2018 Workers' Compensation Part B Fee Schedule

26567-27178

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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)
26567   1 90 2 0 100159 0
26567   2 90 2 0 98739 0
26567   3 90 2 0 92885 0
26567   4 90 2 0 91823 0
26568   1 90 2 0 158458 0
26568   2 90 2 0 147645 0
26568   3 90 2 0 146423 0
26568   4 90 2 0 144648 0
26580   1 90 2 0 314233 0
26580   2 90 2 0 304709 0
26580   3 90 2 0 284593 0
26580   4 90 2 0 280676 0
26587   1 90 2 0 126228 0
26587   2 90 2 0 124283 0
26587   3 90 2 0 116268 0
26587   4 90 2 0 114935 0
26590   1 90 2 0 92165 0
26590   2 90 2 0 90778 0
26590   3 90 2 0 85052 0
26590   4 90 2 0 84039 0
26591   1 90 2 0 48922 0
26591   2 90 2 0 48169 0
26591   3 90 2 0 45050 0
26591   4 90 2 0 44529 0
26593   1 90 2 0 85320 0
26593   2 90 2 0 83967 0
26593   3 90 2 0 78403 0
26593   4 90 2 0 77487 0
26596   1 90 2 0 160246 0
26596   2 90 2 0 157660 0
26596   3 90 2 0 146988 0
26596   4 90 2 0 145239 0
26600   1 90 2 0 31181 24657
26600   2 90 2 0 30722 24277
26600   3 90 2 0 29279 23103
26600   4 90 2 0 28472 22492
26605   1 90 2 0 43314 0
26605   2 90 2 0 45730 0
26605   3 90 2 0 42700 0
26605   4 90 2 0 42438 0
26607   1 90 2 0 80806 0
26607   2 90 2 0 79629 0
26607   3 90 2 0 74771 0
26607   4 90 2 0 73915 0
26608   1 90 2 0 80806 0
26608   2 90 2 0 79629 0
26608   3 90 2 0 74771 0
26608   4 90 2 0 73915 0
26615   1 90 2 0 95383 0
26615   2 90 2 0 93845 0
26615   3 90 2 0 87505 0
26615   4 90 2 0 86463 0
26641   1 90 2 0 42791 0
26641   2 90 2 0 33293 0
26641   3 90 2 0 40563 0
26641   4 90 2 0 31611 0
26645   1 90 2 0 58610 0
26645   2 90 2 0 53497 0
26645   3 90 2 0 54753 0
26645   4 90 2 0 54139 0
26650   1 90 2 0 91120 0
26650   2 90 2 0 91430 0
26650   3 90 2 0 81932 0
26650   4 90 2 0 86254 0
26665   1 90 2 0 128550 0
26665   2 90 2 0 137864 0
26665   3 90 2 0 134283 0
26665   4 90 2 0 130646 0
26670   1 90 2 0 39351 0
26670   2 90 2 0 36954 0
26670   3 90 2 0 37444 0
26670   4 90 2 0 32514 0
26675   1 90 2 0 82110 0
26675   2 90 2 0 63509 0
26675   3 90 2 0 75652 0
26675   4 90 2 0 74737 0
26676   1 90 2 0 94557 0
26676   2 90 2 0 93140 0
26676   3 90 2 0 87256 0
26676   4 90 2 0 86213 0
26685   1 90 2 0 115784 0
26685   2 90 2 0 113986 0
26685   3 90 2 0 106536 0
26685   4 90 2 0 105278 0
26686   1 90 2 0 130083 0
26686   2 90 2 0 128054 0
26686   3 90 2 0 119675 0
26686   4 90 2 0 118270 0
26700   1 90 2 0 27868 0
26700   2 90 2 0 32952 0
26700   3 90 2 0 28428 0
26700   4 90 2 0 26583 0
26705   1 90 2 0 50259 0
26705   2 90 2 0 49519 0
26705   3 90 2 0 48376 0
26705   4 90 2 0 48420 0
26706   1 90 2 0 90898 0
26706   2 90 2 0 89438 0
26706   3 90 2 0 83422 0
26706   4 90 2 0 82428 0
26715   1 90 2 0 89911 0
26715   2 90 2 0 88567 0
26715   3 90 2 0 83025 0
26715   4 90 2 0 82068 0
26720   1 90 2 0 24429 19787
26720   2 90 2 0 24093 19509
26720   3 90 2 0 22704 18377
26720   4 90 2 0 22441 18185
26725   1 90 2 0 38962 0
26725   2 90 2 0 39064 0
26725   3 90 2 0 36617 0
26725   4 90 2 0 36959 0
26727   1 90 2 0 82881 0
26727   2 90 2 0 82516 0
26727   3 90 2 0 62786 0
26727   4 90 2 0 72826 0
26735   1 90 2 0 90490 0
26735   2 90 2 0 86582 0
26735   3 90 2 0 81374 0
26735   4 90 2 0 83901 0
26740   1 90 2 0 21317 0
26740   2 90 2 0 21142 0
26740   3 90 2 0 25283 0
26740   4 90 2 0 20017 0
26742   1 90 2 0 47162 0
26742   2 90 2 0 46638 0
26742   3 90 2 0 42673 0
26742   4 90 2 0 44465 0
26746   1 90 2 0 97479 0
26746   2 90 2 0 98692 0
26746   3 90 2 0 91724 0
26746   4 90 2 0 92907 0
26750   1 90 2 0 21865 0
26750   2 90 2 0 21603 0
26750   3 90 2 0 20519 0
26750   4 90 2 0 20287 0
26755   1 90 2 0 35470 0
26755   2 90 2 0 31951 0
26755   3 90 2 0 30645 0
26755   4 90 2 0 30855 0
26756   1 90 2 0 55769 0
26756   2 90 2 0 55046 0
26756   3 90 2 0 52087 0
26756   4 90 2 0 51513 0
26765   1 90 2 0 78008 0
26765   2 90 2 0 73684 0
26765   3 90 2 0 57765 0
26765   4 90 2 0 66308 0
26770   1 90 2 0 28905 0
26770   2 90 2 0 30152 0
26770   3 90 2 0 27147 0
26770   4 90 2 0 26149 0
26775   1 90 2 0 33360 0
26775   2 90 2 0 39837 0
26775   3 90 2 0 32030 0
26775   4 90 2 0 38684 0
26776   1 90 2 0 60961 0
26776   2 90 2 0 58249 0
26776   3 90 2 0 56977 0
26776   4 90 2 0 56355 0
26785   1 90 2 0 65930 0
26785   2 90 2 0 64958 0
26785   3 90 2 0 60911 0
26785   4 90 2 0 60208 0
26820   1 90 2 0 136153 0
26820   2 90 2 0 134061 0
26820   3 90 2 0 125414 0
26820   4 90 2 0 123936 0
26841   1 90 2 0 122628 0
26841   2 90 2 0 120685 0
26841   3 90 2 0 115619 0
26841   4 90 2 0 115060 0
26842   1 90 2 0 156025 0
26842   2 90 2 0 153422 0
26842   3 90 2 0 142651 0
26842   4 90 2 0 140926 0
26843   1 90 2 0 129094 0
26843   2 90 2 0 127014 0
26843   3 90 2 0 118443 0
26843   4 90 2 0 117048 0
26844   1 90 2 0 147234 0
26844   2 90 2 0 144916 0
26844   3 90 2 0 135339 0
26844   4 90 2 0 133738 0
26850   1 90 2 0 108595 0
26850   2 90 2 0 107527 0
26850   3 90 2 0 101306 0
26850   4 90 2 0 95559 0
26852   1 90 2 0 128737 0
26852   2 90 2 0 123509 0
26852   3 90 2 0 118736 0
26852   4 90 2 0 117370 0
26860   1 90 2 0 87313 0
26860   2 90 2 0 81890 0
26860   3 90 2 0 82006 0
26860   4 90 2 0 82294 0
26861   1 ZZZ 0 0 40817 0
26861   2 ZZZ 0 0 59266 0
26861   3 ZZZ 0 0 57948 0
26861   4 ZZZ 0 0 36521 0
26862   1 90 2 0 149410 0
26862   2 90 2 0 112726 0
26862   3 90 2 0 121772 0
26862   4 90 2 0 104456 0
26863   1 ZZZ 0 0 68931 0
26863   2 ZZZ 0 0 67832 0
26863   3 ZZZ 0 0 63298 0
26863   4 ZZZ 0 0 62559 0
26910   1 90 2 0 118589 0
26910   2 90 2 0 117835 0
26910   3 90 2 0 114132 0
26910   4 90 2 0 114228 0
26951   1 90 2 0 69327 0
26951   2 90 2 0 66990 0
26951   3 90 2 0 62896 0
26951   4 90 2 0 62179 0
26952   1 90 2 0 113313 0
26952   2 90 2 0 112729 0
26952   3 90 2 0 110344 0
26952   4 90 2 0 109930 0
26989     YYY 2 0 0 0
26990   1 90 2 0 73518 0
26990   2 90 2 0 73114 0
26990   3 90 2 0 70531 0
26990   4 90 2 0 67055 0
26991   1 90 2 0 42684 0
26991   2 90 2 0 49381 0
26991   3 90 2 0 47577 0
26991   4 90 2 0 65625 0
26992   1 90 2 0 164976 0
26992   2 90 2 0 163614 0
26992   3 90 2 0 156166 0
26992   4 90 2 0 148287 0
27000   1 90 2 0 63318 0
27000   2 90 2 0 62631 0
27000   3 90 2 0 59814 0
27000   4 90 2 0 59166 0
27001   1 90 2 0 89875 0
27001   2 90 2 0 82741 0
27001   3 90 2 0 80407 0
27001   4 90 2 0 79244 0
27003   1 90 2 0 126566 0
27003   2 90 2 0 124432 0
27003   3 90 2 0 115870 0
27003   4 90 2 0 114478 0
27005   1 90 2 0 111716 0
27005   2 90 2 0 110392 0
27005   3 90 2 0 104950 0
27005   4 90 2 0 103829 0
27006   1 90 2 0 129642 0
27006   2 90 2 0 127939 0
27006   3 90 2 0 120948 0
27006   4 90 2 0 119613 0
27025   1 90 2 0 150910 0
27025   2 90 2 0 148786 0
27025   3 90 2 0 151735 0
27025   4 90 2 0 138459 0
27027   1 90 2 0 122204 0
27027   2 90 2 0 109610 0
27027   3 90 2 0 109610 0
27027   4 90 2 0 109610 0
27030   1 90 2 0 234252 0
27030   2 90 2 0 232757 0
27030   3 90 2 0 204584 0
27030   4 90 2 0 202146 0
27033   1 90 2 0 235606 0
27033   2 90 2 0 234093 0
27033   3 90 2 0 207711 0
27033   4 90 2 0 226820 0
27035   1 90 2 0 261834 0
27035   2 90 2 0 257700 0
27035   3 90 2 0 240662 0
27035   4 90 2 0 237899 0
27036   1 90 2 0 225949 0
27036   2 90 2 0 202150 0
27036   3 90 2 0 196722 0
27036   4 90 2 0 196722 0
27040   1 10 2 0 24258 0
27040   2 10 2 0 25068 0
27040   3 10 2 0 23430 0
27040   4 10 2 0 22902 0
27041   1 90 2 0 68011 0
27041   2 90 2 0 67723 0
27041   3 90 2 0 63769 0
27041   4 90 2 0 63207 0
27043   1 90 2 0 68648 0
27043   2 90 2 0 61112 0
27043   3 90 2 0 61112 0
27043   4 90 2 0 61112 0
27045   1 90 2 0 108995 0
27045   2 90 2 0 97157 0
27045   3 90 2 0 97157 0
27045   4 90 2 0 97157 0
27047   1 90 2 0 66390 0
27047   2 90 2 0 63942 0
27047   3 90 2 0 60299 0
27047   4 90 2 0 75496 0
27048   1 90 2 0 71850 0
27048   2 90 2 0 70959 0
27048   3 90 2 0 87676 0
27048   4 90 2 0 66892 0
27049   1 90 2 0 172818 0
27049   2 90 2 0 170828 0
27049   3 90 2 0 198101 0
27049   4 90 2 0 195804 0
27050   1 90 2 0 87376 0
27050   2 90 2 0 85786 0
27050   3 90 2 0 79184 0
27050   4 90 2 0 78211 0
27052   1 90 2 0 181751 0
27052   2 90 2 0 176584 0
27052   3 90 2 0 128407 0
27052   4 90 2 0 126807 0
27054   1 90 2 0 266594 0
27054   2 90 2 0 250772 0
27054   3 90 2 0 232620 0
27054   4 90 2 0 175931 0
27057   1 90 2 0 132812 0
27057   2 90 2 0 120418 0
27057   3 90 2 0 120418 0
27057   4 90 2 0 120418 0
27059   1 90 2 0 266806 0
27059   2 90 2 0 238995 0
27059   3 90 2 0 238995 0
27059   4 90 2 0 238995 0
27060   1 90 2 0 82048 0
27060   2 90 2 0 78013 0
27060   3 90 2 0 75382 0
27060   4 90 2 0 74507 0
27062   1 90 2 0 84980 0
27062   2 90 2 0 83627 0
27062   3 90 2 0 78047 0
27062   4 90 2 0 77125 0
27065   1 90 2 0 101101 0
27065   2 90 2 0 121888 0
27065   3 90 2 0 102832 0
27065   4 90 2 0 91263 0
27066   1 90 2 0 166290 0
27066   2 90 2 0 164219 0
27066   3 90 2 0 148228 0
27066   4 90 2 0 157603 0
27067   1 90 2 0 230299 0
27067   2 90 2 0 227765 0
27067   3 90 2 0 211334 0
27067   4 90 2 0 208833 0
27070   1 90 2 0 159374 0
27070   2 90 2 0 151684 0
27070   3 90 2 0 147011 0
27070   4 90 2 0 145302 0
27071   1 90 2 0 177216 0
27071   2 90 2 0 179380 0
27071   3 90 2 0 161890 0
27071   4 90 2 0 160998 0
27075   1 90 2 0 278766 0
27075   2 90 2 0 274332 0
27075   3 90 2 0 256026 0
27075   4 90 2 0 253029 0
27076   1 90 2 0 323983 0
27076   2 90 2 0 318869 0
27076   3 90 2 0 297740 0
27076   4 90 2 0 294209 0
27077   1 90 2 0 382714 0
27077   2 90 2 0 376561 0
27077   3 90 2 0 351142 0
27077   4 90 2 0 347010 0
27078   1 90 2 0 254378 0
27078   2 90 2 0 208902 0
27078   3 90 2 0 183624 0
27078   4 90 2 0 181504 0
27080   1 90 2 0 99293 0
27080   2 90 2 0 97674 0
27080   3 90 2 0 91025 0
27080   4 90 2 0 89968 0
27086   1 10 2 0 21231 0
27086   2 10 2 0 18391 0
27086   3 10 2 0 18372 0
27086   4 10 2 0 17756 0
27087   1 90 2 0 91833 0
27087   2 90 2 0 91059 0
27087   3 90 2 0 87846 0
27087   4 90 2 0 98191 0
27090   1 90 2 0 197341 0
27090   2 90 2 0 194387 0
27090   3 90 2 0 182191 0
27090   4 90 2 0 180082 0
27091   1 90 2 0 498773 0
27091   2 90 2 0 494234 0
27091   3 90 2 0 407129 0
27091   4 90 2 0 431093 0
27093   1 0 2 0 18496 0
27093   2 0 2 0 18739 0
27093   3 0 2 0 17123 0
27093   4 0 2 0 17797 0
27095   1 0 2 0 20821 0
27095   2 0 2 0 20544 0
27095   3 0 2 0 19311 0
27095   4 0 2 0 19179 0
27096   1 0 2 0 83816 11288
27096   2 0 2 0 72275 10272
27096   3 0 2 0 72275 10272
27096   4 0 2 0 72275 10272
27097   1 90 2 0 149889 0
27097   2 90 2 0 147470 0
27097   3 90 2 0 137493 0
27097   4 90 2 0 135854 0
27098   1 90 2 0 149889 0
27098   2 90 2 0 147470 0
27098   3 90 2 0 137493 0
27098   4 90 2 0 135854 0
27100   1 90 2 0 186554 0
27100   2 90 2 0 170206 0
27100   3 90 2 0 187243 0
27100   4 90 2 0 157285 0
27105   1 90 2 0 162841 0
27105   2 90 2 0 160367 0
27105   3 90 2 0 150185 0
27105   4 90 2 0 148553 0
27110   1 90 2 0 219532 0
27110   2 90 2 0 242659 0
27110   3 90 2 0 206174 0
27110   4 90 2 0 199163 0
27111   1 90 2 0 216590 0
27111   2 90 2 0 241473 0
27111   3 90 2 0 199232 0
27111   4 90 2 0 196819 0
27120   1 90 2 0 336071 0
27120   2 90 2 0 334139 0
27120   3 90 2 0 301812 0
27120   4 90 2 0 309449 0
27122   1 90 2 0 326611 0
27122   2 90 2 0 316258 0
27122   3 90 2 0 290127 0
27122   4 90 2 0 290847 0
27125   1 90 2 0 315794 0
27125   2 90 2 0 310767 0
27125   3 90 2 0 290002 0
27125   4 90 2 0 285720 0
27130   1 90 2 0 479840 0
27130   2 90 2 0 471216 0
27130   3 90 2 0 442847 0
27130   4 90 2 0 432947 0
27132   1 90 2 0 493267 0
27132   2 90 2 0 523287 0
27132   3 90 2 0 489009 0
27132   4 90 2 0 441621 0
27134   1 90 2 0 607625 0
27134   2 90 2 0 611198 0
27134   3 90 2 0 575897 0
27134   4 90 2 0 562816 0
27137   1 90 2 0 488286 0
27137   2 90 2 0 483952 0
27137   3 90 2 0 454686 0
27137   4 90 2 0 451650 0
27138   1 90 2 0 430697 0
27138   2 90 2 0 425453 0
27138   3 90 2 0 395564 0
27138   4 90 2 0 392476 0
27140   1 90 2 0 212343 0
27140   2 90 2 0 196126 0
27140   3 90 2 0 172907 0
27140   4 90 2 0 192708 0
27146   1 90 2 0 225511 0
27146   2 90 2 0 222383 0
27146   3 90 2 0 209457 0
27146   4 90 2 0 206976 0
27147   1 90 2 0 328080 0
27147   2 90 2 0 319379 0
27147   3 90 2 0 300876 0
27147   4 90 2 0 297289 0
27151   1 90 2 0 344597 0
27151   2 90 2 0 339032 0
27151   3 90 2 0 316068 0
27151   4 90 2 0 312299 0
27156   1 90 2 0 365308 0
27156   2 90 2 0 359444 0
27156   3 90 2 0 335196 0
27156   4 90 2 0 331239 0
27158   1 90 2 0 309306 0
27158   2 90 2 0 304369 0
27158   3 90 2 0 284005 0
27158   4 90 2 0 280722 0
27161   1 90 2 0 279637 0
27161   2 90 2 0 275161 0
27161   3 90 2 0 256670 0
27161   4 90 2 0 253617 0
27165   1 90 2 0 312942 0
27165   2 90 2 0 307854 0
27165   3 90 2 0 286813 0
27165   4 90 2 0 283358 0
27170   1 90 2 0 331558 0
27170   2 90 2 0 323761 0
27170   3 90 2 0 301632 0
27170   4 90 2 0 305163 0
27175   1 90 2 0 73513 0
27175   2 90 2 0 72854 0
27175   3 90 2 0 70180 0
27175   4 90 2 0 69480 0
27176   1 90 2 0 202086 0
27176   2 90 2 0 198827 0
27176   3 90 2 0 185347 0
27176   4 90 2 0 183141 0
27177   1 90 2 0 247735 0
27177   2 90 2 0 287934 0
27177   3 90 2 0 227489 0
27177   4 90 2 0 224804 0
27178   1 90 2 0 199663 0
27178   2 90 2 0 196542 0
27178   3 90 2 0 183615 0
27178   4 90 2 0 181410 0