2018 Workers' Compensation Part B Fee Schedule

15570-19101

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CPT/HCPC Code
Modifier
Medicare Location
Global Surgery Indicator
Multiple Surgery Indicator
Prevailing Charge Amount
Fee Schedule Amount
Site of Service Amount
Implied Decimal 2 (in dollars)
15570   1 90 2 0 272128 0
15570   2 90 2 0 326107 0
15570   3 90 2 0 223639 0
15570   4 90 2 0 117492 0
15572   1 90 2 0 294723 0
15572   2 90 2 0 300130 0
15572   3 90 2 0 279041 0
15572   4 90 2 0 328310 0
15574   1 90 2 0 252213 0
15574   2 90 2 0 259549 0
15574   3 90 2 0 221737 0
15574   4 90 2 0 260549 0
15576   1 90 2 0 268664 0
15576   2 90 2 0 313654 0
15576   3 90 2 0 270636 0
15576   4 90 2 0 267108 0
15600   1 90 2 0 60598 0
15600   2 90 2 0 84487 0
15600   3 90 2 0 53645 0
15600   4 90 2 0 100419 0
15610   1 90 2 0 88361 0
15610   2 90 2 0 59069 0
15610   3 90 2 0 88524 0
15610   4 90 2 0 53200 0
15620   1 90 2 0 113389 0
15620   2 90 2 0 118479 0
15620   3 90 2 0 65347 0
15620   4 90 2 0 64530 0
15630   1 90 2 0 127207 0
15630   2 90 2 0 126557 0
15630   3 90 2 0 123894 0
15630   4 90 2 0 69813 0
15650   1 90 2 0 85669 0
15650   2 90 2 0 95781 0
15650   3 90 2 0 94705 0
15650   4 90 2 0 76490 0
15730   1 90 2 0 192686 114831
15730   2 90 2 0 172132 104281
15730   3 90 2 0 172132 104281
15730   4 90 2 0 172132 104281
15731   1 90 2 0 150108 134905
15731   2 90 2 0 131465 119037
15731   3 90 2 0 131465 119037
15731   4 90 2 0 131465 119037
15733   1 90 2 0 131150 0
15733   2 90 2 0 119164 0
15733   3 90 2 0 119164 0
15733   4 90 2 0 119164 0
15734   1 90 2 0 456392 0
15734   2 90 2 0 458090 0
15734   3 90 2 0 453198 0
15734   4 90 2 0 451602 0
15736   1 90 2 0 379735 0
15736   2 90 2 0 377286 0
15736   3 90 2 0 277907 0
15736   4 90 2 0 274594 0
15738   1 90 2 0 428725 0
15738   2 90 2 0 432063 0
15738   3 90 2 0 423027 0
15738   4 90 2 0 228118 0
15740   1 90 2 0 303624 0
15740   2 90 2 0 291098 0
15740   3 90 2 0 296909 0
15740   4 90 2 0 170824 0
15750   1 90 2 0 217189 0
15750   2 90 2 0 213465 0
15750   3 90 2 0 198076 0
15750   4 90 2 0 195686 0
15756   1 90 2 0 612467 0
15756   2 90 2 0 547784 0
15756   3 90 2 0 533058 0
15756   4 90 2 0 533058 0
15757   1 90 2 0 612467 0
15757   2 90 2 0 547784 0
15757   3 90 2 0 533058 0
15757   4 90 2 0 533058 0
15758   1 90 2 0 612467 0
15758   2 90 2 0 547784 0
15758   3 90 2 0 533058 0
15758   4 90 2 0 533058 0
15760   1 90 2 0 191843 0
15760   2 90 2 0 190902 0
15760   3 90 2 0 187017 0
15760   4 90 2 0 132948 0
15770   1 90 2 0 133363 0
15770   2 90 2 0 131326 0
15770   3 90 2 0 122874 0
15770   4 90 2 0 121368 0
15775     0 2 0 0 0
15776     0 2 0 0 0
15777   1 ZZZ 0 0 30766 0
15777   2 ZZZ 0 0 27614 0
15777   3 ZZZ 0 0 27614 0
15777   4 ZZZ 0 0 27614 0
15780   1 90 2 0 71534 0
15780   2 90 2 0 70906 0
15780   3 90 2 0 151506 0
15780   4 90 2 0 67647 0
15781   1 90 2 0 80596 0
15781   2 90 2 0 75363 0
15781   3 90 2 0 79009 0
15781   4 90 2 0 70354 0
15782   1 90 2 0 47180 0
15782   2 90 2 0 46725 0
15782   3 90 2 0 44847 0
15782   4 90 2 0 72959 0
15783   1 90 2 0 66807 0
15783   2 90 2 0 52720 0
15783   3 90 2 0 50313 0
15783   4 90 2 0 49755 0
15786   1 10 2 0 22770 0
15786   2 10 2 0 22551 0
15786   3 10 2 0 21635 0
15786   4 10 2 0 21405 0
15787   1 ZZZ 0 0 5068 0
15787   2 ZZZ 0 0 5004 0
15787   3 ZZZ 0 0 4717 0
15787   4 ZZZ 0 0 4661 0
15788     90 2 0 0 0
15789     90 2 0 0 0
15792     90 2 0 0 0
15793     90 2 0 0 0
15819   1 90 2 0 154099 0
15819   2 90 2 0 151968 0
15819   3 90 2 0 143154 0
15819   4 90 2 0 141420 0
15820   1 90 2 0 102035 0
15820   2 90 2 0 100513 0
15820   3 90 2 0 94186 0
15820   4 90 2 0 92989 0
15821   1 90 2 0 116856 0
15821   2 90 2 0 115149 0
15821   3 90 2 0 108034 0
15821   4 90 2 0 106643 0
15822   1 90 2 0 97999 0
15822   2 90 2 0 163216 0
15822   3 90 2 0 137569 0
15822   4 90 2 0 145569 0
15823   1 90 2 0 171588 0
15823   2 90 2 0 168878 0
15823   3 90 2 0 161302 0
15823   4 90 2 0 157246 0
15824     XXX 2 0 0 0
15825     XXX 2 0 0 0
15826     XXX 2 0 0 0
15828     XXX 2 0 0 0
15829     XXX 2 0 0 0
15830   1 90 2 0 164021 0
15830   2 90 2 0 142154 0
15830   3 90 2 0 142154 0
15830   4 90 2 0 142154 0
15832     90 2 0 0 0
15833     90 2 0 0 0
15834     90 2 0 0 0
15835     90 2 0 0 0
15836     90 2 0 0 0
15837     90 2 0 0 0
15838     90 2 0 0 0
15839     90 2 0 0 0
15840   1 90 2 0 264784 0
15840   2 90 2 0 260352 0
15840   3 90 2 0 241977 0
15840   4 90 2 0 238985 0
15841   1 90 2 0 360624 0
15841   2 90 2 0 355144 0
15841   3 90 2 0 332494 0
15841   4 90 2 0 328625 0
15842   1 90 2 0 584426 0
15842   2 90 2 0 576975 0
15842   3 90 2 0 546068 0
15842   4 90 2 0 539494 0
15845   1 90 2 0 265850 0
15845   2 90 2 0 261182 0
15845   3 90 2 0 241837 0
15845   4 90 2 0 238855 0
15847     YYY 2 0 0 0
15850     XXX 9 0 0 0
15851     0 2 0 0 0
15852   1 0 2 0 10256 0
15852   2 0 2 0 10169 0
15852   3 0 2 0 9829 0
15852   4 0 2 0 9764 0
15860     0 2 0 0 0
15876     XXX 2 0 0 0
15877     XXX 2 0 0 0
15878     XXX 2 0 0 0
15879     XXX 2 0 0 0
15920   1 90 2 0 95466 0
15920   2 90 2 0 94186 0
15920   3 90 2 0 88935 0
15920   4 90 2 0 87990 0
15922   1 90 2 0 143549 0
15922   2 90 2 0 141332 0
15922   3 90 2 0 132210 0
15922   4 90 2 0 130719 0
15931   1 90 2 0 83958 0
15931   2 90 2 0 100293 0
15931   3 90 2 0 92690 0
15931   4 90 2 0 90289 0
15933   1 90 2 0 157051 0
15933   2 90 2 0 155574 0
15933   3 90 2 0 145545 0
15933   4 90 2 0 143901 0
15934   1 90 2 0 179026 0
15934   2 90 2 0 176241 0
15934   3 90 2 0 164782 0
15934   4 90 2 0 167028 0
15935   1 90 2 0 234950 0
15935   2 90 2 0 230956 0
15935   3 90 2 0 214475 0
15935   4 90 2 0 211997 0
15936   1 90 2 0 209080 0
15936   2 90 2 0 271204 0
15936   3 90 2 0 264988 0
15936   4 90 2 0 188447 0
15937   1 90 2 0 318037 0
15937   2 90 2 0 316108 0
15937   3 90 2 0 308132 0
15937   4 90 2 0 231928 0
15940   1 90 2 0 108795 0
15940   2 90 2 0 107314 0
15940   3 90 2 0 101245 0
15940   4 90 2 0 100155 0
15941   1 90 2 0 153258 0
15941   2 90 2 0 158365 0
15941   3 90 2 0 150377 0
15941   4 90 2 0 148677 0
15944   1 90 2 0 187981 0
15944   2 90 2 0 200851 0
15944   3 90 2 0 195289 0
15944   4 90 2 0 194453 0
15945   1 90 2 0 237597 0
15945   2 90 2 0 236032 0
15945   3 90 2 0 229580 0
15945   4 90 2 0 195603 0
15946   1 90 2 0 350083 0
15946   2 90 2 0 344258 0
15946   3 90 2 0 320247 0
15946   4 90 2 0 316543 0
15950   1 90 2 0 90474 0
15950   2 90 2 0 94493 0
15950   3 90 2 0 90110 0
15950   4 90 2 0 92025 0
15951   1 90 2 0 166243 0
15951   2 90 2 0 163457 0
15951   3 90 2 0 151968 0
15951   4 90 2 0 150233 0
15952   1 90 2 0 167563 0
15952   2 90 2 0 161659 0
15952   3 90 2 0 162048 0
15952   4 90 2 0 149366 0
15953   1 90 2 0 197407 0
15953   2 90 2 0 194100 0
15953   3 90 2 0 199060 0
15953   4 90 2 0 178434 0
15956   1 90 2 0 306987 0
15956   2 90 2 0 301260 0
15956   3 90 2 0 287440 0
15956   4 90 2 0 274265 0
15958   1 90 2 0 316493 0
15958   2 90 2 0 310363 0
15958   3 90 2 0 300789 0
15958   4 90 2 0 281629 0
15999     YYY 2 0 0 0
16000   1 0 2 0 10147 8774
16000   2 0 2 0 10060 8696
16000   3 0 2 0 9551 8308
16000   4 0 2 0 9515 8261
16020   1 0 2 0 9367 8033
16020   2 0 2 0 9268 7954
16020   3 0 2 0 8866 7623
16020   4 0 2 0 8765 7547
16025   1 0 2 0 20058 18169
16025   2 0 2 0 19864 18004
16025   3 0 2 0 19100 17348
16025   4 0 2 0 18903 17175
16030   1 0 2 0 23034 0
16030   2 0 2 0 22797 0
16030   3 0 2 0 21832 0
16030   4 0 2 0 21610 0
16035   1 90 2 0 58572 0
16035   2 90 2 0 57831 0
16035   3 90 2 0 54767 0
16035   4 90 2 0 54178 0
16036   1 ZZZ 0 0 16989 0
16036   2 ZZZ 0 0 15185 0
16036   3 ZZZ 0 0 15185 0
16036   4 ZZZ 0 0 15185 0
17000   1 10 2 0 8027 6290
17000   2 10 2 0 7238 5759
17000   3 10 2 0 7238 5759
17000   4 10 2 0 7238 5759
17003   1 ZZZ 0 0 2236 1701
17003   2 ZZZ 0 0 1998 1539
17003   3 ZZZ 0 0 1998 1539
17003   4 ZZZ 0 0 1998 1539
17004   1 10 2 0 40361 31071
17004   2 10 2 0 36052 28144
17004   3 10 2 0 36052 28144
17004   4 10 2 0 36052 28144
17106   1 90 2 0 57026 0
17106   2 90 2 0 56419 0
17106   3 90 2 0 53937 0
17106   4 90 2 0 53344 0
17107   1 90 2 0 112932 0
17107   2 90 2 0 111714 0
17107   3 90 2 0 106716 0
17107   4 90 2 0 105543 0
17108   1 90 2 0 198652 0
17108   2 90 2 0 196331 0
17108   3 90 2 0 186733 0
17108   4 90 2 0 184509 0
17110   1 10 2 0 8221 6567
17110   2 10 2 0 7440 6033
17110   3 10 2 0 7440 6033
17110   4 10 2 0 7440 6033
17111   1 10 2 0 11988 9507
17111   2 10 2 0 10809 8699
17111   3 10 2 0 10809 8699
17111   4 10 2 0 10809 8699
17250   1 0 2 0 7623 6203
17250   2 0 2 0 7525 6118
17250   3 0 2 0 7121 5794
17250   4 0 2 0 7032 5732
17260   1 10 2 0 23862 0
17260   2 10 2 0 23715 0
17260   3 10 2 0 23191 0
17260   4 10 2 0 23237 0
17261   1 10 2 0 28327 0
17261   2 10 2 0 28392 0
17261   3 10 2 0 27418 0
17261   4 10 2 0 27318 0
17262   1 10 2 0 35455 0
17262   2 10 2 0 34808 0
17262   3 10 2 0 34416 0
17262   4 10 2 0 31340 0
17263   1 10 2 0 41174 0
17263   2 10 2 0 42348 0
17263   3 10 2 0 42107 0
17263   4 10 2 0 38071 0
17264   1 10 2 0 52543 0
17264   2 10 2 0 54053 0
17264   3 10 2 0 51434 0
17264   4 10 2 0 52553 0
17266   1 10 2 0 75830 0
17266   2 10 2 0 75198 0
17266   3 10 2 0 66165 0
17266   4 10 2 0 75196 0
17270   1 10 2 0 29590 0
17270   2 10 2 0 28987 0
17270   3 10 2 0 27819 0
17270   4 10 2 0 28015 0
17271   1 10 2 0 37070 0
17271   2 10 2 0 36277 0
17271   3 10 2 0 35588 0
17271   4 10 2 0 30809 0
17272   1 10 2 0 39860 0
17272   2 10 2 0 39246 0
17272   3 10 2 0 38644 0
17272   4 10 2 0 35302 0
17273   1 10 2 0 41688 0
17273   2 10 2 0 44627 0
17273   3 10 2 0 43985 0
17273   4 10 2 0 41468 0
17274   1 10 2 0 57648 0
17274   2 10 2 0 56649 0
17274   3 10 2 0 55798 0
17274   4 10 2 0 53990 0
17276   1 10 2 0 68711 0
17276   2 10 2 0 67841 0
17276   3 10 2 0 62444 0
17276   4 10 2 0 66055 0
17280   1 10 2 0 33002 0
17280   2 10 2 0 32427 0
17280   3 10 2 0 30016 0
17280   4 10 2 0 30517 0
17281   1 10 2 0 39258 0
17281   2 10 2 0 39338 0
17281   3 10 2 0 38106 0
17281   4 10 2 0 35323 0
17282   1 10 2 0 46972 0
17282   2 10 2 0 46260 0
17282   3 10 2 0 46516 0
17282   4 10 2 0 39254 0
17283   1 10 2 0 50604 0
17283   2 10 2 0 54698 0
17283   3 10 2 0 53996 0
17283   4 10 2 0 48769 0
17284   1 10 2 0 65820 0
17284   2 10 2 0 63265 0
17284   3 10 2 0 57029 0
17284   4 10 2 0 64863 0
17286   1 10 2 0 81530 0
17286   2 10 2 0 80273 0
17286   3 10 2 0 75085 0
17286   4 10 2 0 74186 0
17311   1 0 2 0 95904 50766
17311   2 0 2 0 82798 45904
17311   3 0 2 0 82798 45904
17311   4 0 2 0 82798 45904
17312   1 ZZZ 0 0 58024 27027
17312   2 ZZZ 0 0 49770 24433
17312   3 ZZZ 0 0 49770 24433
17312   4 ZZZ 0 0 49770 24433
17313   1 0 2 0 87635 45519
17313   2 0 2 0 75571 41145
17313   3 0 2 0 75571 41145
17313   4 0 2 0 75571 41145
17314   1 ZZZ 0 0 53739 24990
17314   2 ZZZ 0 0 46093 22595
17314   3 ZZZ 0 0 46093 22595
17314   4 ZZZ 0 0 46093 22595
17315   1 ZZZ 0 0 11260 7060
17315   2 ZZZ 0 0 9826 6392
17315   3 ZZZ 0 0 9826 6392
17315   4 ZZZ 0 0 9826 6392
17340   1 10 2 0 8794 7619
17340   2 10 2 0 8704 7547
17340   3 10 2 0 7686 6706
17340   4 10 2 0 8262 7190
17360   1 10 2 0 12947 11921
17360   2 10 2 0 14279 13169
17360   3 10 2 0 13798 12748
17360   4 10 2 0 13657 12622
17380     XXX 2 0 0 0
17999     YYY 2 0 0 0
19000   1 0 2 0 11600 9942
19000   2 0 2 0 11194 9621
19000   3 0 2 0 11080 9512
19000   4 0 2 0 10817 9281
19001   1 ZZZ 0 0 6162 0
19001   2 ZZZ 0 0 6068 0
19001   3 ZZZ 0 0 5686 0
19001   4 ZZZ 0 0 5629 0
19020   1 90 2 0 43999 0
19020   2 90 2 0 44893 0
19020   3 90 2 0 44102 0
19020   4 90 2 0 37498 0
19030   1 0 2 0 16537 0
19030   2 0 2 0 16378 0
19030   3 0 2 0 15731 0
19030   4 0 2 0 15564 0
19081   1 0 2 0 91324 25376
19081   2 0 2 0 79637 23031
19081   3 0 2 0 79637 23031
19081   4 0 2 0 79637 23031
19082   1 ZZZ 0 0 73438 11883
19082   2 ZZZ 0 0 63765 10929
19082   3 ZZZ 0 0 63765 10929
19082   4 ZZZ 0 0 63765 10929
19083   1 0 2 0 90634 23730
19083   2 0 2 0 78994 21568
19083   3 0 2 0 78994 21568
19083   4 0 2 0 78994 21568
19084   1 ZZZ 0 0 72428 11158
19084   2 ZZZ 0 0 62856 10268
19084   3 ZZZ 0 0 62856 10268
19084   4 ZZZ 0 0 62856 10268
19085   1 0 2 0 137021 27663
19085   2 0 2 0 119039 25173
19085   3 0 2 0 119039 25173
19085   4 0 2 0 119039 25173
19086   1 ZZZ 0 0 108581 11831
19086   2 ZZZ 0 0 94172 11127
19086   3 ZZZ 0 0 94172 11127
19086   4 ZZZ 0 0 94172 11127
19100   1 0 2 0 20939 0
19100   2 0 2 0 22993 0
19100   3 0 2 0 23814 0
19100   4 0 2 0 21000 0
19101   1 10 2 0 53496 0
19101   2 10 2 0 54717 0
19101   3 10 2 0 47795 0
19101   4 10 2 0 47251 0