You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page.
Skip Ribbon Commands
Skip to main content
Turn off Animations
Turn on Animations
An Official
Pennsylvania
Government Website
Translate
DLI
Department of Labor & Industry
I am ...
I am ...
Claimant
Worker
Employer
Researcher
Provider
Services
Services
Unemployment Benefits
Unemployment Tax Services
Workers' Compensation
Disability Determination
Job Search & Career Training
Disability Services
Labor Law Compliance
Occ. & Industrial Safety
Document Downloads
Labor Market & Jobs Data
Divisions
Divisions
Unemployment Compensation
Unemployment Tax Services
Workers' Compensation
PA CareerLink®
PennSERVE
Vocational Rehabilitation
Work Statistics
Labor Law Compliance
Occ. & Industrial Safety
Disability Determinitation
About
About
Contact the Pennsylvania Depar
Equal Opportunity
Guide to Services
Boards
Councils and Committees
Right to Know
Search
Search
Menu
Department of Labor & Industry
Menu
I am ...
I am ...
Claimant
Worker
Employer
Researcher
Provider
Services
Services
Unemployment Benefits
Unemployment Tax Services
Workers' Compensation
Disability Determination
Job Search & Career Training
Disability Services
Labor Law Compliance
Occ. & Industrial Safety
Document Downloads
Labor Market & Jobs Data
Divisions
Divisions
Unemployment Compensation
Unemployment Tax Services
Workers' Compensation
PA CareerLink®
PennSERVE
Vocational Rehabilitation
Work Statistics
Labor Law Compliance
Occ. & Industrial Safety
Disability Determinitation
About
About
Contact the Pennsylvania Depar
Equal Opportunity
Guide to Services
Boards
Councils and Committees
Right to Know
I am a(n)...
Find Services
Bureaus & Offices
Make a Payment
Contact Us
Publications
DLI
>
Businesses
>
Workers' Compensation Services
>
Workers' Compensation
>
Health Care Services Review
>
Medical Fee Review
>
Fee Schedule
>
Fee Schedule 29365-30620
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
29365-30620
View the PDF
CPT/HCPC Code
Modifier
Medicare Location
Global Surgery Indicator
Multiple Surgery Indicator
Prevailing Charge Amount
Fee Schedule Amount
Site of Service Amount
29365
001
0
2
X
311.05
251.04
29365
004
0
2
X
234.48
189.24
29365
002
0
2
X
321.55
259.36
29365
003
0
2
X
244.37
196.88
29405
004
0
2
X
205.65
161.15
29405
001
0
2
X
228.94
179.69
29405
002
0
2
X
232.06
181.58
29405
003
0
2
X
184.60
144.27
29425
001
0
2
X
317.65
247.19
29425
004
0
2
X
272.34
211.64
29425
002
0
2
X
335.69
261.07
29425
003
0
2
X
280.96
218.32
29435
002
0
2
X
446.00
345.40
29435
003
0
2
X
442.56
342.17
29435
004
0
2
X
287.15
222.03
29435
001
0
2
X
444.10
344.40
29440
002
0
2
X
94.04
81.23
29440
003
0
2
X
87.30
75.66
29440
004
0
2
X
91.72
79.52
29440
001
0
2
X
92.58
80.17
29445
001
0
2
X
457.89
X
29445
004
0
2
X
408.93
X
29445
003
0
2
X
414.62
X
29445
002
0
2
X
444.01
X
29450
001
0
2
X
196.33
X
29450
004
0
2
X
150.02
X
29450
002
0
2
X
180.06
X
29450
003
0
2
X
151.64
X
29505
002
0
2
X
151.63
X
29505
003
0
2
X
146.34
X
29505
004
0
2
X
152.53
X
29505
001
0
2
X
161.93
X
29515
001
0
2
X
141.92
115.92
29515
004
0
2
X
130.84
107.11
29515
003
0
2
X
132.35
108.15
29515
002
0
2
X
137.76
112.64
29520
001
0
2
X
103.41
83.92
29520
003
0
2
X
97.17
79.03
29520
002
0
2
X
102.21
83.04
29520
004
0
2
X
96.02
78.19
29530
001
0
2
X
102.33
84.55
29530
004
0
2
X
100.20
83.13
29530
002
0
2
X
104.34
86.14
29530
003
0
2
X
101.41
83.78
29540
003
0
2
X
88.02
72.85
29540
002
0
2
X
92.58
76.54
29540
004
0
2
X
85.95
71.43
29540
001
0
2
X
89.98
74.64
29550
004
0
2
X
70.30
58.43
29550
001
0
2
X
80.14
66.12
29550
002
0
2
X
78.77
64.91
29550
003
0
2
X
81.75
67.65
29580
004
0
2
X
100.61
71.05
29580
001
0
2
X
120.23
85.89
29580
003
0
2
X
103.48
73.07
29580
002
0
2
X
113.67
80.82
29581
001
0
2
X
167.14
61.29
29581
004
0
2
X
145.07
55.81
29581
003
0
2
X
145.07
55.81
29581
002
0
2
X
145.07
55.81
29584
003
0
2
X
109.24
25.42
29584
002
0
2
X
109.24
25.42
29584
001
0
2
X
123.97
26.79
29584
004
0
2
X
109.24
25.42
29700
0
2
X
*
X
29705
0
2
X
*
X
29710
0
2
X
*
X
29720
002
0
2
X
96.70
X
29720
003
0
2
X
99.83
X
29720
004
0
2
X
98.77
X
29720
001
0
2
X
97.59
X
29730
001
0
2
X
116.94
X
29730
003
0
2
X
111.94
X
29730
002
0
2
X
115.69
X
29730
004
0
2
X
109.00
X
29740
004
0
2
X
139.04
X
29740
001
0
2
X
172.95
X
29740
003
0
2
X
163.27
X
29740
002
0
2
X
168.36
X
29750
003
0
2
X
192.09
X
29750
002
0
2
X
201.77
X
29750
004
0
2
X
190.01
X
29750
001
0
2
X
204.16
X
29799
YYY
2
X
#
X
29800
004
90
2
X
1,006.21
X
29800
001
90
2
X
1,093.55
X
29800
002
90
2
X
1,078.86
X
29800
003
90
2
X
1,018.27
X
29804
003
90
2
X
2,393.94
X
29804
002
90
2
X
2,568.69
X
29804
001
90
2
X
2,610.74
X
29804
004
90
2
X
2,362.77
X
29805
004
90
2
X
775.60
X
29805
002
90
2
X
775.60
X
29805
003
90
2
X
775.60
X
29805
001
90
2
X
878.57
X
29806
004
90
3
X
2,153.84
X
29806
001
90
3
X
2,450.41
X
29806
003
90
3
X
2,153.84
X
29806
002
90
3
X
2,153.84
X
29807
001
90
3
X
2,386.87
X
29807
004
90
3
X
2,095.28
X
29807
002
90
3
X
2,095.28
X
29807
003
90
3
X
2,095.28
X
29819
002
90
3
X
2,679.73
X
29819
003
90
3
X
2,520.28
X
29819
004
90
3
X
1,927.95
X
29819
001
90
3
X
2,711.13
X
29820
002
90
3
X
2,042.31
X
29820
003
90
3
X
1,882.21
X
29820
001
90
3
X
2,081.03
X
29820
004
90
3
X
1,859.02
X
29821
001
90
3
X
2,463.10
X
29821
004
90
3
X
2,193.53
X
29821
003
90
3
X
2,221.17
X
29821
002
90
3
X
3,125.67
X
29822
003
90
3
X
1,949.13
X
29822
002
90
3
X
2,112.43
X
29822
001
90
3
X
2,151.93
X
29822
004
90
3
X
1,925.14
X
29823
004
90
3
X
2,613.92
X
29823
002
90
3
X
2,589.13
X
29823
003
90
3
X
2,626.63
X
29823
001
90
3
X
2,640.07
X
29824
002
90
3
X
1,311.17
X
29824
003
90
3
X
1,311.17
X
29824
001
90
3
X
1,494.77
X
29824
004
90
3
X
1,311.17
X
29825
003
90
3
X
2,150.79
X
29825
002
90
3
X
2,338.54
X
29825
004
90
3
X
2,124.16
X
29825
001
90
3
X
2,383.90
X
29826
004
ZZZ
0
X
2,445.82
X
29826
002
ZZZ
0
X
2,815.12
X
29826
003
ZZZ
0
X
2,719.89
X
29826
001
ZZZ
0
X
2,839.93
X
29827
001
90
3
X
2,526.22
X
29827
002
90
3
X
2,232.95
X
29827
003
90
3
X
2,232.95
X
29827
004
90
3
X
2,232.95
X
29828
004
90
3
X
1,480.84
X
29828
001
90
3
X
1,687.31
X
29828
003
90
3
X
1,480.84
X
29828
002
90
3
X
1,480.84
X
29830
001
90
2
X
1,336.55
X
29830
004
90
2
X
1,213.37
X
29830
002
90
2
X
1,315.40
X
29830
003
90
2
X
1,228.00
X
29834
001
90
3
X
1,470.52
X
29834
004
90
3
X
1,796.26
X
29834
003
90
3
X
1,348.61
X
29834
002
90
3
X
1,720.49
X
29835
003
90
3
X
1,391.93
X
29835
002
90
3
X
1,493.24
X
29835
004
90
3
X
1,375.44
X
29835
001
90
3
X
1,517.71
X
29836
001
90
3
X
1,767.02
X
29836
004
90
3
X
1,601.56
X
29836
003
90
3
X
1,620.82
X
29836
002
90
3
X
1,738.52
X
29837
002
90
3
X
1,585.39
X
29837
003
90
3
X
1,937.58
X
29837
001
90
3
X
1,611.50
X
29837
004
90
3
X
1,459.97
X
29838
002
90
3
X
2,144.67
X
29838
003
90
3
X
2,000.43
X
29838
001
90
3
X
1,772.97
X
29838
004
90
3
X
1,607.67
X
29840
004
90
2
X
954.67
X
29840
003
90
2
X
965.64
X
29840
002
90
2
X
1,026.17
X
29840
001
90
2
X
1,040.81
X
29843
004
90
3
X
1,274.43
X
29843
002
90
3
X
1,383.41
X
29843
003
90
3
X
1,289.78
X
29843
001
90
3
X
1,406.01
X
29844
003
90
3
X
1,330.83
X
29844
002
90
3
X
1,427.16
X
29844
004
90
3
X
1,315.10
X
29844
001
90
3
X
1,450.53
X
29845
002
90
3
X
1,732.08
X
29845
003
90
3
X
1,614.63
X
29845
004
90
3
X
1,595.43
X
29845
001
90
3
X
2,033.39
X
29846
004
90
3
X
2,015.42
X
29846
001
90
3
X
2,276.76
X
29846
003
90
3
X
2,040.57
X
29846
002
90
3
X
2,230.78
X
29847
004
90
3
X
1,512.06
X
29847
002
90
3
X
1,636.86
X
29847
003
90
3
X
1,530.51
X
29847
001
90
3
X
1,992.10
X
29848
002
90
2
X
950.93
X
29848
003
90
2
X
886.72
X
29848
004
90
2
X
876.16
X
29848
001
90
2
X
966.43
X
29850
001
90
2
X
2,744.74
X
29850
004
90
2
X
2,630.95
X
29850
003
90
2
X
2,069.54
X
29850
002
90
2
X
2,236.93
X
29851
001
90
2
X
3,012.02
X
29851
003
90
2
X
2,615.33
X
29851
002
90
2
X
2,798.71
X
29851
004
90
2
X
2,886.72
X
29855
002
90
2
X
2,498.22
X
29855
003
90
2
X
2,398.13
X
29855
004
90
2
X
2,375.82
X
29855
001
90
2
X
2,630.47
X
29856
002
90
2
X
2,703.48
X
29856
003
90
2
X
2,801.18
X
29856
001
90
2
X
3,045.90
X
29856
004
90
2
X
2,574.33
X
29860
003
90
2
X
1,206.91
X
29860
002
90
2
X
1,206.91
X
29860
004
90
2
X
1,206.91
X
29860
001
90
2
X
1,351.79
X
29861
001
90
3
X
2,057.62
X
29861
003
90
3
X
1,782.68
X
29861
002
90
3
X
1,782.68
X
29861
004
90
3
X
1,782.68
X
29862
003
90
3
X
1,951.82
X
29862
002
90
3
X
1,951.82
X
29862
004
90
3
X
1,951.82
X
29862
001
90
3
X
2,273.18
X
29863
002
90
3
X
1,789.38
X
29863
003
90
3
X
1,789.38
X
29863
004
90
3
X
1,789.38
X
29863
001
90
3
X
2,056.11
X
29866
001
90
2
X
2,371.27
X
29866
003
90
2
X
2,076.10
X
29866
002
90
2
X
2,076.10
X
29866
004
90
2
X
2,076.10
X
29867
003
90
2
X
2,483.43
X
29867
002
90
2
X
2,483.43
X
29867
004
90
2
X
2,483.43
X
29867
001
90
2
X
2,827.96
X
29868
004
90
2
X
3,365.19
X
29868
003
90
2
X
3,365.19
X
29868
002
90
2
X
3,365.19
X
29868
001
90
2
X
3,843.92
X
29870
004
90
2
X
989.71
X
29870
001
90
2
X
1,023.79
X
29870
003
90
2
X
994.33
X
29870
002
90
2
X
1,081.54
X
29871
001
90
3
X
1,704.81
X
29871
004
90
3
X
1,513.46
X
29871
002
90
3
X
1,564.37
X
29871
003
90
3
X
1,478.44
X
29873
001
90
3
X
1,169.74
X
29873
004
90
3
X
1,027.79
X
29873
002
90
3
X
1,027.79
X
29873
003
90
3
X
1,027.79
X
29874
004
90
3
X
1,913.74
X
29874
002
90
3
X
2,031.23
X
29874
003
90
3
X
1,946.34
X
29874
001
90
3
X
2,072.44
X
29875
001
90
3
X
2,261.68
X
29875
002
90
3
X
2,220.60
X
29875
003
90
3
X
2,060.64
X
29875
004
90
3
X
1,985.89
X
29876
002
90
3
X
2,495.51
X
29876
003
90
3
X
2,325.63
X
29876
004
90
3
X
2,306.55
X
29876
001
90
3
X
2,535.03
X
29877
001
90
3
X
2,381.60
X
29877
004
90
3
X
2,149.49
X
29877
002
90
3
X
2,335.52
X
29877
003
90
3
X
2,154.08
X
29879
004
90
3
X
2,495.51
X
29879
003
90
3
X
2,506.16
X
29879
002
90
3
X
2,682.27
X
29879
001
90
3
X
2,726.81
X
29880
002
90
3
X
2,559.58
X
29880
003
90
3
X
2,355.36
X
29880
001
90
3
X
2,608.87
X
29880
004
90
3
X
2,326.17
X
29881
004
90
3
X
2,129.16
X
29881
002
90
3
X
2,334.74
X
29881
003
90
3
X
2,168.54
X
29881
001
90
3
X
2,374.96
X
29882
002
90
3
X
2,475.39
X
29882
003
90
3
X
2,304.27
X
29882
001
90
3
X
2,514.98
X
29882
004
90
3
X
2,158.51
X
29883
002
90
3
X
3,044.86
X
29883
003
90
3
X
2,793.26
X
29883
004
90
3
X
2,758.46
X
29883
001
90
3
X
3,105.70
X
29884
001
90
3
X
2,502.25
X
29884
004
90
3
X
1,792.18
X
29884
002
90
3
X
2,513.31
X
29884
003
90
3
X
2,327.05
X
29885
001
90
3
X
2,150.10
X
29885
003
90
3
X
1,898.21
X
29885
002
90
3
X
2,036.14
X
29885
004
90
3
X
1,875.60
X
29886
004
90
3
X
1,550.64
X
29886
001
90
3
X
1,711.20
X
29886
002
90
3
X
1,975.04
X
29886
003
90
3
X
1,569.22
X
29887
001
90
3
X
2,376.33
X
29887
002
90
3
X
2,335.23
X
29887
003
90
3
X
2,165.75
X
29887
004
90
3
X
2,139.25
X
29888
004
90
2
X
3,571.88
X
29888
001
90
2
X
3,990.23
X
29888
003
90
2
X
3,616.49
X
29888
002
90
2
X
3,917.49
X
29889
001
90
2
X
2,580.16
X
29889
003
90
2
X
2,366.27
X
29889
002
90
2
X
2,538.41
X
29889
004
90
2
X
2,338.11
X
29891
002
90
2
X
1,671.42
X
29891
003
90
2
X
1,671.42
X
29891
001
90
2
X
1,937.95
X
29891
004
90
2
X
1,671.42
X
29892
004
90
2
X
1,724.78
X
29892
001
90
2
X
1,993.19
X
29892
002
90
2
X
1,724.78
X
29892
003
90
2
X
1,724.78
X
29893
001
90
2
X
1,092.61
X
29893
004
90
2
X
967.79
X
29893
002
90
2
X
967.79
X
29893
003
90
2
X
967.79
X
29894
001
90
2
X
2,070.40
X
29894
004
90
2
X
1,897.58
X
29894
003
90
2
X
1,849.44
X
29894
002
90
2
X
2,169.74
X
29895
002
90
2
X
1,937.97
X
29895
003
90
2
X
1,828.73
X
29895
004
90
2
X
1,769.98
X
29895
001
90
2
X
2,117.11
X
29897
004
90
2
X
2,032.35
X
29897
001
90
2
X
2,135.23
X
29897
003
90
2
X
1,931.14
X
29897
002
90
2
X
2,095.52
X
29898
004
90
2
X
2,188.20
X
29898
001
90
2
X
2,442.93
X
29898
003
90
2
X
2,315.41
X
29898
002
90
2
X
2,398.72
X
29899
001
90
2
X
2,329.10
X
29899
004
90
2
X
2,048.08
X
29899
002
90
2
X
2,048.08
X
29899
003
90
2
X
2,048.08
X
29900
002
90
2
X
930.30
X
29900
003
90
2
X
930.30
X
29900
001
90
2
X
1,060.09
X
29900
004
90
2
X
930.30
X
29901
001
90
2
X
1,169.23
X
29901
004
90
2
X
1,025.94
X
29901
003
90
2
X
1,025.94
X
29901
002
90
2
X
1,025.94
X
29902
001
90
2
X
1,254.87
X
29902
002
90
2
X
1,101.52
X
29902
003
90
2
X
1,101.52
X
29902
004
90
2
X
1,101.52
X
29904
002
90
2
X
992.26
X
29904
003
90
2
X
992.26
X
29904
004
90
2
X
992.26
X
29904
001
90
2
X
1,127.89
X
29905
001
90
2
X
1,215.87
X
29905
003
90
2
X
1,068.68
X
29905
002
90
2
X
1,068.68
X
29905
004
90
2
X
1,068.68
X
29906
002
90
2
X
1,125.51
X
29906
003
90
2
X
1,125.51
X
29906
004
90
2
X
1,125.51
X
29906
001
90
2
X
1,280.69
X
29914
001
90
3
X
1,980.58
X
29914
004
90
3
X
1,783.02
X
29914
003
90
3
X
1,783.02
X
29914
002
90
3
X
1,783.02
X
29915
001
90
3
X
2,017.12
X
29915
003
90
3
X
1,816.54
X
29915
002
90
3
X
1,816.54
X
29915
004
90
3
X
1,816.54
X
29916
002
90
3
X
1,816.54
X
29916
003
90
3
X
1,816.54
X
29916
001
90
3
X
2,017.12
X
29916
004
90
3
X
1,816.54
X
29999
YYY
2
X
#
X
30000
003
10
2
X
252.76
X
30000
002
10
2
X
264.36
X
30000
004
10
2
X
209.32
X
30000
001
10
2
X
223.54
X
30020
004
10
2
X
266.92
X
30020
001
10
2
X
278.17
X
30020
003
10
2
X
261.87
X
30020
002
10
2
X
265.12
X
30100
001
0
2
X
204.16
164.12
30100
004
0
2
X
197.81
158.76
30100
002
0
2
X
203.09
162.76
30100
003
0
2
X
198.71
159.67
30110
004
10
2
X
309.96
245.55
30110
001
10
2
X
336.81
266.57
30110
002
10
2
X
332.35
263.01
30110
003
10
2
X
323.68
256.32
30115
001
90
2
X
737.14
X
30115
003
90
2
X
769.27
X
30115
002
90
2
X
808.77
X
30115
004
90
2
X
625.90
X
30117
003
90
2
X
566.94
X
30117
002
90
2
X
585.08
X
30117
004
90
2
X
548.55
X
30117
001
90
2
X
596.18
X
30118
003
90
2
X
1,893.72
X
30118
002
90
2
X
2,011.07
X
30118
001
90
2
X
2,039.38
X
30118
004
90
2
X
1,968.20
X
30120
004
90
2
X
1,846.02
X
30120
002
90
2
X
1,895.93
X
30120
003
90
2
X
1,852.95
X
30120
001
90
2
X
1,906.33
X
30124
004
90
2
X
586.80
X
30124
003
90
2
X
563.25
X
30124
002
90
2
X
559.04
X
30124
001
90
2
X
500.27
X
30125
004
90
2
X
1,348.39
X
30125
001
90
2
X
1,472.44
X
30125
003
90
2
X
1,600.04
X
30125
002
90
2
X
1,543.15
X
30130
004
90
2
X
519.25
X
30130
002
90
2
X
551.75
X
30130
003
90
2
X
525.20
X
30130
001
90
2
X
558.15
X
30140
002
0
2
X
840.93
X
30140
003
0
2
X
831.73
X
30140
004
0
2
X
817.77
X
30140
001
0
2
X
847.27
X
30150
001
90
2
X
2,820.38
X
30150
004
90
2
X
1,798.80
X
30150
003
90
2
X
2,756.69
X
30150
002
90
2
X
2,808.00
X
30160
004
90
2
X
2,280.71
X
30160
003
90
2
X
2,309.36
X
30160
002
90
2
X
2,455.81
X
30160
001
90
2
X
2,519.36
X
30200
004
0
2
X
114.09
96.98
30200
002
0
2
X
118.53
100.95
30200
003
0
2
X
98.27
83.89
30200
001
0
2
X
120.98
102.62
30210
002
10
2
X
144.23
130.30
30210
003
10
2
X
138.50
125.49
30210
004
10
2
X
137.05
124.23
30210
001
10
2
X
145.58
131.53
30220
001
10
2
X
355.32
X
30220
004
10
2
X
325.55
X
30220
003
10
2
X
329.58
X
30220
002
10
2
X
350.34
X
30300
004
10
2
X
154.54
X
30300
002
10
2
X
166.37
X
30300
001
10
2
X
167.26
X
30300
003
10
2
X
159.19
X
30310
002
10
2
X
405.31
X
30310
003
10
2
X
386.86
X
30310
004
10
2
X
382.13
X
30310
001
10
2
X
415.96
X
30320
001
90
2
X
1,020.91
X
30320
004
90
2
X
937.14
X
30320
003
90
2
X
948.83
X
30320
002
90
2
X
1,007.02
X
30400
001
90
2
X
2,498.62
X
30400
003
90
2
X
2,266.86
X
30400
002
90
2
X
2,425.16
X
30400
004
90
2
X
2,235.03
X
30410
90
2
X
*
X
30420
003
90
2
X
3,899.00
X
30420
002
90
2
X
4,170.68
X
30420
001
90
2
X
4,295.37
X
30420
004
90
2
X
3,843.79
X
30430
001
90
2
X
1,114.30
X
30430
004
90
2
X
1,033.25
X
30430
003
90
2
X
1,045.45
X
30430
002
90
2
X
1,100.93
X
30435
004
90
2
X
1,419.78
X
30435
002
90
2
X
1,527.40
X
30435
003
90
2
X
1,437.22
X
30435
001
90
2
X
1,549.20
X
30450
003
90
2
X
2,309.36
X
30450
002
90
2
X
2,487.14
X
30450
004
90
2
X
2,280.71
X
30450
001
90
2
X
2,529.98
X
30460
001
90
2
X
2,131.91
X
30460
004
90
2
X
1,956.54
X
30460
003
90
2
X
1,980.58
X
30460
002
90
2
X
2,102.45
X
30462
001
90
2
X
4,265.46
X
30462
002
90
2
X
4,206.57
X
30462
003
90
2
X
3,962.21
X
30462
004
90
2
X
3,914.27
X
30465
003
90
2
X
1,830.87
X
30465
002
90
2
X
1,830.87
X
30465
004
90
2
X
1,830.87
X
30465
001
90
2
X
2,040.12
X
30468
001
0
2
X
4,192.45
237.84
30468
004
0
2
X
3,647.08
218.29
30468
003
0
2
X
3,647.08
218.29
30468
002
0
2
X
3,647.08
218.29
30469
004
0
2
X
2,812.90
172.59
30469
003
0
2
X
2,812.90
172.59
30469
002
0
2
X
2,812.90
172.59
30469
001
0
2
X
3,210.19
187.84
30520
002
90
2
X
1,607.60
X
30520
003
90
2
X
1,498.39
X
30520
004
90
2
X
1,479.36
X
30520
001
90
2
X
1,633.85
X
30540
001
90
2
X
1,657.92
X
30540
004
90
2
X
1,522.88
X
30540
003
90
2
X
1,541.60
X
30540
002
90
2
X
1,635.24
X
30545
001
90
2
X
2,531.05
X
30545
004
90
2
X
2,329.17
X
30545
002
90
2
X
2,497.57
X
30545
003
90
2
X
2,358.46
X
30560
004
10
2
X
165.94
X
30560
002
10
2
X
172.53
X
30560
003
10
2
X
167.16
X
30560
001
10
2
X
202.44
X
30580
004
90
2
X
1,368.59
X
30580
001
90
2
X
1,488.22
X
30580
003
90
2
X
1,385.71
X
30580
002
90
2
X
1,468.24
X
30600
003
90
2
X
1,045.45
X
30600
002
90
2
X
1,247.39
X
30600
001
90
2
X
1,114.30
X
30600
004
90
2
X
1,033.25
X
30620
001
90
2
X
1,734.98
X
30620
002
90
2
X
1,706.02
X
30620
003
90
2
X
1,585.74
X
30620
004
90
2
X
1,565.42
X
Return to CPT/HCPC List