.11 |
| 55680 | Physician and practitioner services (fee schedule) | 44 | $279.43 |
| 55700 | Physician and practitioner services (fee schedule) | 11 | $137.87 |
| 55705 | Physician and practitioner services (fee schedule) | 44 | $198.05 |
| 55706 | Physician and practitioner services (fee schedule) | 42 | $212.32 |
| 55707 | Physician and practitioner services (fee schedule) | 38 | $223.31 |
| 55708 | Physician and practitioner services (fee schedule) | 37 | $267.53 |
| 55709 | Physician and practitioner services (fee schedule) | 38 | $377.56 |
| 55710 | Physician and practitioner services (fee schedule) | 38 | $423.45 |
| 55711 | Physician and practitioner services (fee schedule) | 38 | $245.18 |
| 55712 | Physician and practitioner services (fee schedule) | 38 | $393.23 |
| 55713 | Physician and practitioner services (fee schedule) | 37 | $502.88 |
| 55714 | Physician and practitioner services (fee schedule) | 38 | $482.44 |
| 55715 | Physician and practitioner services (fee schedule) | 37 | $55.08 |
| 55720 | Physician and practitioner services (fee schedule) | 44 | $329.27 |
| 55725 | Physician and practitioner services (fee schedule) | 44 | $433.05 |
| 55801 | Physician and practitioner services (fee schedule) | 44 | $800.32 |
| 55810 | Physician and practitioner services (fee schedule) | 44 | $962.92 |
| 55812 | Physician and practitioner services (fee schedule) | 44 | $1,198.19 |
| 55815 | Physician and practitioner services (fee schedule) | 44 | $1,320.19 |
| 55821 | Physician and practitioner services (fee schedule) | 44 | $627.43 |
| 55831 | Physician and practitioner services (fee schedule) | 44 | $660.72 |
| 55840 | Physician and practitioner services (fee schedule) | 44 | $891.99 |
| 55842 | Physician and practitioner services (fee schedule) | 44 | $890.22 |
| 55845 | Physician and practitioner services (fee schedule) | 44 | $1,043.31 |
| 55860 | Physician and practitioner services (fee schedule) | 44 | $639.82 |
| 55862 | Physician and practitioner services (fee schedule) | 44 | $794.39 |
| 55865 | Physician and practitioner services (fee schedule) | 44 | $970.29 |
| 55866 | Physician and practitioner services (fee schedule) | 44 | $928.79 |
| 55867 | Physician and practitioner services (fee schedule) | 41 | $803.30 |
| 55868 | Physician and practitioner services (fee schedule) | 35 | $871.76 |
| 55869 | Physician and practitioner services (fee schedule) | 35 | $1,044.73 |
| 55870 | Physician and practitioner services (fee schedule) | 13 | $130.40 |
| 55873 | Physician and practitioner services (fee schedule) | 41 | $1,060.98 |
| 55874 | Physician and practitioner services (fee schedule) | 36 | $2,212.25 |
| 55875 | Physician and practitioner services (fee schedule) | 43 | $576.18 |
| 55876 | Physician and practitioner services (fee schedule) | 44 | $102.95 |
| 55877 | Physician and practitioner services (fee schedule) | 22 | $518.50 |
| 55880 | Physician and practitioner services (fee schedule) | 30 | $773.14 |
| 55881 | Physician and practitioner services (fee schedule) | 20 | $4,940.41 |
| 55882 | Physician and practitioner services (fee schedule) | 21 | $5,187.78 |
| 55899 | Physician and practitioner services (fee schedule) | 7 | $82.81 |
| 55920 | Physician and practitioner services (fee schedule) | 41 | $320.56 |
| 56405 | Physician and practitioner services (fee schedule) | 44 | $100.66 |
| 56420 | Physician and practitioner services (fee schedule) | 45 | $109.87 |
| 56440 | Physician and practitioner services (fee schedule) | 45 | $147.02 |
| 56441 | Physician and practitioner services (fee schedule) | 44 | $131.05 |
| 56442 | Physician and practitioner services (fee schedule) | 44 | $37.05 |
| 56501 | Physician and practitioner services (fee schedule) | 45 | $121.74 |
| 56515 | Physician and practitioner services (fee schedule) | 45 | $192.17 |
| 56605 | Physician and practitioner services (fee schedule) | 45 | $64.17 |
| 56606 | Physician and practitioner services (fee schedule) | 45 | $28.16 |
| 56620 | Physician and practitioner services (fee schedule) | 44 | $433.20 |
| 56625 | Physician and practitioner services (fee schedule) | 44 | $501.43 |
| 56630 | Physician and practitioner services (fee schedule) | 44 | $718.67 |
| 56631 | Physician and practitioner services (fee schedule) | 44 | $884.69 |
| 56632 | Physician and practitioner services (fee schedule) | 44 | $1,072.72 |
| 56633 | Physician and practitioner services (fee schedule) | 44 | $899.83 |
| 56634 | Physician and practitioner services (fee schedule) | 44 | $964.82 |
| 56637 | Physician and practitioner services (fee schedule) | 44 | $1,117.98 |
| 56640 | Physician and practitioner services (fee schedule) | 44 | $1,128.81 |
| 56700 | Physician and practitioner services (fee schedule) | 44 | $142.98 |
| 56740 | Physician and practitioner services (fee schedule) | 44 | $239.12 |
| 56800 | Physician and practitioner services (fee schedule) | 43 | $184.85 |
| 56805 | Physician and practitioner services (fee schedule) | 40 | $817.70 |
| 56810 | Physician and practitioner services (fee schedule) | 44 | $200.45 |
| 56820 | Physician and practitioner services (fee schedule) | 45 | $86.09 |
| 56821 | Physician and practitioner services (fee schedule) | 45 | $114.28 |
| 57000 | Physician and practitioner services (fee schedule) | 44 | $154.97 |
| 57010 | Physician and practitioner services (fee schedule) | 44 | $325.98 |
| 57020 | Physician and practitioner services (fee schedule) | 44 | $76.68 |
| 57022 | Physician and practitioner services (fee schedule) | 43 | $132.00 |
| 57023 | Physician and practitioner services (fee schedule) | 43 | $236.50 |
| 57061 | Physician and practitioner services (fee schedule) | 45 | $107.16 |
| 57065 | Physician and practitioner services (fee schedule) | 45 | $181.13 |
| 57100 | Physician and practitioner services (fee schedule) | 44 | $67.40 |
| 57105 | Physician and practitioner services (fee schedule) | 44 | $120.60 |
| 57106 | Physician and practitioner services (fee schedule) | 44 | $358.36 |
| 57107 | Physician and practitioner services (fee schedule) | 43 | $1,044.84 |
| 57109 | Physician and practitioner services (fee schedule) | 43 | $1,263.78 |
| 57110 | Physician and practitioner services (fee schedule) | 44 | $644.97 |
| 57111 | Physician and practitioner services (fee schedule) | 44 | $1,258.43 |
| 57120 | Physician and practitioner services (fee schedule) | 44 | $391.71 |
| 57130 | Physician and practitioner services (fee schedule) | 44 | $157.14 |
| 57135 | Physician and practitioner services (fee schedule) | 44 | $170.39 |
| 57150 | Physician and practitioner services (fee schedule) | 43 | $31.68 |
| 57155 | Physician and practitioner services (fee schedule) | 44 | $301.26 |
| 57156 | Physician and practitioner services (fee schedule) | 44 | $138.62 |
| 57160 | Physician and practitioner services (fee schedule) | 45 | $44.94 |
| 57170 | Physician and practitioner services (fee schedule) | 42 | $50.24 |
| 57180 | Physician and practitioner services (fee schedule) | 44 | $119.20 |
| 57200 | Physician and practitioner services (fee schedule) | 44 | $230.43 |
| 57210 | Physician and practitioner services (fee schedule) | 44 | $276.86 |
| 57220 | Physician and practitioner services (fee schedule) | 44 | $252.39 |
| 57230 | Physician and practitioner services (fee schedule) | 44 | $298.61 |
| 57240 | Physician and practitioner services (fee schedule) | 44 | $427.91 |
| 57250 | Physician and practitioner services (fee schedule) | 44 | $420.72 |
| 57260 | Physician and practitioner services (fee schedule) | 44 | $536.08 |
| 57265 | Physician and practitioner services (fee schedule) | 44 | $614.25 |
| 57267 | Physician and practitioner services (fee schedule) | 44 | $187.74 |
| 57268 | Physician and practitioner services (fee schedule) | 44 | $381.38 |
| 57270 | Physician and practitioner services (fee schedule) | 44 | $576.16 |
| 57280 | Physician and practitioner services (fee schedule) | 44 | $686.01 |
| 57282 | Physician and practitioner services (fee schedule) | 44 | $483.46 |
| 57283 | Physician and practitioner services (fee schedule) | 44 | $508.77 |
| 57284 | Physician and practitioner services (fee schedule) | 44 | $612.35 |
| 57285 | Physician and practitioner services (fee schedule) | 44 | $491.72 |
| 57287 | Physician and practitioner services (fee schedule) | 44 | $536.58 |
| 57288 | Physician and practitioner services (fee schedule) | 44 | $577.28 |
| 57289 | Physician and practitioner services (fee schedule) | 44 | $550.50 |
| 57291 | Physician and practitioner services (fee schedule) | 39 | $406.88 |
| 57292 | Physician and practitioner services (fee schedule) | 40 | $591.38 |
| 57295 | Physician and practitioner services (fee schedule) | 43 | $362.94 |
| 57296 | Physician and practitioner services (fee schedule) | 43 | $674.40 |
| 57300 | Physician and practitioner services (fee schedule) | 44 | $454.51 |
| 57305 | Physician and practitioner services (fee schedule) | 44 | $704.23 |
| 57307 | Physician and practitioner services (fee schedule) | 44 | $773.94 |
| 57308 | Physician and practitioner services (fee schedule) | 44 | $506.62 |
| 57310 | Physician and practitioner services (fee schedule) | 44 | $368.26 |
| 57311 | Physician and practitioner services (fee schedule) | 43 | $406.25 |
| 57320 | Physician and practitioner services (fee schedule) | 44 | $425.94 |
| 57330 | Physician and practitioner services (fee schedule) | 44 | $575.05 |
| 57335 | Physician and practitioner services (fee schedule) | 38 | $826.98 |
| 57400 | Physician and practitioner services (fee schedule) | 44 | $101.37 |
| 57410 | Physician and practitioner services (fee schedule) | 44 | $81.85 |
| 57415 | Physician and practitioner services (fee schedule) | 44 | $125.27 |
| 57420 | Physician and practitioner services (fee schedule) | 45 | $92.52 |
| 57421 | Physician and practitioner services (fee schedule) | 45 | $122.38 |
| 57423 | Physician and practitioner services (fee schedule) | 44 | $669.96 |
| 57425 | Physician and practitioner services (fee schedule) | 44 | $679.33 |
| 57426 | Physician and practitioner services (fee schedule) | 43 | $618.87 |
| 57452 | Physician and practitioner services (fee schedule) | 45 | $87.11 |
| 57454 | Physician and practitioner services (fee schedule) | 45 | $120.73 |
| 57455 | Physician and practitioner services (fee schedule) | 45 | $110.50 |
| 57456 | Physician and practitioner services (fee schedule) | 45 | $104.42 |
| 57460 | Physician and practitioner services (fee schedule) | 45 | $197.03 |
| 57461 | Physician and practitioner services (fee schedule) | 45 | $234.85 |
| 57465 | Physician and practitioner services (fee schedule) | 34 | $39.25 |
| 57500 | Physician and practitioner services (fee schedule) | 45 | $94.55 |
| 57505 | Physician and practitioner services (fee schedule) | 45 | $98.59 |
| 57510 | Physician and practitioner services (fee schedule) | 44 | $107.83 |
| 57511 | Physician and practitioner services (fee schedule) | 45 | $130.54 |
| 57513 | Physician and practitioner services (fee schedule) | 44 | $134.16 |
| 57520 | Physician and practitioner services (fee schedule) | 43 | $268.73 |
| 57522 | Physician and practitioner services (fee schedule) | 44 | $231.89 |
| 57530 | Physician and practitioner services (fee schedule) | 44 | $275.31 |
| 57531 | Physician and practitioner services (fee schedule) | 44 | $1,274.32 |
| 57540 | Physician and practitioner services (fee schedule) | 44 | $572.09 |
| 57545 | Physician and practitioner services (fee schedule) | 44 | $584.63 |
| 57550 | Physician and practitioner services (fee schedule) | 44 | $323.99 |
| 57555 | Physician and practitioner services (fee schedule) | 44 | $462.74 |
| 57556 | Physician and practitioner services (fee schedule) | 44 | $444.07 |
| 57558 | Physician and practitioner services (fee schedule) | 44 | $113.65 |
| 57700 | Physician and practitioner services (fee schedule) | 44 | $256.44 |
| 57720 | Physician and practitioner services (fee schedule) | 44 | $251.66 |
| 57800 | Physician and practitioner services (fee schedule) | 45 | $51.24 |
| 58100 | Physician and practitioner services (fee schedule) | 45 | $66.18 |
| 58110 | Physician and practitioner services (fee schedule) | 45 | $38.73 |
| 58120 | Physician and practitioner services (fee schedule) | 43 | $216.70 |
| 58140 | Physician and practitioner services (fee schedule) | 44 | $667.67 |
| 58145 | Physician and practitioner services (fee schedule) | 44 | $421.66 |
| 58146 | Physician and practitioner services (fee schedule) | 44 | $815.46 |
| 58150 | Physician and practitioner services (fee schedule) | 43 | $753.93 |
| 58152 | Physician and practitioner services (fee schedule) | 43 | $879.93 |
| 58180 | Physician and practitioner services (fee schedule) | 42 | $702.27 |
| 58200 | Physician and practitioner services (fee schedule) | 43 | $995.78 |
| 58210 | Physician and practitioner services (fee schedule) | 43 | $1,330.10 |
| 58240 | Physician and practitioner services (fee schedule) | 43 | $2,082.58 |
| 58260 | Physician and practitioner services (fee schedule) | 43 | $627.58 |
| 58262 | Physician and practitioner services (fee schedule) | 43 | $690.76 |
| 58263 | Physician and practitioner services (fee schedule) | 43 | $740.33 |
| 58267 | Physician and practitioner services (fee schedule) | 43 | $797.50 |
| 58270 | Physician and practitioner services (fee schedule) | 43 | $672.68 |
| 58275 | Physician and practitioner services (fee schedule) | 43 | $737.29 |
| 58280 | Physician and practitioner services (fee schedule) | 43 | $758.60 |
| 58285 | Physician and practitioner services (fee schedule) | 43 | $1,005.92 |
| 58290 | Physician and practitioner services (fee schedule) | 44 | $806.62 |
| 58291 | Physician and practitioner services (fee schedule) | 44 | $871.10 |
| 58292 | Physician and practitioner services (fee schedule) | 44 | $917.31 |
| 58294 | Physician and practitioner services (fee schedule) | 44 | $846.19 |
| 58300 | Physician and practitioner services (fee schedule) | 45 | $71.25 |
| 58301 | Physician and practitioner services (fee schedule) | 45 | $75.19 |
| 58340 | Physician and practitioner services (fee schedule) | 41 | $126.76 |
| 58345 | Physician and practitioner services (fee schedule) | 22 | $221.20 |
| 58346 | Physician and practitioner services (fee schedule) | 42 | $347.19 |
| 58350 | Physician and practitioner services (fee schedule) | 26 | $85.20 |
| 58353 | Physician and practitioner services (fee schedule) | 44 | $525.09 |
| 58356 | Physician and practitioner services (fee schedule) | 43 | $760.74 |
| 58400 | Physician and practitioner services (fee schedule) | 42 | $343.39 |
| 58410 | Physician and practitioner services (fee schedule) | 41 | $577.29 |
| 58520 | Physician and practitioner services (fee schedule) | 44 | $568.21 |
| 58540 | Physician and practitioner services (fee schedule) | 41 | $643.97 |
| 58541 | Physician and practitioner services (fee schedule) | 44 | $545.66 |
| 58542 | Physician and practitioner services (fee schedule) | 44 | $618.56 |
| 58543 | Physician and practitioner services (fee schedule) | 43 | $624.93 |
| 58544 | Physician and practitioner services (fee schedule) | 43 | $675.34 |
| 58545 | Physician and practitioner services (fee schedule) | 44 | $642.41 |
| 58546 | Physician and practitioner services (fee schedule) | 44 | $788.45 |
| 58548 | Physician and practitioner services (fee schedule) | 44 | $1,352.35 |
| 58550 | Physician and practitioner services (fee schedule) | 43 | $661.43 |
| 58552 | Physician and practitioner services (fee schedule) | 44 | $698.82 |
| 58553 | Physician and practitioner services (fee schedule) | 44 | $807.09 |
| 58554 | Physician and practitioner services (fee schedule) | 44 | $924.36 |
| 58555 | Physician and practitioner services (fee schedule) | 44 | $171.79 |
| 58558 | Physician and practitioner services (fee schedule) | 44 | $287.63 |
| 58559 | Physician and practitioner services (fee schedule) | 44 | $227.90 |
| 58560 | Physician and practitioner services (fee schedule) | 43 | $244.99 |
| 58561 | Physician and practitioner services (fee schedule) | 44 | $292.62 |
| 58562 | Physician and practitioner services (fee schedule) | 45 | $254.11 |
| 58563 | Physician and practitioner services (fee schedule) | 44 | $1,088.16 |
| 58565 | Physician and practitioner services (fee schedule) | 37 | $1,040.17 |
| 58570 | Physician and practitioner services (fee schedule) | 43 | $620.84 |
| 58571 | Physician and practitioner services (fee schedule) | 43 | $692.38 |
| 58572 | Physician and practitioner services (fee schedule) | 43 | $792.16 |
| 58573 | Physician and practitioner services (fee schedule) | 43 | $904.24 |
| 58575 | Physician and practitioner services (fee schedule) | 44 | $1,490.61 |
| 58578 | Physician and practitioner services (fee schedule) | 7 | $485.61 |
| 58579 | Physician and practitioner services (fee schedule) | 7 | $35.00 |
| 58580 | Physician and practitioner services (fee schedule) | 38 | $1,912.88 |
| 58600 | Physician and practitioner services (fee schedule) | 43 | $271.75 |
| 58605 | Physician and practitioner services (fee schedule) | 43 | $240.42 |
| 58611 | Physician and practitioner services (fee schedule) | 42 | $54.07 |
| 58615 | Physician and practitioner services (fee schedule) | 43 | $198.93 |
| 58660 | Physician and practitioner services (fee schedule) | 44 | $497.98 |
| 58661 | Physician and practitioner services (fee schedule) | 44 | $488.28 |
| 58662 | Physician and practitioner services (fee schedule) | 44 | $513.60 |
| 58670 | Physician and practitioner services (fee schedule) | 44 | $289.06 |
| 58671 | Physician and practitioner services (fee schedule) | 43 | $287.90 |
| 58672 | Physician and practitioner services (fee schedule) | 24 | $562.90 |
| 58673 | Physician and practitioner services (fee schedule) | 38 | $586.35 |
| 58674 | Physician and practitioner services (fee schedule) | 41 | $639.59 |
| 58679 | Physician and practitioner services (fee schedule) | 7 | $138.80 |
| 58700 | Physician and practitioner services (fee schedule) | 43 | $542.44 |
| 58720 | Physician and practitioner services (fee schedule) | 43 | $557.73 |
| 58740 | Physician and practitioner services (fee schedule) | 42 | $626.44 |
| 58750 | Physician and practitioner services (fee schedule) | 13 | $564.51 |
| 58752 | Physician and practitioner services (fee schedule) | 15 | $639.58 |
| 58760 | Physician and practitioner services (fee schedule) | 18 | $589.51 |
| 58770 | Physician and practitioner services (fee schedule) | 34 | $600.14 |
| 58800 | Physician and practitioner services (fee schedule) | 44 | $257.76 |
| 58805 | Physician and practitioner services (fee schedule) | 44 | $328.90 |
| 58820 | Physician and practitioner services (fee schedule) | 44 | $234.55 |
| 58822 | Physician and practitioner services (fee schedule) | 44 | $489.16 |
| 58825 | Physician and practitioner services (fee schedule) | 42 | $495.15 |
| 58900 | Physician and practitioner services (fee schedule) | 44 | $320.67 |
| 58920 | Physician and practitioner services (fee schedule) | 44 | $498.15 |
| 58925 | Physician and practitioner services (fee schedule) | 44 | $556.19 |
| 58940 | Physician and practitioner services (fee schedule) | 43 | $418.93 |
| 58943 | Physician and practitioner services (fee schedule) | 44 | $898.91 |
| 58950 | Physician and practitioner services (fee schedule) | 44 | $833.49 |
| 58951 | Physician and practitioner services (fee schedule) | 44 | $1,051.83 |
| 58952 | Physician and practitioner services (fee schedule) | 44 | $1,200.28 |
| 58953 | Physician and practitioner services (fee schedule) | 44 | $1,462.08 |
| 58954 | Physician and practitioner services (fee schedule) | 44 | $1,583.59 |
| 58956 | Physician and practitioner services (fee schedule) | 44 | $1,006.04 |
| 58957 | Physician and practitioner services (fee schedule) | 5 | $1,181.19 |
| 58958 | Physician and practitioner services (fee schedule) | 43 | $1,161.09 |
| 58960 | Physician and practitioner services (fee schedule) | 44 | $729.47 |
| 58970 | Physician and practitioner services (fee schedule) | 5 | $179.73 |
| 58999 | Physician and practitioner services (fee schedule) | 9 | $128.48 |
| 59000 | Physician and practitioner services (fee schedule) | 44 | $79.35 |
| 59001 | Physician and practitioner services (fee schedule) | 44 | $140.60 |
| 59012 | Physician and practitioner services (fee schedule) | 43 | $161.12 |
| 59015 | Physician and practitioner services (fee schedule) | 43 | $119.37 |
| 59020 | Physician and practitioner services (fee schedule) | 44 | $34.87 |
| 59025 | Physician and practitioner services (fee schedule) | 45 | $27.38 |
| 59030 | Physician and practitioner services (fee schedule) | 42 | $85.57 |
| 59050 | Physician and practitioner services (fee schedule) | 36 | $41.19 |
| 59051 | Physician and practitioner services (fee schedule) | 35 | $34.36 |
| 59070 | Physician and practitioner services (fee schedule) | 41 | $284.77 |
| 59072 | Physician and practitioner services (fee schedule) | 35 | $356.42 |
| 59074 | Physician and practitioner services (fee schedule) | 42 | $272.23 |
| 59076 | Physician and practitioner services (fee schedule) | 43 | $356.42 |
| 59100 | Physician and practitioner services (fee schedule) | 44 | $610.70 |
| 59120 | Physician and practitioner services (fee schedule) | 44 | $600.48 |
| 59121 | Physician and practitioner services (fee schedule) | 44 | $574.34 |
| 59130 | Physician and practitioner services (fee schedule) | 44 | $695.14 |
| 59135 | Physician and practitioner services (fee schedule) | 5 | $696.15 |
| 59136 | Physician and practitioner services (fee schedule) | 44 | $661.41 |
| 59140 | Physician and practitioner services (fee schedule) | 43 | $297.94 |
| 59150 | Physician and practitioner services (fee schedule) | 44 | $551.33 |
| 59151 | Physician and practitioner services (fee schedule) | 44 | $537.86 |
| 59160 | Physician and practitioner services (fee schedule) | 44 | $179.58 |
| 59200 | Physician and practitioner services (fee schedule) | 40 | $68.16 |
| 59300 | Physician and practitioner services (fee schedule) | 45 | $143.78 |
| 59320 | Physician and practitioner services (fee schedule) | 44 | $121.91 |
| 59325 | Physician and practitioner services (fee schedule) | 44 | $193.08 |
| 59350 | Physician and practitioner services (fee schedule) | 44 | $218.95 |
| 59400 | Physician and practitioner services (fee schedule) | 37 | $1,972.60 |
| 59409 | Physician and practitioner services (fee schedule) | 45 | $697.16 |
| 59410 | Physician and practitioner services (fee schedule) | 44 | $900.50 |
| 59412 | Physician and practitioner services (fee schedule) | 41 | $83.24 |
| 59414 | Physician and practitioner services (fee schedule) | 44 | $79.19 |
| 59425 | Physician and practitioner services (fee schedule) | 35 | $415.64 |
| 59426 | Physician and practitioner services (fee schedule) | 35 | $763.32 |
| 59430 | Physician and practitioner services (fee schedule) | 42 | $174.31 |
| 59510 | Physician and practitioner services (fee schedule) | 36 | $1,989.41 |
| 59514 | Physician and practitioner services (fee schedule) | 44 | $711.21 |
| 59515 | Physician and practitioner services (fee schedule) | 44 | $1,043.82 |
| 59525 | Physician and practitioner services (fee schedule) | 43 | $355.01 |
| 59610 | Physician and practitioner services (fee schedule) | 36 | $2,018.48 |
| 59612 | Physician and practitioner services (fee schedule) | 44 | $766.26 |
| 59614 | Physician and practitioner services (fee schedule) | 42 | $935.33 |
| 59618 | Physician and practitioner services (fee schedule) | 35 | $2,090.00 |
| 59620 | Physician and practitioner services (fee schedule) | 43 | $771.34 |
| 59622 | Physician and practitioner services (fee schedule) | 42 | $1,066.54 |
| 59812 | Physician and practitioner services (fee schedule) | 44 | $271.26 |
| 59820 | Physician and practitioner services (fee schedule) | 44 | $327.16 |
| 59821 | Physician and practitioner services (fee schedule) | 44 | $322.41 |
| 59830 | Physician and practitioner services (fee schedule) | 44 | $345.69 |
| 59840 | Physician and practitioner services (fee schedule) | 45 | $191.04 |
| 59841 | Physician and practitioner services (fee schedule) | 45 | $326.93 |
| 59850 | Physician and practitioner services (fee schedule) | 45 | $292.51 |
| 59851 | Physician and practitioner services (fee schedule) | 44 | $315.50 |
| 59852 | Physician and practitioner services (fee schedule) | 43 | $421.26 |
| 59855 | Physician and practitioner services (fee schedule) | 44 | $316.89 |
| 59856 | Physician and practitioner services (fee schedule) | 44 | $389.96 |
| 59857 | Physician and practitioner services (fee schedule) | 43 | $441.70 |
| 59866 | Physician and practitioner services (fee schedule) | 23 | $165.99 |
| 59870 | Physician and practitioner services (fee schedule) | 44 | $368.10 |
| 59871 | Physician and practitioner services (fee schedule) | 43 | $105.38 |
| 59897 | Physician and practitioner services (fee schedule) | 5 | $35.00 |
| 59898 | Physician and practitioner services (fee schedule) | 5 | $130.00 |
| 59899 | Physician and practitioner services (fee schedule) | 9 | $140.00 |
| 60000 | Physician and practitioner services (fee schedule) | 45 | $126.19 |
| 60100 | Physician and practitioner services (fee schedule) | 45 | $73.43 |
| 60200 | Physician and practitioner services (fee schedule) | 44 | $486.88 |
| 60210 | Physician and practitioner services (fee schedule) | 44 | $531.54 |
| 60212 | Physician and practitioner services (fee schedule) | 44 | $747.28 |
| 60220 | Physician and practitioner services (fee schedule) | 44 | $538.70 |
| 60225 | Physician and practitioner services (fee schedule) | 44 | $678.22 |
| 60240 | Physician and practitioner services (fee schedule) | 45 | $692.84 |
| 60252 | Physician and practitioner services (fee schedule) | 44 | $935.14 |
| 60254 | Physician and practitioner services (fee schedule) | 44 | $1,174.34 |
| 60260 | Physician and practitioner services (fee schedule) | 44 | $745.70 |
| 60270 | Physician and practitioner services (fee schedule) | 44 | $962.10 |
| 60271 | Physician and practitioner services (fee schedule) | 45 | $753.11 |
| 60280 | Physician and practitioner services (fee schedule) | 44 | $342.50 |
| 60281 | Physician and practitioner services (fee schedule) | 44 | $429.09 |
| 60300 | Physician and practitioner services (fee schedule) | 43 | $64.36 |
| 60500 | Physician and practitioner services (fee schedule) | 44 | $730.62 |
| 60502 | Physician and practitioner services (fee schedule) | 45 | $935.63 |
| 60505 | Physician and practitioner services (fee schedule) | 44 | $968.30 |
| 60512 | Physician and practitioner services (fee schedule) | 45 | $175.92 |
| 60520 | Physician and practitioner services (fee schedule) | 44 | $770.28 |
| 60521 | Physician and practitioner services (fee schedule) | 45 | $850.53 |
| 60522 | Physician and practitioner services (fee schedule) | 44 | $1,036.68 |
| 60540 | Physician and practitioner services (fee schedule) | 45 | $809.39 |
| 60545 | Physician and practitioner services (fee schedule) | 44 | $919.65 |
| 60600 | Physician and practitioner services (fee schedule) | 44 | $958.11 |
| 60605 | Physician and practitioner services (fee schedule) | 44 | $1,160.01 |
| 60650 | Physician and practitioner services (fee schedule) | 44 | $861.67 |
| 60659 | Physician and practitioner services (fee schedule) | 7 | $130.00 |
| 60660 | Physician and practitioner services (fee schedule) | 31 | $1,715.97 |
| 60661 | Physician and practitioner services (fee schedule) | 32 | $278.09 |
| 60699 | Physician and practitioner services (fee schedule) | 7 | $40.00 |
| 61000 | Physician and practitioner services (fee schedule) | 45 | $88.63 |
| 61001 | Physician and practitioner services (fee schedule) | 44 | $81.86 |
| 61020 | Physician and practitioner services (fee schedule) | 45 | $85.36 |
| 61026 | Physician and practitioner services (fee schedule) | 45 | $91.94 |
| 61050 | Physician and practitioner services (fee schedule) | 45 | $64.15 |
| 61055 | Physician and practitioner services (fee schedule) | 45 | $95.79 |
| 61070 | Physician and practitioner services (fee schedule) | 45 | $45.37 |
| 61105 | Physician and practitioner services (fee schedule) | 45 | $374.14 |
| 61107 | Physician and practitioner services (fee schedule) | 45 | $249.13 |
| 61108 | Physician and practitioner services (fee schedule) | 45 | $705.48 |
| 61120 | Physician and practitioner services (fee schedule) | 45 | $545.64 |
| 61140 | Physician and practitioner services (fee schedule) | 45 | $942.39 |
| 61150 | Physician and practitioner services (fee schedule) | 44 | $1,031.86 |
| 61151 | Physician and practitioner services (fee schedule) | 45 | $745.42 |
| 61154 | Physician and practitioner services (fee schedule) | 45 | $957.70 |
| 61156 | Physician and practitioner services (fee schedule) | 45 | $920.86 |
| 61210 | Physician and practitioner services (fee schedule) | 45 | $284.49 |
| 61215 | Physician and practitioner services (fee schedule) | 45 | $422.96 |
| 61250 | Physician and practitioner services (fee schedule) | 44 | $640.09 |
| 61253 | Physician and practitioner services (fee schedule) | 44 | $740.14 |
| 61304 | Physician and practitioner services (fee schedule) | 44 | $1,222.21 |
| 61305 | Physician and practitioner services (fee schedule) | 44 | $1,510.43 |
| 61312 | Physician and practitioner services (fee schedule) | 44 | $1,511.53 |
| 61313 | Physician and practitioner services (fee schedule) | 44 | $1,462.75 |
| 61314 | Physician and practitioner services (fee schedule) | 44 | $1,359.07 |
| 61315 | Physician and practitioner services (fee schedule) | 44 | $1,532.63 |
| 61316 | Physician and practitioner services (fee schedule) | 44 | $65.66 |
| 61320 | Physician and practitioner services (fee schedule) | 45 | $1,378.39 |
| 61321 | Physician and practitioner services (fee schedule) | 44 | $1,564.97 |
| 61322 | Physician and practitioner services (fee schedule) | 44 | $1,677.09 |
| 61323 | Physician and practitioner services (fee schedule) | 44 | $1,709.87 |
| 61330 | Physician and practitioner services (fee schedule) | 44 | $1,289.24 |
| 61333 | Physician and practitioner services (fee schedule) | 44 | $1,473.95 |
| 61340 | Physician and practitioner services (fee schedule) | 44 | $1,069.23 |
| 61343 | Physician and practitioner services (fee schedule) | 44 | $1,629.07 |
| 61345 | Physician and practitioner services (fee schedule) | 44 | $1,498.24 |
| 61450 | Physician and practitioner services (fee schedule) | 44 | $1,405.11 |
| 61458 | Physician and practitioner services (fee schedule) | 44 | $1,492.30 |
| 61460 | Physician and practitioner services (fee schedule) | 44 | $1,550.67 |
| 61500 | Physician and practitioner services (fee schedule) | 45 | $967.77 |
| 61501 | Physician and practitioner services (fee schedule) | 44 | $856.49 |
| 61510 | Physician and practitioner services (fee schedule) | 44 | $1,625.98 |
| 61512 | Physician and practitioner services (fee schedule) | 44 | $1,873.16 |
| 61514 | Physician and practitioner services (fee schedule) | 44 | $1,423.01 |
| 61516 | Physician and practitioner services (fee schedule) | 44 | $1,386.72 |
| 61517 | Physician and practitioner services (fee schedule) | 45 | $62.73 |
| 61518 | Physician and practitioner services (fee schedule) | 44 | $2,034.97 |
| 61519 | Physician and practitioner services (fee schedule) | 44 | $2,133.96 |
| 61520 | Physician and practitioner services (fee schedule) | 44 | $2,665.83 |
| 61521 | Physician and practitioner services (fee schedule) | 44 | $2,291.28 |
| 61522 | Physician and practitioner services (fee schedule) | 44 | $1,599.74 |
| 61524 | Physician and practitioner services (fee schedule) | 44 | $1,541.11 |
| 61526 | Physician and practitioner services (fee schedule) | 44 | $2,352.56 |
| 61530 | Physician and practitioner services (fee schedule) | 43 | $2,239.43 |
| 61531 | Physician and practitioner services (fee schedule) | 44 | $956.56 |
| 61533 | Physician and practitioner services (fee schedule) | 45 | $1,130.73 |
| 61534 | Physician and practitioner services (fee schedule) | 44 | $1,167.03 |
| 61535 | Physician and practitioner services (fee schedule) | 44 | $713.10 |
| 61536 | Physician and practitioner services (fee schedule) | 44 | $1,870.72 |
| 61537 | Physician and practitioner services (fee schedule) | 44 | $1,730.08 |
| 61538 | Physician and practitioner services (fee schedule) | 44 | $1,864.17 |
| 61539 | Physician and practitioner services (fee schedule) | 44 | $1,694.60 |
| 61540 | Physician and practitioner services (fee schedule) | 44 | $1,592.24 |
| 61541 | Physician and practitioner services (fee schedule) | 44 | $1,582.53 |
| 61543 | Physician and practitioner services (fee schedule) | 44 | $1,590.14 |
| 61544 | Physician and practitioner services (fee schedule) | 44 | $1,410.12 |
| 61545 | Physician and practitioner services (fee schedule) | 44 | $2,314.83 |
| 61546 | Physician and practitioner services (fee schedule) | 44 | $1,683.28 |
| 61548 | Physician and practitioner services (fee schedule) | 44 | $1,192.07 |
| 61550 | Physician and practitioner services (fee schedule) | 44 | $898.14 |
| 61552 | Physician and practitioner services (fee schedule) | 44 | $1,105.25 |
| 61556 | Physician and practitioner services (fee schedule) | 44 | $1,260.97 |
| 61557 | Physician and practitioner services (fee schedule) | 44 | $1,271.29 |
| 61558 | Physician and practitioner services (fee schedule) | 44 | $1,392.01 |
| 61559 | Physician and practitioner services (fee schedule) | 44 | $1,780.42 |
| 61563 | Physician and practitioner services (fee schedule) | 43 | $1,395.53 |
| 61564 | Physician and practitioner services (fee schedule) | 43 | $1,748.23 |
| 61566 | Physician and practitioner services (fee schedule) | 44 | $1,612.50 |
| 61567 | Physician and practitioner services (fee schedule) | 44 | $1,833.04 |
| 61570 | Physician and practitioner services (fee schedule) | 44 | $1,378.44 |
| 61571 | Physician and practitioner services (fee schedule) | 44 | $1,462.63 |
| 61575 | Physician and practitioner services (fee schedule) | 45 | $1,835.17 |
| 61576 | Physician and practitioner services (fee schedule) | 44 | $2,929.55 |
| 61580 | Physician and practitioner services (fee schedule) | 44 | $1,777.17 |
| 61581 | Physician and practitioner services (fee schedule) | 44 | $1,916.08 |
| 61582 | Physician and practitioner services (fee schedule) | 44 | $2,124.40 |
| 61583 | Physician and practitioner services (fee schedule) | 44 | $2,141.83 |
| 61584 | Physician and practitioner services (fee schedule) | 44 | $2,102.84 |
| 61585 | Physician and practitioner services (fee schedule) | 44 | $2,263.78 |
| 61586 | Physician and practitioner services (fee schedule) | 44 | $1,797.07 |
| 61590 | Physician and practitioner services (fee schedule) | 44 | $2,118.28 |
| 61591 | Physician and practitioner services (fee schedule) | 44 | $2,182.45 |
| 61592 | Physician and practitioner services (fee schedule) | 44 | $2,281.86 |
| 61595 | Physician and practitioner services (fee schedule) | 44 | $1,706.46 |
| 61596 | Physician and practitioner services (fee schedule) | 44 | $1,722.83 |
| 61597 | Physician and practitioner services (fee schedule) | 44 | $2,124.08 |
| 61598 | Physician and practitioner services (fee schedule) | 44 | $1,969.33 |
| 61600 | Physician and practitioner services (fee schedule) | 44 | $1,472.47 |
| 61601 | Physician and practitioner services (fee schedule) | 44 | $1,695.92 |
| 61605 | Physician and practitioner services (fee schedule) | 44 | $1,510.22 |
| 61606 | Physician and practitioner services (fee schedule) | 44 | $2,098.66 |
| 61607 | Physician and practitioner services (fee schedule) | 44 | $1,965.26 |
| 61608 | Physician and practitioner services (fee schedule) | 44 | $2,378.72 |
| 61611 | Physician and practitioner services (fee schedule) | 45 | $332.57 |
| 61613 | Physician and practitioner services (fee schedule) | 44 | $2,355.84 |
| 61615 | Physician and practitioner services (fee schedule) | 44 | $1,933.42 |
| 61616 | Physician and practitioner services (fee schedule) | 44 | $2,352.08 |
| 61618 | Physician and practitioner services (fee schedule) | 45 | $932.17 |
| 61619 | Physician and practitioner services (fee schedule) | 43 | $1,172.46 |
| 61623 | Physician and practitioner services (fee schedule) | 44 | $432.19 |
| 61624 | Physician and practitioner services (fee schedule) | 45 | $894.20 |
| 61626 | Physician and practitioner services (fee schedule) | 45 | $818.39 |
| 61630 | Physician and practitioner services (fee schedule) | 29 | $1,000.98 |
| 61635 | Physician and practitioner services (fee schedule) | 31 | $1,133.37 |
| 61640 | Physician and practitioner services (fee schedule) | 19 | $426.35 |
| 61641 | Physician and practitioner services (fee schedule) | 18 | $150.26 |
| 61642 | Physician and practitioner services (fee schedule) | 18 | $300.52 |
| 61645 | Physician and practitioner services (fee schedule) | 42 | $639.76 |
| 61650 | Physician and practitioner services (fee schedule) | 43 | $434.62 |
| 61651 | Physician and practitioner services (fee schedule) | 43 | $185.45 |
| 61680 | Physician and practitioner services (fee schedule) | 44 | $1,677.48 |
| 61682 | Physician and practitioner services (fee schedule) | 44 | $2,975.00 |
| 61684 | Physician and practitioner services (fee schedule) | 44 | $2,077.29 |
| 61686 | Physician and practitioner services (fee schedule) | 44 | $3,201.78 |
| 61690 | Physician and practitioner services (fee schedule) | 44 | $1,626.51 |
| 61692 | Physician and practitioner services (fee schedule) | 44 | $2,644.57 |
| 61697 | Physician and practitioner services (fee schedule) | 44 | $3,048.41 |
| 61698 | Physician and practitioner services (fee schedule) | 44 | $3,295.43 |
| 61700 | Physician and practitioner services (fee schedule) | 44 | $2,444.06 |
| 61702 | Physician and practitioner services (fee schedule) | 44 | $2,853.04 |
| 61703 | Physician and practitioner services (fee schedule) | 44 | $1,010.29 |
| 61705 | Physician and practitioner services (fee schedule) | 44 | $1,905.72 |
| 61708 | Physician and practitioner services (fee schedule) | 44 | $1,768.75 |
| 61710 | Physician and practitioner services (fee schedule) | 45 | $1,575.26 |
| 61711 | Physician and practitioner services (fee schedule) | 43 | $1,870.67 |
| 61715 | Physician and practitioner services (fee schedule) | 30 | $922.75 |
| 61720 | Physician and practitioner services (fee schedule) | 45 | $1,023.81 |
| 61735 | Physician and practitioner services (fee schedule) | 45 | $1,183.67 |
| 61736 | Physician and practitioner services (fee schedule) | 33 | $828.84 |
| 61737 | Physician and practitioner services (fee schedule) | 34 | $999.71 |
| 61750 | Physician and practitioner services (fee schedule) | 45 | $1,058.23 |
| 61751 | Physician and practitioner services (fee schedule) | 45 | $1,067.82 |
| 61760 | Physician and practitioner services (fee schedule) | 45 | $1,186.04 |
| 61770 | Physician and practitioner services (fee schedule) | 44 | $1,203.49 |
| 61781 | Physician and practitioner services (fee schedule) | 44 | $179.40 |
| 61782 | Physician and practitioner services (fee schedule) | 42 | $126.12 |
| 61783 | Physician and practitioner services (fee schedule) | 41 | $179.69 |
| 61790 | Physician and practitioner services (fee schedule) | 45 | $695.51 |
| 61791 | Physician and practitioner services (fee schedule) | 43 | $863.13 |
| 61796 | Physician and practitioner services (fee schedule) | 43 | $685.44 |
| 61797 | Physician and practitioner services (fee schedule) | 43 | $156.55 |
| 61798 | Physician and practitioner services (fee schedule) | 43 | $896.17 |
| 61799 | Physician and practitioner services (fee schedule) | 43 | $216.41 |
| 61800 | Physician and practitioner services (fee schedule) | 43 | $111.26 |
| 61850 | Physician and practitioner services (fee schedule) | 42 | $737.91 |
| 61860 | Physician and practitioner services (fee schedule) | 41 | $1,166.34 |
| 61863 | Physician and practitioner services (fee schedule) | 42 | $1,069.88 |
| 61864 | Physician and practitioner services (fee schedule) | 42 | $208.29 |
| 61867 | Physician and practitioner services (fee schedule) | 43 | $1,601.00 |
| 61868 | Physician and practitioner services (fee schedule) | 43 | $356.53 |
| 61880 | Physician and practitioner services (fee schedule) | 44 | $447.84 |
| 61885 | Physician and practitioner services (fee schedule) | 45 | $433.56 |
| 61886 | Physician and practitioner services (fee schedule) | 45 | $672.71 |
| 61888 | Physician and practitioner services (fee schedule) | 45 | $313.22 |
| 61889 | Physician and practitioner services (fee schedule) | 37 | $1,083.65 |
| 61891 | Physician and practitioner services (fee schedule) | 37 | $510.57 |
| 61892 | Physician and practitioner services (fee schedule) | 37 | $701.59 |
| 62000 | Physician and practitioner services (fee schedule) | 45 | $776.16 |
| 62005 | Physician and practitioner services (fee schedule) | 44 | $945.81 |
| 62010 | Physician and practitioner services (fee schedule) | 44 | $1,152.36 |
| 62100 | Physician and practitioner services (fee schedule) | 44 | $1,155.02 |
| 62115 | Physician and practitioner services (fee schedule) | 43 | $1,201.57 |
| 62117 | Physician and practitioner services (fee schedule) | 43 | $1,420.62 |
| 62120 | Physician and practitioner services (fee schedule) | 44 | $1,525.40 |
| 62121 | Physician and practitioner services (fee schedule) | 44 | $1,156.53 |
| 62140 | Physician and practitioner services (fee schedule) | 45 | $759.73 |
| 62141 | Physician and practitioner services (fee schedule) | 45 | $867.63 |
| 62142 | Physician and practitioner services (fee schedule) | 45 | $683.08 |
| 62143 | Physician and practitioner services (fee schedule) | 44 | $784.18 |
| 62145 | Physician and practitioner services (fee schedule) | 44 | $1,038.87 |
| 62146 | Physician and practitioner services (fee schedule) | 44 | $933.79 |
| 62147 | Physician and practitioner services (fee schedule) | 44 | $1,053.64 |
| 62148 | Physician and practitioner services (fee schedule) | 44 | $91.68 |
| 62160 | Physician and practitioner services (fee schedule) | 44 | $143.39 |
| 62161 | Physician and practitioner services (fee schedule) | 45 | $1,076.74 |
| 62162 | Physician and practitioner services (fee schedule) | 45 | $1,350.99 |
| 62164 | Physician and practitioner services (fee schedule) | 45 | $1,468.97 |
| 62165 | Physician and practitioner services (fee schedule) | 45 | $1,094.13 |
| 62180 | Physician and practitioner services (fee schedule) | 45 | $1,181.23 |
| 62190 | Physician and practitioner services (fee schedule) | 44 | $732.34 |
| 62192 | Physician and practitioner services (fee schedule) | 44 | $760.97 |
| 62194 | Physician and practitioner services (fee schedule) | 45 | $368.96 |
| 62200 | Physician and practitioner services (fee schedule) | 44 | $1,022.16 |
| 62201 | Physician and practitioner services (fee schedule) | 45 | $948.27 |
| 62220 | Physician and practitioner services (fee schedule) | 45 | $754.11 |
| 62223 | Physician and practitioner services (fee schedule) | 45 | $779.71 |
| 62225 | Physician and practitioner services (fee schedule) | 45 | $405.96 |
| 62230 | Physician and practitioner services (fee schedule) | 44 | $631.51 |
| 62252 | Physician and practitioner services (fee schedule) | 44 | $42.49 |
| 62256 | Physician and practitioner services (fee schedule) | 45 | $458.40 |
| 62258 | Physician and practitioner services (fee schedule) | 44 | $843.73 |
| 62263 | Physician and practitioner services (fee schedule) | 43 | $329.88 |
| 62264 | Physician and practitioner services (fee schedule) | 44 | $301.81 |
| 62267 | Physician and practitioner services (fee schedule) | 45 | $151.74 |
| 62268 | Physician and practitioner services (fee schedule) | 43 | $261.08 |
| 62269 | Physician and practitioner services (fee schedule) | 44 | $207.68 |
| 62270 | Physician and practitioner services (fee schedule) | 45 | $103.29 |
| 62272 | Physician and practitioner services (fee schedule) | 45 | $94.52 |
| 62273 | Physician and practitioner services (fee schedule) | 45 | $108.47 |
| 62280 | Physician and practitioner services (fee schedule) | 45 | $161.26 |
| 62281 | Physician and practitioner services (fee schedule) | 45 | $163.72 |
| 62282 | Physician and practitioner services (fee schedule) | 45 | $149.37 |
| 62284 | Physician and practitioner services (fee schedule) | 45 | $106.56 |
| 62287 | Physician and practitioner services (fee schedule) | 43 | $444.46 |
| 62290 | Physician and practitioner services (fee schedule) | 44 | $170.28 |
| 62291 | Physician and practitioner services (fee schedule) | 44 | $151.99 |
| 62292 | Physician and practitioner services (fee schedule) | 41 | $431.12 |
| 62294 | Physician and practitioner services (fee schedule) | 45 | $647.88 |
| 62302 | Physician and practitioner services (fee schedule) | 45 | $149.23 |
| 62303 | Physician and practitioner services (fee schedule) | 45 | $134.43 |
| 62304 | Physician and practitioner services (fee schedule) | 44 | $151.48 |
| 62305 | Physician and practitioner services (fee schedule) | 44 | $165.10 |
| 62320 | Physician and practitioner services (fee schedule) | 45 | $110.90 |
| 62321 | Physician and practitioner services (fee schedule) | 45 | $162.10 |
| 62322 | Physician and practitioner services (fee schedule) | 45 | $92.87 |
| 62323 | Physician and practitioner services (fee schedule) | 45 | $159.53 |
| 62324 | Physician and practitioner services (fee schedule) | 45 | $97.98 |
| 62325 | Physician and practitioner services (fee schedule) | 45 | $153.53 |
| 62326 | Physician and practitioner services (fee schedule) | 45 | $97.77 |
| 62327 | Physician and practitioner services (fee schedule) | 45 | $160.17 |
| 62328 | Physician and practitioner services (fee schedule) | 45 | $137.39 |
| 62329 | Physician and practitioner services (fee schedule) | 45 | $174.45 |
| 62330 | Physician and practitioner services (fee schedule) | 22 | $367.98 |
| 62331 | Physician and practitioner services (fee schedule) | 22 | $147.35 |
| 62350 | Physician and practitioner services (fee schedule) | 45 | $313.09 |
| 62351 | Physician and practitioner services (fee schedule) | 44 | $652.96 |
| 62355 | Physician and practitioner services (fee schedule) | 45 | $233.21 |
| 62360 | Physician and practitioner services (fee schedule) | 45 | $224.36 |
| 62361 | Physician and practitioner services (fee schedule) | 45 | $336.23 |
| 62362 | Physician and practitioner services (fee schedule) | 45 | $313.97 |
| 62365 | Physician and practitioner services (fee schedule) | 45 | $246.79 |
| 62367 | Physician and practitioner services (fee schedule) | 43 | $25.33 |
| 62368 | Physician and practitioner services (fee schedule) | 45 | $35.20 |
| 62369 | Physician and practitioner services (fee schedule) | 45 | $64.42 |
| 62370 | Physician and practitioner services (fee schedule) | 45 | $64.90 |
| 62380 | Physician and practitioner services (fee schedule) | 17 | $583.97 |
| 63001 | Physician and practitioner services (fee schedule) | 44 | $933.78 |
| 63003 | Physician and practitioner services (fee schedule) | 44 | $938.91 |
| 63005 | Physician and practitioner services (fee schedule) | 44 | $926.42 |
| 63011 | Physician and practitioner services (fee schedule) | 44 | $796.98 |
| 63012 | Physician and practitioner services (fee schedule) | 44 | $904.32 |
| 63015 | Physician and practitioner services (fee schedule) | 44 | $1,119.06 |
| 63016 | Physician and practitioner services (fee schedule) | 44 | $1,130.30 |
| 63017 | Physician and practitioner services (fee schedule) | 44 | $963.98 |
| 63020 | Physician and practitioner services (fee schedule) | 43 | $835.36 |
| 63030 | Physician and practitioner services (fee schedule) | 44 | $727.65 |
| 63032 | Physician and practitioner services (fee schedule) | 24 | $103.76 |
| 63035 | Physician and practitioner services (fee schedule) | 43 | $171.37 |
| 63040 | Physician and practitioner services (fee schedule) | 44 | $1,063.71 |
| 63042 | Physician and practitioner services (fee schedule) | 43 | $1,018.19 |
| 63043 | Physician and practitioner services (fee schedule) | 37 | $239.52 |
| 63044 | Physician and practitioner services (fee schedule) | 38 | $235.48 |
| 63045 | Physician and practitioner services (fee schedule) | 45 | $970.89 |
| 63046 | Physician and practitioner services (fee schedule) | 45 | $921.15 |
| 63047 | Physician and practitioner services (fee schedule) | 45 | $860.78 |
| 63048 | Physician and practitioner services (fee schedule) | 44 | $157.37 |
| 63050 | Physician and practitioner services (fee schedule) | 45 | $1,074.95 |
| 63051 | Physician and practitioner services (fee schedule) | 45 | $1,224.82 |
| 63052 | Physician and practitioner services (fee schedule) | 43 | $201.09 |
| 63053 | Physician and practitioner services (fee schedule) | 43 | $165.89 |
| 63055 | Physician and practitioner services (fee schedule) | 45 | $1,242.09 |
| 63056 | Physician and practitioner services (fee schedule) | 45 | $1,104.09 |
| 63057 | Physician and practitioner services (fee schedule) | 44 | $235.20 |
| 63064 | Physician and practitioner services (fee schedule) | 44 | $1,305.28 |
| 63066 | Physician and practitioner services (fee schedule) | 43 | $150.99 |
| 63075 | Physician and practitioner services (fee schedule) | 44 | $1,004.80 |
| 63076 | Physician and practitioner services (fee schedule) | 44 | $186.45 |
| 63077 | Physician and practitioner services (fee schedule) | 45 | $1,117.45 |
| 63078 | Physician and practitioner services (fee schedule) | 44 | $159.26 |
| 63081 | Physician and practitioner services (fee schedule) | 44 | $1,288.68 |
| 63082 | Physician and practitioner services (fee schedule) | 43 | $192.06 |
| 63085 | Physician and practitioner services (fee schedule) | 44 | $1,416.59 |
| 63086 | Physician and practitioner services (fee schedule) | 43 | $141.73 |
| 63087 | Physician and practitioner services (fee schedule) | 44 | $1,759.70 |
| 63088 | Physician and practitioner services (fee schedule) | 43 | $198.41 |
| 63090 | Physician and practitioner services (fee schedule) | 44 | $1,472.71 |
| 63091 | Physician and practitioner services (fee schedule) | 43 | $134.71 |
| 63101 | Physician and practitioner services (fee schedule) | 44 | $1,695.24 |
| 63102 | Physician and practitioner services (fee schedule) | 44 | $1,668.33 |
| 63103 | Physician and practitioner services (fee schedule) | 43 | $201.54 |
| 63170 | Physician and practitioner services (fee schedule) | 44 | $1,184.78 |
| 63172 | Physician and practitioner services (fee schedule) | 44 | $1,067.90 |
| 63173 | Physician and practitioner services (fee schedule) | 44 | $1,276.97 |
| 63185 | Physician and practitioner services (fee schedule) | 45 | $894.68 |
| 63190 | Physician and practitioner services (fee schedule) | 45 | $932.39 |
| 63191 | Physician and practitioner services (fee schedule) | 43 | $1,030.66 |
| 63197 | Physician and practitioner services (fee schedule) | 44 | $1,245.69 |
| 63200 | Physician and practitioner services (fee schedule) | 44 | $1,155.06 |
| 63250 | Physician and practitioner services (fee schedule) | 44 | $2,134.66 |
| 63251 | Physician and practitioner services (fee schedule) | 44 | $2,209.61 |
| 63252 | Physician and practitioner services (fee schedule) | 44 | $2,188.28 |
| 63265 | Physician and practitioner services (fee schedule) | 44 | $1,222.49 |
| 63266 | Physician and practitioner services (fee schedule) | 44 | $1,262.02 |
| 63267 | Physician and practitioner services (fee schedule) | 45 | $1,027.12 |
| 63268 | Physician and practitioner services (fee schedule) | 44 | $1,073.34 |
| 63270 | Physician and practitioner services (fee schedule) | 45 | $1,516.80 |
| 63271 | Physician and practitioner services (fee schedule) | 44 | $1,526.06 |
| 63272 | Physician and practitioner services (fee schedule) | 44 | $1,380.01 |
| 63273 | Physician and practitioner services (fee schedule) | 44 | $1,376.57 |
| 63275 | Physician and practitioner services (fee schedule) | 44 | $1,333.06 |
| 63276 | Physician and practitioner services (fee schedule) | 44 | $1,334.87 |
| 63277 | Physician and practitioner services (fee schedule) | 44 | $1,163.34 |
| 63278 | Physician and practitioner services (fee schedule) | 44 | $1,199.38 |
| 63280 | Physician and practitioner services (fee schedule) | 44 | $1,580.76 |
| 63281 | Physician and practitioner services (fee schedule) | 44 | $1,565.74 |
| 63282 | Physician and practitioner services (fee schedule) | 44 | $1,461.73 |
| 63283 | Physician and practitioner services (fee schedule) | 44 | $1,406.44 |
| 63285 | Physician and practitioner services (fee schedule) | 44 | $1,903.80 |
| 63286 | Physician and practitioner services (fee schedule) | 44 | $1,878.77 |
| 63287 | Physician and practitioner services (fee schedule) | 44 | $2,010.22 |
| 63290 | Physician and practitioner services (fee schedule) | 44 | $2,024.67 |
| 63295 | Physician and practitioner services (fee schedule) | 44 | $236.27 |
| 63300 | Physician and practitioner services (fee schedule) | 45 | $1,321.43 |
| 63301 | Physician and practitioner services (fee schedule) | 44 | $1,618.67 |
| 63302 | Physician and practitioner services (fee schedule) | 44 | $1,600.08 |
| 63303 | Physician and practitioner services (fee schedule) | 44 | $1,677.76 |
| 63304 | Physician and practitioner services (fee schedule) | 43 | $1,683.59 |
| 63305 | Physician and practitioner services (fee schedule) | 44 | $1,801.91 |
| 63306 | Physician and practitioner services (fee schedule) | 44 | $1,802.06 |
| 63307 | Physician and practitioner services (fee schedule) | 45 | $1,741.47 |
| 63308 | Physician and practitioner services (fee schedule) | 44 | $234.85 |
| 63600 | Physician and practitioner services (fee schedule) | 44 | $763.96 |
| 63610 | Physician and practitioner services (fee schedule) | 43 | $421.73 |
| 63620 | Physician and practitioner services (fee schedule) | 43 | $750.28 |
| 63621 | Physician and practitioner services (fee schedule) | 43 | $179.97 |
| 63650 | Physician and practitioner services (fee schedule) | 45 | $437.07 |
| 63655 | Physician and practitioner services (fee schedule) | 44 | $650.14 |
| 63661 | Physician and practitioner services (fee schedule) | 45 | $325.99 |
| 63662 | Physician and practitioner services (fee schedule) | 45 | $592.30 |
| 63663 | Physician and practitioner services (fee schedule) | 45 | $424.55 |
| 63664 | Physician and practitioner services (fee schedule) | 45 | $616.74 |
| 63685 | Physician and practitioner services (fee schedule) | 44 | $273.45 |
| 63688 | Physician and practitioner services (fee schedule) | 45 | $258.74 |
| 63700 | Physician and practitioner services (fee schedule) | 44 | $966.42 |
| 63702 | Physician and practitioner services (fee schedule) | 44 | $1,068.72 |
| 63704 | Physician and practitioner services (fee schedule) | 44 | $1,227.76 |
| 63706 | Physician and practitioner services (fee schedule) | 44 | $1,354.55 |
| 63707 | Physician and practitioner services (fee schedule) | 45 | $707.90 |
| 63709 | Physician and practitioner services (fee schedule) | 44 | $867.17 |
| 63710 | Physician and practitioner services (fee schedule) | 44 | $805.91 |
| 63740 | Physician and practitioner services (fee schedule) | 44 | $751.29 |
| 63741 | Physician and practitioner services (fee schedule) | 44 | $513.45 |
| 63744 | Physician and practitioner services (fee schedule) | 44 | $541.99 |
| 63746 | Physician and practitioner services (fee schedule) | 45 | $460.41 |
| 64400 | Physician and practitioner services (fee schedule) | 45 | $77.75 |
| 64405 | Physician and practitioner services (fee schedule) | 45 | $55.45 |
| 64408 | Physician and practitioner services (fee schedule) | 45 | $54.41 |
| 64415 | Physician and practitioner services (fee schedule) | 45 | $70.47 |
| 64416 | Physician and practitioner services (fee schedule) | 44 | $65.16 |
| 64417 | Physician and practitioner services (fee schedule) | 45 | $81.14 |
| 64418 | Physician and practitioner services (fee schedule) | 45 | $66.20 |
| 64420 | Physician and practitioner services (fee schedule) | 45 | $67.52 |
| 64421 | Physician and practitioner services (fee schedule) | 45 | $28.37 |
| 64425 | Physician and practitioner services (fee schedule) | 45 | $77.11 |
| 64430 | Physician and practitioner services (fee schedule) | 45 | $67.06 |
| 64435 | Physician and practitioner services (fee schedule) | 45 | $60.05 |
| 64445 | Physician and practitioner services (fee schedule) | 45 | $78.56 |
| 64446 | Physician and practitioner services (fee schedule) | 44 | $62.17 |
| 64447 | Physician and practitioner services (fee schedule) | 44 | $69.00 |
| 64448 | Physician and practitioner services (fee schedule) | 44 | $60.07 |
| 64449 | Physician and practitioner services (fee schedule) | 44 | $53.50 |
| 64450 | Physician and practitioner services (fee schedule) | 45 | $54.41 |
| 64451 | Physician and practitioner services (fee schedule) | 39 | $141.85 |
| 64454 | Physician and practitioner services (fee schedule) | 37 | $143.28 |
| 64455 | Physician and practitioner services (fee schedule) | 43 | $34.28 |
| 64461 | Physician and practitioner services (fee schedule) | 43 | $95.42 |
| 64462 | Physician and practitioner services (fee schedule) | 42 | $53.50 |
| 64463 | Physician and practitioner services (fee schedule) | 43 | $127.89 |
| 64466 | Physician and practitioner services (fee schedule) | 37 | $95.89 |
| 64467 | Physician and practitioner services (fee schedule) | 37 | $172.10 |
| 64468 | Physician and practitioner services (fee schedule) | 37 | $110.78 |
| 64469 | Physician and practitioner services (fee schedule) | 37 | $266.04 |
| 64473 | Physician and practitioner services (fee schedule) | 37 | $90.52 |
| 64474 | Physician and practitioner services (fee schedule) | 37 | $169.76 |
| 64479 | Physician and practitioner services (fee schedule) | 43 | $151.77 |
| 64480 | Physician and practitioner services (fee schedule) | 43 | $91.16 |
| 64483 | Physician and practitioner services (fee schedule) | 44 | $146.63 |
| 64484 | Physician and practitioner services (fee schedule) | 44 | $78.98 |
| 64486 | Physician and practitioner services (fee schedule) | 42 | $70.88 |
| 64487 | Physician and practitioner services (fee schedule) | 42 | $114.56 |
| 64488 | Physician and practitioner services (fee schedule) | 42 | $92.28 |
| 64489 | Physician and practitioner services (fee schedule) | 42 | $152.14 |
| 64490 | Physician and practitioner services (fee schedule) | 43 | $113.89 |
| 64491 | Physician and practitioner services (fee schedule) | 43 | $59.33 |
| 64492 | Physician and practitioner services (fee schedule) | 43 | $58.65 |
| 64493 | Physician and practitioner services (fee schedule) | 43 | $101.13 |
| 64494 | Physician and practitioner services (fee schedule) | 43 | $54.76 |
| 64505 | Physician and practitioner services (fee schedule) | 45 | $92.01 |
| 64510 | Physician and practitioner services (fee schedule) | 45 | $76.95 |
| 64517 | Physician and practitioner services (fee schedule) | 43 | $126.82 |
| 64520 | Physician and practitioner services (fee schedule) | 45 | $105.85 |
| 64530 | Physician and practitioner services (fee schedule) | 45 | $118.79 |
| 64553 | Physician and practitioner services (fee schedule) | 40 | $322.04 |
| 64555 | Physician and practitioner services (fee schedule) | 42 | $264.87 |
| 64561 | Physician and practitioner services (fee schedule) | 44 | $497.85 |
| 64566 | Physician and practitioner services (fee schedule) | 36 | $83.05 |
| 64567 | Physician and practitioner services (fee schedule) | 20 | $808.90 |
| 64568 | Physician and practitioner services (fee schedule) | 44 | $512.09 |
| 64569 | Physician and practitioner services (fee schedule) | 44 | $561.89 |
| 64570 | Physician and practitioner services (fee schedule) | 44 | $556.89 |
| 64575 | Physician and practitioner services (fee schedule) | 43 | $244.79 |
| 64580 | Physician and practitioner services (fee schedule) | 39 | $244.96 |
| 64581 | Physician and practitioner services (fee schedule) | 43 | $524.45 |
| 64582 | Physician and practitioner services (fee schedule) | 34 | $629.09 |
| 64583 | Physician and practitioner services (fee schedule) | 33 | $638.21 |
| 64584 | Physician and practitioner services (fee schedule) | 36 | $536.30 |
| 64585 | Physician and practitioner services (fee schedule) | 44 | $145.77 |
| 64590 | Physician and practitioner services (fee schedule) | 44 | $241.34 |
| 64595 | Physician and practitioner services (fee schedule) | 44 | $187.91 |
| 64596 | Physician and practitioner services (fee schedule) | 14 | $650.06 |
| 64597 | Physician and practitioner services (fee schedule) | 14 | $368.34 |
| 64598 | Physician and practitioner services (fee schedule) | 12 | $203.27 |
| 64600 | Physician and practitioner services (fee schedule) | 45 | $238.14 |
| 64605 | Physician and practitioner services (fee schedule) | 45 | $411.99 |
| 64610 | Physician and practitioner services (fee schedule) | 45 | $465.14 |
| 64611 | Physician and practitioner services (fee schedule) | 44 | $91.08 |
| 64612 | Physician and practitioner services (fee schedule) | 44 | $110.98 |
| 64615 | Physician and practitioner services (fee schedule) | 45 | $109.54 |
| 64616 | Physician and practitioner services (fee schedule) | 44 | $94.78 |
| 64617 | Physician and practitioner services (fee schedule) | 43 | $105.91 |
| 64620 | Physician and practitioner services (fee schedule) | 45 | $155.92 |
| 64624 | Physician and practitioner services (fee schedule) | 34 | $268.34 |
| 64625 | Physician and practitioner services (fee schedule) | 31 | $277.91 |
| 64628 | Physician and practitioner services (fee schedule) | 31 | $330.66 |
| 64629 | Physician and practitioner services (fee schedule) | 31 | $156.37 |
| 64630 | Physician and practitioner services (fee schedule) | 45 | $174.87 |
| 64632 | Physician and practitioner services (fee schedule) | 41 | $63.34 |
| 64633 | Physician and practitioner services (fee schedule) | 43 | $260.99 |
| 64634 | Physician and practitioner services (fee schedule) | 44 | $153.01 |
| 64635 | Physician and practitioner services (fee schedule) | 43 | $282.28 |
| 64636 | Physician and practitioner services (fee schedule) | 44 | $142.52 |
| 64640 | Physician and practitioner services (fee schedule) | 45 | $132.16 |
| 64642 | Physician and practitioner services (fee schedule) | 45 | $96.70 |
| 64643 | Physician and practitioner services (fee schedule) | 45 | $61.96 |
| 64644 | Physician and practitioner services (fee schedule) | 45 | $112.17 |
| 64645 | Physician and practitioner services (fee schedule) | 45 | $73.28 |
| 64646 | Physician and practitioner services (fee schedule) | 45 | $102.45 |
| 64647 | Physician and practitioner services (fee schedule) | 45 | $117.51 |
| 64650 | Physician and practitioner services (fee schedule) | 40 | $45.14 |
| 64653 | Physician and practitioner services (fee schedule) | 38 | $54.15 |
| 64654 | Physician and practitioner services (fee schedule) | 15 | $402.59 |
| 64655 | Physician and practitioner services (fee schedule) | 15 | $470.85 |
| 64656 | Physician and practitioner services (fee schedule) | 17 | $309.28 |
| 64657 | Physician and practitioner services (fee schedule) | 16 | $459.18 |
| 64658 | Physician and practitioner services (fee schedule) | 16 | $345.68 |
| 64659 | Physician and practitioner services (fee schedule) | 16 | $320.64 |
| 64680 | Physician and practitioner services (fee schedule) | 45 | $162.74 |
| 64681 | Physician and practitioner services (fee schedule) | 43 | $307.68 |
| 64702 | Physician and practitioner services (fee schedule) | 44 | $384.01 |
| 64704 | Physician and practitioner services (fee schedule) | 44 | $253.05 |
| 64708 | Physician and practitioner services (fee schedule) | 45 | $381.44 |
| 64712 | Physician and practitioner services (fee schedule) | 44 | $449.07 |
| 64713 | Physician and practitioner services (fee schedule) | 45 | $584.72 |
| 64714 | Physician and practitioner services (fee schedule) | 45 | $545.66 |
| 64716 | Physician and practitioner services (fee schedule) | 43 | $378.74 |
| 64718 | Physician and practitioner services (fee schedule) | 44 | $451.21 |
| 64719 | Physician and practitioner services (fee schedule) | 44 | $318.15 |
| 64721 | Physician and practitioner services (fee schedule) | 45 | $356.12 |
| 64722 | Physician and practitioner services (fee schedule) | 43 | $300.63 |
| 64726 | Physician and practitioner services (fee schedule) | 45 | $211.20 |
| 64727 | Physician and practitioner services (fee schedule) | 43 | $140.45 |
| 64728 | Physician and practitioner services (fee schedule) | 23 | $898.07 |
| 64732 | Physician and practitioner services (fee schedule) | 45 | $324.01 |
| 64734 | Physician and practitioner services (fee schedule) | 45 | $389.44 |
| 64736 | Physician and practitioner services (fee schedule) | 45 | $255.78 |
| 64738 | Physician and practitioner services (fee schedule) | 45 | $339.50 |
| 64740 | Physician and practitioner services (fee schedule) | 43 | $344.87 |
| 64742 | Physician and practitioner services (fee schedule) | 43 | $353.28 |
| 64744 | Physician and practitioner services (fee schedule) | 44 | $407.63 |
| 64746 | Physician and practitioner services (fee schedule) | 44 | $316.98 |
| 64755 | Physician and practitioner services (fee schedule) | 43 | $676.70 |
| 64760 | Physician and practitioner services (fee schedule) | 43 | $397.19 |
| 64763 | Physician and practitioner services (fee schedule) | 44 | $376.01 |
| 64766 | Physician and practitioner services (fee schedule) | 44 | $468.50 |
| 64771 | Physician and practitioner services (fee schedule) | 44 | $435.96 |
| 64772 | Physician and practitioner services (fee schedule) | 44 | $411.04 |
| 64774 | Physician and practitioner services (fee schedule) | 44 | $321.68 |
| 64776 | Physician and practitioner services (fee schedule) | 44 | $297.44 |
| 64778 | Physician and practitioner services (fee schedule) | 43 | $137.40 |
| 64782 | Physician and practitioner services (fee schedule) | 44 | $344.77 |
| 64783 | Physician and practitioner services (fee schedule) | 44 | $165.52 |
| 64784 | Physician and practitioner services (fee schedule) | 44 | $533.90 |
| 64786 | Physician and practitioner services (fee schedule) | 44 | $789.01 |
| 64787 | Physician and practitioner services (fee schedule) | 44 | $179.06 |
| 64788 | Physician and practitioner services (fee schedule) | 44 | $305.59 |
| 64790 | Physician and practitioner services (fee schedule) | 44 | $628.44 |
| 64792 | Physician and practitioner services (fee schedule) | 44 | $822.34 |
| 64795 | Physician and practitioner services (fee schedule) | 44 | $151.92 |
| 64802 | Physician and practitioner services (fee schedule) | 44 | $566.90 |
| 64804 | Physician and practitioner services (fee schedule) | 44 | $846.82 |
| 64809 | Physician and practitioner services (fee schedule) | 44 | $759.40 |
| 64818 | Physician and practitioner services (fee schedule) | 44 | $563.95 |
| 64820 | Physician and practitioner services (fee schedule) | 43 | $577.76 |
| 64821 | Physician and practitioner services (fee schedule) | 42 | $520.54 |
| 64822 | Physician and practitioner services (fee schedule) | 42 | $525.23 |
| 64823 | Physician and practitioner services (fee schedule) | 42 | $583.05 |
| 64831 | Physician and practitioner services (fee schedule) | 44 | $509.44 |
| 64832 | Physician and practitioner services (fee schedule) | 44 | $232.15 |
| 64834 | Physician and practitioner services (fee schedule) | 44 | $530.54 |
| 64835 | Physician and practitioner services (fee schedule) | 44 | $592.77 |
| 64836 | Physician and practitioner services (fee schedule) | 44 | $592.65 |
| 64837 | Physician and practitioner services (fee schedule) | 44 | $265.84 |
| 64840 | Physician and practitioner services (fee schedule) | 44 | $692.73 |
| 64856 | Physician and practitioner services (fee schedule) | 44 | $736.48 |
| 64857 | Physician and practitioner services (fee schedule) | 44 | $739.83 |
| 64858 | Physician and practitioner services (fee schedule) | 44 | $832.68 |
| 64859 | Physician and practitioner services (fee schedule) | 43 | $183.74 |
| 64861 | Physician and practitioner services (fee schedule) | 44 | $1,108.56 |
| 64862 | Physician and practitioner services (fee schedule) | 44 | $1,006.33 |
| 64864 | Physician and practitioner services (fee schedule) | 44 | $605.67 |
| 64865 | Physician and practitioner services (fee schedule) | 44 | $795.11 |
| 64866 | Physician and practitioner services (fee schedule) | 44 | $879.97 |
| 64868 | Physician and practitioner services (fee schedule) | 44 | $717.01 |
| 64872 | Physician and practitioner services (fee schedule) | 44 | $85.70 |
| 64874 | Physician and practitioner services (fee schedule) | 44 | $127.99 |
| 64876 | Physician and practitioner services (fee schedule) | 42 | $143.29 |
| 64885 | Physician and practitioner services (fee schedule) | 44 | $803.58 |
| 64886 | Physician and practitioner services (fee schedule) | 44 | $966.30 |
| 64890 | Physician and practitioner services (fee schedule) | 44 | $792.33 |
| 64891 | Physician and practitioner services (fee schedule) | 44 | $821.02 |
| 64892 | Physician and practitioner services (fee schedule) | 44 | $748.02 |
| 64893 | Physician and practitioner services (fee schedule) | 44 | $821.55 |
| 64895 | Physician and practitioner services (fee schedule) | 44 | $944.87 |
| 64896 | Physician and practitioner services (fee schedule) | 44 | $1,054.93 |
| 64897 | Physician and practitioner services (fee schedule) | 44 | $904.01 |
| 64898 | Physician and practitioner services (fee schedule) | 44 | $971.57 |
| 64901 | Physician and practitioner services (fee schedule) | 44 | $434.01 |
| 64902 | Physician and practitioner services (fee schedule) | 44 | $507.30 |
| 64905 | Physician and practitioner services (fee schedule) | 44 | $726.90 |
| 64907 | Physician and practitioner services (fee schedule) | 44 | $926.47 |
| 64910 | Physician and practitioner services (fee schedule) | 42 | $533.30 |
| 64911 | Physician and practitioner services (fee schedule) | 40 | $684.03 |
| 64912 | Physician and practitioner services (fee schedule) | 37 | $674.53 |
| 64913 | Physician and practitioner services (fee schedule) | 37 | $126.07 |
| 64999 | Physician and practitioner services (fee schedule) | 7 | $621.90 |
| 65091 | Physician and practitioner services (fee schedule) | 44 | $513.82 |
| 65093 | Physician and practitioner services (fee schedule) | 44 | $535.42 |
| 65101 | Physician and practitioner services (fee schedule) | 44 | $567.75 |
| 65103 | Physician and practitioner services (fee schedule) | 44 | $618.08 |
| 65105 | Physician and practitioner services (fee schedule) | 44 | $644.70 |
| 65110 | Physician and practitioner services (fee schedule) | 44 | $886.13 |
| 65112 | Physician and practitioner services (fee schedule) | 44 | $993.31 |
| 65114 | Physician and practitioner services (fee schedule) | 44 | $1,038.54 |
| 65125 | Physician and practitioner services (fee schedule) | 39 | $279.92 |
| 65130 | Physician and practitioner services (fee schedule) | 43 | $585.10 |
| 65135 | Physician and practitioner services (fee schedule) | 43 | $591.79 |
| 65140 | Physician and practitioner services (fee schedule) | 43 | $635.24 |
| 65150 | Physician and practitioner services (fee schedule) | 43 | $489.93 |
| 65155 | Physician and practitioner services (fee schedule) | 43 | $665.01 |
| 65175 | Physician and practitioner services (fee schedule) | 43 | $543.96 |
| 65205 | Physician and practitioner services (fee schedule) | 44 | $25.75 |
| 65210 | Physician and practitioner services (fee schedule) | 44 | $32.72 |
| 65220 | Physician and practitioner services (fee schedule) | 45 | $40.90 |
| 65222 | Physician and practitioner services (fee schedule) | 45 | $47.18 |
| 65235 | Physician and practitioner services (fee schedule) | 44 | $503.24 |
| 65260 | Physician and practitioner services (fee schedule) | 44 | $654.25 |
| 65265 | Physician and practitioner services (fee schedule) | 44 | $736.04 |
| 65270 | Physician and practitioner services (fee schedule) | 44 | $142.97 |
| 65272 | Physician and practitioner services (fee schedule) | 44 | $321.13 |
| 65273 | Physician and practitioner services (fee schedule) | 44 | $257.67 |
| 65275 | Physician and practitioner services (fee schedule) | 44 | $371.11 |
| 65280 | Physician and practitioner services (fee schedule) | 44 | $473.43 |
| 65285 | Physician and practitioner services (fee schedule) | 44 | $757.85 |
| 65286 | Physician and practitioner services (fee schedule) | 44 | $441.93 |
| 65290 | Physician and practitioner services (fee schedule) | 44 | $341.60 |
| 65400 | Physician and practitioner services (fee schedule) | 44 | $473.22 |
| 65410 | Physician and practitioner services (fee schedule) | 44 | $92.47 |
| 65420 | Physician and practitioner services (fee schedule) | 44 | $341.34 |
| 65426 | Physician and practitioner services (fee schedule) | 45 | $429.15 |
| 65430 | Physician and practitioner services (fee schedule) | 44 | $87.83 |
| 65435 | Physician and practitioner services (fee schedule) | 44 | $60.89 |
| 65436 | Physician and practitioner services (fee schedule) | 44 | $276.51 |
| 65450 | Physician and practitioner services (fee schedule) | 44 | $248.25 |
| 65600 | Physician and practitioner services (fee schedule) | 43 | $300.11 |
| 65710 | Physician and practitioner services (fee schedule) | 44 | $787.90 |
| 65730 | Physician and practitioner services (fee schedule) | 44 | $861.53 |
| 65750 | Physician and practitioner services (fee schedule) | 44 | $879.90 |
| 65755 | Physician and practitioner services (fee schedule) | 44 | $866.64 |
| 65756 | Physician and practitioner services (fee schedule) | 44 | $812.30 |
| 65757 | Physician and practitioner services (fee schedule) | 20 | $109.79 |
| 65760 | Physician and practitioner services (fee schedule) | 15 | $913.91 |
| 65765 | Physician and practitioner services (fee schedule) | 22 | $924.61 |
| 65767 | Physician and practitioner services (fee schedule) | 19 | $822.52 |
| 65770 | Physician and practitioner services (fee schedule) | 43 | $964.56 |
| 65771 | Physician and practitioner services (fee schedule) | 8 | $425.11 |
| 65772 | Physician and practitioner services (fee schedule) | 43 | $353.53 |
| 65775 | Physician and practitioner services (fee schedule) | 42 | $414.37 |
| 65778 | Physician and practitioner services (fee schedule) | 44 | $812.20 |
| 65779 | Physician and practitioner services (fee schedule) | 43 | $591.36 |
| 65780 | Physician and practitioner services (fee schedule) | 41 | $452.44 |
| 65781 | Physician and practitioner services (fee schedule) | 38 | $909.63 |
| 65782 | Physician and practitioner services (fee schedule) | 40 | $800.39 |
| 65785 | Physician and practitioner services (fee schedule) | 35 | $1,250.99 |
| 65800 | Physician and practitioner services (fee schedule) | 44 | $91.33 |
| 65810 | Physician and practitioner services (fee schedule) | 44 | $329.35 |
| 65815 | Physician and practitioner services (fee schedule) | 44 | $418.49 |
| 65820 | Physician and practitioner services (fee schedule) | 44 | $585.19 |
| 65850 | Physician and practitioner services (fee schedule) | 44 | $608.21 |
| 65855 | Physician and practitioner services (fee schedule) | 44 | $203.28 |
| 65860 | Physician and practitioner services (fee schedule) | 44 | $227.17 |
| 65865 | Physician and practitioner services (fee schedule) | 44 | $343.77 |
| 65870 | Physician and practitioner services (fee schedule) | 44 | $411.10 |
| 65875 | Physician and practitioner services (fee schedule) | 44 | $442.75 |
| 65880 | Physician and practitioner services (fee schedule) | 44 | $463.31 |
| 65900 | Physician and practitioner services (fee schedule) | 44 | $659.72 |
| 65920 | Physician and practitioner services (fee schedule) | 44 | $549.84 |
| 65930 | Physician and practitioner services (fee schedule) | 44 | $455.66 |
| 66020 | Physician and practitioner services (fee schedule) | 44 | $124.55 |
| 66030 | Physician and practitioner services (fee schedule) | 44 | $116.05 |
| 66130 | Physician and practitioner services (fee schedule) | 44 | $478.97 |
| 66150 | Physician and practitioner services (fee schedule) | 44 | $607.72 |
| 66155 | Physician and practitioner services (fee schedule) | 44 | $614.45 |
| 66160 | Physician and practitioner services (fee schedule) | 44 | $694.46 |
| 66170 | Physician and practitioner services (fee schedule) | 44 | $770.57 |
| 66172 | Physician and practitioner services (fee schedule) | 44 | $854.56 |
| 66174 | Physician and practitioner services (fee schedule) | 39 | $480.38 |
| 66175 | Physician and practitioner services (fee schedule) | 37 | $577.11 |
| 66179 | Physician and practitioner services (fee schedule) | 42 | $777.32 |
| 66180 | Physician and practitioner services (fee schedule) | 44 | $797.99 |
| 66183 | Physician and practitioner services (fee schedule) | 42 | $756.73 |
| 66184 | Physician and practitioner services (fee schedule) | 42 | $570.85 |
| 66185 | Physician and practitioner services (fee schedule) | 44 | $555.05 |
| 66225 | Physician and practitioner services (fee schedule) | 42 | $657.41 |
| 66250 | Physician and practitioner services (fee schedule) | 44 | $487.84 |
| 66500 | Physician and practitioner services (fee schedule) | 44 | $272.81 |
| 66505 | Physician and practitioner services (fee schedule) | 44 | $296.44 |
| 66600 | Physician and practitioner services (fee schedule) | 44 | $638.88 |
| 66605 | Physician and practitioner services (fee schedule) | 44 | $764.71 |
| 66625 | Physician and practitioner services (fee schedule) | 44 | $322.25 |
| 66630 | Physician and practitioner services (fee schedule) | 44 | $413.18 |
| 66635 | Physician and practitioner services (fee schedule) | 44 | $417.23 |
| 66680 | Physician and practitioner services (fee schedule) | 44 | $407.29 |
| 66682 | Physician and practitioner services (fee schedule) | 43 | $461.31 |
| 66683 | Physician and practitioner services (fee schedule) | 24 | $570.42 |
| 66700 | Physician and practitioner services (fee schedule) | 42 | $335.18 |
| 66710 | Physician and practitioner services (fee schedule) | 44 | $336.76 |
| 66711 | Physician and practitioner services (fee schedule) | 44 | $386.86 |
| 66720 | Physician and practitioner services (fee schedule) | 44 | $346.43 |
| 66740 | Physician and practitioner services (fee schedule) | 42 | $327.72 |
| 66761 | Physician and practitioner services (fee schedule) | 44 | $239.46 |
| 66762 | Physician and practitioner services (fee schedule) | 43 | $328.39 |
| 66770 | Physician and practitioner services (fee schedule) | 43 | $365.96 |
| 66820 | Physician and practitioner services (fee schedule) | 44 | $327.15 |
| 66821 | Physician and practitioner services (fee schedule) | 44 | $258.19 |
| 66825 | Physician and practitioner services (fee schedule) | 44 | $576.91 |
| 66830 | Physician and practitioner services (fee schedule) | 44 | $498.90 |
| 66840 | Physician and practitioner services (fee schedule) | 44 | $502.73 |
| 66850 | Physician and practitioner services (fee schedule) | 44 | $570.77 |
| 66852 | Physician and practitioner services (fee schedule) | 44 | $599.41 |
| 66920 | Physician and practitioner services (fee schedule) | 44 | $545.62 |
| 66930 | Physician and practitioner services (fee schedule) | 44 | $621.80 |
| 66940 | Physician and practitioner services (fee schedule) | 44 | $555.92 |
| 66982 | Physician and practitioner services (fee schedule) | 44 | $580.84 |
| 66983 | Physician and practitioner services (fee schedule) | 39 | $564.24 |
| 66984 | Physician and practitioner services (fee schedule) | 44 | $428.46 |
| 66985 | Physician and practitioner services (fee schedule) | 44 | $547.33 |
| 66986 | Physician and practitioner services (fee schedule) | 44 | $662.98 |
| 66987 | Physician and practitioner services (fee schedule) | 24 | $693.74 |
| 66988 | Physician and practitioner services (fee schedule) | 26 | $550.16 |
| 66989 | Physician and practitioner services (fee schedule) | 42 | $637.73 |
| 66990 | Physician and practitioner services (fee schedule) | 40 | $60.87 |
| 66991 | Physician and practitioner services (fee schedule) | 43 | $511.52 |
| 66999 | Physician and practitioner services (fee schedule) | 5 | $119.14 |
| 67005 | Physician and practitioner services (fee schedule) | 44 | $347.63 |
| 67010 | Physician and practitioner services (fee schedule) | 44 | $389.37 |
| 67015 | Physician and practitioner services (fee schedule) | 44 | $440.74 |
| 67025 | Physician and practitioner services (fee schedule) | 44 | $504.76 |
| 67027 | Physician and practitioner services (fee schedule) | 43 | $576.09 |
| 67028 | Physician and practitioner services (fee schedule) | 44 | $93.55 |
| 67030 | Physician and practitioner services (fee schedule) | 44 | $396.49 |
| 67031 | Physician and practitioner services (fee schedule) | 44 | $296.99 |
| 67036 | Physician and practitioner services (fee schedule) | 44 | $648.06 |
| 67039 | Physician and practitioner services (fee schedule) | 44 | $708.54 |
| 67040 | Physician and practitioner services (fee schedule) | 44 | $771.74 |
| 67041 | Physician and practitioner services (fee schedule) | 44 | $796.43 |
| 67042 | Physician and practitioner services (fee schedule) | 44 | $821.19 |
| 67043 | Physician and practitioner services (fee schedule) | 44 | $864.47 |
| 67101 | Physician and practitioner services (fee schedule) | 44 | $278.42 |
| 67105 | Physician and practitioner services (fee schedule) | 44 | $251.54 |
| 67107 | Physician and practitioner services (fee schedule) | 44 | $808.20 |
| 67108 | Physician and practitioner services (fee schedule) | 44 | $869.94 |
| 67110 | Physician and practitioner services (fee schedule) | 44 | $678.10 |
| 67113 | Physician and practitioner services (fee schedule) | 44 | $940.37 |
| 67115 | Physician and practitioner services (fee schedule) | 44 | $358.40 |
| 67120 | Physician and practitioner services (fee schedule) | 44 | $448.23 |
| 67121 | Physician and practitioner services (fee schedule) | 44 | $611.25 |
| 67141 | Physician and practitioner services (fee schedule) | 44 | $221.73 |
| 67145 | Physician and practitioner services (fee schedule) | 44 | $206.10 |
| 67208 | Physician and practitioner services (fee schedule) | 44 | $461.08 |
| 67210 | Physician and practitioner services (fee schedule) | 44 | $430.82 |
| 67218 | Physician and practitioner services (fee schedule) | 43 | $956.37 |
| 67220 | Physician and practitioner services (fee schedule) | 44 | $447.22 |
| 67221 | Physician and practitioner services (fee schedule) | 44 | $216.35 |
| 67225 | Physician and practitioner services (fee schedule) | 43 | $23.24 |
| 67227 | Physician and practitioner services (fee schedule) | 44 | $249.37 |
| 67228 | Physician and practitioner services (fee schedule) | 44 | $281.25 |
| 67229 | Physician and practitioner services (fee schedule) | 44 | $788.16 |
| 67250 | Physician and practitioner services (fee schedule) | 44 | $629.64 |
| 67255 | Physician and practitioner services (fee schedule) | 44 | $518.14 |
| 67299 | Physician and practitioner services (fee schedule) | 8 | $316.42 |
| 67311 | Physician and practitioner services (fee schedule) | 44 | $368.70 |
| 67312 | Physician and practitioner services (fee schedule) | 45 | $483.51 |
| 67314 | Physician and practitioner services (fee schedule) | 43 | $380.61 |
| 67316 | Physician and practitioner services (fee schedule) | 44 | $528.14 |
| 67318 | Physician and practitioner services (fee schedule) | 44 | $482.93 |
| 67320 | Physician and practitioner services (fee schedule) | 43 | $145.88 |
| 67331 | Physician and practitioner services (fee schedule) | 43 | $114.00 |
| 67332 | Physician and practitioner services (fee schedule) | 43 | $161.81 |
| 67334 | Physician and practitioner services (fee schedule) | 44 | $103.80 |
| 67335 | Physician and practitioner services (fee schedule) | 43 | $128.92 |
| 67340 | Physician and practitioner services (fee schedule) | 44 | $228.67 |
| 67343 | Physician and practitioner services (fee schedule) | 45 | $477.48 |
| 67345 | Physician and practitioner services (fee schedule) | 44 | $180.80 |
| 67346 | Physician and practitioner services (fee schedule) | 43 | $136.56 |
| 67399 | Physician and practitioner services (fee schedule) | 5 | $283.37 |
| 67400 | Physician and practitioner services (fee schedule) | 44 | $732.73 |
| 67405 | Physician and practitioner services (fee schedule) | 44 | $635.31 |
| 67412 | Physician and practitioner services (fee schedule) | 44 | $711.55 |
| 67413 | Physician and practitioner services (fee schedule) | 44 | $665.84 |
| 67414 | Physician and practitioner services (fee schedule) | 44 | $912.47 |
| 67415 | Physician and practitioner services (fee schedule) | 43 | $73.95 |
| 67420 | Physician and practitioner services (fee schedule) | 44 | $1,156.92 |
| 67430 | Physician and practitioner services (fee schedule) | 44 | $920.25 |
| 67440 | Physician and practitioner services (fee schedule) | 44 | $878.31 |
| 67445 | Physician and practitioner services (fee schedule) | 44 | $979.63 |
| 67450 | Physician and practitioner services (fee schedule) | 44 | $909.67 |
| 67500 | Physician and practitioner services (fee schedule) | 44 | $59.54 |
| 67505 | Physician and practitioner services (fee schedule) | 44 | $65.96 |
| 67515 | Physician and practitioner services (fee schedule) | 44 | $41.80 |
| 67516 | Physician and practitioner services (fee schedule) | 36 | $82.99 |
| 67550 | Physician and practitioner services (fee schedule) | 43 | $768.53 |
| 67560 | Physician and practitioner services (fee schedule) | 43 | $777.79 |
| 67570 | Physician and practitioner services (fee schedule) | 44 | $834.32 |
| 67599 | Physician and practitioner services (fee schedule) | 6 | $52.16 |
| 67700 | Physician and practitioner services (fee schedule) | 44 | $147.60 |
| 67710 | Physician and practitioner services (fee schedule) | 44 | $129.05 |
| 67715 | Physician and practitioner services (fee schedule) | 44 | $126.41 |
| 67800 | Physician and practitioner services (fee schedule) | 44 | $94.03 |
| 67801 | Physician and practitioner services (fee schedule) | 44 | $119.74 |
| 67805 | Physician and practitioner services (fee schedule) | 44 | $146.04 |
| 67808 | Physician and practitioner services (fee schedule) | 44 | $256.09 |
| 67810 | Physician and practitioner services (fee schedule) | 44 | $114.25 |
| 67820 | Physician and practitioner services (fee schedule) | 44 | $17.73 |
| 67825 | Physician and practitioner services (fee schedule) | 44 | $101.64 |
| 67830 | Physician and practitioner services (fee schedule) | 44 | $179.16 |
| 67835 | Physician and practitioner services (fee schedule) | 44 | $322.03 |
| 67840 | Physician and practitioner services (fee schedule) | 44 | $174.55 |
| 67850 | Physician and practitioner services (fee schedule) | 43 | $139.81 |
| 67875 | Physician and practitioner services (fee schedule) | 43 | $110.51 |
| 67880 | Physician and practitioner services (fee schedule) | 44 | $317.93 |
| 67882 | Physician and practitioner services (fee schedule) | 44 | $388.84 |
| 67900 | Physician and practitioner services (fee schedule) | 41 | $449.69 |
| 67901 | Physician and practitioner services (fee schedule) | 44 | $522.68 |
| 67902 | Physician and practitioner services (fee schedule) | 44 | $512.04 |
| 67903 | Physician and practitioner services (fee schedule) | 44 | $434.82 |
| 67904 | Physician and practitioner services (fee schedule) | 44 | $523.52 |
| 67906 | Physician and practitioner services (fee schedule) | 44 | $374.13 |
| 67908 | Physician and practitioner services (fee schedule) | 44 | $386.17 |
| 67909 | Physician and practitioner services (fee schedule) | 44 | $390.68 |
| 67911 | Physician and practitioner services (fee schedule) | 44 | $402.40 |
| 67912 | Physician and practitioner services (fee schedule) | 43 | $570.41 |
| 67914 | Physician and practitioner services (fee schedule) | 44 | $319.11 |
| 67915 | Physician and practitioner services (fee schedule) | 44 | $207.92 |
| 67916 | Physician and practitioner services (fee schedule) | 44 | $398.40 |
| 67917 | Physician and practitioner services (fee schedule) | 44 | $416.32 |
| 67921 | Physician and practitioner services (fee schedule) | 44 | $309.94 |
| 67922 | Physician and practitioner services (fee schedule) | 44 | $205.87 |
| 67923 | Physician and practitioner services (fee schedule) | 44 | $398.46 |
| 67924 | Physician and practitioner services (fee schedule) | 44 | $414.47 |
| 67930 | Physician and practitioner services (fee schedule) | 44 | $247.59 |
| 67935 | Physician and practitioner services (fee schedule) | 44 | $410.68 |
| 67938 | Physician and practitioner services (fee schedule) | 44 | $148.07 |
| 67950 | Physician and practitioner services (fee schedule) | 44 | $403.29 |
| 67961 | Physician and practitioner services (fee schedule) | 44 | $408.48 |
| 67966 | Physician and practitioner services (fee schedule) | 44 | $531.34 |
| 67971 | Physician and practitioner services (fee schedule) | 44 | $521.05 |
| 67973 | Physician and practitioner services (fee schedule) | 44 | $657.44 |
| 67974 | Physician and practitioner services (fee schedule) | 44 | $656.05 |
| 67975 | Physician and practitioner services (fee schedule) | 44 | $474.76 |
| 67999 | Physician and practitioner services (fee schedule) | 8 | $171.73 |
| 68020 | Physician and practitioner services (fee schedule) | 44 | $93.41 |
| 68040 | Physician and practitioner services (fee schedule) | 44 | $46.29 |
| 68100 | Physician and practitioner services (fee schedule) | 44 | $112.32 |
| 68110 | Physician and practitioner services (fee schedule) | 44 | $152.42 |
| 68115 | Physician and practitioner services (fee schedule) | 44 | $192.18 |
| 68130 | Physician and practitioner services (fee schedule) | 43 | $370.88 |
| 68135 | Physician and practitioner services (fee schedule) | 44 | $123.49 |
| 68200 | Physician and practitioner services (fee schedule) | 44 | $30.99 |
| 68320 | Physician and practitioner services (fee schedule) | 44 | $481.32 |
| 68325 | Physician and practitioner services (fee schedule) | 44 | $472.12 |
| 68326 | Physician and practitioner services (fee schedule) | 44 | $460.19 |
| 68328 | Physician and practitioner services (fee schedule) | 43 | $513.83 |
| 68330 | Physician and practitioner services (fee schedule) | 44 | $405.37 |
| 68335 | Physician and practitioner services (fee schedule) | 44 | $457.87 |
| 68340 | Physician and practitioner services (fee schedule) | 43 | $370.61 |
| 68360 | Physician and practitioner services (fee schedule) | 44 | $357.24 |
| 68362 | Physician and practitioner services (fee schedule) | 44 | $452.03 |
| 68371 | Physician and practitioner services (fee schedule) | 31 | $291.44 |
| 68399 | Physician and practitioner services (fee schedule) | 5 | $29.03 |
| 68400 | Physician and practitioner services (fee schedule) | 44 | $149.39 |
| 68420 | Physician and practitioner services (fee schedule) | 44 | $199.28 |
| 68440 | Physician and practitioner services (fee schedule) | 44 | $82.43 |
| 68500 | Physician and practitioner services (fee schedule) | 44 | $709.05 |
| 68505 | Physician and practitioner services (fee schedule) | 44 | $704.51 |
| 68510 | Physician and practitioner services (fee schedule) | 44 | $267.87 |
| 68520 | Physician and practitioner services (fee schedule) | 44 | $518.92 |
| 68525 | Physician and practitioner services (fee schedule) | 44 | $177.19 |
| 68530 | Physician and practitioner services (fee schedule) | 44 | $287.23 |
| 68540 | Physician and practitioner services (fee schedule) | 44 | $662.08 |
| 68550 | Physician and practitioner services (fee schedule) | 44 | $827.71 |
| 68700 | Physician and practitioner services (fee schedule) | 44 | $427.94 |
| 68705 | Physician and practitioner services (fee schedule) | 44 | $162.62 |
| 68720 | Physician and practitioner services (fee schedule) | 44 | $574.71 |
| 68745 | Physician and practitioner services (fee schedule) | 44 | $537.00 |
| 68750 | Physician and practitioner services (fee schedule) | 44 | $592.80 |
| 68760 | Physician and practitioner services (fee schedule) | 44 | $143.05 |
| 68761 | Physician and practitioner services (fee schedule) | 44 | $110.89 |
| 68770 | Physician and practitioner services (fee schedule) | 44 | $428.97 |
| 68801 | Physician and practitioner services (fee schedule) | 44 | $74.23 |
| 68810 | Physician and practitioner services (fee schedule) | 44 | $129.45 |
| 68811 | Physician and practitioner services (fee schedule) | 44 | $108.07 |
| 68815 | Physician and practitioner services (fee schedule) | 45 | $237.61 |
| 68816 | Physician and practitioner services (fee schedule) | 44 | $437.15 |
| 68840 | Physician and practitioner services (fee schedule) | 44 | $99.44 |
| 68841 | Physician and practitioner services (fee schedule) | 31 | $30.47 |
| 68850 | Physician and practitioner services (fee schedule) | 44 | $46.08 |
| 68899 | Physician and practitioner services (fee schedule) | 7 | $36.06 |
| 69000 | Physician and practitioner services (fee schedule) | 44 | $114.79 |
| 69005 | Physician and practitioner services (fee schedule) | 44 | $147.91 |
| 69020 | Physician and practitioner services (fee schedule) | 44 | $146.18 |
| 69100 | Physician and practitioner services (fee schedule) | 44 | $58.81 |
| 69105 | Physician and practitioner services (fee schedule) | 44 | $71.28 |
| 69110 | Physician and practitioner services (fee schedule) | 44 | $297.82 |
| 69120 | Physician and practitioner services (fee schedule) | 44 | $287.78 |
| 69140 | Physician and practitioner services (fee schedule) | 44 | $674.54 |
| 69145 | Physician and practitioner services (fee schedule) | 44 | $249.99 |
| 69150 | Physician and practitioner services (fee schedule) | 44 | $755.10 |
| 69155 | Physician and practitioner services (fee schedule) | 44 | $1,130.26 |
| 69200 | Physician and practitioner services (fee schedule) | 44 | $49.65 |
| 69205 | Physician and practitioner services (fee schedule) | 44 | $75.00 |
| 69209 | Physician and practitioner services (fee schedule) | 40 | $12.12 |
| 69210 | Physician and practitioner services (fee schedule) | 43 | $31.41 |
| 69220 | Physician and practitioner services (fee schedule) | 44 | $50.79 |
| 69222 | Physician and practitioner services (fee schedule) | 44 | $132.32 |
| 69300 | Physician and practitioner services (fee schedule) | 38 | $441.48 |
| 69310 | Physician and practitioner services (fee schedule) | 44 | $829.06 |
| 69320 | Physician and practitioner services (fee schedule) | 44 | $1,097.88 |
| 69399 | Physician and practitioner services (fee schedule) | 6 | $131.92 |
| 69420 | Physician and practitioner services (fee schedule) | 43 | $122.26 |
| 69421 | Physician and practitioner services (fee schedule) | 43 | $116.76 |
| 69424 | Physician and practitioner services (fee schedule) | 44 | $63.16 |
| 69433 | Physician and practitioner services (fee schedule) | 43 | $135.42 |
| 69436 | Physician and practitioner services (fee schedule) | 43 | $122.45 |
| 69440 | Physician and practitioner services (fee schedule) | 44 | $520.60 |
| 69450 | Physician and practitioner services (fee schedule) | 43 | $397.27 |
| 69501 | Physician and practitioner services (fee schedule) | 44 | $540.68 |
| 69502 | Physician and practitioner services (fee schedule) | 44 | $717.37 |
| 69505 | Physician and practitioner services (fee schedule) | 44 | $895.33 |
| 69511 | Physician and practitioner services (fee schedule) | 44 | $922.30 |
| 69530 | Physician and practitioner services (fee schedule) | 44 | $1,198.91 |
| 69535 | Physician and practitioner services (fee schedule) | 43 | $1,894.65 |
| 69540 | Physician and practitioner services (fee schedule) | 44 | $132.42 |
| 69550 | Physician and practitioner services (fee schedule) | 44 | $754.35 |
| 69552 | Physician and practitioner services (fee schedule) | 44 | $1,150.35 |
| 69554 | Physician and practitioner services (fee schedule) | 44 | $1,704.90 |
| 69601 | Physician and practitioner services (fee schedule) | 44 | $757.48 |
| 69602 | Physician and practitioner services (fee schedule) | 44 | $809.36 |
| 69603 | Physician and practitioner services (fee schedule) | 44 | $939.45 |
| 69604 | Physician and practitioner services (fee schedule) | 44 | $840.30 |
| 69610 | Physician and practitioner services (fee schedule) | 44 | $251.08 |
| 69620 | Physician and practitioner services (fee schedule) | 44 | $469.85 |
| 69631 | Physician and practitioner services (fee schedule) | 44 | $669.89 |
| 69632 | Physician and practitioner services (fee schedule) | 44 | $808.95 |
| 69633 | Physician and practitioner services (fee schedule) | 44 | $793.90 |
| 69635 | Physician and practitioner services (fee schedule) | 44 | $936.06 |
| 69636 | Physician and practitioner services (fee schedule) | 44 | $1,037.41 |
| 69637 | Physician and practitioner services (fee schedule) | 44 | $1,031.53 |
| 69641 | Physician and practitioner services (fee schedule) | 44 | $803.34 |
| 69642 | Physician and practitioner services (fee schedule) | 44 | $1,023.43 |
| 69643 | Physician and practitioner services (fee schedule) | 44 | $931.46 |
| 69644 | Physician and practitioner services (fee schedule) | 44 | $1,118.84 |
| 69645 | Physician and practitioner services (fee schedule) | 44 | $1,093.10 |
| 69646 | Physician and practitioner services (fee schedule) | 44 | $1,167.56 |
| 69650 | Physician and practitioner services (fee schedule) | 44 | $613.37 |
| 69660 | Physician and practitioner services (fee schedule) | 44 | $707.55 |
| 69661 | Physician and practitioner services (fee schedule) | 43 | $904.29 |
| 69662 | Physician and practitioner services (fee schedule) | 44 | $883.35 |
| 69666 | Physician and practitioner services (fee schedule) | 44 | $613.01 |
| 69667 | Physician and practitioner services (fee schedule) | 44 | $614.73 |
| 69670 | Physician and practitioner services (fee schedule) | 43 | $688.33 |
| 69676 | Physician and practitioner services (fee schedule) | 44 | $620.45 |
| 69700 | Physician and practitioner services (fee schedule) | 44 | $491.55 |
| 69705 | Physician and practitioner services (fee schedule) | 32 | $1,544.88 |
| 69706 | Physician and practitioner services (fee schedule) | 31 | $1,608.26 |
| 69710 | Physician and practitioner services (fee schedule) | 20 | $671.45 |
| 69711 | Physician and practitioner services (fee schedule) | 36 | $591.89 |
| 69714 | Physician and practitioner services (fee schedule) | 44 | $417.60 |
| 69716 | Physician and practitioner services (fee schedule) | 42 | $475.78 |
| 69717 | Physician and practitioner services (fee schedule) | 44 | $470.46 |
| 69719 | Physician and practitioner services (fee schedule) | 41 | $486.98 |
| 69720 | Physician and practitioner services (fee schedule) | 43 | $873.06 |
| 69725 | Physician and practitioner services (fee schedule) | 43 | $1,322.67 |
| 69726 | Physician and practitioner services (fee schedule) | 42 | $354.49 |
| 69727 | Physician and practitioner services (fee schedule) | 42 | $397.69 |
| 69728 | Physician and practitioner services (fee schedule) | 41 | $442.62 |
| 69729 | Physician and practitioner services (fee schedule) | 41 | $501.69 |
| 69730 | Physician and practitioner services (fee schedule) | 42 | $508.56 |
| 69740 | Physician and practitioner services (fee schedule) | 43 | $830.84 |
| 69745 | Physician and practitioner services (fee schedule) | 43 | $920.48 |
| 69799 | Physician and practitioner services (fee schedule) | 6 | $192.33 |
| 69801 | Physician and practitioner services (fee schedule) | 44 | $179.67 |
| 69805 | Physician and practitioner services (fee schedule) | 44 | $746.97 |
| 69806 | Physician and practitioner services (fee schedule) | 44 | $711.66 |
| 69905 | Physician and practitioner services (fee schedule) | 44 | $704.16 |
| 69910 | Physician and practitioner services (fee schedule) | 44 | $763.14 |
| 69915 | Physician and practitioner services (fee schedule) | 43 | $1,063.36 |
| 69930 | Physician and practitioner services (fee schedule) | 44 | $928.59 |
| 69949 | Physician and practitioner services (fee schedule) | 6 | $71.65 |
| 69950 | Physician and practitioner services (fee schedule) | 42 | $1,208.01 |
| 69955 | Physician and practitioner services (fee schedule) | 43 | $1,369.51 |
| 69960 | Physician and practitioner services (fee schedule) | 44 | $1,303.84 |
| 69970 | Physician and practitioner services (fee schedule) | 44 | $1,470.76 |
| 69979 | Physician and practitioner services (fee schedule) | 6 | $995.59 |
| 69990 | Physician and practitioner services (fee schedule) | 39 | $162.56 |
| 90291 | Physician and practitioner services (fee schedule) | 11 | $350.03 |
| 90371 | Physician and practitioner services (fee schedule) | 33 | $136.95 |
| 90375 | Physician and practitioner services (fee schedule) | 39 | $279.95 |
| 90376 | Physician and practitioner services (fee schedule) | 34 | $453.04 |
| 90377 | Physician and practitioner services (fee schedule) | 29 | $243.20 |
| 90378 | Physician and practitioner services (fee schedule) | 22 | $1,623.45 |
| 90380 | Physician and practitioner services (fee schedule) | 27 | $501.34 |
| 90381 | Physician and practitioner services (fee schedule) | 28 | $498.17 |
| 90382 | Physician and practitioner services (fee schedule) | 22 | $548.77 |
| 90385 | Physician and practitioner services (fee schedule) | 22 | $29.34 |
| 90396 | Physician and practitioner services (fee schedule) | 19 | $1,953.40 |
| 90460 | Physician and practitioner services (fee schedule) | 34 | $19.69 |
| 90461 | Physician and practitioner services (fee schedule) | 22 | $8.28 |
| 90471 | Physician and practitioner services (fee schedule) | 39 | $16.13 |
| 90472 | Physician and practitioner services (fee schedule) | 38 | $12.81 |
| 90473 | Physician and practitioner services (fee schedule) | 36 | $13.82 |
| 90474 | Physician and practitioner services (fee schedule) | 36 | $10.02 |
| 90476 | Physician and practitioner services (fee schedule) | 5 | $22.01 |
| 90480 | Physician and practitioner services (fee schedule) | 40 | $34.61 |
| 90481 | Physician and practitioner services (fee schedule) | 5 | $33.20 |
| 90482 | Physician and practitioner services (fee schedule) | 15 | $11.33 |
| 90483 | Physician and practitioner services (fee schedule) | 15 | $22.68 |
| 90581 | Physician and practitioner services (fee schedule) | 14 | $98.51 |
| 90586 | Physician and practitioner services (fee schedule) | 28 | $163.97 |
| 90587 | Physician and practitioner services (fee schedule) | 12 | $65.67 |
| 90589 | Physician and practitioner services (fee schedule) | 18 | $275.00 |
| 90593 | Physician and practitioner services (fee schedule) | 19 | $282.79 |
| 90611 | Physician and practitioner services (fee schedule) | 29 | $270.00 |
| 90619 | Physician and practitioner services (fee schedule) | 38 | $171.60 |
| 90622 | Physician and practitioner services (fee schedule) | 12 | $0.01 |
| 90623 | Physician and practitioner services (fee schedule) | 34 | $236.38 |
| 90624 | Physician and practitioner services (fee schedule) | 28 | $250.75 |
| 90625 | Physician and practitioner services (fee schedule) | 17 | $283.25 |
| 90626 | Physician and practitioner services (fee schedule) | 18 | $319.10 |
| 90627 | Physician and practitioner services (fee schedule) | 19 | $319.10 |
| 90632 | Physician and practitioner services (fee schedule) | 41 | $74.92 |
| 90636 | Physician and practitioner services (fee schedule) | 38 | $126.82 |
| 90644 | Physician and practitioner services (fee schedule) | 11 | $23.60 |
| 90648 | Physician and practitioner services (fee schedule) | 38 | $13.49 |
| 90649 | Physician and practitioner services (fee schedule) | 24 | $142.91 |
| 90650 | Physician and practitioner services (fee schedule) | 22 | $131.75 |
| 90654 | Physician and practitioner services (fee schedule) | 6 | $18.92 |
| 90655 | Physician and practitioner services (fee schedule) | 23 | $15.45 |
| 90660 | Physician and practitioner services (fee schedule) | 40 | $26.30 |
| 90661 | Physician and practitioner services (fee schedule) | 41 | $46.63 |
| 90670 | Physician and practitioner services (fee schedule) | 37 | $226.93 |
| 90671 | Physician and practitioner services (fee schedule) | 40 | $244.29 |
| 90672 | Physician and practitioner services (fee schedule) | 32 | $24.35 |
| 90674 | Physician and practitioner services (fee schedule) | 33 | $30.36 |
| 90675 | Physician and practitioner services (fee schedule) | 40 | $327.99 |
| 90676 | Physician and practitioner services (fee schedule) | 12 | $152.40 |
| 90677 | Physician and practitioner services (fee schedule) | 41 | $298.04 |
| 90678 | Physician and practitioner services (fee schedule) | 37 | $313.96 |
| 90679 | Physician and practitioner services (fee schedule) | 35 | $314.63 |
| 90681 | Physician and practitioner services (fee schedule) | 30 | $108.24 |
| 90682 | Physician and practitioner services (fee schedule) | 30 | $69.32 |
| 90683 | Physician and practitioner services (fee schedule) | 25 | $315.81 |
| 90684 | Physician and practitioner services (fee schedule) | 36 | $326.11 |
| 90685 | Physician and practitioner services (fee schedule) | 29 | $19.28 |
| 90686 | Physician and practitioner services (fee schedule) | 33 | $19.86 |
| 90687 | Physician and practitioner services (fee schedule) | 27 | $10.43 |
| 90688 | Physician and practitioner services (fee schedule) | 32 | $19.73 |
| 90689 | Physician and practitioner services (fee schedule) | 9 | $19.82 |
| 90690 | Physician and practitioner services (fee schedule) | 24 | $30.39 |
| 90691 | Physician and practitioner services (fee schedule) | 29 | $123.68 |
| 90694 | Physician and practitioner services (fee schedule) | 29 | $73.49 |
| 90697 | Physician and practitioner services (fee schedule) | 27 | $132.77 |
| 90707 | Physician and practitioner services (fee schedule) | 38 | $93.87 |
| 90710 | Physician and practitioner services (fee schedule) | 33 | $267.94 |
| 90713 | Physician and practitioner services (fee schedule) | 37 | $41.04 |
| 90715 | Physician and practitioner services (fee schedule) | 43 | $39.69 |
| 90716 | Physician and practitioner services (fee schedule) | 39 | $182.25 |
| 90717 | Physician and practitioner services (fee schedule) | 26 | $166.69 |
| 90723 | Physician and practitioner services (fee schedule) | 31 | $90.04 |
| 90732 | Physician and practitioner services (fee schedule) | 43 | $122.94 |
| 90733 | Physician and practitioner services (fee schedule) | 23 | $106.49 |
| 90734 | Physician and practitioner services (fee schedule) | 39 | $150.64 |
| 90736 | Physician and practitioner services (fee schedule) | 26 | $188.16 |
| 90738 | Physician and practitioner services (fee schedule) | 15 | $300.60 |
| 90739 | Physician and practitioner services (fee schedule) | 40 | $169.37 |
| 90743 | Physician and practitioner services (fee schedule) | 33 | $71.39 |
| 90746 | Physician and practitioner services (fee schedule) | 42 | $75.07 |
| 90748 | Physician and practitioner services (fee schedule) | 22 | $42.51 |
| 90750 | Physician and practitioner services (fee schedule) | 36 | $217.63 |
| 90756 | Physician and practitioner services (fee schedule) | 30 | $30.67 |
| 90759 | Physician and practitioner services (fee schedule) | 34 | $71.97 |
| 90912 | Physician and practitioner services (fee schedule) | 25 | $56.12 |
| 90913 | Physician and practitioner services (fee schedule) | 25 | $23.41 |
| 90935 | Physician and practitioner services (fee schedule) | 44 | $55.48 |
| 90937 | Physician and practitioner services (fee schedule) | 44 | $81.67 |
| 90940 | Physician and practitioner services (fee schedule) | 12 | $51.76 |
| 90945 | Physician and practitioner services (fee schedule) | 45 | $64.33 |
| 90947 | Physician and practitioner services (fee schedule) | 44 | $93.43 |
| 90951 | Physician and practitioner services (fee schedule) | 42 | $846.87 |
| 90952 | Physician and practitioner services (fee schedule) | 30 | $468.22 |
| 90953 | Physician and practitioner services (fee schedule) | 30 | $315.39 |
| 90954 | Physician and practitioner services (fee schedule) | 42 | $741.27 |
| 90955 | Physician and practitioner services (fee schedule) | 42 | $401.20 |
| 90956 | Physician and practitioner services (fee schedule) | 41 | $277.88 |
| 90957 | Physician and practitioner services (fee schedule) | 42 | $572.09 |
| 90958 | Physician and practitioner services (fee schedule) | 42 | $391.09 |
| 90959 | Physician and practitioner services (fee schedule) | 42 | $258.10 |
| 90960 | Physician and practitioner services (fee schedule) | 42 | $265.97 |
| 90961 | Physician and practitioner services (fee schedule) | 42 | $221.23 |
| 90962 | Physician and practitioner services (fee schedule) | 42 | $163.18 |
| 90963 | Physician and practitioner services (fee schedule) | 41 | $476.95 |
| 90964 | Physician and practitioner services (fee schedule) | 41 | $403.96 |
| 90965 | Physician and practitioner services (fee schedule) | 41 | $390.32 |
| 90966 | Physician and practitioner services (fee schedule) | 41 | $220.06 |
| 90967 | Physician and practitioner services (fee schedule) | 43 | $15.28 |
| 90968 | Physician and practitioner services (fee schedule) | 43 | $13.77 |
| 90969 | Physician and practitioner services (fee schedule) | 43 | $13.50 |
| 90970 | Physician and practitioner services (fee schedule) | 43 | $7.31 |
| 90989 | Physician and practitioner services (fee schedule) | 28 | $399.69 |
| 90993 | Physician and practitioner services (fee schedule) | 28 | $20.66 |
| 90997 | Physician and practitioner services (fee schedule) | 33 | $71.37 |
| 91010 | Physician and practitioner services (fee schedule) | 45 | $113.22 |
| 91013 | Physician and practitioner services (fee schedule) | 44 | $12.69 |
| 91020 | Physician and practitioner services (fee schedule) | 45 | $146.57 |
| 91022 | Physician and practitioner services (fee schedule) | 44 | $90.22 |
| 91030 | Physician and practitioner services (fee schedule) | 45 | $73.81 |
| 91034 | Physician and practitioner services (fee schedule) | 45 | $120.55 |
| 91035 | Physician and practitioner services (fee schedule) | 45 | $310.84 |
| 91037 | Physician and practitioner services (fee schedule) | 45 | $93.71 |
| 91038 | Physician and practitioner services (fee schedule) | 45 | $245.46 |
| 91040 | Physician and practitioner services (fee schedule) | 44 | $341.57 |
| 91065 | Physician and practitioner services (fee schedule) | 44 | $44.04 |
| 91110 | Physician and practitioner services (fee schedule) | 45 | $543.87 |
| 91111 | Physician and practitioner services (fee schedule) | 34 | $577.03 |
| 91112 | Physician and practitioner services (fee schedule) | 33 | $1,016.61 |
| 91113 | Physician and practitioner services (fee schedule) | 33 | $634.70 |
| 91117 | Physician and practitioner services (fee schedule) | 36 | $106.37 |
| 91120 | Physician and practitioner services (fee schedule) | 13 | $348.12 |
| 91122 | Physician and practitioner services (fee schedule) | 13 | $96.39 |
| 91124 | Physician and practitioner services (fee schedule) | 38 | $496.42 |
| 91125 | Physician and practitioner services (fee schedule) | 38 | $178.24 |
| 91132 | Physician and practitioner services (fee schedule) | 31 | $250.55 |
| 91133 | Physician and practitioner services (fee schedule) | 30 | $281.07 |
| 91200 | Physician and practitioner services (fee schedule) | 45 | $17.75 |
| 91299 | Physician and practitioner services (fee schedule) | 7 | $148.13 |
| 91304 | Physician and practitioner services (fee schedule) | 37 | $172.73 |
| 91318 | Physician and practitioner services (fee schedule) | 29 | $59.23 |
| 91319 | Physician and practitioner services (fee schedule) | 34 | $87.78 |
| 91320 | Physician and practitioner services (fee schedule) | 40 | $155.90 |
| 91321 | Physician and practitioner services (fee schedule) | 34 | $138.70 |
| 91322 | Physician and practitioner services (fee schedule) | 40 | $149.10 |
| 91323 | Physician and practitioner services (fee schedule) | 29 | $201.91 |
| 92002 | Physician and practitioner services (fee schedule) | 45 | $54.24 |
| 92004 | Physician and practitioner services (fee schedule) | 45 | $95.42 |
| 92012 | Physician and practitioner services (fee schedule) | 45 | $54.73 |
| 92014 | Physician and practitioner services (fee schedule) | 45 | $72.26 |
| 92015 | Physician and practitioner services (fee schedule) | 40 | $15.33 |
| 92018 | Physician and practitioner services (fee schedule) | 45 | $98.09 |
| 92019 | Physician and practitioner services (fee schedule) | 45 | $53.23 |
| 92020 | Physician and practitioner services (fee schedule) | 45 | $20.33 |
| 92025 | Physician and practitioner services (fee schedule) | 44 | $15.99 |
| 92060 | Physician and practitioner services (fee schedule) | 45 | $30.43 |
| 92065 | Physician and practitioner services (fee schedule) | 37 | $27.20 |
| 92066 | Physician and practitioner services (fee schedule) | 28 | $20.29 |
| 92071 | Physician and practitioner services (fee schedule) | 40 | $28.55 |
| 92072 | Physician and practitioner services (fee schedule) | 39 | $91.74 |
| 92081 | Physician and practitioner services (fee schedule) | 45 | $15.67 |
| 92082 | Physician and practitioner services (fee schedule) | 45 | $22.80 |
| 92083 | Physician and practitioner services (fee schedule) | 45 | $30.38 |
| 92100 | Physician and practitioner services (fee schedule) | 43 | $53.10 |
| 92132 | Physician and practitioner services (fee schedule) | 43 | $14.31 |
| 92133 | Physician and practitioner services (fee schedule) | 45 | $16.40 |
| 92134 | Physician and practitioner services (fee schedule) | 45 | $18.45 |
| 92136 | Physician and practitioner services (fee schedule) | 45 | $27.76 |
| 92137 | Physician and practitioner services (fee schedule) | 37 | $31.08 |
| 92145 | Professional / technical component share of a procedure fee | 25 | $8.16 |
| 92201 | Physician and practitioner services (fee schedule) | 44 | $20.27 |
| 92202 | Physician and practitioner services (fee schedule) | 44 | $12.75 |
| 92227 | Physician and practitioner services (fee schedule) | 35 | $11.96 |
| 92228 | Physician and practitioner services (fee schedule) | 38 | $14.71 |
| 92229 | Physician and practitioner services (fee schedule) | 26 | $35.05 |
| 92230 | Physician and practitioner services (fee schedule) | 43 | $78.79 |
| 92235 | Physician and practitioner services (fee schedule) | 45 | $76.06 |
| 92240 | Physician and practitioner services (fee schedule) | 44 | $126.30 |
| 92242 | Physician and practitioner services (fee schedule) | 44 | $172.85 |
| 92250 | Physician and practitioner services (fee schedule) | 45 | $19.06 |
| 92260 | Physician and practitioner services (fee schedule) | 43 | $15.12 |
| 92265 | Physician and practitioner services (fee schedule) | 44 | $37.01 |
| 92270 | Physician and practitioner services (fee schedule) | 45 | $52.74 |
| 92273 | Physician and practitioner services (fee schedule) | 45 | $74.21 |
| 92274 | Physician and practitioner services (fee schedule) | 45 | $49.12 |
| 92283 | Physician and practitioner services (fee schedule) | 39 | $33.67 |
| 92284 | Physician and practitioner services (fee schedule) | 41 | $25.47 |
| 92285 | Physician and practitioner services (fee schedule) | 40 | $16.69 |
| 92286 | Physician and practitioner services (fee schedule) | 43 | $20.41 |
| 92287 | Physician and practitioner services (fee schedule) | 40 | $89.88 |
| 92310 | Physician and practitioner services (fee schedule) | 38 | $68.49 |
| 92311 | Physician and practitioner services (fee schedule) | 36 | $67.79 |
| 92312 | Physician and practitioner services (fee schedule) | 36 | $77.60 |
| 92313 | Physician and practitioner services (fee schedule) | 34 | $64.57 |
| 92314 | Physician and practitioner services (fee schedule) | 27 | $47.41 |
| 92315 | Physician and practitioner services (fee schedule) | 27 | $48.07 |
| 92316 | Physician and practitioner services (fee schedule) | 27 | $59.71 |
| 92317 | Physician and practitioner services (fee schedule) | 27 | $50.17 |
| 92325 | Physician and practitioner services (fee schedule) | 24 | $35.61 |
| 92326 | Physician and practitioner services (fee schedule) | 30 | $32.32 |
| 92340 | Physician and practitioner services (fee schedule) | 33 | $22.79 |
| 92341 | Physician and practitioner services (fee schedule) | 33 | $26.60 |
| 92342 | Physician and practitioner services (fee schedule) | 31 | $27.97 |
| 92352 | Physician and practitioner services (fee schedule) | 24 | $22.32 |
| 92353 | Physician and practitioner services (fee schedule) | 27 | $28.98 |
| 92354 | Physician and practitioner services (fee schedule) | 16 | $12.71 |
| 92355 | Physician and practitioner services (fee schedule) | 16 | $18.20 |
| 92358 | Physician and practitioner services (fee schedule) | 17 | $11.18 |
| 92370 | Physician and practitioner services (fee schedule) | 35 | $16.43 |
| 92371 | Physician and practitioner services (fee schedule) | 22 | $9.16 |
| 92499 | Physician and practitioner services (fee schedule) | 13 | $18.45 |
| 92502 | Physician and practitioner services (fee schedule) | 45 | $73.95 |
| 92504 | Physician and practitioner services (fee schedule) | 41 | $19.41 |
| 92508 | Physician and practitioner services (fee schedule) | 41 | $19.55 |
| 92511 | Physician and practitioner services (fee schedule) | 44 | $70.51 |
| 92512 | Physician and practitioner services (fee schedule) | 38 | $40.27 |
| 92516 | Physician and practitioner services (fee schedule) | 41 | $33.29 |
| 92517 | Physician and practitioner services (fee schedule) | 32 | $56.97 |
| 92518 | Physician and practitioner services (fee schedule) | 32 | $55.57 |
| 92519 | Physician and practitioner services (fee schedule) | 32 | $89.84 |
| 92520 | Physician and practitioner services (fee schedule) | 41 | $44.04 |
| 92531 | Physician and practitioner services (fee schedule) | 22 | $11.70 |
| 92532 | Physician and practitioner services (fee schedule) | 21 | $11.99 |
| 92533 | Physician and practitioner services (fee schedule) | 25 | $16.54 |
| 92534 | Physician and practitioner services (fee schedule) | 23 | $14.92 |
| 92537 | Physician and practitioner services (fee schedule) | 45 | $25.93 |
| 92538 | Physician and practitioner services (fee schedule) | 45 | $12.98 |
| 92540 | Physician and practitioner services (fee schedule) | 45 | $62.47 |
| 92541 | Physician and practitioner services (fee schedule) | 45 | $18.97 |
| 92542 | Physician and practitioner services (fee schedule) | 45 | $20.97 |
| 92544 | Physician and practitioner services (fee schedule) | 45 | $13.16 |
| 92545 | Physician and practitioner services (fee schedule) | 45 | $11.66 |
| 92546 | Physician and practitioner services (fee schedule) | 44 | $79.85 |
| 92547 | Physician and practitioner services (fee schedule) | 44 | $8.39 |
| 92548 | Physician and practitioner services (fee schedule) | 37 | $30.93 |
| 92549 | Physician and practitioner services (fee schedule) | 33 | $38.83 |
| 92550 | Physician and practitioner services (fee schedule) | 45 | $16.89 |
| 92551 | Physician and practitioner services (fee schedule) | 44 | $10.07 |
| 92552 | Physician and practitioner services (fee schedule) | 45 | $25.62 |
| 92553 | Physician and practitioner services (fee schedule) | 45 | $30.38 |
| 92555 | Physician and practitioner services (fee schedule) | 45 | $18.85 |
| 92556 | Physician and practitioner services (fee schedule) | 44 | $29.57 |
| 92557 | Physician and practitioner services (fee schedule) | 45 | $30.12 |
| 92558 | Physician and practitioner services (fee schedule) | 28 | $7.93 |
| 92561 | Physician and practitioner services (fee schedule) | 5 | $24.87 |
| 92562 | Physician and practitioner services (fee schedule) | 40 | $31.27 |
| 92563 | Physician and practitioner services (fee schedule) | 43 | $23.79 |
| 92564 | Physician and practitioner services (fee schedule) | 6 | $14.94 |
| 92565 | Physician and practitioner services (fee schedule) | 43 | $14.79 |
| 92567 | Physician and practitioner services (fee schedule) | 44 | $12.50 |
| 92568 | Physician and practitioner services (fee schedule) | 45 | $12.36 |
| 92570 | Physician and practitioner services (fee schedule) | 45 | $24.18 |
| 92571 | Physician and practitioner services (fee schedule) | 42 | $20.22 |
| 92572 | Physician and practitioner services (fee schedule) | 42 | $34.49 |
| 92575 | Physician and practitioner services (fee schedule) | 40 | $52.11 |
| 92576 | Physician and practitioner services (fee schedule) | 41 | $27.05 |
| 92577 | Physician and practitioner services (fee schedule) | 42 | $16.62 |
| 92579 | Physician and practitioner services (fee schedule) | 43 | $32.67 |
| 92582 | Physician and practitioner services (fee schedule) | 43 | $57.71 |
| 92583 | Physician and practitioner services (fee schedule) | 39 | $40.51 |
| 92584 | Physician and practitioner services (fee schedule) | 38 | $84.00 |
| 92587 | Physician and practitioner services (fee schedule) | 45 | $16.72 |
| 92588 | Physician and practitioner services (fee schedule) | 45 | $25.82 |
| 92590 | Physician and practitioner services (fee schedule) | 10 | $43.78 |
| 92592 | Physician and practitioner services (fee schedule) | 9 | $16.30 |
| 92593 | Physician and practitioner services (fee schedule) | 9 | $25.00 |
| 92594 | Physician and practitioner services (fee schedule) | 10 | $16.29 |
| 92595 | Physician and practitioner services (fee schedule) | 9 | $30.00 |
| 92596 | Physician and practitioner services (fee schedule) | 25 | $48.15 |
| 92597 | Physician and practitioner services (fee schedule) | 38 | $62.64 |
| 92601 | Physician and practitioner services (fee schedule) | 44 | $116.04 |
| 92602 | Physician and practitioner services (fee schedule) | 44 | $74.70 |
| 92603 | Physician and practitioner services (fee schedule) | 44 | $101.10 |
| 92604 | Physician and practitioner services (fee schedule) | 44 | $59.85 |
| 92605 | Physician and practitioner services (fee schedule) | 17 | $67.81 |
| 92606 | Physician and practitioner services (fee schedule) | 19 | $53.85 |
| 92611 | Physician and practitioner services (fee schedule) | 44 | $73.51 |
| 92612 | Physician and practitioner services (fee schedule) | 43 | $125.03 |
| 92613 | Physician and practitioner services (fee schedule) | 29 | $30.43 |
| 92614 | Physician and practitioner services (fee schedule) | 40 | $95.32 |
| 92615 | Physician and practitioner services (fee schedule) | 31 | $27.53 |
| 92616 | Physician and practitioner services (fee schedule) | 40 | $138.36 |
| 92617 | Physician and practitioner services (fee schedule) | 31 | $34.15 |
| 92618 | Physician and practitioner services (fee schedule) | 13 | $24.02 |
| 92620 | Physician and practitioner services (fee schedule) | 39 | $59.45 |
| 92621 | Physician and practitioner services (fee schedule) | 40 | $14.52 |
| 92622 | Physician and practitioner services (fee schedule) | 41 | $56.65 |
| 92623 | Physician and practitioner services (fee schedule) | 40 | $14.81 |
| 92625 | Physician and practitioner services (fee schedule) | 39 | $46.27 |
| 92626 | Physician and practitioner services (fee schedule) | 42 | $64.44 |
| 92627 | Physician and practitioner services (fee schedule) | 42 | $16.23 |
| 92628 | Physician and practitioner services (fee schedule) | 18 | $42.34 |
| 92629 | Physician and practitioner services (fee schedule) | 16 | $21.14 |
| 92631 | Physician and practitioner services (fee schedule) | 17 | $39.24 |
| 92632 | Physician and practitioner services (fee schedule) | 16 | $15.85 |
| 92634 | Physician and practitioner services (fee schedule) | 9 | $48.14 |
| 92635 | Physician and practitioner services (fee schedule) | 9 | $24.54 |
| 92636 | Physician and practitioner services (fee schedule) | 21 | $25.00 |
| 92637 | Physician and practitioner services (fee schedule) | 19 | $12.64 |
| 92638 | Physician and practitioner services (fee schedule) | 10 | $35.54 |
| 92639 | Physician and practitioner services (fee schedule) | 15 | $34.65 |
| 92640 | Physician and practitioner services (fee schedule) | 37 | $72.22 |
| 92641 | Physician and practitioner services (fee schedule) | 19 | $17.01 |
| 92642 | Physician and practitioner services (fee schedule) | 7 | $29.60 |
| 92650 | Physician and practitioner services (fee schedule) | 44 | $22.40 |
| 92651 | Physician and practitioner services (fee schedule) | 45 | $69.44 |
| 92652 | Physician and practitioner services (fee schedule) | 45 | $90.40 |
| 92653 | Physician and practitioner services (fee schedule) | 45 | $67.20 |
| 92700 | Physician and practitioner services (fee schedule) | 7 | $20.00 |
| 92920 | Physician and practitioner services (fee schedule) | 43 | $364.46 |
| 92924 | Physician and practitioner services (fee schedule) | 43 | $433.29 |
| 92928 | Physician and practitioner services (fee schedule) | 43 | $412.19 |
| 92930 | Physician and practitioner services (fee schedule) | 38 | $400.30 |
| 92933 | Physician and practitioner services (fee schedule) | 43 | $477.50 |
| 92937 | Physician and practitioner services (fee schedule) | 43 | $449.05 |
| 92941 | Physician and practitioner services (fee schedule) | 44 | $501.52 |
| 92943 | Physician and practitioner services (fee schedule) | 44 | $516.95 |
| 92945 | Physician and practitioner services (fee schedule) | 35 | $499.18 |
| 92950 | Physician and practitioner services (fee schedule) | 43 | $213.32 |
| 92953 | Physician and practitioner services (fee schedule) | 42 | $1.06 |
| 92960 | Physician and practitioner services (fee schedule) | 43 | $120.34 |
| 92961 | Physician and practitioner services (fee schedule) | 43 | $184.28 |
| 92970 | Physician and practitioner services (fee schedule) | 43 | $147.56 |
| 92971 | Physician and practitioner services (fee schedule) | 43 | $75.92 |
| 92972 | Physician and practitioner services (fee schedule) | 28 | $105.89 |
| 92973 | Physician and practitioner services (fee schedule) | 44 | $116.25 |
| 92974 | Physician and practitioner services (fee schedule) | 43 | $125.98 |
| 92975 | Physician and practitioner services (fee schedule) | 9 | $381.22 |
| 92977 | Physician and practitioner services (fee schedule) | 9 | $55.46 |
| 92978 | Physician and practitioner services (fee schedule) | 43 | $124.68 |
| 92979 | Physician and practitioner services (fee schedule) | 43 | $69.35 |
| 92986 | Physician and practitioner services (fee schedule) | 44 | $991.90 |
| 92987 | Physician and practitioner services (fee schedule) | 44 | $1,024.79 |
| 92990 | Physician and practitioner services (fee schedule) | 44 | $809.85 |
| 92997 | Physician and practitioner services (fee schedule) | 44 | $524.55 |
| 92998 | Physician and practitioner services (fee schedule) | 43 | $249.40 |
| 93000 | Physician and practitioner services (fee schedule) | 44 | $14.25 |
| 93005 | Physician and practitioner services (fee schedule) | 44 | $6.58 |
| 93010 | Physician and practitioner services (fee schedule) | 44 | $7.34 |
| 93015 | Physician and practitioner services (fee schedule) | 44 | $66.10 |
| 93016 | Physician and practitioner services (fee schedule) | 43 | $18.60 |
| 93017 | Physician and practitioner services (fee schedule) | 42 | $33.43 |
| 93018 | Physician and practitioner services (fee schedule) | 44 | $12.92 |
| 93024 | Physician and practitioner services (fee schedule) | 43 | $51.40 |
| 93025 | Physician and practitioner services (fee schedule) | 43 | $95.69 |
| 93040 | Physician and practitioner services (fee schedule) | 43 | $12.03 |
| 93041 | Physician and practitioner services (fee schedule) | 42 | $5.35 |
| 93042 | Physician and practitioner services (fee schedule) | 42 | $6.07 |
| 93050 | Physician and practitioner services (fee schedule) | 30 | $7.56 |
| 93145 | Physician and practitioner services (fee schedule) | 14 | $31.19 |
| 93146 | Physician and practitioner services (fee schedule) | 14 | $39.96 |
| 93150 | Physician and practitioner services (fee schedule) | 34 | $74.19 |
| 93151 | Physician and practitioner services (fee schedule) | 34 | $63.50 |
| 93152 | Physician and practitioner services (fee schedule) | 30 | $99.24 |
| 93153 | Physician and practitioner services (fee schedule) | 34 | $38.50 |
| 93224 | Physician and practitioner services (fee schedule) | 44 | $66.34 |
| 93225 | Physician and practitioner services (fee schedule) | 44 | $16.59 |
| 93227 | Physician and practitioner services (fee schedule) | 44 | $17.14 |
| 93228 | Physician and practitioner services (fee schedule) | 44 | $20.94 |
| 93229 | Physician and practitioner services (fee schedule) | 40 | $600.90 |
| 93241 | Physician and practitioner services (fee schedule) | 33 | $218.54 |
| 93242 | Physician and practitioner services (fee schedule) | 43 | $10.13 |
| 93244 | Physician and practitioner services (fee schedule) | 44 | $19.41 |
| 93245 | Physician and practitioner services (fee schedule) | 34 | $225.12 |
| 93246 | Physician and practitioner services (fee schedule) | 42 | $10.15 |
| 93248 | Physician and practitioner services (fee schedule) | 43 | $21.34 |
| 93260 | Physician and practitioner services (fee schedule) | 40 | $35.53 |
| 93261 | Physician and practitioner services (fee schedule) | 40 | $31.54 |
| 93268 | Physician and practitioner services (fee schedule) | 44 | $141.37 |
| 93270 | Physician and practitioner services (fee schedule) | 44 | $8.06 |
| 93271 | Physician and practitioner services (fee schedule) | 43 | $112.89 |
| 93272 | Physician and practitioner services (fee schedule) | 44 | $20.78 |
| 93278 | Physician and practitioner services (fee schedule) | 41 | $18.52 |
| 93279 | Physician and practitioner services (fee schedule) | 44 | $29.97 |
| 93280 | Physician and practitioner services (fee schedule) | 44 | $35.13 |
| 93281 | Physician and practitioner services (fee schedule) | 44 | $36.99 |
| 93282 | Physician and practitioner services (fee schedule) | 44 | $36.67 |
| 93283 | Physician and practitioner services (fee schedule) | 44 | $47.67 |
| 93284 | Physician and practitioner services (fee schedule) | 44 | $54.06 |
| 93285 | Physician and practitioner services (fee schedule) | 44 | $27.53 |
| 93286 | Physician and practitioner services (fee schedule) | 42 | $20.78 |
| 93287 | Physician and practitioner services (fee schedule) | 43 | $23.53 |
| 93288 | Physician and practitioner services (fee schedule) | 44 | $28.18 |
| 93289 | Physician and practitioner services (fee schedule) | 44 | $32.87 |
| 93290 | Physician and practitioner services (fee schedule) | 43 | $24.53 |
| 93291 | Physician and practitioner services (fee schedule) | 44 | $24.66 |
| 93292 | Physician and practitioner services (fee schedule) | 44 | $24.01 |
| 93293 | Physician and practitioner services (fee schedule) | 44 | $26.47 |
| 93294 | Physician and practitioner services (fee schedule) | 44 | $25.40 |
| 93295 | Physician and practitioner services (fee schedule) | 44 | $34.69 |
| 93297 | Physician and practitioner services (fee schedule) | 45 | $23.22 |
| 93298 | Physician and practitioner services (fee schedule) | 45 | $45.15 |
| 93303 | Physician and practitioner services (fee schedule) | 45 | $130.66 |
| 93306 | Physician and practitioner services (fee schedule) | 45 | $111.98 |
| 93307 | Physician and practitioner services (fee schedule) | 45 | $81.64 |
| 93308 | Physician and practitioner services (fee schedule) | 44 | $63.05 |
| 93312 | Physician and practitioner services (fee schedule) | 44 | $113.91 |
| 93313 | Physician and practitioner services (fee schedule) | 43 | $10.22 |
| 93314 | Physician and practitioner services (fee schedule) | 43 | $120.36 |
| 93316 | Physician and practitioner services (fee schedule) | 43 | $23.79 |
| 93318 | Physician and practitioner services (fee schedule) | 43 | $110.71 |
| 93319 | Physician and practitioner services (fee schedule) | 36 | $43.00 |
| 93320 | Physician and practitioner services (fee schedule) | 45 | $29.51 |
| 93321 | Physician and practitioner services (fee schedule) | 44 | $15.72 |
| 93325 | Physician and practitioner services (fee schedule) | 44 | $17.63 |
| 93350 | Physician and practitioner services (fee schedule) | 44 | $96.77 |
| 93351 | Physician and practitioner services (fee schedule) | 44 | $130.40 |
| 93352 | Physician and practitioner services (fee schedule) | 40 | $29.20 |
| 93355 | Physician and practitioner services (fee schedule) | 43 | $166.55 |
| 93356 | Physician and practitioner services (fee schedule) | 32 | $27.31 |
| 93451 | Physician and practitioner services (fee schedule) | 44 | $548.40 |
| 93452 | Physician and practitioner services (fee schedule) | 44 | $512.52 |
| 93453 | Physician and practitioner services (fee schedule) | 44 | $656.69 |
| 93454 | Physician and practitioner services (fee schedule) | 44 | $523.75 |
| 93455 | Physician and practitioner services (fee schedule) | 44 | $583.69 |
| 93456 | Physician and practitioner services (fee schedule) | 44 | $645.80 |
| 93457 | Physician and practitioner services (fee schedule) | 44 | $703.36 |
| 93458 | Physician and practitioner services (fee schedule) | 44 | $596.24 |
| 93459 | Physician and practitioner services (fee schedule) | 44 | $631.13 |
| 93460 | Physician and practitioner services (fee schedule) | 44 | $695.28 |
| 93461 | Physician and practitioner services (fee schedule) | 44 | $768.50 |
| 93462 | Physician and practitioner services (fee schedule) | 44 | $161.58 |
| 93463 | Physician and practitioner services (fee schedule) | 43 | $78.89 |
| 93464 | Physician and practitioner services (fee schedule) | 43 | $114.82 |
| 93503 | Physician and practitioner services (fee schedule) | 44 | $79.53 |
| 93505 | Physician and practitioner services (fee schedule) | 44 | $335.22 |
| 93563 | Physician and practitioner services (fee schedule) | 44 | $41.06 |
| 93564 | Physician and practitioner services (fee schedule) | 44 | $44.01 |
| 93565 | Physician and practitioner services (fee schedule) | 44 | $23.81 |
| 93566 | Physician and practitioner services (fee schedule) | 44 | $23.85 |
| 93567 | Physician and practitioner services (fee schedule) | 44 | $31.84 |
| 93568 | Physician and practitioner services (fee schedule) | 44 | $36.71 |
| 93569 | Physician and practitioner services (fee schedule) | 41 | $29.40 |
| 93573 | Physician and practitioner services (fee schedule) | 41 | $48.92 |
| 93574 | Physician and practitioner services (fee schedule) | 41 | $54.53 |
| 93575 | Physician and practitioner services (fee schedule) | 41 | $72.44 |
| 93580 | Physician and practitioner services (fee schedule) | 44 | $728.20 |
| 93581 | Physician and practitioner services (fee schedule) | 42 | $986.26 |
| 93582 | Physician and practitioner services (fee schedule) | 44 | $491.88 |
| 93583 | Physician and practitioner services (fee schedule) | 43 | $506.51 |
| 93584 | Physician and practitioner services (fee schedule) | 40 | $42.35 |
| 93585 | Physician and practitioner services (fee schedule) | 39 | $39.95 |
| 93586 | Physician and practitioner services (fee schedule) | 40 | $51.39 |
| 93587 | Physician and practitioner services (fee schedule) | 40 | $75.02 |
| 93588 | Physician and practitioner services (fee schedule) | 40 | $75.61 |
| 93590 | Physician and practitioner services (fee schedule) | 39 | $809.26 |
| 93591 | Physician and practitioner services (fee schedule) | 39 | $670.85 |
| 93592 | Physician and practitioner services (fee schedule) | 39 | $292.81 |
| 93593 | Physician and practitioner services (fee schedule) | 41 | $155.41 |
| 93594 | Physician and practitioner services (fee schedule) | 40 | $242.82 |
| 93595 | Physician and practitioner services (fee schedule) | 41 | $217.96 |
| 93596 | Physician and practitioner services (fee schedule) | 41 | $271.51 |
| 93597 | Physician and practitioner services (fee schedule) | 41 | $354.46 |
| 93598 | Physician and practitioner services (fee schedule) | 38 | $53.11 |
| 93600 | Physician and practitioner services (fee schedule) | 44 | $100.31 |
| 93602 | Physician and practitioner services (fee schedule) | 44 | $96.11 |
| 93603 | Physician and practitioner services (fee schedule) | 44 | $96.10 |
| 93609 | Physician and practitioner services (fee schedule) | 44 | $227.96 |
| 93610 | Physician and practitioner services (fee schedule) | 44 | $135.08 |
| 93612 | Physician and practitioner services (fee schedule) | 44 | $134.77 |
| 93613 | Physician and practitioner services (fee schedule) | 44 | $242.31 |
| 93615 | Physician and practitioner services (fee schedule) | 43 | $34.22 |
| 93616 | Physician and practitioner services (fee schedule) | 42 | $55.36 |
| 93618 | Physician and practitioner services (fee schedule) | 44 | $183.87 |
| 93619 | Physician and practitioner services (fee schedule) | 44 | $336.91 |
| 93620 | Physician and practitioner services (fee schedule) | 44 | $533.83 |
| 93621 | Physician and practitioner services (fee schedule) | 43 | $101.00 |
| 93622 | Physician and practitioner services (fee schedule) | 43 | $159.52 |
| 93623 | Physician and practitioner services (fee schedule) | 42 | $123.53 |
| 93624 | Physician and practitioner services (fee schedule) | 43 | $207.08 |
| 93631 | Physician and practitioner services (fee schedule) | 42 | $346.91 |
| 93640 | Physician and practitioner services (fee schedule) | 44 | $204.45 |
| 93641 | Physician and practitioner services (fee schedule) | 44 | $267.49 |
| 93642 | Physician and practitioner services (fee schedule) | 44 | $215.72 |
| 93644 | Physician and practitioner services (fee schedule) | 40 | $133.25 |
| 93650 | Physician and practitioner services (fee schedule) | 44 | $448.85 |
| 93653 | Physician and practitioner services (fee schedule) | 44 | $610.05 |
| 93654 | Physician and practitioner services (fee schedule) | 44 | $774.46 |
| 93655 | Physician and practitioner services (fee schedule) | 44 | $250.70 |
| 93656 | Physician and practitioner services (fee schedule) | 44 | $738.02 |
| 93657 | Physician and practitioner services (fee schedule) | 44 | $248.26 |
| 93660 | Physician and practitioner services (fee schedule) | 43 | $77.43 |
| 93662 | Physician and practitioner services (fee schedule) | 43 | $127.67 |
| 93668 | Physician and practitioner services (fee schedule) | 20 | $12.45 |
| 93701 | Physician and practitioner services (fee schedule) | 41 | $21.09 |
| 93702 | Physician and practitioner services (fee schedule) | 26 | $97.99 |
| 93724 | Physician and practitioner services (fee schedule) | 44 | $210.55 |
| 93740 | Physician and practitioner services (fee schedule) | 27 | $7.39 |
| 93745 | Physician and practitioner services (fee schedule) | 25 | $40.36 |
| 93750 | Physician and practitioner services (fee schedule) | 40 | $36.08 |
| 93770 | Physician and practitioner services (fee schedule) | 31 | $7.08 |
| 93784 | Physician and practitioner services (fee schedule) | 37 | $39.60 |
| 93786 | Physician and practitioner services (fee schedule) | 33 | $19.91 |
| 93788 | Physician and practitioner services (fee schedule) | 33 | $4.96 |
| 93790 | Physician and practitioner services (fee schedule) | 35 | $15.06 |
| 93792 | Physician and practitioner services (fee schedule) | 24 | $55.06 |
| 93793 | Physician and practitioner services (fee schedule) | 27 | $9.37 |
| 93797 | Physician and practitioner services (fee schedule) | 37 | $12.07 |
| 93798 | Physician and practitioner services (fee schedule) | 39 | $17.75 |
| 93799 | Physician and practitioner services (fee schedule) | 8 | $79.79 |
| 93890 | Physician and practitioner services (fee schedule) | 7 | $167.13 |
| 93892 | Physician and practitioner services (fee schedule) | 42 | $157.19 |
| 93893 | Physician and practitioner services (fee schedule) | 42 | $168.79 |
| 93895 | Physician and practitioner services (fee schedule) | 6 | $98.53 |
| 93896 | Physician and practitioner services (fee schedule) | 38 | $113.32 |
| 93897 | Physician and practitioner services (fee schedule) | 38 | $154.36 |
| 93898 | Physician and practitioner services (fee schedule) | 36 | $160.48 |
| 93979 | Physician and practitioner services (fee schedule) | 44 | $78.48 |
| 93980 | Physician and practitioner services (fee schedule) | 42 | $58.09 |
| 93981 | Physician and practitioner services (fee schedule) | 41 | $44.31 |
| 93985 | Physician and practitioner services (fee schedule) | 42 | $174.62 |
| 93986 | Physician and practitioner services (fee schedule) | 42 | $96.90 |
| 94002 | Physician and practitioner services (fee schedule) | 38 | $68.58 |
| 94003 | Physician and practitioner services (fee schedule) | 38 | $48.49 |
| 94004 | Physician and practitioner services (fee schedule) | 31 | $36.80 |
| 94005 | Physician and practitioner services (fee schedule) | 6 | $75.16 |
| 94010 | Physician and practitioner services (fee schedule) | 44 | $17.02 |
| 94011 | Physician and practitioner services (fee schedule) | 43 | $62.91 |
| 94012 | Physician and practitioner services (fee schedule) | 43 | $101.57 |
| 94013 | Physician and practitioner services (fee schedule) | 42 | $16.07 |
| 94060 | Physician and practitioner services (fee schedule) | 44 | $27.03 |
| 94070 | Physician and practitioner services (fee schedule) | 42 | $31.99 |
| 94150 | Physician and practitioner services (fee schedule) | 36 | $12.80 |
| 94200 | Physician and practitioner services (fee schedule) | 44 | $10.97 |
| 94375 | Physician and practitioner services (fee schedule) | 44 | $21.23 |
| 94450 | Physician and practitioner services (fee schedule) | 40 | $49.90 |
| 94452 | Physician and practitioner services (fee schedule) | 30 | $31.31 |
| 94453 | Physician and practitioner services (fee schedule) | 30 | $42.82 |
| 94610 | Physician and practitioner services (fee schedule) | 37 | $43.46 |
| 94617 | Physician and practitioner services (fee schedule) | 43 | $51.56 |
| 94618 | Physician and practitioner services (fee schedule) | 44 | $19.19 |
| 94619 | Physician and practitioner services (fee schedule) | 42 | $38.63 |
| 94621 | Physician and practitioner services (fee schedule) | 44 | $70.34 |
| 94625 | Physician and practitioner services (fee schedule) | 41 | $55.59 |
| 94626 | Physician and practitioner services (fee schedule) | 41 | $62.10 |
| 94640 | Physician and practitioner services (fee schedule) | 43 | $8.35 |
| 94642 | Physician and practitioner services (fee schedule) | 38 | $33.26 |
| 94644 | Physician and practitioner services (fee schedule) | 41 | $44.68 |
| 94645 | Physician and practitioner services (fee schedule) | 40 | $12.89 |
| 94662 | Physician and practitioner services (fee schedule) | 11 | $30.83 |
| 94664 | Physician and practitioner services (fee schedule) | 43 | $14.77 |
| 94667 | Physician and practitioner services (fee schedule) | 39 | $19.62 |
| 94668 | Physician and practitioner services (fee schedule) | 37 | $24.92 |
| 94669 | Physician and practitioner services (fee schedule) | 30 | $20.31 |
| 94680 | Physician and practitioner services (fee schedule) | 43 | $34.88 |
| 94681 | Physician and practitioner services (fee schedule) | 43 | $34.27 |
| 94690 | Physician and practitioner services (fee schedule) | 43 | $36.31 |
| 94760 | Physician and practitioner services (fee schedule) | 37 | $2.98 |
| 94761 | Physician and practitioner services (fee schedule) | 38 | $3.58 |
| 94762 | Physician and practitioner services (fee schedule) | 36 | $20.35 |
| 94772 | Physician and practitioner services (fee schedule) | 35 | $98.36 |
| 94774 | Physician and practitioner services (fee schedule) | 6 | $109.81 |
| 94776 | Physician and practitioner services (fee schedule) | 6 | $73.27 |
| 94777 | Physician and practitioner services (fee schedule) | 18 | $29.20 |
| 94799 | Physician and practitioner services (fee schedule) | 10 | $22.24 |
| 95004 | Physician and practitioner services (fee schedule) | 44 | $3.05 |
| 95012 | Physician and practitioner services (fee schedule) | 39 | $15.44 |
| 95017 | Physician and practitioner services (fee schedule) | 42 | $5.66 |
| 95018 | Physician and practitioner services (fee schedule) | 43 | $13.21 |
| 95024 | Physician and practitioner services (fee schedule) | 44 | $5.07 |
| 95027 | Physician and practitioner services (fee schedule) | 41 | $3.87 |
| 95028 | Physician and practitioner services (fee schedule) | 44 | $9.51 |
| 95044 | Physician and practitioner services (fee schedule) | 44 | $4.14 |
| 95052 | Physician and practitioner services (fee schedule) | 41 | $4.96 |
| 95070 | Physician and practitioner services (fee schedule) | 43 | $32.21 |
| 95076 | Physician and practitioner services (fee schedule) | 44 | $83.88 |
| 95079 | Physician and practitioner services (fee schedule) | 43 | $66.20 |
| 95115 | Physician and practitioner services (fee schedule) | 45 | $8.37 |
| 95117 | Physician and practitioner services (fee schedule) | 45 | $10.01 |
| 95120 | Physician and practitioner services (fee schedule) | 24 | $9.58 |
| 95125 | Physician and practitioner services (fee schedule) | 23 | $12.00 |
| 95130 | Physician and practitioner services (fee schedule) | 27 | $14.40 |
| 95131 | Physician and practitioner services (fee schedule) | 27 | $20.00 |
| 95132 | Physician and practitioner services (fee schedule) | 27 | $21.65 |
| 95133 | Physician and practitioner services (fee schedule) | 26 | $23.41 |
| 95134 | Physician and practitioner services (fee schedule) | 25 | $29.03 |
| 95144 | Physician and practitioner services (fee schedule) | 41 | $9.31 |
| 95145 | Physician and practitioner services (fee schedule) | 43 | $21.55 |
| 95146 | Physician and practitioner services (fee schedule) | 43 | $39.19 |
| 95147 | Physician and practitioner services (fee schedule) | 43 | $38.31 |
| 95148 | Physician and practitioner services (fee schedule) | 42 | $56.41 |
| 95149 | Physician and practitioner services (fee schedule) | 42 | $74.67 |
| 95165 | Physician and practitioner services (fee schedule) | 43 | $9.06 |
| 95170 | Physician and practitioner services (fee schedule) | 40 | $7.50 |
| 95180 | Physician and practitioner services (fee schedule) | 43 | $99.11 |
| 95199 | Physician and practitioner services (fee schedule) | 6 | $9.97 |
| 95249 | Physician and practitioner services (fee schedule) | 36 | $48.34 |
| 95250 | Physician and practitioner services (fee schedule) | 40 | $117.04 |
| 95251 | Physician and practitioner services (fee schedule) | 41 | $28.29 |
| 95700 | Physician and practitioner services (fee schedule) | 35 | $201.07 |
| 95705 | Physician and practitioner services (fee schedule) | 36 | $116.23 |
| 95706 | Physician and practitioner services (fee schedule) | 35 | $294.07 |
| 95707 | Physician and practitioner services (fee schedule) | 34 | $353.45 |
| 95708 | Physician and practitioner services (fee schedule) | 36 | $190.90 |
| 95709 | Physician and practitioner services (fee schedule) | 35 | $565.81 |
| 95710 | Physician and practitioner services (fee schedule) | 34 | $689.60 |
| 95712 | Physician and practitioner services (fee schedule) | 35 | $342.03 |
| 95717 | Physician and practitioner services (fee schedule) | 43 | $83.98 |
| 95718 | Physician and practitioner services (fee schedule) | 44 | $105.69 |
| 95719 | Physician and practitioner services (fee schedule) | 44 | $127.99 |
| 95720 | Physician and practitioner services (fee schedule) | 44 | $166.22 |
| 95721 | Physician and practitioner services (fee schedule) | 44 | $167.91 |
| 95722 | Physician and practitioner services (fee schedule) | 44 | $203.23 |
| 95723 | Physician and practitioner services (fee schedule) | 44 | $205.36 |
| 95724 | Physician and practitioner services (fee schedule) | 44 | $258.08 |
| 95725 | Physician and practitioner services (fee schedule) | 44 | $235.96 |
| 95726 | Physician and practitioner services (fee schedule) | 44 | $328.45 |
| 95800 | Physician and practitioner services (fee schedule) | 40 | $89.62 |
| 95801 | Physician and practitioner services (fee schedule) | 30 | $47.56 |
| 95803 | Physician and practitioner services (fee schedule) | 20 | $77.84 |
| 95806 | Physician and practitioner services (fee schedule) | 38 | $52.75 |
| 95824 | Physician and practitioner services (fee schedule) | 41 | $34.42 |
| 95829 | Physician and practitioner services (fee schedule) | 44 | $1,036.32 |
| 95851 | Physician and practitioner services (fee schedule) | 44 | $16.03 |
| 95852 | Physician and practitioner services (fee schedule) | 45 | $13.00 |
| 95857 | Physician and practitioner services (fee schedule) | 43 | $36.30 |
| 95860 | Physician and practitioner services (fee schedule) | 44 | $51.56 |
| 95861 | Physician and practitioner services (fee schedule) | 44 | $69.89 |
| 95863 | Physician and practitioner services (fee schedule) | 44 | $94.82 |
| 95864 | Physician and practitioner services (fee schedule) | 44 | $106.28 |
| 95865 | Physician and practitioner services (fee schedule) | 43 | $69.45 |
| 95866 | Physician and practitioner services (fee schedule) | 43 | $57.68 |
| 95867 | Physician and practitioner services (fee schedule) | 44 | $49.57 |
| 95868 | Physician and practitioner services (fee schedule) | 44 | $57.19 |
| 95869 | Physician and practitioner services (fee schedule) | 44 | $48.11 |
| 95870 | Physician and practitioner services (fee schedule) | 44 | $43.51 |
| 95872 | Physician and practitioner services (fee schedule) | 43 | $112.42 |
| 95873 | Physician and practitioner services (fee schedule) | 42 | $36.76 |
| 95874 | Physician and practitioner services (fee schedule) | 43 | $40.49 |
| 95875 | Physician and practitioner services (fee schedule) | 42 | $54.37 |
| 95885 | Physician and practitioner services (fee schedule) | 44 | $33.07 |
| 95886 | Physician and practitioner services (fee schedule) | 44 | $42.39 |
| 95887 | Physician and practitioner services (fee schedule) | 44 | $37.90 |
| 95905 | Physician and practitioner services (fee schedule) | 42 | $25.95 |
| 95907 | Physician and practitioner services (fee schedule) | 44 | $44.46 |
| 95908 | Physician and practitioner services (fee schedule) | 44 | $55.85 |
| 95909 | Physician and practitioner services (fee schedule) | 44 | $66.68 |
| 95910 | Physician and practitioner services (fee schedule) | 44 | $88.63 |
| 95911 | Physician and practitioner services (fee schedule) | 44 | $110.09 |
| 95912 | Physician and practitioner services (fee schedule) | 44 | $131.68 |
| 95913 | Physician and practitioner services (fee schedule) | 44 | $156.16 |
| 95919 | Physician and practitioner services (fee schedule) | 24 | $8.16 |
| 95921 | Physician and practitioner services (fee schedule) | 41 | $37.13 |
| 95922 | Physician and practitioner services (fee schedule) | 41 | $39.60 |
| 95923 | Physician and practitioner services (fee schedule) | 39 | $62.93 |
| 95924 | Physician and practitioner services (fee schedule) | 40 | $72.62 |
| 95925 | Physician and practitioner services (fee schedule) | 44 | $94.02 |
| 95926 | Physician and practitioner services (fee schedule) | 44 | $83.62 |
| 95927 | Physician and practitioner services (fee schedule) | 44 | $95.05 |
| 95928 | Physician and practitioner services (fee schedule) | 43 | $119.78 |
| 95929 | Physician and practitioner services (fee schedule) | 43 | $123.82 |
| 95930 | Physician and practitioner services (fee schedule) | 44 | $40.11 |
| 95933 | Physician and practitioner services (fee schedule) | 41 | $38.22 |
| 95937 | Physician and practitioner services (fee schedule) | 44 | $50.31 |
| 95938 | Physician and practitioner services (fee schedule) | 44 | $233.79 |
| 95939 | Physician and practitioner services (fee schedule) | 44 | $321.02 |
| 95940 | Physician and practitioner services (fee schedule) | 41 | $23.11 |
| 95941 | Physician and practitioner services (fee schedule) | 13 | $89.04 |
| 95954 | Physician and practitioner services (fee schedule) | 41 | $202.39 |
| 95955 | Physician and practitioner services (fee schedule) | 41 | $105.03 |
| 95957 | Physician and practitioner services (fee schedule) | 42 | $139.44 |
| 95958 | Physician and practitioner services (fee schedule) | 42 | $343.66 |
| 95961 | Physician and practitioner services (fee schedule) | 42 | $151.43 |
| 95962 | Physician and practitioner services (fee schedule) | 41 | $148.93 |
| 95965 | Physician and practitioner services (fee schedule) | 36 | $407.70 |
| 95966 | Physician and practitioner services (fee schedule) | 35 | $183.16 |
| 95967 | Physician and practitioner services (fee schedule) | 35 | $160.30 |
| 95970 | Physician and practitioner services (fee schedule) | 44 | $16.65 |
| 95971 | Physician and practitioner services (fee schedule) | 44 | $36.80 |
| 95972 | Physician and practitioner services (fee schedule) | 44 | $47.72 |
| 95976 | Physician and practitioner services (fee schedule) | 44 | $30.65 |
| 95977 | Physician and practitioner services (fee schedule) | 44 | $41.35 |
| 95980 | Physician and practitioner services (fee schedule) | 35 | $31.38 |
| 95981 | Physician and practitioner services (fee schedule) | 35 | $22.55 |
| 95982 | Physician and practitioner services (fee schedule) | 35 | $36.65 |
| 95983 | Physician and practitioner services (fee schedule) | 42 | $40.46 |
| 95984 | Physician and practitioner services (fee schedule) | 42 | $35.32 |
| 95990 | Physician and practitioner services (fee schedule) | 43 | $65.05 |
| 95991 | Physician and practitioner services (fee schedule) | 43 | $73.91 |
| 95992 | Physician and practitioner services (fee schedule) | 36 | $31.15 |
| 95999 | Physician and practitioner services (fee schedule) | 7 | $52.25 |
| 96000 | Physician and practitioner services (fee schedule) | 29 | $64.63 |
| 96001 | Physician and practitioner services (fee schedule) | 28 | $80.27 |
| 96002 | Physician and practitioner services (fee schedule) | 30 | $15.78 |
| 96003 | Physician and practitioner services (fee schedule) | 5 | $16.07 |
| 96004 | Physician and practitioner services (fee schedule) | 27 | $84.85 |
| 96020 | Physician and practitioner services (fee schedule) | 30 | $125.35 |
| 96041 | Physician and practitioner services (fee schedule) | 23 | $40.37 |
| 96101 | Physician and practitioner services (fee schedule) | 7 | $80.68 |
| 96111 | Physician and practitioner services (fee schedule) | 7 | $62.10 |
| 96118 | Physician and practitioner services (fee schedule) | 5 | $71.11 |
| 96156 | Physician and practitioner services (fee schedule) | 38 | $80.80 |
| 96159 | Physician and practitioner services (fee schedule) | 37 | $18.73 |
| 96164 | Physician and practitioner services (fee schedule) | 33 | $8.52 |
| 96165 | Physician and practitioner services (fee schedule) | 33 | $3.88 |
| 96167 | Physician and practitioner services (fee schedule) | 34 | $58.93 |
| 96168 | Physician and practitioner services (fee schedule) | 34 | $21.09 |
| 96360 | Physician and practitioner services (fee schedule) | 42 | $29.74 |
| 96361 | Physician and practitioner services (fee schedule) | 42 | $10.86 |
| 96379 | Physician and practitioner services (fee schedule) | 9 | $20.96 |
| 96401 | Physician and practitioner services (fee schedule) | 43 | $55.83 |
| 96402 | Physician and practitioner services (fee schedule) | 43 | $29.93 |
| 96405 | Physician and practitioner services (fee schedule) | 43 | $57.07 |
| 96406 | Physician and practitioner services (fee schedule) | 43 | $87.29 |
| 96409 | Physician and practitioner services (fee schedule) | 44 | $82.78 |
| 96411 | Physician and practitioner services (fee schedule) | 43 | $45.48 |
| 96413 | Physician and practitioner services (fee schedule) | 44 | $108.59 |
| 96415 | Physician and practitioner services (fee schedule) | 44 | $23.78 |
| 96416 | Physician and practitioner services (fee schedule) | 44 | $110.64 |
| 96417 | Physician and practitioner services (fee schedule) | 43 | $53.63 |
| 96420 | Physician and practitioner services (fee schedule) | 44 | $80.61 |
| 96422 | Physician and practitioner services (fee schedule) | 44 | $115.17 |
| 96423 | Physician and practitioner services (fee schedule) | 44 | $56.90 |
| 96425 | Physician and practitioner services (fee schedule) | 44 | $133.49 |
| 96440 | Physician and practitioner services (fee schedule) | 44 | $438.89 |
| 96446 | Physician and practitioner services (fee schedule) | 43 | $120.90 |
| 96450 | Physician and practitioner services (fee schedule) | 44 | $129.25 |
| 96521 | Physician and practitioner services (fee schedule) | 44 | $104.50 |
| 96522 | Physician and practitioner services (fee schedule) | 44 | $92.60 |
| 96523 | Physician and practitioner services (fee schedule) | 40 | $20.50 |
| 96542 | Physician and practitioner services (fee schedule) | 44 | $94.80 |
| 96547 | Physician and practitioner services (fee schedule) | 20 | $215.75 |
| 96548 | Physician and practitioner services (fee schedule) | 20 | $99.27 |
| 96549 | Physician and practitioner services (fee schedule) | 6 | $43.98 |
| 96567 | Physician and practitioner services (fee schedule) | 34 | $102.07 |
| 96570 | Physician and practitioner services (fee schedule) | 40 | $45.30 |
| 96571 | Physician and practitioner services (fee schedule) | 39 | $22.89 |
| 96573 | Physician and practitioner services (fee schedule) | 38 | $170.66 |
| 96574 | Physician and practitioner services (fee schedule) | 37 | $213.88 |
| 96900 | Physician and practitioner services (fee schedule) | 42 | $17.21 |
| 96902 | Physician and practitioner services (fee schedule) | 10 | $14.67 |
| 96904 | Physician and practitioner services (fee schedule) | 20 | $54.36 |
| 96910 | Physician and practitioner services (fee schedule) | 43 | $76.39 |
| 96912 | Physician and practitioner services (fee schedule) | 42 | $69.79 |
| 96913 | Physician and practitioner services (fee schedule) | 39 | $105.94 |
| 96920 | Physician and practitioner services (fee schedule) | 41 | $107.80 |
| 96921 | Physician and practitioner services (fee schedule) | 41 | $112.07 |
| 96922 | Physician and practitioner services (fee schedule) | 41 | $140.63 |
| 96931 | Physician and practitioner services (fee schedule) | 17 | $129.68 |
| 96932 | Physician and practitioner services (fee schedule) | 18 | $93.93 |
| 96933 | Physician and practitioner services (fee schedule) | 18 | $35.82 |
| 96934 | Physician and practitioner services (fee schedule) | 18 | $84.20 |
| 96935 | Physician and practitioner services (fee schedule) | 18 | $53.20 |
| 96936 | Physician and practitioner services (fee schedule) | 19 | $34.54 |
| 96999 | Physician and practitioner services (fee schedule) | 7 | $16.92 |
| 97007 | Physician and practitioner services (fee schedule) | 10 | $1,279.27 |
| 97008 | Physician and practitioner services (fee schedule) | 10 | $7.50 |
| 97009 | Physician and practitioner services (fee schedule) | 10 | $4.79 |
| 97010 | Physician and practitioner services (fee schedule) | 23 | $6.95 |
| 97012 | Physician and practitioner services (fee schedule) | 39 | $12.12 |
| 97014 | Physician and practitioner services (fee schedule) | 35 | $11.58 |
| 97016 | Physician and practitioner services (fee schedule) | 39 | $11.04 |
| 97018 | Physician and practitioner services (fee schedule) | 40 | $5.71 |
| 97022 | Physician and practitioner services (fee schedule) | 40 | $13.47 |
| 97024 | Physician and practitioner services (fee schedule) | 36 | $5.83 |
| 97026 | Physician and practitioner services (fee schedule) | 36 | $5.37 |
| 97028 | Physician and practitioner services (fee schedule) | 36 | $6.57 |
| 97032 | Physician and practitioner services (fee schedule) | 38 | $12.53 |
| 97033 | Physician and practitioner services (fee schedule) | 37 | $15.60 |
| 97034 | Physician and practitioner services (fee schedule) | 37 | $11.71 |
| 97035 | Physician and practitioner services (fee schedule) | 39 | $10.86 |
| 97036 | Physician and practitioner services (fee schedule) | 37 | $25.74 |
| 97039 | Physician and practitioner services (fee schedule) | 22 | $11.42 |
| 97113 | Physician and practitioner services (fee schedule) | 41 | $28.29 |
| 97116 | Physician and practitioner services (fee schedule) | 41 | $22.38 |
| 97124 | Physician and practitioner services (fee schedule) | 40 | $21.28 |
| 97139 | Physician and practitioner services (fee schedule) | 23 | $14.38 |
| 97140 | Physician and practitioner services (fee schedule) | 41 | $22.90 |
| 97150 | Physician and practitioner services (fee schedule) | 39 | $14.73 |
| 97535 | Training in daily living skills at home | 39 | $24.24 |
| 97537 | Physician and practitioner services (fee schedule) | 31 | $24.70 |
| 97542 | Physician and practitioner services (fee schedule) | 37 | $24.27 |
| 97545 | Physician and practitioner services (fee schedule) | 7 | $69.43 |
| 97546 | Physician and practitioner services (fee schedule) | 5 | $29.81 |
| 97597 | Physician and practitioner services (fee schedule) | 43 | $59.50 |
| 97598 | Physician and practitioner services (fee schedule) | 43 | $35.97 |
| 97602 | Physician and practitioner services (fee schedule) | 24 | $23.22 |
| 97605 | Physician and practitioner services (fee schedule) | 37 | $27.99 |
| 97606 | Physician and practitioner services (fee schedule) | 37 | $32.16 |
| 97607 | Physician and practitioner services (fee schedule) | 32 | $36.80 |
| 97608 | Physician and practitioner services (fee schedule) | 31 | $45.97 |
| 97610 | Physician and practitioner services (fee schedule) | 20 | $154.07 |
| 97750 | Physician and practitioner services (fee schedule) | 36 | $25.97 |
| 97755 | Physician and practitioner services (fee schedule) | 25 | $29.10 |
| 97799 | Physician and practitioner services (fee schedule) | 9 | $21.00 |
| 97804 | Physician and practitioner services (fee schedule) | 28 | $13.05 |
| 97810 | Physician and practitioner services (fee schedule) | 11 | $22.59 |
| 97811 | Physician and practitioner services (fee schedule) | 10 | $18.79 |
| 97813 | Physician and practitioner services (fee schedule) | 10 | $24.56 |
| 97814 | Physician and practitioner services (fee schedule) | 10 | $19.94 |
| 98000 | Physician and practitioner services (fee schedule) | 17 | $42.26 |
| 98012 | Physician and practitioner services (fee schedule) | 19 | $30.03 |
| 98013 | Physician and practitioner services (fee schedule) | 19 | $52.49 |
| 98925 | Physician and practitioner services (fee schedule) | 41 | $21.35 |
| 98926 | Physician and practitioner services (fee schedule) | 40 | $31.75 |
| 98927 | Physician and practitioner services (fee schedule) | 39 | $42.14 |
| 98928 | Physician and practitioner services (fee schedule) | 39 | $52.40 |
| 98929 | Physician and practitioner services (fee schedule) | 39 | $59.64 |
| 98941 | Physician and practitioner services (fee schedule) | 38 | $27.20 |
| 98942 | Physician and practitioner services (fee schedule) | 38 | $34.49 |
| 98943 | Physician and practitioner services (fee schedule) | 11 | $21.14 |
| 98960 | Physician and practitioner services (fee schedule) | 23 | $24.23 |
| 98961 | Physician and practitioner services (fee schedule) | 19 | $11.54 |
| 98962 | Physician and practitioner services (fee schedule) | 19 | $8.66 |
| 98970 | Physician and practitioner services (fee schedule) | 11 | $8.64 |
| 98971 | Physician and practitioner services (fee schedule) | 12 | $15.55 |
| 98972 | Physician and practitioner services (fee schedule) | 11 | $24.04 |
| 98975 | Physician and practitioner services (fee schedule) | 24 | $16.63 |
| 98976 | Physician and practitioner services (fee schedule) | 23 | $40.91 |
| 98977 | Physician and practitioner services (fee schedule) | 23 | $39.57 |
| 98979 | Physician and practitioner services (fee schedule) | 16 | $14.44 |
| 98980 | Physician and practitioner services (fee schedule) | 25 | $34.51 |
| 98981 | Physician and practitioner services (fee schedule) | 24 | $28.82 |
| 98984 | Physician and practitioner services (fee schedule) | 15 | $36.72 |
| 98985 | Physician and practitioner services (fee schedule) | 14 | $33.50 |
| 99000 | Physician and practitioner services (fee schedule) | 14 | $3.89 |
| 99001 | Physician and practitioner services (fee schedule) | 13 | $3.92 |
| 99050 | Physician and practitioner services (fee schedule) | 22 | $13.01 |
| 99051 | Physician and practitioner services (fee schedule) | 14 | $12.69 |
| 99053 | Physician and practitioner services (fee schedule) | 8 | $11.13 |
| 99056 | Physician and practitioner services (fee schedule) | 8 | $12.65 |
| 99058 | Physician and practitioner services (fee schedule) | 14 | $17.39 |
| 99060 | Physician and practitioner services (fee schedule) | 6 | $9.43 |
| 99070 | Physician and practitioner services (fee schedule) | 14 | $14.95 |
| 99078 | Physician and practitioner services (fee schedule) | 9 | $42.47 |
| 99080 | Physician and practitioner services (fee schedule) | 8 | $22.25 |
| 99082 | Physician and practitioner services (fee schedule) | 15 | $5.60 |
| 99091 | Physician and practitioner services (fee schedule) | 21 | $45.71 |
| 99100 | Physician and practitioner services (fee schedule) | 13 | $17.75 |
| 99116 | Physician and practitioner services (fee schedule) | 10 | $16.83 |
| 99135 | Physician and practitioner services (fee schedule) | 9 | $16.98 |
| 99140 | Physician and practitioner services (fee schedule) | 12 | $17.56 |
| 99151 | Physician and practitioner services (fee schedule) | 43 | $46.60 |
| 99152 | Physician and practitioner services (fee schedule) | 45 | $34.53 |
| 99153 | Physician and practitioner services (fee schedule) | 45 | $9.14 |
| 99155 | Physician and practitioner services (fee schedule) | 44 | $67.49 |
| 99156 | Physician and practitioner services (fee schedule) | 44 | $59.20 |
| 99157 | Physician and practitioner services (fee schedule) | 44 | $45.96 |
| 99170 | Physician and practitioner services (fee schedule) | 39 | $113.45 |
| 99172 | Physician and practitioner services (fee schedule) | 16 | $15.67 |
| 99173 | Physician and practitioner services (fee schedule) | 34 | $2.87 |
| 99174 | Physician and practitioner services (fee schedule) | 24 | $5.63 |
| 99175 | Physician and practitioner services (fee schedule) | 33 | $35.42 |
| 99177 | Physician and practitioner services (fee schedule) | 28 | $4.24 |
| 99183 | Physician and practitioner services (fee schedule) | 44 | $92.73 |
| 99184 | Physician and practitioner services (fee schedule) | 35 | $167.48 |
| 99188 | Physician and practitioner services (fee schedule) | 38 | $18.00 |
| 99190 | Physician and practitioner services (fee schedule) | 23 | $92.88 |
| 99191 | Physician and practitioner services (fee schedule) | 23 | $59.17 |
| 99192 | Physician and practitioner services (fee schedule) | 23 | $43.69 |
| 99195 | Physician and practitioner services (fee schedule) | 43 | $71.71 |
| 99199 | Physician and practitioner services (fee schedule) | 11 | $37.01 |
| 99201 | Physician and practitioner services (fee schedule) | 7 | $36.36 |
| 99211 | Return-patient office visit, level 1 of 5 (often nurse-only) | 45 | $19.16 |
| 99217 | Physician and practitioner services (fee schedule) | 7 | $59.22 |
| 99218 | Physician and practitioner services (fee schedule) | 8 | $63.85 |
| 99219 | Physician and practitioner services (fee schedule) | 9 | $92.91 |
| 99220 | Physician and practitioner services (fee schedule) | 10 | $127.54 |
| 99224 | Physician and practitioner services (fee schedule) | 7 | $26.62 |
| 99225 | Physician and practitioner services (fee schedule) | 7 | $49.33 |
| 99226 | Physician and practitioner services (fee schedule) | 7 | $70.82 |
| 99238 | Physician and practitioner services (fee schedule) | 45 | $59.59 |
| 99239 | Physician and practitioner services (fee schedule) | 45 | $84.94 |
| 99241 | Physician and practitioner services (fee schedule) | 8 | $29.64 |
| 99251 | Physician and practitioner services (fee schedule) | 7 | $38.10 |
| 99284 | Physician and practitioner services (fee schedule) | 45 | $92.73 |
| 99285 | Physician and practitioner services (fee schedule) | 45 | $133.26 |
| 99288 | Physician and practitioner services (fee schedule) | 11 | $43.72 |
| 99291 | Physician and practitioner services (fee schedule) | 44 | $208.75 |
| 99292 | Physician and practitioner services (fee schedule) | 43 | $97.28 |
| 99315 | Physician and practitioner services (fee schedule) | 40 | $62.73 |
| 99316 | Physician and practitioner services (fee schedule) | 40 | $100.19 |
| 99318 | Physician and practitioner services (fee schedule) | 7 | $75.10 |
| 99324 | Physician and practitioner services (fee schedule) | 9 | $48.15 |
| 99325 | Physician and practitioner services (fee schedule) | 9 | $70.13 |
| 99326 | Physician and practitioner services (fee schedule) | 9 | $103.84 |
| 99327 | Physician and practitioner services (fee schedule) | 9 | $136.57 |
| 99328 | Physician and practitioner services (fee schedule) | 9 | $168.99 |
| 99334 | Physician and practitioner services (fee schedule) | 10 | $38.22 |
| 99335 | Physician and practitioner services (fee schedule) | 10 | $60.79 |
| 99336 | Physician and practitioner services (fee schedule) | 9 | $92.48 |
| 99337 | Physician and practitioner services (fee schedule) | 9 | $135.91 |
| 99343 | Physician and practitioner services (fee schedule) | 10 | $112.86 |
| 99354 | Physician and practitioner services (fee schedule) | 11 | $90.61 |
| 99355 | Physician and practitioner services (fee schedule) | 11 | $79.23 |
| 99356 | Physician and practitioner services (fee schedule) | 8 | $77.02 |
| 99357 | Physician and practitioner services (fee schedule) | 8 | $77.58 |
| 99358 | Physician and practitioner services (fee schedule) | 19 | $78.95 |
| 99359 | Physician and practitioner services (fee schedule) | 15 | $32.39 |
| 99360 | Physician and practitioner services (fee schedule) | 26 | $42.19 |
| 99374 | Physician and practitioner services (fee schedule) | 10 | $45.47 |
| 99375 | Physician and practitioner services (fee schedule) | 10 | $72.14 |
| 99377 | Physician and practitioner services (fee schedule) | 10 | $44.77 |
| 99378 | Physician and practitioner services (fee schedule) | 10 | $71.42 |
| 99379 | Physician and practitioner services (fee schedule) | 8 | $44.65 |
| 99380 | Physician and practitioner services (fee schedule) | 8 | $68.34 |
| 99381 | Physician and practitioner services (fee schedule) | 45 | $78.58 |
| 99382 | Physician and practitioner services (fee schedule) | 45 | $83.07 |
| 99383 | Physician and practitioner services (fee schedule) | 45 | $86.22 |
| 99384 | Physician and practitioner services (fee schedule) | 45 | $96.97 |
| 99385 | Physician and practitioner services (fee schedule) | 45 | $94.93 |
| 99386 | Physician and practitioner services (fee schedule) | 43 | $111.91 |
| 99387 | Physician and practitioner services (fee schedule) | 41 | $116.14 |
| 99391 | Physician and practitioner services (fee schedule) | 45 | $69.78 |
| 99392 | Physician and practitioner services (fee schedule) | 45 | $77.92 |
| 99393 | Physician and practitioner services (fee schedule) | 45 | $74.63 |
| 99394 | Physician and practitioner services (fee schedule) | 45 | $90.07 |
| 99395 | Physician and practitioner services (fee schedule) | 45 | $86.72 |
| 99396 | Physician and practitioner services (fee schedule) | 43 | $90.55 |
| 99397 | Physician and practitioner services (fee schedule) | 41 | $96.41 |
| 99401 | Physician and practitioner services (fee schedule) | 39 | $27.28 |
| 99402 | Physician and practitioner services (fee schedule) | 35 | $44.63 |
| 99403 | Physician and practitioner services (fee schedule) | 26 | $61.66 |
| 99404 | Physician and practitioner services (fee schedule) | 26 | $82.69 |
| 99406 | Physician and practitioner services (fee schedule) | 41 | $11.89 |
| 99407 | Physician and practitioner services (fee schedule) | 44 | $22.58 |
| 99411 | Physician and practitioner services (fee schedule) | 14 | $15.36 |
| 99412 | Physician and practitioner services (fee schedule) | 16 | $16.72 |
| 99421 | Physician and practitioner services (fee schedule) | 23 | $12.18 |
| 99422 | Physician and practitioner services (fee schedule) | 23 | $23.81 |
| 99423 | Physician and practitioner services (fee schedule) | 23 | $38.76 |
| 99426 | Physician and practitioner services (fee schedule) | 22 | $52.89 |
| 99427 | Physician and practitioner services (fee schedule) | 21 | $39.64 |
| 99429 | Physician and practitioner services (fee schedule) | 7 | $25.00 |
| 99439 | Physician and practitioner services (fee schedule) | 22 | $32.37 |
| 99441 | Physician and practitioner services (fee schedule) | 9 | $29.97 |
| 99442 | Physician and practitioner services (fee schedule) | 9 | $56.19 |
| 99443 | Physician and practitioner services (fee schedule) | 9 | $83.28 |
| 99445 | Physician and practitioner services (fee schedule) | 22 | $38.00 |
| 99446 | Physician and practitioner services (fee schedule) | 23 | $14.01 |
| 99447 | Physician and practitioner services (fee schedule) | 22 | $27.98 |
| 99448 | Physician and practitioner services (fee schedule) | 22 | $42.36 |
| 99449 | Physician and practitioner services (fee schedule) | 22 | $57.03 |
| 99452 | Physician and practitioner services (fee schedule) | 30 | $27.52 |
| 99453 | Physician and practitioner services (fee schedule) | 30 | $16.46 |
| 99454 | Physician and practitioner services (fee schedule) | 30 | $39.82 |
| 99456 | Physician and practitioner services (fee schedule) | 6 | $136.49 |
| 99457 | Physician and practitioner services (fee schedule) | 31 | $35.37 |
| 99458 | Physician and practitioner services (fee schedule) | 29 | $30.40 |
| 99459 | Physician and practitioner services (fee schedule) | 32 | $16.98 |
| 99460 | Physician and practitioner services (fee schedule) | 45 | $67.65 |
| 99461 | Physician and practitioner services (fee schedule) | 44 | $68.20 |
| 99462 | Physician and practitioner services (fee schedule) | 44 | $29.69 |
| 99463 | Physician and practitioner services (fee schedule) | 45 | $79.22 |
| 99464 | Physician and practitioner services (fee schedule) | 44 | $60.43 |
| 99465 | Physician and practitioner services (fee schedule) | 45 | $120.13 |
| 99466 | Physician and practitioner services (fee schedule) | 37 | $183.69 |
| 99467 | Physician and practitioner services (fee schedule) | 37 | $92.11 |
| 99468 | Physician and practitioner services (fee schedule) | 44 | $707.16 |
| 99469 | Physician and practitioner services (fee schedule) | 44 | $311.74 |
| 99470 | Physician and practitioner services (fee schedule) | 22 | $18.86 |
| 99471 | Physician and practitioner services (fee schedule) | 44 | $629.32 |
| 99472 | Physician and practitioner services (fee schedule) | 44 | $317.77 |
| 99473 | Physician and practitioner services (fee schedule) | 28 | $10.91 |
| 99474 | Physician and practitioner services (fee schedule) | 26 | $10.88 |
| 99475 | Physician and practitioner services (fee schedule) | 44 | $443.73 |
| 99476 | Physician and practitioner services (fee schedule) | 44 | $262.63 |
| 99477 | Physician and practitioner services (fee schedule) | 44 | $278.61 |
| 99478 | Physician and practitioner services (fee schedule) | 44 | $113.30 |
| 99479 | Physician and practitioner services (fee schedule) | 44 | $101.86 |
| 99480 | Physician and practitioner services (fee schedule) | 44 | $97.28 |
| 99483 | Physician and practitioner services (fee schedule) | 26 | $204.15 |
| 99485 | Physician and practitioner services (fee schedule) | 15 | $60.16 |
| 99486 | Physician and practitioner services (fee schedule) | 14 | $51.77 |
| 99487 | Physician and practitioner services (fee schedule) | 11 | $107.12 |
| 99489 | Physician and practitioner services (fee schedule) | 11 | $61.05 |
| 99490 | Physician and practitioner services (fee schedule) | 22 | $45.30 |
| 99492 | Physician and practitioner services (fee schedule) | 31 | $111.16 |
| 99493 | Physician and practitioner services (fee schedule) | 31 | $104.17 |
| 99494 | Physician and practitioner services (fee schedule) | 31 | $46.31 |
| 99495 | Physician and practitioner services (fee schedule) | 21 | $167.42 |
| 99496 | Physician and practitioner services (fee schedule) | 21 | $226.91 |
| 99497 | Physician and practitioner services (fee schedule) | 24 | $69.62 |
| 99498 | Physician and practitioner services (fee schedule) | 23 | $62.64 |
| 99499 | Physician and practitioner services (fee schedule) | 13 | $32.99 |
| 99501 | Physician and practitioner services (fee schedule) | 6 | $63.15 |
| 99502 | Physician and practitioner services (fee schedule) | 6 | $60.00 |
| 99510 | Physician and practitioner services (fee schedule) | 5 | $31.25 |
| 99600 | Other in-home service | 12 | $55.97 |
| 99601 | Physician and practitioner services (fee schedule) | 10 | $75.59 |
| 99602 | Physician and practitioner services (fee schedule) | 8 | $40.93 |
| A0380 | Bls mileage (per mile) | 7 | $4.47 |
| A0390 | Als mileage (per mile) | 6 | $4.61 |
| A2001 | Innovamatrix ac, per square centimeter (add-on | 5 | $81.15 |
| A2002 | Mirragen advanced wound matrix, per square centimeter | 5 | $81.15 |
| A2005 | Microlyte matrix, per square centimeter (add-on | 5 | $81.15 |
| A2006 | Novosorb synpath dermal matrix, per square centimeter | 5 | $81.15 |
| A2007 | Restrata, per square centimeter (add-on | 5 | $81.15 |
| A2008 | Theragenesis, per square centimeter (add-on | 5 | $81.15 |
| A2009 | Symphony, per square centimeter (add-on | 5 | $81.15 |
| A2010 | Apis, per square centimeter (add-on | 5 | $81.15 |
| A2011 | Supra sdrm, per square centimeter (add-on | 5 | $81.15 |
| A2012 | Suprathel, per square centimeter (add-on | 5 | $81.15 |
| A2021 | Neomatrix, per square centimeter (add-on | 5 | $81.15 |
| A2024 | Resolve matrix or xenopatch, per square centimeter (add-on | 5 | $81.15 |
| A2027 | Matriderm, per square centimeter (add-on | 5 | $81.15 |
| A2029 | Mirotract wound matrix sheet, per cubic centimeter (add-on | 5 | $81.15 |
| A2031 | Mirodry wound matrix, per square centimeter (add-on | 6 | $82.32 |
| A2032 | Myriad matrix, per square centimeter (add-on | 6 | $82.32 |
| A2034 | Foundation drs solo, per square centimeter (add-on | 6 | $82.32 |
| A2036 | Cohealyx collagen dermal matrix, per square centimeter | 6 | $82.32 |
| A2038 | Marigen pacto, per square centimeter (add-on | 6 | $82.32 |
| A2039 | Innovamatrix fd, per square centimeter (add-on | 6 | $82.32 |
| A2040 | Microlyte painguard (add-on | 5 | $81.15 |
| A2041 | Foundation drs+ duo (add-on | 5 | $91.83 |
| A2043 | Biobrane (add-on, list separately in addition to primary... | 5 | $81.15 |
| A2045 | Novashield or novogen wound matrix (add-on | 5 | $81.15 |
| C9250 | Human plasma fibrin sealant, vapor-heated | 6 | $142.28 |
| C9285 | Lidocaine 70 mg/tetracaine 70 mg, per patch | 5 | $16.68 |
| C9310 | Injection, leucovorin calcium (avyxa), 1 mg | 8 | $2.54 |
| C9600 | Percutaneous transcatheter placement of drug eluting... | 5 | $519.86 |
| G0008 | Administration of influenza virus vaccine | 15 | $13.57 |
| G0009 | Administration of pneumococcal vaccine | 14 | $9.08 |
| G0010 | Administration of hepatitis b vaccine | 9 | $16.13 |
| G0011 | Individual counseling for pre-exposure prophylaxis | 17 | $22.64 |
| G0012 | Injection of pre-exposure prophylaxis | 15 | $11.88 |
| G0013 | Individual counseling for pre-exposure prophylaxis | 15 | $18.78 |
| G0017 | Psychotherapy for crisis furnished in an applicable site of... | 7 | $176.75 |
| G0018 | Psychotherapy for crisis furnished in an applicable site of... | 7 | $87.61 |
| G0023 | Principal illness navigation services by certified or... | 8 | $68.58 |
| G0024 | Principal illness navigation services | 7 | $43.80 |
| G0027 | Semen analysis; presence and/or motility of sperm excluding... | 9 | $5.85 |
| G0102 | Prostate cancer screening; digital rectal examination | 24 | $12.86 |
| G0104 | Colorectal cancer screening; flexible sigmoidoscopy | 25 | $96.08 |
| G0105 | Colorectal cancer screening | 31 | $253.34 |
| G0106 | Colorectal cancer screening; alternative to g0104 | 6 | $79.58 |
| G0108 | Diabetes outpatient self-management training services | 32 | $43.53 |
| G0109 | Diabetes outpatient self-management training services | 30 | $12.59 |
| G0117 | Glaucoma screening for high risk patients furnished by an... | 18 | $45.59 |
| G0118 | Glaucoma screening for high risk patient furnished under the... | 16 | $29.36 |
| G0120 | Colorectal cancer screening; alternative to g0105 | 6 | $79.58 |
| G0121 | Colorectal cancer screening | 29 | $179.96 |
| G0124 | Screening cytopathology, cervical or vaginal | 19 | $21.01 |
| G0127 | Trimming of dystrophic nails, any number | 21 | $10.34 |
| G0130 | Single energy x-ray absorptiometry | 22 | $23.70 |
| G0136 | Administration of a standardized | 13 | $12.78 |
| G0138 | Intravenous infusion of cipaglucosidase alfa-atga | 11 | $158.63 |
| G0140 | Principal illness navigation - peer support by certified or... | 6 | $73.24 |
| G0141 | Screening cytopathology smears, cervical or vaginal | 16 | $21.27 |
| G0146 | Principal illness navigation - peer support | 6 | $43.89 |
| G0147 | Screening cytopathology smears, cervical or vaginal | 19 | $15.91 |
| G0166 | External counterpulsation, per treatment session | 23 | $85.87 |
| G0168 | Wound closure utilizing tissue adhesive(s) only | 17 | $47.49 |
| G0179 | Physician or allowed practitioner re-certification for... | 9 | $38.51 |
| G0180 | Physician or allowed practitioner certification for... | 10 | $47.73 |
| G0181 | Physician or allowed practitioner supervision of a patient... | 10 | $85.21 |
| G0182 | Physician supervision of a patient under a medicare-approved... | 7 | $88.73 |
| G0186 | Destruction of localized lesion of choroid (for example | 11 | $359.82 |
| G0219 | Pet imaging whole body; melanoma for non-covered indications | 7 | $1,673.39 |
| G0245 | Initial physician evaluation and management of a diabetic... | 13 | $43.56 |
| G0246 | Follow-up physician evaluation and management of a diabetic... | 14 | $26.06 |
| G0247 | Routine foot care by a physician of a diabetic patient with... | 12 | $26.37 |
| G0248 | Demonstration, prior to initiation of home inr monitoring | 18 | $88.87 |
| G0249 | Provision of test materials and equipment for home inr... | 19 | $63.68 |
| G0250 | Physician review, interpretation | 16 | $7.47 |
| G0252 | Pet imaging, full and partial-ring pet scanners only | 10 | $66.50 |
| G0260 | Injection procedure for sacroiliac joint | 8 | $106.04 |
| G0268 | Removal of impacted cerumen | 14 | $33.44 |
| G0270 | Medical nutrition therapy | 14 | $20.11 |
| G0271 | Medical nutrition therapy | 11 | $11.68 |
| G0276 | Blinded procedure for lumbar stenosis | 5 | $357.97 |
| G0277 | Hyperbaric oxygen under pressure, full body chamber | 24 | $133.03 |
| G0278 | Iliac and/or femoral artery angiography, non-selective | 18 | $10.15 |
| G0281 | Electrical stimulation, (unattended), to one or more areas | 12 | $11.07 |
| G0283 | Electrical stimulation (unattended) | 14 | $10.78 |
| G0288 | Reconstruction, computed tomographic angiography of aorta... | 17 | $40.76 |
| G0289 | Arthroscopy, knee, surgical, for removal of loose body | 20 | $65.07 |
| G0296 | Counseling visit to discuss need for lung cancer screening... | 23 | $24.23 |
| G0307 | Complete (cbc), automated (hgb, hct, rbc, wbc | 25 | $6.15 |
| G0310 | Immunization counseling by a physician or other qualified... | 12 | $18.72 |
| G0311 | Immunization counseling by a physician or other qualified... | 11 | $30.65 |
| G0312 | Immunization counseling by a physician or other qualified... | 26 | $22.63 |
| G0313 | Immunization counseling by a physician or other qualified... | 23 | $39.83 |
| G0314 | Immunization counseling by a physician or other qualified... | 22 | $42.02 |
| G0315 | Immunization counseling by a physician or other qualified... | 26 | $22.63 |
| G0317 | Prolonged nursing facility evaluation and management... | 11 | $23.75 |
| G0318 | Prolonged home or residence evaluation and management... | 11 | $23.52 |
| G0328 | Colorectal cancer screening; fecal occult blood test | 25 | $16.28 |
| G0329 | Electromagnetic therapy | 15 | $8.75 |
| G0339 | Image-guided robotic linear accelerator-based stereotactic... | 8 | $1,740.82 |
| G0340 | Image-guided robotic linear accelerator-based stereotactic... | 8 | $1,586.56 |
| G0341 | Percutaneous islet cell transplant | 11 | $1,005.79 |
| G0342 | Laparoscopy for islet cell transplant | 11 | $458.16 |
| G0343 | Laparotomy for islet cell transplant | 12 | $761.41 |
| G0372 | Physician and practitioner services (fee schedule) | 10 | $7.70 |
| G0398 | Home sleep study test (hst) with type ii portable monitor | 9 | $97.07 |
| G0399 | Home sleep test (hst) with type iii portable monitor | 10 | $37.65 |
| G0400 | Home sleep test (hst) with type iv portable monitor | 8 | $42.28 |
| G0402 | Initial preventive physical examination; face-to-face visit | 7 | $120.31 |
| G0404 | Electrocardiogram, routine ecg with 12 leads; tracing only | 5 | $5.33 |
| G0405 | Electrocardiogram, routine ecg with 12 leads | 5 | $5.96 |
| G0412 | Open treatment of iliac spine(s), tuberosity avulsion | 14 | $504.50 |
| G0413 | Percutaneous skeletal fixation of posterior pelvic bone... | 17 | $702.17 |
| G0414 | Open treatment of anterior pelvic bone fracture and/or... | 16 | $626.86 |
| G0415 | Open treatment of posterior pelvic bone fracture and/or... | 15 | $883.31 |
| G0420 | Face-to-face educational services related to the care of... | 10 | $86.26 |
| G0421 | Face-to-face educational services related to the care of... | 10 | $20.54 |
| G0422 | Intensive cardiac rehabilitation | 14 | $81.33 |
| G0423 | Intensive cardiac rehabilitation | 14 | $81.33 |
| G0425 | Telehealth consultation | 12 | $72.58 |
| G0426 | Telehealth consultation | 12 | $98.73 |
| G0427 | Telehealth consultation | 12 | $143.05 |
| G0429 | Dermal filler injection(s) for the treatment of facial... | 8 | $71.50 |
| G0435 | Infectious agent antibody detection by rapid antibody test | 23 | $11.66 |
| G0438 | Annual wellness visit | 11 | $147.64 |
| G0439 | Annual wellness visit | 11 | $110.90 |
| G0442 | Annual alcohol misuse screening, 5 to 15 minutes | 13 | $15.13 |
| G0443 | Brief face-to-face behavioral counseling for alcohol misuse | 12 | $27.67 |
| G0445 | High intensity behavioral counseling to prevent sexually... | 11 | $27.55 |
| G0446 | Annual, face-to-face intensive behavioral therapy for... | 11 | $21.78 |
| G0447 | Face-to-face behavioral counseling for obesity, 15 minutes | 16 | $27.54 |
| G0451 | Development testing, with interpretation and report | 11 | $9.52 |
| G0452 | Molecular pathology procedure | 22 | $35.55 |
| G0453 | Continuous intraoperative neurophysiology monitoring | 16 | $23.61 |
| G0455 | Preparation with instillation of fecal microbiota by any... | 15 | $68.55 |
| G0459 | Inpatient telehealth pharmacologic management | 8 | $31.82 |
| G0463 | Hospital outpatient clinic visit for assessment and... | 6 | $73.33 |
| G0475 | Hiv antigen/antibody, combination assay, screening | 20 | $23.54 |
| G0479 | Drug test(s), presumptive, any number of drug classes | 5 | $47.55 |
| G0480 | Drug test(s), definitive, utilizing | 43 | $91.54 |
| G0481 | Drug test(s), definitive, utilizing | 41 | $125.27 |
| G0482 | Drug test(s), definitive, utilizing | 38 | $164.02 |
| G0483 | Drug test(s), definitive, utilizing | 38 | $205.07 |
| G0498 | Chemotherapy administration, intravenous infusion technique | 7 | $169.86 |
| G0500 | Moderate sedation services provided by the same physician or... | 16 | $44.73 |
| G0508 | Telehealth consultation, critical care, initial | 11 | $151.36 |
| G0509 | Telehealth consultation, critical care, subsequent | 11 | $144.29 |
| G0513 | Prolonged preventive service(s) | 11 | $51.93 |
| G0514 | Prolonged preventive service(s) | 11 | $51.93 |
| G0516 | Insertion of non-biodegradable drug delivery implants | 16 | $114.08 |
| G0517 | Removal of non-biodegradable drug delivery implants | 15 | $126.52 |
| G0518 | Removal with reinsertion | 15 | $200.86 |
| G0537 | Administration of a standardized | 14 | $14.28 |
| G0538 | Atherosclerotic cardiovascular disease | 11 | $11.92 |
| G0544 | Post discharge telephonic follow-up contacts performed in... | 6 | $51.34 |
| G0545 | Visit complexity inherent to hospital inpatient or... | 12 | $33.59 |
| G0546 | Interprofessional telephone/internet/electronic health... | 6 | $15.98 |
| G0547 | Interprofessional telephone/internet/electronic health... | 6 | $32.01 |
| G0548 | Interprofessional telephone/internet/electronic health... | 6 | $48.41 |
| G0549 | Interprofessional telephone/internet/electronic health... | 6 | $65.00 |
| G0550 | Interprofessional telephone/internet/electronic health... | 6 | $29.89 |
| G0551 | Interprofessional telephone/internet/electronic health... | 6 | $31.31 |
| G0556 | Advanced primary care management services for a patient with... | 6 | $12.85 |
| G0557 | Advanced primary care management services for a patient with... | 7 | $41.72 |
| G0558 | Advanced primary care management services for a patient that... | 8 | $90.94 |
| G0559 | Post-operative follow-up visit complexity inherent to... | 8 | $8.14 |
| G0560 | Safety planning interventions | 7 | $35.76 |
| G0561 | Tympanostomy with local or topical anesthesia and insertion... | 13 | $156.21 |
| G0571 | Intraoperative nerve(s) cryoablation for post-surgical pain... | 5 | $46.85 |
| G0659 | Drug test(s), definitive | 22 | $60.88 |
| G1028 | Take-home supply of nasal naloxone | 7 | $126.94 |
| G2010 | Remote evaluation of recorded video and/or images submitted... | 20 | $8.97 |
| G2023 | Specimen collection for severe acute respiratory syndrome... | 10 | $23.46 |
| G2024 | Specimen collection for severe acute respiratory syndrome... | 9 | $25.46 |
| G2067 | Medication assisted treatment, methadone | 11 | $195.79 |
| G2068 | Medication assisted treatment, buprenorphine (oral) | 11 | $217.86 |
| G2074 | Medication assisted treatment | 10 | $149.20 |
| G2076 | Intake activities, including initial medical examination... | 11 | $195.30 |
| G2077 | Periodic assessment; assessing periodically by an otp... | 9 | $111.16 |
| G2080 | Each additional 30 minutes of counseling in a week of... | 7 | $31.19 |
| G2082 | Office or other outpatient visit for the evaluation and... | 15 | $723.08 |
| G2083 | Office or other outpatient visit for the evaluation and... | 15 | $1,026.10 |
| G2086 | Office-based treatment for opioid use disorder | 11 | $393.19 |
| G2087 | Office-based treatment for opioid use disorder | 11 | $354.55 |
| G2088 | Office-based treatment for opioid use disorder | 11 | $48.94 |
| G2213 | Initiation of medication for the treatment of opioid use... | 21 | $53.96 |
| G2214 | Initial or subsequent psychiatric collaborative care... | 22 | $42.93 |
| G3002 | Chronic pain management and treatment | 12 | $65.88 |
| G3003 | Each additional 15 minutes of chronic pain management and... | 12 | $23.36 |
| G6001 | Ultrasonic guidance for placement of radiation therapy... | 10 | $35.17 |
| G6002 | Stereoscopic x-ray guidance for localization of target... | 9 | $43.32 |
| G6003 | Radiation treatment delivery, single treatment area | 7 | $122.33 |
| G6007 | Radiation treatment delivery, 2 separate treatment areas | 7 | $190.63 |
| G6011 | Radiation treatment delivery | 7 | $198.93 |
| G6012 | Radiation treatment delivery | 8 | $190.95 |
| G6013 | Radiation treatment delivery,3 or more separate treatment... | 9 | $218.06 |
| G6014 | Radiation treatment delivery | 9 | $217.50 |
| G6015 | Intensity modulated treatment delivery | 8 | $310.90 |
| G6016 | Compensator-based beam modulation treatment delivery of... | 7 | $288.71 |
| G6017 | Intra-fraction localization and tracking of target or... | 5 | $63.35 |
| G8431 | Screening for depression is documented as being positive and... | 10 | $14.89 |
| G8510 | Screening for depression is documented as negative | 10 | $13.82 |
| G9006 | Coordinated care fee, home monitoring | 5 | $28.33 |
| G9157 | Transesophageal doppler measurement of cardiac output | 7 | $72.42 |
| G9481 | Remote in-home visit for the evaluation and management of a... | 5 | $16.19 |
| G9482 | Remote in-home visit for the evaluation and management of a... | 5 | $30.85 |
| G9483 | Remote in-home visit for the evaluation and management of a... | 5 | $47.96 |
| G9484 | Remote in-home visit for the evaluation and management of a... | 5 | $80.95 |
| G9485 | Remote in-home visit for the evaluation and management of a... | 5 | $105.70 |
| G9486 | Remote in-home visit for the evaluation and management of an... | 5 | $15.89 |
| G9487 | Remote in-home visit for the evaluation and management of an... | 5 | $31.77 |
| G9488 | Remote in-home visit for the evaluation and management of an... | 5 | $48.88 |
| G9489 | Remote in-home visit for the evaluation and management of an... | 6 | $59.77 |
| G9490 | Cms innovation center models | 6 | $30.23 |
| H1001 | Prenatal care, at-risk enhanced service | 11 | $32.09 |
| H1011 | Family assessment by licensed behavioral health professional... | 5 | $92.46 |
| M0201 | Administration of pneumococcal, influenza, hepatitis b | 28 | $35.50 |
| M0220 | Injection, tixagevimab and cilgavimab | 10 | $150.50 |
| M0221 | Injection, tixagevimab and cilgavimab | 9 | $250.50 |
| M0222 | Intravenous injection, bebtelovimab | 9 | $350.50 |
| M0223 | Intravenous injection, bebtelovimab | 8 | $550.50 |
| M0224 | Intravenous infusion, pemivibart | 16 | $450.00 |
| M0232 | Intravenous infusion, tocilizumabbavi | 5 | $427.50 |
| M0240 | Intravenous infusion or subcutaneous injection | 10 | $431.81 |
| M0241 | Intravenous infusion or subcutaneous injection | 11 | $750.00 |
| M0243 | Intravenous infusion or subcutaneous injection | 11 | $413.61 |
| M0244 | Intravenous infusion or subcutaneous injection | 11 | $750.00 |
| M0245 | Intravenous infusion, bamlanivimab and etesevimab | 11 | $450.00 |
| M0246 | Intravenous infusion, bamlanivimab and etesevimab | 10 | $719.46 |
| M0247 | Intravenous infusion, sotrovimab | 11 | $450.00 |
| M0248 | Intravenous infusion, sotrovimab | 13 | $750.00 |
| Q0035 | Cardiokymography | 14 | $11.47 |
| Q0091 | Screening papanicolaou smear; obtaining | 14 | $16.53 |
| Q0092 | Set-up portable x-ray equipment | 19 | $16.29 |
| Q0144 | Azithromycin dihydrate, oral, capsules/powder, 1 gram | 14 | $8.17 |
| Q0155 | Dronabinol (syndros), 0.1 mg, oral | 10 | $3.23 |
| Q0161 | Chlorpromazine hydrochloride, 5 mg, oral | 12 | $0.35 |
| Q0162 | Ondansetron 1 mg, oral | 23 | $0.02 |
| Q0164 | Prochlorperazine maleate, 5 mg, oral | 22 | $0.37 |
| Q0166 | Granisetron hydrochloride, 1 mg, oral | 26 | $1.51 |
| Q0167 | Dronabinol, 2.5 mg, oral | 25 | $1.87 |
| Q0169 | Promethazine hydrochloride, 12.5 mg, oral | 22 | $0.045 |
| Q0173 | Trimethobenzamide hydrochloride, 250 mg, oral | 17 | $0.84 |
| Q0177 | Hydroxyzine pamoate, 25 mg, oral | 20 | $0.055 |
| Q0180 | Dolasetron mesylate, 100 mg, oral | 19 | $66.71 |
| Q0224 | Injection, pemivibart | 22 | $7,239.00 |
| Q0234 | Injection, tocilizumab-bavi | 13 | $6.33 |
| Q0249 | Injection, tocilizumab | 26 | $6.81 |
| Q0478 | Power adapter for use with electric or electric/pneumatic... | 13 | $186.25 |
| Q0479 | Power module for use with electric or electric/pneumatic... | 13 | $12,043.98 |
| Q0506 | Battery, lithium-ion | 15 | $886.93 |
| Q0515 | Injection, sermorelin acetate, 1 microgram | 13 | $1.80 |
| Q2009 | Injection, fosphenytoin, 50 mg phenytoin equivalent | 24 | $1.53 |
| Q2037 | Influenza virus vaccine, split virus | 11 | $17.69 |
| Q2049 | Injection, doxorubicin hydrochloride, liposomal | 21 | $503.63 |
| Q2050 | Injection, doxorubicin hydrochloride, liposomal | 36 | $106.79 |
| Q3014 | Telehealth originating site facility fee | 28 | $23.25 |
| Q3028 | Injection, interferon beta-1a, 1 mcg for subcutaneous use | 16 | $25.33 |
| Q3031 | Collagen skin test | 6 | $10.49 |
| Q4112 | Cymetra, injectable, 1 cc | 15 | $754.72 |
| Q4113 | Graftjacket xpress, injectable, 1 cc | 15 | $902.00 |
| Q4117 | Hyalomatrix, per square centimeter (add-on | 16 | $25.07 |
| Q4128 | Flex hd, or allopatch hd, per square centimeter (add-on | 19 | $79.48 |
| Q4132 | Grafix core and grafixpl core, per square centimeter | 25 | $116.59 |
| Q4134 | Hmatrix, per square centimeter (add-on | 9 | $162.07 |
| Q4137 | Amnioexcel, amnioexcel plus or biodexcel | 14 | $101.72 |
| Q4140 | Biodfence, per square centimeter (add-on | 9 | $92.95 |
| Q4153 | Dermavest and plurivest, per square centimeter (add-on | 11 | $101.84 |
| Q4155 | Neoxflo or clarixflo, 1 mg | 9 | $27.31 |
| Q4159 | Affinity, per square centimeter (add-on | 21 | $137.06 |
| Q4160 | Nushield, per square centimeter (add-on | 22 | $95.10 |
| Q4169 | Artacent wound, per square centimeter (add-on | 10 | $176.06 |
| Q4170 | Cygnus, per square centimeter (add-on | 13 | $52.79 |
| Q4171 | Interfyl, 1 mg | 10 | $10.09 |
| Q4176 | Neopatch or therion, per square centimeter (add-on | 11 | $70.62 |
| Q4182 | Transcyte, per square centimeter (add-on | 6 | $65.85 |
| Q4184 | Cellesta or cellesta duo, per square centimeter (add-on | 10 | $85.57 |
| Q4187 | Epicord, per square centimeter (add-on | 22 | $183.56 |
| Q4193 | Coll-e-derm, per square centimeter (add-on | 9 | $92.95 |
| Q4194 | Novachor, per square centimeter (add-on | 12 | $218.06 |
| Q4199 | Cygnus matrix, per square centimeter (add-on | 13 | $111.15 |
| Q4203 | Derma-gide, per square centimeter (add-on | 11 | $206.74 |
| Q4221 | Amniowrap2, per square centimeter (add-on | 12 | $1,093.13 |
| Q4222 | Progenamatrix, per square centimeter (add-on | 12 | $105.26 |
| Q4225 | Amniobind or dermabind tl, per square centimeter (add-on | 9 | $356.86 |
| Q4227 | Amniocore, per square centimeter (add-on | 10 | $114.56 |
| Q4232 | Corplex, per square centimeter (add-on | 10 | $96.47 |
| Q4234 | Xcellerate, per square centimeter (add-on | 10 | $196.82 |
| Q4238 | Derm-maxx, per square centimeter (add-on | 10 | $623.34 |
| Q4239 | Amnio-maxx or amnio-maxx lite, per square centimeter | 10 | $279.58 |
| Q4247 | Amniotext patch, per square centimeter (add-on | 9 | $132.50 |
| Q4248 | Dermacyte amniotic membrane allograft | 10 | $127.21 |
| Q4249 | Amniply, for topical use only, per square centimeter | 6 | $88.22 |
| Q4254 | Novafix dl, per square centimeter (add-on | 7 | $127.28 |
| Q4257 | Relese, per square centimeter (add-on | 9 | $487.72 |
| Q4263 | Surgraft tl, per square centimeter (add-on | 11 | $453.95 |
| Q4265 | Neostim tl, per square centimeter (add-on | 11 | $346.61 |
| Q4268 | Surgraft ft, per square centimeter (add-on | 9 | $127.28 |
| Q4279 | Vendaje ac, per square centimeter (add-on | 9 | $92.95 |
| Q4280 | Xcell amnio matrix, per square centimeter (add-on | 8 | $128.19 |
| Q4287 | Dermabind dl, per square centimeter (add-on | 5 | $83.49 |
| Q4288 | Dermabind ch, per square centimeter (add-on | 5 | $83.49 |
| Q4289 | Revoshield + amniotic barrier, per square centimeter | 8 | $88.22 |
| Q4291 | Lamellas xt, per square centimeter (add-on | 5 | $83.49 |
| Q4292 | Lamellas, per square centimeter (add-on | 5 | $83.49 |
| Q4298 | Amniocore pro, per square centimeter (add-on | 9 | $2,172.41 |
| Q4300 | Acesso tl, per square centimeter (add-on | 9 | $92.95 |
| Q4302 | Complete aca, per square centimeter (add-on | 9 | $92.95 |
| Q4303 | Complete aa, per square centimeter (add-on | 9 | $92.95 |
| Q4305 | American amnion ac tri-layer, per square centimeter (add-on | 5 | $83.49 |
| Q4306 | American amnion ac, per square centimeter (add-on | 5 | $83.49 |
| Q4307 | American amnion, per square centimeter (add-on | 5 | $83.49 |
| Q4308 | Sanopellis, per square centimeter (add-on | 5 | $83.49 |
| Q4311 | Acesso, per square centimeter (add-on | 5 | $83.49 |
| Q4312 | Acesso ac, per square centimeter (add-on | 6 | $86.57 |
| Q4314 | Reeva ft, per square cenitmeter (add-on | 6 | $86.57 |
| Q4315 | Regenelink amniotic membrane allograft | 5 | $83.49 |
| Q4316 | Amchoplast, per square centimeter (add-on | 7 | $89.64 |
| Q4317 | Vitograft, per square centimeter (add-on | 7 | $89.64 |
| Q4318 | E-graft, per square centimeter (add-on | 5 | $83.49 |
| Q4320 | Pellograft, per square centimeter (add-on | 6 | $86.57 |
| Q4321 | Renograft, per square centimeter (add-on | 6 | $86.57 |
| Q4324 | Amniotx, per square centimeter (add-on | 5 | $83.49 |
| Q4326 | Woundplus, per square centimeter (add-on | 8 | $91.30 |
| Q4327 | Duoamnion, per square centimeter (add-on | 5 | $83.49 |
| Q4329 | Singlay, per square centimeter (add-on | 5 | $83.49 |
| Q4330 | Total, per square centimeter (add-on | 5 | $83.49 |
| Q4331 | Axolotl graft, per square centimeter (add-on | 7 | $89.64 |
| Q4333 | Ardeograft, per square centimeter (add-on | 5 | $83.49 |
| Q4334 | Amnioplast 1, per square centimeter (add-on | 5 | $81.15 |
| Q4335 | Amnioplast 2, per square centimeter (add-on | 5 | $81.15 |
| Q4336 | Artacent c, per square centimeter (add-on | 5 | $81.15 |
| Q4337 | Artacent trident, per square centimeter (add-on | 5 | $81.15 |
| Q4338 | Artacent velos, per square centimeter (add-on | 5 | $81.15 |
| Q4339 | Artacent vericlen, per square centimeter (add-on | 7 | $83.49 |
| Q4340 | Simpligraft, per square centimeter (add-on | 7 | $83.49 |
| Q4341 | Simplimax, per square centimeter (add-on | 7 | $83.49 |
| Q4342 | Theramend, per square centimeter (add-on | 7 | $83.49 |
| Q4344 | Tri-membrane wrap, per square centimeter (add-on | 7 | $83.49 |
| Q4345 | Matrix hd allograft dermis, per square centimeter (add-on | 7 | $83.49 |
| Q4346 | Shelter dm matrix, per square centimeter (add-on | 7 | $89.87 |
| Q4347 | Rampart dl matrix, per square centimeter (add-on | 7 | $89.87 |
| Q4348 | Sentry sl matrix, per square centimeter (add-on | 7 | $89.87 |
| Q4349 | Mantle dl matrix, per square centimeter (add-on | 5 | $83.49 |
| Q4350 | Palisade dm matrix, per square centimeter (add-on | 7 | $89.87 |
| Q4351 | Enclose tl matrix, per square centimeter (add-on | 5 | $83.49 |
| Q4352 | Overlay sl matrix, per square centimeter (add-on | 5 | $83.49 |
| Q4353 | Xceed tl matrix, per square centimeter (add-on | 6 | $88.22 |
| Q4354 | Palingen dual-layer membrane and dual-layer palingen... | 7 | $91.83 |
| Q4356 | Abiomend membrane and abiomend hydromembrane | 7 | $91.83 |
| Q4357 | Xwrap plus, per square centimeter (add-on | 9 | $92.95 |
| Q4360 | Amchoplast fd, per square centimeter (add-on | 7 | $91.83 |
| Q4361 | Epixpress, per square centimeter (add-on | 9 | $92.95 |
| Q4362 | Cygnus disk, per square centimeter (add-on | 7 | $91.83 |
| Q4363 | Amnio burgeon membrane and hydromembrane | 7 | $91.83 |
| Q4364 | Amnio burgeon xplus membrane and xplus hydromembrane | 7 | $91.83 |
| Q4365 | Amnio burgeon dual-layer membrane, per square centimeter | 7 | $91.83 |
| Q4366 | Dual layer amnio burgeon x-membrane, per square centimeter | 7 | $91.83 |
| Q4367 | Amniocore sl, per square centimeter (add-on | 9 | $92.95 |
| Q4368 | Amchothick, per square centimeter (add-on | 7 | $91.83 |
| Q4369 | Amnioplast 3, per square centimeter (add-on | 7 | $91.83 |
| Q4370 | Aeroguard, per square centimeter (add-on | 7 | $91.83 |
| Q4371 | Neoguard, per square centimeter (add-on | 7 | $91.83 |
| Q4372 | Amchoplast excel, per square centimeter (add-on | 7 | $91.83 |
| Q4373 | Membrane wrap lite, per square centimeter (add-on | 7 | $91.83 |
| Q4375 | Duograft ac, per square centimeter (add-on | 7 | $91.83 |
| Q4376 | Duograft aa, per square centimeter (add-on | 7 | $91.83 |
| Q4377 | Trigraft ft, per square centimeter (add-on | 7 | $91.83 |
| Q4378 | Renew ft matrix, per square centimeter (add-on | 7 | $91.83 |
| Q4379 | Amniodefend ft matrix, per square centimeter (add-on | 7 | $91.83 |
| Q4380 | Advograft one, per square centimeter (add-on | 7 | $91.83 |
| Q4382 | Advograft dual, per square centimeter (add-on | 7 | $91.83 |
| Q4383 | Axolotl graft ultra, per square centimeter (add-on | 6 | $87.66 |
| Q4384 | Axolotl dualgraft ultra, per square centimeter (add-on | 6 | $87.66 |
| Q4385 | Apollo ft, per square centimeter (add-on | 6 | $87.66 |
| Q4386 | Acesso trifaca, per square centimeter (add-on | 6 | $87.66 |
| Q4387 | Neothelium ft, per square centimeter (add-on | 6 | $87.66 |
| Q4388 | Neothelium 4l, per square centimeter (add-on | 6 | $87.66 |
| Q4389 | Neothelium 4l+, per square centimeter (add-on | 6 | $87.66 |
| Q4390 | Ascendion, per square centimeter (add-on | 7 | $91.83 |
| Q4391 | Amnioplast double, per square centimeter (add-on | 6 | $87.66 |
| Q4392 | Grafix duo, per square centimeter (add-on | 7 | $91.83 |
| Q4393 | Surgraft ac, per square centimeter (add-on | 6 | $87.66 |
| Q4394 | Surgraft aca, per square centimeter (add-on | 6 | $87.66 |
| Q4395 | Acelagraft, per square centimeter (add-on | 6 | $87.66 |
| Q4396 | Natalin, per square centimeter (add-on | 6 | $87.66 |
| Q4397 | Summit aaa, per square centimeter (add-on | 6 | $87.66 |
| Q4398 | Summit ac, per square centimeter (add-on | 5 | $81.15 |
| Q4399 | Summit fx, per square centimeter (add-on | 5 | $81.15 |
| Q4400 | Polygon3 membrane, per square centimeter (add-on | 5 | $81.15 |
| Q4401 | Absolv3 membrane, per square centimeter (add-on | 5 | $81.15 |
| Q4402 | Xwrap 2.0, per square centimeter (add-on | 5 | $81.15 |
| Q4403 | Xwrap dual plus, per square centimeter (add-on | 5 | $81.15 |
| Q4404 | Xwrap hydro plus, per square centimeter (add-on | 5 | $81.15 |
| Q4405 | Xwrap fenestra plus, per square centimeter (add-on | 5 | $81.15 |
| Q4406 | Xwrap fenestra, per square centimeter (add-on | 5 | $81.15 |
| Q4407 | Xwrap tribus, per square centimeter (add-on | 5 | $81.15 |
| Q4408 | Xwrap hydro, per square centimeter (add-on | 5 | $81.15 |
| Q4409 | Amniomatrixf3x, per square centimeter (add-on | 5 | $81.15 |
| Q4410 | Amchomatrixdl, per square centimeter (add-on | 5 | $81.15 |
| Q4411 | Amniomatrixf4x, per square centimeter (add-on | 5 | $81.15 |
| Q4412 | Choriofix, per square centimeter (add-on | 5 | $81.15 |
| Q4413 | Cygnus solo, per square centimeter (add-on | 5 | $81.15 |
| Q4414 | Simplichor, per square centimeter (add-on | 5 | $81.15 |
| Q4415 | Alexiguard sl-t, per square centimeter (add-on | 5 | $81.15 |
| Q4416 | Alexiguard tl-t, per square centimeter (add-on | 5 | $81.15 |
| Q4417 | Alexiguard dl-t, per square centimeter (add-on | 5 | $81.15 |
| Q4418 | Biolab membrane wrap flow, per square centimeter (add-on | 6 | $86.01 |
| Q4419 | Biolab membrane wrap lite flow, per square centimeter | 6 | $91.35 |
| Q4420 | Nuform, per square centimeter (add-on | 5 | $81.15 |
| Q4421 | Biolab membrane wrap solo, per square centimeter (add-on | 6 | $91.35 |
| Q4422 | A/c wrap, per square centimeter (add-on | 6 | $91.35 |
| Q4423 | Biolab tri-membrane wrap flow, per square centimeter | 6 | $91.35 |
| Q4424 | Revive ft, per square centimeter (add-on | 6 | $91.35 |
| Q4425 | Revive tl, per square centimeter (add-on | 6 | $91.35 |
| Q4426 | Dermabind tl + or dermabind tl x, per square centimeter | 6 | $91.35 |
| Q4427 | Dermabind dl n or dermabind dl + or dermabind dl x | 6 | $91.35 |
| Q4428 | Dermabind sl n or dermabind sl + or dermabind sl x | 6 | $91.35 |
| Q4429 | Dermabind ch n or dermabind ch x, per square centimeter | 6 | $91.35 |
| Q4435 | Renati membrane, per square centimeter (add-on | 6 | $91.35 |
| Q4436 | Renati ac membrane, per square centimeter (add-on | 6 | $91.35 |
| Q4437 | Revival ac, per square centimeter (add-on | 6 | $91.35 |
| Q4438 | Pretect, per square centimeter (add-on | 6 | $91.35 |
| Q4439 | Instagraft, per square centimeter (add-on | 6 | $91.35 |
| Q4440 | Curamatrix, per square centimeter (add-on | 6 | $86.01 |
| Q5108 | Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg | 36 | $69.25 |
| Q5113 | Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg | 33 | $54.94 |
| Q5114 | Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg | 36 | $31.95 |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | 36 | $34.56 |
| Q5122 | Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg | 34 | $136.91 |
| Q5127 | Injection, pegfilgrastim-fpgk (stimufend), biosimilar | 36 | $151.06 |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 35 | $82.53 |
| Q5130 | Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg | 35 | $105.11 |
| Q5137 | Injection, ustekinumab-auub (wezlana), biosimilar | 7 | $61.25 |
| Q5141 | Injection, adalimumab-aaty, biosimilar, 1 mg | 13 | $13.23 |
| Q5142 | Injection, adalimumab-ryvk biosimilar, 1 mg | 15 | $12.98 |
| Q5144 | Injection, adalimumab-aacf (idacio), biosimilar, 1 mg | 16 | $18.07 |
| Q5151 | Injection, eculizumab-aagh (epysqli), biosimilar, 2 mg | 27 | $31.55 |
| Q5152 | Injection, eculizumab-aeeb (bkemv), biosimilar, 2 mg | 26 | $40.91 |
| Q5157 | Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar | 30 | $25.98 |
| Q5159 | Injection, denosumab-dssb (ospomyv/xbryk), biosimilar, 1 mg | 6 | $16.17 |
| Q5166 | Injection, denosumab-desu (osvyrti/jubereq), biosimilar | 14 | $28.89 |
| Q5168 | Injection, ranibizumab-leyk (nufymco), biosimilar, 0.1 mg | 13 | $250.78 |
| Q5169 | Injection, pegfilgrastim-unne (armlupeg), biosimilar, 0.5 mg | 12 | $519.48 |
| Q9953 | Injection, iron-based magnetic resonance contrast agent | 18 | $62.05 |
| Q9954 | Oral magnetic resonance contrast agent, per 100 ml | 18 | $11.37 |
| Q9956 | Injection, octafluoropropane microspheres, per ml | 25 | $40.32 |
| Q9958 | High osmolar contrast material | 20 | $0.075 |
| Q9960 | High osmolar contrast material | 15 | $0.16 |
| Q9962 | High osmolar contrast material | 15 | $0.18 |
| Q9963 | High osmolar contrast material | 21 | $0.21 |
| Q9964 | High osmolar contrast material | 14 | $0.29 |
| Q9965 | Low osmolar contrast material | 29 | $0.96 |
| Q9967 | Low osmolar contrast material | 33 | $0.15 |
| Q9996 | Injection, ustekinumab-ttwe (pyzchiva), subcutaneous, 1 mg | 15 | $46.40 |
| S0020 | Injection, bupivicaine hydrochloride, 30 ml | 5 | $5.17 |
| S0023 | Injection, cimetidine hydrochloride, 300 mg | 10 | $2.72 |
| S0040 | Injection, ticarcillin disodium and clavulanate potassium | 7 | $14.10 |
| S0081 | Injection, piperacillin sodium, 500 mg | 6 | $3.21 |
| S0092 | Injection, hydromorphone hydrochloride, 250 mg | 6 | $89.86 |
| S0104 | Zidovudine, oral, 100 mg | 5 | $1.66 |
| S0109 | Methadone, oral, 5 mg | 10 | $0.27 |
| S0136 | Clozapine, 25 mg | 5 | $0.74 |
| S0140 | Saquinavir, 200 mg | 5 | $4.13 |
| S0145 | Injection, pegylated interferon alfa-2a, 180 mcg per ml | 13 | $1,095.60 |
| S0148 | Injection, pegylated interferon alfa-2b, 10 mcg | 9 | $114.56 |
| S0157 | Becaplermin gel 0.01%, 0.5 gm | 5 | $44.60 |
| S0169 | Calcitrol, oral, 0.25 microgram | 6 | $0.865 |
| S0170 | Anastrozole, oral, 1 mg | 5 | $10.91 |
| S0172 | Chlorambucil, oral, 2 mg | 6 | $27.45 |
| S0176 | Hydroxyurea, oral, 500 mg | 5 | $0.89 |
| S0179 | Megestrol acetate, oral, 20 mg | 6 | $0.675 |
| S0183 | Prochlorperazine maleate, oral, 5 mg | 5 | $0.54 |
| S0187 | Tamoxifen citrate, oral, 10 mg | 6 | $1.22 |
| S0190 | Mifepristone, oral, 200 mg | 19 | $67.33 |
| S0191 | Misoprostol, oral, 200 mcg | 20 | $0.97 |
| S0199 | Medically induced abortion by oral ingestion of medication... | 18 | $358.29 |
| S0265 | Genetic counseling, under physician supervision | 5 | $16.12 |
| S0316 | Disease management program, follow-up/reassessment | 5 | $42.79 |
| S0580 | Polycarbonate lens (list this code in addition to the basic... | 5 | $12.00 |
| S0621 | Routine ophthalmological examination including refraction | 5 | $59.29 |
| S2068 | Breast reconstruction with deep inferior epigastric... | 5 | $1,383.76 |
| S2079 | Laparoscopic esophagomyotomy (heller type) | 5 | $801.19 |
| S2083 | Adjustment of gastric band diameter via subcutaneous port by... | 9 | $79.97 |
| S4005 | Interim labor facility global | 9 | $400.00 |
| S4989 | Contraceptive intrauterine device (e.g., progestacert iud) | 11 | $115.44 |
| S5145 | Foster care, therapeutic, child; per diem | 14 | $177.45 |
| S5520 | Home infusion therapy, all supplies | 7 | $85.00 |
| S5560 | Insulin delivery device, reusable pen; 1.5 ml size | 5 | $35.33 |
| S5561 | Insulin delivery device, reusable pen; 3 ml size | 6 | $30.42 |
| S8096 | Portable peak flow meter | 6 | $27.43 |
| S8100 | Holding chamber or spacer for use with an inhaler or... | 7 | $27.46 |
| S8185 | Flutter device | 15 | $42.23 |
| S8186 | Swivel adapter | 8 | $3.47 |
| S8189 | Tracheostomy supply, not otherwise classified | 7 | $6.00 |
| S8210 | Mucus trap | 6 | $3.45 |
| S8422 | Gradient pressure aid (sleeve), custom made, medium weight | 5 | $149.27 |
| S8428 | Gradient pressure aid (gauntlet), ready made | 9 | $36.82 |
| S8999 | Resuscitation bag (for use by patient on artificial... | 19 | $67.93 |
| S9110 | Telemonitoring of patient in their home | 6 | $89.83 |
| S9152 | Speech therapy, re-evaluation | 9 | $61.68 |
| S9329 | Home infusion therapy, chemotherapy infusion | 7 | $46.68 |
| S9339 | Home therapy; peritoneal dialysis, administrative services | 5 | $51.54 |
| S9342 | Home therapy; enteral nutrition via pump | 5 | $14.84 |
| S9357 | Home infusion therapy | 6 | $73.01 |
| S9370 | Home therapy, intermittent anti-emetic injection therapy | 6 | $26.00 |
| S9442 | Birthing classes, non-physician provider, per session | 5 | $34.84 |
| S9443 | Lactation classes, non-physician provider, per session | 18 | $53.08 |
| S9453 | Smoking cessation classes, non-physician provider | 5 | $20.00 |
| S9480 | Intensive outpatient psychiatric services, per diem | 22 | $172.15 |
| S9562 | Home injectable therapy | 5 | $68.34 |
| T1006 | Alcohol and/or substance abuse services | 9 | $40.52 |
| T1024 | Evaluation and treatment by an integrated | 16 | $89.27 |
| T1032 | Services performed by a doula birth worker, per 15 minutes | 13 | $16.28 |
| T1033 | Services performed by a doula birth worker, per diem | 16 | $765.66 |
| T2045 | Hospice general inpatient care; per diem | 7 | $1,194.29 |
| T4523 | Adult sized disposable incontinence product, brief/diaper | 41 | $0.80 |
| T4533 | Youth sized disposable incontinence product, brief/diaper | 39 | $0.60 |
| T4543 | Adult sized disposable incontinence product | 35 | $1.40 |
| T4544 | Adult sized disposable incontinence product | 32 | $1.32 |
| U0002 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19) | 41 | $50.03 |
| U0005 | Infectious agent detection by nucleic acid (dna or rna) | 8 | $25.00 |
| V2623 | Physician and practitioner services (fee schedule) | 42 | $933.05 |
Physician & professional rates in your statesRates, managed-care rules, Medicare comparison and changes, for the codes you bill.