Service line · Physician & professional
Physician & professional Medicaid rates by code
8,075 physician & professional codes with published Medicaid rates in five or more states. Each page compares every state's rate, unit and managed-care rule.
- Codes
- 8,075
- In 40+ states
- 6,282
Index
All physician & professional codes
| 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) | 39 | $5.00 |
| 00102 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00103 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00104 | Physician and practitioner services (fee schedule) | 40 | $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) | 39 | $5.00 |
| 00124 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00126 | Physician and practitioner services (fee schedule) | 39 | $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) | 39 | $5.00 |
| 00142 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00144 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00145 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00147 | Physician and practitioner services (fee schedule) | 38 | $6.00 |
| 00148 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 0015M | Physician and practitioner services (fee schedule) | 7 | $1,174.83 |
| 00160 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00162 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 00164 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 0016M | Physician and practitioner services (fee schedule) | 9 | $3,140.67 |
| 00170 | Physician and practitioner services (fee schedule) | 41 | $5.00 |
| 00172 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00174 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00176 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 00190 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00192 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 0020M | Physician and practitioner services (fee schedule) | 8 | $2,375.00 |
| 00210 | Physician and practitioner services (fee schedule) | 39 | $11.00 |
| 00211 | Physician and practitioner services (fee schedule) | 38 | $10.00 |
| 00212 | Physician and practitioner services (fee schedule) | 38 | $5.00 |
| 00214 | Physician and practitioner services (fee schedule) | 39 | $9.00 |
| 00215 | Physician and practitioner services (fee schedule) | 39 | $9.00 |
| 00216 | Physician and practitioner services (fee schedule) | 39 | $15.00 |
| 00218 | Physician and practitioner services (fee schedule) | 39 | $13.00 |
| 00220 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 00222 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00300 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 0031A | Physician and practitioner services (fee schedule) | 8 | $39.99 |
| 00320 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00322 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 00326 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 0034A | Physician and practitioner services (fee schedule) | 6 | $40.00 |
| 00350 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 00352 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00400 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 00402 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00404 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00406 | Physician and practitioner services (fee schedule) | 39 | $13.00 |
| 00410 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00450 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00454 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 00470 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00472 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 00474 | Physician and practitioner services (fee schedule) | 39 | $13.00 |
| 00500 | Physician and practitioner services (fee schedule) | 39 | $15.00 |
| 0051A | Physician and practitioner services (fee schedule) | 5 | $40.00 |
| 00520 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00522 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00524 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00528 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 00529 | Physician and practitioner services (fee schedule) | 38 | $11.00 |
| 00530 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00532 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00534 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 00537 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 00539 | Physician and practitioner services (fee schedule) | 39 | $18.00 |
| 00540 | Physician and practitioner services (fee schedule) | 39 | $12.00 |
| 00541 | Physician and practitioner services (fee schedule) | 39 | $15.00 |
| 00542 | Physician and practitioner services (fee schedule) | 39 | $15.00 |
| 00546 | Physician and practitioner services (fee schedule) | 39 | $15.00 |
| 00548 | Physician and practitioner services (fee schedule) | 39 | $17.00 |
| 00550 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 00560 | Physician and practitioner services (fee schedule) | 39 | $15.00 |
| 00561 | Physician and practitioner services (fee schedule) | 39 | $25.00 |
| 00562 | Physician and practitioner services (fee schedule) | 39 | $20.00 |
| 00563 | Physician and practitioner services (fee schedule) | 39 | $25.00 |
| 00566 | Physician and practitioner services (fee schedule) | 39 | $25.00 |
| 00567 | Physician and practitioner services (fee schedule) | 37 | $18.00 |
| 00580 | Physician and practitioner services (fee schedule) | 39 | $20.00 |
| 00600 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 00604 | Physician and practitioner services (fee schedule) | 39 | $13.00 |
| 00620 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 00625 | Physician and practitioner services (fee schedule) | 38 | $13.00 |
| 00626 | Physician and practitioner services (fee schedule) | 38 | $15.00 |
| 00630 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 00632 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 00635 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00640 | Physician and practitioner services (fee schedule) | 38 | $3.00 |
| 0064A | Physician and practitioner services (fee schedule) | 6 | $40.00 |
| 00670 | Physician and practitioner services (fee schedule) | 39 | $13.00 |
| 00700 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00702 | Physician and practitioner services (fee schedule) | 39 | $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) | 39 | $5.00 |
| 00731 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00732 | Physician and practitioner services (fee schedule) | 39 | $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) | 39 | $4.00 |
| 00752 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00754 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 00756 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 0075T | Physician and practitioner services (fee schedule) | 5 | $795.03 |
| 00770 | Physician and practitioner services (fee schedule) | 39 | $15.00 |
| 00790 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 00792 | Physician and practitioner services (fee schedule) | 39 | $13.00 |
| 00794 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 00796 | Physician and practitioner services (fee schedule) | 39 | $30.00 |
| 00797 | Physician and practitioner services (fee schedule) | 38 | $11.00 |
| 00800 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00802 | Physician and practitioner services (fee schedule) | 38 | $5.00 |
| 00811 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00812 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00813 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00820 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00830 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00832 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00834 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00836 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00840 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00842 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00844 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 00846 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 00848 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 00851 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00860 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00862 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 00864 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 00865 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 00866 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 00868 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 00870 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00872 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 00873 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00880 | Physician and practitioner services (fee schedule) | 39 | $15.00 |
| 00882 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 00902 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00904 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 00906 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00908 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00910 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 00912 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00914 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00916 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00918 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00920 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 00921 | Physician and practitioner services (fee schedule) | 37 | $3.00 |
| 00922 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00924 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00926 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00928 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00930 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00932 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00934 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00936 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 00938 | Physician and practitioner services (fee schedule) | 31 | $4.00 |
| 00940 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 00942 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00944 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 00948 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 00950 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 00952 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 0101T | Physician and practitioner services (fee schedule) | 9 | $128.76 |
| 0102T | Physician and practitioner services (fee schedule) | 8 | $1,584.14 |
| 01112 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01120 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 01130 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01140 | Physician and practitioner services (fee schedule) | 39 | $15.00 |
| 01150 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 01160 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01170 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 01173 | Physician and practitioner services (fee schedule) | 39 | $12.00 |
| 01200 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01202 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01210 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 01212 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 01214 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 01215 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 01220 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01230 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 01232 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01234 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 01250 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01260 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01270 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 01272 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01274 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 01320 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01340 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01360 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01380 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01382 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01390 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01392 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01400 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01402 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 01404 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01420 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01430 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01432 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 01440 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 01442 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 01444 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 01462 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01464 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01470 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01472 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01474 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01480 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01482 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01484 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01486 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 01490 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01500 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 01502 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 01520 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01522 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01610 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01620 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01622 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01630 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01634 | Physician and practitioner services (fee schedule) | 39 | $9.00 |
| 01636 | Physician and practitioner services (fee schedule) | 39 | $15.00 |
| 01638 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 01650 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 01652 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 01654 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 01656 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 01670 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01680 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01710 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01712 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01714 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01716 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01730 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01732 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01740 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01742 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01744 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01756 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 01758 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01760 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 01770 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 01772 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 01780 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01782 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01810 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01820 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01829 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01830 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01832 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 01840 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 01842 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 01844 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 0184T | Physician and practitioner services (fee schedule) | 5 | $835.25 |
| 01850 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01852 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01860 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01916 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01920 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 01922 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 01924 | Physician and practitioner services (fee schedule) | 39 | $6.00 |
| 01925 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 01926 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 01930 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01931 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 01932 | Physician and practitioner services (fee schedule) | 39 | $7.00 |
| 01933 | Physician and practitioner services (fee schedule) | 39 | $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) | 38 | $4.00 |
| 01938 | Anesthesia base units (per procedure) | 38 | $4.00 |
| 01939 | Anesthesia base units (per procedure) | 37 | $4.00 |
| 01940 | Anesthesia base units (per procedure) | 38 | $4.00 |
| 01941 | Anesthesia base units (per procedure) | 38 | $5.00 |
| 01942 | Anesthesia base units (per procedure) | 38 | $5.00 |
| 01951 | Physician and practitioner services (fee schedule) | 39 | $3.00 |
| 01952 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01953 | Physician and practitioner services (fee schedule) | 36 | $10.79 |
| 01958 | Physician and practitioner services (fee schedule) | 36 | $5.00 |
| 01960 | Physician and practitioner services (fee schedule) | 39 | $5.00 |
| 01961 | Physician and practitioner services (fee schedule) | 40 | $7.00 |
| 01962 | Physician and practitioner services (fee schedule) | 39 | $8.00 |
| 01963 | Physician and practitioner services (fee schedule) | 39 | $10.00 |
| 01965 | Physician and practitioner services (fee schedule) | 39 | $4.00 |
| 01966 | Physician and practitioner services (fee schedule) | 37 | $4.00 |
| 01967 | Physician and practitioner services (fee schedule) | 40 | $13.91 |
| 01968 | Physician and practitioner services (fee schedule) | 40 | $6.87 |
| 01969 | Physician and practitioner services (fee schedule) | 40 | $5.00 |
| 01990 | Physician and practitioner services (fee schedule) | 27 | $7.00 |
| 01991 | Physician and practitioner services (fee schedule) | 38 | $3.00 |
| 01992 | Physician and practitioner services (fee schedule) | 38 | $5.00 |
| 01996 | Physician and practitioner services (fee schedule) | 42 | $22.70 |
| 01999 | Physician and practitioner services (fee schedule) | 10 | $25.04 |
| 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 |
| 0237T | Physician and practitioner services (fee schedule) | 5 | $1,879.23 |
| 0238T | Physician and practitioner services (fee schedule) | 5 | $1,134.85 |
| 0255U | Physician and practitioner services (fee schedule) | 6 | $30.02 |
| 0402T | Physician and practitioner services (fee schedule) | 12 | $511.69 |
| 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) | 7 | $597.91 |
| 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) | 9 | $235.17 |
| 0480T | Physician and practitioner services (fee schedule) | 8 | $70.00 |
| 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) | 8 | $45.87 |
| 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) | 10 | $613.91 |
| 0627T | Physician and practitioner services (fee schedule) | 9 | $6,174.23 |
| 0629T | Physician and practitioner services (fee schedule) | 9 | $6,346.98 |
| 0689T | Physician and practitioner services (fee schedule) | 9 | $27.10 |
| 0792T | Physician and practitioner services (fee schedule) | 5 | $23.25 |
| 0795T | Physician and practitioner services (fee schedule) | 5 | $417.15 |
| 0861T | Physician and practitioner services (fee schedule) | 7 | $1,089.83 |
| 0862T | Physician and practitioner services (fee schedule) | 7 | $587.87 |
| 0863T | Physician and practitioner services (fee schedule) | 7 | $587.87 |
| 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) | 49 | $38.95 |
| 10005 | Physician and practitioner services (fee schedule) | 50 | $87.59 |
| 10006 | Physician and practitioner services (fee schedule) | 50 | $45.64 |
| 10007 | Physician and practitioner services (fee schedule) | 50 | $195.27 |
| 10008 | Physician and practitioner services (fee schedule) | 50 | $95.09 |
| 10009 | Physician and practitioner services (fee schedule) | 50 | $276.55 |
| 10010 | Physician and practitioner services (fee schedule) | 50 | $157.44 |
| 10011 | Physician and practitioner services (fee schedule) | 24 | $116.49 |
| 10012 | Physician and practitioner services (fee schedule) | 23 | $131.31 |
| 10021 | Physician and practitioner services (fee schedule) | 50 | $71.68 |
| 10030 | Physician and practitioner services (fee schedule) | 50 | $401.12 |
| 10035 | Physician and practitioner services (fee schedule) | 48 | $229.11 |
| 10036 | Physician and practitioner services (fee schedule) | 48 | $191.25 |
| 10040 | Physician and practitioner services (fee schedule) | 46 | $73.04 |
| 10060 | Physician and practitioner services (fee schedule) | 50 | $88.74 |
| 10061 | Physician and practitioner services (fee schedule) | 50 | $153.30 |
| 10080 | Physician and practitioner services (fee schedule) | 50 | $129.47 |
| 10081 | Physician and practitioner services (fee schedule) | 50 | $200.51 |
| 10120 | Physician and practitioner services (fee schedule) | 50 | $98.41 |
| 10121 | Physician and practitioner services (fee schedule) | 50 | $171.22 |
| 10140 | Physician and practitioner services (fee schedule) | 50 | $109.79 |
| 10160 | Physician and practitioner services (fee schedule) | 50 | $86.10 |
| 10180 | Physician and practitioner services (fee schedule) | 50 | $182.52 |
| 1025T | Physician and practitioner services (fee schedule) | 7 | $69.88 |
| 11000 | Physician and practitioner services (fee schedule) | 50 | $38.05 |
| 11001 | Physician and practitioner services (fee schedule) | 50 | $18.34 |
| 11004 | Physician and practitioner services (fee schedule) | 50 | $437.24 |
| 11005 | Physician and practitioner services (fee schedule) | 50 | $594.32 |
| 11006 | Physician and practitioner services (fee schedule) | 50 | $545.22 |
| 11008 | Physician and practitioner services (fee schedule) | 50 | $211.94 |
| 11010 | Physician and practitioner services (fee schedule) | 50 | $286.71 |
| 11011 | Physician and practitioner services (fee schedule) | 50 | $326.17 |
| 11012 | Physician and practitioner services (fee schedule) | 50 | $442.71 |
| 11042 | Physician and practitioner services (fee schedule) | 50 | $84.55 |
| 11043 | Physician and practitioner services (fee schedule) | 50 | $167.89 |
| 11044 | Physician and practitioner services (fee schedule) | 50 | $227.02 |
| 11045 | Physician and practitioner services (fee schedule) | 49 | $27.30 |
| 11046 | Physician and practitioner services (fee schedule) | 49 | $51.51 |
| 11047 | Physician and practitioner services (fee schedule) | 49 | $88.17 |
| 11055 | Physician and practitioner services (fee schedule) | 50 | $40.24 |
| 11056 | Physician and practitioner services (fee schedule) | 50 | $47.35 |
| 11057 | Physician and practitioner services (fee schedule) | 50 | $52.53 |
| 11102 | Physician and practitioner services (fee schedule) | 50 | $71.28 |
| 11103 | Physician and practitioner services (fee schedule) | 50 | $36.83 |
| 11104 | Physician and practitioner services (fee schedule) | 50 | $84.93 |
| 11105 | Physician and practitioner services (fee schedule) | 50 | $42.80 |
| 11106 | Physician and practitioner services (fee schedule) | 50 | $101.36 |
| 11107 | Physician and practitioner services (fee schedule) | 50 | $50.82 |
| 11200 | Physician and practitioner services (fee schedule) | 49 | $64.84 |
| 11201 | Physician and practitioner services (fee schedule) | 47 | $14.79 |
| 11300 | Physician and practitioner services (fee schedule) | 50 | $55.51 |
| 11301 | Physician and practitioner services (fee schedule) | 50 | $67.43 |
| 11302 | Physician and practitioner services (fee schedule) | 50 | $79.75 |
| 11303 | Physician and practitioner services (fee schedule) | 50 | $94.50 |
| 11305 | Physician and practitioner services (fee schedule) | 50 | $64.62 |
| 11306 | Physician and practitioner services (fee schedule) | 50 | $75.26 |
| 11307 | Physician and practitioner services (fee schedule) | 50 | $85.39 |
| 11308 | Physician and practitioner services (fee schedule) | 50 | $95.41 |
| 11310 | Physician and practitioner services (fee schedule) | 50 | $69.57 |
| 11311 | Physician and practitioner services (fee schedule) | 50 | $83.32 |
| 11312 | Physician and practitioner services (fee schedule) | 50 | $95.80 |
| 11313 | Physician and practitioner services (fee schedule) | 50 | $114.32 |
| 11400 | Physician and practitioner services (fee schedule) | 50 | $84.23 |
| 11401 | Physician and practitioner services (fee schedule) | 50 | $104.34 |
| 11402 | Physician and practitioner services (fee schedule) | 50 | $116.86 |
| 11403 | Physician and practitioner services (fee schedule) | 50 | $136.67 |
| 11404 | Physician and practitioner services (fee schedule) | 50 | $156.36 |
| 11406 | Physician and practitioner services (fee schedule) | 50 | $227.85 |
| 11420 | Physician and practitioner services (fee schedule) | 50 | $84.02 |
| 11421 | Physician and practitioner services (fee schedule) | 50 | $107.40 |
| 11422 | Physician and practitioner services (fee schedule) | 50 | $125.79 |
| 11423 | Physician and practitioner services (fee schedule) | 50 | $147.36 |
| 11424 | Physician and practitioner services (fee schedule) | 50 | $168.77 |
| 11426 | Physician and practitioner services (fee schedule) | 50 | $244.62 |
| 11440 | Physician and practitioner services (fee schedule) | 50 | $96.96 |
| 11441 | Physician and practitioner services (fee schedule) | 50 | $121.40 |
| 11442 | Physician and practitioner services (fee schedule) | 50 | $138.82 |
| 11443 | Physician and practitioner services (fee schedule) | 50 | $167.84 |
| 11444 | Physician and practitioner services (fee schedule) | 50 | $209.69 |
| 11446 | Physician and practitioner services (fee schedule) | 50 | $286.76 |
| 11450 | Physician and practitioner services (fee schedule) | 49 | $269.63 |
| 11451 | Physician and practitioner services (fee schedule) | 49 | $363.75 |
| 11462 | Physician and practitioner services (fee schedule) | 49 | $281.68 |
| 11463 | Physician and practitioner services (fee schedule) | 49 | $362.78 |
| 11470 | Physician and practitioner services (fee schedule) | 49 | $295.63 |
| 11471 | Physician and practitioner services (fee schedule) | 50 | $363.08 |
| 11600 | Physician and practitioner services (fee schedule) | 50 | $128.64 |
| 11601 | Physician and practitioner services (fee schedule) | 50 | $151.26 |
| 11602 | Physician and practitioner services (fee schedule) | 50 | $162.41 |
| 11603 | Physician and practitioner services (fee schedule) | 50 | $187.16 |
| 11604 | Physician and practitioner services (fee schedule) | 50 | $210.76 |
| 11606 | Physician and practitioner services (fee schedule) | 50 | $303.92 |
| 11620 | Physician and practitioner services (fee schedule) | 50 | $125.59 |
| 11621 | Physician and practitioner services (fee schedule) | 50 | $151.08 |
| 11622 | Physician and practitioner services (fee schedule) | 50 | $169.32 |
| 11623 | Physician and practitioner services (fee schedule) | 50 | $210.83 |
| 11624 | Physician and practitioner services (fee schedule) | 50 | $235.08 |
| 11626 | Physician and practitioner services (fee schedule) | 50 | $297.83 |
| 11640 | Physician and practitioner services (fee schedule) | 50 | $130.87 |
| 11641 | Physician and practitioner services (fee schedule) | 50 | $169.40 |
| 11642 | Physician and practitioner services (fee schedule) | 50 | $197.87 |
| 11643 | Physician and practitioner services (fee schedule) | 50 | $233.56 |
| 11644 | Physician and practitioner services (fee schedule) | 50 | $292.53 |
| 11646 | Physician and practitioner services (fee schedule) | 50 | $379.88 |
| 11719 | Physician and practitioner services (fee schedule) | 42 | $9.79 |
| 11720 | Physician and practitioner services (fee schedule) | 50 | $21.24 |
| 11721 | Physician and practitioner services (fee schedule) | 50 | $31.94 |
| 11730 | Physician and practitioner services (fee schedule) | 50 | $71.17 |
| 11732 | Physician and practitioner services (fee schedule) | 50 | $23.97 |
| 11740 | Physician and practitioner services (fee schedule) | 50 | $34.97 |
| 11750 | Physician and practitioner services (fee schedule) | 50 | $121.77 |
| 11755 | Physician and practitioner services (fee schedule) | 50 | $81.11 |
| 11760 | Physician and practitioner services (fee schedule) | 50 | $117.19 |
| 11762 | Physician and practitioner services (fee schedule) | 50 | $192.57 |
| 11765 | Physician and practitioner services (fee schedule) | 50 | $102.79 |
| 11770 | Physician and practitioner services (fee schedule) | 50 | $204.66 |
| 11771 | Physician and practitioner services (fee schedule) | 50 | $422.79 |
| 11772 | Physician and practitioner services (fee schedule) | 50 | $553.64 |
| 11900 | Physician and practitioner services (fee schedule) | 48 | $35.15 |
| 11901 | Physician and practitioner services (fee schedule) | 48 | $45.80 |
| 11920 | Physician and practitioner services (fee schedule) | 41 | $142.37 |
| 11921 | Physician and practitioner services (fee schedule) | 41 | $156.62 |
| 11922 | Physician and practitioner services (fee schedule) | 30 | $43.92 |
| 11950 | Physician and practitioner services (fee schedule) | 27 | $60.60 |
| 11951 | Physician and practitioner services (fee schedule) | 27 | $78.82 |
| 11952 | Physician and practitioner services (fee schedule) | 26 | $103.89 |
| 11954 | Physician and practitioner services (fee schedule) | 28 | $113.49 |
| 11960 | Physician and practitioner services (fee schedule) | 50 | $754.14 |
| 11970 | Physician and practitioner services (fee schedule) | 50 | $452.12 |
| 11971 | Physician and practitioner services (fee schedule) | 50 | $377.53 |
| 11976 | Physician and practitioner services (fee schedule) | 50 | $110.39 |
| 11980 | Physician and practitioner services (fee schedule) | 48 | $74.83 |
| 11981 | Physician and practitioner services (fee schedule) | 50 | $83.20 |
| 11982 | Physician and practitioner services (fee schedule) | 50 | $91.31 |
| 11983 | Physician and practitioner services (fee schedule) | 50 | $123.54 |
| 12001 | Physician and practitioner services (fee schedule) | 50 | $74.12 |
| 12002 | Physician and practitioner services (fee schedule) | 50 | $89.55 |
| 12004 | Physician and practitioner services (fee schedule) | 50 | $108.19 |
| 12005 | Physician and practitioner services (fee schedule) | 50 | $137.86 |
| 12006 | Physician and practitioner services (fee schedule) | 50 | $166.07 |
| 12007 | Physician and practitioner services (fee schedule) | 49 | $178.61 |
| 12011 | Physician and practitioner services (fee schedule) | 50 | $81.85 |
| 12013 | Physician and practitioner services (fee schedule) | 50 | $91.59 |
| 12014 | Physician and practitioner services (fee schedule) | 50 | $109.19 |
| 12015 | Physician and practitioner services (fee schedule) | 50 | $139.97 |
| 12016 | Physician and practitioner services (fee schedule) | 50 | $178.98 |
| 12017 | Physician and practitioner services (fee schedule) | 50 | $134.71 |
| 12018 | Physician and practitioner services (fee schedule) | 49 | $153.60 |
| 12020 | Physician and practitioner services (fee schedule) | 49 | $201.92 |
| 12021 | Physician and practitioner services (fee schedule) | 48 | $127.64 |
| 12031 | Physician and practitioner services (fee schedule) | 50 | $160.48 |
| 12032 | Physician and practitioner services (fee schedule) | 50 | $198.31 |
| 12034 | Physician and practitioner services (fee schedule) | 50 | $208.63 |
| 12035 | Physician and practitioner services (fee schedule) | 50 | $249.47 |
| 12036 | Physician and practitioner services (fee schedule) | 50 | $288.13 |
| 12037 | Physician and practitioner services (fee schedule) | 50 | $316.84 |
| 12041 | Physician and practitioner services (fee schedule) | 50 | $159.95 |
| 12042 | Physician and practitioner services (fee schedule) | 50 | $192.69 |
| 12044 | Physician and practitioner services (fee schedule) | 50 | $225.53 |
| 12045 | Physician and practitioner services (fee schedule) | 50 | $266.93 |
| 12046 | Physician and practitioner services (fee schedule) | 50 | $315.80 |
| 12047 | Physician and practitioner services (fee schedule) | 49 | $344.01 |
| 12051 | Physician and practitioner services (fee schedule) | 50 | $175.24 |
| 12052 | Physician and practitioner services (fee schedule) | 50 | $201.15 |
| 12053 | Physician and practitioner services (fee schedule) | 50 | $223.51 |
| 12054 | Physician and practitioner services (fee schedule) | 50 | $223.47 |
| 12055 | Physician and practitioner services (fee schedule) | 50 | $303.76 |
| 12056 | Physician and practitioner services (fee schedule) | 50 | $392.32 |
| 12057 | Physician and practitioner services (fee schedule) | 49 | $406.54 |
| 13100 | Physician and practitioner services (fee schedule) | 50 | $217.06 |
| 13101 | Physician and practitioner services (fee schedule) | 50 | $263.17 |
| 13102 | Physician and practitioner services (fee schedule) | 49 | $78.69 |
| 13120 | Physician and practitioner services (fee schedule) | 50 | $235.54 |
| 13121 | Physician and practitioner services (fee schedule) | 50 | $272.89 |
| 13122 | Physician and practitioner services (fee schedule) | 49 | $86.63 |
| 13131 | Physician and practitioner services (fee schedule) | 50 | $252.59 |
| 13132 | Physician and practitioner services (fee schedule) | 50 | $329.29 |
| 13133 | Physician and practitioner services (fee schedule) | 49 | $122.75 |
| 13151 | Physician and practitioner services (fee schedule) | 50 | $283.98 |
| 13152 | Physician and practitioner services (fee schedule) | 50 | $344.70 |
| 13153 | Physician and practitioner services (fee schedule) | 49 | $133.68 |
| 13160 | Physician and practitioner services (fee schedule) | 50 | $591.70 |
| 14000 | Physician and practitioner services (fee schedule) | 50 | $437.65 |
| 14001 | Physician and practitioner services (fee schedule) | 50 | $561.56 |
| 14020 | Physician and practitioner services (fee schedule) | 50 | $481.56 |
| 14021 | Physician and practitioner services (fee schedule) | 50 | $600.45 |
| 14040 | Physician and practitioner services (fee schedule) | 50 | $528.18 |
| 14041 | Physician and practitioner services (fee schedule) | 50 | $686.49 |
| 14060 | Physician and practitioner services (fee schedule) | 50 | $569.55 |
| 14061 | Physician and practitioner services (fee schedule) | 50 | $741.65 |
| 14301 | Physician and practitioner services (fee schedule) | 50 | $757.07 |
| 14302 | Physician and practitioner services (fee schedule) | 49 | $169.64 |
| 14350 | Physician and practitioner services (fee schedule) | 50 | $520.81 |
| 15002 | Physician and practitioner services (fee schedule) | 50 | $241.79 |
| 15003 | Physician and practitioner services (fee schedule) | 49 | $50.05 |
| 15004 | Physician and practitioner services (fee schedule) | 50 | $282.11 |
| 15005 | Physician and practitioner services (fee schedule) | 49 | $88.08 |
| 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 | $71.98 |
| 15014 | Physician and practitioner services (fee schedule) | 16 | $64.77 |
| 15015 | Physician and practitioner services (fee schedule) | 16 | $546.44 |
| 15016 | Physician and practitioner services (fee schedule) | 16 | $90.22 |
| 15017 | Physician and practitioner services (fee schedule) | 16 | $575.79 |
| 15018 | Physician and practitioner services (fee schedule) | 15 | $114.96 |
| 15040 | Physician and practitioner services (fee schedule) | 47 | $188.97 |
| 15050 | Physician and practitioner services (fee schedule) | 50 | $383.75 |
| 15100 | Physician and practitioner services (fee schedule) | 50 | $628.72 |
| 15101 | Physician and practitioner services (fee schedule) | 49 | $134.66 |
| 15110 | Physician and practitioner services (fee schedule) | 50 | $631.15 |
| 15111 | Physician and practitioner services (fee schedule) | 50 | $92.79 |
| 15115 | Physician and practitioner services (fee schedule) | 50 | $637.85 |
| 15116 | Physician and practitioner services (fee schedule) | 50 | $127.73 |
| 15120 | Physician and practitioner services (fee schedule) | 50 | $630.54 |
| 15121 | Physician and practitioner services (fee schedule) | 49 | $157.02 |
| 15130 | Physician and practitioner services (fee schedule) | 50 | $554.37 |
| 15131 | Physician and practitioner services (fee schedule) | 50 | $78.13 |
| 15135 | Physician and practitioner services (fee schedule) | 50 | $682.38 |
| 15136 | Physician and practitioner services (fee schedule) | 50 | $78.42 |
| 15150 | Physician and practitioner services (fee schedule) | 49 | $551.90 |
| 15151 | Physician and practitioner services (fee schedule) | 49 | $97.52 |
| 15152 | Physician and practitioner services (fee schedule) | 49 | $123.05 |
| 15155 | Physician and practitioner services (fee schedule) | 49 | $590.48 |
| 15156 | Physician and practitioner services (fee schedule) | 49 | $131.11 |
| 15157 | Physician and practitioner services (fee schedule) | 49 | $146.71 |
| 15200 | Physician and practitioner services (fee schedule) | 50 | $579.07 |
| 15201 | Physician and practitioner services (fee schedule) | 49 | $94.97 |
| 15220 | Physician and practitioner services (fee schedule) | 50 | $523.71 |
| 15221 | Physician and practitioner services (fee schedule) | 49 | $91.01 |
| 15240 | Physician and practitioner services (fee schedule) | 50 | $663.80 |
| 15241 | Physician and practitioner services (fee schedule) | 49 | $132.51 |
| 15260 | Physician and practitioner services (fee schedule) | 50 | $732.22 |
| 15261 | Physician and practitioner services (fee schedule) | 49 | $148.65 |
| 15271 | Physician and practitioner services (fee schedule) | 50 | $106.83 |
| 15272 | Physician and practitioner services (fee schedule) | 49 | $18.60 |
| 15273 | Physician and practitioner services (fee schedule) | 50 | $219.44 |
| 15274 | Physician and practitioner services (fee schedule) | 49 | $58.13 |
| 15275 | Physician and practitioner services (fee schedule) | 50 | $109.05 |
| 15276 | Physician and practitioner services (fee schedule) | 49 | $24.95 |
| 15277 | Physician and practitioner services (fee schedule) | 50 | $246.27 |
| 15278 | Physician and practitioner services (fee schedule) | 50 | $68.83 |
| 15570 | Physician and practitioner services (fee schedule) | 50 | $657.03 |
| 15572 | Physician and practitioner services (fee schedule) | 50 | $659.75 |
| 15574 | Physician and practitioner services (fee schedule) | 50 | $657.09 |
| 15576 | Physician and practitioner services (fee schedule) | 49 | $574.35 |
| 15600 | Physician and practitioner services (fee schedule) | 50 | $220.81 |
| 15610 | Physician and practitioner services (fee schedule) | 50 | $241.58 |
| 15620 | Physician and practitioner services (fee schedule) | 50 | $312.01 |
| 15630 | Physician and practitioner services (fee schedule) | 50 | $319.35 |
| 15650 | Physician and practitioner services (fee schedule) | 50 | $369.97 |
| 15730 | Physician and practitioner services (fee schedule) | 50 | $1,076.98 |
| 15731 | Physician and practitioner services (fee schedule) | 49 | $806.25 |
| 15733 | Physician and practitioner services (fee schedule) | 50 | $826.11 |
| 15734 | Physician and practitioner services (fee schedule) | 49 | $1,105.38 |
| 15736 | Physician and practitioner services (fee schedule) | 48 | $966.63 |
| 15738 | Physician and practitioner services (fee schedule) | 49 | $946.21 |
| 15740 | Physician and practitioner services (fee schedule) | 50 | $709.07 |
| 15750 | Physician and practitioner services (fee schedule) | 49 | $688.88 |
| 15756 | Physician and practitioner services (fee schedule) | 50 | $1,709.91 |
| 15757 | Physician and practitioner services (fee schedule) | 50 | $1,697.01 |
| 15758 | Physician and practitioner services (fee schedule) | 50 | $1,692.66 |
| 15760 | Physician and practitioner services (fee schedule) | 50 | $588.55 |
| 15769 | Physician and practitioner services (fee schedule) | 50 | $390.74 |
| 15770 | Physician and practitioner services (fee schedule) | 49 | $493.88 |
| 15771 | Physician and practitioner services (fee schedule) | 44 | $476.75 |
| 15772 | Physician and practitioner services (fee schedule) | 44 | $144.09 |
| 15773 | Physician and practitioner services (fee schedule) | 42 | $462.95 |
| 15774 | Physician and practitioner services (fee schedule) | 42 | $139.47 |
| 15775 | Physician and practitioner services (fee schedule) | 8 | $233.48 |
| 15776 | Physician and practitioner services (fee schedule) | 10 | $320.89 |
| 15777 | Physician and practitioner services (fee schedule) | 48 | $177.01 |
| 15778 | Physician and practitioner services (fee schedule) | 43 | $298.58 |
| 15780 | Physician and practitioner services (fee schedule) | 33 | $529.61 |
| 15781 | Physician and practitioner services (fee schedule) | 34 | $341.88 |
| 15782 | Physician and practitioner services (fee schedule) | 32 | $312.70 |
| 15783 | Physician and practitioner services (fee schedule) | 26 | $279.18 |
| 15786 | Physician and practitioner services (fee schedule) | 34 | $125.51 |
| 15787 | Physician and practitioner services (fee schedule) | 34 | $22.43 |
| 15788 | Physician and practitioner services (fee schedule) | 26 | $204.23 |
| 15789 | Physician and practitioner services (fee schedule) | 26 | $324.85 |
| 15792 | Physician and practitioner services (fee schedule) | 28 | $203.52 |
| 15793 | Physician and practitioner services (fee schedule) | 27 | $299.46 |
| 15819 | Physician and practitioner services (fee schedule) | 5 | $603.61 |
| 15820 | Physician and practitioner services (fee schedule) | 41 | $469.23 |
| 15821 | Physician and practitioner services (fee schedule) | 40 | $504.15 |
| 15822 | Physician and practitioner services (fee schedule) | 43 | $369.11 |
| 15823 | Physician and practitioner services (fee schedule) | 48 | $499.90 |
| 15824 | Physician and practitioner services (fee schedule) | 12 | $367.79 |
| 15825 | Physician and practitioner services (fee schedule) | 11 | $502.07 |
| 15826 | Physician and practitioner services (fee schedule) | 12 | $322.95 |
| 15828 | Physician and practitioner services (fee schedule) | 12 | $838.23 |
| 15829 | Physician and practitioner services (fee schedule) | 11 | $895.01 |
| 15830 | Physician and practitioner services (fee schedule) | 47 | $850.70 |
| 15832 | Physician and practitioner services (fee schedule) | 31 | $680.69 |
| 15833 | Physician and practitioner services (fee schedule) | 29 | $628.29 |
| 15834 | Physician and practitioner services (fee schedule) | 29 | $631.24 |
| 15835 | Physician and practitioner services (fee schedule) | 28 | $655.27 |
| 15836 | Physician and practitioner services (fee schedule) | 29 | $566.82 |
| 15837 | Physician and practitioner services (fee schedule) | 27 | $561.19 |
| 15838 | Physician and practitioner services (fee schedule) | 28 | $447.40 |
| 15839 | Physician and practitioner services (fee schedule) | 35 | $590.86 |
| 15840 | Physician and practitioner services (fee schedule) | 49 | $781.87 |
| 15841 | Physician and practitioner services (fee schedule) | 49 | $1,232.37 |
| 15842 | Physician and practitioner services (fee schedule) | 48 | $1,920.85 |
| 15845 | Physician and practitioner services (fee schedule) | 49 | $792.99 |
| 15847 | Physician and practitioner services (fee schedule) | 29 | $318.44 |
| 15851 | Physician and practitioner services (fee schedule) | 48 | $48.20 |
| 15852 | Physician and practitioner services (fee schedule) | 49 | $35.85 |
| 15853 | Physician and practitioner services (fee schedule) | 45 | $9.58 |
| 15854 | Physician and practitioner services (fee schedule) | 45 | $12.72 |
| 15860 | Physician and practitioner services (fee schedule) | 46 | $84.39 |
| 15876 | Physician and practitioner services (fee schedule) | 12 | $289.93 |
| 15877 | Physician and practitioner services (fee schedule) | 10 | $549.10 |
| 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) | 50 | $486.30 |
| 15922 | Physician and practitioner services (fee schedule) | 50 | $544.15 |
| 15931 | Physician and practitioner services (fee schedule) | 50 | $526.93 |
| 15933 | Physician and practitioner services (fee schedule) | 50 | $655.50 |
| 15934 | Physician and practitioner services (fee schedule) | 50 | $723.52 |
| 15935 | Physician and practitioner services (fee schedule) | 49 | $829.38 |
| 15936 | Physician and practitioner services (fee schedule) | 50 | $712.64 |
| 15937 | Physician and practitioner services (fee schedule) | 50 | $788.18 |
| 15940 | Physician and practitioner services (fee schedule) | 50 | $526.47 |
| 15941 | Physician and practitioner services (fee schedule) | 50 | $690.64 |
| 15944 | Physician and practitioner services (fee schedule) | 50 | $695.76 |
| 15945 | Physician and practitioner services (fee schedule) | 49 | $765.14 |
| 15946 | Physician and practitioner services (fee schedule) | 49 | $1,180.65 |
| 15950 | Physician and practitioner services (fee schedule) | 50 | $466.59 |
| 15951 | Physician and practitioner services (fee schedule) | 50 | $652.84 |
| 15952 | Physician and practitioner services (fee schedule) | 50 | $654.55 |
| 15953 | Physician and practitioner services (fee schedule) | 49 | $728.53 |
| 15956 | Physician and practitioner services (fee schedule) | 49 | $915.68 |
| 15958 | Physician and practitioner services (fee schedule) | 49 | $920.54 |
| 15999 | Physician and practitioner services (fee schedule) | 9 | $84.06 |
| 16000 | Physician and practitioner services (fee schedule) | 49 | $50.39 |
| 16020 | Physician and practitioner services (fee schedule) | 50 | $56.61 |
| 16025 | Physician and practitioner services (fee schedule) | 50 | $105.59 |
| 16030 | Physician and practitioner services (fee schedule) | 50 | $128.43 |
| 16035 | Physician and practitioner services (fee schedule) | 50 | $158.60 |
| 16036 | Physician and practitioner services (fee schedule) | 49 | $64.19 |
| 17000 | Physician and practitioner services (fee schedule) | 50 | $50.59 |
| 17003 | Physician and practitioner services (fee schedule) | 50 | $5.28 |
| 17004 | Physician and practitioner services (fee schedule) | 50 | $127.67 |
| 17106 | Physician and practitioner services (fee schedule) | 50 | $258.80 |
| 17107 | Physician and practitioner services (fee schedule) | 50 | $358.10 |
| 17108 | Physician and practitioner services (fee schedule) | 50 | $518.32 |
| 17110 | Physician and practitioner services (fee schedule) | 50 | $73.30 |
| 17111 | Physician and practitioner services (fee schedule) | 50 | $88.51 |
| 17250 | Physician and practitioner services (fee schedule) | 50 | $49.22 |
| 17260 | Physician and practitioner services (fee schedule) | 50 | $68.14 |
| 17261 | Physician and practitioner services (fee schedule) | 50 | $92.83 |
| 17262 | Physician and practitioner services (fee schedule) | 50 | $116.44 |
| 17263 | Physician and practitioner services (fee schedule) | 50 | $129.63 |
| 17264 | Physician and practitioner services (fee schedule) | 49 | $139.78 |
| 17266 | Physician and practitioner services (fee schedule) | 49 | $162.52 |
| 17270 | Physician and practitioner services (fee schedule) | 50 | $98.85 |
| 17271 | Physician and practitioner services (fee schedule) | 50 | $109.24 |
| 17272 | Physician and practitioner services (fee schedule) | 50 | $127.51 |
| 17273 | Physician and practitioner services (fee schedule) | 50 | $147.67 |
| 17274 | Physician and practitioner services (fee schedule) | 50 | $178.21 |
| 17276 | Physician and practitioner services (fee schedule) | 50 | $210.60 |
| 17280 | Physician and practitioner services (fee schedule) | 50 | $93.26 |
| 17281 | Physician and practitioner services (fee schedule) | 50 | $126.93 |
| 17282 | Physician and practitioner services (fee schedule) | 50 | $149.81 |
| 17283 | Physician and practitioner services (fee schedule) | 49 | $175.61 |
| 17284 | Physician and practitioner services (fee schedule) | 49 | $206.86 |
| 17286 | Physician and practitioner services (fee schedule) | 49 | $273.29 |
| 17311 | Physician and practitioner services (fee schedule) | 50 | $507.77 |
| 17312 | Physician and practitioner services (fee schedule) | 50 | $307.72 |
| 17313 | Physician and practitioner services (fee schedule) | 50 | $448.24 |
| 17314 | Physician and practitioner services (fee schedule) | 50 | $274.55 |
| 17315 | Physician and practitioner services (fee schedule) | 49 | $59.11 |
| 17340 | Physician and practitioner services (fee schedule) | 42 | $39.74 |
| 17360 | Physician and practitioner services (fee schedule) | 29 | $69.68 |
| 17380 | Physician and practitioner services (fee schedule) | 15 | $55.83 |
| 17999 | Physician and practitioner services (fee schedule) | 11 | $100.00 |
| 19000 | Physician and practitioner services (fee schedule) | 50 | $51.79 |
| 19001 | Physician and practitioner services (fee schedule) | 50 | $19.94 |
| 19020 | Physician and practitioner services (fee schedule) | 50 | $304.34 |
| 19030 | Physician and practitioner services (fee schedule) | 49 | $107.12 |
| 19081 | Physician and practitioner services (fee schedule) | 50 | $311.11 |
| 19082 | Physician and practitioner services (fee schedule) | 50 | $240.68 |
| 19083 | Physician and practitioner services (fee schedule) | 50 | $309.04 |
| 19084 | Physician and practitioner services (fee schedule) | 50 | $240.65 |
| 19085 | Physician and practitioner services (fee schedule) | 50 | $450.12 |
| 19086 | Physician and practitioner services (fee schedule) | 50 | $364.29 |
| 19100 | Physician and practitioner services (fee schedule) | 50 | $99.97 |
| 19101 | Physician and practitioner services (fee schedule) | 50 | $235.45 |
| 19105 | Physician and practitioner services (fee schedule) | 41 | $1,530.41 |
| 19110 | Physician and practitioner services (fee schedule) | 50 | $343.59 |
| 19112 | Physician and practitioner services (fee schedule) | 50 | $324.34 |
| 19120 | Physician and practitioner services (fee schedule) | 49 | $374.85 |
| 19125 | Physician and practitioner services (fee schedule) | 50 | $418.62 |
| 19126 | Physician and practitioner services (fee schedule) | 50 | $124.82 |
| 19281 | Physician and practitioner services (fee schedule) | 50 | $148.97 |
| 19282 | Physician and practitioner services (fee schedule) | 50 | $104.45 |
| 19283 | Physician and practitioner services (fee schedule) | 50 | $163.22 |
| 19284 | Physician and practitioner services (fee schedule) | 50 | $119.21 |
| 19285 | Physician and practitioner services (fee schedule) | 50 | $232.45 |
| 19286 | Physician and practitioner services (fee schedule) | 50 | $188.65 |
| 19287 | Physician and practitioner services (fee schedule) | 50 | $396.34 |
| 19288 | Physician and practitioner services (fee schedule) | 50 | $300.57 |
| 19294 | Physician and practitioner services (fee schedule) | 44 | $130.94 |
| 19296 | Physician and practitioner services (fee schedule) | 46 | $2,680.50 |
| 19297 | Physician and practitioner services (fee schedule) | 47 | $72.13 |
| 19298 | Physician and practitioner services (fee schedule) | 46 | $618.54 |
| 19300 | Physician and practitioner services (fee schedule) | 45 | $407.76 |
| 19301 | Physician and practitioner services (fee schedule) | 49 | $492.40 |
| 19302 | Physician and practitioner services (fee schedule) | 50 | $673.40 |
| 19303 | Physician and practitioner services (fee schedule) | 50 | $712.85 |
| 19305 | Physician and practitioner services (fee schedule) | 50 | $853.56 |
| 19306 | Physician and practitioner services (fee schedule) | 50 | $903.38 |
| 19307 | Physician and practitioner services (fee schedule) | 50 | $876.90 |
| 19316 | Physician and practitioner services (fee schedule) | 46 | $605.83 |
| 19318 | Physician and practitioner services (fee schedule) | 49 | $819.01 |
| 19325 | Physician and practitioner services (fee schedule) | 46 | $485.23 |
| 19328 | Physician and practitioner services (fee schedule) | 49 | $399.27 |
| 19330 | Physician and practitioner services (fee schedule) | 47 | $469.46 |
| 19340 | Physician and practitioner services (fee schedule) | 49 | $565.90 |
| 19342 | Physician and practitioner services (fee schedule) | 49 | $601.56 |
| 19350 | Physician and practitioner services (fee schedule) | 50 | $605.42 |
| 19355 | Physician and practitioner services (fee schedule) | 37 | $519.08 |
| 19357 | Physician and practitioner services (fee schedule) | 49 | $932.25 |
| 19361 | Physician and practitioner services (fee schedule) | 49 | $1,163.94 |
| 19364 | Physician and practitioner services (fee schedule) | 49 | $1,980.50 |
| 19367 | Physician and practitioner services (fee schedule) | 49 | $1,328.15 |
| 19368 | Physician and practitioner services (fee schedule) | 49 | $1,577.16 |
| 19369 | Physician and practitioner services (fee schedule) | 50 | $1,471.56 |
| 19370 | Physician and practitioner services (fee schedule) | 49 | $504.00 |
| 19371 | Physician and practitioner services (fee schedule) | 49 | $551.49 |
| 19380 | Physician and practitioner services (fee schedule) | 49 | $594.76 |
| 19396 | Physician and practitioner services (fee schedule) | 32 | $149.76 |
| 19499 | Physician and practitioner services (fee schedule) | 10 | $226.35 |
| 20100 | Physician and practitioner services (fee schedule) | 49 | $456.80 |
| 20101 | Physician and practitioner services (fee schedule) | 50 | $246.17 |
| 20102 | Physician and practitioner services (fee schedule) | 50 | $274.88 |
| 20103 | Physician and practitioner services (fee schedule) | 49 | $367.69 |
| 20150 | Physician and practitioner services (fee schedule) | 49 | $743.56 |
| 20200 | Physician and practitioner services (fee schedule) | 50 | $110.80 |
| 20205 | Physician and practitioner services (fee schedule) | 50 | $184.36 |
| 20206 | Physician and practitioner services (fee schedule) | 50 | $135.57 |
| 20220 | Physician and practitioner services (fee schedule) | 50 | $123.05 |
| 20225 | Physician and practitioner services (fee schedule) | 50 | $243.13 |
| 20240 | Physician and practitioner services (fee schedule) | 50 | $121.60 |
| 20245 | Physician and practitioner services (fee schedule) | 50 | $272.91 |
| 20250 | Physician and practitioner services (fee schedule) | 50 | $305.56 |
| 20251 | Physician and practitioner services (fee schedule) | 49 | $333.74 |
| 20500 | Physician and practitioner services (fee schedule) | 50 | $91.91 |
| 20501 | Physician and practitioner services (fee schedule) | 50 | $89.44 |
| 20520 | Physician and practitioner services (fee schedule) | 50 | $146.75 |
| 20525 | Physician and practitioner services (fee schedule) | 50 | $273.06 |
| 20526 | Physician and practitioner services (fee schedule) | 48 | $56.84 |
| 20527 | Physician and practitioner services (fee schedule) | 47 | $65.72 |
| 20550 | Physician and practitioner services (fee schedule) | 50 | $41.94 |
| 20551 | Physician and practitioner services (fee schedule) | 50 | $45.18 |
| 20552 | Physician and practitioner services (fee schedule) | 49 | $39.13 |
| 20553 | Physician and practitioner services (fee schedule) | 50 | $45.23 |
| 20555 | Physician and practitioner services (fee schedule) | 49 | $240.79 |
| 20560 | Physician and practitioner services (fee schedule) | 18 | $20.62 |
| 20561 | Physician and practitioner services (fee schedule) | 19 | $26.06 |
| 20600 | Physician and practitioner services (fee schedule) | 50 | $36.55 |
| 20604 | Physician and practitioner services (fee schedule) | 49 | $51.86 |
| 20605 | Physician and practitioner services (fee schedule) | 50 | $38.89 |
| 20606 | Physician and practitioner services (fee schedule) | 49 | $60.07 |
| 20610 | Physician and practitioner services (fee schedule) | 50 | $48.01 |
| 20611 | Physician and practitioner services (fee schedule) | 49 | $66.67 |
| 20612 | Physician and practitioner services (fee schedule) | 48 | $45.98 |
| 20615 | Physician and practitioner services (fee schedule) | 50 | $161.13 |
| 20650 | Physician and practitioner services (fee schedule) | 50 | $159.70 |
| 20660 | Physician and practitioner services (fee schedule) | 50 | $176.24 |
| 20661 | Physician and practitioner services (fee schedule) | 50 | $420.62 |
| 20662 | Physician and practitioner services (fee schedule) | 50 | $396.01 |
| 20663 | Physician and practitioner services (fee schedule) | 50 | $352.72 |
| 20664 | Physician and practitioner services (fee schedule) | 49 | $718.49 |
| 20665 | Physician and practitioner services (fee schedule) | 49 | $90.31 |
| 20670 | Physician and practitioner services (fee schedule) | 50 | $177.31 |
| 20680 | Physician and practitioner services (fee schedule) | 50 | $404.31 |
| 20690 | Physician and practitioner services (fee schedule) | 50 | $434.74 |
| 20692 | Physician and practitioner services (fee schedule) | 50 | $822.77 |
| 20693 | Physician and practitioner services (fee schedule) | 50 | $355.64 |
| 20694 | Physician and practitioner services (fee schedule) | 50 | $315.78 |
| 20696 | Physician and practitioner services (fee schedule) | 45 | $852.92 |
| 20697 | Physician and practitioner services (fee schedule) | 46 | $1,245.36 |
| 20700 | Physician and practitioner services (fee schedule) | 46 | $68.54 |
| 20701 | Physician and practitioner services (fee schedule) | 46 | $51.89 |
| 20702 | Physician and practitioner services (fee schedule) | 45 | $115.97 |
| 20703 | Physician and practitioner services (fee schedule) | 45 | $85.45 |
| 20704 | Physician and practitioner services (fee schedule) | 45 | $122.05 |
| 20705 | Physician and practitioner services (fee schedule) | 45 | $101.25 |
| 20802 | Physician and practitioner services (fee schedule) | 47 | $2,032.83 |
| 20805 | Physician and practitioner services (fee schedule) | 48 | $2,414.03 |
| 20808 | Physician and practitioner services (fee schedule) | 47 | $2,904.06 |
| 20816 | Physician and practitioner services (fee schedule) | 48 | $1,546.08 |
| 20822 | Physician and practitioner services (fee schedule) | 49 | $1,388.31 |
| 20824 | Physician and practitioner services (fee schedule) | 48 | $1,581.57 |
| 20827 | Physician and practitioner services (fee schedule) | 48 | $1,411.22 |
| 20838 | Physician and practitioner services (fee schedule) | 47 | $2,074.59 |
| 20900 | Physician and practitioner services (fee schedule) | 49 | $233.63 |
| 20902 | Physician and practitioner services (fee schedule) | 49 | $245.41 |
| 20910 | Physician and practitioner services (fee schedule) | 50 | $367.80 |
| 20912 | Physician and practitioner services (fee schedule) | 49 | $366.14 |
| 20920 | Physician and practitioner services (fee schedule) | 50 | $294.64 |
| 20922 | Physician and practitioner services (fee schedule) | 49 | $427.18 |
| 20924 | Physician and practitioner services (fee schedule) | 49 | $383.00 |
| 20930 | Physician and practitioner services (fee schedule) | 25 | $125.32 |
| 20931 | Physician and practitioner services (fee schedule) | 48 | $85.70 |
| 20932 | Physician and practitioner services (fee schedule) | 47 | $574.98 |
| 20933 | Physician and practitioner services (fee schedule) | 47 | $527.89 |
| 20934 | Physician and practitioner services (fee schedule) | 47 | $578.61 |
| 20936 | Physician and practitioner services (fee schedule) | 26 | $167.19 |
| 20937 | Physician and practitioner services (fee schedule) | 48 | $128.79 |
| 20938 | Physician and practitioner services (fee schedule) | 48 | $140.88 |
| 20939 | Physician and practitioner services (fee schedule) | 43 | $53.92 |
| 20950 | Physician and practitioner services (fee schedule) | 48 | $114.72 |
| 20955 | Physician and practitioner services (fee schedule) | 49 | $1,934.45 |
| 20956 | Physician and practitioner services (fee schedule) | 50 | $1,934.39 |
| 20957 | Physician and practitioner services (fee schedule) | 50 | $1,977.42 |
| 20962 | Physician and practitioner services (fee schedule) | 47 | $2,103.59 |
| 20969 | Physician and practitioner services (fee schedule) | 49 | $2,065.24 |
| 20970 | Physician and practitioner services (fee schedule) | 48 | $2,140.73 |
| 20972 | Physician and practitioner services (fee schedule) | 47 | $2,157.41 |
| 20973 | Physician and practitioner services (fee schedule) | 46 | $2,250.73 |
| 20974 | Physician and practitioner services (fee schedule) | 46 | $65.92 |
| 20975 | Physician and practitioner services (fee schedule) | 45 | $144.52 |
| 20979 | Physician and practitioner services (fee schedule) | 42 | $36.02 |
| 20982 | Physician and practitioner services (fee schedule) | 49 | $1,990.05 |
| 20983 | Physician and practitioner services (fee schedule) | 42 | $3,012.03 |
| 20985 | Physician and practitioner services (fee schedule) | 42 | $106.85 |
| 20999 | Physician and practitioner services (fee schedule) | 8 | $183.37 |
| 21010 | Physician and practitioner services (fee schedule) | 47 | $563.11 |
| 21011 | Physician and practitioner services (fee schedule) | 50 | $255.06 |
| 21012 | Physician and practitioner services (fee schedule) | 50 | $256.33 |
| 21013 | Physician and practitioner services (fee schedule) | 50 | $362.80 |
| 21014 | Physician and practitioner services (fee schedule) | 50 | $384.79 |
| 21015 | Physician and practitioner services (fee schedule) | 49 | $526.77 |
| 21016 | Physician and practitioner services (fee schedule) | 50 | $737.97 |
| 21025 | Physician and practitioner services (fee schedule) | 50 | $573.54 |
| 21026 | Physician and practitioner services (fee schedule) | 49 | $419.51 |
| 21029 | Physician and practitioner services (fee schedule) | 49 | $571.13 |
| 21030 | Physician and practitioner services (fee schedule) | 50 | $355.35 |
| 21031 | Physician and practitioner services (fee schedule) | 48 | $262.30 |
| 21032 | Physician and practitioner services (fee schedule) | 48 | $266.24 |
| 21034 | Physician and practitioner services (fee schedule) | 49 | $868.35 |
| 21040 | Physician and practitioner services (fee schedule) | 50 | $325.11 |
| 21044 | Physician and practitioner services (fee schedule) | 49 | $651.83 |
| 21045 | Physician and practitioner services (fee schedule) | 49 | $902.06 |
| 21046 | Physician and practitioner services (fee schedule) | 50 | $772.41 |
| 21047 | Physician and practitioner services (fee schedule) | 49 | $909.36 |
| 21048 | Physician and practitioner services (fee schedule) | 49 | $772.54 |
| 21049 | Physician and practitioner services (fee schedule) | 49 | $859.86 |
| 21050 | Physician and practitioner services (fee schedule) | 47 | $687.70 |
| 21060 | Physician and practitioner services (fee schedule) | 47 | $616.66 |
| 21070 | Physician and practitioner services (fee schedule) | 49 | $467.88 |
| 21073 | Physician and practitioner services (fee schedule) | 41 | $269.13 |
| 21076 | Physician and practitioner services (fee schedule) | 43 | $672.30 |
| 21077 | Physician and practitioner services (fee schedule) | 40 | $1,695.34 |
| 21079 | Physician and practitioner services (fee schedule) | 43 | $1,214.14 |
| 21080 | Physician and practitioner services (fee schedule) | 43 | $1,329.58 |
| 21081 | Physician and practitioner services (fee schedule) | 42 | $1,213.01 |
| 21082 | Physician and practitioner services (fee schedule) | 43 | $1,127.76 |
| 21083 | Physician and practitioner services (fee schedule) | 43 | $1,116.22 |
| 21084 | Physician and practitioner services (fee schedule) | 43 | $1,202.31 |
| 21085 | Physician and practitioner services (fee schedule) | 45 | $488.98 |
| 21086 | Physician and practitioner services (fee schedule) | 44 | $1,291.02 |
| 21087 | Physician and practitioner services (fee schedule) | 43 | $1,280.53 |
| 21088 | Physician and practitioner services (fee schedule) | 20 | $1,113.07 |
| 21100 | Physician and practitioner services (fee schedule) | 49 | $376.53 |
| 21110 | Physician and practitioner services (fee schedule) | 48 | $586.00 |
| 21116 | Physician and practitioner services (fee schedule) | 50 | $136.01 |
| 21120 | Physician and practitioner services (fee schedule) | 47 | $494.36 |
| 21121 | Physician and practitioner services (fee schedule) | 48 | $492.69 |
| 21122 | Physician and practitioner services (fee schedule) | 47 | $572.25 |
| 21123 | Physician and practitioner services (fee schedule) | 47 | $671.72 |
| 21125 | Physician and practitioner services (fee schedule) | 48 | $1,158.31 |
| 21127 | Physician and practitioner services (fee schedule) | 49 | $1,568.66 |
| 21137 | Physician and practitioner services (fee schedule) | 42 | $568.28 |
| 21138 | Physician and practitioner services (fee schedule) | 44 | $686.93 |
| 21139 | Physician and practitioner services (fee schedule) | 41 | $834.86 |
| 21141 | Physician and practitioner services (fee schedule) | 50 | $1,017.50 |
| 21142 | Physician and practitioner services (fee schedule) | 50 | $1,043.74 |
| 21143 | Physician and practitioner services (fee schedule) | 50 | $1,082.52 |
| 21145 | Physician and practitioner services (fee schedule) | 50 | $1,164.85 |
| 21146 | Physician and practitioner services (fee schedule) | 50 | $1,228.88 |
| 21147 | Physician and practitioner services (fee schedule) | 49 | $1,282.17 |
| 21150 | Physician and practitioner services (fee schedule) | 47 | $1,254.58 |
| 21151 | Physician and practitioner services (fee schedule) | 47 | $1,415.73 |
| 21154 | Physician and practitioner services (fee schedule) | 48 | $1,501.10 |
| 21155 | Physician and practitioner services (fee schedule) | 48 | $1,633.52 |
| 21159 | Physician and practitioner services (fee schedule) | 48 | $1,944.48 |
| 21160 | Physician and practitioner services (fee schedule) | 47 | $2,109.20 |
| 21172 | Physician and practitioner services (fee schedule) | 49 | $1,605.94 |
| 21175 | Physician and practitioner services (fee schedule) | 50 | $1,658.77 |
| 21179 | Physician and practitioner services (fee schedule) | 48 | $1,150.14 |
| 21180 | Physician and practitioner services (fee schedule) | 48 | $1,282.07 |
| 21181 | Physician and practitioner services (fee schedule) | 48 | $581.85 |
| 21182 | Physician and practitioner services (fee schedule) | 47 | $1,590.04 |
| 21183 | Physician and practitioner services (fee schedule) | 47 | $1,725.80 |
| 21184 | Physician and practitioner services (fee schedule) | 46 | $1,876.00 |
| 21188 | Physician and practitioner services (fee schedule) | 49 | $1,257.55 |
| 21193 | Physician and practitioner services (fee schedule) | 49 | $950.84 |
| 21194 | Physician and practitioner services (fee schedule) | 48 | $1,104.18 |
| 21195 | Physician and practitioner services (fee schedule) | 48 | $1,033.95 |
| 21196 | Physician and practitioner services (fee schedule) | 50 | $1,128.14 |
| 21198 | Physician and practitioner services (fee schedule) | 48 | $810.50 |
| 21199 | Physician and practitioner services (fee schedule) | 46 | $762.19 |
| 21206 | Physician and practitioner services (fee schedule) | 48 | $775.99 |
| 21208 | Physician and practitioner services (fee schedule) | 49 | $847.92 |
| 21209 | Physician and practitioner services (fee schedule) | 47 | $552.40 |
| 21210 | Physician and practitioner services (fee schedule) | 50 | $798.75 |
| 21215 | Physician and practitioner services (fee schedule) | 49 | $813.94 |
| 21230 | Physician and practitioner services (fee schedule) | 49 | $603.40 |
| 21235 | Physician and practitioner services (fee schedule) | 50 | $522.30 |
| 21240 | Physician and practitioner services (fee schedule) | 48 | $819.65 |
| 21242 | Physician and practitioner services (fee schedule) | 47 | $767.30 |
| 21243 | Physician and practitioner services (fee schedule) | 48 | $1,202.06 |
| 21244 | Physician and practitioner services (fee schedule) | 48 | $771.35 |
| 21245 | Physician and practitioner services (fee schedule) | 45 | $862.80 |
| 21246 | Physician and practitioner services (fee schedule) | 45 | $677.57 |
| 21247 | Physician and practitioner services (fee schedule) | 49 | $1,253.62 |
| 21248 | Physician and practitioner services (fee schedule) | 44 | $786.08 |
| 21249 | Physician and practitioner services (fee schedule) | 43 | $1,111.97 |
| 21255 | Physician and practitioner services (fee schedule) | 47 | $1,053.84 |
| 21256 | Physician and practitioner services (fee schedule) | 48 | $972.06 |
| 21260 | Physician and practitioner services (fee schedule) | 48 | $1,033.13 |
| 21261 | Physician and practitioner services (fee schedule) | 46 | $1,715.70 |
| 21263 | Physician and practitioner services (fee schedule) | 48 | $1,680.06 |
| 21267 | Physician and practitioner services (fee schedule) | 48 | $1,209.16 |
| 21268 | Physician and practitioner services (fee schedule) | 47 | $1,475.05 |
| 21270 | Physician and practitioner services (fee schedule) | 48 | $715.28 |
| 21275 | Physician and practitioner services (fee schedule) | 48 | $634.05 |
| 21280 | Physician and practitioner services (fee schedule) | 46 | $427.84 |
| 21282 | Physician and practitioner services (fee schedule) | 47 | $320.02 |
| 21295 | Physician and practitioner services (fee schedule) | 44 | $151.40 |
| 21296 | Physician and practitioner services (fee schedule) | 43 | $296.03 |
| 21299 | Physician and practitioner services (fee schedule) | 7 | $32.17 |
| 21310 | Physician and practitioner services (fee schedule) | 5 | $46.31 |
| 21315 | Physician and practitioner services (fee schedule) | 50 | $108.07 |
| 21320 | Physician and practitioner services (fee schedule) | 50 | $149.20 |
| 21325 | Physician and practitioner services (fee schedule) | 50 | $343.77 |
| 21330 | Physician and practitioner services (fee schedule) | 50 | $413.07 |
| 21335 | Physician and practitioner services (fee schedule) | 50 | $560.78 |
| 21336 | Physician and practitioner services (fee schedule) | 50 | $471.03 |
| 21337 | Physician and practitioner services (fee schedule) | 49 | $276.47 |
| 21338 | Physician and practitioner services (fee schedule) | 50 | $513.77 |
| 21339 | Physician and practitioner services (fee schedule) | 50 | $566.36 |
| 21340 | Physician and practitioner services (fee schedule) | 48 | $577.59 |
| 21343 | Physician and practitioner services (fee schedule) | 50 | $816.70 |
| 21344 | Physician and practitioner services (fee schedule) | 50 | $1,036.00 |
| 21345 | Physician and practitioner services (fee schedule) | 50 | $586.50 |
| 21346 | Physician and practitioner services (fee schedule) | 48 | $743.57 |
| 21347 | Physician and practitioner services (fee schedule) | 50 | $793.05 |
| 21348 | Physician and practitioner services (fee schedule) | 50 | $821.29 |
| 21355 | Physician and practitioner services (fee schedule) | 50 | $301.88 |
| 21356 | Physician and practitioner services (fee schedule) | 49 | $391.62 |
| 21360 | Physician and practitioner services (fee schedule) | 49 | $405.96 |
| 21365 | Physician and practitioner services (fee schedule) | 49 | $833.91 |
| 21366 | Physician and practitioner services (fee schedule) | 49 | $956.82 |
| 21385 | Physician and practitioner services (fee schedule) | 49 | $580.61 |
| 21386 | Physician and practitioner services (fee schedule) | 49 | $552.49 |
| 21387 | Physician and practitioner services (fee schedule) | 50 | $601.79 |
| 21390 | Physician and practitioner services (fee schedule) | 49 | $623.64 |
| 21395 | Physician and practitioner services (fee schedule) | 49 | $763.15 |
| 21400 | Physician and practitioner services (fee schedule) | 49 | $158.84 |
| 21401 | Physician and practitioner services (fee schedule) | 50 | $327.17 |
| 21406 | Physician and practitioner services (fee schedule) | 49 | $445.66 |
| 21407 | Physician and practitioner services (fee schedule) | 49 | $500.29 |
| 21408 | Physician and practitioner services (fee schedule) | 49 | $692.07 |
| 21421 | Physician and practitioner services (fee schedule) | 50 | $458.49 |
| 21422 | Physician and practitioner services (fee schedule) | 50 | $508.77 |
| 21423 | Physician and practitioner services (fee schedule) | 50 | $610.64 |
| 21431 | Physician and practitioner services (fee schedule) | 49 | $526.99 |
| 21432 | Physician and practitioner services (fee schedule) | 49 | $551.12 |
| 21433 | Physician and practitioner services (fee schedule) | 49 | $1,272.47 |
| 21435 | Physician and practitioner services (fee schedule) | 50 | $1,019.08 |
| 21436 | Physician and practitioner services (fee schedule) | 49 | $1,459.99 |
| 21440 | Physician and practitioner services (fee schedule) | 49 | $519.96 |
| 21445 | Physician and practitioner services (fee schedule) | 49 | $527.10 |
| 21450 | Physician and practitioner services (fee schedule) | 48 | $403.93 |
| 21451 | Physician and practitioner services (fee schedule) | 50 | $561.24 |
| 21452 | Physician and practitioner services (fee schedule) | 50 | $477.55 |
| 21453 | Physician and practitioner services (fee schedule) | 50 | $767.23 |
| 21454 | Physician and practitioner services (fee schedule) | 50 | $400.94 |
| 21461 | Physician and practitioner services (fee schedule) | 49 | $1,008.03 |
| 21462 | Physician and practitioner services (fee schedule) | 49 | $1,056.29 |
| 21465 | Physician and practitioner services (fee schedule) | 49 | $637.19 |
| 21470 | Physician and practitioner services (fee schedule) | 49 | $915.21 |
| 21480 | Physician and practitioner services (fee schedule) | 49 | $61.15 |
| 21485 | Physician and practitioner services (fee schedule) | 48 | $626.00 |
| 21490 | Physician and practitioner services (fee schedule) | 47 | $600.34 |
| 21495 | Physician and practitioner services (fee schedule) | 5 | $449.50 |
| 21497 | Physician and practitioner services (fee schedule) | 43 | $486.69 |
| 21499 | Physician and practitioner services (fee schedule) | 9 | $241.98 |
| 21501 | Physician and practitioner services (fee schedule) | 50 | $318.79 |
| 21502 | Physician and practitioner services (fee schedule) | 50 | $398.92 |
| 21510 | Physician and practitioner services (fee schedule) | 50 | $363.03 |
| 21550 | Physician and practitioner services (fee schedule) | 50 | $164.77 |
| 21552 | Physician and practitioner services (fee schedule) | 50 | $335.71 |
| 21554 | Physician and practitioner services (fee schedule) | 50 | $539.46 |
| 21555 | Physician and practitioner services (fee schedule) | 50 | $300.83 |
| 21556 | Physician and practitioner services (fee schedule) | 50 | $384.32 |
| 21557 | Physician and practitioner services (fee schedule) | 49 | $704.05 |
| 21558 | Physician and practitioner services (fee schedule) | 50 | $966.70 |
| 21600 | Physician and practitioner services (fee schedule) | 50 | $443.82 |
| 21601 | Physician and practitioner services (fee schedule) | 50 | $908.68 |
| 21602 | Physician and practitioner services (fee schedule) | 50 | $1,237.68 |
| 21603 | Physician and practitioner services (fee schedule) | 50 | $1,361.20 |
| 21610 | Physician and practitioner services (fee schedule) | 49 | $869.58 |
| 21615 | Physician and practitioner services (fee schedule) | 49 | $487.20 |
| 21616 | Physician and practitioner services (fee schedule) | 49 | $558.96 |
| 21620 | Physician and practitioner services (fee schedule) | 50 | $392.24 |
| 21627 | Physician and practitioner services (fee schedule) | 49 | $436.13 |
| 21630 | Physician and practitioner services (fee schedule) | 49 | $943.30 |
| 21632 | Physician and practitioner services (fee schedule) | 7 | $1,080.78 |
| 21685 | Physician and practitioner services (fee schedule) | 47 | $729.72 |
| 21700 | Physician and practitioner services (fee schedule) | 50 | $289.03 |
| 21705 | Physician and practitioner services (fee schedule) | 50 | $420.46 |
| 21720 | Physician and practitioner services (fee schedule) | 50 | $404.78 |
| 21725 | Physician and practitioner services (fee schedule) | 50 | $409.41 |
| 21740 | Physician and practitioner services (fee schedule) | 50 | $774.39 |
| 21742 | Physician and practitioner services (fee schedule) | 32 | $750.84 |
| 21743 | Physician and practitioner services (fee schedule) | 33 | $859.84 |
| 21750 | Physician and practitioner services (fee schedule) | 50 | $532.06 |
| 21811 | Physician and practitioner services (fee schedule) | 44 | $458.54 |
| 21812 | Physician and practitioner services (fee schedule) | 45 | $549.54 |
| 21813 | Physician and practitioner services (fee schedule) | 45 | $748.85 |
| 21820 | Physician and practitioner services (fee schedule) | 49 | $122.56 |
| 21825 | Physician and practitioner services (fee schedule) | 50 | $431.10 |
| 21899 | Physician and practitioner services (fee schedule) | 8 | $162.93 |
| 21920 | Physician and practitioner services (fee schedule) | 50 | $163.99 |
| 21925 | Physician and practitioner services (fee schedule) | 50 | $354.70 |
| 21930 | Physician and practitioner services (fee schedule) | 50 | $356.50 |
| 21931 | Physician and practitioner services (fee schedule) | 50 | $359.77 |
| 21932 | Physician and practitioner services (fee schedule) | 50 | $494.54 |
| 21933 | Physician and practitioner services (fee schedule) | 50 | $548.92 |
| 21935 | Physician and practitioner services (fee schedule) | 50 | $802.08 |
| 21936 | Physician and practitioner services (fee schedule) | 50 | $1,029.06 |
| 22010 | Physician and practitioner services (fee schedule) | 50 | $739.73 |
| 22015 | Physician and practitioner services (fee schedule) | 50 | $718.09 |
| 22100 | Physician and practitioner services (fee schedule) | 49 | $690.70 |
| 22101 | Physician and practitioner services (fee schedule) | 49 | $647.60 |
| 22102 | Physician and practitioner services (fee schedule) | 49 | $560.44 |
| 22103 | Physician and practitioner services (fee schedule) | 50 | $101.76 |
| 22110 | Physician and practitioner services (fee schedule) | 50 | $764.62 |
| 22112 | Physician and practitioner services (fee schedule) | 50 | $814.40 |
| 22114 | Physician and practitioner services (fee schedule) | 49 | $800.94 |
| 22116 | Physician and practitioner services (fee schedule) | 50 | $108.26 |
| 22206 | Physician and practitioner services (fee schedule) | 49 | $1,759.97 |
| 22207 | Physician and practitioner services (fee schedule) | 49 | $1,722.28 |
| 22208 | Physician and practitioner services (fee schedule) | 49 | $411.01 |
| 22210 | Physician and practitioner services (fee schedule) | 50 | $1,329.39 |
| 22212 | Physician and practitioner services (fee schedule) | 50 | $1,138.81 |
| 22214 | Physician and practitioner services (fee schedule) | 50 | $1,125.87 |
| 22216 | Physician and practitioner services (fee schedule) | 50 | $275.48 |
| 22220 | Physician and practitioner services (fee schedule) | 50 | $1,208.80 |
| 22222 | Physician and practitioner services (fee schedule) | 50 | $1,312.68 |
| 22224 | Physician and practitioner services (fee schedule) | 50 | $1,177.29 |
| 22226 | Physician and practitioner services (fee schedule) | 50 | $277.81 |
| 22310 | Physician and practitioner services (fee schedule) | 50 | $245.65 |
| 22315 | Physician and practitioner services (fee schedule) | 50 | $676.45 |
| 22318 | Physician and practitioner services (fee schedule) | 50 | $1,250.77 |
| 22319 | Physician and practitioner services (fee schedule) | 49 | $1,361.08 |
| 22325 | Physician and practitioner services (fee schedule) | 49 | $1,067.04 |
| 22326 | Physician and practitioner services (fee schedule) | 50 | $1,122.87 |
| 22327 | Physician and practitioner services (fee schedule) | 49 | $1,169.23 |
| 22328 | Physician and practitioner services (fee schedule) | 50 | $216.29 |
| 22505 | Physician and practitioner services (fee schedule) | 49 | $118.95 |
| 22510 | Physician and practitioner services (fee schedule) | 48 | $1,168.66 |
| 22511 | Physician and practitioner services (fee schedule) | 48 | $1,144.26 |
| 22512 | Physician and practitioner services (fee schedule) | 47 | $471.80 |
| 22513 | Physician and practitioner services (fee schedule) | 47 | $3,699.38 |
| 22514 | Physician and practitioner services (fee schedule) | 46 | $3,468.87 |
| 22515 | Physician and practitioner services (fee schedule) | 46 | $1,905.32 |
| 22526 | Physician and practitioner services (fee schedule) | 26 | $1,274.91 |
| 22527 | Physician and practitioner services (fee schedule) | 25 | $1,079.91 |
| 22532 | Physician and practitioner services (fee schedule) | 49 | $1,346.22 |
| 22533 | Physician and practitioner services (fee schedule) | 49 | $1,218.50 |
| 22534 | Physician and practitioner services (fee schedule) | 50 | $271.50 |
| 22548 | Physician and practitioner services (fee schedule) | 49 | $1,492.02 |
| 22551 | Physician and practitioner services (fee schedule) | 50 | $1,286.03 |
| 22552 | Physician and practitioner services (fee schedule) | 50 | $289.67 |
| 22554 | Physician and practitioner services (fee schedule) | 49 | $1,028.01 |
| 22556 | Physician and practitioner services (fee schedule) | 49 | $1,321.35 |
| 22558 | Physician and practitioner services (fee schedule) | 49 | $1,198.47 |
| 22585 | Physician and practitioner services (fee schedule) | 50 | $247.15 |
| 22586 | Physician and practitioner services (fee schedule) | 48 | $1,393.95 |
| 22590 | Physician and practitioner services (fee schedule) | 49 | $1,212.61 |
| 22595 | Physician and practitioner services (fee schedule) | 49 | $1,166.34 |
| 22600 | Physician and practitioner services (fee schedule) | 49 | $1,002.55 |
| 22610 | Physician and practitioner services (fee schedule) | 49 | $1,018.12 |
| 22612 | Physician and practitioner services (fee schedule) | 49 | $1,225.89 |
| 22614 | Physician and practitioner services (fee schedule) | 49 | $302.66 |
| 22630 | Physician and practitioner services (fee schedule) | 49 | $1,174.94 |
| 22632 | Physician and practitioner services (fee schedule) | 48 | $246.16 |
| 22633 | Physician and practitioner services (fee schedule) | 50 | $1,329.22 |
| 22634 | Physician and practitioner services (fee schedule) | 49 | $350.93 |
| 22800 | Physician and practitioner services (fee schedule) | 50 | $1,066.47 |
| 22802 | Physician and practitioner services (fee schedule) | 49 | $1,599.17 |
| 22804 | Physician and practitioner services (fee schedule) | 49 | $1,836.76 |
| 22808 | Physician and practitioner services (fee schedule) | 49 | $1,368.13 |
| 22810 | Physician and practitioner services (fee schedule) | 49 | $1,488.66 |
| 22812 | Physician and practitioner services (fee schedule) | 50 | $1,574.40 |
| 22818 | Physician and practitioner services (fee schedule) | 49 | $1,630.20 |
| 22819 | Physician and practitioner services (fee schedule) | 49 | $1,836.62 |
| 22830 | Physician and practitioner services (fee schedule) | 50 | $650.32 |
| 22836 | Physician and practitioner services (fee schedule) | 32 | $1,433.69 |
| 22837 | Physician and practitioner services (fee schedule) | 31 | $1,444.38 |
| 22838 | Physician and practitioner services (fee schedule) | 31 | $1,463.64 |
| 22840 | Physician and practitioner services (fee schedule) | 49 | $555.14 |
| 22841 | Physician and practitioner services (fee schedule) | 23 | $547.42 |
| 22842 | Physician and practitioner services (fee schedule) | 50 | $570.94 |
| 22843 | Physician and practitioner services (fee schedule) | 49 | $619.81 |
| 22844 | Physician and practitioner services (fee schedule) | 50 | $736.18 |
| 22845 | Physician and practitioner services (fee schedule) | 50 | $555.10 |
| 22846 | Physician and practitioner services (fee schedule) | 50 | $565.12 |
| 22847 | Physician and practitioner services (fee schedule) | 50 | $586.26 |
| 22848 | Physician and practitioner services (fee schedule) | 50 | $277.73 |
| 22849 | Physician and practitioner services (fee schedule) | 50 | $988.16 |
| 22850 | Physician and practitioner services (fee schedule) | 50 | $552.17 |
| 22852 | Physician and practitioner services (fee schedule) | 50 | $542.47 |
| 22853 | Physician and practitioner services (fee schedule) | 50 | $198.76 |
| 22854 | Physician and practitioner services (fee schedule) | 49 | $260.21 |
| 22855 | Physician and practitioner services (fee schedule) | 50 | $813.59 |
| 22856 | Physician and practitioner services (fee schedule) | 48 | $1,193.86 |
| 22857 | Physician and practitioner services (fee schedule) | 41 | $1,201.17 |
| 22858 | Physician and practitioner services (fee schedule) | 44 | $385.88 |
| 22859 | Physician and practitioner services (fee schedule) | 49 | $259.91 |
| 22860 | Physician and practitioner services (fee schedule) | 26 | $301.42 |
| 22861 | Physician and practitioner services (fee schedule) | 41 | $1,582.24 |
| 22862 | Physician and practitioner services (fee schedule) | 32 | $1,673.94 |
| 22864 | Physician and practitioner services (fee schedule) | 44 | $1,491.59 |
| 22865 | Physician and practitioner services (fee schedule) | 37 | $1,563.25 |
| 22867 | Physician and practitioner services (fee schedule) | 36 | $868.37 |
| 22868 | Physician and practitioner services (fee schedule) | 36 | $199.12 |
| 22869 | Physician and practitioner services (fee schedule) | 35 | $384.47 |
| 22870 | Physician and practitioner services (fee schedule) | 34 | $99.13 |
| 22899 | Physician and practitioner services (fee schedule) | 9 | $555.11 |
| 22900 | Physician and practitioner services (fee schedule) | 50 | $393.41 |
| 22901 | Physician and practitioner services (fee schedule) | 50 | $488.75 |
| 22902 | Physician and practitioner services (fee schedule) | 50 | $315.96 |
| 22903 | Physician and practitioner services (fee schedule) | 50 | $334.36 |
| 22904 | Physician and practitioner services (fee schedule) | 49 | $755.94 |
| 22905 | Physician and practitioner services (fee schedule) | 50 | $966.20 |
| 22999 | Physician and practitioner services (fee schedule) | 7 | $246.26 |
| 23000 | Physician and practitioner services (fee schedule) | 50 | $337.54 |
| 23020 | Physician and practitioner services (fee schedule) | 49 | $513.63 |
| 23030 | Physician and practitioner services (fee schedule) | 50 | $264.32 |
| 23031 | Physician and practitioner services (fee schedule) | 49 | $271.35 |
| 23035 | Physician and practitioner services (fee schedule) | 50 | $506.66 |
| 23040 | Physician and practitioner services (fee schedule) | 50 | $542.17 |
| 23044 | Physician and practitioner services (fee schedule) | 50 | $441.78 |
| 23065 | Physician and practitioner services (fee schedule) | 50 | $152.06 |
| 23066 | Physician and practitioner services (fee schedule) | 50 | $375.70 |
| 23071 | Physician and practitioner services (fee schedule) | 49 | $319.27 |
| 23073 | Physician and practitioner services (fee schedule) | 49 | $522.35 |
| 23075 | Physician and practitioner services (fee schedule) | 50 | $334.63 |
| 23076 | Physician and practitioner services (fee schedule) | 50 | $433.27 |
| 23077 | Physician and practitioner services (fee schedule) | 49 | $836.08 |
| 23078 | Physician and practitioner services (fee schedule) | 50 | $1,025.60 |
| 23100 | Physician and practitioner services (fee schedule) | 50 | $388.55 |
| 23101 | Physician and practitioner services (fee schedule) | 50 | $362.05 |
| 23105 | Physician and practitioner services (fee schedule) | 50 | $515.04 |
| 23106 | Physician and practitioner services (fee schedule) | 50 | $408.81 |
| 23107 | Physician and practitioner services (fee schedule) | 49 | $517.40 |
| 23120 | Physician and practitioner services (fee schedule) | 49 | $446.51 |
| 23125 | Physician and practitioner services (fee schedule) | 49 | $538.64 |
| 23130 | Physician and practitioner services (fee schedule) | 49 | $478.43 |
| 23140 | Physician and practitioner services (fee schedule) | 50 | $428.41 |
| 23145 | Physician and practitioner services (fee schedule) | 49 | $518.26 |
| 23146 | Physician and practitioner services (fee schedule) | 50 | $473.00 |
| 23150 | Physician and practitioner services (fee schedule) | 49 | $499.05 |
| 23155 | Physician and practitioner services (fee schedule) | 49 | $590.41 |
| 23156 | Physician and practitioner services (fee schedule) | 50 | $510.00 |
| 23170 | Physician and practitioner services (fee schedule) | 50 | $440.25 |
| 23172 | Physician and practitioner services (fee schedule) | 50 | $433.45 |
| 23174 | Physician and practitioner services (fee schedule) | 49 | $563.70 |
| 23180 | Physician and practitioner services (fee schedule) | 49 | $529.27 |
| 23182 | Physician and practitioner services (fee schedule) | 49 | $505.90 |
| 23184 | Physician and practitioner services (fee schedule) | 49 | $560.43 |
| 23190 | Physician and practitioner services (fee schedule) | 49 | $432.89 |
| 23195 | Physician and practitioner services (fee schedule) | 49 | $561.19 |
| 23200 | Physician and practitioner services (fee schedule) | 49 | $991.62 |
| 23210 | Physician and practitioner services (fee schedule) | 49 | $1,190.79 |
| 23220 | Physician and practitioner services (fee schedule) | 49 | $1,303.50 |
| 23330 | Physician and practitioner services (fee schedule) | 50 | $173.29 |
| 23333 | Physician and practitioner services (fee schedule) | 48 | $374.26 |
| 23334 | Physician and practitioner services (fee schedule) | 49 | $818.78 |
| 23335 | Physician and practitioner services (fee schedule) | 50 | $986.35 |
| 23350 | Physician and practitioner services (fee schedule) | 49 | $103.46 |
| 23395 | Physician and practitioner services (fee schedule) | 48 | $944.84 |
| 23397 | Physician and practitioner services (fee schedule) | 50 | $849.56 |
| 23400 | Physician and practitioner services (fee schedule) | 49 | $721.01 |
| 23405 | Physician and practitioner services (fee schedule) | 50 | $459.20 |
| 23406 | Physician and practitioner services (fee schedule) | 50 | $562.92 |
| 23410 | Physician and practitioner services (fee schedule) | 49 | $643.37 |
| 23412 | Physician and practitioner services (fee schedule) | 49 | $684.66 |
| 23415 | Physician and practitioner services (fee schedule) | 49 | $540.96 |
| 23420 | Physician and practitioner services (fee schedule) | 49 | $747.44 |
| 23430 | Physician and practitioner services (fee schedule) | 49 | $550.79 |
| 23440 | Physician and practitioner services (fee schedule) | 49 | $558.07 |
| 23450 | Physician and practitioner services (fee schedule) | 49 | $710.68 |
| 23455 | Physician and practitioner services (fee schedule) | 49 | $747.89 |
| 23460 | Physician and practitioner services (fee schedule) | 49 | $818.12 |
| 23462 | Physician and practitioner services (fee schedule) | 49 | $809.42 |
| 23465 | Physician and practitioner services (fee schedule) | 49 | $838.57 |
| 23466 | Physician and practitioner services (fee schedule) | 49 | $847.98 |
| 23470 | Physician and practitioner services (fee schedule) | 50 | $898.81 |
| 23472 | Physician and practitioner services (fee schedule) | 49 | $1,081.78 |
| 23473 | Physician and practitioner services (fee schedule) | 50 | $1,213.60 |
| 23474 | Physician and practitioner services (fee schedule) | 50 | $1,315.97 |
| 23480 | Physician and practitioner services (fee schedule) | 50 | $616.44 |
| 23485 | Physician and practitioner services (fee schedule) | 49 | $716.49 |
| 23490 | Physician and practitioner services (fee schedule) | 48 | $646.05 |
| 23491 | Physician and practitioner services (fee schedule) | 48 | $774.15 |
| 23500 | Physician and practitioner services (fee schedule) | 50 | $190.12 |
| 23505 | Physician and practitioner services (fee schedule) | 50 | $281.77 |
| 23515 | Physician and practitioner services (fee schedule) | 50 | $513.86 |
| 23520 | Physician and practitioner services (fee schedule) | 49 | $197.51 |
| 23525 | Physician and practitioner services (fee schedule) | 50 | $302.67 |
| 23530 | Physician and practitioner services (fee schedule) | 50 | $441.80 |
| 23532 | Physician and practitioner services (fee schedule) | 50 | $480.12 |
| 23540 | Physician and practitioner services (fee schedule) | 49 | $195.99 |
| 23545 | Physician and practitioner services (fee schedule) | 50 | $291.47 |
| 23550 | Physician and practitioner services (fee schedule) | 50 | $438.56 |
| 23552 | Physician and practitioner services (fee schedule) | 49 | $492.54 |
| 23570 | Physician and practitioner services (fee schedule) | 50 | $194.83 |
| 23575 | Physician and practitioner services (fee schedule) | 50 | $314.18 |
| 23585 | Physician and practitioner services (fee schedule) | 50 | $675.89 |
| 23600 | Physician and practitioner services (fee schedule) | 50 | $264.55 |
| 23605 | Physician and practitioner services (fee schedule) | 50 | $382.66 |
| 23615 | Physician and practitioner services (fee schedule) | 49 | $644.74 |
| 23616 | Physician and practitioner services (fee schedule) | 49 | $953.93 |
| 23620 | Physician and practitioner services (fee schedule) | 50 | $217.39 |
| 23625 | Physician and practitioner services (fee schedule) | 50 | $312.71 |
| 23630 | Physician and practitioner services (fee schedule) | 50 | $539.91 |
| 23650 | Physician and practitioner services (fee schedule) | 50 | $270.41 |
| 23655 | Physician and practitioner services (fee schedule) | 50 | $320.74 |
| 23660 | Physician and practitioner services (fee schedule) | 50 | $448.21 |
| 23665 | Physician and practitioner services (fee schedule) | 50 | $342.00 |
| 23670 | Physician and practitioner services (fee schedule) | 49 | $635.92 |
| 23675 | Physician and practitioner services (fee schedule) | 50 | $427.85 |
| 23680 | Physician and practitioner services (fee schedule) | 49 | $676.64 |
| 23700 | Physician and practitioner services (fee schedule) | 50 | $154.14 |
| 23800 | Physician and practitioner services (fee schedule) | 48 | $777.05 |
| 23802 | Physician and practitioner services (fee schedule) | 49 | $919.59 |
| 23900 | Physician and practitioner services (fee schedule) | 50 | $997.58 |
| 23920 | Physician and practitioner services (fee schedule) | 49 | $832.27 |
| 23921 | Physician and practitioner services (fee schedule) | 49 | $363.27 |
| 23929 | Physician and practitioner services (fee schedule) | 6 | $191.91 |
| 23930 | Physician and practitioner services (fee schedule) | 49 | $225.67 |
| 23931 | Physician and practitioner services (fee schedule) | 50 | $179.04 |
| 23935 | Physician and practitioner services (fee schedule) | 50 | $411.40 |
| 24000 | Physician and practitioner services (fee schedule) | 50 | $373.78 |
| 24006 | Physician and practitioner services (fee schedule) | 50 | $538.34 |
| 24065 | Physician and practitioner services (fee schedule) | 50 | $167.52 |
| 24066 | Physician and practitioner services (fee schedule) | 50 | $413.66 |
| 24071 | Physician and practitioner services (fee schedule) | 49 | $307.37 |
| 24073 | Physician and practitioner services (fee schedule) | 49 | $519.47 |
| 24075 | Physician and practitioner services (fee schedule) | 50 | $331.56 |
| 24076 | Physician and practitioner services (fee schedule) | 50 | $410.38 |
| 24077 | Physician and practitioner services (fee schedule) | 50 | $765.81 |
| 24079 | Physician and practitioner services (fee schedule) | 49 | $961.42 |
| 24100 | Physician and practitioner services (fee schedule) | 50 | $328.87 |
| 24101 | Physician and practitioner services (fee schedule) | 50 | $400.53 |
| 24102 | Physician and practitioner services (fee schedule) | 50 | $472.69 |
| 24105 | Physician and practitioner services (fee schedule) | 50 | $284.21 |
| 24110 | Physician and practitioner services (fee schedule) | 49 | $478.97 |
| 24115 | Physician and practitioner services (fee schedule) | 49 | $546.60 |
| 24116 | Physician and practitioner services (fee schedule) | 49 | $640.86 |
| 24120 | Physician and practitioner services (fee schedule) | 50 | $420.88 |
| 24125 | Physician and practitioner services (fee schedule) | 49 | $469.11 |
| 24126 | Physician and practitioner services (fee schedule) | 50 | $491.31 |
| 24130 | Physician and practitioner services (fee schedule) | 49 | $410.59 |
| 24134 | Physician and practitioner services (fee schedule) | 49 | $566.55 |
| 24136 | Physician and practitioner services (fee schedule) | 49 | $493.46 |
| 24138 | Physician and practitioner services (fee schedule) | 49 | $521.86 |
| 24140 | Physician and practitioner services (fee schedule) | 49 | $534.29 |
| 24145 | Physician and practitioner services (fee schedule) | 49 | $456.78 |
| 24147 | Physician and practitioner services (fee schedule) | 49 | $484.07 |
| 24149 | Physician and practitioner services (fee schedule) | 49 | $879.25 |
| 24150 | Physician and practitioner services (fee schedule) | 49 | $1,015.53 |
| 24152 | Physician and practitioner services (fee schedule) | 49 | $886.94 |
| 24155 | Physician and practitioner services (fee schedule) | 49 | $635.34 |
| 24160 | Physician and practitioner services (fee schedule) | 50 | $873.34 |
| 24164 | Physician and practitioner services (fee schedule) | 50 | $537.46 |
| 24200 | Physician and practitioner services (fee schedule) | 50 | $147.91 |
| 24201 | Physician and practitioner services (fee schedule) | 50 | $388.91 |
| 24220 | Physician and practitioner services (fee schedule) | 49 | $118.85 |
| 24300 | Physician and practitioner services (fee schedule) | 49 | $354.00 |
| 24301 | Physician and practitioner services (fee schedule) | 49 | $564.24 |
| 24305 | Physician and practitioner services (fee schedule) | 50 | $433.44 |
| 24310 | Physician and practitioner services (fee schedule) | 50 | $354.55 |
| 24320 | Physician and practitioner services (fee schedule) | 49 | $583.17 |
| 24330 | Physician and practitioner services (fee schedule) | 50 | $541.66 |
| 24331 | Physician and practitioner services (fee schedule) | 49 | $590.31 |
| 24332 | Physician and practitioner services (fee schedule) | 50 | $467.76 |
| 24340 | Physician and practitioner services (fee schedule) | 49 | $461.12 |
| 24341 | Physician and practitioner services (fee schedule) | 49 | $550.71 |
| 24342 | Physician and practitioner services (fee schedule) | 49 | $585.77 |
| 24343 | Physician and practitioner services (fee schedule) | 49 | $545.32 |
| 24344 | Physician and practitioner services (fee schedule) | 49 | $824.32 |
| 24345 | Physician and practitioner services (fee schedule) | 48 | $537.74 |
| 24346 | Physician and practitioner services (fee schedule) | 50 | $820.72 |
| 24357 | Physician and practitioner services (fee schedule) | 49 | $321.22 |
| 24358 | Physician and practitioner services (fee schedule) | 49 | $395.92 |
| 24359 | Physician and practitioner services (fee schedule) | 49 | $488.66 |
| 24360 | Physician and practitioner services (fee schedule) | 49 | $691.38 |
| 24361 | Physician and practitioner services (fee schedule) | 49 | $766.79 |
| 24362 | Physician and practitioner services (fee schedule) | 49 | $794.72 |
| 24363 | Physician and practitioner services (fee schedule) | 48 | $1,101.00 |
| 24365 | Physician and practitioner services (fee schedule) | 49 | $477.77 |
| 24366 | Physician and practitioner services (fee schedule) | 49 | $523.91 |
| 24370 | Physician and practitioner services (fee schedule) | 50 | $1,159.67 |
| 24371 | Physician and practitioner services (fee schedule) | 50 | $1,326.77 |
| 24400 | Physician and practitioner services (fee schedule) | 49 | $611.28 |
| 24410 | Physician and practitioner services (fee schedule) | 49 | $775.28 |
| 24420 | Physician and practitioner services (fee schedule) | 49 | $790.38 |
| 24430 | Physician and practitioner services (fee schedule) | 49 | $778.89 |
| 24435 | Physician and practitioner services (fee schedule) | 49 | $813.63 |
| 24470 | Physician and practitioner services (fee schedule) | 49 | $503.88 |
| 24495 | Physician and practitioner services (fee schedule) | 50 | $630.46 |
| 24498 | Physician and practitioner services (fee schedule) | 48 | $651.30 |
| 24500 | Physician and practitioner services (fee schedule) | 50 | $285.73 |
| 24505 | Physician and practitioner services (fee schedule) | 50 | $405.11 |
| 24515 | Physician and practitioner services (fee schedule) | 49 | $649.08 |
| 24516 | Physician and practitioner services (fee schedule) | 49 | $640.85 |
| 24530 | Physician and practitioner services (fee schedule) | 50 | $305.15 |
| 24535 | Physician and practitioner services (fee schedule) | 49 | $500.44 |
| 24538 | Physician and practitioner services (fee schedule) | 49 | $608.85 |
| 24545 | Physician and practitioner services (fee schedule) | 49 | $679.08 |
| 24546 | Physician and practitioner services (fee schedule) | 49 | $775.55 |
| 24560 | Physician and practitioner services (fee schedule) | 49 | $264.50 |
| 24565 | Physician and practitioner services (fee schedule) | 49 | $422.16 |
| 24566 | Physician and practitioner services (fee schedule) | 49 | $545.60 |
| 24575 | Physician and practitioner services (fee schedule) | 49 | $561.54 |
| 24576 | Physician and practitioner services (fee schedule) | 49 | $277.18 |
| 24577 | Physician and practitioner services (fee schedule) | 49 | $437.65 |
| 24579 | Physician and practitioner services (fee schedule) | 49 | $629.08 |
| 24582 | Physician and practitioner services (fee schedule) | 49 | $623.04 |
| 24586 | Physician and practitioner services (fee schedule) | 49 | $819.42 |
| 24587 | Physician and practitioner services (fee schedule) | 49 | $816.85 |
| 24600 | Physician and practitioner services (fee schedule) | 49 | $318.36 |
| 24605 | Physician and practitioner services (fee schedule) | 49 | $378.21 |
| 24615 | Physician and practitioner services (fee schedule) | 49 | $541.55 |
| 24620 | Physician and practitioner services (fee schedule) | 49 | $449.31 |
| 24635 | Physician and practitioner services (fee schedule) | 49 | $545.26 |
| 24640 | Physician and practitioner services (fee schedule) | 49 | $80.82 |
| 24650 | Physician and practitioner services (fee schedule) | 49 | $216.21 |
| 24655 | Physician and practitioner services (fee schedule) | 49 | $358.17 |
| 24665 | Physician and practitioner services (fee schedule) | 49 | $492.28 |
| 24666 | Physician and practitioner services (fee schedule) | 49 | $556.48 |
| 24670 | Physician and practitioner services (fee schedule) | 49 | $234.91 |
| 24675 | Physician and practitioner services (fee schedule) | 49 | $366.90 |
| 24685 | Physician and practitioner services (fee schedule) | 49 | $502.59 |
| 24800 | Physician and practitioner services (fee schedule) | 49 | $630.75 |
| 24802 | Physician and practitioner services (fee schedule) | 49 | $750.35 |
| 24900 | Physician and practitioner services (fee schedule) | 49 | $560.07 |
| 24920 | Physician and practitioner services (fee schedule) | 49 | $552.78 |
| 24925 | Physician and practitioner services (fee schedule) | 49 | $430.65 |
| 24930 | Physician and practitioner services (fee schedule) | 49 | $579.13 |
| 24931 | Physician and practitioner services (fee schedule) | 49 | $676.44 |
| 24935 | Physician and practitioner services (fee schedule) | 48 | $896.15 |
| 24940 | Physician and practitioner services (fee schedule) | 39 | $602.42 |
| 24999 | Physician and practitioner services (fee schedule) | 6 | $89.24 |
| 25000 | Physician and practitioner services (fee schedule) | 49 | $280.12 |
| 25001 | Physician and practitioner services (fee schedule) | 49 | $271.81 |
| 25020 | Physician and practitioner services (fee schedule) | 49 | $561.36 |
| 25023 | Physician and practitioner services (fee schedule) | 49 | $1,000.42 |
| 25024 | Physician and practitioner services (fee schedule) | 49 | $602.37 |
| 25025 | Physician and practitioner services (fee schedule) | 49 | $930.90 |
| 25028 | Physician and practitioner services (fee schedule) | 50 | $528.21 |
| 25031 | Physician and practitioner services (fee schedule) | 49 | $296.07 |
| 25035 | Physician and practitioner services (fee schedule) | 49 | $475.89 |
| 25040 | Physician and practitioner services (fee schedule) | 49 | $444.75 |
| 25065 | Physician and practitioner services (fee schedule) | 48 | $161.19 |
| 25066 | Physician and practitioner services (fee schedule) | 49 | $292.10 |
| 25071 | Physician and practitioner services (fee schedule) | 49 | $319.88 |
| 25073 | Physician and practitioner services (fee schedule) | 49 | $407.66 |
| 25075 | Physician and practitioner services (fee schedule) | 49 | $329.18 |
| 25076 | Physician and practitioner services (fee schedule) | 49 | $407.54 |
| 25077 | Physician and practitioner services (fee schedule) | 49 | $684.32 |
| 25078 | Physician and practitioner services (fee schedule) | 48 | $845.76 |
| 25085 | Physician and practitioner services (fee schedule) | 49 | $349.35 |
| 25100 | Physician and practitioner services (fee schedule) | 49 | $284.84 |
| 25101 | Physician and practitioner services (fee schedule) | 49 | $330.57 |
| 25105 | Physician and practitioner services (fee schedule) | 49 | $382.77 |
| 25107 | Physician and practitioner services (fee schedule) | 49 | $465.92 |
| 25109 | Physician and practitioner services (fee schedule) | 48 | $415.32 |
| 25110 | Physician and practitioner services (fee schedule) | 49 | $284.59 |
| 25111 | Physician and practitioner services (fee schedule) | 48 | $261.73 |
| 25112 | Physician and practitioner services (fee schedule) | 48 | $317.35 |
| 25115 | Physician and practitioner services (fee schedule) | 49 | $609.38 |
| 25116 | Physician and practitioner services (fee schedule) | 49 | $490.94 |
| 25118 | Physician and practitioner services (fee schedule) | 49 | $312.29 |
| 25119 | Physician and practitioner services (fee schedule) | 49 | $394.19 |
| 25120 | Physician and practitioner services (fee schedule) | 49 | $402.09 |
| 25125 | Physician and practitioner services (fee schedule) | 49 | $482.97 |
| 25126 | Physician and practitioner services (fee schedule) | 49 | $470.24 |
| 25130 | Physician and practitioner services (fee schedule) | 49 | $351.25 |
| 25135 | Physician and practitioner services (fee schedule) | 49 | $429.00 |
| 25136 | Physician and practitioner services (fee schedule) | 49 | $382.43 |
| 25145 | Physician and practitioner services (fee schedule) | 49 | $410.22 |
| 25150 | Physician and practitioner services (fee schedule) | 49 | $439.18 |
| 25151 | Physician and practitioner services (fee schedule) | 49 | $449.87 |
| 25170 | Physician and practitioner services (fee schedule) | 49 | $970.13 |
| 25210 | Physician and practitioner services (fee schedule) | 49 | $382.82 |
| 25215 | Physician and practitioner services (fee schedule) | 49 | $473.23 |
| 25230 | Physician and practitioner services (fee schedule) | 48 | $337.62 |
| 25240 | Physician and practitioner services (fee schedule) | 49 | $349.60 |
| 25246 | Physician and practitioner services (fee schedule) | 49 | $119.71 |
| 25248 | Physician and practitioner services (fee schedule) | 49 | $338.04 |
| 25250 | Physician and practitioner services (fee schedule) | 48 | $412.07 |
| 25251 | Physician and practitioner services (fee schedule) | 48 | $543.36 |
| 25259 | Physician and practitioner services (fee schedule) | 47 | $348.99 |
| 25260 | Physician and practitioner services (fee schedule) | 49 | $507.16 |
| 25263 | Physician and practitioner services (fee schedule) | 49 | $492.03 |
| 25265 | Physician and practitioner services (fee schedule) | 48 | $570.53 |
| 25270 | Physician and practitioner services (fee schedule) | 49 | $397.19 |
| 25272 | Physician and practitioner services (fee schedule) | 49 | $443.04 |
| 25274 | Physician and practitioner services (fee schedule) | 49 | $522.36 |
| 25275 | Physician and practitioner services (fee schedule) | 49 | $514.17 |
| 25280 | Physician and practitioner services (fee schedule) | 49 | $439.81 |
| 25290 | Physician and practitioner services (fee schedule) | 49 | $355.98 |
| 25295 | Physician and practitioner services (fee schedule) | 49 | $420.73 |
| 25300 | Physician and practitioner services (fee schedule) | 48 | $528.24 |
| 25301 | Physician and practitioner services (fee schedule) | 49 | $484.91 |
| 25310 | Physician and practitioner services (fee schedule) | 49 | $519.80 |
| 25312 | Physician and practitioner services (fee schedule) | 49 | $545.26 |
| 25315 | Physician and practitioner services (fee schedule) | 49 | $582.49 |
| 25316 | Physician and practitioner services (fee schedule) | 48 | $690.49 |
| 25320 | Physician and practitioner services (fee schedule) | 49 | $721.38 |
| 25332 | Physician and practitioner services (fee schedule) | 49 | $640.05 |
| 25335 | Physician and practitioner services (fee schedule) | 49 | $722.27 |
| 25337 | Physician and practitioner services (fee schedule) | 49 | $702.03 |
| 25350 | Physician and practitioner services (fee schedule) | 49 | $531.61 |
| 25355 | Physician and practitioner services (fee schedule) | 49 | $579.16 |
| 25360 | Physician and practitioner services (fee schedule) | 49 | $500.12 |
| 25365 | Physician and practitioner services (fee schedule) | 49 | $691.82 |
| 25370 | Physician and practitioner services (fee schedule) | 49 | $763.86 |
| 25375 | Physician and practitioner services (fee schedule) | 49 | $718.46 |
| 25390 | Physician and practitioner services (fee schedule) | 49 | $583.17 |
| 25391 | Physician and practitioner services (fee schedule) | 49 | $759.56 |
| 25392 | Physician and practitioner services (fee schedule) | 49 | $776.07 |
| 25393 | Physician and practitioner services (fee schedule) | 49 | $874.68 |
| 25394 | Physician and practitioner services (fee schedule) | 48 | $592.65 |
| 25400 | Physician and practitioner services (fee schedule) | 49 | $625.93 |
| 25405 | Physician and practitioner services (fee schedule) | 49 | $779.78 |
| 25415 | Physician and practitioner services (fee schedule) | 49 | $739.62 |
| 25420 | Physician and practitioner services (fee schedule) | 49 | $884.39 |
| 25425 | Physician and practitioner services (fee schedule) | 49 | $732.87 |
| 25426 | Physician and practitioner services (fee schedule) | 49 | $822.54 |
| 25430 | Physician and practitioner services (fee schedule) | 48 | $566.29 |
| 25431 | Physician and practitioner services (fee schedule) | 48 | $594.37 |
| 25440 | Physician and practitioner services (fee schedule) | 49 | $571.15 |
| 25441 | Physician and practitioner services (fee schedule) | 49 | $697.92 |
| 25442 | Physician and practitioner services (fee schedule) | 49 | $587.19 |
| 25443 | Physician and practitioner services (fee schedule) | 49 | $581.83 |
| 25444 | Physician and practitioner services (fee schedule) | 49 | $627.18 |
| 25445 | Physician and practitioner services (fee schedule) | 49 | $562.28 |
| 25446 | Physician and practitioner services (fee schedule) | 49 | $874.68 |
| 25447 | Physician and practitioner services (fee schedule) | 50 | $597.84 |
| 25448 | Physician and practitioner services (fee schedule) | 41 | $668.92 |
| 25449 | Physician and practitioner services (fee schedule) | 49 | $750.37 |
| 25450 | Physician and practitioner services (fee schedule) | 49 | $484.06 |
| 25455 | Physician and practitioner services (fee schedule) | 49 | $557.60 |
| 25490 | Physician and practitioner services (fee schedule) | 48 | $559.16 |
| 25491 | Physician and practitioner services (fee schedule) | 48 | $581.60 |
| 25492 | Physician and practitioner services (fee schedule) | 48 | $708.59 |
| 25500 | Physician and practitioner services (fee schedule) | 49 | $228.84 |
| 25505 | Physician and practitioner services (fee schedule) | 49 | $405.53 |
| 25515 | Physician and practitioner services (fee schedule) | 49 | $510.66 |
| 25520 | Physician and practitioner services (fee schedule) | 49 | $474.46 |
| 25525 | Physician and practitioner services (fee schedule) | 49 | $638.28 |
| 25526 | Physician and practitioner services (fee schedule) | 49 | $737.46 |
| 25530 | Physician and practitioner services (fee schedule) | 49 | $216.67 |
| 25535 | Physician and practitioner services (fee schedule) | 49 | $392.65 |
| 25545 | Physician and practitioner services (fee schedule) | 49 | $479.78 |
| 25560 | Physician and practitioner services (fee schedule) | 49 | $231.84 |
| 25565 | Physician and practitioner services (fee schedule) | 49 | $429.20 |
| 25574 | Physician and practitioner services (fee schedule) | 49 | $518.63 |
| 25575 | Physician and practitioner services (fee schedule) | 49 | $667.91 |
| 25600 | Physician and practitioner services (fee schedule) | 49 | $266.01 |
| 25605 | Physician and practitioner services (fee schedule) | 49 | $438.98 |
| 25606 | Physician and practitioner services (fee schedule) | 49 | $524.84 |
| 25607 | Physician and practitioner services (fee schedule) | 49 | $564.61 |
| 25608 | Physician and practitioner services (fee schedule) | 49 | $628.87 |
| 25609 | Physician and practitioner services (fee schedule) | 49 | $784.23 |
| 25622 | Physician and practitioner services (fee schedule) | 49 | $251.96 |
| 25624 | Physician and practitioner services (fee schedule) | 49 | $386.57 |
| 25628 | Physician and practitioner services (fee schedule) | 49 | $541.67 |
| 25630 | Physician and practitioner services (fee schedule) | 49 | $250.99 |
| 25635 | Physician and practitioner services (fee schedule) | 49 | $361.29 |
| 25645 | Physician and practitioner services (fee schedule) | 49 | $436.91 |
| 25650 | Physician and practitioner services (fee schedule) | 49 | $270.43 |
| 25651 | Physician and practitioner services (fee schedule) | 48 | $379.75 |
| 25652 | Physician and practitioner services (fee schedule) | 48 | $481.91 |
| 25660 | Physician and practitioner services (fee schedule) | 49 | $346.79 |
| 25670 | Physician and practitioner services (fee schedule) | 49 | $457.71 |
| 25671 | Physician and practitioner services (fee schedule) | 48 | $426.77 |
| 25675 | Physician and practitioner services (fee schedule) | 49 | $374.62 |
| 25676 | Physician and practitioner services (fee schedule) | 49 | $481.38 |
| 25680 | Physician and practitioner services (fee schedule) | 49 | $409.83 |
| 25685 | Physician and practitioner services (fee schedule) | 49 | $557.34 |
| 25690 | Physician and practitioner services (fee schedule) | 49 | $380.78 |
| 25695 | Physician and practitioner services (fee schedule) | 49 | $474.09 |
| 25800 | Physician and practitioner services (fee schedule) | 49 | $556.00 |
| 25805 | Physician and practitioner services (fee schedule) | 49 | $652.78 |
| 25810 | Physician and practitioner services (fee schedule) | 49 | $656.09 |
| 25820 | Physician and practitioner services (fee schedule) | 49 | $501.05 |
| 25825 | Physician and practitioner services (fee schedule) | 49 | $608.24 |
| 25830 | Physician and practitioner services (fee schedule) | 49 | $765.36 |
| 25900 | Physician and practitioner services (fee schedule) | 49 | $551.46 |
| 25905 | Physician and practitioner services (fee schedule) | 49 | $532.12 |
| 25907 | Physician and practitioner services (fee schedule) | 49 | $468.31 |
| 25909 | Physician and practitioner services (fee schedule) | 49 | $520.52 |
| 25915 | Physician and practitioner services (fee schedule) | 48 | $906.35 |
| 25920 | Physician and practitioner services (fee schedule) | 49 | $551.54 |
| 25922 | Physician and practitioner services (fee schedule) | 49 | $479.31 |
| 25924 | Physician and practitioner services (fee schedule) | 49 | $538.11 |
| 25927 | Physician and practitioner services (fee schedule) | 49 | $663.68 |
| 25929 | Physician and practitioner services (fee schedule) | 49 | $451.09 |
| 25931 | Physician and practitioner services (fee schedule) | 49 | $618.35 |
| 25999 | Physician and practitioner services (fee schedule) | 8 | $311.21 |
| 26010 | Physician and practitioner services (fee schedule) | 49 | $178.03 |
| 26011 | Physician and practitioner services (fee schedule) | 49 | $201.93 |
| 26020 | Physician and practitioner services (fee schedule) | 49 | $421.43 |
| 26025 | Physician and practitioner services (fee schedule) | 49 | $340.06 |
| 26030 | Physician and practitioner services (fee schedule) | 49 | $382.14 |
| 26034 | Physician and practitioner services (fee schedule) | 49 | $430.02 |
| 26035 | Physician and practitioner services (fee schedule) | 48 | $655.74 |
| 26037 | Physician and practitioner services (fee schedule) | 49 | $446.81 |
| 26040 | Physician and practitioner services (fee schedule) | 49 | $256.77 |
| 26045 | Physician and practitioner services (fee schedule) | 49 | $384.22 |
| 26055 | Physician and practitioner services (fee schedule) | 49 | $311.81 |
| 26060 | Physician and practitioner services (fee schedule) | 49 | $198.90 |
| 26070 | Physician and practitioner services (fee schedule) | 49 | $255.79 |
| 26075 | Physician and practitioner services (fee schedule) | 49 | $268.96 |
| 26080 | Physician and practitioner services (fee schedule) | 49 | $317.06 |
| 26100 | Physician and practitioner services (fee schedule) | 49 | $275.96 |
| 26105 | Physician and practitioner services (fee schedule) | 49 | $277.23 |
| 26110 | Physician and practitioner services (fee schedule) | 49 | $259.93 |
| 26111 | Physician and practitioner services (fee schedule) | 49 | $317.02 |
| 26113 | Physician and practitioner services (fee schedule) | 49 | $406.16 |
| 26115 | Physician and practitioner services (fee schedule) | 49 | $348.36 |
| 26116 | Physician and practitioner services (fee schedule) | 49 | $403.21 |
| 26117 | Physician and practitioner services (fee schedule) | 49 | $577.07 |
| 26118 | Physician and practitioner services (fee schedule) | 48 | $762.50 |
| 26121 | Physician and practitioner services (fee schedule) | 49 | $487.18 |
| 26123 | Physician and practitioner services (fee schedule) | 49 | $661.85 |
| 26125 | Physician and practitioner services (fee schedule) | 48 | $208.20 |
| 26130 | Physician and practitioner services (fee schedule) | 49 | $374.14 |
| 26135 | Physician and practitioner services (fee schedule) | 49 | $421.61 |
| 26140 | Physician and practitioner services (fee schedule) | 49 | $393.90 |
| 26145 | Physician and practitioner services (fee schedule) | 49 | $412.13 |
| 26160 | Physician and practitioner services (fee schedule) | 49 | $318.32 |
| 26170 | Physician and practitioner services (fee schedule) | 49 | $320.27 |
| 26180 | Physician and practitioner services (fee schedule) | 49 | $351.39 |
| 26185 | Physician and practitioner services (fee schedule) | 49 | $403.70 |
| 26200 | Physician and practitioner services (fee schedule) | 49 | $348.57 |
| 26205 | Physician and practitioner services (fee schedule) | 49 | $472.75 |
| 26210 | Physician and practitioner services (fee schedule) | 49 | $350.09 |
| 26215 | Physician and practitioner services (fee schedule) | 49 | $445.23 |
| 26230 | Physician and practitioner services (fee schedule) | 49 | $387.35 |
| 26235 | Physician and practitioner services (fee schedule) | 49 | $377.52 |
| 26236 | Physician and practitioner services (fee schedule) | 49 | $345.56 |
| 26250 | Physician and practitioner services (fee schedule) | 49 | $774.16 |
| 26260 | Physician and practitioner services (fee schedule) | 49 | $543.87 |
| 26262 | Physician and practitioner services (fee schedule) | 49 | $438.69 |
| 26320 | Physician and practitioner services (fee schedule) | 49 | $275.53 |
| 26340 | Physician and practitioner services (fee schedule) | 46 | $289.24 |
| 26341 | Physician and practitioner services (fee schedule) | 45 | $85.39 |
| 26350 | Physician and practitioner services (fee schedule) | 49 | $591.46 |
| 26352 | Physician and practitioner services (fee schedule) | 49 | $638.20 |
| 26356 | Physician and practitioner services (fee schedule) | 49 | $636.96 |
| 26357 | Physician and practitioner services (fee schedule) | 49 | $681.12 |
| 26358 | Physician and practitioner services (fee schedule) | 49 | $736.51 |
| 26370 | Physician and practitioner services (fee schedule) | 49 | $613.84 |
| 26372 | Physician and practitioner services (fee schedule) | 49 | $698.26 |
| 26373 | Physician and practitioner services (fee schedule) | 49 | $676.96 |
| 26390 | Physician and practitioner services (fee schedule) | 49 | $664.13 |
| 26392 | Physician and practitioner services (fee schedule) | 49 | $768.65 |
| 26410 | Physician and practitioner services (fee schedule) | 49 | $475.11 |
| 26412 | Physician and practitioner services (fee schedule) | 49 | $562.18 |
| 26415 | Physician and practitioner services (fee schedule) | 48 | $660.57 |
| 26416 | Physician and practitioner services (fee schedule) | 48 | $722.68 |
| 26418 | Physician and practitioner services (fee schedule) | 49 | $497.97 |
| 26420 | Physician and practitioner services (fee schedule) | 48 | $580.76 |
| 26426 | Physician and practitioner services (fee schedule) | 49 | $411.04 |
| 26428 | Physician and practitioner services (fee schedule) | 49 | $629.82 |
| 26432 | Physician and practitioner services (fee schedule) | 49 | $434.69 |
| 26433 | Physician and practitioner services (fee schedule) | 49 | $455.06 |
| 26434 | Physician and practitioner services (fee schedule) | 49 | $539.28 |
| 26437 | Physician and practitioner services (fee schedule) | 49 | $523.71 |
| 26440 | Physician and practitioner services (fee schedule) | 49 | $513.20 |
| 26442 | Physician and practitioner services (fee schedule) | 49 | $766.59 |
| 26445 | Physician and practitioner services (fee schedule) | 49 | $480.50 |
| 26449 | Physician and practitioner services (fee schedule) | 49 | $541.29 |
| 26450 | Physician and practitioner services (fee schedule) | 49 | $366.79 |
| 26455 | Physician and practitioner services (fee schedule) | 49 | $364.37 |
| 26460 | Physician and practitioner services (fee schedule) | 49 | $357.71 |
| 26471 | Physician and practitioner services (fee schedule) | 49 | $515.09 |
| 26474 | Physician and practitioner services (fee schedule) | 49 | $512.77 |
| 26476 | Physician and practitioner services (fee schedule) | 49 | $512.93 |
| 26477 | Physician and practitioner services (fee schedule) | 49 | $487.19 |
| 26478 | Physician and practitioner services (fee schedule) | 48 | $520.54 |
| 26479 | Physician and practitioner services (fee schedule) | 49 | $530.08 |
| 26480 | Physician and practitioner services (fee schedule) | 49 | $578.70 |
| 26483 | Physician and practitioner services (fee schedule) | 49 | $675.89 |
| 26485 | Physician and practitioner services (fee schedule) | 49 | $640.53 |
| 26489 | Physician and practitioner services (fee schedule) | 49 | $744.30 |
| 26490 | Physician and practitioner services (fee schedule) | 49 | $653.28 |
| 26492 | Physician and practitioner services (fee schedule) | 49 | $696.13 |
| 26494 | Physician and practitioner services (fee schedule) | 49 | $651.38 |
| 26496 | Physician and practitioner services (fee schedule) | 49 | $699.23 |
| 26497 | Physician and practitioner services (fee schedule) | 49 | $684.24 |
| 26498 | Physician and practitioner services (fee schedule) | 49 | $884.13 |
| 26499 | Physician and practitioner services (fee schedule) | 47 | $661.38 |
| 26500 | Physician and practitioner services (fee schedule) | 49 | $543.42 |
| 26502 | Physician and practitioner services (fee schedule) | 49 | $579.55 |
| 26508 | Physician and practitioner services (fee schedule) | 49 | $513.32 |
| 26510 | Physician and practitioner services (fee schedule) | 48 | $500.10 |
| 26516 | Physician and practitioner services (fee schedule) | 49 | $572.43 |
| 26517 | Physician and practitioner services (fee schedule) | 49 | $657.48 |
| 26518 | Physician and practitioner services (fee schedule) | 49 | $634.75 |
| 26520 | Physician and practitioner services (fee schedule) | 49 | $538.27 |
| 26525 | Physician and practitioner services (fee schedule) | 49 | $540.48 |
| 26530 | Physician and practitioner services (fee schedule) | 49 | $413.97 |
| 26531 | Physician and practitioner services (fee schedule) | 49 | $474.42 |
| 26535 | Physician and practitioner services (fee schedule) | 49 | $355.03 |
| 26536 | Physician and practitioner services (fee schedule) | 49 | $580.21 |
| 26540 | Physician and practitioner services (fee schedule) | 49 | $542.64 |
| 26541 | Physician and practitioner services (fee schedule) | 49 | $634.15 |
| 26542 | Physician and practitioner services (fee schedule) | 48 | $563.81 |
| 26545 | Physician and practitioner services (fee schedule) | 49 | $565.00 |
| 26546 | Physician and practitioner services (fee schedule) | 49 | $787.91 |
| 26548 | Physician and practitioner services (fee schedule) | 49 | $621.60 |
| 26550 | Physician and practitioner services (fee schedule) | 49 | $1,219.54 |
| 26551 | Physician and practitioner services (fee schedule) | 48 | $2,444.85 |
| 26553 | Physician and practitioner services (fee schedule) | 48 | $2,428.27 |
| 26554 | Physician and practitioner services (fee schedule) | 48 | $2,843.49 |
| 26555 | Physician and practitioner services (fee schedule) | 48 | $1,003.36 |
| 26556 | Physician and practitioner services (fee schedule) | 48 | $2,521.84 |
| 26560 | Physician and practitioner services (fee schedule) | 49 | $499.58 |
| 26561 | Physician and practitioner services (fee schedule) | 49 | $747.33 |
| 26562 | Physician and practitioner services (fee schedule) | 49 | $1,018.82 |
| 26565 | Physician and practitioner services (fee schedule) | 49 | $547.33 |
| 26567 | Physician and practitioner services (fee schedule) | 49 | $558.41 |
| 26568 | Physician and practitioner services (fee schedule) | 47 | $720.41 |
| 26580 | Physician and practitioner services (fee schedule) | 46 | $1,156.18 |
| 26587 | Physician and practitioner services (fee schedule) | 48 | $791.30 |
| 26590 | Physician and practitioner services (fee schedule) | 49 | $1,056.88 |
| 26591 | Physician and practitioner services (fee schedule) | 49 | $393.28 |
| 26593 | Physician and practitioner services (fee schedule) | 48 | $505.63 |
| 26596 | Physician and practitioner services (fee schedule) | 48 | $628.71 |
| 26600 | Physician and practitioner services (fee schedule) | 49 | $245.60 |
| 26605 | Physician and practitioner services (fee schedule) | 49 | $264.11 |
| 26607 | Physician and practitioner services (fee schedule) | 49 | $406.36 |
| 26608 | Physician and practitioner services (fee schedule) | 49 | $378.23 |
| 26615 | Physician and practitioner services (fee schedule) | 49 | $434.17 |
| 26641 | Physician and practitioner services (fee schedule) | 49 | $320.62 |
| 26645 | Physician and practitioner services (fee schedule) | 49 | $339.41 |
| 26650 | Physician and practitioner services (fee schedule) | 49 | $382.94 |
| 26665 | Physician and practitioner services (fee schedule) | 49 | $475.26 |
| 26670 | Physician and practitioner services (fee schedule) | 49 | $287.35 |
| 26675 | Physician and practitioner services (fee schedule) | 49 | $354.71 |
| 26676 | Physician and practitioner services (fee schedule) | 49 | $398.66 |
| 26685 | Physician and practitioner services (fee schedule) | 49 | $439.32 |
| 26686 | Physician and practitioner services (fee schedule) | 49 | $478.44 |
| 26700 | Physician and practitioner services (fee schedule) | 49 | $278.10 |
| 26705 | Physician and practitioner services (fee schedule) | 49 | $333.33 |
| 26706 | Physician and practitioner services (fee schedule) | 48 | $341.51 |
| 26715 | Physician and practitioner services (fee schedule) | 49 | $438.55 |
| 26720 | Physician and practitioner services (fee schedule) | 49 | $162.95 |
| 26725 | Physician and practitioner services (fee schedule) | 49 | $270.35 |
| 26727 | Physician and practitioner services (fee schedule) | 49 | $362.77 |
| 26735 | Physician and practitioner services (fee schedule) | 49 | $447.32 |
| 26740 | Physician and practitioner services (fee schedule) | 49 | $191.05 |
| 26742 | Physician and practitioner services (fee schedule) | 49 | $296.11 |
| 26746 | Physician and practitioner services (fee schedule) | 49 | $543.92 |
| 26750 | Physician and practitioner services (fee schedule) | 49 | $158.38 |
| 26755 | Physician and practitioner services (fee schedule) | 49 | $257.69 |
| 26756 | Physician and practitioner services (fee schedule) | 49 | $330.82 |
| 26765 | Physician and practitioner services (fee schedule) | 49 | $385.56 |
| 26770 | Physician and practitioner services (fee schedule) | 49 | $237.00 |
| 26775 | Physician and practitioner services (fee schedule) | 49 | $306.41 |
| 26776 | Physician and practitioner services (fee schedule) | 49 | $349.35 |
| 26785 | Physician and practitioner services (fee schedule) | 49 | $415.57 |
| 26820 | Physician and practitioner services (fee schedule) | 49 | $617.12 |
| 26841 | Physician and practitioner services (fee schedule) | 49 | $595.47 |
| 26842 | Physician and practitioner services (fee schedule) | 49 | $645.02 |
| 26843 | Physician and practitioner services (fee schedule) | 49 | $598.51 |
| 26844 | Physician and practitioner services (fee schedule) | 49 | $627.54 |
| 26850 | Physician and practitioner services (fee schedule) | 49 | $563.90 |
| 26852 | Physician and practitioner services (fee schedule) | 49 | $618.51 |
| 26860 | Physician and practitioner services (fee schedule) | 49 | $483.19 |
| 26861 | Physician and practitioner services (fee schedule) | 49 | $81.53 |
| 26862 | Physician and practitioner services (fee schedule) | 49 | $567.56 |
| 26863 | Physician and practitioner services (fee schedule) | 49 | $166.09 |
| 26910 | Physician and practitioner services (fee schedule) | 49 | $592.80 |
| 26951 | Physician and practitioner services (fee schedule) | 49 | $549.67 |
| 26952 | Physician and practitioner services (fee schedule) | 49 | $535.13 |
| 26989 | Physician and practitioner services (fee schedule) | 8 | $105.27 |
| 26990 | Physician and practitioner services (fee schedule) | 49 | $521.38 |
| 26991 | Physician and practitioner services (fee schedule) | 49 | $476.41 |
| 26992 | Physician and practitioner services (fee schedule) | 49 | $760.52 |
| 27000 | Physician and practitioner services (fee schedule) | 49 | $302.09 |
| 27001 | Physician and practitioner services (fee schedule) | 49 | $399.79 |
| 27003 | Physician and practitioner services (fee schedule) | 49 | $456.70 |
| 27005 | Physician and practitioner services (fee schedule) | 49 | $532.52 |
| 27006 | Physician and practitioner services (fee schedule) | 49 | $537.85 |
| 27025 | Physician and practitioner services (fee schedule) | 49 | $691.83 |
| 27027 | Physician and practitioner services (fee schedule) | 49 | $670.13 |
| 27030 | Physician and practitioner services (fee schedule) | 49 | $702.96 |
| 27033 | Physician and practitioner services (fee schedule) | 49 | $716.19 |
| 27035 | Physician and practitioner services (fee schedule) | 48 | $834.95 |
| 27036 | Physician and practitioner services (fee schedule) | 49 | $757.39 |
| 27040 | Physician and practitioner services (fee schedule) | 49 | $202.02 |
| 27041 | Physician and practitioner services (fee schedule) | 49 | $526.85 |
| 27043 | Physician and practitioner services (fee schedule) | 49 | $373.73 |
| 27045 | Physician and practitioner services (fee schedule) | 49 | $549.76 |
| 27047 | Physician and practitioner services (fee schedule) | 49 | $367.95 |
| 27048 | Physician and practitioner services (fee schedule) | 49 | $423.58 |
| 27049 | Physician and practitioner services (fee schedule) | 49 | $938.42 |
| 27050 | Physician and practitioner services (fee schedule) | 49 | $324.81 |
| 27052 | Physician and practitioner services (fee schedule) | 49 | $441.47 |
| 27054 | Physician and practitioner services (fee schedule) | 49 | $537.37 |
| 27057 | Physician and practitioner services (fee schedule) | 49 | $748.34 |
| 27059 | Physician and practitioner services (fee schedule) | 49 | $1,292.23 |
| 27060 | Physician and practitioner services (fee schedule) | 49 | $356.68 |
| 27062 | Physician and practitioner services (fee schedule) | 49 | $351.13 |
| 27065 | Physician and practitioner services (fee schedule) | 49 | $407.54 |
| 27066 | Physician and practitioner services (fee schedule) | 49 | $611.10 |
| 27067 | Physician and practitioner services (fee schedule) | 49 | $754.70 |
| 27070 | Physician and practitioner services (fee schedule) | 49 | $642.41 |
| 27071 | Physician and practitioner services (fee schedule) | 49 | $723.25 |
| 27075 | Physician and practitioner services (fee schedule) | 49 | $1,445.36 |
| 27076 | Physician and practitioner services (fee schedule) | 49 | $1,584.30 |
| 27077 | Physician and practitioner services (fee schedule) | 49 | $1,894.03 |
| 27078 | Physician and practitioner services (fee schedule) | 49 | $1,340.78 |
| 27080 | Physician and practitioner services (fee schedule) | 48 | $390.55 |
| 27086 | Physician and practitioner services (fee schedule) | 49 | $176.22 |
| 27087 | Physician and practitioner services (fee schedule) | 49 | $468.38 |
| 27090 | Physician and practitioner services (fee schedule) | 49 | $610.12 |
| 27091 | Physician and practitioner services (fee schedule) | 49 | $1,184.90 |
| 27093 | Physician and practitioner services (fee schedule) | 49 | $146.96 |
| 27095 | Physician and practitioner services (fee schedule) | 49 | $197.90 |
| 27096 | Physician and practitioner services (fee schedule) | 49 | $136.20 |
| 27097 | Physician and practitioner services (fee schedule) | 49 | $507.98 |
| 27098 | Physician and practitioner services (fee schedule) | 49 | $519.12 |
| 27100 | Physician and practitioner services (fee schedule) | 49 | $605.27 |
| 27105 | Physician and practitioner services (fee schedule) | 48 | $636.42 |
| 27110 | Physician and practitioner services (fee schedule) | 49 | $702.09 |
| 27111 | Physician and practitioner services (fee schedule) | 49 | $673.44 |
| 27120 | Physician and practitioner services (fee schedule) | 49 | $953.60 |
| 27122 | Physician and practitioner services (fee schedule) | 49 | $856.19 |
| 27125 | Physician and practitioner services (fee schedule) | 49 | $880.34 |
| 27130 | Physician and practitioner services (fee schedule) | 49 | $1,021.01 |
| 27132 | Physician and practitioner services (fee schedule) | 48 | $1,291.77 |
| 27134 | Physician and practitioner services (fee schedule) | 49 | $1,445.44 |
| 27137 | Physician and practitioner services (fee schedule) | 49 | $1,122.15 |
| 27138 | Physician and practitioner services (fee schedule) | 48 | $1,159.51 |
| 27140 | Physician and practitioner services (fee schedule) | 49 | $669.29 |
| 27146 | Physician and practitioner services (fee schedule) | 49 | $935.53 |
| 27147 | Physician and practitioner services (fee schedule) | 49 | $1,071.24 |
| 27151 | Physician and practitioner services (fee schedule) | 49 | $1,153.18 |
| 27156 | Physician and practitioner services (fee schedule) | 49 | $1,234.74 |
| 27158 | Physician and practitioner services (fee schedule) | 49 | $1,012.99 |
| 27161 | Physician and practitioner services (fee schedule) | 49 | $891.45 |
| 27165 | Physician and practitioner services (fee schedule) | 49 | $1,009.60 |
| 27170 | Physician and practitioner services (fee schedule) | 49 | $874.77 |
| 27175 | Physician and practitioner services (fee schedule) | 49 | $498.84 |
| 27176 | Physician and practitioner services (fee schedule) | 49 | $675.52 |
| 27177 | Physician and practitioner services (fee schedule) | 49 | $822.96 |
| 27178 | Physician and practitioner services (fee schedule) | 49 | $688.44 |
| 27179 | Physician and practitioner services (fee schedule) | 49 | $725.25 |
| 27181 | Physician and practitioner services (fee schedule) | 49 | $839.86 |
| 27185 | Physician and practitioner services (fee schedule) | 49 | $544.78 |
| 27187 | Physician and practitioner services (fee schedule) | 48 | $779.25 |
| 27197 | Physician and practitioner services (fee schedule) | 49 | $102.75 |
| 27198 | Physician and practitioner services (fee schedule) | 49 | $246.24 |
| 27200 | Physician and practitioner services (fee schedule) | 48 | $155.37 |
| 27202 | Physician and practitioner services (fee schedule) | 48 | $415.17 |
| 27215 | Physician and practitioner services (fee schedule) | 48 | $491.91 |
| 27216 | Physician and practitioner services (fee schedule) | 47 | $675.67 |
| 27217 | Physician and practitioner services (fee schedule) | 48 | $663.30 |
| 27218 | Physician and practitioner services (fee schedule) | 48 | $888.60 |
| 27220 | Physician and practitioner services (fee schedule) | 49 | $357.02 |
| 27222 | Physician and practitioner services (fee schedule) | 49 | $736.01 |
| 27226 | Physician and practitioner services (fee schedule) | 49 | $822.16 |
| 27227 | Physician and practitioner services (fee schedule) | 49 | $1,225.97 |
| 27228 | Physician and practitioner services (fee schedule) | 49 | $1,403.38 |
| 27230 | Physician and practitioner services (fee schedule) | 49 | $396.15 |
| 27232 | Physician and practitioner services (fee schedule) | 49 | $578.46 |
| 27235 | Physician and practitioner services (fee schedule) | 49 | $703.76 |
| 27236 | Physician and practitioner services (fee schedule) | 49 | $920.45 |
| 27238 | Physician and practitioner services (fee schedule) | 49 | $371.11 |
| 27240 | Physician and practitioner services (fee schedule) | 49 | $741.74 |
| 27244 | Physician and practitioner services (fee schedule) | 49 | $915.73 |
| 27245 | Physician and practitioner services (fee schedule) | 49 | $950.84 |
| 27246 | Physician and practitioner services (fee schedule) | 49 | $321.84 |
| 27248 | Physician and practitioner services (fee schedule) | 49 | $582.50 |
| 27250 | Physician and practitioner services (fee schedule) | 49 | $155.24 |
| 27252 | Physician and practitioner services (fee schedule) | 49 | $566.68 |
| 27253 | Physician and practitioner services (fee schedule) | 49 | $706.21 |
| 27254 | Physician and practitioner services (fee schedule) | 49 | $925.34 |
| 27256 | Physician and practitioner services (fee schedule) | 49 | $256.84 |
| 27257 | Physician and practitioner services (fee schedule) | 49 | $283.09 |
| 27258 | Physician and practitioner services (fee schedule) | 49 | $833.16 |
| 27259 | Physician and practitioner services (fee schedule) | 49 | $1,148.63 |
| 27265 | Physician and practitioner services (fee schedule) | 48 | $345.90 |
| 27266 | Physician and practitioner services (fee schedule) | 49 | $458.01 |
| 27267 | Physician and practitioner services (fee schedule) | 49 | $340.68 |
| 27268 | Physician and practitioner services (fee schedule) | 49 | $407.51 |
| 27269 | Physician and practitioner services (fee schedule) | 49 | $895.60 |
| 27275 | Physician and practitioner services (fee schedule) | 49 | $148.82 |
| 27278 | Physician and practitioner services (fee schedule) | 39 | $7,718.99 |
| 27279 | Physician and practitioner services (fee schedule) | 47 | $588.92 |
| 27280 | Physician and practitioner services (fee schedule) | 49 | $987.42 |
| 27282 | Physician and practitioner services (fee schedule) | 49 | $646.10 |
| 27284 | Physician and practitioner services (fee schedule) | 49 | $1,082.94 |
| 27286 | Physician and practitioner services (fee schedule) | 49 | $1,131.68 |
| 27290 | Physician and practitioner services (fee schedule) | 49 | $1,217.86 |
| 27295 | Physician and practitioner services (fee schedule) | 49 | $953.35 |
| 27299 | Physician and practitioner services (fee schedule) | 9 | $530.14 |
| 27301 | Physician and practitioner services (fee schedule) | 49 | $482.07 |
| 27303 | Physician and practitioner services (fee schedule) | 49 | $483.26 |
| 27305 | Physician and practitioner services (fee schedule) | 49 | $366.84 |
| 27306 | Physician and practitioner services (fee schedule) | 49 | $272.78 |
| 27307 | Physician and practitioner services (fee schedule) | 49 | $320.53 |
| 27310 | Physician and practitioner services (fee schedule) | 49 | $544.88 |
| 27323 | Physician and practitioner services (fee schedule) | 49 | $177.41 |
| 27324 | Physician and practitioner services (fee schedule) | 49 | $317.99 |
| 27325 | Physician and practitioner services (fee schedule) | 48 | $419.96 |
| 27326 | Physician and practitioner services (fee schedule) | 49 | $398.31 |
| 27327 | Physician and practitioner services (fee schedule) | 49 | $322.87 |
| 27328 | Physician and practitioner services (fee schedule) | 49 | $463.78 |
| 27329 | Physician and practitioner services (fee schedule) | 49 | $762.76 |
| 27330 | Physician and practitioner services (fee schedule) | 49 | $344.32 |
| 27331 | Physician and practitioner services (fee schedule) | 49 | $372.24 |
| 27332 | Physician and practitioner services (fee schedule) | 49 | $501.67 |
| 27333 | Physician and practitioner services (fee schedule) | 49 | $456.35 |
| 27334 | Physician and practitioner services (fee schedule) | 49 | $530.50 |
| 27335 | Physician and practitioner services (fee schedule) | 49 | $591.99 |
| 27337 | Physician and practitioner services (fee schedule) | 49 | $319.80 |
| 27339 | Physician and practitioner services (fee schedule) | 49 | $560.44 |
| 27340 | Physician and practitioner services (fee schedule) | 49 | $300.88 |
| 27345 | Physician and practitioner services (fee schedule) | 49 | $372.10 |
| 27347 | Physician and practitioner services (fee schedule) | 49 | $401.68 |
| 27350 | Physician and practitioner services (fee schedule) | 49 | $500.80 |
| 27355 | Physician and practitioner services (fee schedule) | 49 | $463.29 |
| 27356 | Physician and practitioner services (fee schedule) | 49 | $561.14 |
| 27357 | Physician and practitioner services (fee schedule) | 49 | $604.64 |
| 27358 | Physician and practitioner services (fee schedule) | 49 | $220.32 |
| 27360 | Physician and practitioner services (fee schedule) | 49 | $676.09 |
| 27364 | Physician and practitioner services (fee schedule) | 49 | $1,143.19 |
| 27365 | Physician and practitioner services (fee schedule) | 49 | $1,384.07 |
| 27369 | Physician and practitioner services (fee schedule) | 49 | $118.58 |
| 27372 | Physician and practitioner services (fee schedule) | 49 | $403.30 |
| 27380 | Physician and practitioner services (fee schedule) | 49 | $478.76 |
| 27381 | Physician and practitioner services (fee schedule) | 49 | $626.11 |
| 27385 | Physician and practitioner services (fee schedule) | 49 | $479.53 |
| 27386 | Physician and practitioner services (fee schedule) | 49 | $652.32 |
| 27390 | Physician and practitioner services (fee schedule) | 49 | $344.79 |
| 27391 | Physician and practitioner services (fee schedule) | 49 | $446.02 |
| 27392 | Physician and practitioner services (fee schedule) | 49 | $538.76 |
| 27393 | Physician and practitioner services (fee schedule) | 49 | $373.46 |
| 27394 | Physician and practitioner services (fee schedule) | 49 | $497.08 |
| 27395 | Physician and practitioner services (fee schedule) | 49 | $648.43 |
| 27396 | Physician and practitioner services (fee schedule) | 49 | $470.91 |
| 27397 | Physician and practitioner services (fee schedule) | 49 | $675.43 |
| 27400 | Physician and practitioner services (fee schedule) | 49 | $519.81 |
| 27403 | Physician and practitioner services (fee schedule) | 49 | $499.63 |
| 27405 | Physician and practitioner services (fee schedule) | 49 | $514.81 |
| 27407 | Physician and practitioner services (fee schedule) | 49 | $590.11 |
| 27409 | Physician and practitioner services (fee schedule) | 49 | $728.34 |
| 27412 | Physician and practitioner services (fee schedule) | 42 | $1,230.94 |
| 27415 | Physician and practitioner services (fee schedule) | 45 | $1,027.64 |
| 27416 | Physician and practitioner services (fee schedule) | 47 | $733.15 |
| 27418 | Physician and practitioner services (fee schedule) | 49 | $648.94 |
| 27420 | Physician and practitioner services (fee schedule) | 49 | $580.35 |
| 27422 | Physician and practitioner services (fee schedule) | 49 | $587.79 |
| 27424 | Physician and practitioner services (fee schedule) | 49 | $589.88 |
| 27425 | Physician and practitioner services (fee schedule) | 49 | $361.11 |
| 27427 | Physician and practitioner services (fee schedule) | 49 | $546.55 |
| 27428 | Physician and practitioner services (fee schedule) | 49 | $836.40 |
| 27429 | Physician and practitioner services (fee schedule) | 48 | $917.85 |
| 27430 | Physician and practitioner services (fee schedule) | 49 | $562.27 |
| 27435 | Physician and practitioner services (fee schedule) | 49 | $591.50 |
| 27437 | Physician and practitioner services (fee schedule) | 48 | $523.28 |
| 27438 | Physician and practitioner services (fee schedule) | 48 | $653.72 |
| 27440 | Physician and practitioner services (fee schedule) | 49 | $602.90 |
| 27441 | Physician and practitioner services (fee schedule) | 49 | $617.64 |
| 27442 | Physician and practitioner services (fee schedule) | 49 | $664.88 |
| 27443 | Physician and practitioner services (fee schedule) | 49 | $646.31 |
| 27445 | Physician and practitioner services (fee schedule) | 12 | $976.32 |
| 27446 | Physician and practitioner services (fee schedule) | 49 | $890.72 |
| 27447 | Physician and practitioner services (fee schedule) | 49 | $1,019.96 |
| 27448 | Physician and practitioner services (fee schedule) | 49 | $624.89 |
| 27450 | Physician and practitioner services (fee schedule) | 49 | $768.29 |
| 27454 | Physician and practitioner services (fee schedule) | 49 | $949.60 |
| 27455 | Physician and practitioner services (fee schedule) | 49 | $721.93 |
| 27457 | Physician and practitioner services (fee schedule) | 49 | $728.49 |
| 27458 | Physician and practitioner services (fee schedule) | 31 | $1,369.86 |
| 27465 | Physician and practitioner services (fee schedule) | 49 | $932.34 |
| 27466 | Physician and practitioner services (fee schedule) | 49 | $980.05 |
| 27468 | Physician and practitioner services (fee schedule) | 13 | $1,085.58 |
| 27470 | Physician and practitioner services (fee schedule) | 49 | $884.84 |
| 27472 | Physician and practitioner services (fee schedule) | 49 | $945.79 |
| 27475 | Physician and practitioner services (fee schedule) | 49 | $531.46 |
| 27477 | Physician and practitioner services (fee schedule) | 49 | $591.29 |
| 27479 | Physician and practitioner services (fee schedule) | 49 | $702.05 |
| 27485 | Physician and practitioner services (fee schedule) | 49 | $536.70 |
| 27486 | Physician and practitioner services (fee schedule) | 49 | $1,047.31 |
| 27487 | Physician and practitioner services (fee schedule) | 49 | $1,340.91 |
| 27488 | Physician and practitioner services (fee schedule) | 49 | $905.32 |
| 27495 | Physician and practitioner services (fee schedule) | 47 | $886.41 |
| 27496 | Physician and practitioner services (fee schedule) | 49 | $423.54 |
| 27497 | Physician and practitioner services (fee schedule) | 49 | $453.39 |
| 27498 | Physician and practitioner services (fee schedule) | 49 | $501.32 |
| 27499 | Physician and practitioner services (fee schedule) | 48 | $528.32 |
| 27500 | Physician and practitioner services (fee schedule) | 49 | $425.31 |
| 27501 | Physician and practitioner services (fee schedule) | 49 | $415.33 |
| 27502 | Physician and practitioner services (fee schedule) | 49 | $605.66 |
| 27503 | Physician and practitioner services (fee schedule) | 49 | $630.06 |
| 27506 | Physician and practitioner services (fee schedule) | 49 | $979.98 |
| 27507 | Physician and practitioner services (fee schedule) | 49 | $751.31 |
| 27508 | Physician and practitioner services (fee schedule) | 49 | $428.27 |
| 27509 | Physician and practitioner services (fee schedule) | 49 | $530.11 |
| 27510 | Physician and practitioner services (fee schedule) | 49 | $540.21 |
| 27511 | Physician and practitioner services (fee schedule) | 49 | $766.60 |
| 27513 | Physician and practitioner services (fee schedule) | 49 | $950.76 |
| 27514 | Physician and practitioner services (fee schedule) | 49 | $758.10 |
| 27516 | Physician and practitioner services (fee schedule) | 48 | $424.89 |
| 27517 | Physician and practitioner services (fee schedule) | 48 | $542.82 |
| 27519 | Physician and practitioner services (fee schedule) | 49 | $702.55 |
| 27520 | Physician and practitioner services (fee schedule) | 49 | $266.46 |
| 27524 | Physician and practitioner services (fee schedule) | 49 | $580.88 |
| 27530 | Physician and practitioner services (fee schedule) | 49 | $265.29 |
| 27532 | Physician and practitioner services (fee schedule) | 49 | $482.66 |
| 27535 | Physician and practitioner services (fee schedule) | 49 | $673.76 |
| 27536 | Physician and practitioner services (fee schedule) | 49 | $873.79 |
| 27538 | Physician and practitioner services (fee schedule) | 49 | $390.43 |
| 27540 | Physician and practitioner services (fee schedule) | 49 | $652.02 |
| 27550 | Physician and practitioner services (fee schedule) | 49 | $413.50 |
| 27552 | Physician and practitioner services (fee schedule) | 49 | $478.80 |
| 27556 | Physician and practitioner services (fee schedule) | 49 | $677.67 |
| 27557 | Physician and practitioner services (fee schedule) | 49 | $811.87 |
| 27558 | Physician and practitioner services (fee schedule) | 49 | $909.08 |
| 27560 | Physician and practitioner services (fee schedule) | 49 | $306.68 |
| 27562 | Physician and practitioner services (fee schedule) | 49 | $376.69 |
| 27566 | Physician and practitioner services (fee schedule) | 49 | $661.22 |
| 27570 | Physician and practitioner services (fee schedule) | 49 | $124.24 |
| 27580 | Physician and practitioner services (fee schedule) | 49 | $1,106.20 |
| 27590 | Physician and practitioner services (fee schedule) | 49 | $613.07 |
| 27591 | Physician and practitioner services (fee schedule) | 48 | $711.98 |
| 27592 | Physician and practitioner services (fee schedule) | 49 | $519.92 |
| 27594 | Physician and practitioner services (fee schedule) | 49 | $381.93 |
| 27596 | Physician and practitioner services (fee schedule) | 49 | $547.76 |
| 27598 | Physician and practitioner services (fee schedule) | 49 | $536.00 |
| 27599 | Physician and practitioner services (fee schedule) | 9 | $437.46 |
| 27600 | Physician and practitioner services (fee schedule) | 49 | $310.85 |
| 27601 | Physician and practitioner services (fee schedule) | 49 | $354.61 |
| 27602 | Physician and practitioner services (fee schedule) | 49 | $368.92 |
| 27603 | Physician and practitioner services (fee schedule) | 50 | $369.22 |
| 27604 | Physician and practitioner services (fee schedule) | 49 | $324.22 |
| 27605 | Physician and practitioner services (fee schedule) | 50 | $198.27 |
| 27606 | Physician and practitioner services (fee schedule) | 50 | $218.51 |
| 27607 | Physician and practitioner services (fee schedule) | 50 | $462.99 |
| 27610 | Physician and practitioner services (fee schedule) | 50 | $503.85 |
| 27612 | Physician and practitioner services (fee schedule) | 49 | $441.50 |
| 27613 | Physician and practitioner services (fee schedule) | 50 | $168.96 |
| 27614 | Physician and practitioner services (fee schedule) | 50 | $401.43 |
| 27615 | Physician and practitioner services (fee schedule) | 49 | $791.48 |
| 27616 | Physician and practitioner services (fee schedule) | 49 | $962.35 |
| 27618 | Physician and practitioner services (fee schedule) | 50 | $327.19 |
| 27619 | Physician and practitioner services (fee schedule) | 50 | $377.04 |
| 27620 | Physician and practitioner services (fee schedule) | 50 | $359.01 |
| 27625 | Physician and practitioner services (fee schedule) | 50 | $462.71 |
| 27626 | Physician and practitioner services (fee schedule) | 49 | $488.72 |
| 27630 | Physician and practitioner services (fee schedule) | 50 | $367.15 |
| 27632 | Physician and practitioner services (fee schedule) | 49 | $316.04 |
| 27634 | Physician and practitioner services (fee schedule) | 49 | $517.46 |
| 27635 | Physician and practitioner services (fee schedule) | 50 | $461.78 |
| 27637 | Physician and practitioner services (fee schedule) | 49 | $571.71 |
| 27638 | Physician and practitioner services (fee schedule) | 49 | $574.61 |
| 27640 | Physician and practitioner services (fee schedule) | 49 | $642.37 |
| 27641 | Physician and practitioner services (fee schedule) | 49 | $519.04 |
| 27645 | Physician and practitioner services (fee schedule) | 49 | $1,190.79 |
| 27646 | Physician and practitioner services (fee schedule) | 49 | $1,009.92 |
| 27647 | Physician and practitioner services (fee schedule) | 49 | $731.89 |
| 27648 | Physician and practitioner services (fee schedule) | 49 | $145.48 |
| 27650 | Physician and practitioner services (fee schedule) | 49 | $510.09 |
| 27652 | Physician and practitioner services (fee schedule) | 49 | $543.16 |
| 27654 | Physician and practitioner services (fee schedule) | 49 | $564.46 |
| 27656 | Physician and practitioner services (fee schedule) | 49 | $332.49 |
| 27658 | Physician and practitioner services (fee schedule) | 49 | $285.53 |
| 27659 | Physician and practitioner services (fee schedule) | 49 | $369.95 |
| 27664 | Physician and practitioner services (fee schedule) | 49 | $281.54 |
| 27665 | Physician and practitioner services (fee schedule) | 48 | $317.47 |
| 27675 | Physician and practitioner services (fee schedule) | 49 | $382.45 |
| 27676 | Physician and practitioner services (fee schedule) | 49 | $461.41 |
| 27680 | Physician and practitioner services (fee schedule) | 49 | $337.84 |
| 27681 | Physician and practitioner services (fee schedule) | 49 | $403.86 |
| 27685 | Physician and practitioner services (fee schedule) | 49 | $429.58 |
| 27686 | Physician and practitioner services (fee schedule) | 49 | $414.59 |
| 27687 | Physician and practitioner services (fee schedule) | 49 | $354.16 |
| 27690 | Physician and practitioner services (fee schedule) | 49 | $496.26 |
| 27691 | Physician and practitioner services (fee schedule) | 49 | $562.02 |
| 27692 | Physician and practitioner services (fee schedule) | 49 | $78.56 |
| 27695 | Physician and practitioner services (fee schedule) | 49 | $394.26 |
| 27696 | Physician and practitioner services (fee schedule) | 49 | $447.47 |
| 27698 | Physician and practitioner services (fee schedule) | 49 | $514.37 |
| 27700 | Physician and practitioner services (fee schedule) | 49 | $550.71 |
| 27702 | Physician and practitioner services (fee schedule) | 49 | $753.02 |
| 27703 | Physician and practitioner services (fee schedule) | 48 | $860.50 |
| 27704 | Physician and practitioner services (fee schedule) | 49 | $437.49 |
| 27705 | Physician and practitioner services (fee schedule) | 49 | $573.86 |
| 27707 | Physician and practitioner services (fee schedule) | 49 | $320.33 |
| 27709 | Physician and practitioner services (fee schedule) | 49 | $817.50 |
| 27712 | Physician and practitioner services (fee schedule) | 49 | $807.40 |
| 27713 | Physician and practitioner services (fee schedule) | 32 | $1,372.86 |
| 27715 | Physician and practitioner services (fee schedule) | 49 | $916.43 |
| 27720 | Physician and practitioner services (fee schedule) | 49 | $658.09 |
| 27722 | Physician and practitioner services (fee schedule) | 49 | $669.89 |
| 27724 | Physician and practitioner services (fee schedule) | 49 | $905.93 |
| 27725 | Physician and practitioner services (fee schedule) | 48 | $893.64 |
| 27726 | Physician and practitioner services (fee schedule) | 48 | $710.34 |
| 27727 | Physician and practitioner services (fee schedule) | 48 | $769.07 |
| 27730 | Physician and practitioner services (fee schedule) | 49 | $452.81 |
| 27732 | Physician and practitioner services (fee schedule) | 49 | $348.99 |
| 27734 | Physician and practitioner services (fee schedule) | 49 | $527.17 |
| 27740 | Physician and practitioner services (fee schedule) | 49 | $537.63 |
| 27742 | Physician and practitioner services (fee schedule) | 49 | $588.30 |
| 27745 | Physician and practitioner services (fee schedule) | 47 | $561.45 |
| 27750 | Physician and practitioner services (fee schedule) | 49 | $284.47 |
| 27752 | Physician and practitioner services (fee schedule) | 49 | $438.67 |
| 27756 | Physician and practitioner services (fee schedule) | 49 | $450.00 |
| 27758 | Physician and practitioner services (fee schedule) | 49 | $687.44 |
| 27759 | Physician and practitioner services (fee schedule) | 49 | $785.57 |
| 27760 | Physician and practitioner services (fee schedule) | 49 | $269.45 |
| 27762 | Physician and practitioner services (fee schedule) | 49 | $399.80 |
| 27766 | Physician and practitioner services (fee schedule) | 49 | $475.98 |
| 27767 | Physician and practitioner services (fee schedule) | 49 | $240.86 |
| 27768 | Physician and practitioner services (fee schedule) | 49 | $350.62 |
| 27769 | Physician and practitioner services (fee schedule) | 49 | $544.96 |
| 27780 | Physician and practitioner services (fee schedule) | 49 | $246.39 |
| 27781 | Physician and practitioner services (fee schedule) | 49 | $351.66 |
| 27784 | Physician and practitioner services (fee schedule) | 49 | $542.38 |
| 27786 | Physician and practitioner services (fee schedule) | 50 | $252.10 |
| 27788 | Physician and practitioner services (fee schedule) | 50 | $345.30 |
| 27792 | Physician and practitioner services (fee schedule) | 49 | $509.41 |
| 27808 | Physician and practitioner services (fee schedule) | 49 | $274.07 |
| 27810 | Physician and practitioner services (fee schedule) | 49 | $388.99 |
| 27814 | Physician and practitioner services (fee schedule) | 49 | $593.97 |
| 27816 | Physician and practitioner services (fee schedule) | 49 | $271.70 |
| 27818 | Physician and practitioner services (fee schedule) | 50 | $407.34 |
| 27822 | Physician and practitioner services (fee schedule) | 49 | $670.52 |
| 27823 | Physician and practitioner services (fee schedule) | 49 | $759.72 |
| 27824 | Physician and practitioner services (fee schedule) | 49 | $267.84 |
| 27825 | Physician and practitioner services (fee schedule) | 49 | $445.58 |
| 27826 | Physician and practitioner services (fee schedule) | 49 | $667.52 |
| 27827 | Physician and practitioner services (fee schedule) | 49 | $851.50 |
| 27828 | Physician and practitioner services (fee schedule) | 49 | $991.39 |
| 27829 | Physician and practitioner services (fee schedule) | 49 | $546.54 |
| 27830 | Physician and practitioner services (fee schedule) | 49 | $303.39 |
| 27831 | Physician and practitioner services (fee schedule) | 49 | $317.93 |
| 27832 | Physician and practitioner services (fee schedule) | 49 | $557.47 |
| 27840 | Physician and practitioner services (fee schedule) | 49 | $317.96 |
| 27842 | Physician and practitioner services (fee schedule) | 50 | $384.90 |
| 27846 | Physician and practitioner services (fee schedule) | 49 | $543.14 |
| 27848 | Physician and practitioner services (fee schedule) | 49 | $623.32 |
| 27860 | Physician and practitioner services (fee schedule) | 50 | $131.18 |
| 27870 | Physician and practitioner services (fee schedule) | 49 | $771.90 |
| 27871 | Physician and practitioner services (fee schedule) | 49 | $523.35 |
| 27880 | Physician and practitioner services (fee schedule) | 49 | $656.87 |
| 27881 | Physician and practitioner services (fee schedule) | 48 | $655.60 |
| 27882 | Physician and practitioner services (fee schedule) | 49 | $470.46 |
| 27884 | Physician and practitioner services (fee schedule) | 49 | $452.41 |
| 27886 | Physician and practitioner services (fee schedule) | 49 | $498.56 |
| 27888 | Physician and practitioner services (fee schedule) | 49 | $470.19 |
| 27889 | Physician and practitioner services (fee schedule) | 49 | $514.83 |
| 27892 | Physician and practitioner services (fee schedule) | 49 | $427.91 |
| 27893 | Physician and practitioner services (fee schedule) | 49 | $467.88 |
| 27894 | Physician and practitioner services (fee schedule) | 49 | $605.40 |
| 27899 | Physician and practitioner services (fee schedule) | 8 | $339.42 |
| 28001 | Physician and practitioner services (fee schedule) | 49 | $126.35 |
| 28002 | Physician and practitioner services (fee schedule) | 49 | $195.54 |
| 28003 | Physician and practitioner services (fee schedule) | 49 | $301.76 |
| 28005 | Physician and practitioner services (fee schedule) | 50 | $457.14 |
| 28008 | Physician and practitioner services (fee schedule) | 50 | $281.46 |
| 28010 | Physician and practitioner services (fee schedule) | 50 | $185.41 |
| 28011 | Physician and practitioner services (fee schedule) | 50 | $241.98 |
| 28020 | Physician and practitioner services (fee schedule) | 50 | $370.21 |
| 28022 | Physician and practitioner services (fee schedule) | 49 | $318.49 |
| 28024 | Physician and practitioner services (fee schedule) | 49 | $303.13 |
| 28035 | Physician and practitioner services (fee schedule) | 49 | $370.81 |
| 28039 | Physician and practitioner services (fee schedule) | 49 | $342.75 |
| 28041 | Physician and practitioner services (fee schedule) | 49 | $352.38 |
| 28043 | Physician and practitioner services (fee schedule) | 49 | $258.40 |
| 28045 | Physician and practitioner services (fee schedule) | 49 | $338.12 |
| 28046 | Physician and practitioner services (fee schedule) | 49 | $566.29 |
| 28047 | Physician and practitioner services (fee schedule) | 48 | $769.11 |
| 28050 | Physician and practitioner services (fee schedule) | 49 | $281.95 |
| 28052 | Physician and practitioner services (fee schedule) | 49 | $244.36 |
| 28054 | Physician and practitioner services (fee schedule) | 49 | $241.41 |
| 28055 | Physician and practitioner services (fee schedule) | 49 | $312.02 |
| 28060 | Physician and practitioner services (fee schedule) | 49 | $356.56 |
| 28062 | Physician and practitioner services (fee schedule) | 49 | $428.46 |
| 28070 | Physician and practitioner services (fee schedule) | 49 | $351.06 |
| 28072 | Physician and practitioner services (fee schedule) | 49 | $335.12 |
| 28080 | Physician and practitioner services (fee schedule) | 49 | $368.20 |
| 28086 | Physician and practitioner services (fee schedule) | 49 | $326.70 |
| 28088 | Physician and practitioner services (fee schedule) | 49 | $306.92 |
| 28090 | Physician and practitioner services (fee schedule) | 49 | $316.47 |
| 28092 | Physician and practitioner services (fee schedule) | 49 | $277.25 |
| 28100 | Physician and practitioner services (fee schedule) | 49 | $396.00 |
| 28102 | Physician and practitioner services (fee schedule) | 49 | $471.22 |
| 28103 | Physician and practitioner services (fee schedule) | 49 | $322.21 |
| 28104 | Physician and practitioner services (fee schedule) | 49 | $338.75 |
| 28106 | Physician and practitioner services (fee schedule) | 49 | $343.75 |
| 28107 | Physician and practitioner services (fee schedule) | 49 | $338.15 |
| 28108 | Physician and practitioner services (fee schedule) | 48 | $291.57 |
| 28110 | Physician and practitioner services (fee schedule) | 49 | $304.34 |
| 28111 | Physician and practitioner services (fee schedule) | 49 | $326.17 |
| 28112 | Physician and practitioner services (fee schedule) | 49 | $324.60 |
| 28113 | Physician and practitioner services (fee schedule) | 49 | $395.52 |
| 28114 | Physician and practitioner services (fee schedule) | 49 | $751.97 |
| 28116 | Physician and practitioner services (fee schedule) | 49 | $485.43 |
| 28118 | Physician and practitioner services (fee schedule) | 49 | $403.00 |
| 28119 | Physician and practitioner services (fee schedule) | 49 | $359.41 |
| 28120 | Physician and practitioner services (fee schedule) | 49 | $455.91 |
| 28122 | Physician and practitioner services (fee schedule) | 49 | $406.47 |
| 28124 | Physician and practitioner services (fee schedule) | 49 | $321.97 |
| 28126 | Physician and practitioner services (fee schedule) | 49 | $247.15 |
| 28130 | Physician and practitioner services (fee schedule) | 49 | $488.18 |
| 28140 | Physician and practitioner services (fee schedule) | 49 | $389.70 |
| 28150 | Physician and practitioner services (fee schedule) | 49 | $280.11 |
| 28153 | Physician and practitioner services (fee schedule) | 49 | $260.25 |
| 28160 | Physician and practitioner services (fee schedule) | 49 | $265.21 |
| 28171 | Physician and practitioner services (fee schedule) | 48 | $729.54 |
| 28173 | Physician and practitioner services (fee schedule) | 49 | $535.23 |
| 28175 | Physician and practitioner services (fee schedule) | 49 | $378.47 |
| 28190 | Physician and practitioner services (fee schedule) | 49 | $160.31 |
| 28192 | Physician and practitioner services (fee schedule) | 49 | $310.60 |
| 28193 | Physician and practitioner services (fee schedule) | 49 | $354.44 |
| 28200 | Physician and practitioner services (fee schedule) | 49 | $335.45 |
| 28202 | Physician and practitioner services (fee schedule) | 49 | $413.27 |
| 28208 | Physician and practitioner services (fee schedule) | 49 | $304.36 |
| 28210 | Physician and practitioner services (fee schedule) | 49 | $400.60 |
| 28220 | Physician and practitioner services (fee schedule) | 49 | $301.83 |
| 28222 | Physician and practitioner services (fee schedule) | 49 | $368.64 |
| 28225 | Physician and practitioner services (fee schedule) | 49 | $260.61 |
| 28226 | Physician and practitioner services (fee schedule) | 49 | $374.29 |
| 28230 | Physician and practitioner services (fee schedule) | 49 | $280.08 |
| 28232 | Physician and practitioner services (fee schedule) | 49 | $239.72 |
| 28234 | Physician and practitioner services (fee schedule) | 50 | $259.47 |
| 28238 | Physician and practitioner services (fee schedule) | 49 | $464.69 |
| 28240 | Physician and practitioner services (fee schedule) | 49 | $287.52 |
| 28250 | Physician and practitioner services (fee schedule) | 49 | $380.68 |
| 28260 | Physician and practitioner services (fee schedule) | 49 | $486.14 |
| 28261 | Physician and practitioner services (fee schedule) | 49 | $752.05 |
| 28262 | Physician and practitioner services (fee schedule) | 49 | $995.42 |
| 28264 | Physician and practitioner services (fee schedule) | 49 | $644.69 |
| 28270 | Physician and practitioner services (fee schedule) | 49 | $330.13 |
| 28272 | Physician and practitioner services (fee schedule) | 49 | $251.62 |
| 28280 | Physician and practitioner services (fee schedule) | 49 | $334.26 |
| 28285 | Physician and practitioner services (fee schedule) | 48 | $349.28 |
| 28286 | Physician and practitioner services (fee schedule) | 49 | $291.09 |
| 28288 | Physician and practitioner services (fee schedule) | 49 | $389.36 |
| 28289 | Physician and practitioner services (fee schedule) | 48 | $438.46 |
| 28291 | Physician and practitioner services (fee schedule) | 45 | $487.17 |
| 28292 | Physician and practitioner services (fee schedule) | 48 | $467.31 |
| 28295 | Physician and practitioner services (fee schedule) | 46 | $635.94 |
| 28296 | Physician and practitioner services (fee schedule) | 48 | $555.74 |
| 28297 | Physician and practitioner services (fee schedule) | 48 | $622.75 |
| 28298 | Physician and practitioner services (fee schedule) | 48 | $518.15 |
| 28299 | Physician and practitioner services (fee schedule) | 48 | $618.52 |
| 28300 | Physician and practitioner services (fee schedule) | 49 | $507.39 |
| 28302 | Physician and practitioner services (fee schedule) | 49 | $542.55 |
| 28304 | Physician and practitioner services (fee schedule) | 49 | $555.93 |
| 28305 | Physician and practitioner services (fee schedule) | 49 | $533.37 |
| 28306 | Physician and practitioner services (fee schedule) | 49 | $385.00 |
| 28307 | Physician and practitioner services (fee schedule) | 49 | $536.36 |
| 28308 | Physician and practitioner services (fee schedule) | 49 | $358.64 |
| 28309 | Physician and practitioner services (fee schedule) | 48 | $686.16 |
| 28310 | Physician and practitioner services (fee schedule) | 49 | $360.40 |
| 28312 | Physician and practitioner services (fee schedule) | 49 | $350.95 |
| 28313 | Physician and practitioner services (fee schedule) | 48 | $368.93 |
| 28315 | Physician and practitioner services (fee schedule) | 49 | $308.34 |
| 28320 | Physician and practitioner services (fee schedule) | 49 | $480.86 |
| 28322 | Physician and practitioner services (fee schedule) | 49 | $505.38 |
| 28340 | Physician and practitioner services (fee schedule) | 49 | $434.65 |
| 28341 | Physician and practitioner services (fee schedule) | 49 | $517.80 |
| 28344 | Physician and practitioner services (fee schedule) | 49 | $307.90 |
| 28345 | Physician and practitioner services (fee schedule) | 49 | $391.96 |
| 28360 | Physician and practitioner services (fee schedule) | 47 | $829.92 |
| 28400 | Physician and practitioner services (fee schedule) | 49 | $200.74 |
| 28405 | Physician and practitioner services (fee schedule) | 49 | $346.35 |
| 28406 | Physician and practitioner services (fee schedule) | 49 | $448.65 |
| 28415 | Physician and practitioner services (fee schedule) | 49 | $868.74 |
| 28420 | Physician and practitioner services (fee schedule) | 49 | $973.74 |
| 28430 | Physician and practitioner services (fee schedule) | 49 | $194.46 |
| 28435 | Physician and practitioner services (fee schedule) | 49 | $289.65 |
| 28436 | Physician and practitioner services (fee schedule) | 49 | $396.03 |
| 28445 | Physician and practitioner services (fee schedule) | 49 | $775.67 |
| 28446 | Physician and practitioner services (fee schedule) | 46 | $900.85 |
| 28450 | Physician and practitioner services (fee schedule) | 49 | $171.06 |
| 28455 | Physician and practitioner services (fee schedule) | 49 | $209.23 |
| 28456 | Physician and practitioner services (fee schedule) | 49 | $295.46 |
| 28465 | Physician and practitioner services (fee schedule) | 49 | $510.98 |
| 28470 | Physician and practitioner services (fee schedule) | 49 | $175.85 |
| 28475 | Physician and practitioner services (fee schedule) | 49 | $203.50 |
| 28476 | Physician and practitioner services (fee schedule) | 49 | $309.09 |
| 28485 | Physician and practitioner services (fee schedule) | 49 | $446.89 |
| 28490 | Physician and practitioner services (fee schedule) | 49 | $108.47 |
| 28495 | Physician and practitioner services (fee schedule) | 49 | $132.10 |
| 28496 | Physician and practitioner services (fee schedule) | 49 | $319.46 |
| 28505 | Physician and practitioner services (fee schedule) | 49 | $452.36 |
| 28510 | Physician and practitioner services (fee schedule) | 49 | $98.06 |
| 28515 | Physician and practitioner services (fee schedule) | 49 | $125.44 |
| 28525 | Physician and practitioner services (fee schedule) | 49 | $372.28 |
| 28530 | Physician and practitioner services (fee schedule) | 48 | $93.54 |
| 28531 | Physician and practitioner services (fee schedule) | 47 | $214.96 |
| 28540 | Physician and practitioner services (fee schedule) | 49 | $152.57 |
| 28545 | Physician and practitioner services (fee schedule) | 49 | $234.73 |
| 28546 | Physician and practitioner services (fee schedule) | 49 | $368.25 |
| 28555 | Physician and practitioner services (fee schedule) | 49 | $534.28 |
| 28570 | Physician and practitioner services (fee schedule) | 49 | $177.66 |
| 28575 | Physician and practitioner services (fee schedule) | 49 | $287.19 |
| 28576 | Physician and practitioner services (fee schedule) | 49 | $300.55 |
| 28585 | Physician and practitioner services (fee schedule) | 49 | $605.13 |
| 28600 | Physician and practitioner services (fee schedule) | 49 | $151.09 |
| 28605 | Physician and practitioner services (fee schedule) | 49 | $263.71 |
| 28606 | Physician and practitioner services (fee schedule) | 49 | $317.58 |
| 28615 | Physician and practitioner services (fee schedule) | 49 | $629.16 |
| 28630 | Physician and practitioner services (fee schedule) | 48 | $114.30 |
| 28635 | Physician and practitioner services (fee schedule) | 49 | $123.99 |
| 28636 | Physician and practitioner services (fee schedule) | 49 | $231.69 |
| 28645 | Physician and practitioner services (fee schedule) | 49 | $450.07 |
| 28660 | Physician and practitioner services (fee schedule) | 48 | $95.73 |
| 28665 | Physician and practitioner services (fee schedule) | 49 | $117.09 |
| 28666 | Physician and practitioner services (fee schedule) | 49 | $144.65 |
| 28675 | Physician and practitioner services (fee schedule) | 49 | $381.43 |
| 28705 | Physician and practitioner services (fee schedule) | 49 | $928.89 |
| 28715 | Physician and practitioner services (fee schedule) | 49 | $728.07 |
| 28725 | Physician and practitioner services (fee schedule) | 49 | $604.20 |
| 28730 | Physician and practitioner services (fee schedule) | 49 | $564.51 |
| 28735 | Physician and practitioner services (fee schedule) | 47 | $590.56 |
| 28737 | Physician and practitioner services (fee schedule) | 49 | $526.23 |
| 28740 | Physician and practitioner services (fee schedule) | 49 | $541.02 |
| 28750 | Physician and practitioner services (fee schedule) | 49 | $555.56 |
| 28755 | Physician and practitioner services (fee schedule) | 49 | $350.64 |
| 28760 | Physician and practitioner services (fee schedule) | 49 | $495.04 |
| 28800 | Physician and practitioner services (fee schedule) | 49 | $421.82 |
| 28805 | Physician and practitioner services (fee schedule) | 49 | $534.83 |
| 28810 | Physician and practitioner services (fee schedule) | 49 | $338.15 |
| 28820 | Physician and practitioner services (fee schedule) | 49 | $218.18 |
| 28825 | Physician and practitioner services (fee schedule) | 49 | $202.53 |
| 28890 | Physician and practitioner services (fee schedule) | 36 | $247.78 |
| 28899 | Physician and practitioner services (fee schedule) | 8 | $148.27 |
| 29000 | Physician and practitioner services (fee schedule) | 49 | $214.93 |
| 29010 | Physician and practitioner services (fee schedule) | 49 | $186.32 |
| 29015 | Physician and practitioner services (fee schedule) | 49 | $195.24 |
| 29035 | Physician and practitioner services (fee schedule) | 49 | $172.54 |
| 29040 | Physician and practitioner services (fee schedule) | 49 | $196.30 |
| 29044 | Physician and practitioner services (fee schedule) | 49 | $192.32 |
| 29046 | Physician and practitioner services (fee schedule) | 49 | $210.06 |
| 29049 | Physician and practitioner services (fee schedule) | 49 | $73.99 |
| 29055 | Physician and practitioner services (fee schedule) | 49 | $151.16 |
| 29058 | Physician and practitioner services (fee schedule) | 49 | $94.67 |
| 29065 | Physician and practitioner services (fee schedule) | 49 | $73.20 |
| 29075 | Physician and practitioner services (fee schedule) | 49 | $65.86 |
| 29085 | Physician and practitioner services (fee schedule) | 49 | $70.94 |
| 29086 | Physician and practitioner services (fee schedule) | 47 | $53.99 |
| 29105 | Physician and practitioner services (fee schedule) | 49 | $62.64 |
| 29125 | Physician and practitioner services (fee schedule) | 50 | $43.18 |
| 29126 | Physician and practitioner services (fee schedule) | 50 | $55.94 |
| 29130 | Physician and practitioner services (fee schedule) | 48 | $28.90 |
| 29131 | Physician and practitioner services (fee schedule) | 49 | $40.07 |
| 29200 | Physician and practitioner services (fee schedule) | 49 | $24.18 |
| 29240 | Physician and practitioner services (fee schedule) | 49 | $23.24 |
| 29260 | Physician and practitioner services (fee schedule) | 49 | $21.87 |
| 29280 | Physician and practitioner services (fee schedule) | 47 | $22.64 |
| 29305 | Physician and practitioner services (fee schedule) | 50 | $183.03 |
| 29325 | Physician and practitioner services (fee schedule) | 50 | $194.00 |
| 29345 | Physician and practitioner services (fee schedule) | 49 | $102.08 |
| 29355 | Physician and practitioner services (fee schedule) | 50 | $106.91 |
| 29358 | Physician and practitioner services (fee schedule) | 50 | $121.82 |
| 29365 | Physician and practitioner services (fee schedule) | 50 | $93.12 |
| 29405 | Physician and practitioner services (fee schedule) | 50 | $61.66 |
| 29425 | Physician and practitioner services (fee schedule) | 50 | $61.25 |
| 29435 | Physician and practitioner services (fee schedule) | 50 | $93.68 |
| 29440 | Physician and practitioner services (fee schedule) | 50 | $30.18 |
| 29445 | Physician and practitioner services (fee schedule) | 50 | $104.57 |
| 29450 | Physician and practitioner services (fee schedule) | 49 | $100.77 |
| 29505 | Physician and practitioner services (fee schedule) | 49 | $63.02 |
| 29515 | Physician and practitioner services (fee schedule) | 50 | $52.65 |
| 29520 | Physician and practitioner services (fee schedule) | 49 | $27.73 |
| 29530 | Physician and practitioner services (fee schedule) | 49 | $23.58 |
| 29540 | Physician and practitioner services (fee schedule) | 49 | $21.35 |
| 29550 | Physician and practitioner services (fee schedule) | 49 | $16.13 |
| 29580 | Physician and practitioner services (fee schedule) | 49 | $39.42 |
| 29581 | Physician and practitioner services (fee schedule) | 49 | $62.81 |
| 29584 | Physician and practitioner services (fee schedule) | 48 | $50.38 |
| 29700 | Physician and practitioner services (fee schedule) | 47 | $42.02 |
| 29705 | Physician and practitioner services (fee schedule) | 47 | $48.07 |
| 29710 | Physician and practitioner services (fee schedule) | 47 | $85.73 |
| 29720 | Physician and practitioner services (fee schedule) | 48 | $62.85 |
| 29730 | Physician and practitioner services (fee schedule) | 48 | $43.27 |
| 29740 | Physician and practitioner services (fee schedule) | 49 | $72.97 |
| 29750 | Physician and practitioner services (fee schedule) | 48 | $72.47 |
| 29799 | Physician and practitioner services (fee schedule) | 8 | $36.14 |
| 29800 | Physician and practitioner services (fee schedule) | 46 | $419.44 |
| 29804 | Physician and practitioner services (fee schedule) | 45 | $471.73 |
| 29805 | Physician and practitioner services (fee schedule) | 49 | $363.45 |
| 29806 | Physician and practitioner services (fee schedule) | 49 | $804.56 |
| 29807 | Physician and practitioner services (fee schedule) | 49 | $786.92 |
| 29819 | Physician and practitioner services (fee schedule) | 49 | $467.04 |
| 29820 | Physician and practitioner services (fee schedule) | 49 | $423.59 |
| 29821 | Physician and practitioner services (fee schedule) | 49 | $464.42 |
| 29822 | Physician and practitioner services (fee schedule) | 49 | $436.81 |
| 29823 | Physician and practitioner services (fee schedule) | 49 | $459.58 |
| 29824 | Physician and practitioner services (fee schedule) | 49 | $514.46 |
| 29825 | Physician and practitioner services (fee schedule) | 49 | $455.05 |
| 29826 | Physician and practitioner services (fee schedule) | 49 | $145.46 |
| 29827 | Physician and practitioner services (fee schedule) | 49 | $802.13 |
| 29828 | Physician and practitioner services (fee schedule) | 49 | $678.76 |
| 29830 | Physician and practitioner services (fee schedule) | 49 | $371.57 |
| 29834 | Physician and practitioner services (fee schedule) | 49 | $396.76 |
| 29835 | Physician and practitioner services (fee schedule) | 49 | $396.73 |
| 29836 | Physician and practitioner services (fee schedule) | 49 | $450.00 |
| 29837 | Physician and practitioner services (fee schedule) | 49 | $409.06 |
| 29838 | Physician and practitioner services (fee schedule) | 49 | $464.97 |
| 29840 | Physician and practitioner services (fee schedule) | 49 | $360.69 |
| 29843 | Physician and practitioner services (fee schedule) | 49 | $370.63 |
| 29844 | Physician and practitioner services (fee schedule) | 49 | $381.85 |
| 29845 | Physician and practitioner services (fee schedule) | 49 | $449.71 |
| 29846 | Physician and practitioner services (fee schedule) | 49 | $422.74 |
| 29847 | Physician and practitioner services (fee schedule) | 49 | $424.87 |
| 29848 | Physician and practitioner services (fee schedule) | 49 | $394.58 |
| 29850 | Physician and practitioner services (fee schedule) | 49 | $507.10 |
| 29851 | Physician and practitioner services (fee schedule) | 49 | $699.25 |
| 29855 | Physician and practitioner services (fee schedule) | 49 | $603.68 |
| 29856 | Physician and practitioner services (fee schedule) | 49 | $748.91 |
| 29860 | Physician and practitioner services (fee schedule) | 49 | $478.50 |
| 29861 | Physician and practitioner services (fee schedule) | 49 | $543.85 |
| 29862 | Physician and practitioner services (fee schedule) | 49 | $613.48 |
| 29863 | Physician and practitioner services (fee schedule) | 49 | $611.91 |
| 29866 | Physician and practitioner services (fee schedule) | 45 | $801.32 |
| 29867 | Physician and practitioner services (fee schedule) | 45 | $974.26 |
| 29868 | Physician and practitioner services (fee schedule) | 45 | $1,318.43 |
| 29870 | Physician and practitioner services (fee schedule) | 49 | $405.97 |
| 29871 | Physician and practitioner services (fee schedule) | 49 | $415.88 |
| 29873 | Physician and practitioner services (fee schedule) | 48 | $424.23 |
| 29874 | Physician and practitioner services (fee schedule) | 49 | $438.37 |
| 29875 | Physician and practitioner services (fee schedule) | 49 | $403.08 |
| 29876 | Physician and practitioner services (fee schedule) | 49 | $525.93 |
| 29877 | Physician and practitioner services (fee schedule) | 49 | $497.20 |
| 29879 | Physician and practitioner services (fee schedule) | 49 | $533.03 |
| 29880 | Physician and practitioner services (fee schedule) | 49 | $491.35 |
| 29881 | Physician and practitioner services (fee schedule) | 49 | $465.87 |
| 29882 | Physician and practitioner services (fee schedule) | 49 | $558.45 |
| 29883 | Physician and practitioner services (fee schedule) | 49 | $648.41 |
| 29884 | Physician and practitioner services (fee schedule) | 49 | $478.61 |
| 29885 | Physician and practitioner services (fee schedule) | 49 | $586.13 |
| 29886 | Physician and practitioner services (fee schedule) | 49 | $500.74 |
| 29887 | Physician and practitioner services (fee schedule) | 49 | $583.17 |
| 29888 | Physician and practitioner services (fee schedule) | 49 | $756.27 |
| 29889 | Physician and practitioner services (fee schedule) | 49 | $897.11 |
| 29891 | Physician and practitioner services (fee schedule) | 49 | $524.93 |
| 29892 | Physician and practitioner services (fee schedule) | 49 | $517.65 |
| 29893 | Physician and practitioner services (fee schedule) | 49 | $446.76 |
| 29894 | Physician and practitioner services (fee schedule) | 49 | $416.76 |
| 29895 | Physician and practitioner services (fee schedule) | 49 | $376.53 |
| 29897 | Physician and practitioner services (fee schedule) | 49 | $402.40 |
| 29898 | Physician and practitioner services (fee schedule) | 49 | $453.70 |
| 29899 | Physician and practitioner services (fee schedule) | 48 | $759.90 |
| 29900 | Physician and practitioner services (fee schedule) | 49 | $400.45 |
| 29901 | Physician and practitioner services (fee schedule) | 49 | $414.39 |
| 29902 | Physician and practitioner services (fee schedule) | 49 | $438.12 |
| 29904 | Physician and practitioner services (fee schedule) | 49 | $475.19 |
| 29905 | Physician and practitioner services (fee schedule) | 49 | $416.33 |
| 29906 | Physician and practitioner services (fee schedule) | 49 | $511.17 |
| 29907 | Physician and practitioner services (fee schedule) | 48 | $653.00 |
| 29914 | Physician and practitioner services (fee schedule) | 48 | $785.44 |
| 29915 | Physician and practitioner services (fee schedule) | 48 | $800.10 |
| 29916 | Physician and practitioner services (fee schedule) | 49 | $791.25 |
| 29999 | Physician and practitioner services (fee schedule) | 9 | $486.41 |
| 30000 | Physician and practitioner services (fee schedule) | 50 | $124.43 |
| 30020 | Physician and practitioner services (fee schedule) | 50 | $125.35 |
| 30100 | Physician and practitioner services (fee schedule) | 50 | $72.97 |
| 30110 | Physician and practitioner services (fee schedule) | 49 | $138.16 |
| 30115 | Physician and practitioner services (fee schedule) | 49 | $346.61 |
| 30117 | Physician and practitioner services (fee schedule) | 50 | $470.05 |
| 30118 | Physician and practitioner services (fee schedule) | 50 | $522.08 |
| 30120 | Physician and practitioner services (fee schedule) | 45 | $387.37 |
| 30124 | Physician and practitioner services (fee schedule) | 50 | $223.57 |
| 30125 | Physician and practitioner services (fee schedule) | 50 | $466.05 |
| 30130 | Physician and practitioner services (fee schedule) | 50 | $304.25 |
| 30140 | Physician and practitioner services (fee schedule) | 50 | $236.95 |
| 30150 | Physician and practitioner services (fee schedule) | 50 | $572.33 |
| 30160 | Physician and practitioner services (fee schedule) | 50 | $589.99 |
| 30200 | Physician and practitioner services (fee schedule) | 49 | $63.51 |
| 30210 | Physician and practitioner services (fee schedule) | 48 | $94.61 |
| 30220 | Physician and practitioner services (fee schedule) | 48 | $140.83 |
| 30300 | Physician and practitioner services (fee schedule) | 50 | $120.22 |
| 30310 | Physician and practitioner services (fee schedule) | 50 | $153.59 |
| 30320 | Physician and practitioner services (fee schedule) | 50 | $360.40 |
| 30400 | Physician and practitioner services (fee schedule) | 45 | $957.22 |
| 30410 | Physician and practitioner services (fee schedule) | 46 | $1,079.70 |
| 30420 | Physician and practitioner services (fee schedule) | 47 | $1,077.19 |
| 30430 | Physician and practitioner services (fee schedule) | 44 | $824.21 |
| 30435 | Physician and practitioner services (fee schedule) | 42 | $1,012.86 |
| 30450 | Physician and practitioner services (fee schedule) | 43 | $1,302.45 |
| 30460 | Physician and practitioner services (fee schedule) | 49 | $614.27 |
| 30462 | Physician and practitioner services (fee schedule) | 48 | $1,168.53 |
| 30465 | Physician and practitioner services (fee schedule) | 50 | $767.53 |
| 30468 | Physician and practitioner services (fee schedule) | 40 | $1,564.97 |
| 30469 | Physician and practitioner services (fee schedule) | 38 | $380.18 |
| 30520 | Physician and practitioner services (fee schedule) | 50 | $508.02 |
| 30540 | Physician and practitioner services (fee schedule) | 50 | $530.57 |
| 30545 | Physician and practitioner services (fee schedule) | 50 | $706.49 |
| 30560 | Physician and practitioner services (fee schedule) | 50 | $147.16 |
| 30580 | Physician and practitioner services (fee schedule) | 50 | $438.00 |
| 30600 | Physician and practitioner services (fee schedule) | 50 | $392.59 |
| 30620 | Physician and practitioner services (fee schedule) | 50 | $500.23 |
| 30630 | Physician and practitioner services (fee schedule) | 50 | $489.49 |
| 30801 | Physician and practitioner services (fee schedule) | 50 | $141.86 |
| 30802 | Physician and practitioner services (fee schedule) | 50 | $183.73 |
| 30901 | Physician and practitioner services (fee schedule) | 50 | $76.41 |
| 30903 | Physician and practitioner services (fee schedule) | 49 | $126.34 |
| 30905 | Physician and practitioner services (fee schedule) | 50 | $162.22 |
| 30906 | Physician and practitioner services (fee schedule) | 50 | $163.83 |
| 30915 | Physician and practitioner services (fee schedule) | 50 | $444.11 |
| 30920 | Physician and practitioner services (fee schedule) | 50 | $643.72 |
| 30930 | Physician and practitioner services (fee schedule) | 50 | $89.40 |
| 30999 | Physician and practitioner services (fee schedule) | 9 | $150.00 |
| 31000 | Physician and practitioner services (fee schedule) | 50 | $106.00 |
| 31002 | Physician and practitioner services (fee schedule) | 50 | $135.97 |
| 31020 | Physician and practitioner services (fee schedule) | 49 | $332.94 |
| 31030 | Physician and practitioner services (fee schedule) | 49 | $504.11 |
| 31032 | Physician and practitioner services (fee schedule) | 49 | $454.50 |
| 31040 | Physician and practitioner services (fee schedule) | 48 | $581.55 |
| 31050 | Physician and practitioner services (fee schedule) | 50 | $385.83 |
| 31051 | Physician and practitioner services (fee schedule) | 50 | $508.08 |
| 31070 | Physician and practitioner services (fee schedule) | 49 | $354.45 |
| 31075 | Physician and practitioner services (fee schedule) | 49 | $614.88 |
| 31080 | Physician and practitioner services (fee schedule) | 49 | $807.01 |
| 31081 | Physician and practitioner services (fee schedule) | 49 | $860.59 |
| 31084 | Physician and practitioner services (fee schedule) | 49 | $874.68 |
| 31085 | Physician and practitioner services (fee schedule) | 49 | $913.09 |
| 31086 | Physician and practitioner services (fee schedule) | 49 | $866.53 |
| 31087 | Physician and practitioner services (fee schedule) | 49 | $815.18 |
| 31090 | Physician and practitioner services (fee schedule) | 50 | $810.88 |
| 31200 | Physician and practitioner services (fee schedule) | 50 | $468.43 |
| 31201 | Physician and practitioner services (fee schedule) | 50 | $567.59 |
| 31205 | Physician and practitioner services (fee schedule) | 49 | $646.37 |
| 31225 | Physician and practitioner services (fee schedule) | 49 | $1,283.46 |
| 31230 | Physician and practitioner services (fee schedule) | 49 | $1,399.56 |
| 31231 | Physician and practitioner services (fee schedule) | 50 | $106.86 |
| 31233 | Physician and practitioner services (fee schedule) | 49 | $183.00 |
| 31235 | Physician and practitioner services (fee schedule) | 49 | $209.11 |
| 31237 | Physician and practitioner services (fee schedule) | 49 | $181.29 |
| 31238 | Physician and practitioner services (fee schedule) | 49 | $196.83 |
| 31239 | Physician and practitioner services (fee schedule) | 49 | $482.58 |
| 31240 | Physician and practitioner services (fee schedule) | 49 | $128.53 |
| 31241 | Physician and practitioner services (fee schedule) | 49 | $333.91 |
| 31242 | Physician and practitioner services (fee schedule) | 33 | $1,527.64 |
| 31243 | Physician and practitioner services (fee schedule) | 33 | $1,483.33 |
| 31253 | Physician and practitioner services (fee schedule) | 49 | $376.02 |
| 31254 | Physician and practitioner services (fee schedule) | 50 | $282.90 |
| 31255 | Physician and practitioner services (fee schedule) | 49 | $275.02 |
| 31256 | Physician and practitioner services (fee schedule) | 49 | $148.23 |
| 31257 | Physician and practitioner services (fee schedule) | 49 | $335.59 |
| 31259 | Physician and practitioner services (fee schedule) | 49 | $355.30 |
| 31267 | Physician and practitioner services (fee schedule) | 49 | $217.62 |
| 31276 | Physician and practitioner services (fee schedule) | 49 | $308.74 |
| 31287 | Physician and practitioner services (fee schedule) | 49 | $171.76 |
| 31288 | Physician and practitioner services (fee schedule) | 49 | $199.54 |
| 31290 | Physician and practitioner services (fee schedule) | 49 | $870.14 |
| 31291 | Physician and practitioner services (fee schedule) | 49 | $932.87 |
| 31292 | Physician and practitioner services (fee schedule) | 49 | $749.86 |
| 31293 | Physician and practitioner services (fee schedule) | 49 | $819.55 |
| 31294 | Physician and practitioner services (fee schedule) | 49 | $935.44 |
| 31295 | Physician and practitioner services (fee schedule) | 46 | $1,051.20 |
| 31296 | Physician and practitioner services (fee schedule) | 46 | $1,051.26 |
| 31297 | Physician and practitioner services (fee schedule) | 46 | $1,189.76 |
| 31298 | Physician and practitioner services (fee schedule) | 47 | $2,266.27 |
| 31299 | Physician and practitioner services (fee schedule) | 6 | $131.30 |
| 31300 | Physician and practitioner services (fee schedule) | 49 | $914.14 |
| 31360 | Physician and practitioner services (fee schedule) | 50 | $1,430.86 |
| 31365 | Physician and practitioner services (fee schedule) | 49 | $1,748.94 |
| 31367 | Physician and practitioner services (fee schedule) | 50 | $1,439.72 |
| 31368 | Physician and practitioner services (fee schedule) | 50 | $1,712.49 |
| 31370 | Physician and practitioner services (fee schedule) | 50 | $1,440.93 |
| 31375 | Physician and practitioner services (fee schedule) | 50 | $1,291.28 |
| 31380 | Physician and practitioner services (fee schedule) | 50 | $1,300.88 |
| 31382 | Physician and practitioner services (fee schedule) | 50 | $1,377.39 |
| 31390 | Physician and practitioner services (fee schedule) | 50 | $1,911.57 |
| 31395 | Physician and practitioner services (fee schedule) | 50 | $2,046.22 |
| 31400 | Physician and practitioner services (fee schedule) | 50 | $730.21 |
| 31420 | Physician and practitioner services (fee schedule) | 50 | $601.87 |
| 31500 | Physician and practitioner services (fee schedule) | 50 | $104.80 |
| 31502 | Physician and practitioner services (fee schedule) | 48 | $27.56 |
| 31505 | Physician and practitioner services (fee schedule) | 49 | $56.45 |
| 31510 | Physician and practitioner services (fee schedule) | 49 | $113.01 |
| 31511 | Physician and practitioner services (fee schedule) | 49 | $137.75 |
| 31512 | Physician and practitioner services (fee schedule) | 49 | $135.09 |
| 31513 | Physician and practitioner services (fee schedule) | 47 | $105.47 |
| 31515 | Physician and practitioner services (fee schedule) | 50 | $125.76 |
| 31520 | Physician and practitioner services (fee schedule) | 50 | $117.27 |
| 31525 | Physician and practitioner services (fee schedule) | 50 | $169.09 |
| 31526 | Physician and practitioner services (fee schedule) | 50 | $126.13 |
| 31527 | Physician and practitioner services (fee schedule) | 48 | $151.91 |
| 31528 | Physician and practitioner services (fee schedule) | 50 | $113.19 |
| 31529 | Physician and practitioner services (fee schedule) | 48 | $123.70 |
| 31530 | Physician and practitioner services (fee schedule) | 50 | $159.83 |
| 31531 | Physician and practitioner services (fee schedule) | 50 | $169.77 |
| 31535 | Physician and practitioner services (fee schedule) | 49 | $152.54 |
| 31536 | Physician and practitioner services (fee schedule) | 50 | $170.26 |
| 31540 | Physician and practitioner services (fee schedule) | 50 | $192.95 |
| 31541 | Physician and practitioner services (fee schedule) | 50 | $210.55 |
| 31545 | Physician and practitioner services (fee schedule) | 49 | $272.81 |
| 31546 | Physician and practitioner services (fee schedule) | 49 | $424.22 |
| 31551 | Physician and practitioner services (fee schedule) | 50 | $1,159.51 |
| 31552 | Physician and practitioner services (fee schedule) | 49 | $1,140.36 |
| 31553 | Physician and practitioner services (fee schedule) | 50 | $1,266.79 |
| 31554 | Physician and practitioner services (fee schedule) | 50 | $1,301.88 |
| 31560 | Physician and practitioner services (fee schedule) | 50 | $239.42 |
| 31561 | Physician and practitioner services (fee schedule) | 50 | $271.37 |
| 31570 | Physician and practitioner services (fee schedule) | 50 | $254.16 |
| 31571 | Physician and practitioner services (fee schedule) | 50 | $191.38 |
| 31572 | Physician and practitioner services (fee schedule) | 49 | $326.32 |
| 31573 | Physician and practitioner services (fee schedule) | 48 | $180.98 |
| 31574 | Physician and practitioner services (fee schedule) | 48 | $579.50 |
| 31575 | Physician and practitioner services (fee schedule) | 50 | $83.16 |
| 31576 | Physician and practitioner services (fee schedule) | 49 | $171.25 |
| 31577 | Physician and practitioner services (fee schedule) | 49 | $168.89 |
| 31578 | Physician and practitioner services (fee schedule) | 49 | $194.04 |
| 31579 | Physician and practitioner services (fee schedule) | 50 | $149.54 |
| 31580 | Physician and practitioner services (fee schedule) | 49 | $906.60 |
| 31584 | Physician and practitioner services (fee schedule) | 49 | $1,073.86 |
| 31587 | Physician and practitioner services (fee schedule) | 49 | $873.23 |
| 31590 | Physician and practitioner services (fee schedule) | 47 | $701.04 |
| 31591 | Physician and practitioner services (fee schedule) | 48 | $854.37 |
| 31592 | Physician and practitioner services (fee schedule) | 48 | $1,340.08 |
| 31599 | Physician and practitioner services (fee schedule) | 7 | $460.85 |
| 31600 | Physician and practitioner services (fee schedule) | 50 | $238.54 |
| 31601 | Physician and practitioner services (fee schedule) | 50 | $284.04 |
| 31603 | Physician and practitioner services (fee schedule) | 50 | $221.97 |
| 31605 | Physician and practitioner services (fee schedule) | 50 | $235.47 |
| 31610 | Physician and practitioner services (fee schedule) | 50 | $653.38 |
| 31611 | Physician and practitioner services (fee schedule) | 48 | $397.14 |
| 31612 | Physician and practitioner services (fee schedule) | 50 | $59.81 |
| 31613 | Physician and practitioner services (fee schedule) | 50 | $321.11 |
| 31614 | Physician and practitioner services (fee schedule) | 49 | $528.35 |
| 31615 | Physician and practitioner services (fee schedule) | 49 | $130.96 |
| 31622 | Physician and practitioner services (fee schedule) | 50 | $190.35 |
| 31623 | Physician and practitioner services (fee schedule) | 50 | $203.77 |
| 31624 | Physician and practitioner services (fee schedule) | 50 | $192.84 |
| 31625 | Physician and practitioner services (fee schedule) | 50 | $227.54 |
| 31626 | Physician and practitioner services (fee schedule) | 46 | $389.43 |
| 31627 | Physician and practitioner services (fee schedule) | 43 | $696.75 |
| 31628 | Physician and practitioner services (fee schedule) | 50 | $266.77 |
| 31629 | Physician and practitioner services (fee schedule) | 50 | $323.78 |
| 31630 | Physician and practitioner services (fee schedule) | 50 | $162.66 |
| 31631 | Physician and practitioner services (fee schedule) | 50 | $184.97 |
| 31632 | Physician and practitioner services (fee schedule) | 48 | $52.77 |
| 31633 | Physician and practitioner services (fee schedule) | 49 | $65.50 |
| 31634 | Physician and practitioner services (fee schedule) | 47 | $849.60 |
| 31635 | Physician and practitioner services (fee schedule) | 50 | $219.63 |
| 31636 | Physician and practitioner services (fee schedule) | 49 | $175.24 |
| 31637 | Physician and practitioner services (fee schedule) | 49 | $60.38 |
| 31638 | Physician and practitioner services (fee schedule) | 49 | $197.26 |
| 31640 | Physician and practitioner services (fee schedule) | 50 | $194.90 |
| 31641 | Physician and practitioner services (fee schedule) | 50 | $204.51 |
| 31643 | Physician and practitioner services (fee schedule) | 50 | $138.94 |
| 31645 | Physician and practitioner services (fee schedule) | 50 | $202.14 |
| 31646 | Physician and practitioner services (fee schedule) | 50 | $115.02 |
| 31647 | Physician and practitioner services (fee schedule) | 43 | $160.30 |
| 31648 | Physician and practitioner services (fee schedule) | 43 | $159.55 |
| 31649 | Physician and practitioner services (fee schedule) | 43 | $58.86 |
| 31651 | Physician and practitioner services (fee schedule) | 41 | $65.52 |
| 31652 | Physician and practitioner services (fee schedule) | 50 | $701.44 |
| 31653 | Physician and practitioner services (fee schedule) | 50 | $737.02 |
| 31654 | Physician and practitioner services (fee schedule) | 48 | $84.34 |
| 31660 | Physician and practitioner services (fee schedule) | 32 | $150.35 |
| 31661 | Physician and practitioner services (fee schedule) | 32 | $158.55 |
| 31717 | Physician and practitioner services (fee schedule) | 50 | $143.59 |
| 31720 | Physician and practitioner services (fee schedule) | 50 | $40.23 |
| 31725 | Physician and practitioner services (fee schedule) | 50 | $65.36 |
| 31730 | Physician and practitioner services (fee schedule) | 48 | $411.04 |
| 31750 | Physician and practitioner services (fee schedule) | 49 | $933.22 |
| 31755 | Physician and practitioner services (fee schedule) | 49 | $1,203.13 |
| 31760 | Physician and practitioner services (fee schedule) | 50 | $1,022.54 |
| 31766 | Physician and practitioner services (fee schedule) | 49 | $1,366.42 |
| 31770 | Physician and practitioner services (fee schedule) | 50 | $1,025.73 |
| 31775 | Physician and practitioner services (fee schedule) | 50 | $1,078.53 |
| 31780 | Physician and practitioner services (fee schedule) | 50 | $875.45 |
| 31781 | Physician and practitioner services (fee schedule) | 50 | $1,056.09 |
| 31785 | Physician and practitioner services (fee schedule) | 49 | $789.46 |
| 31786 | Physician and practitioner services (fee schedule) | 50 | $1,108.78 |
| 31800 | Physician and practitioner services (fee schedule) | 50 | $515.82 |
| 31805 | Physician and practitioner services (fee schedule) | 50 | $635.58 |
| 31820 | Physician and practitioner services (fee schedule) | 50 | $307.65 |
| 31825 | Physician and practitioner services (fee schedule) | 50 | $422.73 |
| 31830 | Physician and practitioner services (fee schedule) | 50 | $333.05 |
| 31899 | Physician and practitioner services (fee schedule) | 7 | $192.07 |
| 32035 | Physician and practitioner services (fee schedule) | 50 | $537.40 |
| 32036 | Physician and practitioner services (fee schedule) | 49 | $581.90 |
| 32096 | Physician and practitioner services (fee schedule) | 49 | $600.96 |
| 32097 | Physician and practitioner services (fee schedule) | 50 | $622.81 |
| 32098 | Physician and practitioner services (fee schedule) | 50 | $584.66 |
| 32100 | Physician and practitioner services (fee schedule) | 50 | $643.52 |
| 32110 | Physician and practitioner services (fee schedule) | 50 | $1,050.80 |
| 32120 | Physician and practitioner services (fee schedule) | 50 | $662.29 |
| 32124 | Physician and practitioner services (fee schedule) | 49 | $699.30 |
| 32140 | Physician and practitioner services (fee schedule) | 50 | $745.50 |
| 32141 | Physician and practitioner services (fee schedule) | 50 | $1,082.98 |
| 32150 | Physician and practitioner services (fee schedule) | 50 | $759.33 |
| 32151 | Physician and practitioner services (fee schedule) | 50 | $740.31 |
| 32160 | Physician and practitioner services (fee schedule) | 50 | $601.40 |
| 32200 | Physician and practitioner services (fee schedule) | 50 | $821.97 |
| 32215 | Physician and practitioner services (fee schedule) | 50 | $596.67 |
| 32220 | Physician and practitioner services (fee schedule) | 50 | $1,197.95 |
| 32225 | Physician and practitioner services (fee schedule) | 50 | $750.36 |
| 32310 | Physician and practitioner services (fee schedule) | 50 | $701.23 |
| 32320 | Physician and practitioner services (fee schedule) | 50 | $1,193.33 |
| 32400 | Physician and practitioner services (fee schedule) | 50 | $99.93 |
| 32408 | Physician and practitioner services (fee schedule) | 49 | $628.58 |
| 32440 | Physician and practitioner services (fee schedule) | 49 | $1,166.34 |
| 32442 | Physician and practitioner services (fee schedule) | 49 | $2,134.02 |
| 32445 | Physician and practitioner services (fee schedule) | 49 | $2,475.62 |
| 32480 | Physician and practitioner services (fee schedule) | 49 | $1,110.19 |
| 32482 | Physician and practitioner services (fee schedule) | 49 | $1,180.56 |
| 32484 | Physician and practitioner services (fee schedule) | 49 | $1,116.95 |
| 32486 | Physician and practitioner services (fee schedule) | 49 | $1,671.01 |
| 32488 | Physician and practitioner services (fee schedule) | 49 | $1,711.33 |
| 32491 | Physician and practitioner services (fee schedule) | 41 | $1,170.77 |
| 32501 | Physician and practitioner services (fee schedule) | 50 | $191.11 |
| 32503 | Physician and practitioner services (fee schedule) | 49 | $1,325.07 |
| 32504 | Physician and practitioner services (fee schedule) | 49 | $1,576.89 |
| 32505 | Physician and practitioner services (fee schedule) | 50 | $724.26 |
| 32506 | Physician and practitioner services (fee schedule) | 50 | $114.99 |
| 32507 | Physician and practitioner services (fee schedule) | 49 | $110.88 |
| 32540 | Physician and practitioner services (fee schedule) | 49 | $1,219.51 |
| 32550 | Physician and practitioner services (fee schedule) | 49 | $525.65 |
| 32551 | Physician and practitioner services (fee schedule) | 49 | $127.44 |
| 32552 | Physician and practitioner services (fee schedule) | 48 | $141.56 |
| 32553 | Physician and practitioner services (fee schedule) | 47 | $326.47 |
| 32554 | Physician and practitioner services (fee schedule) | 49 | $175.44 |
| 32555 | Physician and practitioner services (fee schedule) | 49 | $209.82 |
| 32556 | Physician and practitioner services (fee schedule) | 49 | $466.97 |
| 32557 | Physician and practitioner services (fee schedule) | 49 | $424.07 |
| 32560 | Physician and practitioner services (fee schedule) | 49 | $200.03 |
| 32561 | Physician and practitioner services (fee schedule) | 48 | $64.38 |
| 32562 | Physician and practitioner services (fee schedule) | 48 | $57.96 |
| 32601 | Physician and practitioner services (fee schedule) | 49 | $246.05 |
| 32604 | Physician and practitioner services (fee schedule) | 49 | $380.92 |
| 32606 | Physician and practitioner services (fee schedule) | 49 | $366.04 |
| 32607 | Physician and practitioner services (fee schedule) | 49 | $244.11 |
| 32608 | Physician and practitioner services (fee schedule) | 49 | $299.60 |
| 32609 | Physician and practitioner services (fee schedule) | 49 | $202.63 |
| 32650 | Physician and practitioner services (fee schedule) | 49 | $518.91 |
| 32651 | Physician and practitioner services (fee schedule) | 49 | $817.38 |
| 32652 | Physician and practitioner services (fee schedule) | 49 | $1,220.92 |
| 32653 | Physician and practitioner services (fee schedule) | 49 | $793.53 |
| 32654 | Physician and practitioner services (fee schedule) | 49 | $877.25 |
| 32655 | Physician and practitioner services (fee schedule) | 49 | $761.33 |
| 32656 | Physician and practitioner services (fee schedule) | 49 | $645.60 |
| 32658 | Physician and practitioner services (fee schedule) | 49 | $576.06 |
| 32659 | Physician and practitioner services (fee schedule) | 49 | $590.54 |
| 32661 | Physician and practitioner services (fee schedule) | 49 | $630.20 |
| 32662 | Physician and practitioner services (fee schedule) | 49 | $715.73 |
| 32663 | Physician and practitioner services (fee schedule) | 49 | $1,077.97 |
| 32664 | Physician and practitioner services (fee schedule) | 49 | $678.41 |
| 32665 | Physician and practitioner services (fee schedule) | 49 | $915.28 |
| 32666 | Physician and practitioner services (fee schedule) | 49 | $696.20 |
| 32667 | Physician and practitioner services (fee schedule) | 48 | $120.31 |
| 32668 | Physician and practitioner services (fee schedule) | 49 | $119.57 |
| 32669 | Physician and practitioner services (fee schedule) | 49 | $1,057.15 |
| 32670 | Physician and practitioner services (fee schedule) | 49 | $1,253.12 |
| 32671 | Physician and practitioner services (fee schedule) | 49 | $1,387.15 |
| 32672 | Physician and practitioner services (fee schedule) | 49 | $1,191.47 |
| 32673 | Physician and practitioner services (fee schedule) | 49 | $959.32 |
| 32674 | Physician and practitioner services (fee schedule) | 49 | $164.47 |
| 32701 | Physician and practitioner services (fee schedule) | 45 | $164.80 |
| 32800 | Physician and practitioner services (fee schedule) | 48 | $715.83 |
| 32810 | Physician and practitioner services (fee schedule) | 49 | $689.20 |
| 32815 | Physician and practitioner services (fee schedule) | 49 | $1,969.81 |
| 32820 | Physician and practitioner services (fee schedule) | 48 | $1,034.40 |
| 32850 | Physician and practitioner services (fee schedule) | 8 | $903.46 |
| 32851 | Physician and practitioner services (fee schedule) | 45 | $2,337.44 |
| 32852 | Physician and practitioner services (fee schedule) | 46 | $2,517.95 |
| 32853 | Physician and practitioner services (fee schedule) | 46 | $3,295.31 |
| 32854 | Physician and practitioner services (fee schedule) | 46 | $3,493.67 |
| 32855 | Physician and practitioner services (fee schedule) | 17 | $191.94 |
| 32856 | Physician and practitioner services (fee schedule) | 18 | $202.67 |
| 32900 | Physician and practitioner services (fee schedule) | 49 | $1,005.06 |
| 32905 | Physician and practitioner services (fee schedule) | 49 | $986.21 |
| 32906 | Physician and practitioner services (fee schedule) | 49 | $1,223.12 |
| 32940 | Physician and practitioner services (fee schedule) | 49 | $913.87 |
| 32960 | Physician and practitioner services (fee schedule) | 49 | $91.82 |
| 32994 | Physician and practitioner services (fee schedule) | 42 | $2,826.87 |
| 32997 | Physician and practitioner services (fee schedule) | 47 | $260.06 |
| 32998 | Physician and practitioner services (fee schedule) | 41 | $2,265.01 |
| 32999 | Physician and practitioner services (fee schedule) | 8 | $429.94 |
| 33016 | Physician and practitioner services (fee schedule) | 49 | $176.79 |
| 33017 | Physician and practitioner services (fee schedule) | 49 | $185.47 |
| 33018 | Physician and practitioner services (fee schedule) | 49 | $217.35 |
| 33019 | Physician and practitioner services (fee schedule) | 49 | $155.77 |
| 33020 | Physician and practitioner services (fee schedule) | 49 | $667.96 |
| 33025 | Physician and practitioner services (fee schedule) | 49 | $630.46 |
| 33030 | Physician and practitioner services (fee schedule) | 49 | $1,406.42 |
| 33031 | Physician and practitioner services (fee schedule) | 49 | $1,766.75 |
| 33050 | Physician and practitioner services (fee schedule) | 49 | $762.71 |
| 33120 | Physician and practitioner services (fee schedule) | 49 | $1,524.34 |
| 33130 | Physician and practitioner services (fee schedule) | 48 | $1,027.21 |
| 33140 | Physician and practitioner services (fee schedule) | 45 | $1,149.63 |
| 33141 | Physician and practitioner services (fee schedule) | 44 | $107.73 |
| 33202 | Physician and practitioner services (fee schedule) | 49 | $616.26 |
| 33203 | Physician and practitioner services (fee schedule) | 47 | $605.37 |
| 33206 | Physician and practitioner services (fee schedule) | 49 | $365.26 |
| 33207 | Physician and practitioner services (fee schedule) | 49 | $389.44 |
| 33208 | Physician and practitioner services (fee schedule) | 49 | $412.14 |
| 33210 | Physician and practitioner services (fee schedule) | 49 | $133.22 |
| 33211 | Physician and practitioner services (fee schedule) | 49 | $136.81 |
| 33212 | Physician and practitioner services (fee schedule) | 49 | $259.19 |
| 33213 | Physician and practitioner services (fee schedule) | 49 | $276.56 |
| 33214 | Physician and practitioner services (fee schedule) | 49 | $374.35 |
| 33215 | Physician and practitioner services (fee schedule) | 48 | $240.24 |
| 33216 | Physician and practitioner services (fee schedule) | 49 | $296.78 |
| 33217 | Physician and practitioner services (fee schedule) | 49 | $291.78 |
| 33218 | Physician and practitioner services (fee schedule) | 49 | $291.61 |
| 33220 | Physician and practitioner services (fee schedule) | 49 | $299.72 |
| 33221 | Physician and practitioner services (fee schedule) | 49 | $276.04 |
| 33222 | Physician and practitioner services (fee schedule) | 49 | $277.33 |
| 33223 | Physician and practitioner services (fee schedule) | 49 | $326.84 |
| 33224 | Physician and practitioner services (fee schedule) | 48 | $379.19 |
| 33225 | Physician and practitioner services (fee schedule) | 48 | $339.84 |
| 33226 | Physician and practitioner services (fee schedule) | 48 | $364.39 |
| 33227 | Physician and practitioner services (fee schedule) | 49 | $261.57 |
| 33228 | Physician and practitioner services (fee schedule) | 49 | $273.15 |
| 33229 | Physician and practitioner services (fee schedule) | 49 | $280.76 |
| 33230 | Physician and practitioner services (fee schedule) | 49 | $288.48 |
| 33231 | Physician and practitioner services (fee schedule) | 49 | $302.52 |
| 33233 | Physician and practitioner services (fee schedule) | 49 | $182.62 |
| 33234 | Physician and practitioner services (fee schedule) | 49 | $377.48 |
| 33235 | Physician and practitioner services (fee schedule) | 49 | $491.90 |
| 33236 | Physician and practitioner services (fee schedule) | 49 | $622.82 |
| 33237 | Physician and practitioner services (fee schedule) | 49 | $674.49 |
| 33238 | Physician and practitioner services (fee schedule) | 49 | $754.00 |
| 33240 | Physician and practitioner services (fee schedule) | 49 | $290.60 |
| 33241 | Physician and practitioner services (fee schedule) | 49 | $169.58 |
| 33243 | Physician and practitioner services (fee schedule) | 49 | $1,025.42 |
| 33244 | Physician and practitioner services (fee schedule) | 49 | $653.20 |
| 33249 | Physician and practitioner services (fee schedule) | 49 | $721.88 |
| 33250 | Physician and practitioner services (fee schedule) | 49 | $1,094.65 |
| 33251 | Physician and practitioner services (fee schedule) | 49 | $1,269.89 |
| 33254 | Physician and practitioner services (fee schedule) | 49 | $1,016.13 |
| 33255 | Physician and practitioner services (fee schedule) | 49 | $1,219.00 |
| 33256 | Physician and practitioner services (fee schedule) | 49 | $1,434.01 |
| 33257 | Physician and practitioner services (fee schedule) | 49 | $449.68 |
| 33258 | Physician and practitioner services (fee schedule) | 48 | $500.44 |
| 33259 | Physician and practitioner services (fee schedule) | 49 | $655.55 |
| 33261 | Physician and practitioner services (fee schedule) | 48 | $1,268.92 |
| 33262 | Physician and practitioner services (fee schedule) | 49 | $280.50 |
| 33263 | Physician and practitioner services (fee schedule) | 48 | $288.30 |
| 33264 | Physician and practitioner services (fee schedule) | 49 | $302.81 |
| 33265 | Physician and practitioner services (fee schedule) | 48 | $1,012.46 |
| 33266 | Physician and practitioner services (fee schedule) | 48 | $1,359.24 |
| 33267 | Physician and practitioner services (fee schedule) | 38 | $827.40 |
| 33268 | Physician and practitioner services (fee schedule) | 39 | $104.15 |
| 33269 | Physician and practitioner services (fee schedule) | 38 | $662.05 |
| 33270 | Physician and practitioner services (fee schedule) | 47 | $434.34 |
| 33271 | Physician and practitioner services (fee schedule) | 47 | $357.71 |
| 33272 | Physician and practitioner services (fee schedule) | 47 | $279.09 |
| 33273 | Physician and practitioner services (fee schedule) | 47 | $312.85 |
| 33274 | Physician and practitioner services (fee schedule) | 37 | $379.94 |
| 33275 | Physician and practitioner services (fee schedule) | 38 | $398.12 |
| 33276 | Physician and practitioner services (fee schedule) | 37 | $435.93 |
| 33277 | Physician and practitioner services (fee schedule) | 37 | $221.06 |
| 33278 | Physician and practitioner services (fee schedule) | 37 | $430.56 |
| 33279 | Physician and practitioner services (fee schedule) | 37 | $261.48 |
| 33280 | Physician and practitioner services (fee schedule) | 37 | $158.63 |
| 33281 | Physician and practitioner services (fee schedule) | 37 | $283.05 |
| 33285 | Physician and practitioner services (fee schedule) | 49 | $2,397.99 |
| 33286 | Physician and practitioner services (fee schedule) | 49 | $90.14 |
| 33287 | Physician and practitioner services (fee schedule) | 36 | $287.78 |
| 33288 | Physician and practitioner services (fee schedule) | 36 | $383.86 |
| 33289 | Physician and practitioner services (fee schedule) | 32 | $257.11 |
| 33300 | Physician and practitioner services (fee schedule) | 49 | $1,735.96 |
| 33305 | Physician and practitioner services (fee schedule) | 49 | $2,850.65 |
| 33310 | Physician and practitioner services (fee schedule) | 49 | $891.26 |
| 33315 | Physician and practitioner services (fee schedule) | 49 | $1,387.18 |
| 33320 | Physician and practitioner services (fee schedule) | 49 | $847.49 |
| 33321 | Physician and practitioner services (fee schedule) | 49 | $961.28 |
| 33322 | Physician and practitioner services (fee schedule) | 49 | $1,121.38 |
| 33330 | Physician and practitioner services (fee schedule) | 49 | $1,095.64 |
| 33335 | Physician and practitioner services (fee schedule) | 49 | $1,387.85 |
| 33340 | Physician and practitioner services (fee schedule) | 39 | $561.64 |
| 33361 | Physician and practitioner services (fee schedule) | 49 | $924.00 |
| 33362 | Physician and practitioner services (fee schedule) | 49 | $1,006.41 |
| 33363 | Physician and practitioner services (fee schedule) | 49 | $1,045.52 |
| 33364 | Physician and practitioner services (fee schedule) | 49 | $1,078.50 |
| 33365 | Physician and practitioner services (fee schedule) | 49 | $1,103.88 |
| 33366 | Physician and practitioner services (fee schedule) | 48 | $1,213.17 |
| 33367 | Physician and practitioner services (fee schedule) | 49 | $476.00 |
| 33368 | Physician and practitioner services (fee schedule) | 49 | $576.22 |
| 33369 | Physician and practitioner services (fee schedule) | 49 | $760.51 |
| 33370 | Physician and practitioner services (fee schedule) | 37 | $104.94 |
| 33390 | Physician and practitioner services (fee schedule) | 49 | $1,514.54 |
| 33391 | Physician and practitioner services (fee schedule) | 49 | $1,810.15 |
| 33404 | Physician and practitioner services (fee schedule) | 49 | $1,400.52 |
| 33405 | Physician and practitioner services (fee schedule) | 49 | $1,778.50 |
| 33406 | Physician and practitioner services (fee schedule) | 49 | $2,118.52 |
| 33410 | Physician and practitioner services (fee schedule) | 48 | $1,871.85 |
| 33411 | Physician and practitioner services (fee schedule) | 48 | $2,424.93 |
| 33412 | Physician and practitioner services (fee schedule) | 49 | $2,291.37 |
| 33413 | Physician and practitioner services (fee schedule) | 49 | $2,350.81 |
| 33414 | Physician and practitioner services (fee schedule) | 49 | $1,671.64 |
| 33415 | Physician and practitioner services (fee schedule) | 49 | $1,579.89 |
| 33416 | Physician and practitioner services (fee schedule) | 49 | $1,591.02 |
| 33417 | Physician and practitioner services (fee schedule) | 48 | $1,294.78 |
| 33418 | Physician and practitioner services (fee schedule) | 44 | $1,382.30 |
| 33419 | Physician and practitioner services (fee schedule) | 44 | $329.62 |
| 33420 | Physician and practitioner services (fee schedule) | 49 | $1,110.12 |
| 33422 | Physician and practitioner services (fee schedule) | 49 | $1,326.10 |
| 33425 | Physician and practitioner services (fee schedule) | 49 | $1,983.09 |
| 33426 | Physician and practitioner services (fee schedule) | 49 | $1,827.40 |
| 33427 | Physician and practitioner services (fee schedule) | 49 | $1,930.99 |
| 33430 | Physician and practitioner services (fee schedule) | 49 | $2,050.80 |
| 33440 | Physician and practitioner services (fee schedule) | 48 | $2,694.39 |
| 33460 | Physician and practitioner services (fee schedule) | 49 | $1,745.40 |
| 33463 | Physician and practitioner services (fee schedule) | 49 | $2,293.21 |
| 33464 | Physician and practitioner services (fee schedule) | 49 | $1,822.21 |
| 33465 | Physician and practitioner services (fee schedule) | 49 | $1,996.03 |
| 33468 | Physician and practitioner services (fee schedule) | 49 | $1,817.94 |
| 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) | 49 | $1,583.24 |
| 33475 | Physician and practitioner services (fee schedule) | 49 | $1,801.58 |
| 33476 | Physician and practitioner services (fee schedule) | 48 | $1,209.60 |
| 33477 | Physician and practitioner services (fee schedule) | 49 | $1,006.16 |
| 33478 | Physician and practitioner services (fee schedule) | 49 | $1,244.90 |
| 33496 | Physician and practitioner services (fee schedule) | 48 | $1,339.11 |
| 33500 | Physician and practitioner services (fee schedule) | 48 | $1,253.16 |
| 33501 | Physician and practitioner services (fee schedule) | 48 | $884.47 |
| 33502 | Physician and practitioner services (fee schedule) | 48 | $967.80 |
| 33503 | Physician and practitioner services (fee schedule) | 49 | $1,061.92 |
| 33504 | Physician and practitioner services (fee schedule) | 49 | $1,168.46 |
| 33505 | Physician and practitioner services (fee schedule) | 48 | $1,522.03 |
| 33506 | Physician and practitioner services (fee schedule) | 48 | $1,582.23 |
| 33507 | Physician and practitioner services (fee schedule) | 49 | $1,342.03 |
| 33508 | Physician and practitioner services (fee schedule) | 48 | $12.28 |
| 33509 | Physician and practitioner services (fee schedule) | 47 | $135.31 |
| 33510 | Physician and practitioner services (fee schedule) | 49 | $1,534.78 |
| 33511 | Physician and practitioner services (fee schedule) | 49 | $1,668.38 |
| 33512 | Physician and practitioner services (fee schedule) | 49 | $1,858.08 |
| 33513 | Physician and practitioner services (fee schedule) | 49 | $1,941.66 |
| 33514 | Physician and practitioner services (fee schedule) | 49 | $2,054.62 |
| 33516 | Physician and practitioner services (fee schedule) | 49 | $2,139.09 |
| 33517 | Physician and practitioner services (fee schedule) | 49 | $147.22 |
| 33518 | Physician and practitioner services (fee schedule) | 49 | $313.06 |
| 33519 | Physician and practitioner services (fee schedule) | 49 | $423.59 |
| 33521 | Physician and practitioner services (fee schedule) | 49 | $508.95 |
| 33522 | Physician and practitioner services (fee schedule) | 49 | $575.44 |
| 33523 | Physician and practitioner services (fee schedule) | 49 | $655.38 |
| 33530 | Physician and practitioner services (fee schedule) | 48 | $387.34 |
| 33533 | Physician and practitioner services (fee schedule) | 49 | $1,500.74 |
| 33534 | Physician and practitioner services (fee schedule) | 49 | $1,749.22 |
| 33535 | Physician and practitioner services (fee schedule) | 49 | $1,929.34 |
| 33536 | Physician and practitioner services (fee schedule) | 49 | $2,102.40 |
| 33542 | Physician and practitioner services (fee schedule) | 49 | $1,909.83 |
| 33545 | Physician and practitioner services (fee schedule) | 49 | $2,243.06 |
| 33548 | Physician and practitioner services (fee schedule) | 45 | $2,164.59 |
| 33572 | Physician and practitioner services (fee schedule) | 49 | $181.42 |
| 33600 | Physician and practitioner services (fee schedule) | 48 | $1,360.23 |
| 33602 | Physician and practitioner services (fee schedule) | 48 | $1,321.52 |
| 33606 | Physician and practitioner services (fee schedule) | 47 | $1,409.84 |
| 33608 | Physician and practitioner services (fee schedule) | 48 | $1,442.10 |
| 33610 | Physician and practitioner services (fee schedule) | 48 | $1,404.26 |
| 33611 | Physician and practitioner services (fee schedule) | 48 | $1,538.20 |
| 33612 | Physician and practitioner services (fee schedule) | 48 | $1,583.69 |
| 33615 | Physician and practitioner services (fee schedule) | 49 | $1,583.73 |
| 33617 | Physician and practitioner services (fee schedule) | 49 | $1,708.66 |
| 33619 | Physician and practitioner services (fee schedule) | 49 | $2,151.20 |
| 33620 | Physician and practitioner services (fee schedule) | 47 | $1,286.52 |
| 33621 | Physician and practitioner services (fee schedule) | 46 | $698.73 |
| 33622 | Physician and practitioner services (fee schedule) | 47 | $2,650.52 |
| 33641 | Physician and practitioner services (fee schedule) | 49 | $1,294.35 |
| 33645 | Physician and practitioner services (fee schedule) | 49 | $1,328.88 |
| 33647 | Physician and practitioner services (fee schedule) | 49 | $1,447.59 |
| 33660 | Physician and practitioner services (fee schedule) | 49 | $1,385.38 |
| 33665 | Physician and practitioner services (fee schedule) | 49 | $1,503.45 |
| 33670 | Physician and practitioner services (fee schedule) | 49 | $1,546.76 |
| 33675 | Physician and practitioner services (fee schedule) | 48 | $1,544.13 |
| 33676 | Physician and practitioner services (fee schedule) | 48 | $1,584.44 |
| 33677 | Physician and practitioner services (fee schedule) | 47 | $1,654.34 |
| 33681 | Physician and practitioner services (fee schedule) | 49 | $1,455.46 |
| 33684 | Physician and practitioner services (fee schedule) | 49 | $1,488.10 |
| 33688 | Physician and practitioner services (fee schedule) | 49 | $1,478.87 |
| 33690 | Physician and practitioner services (fee schedule) | 49 | $931.39 |
| 33692 | Physician and practitioner services (fee schedule) | 49 | $1,516.44 |
| 33694 | Physician and practitioner services (fee schedule) | 49 | $1,536.52 |
| 33697 | Physician and practitioner services (fee schedule) | 49 | $1,632.36 |
| 33702 | Physician and practitioner services (fee schedule) | 49 | $1,228.88 |
| 33710 | Physician and practitioner services (fee schedule) | 48 | $1,606.28 |
| 33720 | Physician and practitioner services (fee schedule) | 49 | $1,222.59 |
| 33724 | Physician and practitioner services (fee schedule) | 49 | $1,162.72 |
| 33726 | Physician and practitioner services (fee schedule) | 49 | $1,524.96 |
| 33730 | Physician and practitioner services (fee schedule) | 49 | $1,546.99 |
| 33732 | Physician and practitioner services (fee schedule) | 49 | $1,309.32 |
| 33735 | Physician and practitioner services (fee schedule) | 49 | $982.04 |
| 33736 | Physician and practitioner services (fee schedule) | 49 | $1,117.91 |
| 33737 | Physician and practitioner services (fee schedule) | 7 | $1,145.31 |
| 33741 | Physician and practitioner services (fee schedule) | 47 | $562.79 |
| 33745 | Physician and practitioner services (fee schedule) | 47 | $796.52 |
| 33746 | Physician and practitioner services (fee schedule) | 45 | $313.33 |
| 33750 | Physician and practitioner services (fee schedule) | 49 | $1,001.47 |
| 33755 | Physician and practitioner services (fee schedule) | 47 | $1,047.56 |
| 33762 | Physician and practitioner services (fee schedule) | 48 | $1,015.49 |
| 33764 | Physician and practitioner services (fee schedule) | 49 | $1,051.98 |
| 33766 | Physician and practitioner services (fee schedule) | 49 | $1,050.16 |
| 33767 | Physician and practitioner services (fee schedule) | 49 | $1,142.44 |
| 33768 | Physician and practitioner services (fee schedule) | 49 | $323.24 |
| 33770 | Physician and practitioner services (fee schedule) | 49 | $1,674.50 |
| 33771 | Physician and practitioner services (fee schedule) | 49 | $1,706.56 |
| 33774 | Physician and practitioner services (fee schedule) | 49 | $1,426.05 |
| 33775 | Physician and practitioner services (fee schedule) | 49 | $1,490.36 |
| 33776 | Physician and practitioner services (fee schedule) | 49 | $1,561.01 |
| 33777 | Physician and practitioner services (fee schedule) | 49 | $1,529.32 |
| 33778 | Physician and practitioner services (fee schedule) | 49 | $1,870.99 |
| 33779 | Physician and practitioner services (fee schedule) | 49 | $1,832.20 |
| 33780 | Physician and practitioner services (fee schedule) | 49 | $1,875.72 |
| 33781 | Physician and practitioner services (fee schedule) | 49 | $1,818.10 |
| 33782 | Physician and practitioner services (fee schedule) | 47 | $2,308.97 |
| 33783 | Physician and practitioner services (fee schedule) | 46 | $2,493.76 |
| 33786 | Physician and practitioner services (fee schedule) | 49 | $1,790.12 |
| 33788 | Physician and practitioner services (fee schedule) | 48 | $1,225.17 |
| 33800 | Physician and practitioner services (fee schedule) | 49 | $783.98 |
| 33802 | Physician and practitioner services (fee schedule) | 49 | $868.67 |
| 33803 | Physician and practitioner services (fee schedule) | 47 | $906.46 |
| 33813 | Physician and practitioner services (fee schedule) | 7 | $1,068.94 |
| 33814 | Physician and practitioner services (fee schedule) | 49 | $1,213.20 |
| 33820 | Physician and practitioner services (fee schedule) | 49 | $787.50 |
| 33822 | Physician and practitioner services (fee schedule) | 49 | $814.84 |
| 33824 | Physician and practitioner services (fee schedule) | 49 | $940.88 |
| 33840 | Physician and practitioner services (fee schedule) | 49 | $989.29 |
| 33845 | Physician and practitioner services (fee schedule) | 49 | $1,065.79 |
| 33851 | Physician and practitioner services (fee schedule) | 49 | $1,015.56 |
| 33852 | Physician and practitioner services (fee schedule) | 49 | $1,113.79 |
| 33853 | Physician and practitioner services (fee schedule) | 49 | $1,480.86 |
| 33858 | Physician and practitioner services (fee schedule) | 49 | $2,662.55 |
| 33859 | Physician and practitioner services (fee schedule) | 49 | $1,927.75 |
| 33863 | Physician and practitioner services (fee schedule) | 49 | $2,274.24 |
| 33864 | Physician and practitioner services (fee schedule) | 48 | $2,307.06 |
| 33866 | Physician and practitioner services (fee schedule) | 47 | $723.73 |
| 33871 | Physician and practitioner services (fee schedule) | 48 | $2,560.16 |
| 33875 | Physician and practitioner services (fee schedule) | 48 | $1,974.81 |
| 33877 | Physician and practitioner services (fee schedule) | 48 | $2,718.82 |
| 33880 | Physician and practitioner services (fee schedule) | 49 | $1,140.55 |
| 33881 | Physician and practitioner services (fee schedule) | 49 | $959.09 |
| 33882 | Physician and practitioner services (fee schedule) | 39 | $1,371.07 |
| 33883 | Physician and practitioner services (fee schedule) | 49 | $833.04 |
| 33884 | Physician and practitioner services (fee schedule) | 10 | $334.45 |
| 33886 | Physician and practitioner services (fee schedule) | 49 | $768.77 |
| 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) | 47 | $734.66 |
| 33895 | Physician and practitioner services (fee schedule) | 47 | $584.78 |
| 33897 | Physician and practitioner services (fee schedule) | 47 | $434.61 |
| 33900 | Physician and practitioner services (fee schedule) | 45 | $442.14 |
| 33901 | Physician and practitioner services (fee schedule) | 46 | $579.25 |
| 33902 | Physician and practitioner services (fee schedule) | 46 | $559.13 |
| 33903 | Physician and practitioner services (fee schedule) | 46 | $659.74 |
| 33904 | Physician and practitioner services (fee schedule) | 45 | $222.26 |
| 33910 | Physician and practitioner services (fee schedule) | 49 | $1,840.49 |
| 33915 | Physician and practitioner services (fee schedule) | 48 | $1,015.29 |
| 33916 | Physician and practitioner services (fee schedule) | 49 | $2,910.92 |
| 33917 | Physician and practitioner services (fee schedule) | 49 | $1,183.97 |
| 33920 | Physician and practitioner services (fee schedule) | 49 | $1,443.06 |
| 33922 | Physician and practitioner services (fee schedule) | 48 | $1,115.14 |
| 33924 | Physician and practitioner services (fee schedule) | 49 | $223.96 |
| 33925 | Physician and practitioner services (fee schedule) | 48 | $1,345.16 |
| 33926 | Physician and practitioner services (fee schedule) | 49 | $1,857.21 |
| 33927 | Physician and practitioner services (fee schedule) | 32 | $2,024.43 |
| 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) | 11 | $1,271.37 |
| 33933 | Physician and practitioner services (fee schedule) | 11 | $274.79 |
| 33935 | Physician and practitioner services (fee schedule) | 44 | $3,362.86 |
| 33940 | Physician and practitioner services (fee schedule) | 12 | $1,570.60 |
| 33944 | Physician and practitioner services (fee schedule) | 18 | $206.29 |
| 33945 | Physician and practitioner services (fee schedule) | 46 | $3,490.20 |
| 33946 | Physician and practitioner services (fee schedule) | 48 | $242.04 |
| 33947 | Physician and practitioner services (fee schedule) | 48 | $266.78 |
| 33948 | Physician and practitioner services (fee schedule) | 48 | $187.95 |
| 33949 | Physician and practitioner services (fee schedule) | 48 | $181.73 |
| 33951 | Physician and practitioner services (fee schedule) | 48 | $331.54 |
| 33952 | Physician and practitioner services (fee schedule) | 48 | $326.44 |
| 33953 | Physician and practitioner services (fee schedule) | 48 | $368.32 |
| 33954 | Physician and practitioner services (fee schedule) | 48 | $363.23 |
| 33955 | Physician and practitioner services (fee schedule) | 48 | $648.40 |
| 33956 | Physician and practitioner services (fee schedule) | 48 | $649.75 |
| 33957 | Physician and practitioner services (fee schedule) | 48 | $147.37 |
| 33958 | Physician and practitioner services (fee schedule) | 48 | $149.04 |
| 33959 | Physician and practitioner services (fee schedule) | 48 | $186.09 |
| 33962 | Physician and practitioner services (fee schedule) | 48 | $186.09 |
| 33963 | Physician and practitioner services (fee schedule) | 47 | $367.04 |
| 33964 | Physician and practitioner services (fee schedule) | 48 | $388.92 |
| 33965 | Physician and practitioner services (fee schedule) | 48 | $147.37 |
| 33966 | Physician and practitioner services (fee schedule) | 48 | $186.97 |
| 33967 | Physician and practitioner services (fee schedule) | 49 | $198.21 |
| 33968 | Physician and practitioner services (fee schedule) | 48 | $26.66 |
| 33969 | Physician and practitioner services (fee schedule) | 48 | $215.75 |
| 33970 | Physician and practitioner services (fee schedule) | 48 | $268.65 |
| 33971 | Physician and practitioner services (fee schedule) | 47 | $530.10 |
| 33973 | Physician and practitioner services (fee schedule) | 48 | $397.01 |
| 33974 | Physician and practitioner services (fee schedule) | 47 | $714.04 |
| 33975 | Physician and practitioner services (fee schedule) | 48 | $1,005.70 |
| 33976 | Physician and practitioner services (fee schedule) | 48 | $1,221.88 |
| 33977 | Physician and practitioner services (fee schedule) | 48 | $891.15 |
| 33978 | Physician and practitioner services (fee schedule) | 48 | $1,040.11 |
| 33979 | Physician and practitioner services (fee schedule) | 48 | $1,493.93 |
| 33980 | Physician and practitioner services (fee schedule) | 42 | $1,389.12 |
| 33981 | Physician and practitioner services (fee schedule) | 40 | $661.33 |
| 33982 | Physician and practitioner services (fee schedule) | 39 | $1,515.71 |
| 33983 | Physician and practitioner services (fee schedule) | 39 | $1,782.30 |
| 33984 | Physician and practitioner services (fee schedule) | 48 | $223.66 |
| 33985 | Physician and practitioner services (fee schedule) | 48 | $405.31 |
| 33986 | Physician and practitioner services (fee schedule) | 48 | $413.12 |
| 33987 | Physician and practitioner services (fee schedule) | 47 | $163.12 |
| 33988 | Physician and practitioner services (fee schedule) | 48 | $603.21 |
| 33989 | Physician and practitioner services (fee schedule) | 47 | $383.33 |
| 33990 | Physician and practitioner services (fee schedule) | 48 | $269.74 |
| 33991 | Physician and practitioner services (fee schedule) | 47 | $360.24 |
| 33992 | Physician and practitioner services (fee schedule) | 48 | $142.19 |
| 33993 | Physician and practitioner services (fee schedule) | 47 | $122.20 |
| 33995 | Physician and practitioner services (fee schedule) | 45 | $270.83 |
| 33997 | Physician and practitioner services (fee schedule) | 45 | $120.95 |
| 33999 | Physician and practitioner services (fee schedule) | 8 | $1,021.87 |
| 34001 | Physician and practitioner services (fee schedule) | 49 | $694.62 |
| 34051 | Physician and practitioner services (fee schedule) | 49 | $750.74 |
| 34101 | Physician and practitioner services (fee schedule) | 49 | $469.00 |
| 34111 | Physician and practitioner services (fee schedule) | 48 | $457.53 |
| 34151 | Physician and practitioner services (fee schedule) | 49 | $979.19 |
| 34201 | Physician and practitioner services (fee schedule) | 49 | $718.43 |
| 34203 | Physician and practitioner services (fee schedule) | 49 | $699.30 |
| 34401 | Physician and practitioner services (fee schedule) | 49 | $943.36 |
| 34421 | Physician and practitioner services (fee schedule) | 49 | $534.59 |
| 34451 | Physician and practitioner services (fee schedule) | 49 | $1,009.18 |
| 34471 | Physician and practitioner services (fee schedule) | 49 | $760.64 |
| 34490 | Physician and practitioner services (fee schedule) | 49 | $457.18 |
| 34501 | Physician and practitioner services (fee schedule) | 48 | $637.50 |
| 34502 | Physician and practitioner services (fee schedule) | 48 | $1,225.32 |
| 34510 | Physician and practitioner services (fee schedule) | 48 | $722.97 |
| 34520 | Physician and practitioner services (fee schedule) | 48 | $700.98 |
| 34530 | Physician and practitioner services (fee schedule) | 48 | $737.59 |
| 34701 | Physician and practitioner services (fee schedule) | 48 | $948.11 |
| 34702 | Physician and practitioner services (fee schedule) | 48 | $1,385.31 |
| 34703 | Physician and practitioner services (fee schedule) | 48 | $1,052.86 |
| 34704 | Physician and practitioner services (fee schedule) | 48 | $1,734.66 |
| 34705 | Physician and practitioner services (fee schedule) | 48 | $1,168.71 |
| 34706 | Physician and practitioner services (fee schedule) | 48 | $1,745.08 |
| 34707 | Physician and practitioner services (fee schedule) | 48 | $893.74 |
| 34708 | Physician and practitioner services (fee schedule) | 48 | $1,403.61 |
| 34709 | Physician and practitioner services (fee schedule) | 48 | $246.00 |
| 34710 | Physician and practitioner services (fee schedule) | 49 | $618.34 |
| 34711 | Physician and practitioner services (fee schedule) | 49 | $226.86 |
| 34712 | Physician and practitioner services (fee schedule) | 48 | $510.70 |
| 34713 | Physician and practitioner services (fee schedule) | 48 | $94.03 |
| 34714 | Physician and practitioner services (fee schedule) | 48 | $208.37 |
| 34715 | Physician and practitioner services (fee schedule) | 48 | $229.46 |
| 34716 | Physician and practitioner services (fee schedule) | 48 | $287.49 |
| 34717 | Physician and practitioner services (fee schedule) | 47 | $341.94 |
| 34718 | Physician and practitioner services (fee schedule) | 47 | $961.86 |
| 34808 | Physician and practitioner services (fee schedule) | 48 | $156.98 |
| 34812 | Physician and practitioner services (fee schedule) | 49 | $161.98 |
| 34813 | Physician and practitioner services (fee schedule) | 48 | $182.60 |
| 34820 | Physician and practitioner services (fee schedule) | 48 | $263.79 |
| 34830 | Physician and practitioner services (fee schedule) | 48 | $1,372.18 |
| 34831 | Physician and practitioner services (fee schedule) | 48 | $1,485.23 |
| 34832 | Physician and practitioner services (fee schedule) | 48 | $1,474.78 |
| 34833 | Physician and practitioner services (fee schedule) | 47 | $307.65 |
| 34834 | Physician and practitioner services (fee schedule) | 47 | $102.15 |
| 34841 | Physician and practitioner services (fee schedule) | 26 | $1,177.81 |
| 34842 | Physician and practitioner services (fee schedule) | 27 | $1,216.23 |
| 34843 | Physician and practitioner services (fee schedule) | 26 | $1,325.43 |
| 34844 | Physician and practitioner services (fee schedule) | 26 | $1,492.68 |
| 34845 | Physician and practitioner services (fee schedule) | 28 | $1,386.05 |
| 34846 | Physician and practitioner services (fee schedule) | 27 | $1,495.92 |
| 34847 | Physician and practitioner services (fee schedule) | 28 | $1,558.54 |
| 34848 | Physician and practitioner services (fee schedule) | 26 | $1,637.58 |
| 35001 | Physician and practitioner services (fee schedule) | 49 | $868.56 |
| 35002 | Physician and practitioner services (fee schedule) | 48 | $896.89 |
| 35005 | Physician and practitioner services (fee schedule) | 48 | $776.95 |
| 35011 | Physician and practitioner services (fee schedule) | 48 | $762.29 |
| 35013 | Physician and practitioner services (fee schedule) | 48 | $929.78 |
| 35021 | Physician and practitioner services (fee schedule) | 49 | $978.27 |
| 35022 | Physician and practitioner services (fee schedule) | 49 | $1,140.86 |
| 35045 | Physician and practitioner services (fee schedule) | 47 | $711.54 |
| 35081 | Physician and practitioner services (fee schedule) | 49 | $1,224.04 |
| 35082 | Physician and practitioner services (fee schedule) | 49 | $1,647.79 |
| 35091 | Physician and practitioner services (fee schedule) | 49 | $1,375.47 |
| 35092 | Physician and practitioner services (fee schedule) | 49 | $1,936.81 |
| 35102 | Physician and practitioner services (fee schedule) | 49 | $1,423.35 |
| 35103 | Physician and practitioner services (fee schedule) | 49 | $1,683.66 |
| 35111 | Physician and practitioner services (fee schedule) | 49 | $999.15 |
| 35112 | Physician and practitioner services (fee schedule) | 49 | $1,149.51 |
| 35121 | Physician and practitioner services (fee schedule) | 49 | $1,212.55 |
| 35122 | Physician and practitioner services (fee schedule) | 49 | $1,478.81 |
| 35131 | Physician and practitioner services (fee schedule) | 49 | $979.34 |
| 35132 | Physician and practitioner services (fee schedule) | 49 | $1,242.95 |
| 35141 | Physician and practitioner services (fee schedule) | 49 | $833.91 |
| 35142 | Physician and practitioner services (fee schedule) | 49 | $1,005.46 |
| 35151 | Physician and practitioner services (fee schedule) | 49 | $932.72 |
| 35152 | Physician and practitioner services (fee schedule) | 49 | $983.87 |
| 35180 | Physician and practitioner services (fee schedule) | 48 | $609.00 |
| 35182 | Physician and practitioner services (fee schedule) | 47 | $1,285.76 |
| 35184 | Physician and practitioner services (fee schedule) | 47 | $696.41 |
| 35188 | Physician and practitioner services (fee schedule) | 49 | $867.67 |
| 35189 | Physician and practitioner services (fee schedule) | 48 | $1,061.20 |
| 35190 | Physician and practitioner services (fee schedule) | 49 | $585.91 |
| 35201 | Physician and practitioner services (fee schedule) | 49 | $668.98 |
| 35206 | Physician and practitioner services (fee schedule) | 49 | $583.17 |
| 35207 | Physician and practitioner services (fee schedule) | 49 | $571.51 |
| 35211 | Physician and practitioner services (fee schedule) | 49 | $1,073.04 |
| 35216 | Physician and practitioner services (fee schedule) | 49 | $1,483.55 |
| 35221 | Physician and practitioner services (fee schedule) | 49 | $1,042.53 |
| 35226 | Physician and practitioner services (fee schedule) | 49 | $601.56 |
| 35231 | Physician and practitioner services (fee schedule) | 49 | $860.51 |
| 35236 | Physician and practitioner services (fee schedule) | 49 | $713.33 |
| 35241 | Physician and practitioner services (fee schedule) | 49 | $1,135.86 |
| 35246 | Physician and practitioner services (fee schedule) | 49 | $1,165.20 |
| 35251 | Physician and practitioner services (fee schedule) | 49 | $1,214.95 |
| 35256 | Physician and practitioner services (fee schedule) | 49 | $725.16 |
| 35261 | Physician and practitioner services (fee schedule) | 49 | $722.49 |
| 35266 | Physician and practitioner services (fee schedule) | 49 | $612.80 |
| 35271 | Physician and practitioner services (fee schedule) | 49 | $1,059.83 |
| 35276 | Physician and practitioner services (fee schedule) | 49 | $1,088.79 |
| 35281 | Physician and practitioner services (fee schedule) | 49 | $1,154.62 |
| 35286 | Physician and practitioner services (fee schedule) | 49 | $687.02 |
| 35301 | Physician and practitioner services (fee schedule) | 49 | $860.95 |
| 35302 | Physician and practitioner services (fee schedule) | 49 | $851.83 |
| 35303 | Physician and practitioner services (fee schedule) | 49 | $937.39 |
| 35304 | Physician and practitioner services (fee schedule) | 49 | $965.50 |
| 35305 | Physician and practitioner services (fee schedule) | 49 | $929.30 |
| 35306 | Physician and practitioner services (fee schedule) | 49 | $344.03 |
| 35311 | Physician and practitioner services (fee schedule) | 49 | $1,145.38 |
| 35321 | Physician and practitioner services (fee schedule) | 49 | $712.00 |
| 35331 | Physician and practitioner services (fee schedule) | 49 | $1,072.46 |
| 35341 | Physician and practitioner services (fee schedule) | 49 | $1,046.93 |
| 35351 | Physician and practitioner services (fee schedule) | 49 | $994.13 |
| 35355 | Physician and practitioner services (fee schedule) | 49 | $807.87 |
| 35361 | Physician and practitioner services (fee schedule) | 49 | $1,185.72 |
| 35363 | Physician and practitioner services (fee schedule) | 48 | $1,264.04 |
| 35371 | Physician and practitioner services (fee schedule) | 49 | $641.96 |
| 35372 | Physician and practitioner services (fee schedule) | 49 | $761.06 |
| 35390 | Physician and practitioner services (fee schedule) | 48 | $123.84 |
| 35400 | Physician and practitioner services (fee schedule) | 48 | $113.12 |
| 35500 | Physician and practitioner services (fee schedule) | 46 | $244.75 |
| 35501 | Physician and practitioner services (fee schedule) | 49 | $1,119.94 |
| 35506 | Physician and practitioner services (fee schedule) | 49 | $993.59 |
| 35508 | Physician and practitioner services (fee schedule) | 48 | $1,030.93 |
| 35509 | Physician and practitioner services (fee schedule) | 49 | $1,092.21 |
| 35510 | Physician and practitioner services (fee schedule) | 48 | $958.36 |
| 35511 | Physician and practitioner services (fee schedule) | 49 | $873.24 |
| 35512 | Physician and practitioner services (fee schedule) | 49 | $939.56 |
| 35515 | Physician and practitioner services (fee schedule) | 49 | $987.74 |
| 35516 | Physician and practitioner services (fee schedule) | 49 | $936.57 |
| 35518 | Physician and practitioner services (fee schedule) | 48 | $896.48 |
| 35521 | Physician and practitioner services (fee schedule) | 49 | $958.76 |
| 35522 | Physician and practitioner services (fee schedule) | 49 | $911.82 |
| 35523 | Physician and practitioner services (fee schedule) | 48 | $954.45 |
| 35525 | Physician and practitioner services (fee schedule) | 49 | $858.07 |
| 35526 | Physician and practitioner services (fee schedule) | 49 | $1,271.32 |
| 35531 | Physician and practitioner services (fee schedule) | 49 | $1,369.14 |
| 35533 | Physician and practitioner services (fee schedule) | 48 | $1,169.98 |
| 35535 | Physician and practitioner services (fee schedule) | 48 | $1,485.44 |
| 35536 | Physician and practitioner services (fee schedule) | 49 | $1,309.46 |
| 35537 | Physician and practitioner services (fee schedule) | 49 | $1,619.72 |
| 35538 | Physician and practitioner services (fee schedule) | 49 | $1,814.51 |
| 35539 | Physician and practitioner services (fee schedule) | 49 | $1,705.73 |
| 35540 | Physician and practitioner services (fee schedule) | 49 | $1,901.33 |
| 35556 | Physician and practitioner services (fee schedule) | 49 | $1,045.93 |
| 35558 | Physician and practitioner services (fee schedule) | 49 | $894.82 |
| 35560 | Physician and practitioner services (fee schedule) | 48 | $1,317.29 |
| 35563 | Physician and practitioner services (fee schedule) | 49 | $932.33 |
| 35565 | Physician and practitioner services (fee schedule) | 49 | $965.59 |
| 35566 | Physician and practitioner services (fee schedule) | 49 | $1,245.24 |
| 35570 | Physician and practitioner services (fee schedule) | 48 | $1,152.90 |
| 35571 | Physician and practitioner services (fee schedule) | 49 | $1,010.81 |
| 35572 | Physician and practitioner services (fee schedule) | 48 | $264.61 |
| 35583 | Physician and practitioner services (fee schedule) | 49 | $1,096.47 |
| 35585 | Physician and practitioner services (fee schedule) | 49 | $1,287.06 |
| 35587 | Physician and practitioner services (fee schedule) | 49 | $1,038.98 |
| 35600 | Physician and practitioner services (fee schedule) | 48 | $148.16 |
| 35601 | Physician and practitioner services (fee schedule) | 49 | $999.72 |
| 35602 | Physician and practitioner services (fee schedule) | 39 | $896.09 |
| 35606 | Physician and practitioner services (fee schedule) | 49 | $922.45 |
| 35612 | Physician and practitioner services (fee schedule) | 49 | $803.03 |
| 35616 | Physician and practitioner services (fee schedule) | 49 | $862.03 |
| 35621 | Physician and practitioner services (fee schedule) | 49 | $857.93 |
| 35623 | Physician and practitioner services (fee schedule) | 49 | $925.62 |
| 35626 | Physician and practitioner services (fee schedule) | 49 | $1,240.74 |
| 35631 | Physician and practitioner services (fee schedule) | 49 | $1,301.50 |
| 35632 | Physician and practitioner services (fee schedule) | 48 | $1,410.31 |
| 35633 | Physician and practitioner services (fee schedule) | 49 | $1,544.69 |
| 35634 | Physician and practitioner services (fee schedule) | 49 | $1,383.97 |
| 35636 | Physician and practitioner services (fee schedule) | 49 | $1,127.66 |
| 35637 | Physician and practitioner services (fee schedule) | 49 | $1,272.70 |
| 35638 | Physician and practitioner services (fee schedule) | 49 | $1,229.75 |
| 35642 | Physician and practitioner services (fee schedule) | 48 | $779.11 |
| 35645 | Physician and practitioner services (fee schedule) | 48 | $747.72 |
| 35646 | Physician and practitioner services (fee schedule) | 49 | $1,321.88 |
| 35647 | Physician and practitioner services (fee schedule) | 48 | $1,174.62 |
| 35650 | Physician and practitioner services (fee schedule) | 49 | $805.76 |
| 35654 | Physician and practitioner services (fee schedule) | 49 | $1,065.18 |
| 35656 | Physician and practitioner services (fee schedule) | 49 | $835.45 |
| 35661 | Physician and practitioner services (fee schedule) | 49 | $825.29 |
| 35663 | Physician and practitioner services (fee schedule) | 49 | $908.67 |
| 35665 | Physician and practitioner services (fee schedule) | 48 | $910.68 |
| 35666 | Physician and practitioner services (fee schedule) | 49 | $998.41 |
| 35671 | Physician and practitioner services (fee schedule) | 49 | $879.51 |
| 35681 | Physician and practitioner services (fee schedule) | 47 | $62.94 |
| 35682 | Physician and practitioner services (fee schedule) | 49 | $275.83 |
| 35683 | Physician and practitioner services (fee schedule) | 48 | $320.31 |
| 35685 | Physician and practitioner services (fee schedule) | 47 | $153.36 |
| 35686 | Physician and practitioner services (fee schedule) | 48 | $125.82 |
| 35691 | Physician and practitioner services (fee schedule) | 49 | $747.23 |
| 35693 | Physician and practitioner services (fee schedule) | 49 | $663.81 |
| 35694 | Physician and practitioner services (fee schedule) | 49 | $778.62 |
| 35695 | Physician and practitioner services (fee schedule) | 49 | $801.60 |
| 35697 | Physician and practitioner services (fee schedule) | 49 | $113.36 |
| 35700 | Physician and practitioner services (fee schedule) | 48 | $117.39 |
| 35701 | Physician and practitioner services (fee schedule) | 49 | $331.15 |
| 35702 | Physician and practitioner services (fee schedule) | 48 | $320.02 |
| 35703 | Physician and practitioner services (fee schedule) | 48 | $329.87 |
| 35800 | Physician and practitioner services (fee schedule) | 48 | $503.50 |
| 35820 | Physician and practitioner services (fee schedule) | 49 | $1,437.54 |
| 35840 | Physician and practitioner services (fee schedule) | 49 | $836.68 |
| 35860 | Physician and practitioner services (fee schedule) | 49 | $583.16 |
| 35870 | Physician and practitioner services (fee schedule) | 48 | $966.35 |
| 35875 | Physician and practitioner services (fee schedule) | 49 | $463.60 |
| 35876 | Physician and practitioner services (fee schedule) | 49 | $717.79 |
| 35879 | Physician and practitioner services (fee schedule) | 49 | $719.63 |
| 35881 | Physician and practitioner services (fee schedule) | 49 | $798.37 |
| 35883 | Physician and practitioner services (fee schedule) | 48 | $920.63 |
| 35884 | Physician and practitioner services (fee schedule) | 48 | $926.66 |
| 35901 | Physician and practitioner services (fee schedule) | 49 | $380.41 |
| 35903 | Physician and practitioner services (fee schedule) | 49 | $445.24 |
| 35905 | Physician and practitioner services (fee schedule) | 49 | $1,179.56 |
| 35907 | Physician and practitioner services (fee schedule) | 49 | $1,338.05 |
| 36000 | Physician and practitioner services (fee schedule) | 39 | $18.00 |
| 36002 | Physician and practitioner services (fee schedule) | 48 | $113.53 |
| 36005 | Physician and practitioner services (fee schedule) | 49 | $180.02 |
| 36010 | Physician and practitioner services (fee schedule) | 49 | $272.83 |
| 36011 | Physician and practitioner services (fee schedule) | 49 | $511.91 |
| 36012 | Physician and practitioner services (fee schedule) | 49 | $524.18 |
| 36013 | Physician and practitioner services (fee schedule) | 49 | $494.37 |
| 36014 | Physician and practitioner services (fee schedule) | 49 | $491.17 |
| 36015 | Physician and practitioner services (fee schedule) | 49 | $520.21 |
| 36100 | Physician and practitioner services (fee schedule) | 49 | $329.09 |
| 36140 | Physician and practitioner services (fee schedule) | 49 | $258.47 |
| 36160 | Physician and practitioner services (fee schedule) | 49 | $347.83 |
| 36200 | Physician and practitioner services (fee schedule) | 49 | $300.07 |
| 36215 | Physician and practitioner services (fee schedule) | 49 | $678.62 |
| 36216 | Physician and practitioner services (fee schedule) | 49 | $689.06 |
| 36217 | Physician and practitioner services (fee schedule) | 49 | $1,260.11 |
| 36218 | Physician and practitioner services (fee schedule) | 49 | $151.28 |
| 36221 | Physician and practitioner services (fee schedule) | 49 | $606.87 |
| 36222 | Physician and practitioner services (fee schedule) | 49 | $751.34 |
| 36223 | Physician and practitioner services (fee schedule) | 49 | $994.28 |
| 36224 | Physician and practitioner services (fee schedule) | 49 | $1,247.21 |
| 36225 | Physician and practitioner services (fee schedule) | 49 | $943.76 |
| 36226 | Physician and practitioner services (fee schedule) | 49 | $1,202.66 |
| 36227 | Physician and practitioner services (fee schedule) | 49 | $152.74 |
| 36228 | Physician and practitioner services (fee schedule) | 49 | $775.14 |
| 36245 | Physician and practitioner services (fee schedule) | 49 | $780.10 |
| 36246 | Physician and practitioner services (fee schedule) | 49 | $533.39 |
| 36247 | Physician and practitioner services (fee schedule) | 49 | $890.36 |
| 36248 | Physician and practitioner services (fee schedule) | 49 | $78.83 |
| 36251 | Physician and practitioner services (fee schedule) | 49 | $808.91 |
| 36252 | Physician and practitioner services (fee schedule) | 48 | $893.97 |
| 36253 | Physician and practitioner services (fee schedule) | 49 | $1,264.84 |
| 36254 | Physician and practitioner services (fee schedule) | 49 | $1,257.09 |
| 36260 | Physician and practitioner services (fee schedule) | 49 | $511.97 |
| 36261 | Physician and practitioner services (fee schedule) | 48 | $297.94 |
| 36262 | Physician and practitioner services (fee schedule) | 48 | $235.09 |
| 36299 | Physician and practitioner services (fee schedule) | 6 | $107.70 |
| 36400 | Physician and practitioner services (fee schedule) | 46 | $18.68 |
| 36405 | Physician and practitioner services (fee schedule) | 46 | $18.48 |
| 36406 | Physician and practitioner services (fee schedule) | 46 | $14.85 |
| 36410 | Physician and practitioner services (fee schedule) | 43 | $13.73 |
| 36415 | Physician and practitioner services (fee schedule) | 42 | $7.27 |
| 36416 | Physician and practitioner services (fee schedule) | 27 | $3.40 |
| 36420 | Physician and practitioner services (fee schedule) | 48 | $39.55 |
| 36425 | Physician and practitioner services (fee schedule) | 48 | $29.88 |
| 36430 | Physician and practitioner services (fee schedule) | 49 | $34.35 |
| 36440 | Physician and practitioner services (fee schedule) | 48 | $40.28 |
| 36450 | Physician and practitioner services (fee schedule) | 49 | $124.31 |
| 36455 | Physician and practitioner services (fee schedule) | 48 | $101.23 |
| 36456 | Physician and practitioner services (fee schedule) | 44 | $77.03 |
| 36460 | Physician and practitioner services (fee schedule) | 49 | $257.81 |
| 36465 | Physician and practitioner services (fee schedule) | 43 | $1,004.25 |
| 36466 | Physician and practitioner services (fee schedule) | 43 | $1,047.98 |
| 36468 | Physician and practitioner services (fee schedule) | 18 | $41.08 |
| 36470 | Physician and practitioner services (fee schedule) | 45 | $77.11 |
| 36471 | Physician and practitioner services (fee schedule) | 46 | $122.82 |
| 36473 | Physician and practitioner services (fee schedule) | 41 | $783.19 |
| 36474 | Physician and practitioner services (fee schedule) | 41 | $159.35 |
| 36475 | Physician and practitioner services (fee schedule) | 49 | $811.52 |
| 36476 | Physician and practitioner services (fee schedule) | 49 | $192.03 |
| 36478 | Physician and practitioner services (fee schedule) | 49 | $770.42 |
| 36479 | Physician and practitioner services (fee schedule) | 49 | $233.62 |
| 36481 | Physician and practitioner services (fee schedule) | 49 | $986.51 |
| 36482 | Physician and practitioner services (fee schedule) | 37 | $1,296.82 |
| 36483 | Physician and practitioner services (fee schedule) | 37 | $103.78 |
| 36500 | Physician and practitioner services (fee schedule) | 49 | $136.07 |
| 36510 | Physician and practitioner services (fee schedule) | 49 | $58.95 |
| 36511 | Physician and practitioner services (fee schedule) | 48 | $78.49 |
| 36512 | Physician and practitioner services (fee schedule) | 48 | $74.51 |
| 36513 | Physician and practitioner services (fee schedule) | 47 | $76.39 |
| 36514 | Physician and practitioner services (fee schedule) | 48 | $443.37 |
| 36516 | Physician and practitioner services (fee schedule) | 46 | $1,453.80 |
| 36522 | Physician and practitioner services (fee schedule) | 47 | $772.15 |
| 36555 | Physician and practitioner services (fee schedule) | 49 | $154.75 |
| 36556 | Physician and practitioner services (fee schedule) | 49 | $174.69 |
| 36557 | Physician and practitioner services (fee schedule) | 49 | $686.24 |
| 36558 | Physician and practitioner services (fee schedule) | 49 | $520.94 |
| 36560 | Physician and practitioner services (fee schedule) | 49 | $894.89 |
| 36561 | Physician and practitioner services (fee schedule) | 49 | $645.27 |
| 36563 | Physician and practitioner services (fee schedule) | 49 | $852.17 |
| 36565 | Physician and practitioner services (fee schedule) | 49 | $578.52 |
| 36566 | Physician and practitioner services (fee schedule) | 49 | $2,394.38 |
| 36568 | Physician and practitioner services (fee schedule) | 49 | $72.63 |
| 36569 | Physician and practitioner services (fee schedule) | 49 | $74.89 |
| 36570 | Physician and practitioner services (fee schedule) | 49 | $1,038.71 |
| 36571 | Physician and practitioner services (fee schedule) | 49 | $879.38 |
| 36572 | Physician and practitioner services (fee schedule) | 49 | $244.78 |
| 36573 | Physician and practitioner services (fee schedule) | 49 | $245.52 |
| 36575 | Physician and practitioner services (fee schedule) | 49 | $99.09 |
| 36576 | Physician and practitioner services (fee schedule) | 49 | $240.83 |
| 36578 | Physician and practitioner services (fee schedule) | 49 | $294.51 |
| 36580 | Physician and practitioner services (fee schedule) | 49 | $129.77 |
| 36581 | Physician and practitioner services (fee schedule) | 49 | $483.30 |
| 36582 | Physician and practitioner services (fee schedule) | 49 | $574.76 |
| 36583 | Physician and practitioner services (fee schedule) | 49 | $623.78 |
| 36584 | Physician and practitioner services (fee schedule) | 49 | $201.05 |
| 36585 | Physician and practitioner services (fee schedule) | 48 | $964.53 |
| 36589 | Physician and practitioner services (fee schedule) | 49 | $131.35 |
| 36590 | Physician and practitioner services (fee schedule) | 49 | $178.46 |
| 36591 | Physician and practitioner services (fee schedule) | 41 | $22.22 |
| 36592 | Physician and practitioner services (fee schedule) | 40 | $23.72 |
| 36593 | Physician and practitioner services (fee schedule) | 49 | $29.58 |
| 36595 | Physician and practitioner services (fee schedule) | 48 | $452.92 |
| 36596 | Physician and practitioner services (fee schedule) | 49 | $90.56 |
| 36597 | Physician and practitioner services (fee schedule) | 49 | $76.86 |
| 36598 | Physician and practitioner services (fee schedule) | 48 | $91.64 |
| 36600 | Physician and practitioner services (fee schedule) | 47 | $18.54 |
| 36620 | Physician and practitioner services (fee schedule) | 50 | $38.82 |
| 36625 | Physician and practitioner services (fee schedule) | 49 | $82.75 |
| 36640 | Physician and practitioner services (fee schedule) | 49 | $90.94 |
| 36660 | Physician and practitioner services (fee schedule) | 49 | $49.99 |
| 36680 | Physician and practitioner services (fee schedule) | 49 | $49.98 |
| 36800 | Physician and practitioner services (fee schedule) | 49 | $101.52 |
| 36810 | Physician and practitioner services (fee schedule) | 49 | $166.72 |
| 36815 | Physician and practitioner services (fee schedule) | 49 | $111.21 |
| 36818 | Physician and practitioner services (fee schedule) | 49 | $537.03 |
| 36819 | Physician and practitioner services (fee schedule) | 49 | $574.94 |
| 36820 | Physician and practitioner services (fee schedule) | 48 | $570.38 |
| 36821 | Physician and practitioner services (fee schedule) | 49 | $471.67 |
| 36823 | Physician and practitioner services (fee schedule) | 44 | $1,042.89 |
| 36825 | Physician and practitioner services (fee schedule) | 49 | $562.93 |
| 36830 | Physician and practitioner services (fee schedule) | 49 | $510.42 |
| 36831 | Physician and practitioner services (fee schedule) | 49 | $439.05 |
| 36832 | Physician and practitioner services (fee schedule) | 49 | $539.67 |
| 36833 | Physician and practitioner services (fee schedule) | 49 | $572.79 |
| 36835 | Physician and practitioner services (fee schedule) | 48 | $390.14 |
| 36836 | Physician and practitioner services (fee schedule) | 43 | $4,571.27 |
| 36837 | Physician and practitioner services (fee schedule) | 43 | $5,427.73 |
| 36838 | Physician and practitioner services (fee schedule) | 48 | $888.78 |
| 36860 | Physician and practitioner services (fee schedule) | 48 | $139.89 |
| 36861 | Physician and practitioner services (fee schedule) | 48 | $109.76 |
| 36901 | Physician and practitioner services (fee schedule) | 49 | $429.95 |
| 36902 | Physician and practitioner services (fee schedule) | 49 | $798.84 |
| 36903 | Physician and practitioner services (fee schedule) | 49 | $3,263.63 |
| 36904 | Physician and practitioner services (fee schedule) | 49 | $1,165.55 |
| 36905 | Physician and practitioner services (fee schedule) | 49 | $1,476.48 |
| 36906 | Physician and practitioner services (fee schedule) | 49 | $3,948.69 |
| 36907 | Physician and practitioner services (fee schedule) | 49 | $387.75 |
| 36908 | Physician and practitioner services (fee schedule) | 49 | $1,086.57 |
| 36909 | Physician and practitioner services (fee schedule) | 49 | $1,224.53 |
| 37140 | Physician and practitioner services (fee schedule) | 49 | $1,646.72 |
| 37145 | Physician and practitioner services (fee schedule) | 49 | $1,391.59 |
| 37160 | Physician and practitioner services (fee schedule) | 49 | $1,520.61 |
| 37180 | Physician and practitioner services (fee schedule) | 49 | $1,461.62 |
| 37181 | Physician and practitioner services (fee schedule) | 49 | $1,605.76 |
| 37182 | Physician and practitioner services (fee schedule) | 49 | $631.25 |
| 37183 | Physician and practitioner services (fee schedule) | 49 | $2,901.50 |
| 37184 | Physician and practitioner services (fee schedule) | 49 | $1,293.34 |
| 37185 | Physician and practitioner services (fee schedule) | 49 | $353.94 |
| 37186 | Physician and practitioner services (fee schedule) | 48 | $833.07 |
| 37187 | Physician and practitioner services (fee schedule) | 49 | $1,267.97 |
| 37188 | Physician and practitioner services (fee schedule) | 49 | $1,093.53 |
| 37191 | Physician and practitioner services (fee schedule) | 49 | $1,259.46 |
| 37192 | Physician and practitioner services (fee schedule) | 49 | $881.52 |
| 37193 | Physician and practitioner services (fee schedule) | 49 | $929.88 |
| 37195 | Physician and practitioner services (fee schedule) | 44 | $251.28 |
| 37197 | Physician and practitioner services (fee schedule) | 48 | $909.63 |
| 37200 | Physician and practitioner services (fee schedule) | 49 | $170.76 |
| 37211 | Physician and practitioner services (fee schedule) | 49 | $291.21 |
| 37212 | Physician and practitioner services (fee schedule) | 49 | $255.21 |
| 37213 | Physician and practitioner services (fee schedule) | 49 | $175.35 |
| 37214 | Physician and practitioner services (fee schedule) | 49 | $95.91 |
| 37215 | Physician and practitioner services (fee schedule) | 49 | $784.86 |
| 37216 | Physician and practitioner services (fee schedule) | 43 | $748.89 |
| 37217 | Physician and practitioner services (fee schedule) | 48 | $830.60 |
| 37218 | Physician and practitioner services (fee schedule) | 47 | $642.65 |
| 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) | 48 | $1,608.08 |
| 37237 | Physician and practitioner services (fee schedule) | 49 | $796.90 |
| 37238 | Physician and practitioner services (fee schedule) | 48 | $2,099.92 |
| 37239 | Physician and practitioner services (fee schedule) | 49 | $1,069.45 |
| 37241 | Physician and practitioner services (fee schedule) | 48 | $2,712.50 |
| 37242 | Physician and practitioner services (fee schedule) | 48 | $4,225.51 |
| 37243 | Physician and practitioner services (fee schedule) | 48 | $5,111.41 |
| 37244 | Physician and practitioner services (fee schedule) | 48 | $3,715.35 |
| 37246 | Physician and practitioner services (fee schedule) | 48 | $1,129.68 |
| 37247 | Physician and practitioner services (fee schedule) | 48 | $399.74 |
| 37248 | Physician and practitioner services (fee schedule) | 49 | $874.06 |
| 37249 | Physician and practitioner services (fee schedule) | 49 | $316.66 |
| 37252 | Physician and practitioner services (fee schedule) | 48 | $628.26 |
| 37253 | Physician and practitioner services (fee schedule) | 48 | $120.05 |
| 37254 | Physician and practitioner services (fee schedule) | 42 | $1,340.26 |
| 37255 | Physician and practitioner services (fee schedule) | 42 | $332.83 |
| 37256 | Physician and practitioner services (fee schedule) | 42 | $1,578.15 |
| 37257 | Physician and practitioner services (fee schedule) | 42 | $378.23 |
| 37258 | Physician and practitioner services (fee schedule) | 42 | $2,292.75 |
| 37259 | Physician and practitioner services (fee schedule) | 42 | $779.26 |
| 37260 | Physician and practitioner services (fee schedule) | 42 | $5,403.99 |
| 37261 | Physician and practitioner services (fee schedule) | 42 | $2,151.76 |
| 37262 | Physician and practitioner services (fee schedule) | 34 | $2,142.73 |
| 37263 | Physician and practitioner services (fee schedule) | 42 | $3,532.96 |
| 37264 | Physician and practitioner services (fee schedule) | 42 | $1,420.16 |
| 37265 | Physician and practitioner services (fee schedule) | 42 | $4,445.62 |
| 37266 | Physician and practitioner services (fee schedule) | 42 | $1,590.00 |
| 37267 | Physician and practitioner services (fee schedule) | 42 | $3,394.01 |
| 37268 | Physician and practitioner services (fee schedule) | 42 | $2,182.52 |
| 37269 | Physician and practitioner services (fee schedule) | 42 | $7,511.29 |
| 37270 | Physician and practitioner services (fee schedule) | 41 | $2,249.19 |
| 37271 | Physician and practitioner services (fee schedule) | 42 | $6,849.68 |
| 37272 | Physician and practitioner services (fee schedule) | 42 | $1,522.66 |
| 37273 | Physician and practitioner services (fee schedule) | 42 | $8,583.34 |
| 37274 | Physician and practitioner services (fee schedule) | 42 | $1,624.77 |
| 37275 | Physician and practitioner services (fee schedule) | 42 | $6,570.23 |
| 37276 | Physician and practitioner services (fee schedule) | 42 | $2,247.80 |
| 37277 | Physician and practitioner services (fee schedule) | 42 | $10,007.32 |
| 37278 | Physician and practitioner services (fee schedule) | 42 | $2,522.12 |
| 37279 | Physician and practitioner services (fee schedule) | 34 | $2,913.80 |
| 37280 | Physician and practitioner services (fee schedule) | 42 | $1,745.22 |
| 37281 | Physician and practitioner services (fee schedule) | 42 | $476.90 |
| 37282 | Physician and practitioner services (fee schedule) | 42 | $3,916.61 |
| 37283 | Physician and practitioner services (fee schedule) | 42 | $561.41 |
| 37284 | Physician and practitioner services (fee schedule) | 42 | $3,612.19 |
| 37285 | Physician and practitioner services (fee schedule) | 42 | $1,783.34 |
| 37286 | Physician and practitioner services (fee schedule) | 42 | $6,634.73 |
| 37287 | Physician and practitioner services (fee schedule) | 42 | $3,157.83 |
| 37288 | Physician and practitioner services (fee schedule) | 42 | $4,997.94 |
| 37289 | Physician and practitioner services (fee schedule) | 42 | $599.81 |
| 37290 | Physician and practitioner services (fee schedule) | 42 | $6,821.32 |
| 37291 | Physician and practitioner services (fee schedule) | 42 | $702.34 |
| 37292 | Physician and practitioner services (fee schedule) | 41 | $6,577.51 |
| 37293 | Physician and practitioner services (fee schedule) | 42 | $2,250.69 |
| 37294 | Physician and practitioner services (fee schedule) | 42 | $9,719.83 |
| 37295 | Physician and practitioner services (fee schedule) | 42 | $3,841.55 |
| 37296 | Physician and practitioner services (fee schedule) | 42 | $1,997.86 |
| 37297 | Physician and practitioner services (fee schedule) | 42 | $548.93 |
| 37298 | Physician and practitioner services (fee schedule) | 42 | $2,250.44 |
| 37299 | Physician and practitioner services (fee schedule) | 42 | $597.56 |
| 37500 | Physician and practitioner services (fee schedule) | 13 | $520.60 |
| 37501 | Physician and practitioner services (fee schedule) | 5 | $437.90 |
| 37565 | Physician and practitioner services (fee schedule) | 48 | $519.25 |
| 37600 | Physician and practitioner services (fee schedule) | 48 | $522.34 |
| 37605 | Physician and practitioner services (fee schedule) | 49 | $521.85 |
| 37606 | Physician and practitioner services (fee schedule) | 49 | $496.51 |
| 37607 | Physician and practitioner services (fee schedule) | 49 | $289.90 |
| 37609 | Physician and practitioner services (fee schedule) | 49 | $193.68 |
| 37615 | Physician and practitioner services (fee schedule) | 49 | $366.84 |
| 37616 | Physician and practitioner services (fee schedule) | 48 | $839.33 |
| 37617 | Physician and practitioner services (fee schedule) | 49 | $936.73 |
| 37618 | Physician and practitioner services (fee schedule) | 49 | $290.43 |
| 37619 | Physician and practitioner services (fee schedule) | 49 | $1,255.41 |
| 37650 | Physician and practitioner services (fee schedule) | 49 | $344.57 |
| 37660 | Physician and practitioner services (fee schedule) | 49 | $945.59 |
| 37700 | Physician and practitioner services (fee schedule) | 49 | $197.34 |
| 37718 | Physician and practitioner services (fee schedule) | 49 | $309.85 |
| 37722 | Physician and practitioner services (fee schedule) | 49 | $363.23 |
| 37735 | Physician and practitioner services (fee schedule) | 49 | $458.82 |
| 37760 | Physician and practitioner services (fee schedule) | 49 | $458.31 |
| 37761 | Physician and practitioner services (fee schedule) | 48 | $381.35 |
| 37765 | Physician and practitioner services (fee schedule) | 47 | $327.94 |
| 37766 | Physician and practitioner services (fee schedule) | 47 | $392.72 |
| 37780 | Physician and practitioner services (fee schedule) | 49 | $177.84 |
| 37785 | Physician and practitioner services (fee schedule) | 49 | $239.90 |
| 37788 | Physician and practitioner services (fee schedule) | 39 | $967.88 |
| 37790 | Physician and practitioner services (fee schedule) | 42 | $388.20 |
| 37799 | Physician and practitioner services (fee schedule) | 9 | $520.81 |
| 38100 | Physician and practitioner services (fee schedule) | 49 | $835.16 |
| 38101 | Physician and practitioner services (fee schedule) | 49 | $842.13 |
| 38102 | Physician and practitioner services (fee schedule) | 48 | $200.18 |
| 38115 | Physician and practitioner services (fee schedule) | 49 | $930.98 |
| 38120 | Physician and practitioner services (fee schedule) | 48 | $799.27 |
| 38129 | Physician and practitioner services (fee schedule) | 7 | $130.00 |
| 38200 | Physician and practitioner services (fee schedule) | 49 | $94.95 |
| 38204 | Physician and practitioner services (fee schedule) | 11 | $73.59 |
| 38205 | Physician and practitioner services (fee schedule) | 39 | $63.50 |
| 38206 | Physician and practitioner services (fee schedule) | 43 | $60.97 |
| 38207 | Physician and practitioner services (fee schedule) | 25 | $36.02 |
| 38208 | Physician and practitioner services (fee schedule) | 24 | $24.07 |
| 38209 | Physician and practitioner services (fee schedule) | 22 | $10.72 |
| 38210 | Physician and practitioner services (fee schedule) | 20 | $56.68 |
| 38211 | Physician and practitioner services (fee schedule) | 19 | $50.08 |
| 38212 | Physician and practitioner services (fee schedule) | 20 | $36.26 |
| 38213 | Physician and practitioner services (fee schedule) | 19 | $9.47 |
| 38214 | Physician and practitioner services (fee schedule) | 20 | $30.03 |
| 38215 | Physician and practitioner services (fee schedule) | 19 | $36.47 |
| 38220 | Physician and practitioner services (fee schedule) | 49 | $128.76 |
| 38221 | Physician and practitioner services (fee schedule) | 49 | $134.22 |
| 38222 | Physician and practitioner services (fee schedule) | 49 | $119.68 |
| 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) | 38 | $215.17 |
| 38230 | Physician and practitioner services (fee schedule) | 47 | $168.30 |
| 38232 | Physician and practitioner services (fee schedule) | 47 | $136.86 |
| 38240 | Physician and practitioner services (fee schedule) | 47 | $171.71 |
| 38241 | Physician and practitioner services (fee schedule) | 47 | $123.60 |
| 38242 | Physician and practitioner services (fee schedule) | 46 | $84.94 |
| 38243 | Physician and practitioner services (fee schedule) | 44 | $91.23 |
| 38300 | Physician and practitioner services (fee schedule) | 49 | $210.40 |
| 38305 | Physician and practitioner services (fee schedule) | 49 | $370.77 |
| 38308 | Physician and practitioner services (fee schedule) | 49 | $322.81 |
| 38380 | Physician and practitioner services (fee schedule) | 49 | $414.13 |
| 38381 | Physician and practitioner services (fee schedule) | 49 | $619.05 |
| 38382 | Physician and practitioner services (fee schedule) | 48 | $524.36 |
| 38500 | Physician and practitioner services (fee schedule) | 49 | $246.73 |
| 38505 | Physician and practitioner services (fee schedule) | 49 | $107.28 |
| 38510 | Physician and practitioner services (fee schedule) | 49 | $370.64 |
| 38520 | Physician and practitioner services (fee schedule) | 49 | $347.05 |
| 38525 | Physician and practitioner services (fee schedule) | 49 | $336.24 |
| 38530 | Physician and practitioner services (fee schedule) | 49 | $389.46 |
| 38531 | Physician and practitioner services (fee schedule) | 49 | $367.04 |
| 38542 | Physician and practitioner services (fee schedule) | 48 | $369.64 |
| 38550 | Physician and practitioner services (fee schedule) | 49 | $402.64 |
| 38555 | Physician and practitioner services (fee schedule) | 49 | $764.34 |
| 38562 | Physician and practitioner services (fee schedule) | 47 | $555.73 |
| 38564 | Physician and practitioner services (fee schedule) | 48 | $527.63 |
| 38570 | Physician and practitioner services (fee schedule) | 49 | $400.70 |
| 38571 | Physician and practitioner services (fee schedule) | 49 | $520.51 |
| 38572 | Physician and practitioner services (fee schedule) | 49 | $694.86 |
| 38573 | Physician and practitioner services (fee schedule) | 49 | $926.52 |
| 38589 | Physician and practitioner services (fee schedule) | 7 | $130.00 |
| 38700 | Physician and practitioner services (fee schedule) | 49 | $595.37 |
| 38720 | Physician and practitioner services (fee schedule) | 49 | $968.90 |
| 38724 | Physician and practitioner services (fee schedule) | 49 | $1,027.01 |
| 38740 | Physician and practitioner services (fee schedule) | 49 | $510.24 |
| 38745 | Physician and practitioner services (fee schedule) | 49 | $653.32 |
| 38746 | Physician and practitioner services (fee schedule) | 49 | $169.05 |
| 38747 | Physician and practitioner services (fee schedule) | 49 | $201.11 |
| 38760 | Physician and practitioner services (fee schedule) | 49 | $607.08 |
| 38765 | Physician and practitioner services (fee schedule) | 49 | $954.70 |
| 38770 | Physician and practitioner services (fee schedule) | 49 | $639.34 |
| 38780 | Physician and practitioner services (fee schedule) | 49 | $817.64 |
| 38790 | Physician and practitioner services (fee schedule) | 48 | $68.62 |
| 38792 | Physician and practitioner services (fee schedule) | 48 | $51.89 |
| 38794 | Physician and practitioner services (fee schedule) | 46 | $222.45 |
| 38900 | Physician and practitioner services (fee schedule) | 49 | $112.74 |
| 38999 | Physician and practitioner services (fee schedule) | 8 | $224.22 |
| 39000 | Physician and practitioner services (fee schedule) | 49 | $386.31 |
| 39010 | Physician and practitioner services (fee schedule) | 49 | $616.01 |
| 39200 | Physician and practitioner services (fee schedule) | 49 | $683.47 |
| 39220 | Physician and practitioner services (fee schedule) | 49 | $880.26 |
| 39401 | Physician and practitioner services (fee schedule) | 48 | $248.28 |
| 39402 | Physician and practitioner services (fee schedule) | 48 | $322.27 |
| 39499 | Physician and practitioner services (fee schedule) | 5 | $70.00 |
| 39501 | Physician and practitioner services (fee schedule) | 49 | $666.50 |
| 39503 | Physician and practitioner services (fee schedule) | 49 | $4,154.42 |
| 39540 | Physician and practitioner services (fee schedule) | 49 | $680.26 |
| 39541 | Physician and practitioner services (fee schedule) | 49 | $710.84 |
| 39545 | Physician and practitioner services (fee schedule) | 49 | $680.45 |
| 39560 | Physician and practitioner services (fee schedule) | 49 | $618.19 |
| 39561 | Physician and practitioner services (fee schedule) | 49 | $947.12 |
| 39599 | Physician and practitioner services (fee schedule) | 5 | $70.00 |
| 40490 | Physician and practitioner services (fee schedule) | 50 | $77.09 |
| 40500 | Physician and practitioner services (fee schedule) | 50 | $359.94 |
| 40510 | Physician and practitioner services (fee schedule) | 50 | $346.10 |
| 40520 | Physician and practitioner services (fee schedule) | 50 | $350.64 |
| 40525 | Physician and practitioner services (fee schedule) | 49 | $442.29 |
| 40527 | Physician and practitioner services (fee schedule) | 50 | $521.31 |
| 40530 | Physician and practitioner services (fee schedule) | 50 | $380.36 |
| 40650 | Physician and practitioner services (fee schedule) | 50 | $323.81 |
| 40652 | Physician and practitioner services (fee schedule) | 50 | $369.43 |
| 40654 | Physician and practitioner services (fee schedule) | 50 | $400.68 |
| 40700 | Physician and practitioner services (fee schedule) | 50 | $732.90 |
| 40701 | Physician and practitioner services (fee schedule) | 50 | $914.40 |
| 40702 | Physician and practitioner services (fee schedule) | 50 | $724.69 |
| 40720 | Physician and practitioner services (fee schedule) | 49 | $770.28 |
| 40761 | Physician and practitioner services (fee schedule) | 50 | $793.19 |
| 40799 | Physician and practitioner services (fee schedule) | 6 | $103.08 |
| 40800 | Physician and practitioner services (fee schedule) | 50 | $114.90 |
| 40801 | Physician and practitioner services (fee schedule) | 50 | $190.58 |
| 40804 | Physician and practitioner services (fee schedule) | 50 | $113.64 |
| 40805 | Physician and practitioner services (fee schedule) | 49 | $185.95 |
| 40806 | Physician and practitioner services (fee schedule) | 47 | $51.36 |
| 40808 | Physician and practitioner services (fee schedule) | 50 | $104.91 |
| 40810 | Physician and practitioner services (fee schedule) | 49 | $128.29 |
| 40812 | Physician and practitioner services (fee schedule) | 50 | $176.72 |
| 40814 | Physician and practitioner services (fee schedule) | 50 | $257.95 |
| 40816 | Physician and practitioner services (fee schedule) | 50 | $275.82 |
| 40818 | Physician and practitioner services (fee schedule) | 48 | $237.02 |
| 40819 | Physician and practitioner services (fee schedule) | 48 | $186.04 |
| 40820 | Physician and practitioner services (fee schedule) | 50 | $160.69 |
| 40830 | Physician and practitioner services (fee schedule) | 50 | $138.87 |
| 40831 | Physician and practitioner services (fee schedule) | 50 | $192.59 |
| 40840 | Physician and practitioner services (fee schedule) | 48 | $514.09 |
| 40842 | Physician and practitioner services (fee schedule) | 46 | $539.61 |
| 40843 | Physician and practitioner services (fee schedule) | 46 | $706.74 |
| 40844 | Physician and practitioner services (fee schedule) | 46 | $925.99 |
| 40845 | Physician and practitioner services (fee schedule) | 47 | $1,087.40 |
| 40899 | Physician and practitioner services (fee schedule) | 7 | $78.87 |
| 41000 | Physician and practitioner services (fee schedule) | 50 | $102.35 |
| 41005 | Physician and practitioner services (fee schedule) | 50 | $119.84 |
| 41006 | Physician and practitioner services (fee schedule) | 50 | $219.13 |
| 41007 | Physician and practitioner services (fee schedule) | 50 | $214.09 |
| 41008 | Physician and practitioner services (fee schedule) | 50 | $252.28 |
| 41009 | Physician and practitioner services (fee schedule) | 50 | $271.27 |
| 41010 | Physician and practitioner services (fee schedule) | 50 | $126.48 |
| 41015 | Physician and practitioner services (fee schedule) | 50 | $269.61 |
| 41016 | Physician and practitioner services (fee schedule) | 50 | $312.16 |
| 41017 | Physician and practitioner services (fee schedule) | 50 | $318.23 |
| 41018 | Physician and practitioner services (fee schedule) | 50 | $358.55 |
| 41019 | Physician and practitioner services (fee schedule) | 49 | $345.26 |
| 41100 | Physician and practitioner services (fee schedule) | 50 | $110.21 |
| 41105 | Physician and practitioner services (fee schedule) | 49 | $114.00 |
| 41108 | Physician and practitioner services (fee schedule) | 50 | $97.22 |
| 41110 | Physician and practitioner services (fee schedule) | 50 | $128.53 |
| 41112 | Physician and practitioner services (fee schedule) | 50 | $228.08 |
| 41113 | Physician and practitioner services (fee schedule) | 49 | $248.28 |
| 41114 | Physician and practitioner services (fee schedule) | 49 | $470.95 |
| 41115 | Physician and practitioner services (fee schedule) | 50 | $161.85 |
| 41116 | Physician and practitioner services (fee schedule) | 50 | $211.03 |
| 41120 | Physician and practitioner services (fee schedule) | 49 | $760.35 |
| 41130 | Physician and practitioner services (fee schedule) | 50 | $928.81 |
| 41135 | Physician and practitioner services (fee schedule) | 50 | $1,471.41 |
| 41140 | Physician and practitioner services (fee schedule) | 50 | $1,532.23 |
| 41145 | Physician and practitioner services (fee schedule) | 50 | $1,852.65 |
| 41150 | Physician and practitioner services (fee schedule) | 50 | $1,532.48 |
| 41153 | Physician and practitioner services (fee schedule) | 50 | $1,682.79 |
| 41155 | Physician and practitioner services (fee schedule) | 50 | $2,092.64 |
| 41250 | Physician and practitioner services (fee schedule) | 50 | $152.21 |
| 41251 | Physician and practitioner services (fee schedule) | 50 | $189.08 |
| 41252 | Physician and practitioner services (fee schedule) | 50 | $202.93 |
| 41510 | Physician and practitioner services (fee schedule) | 48 | $352.71 |
| 41512 | Physician and practitioner services (fee schedule) | 39 | $515.73 |
| 41520 | Physician and practitioner services (fee schedule) | 49 | $242.95 |
| 41530 | Physician and practitioner services (fee schedule) | 39 | $530.08 |
| 41599 | Physician and practitioner services (fee schedule) | 8 | $164.83 |
| 41800 | Physician and practitioner services (fee schedule) | 50 | $161.53 |
| 41805 | Physician and practitioner services (fee schedule) | 50 | $184.50 |
| 41806 | Physician and practitioner services (fee schedule) | 50 | $244.24 |
| 41820 | Physician and practitioner services (fee schedule) | 35 | $125.00 |
| 41821 | Physician and practitioner services (fee schedule) | 30 | $39.06 |
| 41822 | Physician and practitioner services (fee schedule) | 48 | $210.01 |
| 41823 | Physician and practitioner services (fee schedule) | 48 | $326.08 |
| 41825 | Physician and practitioner services (fee schedule) | 49 | $127.68 |
| 41826 | Physician and practitioner services (fee schedule) | 49 | $180.62 |
| 41827 | Physician and practitioner services (fee schedule) | 50 | $271.47 |
| 41828 | Physician and practitioner services (fee schedule) | 46 | $230.49 |
| 41830 | Physician and practitioner services (fee schedule) | 48 | $313.94 |
| 41850 | Physician and practitioner services (fee schedule) | 32 | $33.01 |
| 41870 | Physician and practitioner services (fee schedule) | 27 | $215.24 |
| 41872 | Physician and practitioner services (fee schedule) | 45 | $307.54 |
| 41874 | Physician and practitioner services (fee schedule) | 46 | $260.59 |
| 41899 | Physician and practitioner services (fee schedule) | 10 | $75.00 |
| 42000 | Physician and practitioner services (fee schedule) | 50 | $100.87 |
| 42100 | Physician and practitioner services (fee schedule) | 50 | $101.12 |
| 42104 | Physician and practitioner services (fee schedule) | 50 | $126.77 |
| 42106 | Physician and practitioner services (fee schedule) | 50 | $166.80 |
| 42107 | Physician and practitioner services (fee schedule) | 48 | $312.13 |
| 42120 | Physician and practitioner services (fee schedule) | 49 | $709.43 |
| 42140 | Physician and practitioner services (fee schedule) | 50 | $154.52 |
| 42145 | Physician and practitioner services (fee schedule) | 50 | $529.04 |
| 42160 | Physician and practitioner services (fee schedule) | 50 | $146.37 |
| 42180 | Physician and practitioner services (fee schedule) | 50 | $170.90 |
| 42182 | Physician and practitioner services (fee schedule) | 50 | $229.68 |
| 42200 | Physician and practitioner services (fee schedule) | 50 | $682.62 |
| 42205 | Physician and practitioner services (fee schedule) | 50 | $698.28 |
| 42210 | Physician and practitioner services (fee schedule) | 49 | $810.82 |
| 42215 | Physician and practitioner services (fee schedule) | 50 | $531.65 |
| 42220 | Physician and practitioner services (fee schedule) | 49 | $438.88 |
| 42225 | Physician and practitioner services (fee schedule) | 49 | $757.38 |
| 42226 | Physician and practitioner services (fee schedule) | 50 | $692.01 |
| 42227 | Physician and practitioner services (fee schedule) | 49 | $635.66 |
| 42235 | Physician and practitioner services (fee schedule) | 50 | $545.00 |
| 42260 | Physician and practitioner services (fee schedule) | 50 | $552.96 |
| 42280 | Physician and practitioner services (fee schedule) | 46 | $112.23 |
| 42281 | Physician and practitioner services (fee schedule) | 47 | $154.00 |
| 42299 | Physician and practitioner services (fee schedule) | 5 | $70.00 |
| 42300 | Physician and practitioner services (fee schedule) | 50 | $143.70 |
| 42305 | Physician and practitioner services (fee schedule) | 50 | $316.08 |
| 42310 | Physician and practitioner services (fee schedule) | 50 | $123.42 |
| 42320 | Physician and practitioner services (fee schedule) | 50 | $167.13 |
| 42330 | Physician and practitioner services (fee schedule) | 50 | $153.55 |
| 42335 | Physician and practitioner services (fee schedule) | 50 | $271.58 |
| 42340 | Physician and practitioner services (fee schedule) | 50 | $344.70 |
| 42400 | Physician and practitioner services (fee schedule) | 50 | $59.62 |
| 42405 | Physician and practitioner services (fee schedule) | 50 | $207.22 |
| 42408 | Physician and practitioner services (fee schedule) | 50 | $328.62 |
| 42409 | Physician and practitioner services (fee schedule) | 50 | $240.30 |
| 42410 | Physician and practitioner services (fee schedule) | 49 | $465.38 |
| 42415 | Physician and practitioner services (fee schedule) | 49 | $813.01 |
| 42420 | Physician and practitioner services (fee schedule) | 49 | $911.09 |
| 42425 | Physician and practitioner services (fee schedule) | 49 | $632.81 |
| 42426 | Physician and practitioner services (fee schedule) | 50 | $1,008.64 |
| 42440 | Physician and practitioner services (fee schedule) | 49 | $339.54 |
| 42450 | Physician and practitioner services (fee schedule) | 50 | $322.27 |
| 42500 | Physician and practitioner services (fee schedule) | 49 | $315.97 |
| 42505 | Physician and practitioner services (fee schedule) | 49 | $422.47 |
| 42507 | Physician and practitioner services (fee schedule) | 48 | $369.58 |
| 42509 | Physician and practitioner services (fee schedule) | 47 | $616.37 |
| 42510 | Physician and practitioner services (fee schedule) | 47 | $463.13 |
| 42550 | Physician and practitioner services (fee schedule) | 50 | $73.09 |
| 42600 | Physician and practitioner services (fee schedule) | 50 | $341.50 |
| 42650 | Physician and practitioner services (fee schedule) | 50 | $52.15 |
| 42660 | Physician and practitioner services (fee schedule) | 50 | $69.55 |
| 42665 | Physician and practitioner services (fee schedule) | 50 | $201.85 |
| 42699 | Physician and practitioner services (fee schedule) | 7 | $132.98 |
| 42700 | Physician and practitioner services (fee schedule) | 50 | $129.69 |
| 42720 | Physician and practitioner services (fee schedule) | 50 | $306.52 |
| 42725 | Physician and practitioner services (fee schedule) | 49 | $566.69 |
| 42800 | Physician and practitioner services (fee schedule) | 50 | $107.70 |
| 42804 | Physician and practitioner services (fee schedule) | 50 | $114.22 |
| 42806 | Physician and practitioner services (fee schedule) | 50 | $144.60 |
| 42808 | Physician and practitioner services (fee schedule) | 50 | $161.07 |
| 42809 | Physician and practitioner services (fee schedule) | 50 | $127.50 |
| 42810 | Physician and practitioner services (fee schedule) | 50 | $259.51 |
| 42815 | Physician and practitioner services (fee schedule) | 49 | $412.10 |
| 42820 | Physician and practitioner services (fee schedule) | 49 | $220.92 |
| 42821 | Physician and practitioner services (fee schedule) | 49 | $235.82 |
| 42825 | Physician and practitioner services (fee schedule) | 49 | $204.99 |
| 42826 | Physician and practitioner services (fee schedule) | 49 | $201.93 |
| 42830 | Physician and practitioner services (fee schedule) | 49 | $162.43 |
| 42831 | Physician and practitioner services (fee schedule) | 49 | $175.11 |
| 42835 | Physician and practitioner services (fee schedule) | 49 | $150.47 |
| 42836 | Physician and practitioner services (fee schedule) | 49 | $187.31 |
| 42842 | Physician and practitioner services (fee schedule) | 50 | $738.08 |
| 42844 | Physician and practitioner services (fee schedule) | 49 | $983.15 |
| 42845 | Physician and practitioner services (fee schedule) | 50 | $1,528.26 |
| 42860 | Physician and practitioner services (fee schedule) | 50 | $147.89 |
| 42870 | Physician and practitioner services (fee schedule) | 50 | $439.21 |
| 42890 | Physician and practitioner services (fee schedule) | 50 | $990.38 |
| 42892 | Physician and practitioner services (fee schedule) | 49 | $1,315.52 |
| 42894 | Physician and practitioner services (fee schedule) | 49 | $1,661.33 |
| 42900 | Physician and practitioner services (fee schedule) | 50 | $258.18 |
| 42950 | Physician and practitioner services (fee schedule) | 49 | $586.73 |
| 42953 | Physician and practitioner services (fee schedule) | 48 | $732.15 |
| 42955 | Physician and practitioner services (fee schedule) | 49 | $543.03 |
| 42960 | Physician and practitioner services (fee schedule) | 50 | $121.39 |
| 42961 | Physician and practitioner services (fee schedule) | 50 | $301.51 |
| 42962 | Physician and practitioner services (fee schedule) | 50 | $383.33 |
| 42970 | Physician and practitioner services (fee schedule) | 50 | $288.96 |
| 42971 | Physician and practitioner services (fee schedule) | 50 | $323.18 |
| 42972 | Physician and practitioner services (fee schedule) | 50 | $366.48 |
| 42975 | Physician and practitioner services (fee schedule) | 41 | $83.34 |
| 42999 | Physician and practitioner services (fee schedule) | 9 | $70.00 |
| 43020 | Physician and practitioner services (fee schedule) | 49 | $429.43 |
| 43030 | Physician and practitioner services (fee schedule) | 49 | $397.85 |
| 43045 | Physician and practitioner services (fee schedule) | 49 | $980.36 |
| 43100 | Physician and practitioner services (fee schedule) | 50 | $471.53 |
| 43101 | Physician and practitioner services (fee schedule) | 50 | $753.83 |
| 43107 | Physician and practitioner services (fee schedule) | 49 | $2,068.49 |
| 43108 | Physician and practitioner services (fee schedule) | 49 | $3,166.93 |
| 43112 | Physician and practitioner services (fee schedule) | 49 | $2,356.14 |
| 43113 | Physician and practitioner services (fee schedule) | 48 | $3,115.83 |
| 43116 | Physician and practitioner services (fee schedule) | 49 | $3,539.29 |
| 43117 | Physician and practitioner services (fee schedule) | 49 | $2,268.22 |
| 43118 | Physician and practitioner services (fee schedule) | 49 | $2,608.62 |
| 43121 | Physician and practitioner services (fee schedule) | 49 | $2,081.73 |
| 43122 | Physician and practitioner services (fee schedule) | 49 | $1,817.10 |
| 43123 | Physician and practitioner services (fee schedule) | 49 | $3,214.23 |
| 43124 | Physician and practitioner services (fee schedule) | 48 | $2,762.40 |
| 43130 | Physician and practitioner services (fee schedule) | 49 | $596.55 |
| 43135 | Physician and practitioner services (fee schedule) | 49 | $1,038.71 |
| 43180 | Physician and practitioner services (fee schedule) | 49 | $425.06 |
| 43191 | Physician and practitioner services (fee schedule) | 50 | $110.11 |
| 43192 | Physician and practitioner services (fee schedule) | 49 | $122.33 |
| 43193 | Physician and practitioner services (fee schedule) | 50 | $130.53 |
| 43194 | Physician and practitioner services (fee schedule) | 49 | $132.82 |
| 43195 | Physician and practitioner services (fee schedule) | 50 | $138.76 |
| 43196 | Physician and practitioner services (fee schedule) | 49 | $150.31 |
| 43197 | Physician and practitioner services (fee schedule) | 50 | $116.06 |
| 43198 | Physician and practitioner services (fee schedule) | 50 | $135.22 |
| 43200 | Physician and practitioner services (fee schedule) | 50 | $167.52 |
| 43201 | Physician and practitioner services (fee schedule) | 49 | $186.99 |
| 43202 | Physician and practitioner services (fee schedule) | 50 | $234.30 |
| 43204 | Physician and practitioner services (fee schedule) | 50 | $122.89 |
| 43205 | Physician and practitioner services (fee schedule) | 50 | $124.53 |
| 43206 | Physician and practitioner services (fee schedule) | 28 | $248.16 |
| 43210 | Physician and practitioner services (fee schedule) | 41 | $333.01 |
| 43211 | Physician and practitioner services (fee schedule) | 49 | $180.48 |
| 43212 | Physician and practitioner services (fee schedule) | 49 | $147.78 |
| 43213 | Physician and practitioner services (fee schedule) | 49 | $676.11 |
| 43214 | Physician and practitioner services (fee schedule) | 50 | $151.14 |
| 43215 | Physician and practitioner services (fee schedule) | 50 | $227.54 |
| 43216 | Physician and practitioner services (fee schedule) | 50 | $243.07 |
| 43217 | Physician and practitioner services (fee schedule) | 50 | $262.36 |
| 43220 | Physician and practitioner services (fee schedule) | 50 | $340.86 |
| 43226 | Physician and practitioner services (fee schedule) | 50 | $237.50 |
| 43227 | Physician and practitioner services (fee schedule) | 50 | $358.06 |
| 43229 | Physician and practitioner services (fee schedule) | 49 | $411.59 |
| 43231 | Physician and practitioner services (fee schedule) | 49 | $132.02 |
| 43232 | Physician and practitioner services (fee schedule) | 49 | $168.71 |
| 43233 | Physician and practitioner services (fee schedule) | 49 | $178.32 |
| 43235 | Physician and practitioner services (fee schedule) | 50 | $215.32 |
| 43236 | Physician and practitioner services (fee schedule) | 50 | $262.66 |
| 43237 | Physician and practitioner services (fee schedule) | 50 | $153.76 |
| 43238 | Physician and practitioner services (fee schedule) | 49 | $183.60 |
| 43239 | Physician and practitioner services (fee schedule) | 50 | $270.53 |
| 43240 | Physician and practitioner services (fee schedule) | 49 | $305.63 |
| 43241 | Physician and practitioner services (fee schedule) | 49 | $120.65 |
| 43242 | Physician and practitioner services (fee schedule) | 50 | $212.44 |
| 43243 | Physician and practitioner services (fee schedule) | 50 | $198.92 |
| 43244 | Physician and practitioner services (fee schedule) | 50 | $205.82 |
| 43245 | Physician and practitioner services (fee schedule) | 50 | $324.78 |
| 43246 | Physician and practitioner services (fee schedule) | 50 | $167.69 |
| 43247 | Physician and practitioner services (fee schedule) | 50 | $224.89 |
| 43248 | Physician and practitioner services (fee schedule) | 50 | $260.61 |
| 43249 | Physician and practitioner services (fee schedule) | 50 | $584.18 |
| 43250 | Physician and practitioner services (fee schedule) | 50 | $289.83 |
| 43251 | Physician and practitioner services (fee schedule) | 49 | $288.87 |
| 43252 | Physician and practitioner services (fee schedule) | 32 | $272.34 |
| 43253 | Physician and practitioner services (fee schedule) | 49 | $200.74 |
| 43254 | Physician and practitioner services (fee schedule) | 49 | $205.15 |
| 43255 | Physician and practitioner services (fee schedule) | 50 | $305.81 |
| 43257 | Physician and practitioner services (fee schedule) | 40 | $197.54 |
| 43259 | Physician and practitioner services (fee schedule) | 50 | $190.17 |
| 43260 | Physician and practitioner services (fee schedule) | 50 | $254.41 |
| 43261 | Physician and practitioner services (fee schedule) | 50 | $277.89 |
| 43262 | Physician and practitioner services (fee schedule) | 50 | $288.13 |
| 43263 | Physician and practitioner services (fee schedule) | 50 | $280.30 |
| 43264 | Physician and practitioner services (fee schedule) | 50 | $304.02 |
| 43265 | Physician and practitioner services (fee schedule) | 48 | $360.60 |
| 43266 | Physician and practitioner services (fee schedule) | 49 | $167.82 |
| 43270 | Physician and practitioner services (fee schedule) | 49 | $424.15 |
| 43273 | Physician and practitioner services (fee schedule) | 50 | $92.04 |
| 43274 | Physician and practitioner services (fee schedule) | 50 | $355.28 |
| 43275 | Physician and practitioner services (fee schedule) | 50 | $289.64 |
| 43276 | Physician and practitioner services (fee schedule) | 50 | $370.21 |
| 43277 | Physician and practitioner services (fee schedule) | 50 | $291.32 |
| 43278 | Physician and practitioner services (fee schedule) | 50 | $332.47 |
| 43279 | Physician and practitioner services (fee schedule) | 50 | $937.04 |
| 43280 | Physician and practitioner services (fee schedule) | 49 | $820.29 |
| 43281 | Physician and practitioner services (fee schedule) | 50 | $1,106.81 |
| 43282 | Physician and practitioner services (fee schedule) | 50 | $1,243.81 |
| 43283 | Physician and practitioner services (fee schedule) | 49 | $119.36 |
| 43284 | Physician and practitioner services (fee schedule) | 34 | $546.45 |
| 43285 | Physician and practitioner services (fee schedule) | 36 | $531.57 |
| 43286 | Physician and practitioner services (fee schedule) | 50 | $2,483.81 |
| 43287 | Physician and practitioner services (fee schedule) | 49 | $2,752.21 |
| 43288 | Physician and practitioner services (fee schedule) | 49 | $2,894.27 |
| 43289 | Physician and practitioner services (fee schedule) | 9 | $329.00 |
| 43290 | Physician and practitioner services (fee schedule) | 30 | $1,142.01 |
| 43291 | Physician and practitioner services (fee schedule) | 34 | $287.79 |
| 43300 | Physician and practitioner services (fee schedule) | 49 | $473.66 |
| 43305 | Physician and practitioner services (fee schedule) | 50 | $812.57 |
| 43310 | Physician and practitioner services (fee schedule) | 49 | $1,096.60 |
| 43312 | Physician and practitioner services (fee schedule) | 49 | $1,223.79 |
| 43313 | Physician and practitioner services (fee schedule) | 48 | $2,103.10 |
| 43314 | Physician and practitioner services (fee schedule) | 48 | $2,235.38 |
| 43320 | Physician and practitioner services (fee schedule) | 49 | $980.85 |
| 43325 | Physician and practitioner services (fee schedule) | 49 | $986.72 |
| 43327 | Physician and practitioner services (fee schedule) | 50 | $633.80 |
| 43328 | Physician and practitioner services (fee schedule) | 50 | $888.57 |
| 43330 | Physician and practitioner services (fee schedule) | 49 | $955.68 |
| 43331 | Physician and practitioner services (fee schedule) | 49 | $997.26 |
| 43332 | Physician and practitioner services (fee schedule) | 50 | $870.92 |
| 43333 | Physician and practitioner services (fee schedule) | 50 | $949.60 |
| 43334 | Physician and practitioner services (fee schedule) | 50 | $979.80 |
| 43335 | Physician and practitioner services (fee schedule) | 50 | $1,051.85 |
| 43336 | Physician and practitioner services (fee schedule) | 50 | $1,143.90 |
| 43337 | Physician and practitioner services (fee schedule) | 50 | $1,217.85 |
| 43338 | Physician and practitioner services (fee schedule) | 50 | $87.99 |
| 43340 | Physician and practitioner services (fee schedule) | 49 | $992.01 |
| 43341 | Physician and practitioner services (fee schedule) | 49 | $1,024.31 |
| 43351 | Physician and practitioner services (fee schedule) | 50 | $920.55 |
| 43352 | Physician and practitioner services (fee schedule) | 50 | $775.85 |
| 43360 | Physician and practitioner services (fee schedule) | 49 | $1,649.41 |
| 43361 | Physician and practitioner services (fee schedule) | 49 | $1,945.27 |
| 43400 | Physician and practitioner services (fee schedule) | 50 | $1,054.20 |
| 43405 | Physician and practitioner services (fee schedule) | 48 | $1,087.26 |
| 43410 | Physician and practitioner services (fee schedule) | 48 | $716.10 |
| 43415 | Physician and practitioner services (fee schedule) | 49 | $1,760.65 |
| 43420 | Physician and practitioner services (fee schedule) | 50 | $705.58 |
| 43425 | Physician and practitioner services (fee schedule) | 49 | $1,023.82 |
| 43450 | Physician and practitioner services (fee schedule) | 50 | $107.22 |
| 43453 | Physician and practitioner services (fee schedule) | 50 | $148.83 |
| 43460 | Physician and practitioner services (fee schedule) | 49 | $159.94 |
| 43496 | Physician and practitioner services (fee schedule) | 35 | $1,054.64 |
| 43497 | Physician and practitioner services (fee schedule) | 43 | $626.94 |
| 43499 | Physician and practitioner services (fee schedule) | 9 | $400.67 |
| 43500 | Physician and practitioner services (fee schedule) | 50 | $569.43 |
| 43501 | Physician and practitioner services (fee schedule) | 50 | $975.00 |
| 43502 | Physician and practitioner services (fee schedule) | 50 | $1,078.59 |
| 43510 | Physician and practitioner services (fee schedule) | 49 | $667.34 |
| 43520 | Physician and practitioner services (fee schedule) | 50 | $508.25 |
| 43605 | Physician and practitioner services (fee schedule) | 50 | $588.29 |
| 43610 | Physician and practitioner services (fee schedule) | 50 | $701.70 |
| 43611 | Physician and practitioner services (fee schedule) | 50 | $882.23 |
| 43620 | Physician and practitioner services (fee schedule) | 49 | $1,376.40 |
| 43621 | Physician and practitioner services (fee schedule) | 49 | $1,626.68 |
| 43622 | Physician and practitioner services (fee schedule) | 49 | $1,647.72 |
| 43631 | Physician and practitioner services (fee schedule) | 49 | $1,054.41 |
| 43632 | Physician and practitioner services (fee schedule) | 49 | $1,457.38 |
| 43633 | Physician and practitioner services (fee schedule) | 49 | $1,380.34 |
| 43634 | Physician and practitioner services (fee schedule) | 48 | $1,487.67 |
| 43635 | Physician and practitioner services (fee schedule) | 50 | $89.41 |
| 43640 | Physician and practitioner services (fee schedule) | 49 | $847.52 |
| 43641 | Physician and practitioner services (fee schedule) | 49 | $862.04 |
| 43644 | Physician and practitioner services (fee schedule) | 48 | $1,250.39 |
| 43645 | Physician and practitioner services (fee schedule) | 45 | $1,336.26 |
| 43647 | Physician and practitioner services (fee schedule) | 24 | $553.66 |
| 43648 | Physician and practitioner services (fee schedule) | 25 | $539.00 |
| 43651 | Physician and practitioner services (fee schedule) | 49 | $493.04 |
| 43652 | Physician and practitioner services (fee schedule) | 49 | $569.68 |
| 43653 | Physician and practitioner services (fee schedule) | 49 | $440.98 |
| 43659 | Physician and practitioner services (fee schedule) | 11 | $592.63 |
| 43752 | Physician and practitioner services (fee schedule) | 45 | $31.56 |
| 43753 | Physician and practitioner services (fee schedule) | 50 | $16.65 |
| 43754 | Physician and practitioner services (fee schedule) | 50 | $67.76 |
| 43755 | Physician and practitioner services (fee schedule) | 50 | $106.78 |
| 43756 | Physician and practitioner services (fee schedule) | 50 | $163.48 |
| 43757 | Physician and practitioner services (fee schedule) | 50 | $219.90 |
| 43761 | Physician and practitioner services (fee schedule) | 50 | $93.50 |
| 43762 | Physician and practitioner services (fee schedule) | 50 | $170.41 |
| 43763 | Physician and practitioner services (fee schedule) | 50 | $234.33 |
| 43770 | Physician and practitioner services (fee schedule) | 47 | $829.49 |
| 43771 | Physician and practitioner services (fee schedule) | 47 | $910.37 |
| 43772 | Physician and practitioner services (fee schedule) | 46 | $691.94 |
| 43773 | Physician and practitioner services (fee schedule) | 47 | $911.12 |
| 43774 | Physician and practitioner services (fee schedule) | 47 | $704.34 |
| 43775 | Physician and practitioner services (fee schedule) | 48 | $775.62 |
| 43800 | Physician and practitioner services (fee schedule) | 49 | $677.48 |
| 43810 | Physician and practitioner services (fee schedule) | 50 | $705.92 |
| 43820 | Physician and practitioner services (fee schedule) | 49 | $957.37 |
| 43825 | Physician and practitioner services (fee schedule) | 50 | $924.36 |
| 43830 | Physician and practitioner services (fee schedule) | 50 | $508.36 |
| 43831 | Physician and practitioner services (fee schedule) | 50 | $451.70 |
| 43832 | Physician and practitioner services (fee schedule) | 50 | $747.28 |
| 43840 | Physician and practitioner services (fee schedule) | 49 | $952.38 |
| 43842 | Physician and practitioner services (fee schedule) | 41 | $836.80 |
| 43843 | Physician and practitioner services (fee schedule) | 42 | $936.84 |
| 43845 | Physician and practitioner services (fee schedule) | 39 | $1,410.67 |
| 43846 | Physician and practitioner services (fee schedule) | 47 | $1,171.75 |
| 43847 | Physician and practitioner services (fee schedule) | 45 | $1,259.77 |
| 43848 | Physician and practitioner services (fee schedule) | 45 | $1,389.85 |
| 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) | 49 | $1,178.73 |
| 43865 | Physician and practitioner services (fee schedule) | 49 | $1,188.52 |
| 43870 | Physician and practitioner services (fee schedule) | 49 | $505.56 |
| 43880 | Physician and practitioner services (fee schedule) | 50 | $1,136.97 |
| 43881 | Physician and practitioner services (fee schedule) | 21 | $557.63 |
| 43882 | Physician and practitioner services (fee schedule) | 21 | $583.17 |
| 43886 | Physician and practitioner services (fee schedule) | 43 | $291.13 |
| 43887 | Physician and practitioner services (fee schedule) | 42 | $260.92 |
| 43888 | Physician and practitioner services (fee schedule) | 42 | $359.18 |
| 43889 | Physician and practitioner services (fee schedule) | 25 | $559.98 |
| 43999 | Physician and practitioner services (fee schedule) | 8 | $108.27 |
| 44005 | Physician and practitioner services (fee schedule) | 50 | $791.18 |
| 44010 | Physician and practitioner services (fee schedule) | 49 | $608.64 |
| 44015 | Physician and practitioner services (fee schedule) | 50 | $109.88 |
| 44020 | Physician and practitioner services (fee schedule) | 50 | $704.38 |
| 44021 | Physician and practitioner services (fee schedule) | 49 | $706.84 |
| 44025 | Physician and practitioner services (fee schedule) | 49 | $715.15 |
| 44050 | Physician and practitioner services (fee schedule) | 50 | $662.65 |
| 44055 | Physician and practitioner services (fee schedule) | 49 | $1,071.08 |
| 44100 | Physician and practitioner services (fee schedule) | 50 | $86.06 |
| 44110 | Physician and practitioner services (fee schedule) | 50 | $600.49 |
| 44111 | Physician and practitioner services (fee schedule) | 50 | $710.32 |
| 44120 | Physician and practitioner services (fee schedule) | 49 | $883.74 |
| 44121 | Physician and practitioner services (fee schedule) | 49 | $185.18 |
| 44125 | Physician and practitioner services (fee schedule) | 49 | $856.88 |
| 44126 | Physician and practitioner services (fee schedule) | 49 | $1,777.35 |
| 44127 | Physician and practitioner services (fee schedule) | 50 | $2,048.11 |
| 44128 | Physician and practitioner services (fee schedule) | 50 | $182.59 |
| 44130 | Physician and practitioner services (fee schedule) | 50 | $916.05 |
| 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) | 20 | $1,165.85 |
| 44136 | Physician and practitioner services (fee schedule) | 14 | $987.03 |
| 44137 | Physician and practitioner services (fee schedule) | 15 | $895.33 |
| 44139 | Physician and practitioner services (fee schedule) | 50 | $92.64 |
| 44140 | Physician and practitioner services (fee schedule) | 49 | $974.96 |
| 44141 | Physician and practitioner services (fee schedule) | 49 | $1,276.15 |
| 44143 | Physician and practitioner services (fee schedule) | 49 | $1,190.53 |
| 44144 | Physician and practitioner services (fee schedule) | 49 | $1,271.32 |
| 44145 | Physician and practitioner services (fee schedule) | 49 | $1,195.86 |
| 44146 | Physician and practitioner services (fee schedule) | 49 | $1,510.05 |
| 44147 | Physician and practitioner services (fee schedule) | 49 | $1,367.95 |
| 44150 | Physician and practitioner services (fee schedule) | 49 | $1,345.87 |
| 44151 | Physician and practitioner services (fee schedule) | 48 | $1,503.71 |
| 44155 | Physician and practitioner services (fee schedule) | 49 | $1,493.42 |
| 44156 | Physician and practitioner services (fee schedule) | 48 | $1,647.14 |
| 44157 | Physician and practitioner services (fee schedule) | 50 | $1,565.53 |
| 44158 | Physician and practitioner services (fee schedule) | 50 | $1,603.93 |
| 44160 | Physician and practitioner services (fee schedule) | 48 | $911.20 |
| 44180 | Physician and practitioner services (fee schedule) | 49 | $672.59 |
| 44186 | Physician and practitioner services (fee schedule) | 50 | $483.40 |
| 44187 | Physician and practitioner services (fee schedule) | 50 | $802.35 |
| 44188 | Physician and practitioner services (fee schedule) | 50 | $890.74 |
| 44202 | Physician and practitioner services (fee schedule) | 50 | $1,009.53 |
| 44203 | Physician and practitioner services (fee schedule) | 50 | $181.19 |
| 44204 | Physician and practitioner services (fee schedule) | 50 | $1,118.64 |
| 44205 | Physician and practitioner services (fee schedule) | 50 | $974.19 |
| 44206 | Physician and practitioner services (fee schedule) | 48 | $1,267.49 |
| 44207 | Physician and practitioner services (fee schedule) | 49 | $1,321.24 |
| 44208 | Physician and practitioner services (fee schedule) | 49 | $1,441.19 |
| 44210 | Physician and practitioner services (fee schedule) | 49 | $1,299.28 |
| 44211 | Physician and practitioner services (fee schedule) | 48 | $1,557.47 |
| 44212 | Physician and practitioner services (fee schedule) | 49 | $1,493.25 |
| 44213 | Physician and practitioner services (fee schedule) | 50 | $140.53 |
| 44227 | Physician and practitioner services (fee schedule) | 50 | $1,196.39 |
| 44238 | Physician and practitioner services (fee schedule) | 12 | $768.85 |
| 44300 | Physician and practitioner services (fee schedule) | 50 | $595.63 |
| 44310 | Physician and practitioner services (fee schedule) | 49 | $754.56 |
| 44312 | Physician and practitioner services (fee schedule) | 50 | $442.12 |
| 44314 | Physician and practitioner services (fee schedule) | 50 | $728.84 |
| 44316 | Physician and practitioner services (fee schedule) | 49 | $1,000.52 |
| 44320 | Physician and practitioner services (fee schedule) | 50 | $866.42 |
| 44322 | Physician and practitioner services (fee schedule) | 49 | $753.21 |
| 44340 | Physician and practitioner services (fee schedule) | 50 | $470.24 |
| 44345 | Physician and practitioner services (fee schedule) | 49 | $767.36 |
| 44346 | Physician and practitioner services (fee schedule) | 50 | $860.00 |
| 44360 | Physician and practitioner services (fee schedule) | 50 | $119.28 |
| 44361 | Physician and practitioner services (fee schedule) | 50 | $131.67 |
| 44363 | Physician and practitioner services (fee schedule) | 50 | $160.11 |
| 44364 | Physician and practitioner services (fee schedule) | 50 | $171.57 |
| 44365 | Physician and practitioner services (fee schedule) | 49 | $146.66 |
| 44366 | Physician and practitioner services (fee schedule) | 50 | $191.69 |
| 44369 | Physician and practitioner services (fee schedule) | 49 | $200.05 |
| 44370 | Physician and practitioner services (fee schedule) | 49 | $198.04 |
| 44372 | Physician and practitioner services (fee schedule) | 50 | $198.49 |
| 44373 | Physician and practitioner services (fee schedule) | 50 | $154.17 |
| 44376 | Physician and practitioner services (fee schedule) | 50 | $233.62 |
| 44377 | Physician and practitioner services (fee schedule) | 49 | $243.43 |
| 44378 | Physician and practitioner services (fee schedule) | 50 | $311.14 |
| 44379 | Physician and practitioner services (fee schedule) | 48 | $312.89 |
| 44380 | Physician and practitioner services (fee schedule) | 50 | $110.13 |
| 44381 | Physician and practitioner services (fee schedule) | 40 | $621.92 |
| 44382 | Physician and practitioner services (fee schedule) | 50 | $150.03 |
| 44384 | Physician and practitioner services (fee schedule) | 37 | $120.74 |
| 44385 | Physician and practitioner services (fee schedule) | 49 | $141.22 |
| 44386 | Physician and practitioner services (fee schedule) | 50 | $170.79 |
| 44388 | Physician and practitioner services (fee schedule) | 50 | $183.45 |
| 44389 | Physician and practitioner services (fee schedule) | 50 | $272.99 |
| 44390 | Physician and practitioner services (fee schedule) | 50 | $286.00 |
| 44391 | Physician and practitioner services (fee schedule) | 49 | $329.78 |
| 44392 | Physician and practitioner services (fee schedule) | 50 | $282.96 |
| 44394 | Physician and practitioner services (fee schedule) | 50 | $315.23 |
| 44401 | Physician and practitioner services (fee schedule) | 40 | $1,502.03 |
| 44402 | Physician and practitioner services (fee schedule) | 40 | $205.37 |
| 44403 | Physician and practitioner services (fee schedule) | 41 | $226.26 |
| 44404 | Physician and practitioner services (fee schedule) | 41 | $324.58 |
| 44405 | Physician and practitioner services (fee schedule) | 41 | $403.82 |
| 44406 | Physician and practitioner services (fee schedule) | 41 | $176.42 |
| 44407 | Physician and practitioner services (fee schedule) | 41 | $205.16 |
| 44408 | Physician and practitioner services (fee schedule) | 42 | $175.95 |
| 44500 | Physician and practitioner services (fee schedule) | 49 | $15.48 |
| 44602 | Physician and practitioner services (fee schedule) | 49 | $1,003.85 |
| 44603 | Physician and practitioner services (fee schedule) | 49 | $1,154.42 |
| 44604 | Physician and practitioner services (fee schedule) | 49 | $766.08 |
| 44605 | Physician and practitioner services (fee schedule) | 49 | $943.54 |
| 44615 | Physician and practitioner services (fee schedule) | 49 | $773.86 |
| 44620 | Physician and practitioner services (fee schedule) | 50 | $609.10 |
| 44625 | Physician and practitioner services (fee schedule) | 50 | $735.63 |
| 44626 | Physician and practitioner services (fee schedule) | 50 | $1,143.48 |
| 44640 | Physician and practitioner services (fee schedule) | 50 | $976.06 |
| 44650 | Physician and practitioner services (fee schedule) | 50 | $1,005.54 |
| 44660 | Physician and practitioner services (fee schedule) | 50 | $913.86 |
| 44661 | Physician and practitioner services (fee schedule) | 49 | $1,099.87 |
| 44680 | Physician and practitioner services (fee schedule) | 49 | $782.26 |
| 44700 | Physician and practitioner services (fee schedule) | 49 | $743.38 |
| 44701 | Physician and practitioner services (fee schedule) | 47 | $122.03 |
| 44705 | Physician and practitioner services (fee schedule) | 15 | $65.14 |
| 44715 | Physician and practitioner services (fee schedule) | 13 | $311.96 |
| 44720 | Physician and practitioner services (fee schedule) | 29 | $197.16 |
| 44721 | Physician and practitioner services (fee schedule) | 29 | $275.54 |
| 44799 | Physician and practitioner services (fee schedule) | 8 | $105.88 |
| 44800 | Physician and practitioner services (fee schedule) | 50 | $568.97 |
| 44820 | Physician and practitioner services (fee schedule) | 50 | $600.66 |
| 44850 | Physician and practitioner services (fee schedule) | 50 | $534.17 |
| 44899 | Physician and practitioner services (fee schedule) | 6 | $157.14 |
| 44900 | Physician and practitioner services (fee schedule) | 50 | $541.97 |
| 44950 | Physician and practitioner services (fee schedule) | 50 | $471.26 |
| 44955 | Physician and practitioner services (fee schedule) | 49 | $64.94 |
| 44960 | Physician and practitioner services (fee schedule) | 49 | $640.95 |
| 44970 | Physician and practitioner services (fee schedule) | 49 | $450.13 |
| 44979 | Physician and practitioner services (fee schedule) | 9 | $349.95 |
| 45000 | Physician and practitioner services (fee schedule) | 50 | $323.57 |
| 45005 | Physician and practitioner services (fee schedule) | 50 | $199.33 |
| 45020 | Physician and practitioner services (fee schedule) | 50 | $429.80 |
| 45100 | Physician and practitioner services (fee schedule) | 50 | $237.09 |
| 45108 | Physician and practitioner services (fee schedule) | 50 | $291.36 |
| 45110 | Physician and practitioner services (fee schedule) | 49 | $1,334.22 |
| 45111 | Physician and practitioner services (fee schedule) | 49 | $805.53 |
| 45112 | Physician and practitioner services (fee schedule) | 49 | $1,324.43 |
| 45113 | Physician and practitioner services (fee schedule) | 49 | $1,411.52 |
| 45114 | Physician and practitioner services (fee schedule) | 49 | $1,307.81 |
| 45116 | Physician and practitioner services (fee schedule) | 49 | $1,127.46 |
| 45119 | Physician and practitioner services (fee schedule) | 49 | $1,381.86 |
| 45120 | Physician and practitioner services (fee schedule) | 49 | $1,173.31 |
| 45121 | Physician and practitioner services (fee schedule) | 50 | $1,271.56 |
| 45123 | Physician and practitioner services (fee schedule) | 49 | $821.06 |
| 45126 | Physician and practitioner services (fee schedule) | 48 | $1,992.52 |
| 45130 | Physician and practitioner services (fee schedule) | 50 | $782.40 |
| 45135 | Physician and practitioner services (fee schedule) | 49 | $958.84 |
| 45136 | Physician and practitioner services (fee schedule) | 49 | $1,315.05 |
| 45150 | Physician and practitioner services (fee schedule) | 49 | $325.23 |
| 45160 | Physician and practitioner services (fee schedule) | 49 | $757.98 |
| 45171 | Physician and practitioner services (fee schedule) | 50 | $458.23 |
| 45172 | Physician and practitioner services (fee schedule) | 50 | $605.24 |
| 45190 | Physician and practitioner services (fee schedule) | 50 | $528.76 |
| 45300 | Physician and practitioner services (fee schedule) | 50 | $70.64 |
| 45303 | Physician and practitioner services (fee schedule) | 50 | $314.57 |
| 45305 | Physician and practitioner services (fee schedule) | 50 | $88.92 |
| 45307 | Physician and practitioner services (fee schedule) | 50 | $114.25 |
| 45308 | Physician and practitioner services (fee schedule) | 50 | $113.05 |
| 45309 | Physician and practitioner services (fee schedule) | 50 | $132.04 |
| 45315 | Physician and practitioner services (fee schedule) | 50 | $119.84 |
| 45317 | Physician and practitioner services (fee schedule) | 50 | $133.28 |
| 45320 | Physician and practitioner services (fee schedule) | 50 | $142.89 |
| 45321 | Physician and practitioner services (fee schedule) | 50 | $83.75 |
| 45327 | Physician and practitioner services (fee schedule) | 49 | $88.17 |
| 45330 | Physician and practitioner services (fee schedule) | 50 | $81.35 |
| 45331 | Physician and practitioner services (fee schedule) | 50 | $142.56 |
| 45332 | Physician and practitioner services (fee schedule) | 50 | $141.86 |
| 45333 | Physician and practitioner services (fee schedule) | 50 | $154.51 |
| 45334 | Physician and practitioner services (fee schedule) | 50 | $252.29 |
| 45335 | Physician and practitioner services (fee schedule) | 49 | $153.39 |
| 45337 | Physician and practitioner services (fee schedule) | 50 | $98.53 |
| 45338 | Physician and practitioner services (fee schedule) | 50 | $184.41 |
| 45340 | Physician and practitioner services (fee schedule) | 49 | $263.54 |
| 45341 | Physician and practitioner services (fee schedule) | 50 | $107.22 |
| 45342 | Physician and practitioner services (fee schedule) | 49 | $147.39 |
| 45346 | Physician and practitioner services (fee schedule) | 42 | $1,450.24 |
| 45347 | Physician and practitioner services (fee schedule) | 42 | $121.25 |
| 45349 | Physician and practitioner services (fee schedule) | 41 | $150.48 |
| 45350 | Physician and practitioner services (fee schedule) | 41 | $421.48 |
| 45378 | Physician and practitioner services (fee schedule) | 50 | $248.85 |
| 45379 | Physician and practitioner services (fee schedule) | 50 | $350.34 |
| 45380 | Physician and practitioner services (fee schedule) | 50 | $326.81 |
| 45381 | Physician and practitioner services (fee schedule) | 50 | $335.86 |
| 45382 | Physician and practitioner services (fee schedule) | 50 | $440.56 |
| 45384 | Physician and practitioner services (fee schedule) | 50 | $359.80 |
| 45385 | Physician and practitioner services (fee schedule) | 50 | $357.84 |
| 45386 | Physician and practitioner services (fee schedule) | 49 | $493.87 |
| 45388 | Physician and practitioner services (fee schedule) | 44 | $1,549.40 |
| 45389 | Physician and practitioner services (fee schedule) | 42 | $229.96 |
| 45390 | Physician and practitioner services (fee schedule) | 45 | $249.46 |
| 45391 | Physician and practitioner services (fee schedule) | 49 | $207.01 |
| 45392 | Physician and practitioner services (fee schedule) | 48 | $248.14 |
| 45393 | Physician and practitioner services (fee schedule) | 43 | $195.87 |
| 45395 | Physician and practitioner services (fee schedule) | 50 | $1,432.80 |
| 45397 | Physician and practitioner services (fee schedule) | 50 | $1,556.42 |
| 45398 | Physician and practitioner services (fee schedule) | 45 | $476.31 |
| 45399 | Physician and practitioner services (fee schedule) | 8 | $238.30 |
| 45400 | Physician and practitioner services (fee schedule) | 50 | $832.93 |
| 45402 | Physician and practitioner services (fee schedule) | 50 | $1,110.07 |
| 45499 | Physician and practitioner services (fee schedule) | 8 | $613.62 |
| 45500 | Physician and practitioner services (fee schedule) | 50 | $434.46 |
| 45505 | Physician and practitioner services (fee schedule) | 50 | $458.39 |
| 45520 | Physician and practitioner services (fee schedule) | 49 | $43.18 |
| 45540 | Physician and practitioner services (fee schedule) | 50 | $760.81 |
| 45541 | Physician and practitioner services (fee schedule) | 49 | $670.29 |
| 45550 | Physician and practitioner services (fee schedule) | 49 | $1,023.50 |
| 45560 | Physician and practitioner services (fee schedule) | 49 | $492.79 |
| 45562 | Physician and practitioner services (fee schedule) | 50 | $832.09 |
| 45563 | Physician and practitioner services (fee schedule) | 49 | $1,218.72 |
| 45800 | Physician and practitioner services (fee schedule) | 50 | $882.10 |
| 45805 | Physician and practitioner services (fee schedule) | 49 | $1,015.85 |
| 45820 | Physician and practitioner services (fee schedule) | 49 | $892.55 |
| 45825 | Physician and practitioner services (fee schedule) | 49 | $1,073.91 |
| 45900 | Physician and practitioner services (fee schedule) | 49 | $164.43 |
| 45905 | Physician and practitioner services (fee schedule) | 50 | $134.00 |
| 45910 | Physician and practitioner services (fee schedule) | 50 | $149.18 |
| 45915 | Physician and practitioner services (fee schedule) | 50 | $235.47 |
| 45990 | Physician and practitioner services (fee schedule) | 49 | $79.66 |
| 45999 | Physician and practitioner services (fee schedule) | 7 | $100.00 |
| 46020 | Physician and practitioner services (fee schedule) | 49 | $107.33 |
| 46030 | Physician and practitioner services (fee schedule) | 49 | $85.68 |
| 46040 | Physician and practitioner services (fee schedule) | 50 | $394.36 |
| 46045 | Physician and practitioner services (fee schedule) | 50 | $339.97 |
| 46050 | Physician and practitioner services (fee schedule) | 50 | $108.28 |
| 46060 | Physician and practitioner services (fee schedule) | 50 | $386.62 |
| 46070 | Physician and practitioner services (fee schedule) | 50 | $197.01 |
| 46080 | Physician and practitioner services (fee schedule) | 50 | $155.74 |
| 46083 | Physician and practitioner services (fee schedule) | 50 | $130.88 |
| 46200 | Physician and practitioner services (fee schedule) | 50 | $305.39 |
| 46220 | Physician and practitioner services (fee schedule) | 50 | $151.67 |
| 46221 | Physician and practitioner services (fee schedule) | 50 | $201.35 |
| 46230 | Physician and practitioner services (fee schedule) | 50 | $182.37 |
| 46250 | Physician and practitioner services (fee schedule) | 50 | $308.79 |
| 46255 | Physician and practitioner services (fee schedule) | 50 | $359.43 |
| 46257 | Physician and practitioner services (fee schedule) | 50 | $335.78 |
| 46258 | Physician and practitioner services (fee schedule) | 50 | $380.60 |
| 46260 | Physician and practitioner services (fee schedule) | 50 | $385.50 |
| 46261 | Physician and practitioner services (fee schedule) | 50 | $417.69 |
| 46262 | Physician and practitioner services (fee schedule) | 50 | $459.65 |
| 46270 | Physician and practitioner services (fee schedule) | 50 | $373.50 |
| 46275 | Physician and practitioner services (fee schedule) | 50 | $425.59 |
| 46280 | Physician and practitioner services (fee schedule) | 50 | $386.60 |
| 46285 | Physician and practitioner services (fee schedule) | 50 | $378.44 |
| 46288 | Physician and practitioner services (fee schedule) | 50 | $440.19 |
| 46320 | Physician and practitioner services (fee schedule) | 50 | $132.23 |
| 46500 | Physician and practitioner services (fee schedule) | 49 | $194.24 |
| 46505 | Physician and practitioner services (fee schedule) | 47 | $226.47 |
| 46600 | Physician and practitioner services (fee schedule) | 50 | $64.75 |
| 46601 | Physician and practitioner services (fee schedule) | 35 | $108.35 |
| 46604 | Physician and practitioner services (fee schedule) | 50 | $378.89 |
| 46606 | Physician and practitioner services (fee schedule) | 50 | $161.01 |
| 46607 | Physician and practitioner services (fee schedule) | 36 | $154.48 |
| 46608 | Physician and practitioner services (fee schedule) | 50 | $164.04 |
| 46610 | Physician and practitioner services (fee schedule) | 50 | $155.25 |
| 46611 | Physician and practitioner services (fee schedule) | 50 | $139.36 |
| 46612 | Physician and practitioner services (fee schedule) | 50 | $185.41 |
| 46614 | Physician and practitioner services (fee schedule) | 49 | $116.94 |
| 46615 | Physician and practitioner services (fee schedule) | 50 | $129.04 |
| 46700 | Physician and practitioner services (fee schedule) | 50 | $494.91 |
| 46705 | Physician and practitioner services (fee schedule) | 50 | $413.57 |
| 46706 | Physician and practitioner services (fee schedule) | 46 | $134.29 |
| 46707 | Physician and practitioner services (fee schedule) | 48 | $400.15 |
| 46710 | Physician and practitioner services (fee schedule) | 49 | $822.14 |
| 46712 | Physician and practitioner services (fee schedule) | 50 | $1,590.90 |
| 46715 | Physician and practitioner services (fee schedule) | 50 | $423.98 |
| 46716 | Physician and practitioner services (fee schedule) | 49 | $886.97 |
| 46730 | Physician and practitioner services (fee schedule) | 50 | $1,382.39 |
| 46735 | Physician and practitioner services (fee schedule) | 49 | $1,592.99 |
| 46740 | Physician and practitioner services (fee schedule) | 49 | $1,526.22 |
| 46742 | Physician and practitioner services (fee schedule) | 48 | $1,744.47 |
| 46744 | Physician and practitioner services (fee schedule) | 49 | $2,474.09 |
| 46746 | Physician and practitioner services (fee schedule) | 47 | $2,811.33 |
| 46748 | Physician and practitioner services (fee schedule) | 49 | $2,983.61 |
| 46750 | Physician and practitioner services (fee schedule) | 50 | $518.28 |
| 46751 | Physician and practitioner services (fee schedule) | 50 | $475.31 |
| 46753 | Physician and practitioner services (fee schedule) | 50 | $463.42 |
| 46754 | Physician and practitioner services (fee schedule) | 48 | $220.52 |
| 46760 | Physician and practitioner services (fee schedule) | 49 | $772.15 |
| 46761 | Physician and practitioner services (fee schedule) | 49 | $645.53 |
| 46900 | Physician and practitioner services (fee schedule) | 50 | $148.98 |
| 46910 | Physician and practitioner services (fee schedule) | 50 | $151.84 |
| 46916 | Physician and practitioner services (fee schedule) | 50 | $155.93 |
| 46917 | Physician and practitioner services (fee schedule) | 50 | $187.14 |
| 46922 | Physician and practitioner services (fee schedule) | 50 | $146.53 |
| 46924 | Physician and practitioner services (fee schedule) | 50 | $268.60 |
| 46930 | Physician and practitioner services (fee schedule) | 50 | $156.87 |
| 46940 | Physician and practitioner services (fee schedule) | 50 | $155.96 |
| 46942 | Physician and practitioner services (fee schedule) | 50 | $135.50 |
| 46945 | Physician and practitioner services (fee schedule) | 50 | $254.72 |
| 46946 | Physician and practitioner services (fee schedule) | 50 | $276.46 |
| 46947 | Physician and practitioner services (fee schedule) | 48 | $300.56 |
| 46948 | Physician and practitioner services (fee schedule) | 43 | $363.96 |
| 46999 | Physician and practitioner services (fee schedule) | 8 | $148.89 |
| 47000 | Physician and practitioner services (fee schedule) | 50 | $161.15 |
| 47001 | Physician and practitioner services (fee schedule) | 49 | $80.15 |
| 47010 | Physician and practitioner services (fee schedule) | 50 | $849.85 |
| 47015 | Physician and practitioner services (fee schedule) | 49 | $857.21 |
| 47100 | Physician and practitioner services (fee schedule) | 50 | $594.61 |
| 47120 | Physician and practitioner services (fee schedule) | 50 | $1,643.61 |
| 47122 | Physician and practitioner services (fee schedule) | 49 | $2,444.23 |
| 47125 | Physician and practitioner services (fee schedule) | 49 | $2,116.46 |
| 47130 | Physician and practitioner services (fee schedule) | 49 | $2,348.70 |
| 47133 | Physician and practitioner services (fee schedule) | 13 | $1,020.53 |
| 47135 | Physician and practitioner services (fee schedule) | 47 | $3,944.91 |
| 47140 | Physician and practitioner services (fee schedule) | 39 | $2,493.19 |
| 47141 | Physician and practitioner services (fee schedule) | 38 | $2,850.34 |
| 47142 | Physician and practitioner services (fee schedule) | 38 | $3,251.84 |
| 47143 | Physician and practitioner services (fee schedule) | 24 | $242.19 |
| 47144 | Physician and practitioner services (fee schedule) | 20 | $353.03 |
| 47145 | Physician and practitioner services (fee schedule) | 17 | $351.91 |
| 47146 | Physician and practitioner services (fee schedule) | 33 | $235.95 |
| 47147 | Physician and practitioner services (fee schedule) | 33 | $274.94 |
| 47300 | Physician and practitioner services (fee schedule) | 50 | $784.30 |
| 47350 | Physician and practitioner services (fee schedule) | 49 | $981.90 |
| 47360 | Physician and practitioner services (fee schedule) | 49 | $1,337.38 |
| 47361 | Physician and practitioner services (fee schedule) | 49 | $2,154.02 |
| 47362 | Physician and practitioner services (fee schedule) | 49 | $1,040.64 |
| 47370 | Physician and practitioner services (fee schedule) | 47 | $911.80 |
| 47371 | Physician and practitioner services (fee schedule) | 47 | $898.41 |
| 47379 | Physician and practitioner services (fee schedule) | 9 | $724.83 |
| 47380 | Physician and practitioner services (fee schedule) | 49 | $1,048.33 |
| 47381 | Physician and practitioner services (fee schedule) | 50 | $1,056.21 |
| 47382 | Physician and practitioner services (fee schedule) | 49 | $1,638.16 |
| 47383 | Physician and practitioner services (fee schedule) | 45 | $2,619.04 |
| 47384 | Physician and practitioner services (fee schedule) | 23 | $334.55 |
| 47399 | Physician and practitioner services (fee schedule) | 6 | $299.49 |
| 47400 | Physician and practitioner services (fee schedule) | 49 | $1,491.57 |
| 47420 | Physician and practitioner services (fee schedule) | 50 | $943.99 |
| 47425 | Physician and practitioner services (fee schedule) | 49 | $965.34 |
| 47460 | Physician and practitioner services (fee schedule) | 50 | $911.22 |
| 47480 | Physician and practitioner services (fee schedule) | 48 | $609.60 |
| 47490 | Physician and practitioner services (fee schedule) | 50 | $273.82 |
| 47531 | Physician and practitioner services (fee schedule) | 50 | $256.77 |
| 47532 | Physician and practitioner services (fee schedule) | 50 | $529.88 |
| 47533 | Physician and practitioner services (fee schedule) | 50 | $718.03 |
| 47534 | Physician and practitioner services (fee schedule) | 50 | $842.63 |
| 47535 | Physician and practitioner services (fee schedule) | 49 | $554.86 |
| 47536 | Physician and practitioner services (fee schedule) | 49 | $394.55 |
| 47537 | Physician and practitioner services (fee schedule) | 49 | $281.55 |
| 47538 | Physician and practitioner services (fee schedule) | 50 | $2,233.52 |
| 47539 | Physician and practitioner services (fee schedule) | 50 | $2,545.90 |
| 47540 | Physician and practitioner services (fee schedule) | 49 | $2,523.20 |
| 47541 | Physician and practitioner services (fee schedule) | 49 | $754.23 |
| 47542 | Physician and practitioner services (fee schedule) | 49 | $312.45 |
| 47543 | Physician and practitioner services (fee schedule) | 49 | $252.20 |
| 47544 | Physician and practitioner services (fee schedule) | 49 | $517.04 |
| 47550 | Physician and practitioner services (fee schedule) | 50 | $124.15 |
| 47552 | Physician and practitioner services (fee schedule) | 50 | $219.27 |
| 47553 | Physician and practitioner services (fee schedule) | 50 | $226.94 |
| 47554 | Physician and practitioner services (fee schedule) | 50 | $344.99 |
| 47555 | Physician and practitioner services (fee schedule) | 50 | $260.32 |
| 47556 | Physician and practitioner services (fee schedule) | 50 | $296.71 |
| 47562 | Physician and practitioner services (fee schedule) | 49 | $522.64 |
| 47563 | Physician and practitioner services (fee schedule) | 49 | $566.26 |
| 47564 | Physician and practitioner services (fee schedule) | 49 | $823.90 |
| 47570 | Physician and practitioner services (fee schedule) | 50 | $604.78 |
| 47579 | Physician and practitioner services (fee schedule) | 7 | $130.00 |
| 47600 | Physician and practitioner services (fee schedule) | 50 | $772.41 |
| 47605 | Physician and practitioner services (fee schedule) | 50 | $780.18 |
| 47610 | Physician and practitioner services (fee schedule) | 50 | $891.82 |
| 47612 | Physician and practitioner services (fee schedule) | 49 | $926.60 |
| 47620 | Physician and practitioner services (fee schedule) | 49 | $981.50 |
| 47700 | Physician and practitioner services (fee schedule) | 49 | $770.56 |
| 47701 | Physician and practitioner services (fee schedule) | 50 | $1,292.68 |
| 47711 | Physician and practitioner services (fee schedule) | 49 | $1,118.75 |
| 47712 | Physician and practitioner services (fee schedule) | 49 | $1,433.68 |
| 47715 | Physician and practitioner services (fee schedule) | 50 | $956.32 |
| 47720 | Physician and practitioner services (fee schedule) | 49 | $809.84 |
| 47721 | Physician and practitioner services (fee schedule) | 49 | $958.07 |
| 47740 | Physician and practitioner services (fee schedule) | 49 | $918.17 |
| 47741 | Physician and practitioner services (fee schedule) | 49 | $1,073.84 |
| 47760 | Physician and practitioner services (fee schedule) | 49 | $1,549.40 |
| 47765 | Physician and practitioner services (fee schedule) | 49 | $2,090.88 |
| 47780 | Physician and practitioner services (fee schedule) | 49 | $1,731.02 |
| 47785 | Physician and practitioner services (fee schedule) | 49 | $2,308.17 |
| 47800 | Physician and practitioner services (fee schedule) | 49 | $1,129.73 |
| 47801 | Physician and practitioner services (fee schedule) | 49 | $796.80 |
| 47802 | Physician and practitioner services (fee schedule) | 5 | $974.26 |
| 47900 | Physician and practitioner services (fee schedule) | 49 | $1,006.78 |
| 47999 | Physician and practitioner services (fee schedule) | 7 | $630.22 |
| 48000 | Physician and practitioner services (fee schedule) | 50 | $1,330.30 |
| 48001 | Physician and practitioner services (fee schedule) | 50 | $1,623.02 |
| 48020 | Physician and practitioner services (fee schedule) | 50 | $821.20 |
| 48100 | Physician and practitioner services (fee schedule) | 50 | $617.11 |
| 48102 | Physician and practitioner services (fee schedule) | 50 | $318.64 |
| 48105 | Physician and practitioner services (fee schedule) | 50 | $2,013.75 |
| 48120 | Physician and practitioner services (fee schedule) | 50 | $802.15 |
| 48140 | Physician and practitioner services (fee schedule) | 49 | $1,132.86 |
| 48145 | Physician and practitioner services (fee schedule) | 49 | $1,184.96 |
| 48146 | Physician and practitioner services (fee schedule) | 49 | $1,374.97 |
| 48148 | Physician and practitioner services (fee schedule) | 49 | $897.91 |
| 48150 | Physician and practitioner services (fee schedule) | 49 | $2,234.50 |
| 48152 | Physician and practitioner services (fee schedule) | 49 | $2,076.53 |
| 48153 | Physician and practitioner services (fee schedule) | 49 | $2,239.05 |
| 48154 | Physician and practitioner services (fee schedule) | 48 | $2,080.63 |
| 48155 | Physician and practitioner services (fee schedule) | 48 | $1,331.86 |
| 48160 | Physician and practitioner services (fee schedule) | 15 | $1,754.00 |
| 48400 | Physician and practitioner services (fee schedule) | 48 | $82.52 |
| 48500 | Physician and practitioner services (fee schedule) | 49 | $806.92 |
| 48510 | Physician and practitioner services (fee schedule) | 50 | $810.81 |
| 48520 | Physician and practitioner services (fee schedule) | 49 | $804.51 |
| 48540 | Physician and practitioner services (fee schedule) | 49 | $945.72 |
| 48545 | Physician and practitioner services (fee schedule) | 49 | $979.84 |
| 48547 | Physician and practitioner services (fee schedule) | 49 | $1,289.59 |
| 48548 | Physician and practitioner services (fee schedule) | 49 | $1,198.07 |
| 48550 | Physician and practitioner services (fee schedule) | 8 | $945.06 |
| 48551 | Physician and practitioner services (fee schedule) | 19 | $225.76 |
| 48552 | Physician and practitioner services (fee schedule) | 30 | $175.52 |
| 48554 | Physician and practitioner services (fee schedule) | 41 | $1,858.79 |
| 48556 | Physician and practitioner services (fee schedule) | 38 | $897.88 |
| 48999 | Physician and practitioner services (fee schedule) | 6 | $235.34 |
| 49000 | Physician and practitioner services (fee schedule) | 50 | $567.77 |
| 49002 | Physician and practitioner services (fee schedule) | 49 | $759.06 |
| 49010 | Physician and practitioner services (fee schedule) | 50 | $672.95 |
| 49013 | Physician and practitioner services (fee schedule) | 47 | $354.93 |
| 49014 | Physician and practitioner services (fee schedule) | 47 | $294.26 |
| 49020 | Physician and practitioner services (fee schedule) | 50 | $1,159.16 |
| 49040 | Physician and practitioner services (fee schedule) | 50 | $727.79 |
| 49060 | Physician and practitioner services (fee schedule) | 50 | $799.81 |
| 49062 | Physician and practitioner services (fee schedule) | 49 | $570.46 |
| 49082 | Physician and practitioner services (fee schedule) | 50 | $139.77 |
| 49083 | Physician and practitioner services (fee schedule) | 50 | $200.43 |
| 49084 | Physician and practitioner services (fee schedule) | 50 | $81.82 |
| 49180 | Physician and practitioner services (fee schedule) | 50 | $124.84 |
| 49185 | Physician and practitioner services (fee schedule) | 46 | $706.98 |
| 49186 | Physician and practitioner services (fee schedule) | 46 | $976.32 |
| 49187 | Physician and practitioner services (fee schedule) | 46 | $1,239.05 |
| 49188 | Physician and practitioner services (fee schedule) | 46 | $1,482.80 |
| 49189 | Physician and practitioner services (fee schedule) | 46 | $1,720.97 |
| 49190 | Physician and practitioner services (fee schedule) | 46 | $2,118.27 |
| 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) | 50 | $1,565.72 |
| 49250 | Physician and practitioner services (fee schedule) | 50 | $444.32 |
| 49255 | Physician and practitioner services (fee schedule) | 50 | $586.08 |
| 49320 | Physician and practitioner services (fee schedule) | 49 | $261.53 |
| 49321 | Physician and practitioner services (fee schedule) | 49 | $272.73 |
| 49322 | Physician and practitioner services (fee schedule) | 49 | $294.24 |
| 49323 | Physician and practitioner services (fee schedule) | 49 | $473.25 |
| 49324 | Physician and practitioner services (fee schedule) | 49 | $285.03 |
| 49325 | Physician and practitioner services (fee schedule) | 49 | $304.33 |
| 49326 | Physician and practitioner services (fee schedule) | 49 | $135.30 |
| 49327 | Physician and practitioner services (fee schedule) | 48 | $98.73 |
| 49329 | Physician and practitioner services (fee schedule) | 8 | $282.04 |
| 49400 | Physician and practitioner services (fee schedule) | 49 | $97.35 |
| 49402 | Physician and practitioner services (fee schedule) | 50 | $629.80 |
| 49405 | Physician and practitioner services (fee schedule) | 49 | $449.00 |
| 49406 | Physician and practitioner services (fee schedule) | 50 | $494.58 |
| 49407 | Physician and practitioner services (fee schedule) | 49 | $407.57 |
| 49411 | Physician and practitioner services (fee schedule) | 47 | $300.12 |
| 49412 | Physician and practitioner services (fee schedule) | 46 | $59.10 |
| 49418 | Physician and practitioner services (fee schedule) | 48 | $621.53 |
| 49419 | Physician and practitioner services (fee schedule) | 49 | $326.34 |
| 49421 | Physician and practitioner services (fee schedule) | 50 | $198.78 |
| 49422 | Physician and practitioner services (fee schedule) | 50 | $182.67 |
| 49423 | Physician and practitioner services (fee schedule) | 50 | $322.62 |
| 49424 | Physician and practitioner services (fee schedule) | 50 | $103.76 |
| 49425 | Physician and practitioner services (fee schedule) | 50 | $579.68 |
| 49426 | Physician and practitioner services (fee schedule) | 49 | $514.29 |
| 49427 | Physician and practitioner services (fee schedule) | 49 | $32.97 |
| 49428 | Physician and practitioner services (fee schedule) | 49 | $323.81 |
| 49429 | Physician and practitioner services (fee schedule) | 49 | $361.42 |
| 49435 | Physician and practitioner services (fee schedule) | 47 | $81.87 |
| 49436 | Physician and practitioner services (fee schedule) | 49 | $182.71 |
| 49440 | Physician and practitioner services (fee schedule) | 50 | $523.07 |
| 49441 | Physician and practitioner services (fee schedule) | 50 | $651.09 |
| 49442 | Physician and practitioner services (fee schedule) | 50 | $538.27 |
| 49446 | Physician and practitioner services (fee schedule) | 50 | $504.67 |
| 49450 | Physician and practitioner services (fee schedule) | 49 | $442.42 |
| 49451 | Physician and practitioner services (fee schedule) | 49 | $402.86 |
| 49452 | Physician and practitioner services (fee schedule) | 49 | $568.89 |
| 49460 | Physician and practitioner services (fee schedule) | 50 | $514.28 |
| 49465 | Physician and practitioner services (fee schedule) | 49 | $101.37 |
| 49491 | Physician and practitioner services (fee schedule) | 50 | $593.73 |
| 49492 | Physician and practitioner services (fee schedule) | 50 | $712.20 |
| 49495 | Physician and practitioner services (fee schedule) | 50 | $320.53 |
| 49496 | Physician and practitioner services (fee schedule) | 50 | $463.53 |
| 49500 | Physician and practitioner services (fee schedule) | 49 | $317.43 |
| 49501 | Physician and practitioner services (fee schedule) | 49 | $450.78 |
| 49505 | Physician and practitioner services (fee schedule) | 49 | $389.09 |
| 49507 | Physician and practitioner services (fee schedule) | 49 | $453.47 |
| 49520 | Physician and practitioner services (fee schedule) | 49 | $473.04 |
| 49521 | Physician and practitioner services (fee schedule) | 49 | $532.79 |
| 49525 | Physician and practitioner services (fee schedule) | 49 | $437.95 |
| 49540 | Physician and practitioner services (fee schedule) | 49 | $500.58 |
| 49550 | Physician and practitioner services (fee schedule) | 49 | $421.52 |
| 49553 | Physician and practitioner services (fee schedule) | 49 | $469.51 |
| 49555 | Physician and practitioner services (fee schedule) | 49 | $453.24 |
| 49557 | Physician and practitioner services (fee schedule) | 49 | $538.48 |
| 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) | 50 | $251.12 |
| 49592 | Physician and practitioner services (fee schedule) | 50 | $348.06 |
| 49593 | Physician and practitioner services (fee schedule) | 50 | $418.75 |
| 49594 | Physician and practitioner services (fee schedule) | 50 | $544.37 |
| 49595 | Physician and practitioner services (fee schedule) | 50 | $562.15 |
| 49596 | Physician and practitioner services (fee schedule) | 50 | $746.77 |
| 49600 | Physician and practitioner services (fee schedule) | 49 | $533.03 |
| 49605 | Physician and practitioner services (fee schedule) | 49 | $3,472.56 |
| 49606 | Physician and practitioner services (fee schedule) | 49 | $824.51 |
| 49610 | Physician and practitioner services (fee schedule) | 49 | $514.68 |
| 49611 | Physician and practitioner services (fee schedule) | 49 | $458.82 |
| 49613 | Physician and practitioner services (fee schedule) | 50 | $308.70 |
| 49614 | Physician and practitioner services (fee schedule) | 50 | $417.83 |
| 49615 | Physician and practitioner services (fee schedule) | 50 | $466.43 |
| 49616 | Physician and practitioner services (fee schedule) | 50 | $625.67 |
| 49617 | Physician and practitioner services (fee schedule) | 50 | $645.45 |
| 49618 | Physician and practitioner services (fee schedule) | 50 | $903.41 |
| 49621 | Physician and practitioner services (fee schedule) | 49 | $546.91 |
| 49622 | Physician and practitioner services (fee schedule) | 49 | $680.02 |
| 49623 | Physician and practitioner services (fee schedule) | 50 | $143.01 |
| 49650 | Physician and practitioner services (fee schedule) | 49 | $344.56 |
| 49651 | Physician and practitioner services (fee schedule) | 49 | $436.10 |
| 49659 | Physician and practitioner services (fee schedule) | 10 | $239.78 |
| 49900 | Physician and practitioner services (fee schedule) | 50 | $599.90 |
| 49904 | Physician and practitioner services (fee schedule) | 48 | $1,076.28 |
| 49905 | Physician and practitioner services (fee schedule) | 50 | $269.66 |
| 49906 | Physician and practitioner services (fee schedule) | 32 | $1,254.38 |
| 49999 | Physician and practitioner services (fee schedule) | 10 | $123.33 |
| 50010 | Physician and practitioner services (fee schedule) | 50 | $538.45 |
| 50020 | Physician and practitioner services (fee schedule) | 49 | $739.68 |
| 50040 | Physician and practitioner services (fee schedule) | 49 | $678.27 |
| 50045 | Physician and practitioner services (fee schedule) | 50 | $682.28 |
| 50060 | Physician and practitioner services (fee schedule) | 50 | $829.21 |
| 50065 | Physician and practitioner services (fee schedule) | 50 | $921.06 |
| 50070 | Physician and practitioner services (fee schedule) | 50 | $882.73 |
| 50075 | Physician and practitioner services (fee schedule) | 50 | $1,056.19 |
| 50080 | Physician and practitioner services (fee schedule) | 50 | $565.01 |
| 50081 | Physician and practitioner services (fee schedule) | 50 | $869.84 |
| 50100 | Physician and practitioner services (fee schedule) | 49 | $778.89 |
| 50120 | Physician and practitioner services (fee schedule) | 50 | $698.90 |
| 50125 | Physician and practitioner services (fee schedule) | 49 | $718.82 |
| 50130 | Physician and practitioner services (fee schedule) | 49 | $785.74 |
| 50135 | Physician and practitioner services (fee schedule) | 5 | $954.40 |
| 50200 | Physician and practitioner services (fee schedule) | 50 | $201.67 |
| 50205 | Physician and practitioner services (fee schedule) | 50 | $556.04 |
| 50220 | Physician and practitioner services (fee schedule) | 50 | $817.80 |
| 50225 | Physician and practitioner services (fee schedule) | 49 | $899.81 |
| 50230 | Physician and practitioner services (fee schedule) | 49 | $1,000.87 |
| 50234 | Physician and practitioner services (fee schedule) | 50 | $944.86 |
| 50236 | Physician and practitioner services (fee schedule) | 48 | $1,089.65 |
| 50240 | Physician and practitioner services (fee schedule) | 49 | $1,009.43 |
| 50250 | Physician and practitioner services (fee schedule) | 48 | $880.95 |
| 50280 | Physician and practitioner services (fee schedule) | 50 | $701.99 |
| 50290 | Physician and practitioner services (fee schedule) | 50 | $663.91 |
| 50300 | Physician and practitioner services (fee schedule) | 25 | $600.77 |
| 50320 | Physician and practitioner services (fee schedule) | 45 | $1,147.22 |
| 50323 | Physician and practitioner services (fee schedule) | 25 | $163.56 |
| 50325 | Physician and practitioner services (fee schedule) | 23 | $132.76 |
| 50327 | Physician and practitioner services (fee schedule) | 34 | $154.78 |
| 50328 | Physician and practitioner services (fee schedule) | 34 | $138.53 |
| 50329 | Physician and practitioner services (fee schedule) | 33 | $129.85 |
| 50340 | Physician and practitioner services (fee schedule) | 48 | $736.90 |
| 50360 | Physician and practitioner services (fee schedule) | 49 | $1,785.58 |
| 50365 | Physician and practitioner services (fee schedule) | 49 | $2,173.67 |
| 50370 | Physician and practitioner services (fee schedule) | 49 | $908.59 |
| 50380 | Physician and practitioner services (fee schedule) | 46 | $1,525.42 |
| 50382 | Physician and practitioner services (fee schedule) | 49 | $754.88 |
| 50384 | Physician and practitioner services (fee schedule) | 49 | $655.38 |
| 50385 | Physician and practitioner services (fee schedule) | 49 | $787.59 |
| 50386 | Physician and practitioner services (fee schedule) | 48 | $583.63 |
| 50387 | Physician and practitioner services (fee schedule) | 49 | $407.04 |
| 50389 | Physician and practitioner services (fee schedule) | 49 | $310.81 |
| 50390 | Physician and practitioner services (fee schedule) | 50 | $75.73 |
| 50391 | Physician and practitioner services (fee schedule) | 48 | $98.49 |
| 50396 | Physician and practitioner services (fee schedule) | 50 | $85.34 |
| 50400 | Physician and practitioner services (fee schedule) | 50 | $882.12 |
| 50405 | Physician and practitioner services (fee schedule) | 50 | $1,062.59 |
| 50430 | Physician and practitioner services (fee schedule) | 49 | $384.28 |
| 50431 | Physician and practitioner services (fee schedule) | 49 | $147.06 |
| 50432 | Physician and practitioner services (fee schedule) | 48 | $558.07 |
| 50433 | Physician and practitioner services (fee schedule) | 48 | $705.97 |
| 50434 | Physician and practitioner services (fee schedule) | 48 | $567.49 |
| 50435 | Physician and practitioner services (fee schedule) | 48 | $348.85 |
| 50436 | Physician and practitioner services (fee schedule) | 49 | $118.84 |
| 50437 | Physician and practitioner services (fee schedule) | 49 | $198.42 |
| 50500 | Physician and practitioner services (fee schedule) | 49 | $932.24 |
| 50520 | Physician and practitioner services (fee schedule) | 50 | $834.95 |
| 50525 | Physician and practitioner services (fee schedule) | 49 | $1,072.33 |
| 50526 | Physician and practitioner services (fee schedule) | 49 | $1,145.59 |
| 50540 | Physician and practitioner services (fee schedule) | 49 | $870.95 |
| 50541 | Physician and practitioner services (fee schedule) | 49 | $697.00 |
| 50542 | Physician and practitioner services (fee schedule) | 47 | $846.82 |
| 50543 | Physician and practitioner services (fee schedule) | 50 | $1,082.36 |
| 50544 | Physician and practitioner services (fee schedule) | 49 | $932.72 |
| 50545 | Physician and practitioner services (fee schedule) | 49 | $1,009.76 |
| 50546 | Physician and practitioner services (fee schedule) | 50 | $894.06 |
| 50547 | Physician and practitioner services (fee schedule) | 46 | $1,199.68 |
| 50548 | Physician and practitioner services (fee schedule) | 50 | $979.55 |
| 50549 | Physician and practitioner services (fee schedule) | 7 | $456.78 |
| 50551 | Physician and practitioner services (fee schedule) | 50 | $267.25 |
| 50553 | Physician and practitioner services (fee schedule) | 50 | $285.12 |
| 50555 | Physician and practitioner services (fee schedule) | 50 | $328.44 |
| 50557 | Physician and practitioner services (fee schedule) | 50 | $333.19 |
| 50561 | Physician and practitioner services (fee schedule) | 50 | $371.97 |
| 50562 | Physician and practitioner services (fee schedule) | 47 | $419.24 |
| 50570 | Physician and practitioner services (fee schedule) | 50 | $350.75 |
| 50572 | Physician and practitioner services (fee schedule) | 50 | $398.45 |
| 50574 | Physician and practitioner services (fee schedule) | 49 | $424.93 |
| 50575 | Physician and practitioner services (fee schedule) | 49 | $569.52 |
| 50576 | Physician and practitioner services (fee schedule) | 50 | $422.11 |
| 50580 | Physician and practitioner services (fee schedule) | 50 | $452.80 |
| 50590 | Physician and practitioner services (fee schedule) | 50 | $600.84 |
| 50592 | Physician and practitioner services (fee schedule) | 48 | $1,681.61 |
| 50593 | Physician and practitioner services (fee schedule) | 47 | $2,236.07 |
| 50600 | Physician and practitioner services (fee schedule) | 50 | $692.47 |
| 50605 | Physician and practitioner services (fee schedule) | 50 | $745.00 |
| 50606 | Physician and practitioner services (fee schedule) | 48 | $317.81 |
| 50610 | Physician and practitioner services (fee schedule) | 49 | $718.17 |
| 50620 | Physician and practitioner services (fee schedule) | 49 | $688.07 |
| 50630 | Physician and practitioner services (fee schedule) | 50 | $683.77 |
| 50650 | Physician and practitioner services (fee schedule) | 49 | $758.42 |
| 50660 | Physician and practitioner services (fee schedule) | 49 | $843.29 |
| 50684 | Physician and practitioner services (fee schedule) | 50 | $85.36 |
| 50686 | Physician and practitioner services (fee schedule) | 49 | $99.59 |
| 50688 | Physician and practitioner services (fee schedule) | 49 | $61.63 |
| 50690 | Physician and practitioner services (fee schedule) | 50 | $74.33 |
| 50693 | Physician and practitioner services (fee schedule) | 49 | $624.50 |
| 50694 | Physician and practitioner services (fee schedule) | 49 | $698.93 |
| 50695 | Physician and practitioner services (fee schedule) | 49 | $839.87 |
| 50700 | Physician and practitioner services (fee schedule) | 49 | $706.09 |
| 50705 | Physician and practitioner services (fee schedule) | 46 | $1,135.05 |
| 50706 | Physician and practitioner services (fee schedule) | 48 | $512.45 |
| 50715 | Physician and practitioner services (fee schedule) | 50 | $888.34 |
| 50722 | Physician and practitioner services (fee schedule) | 49 | $759.94 |
| 50725 | Physician and practitioner services (fee schedule) | 49 | $846.73 |
| 50727 | Physician and practitioner services (fee schedule) | 49 | $404.28 |
| 50728 | Physician and practitioner services (fee schedule) | 50 | $548.63 |
| 50740 | Physician and practitioner services (fee schedule) | 49 | $897.53 |
| 50750 | Physician and practitioner services (fee schedule) | 49 | $912.52 |
| 50760 | Physician and practitioner services (fee schedule) | 49 | $871.79 |
| 50770 | Physician and practitioner services (fee schedule) | 49 | $884.77 |
| 50780 | Physician and practitioner services (fee schedule) | 50 | $857.32 |
| 50782 | Physician and practitioner services (fee schedule) | 49 | $834.49 |
| 50783 | Physician and practitioner services (fee schedule) | 49 | $880.26 |
| 50785 | Physician and practitioner services (fee schedule) | 49 | $932.72 |
| 50800 | Physician and practitioner services (fee schedule) | 49 | $713.54 |
| 50810 | Physician and practitioner services (fee schedule) | 49 | $1,031.85 |
| 50815 | Physician and practitioner services (fee schedule) | 49 | $950.52 |
| 50820 | Physician and practitioner services (fee schedule) | 50 | $1,005.51 |
| 50825 | Physician and practitioner services (fee schedule) | 49 | $1,258.10 |
| 50830 | Physician and practitioner services (fee schedule) | 48 | $1,335.84 |
| 50840 | Physician and practitioner services (fee schedule) | 49 | $917.22 |
| 50845 | Physician and practitioner services (fee schedule) | 48 | $961.68 |
| 50860 | Physician and practitioner services (fee schedule) | 50 | $706.51 |
| 50900 | Physician and practitioner services (fee schedule) | 49 | $649.24 |
| 50920 | Physician and practitioner services (fee schedule) | 50 | $651.58 |
| 50930 | Physician and practitioner services (fee schedule) | 49 | $812.26 |
| 50940 | Physician and practitioner services (fee schedule) | 49 | $677.96 |
| 50945 | Physician and practitioner services (fee schedule) | 49 | $718.17 |
| 50947 | Physician and practitioner services (fee schedule) | 49 | $1,059.89 |
| 50948 | Physician and practitioner services (fee schedule) | 48 | $967.22 |
| 50949 | Physician and practitioner services (fee schedule) | 7 | $842.49 |
| 50951 | Physician and practitioner services (fee schedule) | 50 | $283.69 |
| 50953 | Physician and practitioner services (fee schedule) | 50 | $303.00 |
| 50955 | Physician and practitioner services (fee schedule) | 50 | $328.42 |
| 50957 | Physician and practitioner services (fee schedule) | 50 | $327.17 |
| 50961 | Physician and practitioner services (fee schedule) | 50 | $300.31 |
| 50970 | Physician and practitioner services (fee schedule) | 50 | $280.63 |
| 50972 | Physician and practitioner services (fee schedule) | 49 | $258.51 |
| 50974 | Physician and practitioner services (fee schedule) | 50 | $354.79 |
| 50976 | Physician and practitioner services (fee schedule) | 50 | $349.88 |
| 50980 | Physician and practitioner services (fee schedule) | 50 | $269.67 |
| 51020 | Physician and practitioner services (fee schedule) | 48 | $373.29 |
| 51030 | Physician and practitioner services (fee schedule) | 6 | $421.57 |
| 51040 | Physician and practitioner services (fee schedule) | 49 | $232.55 |
| 51045 | Physician and practitioner services (fee schedule) | 50 | $376.65 |
| 51050 | Physician and practitioner services (fee schedule) | 49 | $366.78 |
| 51060 | Physician and practitioner services (fee schedule) | 49 | $461.21 |
| 51065 | Physician and practitioner services (fee schedule) | 50 | $456.41 |
| 51080 | Physician and practitioner services (fee schedule) | 49 | $311.17 |
| 51100 | Physician and practitioner services (fee schedule) | 50 | $48.97 |
| 51101 | Physician and practitioner services (fee schedule) | 50 | $101.47 |
| 51102 | Physician and practitioner services (fee schedule) | 50 | $185.71 |
| 51500 | Physician and practitioner services (fee schedule) | 49 | $489.56 |
| 51520 | Physician and practitioner services (fee schedule) | 49 | $463.20 |
| 51525 | Physician and practitioner services (fee schedule) | 49 | $663.04 |
| 51530 | Physician and practitioner services (fee schedule) | 50 | $574.56 |
| 51535 | Physician and practitioner services (fee schedule) | 49 | $573.07 |
| 51550 | Physician and practitioner services (fee schedule) | 50 | $714.84 |
| 51555 | Physician and practitioner services (fee schedule) | 49 | $924.38 |
| 51565 | Physician and practitioner services (fee schedule) | 50 | $959.37 |
| 51570 | Physician and practitioner services (fee schedule) | 49 | $1,094.12 |
| 51575 | Physician and practitioner services (fee schedule) | 49 | $1,323.90 |
| 51580 | Physician and practitioner services (fee schedule) | 49 | $1,397.67 |
| 51585 | Physician and practitioner services (fee schedule) | 49 | $1,533.80 |
| 51590 | Physician and practitioner services (fee schedule) | 49 | $1,456.97 |
| 51595 | Physician and practitioner services (fee schedule) | 49 | $1,647.87 |
| 51596 | Physician and practitioner services (fee schedule) | 49 | $1,794.80 |
| 51597 | Physician and practitioner services (fee schedule) | 49 | $1,752.60 |
| 51600 | Physician and practitioner services (fee schedule) | 50 | $133.90 |
| 51605 | Physician and practitioner services (fee schedule) | 48 | $30.91 |
| 51610 | Physician and practitioner services (fee schedule) | 50 | $80.78 |
| 51700 | Physician and practitioner services (fee schedule) | 50 | $58.03 |
| 51701 | Physician and practitioner services (fee schedule) | 49 | $35.54 |
| 51702 | Physician and practitioner services (fee schedule) | 48 | $50.19 |
| 51703 | Physician and practitioner services (fee schedule) | 49 | $104.43 |
| 51705 | Physician and practitioner services (fee schedule) | 49 | $64.54 |
| 51710 | Physician and practitioner services (fee schedule) | 50 | $94.85 |
| 51715 | Physician and practitioner services (fee schedule) | 49 | $231.31 |
| 51720 | Physician and practitioner services (fee schedule) | 49 | $69.98 |
| 51721 | Physician and practitioner services (fee schedule) | 27 | $359.97 |
| 51725 | Physician and practitioner services (fee schedule) | 50 | $98.29 |
| 51726 | Physician and practitioner services (fee schedule) | 50 | $150.36 |
| 51727 | Physician and practitioner services (fee schedule) | 50 | $174.73 |
| 51728 | Physician and practitioner services (fee schedule) | 50 | $180.56 |
| 51729 | Physician and practitioner services (fee schedule) | 50 | $183.49 |
| 51736 | Physician and practitioner services (fee schedule) | 50 | $10.10 |
| 51741 | Physician and practitioner services (fee schedule) | 50 | $11.75 |
| 51784 | Physician and practitioner services (fee schedule) | 50 | $49.44 |
| 51785 | Physician and practitioner services (fee schedule) | 50 | $199.32 |
| 51792 | Physician and practitioner services (fee schedule) | 49 | $151.48 |
| 51797 | Physician and practitioner services (fee schedule) | 50 | $89.72 |
| 51798 | Physician and practitioner services (fee schedule) | 48 | $10.87 |
| 51800 | Physician and practitioner services (fee schedule) | 50 | $794.50 |
| 51820 | Physician and practitioner services (fee schedule) | 49 | $821.14 |
| 51840 | Physician and practitioner services (fee schedule) | 50 | $529.58 |
| 51841 | Physician and practitioner services (fee schedule) | 50 | $614.68 |
| 51845 | Physician and practitioner services (fee schedule) | 50 | $456.86 |
| 51860 | Physician and practitioner services (fee schedule) | 49 | $554.26 |
| 51865 | Physician and practitioner services (fee schedule) | 50 | $671.29 |
| 51880 | Physician and practitioner services (fee schedule) | 49 | $354.17 |
| 51900 | Physician and practitioner services (fee schedule) | 49 | $638.71 |
| 51920 | Physician and practitioner services (fee schedule) | 49 | $585.25 |
| 51925 | Physician and practitioner services (fee schedule) | 49 | $785.68 |
| 51940 | Physician and practitioner services (fee schedule) | 49 | $1,194.64 |
| 51960 | Physician and practitioner services (fee schedule) | 49 | $1,071.47 |
| 51980 | Physician and practitioner services (fee schedule) | 50 | $524.91 |
| 51990 | Physician and practitioner services (fee schedule) | 49 | $568.15 |
| 51992 | Physician and practitioner services (fee schedule) | 49 | $614.37 |
| 51999 | Physician and practitioner services (fee schedule) | 6 | $705.12 |
| 52000 | Physician and practitioner services (fee schedule) | 50 | $135.54 |
| 52001 | Physician and practitioner services (fee schedule) | 49 | $277.70 |
| 52005 | Physician and practitioner services (fee schedule) | 50 | $188.69 |
| 52007 | Physician and practitioner services (fee schedule) | 50 | $288.84 |
| 52010 | Physician and practitioner services (fee schedule) | 50 | $240.14 |
| 52204 | Physician and practitioner services (fee schedule) | 50 | $238.17 |
| 52214 | Physician and practitioner services (fee schedule) | 50 | $423.85 |
| 52224 | Physician and practitioner services (fee schedule) | 50 | $492.38 |
| 52234 | Physician and practitioner services (fee schedule) | 50 | $198.81 |
| 52235 | Physician and practitioner services (fee schedule) | 50 | $243.53 |
| 52240 | Physician and practitioner services (fee schedule) | 50 | $332.70 |
| 52250 | Physician and practitioner services (fee schedule) | 49 | $190.11 |
| 52260 | Physician and practitioner services (fee schedule) | 50 | $161.19 |
| 52265 | Physician and practitioner services (fee schedule) | 50 | $226.40 |
| 52270 | Physician and practitioner services (fee schedule) | 50 | $269.10 |
| 52275 | Physician and practitioner services (fee schedule) | 50 | $324.50 |
| 52276 | Physician and practitioner services (fee schedule) | 49 | $209.26 |
| 52277 | Physician and practitioner services (fee schedule) | 49 | $257.59 |
| 52281 | Physician and practitioner services (fee schedule) | 49 | $187.50 |
| 52282 | Physician and practitioner services (fee schedule) | 49 | $268.46 |
| 52283 | Physician and practitioner services (fee schedule) | 49 | $209.52 |
| 52284 | Physician and practitioner services (fee schedule) | 33 | $2,091.61 |
| 52285 | Physician and practitioner services (fee schedule) | 49 | $207.20 |
| 52287 | Physician and practitioner services (fee schedule) | 49 | $231.96 |
| 52290 | Physician and practitioner services (fee schedule) | 49 | $186.63 |
| 52300 | Physician and practitioner services (fee schedule) | 49 | $221.57 |
| 52301 | Physician and practitioner services (fee schedule) | 49 | $231.23 |
| 52305 | Physician and practitioner services (fee schedule) | 49 | $226.55 |
| 52310 | Physician and practitioner services (fee schedule) | 49 | $202.03 |
| 52315 | Physician and practitioner services (fee schedule) | 49 | $309.77 |
| 52317 | Physician and practitioner services (fee schedule) | 49 | $537.60 |
| 52318 | Physician and practitioner services (fee schedule) | 49 | $379.84 |
| 52320 | Physician and practitioner services (fee schedule) | 49 | $196.84 |
| 52325 | Physician and practitioner services (fee schedule) | 49 | $255.94 |
| 52327 | Physician and practitioner services (fee schedule) | 49 | $218.92 |
| 52330 | Physician and practitioner services (fee schedule) | 49 | $396.50 |
| 52332 | Physician and practitioner services (fee schedule) | 49 | $251.01 |
| 52334 | Physician and practitioner services (fee schedule) | 49 | $155.78 |
| 52341 | Physician and practitioner services (fee schedule) | 48 | $226.53 |
| 52342 | Physician and practitioner services (fee schedule) | 48 | $246.54 |
| 52343 | Physician and practitioner services (fee schedule) | 48 | $274.43 |
| 52344 | Physician and practitioner services (fee schedule) | 48 | $294.30 |
| 52345 | Physician and practitioner services (fee schedule) | 48 | $313.88 |
| 52346 | Physician and practitioner services (fee schedule) | 47 | $351.70 |
| 52351 | Physician and practitioner services (fee schedule) | 49 | $239.53 |
| 52352 | Physician and practitioner services (fee schedule) | 48 | $285.42 |
| 52353 | Physician and practitioner services (fee schedule) | 49 | $314.61 |
| 52354 | Physician and practitioner services (fee schedule) | 48 | $327.79 |
| 52355 | Physician and practitioner services (fee schedule) | 48 | $368.05 |
| 52356 | Physician and practitioner services (fee schedule) | 49 | $316.42 |
| 52400 | Physician and practitioner services (fee schedule) | 49 | $388.08 |
| 52402 | Physician and practitioner services (fee schedule) | 47 | $207.82 |
| 52441 | Physician and practitioner services (fee schedule) | 48 | $820.56 |
| 52442 | Physician and practitioner services (fee schedule) | 48 | $565.06 |
| 52443 | Physician and practitioner services (fee schedule) | 25 | $3,656.48 |
| 52450 | Physician and practitioner services (fee schedule) | 48 | $382.57 |
| 52500 | Physician and practitioner services (fee schedule) | 49 | $343.08 |
| 52597 | Physician and practitioner services (fee schedule) | 28 | $436.34 |
| 52601 | Physician and practitioner services (fee schedule) | 49 | $546.00 |
| 52630 | Physician and practitioner services (fee schedule) | 49 | $350.61 |
| 52640 | Physician and practitioner services (fee schedule) | 49 | $266.23 |
| 52647 | Physician and practitioner services (fee schedule) | 11 | $651.79 |
| 52648 | Physician and practitioner services (fee schedule) | 49 | $555.27 |
| 52649 | Physician and practitioner services (fee schedule) | 49 | $620.85 |
| 52700 | Physician and practitioner services (fee schedule) | 49 | $341.56 |
| 53000 | Physician and practitioner services (fee schedule) | 49 | $117.99 |
| 53010 | Physician and practitioner services (fee schedule) | 49 | $235.29 |
| 53020 | Physician and practitioner services (fee schedule) | 49 | $75.64 |
| 53025 | Physician and practitioner services (fee schedule) | 49 | $53.66 |
| 53040 | Physician and practitioner services (fee schedule) | 49 | $295.49 |
| 53060 | Physician and practitioner services (fee schedule) | 49 | $142.30 |
| 53080 | Physician and practitioner services (fee schedule) | 49 | $326.80 |
| 53085 | Physician and practitioner services (fee schedule) | 48 | $490.04 |
| 53200 | Physician and practitioner services (fee schedule) | 49 | $124.20 |
| 53210 | Physician and practitioner services (fee schedule) | 49 | $561.73 |
| 53215 | Physician and practitioner services (fee schedule) | 49 | $679.55 |
| 53220 | Physician and practitioner services (fee schedule) | 49 | $355.59 |
| 53230 | Physician and practitioner services (fee schedule) | 49 | $474.07 |
| 53235 | Physician and practitioner services (fee schedule) | 49 | $470.11 |
| 53240 | Physician and practitioner services (fee schedule) | 49 | $329.43 |
| 53250 | Physician and practitioner services (fee schedule) | 49 | $308.28 |
| 53260 | Physician and practitioner services (fee schedule) | 49 | $151.07 |
| 53265 | Physician and practitioner services (fee schedule) | 49 | $161.77 |
| 53270 | Physician and practitioner services (fee schedule) | 49 | $149.66 |
| 53275 | Physician and practitioner services (fee schedule) | 49 | $201.16 |
| 53400 | Physician and practitioner services (fee schedule) | 49 | $587.44 |
| 53405 | Physician and practitioner services (fee schedule) | 49 | $666.93 |
| 53410 | Physician and practitioner services (fee schedule) | 49 | $717.54 |
| 53415 | Physician and practitioner services (fee schedule) | 49 | $868.18 |
| 53420 | Physician and practitioner services (fee schedule) | 49 | $656.25 |
| 53425 | Physician and practitioner services (fee schedule) | 49 | $712.37 |
| 53430 | Physician and practitioner services (fee schedule) | 49 | $714.60 |
| 53431 | Physician and practitioner services (fee schedule) | 49 | $866.49 |
| 53440 | Physician and practitioner services (fee schedule) | 49 | $584.01 |
| 53442 | Physician and practitioner services (fee schedule) | 48 | $524.20 |
| 53444 | Physician and practitioner services (fee schedule) | 48 | $594.64 |
| 53445 | Physician and practitioner services (fee schedule) | 48 | $603.53 |
| 53446 | Physician and practitioner services (fee schedule) | 49 | $508.68 |
| 53447 | Physician and practitioner services (fee schedule) | 49 | $613.52 |
| 53448 | Physician and practitioner services (fee schedule) | 49 | $970.39 |
| 53449 | Physician and practitioner services (fee schedule) | 45 | $470.51 |
| 53450 | Physician and practitioner services (fee schedule) | 49 | $309.08 |
| 53451 | Physician and practitioner services (fee schedule) | 6 | $228.48 |
| 53452 | Physician and practitioner services (fee schedule) | 6 | $171.06 |
| 53453 | Physician and practitioner services (fee schedule) | 6 | $39.71 |
| 53454 | Physician and practitioner services (fee schedule) | 7 | $41.06 |
| 53460 | Physician and practitioner services (fee schedule) | 49 | $343.47 |
| 53500 | Physician and practitioner services (fee schedule) | 49 | $552.95 |
| 53502 | Physician and practitioner services (fee schedule) | 48 | $369.97 |
| 53505 | Physician and practitioner services (fee schedule) | 49 | $375.83 |
| 53510 | Physician and practitioner services (fee schedule) | 49 | $473.56 |
| 53515 | Physician and practitioner services (fee schedule) | 49 | $607.64 |
| 53520 | Physician and practitioner services (fee schedule) | 49 | $420.00 |
| 53600 | Physician and practitioner services (fee schedule) | 49 | $62.11 |
| 53601 | Physician and practitioner services (fee schedule) | 49 | $60.61 |
| 53605 | Physician and practitioner services (fee schedule) | 49 | $48.32 |
| 53620 | Physician and practitioner services (fee schedule) | 49 | $110.76 |
| 53621 | Physician and practitioner services (fee schedule) | 49 | $94.13 |
| 53660 | Physician and practitioner services (fee schedule) | 49 | $52.01 |
| 53661 | Physician and practitioner services (fee schedule) | 49 | $52.40 |
| 53665 | Physician and practitioner services (fee schedule) | 49 | $30.81 |
| 53850 | Physician and practitioner services (fee schedule) | 49 | $1,114.62 |
| 53852 | Physician and practitioner services (fee schedule) | 48 | $1,012.16 |
| 53854 | Physician and practitioner services (fee schedule) | 39 | $1,390.67 |
| 53855 | Physician and practitioner services (fee schedule) | 44 | $433.91 |
| 53860 | Physician and practitioner services (fee schedule) | 37 | $1,263.01 |
| 53865 | Physician and practitioner services (fee schedule) | 28 | $2,116.82 |
| 53866 | Physician and practitioner services (fee schedule) | 27 | $102.91 |
| 53899 | Physician and practitioner services (fee schedule) | 6 | $62.73 |
| 54000 | Physician and practitioner services (fee schedule) | 48 | $113.88 |
| 54001 | Physician and practitioner services (fee schedule) | 49 | $142.58 |
| 54015 | Physician and practitioner services (fee schedule) | 49 | $234.25 |
| 54050 | Physician and practitioner services (fee schedule) | 50 | $98.59 |
| 54055 | Physician and practitioner services (fee schedule) | 49 | $95.47 |
| 54056 | Physician and practitioner services (fee schedule) | 50 | $103.21 |
| 54057 | Physician and practitioner services (fee schedule) | 49 | $97.99 |
| 54060 | Physician and practitioner services (fee schedule) | 49 | $135.67 |
| 54065 | Physician and practitioner services (fee schedule) | 49 | $170.07 |
| 54100 | Physician and practitioner services (fee schedule) | 49 | $130.59 |
| 54105 | Physician and practitioner services (fee schedule) | 49 | $202.89 |
| 54110 | Physician and practitioner services (fee schedule) | 49 | $480.03 |
| 54111 | Physician and practitioner services (fee schedule) | 47 | $624.13 |
| 54112 | Physician and practitioner services (fee schedule) | 48 | $719.23 |
| 54115 | Physician and practitioner services (fee schedule) | 47 | $355.58 |
| 54120 | Physician and practitioner services (fee schedule) | 49 | $466.25 |
| 54125 | Physician and practitioner services (fee schedule) | 49 | $606.49 |
| 54130 | Physician and practitioner services (fee schedule) | 49 | $906.46 |
| 54135 | Physician and practitioner services (fee schedule) | 49 | $1,150.33 |
| 54150 | Physician and practitioner services (fee schedule) | 46 | $103.88 |
| 54160 | Physician and practitioner services (fee schedule) | 45 | $154.57 |
| 54161 | Physician and practitioner services (fee schedule) | 49 | $156.99 |
| 54162 | Physician and practitioner services (fee schedule) | 48 | $200.26 |
| 54163 | Physician and practitioner services (fee schedule) | 49 | $174.95 |
| 54164 | Physician and practitioner services (fee schedule) | 48 | $154.95 |
| 54200 | Physician and practitioner services (fee schedule) | 49 | $81.74 |
| 54205 | Physician and practitioner services (fee schedule) | 48 | $404.31 |
| 54220 | Physician and practitioner services (fee schedule) | 49 | $160.82 |
| 54230 | Physician and practitioner services (fee schedule) | 43 | $74.95 |
| 54231 | Physician and practitioner services (fee schedule) | 41 | $109.06 |
| 54235 | Physician and practitioner services (fee schedule) | 41 | $65.23 |
| 54240 | Physician and practitioner services (fee schedule) | 36 | $52.97 |
| 54250 | Physician and practitioner services (fee schedule) | 33 | $85.83 |
| 54300 | Physician and practitioner services (fee schedule) | 49 | $496.43 |
| 54304 | Physician and practitioner services (fee schedule) | 49 | $580.28 |
| 54308 | Physician and practitioner services (fee schedule) | 49 | $548.50 |
| 54312 | Physician and practitioner services (fee schedule) | 49 | $634.94 |
| 54316 | Physician and practitioner services (fee schedule) | 49 | $766.07 |
| 54318 | Physician and practitioner services (fee schedule) | 49 | $554.39 |
| 54322 | Physician and practitioner services (fee schedule) | 49 | $604.30 |
| 54324 | Physician and practitioner services (fee schedule) | 49 | $746.24 |
| 54326 | Physician and practitioner services (fee schedule) | 49 | $727.18 |
| 54328 | Physician and practitioner services (fee schedule) | 49 | $730.04 |
| 54332 | Physician and practitioner services (fee schedule) | 49 | $769.07 |
| 54336 | Physician and practitioner services (fee schedule) | 49 | $928.62 |
| 54340 | Physician and practitioner services (fee schedule) | 49 | $445.52 |
| 54344 | Physician and practitioner services (fee schedule) | 49 | $735.82 |
| 54348 | Physician and practitioner services (fee schedule) | 49 | $778.89 |
| 54352 | Physician and practitioner services (fee schedule) | 48 | $1,078.52 |
| 54360 | Physician and practitioner services (fee schedule) | 49 | $540.25 |
| 54380 | Physician and practitioner services (fee schedule) | 49 | $611.91 |
| 54385 | Physician and practitioner services (fee schedule) | 48 | $682.94 |
| 54390 | Physician and practitioner services (fee schedule) | 49 | $942.61 |
| 54400 | Physician and practitioner services (fee schedule) | 29 | $394.69 |
| 54401 | Physician and practitioner services (fee schedule) | 26 | $499.72 |
| 54405 | Physician and practitioner services (fee schedule) | 28 | $583.85 |
| 54406 | Physician and practitioner services (fee schedule) | 37 | $539.46 |
| 54408 | Physician and practitioner services (fee schedule) | 29 | $582.22 |
| 54410 | Physician and practitioner services (fee schedule) | 30 | $667.09 |
| 54411 | Physician and practitioner services (fee schedule) | 29 | $754.13 |
| 54415 | Physician and practitioner services (fee schedule) | 37 | $398.95 |
| 54416 | Physician and practitioner services (fee schedule) | 32 | $518.70 |
| 54417 | Physician and practitioner services (fee schedule) | 33 | $659.17 |
| 54420 | Physician and practitioner services (fee schedule) | 49 | $544.18 |
| 54430 | Physician and practitioner services (fee schedule) | 49 | $497.88 |
| 54435 | Physician and practitioner services (fee schedule) | 49 | $335.74 |
| 54437 | Physician and practitioner services (fee schedule) | 49 | $530.03 |
| 54438 | Physician and practitioner services (fee schedule) | 5 | $1,147.21 |
| 54440 | Physician and practitioner services (fee schedule) | 40 | $467.25 |
| 54450 | Physician and practitioner services (fee schedule) | 48 | $55.12 |
| 54500 | Physician and practitioner services (fee schedule) | 49 | $58.16 |
| 54505 | Physician and practitioner services (fee schedule) | 49 | $165.03 |
| 54512 | Physician and practitioner services (fee schedule) | 48 | $422.28 |
| 54520 | Physician and practitioner services (fee schedule) | 49 | $265.97 |
| 54522 | Physician and practitioner services (fee schedule) | 48 | $454.94 |
| 54530 | Physician and practitioner services (fee schedule) | 49 | $406.54 |
| 54535 | Physician and practitioner services (fee schedule) | 49 | $577.39 |
| 54550 | Physician and practitioner services (fee schedule) | 49 | $371.61 |
| 54560 | Physician and practitioner services (fee schedule) | 49 | $509.87 |
| 54600 | Physician and practitioner services (fee schedule) | 49 | $356.71 |
| 54620 | Physician and practitioner services (fee schedule) | 49 | $236.11 |
| 54640 | Physician and practitioner services (fee schedule) | 49 | $350.68 |
| 54650 | Physician and practitioner services (fee schedule) | 49 | $552.58 |
| 54660 | Physician and practitioner services (fee schedule) | 38 | $286.97 |
| 54670 | Physician and practitioner services (fee schedule) | 49 | $323.41 |
| 54680 | Physician and practitioner services (fee schedule) | 48 | $577.76 |
| 54690 | Physician and practitioner services (fee schedule) | 49 | $501.99 |
| 54692 | Physician and practitioner services (fee schedule) | 49 | $594.11 |
| 54699 | Physician and practitioner services (fee schedule) | 5 | $70.00 |
| 54700 | Physician and practitioner services (fee schedule) | 49 | $168.66 |
| 54800 | Physician and practitioner services (fee schedule) | 49 | $97.67 |
| 54830 | Physician and practitioner services (fee schedule) | 49 | $291.61 |
| 54840 | Physician and practitioner services (fee schedule) | 49 | $261.77 |
| 54860 | Physician and practitioner services (fee schedule) | 49 | $332.61 |
| 54861 | Physician and practitioner services (fee schedule) | 49 | $450.93 |
| 54865 | Physician and practitioner services (fee schedule) | 49 | $281.26 |
| 54900 | Physician and practitioner services (fee schedule) | 31 | $606.49 |
| 54901 | Physician and practitioner services (fee schedule) | 32 | $796.59 |
| 55000 | Physician and practitioner services (fee schedule) | 49 | $85.49 |
| 55040 | Physician and practitioner services (fee schedule) | 49 | $272.86 |
| 55041 | Physician and practitioner services (fee schedule) | 49 | $407.99 |
| 55060 | Physician and practitioner services (fee schedule) | 49 | $301.98 |
| 55100 | Physician and practitioner services (fee schedule) | 49 | $169.09 |
| 55110 | Physician and practitioner services (fee schedule) | 48 | $306.24 |
| 55120 | Physician and practitioner services (fee schedule) | 49 | $267.91 |
| 55150 | Physician and practitioner services (fee schedule) | 49 | $370.80 |
| 55175 | Physician and practitioner services (fee schedule) | 48 | $292.60 |
| 55180 | Physician and practitioner services (fee schedule) | 48 | $537.28 |
| 55200 | Physician and practitioner services (fee schedule) | 43 | $267.69 |
| 55250 | Physician and practitioner services (fee schedule) | 49 | $265.86 |
| 55300 | Physician and practitioner services (fee schedule) | 40 | $146.25 |
| 55400 | Physician and practitioner services (fee schedule) | 17 | $369.14 |
| 55500 | Physician and practitioner services (fee schedule) | 49 | $312.23 |
| 55520 | Physician and practitioner services (fee schedule) | 49 | $338.10 |
| 55530 | Physician and practitioner services (fee schedule) | 49 | $282.99 |
| 55535 | Physician and practitioner services (fee schedule) | 49 | $324.22 |
| 55540 | Physician and practitioner services (fee schedule) | 49 | $420.12 |
| 55550 | Physician and practitioner services (fee schedule) | 49 | $333.48 |
| 55559 | Physician and practitioner services (fee schedule) | 7 | $225.95 |
| 55600 | Physician and practitioner services (fee schedule) | 48 | $333.63 |
| 55605 | Physician and practitioner services (fee schedule) | 47 | $412.01 |
| 55650 | Physician and practitioner services (fee schedule) | 49 | $547.42 |
| 55680 | Physician and practitioner services (fee schedule) | 49 | $281.74 |
| 55700 | Physician and practitioner services (fee schedule) | 11 | $137.87 |
| 55705 | Physician and practitioner services (fee schedule) | 49 | $201.97 |
| 55706 | Physician and practitioner services (fee schedule) | 47 | $213.24 |
| 55707 | Physician and practitioner services (fee schedule) | 41 | $229.12 |
| 55708 | Physician and practitioner services (fee schedule) | 40 | $281.08 |
| 55709 | Physician and practitioner services (fee schedule) | 41 | $386.80 |
| 55710 | Physician and practitioner services (fee schedule) | 41 | $433.97 |
| 55711 | Physician and practitioner services (fee schedule) | 41 | $247.25 |
| 55712 | Physician and practitioner services (fee schedule) | 41 | $403.01 |
| 55713 | Physician and practitioner services (fee schedule) | 40 | $519.56 |
| 55714 | Physician and practitioner services (fee schedule) | 41 | $494.80 |
| 55715 | Physician and practitioner services (fee schedule) | 40 | $55.75 |
| 55720 | Physician and practitioner services (fee schedule) | 49 | $334.78 |
| 55725 | Physician and practitioner services (fee schedule) | 49 | $440.95 |
| 55801 | Physician and practitioner services (fee schedule) | 49 | $816.69 |
| 55810 | Physician and practitioner services (fee schedule) | 49 | $990.58 |
| 55812 | Physician and practitioner services (fee schedule) | 49 | $1,239.29 |
| 55815 | Physician and practitioner services (fee schedule) | 49 | $1,354.75 |
| 55821 | Physician and practitioner services (fee schedule) | 49 | $647.84 |
| 55831 | Physician and practitioner services (fee schedule) | 49 | $671.30 |
| 55840 | Physician and practitioner services (fee schedule) | 49 | $905.38 |
| 55842 | Physician and practitioner services (fee schedule) | 49 | $909.04 |
| 55845 | Physician and practitioner services (fee schedule) | 49 | $1,081.89 |
| 55860 | Physician and practitioner services (fee schedule) | 48 | $670.28 |
| 55862 | Physician and practitioner services (fee schedule) | 48 | $817.14 |
| 55865 | Physician and practitioner services (fee schedule) | 48 | $1,017.44 |
| 55866 | Physician and practitioner services (fee schedule) | 49 | $942.06 |
| 55867 | Physician and practitioner services (fee schedule) | 45 | $812.26 |
| 55868 | Physician and practitioner services (fee schedule) | 38 | $883.75 |
| 55869 | Physician and practitioner services (fee schedule) | 38 | $1,060.01 |
| 55870 | Physician and practitioner services (fee schedule) | 14 | $130.87 |
| 55873 | Physician and practitioner services (fee schedule) | 46 | $3,366.72 |
| 55874 | Physician and practitioner services (fee schedule) | 41 | $2,379.04 |
| 55875 | Physician and practitioner services (fee schedule) | 48 | $592.75 |
| 55876 | Physician and practitioner services (fee schedule) | 49 | $106.29 |
| 55877 | Physician and practitioner services (fee schedule) | 25 | $525.83 |
| 55880 | Physician and practitioner services (fee schedule) | 34 | $795.83 |
| 55881 | Physician and practitioner services (fee schedule) | 23 | $5,559.34 |
| 55882 | Physician and practitioner services (fee schedule) | 24 | $5,948.44 |
| 55899 | Physician and practitioner services (fee schedule) | 7 | $82.81 |
| 55920 | Physician and practitioner services (fee schedule) | 46 | $331.37 |
| 56405 | Physician and practitioner services (fee schedule) | 49 | $108.06 |
| 56420 | Physician and practitioner services (fee schedule) | 50 | $112.31 |
| 56440 | Physician and practitioner services (fee schedule) | 50 | $148.73 |
| 56441 | Physician and practitioner services (fee schedule) | 49 | $138.65 |
| 56442 | Physician and practitioner services (fee schedule) | 49 | $38.08 |
| 56501 | Physician and practitioner services (fee schedule) | 50 | $124.18 |
| 56515 | Physician and practitioner services (fee schedule) | 50 | $194.74 |
| 56605 | Physician and practitioner services (fee schedule) | 50 | $68.30 |
| 56606 | Physician and practitioner services (fee schedule) | 50 | $30.45 |
| 56620 | Physician and practitioner services (fee schedule) | 49 | $442.46 |
| 56625 | Physician and practitioner services (fee schedule) | 49 | $504.19 |
| 56630 | Physician and practitioner services (fee schedule) | 49 | $737.50 |
| 56631 | Physician and practitioner services (fee schedule) | 49 | $929.77 |
| 56632 | Physician and practitioner services (fee schedule) | 49 | $1,108.36 |
| 56633 | Physician and practitioner services (fee schedule) | 49 | $921.61 |
| 56634 | Physician and practitioner services (fee schedule) | 49 | $1,014.25 |
| 56637 | Physician and practitioner services (fee schedule) | 49 | $1,135.63 |
| 56640 | Physician and practitioner services (fee schedule) | 49 | $1,137.26 |
| 56700 | Physician and practitioner services (fee schedule) | 49 | $146.04 |
| 56740 | Physician and practitioner services (fee schedule) | 49 | $242.55 |
| 56800 | Physician and practitioner services (fee schedule) | 48 | $190.12 |
| 56805 | Physician and practitioner services (fee schedule) | 45 | $873.26 |
| 56810 | Physician and practitioner services (fee schedule) | 49 | $205.79 |
| 56820 | Physician and practitioner services (fee schedule) | 49 | $88.82 |
| 56821 | Physician and practitioner services (fee schedule) | 49 | $119.07 |
| 57000 | Physician and practitioner services (fee schedule) | 49 | $162.79 |
| 57010 | Physician and practitioner services (fee schedule) | 49 | $329.70 |
| 57020 | Physician and practitioner services (fee schedule) | 49 | $80.00 |
| 57022 | Physician and practitioner services (fee schedule) | 47 | $136.07 |
| 57023 | Physician and practitioner services (fee schedule) | 47 | $239.71 |
| 57061 | Physician and practitioner services (fee schedule) | 50 | $109.62 |
| 57065 | Physician and practitioner services (fee schedule) | 50 | $185.03 |
| 57100 | Physician and practitioner services (fee schedule) | 49 | $70.41 |
| 57105 | Physician and practitioner services (fee schedule) | 49 | $130.09 |
| 57106 | Physician and practitioner services (fee schedule) | 49 | $382.90 |
| 57107 | Physician and practitioner services (fee schedule) | 48 | $1,074.73 |
| 57109 | Physician and practitioner services (fee schedule) | 48 | $1,280.08 |
| 57110 | Physician and practitioner services (fee schedule) | 49 | $672.03 |
| 57111 | Physician and practitioner services (fee schedule) | 49 | $1,276.88 |
| 57120 | Physician and practitioner services (fee schedule) | 49 | $399.60 |
| 57130 | Physician and practitioner services (fee schedule) | 49 | $158.98 |
| 57135 | Physician and practitioner services (fee schedule) | 49 | $173.86 |
| 57150 | Physician and practitioner services (fee schedule) | 48 | $33.76 |
| 57155 | Physician and practitioner services (fee schedule) | 49 | $321.22 |
| 57156 | Physician and practitioner services (fee schedule) | 49 | $144.03 |
| 57160 | Physician and practitioner services (fee schedule) | 50 | $46.96 |
| 57170 | Physician and practitioner services (fee schedule) | 47 | $53.93 |
| 57180 | Physician and practitioner services (fee schedule) | 49 | $122.95 |
| 57200 | Physician and practitioner services (fee schedule) | 49 | $237.58 |
| 57210 | Physician and practitioner services (fee schedule) | 49 | $282.06 |
| 57220 | Physician and practitioner services (fee schedule) | 49 | $258.27 |
| 57230 | Physician and practitioner services (fee schedule) | 49 | $301.98 |
| 57240 | Physician and practitioner services (fee schedule) | 49 | $435.22 |
| 57250 | Physician and practitioner services (fee schedule) | 49 | $434.97 |
| 57260 | Physician and practitioner services (fee schedule) | 49 | $548.23 |
| 57265 | Physician and practitioner services (fee schedule) | 49 | $644.56 |
| 57267 | Physician and practitioner services (fee schedule) | 49 | $196.30 |
| 57268 | Physician and practitioner services (fee schedule) | 49 | $390.52 |
| 57270 | Physician and practitioner services (fee schedule) | 49 | $605.58 |
| 57280 | Physician and practitioner services (fee schedule) | 49 | $715.97 |
| 57282 | Physician and practitioner services (fee schedule) | 49 | $495.01 |
| 57283 | Physician and practitioner services (fee schedule) | 49 | $519.96 |
| 57284 | Physician and practitioner services (fee schedule) | 49 | $631.62 |
| 57285 | Physician and practitioner services (fee schedule) | 49 | $494.31 |
| 57287 | Physician and practitioner services (fee schedule) | 48 | $555.16 |
| 57288 | Physician and practitioner services (fee schedule) | 49 | $594.15 |
| 57289 | Physician and practitioner services (fee schedule) | 49 | $562.29 |
| 57291 | Physician and practitioner services (fee schedule) | 43 | $410.96 |
| 57292 | Physician and practitioner services (fee schedule) | 44 | $617.02 |
| 57295 | Physician and practitioner services (fee schedule) | 48 | $376.40 |
| 57296 | Physician and practitioner services (fee schedule) | 48 | $687.90 |
| 57300 | Physician and practitioner services (fee schedule) | 49 | $466.72 |
| 57305 | Physician and practitioner services (fee schedule) | 49 | $710.97 |
| 57307 | Physician and practitioner services (fee schedule) | 49 | $811.99 |
| 57308 | Physician and practitioner services (fee schedule) | 49 | $526.18 |
| 57310 | Physician and practitioner services (fee schedule) | 49 | $374.66 |
| 57311 | Physician and practitioner services (fee schedule) | 47 | $415.32 |
| 57320 | Physician and practitioner services (fee schedule) | 49 | $441.43 |
| 57330 | Physician and practitioner services (fee schedule) | 49 | $584.47 |
| 57335 | Physician and practitioner services (fee schedule) | 42 | $881.30 |
| 57400 | Physician and practitioner services (fee schedule) | 49 | $102.61 |
| 57410 | Physician and practitioner services (fee schedule) | 49 | $83.68 |
| 57415 | Physician and practitioner services (fee schedule) | 49 | $126.85 |
| 57420 | Physician and practitioner services (fee schedule) | 50 | $96.39 |
| 57421 | Physician and practitioner services (fee schedule) | 49 | $127.12 |
| 57423 | Physician and practitioner services (fee schedule) | 49 | $688.10 |
| 57425 | Physician and practitioner services (fee schedule) | 49 | $722.53 |
| 57426 | Physician and practitioner services (fee schedule) | 48 | $631.54 |
| 57452 | Physician and practitioner services (fee schedule) | 50 | $91.72 |
| 57454 | Physician and practitioner services (fee schedule) | 50 | $122.54 |
| 57455 | Physician and practitioner services (fee schedule) | 50 | $118.82 |
| 57456 | Physician and practitioner services (fee schedule) | 50 | $111.06 |
| 57460 | Physician and practitioner services (fee schedule) | 50 | $208.88 |
| 57461 | Physician and practitioner services (fee schedule) | 50 | $252.97 |
| 57465 | Physician and practitioner services (fee schedule) | 38 | $42.78 |
| 57500 | Physician and practitioner services (fee schedule) | 50 | $99.01 |
| 57505 | Physician and practitioner services (fee schedule) | 50 | $100.37 |
| 57510 | Physician and practitioner services (fee schedule) | 49 | $111.50 |
| 57511 | Physician and practitioner services (fee schedule) | 50 | $133.29 |
| 57513 | Physician and practitioner services (fee schedule) | 49 | $135.26 |
| 57520 | Physician and practitioner services (fee schedule) | 48 | $271.15 |
| 57522 | Physician and practitioner services (fee schedule) | 49 | $235.38 |
| 57530 | Physician and practitioner services (fee schedule) | 49 | $281.00 |
| 57531 | Physician and practitioner services (fee schedule) | 49 | $1,296.75 |
| 57540 | Physician and practitioner services (fee schedule) | 49 | $588.06 |
| 57545 | Physician and practitioner services (fee schedule) | 49 | $590.18 |
| 57550 | Physician and practitioner services (fee schedule) | 49 | $328.64 |
| 57555 | Physician and practitioner services (fee schedule) | 49 | $469.34 |
| 57556 | Physician and practitioner services (fee schedule) | 49 | $461.77 |
| 57558 | Physician and practitioner services (fee schedule) | 49 | $116.32 |
| 57700 | Physician and practitioner services (fee schedule) | 49 | $261.88 |
| 57720 | Physician and practitioner services (fee schedule) | 49 | $254.55 |
| 57800 | Physician and practitioner services (fee schedule) | 50 | $52.29 |
| 58100 | Physician and practitioner services (fee schedule) | 50 | $67.96 |
| 58110 | Physician and practitioner services (fee schedule) | 50 | $39.52 |
| 58120 | Physician and practitioner services (fee schedule) | 48 | $220.69 |
| 58140 | Physician and practitioner services (fee schedule) | 49 | $693.79 |
| 58145 | Physician and practitioner services (fee schedule) | 49 | $426.93 |
| 58146 | Physician and practitioner services (fee schedule) | 49 | $858.21 |
| 58150 | Physician and practitioner services (fee schedule) | 48 | $786.54 |
| 58152 | Physician and practitioner services (fee schedule) | 48 | $926.80 |
| 58180 | Physician and practitioner services (fee schedule) | 47 | $722.11 |
| 58200 | Physician and practitioner services (fee schedule) | 48 | $1,005.58 |
| 58210 | Physician and practitioner services (fee schedule) | 48 | $1,376.80 |
| 58240 | Physician and practitioner services (fee schedule) | 48 | $2,098.59 |
| 58260 | Physician and practitioner services (fee schedule) | 48 | $635.41 |
| 58262 | Physician and practitioner services (fee schedule) | 48 | $703.76 |
| 58263 | Physician and practitioner services (fee schedule) | 48 | $753.58 |
| 58267 | Physician and practitioner services (fee schedule) | 48 | $803.92 |
| 58270 | Physician and practitioner services (fee schedule) | 48 | $689.68 |
| 58275 | Physician and practitioner services (fee schedule) | 48 | $748.40 |
| 58280 | Physician and practitioner services (fee schedule) | 48 | $782.36 |
| 58285 | Physician and practitioner services (fee schedule) | 48 | $1,033.96 |
| 58290 | Physician and practitioner services (fee schedule) | 49 | $852.15 |
| 58291 | Physician and practitioner services (fee schedule) | 49 | $922.66 |
| 58292 | Physician and practitioner services (fee schedule) | 49 | $972.16 |
| 58294 | Physician and practitioner services (fee schedule) | 49 | $878.82 |
| 58300 | Physician and practitioner services (fee schedule) | 50 | $71.86 |
| 58301 | Physician and practitioner services (fee schedule) | 50 | $80.38 |
| 58340 | Physician and practitioner services (fee schedule) | 46 | $140.46 |
| 58345 | Physician and practitioner services (fee schedule) | 23 | $223.90 |
| 58346 | Physician and practitioner services (fee schedule) | 46 | $357.28 |
| 58350 | Physician and practitioner services (fee schedule) | 27 | $85.27 |
| 58353 | Physician and practitioner services (fee schedule) | 48 | $589.57 |
| 58356 | Physician and practitioner services (fee schedule) | 48 | $1,044.58 |
| 58400 | Physician and practitioner services (fee schedule) | 47 | $347.18 |
| 58410 | Physician and practitioner services (fee schedule) | 46 | $607.38 |
| 58520 | Physician and practitioner services (fee schedule) | 49 | $578.90 |
| 58540 | Physician and practitioner services (fee schedule) | 46 | $682.40 |
| 58541 | Physician and practitioner services (fee schedule) | 49 | $554.76 |
| 58542 | Physician and practitioner services (fee schedule) | 49 | $627.60 |
| 58543 | Physician and practitioner services (fee schedule) | 48 | $632.12 |
| 58544 | Physician and practitioner services (fee schedule) | 48 | $681.37 |
| 58545 | Physician and practitioner services (fee schedule) | 49 | $670.08 |
| 58546 | Physician and practitioner services (fee schedule) | 49 | $827.89 |
| 58548 | Physician and practitioner services (fee schedule) | 49 | $1,371.01 |
| 58550 | Physician and practitioner services (fee schedule) | 48 | $671.95 |
| 58552 | Physician and practitioner services (fee schedule) | 49 | $730.15 |
| 58553 | Physician and practitioner services (fee schedule) | 49 | $832.72 |
| 58554 | Physician and practitioner services (fee schedule) | 49 | $962.58 |
| 58555 | Physician and practitioner services (fee schedule) | 49 | $203.05 |
| 58558 | Physician and practitioner services (fee schedule) | 49 | $527.06 |
| 58559 | Physician and practitioner services (fee schedule) | 49 | $229.28 |
| 58560 | Physician and practitioner services (fee schedule) | 48 | $251.31 |
| 58561 | Physician and practitioner services (fee schedule) | 49 | $296.40 |
| 58562 | Physician and practitioner services (fee schedule) | 50 | $270.43 |
| 58563 | Physician and practitioner services (fee schedule) | 49 | $1,281.20 |
| 58565 | Physician and practitioner services (fee schedule) | 39 | $1,043.76 |
| 58570 | Physician and practitioner services (fee schedule) | 48 | $635.93 |
| 58571 | Physician and practitioner services (fee schedule) | 48 | $706.99 |
| 58572 | Physician and practitioner services (fee schedule) | 48 | $804.42 |
| 58573 | Physician and practitioner services (fee schedule) | 48 | $935.27 |
| 58575 | Physician and practitioner services (fee schedule) | 49 | $1,514.98 |
| 58578 | Physician and practitioner services (fee schedule) | 8 | $509.19 |
| 58579 | Physician and practitioner services (fee schedule) | 7 | $70.00 |
| 58580 | Physician and practitioner services (fee schedule) | 42 | $2,050.80 |
| 58600 | Physician and practitioner services (fee schedule) | 48 | $271.80 |
| 58605 | Physician and practitioner services (fee schedule) | 48 | $246.59 |
| 58611 | Physician and practitioner services (fee schedule) | 47 | $56.01 |
| 58615 | Physician and practitioner services (fee schedule) | 48 | $199.37 |
| 58660 | Physician and practitioner services (fee schedule) | 49 | $511.27 |
| 58661 | Physician and practitioner services (fee schedule) | 49 | $501.32 |
| 58662 | Physician and practitioner services (fee schedule) | 49 | $537.41 |
| 58670 | Physician and practitioner services (fee schedule) | 49 | $299.50 |
| 58671 | Physician and practitioner services (fee schedule) | 48 | $298.62 |
| 58672 | Physician and practitioner services (fee schedule) | 28 | $601.27 |
| 58673 | Physician and practitioner services (fee schedule) | 42 | $591.72 |
| 58674 | Physician and practitioner services (fee schedule) | 46 | $648.80 |
| 58679 | Physician and practitioner services (fee schedule) | 8 | $298.80 |
| 58700 | Physician and practitioner services (fee schedule) | 48 | $572.90 |
| 58720 | Physician and practitioner services (fee schedule) | 48 | $574.55 |
| 58740 | Physician and practitioner services (fee schedule) | 47 | $651.66 |
| 58750 | Physician and practitioner services (fee schedule) | 14 | $621.18 |
| 58752 | Physician and practitioner services (fee schedule) | 17 | $649.44 |
| 58760 | Physician and practitioner services (fee schedule) | 21 | $598.60 |
| 58770 | Physician and practitioner services (fee schedule) | 38 | $606.73 |
| 58800 | Physician and practitioner services (fee schedule) | 49 | $261.67 |
| 58805 | Physician and practitioner services (fee schedule) | 49 | $335.61 |
| 58820 | Physician and practitioner services (fee schedule) | 49 | $236.13 |
| 58822 | Physician and practitioner services (fee schedule) | 49 | $503.37 |
| 58825 | Physician and practitioner services (fee schedule) | 46 | $515.26 |
| 58900 | Physician and practitioner services (fee schedule) | 49 | $326.30 |
| 58920 | Physician and practitioner services (fee schedule) | 48 | $504.10 |
| 58925 | Physician and practitioner services (fee schedule) | 49 | $573.64 |
| 58940 | Physician and practitioner services (fee schedule) | 48 | $424.86 |
| 58943 | Physician and practitioner services (fee schedule) | 49 | $932.72 |
| 58950 | Physician and practitioner services (fee schedule) | 49 | $850.90 |
| 58951 | Physician and practitioner services (fee schedule) | 49 | $1,111.19 |
| 58952 | Physician and practitioner services (fee schedule) | 49 | $1,221.91 |
| 58953 | Physician and practitioner services (fee schedule) | 49 | $1,540.37 |
| 58954 | Physician and practitioner services (fee schedule) | 49 | $1,667.75 |
| 58956 | Physician and practitioner services (fee schedule) | 49 | $1,023.21 |
| 58957 | Physician and practitioner services (fee schedule) | 5 | $1,181.19 |
| 58958 | Physician and practitioner services (fee schedule) | 48 | $1,181.04 |
| 58960 | Physician and practitioner services (fee schedule) | 49 | $744.06 |
| 58970 | Physician and practitioner services (fee schedule) | 5 | $179.73 |
| 58976 | Physician and practitioner services (fee schedule) | 5 | $199.10 |
| 58999 | Physician and practitioner services (fee schedule) | 10 | $189.79 |
| 59000 | Physician and practitioner services (fee schedule) | 49 | $84.03 |
| 59001 | Physician and practitioner services (fee schedule) | 49 | $141.28 |
| 59012 | Physician and practitioner services (fee schedule) | 48 | $161.15 |
| 59015 | Physician and practitioner services (fee schedule) | 48 | $122.80 |
| 59020 | Physician and practitioner services (fee schedule) | 49 | $35.45 |
| 59025 | Physician and practitioner services (fee schedule) | 50 | $28.17 |
| 59030 | Physician and practitioner services (fee schedule) | 47 | $86.77 |
| 59050 | Physician and practitioner services (fee schedule) | 41 | $41.29 |
| 59051 | Physician and practitioner services (fee schedule) | 40 | $34.69 |
| 59070 | Physician and practitioner services (fee schedule) | 46 | $290.79 |
| 59072 | Physician and practitioner services (fee schedule) | 40 | $392.74 |
| 59074 | Physician and practitioner services (fee schedule) | 47 | $279.77 |
| 59076 | Physician and practitioner services (fee schedule) | 48 | $365.00 |
| 59100 | Physician and practitioner services (fee schedule) | 49 | $632.97 |
| 59120 | Physician and practitioner services (fee schedule) | 49 | $612.06 |
| 59121 | Physician and practitioner services (fee schedule) | 49 | $596.93 |
| 59130 | Physician and practitioner services (fee schedule) | 49 | $700.43 |
| 59135 | Physician and practitioner services (fee schedule) | 5 | $696.15 |
| 59136 | Physician and practitioner services (fee schedule) | 49 | $686.71 |
| 59140 | Physician and practitioner services (fee schedule) | 48 | $303.51 |
| 59150 | Physician and practitioner services (fee schedule) | 49 | $577.72 |
| 59151 | Physician and practitioner services (fee schedule) | 49 | $564.60 |
| 59160 | Physician and practitioner services (fee schedule) | 49 | $181.64 |
| 59200 | Physician and practitioner services (fee schedule) | 45 | $75.86 |
| 59300 | Physician and practitioner services (fee schedule) | 50 | $147.41 |
| 59320 | Physician and practitioner services (fee schedule) | 49 | $121.96 |
| 59325 | Physician and practitioner services (fee schedule) | 49 | $193.21 |
| 59350 | Physician and practitioner services (fee schedule) | 49 | $221.50 |
| 59400 | Physician and practitioner services (fee schedule) | 42 | $2,092.38 |
| 59409 | Physician and practitioner services (fee schedule) | 50 | $697.55 |
| 59410 | Physician and practitioner services (fee schedule) | 48 | $900.50 |
| 59412 | Physician and practitioner services (fee schedule) | 46 | $83.65 |
| 59414 | Physician and practitioner services (fee schedule) | 49 | $79.24 |
| 59425 | Physician and practitioner services (fee schedule) | 40 | $446.85 |
| 59426 | Physician and practitioner services (fee schedule) | 40 | $820.52 |
| 59430 | Physician and practitioner services (fee schedule) | 47 | $190.76 |
| 59510 | Physician and practitioner services (fee schedule) | 41 | $2,158.21 |
| 59514 | Physician and practitioner services (fee schedule) | 49 | $724.48 |
| 59515 | Physician and practitioner services (fee schedule) | 48 | $1,056.42 |
| 59525 | Physician and practitioner services (fee schedule) | 48 | $370.46 |
| 59610 | Physician and practitioner services (fee schedule) | 41 | $2,056.01 |
| 59612 | Physician and practitioner services (fee schedule) | 49 | $772.20 |
| 59614 | Physician and practitioner services (fee schedule) | 46 | $935.33 |
| 59618 | Physician and practitioner services (fee schedule) | 40 | $2,186.83 |
| 59620 | Physician and practitioner services (fee schedule) | 48 | $790.69 |
| 59622 | Physician and practitioner services (fee schedule) | 46 | $1,089.87 |
| 59812 | Physician and practitioner services (fee schedule) | 49 | $280.79 |
| 59820 | Physician and practitioner services (fee schedule) | 49 | $334.57 |
| 59821 | Physician and practitioner services (fee schedule) | 49 | $332.71 |
| 59830 | Physician and practitioner services (fee schedule) | 49 | $352.94 |
| 59840 | Physician and practitioner services (fee schedule) | 49 | $194.22 |
| 59841 | Physician and practitioner services (fee schedule) | 49 | $329.64 |
| 59850 | Physician and practitioner services (fee schedule) | 49 | $293.87 |
| 59851 | Physician and practitioner services (fee schedule) | 48 | $317.84 |
| 59852 | Physician and practitioner services (fee schedule) | 47 | $434.58 |
| 59855 | Physician and practitioner services (fee schedule) | 48 | $326.41 |
| 59856 | Physician and practitioner services (fee schedule) | 47 | $394.73 |
| 59857 | Physician and practitioner services (fee schedule) | 46 | $456.89 |
| 59866 | Physician and practitioner services (fee schedule) | 26 | $171.90 |
| 59870 | Physician and practitioner services (fee schedule) | 49 | $378.74 |
| 59871 | Physician and practitioner services (fee schedule) | 48 | $106.57 |
| 59897 | Physician and practitioner services (fee schedule) | 6 | $55.00 |
| 59898 | Physician and practitioner services (fee schedule) | 6 | $100.00 |
| 59899 | Physician and practitioner services (fee schedule) | 11 | $140.00 |
| 60000 | Physician and practitioner services (fee schedule) | 50 | $126.83 |
| 60100 | Physician and practitioner services (fee schedule) | 50 | $75.55 |
| 60200 | Physician and practitioner services (fee schedule) | 49 | $498.13 |
| 60210 | Physician and practitioner services (fee schedule) | 49 | $551.44 |
| 60212 | Physician and practitioner services (fee schedule) | 49 | $757.23 |
| 60220 | Physician and practitioner services (fee schedule) | 49 | $545.76 |
| 60225 | Physician and practitioner services (fee schedule) | 49 | $684.31 |
| 60240 | Physician and practitioner services (fee schedule) | 50 | $703.54 |
| 60252 | Physician and practitioner services (fee schedule) | 49 | $970.78 |
| 60254 | Physician and practitioner services (fee schedule) | 49 | $1,202.75 |
| 60260 | Physician and practitioner services (fee schedule) | 49 | $767.34 |
| 60270 | Physician and practitioner services (fee schedule) | 49 | $975.31 |
| 60271 | Physician and practitioner services (fee schedule) | 50 | $782.49 |
| 60280 | Physician and practitioner services (fee schedule) | 49 | $348.14 |
| 60281 | Physician and practitioner services (fee schedule) | 49 | $447.81 |
| 60300 | Physician and practitioner services (fee schedule) | 48 | $68.46 |
| 60500 | Physician and practitioner services (fee schedule) | 49 | $745.31 |
| 60502 | Physician and practitioner services (fee schedule) | 50 | $956.56 |
| 60505 | Physician and practitioner services (fee schedule) | 49 | $995.26 |
| 60512 | Physician and practitioner services (fee schedule) | 50 | $181.92 |
| 60520 | Physician and practitioner services (fee schedule) | 49 | $775.84 |
| 60521 | Physician and practitioner services (fee schedule) | 50 | $881.46 |
| 60522 | Physician and practitioner services (fee schedule) | 49 | $1,062.70 |
| 60540 | Physician and practitioner services (fee schedule) | 50 | $815.98 |
| 60545 | Physician and practitioner services (fee schedule) | 49 | $932.72 |
| 60600 | Physician and practitioner services (fee schedule) | 49 | $988.01 |
| 60605 | Physician and practitioner services (fee schedule) | 49 | $1,161.48 |
| 60650 | Physician and practitioner services (fee schedule) | 49 | $870.95 |
| 60659 | Physician and practitioner services (fee schedule) | 7 | $130.00 |
| 60660 | Physician and practitioner services (fee schedule) | 34 | $1,865.16 |
| 60661 | Physician and practitioner services (fee schedule) | 35 | $307.67 |
| 60699 | Physician and practitioner services (fee schedule) | 8 | $185.00 |
| 61000 | Physician and practitioner services (fee schedule) | 50 | $89.68 |
| 61001 | Physician and practitioner services (fee schedule) | 49 | $83.89 |
| 61020 | Physician and practitioner services (fee schedule) | 50 | $86.03 |
| 61026 | Physician and practitioner services (fee schedule) | 50 | $93.45 |
| 61050 | Physician and practitioner services (fee schedule) | 50 | $65.83 |
| 61055 | Physician and practitioner services (fee schedule) | 50 | $95.83 |
| 61070 | Physician and practitioner services (fee schedule) | 50 | $45.67 |
| 61105 | Physician and practitioner services (fee schedule) | 50 | $380.31 |
| 61107 | Physician and practitioner services (fee schedule) | 50 | $249.42 |
| 61108 | Physician and practitioner services (fee schedule) | 50 | $719.72 |
| 61120 | Physician and practitioner services (fee schedule) | 50 | $565.70 |
| 61140 | Physician and practitioner services (fee schedule) | 50 | $951.39 |
| 61150 | Physician and practitioner services (fee schedule) | 49 | $1,065.19 |
| 61151 | Physician and practitioner services (fee schedule) | 50 | $755.00 |
| 61154 | Physician and practitioner services (fee schedule) | 50 | $982.01 |
| 61156 | Physician and practitioner services (fee schedule) | 50 | $939.16 |
| 61210 | Physician and practitioner services (fee schedule) | 50 | $284.65 |
| 61215 | Physician and practitioner services (fee schedule) | 50 | $429.44 |
| 61250 | Physician and practitioner services (fee schedule) | 49 | $655.87 |
| 61253 | Physician and practitioner services (fee schedule) | 49 | $742.67 |
| 61304 | Physician and practitioner services (fee schedule) | 49 | $1,251.32 |
| 61305 | Physician and practitioner services (fee schedule) | 49 | $1,546.76 |
| 61312 | Physician and practitioner services (fee schedule) | 49 | $1,526.91 |
| 61313 | Physician and practitioner services (fee schedule) | 49 | $1,490.23 |
| 61314 | Physician and practitioner services (fee schedule) | 49 | $1,396.04 |
| 61315 | Physician and practitioner services (fee schedule) | 49 | $1,568.76 |
| 61316 | Physician and practitioner services (fee schedule) | 49 | $67.41 |
| 61320 | Physician and practitioner services (fee schedule) | 50 | $1,392.03 |
| 61321 | Physician and practitioner services (fee schedule) | 49 | $1,578.21 |
| 61322 | Physician and practitioner services (fee schedule) | 48 | $1,736.23 |
| 61323 | Physician and practitioner services (fee schedule) | 49 | $1,749.72 |
| 61330 | Physician and practitioner services (fee schedule) | 49 | $1,323.92 |
| 61333 | Physician and practitioner services (fee schedule) | 49 | $1,485.23 |
| 61340 | Physician and practitioner services (fee schedule) | 49 | $1,073.46 |
| 61343 | Physician and practitioner services (fee schedule) | 49 | $1,691.85 |
| 61345 | Physician and practitioner services (fee schedule) | 49 | $1,505.48 |
| 61450 | Physician and practitioner services (fee schedule) | 49 | $1,413.98 |
| 61458 | Physician and practitioner services (fee schedule) | 49 | $1,527.19 |
| 61460 | Physician and practitioner services (fee schedule) | 49 | $1,553.54 |
| 61500 | Physician and practitioner services (fee schedule) | 50 | $995.94 |
| 61501 | Physician and practitioner services (fee schedule) | 48 | $889.97 |
| 61510 | Physician and practitioner services (fee schedule) | 49 | $1,655.65 |
| 61512 | Physician and practitioner services (fee schedule) | 49 | $1,875.68 |
| 61514 | Physician and practitioner services (fee schedule) | 49 | $1,436.98 |
| 61516 | Physician and practitioner services (fee schedule) | 49 | $1,417.05 |
| 61517 | Physician and practitioner services (fee schedule) | 49 | $64.39 |
| 61518 | Physician and practitioner services (fee schedule) | 49 | $2,047.05 |
| 61519 | Physician and practitioner services (fee schedule) | 49 | $2,149.40 |
| 61520 | Physician and practitioner services (fee schedule) | 49 | $2,716.35 |
| 61521 | Physician and practitioner services (fee schedule) | 49 | $2,341.57 |
| 61522 | Physician and practitioner services (fee schedule) | 49 | $1,609.10 |
| 61524 | Physician and practitioner services (fee schedule) | 49 | $1,558.42 |
| 61526 | Physician and practitioner services (fee schedule) | 49 | $2,462.74 |
| 61530 | Physician and practitioner services (fee schedule) | 48 | $2,259.43 |
| 61531 | Physician and practitioner services (fee schedule) | 49 | $999.52 |
| 61533 | Physician and practitioner services (fee schedule) | 50 | $1,161.61 |
| 61534 | Physician and practitioner services (fee schedule) | 49 | $1,221.87 |
| 61535 | Physician and practitioner services (fee schedule) | 49 | $759.57 |
| 61536 | Physician and practitioner services (fee schedule) | 49 | $1,886.85 |
| 61537 | Physician and practitioner services (fee schedule) | 49 | $1,786.61 |
| 61538 | Physician and practitioner services (fee schedule) | 49 | $1,901.60 |
| 61539 | Physician and practitioner services (fee schedule) | 49 | $1,732.40 |
| 61540 | Physician and practitioner services (fee schedule) | 49 | $1,610.55 |
| 61541 | Physician and practitioner services (fee schedule) | 49 | $1,624.35 |
| 61543 | Physician and practitioner services (fee schedule) | 49 | $1,608.28 |
| 61544 | Physician and practitioner services (fee schedule) | 49 | $1,436.27 |
| 61545 | Physician and practitioner services (fee schedule) | 49 | $2,337.53 |
| 61546 | Physician and practitioner services (fee schedule) | 49 | $1,696.45 |
| 61548 | Physician and practitioner services (fee schedule) | 49 | $1,219.12 |
| 61550 | Physician and practitioner services (fee schedule) | 49 | $920.94 |
| 61552 | Physician and practitioner services (fee schedule) | 49 | $1,112.14 |
| 61556 | Physician and practitioner services (fee schedule) | 49 | $1,283.55 |
| 61557 | Physician and practitioner services (fee schedule) | 48 | $1,293.64 |
| 61558 | Physician and practitioner services (fee schedule) | 49 | $1,438.35 |
| 61559 | Physician and practitioner services (fee schedule) | 49 | $1,838.63 |
| 61563 | Physician and practitioner services (fee schedule) | 48 | $1,460.03 |
| 61564 | Physician and practitioner services (fee schedule) | 48 | $1,773.57 |
| 61566 | Physician and practitioner services (fee schedule) | 49 | $1,648.22 |
| 61567 | Physician and practitioner services (fee schedule) | 49 | $1,876.85 |
| 61570 | Physician and practitioner services (fee schedule) | 49 | $1,383.48 |
| 61571 | Physician and practitioner services (fee schedule) | 49 | $1,469.61 |
| 61575 | Physician and practitioner services (fee schedule) | 50 | $1,880.45 |
| 61576 | Physician and practitioner services (fee schedule) | 49 | $3,091.88 |
| 61580 | Physician and practitioner services (fee schedule) | 49 | $1,834.00 |
| 61581 | Physician and practitioner services (fee schedule) | 49 | $1,990.74 |
| 61582 | Physician and practitioner services (fee schedule) | 49 | $2,350.85 |
| 61583 | Physician and practitioner services (fee schedule) | 49 | $2,212.30 |
| 61584 | Physician and practitioner services (fee schedule) | 49 | $2,160.31 |
| 61585 | Physician and practitioner services (fee schedule) | 49 | $2,419.26 |
| 61586 | Physician and practitioner services (fee schedule) | 49 | $1,916.77 |
| 61590 | Physician and practitioner services (fee schedule) | 49 | $2,261.54 |
| 61591 | Physician and practitioner services (fee schedule) | 49 | $2,278.63 |
| 61592 | Physician and practitioner services (fee schedule) | 49 | $2,345.65 |
| 61595 | Physician and practitioner services (fee schedule) | 49 | $1,776.55 |
| 61596 | Physician and practitioner services (fee schedule) | 49 | $1,787.02 |
| 61597 | Physician and practitioner services (fee schedule) | 49 | $2,220.89 |
| 61598 | Physician and practitioner services (fee schedule) | 49 | $2,110.60 |
| 61600 | Physician and practitioner services (fee schedule) | 49 | $1,531.73 |
| 61601 | Physician and practitioner services (fee schedule) | 49 | $1,816.62 |
| 61605 | Physician and practitioner services (fee schedule) | 49 | $1,594.57 |
| 61606 | Physician and practitioner services (fee schedule) | 49 | $2,155.79 |
| 61607 | Physician and practitioner services (fee schedule) | 49 | $2,002.77 |
| 61608 | Physician and practitioner services (fee schedule) | 49 | $2,426.97 |
| 61611 | Physician and practitioner services (fee schedule) | 50 | $345.93 |
| 61613 | Physician and practitioner services (fee schedule) | 49 | $2,412.83 |
| 61615 | Physician and practitioner services (fee schedule) | 49 | $1,964.03 |
| 61616 | Physician and practitioner services (fee schedule) | 49 | $2,440.91 |
| 61618 | Physician and practitioner services (fee schedule) | 50 | $947.67 |
| 61619 | Physician and practitioner services (fee schedule) | 48 | $1,187.84 |
| 61623 | Physician and practitioner services (fee schedule) | 48 | $442.49 |
| 61624 | Physician and practitioner services (fee schedule) | 50 | $907.01 |
| 61626 | Physician and practitioner services (fee schedule) | 50 | $840.39 |
| 61630 | Physician and practitioner services (fee schedule) | 34 | $1,051.86 |
| 61635 | Physician and practitioner services (fee schedule) | 36 | $1,164.95 |
| 61640 | Physician and practitioner services (fee schedule) | 23 | $429.18 |
| 61641 | Physician and practitioner services (fee schedule) | 23 | $150.77 |
| 61642 | Physician and practitioner services (fee schedule) | 22 | $310.57 |
| 61645 | Physician and practitioner services (fee schedule) | 46 | $653.84 |
| 61650 | Physician and practitioner services (fee schedule) | 48 | $444.97 |
| 61651 | Physician and practitioner services (fee schedule) | 48 | $189.45 |
| 61680 | Physician and practitioner services (fee schedule) | 49 | $1,736.20 |
| 61682 | Physician and practitioner services (fee schedule) | 49 | $3,024.55 |
| 61684 | Physician and practitioner services (fee schedule) | 49 | $2,124.15 |
| 61686 | Physician and practitioner services (fee schedule) | 49 | $3,263.71 |
| 61690 | Physician and practitioner services (fee schedule) | 49 | $1,725.76 |
| 61692 | Physician and practitioner services (fee schedule) | 49 | $2,696.16 |
| 61697 | Physician and practitioner services (fee schedule) | 49 | $3,114.39 |
| 61698 | Physician and practitioner services (fee schedule) | 49 | $3,369.73 |
| 61700 | Physician and practitioner services (fee schedule) | 49 | $2,480.13 |
| 61702 | Physician and practitioner services (fee schedule) | 49 | $2,860.11 |
| 61703 | Physician and practitioner services (fee schedule) | 49 | $1,014.64 |
| 61705 | Physician and practitioner services (fee schedule) | 49 | $1,934.81 |
| 61708 | Physician and practitioner services (fee schedule) | 49 | $1,817.61 |
| 61710 | Physician and practitioner services (fee schedule) | 50 | $1,576.40 |
| 61711 | Physician and practitioner services (fee schedule) | 48 | $1,891.20 |
| 61715 | Physician and practitioner services (fee schedule) | 33 | $929.18 |
| 61720 | Physician and practitioner services (fee schedule) | 50 | $1,041.70 |
| 61735 | Physician and practitioner services (fee schedule) | 50 | $1,202.41 |
| 61736 | Physician and practitioner services (fee schedule) | 36 | $856.98 |
| 61737 | Physician and practitioner services (fee schedule) | 37 | $1,018.88 |
| 61750 | Physician and practitioner services (fee schedule) | 50 | $1,080.09 |
| 61751 | Physician and practitioner services (fee schedule) | 50 | $1,076.39 |
| 61760 | Physician and practitioner services (fee schedule) | 50 | $1,198.93 |
| 61770 | Physician and practitioner services (fee schedule) | 49 | $1,232.61 |
| 61781 | Physician and practitioner services (fee schedule) | 49 | $186.34 |
| 61782 | Physician and practitioner services (fee schedule) | 47 | $129.35 |
| 61783 | Physician and practitioner services (fee schedule) | 46 | $181.00 |
| 61790 | Physician and practitioner services (fee schedule) | 50 | $716.88 |
| 61791 | Physician and practitioner services (fee schedule) | 47 | $876.21 |
| 61796 | Physician and practitioner services (fee schedule) | 48 | $756.64 |
| 61797 | Physician and practitioner services (fee schedule) | 48 | $160.86 |
| 61798 | Physician and practitioner services (fee schedule) | 48 | $1,008.49 |
| 61799 | Physician and practitioner services (fee schedule) | 48 | $222.13 |
| 61800 | Physician and practitioner services (fee schedule) | 48 | $112.79 |
| 61850 | Physician and practitioner services (fee schedule) | 47 | $746.28 |
| 61860 | Physician and practitioner services (fee schedule) | 46 | $1,176.38 |
| 61863 | Physician and practitioner services (fee schedule) | 47 | $1,121.42 |
| 61864 | Physician and practitioner services (fee schedule) | 47 | $218.34 |
| 61867 | Physician and practitioner services (fee schedule) | 48 | $1,663.68 |
| 61868 | Physician and practitioner services (fee schedule) | 48 | $367.93 |
| 61880 | Physician and practitioner services (fee schedule) | 49 | $471.51 |
| 61885 | Physician and practitioner services (fee schedule) | 50 | $442.65 |
| 61886 | Physician and practitioner services (fee schedule) | 50 | $706.47 |
| 61888 | Physician and practitioner services (fee schedule) | 50 | $321.03 |
| 61889 | Physician and practitioner services (fee schedule) | 40 | $1,099.71 |
| 61891 | Physician and practitioner services (fee schedule) | 39 | $510.62 |
| 61892 | Physician and practitioner services (fee schedule) | 39 | $702.09 |
| 62000 | Physician and practitioner services (fee schedule) | 50 | $787.14 |
| 62005 | Physician and practitioner services (fee schedule) | 49 | $950.41 |
| 62010 | Physician and practitioner services (fee schedule) | 49 | $1,180.40 |
| 62100 | Physician and practitioner services (fee schedule) | 49 | $1,166.34 |
| 62115 | Physician and practitioner services (fee schedule) | 47 | $1,256.84 |
| 62117 | Physician and practitioner services (fee schedule) | 48 | $1,445.81 |
| 62120 | Physician and practitioner services (fee schedule) | 49 | $1,565.50 |
| 62121 | Physician and practitioner services (fee schedule) | 49 | $1,182.41 |
| 62140 | Physician and practitioner services (fee schedule) | 50 | $761.14 |
| 62141 | Physician and practitioner services (fee schedule) | 50 | $897.67 |
| 62142 | Physician and practitioner services (fee schedule) | 50 | $700.09 |
| 62143 | Physician and practitioner services (fee schedule) | 49 | $811.00 |
| 62145 | Physician and practitioner services (fee schedule) | 49 | $1,049.78 |
| 62146 | Physician and practitioner services (fee schedule) | 49 | $954.60 |
| 62147 | Physician and practitioner services (fee schedule) | 49 | $1,110.71 |
| 62148 | Physician and practitioner services (fee schedule) | 48 | $95.75 |
| 62160 | Physician and practitioner services (fee schedule) | 48 | $145.81 |
| 62161 | Physician and practitioner services (fee schedule) | 49 | $1,125.34 |
| 62162 | Physician and practitioner services (fee schedule) | 49 | $1,391.03 |
| 62164 | Physician and practitioner services (fee schedule) | 49 | $1,546.47 |
| 62165 | Physician and practitioner services (fee schedule) | 49 | $1,126.36 |
| 62180 | Physician and practitioner services (fee schedule) | 50 | $1,183.36 |
| 62190 | Physician and practitioner services (fee schedule) | 49 | $738.09 |
| 62192 | Physician and practitioner services (fee schedule) | 49 | $774.20 |
| 62194 | Physician and practitioner services (fee schedule) | 50 | $377.72 |
| 62200 | Physician and practitioner services (fee schedule) | 49 | $1,041.53 |
| 62201 | Physician and practitioner services (fee schedule) | 50 | $988.80 |
| 62220 | Physician and practitioner services (fee schedule) | 50 | $771.36 |
| 62223 | Physician and practitioner services (fee schedule) | 50 | $796.26 |
| 62225 | Physician and practitioner services (fee schedule) | 50 | $422.00 |
| 62230 | Physician and practitioner services (fee schedule) | 49 | $650.82 |
| 62252 | Physician and practitioner services (fee schedule) | 48 | $43.57 |
| 62256 | Physician and practitioner services (fee schedule) | 50 | $462.95 |
| 62258 | Physician and practitioner services (fee schedule) | 49 | $857.46 |
| 62263 | Physician and practitioner services (fee schedule) | 48 | $375.28 |
| 62264 | Physician and practitioner services (fee schedule) | 47 | $323.88 |
| 62267 | Physician and practitioner services (fee schedule) | 50 | $163.55 |
| 62268 | Physician and practitioner services (fee schedule) | 46 | $263.72 |
| 62269 | Physician and practitioner services (fee schedule) | 48 | $209.34 |
| 62270 | Physician and practitioner services (fee schedule) | 50 | $105.99 |
| 62272 | Physician and practitioner services (fee schedule) | 50 | $109.04 |
| 62273 | Physician and practitioner services (fee schedule) | 50 | $110.67 |
| 62280 | Physician and practitioner services (fee schedule) | 50 | $180.92 |
| 62281 | Physician and practitioner services (fee schedule) | 50 | $167.65 |
| 62282 | Physician and practitioner services (fee schedule) | 50 | $166.78 |
| 62284 | Physician and practitioner services (fee schedule) | 50 | $116.70 |
| 62287 | Physician and practitioner services (fee schedule) | 48 | $457.17 |
| 62290 | Physician and practitioner services (fee schedule) | 49 | $183.61 |
| 62291 | Physician and practitioner services (fee schedule) | 49 | $179.58 |
| 62292 | Physician and practitioner services (fee schedule) | 46 | $446.10 |
| 62294 | Physician and practitioner services (fee schedule) | 50 | $710.85 |
| 62302 | Physician and practitioner services (fee schedule) | 49 | $156.13 |
| 62303 | Physician and practitioner services (fee schedule) | 49 | $158.69 |
| 62304 | Physician and practitioner services (fee schedule) | 48 | $158.70 |
| 62305 | Physician and practitioner services (fee schedule) | 49 | $176.90 |
| 62320 | Physician and practitioner services (fee schedule) | 50 | $114.87 |
| 62321 | Physician and practitioner services (fee schedule) | 50 | $174.95 |
| 62322 | Physician and practitioner services (fee schedule) | 50 | $101.33 |
| 62323 | Physician and practitioner services (fee schedule) | 50 | $177.28 |
| 62324 | Physician and practitioner services (fee schedule) | 50 | $104.72 |
| 62325 | Physician and practitioner services (fee schedule) | 50 | $169.67 |
| 62326 | Physician and practitioner services (fee schedule) | 50 | $105.71 |
| 62327 | Physician and practitioner services (fee schedule) | 50 | $173.72 |
| 62328 | Physician and practitioner services (fee schedule) | 50 | $155.71 |
| 62329 | Physician and practitioner services (fee schedule) | 50 | $196.20 |
| 62330 | Physician and practitioner services (fee schedule) | 25 | $390.30 |
| 62331 | Physician and practitioner services (fee schedule) | 25 | $154.75 |
| 62350 | Physician and practitioner services (fee schedule) | 50 | $322.90 |
| 62351 | Physician and practitioner services (fee schedule) | 49 | $699.38 |
| 62355 | Physician and practitioner services (fee schedule) | 50 | $238.17 |
| 62360 | Physician and practitioner services (fee schedule) | 50 | $242.74 |
| 62361 | Physician and practitioner services (fee schedule) | 50 | $351.45 |
| 62362 | Physician and practitioner services (fee schedule) | 50 | $316.25 |
| 62365 | Physician and practitioner services (fee schedule) | 50 | $249.84 |
| 62367 | Physician and practitioner services (fee schedule) | 48 | $26.21 |
| 62368 | Physician and practitioner services (fee schedule) | 50 | $36.44 |
| 62369 | Physician and practitioner services (fee schedule) | 50 | $74.80 |
| 62370 | Physician and practitioner services (fee schedule) | 50 | $74.65 |
| 62380 | Physician and practitioner services (fee schedule) | 17 | $583.97 |
| 63001 | Physician and practitioner services (fee schedule) | 49 | $973.13 |
| 63003 | Physician and practitioner services (fee schedule) | 49 | $977.00 |
| 63005 | Physician and practitioner services (fee schedule) | 49 | $936.90 |
| 63011 | Physician and practitioner services (fee schedule) | 49 | $815.67 |
| 63012 | Physician and practitioner services (fee schedule) | 49 | $939.39 |
| 63015 | Physician and practitioner services (fee schedule) | 49 | $1,129.85 |
| 63016 | Physician and practitioner services (fee schedule) | 49 | $1,138.06 |
| 63017 | Physician and practitioner services (fee schedule) | 49 | $968.43 |
| 63020 | Physician and practitioner services (fee schedule) | 48 | $852.49 |
| 63030 | Physician and practitioner services (fee schedule) | 49 | $745.77 |
| 63032 | Physician and practitioner services (fee schedule) | 27 | $104.44 |
| 63035 | Physician and practitioner services (fee schedule) | 48 | $177.30 |
| 63040 | Physician and practitioner services (fee schedule) | 49 | $1,077.80 |
| 63042 | Physician and practitioner services (fee schedule) | 48 | $1,041.89 |
| 63043 | Physician and practitioner services (fee schedule) | 39 | $239.52 |
| 63044 | Physician and practitioner services (fee schedule) | 41 | $237.15 |
| 63045 | Physician and practitioner services (fee schedule) | 50 | $1,009.92 |
| 63046 | Physician and practitioner services (fee schedule) | 50 | $968.00 |
| 63047 | Physician and practitioner services (fee schedule) | 50 | $885.69 |
| 63048 | Physician and practitioner services (fee schedule) | 49 | $162.33 |
| 63050 | Physician and practitioner services (fee schedule) | 50 | $1,087.74 |
| 63051 | Physician and practitioner services (fee schedule) | 50 | $1,244.30 |
| 63052 | Physician and practitioner services (fee schedule) | 47 | $201.09 |
| 63053 | Physician and practitioner services (fee schedule) | 47 | $166.31 |
| 63055 | Physician and practitioner services (fee schedule) | 50 | $1,275.55 |
| 63056 | Physician and practitioner services (fee schedule) | 50 | $1,186.80 |
| 63057 | Physician and practitioner services (fee schedule) | 49 | $244.52 |
| 63064 | Physician and practitioner services (fee schedule) | 49 | $1,314.21 |
| 63066 | Physician and practitioner services (fee schedule) | 48 | $158.61 |
| 63075 | Physician and practitioner services (fee schedule) | 49 | $1,051.45 |
| 63076 | Physician and practitioner services (fee schedule) | 49 | $189.16 |
| 63077 | Physician and practitioner services (fee schedule) | 50 | $1,134.72 |
| 63078 | Physician and practitioner services (fee schedule) | 49 | $160.05 |
| 63081 | Physician and practitioner services (fee schedule) | 49 | $1,361.23 |
| 63082 | Physician and practitioner services (fee schedule) | 48 | $203.01 |
| 63085 | Physician and practitioner services (fee schedule) | 49 | $1,523.24 |
| 63086 | Physician and practitioner services (fee schedule) | 48 | $146.85 |
| 63087 | Physician and practitioner services (fee schedule) | 49 | $1,793.15 |
| 63088 | Physician and practitioner services (fee schedule) | 48 | $202.84 |
| 63090 | Physician and practitioner services (fee schedule) | 49 | $1,530.60 |
| 63091 | Physician and practitioner services (fee schedule) | 48 | $137.25 |
| 63101 | Physician and practitioner services (fee schedule) | 49 | $1,724.62 |
| 63102 | Physician and practitioner services (fee schedule) | 49 | $1,690.85 |
| 63103 | Physician and practitioner services (fee schedule) | 48 | $213.61 |
| 63170 | Physician and practitioner services (fee schedule) | 49 | $1,207.81 |
| 63172 | Physician and practitioner services (fee schedule) | 49 | $1,134.34 |
| 63173 | Physician and practitioner services (fee schedule) | 49 | $1,318.14 |
| 63185 | Physician and practitioner services (fee schedule) | 50 | $927.00 |
| 63190 | Physician and practitioner services (fee schedule) | 50 | $945.82 |
| 63191 | Physician and practitioner services (fee schedule) | 47 | $1,058.78 |
| 63197 | Physician and practitioner services (fee schedule) | 49 | $1,264.61 |
| 63200 | Physician and practitioner services (fee schedule) | 49 | $1,174.38 |
| 63250 | Physician and practitioner services (fee schedule) | 49 | $2,162.57 |
| 63251 | Physician and practitioner services (fee schedule) | 49 | $2,219.58 |
| 63252 | Physician and practitioner services (fee schedule) | 49 | $2,218.94 |
| 63265 | Physician and practitioner services (fee schedule) | 49 | $1,241.94 |
| 63266 | Physician and practitioner services (fee schedule) | 49 | $1,289.50 |
| 63267 | Physician and practitioner services (fee schedule) | 50 | $1,076.63 |
| 63268 | Physician and practitioner services (fee schedule) | 49 | $1,098.43 |
| 63270 | Physician and practitioner services (fee schedule) | 50 | $1,537.27 |
| 63271 | Physician and practitioner services (fee schedule) | 49 | $1,562.27 |
| 63272 | Physician and practitioner services (fee schedule) | 49 | $1,419.59 |
| 63273 | Physician and practitioner services (fee schedule) | 49 | $1,399.39 |
| 63275 | Physician and practitioner services (fee schedule) | 49 | $1,399.60 |
| 63276 | Physician and practitioner services (fee schedule) | 49 | $1,406.59 |
| 63277 | Physician and practitioner services (fee schedule) | 49 | $1,225.74 |
| 63278 | Physician and practitioner services (fee schedule) | 49 | $1,228.46 |
| 63280 | Physician and practitioner services (fee schedule) | 49 | $1,604.08 |
| 63281 | Physician and practitioner services (fee schedule) | 49 | $1,637.94 |
| 63282 | Physician and practitioner services (fee schedule) | 49 | $1,486.98 |
| 63283 | Physician and practitioner services (fee schedule) | 49 | $1,433.25 |
| 63285 | Physician and practitioner services (fee schedule) | 49 | $1,920.65 |
| 63286 | Physician and practitioner services (fee schedule) | 49 | $1,899.21 |
| 63287 | Physician and practitioner services (fee schedule) | 49 | $2,063.19 |
| 63290 | Physician and practitioner services (fee schedule) | 49 | $2,045.59 |
| 63295 | Physician and practitioner services (fee schedule) | 49 | $237.05 |
| 63300 | Physician and practitioner services (fee schedule) | 50 | $1,348.32 |
| 63301 | Physician and practitioner services (fee schedule) | 49 | $1,640.86 |
| 63302 | Physician and practitioner services (fee schedule) | 49 | $1,622.56 |
| 63303 | Physician and practitioner services (fee schedule) | 49 | $1,701.08 |
| 63304 | Physician and practitioner services (fee schedule) | 48 | $1,728.54 |
| 63305 | Physician and practitioner services (fee schedule) | 49 | $1,833.70 |
| 63306 | Physician and practitioner services (fee schedule) | 49 | $1,812.59 |
| 63307 | Physician and practitioner services (fee schedule) | 50 | $1,768.71 |
| 63308 | Physician and practitioner services (fee schedule) | 49 | $245.52 |
| 63600 | Physician and practitioner services (fee schedule) | 49 | $810.79 |
| 63610 | Physician and practitioner services (fee schedule) | 48 | $457.81 |
| 63620 | Physician and practitioner services (fee schedule) | 48 | $816.28 |
| 63621 | Physician and practitioner services (fee schedule) | 48 | $185.41 |
| 63650 | Physician and practitioner services (fee schedule) | 50 | $927.55 |
| 63655 | Physician and practitioner services (fee schedule) | 49 | $657.34 |
| 63661 | Physician and practitioner services (fee schedule) | 50 | $337.03 |
| 63662 | Physician and practitioner services (fee schedule) | 50 | $628.47 |
| 63663 | Physician and practitioner services (fee schedule) | 50 | $466.49 |
| 63664 | Physician and practitioner services (fee schedule) | 50 | $655.63 |
| 63685 | Physician and practitioner services (fee schedule) | 49 | $277.01 |
| 63688 | Physician and practitioner services (fee schedule) | 50 | $259.96 |
| 63700 | Physician and practitioner services (fee schedule) | 49 | $984.78 |
| 63702 | Physician and practitioner services (fee schedule) | 49 | $1,077.55 |
| 63704 | Physician and practitioner services (fee schedule) | 49 | $1,246.11 |
| 63706 | Physician and practitioner services (fee schedule) | 49 | $1,377.87 |
| 63707 | Physician and practitioner services (fee schedule) | 50 | $723.71 |
| 63709 | Physician and practitioner services (fee schedule) | 49 | $912.33 |
| 63710 | Physician and practitioner services (fee schedule) | 49 | $813.34 |
| 63740 | Physician and practitioner services (fee schedule) | 49 | $763.80 |
| 63741 | Physician and practitioner services (fee schedule) | 49 | $528.87 |
| 63744 | Physician and practitioner services (fee schedule) | 49 | $550.83 |
| 63746 | Physician and practitioner services (fee schedule) | 50 | $481.82 |
| 64400 | Physician and practitioner services (fee schedule) | 50 | $81.21 |
| 64405 | Physician and practitioner services (fee schedule) | 50 | $57.05 |
| 64408 | Physician and practitioner services (fee schedule) | 50 | $58.39 |
| 64415 | Physician and practitioner services (fee schedule) | 50 | $80.01 |
| 64416 | Physician and practitioner services (fee schedule) | 48 | $66.41 |
| 64417 | Physician and practitioner services (fee schedule) | 50 | $91.77 |
| 64418 | Physician and practitioner services (fee schedule) | 50 | $68.33 |
| 64420 | Physician and practitioner services (fee schedule) | 50 | $71.58 |
| 64421 | Physician and practitioner services (fee schedule) | 50 | $29.03 |
| 64425 | Physician and practitioner services (fee schedule) | 50 | $81.27 |
| 64430 | Physician and practitioner services (fee schedule) | 50 | $69.65 |
| 64435 | Physician and practitioner services (fee schedule) | 50 | $60.88 |
| 64445 | Physician and practitioner services (fee schedule) | 50 | $89.30 |
| 64446 | Physician and practitioner services (fee schedule) | 49 | $64.29 |
| 64447 | Physician and practitioner services (fee schedule) | 49 | $72.19 |
| 64448 | Physician and practitioner services (fee schedule) | 49 | $61.46 |
| 64449 | Physician and practitioner services (fee schedule) | 49 | $55.56 |
| 64450 | Physician and practitioner services (fee schedule) | 50 | $54.68 |
| 64451 | Physician and practitioner services (fee schedule) | 44 | $157.08 |
| 64454 | Physician and practitioner services (fee schedule) | 42 | $149.07 |
| 64455 | Physician and practitioner services (fee schedule) | 48 | $35.31 |
| 64461 | Physician and practitioner services (fee schedule) | 48 | $103.56 |
| 64462 | Physician and practitioner services (fee schedule) | 47 | $56.40 |
| 64463 | Physician and practitioner services (fee schedule) | 48 | $141.27 |
| 64466 | Physician and practitioner services (fee schedule) | 40 | $96.76 |
| 64467 | Physician and practitioner services (fee schedule) | 40 | $179.75 |
| 64468 | Physician and practitioner services (fee schedule) | 40 | $111.86 |
| 64469 | Physician and practitioner services (fee schedule) | 40 | $273.58 |
| 64473 | Physician and practitioner services (fee schedule) | 40 | $91.55 |
| 64474 | Physician and practitioner services (fee schedule) | 40 | $177.26 |
| 64479 | Physician and practitioner services (fee schedule) | 48 | $172.38 |
| 64480 | Physician and practitioner services (fee schedule) | 48 | $102.67 |
| 64483 | Physician and practitioner services (fee schedule) | 49 | $168.91 |
| 64484 | Physician and practitioner services (fee schedule) | 49 | $88.78 |
| 64486 | Physician and practitioner services (fee schedule) | 46 | $82.14 |
| 64487 | Physician and practitioner services (fee schedule) | 46 | $126.63 |
| 64488 | Physician and practitioner services (fee schedule) | 46 | $99.48 |
| 64489 | Physician and practitioner services (fee schedule) | 46 | $166.46 |
| 64490 | Physician and practitioner services (fee schedule) | 48 | $123.05 |
| 64491 | Physician and practitioner services (fee schedule) | 48 | $64.19 |
| 64492 | Physician and practitioner services (fee schedule) | 48 | $64.68 |
| 64493 | Physician and practitioner services (fee schedule) | 48 | $113.43 |
| 64494 | Physician and practitioner services (fee schedule) | 48 | $58.12 |
| 64495 | Physician and practitioner services (fee schedule) | 48 | $57.78 |
| 64505 | Physician and practitioner services (fee schedule) | 50 | $93.90 |
| 64510 | Physician and practitioner services (fee schedule) | 50 | $85.31 |
| 64517 | Physician and practitioner services (fee schedule) | 48 | $137.35 |
| 64520 | Physician and practitioner services (fee schedule) | 50 | $118.18 |
| 64530 | Physician and practitioner services (fee schedule) | 50 | $130.69 |
| 64553 | Physician and practitioner services (fee schedule) | 45 | $388.94 |
| 64555 | Physician and practitioner services (fee schedule) | 47 | $298.20 |
| 64561 | Physician and practitioner services (fee schedule) | 49 | $570.69 |
| 64566 | Physician and practitioner services (fee schedule) | 41 | $91.08 |
| 64567 | Physician and practitioner services (fee schedule) | 22 | $872.09 |
| 64568 | Physician and practitioner services (fee schedule) | 49 | $516.35 |
| 64569 | Physician and practitioner services (fee schedule) | 49 | $575.51 |
| 64570 | Physician and practitioner services (fee schedule) | 48 | $589.44 |
| 64575 | Physician and practitioner services (fee schedule) | 48 | $250.16 |
| 64580 | Physician and practitioner services (fee schedule) | 44 | $247.02 |
| 64581 | Physician and practitioner services (fee schedule) | 47 | $526.49 |
| 64582 | Physician and practitioner services (fee schedule) | 38 | $655.48 |
| 64583 | Physician and practitioner services (fee schedule) | 36 | $648.13 |
| 64584 | Physician and practitioner services (fee schedule) | 38 | $545.73 |
| 64585 | Physician and practitioner services (fee schedule) | 49 | $150.97 |
| 64590 | Physician and practitioner services (fee schedule) | 49 | $257.96 |
| 64595 | Physician and practitioner services (fee schedule) | 49 | $208.76 |
| 64596 | Physician and practitioner services (fee schedule) | 15 | $882.63 |
| 64597 | Physician and practitioner services (fee schedule) | 15 | $371.16 |
| 64598 | Physician and practitioner services (fee schedule) | 12 | $203.27 |
| 64600 | Physician and practitioner services (fee schedule) | 50 | $274.95 |
| 64605 | Physician and practitioner services (fee schedule) | 50 | $494.05 |
| 64610 | Physician and practitioner services (fee schedule) | 50 | $496.03 |
| 64611 | Physician and practitioner services (fee schedule) | 49 | $96.14 |
| 64612 | Physician and practitioner services (fee schedule) | 49 | $112.25 |
| 64615 | Physician and practitioner services (fee schedule) | 50 | $112.11 |
| 64616 | Physician and practitioner services (fee schedule) | 48 | $98.90 |
| 64617 | Physician and practitioner services (fee schedule) | 47 | $107.60 |
| 64620 | Physician and practitioner services (fee schedule) | 50 | $165.15 |
| 64624 | Physician and practitioner services (fee schedule) | 39 | $284.11 |
| 64625 | Physician and practitioner services (fee schedule) | 36 | $334.64 |
| 64628 | Physician and practitioner services (fee schedule) | 35 | $336.64 |
| 64629 | Physician and practitioner services (fee schedule) | 35 | $157.94 |
| 64630 | Physician and practitioner services (fee schedule) | 50 | $183.20 |
| 64632 | Physician and practitioner services (fee schedule) | 46 | $66.63 |
| 64633 | Physician and practitioner services (fee schedule) | 48 | $307.03 |
| 64634 | Physician and practitioner services (fee schedule) | 49 | $165.20 |
| 64635 | Physician and practitioner services (fee schedule) | 47 | $305.97 |
| 64636 | Physician and practitioner services (fee schedule) | 48 | $150.94 |
| 64640 | Physician and practitioner services (fee schedule) | 49 | $144.79 |
| 64642 | Physician and practitioner services (fee schedule) | 50 | $104.42 |
| 64643 | Physician and practitioner services (fee schedule) | 50 | $65.37 |
| 64644 | Physician and practitioner services (fee schedule) | 50 | $122.13 |
| 64645 | Physician and practitioner services (fee schedule) | 50 | $80.18 |
| 64646 | Physician and practitioner services (fee schedule) | 49 | $108.63 |
| 64647 | Physician and practitioner services (fee schedule) | 49 | $120.77 |
| 64650 | Physician and practitioner services (fee schedule) | 44 | $46.41 |
| 64653 | Physician and practitioner services (fee schedule) | 43 | $58.45 |
| 64654 | Physician and practitioner services (fee schedule) | 16 | $414.83 |
| 64655 | Physician and practitioner services (fee schedule) | 16 | $480.60 |
| 64656 | Physician and practitioner services (fee schedule) | 18 | $310.03 |
| 64657 | Physician and practitioner services (fee schedule) | 17 | $462.14 |
| 64658 | Physician and practitioner services (fee schedule) | 17 | $347.25 |
| 64659 | Physician and practitioner services (fee schedule) | 17 | $321.77 |
| 64680 | Physician and practitioner services (fee schedule) | 50 | $177.53 |
| 64681 | Physician and practitioner services (fee schedule) | 48 | $342.06 |
| 64702 | Physician and practitioner services (fee schedule) | 49 | $388.44 |
| 64704 | Physician and practitioner services (fee schedule) | 49 | $255.93 |
| 64708 | Physician and practitioner services (fee schedule) | 50 | $382.18 |
| 64712 | Physician and practitioner services (fee schedule) | 49 | $458.70 |
| 64713 | Physician and practitioner services (fee schedule) | 50 | $596.80 |
| 64714 | Physician and practitioner services (fee schedule) | 50 | $566.65 |
| 64716 | Physician and practitioner services (fee schedule) | 48 | $385.13 |
| 64718 | Physician and practitioner services (fee schedule) | 49 | $455.51 |
| 64719 | Physician and practitioner services (fee schedule) | 49 | $327.85 |
| 64721 | Physician and practitioner services (fee schedule) | 50 | $359.43 |
| 64722 | Physician and practitioner services (fee schedule) | 48 | $301.49 |
| 64726 | Physician and practitioner services (fee schedule) | 50 | $213.51 |
| 64727 | Physician and practitioner services (fee schedule) | 48 | $140.87 |
| 64728 | Physician and practitioner services (fee schedule) | 26 | $992.30 |
| 64732 | Physician and practitioner services (fee schedule) | 50 | $345.80 |
| 64734 | Physician and practitioner services (fee schedule) | 50 | $396.94 |
| 64736 | Physician and practitioner services (fee schedule) | 50 | $259.76 |
| 64738 | Physician and practitioner services (fee schedule) | 50 | $343.42 |
| 64740 | Physician and practitioner services (fee schedule) | 48 | $351.57 |
| 64742 | Physician and practitioner services (fee schedule) | 48 | $365.72 |
| 64744 | Physician and practitioner services (fee schedule) | 49 | $414.15 |
| 64746 | Physician and practitioner services (fee schedule) | 49 | $324.40 |
| 64755 | Physician and practitioner services (fee schedule) | 48 | $678.85 |
| 64760 | Physician and practitioner services (fee schedule) | 48 | $401.29 |
| 64763 | Physician and practitioner services (fee schedule) | 49 | $392.25 |
| 64766 | Physician and practitioner services (fee schedule) | 49 | $481.02 |
| 64771 | Physician and practitioner services (fee schedule) | 48 | $441.81 |
| 64772 | Physician and practitioner services (fee schedule) | 49 | $412.56 |
| 64774 | Physician and practitioner services (fee schedule) | 49 | $324.60 |
| 64776 | Physician and practitioner services (fee schedule) | 49 | $301.75 |
| 64778 | Physician and practitioner services (fee schedule) | 48 | $140.16 |
| 64782 | Physician and practitioner services (fee schedule) | 49 | $348.51 |
| 64783 | Physician and practitioner services (fee schedule) | 49 | $168.08 |
| 64784 | Physician and practitioner services (fee schedule) | 49 | $541.14 |
| 64786 | Physician and practitioner services (fee schedule) | 49 | $792.62 |
| 64787 | Physician and practitioner services (fee schedule) | 49 | $185.51 |
| 64788 | Physician and practitioner services (fee schedule) | 49 | $308.86 |
| 64790 | Physician and practitioner services (fee schedule) | 49 | $632.77 |
| 64792 | Physician and practitioner services (fee schedule) | 49 | $845.15 |
| 64795 | Physician and practitioner services (fee schedule) | 49 | $156.64 |
| 64802 | Physician and practitioner services (fee schedule) | 49 | $574.42 |
| 64804 | Physician and practitioner services (fee schedule) | 49 | $857.76 |
| 64809 | Physician and practitioner services (fee schedule) | 49 | $771.40 |
| 64818 | Physician and practitioner services (fee schedule) | 49 | $576.30 |
| 64820 | Physician and practitioner services (fee schedule) | 48 | $596.17 |
| 64821 | Physician and practitioner services (fee schedule) | 46 | $529.49 |
| 64822 | Physician and practitioner services (fee schedule) | 47 | $535.57 |
| 64823 | Physician and practitioner services (fee schedule) | 47 | $597.63 |
| 64831 | Physician and practitioner services (fee schedule) | 49 | $518.20 |
| 64832 | Physician and practitioner services (fee schedule) | 49 | $241.09 |
| 64834 | Physician and practitioner services (fee schedule) | 49 | $544.52 |
| 64835 | Physician and practitioner services (fee schedule) | 49 | $595.23 |
| 64836 | Physician and practitioner services (fee schedule) | 49 | $605.75 |
| 64837 | Physician and practitioner services (fee schedule) | 49 | $269.97 |
| 64840 | Physician and practitioner services (fee schedule) | 49 | $708.97 |
| 64856 | Physician and practitioner services (fee schedule) | 49 | $743.08 |
| 64857 | Physician and practitioner services (fee schedule) | 49 | $755.13 |
| 64858 | Physician and practitioner services (fee schedule) | 49 | $875.09 |
| 64859 | Physician and practitioner services (fee schedule) | 48 | $190.16 |
| 64861 | Physician and practitioner services (fee schedule) | 49 | $1,132.65 |
| 64862 | Physician and practitioner services (fee schedule) | 49 | $1,048.50 |
| 64864 | Physician and practitioner services (fee schedule) | 49 | $631.78 |
| 64865 | Physician and practitioner services (fee schedule) | 49 | $808.20 |
| 64866 | Physician and practitioner services (fee schedule) | 49 | $884.12 |
| 64868 | Physician and practitioner services (fee schedule) | 49 | $727.89 |
| 64872 | Physician and practitioner services (fee schedule) | 49 | $86.47 |
| 64874 | Physician and practitioner services (fee schedule) | 49 | $129.88 |
| 64876 | Physician and practitioner services (fee schedule) | 47 | $145.54 |
| 64885 | Physician and practitioner services (fee schedule) | 49 | $825.01 |
| 64886 | Physician and practitioner services (fee schedule) | 49 | $990.97 |
| 64890 | Physician and practitioner services (fee schedule) | 49 | $801.43 |
| 64891 | Physician and practitioner services (fee schedule) | 49 | $826.78 |
| 64892 | Physician and practitioner services (fee schedule) | 49 | $763.49 |
| 64893 | Physician and practitioner services (fee schedule) | 49 | $834.84 |
| 64895 | Physician and practitioner services (fee schedule) | 49 | $954.57 |
| 64896 | Physician and practitioner services (fee schedule) | 49 | $1,061.72 |
| 64897 | Physician and practitioner services (fee schedule) | 49 | $910.90 |
| 64898 | Physician and practitioner services (fee schedule) | 49 | $982.97 |
| 64901 | Physician and practitioner services (fee schedule) | 49 | $440.97 |
| 64902 | Physician and practitioner services (fee schedule) | 49 | $522.23 |
| 64905 | Physician and practitioner services (fee schedule) | 49 | $744.50 |
| 64907 | Physician and practitioner services (fee schedule) | 49 | $936.43 |
| 64910 | Physician and practitioner services (fee schedule) | 46 | $558.51 |
| 64911 | Physician and practitioner services (fee schedule) | 45 | $700.51 |
| 64912 | Physician and practitioner services (fee schedule) | 41 | $675.23 |
| 64913 | Physician and practitioner services (fee schedule) | 41 | $126.90 |
| 64999 | Physician and practitioner services (fee schedule) | 8 | $671.80 |
| 65091 | Physician and practitioner services (fee schedule) | 49 | $534.04 |
| 65093 | Physician and practitioner services (fee schedule) | 49 | $537.82 |
| 65101 | Physician and practitioner services (fee schedule) | 49 | $590.72 |
| 65103 | Physician and practitioner services (fee schedule) | 49 | $631.59 |
| 65105 | Physician and practitioner services (fee schedule) | 49 | $659.30 |
| 65110 | Physician and practitioner services (fee schedule) | 49 | $930.40 |
| 65112 | Physician and practitioner services (fee schedule) | 49 | $994.97 |
| 65114 | Physician and practitioner services (fee schedule) | 49 | $1,057.01 |
| 65125 | Physician and practitioner services (fee schedule) | 44 | $304.59 |
| 65130 | Physician and practitioner services (fee schedule) | 48 | $603.10 |
| 65135 | Physician and practitioner services (fee schedule) | 48 | $621.84 |
| 65140 | Physician and practitioner services (fee schedule) | 48 | $652.78 |
| 65150 | Physician and practitioner services (fee schedule) | 48 | $500.38 |
| 65155 | Physician and practitioner services (fee schedule) | 48 | $676.82 |
| 65175 | Physician and practitioner services (fee schedule) | 48 | $567.66 |
| 65205 | Physician and practitioner services (fee schedule) | 49 | $26.00 |
| 65210 | Physician and practitioner services (fee schedule) | 49 | $32.96 |
| 65220 | Physician and practitioner services (fee schedule) | 50 | $43.66 |
| 65222 | Physician and practitioner services (fee schedule) | 50 | $49.02 |
| 65235 | Physician and practitioner services (fee schedule) | 49 | $516.36 |
| 65260 | Physician and practitioner services (fee schedule) | 49 | $680.99 |
| 65265 | Physician and practitioner services (fee schedule) | 49 | $766.53 |
| 65270 | Physician and practitioner services (fee schedule) | 49 | $151.65 |
| 65272 | Physician and practitioner services (fee schedule) | 49 | $335.69 |
| 65273 | Physician and practitioner services (fee schedule) | 49 | $266.27 |
| 65275 | Physician and practitioner services (fee schedule) | 49 | $398.45 |
| 65280 | Physician and practitioner services (fee schedule) | 49 | $482.37 |
| 65285 | Physician and practitioner services (fee schedule) | 49 | $770.09 |
| 65286 | Physician and practitioner services (fee schedule) | 49 | $467.99 |
| 65290 | Physician and practitioner services (fee schedule) | 49 | $346.54 |
| 65400 | Physician and practitioner services (fee schedule) | 49 | $475.33 |
| 65410 | Physician and practitioner services (fee schedule) | 49 | $97.86 |
| 65420 | Physician and practitioner services (fee schedule) | 49 | $344.69 |
| 65426 | Physician and practitioner services (fee schedule) | 50 | $451.03 |
| 65430 | Physician and practitioner services (fee schedule) | 49 | $88.88 |
| 65435 | Physician and practitioner services (fee schedule) | 49 | $62.89 |
| 65436 | Physician and practitioner services (fee schedule) | 49 | $280.26 |
| 65450 | Physician and practitioner services (fee schedule) | 49 | $256.55 |
| 65600 | Physician and practitioner services (fee schedule) | 48 | $310.82 |
| 65710 | Physician and practitioner services (fee schedule) | 49 | $816.44 |
| 65730 | Physician and practitioner services (fee schedule) | 49 | $889.37 |
| 65750 | Physician and practitioner services (fee schedule) | 49 | $911.57 |
| 65755 | Physician and practitioner services (fee schedule) | 49 | $888.72 |
| 65756 | Physician and practitioner services (fee schedule) | 49 | $821.85 |
| 65757 | Physician and practitioner services (fee schedule) | 21 | $110.87 |
| 65760 | Physician and practitioner services (fee schedule) | 17 | $913.91 |
| 65765 | Physician and practitioner services (fee schedule) | 22 | $924.61 |
| 65767 | Physician and practitioner services (fee schedule) | 18 | $848.25 |
| 65770 | Physician and practitioner services (fee schedule) | 46 | $985.55 |
| 65771 | Physician and practitioner services (fee schedule) | 8 | $425.11 |
| 65772 | Physician and practitioner services (fee schedule) | 46 | $356.52 |
| 65775 | Physician and practitioner services (fee schedule) | 46 | $425.63 |
| 65778 | Physician and practitioner services (fee schedule) | 49 | $827.64 |
| 65779 | Physician and practitioner services (fee schedule) | 48 | $728.63 |
| 65780 | Physician and practitioner services (fee schedule) | 45 | $474.38 |
| 65781 | Physician and practitioner services (fee schedule) | 43 | $939.17 |
| 65782 | Physician and practitioner services (fee schedule) | 44 | $821.27 |
| 65785 | Physician and practitioner services (fee schedule) | 38 | $1,326.89 |
| 65800 | Physician and practitioner services (fee schedule) | 49 | $96.95 |
| 65810 | Physician and practitioner services (fee schedule) | 49 | $333.35 |
| 65815 | Physician and practitioner services (fee schedule) | 49 | $429.93 |
| 65820 | Physician and practitioner services (fee schedule) | 49 | $589.43 |
| 65850 | Physician and practitioner services (fee schedule) | 49 | $618.63 |
| 65855 | Physician and practitioner services (fee schedule) | 49 | $207.51 |
| 65860 | Physician and practitioner services (fee schedule) | 49 | $237.74 |
| 65865 | Physician and practitioner services (fee schedule) | 49 | $354.88 |
| 65870 | Physician and practitioner services (fee schedule) | 49 | $425.84 |
| 65875 | Physician and practitioner services (fee schedule) | 49 | $454.33 |
| 65880 | Physician and practitioner services (fee schedule) | 49 | $476.83 |
| 65900 | Physician and practitioner services (fee schedule) | 49 | $690.82 |
| 65920 | Physician and practitioner services (fee schedule) | 49 | $565.69 |
| 65930 | Physician and practitioner services (fee schedule) | 49 | $467.04 |
| 66020 | Physician and practitioner services (fee schedule) | 49 | $131.27 |
| 66030 | Physician and practitioner services (fee schedule) | 49 | $118.44 |
| 66130 | Physician and practitioner services (fee schedule) | 49 | $480.83 |
| 66150 | Physician and practitioner services (fee schedule) | 49 | $618.20 |
| 66155 | Physician and practitioner services (fee schedule) | 49 | $621.78 |
| 66160 | Physician and practitioner services (fee schedule) | 49 | $704.30 |
| 66170 | Physician and practitioner services (fee schedule) | 49 | $779.47 |
| 66172 | Physician and practitioner services (fee schedule) | 49 | $891.49 |
| 66174 | Physician and practitioner services (fee schedule) | 43 | $498.83 |
| 66175 | Physician and practitioner services (fee schedule) | 41 | $593.73 |
| 66179 | Physician and practitioner services (fee schedule) | 47 | $800.06 |
| 66180 | Physician and practitioner services (fee schedule) | 49 | $826.50 |
| 66183 | Physician and practitioner services (fee schedule) | 47 | $776.29 |
| 66184 | Physician and practitioner services (fee schedule) | 47 | $583.06 |
| 66185 | Physician and practitioner services (fee schedule) | 49 | $582.81 |
| 66225 | Physician and practitioner services (fee schedule) | 47 | $676.04 |
| 66250 | Physician and practitioner services (fee schedule) | 49 | $503.37 |
| 66500 | Physician and practitioner services (fee schedule) | 49 | $279.63 |
| 66505 | Physician and practitioner services (fee schedule) | 49 | $308.33 |
| 66600 | Physician and practitioner services (fee schedule) | 49 | $651.50 |
| 66605 | Physician and practitioner services (fee schedule) | 49 | $772.07 |
| 66625 | Physician and practitioner services (fee schedule) | 49 | $326.70 |
| 66630 | Physician and practitioner services (fee schedule) | 49 | $421.30 |
| 66635 | Physician and practitioner services (fee schedule) | 49 | $425.06 |
| 66680 | Physician and practitioner services (fee schedule) | 49 | $409.79 |
| 66682 | Physician and practitioner services (fee schedule) | 48 | $471.27 |
| 66683 | Physician and practitioner services (fee schedule) | 27 | $587.03 |
| 66700 | Physician and practitioner services (fee schedule) | 47 | $348.42 |
| 66710 | Physician and practitioner services (fee schedule) | 49 | $347.74 |
| 66711 | Physician and practitioner services (fee schedule) | 48 | $393.60 |
| 66720 | Physician and practitioner services (fee schedule) | 49 | $363.37 |
| 66740 | Physician and practitioner services (fee schedule) | 47 | $339.53 |
| 66761 | Physician and practitioner services (fee schedule) | 49 | $241.54 |
| 66762 | Physician and practitioner services (fee schedule) | 48 | $346.75 |
| 66770 | Physician and practitioner services (fee schedule) | 48 | $384.73 |
| 66820 | Physician and practitioner services (fee schedule) | 49 | $333.08 |
| 66821 | Physician and practitioner services (fee schedule) | 49 | $260.35 |
| 66825 | Physician and practitioner services (fee schedule) | 49 | $591.74 |
| 66830 | Physician and practitioner services (fee schedule) | 49 | $503.62 |
| 66840 | Physician and practitioner services (fee schedule) | 49 | $506.97 |
| 66850 | Physician and practitioner services (fee schedule) | 49 | $577.60 |
| 66852 | Physician and practitioner services (fee schedule) | 49 | $627.71 |
| 66920 | Physician and practitioner services (fee schedule) | 49 | $560.93 |
| 66930 | Physician and practitioner services (fee schedule) | 49 | $629.05 |
| 66940 | Physician and practitioner services (fee schedule) | 49 | $578.70 |
| 66982 | Physician and practitioner services (fee schedule) | 49 | $582.44 |
| 66983 | Physician and practitioner services (fee schedule) | 42 | $573.32 |
| 66984 | Physician and practitioner services (fee schedule) | 49 | $450.63 |
| 66985 | Physician and practitioner services (fee schedule) | 49 | $560.52 |
| 66986 | Physician and practitioner services (fee schedule) | 49 | $675.51 |
| 66987 | Physician and practitioner services (fee schedule) | 25 | $706.70 |
| 66988 | Physician and practitioner services (fee schedule) | 27 | $555.85 |
| 66989 | Physician and practitioner services (fee schedule) | 46 | $639.24 |
| 66990 | Physician and practitioner services (fee schedule) | 45 | $63.00 |
| 66991 | Physician and practitioner services (fee schedule) | 47 | $517.62 |
| 66999 | Physician and practitioner services (fee schedule) | 5 | $119.14 |
| 67005 | Physician and practitioner services (fee schedule) | 49 | $358.45 |
| 67010 | Physician and practitioner services (fee schedule) | 49 | $405.67 |
| 67015 | Physician and practitioner services (fee schedule) | 49 | $454.28 |
| 67025 | Physician and practitioner services (fee schedule) | 49 | $560.87 |
| 67027 | Physician and practitioner services (fee schedule) | 48 | $595.56 |
| 67028 | Physician and practitioner services (fee schedule) | 49 | $96.73 |
| 67030 | Physician and practitioner services (fee schedule) | 49 | $409.37 |
| 67031 | Physician and practitioner services (fee schedule) | 49 | $306.25 |
| 67036 | Physician and practitioner services (fee schedule) | 49 | $670.35 |
| 67039 | Physician and practitioner services (fee schedule) | 49 | $718.24 |
| 67040 | Physician and practitioner services (fee schedule) | 49 | $821.14 |
| 67041 | Physician and practitioner services (fee schedule) | 49 | $823.40 |
| 67042 | Physician and practitioner services (fee schedule) | 49 | $844.66 |
| 67043 | Physician and practitioner services (fee schedule) | 49 | $888.27 |
| 67101 | Physician and practitioner services (fee schedule) | 49 | $283.77 |
| 67105 | Physician and practitioner services (fee schedule) | 49 | $259.84 |
| 67107 | Physician and practitioner services (fee schedule) | 49 | $815.95 |
| 67108 | Physician and practitioner services (fee schedule) | 49 | $885.68 |
| 67110 | Physician and practitioner services (fee schedule) | 49 | $690.68 |
| 67113 | Physician and practitioner services (fee schedule) | 49 | $982.34 |
| 67115 | Physician and practitioner services (fee schedule) | 48 | $363.33 |
| 67120 | Physician and practitioner services (fee schedule) | 49 | $494.30 |
| 67121 | Physician and practitioner services (fee schedule) | 49 | $634.14 |
| 67141 | Physician and practitioner services (fee schedule) | 49 | $226.43 |
| 67145 | Physician and practitioner services (fee schedule) | 49 | $212.80 |
| 67208 | Physician and practitioner services (fee schedule) | 48 | $472.82 |
| 67210 | Physician and practitioner services (fee schedule) | 49 | $431.96 |
| 67218 | Physician and practitioner services (fee schedule) | 48 | $994.07 |
| 67220 | Physician and practitioner services (fee schedule) | 49 | $453.60 |
| 67221 | Physician and practitioner services (fee schedule) | 49 | $224.07 |
| 67225 | Physician and practitioner services (fee schedule) | 48 | $23.96 |
| 67227 | Physician and practitioner services (fee schedule) | 49 | $253.21 |
| 67228 | Physician and practitioner services (fee schedule) | 49 | $288.95 |
| 67229 | Physician and practitioner services (fee schedule) | 49 | $803.75 |
| 67250 | Physician and practitioner services (fee schedule) | 49 | $653.18 |
| 67255 | Physician and practitioner services (fee schedule) | 49 | $531.02 |
| 67299 | Physician and practitioner services (fee schedule) | 9 | $437.61 |
| 67311 | Physician and practitioner services (fee schedule) | 49 | $375.19 |
| 67312 | Physician and practitioner services (fee schedule) | 50 | $492.94 |
| 67314 | Physician and practitioner services (fee schedule) | 48 | $386.44 |
| 67316 | Physician and practitioner services (fee schedule) | 49 | $531.52 |
| 67318 | Physician and practitioner services (fee schedule) | 49 | $501.45 |
| 67320 | Physician and practitioner services (fee schedule) | 48 | $149.95 |
| 67331 | Physician and practitioner services (fee schedule) | 48 | $111.82 |
| 67332 | Physician and practitioner services (fee schedule) | 48 | $166.99 |
| 67334 | Physician and practitioner services (fee schedule) | 49 | $103.85 |
| 67335 | Physician and practitioner services (fee schedule) | 48 | $132.47 |
| 67340 | Physician and practitioner services (fee schedule) | 49 | $229.71 |
| 67343 | Physician and practitioner services (fee schedule) | 50 | $489.87 |
| 67345 | Physician and practitioner services (fee schedule) | 49 | $189.29 |
| 67346 | Physician and practitioner services (fee schedule) | 48 | $139.19 |
| 67399 | Physician and practitioner services (fee schedule) | 6 | $320.26 |
| 67400 | Physician and practitioner services (fee schedule) | 49 | $738.00 |
| 67405 | Physician and practitioner services (fee schedule) | 49 | $648.74 |
| 67412 | Physician and practitioner services (fee schedule) | 49 | $728.78 |
| 67413 | Physician and practitioner services (fee schedule) | 49 | $686.03 |
| 67414 | Physician and practitioner services (fee schedule) | 49 | $982.59 |
| 67415 | Physician and practitioner services (fee schedule) | 48 | $74.94 |
| 67420 | Physician and practitioner services (fee schedule) | 49 | $1,218.31 |
| 67430 | Physician and practitioner services (fee schedule) | 49 | $929.66 |
| 67440 | Physician and practitioner services (fee schedule) | 49 | $902.46 |
| 67445 | Physician and practitioner services (fee schedule) | 49 | $1,006.43 |
| 67450 | Physician and practitioner services (fee schedule) | 49 | $933.51 |
| 67500 | Physician and practitioner services (fee schedule) | 49 | $60.30 |
| 67505 | Physician and practitioner services (fee schedule) | 49 | $68.04 |
| 67515 | Physician and practitioner services (fee schedule) | 49 | $42.95 |
| 67516 | Physician and practitioner services (fee schedule) | 40 | $86.58 |
| 67550 | Physician and practitioner services (fee schedule) | 48 | $790.62 |
| 67560 | Physician and practitioner services (fee schedule) | 48 | $795.66 |
| 67570 | Physician and practitioner services (fee schedule) | 49 | $870.68 |
| 67599 | Physician and practitioner services (fee schedule) | 6 | $62.16 |
| 67700 | Physician and practitioner services (fee schedule) | 49 | $173.08 |
| 67710 | Physician and practitioner services (fee schedule) | 49 | $149.02 |
| 67715 | Physician and practitioner services (fee schedule) | 49 | $134.23 |
| 67800 | Physician and practitioner services (fee schedule) | 49 | $98.53 |
| 67801 | Physician and practitioner services (fee schedule) | 49 | $126.33 |
| 67805 | Physician and practitioner services (fee schedule) | 49 | $150.02 |
| 67808 | Physician and practitioner services (fee schedule) | 49 | $259.41 |
| 67810 | Physician and practitioner services (fee schedule) | 49 | $122.02 |
| 67820 | Physician and practitioner services (fee schedule) | 49 | $18.23 |
| 67825 | Physician and practitioner services (fee schedule) | 49 | $105.59 |
| 67830 | Physician and practitioner services (fee schedule) | 49 | $198.21 |
| 67835 | Physician and practitioner services (fee schedule) | 49 | $328.70 |
| 67840 | Physician and practitioner services (fee schedule) | 49 | $187.82 |
| 67850 | Physician and practitioner services (fee schedule) | 48 | $146.81 |
| 67875 | Physician and practitioner services (fee schedule) | 48 | $120.96 |
| 67880 | Physician and practitioner services (fee schedule) | 49 | $325.30 |
| 67882 | Physician and practitioner services (fee schedule) | 49 | $405.06 |
| 67900 | Physician and practitioner services (fee schedule) | 46 | $496.02 |
| 67901 | Physician and practitioner services (fee schedule) | 49 | $532.75 |
| 67902 | Physician and practitioner services (fee schedule) | 49 | $532.99 |
| 67903 | Physician and practitioner services (fee schedule) | 49 | $466.22 |
| 67904 | Physician and practitioner services (fee schedule) | 49 | $538.65 |
| 67906 | Physician and practitioner services (fee schedule) | 49 | $379.58 |
| 67908 | Physician and practitioner services (fee schedule) | 49 | $394.65 |
| 67909 | Physician and practitioner services (fee schedule) | 49 | $396.48 |
| 67911 | Physician and practitioner services (fee schedule) | 49 | $406.70 |
| 67912 | Physician and practitioner services (fee schedule) | 48 | $647.13 |
| 67914 | Physician and practitioner services (fee schedule) | 49 | $331.84 |
| 67915 | Physician and practitioner services (fee schedule) | 49 | $212.92 |
| 67916 | Physician and practitioner services (fee schedule) | 49 | $414.44 |
| 67917 | Physician and practitioner services (fee schedule) | 49 | $424.42 |
| 67921 | Physician and practitioner services (fee schedule) | 49 | $322.59 |
| 67922 | Physician and practitioner services (fee schedule) | 49 | $209.80 |
| 67923 | Physician and practitioner services (fee schedule) | 49 | $413.92 |
| 67924 | Physician and practitioner services (fee schedule) | 49 | $441.40 |
| 67930 | Physician and practitioner services (fee schedule) | 49 | $263.55 |
| 67935 | Physician and practitioner services (fee schedule) | 49 | $464.94 |
| 67938 | Physician and practitioner services (fee schedule) | 49 | $161.14 |
| 67950 | Physician and practitioner services (fee schedule) | 49 | $412.86 |
| 67961 | Physician and practitioner services (fee schedule) | 49 | $431.27 |
| 67966 | Physician and practitioner services (fee schedule) | 49 | $545.64 |
| 67971 | Physician and practitioner services (fee schedule) | 49 | $537.37 |
| 67973 | Physician and practitioner services (fee schedule) | 49 | $673.44 |
| 67974 | Physician and practitioner services (fee schedule) | 49 | $673.44 |
| 67975 | Physician and practitioner services (fee schedule) | 49 | $486.87 |
| 67999 | Physician and practitioner services (fee schedule) | 8 | $171.73 |
| 68020 | Physician and practitioner services (fee schedule) | 49 | $94.01 |
| 68040 | Physician and practitioner services (fee schedule) | 49 | $47.60 |
| 68100 | Physician and practitioner services (fee schedule) | 49 | $119.07 |
| 68110 | Physician and practitioner services (fee schedule) | 49 | $154.21 |
| 68115 | Physician and practitioner services (fee schedule) | 49 | $202.72 |
| 68130 | Physician and practitioner services (fee schedule) | 48 | $372.74 |
| 68135 | Physician and practitioner services (fee schedule) | 49 | $124.20 |
| 68200 | Physician and practitioner services (fee schedule) | 49 | $31.32 |
| 68320 | Physician and practitioner services (fee schedule) | 49 | $488.82 |
| 68325 | Physician and practitioner services (fee schedule) | 49 | $482.07 |
| 68326 | Physician and practitioner services (fee schedule) | 49 | $469.51 |
| 68328 | Physician and practitioner services (fee schedule) | 48 | $516.16 |
| 68330 | Physician and practitioner services (fee schedule) | 49 | $417.27 |
| 68335 | Physician and practitioner services (fee schedule) | 49 | $461.14 |
| 68340 | Physician and practitioner services (fee schedule) | 48 | $399.44 |
| 68360 | Physician and practitioner services (fee schedule) | 49 | $368.60 |
| 68362 | Physician and practitioner services (fee schedule) | 49 | $464.64 |
| 68371 | Physician and practitioner services (fee schedule) | 35 | $310.07 |
| 68399 | Physician and practitioner services (fee schedule) | 5 | $70.00 |
| 68400 | Physician and practitioner services (fee schedule) | 49 | $173.35 |
| 68420 | Physician and practitioner services (fee schedule) | 49 | $210.87 |
| 68440 | Physician and practitioner services (fee schedule) | 49 | $84.36 |
| 68500 | Physician and practitioner services (fee schedule) | 49 | $739.85 |
| 68505 | Physician and practitioner services (fee schedule) | 49 | $713.59 |
| 68510 | Physician and practitioner services (fee schedule) | 49 | $287.55 |
| 68520 | Physician and practitioner services (fee schedule) | 49 | $522.22 |
| 68525 | Physician and practitioner services (fee schedule) | 49 | $179.62 |
| 68530 | Physician and practitioner services (fee schedule) | 49 | $293.74 |
| 68540 | Physician and practitioner services (fee schedule) | 49 | $680.08 |
| 68550 | Physician and practitioner services (fee schedule) | 49 | $845.29 |
| 68700 | Physician and practitioner services (fee schedule) | 49 | $439.50 |
| 68705 | Physician and practitioner services (fee schedule) | 49 | $172.75 |
| 68720 | Physician and practitioner services (fee schedule) | 49 | $582.13 |
| 68745 | Physician and practitioner services (fee schedule) | 49 | $549.16 |
| 68750 | Physician and practitioner services (fee schedule) | 49 | $607.41 |
| 68760 | Physician and practitioner services (fee schedule) | 49 | $150.98 |
| 68761 | Physician and practitioner services (fee schedule) | 49 | $116.16 |
| 68770 | Physician and practitioner services (fee schedule) | 49 | $444.55 |
| 68801 | Physician and practitioner services (fee schedule) | 49 | $76.41 |
| 68810 | Physician and practitioner services (fee schedule) | 49 | $130.32 |
| 68811 | Physician and practitioner services (fee schedule) | 49 | $111.83 |
| 68815 | Physician and practitioner services (fee schedule) | 50 | $249.51 |
| 68816 | Physician and practitioner services (fee schedule) | 49 | $490.74 |
| 68840 | Physician and practitioner services (fee schedule) | 49 | $103.69 |
| 68841 | Physician and practitioner services (fee schedule) | 35 | $31.51 |
| 68850 | Physician and practitioner services (fee schedule) | 49 | $46.84 |
| 68899 | Physician and practitioner services (fee schedule) | 8 | $114.09 |
| 69000 | Physician and practitioner services (fee schedule) | 49 | $121.45 |
| 69005 | Physician and practitioner services (fee schedule) | 49 | $149.88 |
| 69020 | Physician and practitioner services (fee schedule) | 49 | $150.30 |
| 69100 | Physician and practitioner services (fee schedule) | 49 | $61.73 |
| 69105 | Physician and practitioner services (fee schedule) | 49 | $89.19 |
| 69110 | Physician and practitioner services (fee schedule) | 49 | $310.53 |
| 69120 | Physician and practitioner services (fee schedule) | 49 | $288.71 |
| 69140 | Physician and practitioner services (fee schedule) | 49 | $677.98 |
| 69145 | Physician and practitioner services (fee schedule) | 49 | $258.16 |
| 69150 | Physician and practitioner services (fee schedule) | 49 | $769.56 |
| 69155 | Physician and practitioner services (fee schedule) | 49 | $1,166.28 |
| 69200 | Physician and practitioner services (fee schedule) | 49 | $52.19 |
| 69205 | Physician and practitioner services (fee schedule) | 49 | $76.35 |
| 69209 | Physician and practitioner services (fee schedule) | 44 | $12.56 |
| 69210 | Physician and practitioner services (fee schedule) | 48 | $32.70 |
| 69220 | Physician and practitioner services (fee schedule) | 49 | $53.44 |
| 69222 | Physician and practitioner services (fee schedule) | 49 | $138.24 |
| 69300 | Physician and practitioner services (fee schedule) | 42 | $443.41 |
| 69310 | Physician and practitioner services (fee schedule) | 49 | $856.26 |
| 69320 | Physician and practitioner services (fee schedule) | 49 | $1,141.13 |
| 69399 | Physician and practitioner services (fee schedule) | 6 | $156.92 |
| 69420 | Physician and practitioner services (fee schedule) | 48 | $127.02 |
| 69421 | Physician and practitioner services (fee schedule) | 48 | $117.62 |
| 69424 | Physician and practitioner services (fee schedule) | 49 | $66.41 |
| 69433 | Physician and practitioner services (fee schedule) | 48 | $137.15 |
| 69436 | Physician and practitioner services (fee schedule) | 48 | $123.96 |
| 69440 | Physician and practitioner services (fee schedule) | 49 | $536.13 |
| 69450 | Physician and practitioner services (fee schedule) | 48 | $399.98 |
| 69501 | Physician and practitioner services (fee schedule) | 49 | $545.25 |
| 69502 | Physician and practitioner services (fee schedule) | 49 | $722.64 |
| 69505 | Physician and practitioner services (fee schedule) | 49 | $902.37 |
| 69511 | Physician and practitioner services (fee schedule) | 49 | $941.88 |
| 69530 | Physician and practitioner services (fee schedule) | 49 | $1,223.92 |
| 69535 | Physician and practitioner services (fee schedule) | 48 | $1,973.27 |
| 69540 | Physician and practitioner services (fee schedule) | 49 | $135.46 |
| 69550 | Physician and practitioner services (fee schedule) | 49 | $782.89 |
| 69552 | Physician and practitioner services (fee schedule) | 49 | $1,171.27 |
| 69554 | Physician and practitioner services (fee schedule) | 49 | $1,822.03 |
| 69601 | Physician and practitioner services (fee schedule) | 49 | $766.71 |
| 69602 | Physician and practitioner services (fee schedule) | 49 | $836.24 |
| 69603 | Physician and practitioner services (fee schedule) | 49 | $955.60 |
| 69604 | Physician and practitioner services (fee schedule) | 49 | $853.84 |
| 69610 | Physician and practitioner services (fee schedule) | 49 | $258.48 |
| 69620 | Physician and practitioner services (fee schedule) | 49 | $498.25 |
| 69631 | Physician and practitioner services (fee schedule) | 49 | $676.45 |
| 69632 | Physician and practitioner services (fee schedule) | 49 | $831.91 |
| 69633 | Physician and practitioner services (fee schedule) | 49 | $798.38 |
| 69635 | Physician and practitioner services (fee schedule) | 49 | $941.06 |
| 69636 | Physician and practitioner services (fee schedule) | 49 | $1,053.91 |
| 69637 | Physician and practitioner services (fee schedule) | 49 | $1,049.90 |
| 69641 | Physician and practitioner services (fee schedule) | 49 | $804.72 |
| 69642 | Physician and practitioner services (fee schedule) | 49 | $1,027.21 |
| 69643 | Physician and practitioner services (fee schedule) | 49 | $942.13 |
| 69644 | Physician and practitioner services (fee schedule) | 49 | $1,127.70 |
| 69645 | Physician and practitioner services (fee schedule) | 49 | $1,110.87 |
| 69646 | Physician and practitioner services (fee schedule) | 49 | $1,174.72 |
| 69650 | Physician and practitioner services (fee schedule) | 49 | $621.53 |
| 69660 | Physician and practitioner services (fee schedule) | 49 | $709.49 |
| 69661 | Physician and practitioner services (fee schedule) | 48 | $919.74 |
| 69662 | Physician and practitioner services (fee schedule) | 49 | $895.81 |
| 69666 | Physician and practitioner services (fee schedule) | 49 | $624.71 |
| 69667 | Physician and practitioner services (fee schedule) | 49 | $627.03 |
| 69670 | Physician and practitioner services (fee schedule) | 48 | $709.87 |
| 69676 | Physician and practitioner services (fee schedule) | 49 | $632.97 |
| 69700 | Physician and practitioner services (fee schedule) | 49 | $502.38 |
| 69705 | Physician and practitioner services (fee schedule) | 36 | $1,718.91 |
| 69706 | Physician and practitioner services (fee schedule) | 35 | $1,779.33 |
| 69710 | Physician and practitioner services (fee schedule) | 22 | $652.44 |
| 69711 | Physician and practitioner services (fee schedule) | 41 | $619.07 |
| 69714 | Physician and practitioner services (fee schedule) | 49 | $424.48 |
| 69716 | Physician and practitioner services (fee schedule) | 47 | $499.59 |
| 69717 | Physician and practitioner services (fee schedule) | 49 | $478.01 |
| 69719 | Physician and practitioner services (fee schedule) | 46 | $498.74 |
| 69720 | Physician and practitioner services (fee schedule) | 48 | $906.25 |
| 69725 | Physician and practitioner services (fee schedule) | 48 | $1,366.14 |
| 69726 | Physician and practitioner services (fee schedule) | 46 | $361.99 |
| 69727 | Physician and practitioner services (fee schedule) | 46 | $401.92 |
| 69728 | Physician and practitioner services (fee schedule) | 45 | $450.23 |
| 69729 | Physician and practitioner services (fee schedule) | 45 | $509.84 |
| 69730 | Physician and practitioner services (fee schedule) | 46 | $518.65 |
| 69740 | Physician and practitioner services (fee schedule) | 48 | $867.30 |
| 69745 | Physician and practitioner services (fee schedule) | 48 | $931.23 |
| 69799 | Physician and practitioner services (fee schedule) | 6 | $214.78 |
| 69801 | Physician and practitioner services (fee schedule) | 49 | $185.01 |
| 69805 | Physician and practitioner services (fee schedule) | 49 | $772.13 |
| 69806 | Physician and practitioner services (fee schedule) | 49 | $727.27 |
| 69905 | Physician and practitioner services (fee schedule) | 49 | $709.20 |
| 69910 | Physician and practitioner services (fee schedule) | 49 | $774.72 |
| 69915 | Physician and practitioner services (fee schedule) | 48 | $1,112.20 |
| 69930 | Physician and practitioner services (fee schedule) | 49 | $957.43 |
| 69949 | Physician and practitioner services (fee schedule) | 6 | $81.65 |
| 69950 | Physician and practitioner services (fee schedule) | 47 | $1,269.07 |
| 69955 | Physician and practitioner services (fee schedule) | 48 | $1,407.77 |
| 69960 | Physician and practitioner services (fee schedule) | 49 | $1,369.90 |
| 69970 | Physician and practitioner services (fee schedule) | 49 | $1,542.81 |
| 69979 | Physician and practitioner services (fee schedule) | 6 | $995.59 |
| 69990 | Physician and practitioner services (fee schedule) | 44 | $167.51 |
| 90291 | Physician and practitioner services (fee schedule) | 11 | $350.03 |
| 90371 | Physician and practitioner services (fee schedule) | 36 | $136.95 |
| 90375 | Physician and practitioner services (fee schedule) | 43 | $279.95 |
| 90376 | Physician and practitioner services (fee schedule) | 37 | $453.50 |
| 90377 | Physician and practitioner services (fee schedule) | 32 | $243.20 |
| 90378 | Physician and practitioner services (fee schedule) | 23 | $1,618.62 |
| 90380 | Physician and practitioner services (fee schedule) | 29 | $501.34 |
| 90381 | Physician and practitioner services (fee schedule) | 30 | $498.17 |
| 90382 | Physician and practitioner services (fee schedule) | 22 | $548.77 |
| 90385 | Physician and practitioner services (fee schedule) | 24 | $29.79 |
| 90396 | Physician and practitioner services (fee schedule) | 21 | $695.50 |
| 90460 | Physician and practitioner services (fee schedule) | 38 | $19.94 |
| 90461 | Physician and practitioner services (fee schedule) | 24 | $8.28 |
| 90471 | Physician and practitioner services (fee schedule) | 44 | $16.78 |
| 90472 | Physician and practitioner services (fee schedule) | 43 | $12.96 |
| 90473 | Physician and practitioner services (fee schedule) | 41 | $14.06 |
| 90474 | Physician and practitioner services (fee schedule) | 41 | $10.41 |
| 90476 | Physician and practitioner services (fee schedule) | 5 | $22.01 |
| 90480 | Physician and practitioner services (fee schedule) | 45 | $33.20 |
| 90481 | Physician and practitioner services (fee schedule) | 5 | $33.20 |
| 90482 | Physician and practitioner services (fee schedule) | 18 | $11.59 |
| 90483 | Physician and practitioner services (fee schedule) | 18 | $23.89 |
| 90581 | Physician and practitioner services (fee schedule) | 13 | $99.00 |
| 90586 | Physician and practitioner services (fee schedule) | 30 | $163.97 |
| 90587 | Physician and practitioner services (fee schedule) | 13 | $66.00 |
| 90589 | Physician and practitioner services (fee schedule) | 18 | $275.00 |
| 90593 | Physician and practitioner services (fee schedule) | 20 | $281.64 |
| 90611 | Physician and practitioner services (fee schedule) | 31 | $276.31 |
| 90619 | Physician and practitioner services (fee schedule) | 41 | $171.97 |
| 90623 | Physician and practitioner services (fee schedule) | 35 | $237.65 |
| 90624 | Physician and practitioner services (fee schedule) | 29 | $250.75 |
| 90625 | Physician and practitioner services (fee schedule) | 18 | $287.38 |
| 90626 | Physician and practitioner services (fee schedule) | 19 | $319.10 |
| 90627 | Physician and practitioner services (fee schedule) | 20 | $319.10 |
| 90632 | Physician and practitioner services (fee schedule) | 46 | $74.92 |
| 90636 | Physician and practitioner services (fee schedule) | 42 | $128.77 |
| 90644 | Physician and practitioner services (fee schedule) | 11 | $23.60 |
| 90648 | Physician and practitioner services (fee schedule) | 41 | $13.54 |
| 90649 | Physician and practitioner services (fee schedule) | 26 | $142.91 |
| 90650 | Physician and practitioner services (fee schedule) | 23 | $131.13 |
| 90654 | Physician and practitioner services (fee schedule) | 6 | $19.64 |
| 90655 | Physician and practitioner services (fee schedule) | 24 | $17.02 |
| 90660 | Physician and practitioner services (fee schedule) | 43 | $26.71 |
| 90661 | Physician and practitioner services (fee schedule) | 44 | $48.27 |
| 90670 | Physician and practitioner services (fee schedule) | 40 | $229.88 |
| 90671 | Physician and practitioner services (fee schedule) | 44 | $246.20 |
| 90672 | Physician and practitioner services (fee schedule) | 35 | $24.69 |
| 90674 | Physician and practitioner services (fee schedule) | 36 | $30.23 |
| 90675 | Physician and practitioner services (fee schedule) | 45 | $327.99 |
| 90676 | Physician and practitioner services (fee schedule) | 11 | $158.80 |
| 90677 | Physician and practitioner services (fee schedule) | 46 | $298.88 |
| 90678 | Physician and practitioner services (fee schedule) | 41 | $313.96 |
| 90679 | Physician and practitioner services (fee schedule) | 38 | $310.47 |
| 90681 | Physician and practitioner services (fee schedule) | 32 | $108.24 |
| 90682 | Physician and practitioner services (fee schedule) | 33 | $68.90 |
| 90683 | Physician and practitioner services (fee schedule) | 26 | $314.86 |
| 90684 | Physician and practitioner services (fee schedule) | 40 | $336.07 |
| 90685 | Physician and practitioner services (fee schedule) | 31 | $19.52 |
| 90686 | Physician and practitioner services (fee schedule) | 36 | $19.90 |
| 90687 | Physician and practitioner services (fee schedule) | 29 | $10.44 |
| 90688 | Physician and practitioner services (fee schedule) | 35 | $19.67 |
| 90689 | Physician and practitioner services (fee schedule) | 8 | $21.51 |
| 90690 | Physician and practitioner services (fee schedule) | 26 | $30.64 |
| 90691 | Physician and practitioner services (fee schedule) | 33 | $123.68 |
| 90694 | Physician and practitioner services (fee schedule) | 32 | $74.65 |
| 90697 | Physician and practitioner services (fee schedule) | 27 | $139.82 |
| 90707 | Physician and practitioner services (fee schedule) | 42 | $91.80 |
| 90710 | Physician and practitioner services (fee schedule) | 36 | $260.85 |
| 90713 | Physician and practitioner services (fee schedule) | 41 | $37.05 |
| 90714 | Physician and practitioner services (fee schedule) | 47 | $36.14 |
| 90715 | Physician and practitioner services (fee schedule) | 48 | $39.69 |
| 90716 | Physician and practitioner services (fee schedule) | 43 | $176.43 |
| 90717 | Physician and practitioner services (fee schedule) | 29 | $174.06 |
| 90723 | Physician and practitioner services (fee schedule) | 33 | $90.04 |
| 90732 | Physician and practitioner services (fee schedule) | 48 | $125.36 |
| 90733 | Physician and practitioner services (fee schedule) | 26 | $106.49 |
| 90734 | Physician and practitioner services (fee schedule) | 43 | $150.64 |
| 90736 | Physician and practitioner services (fee schedule) | 29 | $188.66 |
| 90738 | Physician and practitioner services (fee schedule) | 16 | $302.12 |
| 90739 | Physician and practitioner services (fee schedule) | 45 | $170.05 |
| 90743 | Physician and practitioner services (fee schedule) | 36 | $71.84 |
| 90746 | Physician and practitioner services (fee schedule) | 47 | $75.10 |
| 90748 | Physician and practitioner services (fee schedule) | 23 | $42.39 |
| 90750 | Physician and practitioner services (fee schedule) | 40 | $217.02 |
| 90756 | Physician and practitioner services (fee schedule) | 33 | $30.58 |
| 90759 | Physician and practitioner services (fee schedule) | 35 | $73.81 |
| 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) | 49 | $55.63 |
| 90937 | Physician and practitioner services (fee schedule) | 49 | $85.63 |
| 90940 | Physician and practitioner services (fee schedule) | 11 | $53.00 |
| 90945 | Physician and practitioner services (fee schedule) | 50 | $66.35 |
| 90947 | Physician and practitioner services (fee schedule) | 49 | $95.52 |
| 90951 | Physician and practitioner services (fee schedule) | 47 | $876.80 |
| 90952 | Physician and practitioner services (fee schedule) | 33 | $490.71 |
| 90953 | Physician and practitioner services (fee schedule) | 33 | $314.71 |
| 90954 | Physician and practitioner services (fee schedule) | 47 | $779.61 |
| 90955 | Physician and practitioner services (fee schedule) | 47 | $412.74 |
| 90956 | Physician and practitioner services (fee schedule) | 46 | $288.85 |
| 90957 | Physician and practitioner services (fee schedule) | 47 | $592.41 |
| 90958 | Physician and practitioner services (fee schedule) | 47 | $400.91 |
| 90959 | Physician and practitioner services (fee schedule) | 47 | $262.43 |
| 90960 | Physician and practitioner services (fee schedule) | 47 | $282.25 |
| 90961 | Physician and practitioner services (fee schedule) | 47 | $235.17 |
| 90962 | Physician and practitioner services (fee schedule) | 47 | $163.73 |
| 90963 | Physician and practitioner services (fee schedule) | 45 | $489.43 |
| 90964 | Physician and practitioner services (fee schedule) | 45 | $413.98 |
| 90965 | Physician and practitioner services (fee schedule) | 45 | $393.88 |
| 90966 | Physician and practitioner services (fee schedule) | 45 | $227.23 |
| 90967 | Physician and practitioner services (fee schedule) | 48 | $15.44 |
| 90968 | Physician and practitioner services (fee schedule) | 48 | $13.93 |
| 90969 | Physician and practitioner services (fee schedule) | 48 | $13.64 |
| 90970 | Physician and practitioner services (fee schedule) | 48 | $7.65 |
| 90989 | Physician and practitioner services (fee schedule) | 31 | $394.96 |
| 90993 | Physician and practitioner services (fee schedule) | 29 | $20.17 |
| 90997 | Physician and practitioner services (fee schedule) | 38 | $73.88 |
| 91010 | Physician and practitioner services (fee schedule) | 50 | $115.99 |
| 91013 | Physician and practitioner services (fee schedule) | 49 | $13.50 |
| 91020 | Physician and practitioner services (fee schedule) | 50 | $148.06 |
| 91022 | Physician and practitioner services (fee schedule) | 49 | $95.00 |
| 91030 | Physician and practitioner services (fee schedule) | 50 | $75.66 |
| 91034 | Physician and practitioner services (fee schedule) | 50 | $123.84 |
| 91035 | Physician and practitioner services (fee schedule) | 50 | $319.09 |
| 91037 | Physician and practitioner services (fee schedule) | 50 | $100.58 |
| 91038 | Physician and practitioner services (fee schedule) | 50 | $247.41 |
| 91040 | Physician and practitioner services (fee schedule) | 49 | $349.88 |
| 91065 | Physician and practitioner services (fee schedule) | 49 | $45.26 |
| 91110 | Physician and practitioner services (fee schedule) | 50 | $558.15 |
| 91111 | Physician and practitioner services (fee schedule) | 39 | $584.25 |
| 91112 | Physician and practitioner services (fee schedule) | 37 | $1,051.88 |
| 91113 | Physician and practitioner services (fee schedule) | 36 | $646.42 |
| 91117 | Physician and practitioner services (fee schedule) | 40 | $109.11 |
| 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) | 41 | $520.98 |
| 91125 | Physician and practitioner services (fee schedule) | 41 | $193.23 |
| 91132 | Physician and practitioner services (fee schedule) | 35 | $304.94 |
| 91133 | Physician and practitioner services (fee schedule) | 34 | $330.84 |
| 91200 | Physician and practitioner services (fee schedule) | 49 | $18.46 |
| 91299 | Physician and practitioner services (fee schedule) | 5 | $154.78 |
| 91304 | Physician and practitioner services (fee schedule) | 40 | $178.23 |
| 91318 | Physician and practitioner services (fee schedule) | 31 | $60.37 |
| 91319 | Physician and practitioner services (fee schedule) | 38 | $87.78 |
| 91320 | Physician and practitioner services (fee schedule) | 44 | $158.13 |
| 91321 | Physician and practitioner services (fee schedule) | 38 | $145.92 |
| 91322 | Physician and practitioner services (fee schedule) | 44 | $151.82 |
| 91323 | Physician and practitioner services (fee schedule) | 32 | $201.91 |
| 92002 | Physician and practitioner services (fee schedule) | 50 | $57.10 |
| 92004 | Physician and practitioner services (fee schedule) | 50 | $98.32 |
| 92012 | Physician and practitioner services (fee schedule) | 50 | $57.27 |
| 92014 | Physician and practitioner services (fee schedule) | 50 | $79.27 |
| 92015 | Physician and practitioner services (fee schedule) | 45 | $16.29 |
| 92018 | Physician and practitioner services (fee schedule) | 50 | $102.65 |
| 92019 | Physician and practitioner services (fee schedule) | 50 | $54.50 |
| 92020 | Physician and practitioner services (fee schedule) | 50 | $20.99 |
| 92025 | Physician and practitioner services (fee schedule) | 49 | $16.45 |
| 92060 | Physician and practitioner services (fee schedule) | 50 | $31.51 |
| 92065 | Physician and practitioner services (fee schedule) | 42 | $29.48 |
| 92066 | Physician and practitioner services (fee schedule) | 29 | $20.32 |
| 92071 | Physician and practitioner services (fee schedule) | 44 | $29.55 |
| 92072 | Physician and practitioner services (fee schedule) | 43 | $96.16 |
| 92081 | Physician and practitioner services (fee schedule) | 50 | $16.06 |
| 92082 | Physician and practitioner services (fee schedule) | 50 | $23.43 |
| 92083 | Physician and practitioner services (fee schedule) | 50 | $30.95 |
| 92100 | Physician and practitioner services (fee schedule) | 48 | $55.48 |
| 92132 | Physician and practitioner services (fee schedule) | 48 | $15.06 |
| 92133 | Physician and practitioner services (fee schedule) | 50 | $17.93 |
| 92134 | Physician and practitioner services (fee schedule) | 50 | $19.22 |
| 92136 | Physician and practitioner services (fee schedule) | 50 | $29.07 |
| 92137 | Physician and practitioner services (fee schedule) | 40 | $32.10 |
| 92145 | Professional / technical component share of a procedure fee | 29 | $8.43 |
| 92201 | Physician and practitioner services (fee schedule) | 49 | $20.65 |
| 92202 | Physician and practitioner services (fee schedule) | 49 | $13.06 |
| 92227 | Physician and practitioner services (fee schedule) | 38 | $13.41 |
| 92228 | Physician and practitioner services (fee schedule) | 41 | $15.00 |
| 92229 | Physician and practitioner services (fee schedule) | 29 | $36.09 |
| 92230 | Physician and practitioner services (fee schedule) | 48 | $82.50 |
| 92235 | Physician and practitioner services (fee schedule) | 50 | $76.76 |
| 92240 | Physician and practitioner services (fee schedule) | 49 | $132.30 |
| 92242 | Physician and practitioner services (fee schedule) | 49 | $180.20 |
| 92250 | Physician and practitioner services (fee schedule) | 50 | $19.81 |
| 92260 | Physician and practitioner services (fee schedule) | 48 | $15.24 |
| 92265 | Physician and practitioner services (fee schedule) | 49 | $38.04 |
| 92270 | Physician and practitioner services (fee schedule) | 50 | $53.72 |
| 92273 | Physician and practitioner services (fee schedule) | 50 | $75.69 |
| 92274 | Physician and practitioner services (fee schedule) | 50 | $50.11 |
| 92283 | Physician and practitioner services (fee schedule) | 44 | $35.47 |
| 92284 | Physician and practitioner services (fee schedule) | 46 | $25.58 |
| 92285 | Physician and practitioner services (fee schedule) | 45 | $16.96 |
| 92286 | Physician and practitioner services (fee schedule) | 48 | $20.93 |
| 92287 | Physician and practitioner services (fee schedule) | 44 | $91.41 |
| 92310 | Physician and practitioner services (fee schedule) | 43 | $75.28 |
| 92311 | Physician and practitioner services (fee schedule) | 41 | $71.26 |
| 92312 | Physician and practitioner services (fee schedule) | 41 | $81.42 |
| 92313 | Physician and practitioner services (fee schedule) | 39 | $65.90 |
| 92314 | Physician and practitioner services (fee schedule) | 31 | $52.30 |
| 92315 | Physician and practitioner services (fee schedule) | 32 | $51.18 |
| 92316 | Physician and practitioner services (fee schedule) | 32 | $63.28 |
| 92317 | Physician and practitioner services (fee schedule) | 32 | $53.90 |
| 92325 | Physician and practitioner services (fee schedule) | 27 | $38.10 |
| 92326 | Physician and practitioner services (fee schedule) | 33 | $32.76 |
| 92340 | Physician and practitioner services (fee schedule) | 37 | $24.36 |
| 92341 | Physician and practitioner services (fee schedule) | 37 | $29.14 |
| 92342 | Physician and practitioner services (fee schedule) | 35 | $28.96 |
| 92352 | Physician and practitioner services (fee schedule) | 26 | $24.86 |
| 92353 | Physician and practitioner services (fee schedule) | 29 | $30.85 |
| 92354 | Physician and practitioner services (fee schedule) | 17 | $13.56 |
| 92355 | Physician and practitioner services (fee schedule) | 17 | $18.33 |
| 92358 | Physician and practitioner services (fee schedule) | 18 | $11.97 |
| 92370 | Physician and practitioner services (fee schedule) | 40 | $19.57 |
| 92371 | Physician and practitioner services (fee schedule) | 24 | $9.54 |
| 92499 | Physician and practitioner services (fee schedule) | 13 | $30.00 |
| 92502 | Physician and practitioner services (fee schedule) | 50 | $76.44 |
| 92504 | Physician and practitioner services (fee schedule) | 46 | $21.68 |
| 92508 | Physician and practitioner services (fee schedule) | 46 | $20.35 |
| 92511 | Physician and practitioner services (fee schedule) | 49 | $78.05 |
| 92512 | Physician and practitioner services (fee schedule) | 43 | $43.43 |
| 92516 | Physician and practitioner services (fee schedule) | 46 | $44.18 |
| 92517 | Physician and practitioner services (fee schedule) | 35 | $59.95 |
| 92518 | Physician and practitioner services (fee schedule) | 35 | $60.95 |
| 92519 | Physician and practitioner services (fee schedule) | 35 | $95.77 |
| 92520 | Physician and practitioner services (fee schedule) | 46 | $51.18 |
| 92531 | Physician and practitioner services (fee schedule) | 23 | $11.60 |
| 92532 | Physician and practitioner services (fee schedule) | 23 | $11.99 |
| 92533 | Physician and practitioner services (fee schedule) | 27 | $16.54 |
| 92534 | Physician and practitioner services (fee schedule) | 24 | $13.13 |
| 92537 | Physician and practitioner services (fee schedule) | 48 | $26.16 |
| 92538 | Physician and practitioner services (fee schedule) | 48 | $13.25 |
| 92540 | Physician and practitioner services (fee schedule) | 50 | $63.75 |
| 92541 | Physician and practitioner services (fee schedule) | 50 | $19.01 |
| 92542 | Physician and practitioner services (fee schedule) | 50 | $21.48 |
| 92544 | Physician and practitioner services (fee schedule) | 50 | $13.37 |
| 92545 | Physician and practitioner services (fee schedule) | 50 | $12.32 |
| 92546 | Physician and practitioner services (fee schedule) | 49 | $81.48 |
| 92547 | Physician and practitioner services (fee schedule) | 49 | $8.76 |
| 92548 | Physician and practitioner services (fee schedule) | 42 | $32.88 |
| 92549 | Physician and practitioner services (fee schedule) | 37 | $40.65 |
| 92550 | Physician and practitioner services (fee schedule) | 50 | $17.58 |
| 92551 | Physician and practitioner services (fee schedule) | 48 | $10.78 |
| 92552 | Physician and practitioner services (fee schedule) | 50 | $27.63 |
| 92553 | Physician and practitioner services (fee schedule) | 50 | $31.41 |
| 92555 | Physician and practitioner services (fee schedule) | 50 | $20.62 |
| 92556 | Physician and practitioner services (fee schedule) | 49 | $30.85 |
| 92557 | Physician and practitioner services (fee schedule) | 50 | $30.15 |
| 92558 | Physician and practitioner services (fee schedule) | 32 | $8.44 |
| 92561 | Physician and practitioner services (fee schedule) | 5 | $24.87 |
| 92562 | Physician and practitioner services (fee schedule) | 45 | $36.22 |
| 92563 | Physician and practitioner services (fee schedule) | 48 | $26.66 |
| 92564 | Physician and practitioner services (fee schedule) | 6 | $14.94 |
| 92565 | Physician and practitioner services (fee schedule) | 48 | $15.89 |
| 92567 | Physician and practitioner services (fee schedule) | 49 | $12.94 |
| 92568 | Physician and practitioner services (fee schedule) | 50 | $12.78 |
| 92570 | Physician and practitioner services (fee schedule) | 49 | $25.36 |
| 92571 | Physician and practitioner services (fee schedule) | 47 | $22.91 |
| 92572 | Physician and practitioner services (fee schedule) | 47 | $39.92 |
| 92575 | Physician and practitioner services (fee schedule) | 45 | $57.12 |
| 92576 | Physician and practitioner services (fee schedule) | 46 | $30.34 |
| 92577 | Physician and practitioner services (fee schedule) | 47 | $17.75 |
| 92579 | Physician and practitioner services (fee schedule) | 48 | $33.77 |
| 92582 | Physician and practitioner services (fee schedule) | 48 | $61.81 |
| 92583 | Physician and practitioner services (fee schedule) | 44 | $44.05 |
| 92584 | Physician and practitioner services (fee schedule) | 43 | $85.51 |
| 92587 | Physician and practitioner services (fee schedule) | 50 | $17.10 |
| 92588 | Physician and practitioner services (fee schedule) | 50 | $26.27 |
| 92590 | Physician and practitioner services (fee schedule) | 11 | $45.00 |
| 92591 | Physician and practitioner services (fee schedule) | 11 | $57.03 |
| 92592 | Physician and practitioner services (fee schedule) | 10 | $16.54 |
| 92593 | Physician and practitioner services (fee schedule) | 10 | $26.27 |
| 92594 | Physician and practitioner services (fee schedule) | 11 | $16.30 |
| 92595 | Physician and practitioner services (fee schedule) | 10 | $31.32 |
| 92596 | Physician and practitioner services (fee schedule) | 29 | $57.66 |
| 92597 | Physician and practitioner services (fee schedule) | 43 | $63.75 |
| 92601 | Physician and practitioner services (fee schedule) | 49 | $122.87 |
| 92602 | Physician and practitioner services (fee schedule) | 49 | $78.74 |
| 92603 | Physician and practitioner services (fee schedule) | 49 | $110.55 |
| 92604 | Physician and practitioner services (fee schedule) | 49 | $66.62 |
| 92605 | Physician and practitioner services (fee schedule) | 19 | $70.24 |
| 92606 | Physician and practitioner services (fee schedule) | 21 | $60.46 |
| 92611 | Physician and practitioner services (fee schedule) | 48 | $74.50 |
| 92612 | Physician and practitioner services (fee schedule) | 47 | $131.03 |
| 92613 | Physician and practitioner services (fee schedule) | 33 | $31.43 |
| 92614 | Physician and practitioner services (fee schedule) | 44 | $99.65 |
| 92615 | Physician and practitioner services (fee schedule) | 35 | $27.97 |
| 92616 | Physician and practitioner services (fee schedule) | 44 | $145.28 |
| 92617 | Physician and practitioner services (fee schedule) | 35 | $35.41 |
| 92618 | Physician and practitioner services (fee schedule) | 14 | $24.49 |
| 92620 | Physician and practitioner services (fee schedule) | 44 | $61.53 |
| 92621 | Physician and practitioner services (fee schedule) | 45 | $14.78 |
| 92622 | Physician and practitioner services (fee schedule) | 44 | $60.27 |
| 92623 | Physician and practitioner services (fee schedule) | 43 | $15.43 |
| 92625 | Physician and practitioner services (fee schedule) | 44 | $50.81 |
| 92626 | Physician and practitioner services (fee schedule) | 47 | $66.62 |
| 92627 | Physician and practitioner services (fee schedule) | 47 | $16.31 |
| 92628 | Physician and practitioner services (fee schedule) | 21 | $42.37 |
| 92629 | Physician and practitioner services (fee schedule) | 19 | $22.14 |
| 92630 | Physician and practitioner services (fee schedule) | 26 | $54.98 |
| 92631 | Physician and practitioner services (fee schedule) | 20 | $39.83 |
| 92632 | Physician and practitioner services (fee schedule) | 19 | $18.00 |
| 92633 | Physician and practitioner services (fee schedule) | 26 | $54.98 |
| 92634 | Physician and practitioner services (fee schedule) | 11 | $57.44 |
| 92635 | Physician and practitioner services (fee schedule) | 11 | $24.33 |
| 92636 | Physician and practitioner services (fee schedule) | 24 | $26.86 |
| 92637 | Physician and practitioner services (fee schedule) | 22 | $13.50 |
| 92638 | Physician and practitioner services (fee schedule) | 11 | $35.35 |
| 92639 | Physician and practitioner services (fee schedule) | 17 | $35.33 |
| 92640 | Physician and practitioner services (fee schedule) | 42 | $80.78 |
| 92641 | Physician and practitioner services (fee schedule) | 22 | $20.95 |
| 92642 | Physician and practitioner services (fee schedule) | 7 | $29.60 |
| 92650 | Physician and practitioner services (fee schedule) | 49 | $23.35 |
| 92651 | Physician and practitioner services (fee schedule) | 50 | $69.83 |
| 92652 | Physician and practitioner services (fee schedule) | 50 | $92.90 |
| 92653 | Physician and practitioner services (fee schedule) | 50 | $67.60 |
| 92700 | Physician and practitioner services (fee schedule) | 7 | $20.00 |
| 92920 | Physician and practitioner services (fee schedule) | 48 | $368.98 |
| 92924 | Physician and practitioner services (fee schedule) | 48 | $440.53 |
| 92928 | Physician and practitioner services (fee schedule) | 48 | $415.38 |
| 92930 | Physician and practitioner services (fee schedule) | 41 | $404.43 |
| 92933 | Physician and practitioner services (fee schedule) | 48 | $485.63 |
| 92937 | Physician and practitioner services (fee schedule) | 48 | $453.12 |
| 92941 | Physician and practitioner services (fee schedule) | 49 | $509.45 |
| 92943 | Physician and practitioner services (fee schedule) | 49 | $535.59 |
| 92945 | Physician and practitioner services (fee schedule) | 37 | $501.93 |
| 92950 | Physician and practitioner services (fee schedule) | 48 | $240.45 |
| 92953 | Physician and practitioner services (fee schedule) | 47 | $1.01 |
| 92960 | Physician and practitioner services (fee schedule) | 48 | $123.01 |
| 92961 | Physician and practitioner services (fee schedule) | 47 | $190.73 |
| 92970 | Physician and practitioner services (fee schedule) | 48 | $147.64 |
| 92971 | Physician and practitioner services (fee schedule) | 48 | $77.12 |
| 92972 | Physician and practitioner services (fee schedule) | 31 | $105.90 |
| 92973 | Physician and practitioner services (fee schedule) | 49 | $114.51 |
| 92974 | Physician and practitioner services (fee schedule) | 48 | $126.17 |
| 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) | 48 | $120.58 |
| 92979 | Physician and practitioner services (fee schedule) | 48 | $69.31 |
| 92986 | Physician and practitioner services (fee schedule) | 49 | $1,018.74 |
| 92987 | Physician and practitioner services (fee schedule) | 49 | $1,050.94 |
| 92990 | Physician and practitioner services (fee schedule) | 49 | $836.81 |
| 92997 | Physician and practitioner services (fee schedule) | 49 | $523.02 |
| 92998 | Physician and practitioner services (fee schedule) | 48 | $249.50 |
| 93000 | Physician and practitioner services (fee schedule) | 49 | $14.40 |
| 93005 | Physician and practitioner services (fee schedule) | 49 | $6.59 |
| 93010 | Physician and practitioner services (fee schedule) | 49 | $7.39 |
| 93015 | Physician and practitioner services (fee schedule) | 49 | $66.76 |
| 93016 | Physician and practitioner services (fee schedule) | 48 | $18.68 |
| 93017 | Physician and practitioner services (fee schedule) | 47 | $36.78 |
| 93018 | Physician and practitioner services (fee schedule) | 49 | $12.93 |
| 93024 | Physician and practitioner services (fee schedule) | 48 | $53.85 |
| 93025 | Physician and practitioner services (fee schedule) | 48 | $108.33 |
| 93040 | Physician and practitioner services (fee schedule) | 48 | $12.05 |
| 93041 | Physician and practitioner services (fee schedule) | 47 | $5.41 |
| 93042 | Physician and practitioner services (fee schedule) | 47 | $6.10 |
| 93050 | Physician and practitioner services (fee schedule) | 32 | $7.91 |
| 93145 | Physician and practitioner services (fee schedule) | 15 | $33.34 |
| 93146 | Physician and practitioner services (fee schedule) | 15 | $40.72 |
| 93150 | Physician and practitioner services (fee schedule) | 36 | $74.95 |
| 93151 | Physician and practitioner services (fee schedule) | 36 | $64.69 |
| 93152 | Physician and practitioner services (fee schedule) | 32 | $106.39 |
| 93153 | Physician and practitioner services (fee schedule) | 36 | $39.00 |
| 93224 | Physician and practitioner services (fee schedule) | 49 | $68.36 |
| 93225 | Physician and practitioner services (fee schedule) | 49 | $17.05 |
| 93226 | Physician and practitioner services (fee schedule) | 50 | $33.45 |
| 93227 | Physician and practitioner services (fee schedule) | 49 | $17.33 |
| 93228 | Physician and practitioner services (fee schedule) | 49 | $21.27 |
| 93229 | Physician and practitioner services (fee schedule) | 42 | $623.07 |
| 93241 | Physician and practitioner services (fee schedule) | 36 | $221.07 |
| 93242 | Physician and practitioner services (fee schedule) | 47 | $10.16 |
| 93243 | Physician and practitioner services (fee schedule) | 38 | $192.15 |
| 93244 | Physician and practitioner services (fee schedule) | 47 | $19.61 |
| 93245 | Physician and practitioner services (fee schedule) | 37 | $230.91 |
| 93246 | Physician and practitioner services (fee schedule) | 46 | $10.21 |
| 93247 | Physician and practitioner services (fee schedule) | 38 | $201.22 |
| 93248 | Physician and practitioner services (fee schedule) | 46 | $21.39 |
| 93260 | Physician and practitioner services (fee schedule) | 44 | $37.14 |
| 93261 | Physician and practitioner services (fee schedule) | 44 | $32.34 |
| 93264 | Physician and practitioner services (fee schedule) | 32 | $36.17 |
| 93268 | Physician and practitioner services (fee schedule) | 49 | $143.43 |
| 93270 | Physician and practitioner services (fee schedule) | 49 | $8.05 |
| 93271 | Physician and practitioner services (fee schedule) | 48 | $115.65 |
| 93272 | Physician and practitioner services (fee schedule) | 49 | $21.02 |
| 93278 | Physician and practitioner services (fee schedule) | 46 | $19.77 |
| 93279 | Physician and practitioner services (fee schedule) | 49 | $30.44 |
| 93280 | Physician and practitioner services (fee schedule) | 49 | $35.61 |
| 93281 | Physician and practitioner services (fee schedule) | 49 | $39.64 |
| 93282 | Physician and practitioner services (fee schedule) | 49 | $37.24 |
| 93283 | Physician and practitioner services (fee schedule) | 49 | $48.95 |
| 93284 | Physician and practitioner services (fee schedule) | 49 | $55.25 |
| 93285 | Physician and practitioner services (fee schedule) | 49 | $28.41 |
| 93286 | Physician and practitioner services (fee schedule) | 47 | $23.26 |
| 93287 | Physician and practitioner services (fee schedule) | 48 | $24.12 |
| 93288 | Physician and practitioner services (fee schedule) | 49 | $28.83 |
| 93289 | Physician and practitioner services (fee schedule) | 49 | $34.12 |
| 93290 | Physician and practitioner services (fee schedule) | 48 | $25.73 |
| 93291 | Physician and practitioner services (fee schedule) | 49 | $25.64 |
| 93292 | Physician and practitioner services (fee schedule) | 49 | $24.57 |
| 93293 | Physician and practitioner services (fee schedule) | 49 | $28.84 |
| 93294 | Physician and practitioner services (fee schedule) | 49 | $25.67 |
| 93295 | Physician and practitioner services (fee schedule) | 49 | $34.28 |
| 93296 | Physician and practitioner services (fee schedule) | 47 | $24.30 |
| 93297 | Physician and practitioner services (fee schedule) | 50 | $26.65 |
| 93298 | Physician and practitioner services (fee schedule) | 50 | $49.98 |
| 93303 | Physician and practitioner services (fee schedule) | 50 | $132.31 |
| 93304 | Physician and practitioner services (fee schedule) | 49 | $92.07 |
| 93306 | Physician and practitioner services (fee schedule) | 50 | $122.63 |
| 93307 | Physician and practitioner services (fee schedule) | 50 | $82.25 |
| 93308 | Physician and practitioner services (fee schedule) | 49 | $63.88 |
| 93312 | Physician and practitioner services (fee schedule) | 49 | $116.32 |
| 93313 | Physician and practitioner services (fee schedule) | 48 | $10.16 |
| 93314 | Physician and practitioner services (fee schedule) | 48 | $122.06 |
| 93315 | Physician and practitioner services (fee schedule) | 49 | $146.96 |
| 93316 | Physician and practitioner services (fee schedule) | 48 | $23.59 |
| 93317 | Physician and practitioner services (fee schedule) | 48 | $108.66 |
| 93318 | Physician and practitioner services (fee schedule) | 48 | $111.12 |
| 93319 | Physician and practitioner services (fee schedule) | 40 | $43.72 |
| 93320 | Physician and practitioner services (fee schedule) | 50 | $33.52 |
| 93321 | Physician and practitioner services (fee schedule) | 49 | $17.46 |
| 93325 | Physician and practitioner services (fee schedule) | 49 | $17.96 |
| 93350 | Physician and practitioner services (fee schedule) | 49 | $97.76 |
| 93351 | Physician and practitioner services (fee schedule) | 49 | $141.41 |
| 93352 | Physician and practitioner services (fee schedule) | 45 | $30.01 |
| 93355 | Physician and practitioner services (fee schedule) | 46 | $172.19 |
| 93356 | Physician and practitioner services (fee schedule) | 37 | $28.73 |
| 93451 | Physician and practitioner services (fee schedule) | 49 | $561.02 |
| 93452 | Physician and practitioner services (fee schedule) | 49 | $525.97 |
| 93453 | Physician and practitioner services (fee schedule) | 49 | $670.84 |
| 93454 | Physician and practitioner services (fee schedule) | 49 | $534.36 |
| 93455 | Physician and practitioner services (fee schedule) | 49 | $592.19 |
| 93456 | Physician and practitioner services (fee schedule) | 49 | $660.85 |
| 93457 | Physician and practitioner services (fee schedule) | 49 | $712.48 |
| 93458 | Physician and practitioner services (fee schedule) | 49 | $604.16 |
| 93459 | Physician and practitioner services (fee schedule) | 49 | $644.25 |
| 93460 | Physician and practitioner services (fee schedule) | 49 | $703.83 |
| 93461 | Physician and practitioner services (fee schedule) | 49 | $777.67 |
| 93462 | Physician and practitioner services (fee schedule) | 49 | $166.05 |
| 93463 | Physician and practitioner services (fee schedule) | 48 | $82.13 |
| 93464 | Physician and practitioner services (fee schedule) | 48 | $125.99 |
| 93503 | Physician and practitioner services (fee schedule) | 49 | $79.47 |
| 93505 | Physician and practitioner services (fee schedule) | 49 | $341.43 |
| 93563 | Physician and practitioner services (fee schedule) | 48 | $42.90 |
| 93564 | Physician and practitioner services (fee schedule) | 48 | $44.87 |
| 93565 | Physician and practitioner services (fee schedule) | 49 | $23.61 |
| 93566 | Physician and practitioner services (fee schedule) | 49 | $23.74 |
| 93567 | Physician and practitioner services (fee schedule) | 49 | $32.31 |
| 93568 | Physician and practitioner services (fee schedule) | 49 | $38.39 |
| 93569 | Physician and practitioner services (fee schedule) | 45 | $30.45 |
| 93571 | Physician and practitioner services (fee schedule) | 49 | $132.44 |
| 93572 | Physician and practitioner services (fee schedule) | 47 | $75.69 |
| 93573 | Physician and practitioner services (fee schedule) | 45 | $50.49 |
| 93574 | Physician and practitioner services (fee schedule) | 45 | $55.53 |
| 93575 | Physician and practitioner services (fee schedule) | 45 | $74.32 |
| 93580 | Physician and practitioner services (fee schedule) | 48 | $742.96 |
| 93581 | Physician and practitioner services (fee schedule) | 46 | $1,004.64 |
| 93582 | Physician and practitioner services (fee schedule) | 48 | $494.47 |
| 93583 | Physician and practitioner services (fee schedule) | 45 | $540.98 |
| 93584 | Physician and practitioner services (fee schedule) | 44 | $42.60 |
| 93585 | Physician and practitioner services (fee schedule) | 43 | $40.06 |
| 93586 | Physician and practitioner services (fee schedule) | 44 | $51.50 |
| 93587 | Physician and practitioner services (fee schedule) | 44 | $75.12 |
| 93588 | Physician and practitioner services (fee schedule) | 44 | $75.79 |
| 93590 | Physician and practitioner services (fee schedule) | 43 | $852.36 |
| 93591 | Physician and practitioner services (fee schedule) | 43 | $688.24 |
| 93592 | Physician and practitioner services (fee schedule) | 43 | $306.29 |
| 93593 | Physician and practitioner services (fee schedule) | 45 | $157.65 |
| 93594 | Physician and practitioner services (fee schedule) | 44 | $246.32 |
| 93595 | Physician and practitioner services (fee schedule) | 44 | $218.63 |
| 93596 | Physician and practitioner services (fee schedule) | 45 | $273.44 |
| 93597 | Physician and practitioner services (fee schedule) | 45 | $356.48 |
| 93598 | Physician and practitioner services (fee schedule) | 41 | $54.76 |
| 93600 | Physician and practitioner services (fee schedule) | 49 | $100.50 |
| 93602 | Physician and practitioner services (fee schedule) | 49 | $99.07 |
| 93603 | Physician and practitioner services (fee schedule) | 49 | $99.31 |
| 93609 | Physician and practitioner services (fee schedule) | 49 | $236.38 |
| 93610 | Physician and practitioner services (fee schedule) | 49 | $135.95 |
| 93612 | Physician and practitioner services (fee schedule) | 49 | $136.26 |
| 93613 | Physician and practitioner services (fee schedule) | 49 | $239.28 |
| 93615 | Physician and practitioner services (fee schedule) | 48 | $34.34 |
| 93616 | Physician and practitioner services (fee schedule) | 47 | $57.15 |
| 93618 | Physician and practitioner services (fee schedule) | 49 | $187.21 |
| 93619 | Physician and practitioner services (fee schedule) | 49 | $338.05 |
| 93620 | Physician and practitioner services (fee schedule) | 49 | $535.57 |
| 93621 | Physician and practitioner services (fee schedule) | 48 | $100.23 |
| 93622 | Physician and practitioner services (fee schedule) | 48 | $166.18 |
| 93623 | Physician and practitioner services (fee schedule) | 47 | $111.14 |
| 93624 | Physician and practitioner services (fee schedule) | 48 | $207.52 |
| 93631 | Physician and practitioner services (fee schedule) | 47 | $352.83 |
| 93640 | Physician and practitioner services (fee schedule) | 49 | $201.47 |
| 93641 | Physician and practitioner services (fee schedule) | 49 | $278.68 |
| 93642 | Physician and practitioner services (fee schedule) | 49 | $220.68 |
| 93644 | Physician and practitioner services (fee schedule) | 44 | $143.33 |
| 93650 | Physician and practitioner services (fee schedule) | 49 | $457.27 |
| 93653 | Physician and practitioner services (fee schedule) | 49 | $616.32 |
| 93654 | Physician and practitioner services (fee schedule) | 49 | $788.02 |
| 93655 | Physician and practitioner services (fee schedule) | 49 | $251.86 |
| 93656 | Physician and practitioner services (fee schedule) | 49 | $740.97 |
| 93657 | Physician and practitioner services (fee schedule) | 49 | $249.74 |
| 93660 | Physician and practitioner services (fee schedule) | 48 | $80.93 |
| 93662 | Physician and practitioner services (fee schedule) | 47 | $127.67 |
| 93668 | Physician and practitioner services (fee schedule) | 24 | $12.60 |
| 93701 | Physician and practitioner services (fee schedule) | 45 | $21.38 |
| 93702 | Physician and practitioner services (fee schedule) | 28 | $100.08 |
| 93724 | Physician and practitioner services (fee schedule) | 49 | $216.43 |
| 93740 | Physician and practitioner services (fee schedule) | 30 | $7.88 |
| 93745 | Physician and practitioner services (fee schedule) | 25 | $48.69 |
| 93750 | Physician and practitioner services (fee schedule) | 45 | $38.51 |
| 93770 | Physician and practitioner services (fee schedule) | 34 | $7.14 |
| 93784 | Physician and practitioner services (fee schedule) | 42 | $41.35 |
| 93786 | Physician and practitioner services (fee schedule) | 38 | $20.05 |
| 93788 | Physician and practitioner services (fee schedule) | 38 | $5.04 |
| 93790 | Physician and practitioner services (fee schedule) | 40 | $15.71 |
| 93792 | Physician and practitioner services (fee schedule) | 26 | $56.42 |
| 93793 | Physician and practitioner services (fee schedule) | 29 | $9.38 |
| 93797 | Physician and practitioner services (fee schedule) | 42 | $13.79 |
| 93798 | Physician and practitioner services (fee schedule) | 44 | $20.15 |
| 93799 | Physician and practitioner services (fee schedule) | 8 | $119.34 |
| 93880 | Physician and practitioner services (fee schedule) | 50 | $127.09 |
| 93882 | Physician and practitioner services (fee schedule) | 49 | $83.99 |
| 93886 | Physician and practitioner services (fee schedule) | 49 | $179.70 |
| 93888 | Physician and practitioner services (fee schedule) | 49 | $103.98 |
| 93890 | Physician and practitioner services (fee schedule) | 7 | $167.13 |
| 93892 | Physician and practitioner services (fee schedule) | 47 | $158.05 |
| 93893 | Physician and practitioner services (fee schedule) | 47 | $169.54 |
| 93895 | Physician and practitioner services (fee schedule) | 5 | $144.16 |
| 93896 | Physician and practitioner services (fee schedule) | 41 | $121.77 |
| 93897 | Physician and practitioner services (fee schedule) | 41 | $156.24 |
| 93898 | Physician and practitioner services (fee schedule) | 39 | $168.00 |
| 93922 | Physician and practitioner services (fee schedule) | 50 | $58.76 |
| 93923 | Physician and practitioner services (fee schedule) | 50 | $91.15 |
| 93924 | Physician and practitioner services (fee schedule) | 49 | $110.15 |
| 93925 | Physician and practitioner services (fee schedule) | 50 | $156.82 |
| 93926 | Physician and practitioner services (fee schedule) | 49 | $89.81 |
| 93930 | Physician and practitioner services (fee schedule) | 50 | $134.31 |
| 93931 | Physician and practitioner services (fee schedule) | 49 | $82.86 |
| 93970 | Physician and practitioner services (fee schedule) | 50 | $127.69 |
| 93971 | Physician and practitioner services (fee schedule) | 50 | $80.71 |
| 93975 | Physician and practitioner services (fee schedule) | 50 | $166.44 |
| 93976 | Physician and practitioner services (fee schedule) | 49 | $100.52 |
| 93978 | Physician and practitioner services (fee schedule) | 50 | $119.77 |
| 93979 | Physician and practitioner services (fee schedule) | 49 | $79.32 |
| 93980 | Physician and practitioner services (fee schedule) | 47 | $68.34 |
| 93981 | Physician and practitioner services (fee schedule) | 46 | $48.09 |
| 93985 | Physician and practitioner services (fee schedule) | 47 | $179.49 |
| 93986 | Physician and practitioner services (fee schedule) | 47 | $100.60 |
| 93990 | Physician and practitioner services (fee schedule) | 50 | $94.72 |
| 94002 | Physician and practitioner services (fee schedule) | 43 | $70.50 |
| 94003 | Physician and practitioner services (fee schedule) | 43 | $49.33 |
| 94004 | Physician and practitioner services (fee schedule) | 34 | $37.76 |
| 94005 | Physician and practitioner services (fee schedule) | 7 | $82.93 |
| 94010 | Physician and practitioner services (fee schedule) | 49 | $17.84 |
| 94011 | Physician and practitioner services (fee schedule) | 48 | $64.52 |
| 94012 | Physician and practitioner services (fee schedule) | 48 | $103.21 |
| 94013 | Physician and practitioner services (fee schedule) | 47 | $16.04 |
| 94014 | Physician and practitioner services (fee schedule) | 41 | $43.38 |
| 94015 | Physician and practitioner services (fee schedule) | 35 | $27.14 |
| 94016 | Physician and practitioner services (fee schedule) | 41 | $20.79 |
| 94060 | Physician and practitioner services (fee schedule) | 49 | $27.61 |
| 94070 | Physician and practitioner services (fee schedule) | 47 | $33.38 |
| 94150 | Physician and practitioner services (fee schedule) | 39 | $12.97 |
| 94200 | Physician and practitioner services (fee schedule) | 49 | $11.30 |
| 94375 | Physician and practitioner services (fee schedule) | 49 | $21.56 |
| 94450 | Physician and practitioner services (fee schedule) | 45 | $52.68 |
| 94452 | Physician and practitioner services (fee schedule) | 35 | $32.66 |
| 94453 | Physician and practitioner services (fee schedule) | 35 | $46.25 |
| 94610 | Physician and practitioner services (fee schedule) | 42 | $44.29 |
| 94617 | Physician and practitioner services (fee schedule) | 46 | $52.60 |
| 94618 | Physician and practitioner services (fee schedule) | 47 | $19.49 |
| 94619 | Physician and practitioner services (fee schedule) | 46 | $40.16 |
| 94621 | Physician and practitioner services (fee schedule) | 49 | $75.73 |
| 94625 | Physician and practitioner services (fee schedule) | 43 | $56.66 |
| 94626 | Physician and practitioner services (fee schedule) | 43 | $64.56 |
| 94640 | Physician and practitioner services (fee schedule) | 48 | $8.28 |
| 94642 | Physician and practitioner services (fee schedule) | 41 | $28.22 |
| 94644 | Physician and practitioner services (fee schedule) | 46 | $47.13 |
| 94645 | Physician and practitioner services (fee schedule) | 45 | $13.15 |
| 94660 | Physician and practitioner services (fee schedule) | 41 | $47.05 |
| 94662 | Physician and practitioner services (fee schedule) | 11 | $30.83 |
| 94664 | Physician and practitioner services (fee schedule) | 48 | $15.23 |
| 94667 | Physician and practitioner services (fee schedule) | 44 | $21.12 |
| 94668 | Physician and practitioner services (fee schedule) | 42 | $27.68 |
| 94669 | Physician and practitioner services (fee schedule) | 34 | $20.98 |
| 94680 | Physician and practitioner services (fee schedule) | 48 | $35.83 |
| 94681 | Physician and practitioner services (fee schedule) | 48 | $34.66 |
| 94690 | Physician and practitioner services (fee schedule) | 48 | $37.34 |
| 94726 | Physician and practitioner services (fee schedule) | 49 | $36.20 |
| 94727 | Physician and practitioner services (fee schedule) | 49 | $27.97 |
| 94728 | Physician and practitioner services (fee schedule) | 48 | $27.69 |
| 94729 | Physician and practitioner services (fee schedule) | 49 | $39.46 |
| 94760 | Physician and practitioner services (fee schedule) | 41 | $3.07 |
| 94761 | Physician and practitioner services (fee schedule) | 42 | $3.62 |
| 94762 | Physician and practitioner services (fee schedule) | 41 | $20.93 |
| 94772 | Physician and practitioner services (fee schedule) | 38 | $98.62 |
| 94774 | Physician and practitioner services (fee schedule) | 7 | $104.62 |
| 94776 | Physician and practitioner services (fee schedule) | 7 | $58.77 |
| 94777 | Physician and practitioner services (fee schedule) | 20 | $29.20 |
| 94780 | Physician and practitioner services (fee schedule) | 30 | $38.07 |
| 94781 | Physician and practitioner services (fee schedule) | 30 | $15.12 |
| 94799 | Physician and practitioner services (fee schedule) | 9 | $22.87 |
| 95004 | Physician and practitioner services (fee schedule) | 49 | $3.12 |
| 95012 | Physician and practitioner services (fee schedule) | 43 | $15.53 |
| 95017 | Physician and practitioner services (fee schedule) | 47 | $6.40 |
| 95018 | Physician and practitioner services (fee schedule) | 48 | $15.27 |
| 95024 | Physician and practitioner services (fee schedule) | 49 | $5.23 |
| 95027 | Physician and practitioner services (fee schedule) | 46 | $3.91 |
| 95028 | Physician and practitioner services (fee schedule) | 49 | $9.55 |
| 95044 | Physician and practitioner services (fee schedule) | 49 | $4.19 |
| 95052 | Physician and practitioner services (fee schedule) | 46 | $5.01 |
| 95056 | Physician and practitioner services (fee schedule) | 45 | $36.78 |
| 95060 | Physician and practitioner services (fee schedule) | 49 | $29.44 |
| 95065 | Physician and practitioner services (fee schedule) | 47 | $21.71 |
| 95070 | Physician and practitioner services (fee schedule) | 48 | $32.83 |
| 95076 | Physician and practitioner services (fee schedule) | 48 | $91.18 |
| 95079 | Physician and practitioner services (fee schedule) | 47 | $67.47 |
| 95115 | Physician and practitioner services (fee schedule) | 50 | $8.59 |
| 95117 | Physician and practitioner services (fee schedule) | 50 | $10.26 |
| 95120 | Physician and practitioner services (fee schedule) | 27 | $9.00 |
| 95125 | Physician and practitioner services (fee schedule) | 26 | $12.93 |
| 95130 | Physician and practitioner services (fee schedule) | 30 | $14.74 |
| 95131 | Physician and practitioner services (fee schedule) | 29 | $20.00 |
| 95132 | Physician and practitioner services (fee schedule) | 29 | $21.65 |
| 95133 | Physician and practitioner services (fee schedule) | 28 | $24.18 |
| 95134 | Physician and practitioner services (fee schedule) | 26 | $29.86 |
| 95144 | Physician and practitioner services (fee schedule) | 46 | $10.60 |
| 95145 | Physician and practitioner services (fee schedule) | 48 | $22.07 |
| 95146 | Physician and practitioner services (fee schedule) | 48 | $40.32 |
| 95147 | Physician and practitioner services (fee schedule) | 48 | $39.71 |
| 95148 | Physician and practitioner services (fee schedule) | 47 | $56.89 |
| 95149 | Physician and practitioner services (fee schedule) | 47 | $75.62 |
| 95165 | Physician and practitioner services (fee schedule) | 48 | $11.15 |
| 95170 | Physician and practitioner services (fee schedule) | 45 | $8.26 |
| 95180 | Physician and practitioner services (fee schedule) | 48 | $104.17 |
| 95199 | Physician and practitioner services (fee schedule) | 5 | $14.37 |
| 95249 | Physician and practitioner services (fee schedule) | 40 | $48.72 |
| 95250 | Physician and practitioner services (fee schedule) | 44 | $119.33 |
| 95251 | Physician and practitioner services (fee schedule) | 46 | $28.86 |
| 95700 | Physician and practitioner services (fee schedule) | 38 | $202.20 |
| 95705 | Physician and practitioner services (fee schedule) | 38 | $129.03 |
| 95706 | Physician and practitioner services (fee schedule) | 37 | $294.07 |
| 95707 | Physician and practitioner services (fee schedule) | 36 | $353.45 |
| 95708 | Physician and practitioner services (fee schedule) | 39 | $225.65 |
| 95709 | Physician and practitioner services (fee schedule) | 37 | $565.81 |
| 95710 | Physician and practitioner services (fee schedule) | 36 | $689.60 |
| 95711 | Physician and practitioner services (fee schedule) | 37 | $164.52 |
| 95712 | Physician and practitioner services (fee schedule) | 37 | $342.03 |
| 95713 | Physician and practitioner services (fee schedule) | 36 | $460.64 |
| 95714 | Physician and practitioner services (fee schedule) | 38 | $233.79 |
| 95715 | Physician and practitioner services (fee schedule) | 37 | $653.24 |
| 95716 | Physician and practitioner services (fee schedule) | 36 | $887.20 |
| 95717 | Physician and practitioner services (fee schedule) | 48 | $87.20 |
| 95718 | Physician and practitioner services (fee schedule) | 49 | $110.15 |
| 95719 | Physician and practitioner services (fee schedule) | 49 | $131.82 |
| 95720 | Physician and practitioner services (fee schedule) | 49 | $169.40 |
| 95721 | Physician and practitioner services (fee schedule) | 49 | $174.32 |
| 95722 | Physician and practitioner services (fee schedule) | 49 | $210.43 |
| 95723 | Physician and practitioner services (fee schedule) | 49 | $211.40 |
| 95724 | Physician and practitioner services (fee schedule) | 49 | $266.87 |
| 95725 | Physician and practitioner services (fee schedule) | 49 | $243.60 |
| 95726 | Physician and practitioner services (fee schedule) | 49 | $340.45 |
| 95782 | Physician and practitioner services (fee schedule) | 49 | $712.58 |
| 95783 | Physician and practitioner services (fee schedule) | 49 | $742.96 |
| 95800 | Physician and practitioner services (fee schedule) | 45 | $96.60 |
| 95801 | Physician and practitioner services (fee schedule) | 33 | $49.65 |
| 95803 | Physician and practitioner services (fee schedule) | 23 | $78.43 |
| 95805 | Physician and practitioner services (fee schedule) | 49 | $283.22 |
| 95806 | Physician and practitioner services (fee schedule) | 43 | $56.54 |
| 95807 | Physician and practitioner services (fee schedule) | 48 | $284.75 |
| 95808 | Physician and practitioner services (fee schedule) | 49 | $342.78 |
| 95810 | Physician and practitioner services (fee schedule) | 49 | $422.72 |
| 95811 | Physician and practitioner services (fee schedule) | 49 | $452.32 |
| 95812 | Physician and practitioner services (fee schedule) | 49 | $215.96 |
| 95813 | Physician and practitioner services (fee schedule) | 49 | $267.08 |
| 95816 | Physician and practitioner services (fee schedule) | 49 | $227.70 |
| 95819 | Physician and practitioner services (fee schedule) | 49 | $271.36 |
| 95822 | Physician and practitioner services (fee schedule) | 48 | $248.59 |
| 95824 | Physician and practitioner services (fee schedule) | 46 | $34.55 |
| 95829 | Physician and practitioner services (fee schedule) | 49 | $1,043.27 |
| 95830 | Physician and practitioner services (fee schedule) | 46 | $245.22 |
| 95836 | Physician and practitioner services (fee schedule) | 41 | $85.56 |
| 95851 | Physician and practitioner services (fee schedule) | 49 | $16.77 |
| 95852 | Physician and practitioner services (fee schedule) | 50 | $13.65 |
| 95857 | Physician and practitioner services (fee schedule) | 48 | $38.76 |
| 95860 | Physician and practitioner services (fee schedule) | 49 | $54.04 |
| 95861 | Physician and practitioner services (fee schedule) | 49 | $72.26 |
| 95863 | Physician and practitioner services (fee schedule) | 49 | $97.54 |
| 95864 | Physician and practitioner services (fee schedule) | 49 | $108.63 |
| 95865 | Physician and practitioner services (fee schedule) | 48 | $73.52 |
| 95866 | Physician and practitioner services (fee schedule) | 48 | $59.22 |
| 95867 | Physician and practitioner services (fee schedule) | 49 | $51.47 |
| 95868 | Physician and practitioner services (fee schedule) | 49 | $57.72 |
| 95869 | Physician and practitioner services (fee schedule) | 49 | $48.17 |
| 95870 | Physician and practitioner services (fee schedule) | 49 | $44.47 |
| 95872 | Physician and practitioner services (fee schedule) | 48 | $121.19 |
| 95873 | Physician and practitioner services (fee schedule) | 47 | $39.28 |
| 95874 | Physician and practitioner services (fee schedule) | 48 | $41.14 |
| 95875 | Physician and practitioner services (fee schedule) | 47 | $55.74 |
| 95885 | Physician and practitioner services (fee schedule) | 49 | $34.80 |
| 95886 | Physician and practitioner services (fee schedule) | 49 | $43.23 |
| 95887 | Physician and practitioner services (fee schedule) | 49 | $39.60 |
| 95905 | Physician and practitioner services (fee schedule) | 47 | $26.63 |
| 95907 | Physician and practitioner services (fee schedule) | 49 | $45.84 |
| 95908 | Physician and practitioner services (fee schedule) | 49 | $57.49 |
| 95909 | Physician and practitioner services (fee schedule) | 49 | $68.75 |
| 95910 | Physician and practitioner services (fee schedule) | 49 | $90.63 |
| 95911 | Physician and practitioner services (fee schedule) | 49 | $112.62 |
| 95912 | Physician and practitioner services (fee schedule) | 49 | $134.49 |
| 95913 | Physician and practitioner services (fee schedule) | 49 | $159.44 |
| 95919 | Physician and practitioner services (fee schedule) | 27 | $8.59 |
| 95921 | Physician and practitioner services (fee schedule) | 46 | $38.33 |
| 95922 | Physician and practitioner services (fee schedule) | 46 | $40.19 |
| 95923 | Physician and practitioner services (fee schedule) | 44 | $64.72 |
| 95924 | Physician and practitioner services (fee schedule) | 45 | $73.74 |
| 95925 | Physician and practitioner services (fee schedule) | 49 | $96.17 |
| 95926 | Physician and practitioner services (fee schedule) | 49 | $85.47 |
| 95927 | Physician and practitioner services (fee schedule) | 49 | $110.89 |
| 95928 | Physician and practitioner services (fee schedule) | 48 | $124.39 |
| 95929 | Physician and practitioner services (fee schedule) | 48 | $124.70 |
| 95930 | Physician and practitioner services (fee schedule) | 49 | $41.12 |
| 95933 | Physician and practitioner services (fee schedule) | 46 | $40.00 |
| 95937 | Physician and practitioner services (fee schedule) | 49 | $52.97 |
| 95938 | Physician and practitioner services (fee schedule) | 49 | $244.21 |
| 95939 | Physician and practitioner services (fee schedule) | 49 | $344.17 |
| 95940 | Physician and practitioner services (fee schedule) | 46 | $23.47 |
| 95941 | Physician and practitioner services (fee schedule) | 14 | $94.45 |
| 95954 | Physician and practitioner services (fee schedule) | 46 | $211.00 |
| 95955 | Physician and practitioner services (fee schedule) | 46 | $111.60 |
| 95957 | Physician and practitioner services (fee schedule) | 47 | $161.62 |
| 95958 | Physician and practitioner services (fee schedule) | 47 | $351.62 |
| 95961 | Physician and practitioner services (fee schedule) | 47 | $155.06 |
| 95962 | Physician and practitioner services (fee schedule) | 46 | $154.18 |
| 95965 | Physician and practitioner services (fee schedule) | 41 | $408.83 |
| 95966 | Physician and practitioner services (fee schedule) | 40 | $196.14 |
| 95967 | Physician and practitioner services (fee schedule) | 40 | $180.58 |
| 95970 | Physician and practitioner services (fee schedule) | 49 | $16.86 |
| 95971 | Physician and practitioner services (fee schedule) | 49 | $37.82 |
| 95972 | Physician and practitioner services (fee schedule) | 49 | $48.96 |
| 95976 | Physician and practitioner services (fee schedule) | 49 | $31.41 |
| 95977 | Physician and practitioner services (fee schedule) | 49 | $42.74 |
| 95980 | Physician and practitioner services (fee schedule) | 40 | $32.14 |
| 95981 | Physician and practitioner services (fee schedule) | 40 | $26.06 |
| 95982 | Physician and practitioner services (fee schedule) | 40 | $39.97 |
| 95983 | Physician and practitioner services (fee schedule) | 47 | $41.30 |
| 95984 | Physician and practitioner services (fee schedule) | 47 | $35.97 |
| 95990 | Physician and practitioner services (fee schedule) | 47 | $67.69 |
| 95991 | Physician and practitioner services (fee schedule) | 48 | $78.07 |
| 95992 | Physician and practitioner services (fee schedule) | 41 | $33.08 |
| 95999 | Physician and practitioner services (fee schedule) | 6 | $115.20 |
| 96000 | Physician and practitioner services (fee schedule) | 32 | $66.57 |
| 96001 | Physician and practitioner services (fee schedule) | 31 | $81.22 |
| 96002 | Physician and practitioner services (fee schedule) | 34 | $16.12 |
| 96003 | Physician and practitioner services (fee schedule) | 5 | $16.07 |
| 96004 | Physician and practitioner services (fee schedule) | 32 | $90.58 |
| 96020 | Physician and practitioner services (fee schedule) | 35 | $131.37 |
| 96041 | Physician and practitioner services (fee schedule) | 25 | $41.16 |
| 96101 | Physician and practitioner services (fee schedule) | 7 | $80.68 |
| 96105 | Physician and practitioner services (fee schedule) | 43 | $77.89 |
| 96110 | Physician and practitioner services (fee schedule) | 49 | $10.34 |
| 96111 | Physician and practitioner services (fee schedule) | 7 | $62.10 |
| 96112 | Physician and practitioner services (fee schedule) | 49 | $108.62 |
| 96113 | Physician and practitioner services (fee schedule) | 48 | $47.27 |
| 96116 | Physician and practitioner services (fee schedule) | 45 | $78.39 |
| 96118 | Physician and practitioner services (fee schedule) | 5 | $71.11 |
| 96121 | Physician and practitioner services (fee schedule) | 41 | $67.59 |
| 96125 | Physician and practitioner services (fee schedule) | 36 | $85.10 |
| 96127 | Physician and practitioner services (fee schedule) | 45 | $4.29 |
| 96130 | Physician and practitioner services (fee schedule) | 50 | $102.60 |
| 96131 | Physician and practitioner services (fee schedule) | 50 | $74.63 |
| 96132 | Physician and practitioner services (fee schedule) | 49 | $105.17 |
| 96133 | Physician and practitioner services (fee schedule) | 49 | $83.84 |
| 96136 | Physician and practitioner services (fee schedule) | 50 | $37.57 |
| 96137 | Physician and practitioner services (fee schedule) | 50 | $32.73 |
| 96138 | Physician and practitioner services (fee schedule) | 39 | $31.86 |
| 96139 | Physician and practitioner services (fee schedule) | 39 | $31.33 |
| 96146 | Physician and practitioner services (fee schedule) | 38 | $1.89 |
| 96156 | Physician and practitioner services (fee schedule) | 41 | $83.11 |
| 96158 | Physician and practitioner services (fee schedule) | 40 | $53.88 |
| 96159 | Physician and practitioner services (fee schedule) | 40 | $19.45 |
| 96160 | Physician and practitioner services (fee schedule) | 41 | $3.03 |
| 96161 | Physician and practitioner services (fee schedule) | 42 | $3.23 |
| 96164 | Physician and practitioner services (fee schedule) | 35 | $8.59 |
| 96165 | Physician and practitioner services (fee schedule) | 35 | $3.97 |
| 96167 | Physician and practitioner services (fee schedule) | 37 | $60.45 |
| 96168 | Physician and practitioner services (fee schedule) | 37 | $21.77 |
| 96170 | Physician and practitioner services (fee schedule) | 25 | $60.24 |
| 96171 | Physician and practitioner services (fee schedule) | 26 | $21.83 |
| 96202 | Physician and practitioner services (fee schedule) | 12 | $17.69 |
| 96203 | Physician and practitioner services (fee schedule) | 11 | $5.04 |
| 96360 | Physician and practitioner services (fee schedule) | 47 | $30.90 |
| 96361 | Physician and practitioner services (fee schedule) | 47 | $11.13 |
| 96365 | Physician and practitioner services (fee schedule) | 49 | $53.34 |
| 96366 | Physician and practitioner services (fee schedule) | 49 | $17.31 |
| 96367 | Physician and practitioner services (fee schedule) | 49 | $25.05 |
| 96368 | Physician and practitioner services (fee schedule) | 49 | $16.52 |
| 96369 | Physician and practitioner services (fee schedule) | 47 | $120.13 |
| 96370 | Physician and practitioner services (fee schedule) | 47 | $13.37 |
| 96371 | Physician and practitioner services (fee schedule) | 47 | $48.90 |
| 96372 | Physician and practitioner services (fee schedule) | 49 | $12.88 |
| 96373 | Physician and practitioner services (fee schedule) | 45 | $15.33 |
| 96374 | Physician and practitioner services (fee schedule) | 49 | $32.50 |
| 96375 | Physician and practitioner services (fee schedule) | 49 | $13.69 |
| 96377 | Physician and practitioner services (fee schedule) | 35 | $15.40 |
| 96379 | Physician and practitioner services (fee schedule) | 8 | $20.97 |
| 96380 | Physician and practitioner services (fee schedule) | 43 | $20.33 |
| 96381 | Physician and practitioner services (fee schedule) | 40 | $17.02 |
| 96401 | Physician and practitioner services (fee schedule) | 48 | $56.54 |
| 96402 | Physician and practitioner services (fee schedule) | 48 | $30.44 |
| 96405 | Physician and practitioner services (fee schedule) | 48 | $64.36 |
| 96406 | Physician and practitioner services (fee schedule) | 48 | $96.27 |
| 96409 | Physician and practitioner services (fee schedule) | 49 | $84.79 |
| 96411 | Physician and practitioner services (fee schedule) | 48 | $46.46 |
| 96413 | Physician and practitioner services (fee schedule) | 49 | $109.91 |
| 96415 | Physician and practitioner services (fee schedule) | 49 | $23.90 |
| 96416 | Physician and practitioner services (fee schedule) | 49 | $111.88 |
| 96417 | Physician and practitioner services (fee schedule) | 48 | $53.81 |
| 96420 | Physician and practitioner services (fee schedule) | 49 | $81.83 |
| 96422 | Physician and practitioner services (fee schedule) | 49 | $117.61 |
| 96423 | Physician and practitioner services (fee schedule) | 49 | $58.14 |
| 96425 | Physician and practitioner services (fee schedule) | 49 | $135.41 |
| 96440 | Physician and practitioner services (fee schedule) | 49 | $489.47 |
| 96446 | Physician and practitioner services (fee schedule) | 47 | $123.01 |
| 96450 | Physician and practitioner services (fee schedule) | 49 | $130.64 |
| 96521 | Physician and practitioner services (fee schedule) | 49 | $111.92 |
| 96522 | Physician and practitioner services (fee schedule) | 49 | $94.08 |
| 96523 | Physician and practitioner services (fee schedule) | 45 | $21.18 |
| 96542 | Physician and practitioner services (fee schedule) | 49 | $103.44 |
| 96547 | Physician and practitioner services (fee schedule) | 23 | $247.90 |
| 96548 | Physician and practitioner services (fee schedule) | 23 | $113.95 |
| 96549 | Physician and practitioner services (fee schedule) | 7 | $41.60 |
| 96567 | Physician and practitioner services (fee schedule) | 38 | $102.55 |
| 96570 | Physician and practitioner services (fee schedule) | 44 | $45.98 |
| 96571 | Physician and practitioner services (fee schedule) | 43 | $22.98 |
| 96573 | Physician and practitioner services (fee schedule) | 41 | $171.61 |
| 96574 | Physician and practitioner services (fee schedule) | 40 | $216.18 |
| 96900 | Physician and practitioner services (fee schedule) | 47 | $18.41 |
| 96902 | Physician and practitioner services (fee schedule) | 13 | $16.72 |
| 96904 | Physician and practitioner services (fee schedule) | 24 | $56.29 |
| 96910 | Physician and practitioner services (fee schedule) | 48 | $88.71 |
| 96912 | Physician and practitioner services (fee schedule) | 47 | $75.59 |
| 96913 | Physician and practitioner services (fee schedule) | 43 | $114.03 |
| 96920 | Physician and practitioner services (fee schedule) | 45 | $110.13 |
| 96921 | Physician and practitioner services (fee schedule) | 45 | $118.19 |
| 96922 | Physician and practitioner services (fee schedule) | 45 | $142.65 |
| 96931 | Physician and practitioner services (fee schedule) | 19 | $135.22 |
| 96932 | Physician and practitioner services (fee schedule) | 20 | $95.87 |
| 96933 | Physician and practitioner services (fee schedule) | 20 | $36.41 |
| 96934 | Physician and practitioner services (fee schedule) | 20 | $90.48 |
| 96935 | Physician and practitioner services (fee schedule) | 20 | $59.02 |
| 96936 | Physician and practitioner services (fee schedule) | 21 | $35.03 |
| 96999 | Physician and practitioner services (fee schedule) | 6 | $23.46 |
| 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) | 25 | $6.95 |
| 97012 | Physician and practitioner services (fee schedule) | 43 | $12.44 |
| 97014 | Physician and practitioner services (fee schedule) | 38 | $11.61 |
| 97016 | Physician and practitioner services (fee schedule) | 43 | $11.04 |
| 97018 | Physician and practitioner services (fee schedule) | 44 | $5.71 |
| 97022 | Physician and practitioner services (fee schedule) | 45 | $13.66 |
| 97024 | Physician and practitioner services (fee schedule) | 40 | $5.96 |
| 97026 | Physician and practitioner services (fee schedule) | 40 | $5.52 |
| 97028 | Physician and practitioner services (fee schedule) | 40 | $6.86 |
| 97032 | Physician and practitioner services (fee schedule) | 43 | $12.73 |
| 97033 | Physician and practitioner services (fee schedule) | 41 | $15.99 |
| 97034 | Physician and practitioner services (fee schedule) | 41 | $11.85 |
| 97035 | Physician and practitioner services (fee schedule) | 44 | $11.31 |
| 97036 | Physician and practitioner services (fee schedule) | 41 | $27.01 |
| 97039 | Physician and practitioner services (fee schedule) | 24 | $11.42 |
| 97113 | Physician and practitioner services (fee schedule) | 46 | $30.21 |
| 97116 | Physician and practitioner services (fee schedule) | 46 | $23.47 |
| 97124 | Physician and practitioner services (fee schedule) | 43 | $22.49 |
| 97139 | Physician and practitioner services (fee schedule) | 26 | $14.20 |
| 97140 | Physician and practitioner services (fee schedule) | 46 | $23.23 |
| 97150 | Physician and practitioner services (fee schedule) | 44 | $14.90 |
| 97535 | Training in daily living skills at home | 43 | $24.95 |
| 97537 | Physician and practitioner services (fee schedule) | 34 | $25.54 |
| 97542 | Physician and practitioner services (fee schedule) | 42 | $25.86 |
| 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) | 48 | $63.09 |
| 97598 | Physician and practitioner services (fee schedule) | 48 | $36.96 |
| 97602 | Physician and practitioner services (fee schedule) | 27 | $23.64 |
| 97605 | Physician and practitioner services (fee schedule) | 41 | $28.30 |
| 97606 | Physician and practitioner services (fee schedule) | 41 | $33.67 |
| 97607 | Physician and practitioner services (fee schedule) | 35 | $201.86 |
| 97608 | Physician and practitioner services (fee schedule) | 34 | $219.44 |
| 97610 | Physician and practitioner services (fee schedule) | 22 | $210.53 |
| 97750 | Physician and practitioner services (fee schedule) | 40 | $26.55 |
| 97755 | Physician and practitioner services (fee schedule) | 29 | $30.52 |
| 97799 | Physician and practitioner services (fee schedule) | 9 | $28.13 |
| 97804 | Physician and practitioner services (fee schedule) | 32 | $13.23 |
| 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) | 11 | $24.37 |
| 97814 | Physician and practitioner services (fee schedule) | 11 | $19.87 |
| 98000 | Physician and practitioner services (fee schedule) | 18 | $42.35 |
| 98001 | Physician and practitioner services (fee schedule) | 18 | $71.15 |
| 98002 | Physician and practitioner services (fee schedule) | 18 | $111.91 |
| 98003 | Physician and practitioner services (fee schedule) | 17 | $148.68 |
| 98004 | Physician and practitioner services (fee schedule) | 18 | $32.83 |
| 98005 | Physician and practitioner services (fee schedule) | 18 | $57.39 |
| 98006 | Physician and practitioner services (fee schedule) | 18 | $84.67 |
| 98007 | Physician and practitioner services (fee schedule) | 17 | $112.55 |
| 98008 | Physician and practitioner services (fee schedule) | 16 | $40.14 |
| 98009 | Physician and practitioner services (fee schedule) | 16 | $66.61 |
| 98010 | Physician and practitioner services (fee schedule) | 15 | $103.06 |
| 98011 | Physician and practitioner services (fee schedule) | 14 | $134.86 |
| 98012 | Physician and practitioner services (fee schedule) | 21 | $30.26 |
| 98013 | Physician and practitioner services (fee schedule) | 21 | $52.73 |
| 98014 | Physician and practitioner services (fee schedule) | 19 | $76.49 |
| 98015 | Physician and practitioner services (fee schedule) | 17 | $111.77 |
| 98016 | Physician and practitioner services (fee schedule) | 27 | $12.36 |
| 98925 | Physician and practitioner services (fee schedule) | 46 | $22.36 |
| 98926 | Physician and practitioner services (fee schedule) | 45 | $33.54 |
| 98927 | Physician and practitioner services (fee schedule) | 44 | $44.57 |
| 98928 | Physician and practitioner services (fee schedule) | 44 | $53.80 |
| 98929 | Physician and practitioner services (fee schedule) | 44 | $63.73 |
| 98940 | Physician and practitioner services (fee schedule) | 42 | $20.50 |
| 98941 | Physician and practitioner services (fee schedule) | 42 | $29.41 |
| 98942 | Physician and practitioner services (fee schedule) | 42 | $35.46 |
| 98943 | Physician and practitioner services (fee schedule) | 12 | $21.78 |
| 98960 | Physician and practitioner services (fee schedule) | 25 | $25.98 |
| 98961 | Physician and practitioner services (fee schedule) | 21 | $12.09 |
| 98962 | Physician and practitioner services (fee schedule) | 21 | $9.26 |
| 98966 | Physician and practitioner services (fee schedule) | 24 | $11.48 |
| 98967 | Physician and practitioner services (fee schedule) | 24 | $21.18 |
| 98968 | Physician and practitioner services (fee schedule) | 24 | $29.59 |
| 98970 | Physician and practitioner services (fee schedule) | 12 | $8.95 |
| 98971 | Physician and practitioner services (fee schedule) | 13 | $16.06 |
| 98972 | Physician and practitioner services (fee schedule) | 12 | $24.89 |
| 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) | 17 | $16.83 |
| 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) | 16 | $3.86 |
| 99001 | Physician and practitioner services (fee schedule) | 14 | $3.94 |
| 99050 | Physician and practitioner services (fee schedule) | 24 | $13.08 |
| 99051 | Physician and practitioner services (fee schedule) | 15 | $13.38 |
| 99053 | Physician and practitioner services (fee schedule) | 9 | $12.87 |
| 99056 | Physician and practitioner services (fee schedule) | 8 | $12.65 |
| 99058 | Physician and practitioner services (fee schedule) | 16 | $17.39 |
| 99060 | Physician and practitioner services (fee schedule) | 6 | $9.43 |
| 99070 | Physician and practitioner services (fee schedule) | 15 | $14.58 |
| 99078 | Physician and practitioner services (fee schedule) | 10 | $41.24 |
| 99080 | Physician and practitioner services (fee schedule) | 9 | $17.42 |
| 99082 | Physician and practitioner services (fee schedule) | 15 | $5.60 |
| 99091 | Physician and practitioner services (fee schedule) | 22 | $45.84 |
| 99100 | Physician and practitioner services (fee schedule) | 13 | $18.08 |
| 99116 | Physician and practitioner services (fee schedule) | 10 | $17.56 |
| 99135 | Physician and practitioner services (fee schedule) | 9 | $17.75 |
| 99140 | Physician and practitioner services (fee schedule) | 12 | $17.92 |
| 99151 | Physician and practitioner services (fee schedule) | 47 | $48.49 |
| 99152 | Physician and practitioner services (fee schedule) | 50 | $37.61 |
| 99153 | Physician and practitioner services (fee schedule) | 50 | $9.46 |
| 99155 | Physician and practitioner services (fee schedule) | 48 | $69.54 |
| 99156 | Physician and practitioner services (fee schedule) | 48 | $60.87 |
| 99157 | Physician and practitioner services (fee schedule) | 48 | $46.53 |
| 99170 | Physician and practitioner services (fee schedule) | 43 | $118.70 |
| 99172 | Physician and practitioner services (fee schedule) | 17 | $15.69 |
| 99173 | Physician and practitioner services (fee schedule) | 39 | $3.20 |
| 99174 | Physician and practitioner services (fee schedule) | 26 | $5.76 |
| 99175 | Physician and practitioner services (fee schedule) | 38 | $36.14 |
| 99177 | Physician and practitioner services (fee schedule) | 32 | $4.33 |
| 99183 | Physician and practitioner services (fee schedule) | 49 | $93.32 |
| 99184 | Physician and practitioner services (fee schedule) | 39 | $172.66 |
| 99188 | Physician and practitioner services (fee schedule) | 41 | $18.75 |
| 99190 | Physician and practitioner services (fee schedule) | 25 | $93.26 |
| 99191 | Physician and practitioner services (fee schedule) | 26 | $59.93 |
| 99192 | Physician and practitioner services (fee schedule) | 25 | $44.06 |
| 99195 | Physician and practitioner services (fee schedule) | 48 | $76.13 |
| 99199 | Physician and practitioner services (fee schedule) | 11 | $37.01 |
| 99201 | Physician and practitioner services (fee schedule) | 7 | $36.36 |
| 99202 | New-patient office visit, level 1 of 4 | 50 | $59.62 |
| 99203 | New-patient office visit, level 2 of 4 | 50 | $92.18 |
| 99204 | New-patient office visit, level 3 of 4 | 50 | $142.06 |
| 99205 | New-patient office visit, level 4 of 4 | 50 | $185.75 |
| 99211 | Return-patient office visit, level 1 of 5 (often nurse-only) | 50 | $19.36 |
| 99212 | Return-patient office visit, level 2 of 5 | 50 | $46.29 |
| 99213 | Return-patient office visit, level 3 of 5 | 50 | $75.27 |
| 99214 | Return-patient office visit, level 4 of 5 | 50 | $108.69 |
| 99215 | Return-patient office visit, level 5 of 5 | 50 | $147.32 |
| 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 |
| 99221 | Physician and practitioner services (fee schedule) | 50 | $62.40 |
| 99222 | Physician and practitioner services (fee schedule) | 50 | $98.28 |
| 99223 | Physician and practitioner services (fee schedule) | 50 | $134.87 |
| 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 |
| 99231 | Physician and practitioner services (fee schedule) | 50 | $34.65 |
| 99232 | Physician and practitioner services (fee schedule) | 50 | $57.90 |
| 99233 | Physician and practitioner services (fee schedule) | 50 | $85.42 |
| 99234 | Physician and practitioner services (fee schedule) | 50 | $79.33 |
| 99235 | Physician and practitioner services (fee schedule) | 50 | $124.20 |
| 99236 | Physician and practitioner services (fee schedule) | 50 | $163.79 |
| 99238 | Physician and practitioner services (fee schedule) | 50 | $61.04 |
| 99239 | Physician and practitioner services (fee schedule) | 49 | $86.27 |
| 99241 | Physician and practitioner services (fee schedule) | 8 | $29.64 |
| 99242 | Physician and practitioner services (fee schedule) | 35 | $62.49 |
| 99243 | Physician and practitioner services (fee schedule) | 35 | $87.37 |
| 99244 | Physician and practitioner services (fee schedule) | 35 | $128.22 |
| 99245 | Physician and practitioner services (fee schedule) | 35 | $162.16 |
| 99251 | Physician and practitioner services (fee schedule) | 7 | $38.10 |
| 99252 | Physician and practitioner services (fee schedule) | 33 | $56.27 |
| 99253 | Physician and practitioner services (fee schedule) | 33 | $78.42 |
| 99254 | Physician and practitioner services (fee schedule) | 33 | $109.02 |
| 99255 | Physician and practitioner services (fee schedule) | 33 | $146.47 |
| 99281 | Physician and practitioner services (fee schedule) | 49 | $10.86 |
| 99282 | Physician and practitioner services (fee schedule) | 50 | $34.17 |
| 99283 | Physician and practitioner services (fee schedule) | 50 | $56.19 |
| 99284 | Physician and practitioner services (fee schedule) | 50 | $95.57 |
| 99285 | Physician and practitioner services (fee schedule) | 50 | $138.99 |
| 99288 | Physician and practitioner services (fee schedule) | 14 | $41.50 |
| 99291 | Physician and practitioner services (fee schedule) | 49 | $215.02 |
| 99292 | Physician and practitioner services (fee schedule) | 48 | $97.51 |
| 99304 | Physician and practitioner services (fee schedule) | 50 | $64.07 |
| 99305 | Physician and practitioner services (fee schedule) | 50 | $108.10 |
| 99306 | Physician and practitioner services (fee schedule) | 50 | $144.79 |
| 99307 | Physician and practitioner services (fee schedule) | 50 | $34.03 |
| 99308 | Physician and practitioner services (fee schedule) | 50 | $59.89 |
| 99309 | Physician and practitioner services (fee schedule) | 50 | $86.34 |
| 99310 | Physician and practitioner services (fee schedule) | 50 | $121.89 |
| 99315 | Physician and practitioner services (fee schedule) | 44 | $66.03 |
| 99316 | Physician and practitioner services (fee schedule) | 44 | $104.33 |
| 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 |
| 99341 | Physician and practitioner services (fee schedule) | 50 | $45.20 |
| 99342 | Physician and practitioner services (fee schedule) | 50 | $70.81 |
| 99343 | Physician and practitioner services (fee schedule) | 10 | $112.86 |
| 99344 | Physician and practitioner services (fee schedule) | 49 | $129.84 |
| 99345 | Physician and practitioner services (fee schedule) | 49 | $180.15 |
| 99347 | Physician and practitioner services (fee schedule) | 50 | $40.94 |
| 99348 | Physician and practitioner services (fee schedule) | 50 | $69.28 |
| 99349 | Physician and practitioner services (fee schedule) | 50 | $110.94 |
| 99350 | Physician and practitioner services (fee schedule) | 49 | $160.13 |
| 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) | 21 | $84.44 |
| 99359 | Physician and practitioner services (fee schedule) | 17 | $35.76 |
| 99360 | Physician and practitioner services (fee schedule) | 30 | $44.94 |
| 99366 | Physician and practitioner services (fee schedule) | 21 | $34.81 |
| 99367 | Physician and practitioner services (fee schedule) | 19 | $40.62 |
| 99368 | Physician and practitioner services (fee schedule) | 18 | $26.22 |
| 99374 | Physician and practitioner services (fee schedule) | 11 | $45.64 |
| 99375 | Physician and practitioner services (fee schedule) | 10 | $72.14 |
| 99377 | Physician and practitioner services (fee schedule) | 11 | $45.29 |
| 99378 | Physician and practitioner services (fee schedule) | 10 | $71.42 |
| 99379 | Physician and practitioner services (fee schedule) | 9 | $45.06 |
| 99380 | Physician and practitioner services (fee schedule) | 9 | $68.49 |
| 99381 | Physician and practitioner services (fee schedule) | 50 | $82.26 |
| 99382 | Physician and practitioner services (fee schedule) | 50 | $90.35 |
| 99383 | Physician and practitioner services (fee schedule) | 50 | $91.95 |
| 99384 | Physician and practitioner services (fee schedule) | 50 | $105.77 |
| 99385 | Physician and practitioner services (fee schedule) | 50 | $99.41 |
| 99386 | Physician and practitioner services (fee schedule) | 48 | $117.53 |
| 99387 | Physician and practitioner services (fee schedule) | 46 | $120.43 |
| 99391 | Physician and practitioner services (fee schedule) | 50 | $77.28 |
| 99392 | Physician and practitioner services (fee schedule) | 50 | $81.31 |
| 99393 | Physician and practitioner services (fee schedule) | 50 | $81.19 |
| 99394 | Physician and practitioner services (fee schedule) | 50 | $92.55 |
| 99395 | Physician and practitioner services (fee schedule) | 50 | $94.00 |
| 99396 | Physician and practitioner services (fee schedule) | 48 | $97.93 |
| 99397 | Physician and practitioner services (fee schedule) | 46 | $101.08 |
| 99401 | Physician and practitioner services (fee schedule) | 44 | $27.90 |
| 99402 | Physician and practitioner services (fee schedule) | 39 | $45.45 |
| 99403 | Physician and practitioner services (fee schedule) | 29 | $64.92 |
| 99404 | Physician and practitioner services (fee schedule) | 29 | $85.91 |
| 99406 | Physician and practitioner services (fee schedule) | 46 | $12.34 |
| 99407 | Physician and practitioner services (fee schedule) | 49 | $23.57 |
| 99408 | Physician and practitioner services (fee schedule) | 35 | $29.59 |
| 99409 | Physician and practitioner services (fee schedule) | 30 | $57.65 |
| 99411 | Physician and practitioner services (fee schedule) | 16 | $15.97 |
| 99412 | Physician and practitioner services (fee schedule) | 18 | $18.55 |
| 99415 | Physician and practitioner services (fee schedule) | 30 | $16.81 |
| 99416 | Physician and practitioner services (fee schedule) | 30 | $8.95 |
| 99417 | Physician and practitioner services (fee schedule) | 33 | $27.52 |
| 99418 | Physician and practitioner services (fee schedule) | 34 | $29.84 |
| 99421 | Physician and practitioner services (fee schedule) | 25 | $12.46 |
| 99422 | Physician and practitioner services (fee schedule) | 25 | $24.35 |
| 99423 | Physician and practitioner services (fee schedule) | 25 | $39.13 |
| 99424 | Physician and practitioner services (fee schedule) | 22 | $70.68 |
| 99425 | Physician and practitioner services (fee schedule) | 21 | $50.26 |
| 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) | 8 | $26.29 |
| 99437 | Physician and practitioner services (fee schedule) | 19 | $49.42 |
| 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) | 24 | $14.09 |
| 99447 | Physician and practitioner services (fee schedule) | 24 | $28.52 |
| 99448 | Physician and practitioner services (fee schedule) | 24 | $42.85 |
| 99449 | Physician and practitioner services (fee schedule) | 23 | $57.82 |
| 99451 | Physician and practitioner services (fee schedule) | 34 | $28.95 |
| 99452 | Physician and practitioner services (fee schedule) | 31 | $27.53 |
| 99453 | Physician and practitioner services (fee schedule) | 32 | $16.75 |
| 99454 | Physician and practitioner services (fee schedule) | 32 | $39.82 |
| 99456 | Physician and practitioner services (fee schedule) | 7 | $152.54 |
| 99457 | Physician and practitioner services (fee schedule) | 33 | $37.16 |
| 99458 | Physician and practitioner services (fee schedule) | 31 | $30.85 |
| 99459 | Physician and practitioner services (fee schedule) | 35 | $17.37 |
| 99460 | Physician and practitioner services (fee schedule) | 50 | $69.92 |
| 99461 | Physician and practitioner services (fee schedule) | 49 | $72.76 |
| 99462 | Physician and practitioner services (fee schedule) | 49 | $30.76 |
| 99463 | Physician and practitioner services (fee schedule) | 50 | $84.82 |
| 99464 | Physician and practitioner services (fee schedule) | 49 | $61.35 |
| 99465 | Physician and practitioner services (fee schedule) | 50 | $120.30 |
| 99466 | Physician and practitioner services (fee schedule) | 41 | $186.25 |
| 99467 | Physician and practitioner services (fee schedule) | 41 | $93.43 |
| 99468 | Physician and practitioner services (fee schedule) | 49 | $725.83 |
| 99469 | Physician and practitioner services (fee schedule) | 49 | $317.03 |
| 99470 | Physician and practitioner services (fee schedule) | 23 | $19.81 |
| 99471 | Physician and practitioner services (fee schedule) | 49 | $635.02 |
| 99472 | Physician and practitioner services (fee schedule) | 49 | $327.50 |
| 99473 | Physician and practitioner services (fee schedule) | 31 | $11.14 |
| 99474 | Physician and practitioner services (fee schedule) | 29 | $11.72 |
| 99475 | Physician and practitioner services (fee schedule) | 49 | $451.53 |
| 99476 | Physician and practitioner services (fee schedule) | 49 | $265.32 |
| 99477 | Physician and practitioner services (fee schedule) | 49 | $282.03 |
| 99478 | Physician and practitioner services (fee schedule) | 49 | $113.26 |
| 99479 | Physician and practitioner services (fee schedule) | 49 | $102.31 |
| 99480 | Physician and practitioner services (fee schedule) | 49 | $97.88 |
| 99483 | Physician and practitioner services (fee schedule) | 28 | $211.25 |
| 99484 | Physician and practitioner services (fee schedule) | 20 | $41.75 |
| 99485 | Physician and practitioner services (fee schedule) | 16 | $60.33 |
| 99486 | Physician and practitioner services (fee schedule) | 15 | $52.20 |
| 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) | 23 | $45.48 |
| 99491 | Physician and practitioner services (fee schedule) | 17 | $71.19 |
| 99492 | Physician and practitioner services (fee schedule) | 33 | $117.01 |
| 99493 | Physician and practitioner services (fee schedule) | 33 | $107.08 |
| 99494 | Physician and practitioner services (fee schedule) | 33 | $49.24 |
| 99495 | Physician and practitioner services (fee schedule) | 24 | $174.67 |
| 99496 | Physician and practitioner services (fee schedule) | 24 | $237.16 |
| 99497 | Physician and practitioner services (fee schedule) | 27 | $71.33 |
| 99498 | Physician and practitioner services (fee schedule) | 26 | $64.56 |
| 99499 | Physician and practitioner services (fee schedule) | 14 | $35.15 |
| 99501 | Physician and practitioner services (fee schedule) | 7 | $58.29 |
| 99502 | Physician and practitioner services (fee schedule) | 7 | $60.00 |
| 99504 | Physician and practitioner services (fee schedule) | 5 | $36.12 |
| 99510 | Physician and practitioner services (fee schedule) | 5 | $31.25 |
| 99600 | Other in-home service | 16 | $51.34 |
| 99601 | Physician and practitioner services (fee schedule) | 11 | $83.71 |
| 99602 | Physician and practitioner services (fee schedule) | 9 | $41.85 |
| 99605 | Physician and practitioner services (fee schedule) | 18 | $50.34 |
| 99606 | Physician and practitioner services (fee schedule) | 19 | $31.97 |
| 99607 | Physician and practitioner services (fee schedule) | 14 | $24.77 |
| A0380 | Bls mileage (per mile) | 8 | $4.61 |
| A0390 | Als mileage (per mile) | 7 | $4.74 |
| A2001 | Innovamatrix ac, per square centimeter (add-on | 7 | $83.49 |
| A2002 | Mirragen advanced wound matrix, per square centimeter | 7 | $83.49 |
| A2005 | Microlyte matrix, per square centimeter (add-on | 7 | $83.49 |
| A2006 | Novosorb synpath dermal matrix, per square centimeter | 7 | $83.49 |
| A2007 | Restrata, per square centimeter (add-on | 7 | $83.49 |
| A2008 | Theragenesis, per square centimeter (add-on | 7 | $83.49 |
| A2009 | Symphony, per square centimeter (add-on | 7 | $83.49 |
| A2010 | Apis, per square centimeter (add-on | 7 | $83.49 |
| A2011 | Supra sdrm, per square centimeter (add-on | 6 | $88.22 |
| A2012 | Suprathel, per square centimeter (add-on | 6 | $88.22 |
| A2013 | Innovamatrix fs, per square centimeter (add-on | 6 | $88.22 |
| A2015 | Phoenix wound matrix, per square centimeter (add-on | 6 | $88.22 |
| A2016 | Permeaderm b, per square centimeter (add-on | 6 | $88.22 |
| A2018 | Permeaderm c, per square centimeter (add-on | 6 | $88.22 |
| A2021 | Neomatrix, per square centimeter (add-on | 7 | $83.49 |
| A2024 | Resolve matrix or xenopatch, per square centimeter (add-on | 6 | $88.22 |
| A2027 | Matriderm, per square centimeter (add-on | 7 | $83.49 |
| A2029 | Mirotract wound matrix sheet, per cubic centimeter (add-on | 7 | $83.49 |
| A2031 | Mirodry wound matrix, per square centimeter (add-on | 8 | $88.22 |
| A2032 | Myriad matrix, per square centimeter (add-on | 8 | $88.22 |
| A2034 | Foundation drs solo, per square centimeter (add-on | 8 | $88.22 |
| A2036 | Cohealyx collagen dermal matrix, per square centimeter | 7 | $83.49 |
| A2038 | Marigen pacto, per square centimeter (add-on | 7 | $83.49 |
| A2039 | Innovamatrix fd, per square centimeter (add-on | 7 | $83.49 |
| 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 |
| C9310 | Injection, leucovorin calcium (avyxa), 1 mg | 8 | $2.54 |
| G0008 | Administration of influenza virus vaccine | 17 | $15.45 |
| G0009 | Administration of pneumococcal vaccine | 15 | $10.00 |
| G0010 | Administration of hepatitis b vaccine | 10 | $16.40 |
| G0011 | Individual counseling for pre-exposure prophylaxis | 20 | $23.12 |
| G0012 | Injection of pre-exposure prophylaxis | 18 | $12.04 |
| G0013 | Individual counseling for pre-exposure prophylaxis | 18 | $19.16 |
| G0017 | Psychotherapy for crisis furnished in an applicable site of... | 8 | $173.76 |
| G0018 | Psychotherapy for crisis furnished in an applicable site of... | 8 | $86.18 |
| G0019 | Community health integration services performed by certified... | 10 | $67.92 |
| G0022 | Community health integration services | 10 | $44.34 |
| 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 | 26 | $14.56 |
| G0104 | Colorectal cancer screening; flexible sigmoidoscopy | 30 | $116.53 |
| G0105 | Colorectal cancer screening | 36 | $256.92 |
| G0106 | Colorectal cancer screening; alternative to g0104 | 6 | $79.58 |
| G0108 | Diabetes outpatient self-management training services | 35 | $44.90 |
| G0109 | Diabetes outpatient self-management training services | 33 | $13.04 |
| G0117 | Glaucoma screening for high risk patients furnished by an... | 22 | $51.15 |
| G0118 | Glaucoma screening for high risk patient furnished under the... | 19 | $34.39 |
| G0120 | Colorectal cancer screening; alternative to g0105 | 6 | $79.58 |
| G0121 | Colorectal cancer screening | 34 | $224.38 |
| G0124 | Screening cytopathology, cervical or vaginal | 22 | $21.79 |
| G0127 | Trimming of dystrophic nails, any number | 23 | $11.98 |
| G0130 | Single energy x-ray absorptiometry | 25 | $24.21 |
| G0136 | Administration of a standardized | 14 | $14.11 |
| G0138 | Intravenous infusion of cipaglucosidase alfa-atga | 12 | $160.68 |
| G0140 | Principal illness navigation - peer support by certified or... | 6 | $73.24 |
| G0141 | Screening cytopathology smears, cervical or vaginal | 18 | $21.65 |
| G0146 | Principal illness navigation - peer support | 6 | $43.89 |
| G0147 | Screening cytopathology smears, cervical or vaginal | 20 | $16.30 |
| G0166 | External counterpulsation, per treatment session | 26 | $86.72 |
| G0168 | Wound closure utilizing tissue adhesive(s) only | 20 | $48.72 |
| G0179 | Physician or allowed practitioner re-certification for... | 11 | $38.51 |
| G0180 | Physician or allowed practitioner certification for... | 12 | $48.02 |
| G0181 | Physician or allowed practitioner supervision of a patient... | 11 | $89.80 |
| G0182 | Physician supervision of a patient under a medicare-approved... | 7 | $88.73 |
| G0186 | Destruction of localized lesion of choroid (for example | 11 | $430.39 |
| G0219 | Pet imaging whole body; melanoma for non-covered indications | 7 | $1,673.39 |
| G0245 | Initial physician evaluation and management of a diabetic... | 14 | $45.06 |
| G0246 | Follow-up physician evaluation and management of a diabetic... | 15 | $27.85 |
| G0247 | Routine foot care by a physician of a diabetic patient with... | 13 | $30.66 |
| G0248 | Demonstration, prior to initiation of home inr monitoring | 20 | $88.87 |
| G0249 | Provision of test materials and equipment for home inr... | 21 | $63.68 |
| G0250 | Physician review, interpretation | 18 | $7.50 |
| G0252 | Pet imaging, full and partial-ring pet scanners only | 11 | $68.60 |
| G0260 | Injection procedure for sacroiliac joint | 8 | $106.04 |
| G0268 | Removal of impacted cerumen | 18 | $36.97 |
| G0270 | Medical nutrition therapy | 16 | $21.81 |
| G0271 | Medical nutrition therapy | 13 | $13.10 |
| G0276 | Blinded procedure for lumbar stenosis | 5 | $357.97 |
| G0277 | Hyperbaric oxygen under pressure, full body chamber | 28 | $149.06 |
| G0278 | Iliac and/or femoral artery angiography, non-selective | 21 | $10.36 |
| G0281 | Electrical stimulation, (unattended), to one or more areas | 13 | $10.75 |
| G0283 | Electrical stimulation (unattended) | 15 | $10.95 |
| G0288 | Reconstruction, computed tomographic angiography of aorta... | 21 | $42.98 |
| G0289 | Arthroscopy, knee, surgical, for removal of loose body | 23 | $66.44 |
| G0296 | Counseling visit to discuss need for lung cancer screening... | 26 | $25.05 |
| G0307 | Complete (cbc), automated (hgb, hct, rbc, wbc | 28 | $6.44 |
| 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... | 28 | $22.63 |
| G0313 | Immunization counseling by a physician or other qualified... | 25 | $39.90 |
| G0314 | Immunization counseling by a physician or other qualified... | 24 | $42.02 |
| G0315 | Immunization counseling by a physician or other qualified... | 28 | $22.63 |
| G0317 | Prolonged nursing facility evaluation and management... | 13 | $26.17 |
| G0318 | Prolonged home or residence evaluation and management... | 13 | $27.21 |
| G0323 | Care management services for behavioral health conditions | 8 | $42.50 |
| G0328 | Colorectal cancer screening; fecal occult blood test | 28 | $17.82 |
| G0329 | Electromagnetic therapy | 17 | $8.81 |
| G0333 | Pharmacy dispensing fee for inhalation drug(s) | 6 | $47.03 |
| G0339 | Image-guided robotic linear accelerator-based stereotactic... | 10 | $1,336.05 |
| G0340 | Image-guided robotic linear accelerator-based stereotactic... | 10 | $1,431.30 |
| G0341 | Percutaneous islet cell transplant | 13 | $1,257.92 |
| G0342 | Laparoscopy for islet cell transplant | 13 | $554.10 |
| G0343 | Laparotomy for islet cell transplant | 14 | $842.09 |
| G0372 | Physician and practitioner services (fee schedule) | 11 | $8.04 |
| G0396 | Alcohol and/or substance | 16 | $28.40 |
| G0397 | Alcohol and/or substance | 16 | $52.50 |
| G0398 | Home sleep study test (hst) with type ii portable monitor | 9 | $97.07 |
| G0399 | Home sleep test (hst) with type iii portable monitor | 11 | $38.34 |
| 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 | 8 | $6.37 |
| G0405 | Electrocardiogram, routine ecg with 12 leads | 8 | $6.73 |
| G0406 | Follow-up inpatient consultation, limited | 15 | $29.75 |
| G0407 | Follow-up inpatient consultation, intermediate | 15 | $54.36 |
| G0408 | Follow-up inpatient consultation, complex | 15 | $78.06 |
| G0412 | Open treatment of iliac spine(s), tuberosity avulsion | 16 | $504.50 |
| G0413 | Percutaneous skeletal fixation of posterior pelvic bone... | 18 | $710.02 |
| G0414 | Open treatment of anterior pelvic bone fracture and/or... | 17 | $664.34 |
| G0415 | Open treatment of posterior pelvic bone fracture and/or... | 17 | $883.31 |
| G0416 | Surgical pathology, gross and microscopic examinations | 21 | $211.78 |
| 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 | 15 | $83.34 |
| G0423 | Intensive cardiac rehabilitation | 15 | $83.34 |
| G0425 | Telehealth consultation | 13 | $77.79 |
| G0426 | Telehealth consultation | 13 | $103.64 |
| G0427 | Telehealth consultation | 13 | $151.38 |
| G0429 | Dermal filler injection(s) for the treatment of facial... | 10 | $77.60 |
| G0435 | Infectious agent antibody detection by rapid antibody test | 24 | $11.71 |
| G0438 | Annual wellness visit | 13 | $151.11 |
| G0439 | Annual wellness visit | 13 | $118.88 |
| G0442 | Annual alcohol misuse screening, 5 to 15 minutes | 13 | $15.13 |
| G0443 | Brief face-to-face behavioral counseling for alcohol misuse | 13 | $27.79 |
| G0445 | High intensity behavioral counseling to prevent sexually... | 12 | $28.07 |
| 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 | 12 | $9.77 |
| G0452 | Molecular pathology procedure | 21 | $36.76 |
| G0453 | Continuous intraoperative neurophysiology monitoring | 17 | $23.74 |
| G0455 | Preparation with instillation of fecal microbiota by any... | 17 | $93.29 |
| 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 | 23 | $23.60 |
| G0479 | Drug test(s), presumptive, any number of drug classes | 5 | $47.55 |
| G0480 | Drug test(s), definitive, utilizing | 47 | $91.54 |
| G0481 | Drug test(s), definitive, utilizing | 45 | $128.79 |
| G0482 | Drug test(s), definitive, utilizing | 42 | $165.06 |
| G0483 | Drug test(s), definitive, utilizing | 42 | $205.07 |
| G0498 | Chemotherapy administration, intravenous infusion technique | 8 | $167.89 |
| G0499 | Hepatitis b screening in non-pregnant | 21 | $27.56 |
| G0500 | Moderate sedation services provided by the same physician or... | 19 | $51.97 |
| 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 | 17 | $116.55 |
| G0517 | Removal of non-biodegradable drug delivery implants | 16 | $128.05 |
| G0518 | Removal with reinsertion | 16 | $213.66 |
| G0537 | Administration of a standardized | 15 | $14.46 |
| G0538 | Atherosclerotic cardiovascular disease | 12 | $12.52 |
| 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 | 8 | $36.05 |
| G0561 | Tympanostomy with local or topical anesthesia and insertion... | 14 | $160.06 |
| G0571 | Intraoperative nerve(s) cryoablation for post-surgical pain... | 6 | $46.97 |
| G1028 | Take-home supply of nasal naloxone | 7 | $126.94 |
| G2010 | Remote evaluation of recorded video and/or images submitted... | 20 | $8.97 |
| G2011 | Alcohol and/or substance | 13 | $13.27 |
| 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 | 12 | $197.44 |
| G2068 | Medication assisted treatment, buprenorphine (oral) | 11 | $217.86 |
| G2074 | Medication assisted treatment | 11 | $155.16 |
| G2076 | Intake activities, including initial medical examination... | 12 | $207.79 |
| G2077 | Periodic assessment; assessing periodically by an otp... | 10 | $113.44 |
| 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 | $40.85 |
| 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 | $14.70 |
| G8510 | Screening for depression is documented as negative | 10 | $13.82 |
| G9006 | Coordinated care fee, home monitoring | 5 | $28.33 |
| G9008 | Coordinated care fee | 6 | $23.35 |
| G9157 | Transesophageal doppler measurement of cardiac output | 9 | $78.91 |
| 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 |
| G9919 | Screening performed and positive and provision of... | 5 | $29.00 |
| G9920 | Screening performed and negative | 5 | $29.00 |
| H0001 | Alcohol and/or drug assessment | 32 | $111.48 |
| H1001 | Prenatal care, at-risk enhanced service | 13 | $32.09 |
| H1011 | Family assessment by licensed behavioral health professional... | 6 | $88.88 |
| H2010 | Comprehensive medication services, per 15 minutes | 18 | $25.63 |
| M0201 | Administration of pneumococcal, influenza, hepatitis b | 31 | $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 | 19 | $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 | 16 | $13.83 |
| Q0081 | Infusion therapy, using other than chemotherapeutic drugs | 8 | $45.50 |
| Q0092 | Set-up portable x-ray equipment | 21 | $16.40 |
| Q0144 | Azithromycin dihydrate, oral, capsules/powder, 1 gram | 15 | $15.05 |
| Q0155 | Dronabinol (syndros), 0.1 mg, oral | 10 | $3.23 |
| Q0161 | Chlorpromazine hydrochloride, 5 mg, oral | 13 | $0.35 |
| Q0162 | Ondansetron 1 mg, oral | 16 | $0.02 |
| Q0164 | Prochlorperazine maleate, 5 mg, oral | 23 | $0.38 |
| Q0166 | Granisetron hydrochloride, 1 mg, oral | 28 | $1.46 |
| Q0167 | Dronabinol, 2.5 mg, oral | 27 | $1.87 |
| Q0173 | Trimethobenzamide hydrochloride, 250 mg, oral | 18 | $0.865 |
| Q0177 | Hydroxyzine pamoate, 25 mg, oral | 21 | $0.05 |
| Q0224 | Injection, pemivibart | 24 | $7,239.00 |
| Q0234 | Injection, tocilizumab-bavi | 13 | $6.33 |
| Q0249 | Injection, tocilizumab | 28 | $7.56 |
| Q0478 | Power adapter for use with electric or electric/pneumatic... | 14 | $188.54 |
| Q0479 | Power module for use with electric or electric/pneumatic... | 14 | $12,238.32 |
| Q0506 | Battery, lithium-ion | 16 | $922.89 |
| Q0513 | Pharmacy dispensing fee for inhalation drug(s); per 30 days | 6 | $27.23 |
| Q0515 | Injection, sermorelin acetate, 1 microgram | 13 | $1.80 |
| Q2009 | Injection, fosphenytoin, 50 mg phenytoin equivalent | 25 | $1.53 |
| Q2037 | Influenza virus vaccine, split virus | 13 | $17.69 |
| Q2050 | Injection, doxorubicin hydrochloride, liposomal | 39 | $104.01 |
| Q3014 | Telehealth originating site facility fee | 31 | $23.56 |
| Q3031 | Collagen skin test | 5 | $11.19 |
| Q4112 | Cymetra, injectable, 1 cc | 17 | $754.72 |
| Q4113 | Graftjacket xpress, injectable, 1 cc | 17 | $902.00 |
| Q4117 | Hyalomatrix, per square centimeter (add-on | 18 | $39.62 |
| Q4125 | Arthroflex, per square centimeter (add-on | 6 | $82.32 |
| Q4128 | Flex hd, or allopatch hd, per square centimeter (add-on | 21 | $81.15 |
| Q4130 | Strattice tm, per square centimeter (add-on | 5 | $83.49 |
| Q4132 | Grafix core and grafixpl core, per square centimeter | 28 | $118.26 |
| Q4134 | Hmatrix, per square centimeter (add-on | 11 | $127.26 |
| Q4135 | Mediskin, per square centimeter (add-on | 6 | $92.33 |
| Q4136 | Ez-derm, per square centimeter (add-on | 6 | $92.33 |
| Q4138 | Biodfence dryflex, per square centimeter (add-on | 10 | $93.26 |
| Q4140 | Biodfence, per square centimeter (add-on | 11 | $101.16 |
| Q4141 | Alloskin ac, per square centimeter (add-on | 13 | $64.75 |
| Q4142 | Xcm biologic tissue matrix, per square centimeter (add-on | 7 | $83.49 |
| Q4146 | Tensix, per square centimeter (add-on | 7 | $83.49 |
| Q4153 | Dermavest and plurivest, per square centimeter (add-on | 13 | $108.60 |
| Q4155 | Neoxflo or clarixflo, 1 mg | 11 | $27.31 |
| Q4156 | Neox 100 or clarix 100, per square centimeter (add-on | 11 | $66.35 |
| Q4157 | Revitalon, per square centimeter (add-on | 6 | $82.32 |
| Q4159 | Affinity, per square centimeter (add-on | 24 | $132.17 |
| Q4160 | Nushield, per square centimeter (add-on | 24 | $96.95 |
| Q4165 | Keramatrix or kerasorb, per square centimeter (add-on | 7 | $81.15 |
| Q4166 | Cytal, per square centimeter (add-on | 11 | $20.56 |
| Q4167 | Truskin, per square centimeter (add-on | 7 | $83.49 |
| Q4169 | Artacent wound, per square centimeter (add-on | 12 | $151.66 |
| Q4170 | Cygnus, per square centimeter (add-on | 16 | $82.32 |
| Q4171 | Interfyl, 1 mg | 12 | $10.16 |
| Q4176 | Neopatch or therion, per square centimeter (add-on | 13 | $81.15 |
| Q4178 | Floweramniopatch, per square centimeter (add-on | 11 | $86.52 |
| Q4179 | Flowerderm, per square centimeter (add-on | 6 | $88.22 |
| Q4181 | Amnio wound, per square centimeter (add-on | 6 | $88.22 |
| Q4182 | Transcyte, per square centimeter (add-on | 8 | $82.32 |
| Q4183 | Surgigraft, per square centimeter (add-on | 6 | $88.22 |
| Q4184 | Cellesta or cellesta duo, per square centimeter (add-on | 12 | $103.79 |
| Q4187 | Epicord, per square centimeter (add-on | 25 | $159.86 |
| Q4193 | Coll-e-derm, per square centimeter (add-on | 11 | $119.93 |
| Q4194 | Novachor, per square centimeter (add-on | 14 | $146.59 |
| Q4198 | Genesis amniotic membrane, per square centimeter (add-on | 6 | $88.22 |
| Q4199 | Cygnus matrix, per square centimeter (add-on | 15 | $119.93 |
| Q4200 | Skin te, per square centimeter (add-on | 6 | $88.22 |
| Q4203 | Derma-gide, per square centimeter (add-on | 13 | $137.06 |
| Q4221 | Amniowrap2, per square centimeter (add-on | 14 | $308.77 |
| Q4222 | Progenamatrix, per square centimeter (add-on | 14 | $112.82 |
| Q4224 | Human health factor 10 amniotic patch (hhf10-p) | 6 | $88.22 |
| Q4225 | Amniobind or dermabind tl, per square centimeter (add-on | 11 | $127.26 |
| Q4227 | Amniocore, per square centimeter (add-on | 12 | $123.60 |
| Q4232 | Corplex, per square centimeter (add-on | 12 | $114.69 |
| Q4234 | Xcellerate, per square centimeter (add-on | 12 | $132.88 |
| Q4237 | Cryo-cord, per square centimeter (add-on | 5 | $83.49 |
| Q4238 | Derm-maxx, per square centimeter (add-on | 12 | $245.16 |
| Q4239 | Amnio-maxx or amnio-maxx lite, per square centimeter | 12 | $123.60 |
| Q4247 | Amniotext patch, per square centimeter (add-on | 11 | $127.28 |
| Q4248 | Dermacyte amniotic membrane allograft | 12 | $127.20 |
| Q4249 | Amniply, for topical use only, per square centimeter | 8 | $106.44 |
| Q4251 | Vim, per square centimeter (add-on | 6 | $88.22 |
| Q4254 | Novafix dl, per square centimeter (add-on | 9 | $119.93 |
| Q4255 | Reguard, for topical use only, per square centimeter | 6 | $88.22 |
| Q4257 | Relese, per square centimeter (add-on | 11 | $228.77 |
| Q4260 | Signature apatch, per square centimeter (add-on | 6 | $88.22 |
| Q4262 | Dual layer impax membrane, per square centimeter (add-on | 11 | $92.95 |
| Q4263 | Surgraft tl, per square centimeter (add-on | 13 | $127.26 |
| Q4265 | Neostim tl, per square centimeter (add-on | 13 | $127.28 |
| Q4268 | Surgraft ft, per square centimeter (add-on | 11 | $127.26 |
| Q4276 | Orion, per square centimeter (add-on | 10 | $123.60 |
| Q4279 | Vendaje ac, per square centimeter (add-on | 11 | $119.93 |
| Q4280 | Xcell amnio matrix, per square centimeter (add-on | 10 | $123.60 |
| Q4287 | Dermabind dl, per square centimeter (add-on | 7 | $91.83 |
| Q4288 | Dermabind ch, per square centimeter (add-on | 7 | $91.83 |
| Q4289 | Revoshield + amniotic barrier, per square centimeter | 10 | $106.44 |
| Q4291 | Lamellas xt, per square centimeter (add-on | 7 | $91.83 |
| Q4292 | Lamellas, per square centimeter (add-on | 7 | $91.83 |
| Q4298 | Amniocore pro, per square centimeter (add-on | 11 | $119.93 |
| Q4300 | Acesso tl, per square centimeter (add-on | 11 | $119.93 |
| Q4302 | Complete aca, per square centimeter (add-on | 11 | $119.93 |
| Q4303 | Complete aa, per square centimeter (add-on | 11 | $119.93 |
| Q4305 | American amnion ac tri-layer, per square centimeter (add-on | 7 | $87.89 |
| Q4306 | American amnion ac, per square centimeter (add-on | 7 | $87.89 |
| Q4307 | American amnion, per square centimeter (add-on | 7 | $87.89 |
| Q4308 | Sanopellis, per square centimeter (add-on | 7 | $87.89 |
| Q4311 | Acesso, per square centimeter (add-on | 7 | $89.64 |
| Q4312 | Acesso ac, per square centimeter (add-on | 8 | $91.30 |
| Q4314 | Reeva ft, per square cenitmeter (add-on | 8 | $91.30 |
| Q4315 | Regenelink amniotic membrane allograft | 7 | $89.64 |
| Q4316 | Amchoplast, per square centimeter (add-on | 9 | $92.95 |
| Q4317 | Vitograft, per square centimeter (add-on | 9 | $92.95 |
| Q4318 | E-graft, per square centimeter (add-on | 7 | $89.64 |
| Q4320 | Pellograft, per square centimeter (add-on | 8 | $91.30 |
| Q4321 | Renograft, per square centimeter (add-on | 8 | $91.30 |
| Q4324 | Amniotx, per square centimeter (add-on | 7 | $89.64 |
| Q4326 | Woundplus, per square centimeter (add-on | 10 | $106.44 |
| Q4327 | Duoamnion, per square centimeter (add-on | 7 | $89.64 |
| Q4329 | Singlay, per square centimeter (add-on | 7 | $89.64 |
| Q4330 | Total, per square centimeter (add-on | 7 | $89.64 |
| Q4331 | Axolotl graft, per square centimeter (add-on | 9 | $92.95 |
| Q4332 | Axolotl dualgraft, per square centimeter (add-on | 11 | $119.93 |
| Q4333 | Ardeograft, per square centimeter (add-on | 7 | $89.64 |
| Q4334 | Amnioplast 1, per square centimeter (add-on | 7 | $83.49 |
| Q4335 | Amnioplast 2, per square centimeter (add-on | 7 | $83.49 |
| Q4336 | Artacent c, per square centimeter (add-on | 7 | $83.49 |
| Q4337 | Artacent trident, per square centimeter (add-on | 7 | $83.49 |
| Q4338 | Artacent velos, per square centimeter (add-on | 7 | $83.49 |
| Q4339 | Artacent vericlen, per square centimeter (add-on | 9 | $92.95 |
| Q4340 | Simpligraft, per square centimeter (add-on | 9 | $92.95 |
| Q4341 | Simplimax, per square centimeter (add-on | 9 | $92.95 |
| Q4342 | Theramend, per square centimeter (add-on | 9 | $92.95 |
| Q4344 | Tri-membrane wrap, per square centimeter (add-on | 9 | $92.95 |
| Q4345 | Matrix hd allograft dermis, per square centimeter (add-on | 9 | $92.95 |
| Q4346 | Shelter dm matrix, per square centimeter (add-on | 9 | $92.95 |
| Q4347 | Rampart dl matrix, per square centimeter (add-on | 9 | $92.95 |
| Q4348 | Sentry sl matrix, per square centimeter (add-on | 9 | $92.95 |
| Q4349 | Mantle dl matrix, per square centimeter (add-on | 7 | $89.87 |
| Q4350 | Palisade dm matrix, per square centimeter (add-on | 9 | $92.95 |
| Q4351 | Enclose tl matrix, per square centimeter (add-on | 7 | $89.87 |
| Q4352 | Overlay sl matrix, per square centimeter (add-on | 7 | $89.87 |
| Q4353 | Xceed tl matrix, per square centimeter (add-on | 8 | $106.44 |
| Q4354 | Palingen dual-layer membrane and dual-layer palingen... | 8 | $92.39 |
| Q4356 | Abiomend membrane and abiomend hydromembrane | 8 | $92.39 |
| Q4357 | Xwrap plus, per square centimeter (add-on | 10 | $106.44 |
| Q4360 | Amchoplast fd, per square centimeter (add-on | 8 | $92.39 |
| Q4361 | Epixpress, per square centimeter (add-on | 10 | $106.44 |
| Q4362 | Cygnus disk, per square centimeter (add-on | 8 | $92.39 |
| Q4363 | Amnio burgeon membrane and hydromembrane | 8 | $92.39 |
| Q4364 | Amnio burgeon xplus membrane and xplus hydromembrane | 8 | $92.39 |
| Q4365 | Amnio burgeon dual-layer membrane, per square centimeter | 8 | $92.39 |
| Q4366 | Dual layer amnio burgeon x-membrane, per square centimeter | 8 | $92.39 |
| Q4367 | Amniocore sl, per square centimeter (add-on | 10 | $106.44 |
| Q4368 | Amchothick, per square centimeter (add-on | 8 | $92.39 |
| Q4369 | Amnioplast 3, per square centimeter (add-on | 8 | $92.39 |
| Q4370 | Aeroguard, per square centimeter (add-on | 8 | $92.39 |
| Q4371 | Neoguard, per square centimeter (add-on | 8 | $92.39 |
| Q4372 | Amchoplast excel, per square centimeter (add-on | 8 | $92.39 |
| Q4373 | Membrane wrap lite, per square centimeter (add-on | 8 | $92.39 |
| Q4375 | Duograft ac, per square centimeter (add-on | 8 | $92.39 |
| Q4376 | Duograft aa, per square centimeter (add-on | 8 | $92.39 |
| Q4377 | Trigraft ft, per square centimeter (add-on | 8 | $92.39 |
| Q4378 | Renew ft matrix, per square centimeter (add-on | 8 | $92.39 |
| Q4379 | Amniodefend ft matrix, per square centimeter (add-on | 8 | $92.39 |
| Q4380 | Advograft one, per square centimeter (add-on | 8 | $92.39 |
| Q4382 | Advograft dual, per square centimeter (add-on | 8 | $92.39 |
| Q4383 | Axolotl graft ultra, per square centimeter (add-on | 7 | $91.83 |
| Q4384 | Axolotl dualgraft ultra, per square centimeter (add-on | 7 | $91.83 |
| Q4385 | Apollo ft, per square centimeter (add-on | 7 | $91.83 |
| Q4386 | Acesso trifaca, per square centimeter (add-on | 7 | $91.83 |
| Q4387 | Neothelium ft, per square centimeter (add-on | 7 | $91.83 |
| Q4388 | Neothelium 4l, per square centimeter (add-on | 7 | $91.83 |
| Q4389 | Neothelium 4l+, per square centimeter (add-on | 7 | $91.83 |
| Q4390 | Ascendion, per square centimeter (add-on | 8 | $92.39 |
| Q4391 | Amnioplast double, per square centimeter (add-on | 7 | $91.83 |
| Q4392 | Grafix duo, per square centimeter (add-on | 8 | $92.39 |
| Q4393 | Surgraft ac, per square centimeter (add-on | 7 | $91.83 |
| Q4394 | Surgraft aca, per square centimeter (add-on | 7 | $91.83 |
| Q4395 | Acelagraft, per square centimeter (add-on | 7 | $91.83 |
| Q4396 | Natalin, per square centimeter (add-on | 7 | $91.83 |
| Q4397 | Summit aaa, per square centimeter (add-on | 7 | $91.83 |
| Q4398 | Summit ac, per square centimeter (add-on | 6 | $82.32 |
| Q4399 | Summit fx, per square centimeter (add-on | 6 | $82.32 |
| Q4400 | Polygon3 membrane, per square centimeter (add-on | 6 | $82.32 |
| Q4401 | Absolv3 membrane, per square centimeter (add-on | 6 | $82.32 |
| Q4402 | Xwrap 2.0, per square centimeter (add-on | 6 | $82.32 |
| Q4403 | Xwrap dual plus, per square centimeter (add-on | 6 | $82.32 |
| Q4404 | Xwrap hydro plus, per square centimeter (add-on | 6 | $82.32 |
| Q4405 | Xwrap fenestra plus, per square centimeter (add-on | 6 | $82.32 |
| Q4406 | Xwrap fenestra, per square centimeter (add-on | 6 | $82.32 |
| Q4407 | Xwrap tribus, per square centimeter (add-on | 6 | $82.32 |
| Q4408 | Xwrap hydro, per square centimeter (add-on | 6 | $82.32 |
| Q4409 | Amniomatrixf3x, per square centimeter (add-on | 6 | $82.32 |
| Q4410 | Amchomatrixdl, per square centimeter (add-on | 6 | $82.32 |
| Q4411 | Amniomatrixf4x, per square centimeter (add-on | 6 | $82.32 |
| Q4412 | Choriofix, per square centimeter (add-on | 6 | $82.32 |
| Q4413 | Cygnus solo, per square centimeter (add-on | 6 | $82.32 |
| Q4414 | Simplichor, per square centimeter (add-on | 6 | $82.32 |
| Q4415 | Alexiguard sl-t, per square centimeter (add-on | 6 | $82.32 |
| Q4416 | Alexiguard tl-t, per square centimeter (add-on | 6 | $82.32 |
| Q4417 | Alexiguard dl-t, per square centimeter (add-on | 6 | $82.32 |
| 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 | 6 | $82.32 |
| 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 | 39 | $71.48 |
| Q5113 | Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg | 35 | $55.30 |
| Q5114 | Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg | 39 | $31.95 |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | 39 | $34.56 |
| Q5122 | Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg | 37 | $136.91 |
| Q5127 | Injection, pegfilgrastim-fpgk (stimufend), biosimilar | 39 | $153.98 |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 38 | $82.53 |
| Q5130 | Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg | 37 | $105.11 |
| Q5137 | Injection, ustekinumab-auub (wezlana), biosimilar | 7 | $61.87 |
| Q5141 | Injection, adalimumab-aaty, biosimilar, 1 mg | 13 | $23.70 |
| Q5142 | Injection, adalimumab-ryvk biosimilar, 1 mg | 15 | $12.98 |
| Q5144 | Injection, adalimumab-aacf (idacio), biosimilar, 1 mg | 16 | $21.80 |
| Q5151 | Injection, eculizumab-aagh (epysqli), biosimilar, 2 mg | 29 | $31.55 |
| Q5152 | Injection, eculizumab-aeeb (bkemv), biosimilar, 2 mg | 28 | $40.91 |
| Q5157 | Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar | 31 | $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 | 14 | $246.59 |
| Q5169 | Injection, pegfilgrastim-unne (armlupeg), biosimilar, 0.5 mg | 13 | $519.48 |
| Q9956 | Injection, octafluoropropane microspheres, per ml | 28 | $40.32 |
| Q9958 | High osmolar contrast material | 23 | $0.08 |
| Q9960 | High osmolar contrast material | 17 | $0.21 |
| Q9962 | High osmolar contrast material | 16 | $0.18 |
| Q9963 | High osmolar contrast material | 24 | $0.2145 |
| Q9964 | High osmolar contrast material | 15 | $0.29 |
| Q9965 | Low osmolar contrast material | 34 | $0.965 |
| Q9967 | Low osmolar contrast material | 38 | $0.16 |
| Q9996 | Injection, ustekinumab-ttwe (pyzchiva), subcutaneous, 1 mg | 15 | $47.33 |
| S0020 | Injection, bupivicaine hydrochloride, 30 ml | 5 | $5.17 |
| S0023 | Injection, cimetidine hydrochloride, 300 mg | 11 | $3.00 |
| S0040 | Injection, ticarcillin disodium and clavulanate potassium | 6 | $15.56 |
| S0081 | Injection, piperacillin sodium, 500 mg | 5 | $4.25 |
| S0092 | Injection, hydromorphone hydrochloride, 250 mg | 5 | $96.06 |
| 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 | 12 | $1,113.42 |
| 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 | 21 | $68.33 |
| S0191 | Misoprostol, oral, 200 mcg | 21 | $0.98 |
| S0197 | Prenatal vitamins, 30-day supply | 5 | $5.00 |
| S0199 | Medically induced abortion by oral ingestion of medication... | 19 | $356.04 |
| S0265 | Genetic counseling, under physician supervision | 5 | $16.12 |
| S0316 | Disease management program, follow-up/reassessment | 5 | $42.79 |
| S0390 | Routine foot care; removal and/or trimming of corns | 5 | $22.08 |
| 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... | 12 | $84.99 |
| S4005 | Interim labor facility global | 11 | $400.00 |
| S4989 | Contraceptive intrauterine device (e.g., progestacert iud) | 10 | $121.99 |
| S5145 | Foster care, therapeutic, child; per diem | 16 | $177.45 |
| S5517 | Home infusion therapy | 5 | $13.95 |
| S5520 | Home infusion therapy, all supplies | 8 | $87.50 |
| 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 | 7 | $27.22 |
| S8100 | Holding chamber or spacer for use with an inhaler or... | 8 | $27.03 |
| S8101 | Holding chamber or spacer for use with an inhaler or... | 11 | $28.03 |
| S8185 | Flutter device | 15 | $42.23 |
| S8186 | Swivel adapter | 9 | $3.50 |
| S8189 | Tracheostomy supply, not otherwise classified | 7 | $6.00 |
| 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 | 6 | $51.57 |
| S9342 | Home therapy; enteral nutrition via pump | 5 | $14.84 |
| S9357 | Home infusion therapy | 7 | $73.22 |
| S9364 | Home infusion therapy, total parenteral nutrition (tpn) | 7 | $100.00 |
| S9370 | Home therapy, intermittent anti-emetic injection therapy | 6 | $26.00 |
| S9373 | Home infusion therapy, hydration therapy | 8 | $36.27 |
| S9442 | Birthing classes, non-physician provider, per session | 5 | $34.84 |
| S9443 | Lactation classes, non-physician provider, per session | 19 | $51.95 |
| S9444 | Parenting classes, non-physician provider, per session | 6 | $31.65 |
| S9453 | Smoking cessation classes, non-physician provider | 5 | $20.00 |
| S9475 | Ambulatory setting substance abuse treatment or... | 5 | $371.40 |
| S9480 | Intensive outpatient psychiatric services, per diem | 23 | $152.29 |
| S9562 | Home injectable therapy | 5 | $68.34 |
| T1006 | Alcohol and/or substance abuse services | 11 | $38.26 |
| T1018 | School-based individualized education program | 5 | $92.97 |
| T1024 | Evaluation and treatment by an integrated | 18 | $89.27 |
| T1032 | Services performed by a doula birth worker, per 15 minutes | 14 | $16.45 |
| T1033 | Services performed by a doula birth worker, per diem | 17 | $750.00 |
| T2045 | Hospice general inpatient care; per diem | 7 | $1,194.29 |
| T4523 | Adult sized disposable incontinence product, brief/diaper | 44 | $0.80 |
| T4533 | Youth sized disposable incontinence product, brief/diaper | 41 | $0.60 |
| T4544 | Adult sized disposable incontinence product | 34 | $1.35 |
| U0002 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19) | 46 | $50.03 |
| U0005 | Infectious agent detection by nucleic acid (dna or rna) | 8 | $25.00 |
About this line
What the physician & professional line covers
The physician & professional line groups the codes billed mostly by physicians, nurse practitioners, physician assistants and other licensed practitioners. Across the 51 state programs we cover, 8,075 codes in this line have a published fee-for-service rate in five or more states. By code set, the line is made up of 5,978 CPT surgery codes, 982 CPT medicine codes, 278 CPT anesthesia codes and 245 HCPCS Level II temporary codes and a few others.
How to read the index
- Code opens the code's page: every state's rate ranked, the unit, a per-hour figure for timed codes, the managed-care rule and a Medicare comparison where the units match.
- States is the number of state Medicaid programs that publish a fee-for-service rate for the code. A higher count makes the median more representative.
- Median rate is the middle published amount across those states, in the units they use. When states publish a code in different units, the median mixes them, so open the code before relying on it.
Why physician & professional rates differ between states
- Each state sets its own physician conversion factor or fee for every code, and many update them on a state budget cycle rather than on Medicare's calendar.
- Some states pay physician services as a percentage of the Medicare fee schedule; others keep a schedule of their own that may not have been rebased for years.
- Many schedules pay differently by place of service (office versus facility) and by practitioner, and nurse practitioners and physician assistants are often paid a percentage of the physician amount.
- Primary-care and pediatric add-ons, enhanced rates for certain specialties and targeted increases for access problems change individual codes without moving the rest of the schedule.
Billing and units
Physician-fee-schedule codes are billed per service: one unit is one occurrence unless the code itself is defined by time or quantity. Where a state publishes separate facility and non-facility amounts, the non-facility (office) amount is usually higher because the practice carries the overhead. Practitioners who are not physicians are often paid a reduced percentage of the published amount, so check the schedule for the reduction that applies to your provider type.
FAQ
Frequently asked questions
How many physician & professional codes have Medicaid rates here?
8,075 codes with a published fee-for-service rate in at least five state Medicaid programs, 6,282 of them in 40 or more states. The typical code in this line is published by 49 states.
Which physician & professional codes are published by the most states?
10005 (50 states), 10006 (50 states), 10007 (50 states), 10008 (50 states) and 10009 (50 states).
Can I compare the median rates in this list?
Only with care. Each median is taken across the states that publish the code, in the units they publish it in. Open a code to see the unit each state uses and whether the code is ranked like-for-like.
How are physician & professional services billed?
Physician-fee-schedule codes are billed per service: one unit is one occurrence unless the code itself is defined by time or quantity. Where a state publishes separate facility and non-facility amounts, the non-facility (office) amount is usually higher because the practice carries the overhead. Practitioners who are not physicians are often paid a reduced percentage of the published amount, so check the schedule for the reduction that applies to your provider type.
Where do these rates come from?
From each state's official Medicaid fee schedules, rate notices and provider bulletins. Every rate on a code page links to its source document and effective date.
MedicaidRate workspacePhysician & professional rates in your statesRates, managed-care rules, Medicare comparison and changes, for the codes you bill.