2018 Workers' Compensation Part B Fee Schedule

45332-47130

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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
45332   1 0 3 0 364.58 0
45332   2 0 3 0 361.86 0
45332   3 0 3 0 339.15 0
45332   4 0 3 0 358.54 0
45333   1 0 3 0 379.66 0
45333   2 0 3 0 374.13 0
45333   3 0 3 0 351.16 0
45333   4 0 3 0 346.82 0
45334   1 0 3 0 478.64 0
45334   2 0 3 0 472.50 0
45334   3 0 3 0 446.98 0
45334   4 0 3 0 441.49 0
45335   1 0 3 0 265.05 138.89
45335   2 0 3 0 233.78 126.44
45335   3 0 3 0 233.78 126.44
45335   4 0 3 0 233.78 126.44
45337   1 0 3 0 481.73 0
45337   2 0 3 0 474.17 0
45337   3 0 3 0 463.32 0
45337   4 0 3 0 463.81 0
45338   1 0 3 0 379.66 0
45338   2 0 3 0 374.13 0
45338   3 0 3 0 351.16 0
45338   4 0 3 0 346.82 0
45340   1 0 3 0 609.09 165.83
45340   2 0 3 0 528.74 151.65
45340   3 0 3 0 528.74 151.65
45340   4 0 3 0 528.74 151.65
45341   1 0 2 0 389.90 0
45341   2 0 2 0 353.50 0
45341   3 0 2 0 353.50 0
45341   4 0 2 0 353.50 0
45342   1 0 2 0 449.32 0
45342   2 0 2 0 407.77 0
45342   3 0 2 0 407.77 0
45342   4 0 2 0 407.77 0
45346     0 3 0 * 0
45347     0 3 0 * 0
45349     0 3 0 * 0
45350     0 3 0 * 0
45378   1 0 2 0 704.82 0
45378   2 0 2 0 690.70 0
45378   3 0 2 0 650.46 0
45378   4 0 2 0 644.56 0
45379   1 0 3 0 937.75 0
45379   2 0 3 0 927.24 0
45379   3 0 3 0 866.89 0
45379   4 0 3 0 871.13 0
45380   1 0 3 0 792.41 0
45380   2 0 3 0 777.20 0
45380   3 0 3 0 747.91 0
45380   4 0 3 0 744.09 0
45381   1 0 3 0 713.93 407.14
45381   2 0 3 0 633.14 372.17
45381   3 0 3 0 633.14 372.17
45381   4 0 3 0 633.14 372.17
45382   1 0 3 0 999.68 0
45382   2 0 3 0 988.81 0
45382   3 0 3 0 929.41 0
45382   4 0 3 0 928.67 0
45384   1 0 3 0 1,117.61 0
45384   2 0 3 0 1,096.92 0
45384   3 0 3 0 1,030.18 0
45384   4 0 3 0 1,019.32 0
45385   1 0 3 0 1,117.61 0
45385   2 0 3 0 1,096.92 0
45385   3 0 3 0 1,030.18 0
45385   4 0 3 0 1,019.32 0
45386   1 0 3 0 1,368.56 441.33
45386   2 0 3 0 1,192.92 404.10
45386   3 0 3 0 1,192.92 404.10
45386   4 0 3 0 1,192.92 404.10
45388     0 3 0 * 0
45389     0 3 0 * 0
45390     0 3 0 * 0
45391   1 0 3 0 486.60 0
45391   2 0 3 0 443.42 0
45391   3 0 3 0 443.42 0
45391   4 0 3 0 443.42 0
45392   1 0 3 0 611.59 0
45392   2 0 3 0 560.97 0
45392   3 0 3 0 560.97 0
45392   4 0 3 0 560.97 0
45393     0 3 0 * 0
45395   1 90 2 0 2,876.46 0
45395   2 90 2 0 2,575.15 0
45395   3 90 2 0 2,575.15 0
45395   4 90 2 0 2,575.15 0
45397   1 90 2 0 3,116.24 0
45397   2 90 2 0 2,803.75 0
45397   3 90 2 0 2,803.75 0
45397   4 90 2 0 2,803.75 0
45398     0 3 0 * 0
45399     XXX 2 0 * 0
45400   1 90 2 0 1,676.98 0
45400   2 90 2 0 1,505.62 0
45400   3 90 2 0 1,505.62 0
45400   4 90 2 0 1,505.62 0
45402   1 90 2 0 2,271.57 0
45402   2 90 2 0 2,043.62 0
45402   3 90 2 0 2,043.62 0
45402   4 90 2 0 2,043.62 0
45499     YYY 2 0 * 0
45500   1 90 2 0 1,268.54 0
45500   2 90 2 0 1,298.22 0
45500   3 90 2 0 1,109.45 0
45500   4 90 2 0 1,280.42 0
45505   1 90 2 0 1,159.52 0
45505   2 90 2 0 1,240.99 0
45505   3 90 2 0 1,261.48 0
45505   4 90 2 0 1,256.20 0
45520   1 0 2 0 104.40 0
45520   2 0 2 0 122.43 0
45520   3 0 2 0 95.46 0
45520   4 0 2 0 94.29 0
45540   1 90 2 0 2,121.46 0
45540   2 90 2 0 2,085.15 0
45540   3 90 2 0 1,935.52 0
45540   4 90 2 0 1,956.30 0
45541   1 90 2 0 2,003.66 0
45541   2 90 2 0 1,917.37 0
45541   3 90 2 0 1,845.36 0
45541   4 90 2 0 1,888.61 0
45550   1 90 2 0 2,682.99 0
45550   2 90 2 0 2,593.59 0
45550   3 90 2 0 2,495.99 0
45550   4 90 2 0 2,518.98 0
45560   1 90 2 0 1,164.33 0
45560   2 90 2 0 1,146.20 0
45560   3 90 2 0 1,071.80 0
45560   4 90 2 0 1,150.16 0
45562   1 90 2 0 1,959.69 0
45562   2 90 2 0 1,901.09 0
45562   3 90 2 0 1,780.22 0
45562   4 90 2 0 1,756.65 0
45563   1 90 2 0 3,091.19 0
45563   2 90 2 0 2,998.78 0
45563   3 90 2 0 2,808.17 0
45563   4 90 2 0 2,770.96 0
45800   1 90 2 0 2,594.37 0
45800   2 90 2 0 2,523.82 0
45800   3 90 2 0 2,251.46 0
45800   4 90 2 0 2,445.41 0
45805   1 90 2 0 2,987.77 0
45805   2 90 2 0 2,585.17 0
45805   3 90 2 0 2,406.73 0
45805   4 90 2 0 2,825.95 0
45820   1 90 2 0 2,243.25 0
45820   2 90 2 0 2,016.87 0
45820   3 90 2 0 2,408.39 0
45820   4 90 2 0 1,879.83 0
45825   1 90 2 0 2,357.13 0
45825   2 90 2 0 2,323.15 0
45825   3 90 2 0 2,183.24 0
45825   4 90 2 0 2,158.41 0
45900   1 10 2 0 205.71 0
45900   2 10 2 0 343.88 0
45900   3 10 2 0 192.99 0
45900   4 10 2 0 411.08 0
45905   1 10 2 0 203.63 0
45905   2 10 2 0 201.00 0
45905   3 10 2 0 196.11 0
45905   4 10 2 0 188.06 0
45910   1 10 2 0 247.57 0
45910   2 10 2 0 244.50 0
45910   3 10 2 0 231.84 0
45910   4 10 2 0 229.29 0
45915   1 10 2 0 218.25 0
45915   2 10 2 0 216.61 0
45915   3 10 2 0 205.88 0
45915   4 10 2 0 208.32 0
45990   1 0 2 0 165.15 0
45990   2 0 2 0 149.02 0
45990   3 0 2 0 149.02 0
45990   4 0 2 0 149.02 0
45999     YYY 2 0 * 0
46020   1 10 2 0 421.49 370.95
46020   2 10 2 0 374.41 331.46
46020   3 10 2 0 374.41 331.46
46020   4 10 2 0 374.41 331.46
46030   1 10 2 0 243.53 0
46030   2 10 2 0 219.74 0
46030   3 10 2 0 135.17 0
46030   4 10 2 0 231.94 0
46040   1 90 2 0 600.80 0
46040   2 90 2 0 593.35 0
46040   3 90 2 0 556.26 0
46040   4 90 2 0 560.32 0
46045   1 90 2 0 424.79 0
46045   2 90 2 0 528.12 0
46045   3 90 2 0 416.04 0
46045   4 90 2 0 398.86 0
46050   1 10 2 0 253.09 0
46050   2 10 2 0 217.72 0
46050   3 10 2 0 178.17 0
46050   4 10 2 0 240.35 0
46060   1 90 2 0 1,023.26 0
46060   2 90 2 0 1,004.51 0
46060   3 90 2 0 942.82 0
46060   4 90 2 0 938.27 0
46070   1 90 2 0 381.13 0
46070   2 90 2 0 375.30 0
46070   3 90 2 0 351.22 0
46070   4 90 2 0 347.40 0
46080   1 10 2 0 596.36 0
46080   2 10 2 0 610.47 0
46080   3 10 2 0 573.34 0
46080   4 10 2 0 544.34 0
46083   1 10 2 0 166.21 141.14
46083   2 10 2 0 164.26 139.51
46083   3 10 2 0 156.17 132.84
46083   4 10 2 0 154.45 131.47
46200   1 90 2 0 753.73 0
46200   2 90 2 0 683.61 0
46200   3 90 2 0 584.12 0
46200   4 90 2 0 578.67 0
46220   1 10 2 0 209.44 0
46220   2 10 2 0 208.37 0
46220   3 10 2 0 203.96 0
46220   4 10 2 0 203.10 0
46221   1 10 2 0 164.37 140.48
46221   2 10 2 0 165.98 141.75
46221   3 10 2 0 161.47 137.39
46221   4 10 2 0 168.11 143.67
46230   1 10 2 0 280.51 247.33
46230   2 10 2 0 295.75 261.07
46230   3 10 2 0 282.33 249.53
46230   4 10 2 0 279.34 247.14
46250   1 90 2 0 611.62 0
46250   2 90 2 0 660.98 0
46250   3 90 2 0 619.33 0
46250   4 90 2 0 612.29 0
46255   1 90 2 0 927.61 0
46255   2 90 2 0 976.23 0
46255   3 90 2 0 847.92 0
46255   4 90 2 0 837.86 0
46257   1 90 2 0 1,163.76 0
46257   2 90 2 0 1,111.80 0
46257   3 90 2 0 1,009.25 0
46257   4 90 2 0 991.27 0
46258   1 90 2 0 1,184.14 0
46258   2 90 2 0 1,163.26 0
46258   3 90 2 0 1,077.25 0
46258   4 90 2 0 1,064.70 0
46260   1 90 2 0 1,241.56 0
46260   2 90 2 0 1,339.42 0
46260   3 90 2 0 1,174.51 0
46260   4 90 2 0 1,192.58 0
46261   1 90 2 0 1,285.75 0
46261   2 90 2 0 1,262.78 0
46261   3 90 2 0 1,168.24 0
46261   4 90 2 0 1,154.49 0
46262   1 90 2 0 1,321.86 0
46262   2 90 2 0 1,298.16 0
46262   3 90 2 0 1,200.38 0
46262   4 90 2 0 1,186.34 0
46270   1 90 2 0 650.73 0
46270   2 90 2 0 662.42 0
46270   3 90 2 0 591.38 0
46270   4 90 2 0 611.14 0
46275   1 90 2 0 1,022.61 0
46275   2 90 2 0 960.68 0
46275   3 90 2 0 946.36 0
46275   4 90 2 0 949.21 0
46280   1 90 2 0 1,252.10 0
46280   2 90 2 0 1,251.82 0
46280   3 90 2 0 1,198.18 0
46280   4 90 2 0 1,235.85 0
46285   1 90 2 0 618.54 0
46285   2 90 2 0 567.96 0
46285   3 90 2 0 533.44 0
46285   4 90 2 0 614.30 0
46288   1 90 2 0 987.82 0
46288   2 90 2 0 972.76 0
46288   3 90 2 0 910.88 0
46288   4 90 2 0 901.01 0
46320   1 10 2 0 228.74 196.11
46320   2 10 2 0 204.81 175.51
46320   3 10 2 0 194.25 166.53
46320   4 10 2 0 192.10 164.86
46500   1 10 2 0 135.05 124.28
46500   2 10 2 0 122.34 112.38
46500   3 10 2 0 121.53 112.27
46500   4 10 2 0 131.89 121.38
46505   1 10 2 0 363.73 296.66
46505   2 10 2 0 321.93 267.16
46505   3 10 2 0 321.93 267.16
46505   4 10 2 0 321.93 267.16
46600   1 0 2 0 62.00 51.72
46600   2 0 2 0 61.62 51.38
46600   3 0 2 0 60.86 50.72
46600   4 0 2 0 60.45 50.48
46601     0 3 0 * 0
46604   1 0 3 0 162.79 145.92
46604   2 0 3 0 140.41 125.93
46604   3 0 3 0 141.68 126.89
46604   4 0 3 0 146.07 131.06
46606   1 0 3 0 88.20 0
46606   2 0 3 0 87.44 0
46606   3 0 3 0 84.26 0
46606   4 0 3 0 83.65 0
46607     0 3 0 * 0
46608   1 0 3 0 218.76 0
46608   2 0 3 0 287.46 0
46608   3 0 3 0 288.31 0
46608   4 0 3 0 278.68 0
46610   1 0 3 0 219.23 0
46610   2 0 3 0 216.12 0
46610   3 0 3 0 212.17 0
46610   4 0 3 0 211.20 0
46611   1 0 3 0 219.23 0
46611   2 0 3 0 216.12 0
46611   3 0 3 0 212.17 0
46611   4 0 3 0 211.20 0
46612   1 0 3 0 279.94 0
46612   2 0 3 0 295.16 0
46612   3 0 3 0 258.55 0
46612   4 0 3 0 255.49 0
46614   1 0 3 0 393.27 315.24
46614   2 0 3 0 380.59 304.93
46614   3 0 3 0 382.52 306.90
46614   4 0 3 0 358.83 287.37
46615   1 0 3 0 412.05 334.01
46615   2 0 3 0 399.28 323.54
46615   3 0 3 0 400.72 325.13
46615   4 0 3 0 376.91 305.41
46700   1 90 2 0 1,279.92 0
46700   2 90 2 0 1,262.68 0
46700   3 90 2 0 1,236.61 0
46700   4 90 2 0 1,272.02 0
46705   1 90 2 0 944.15 0
46705   2 90 2 0 929.87 0
46705   3 90 2 0 871.07 0
46705   4 90 2 0 861.42 0
46706   1 90 2 0 255.00 0
46706   2 90 2 0 230.28 0
46706   3 90 2 0 230.28 0
46706   4 90 2 0 230.28 0
46707   1 90 2 0 657.82 0
46707   2 90 2 0 588.78 0
46707   3 90 2 0 588.78 0
46707   4 90 2 0 588.78 0
46710   1 90 2 0 1,504.40 0
46710   2 90 2 0 1,356.70 0
46710   3 90 2 0 1,356.70 0
46710   4 90 2 0 1,356.70 0
46712   1 90 2 0 3,164.63 0
46712   2 90 2 0 2,843.33 0
46712   3 90 2 0 2,843.33 0
46712   4 90 2 0 2,843.33 0
46715   1 90 2 0 972.32 0
46715   2 90 2 0 957.45 0
46715   3 90 2 0 896.50 0
46715   4 90 2 0 886.77 0
46716   1 90 2 0 2,545.19 0
46716   2 90 2 0 1,648.25 0
46716   3 90 2 0 1,543.57 0
46716   4 90 2 0 1,526.77 0
46730   1 90 2 0 2,970.55 0
46730   2 90 2 0 2,925.26 0
46730   3 90 2 0 2,739.14 0
46730   4 90 2 0 2,709.35 0
46735   1 90 2 0 3,603.61 0
46735   2 90 2 0 3,548.65 0
46735   3 90 2 0 3,322.86 0
46735   4 90 2 0 3,076.83 0
46740   1 90 2 0 3,192.71 0
46740   2 90 2 0 3,144.13 0
46740   3 90 2 0 2,944.37 0
46740   4 90 2 0 2,912.41 0
46742   1 90 2 0 4,274.32 0
46742   2 90 2 0 4,220.95 0
46742   3 90 2 0 3,999.90 0
46742   4 90 2 0 3,952.66 0
46744   1 90 2 0 4,798.73 0
46744   2 90 2 0 4,738.78 0
46744   3 90 2 0 4,490.61 0
46744   4 90 2 0 4,437.55 0
46746   1 90 2 0 5,250.64 0
46746   2 90 2 0 5,185.09 0
46746   3 90 2 0 4,913.38 0
46746   4 90 2 0 4,855.35 0
46748   1 90 2 0 5,849.19 0
46748   2 90 2 0 5,776.15 0
46748   3 90 2 0 5,473.61 0
46748   4 90 2 0 5,408.90 0
46750   1 90 2 0 1,287.05 0
46750   2 90 2 0 1,265.54 0
46750   3 90 2 0 1,241.57 0
46750   4 90 2 0 1,235.92 0
46751   1 90 2 0 1,126.18 0
46751   2 90 2 0 1,109.02 0
46751   3 90 2 0 1,038.39 0
46751   4 90 2 0 1,027.07 0
46753   1 90 2 0 1,170.92 0
46753   2 90 2 0 1,155.90 0
46753   3 90 2 0 1,132.61 0
46753   4 90 2 0 1,127.94 0
46754   1 10 2 0 291.95 0
46754   2 10 2 0 206.33 0
46754   3 10 2 0 265.59 0
46754   4 10 2 0 262.50 0
46760   1 90 2 0 1,656.62 0
46760   2 90 2 0 1,630.65 0
46760   3 90 2 0 1,524.06 0
46760   4 90 2 0 1,507.03 0
46761   1 90 2 0 1,612.90 0
46761   2 90 2 0 1,563.77 0
46761   3 90 2 0 1,484.19 0
46761   4 90 2 0 1,467.42 0
46762   1 90 2 0 1,423.02 0
46762   2 90 2 0 1,400.86 0
46762   3 90 2 0 1,309.94 0
46762   4 90 2 0 1,295.38 0
46900   1 10 2 0 169.22 155.24
46900   2 10 2 0 166.87 152.88
46900   3 10 2 0 162.72 149.62
46900   4 10 2 0 162.67 149.07
46910   1 10 2 0 308.29 0
46910   2 10 2 0 280.97 0
46910   3 10 2 0 299.93 0
46910   4 10 2 0 203.58 0
46916   1 10 2 0 328.39 0
46916   2 10 2 0 281.82 0
46916   3 10 2 0 308.47 0
46916   4 10 2 0 204.23 0
46917   1 10 2 0 466.54 0
46917   2 10 2 0 464.11 0
46917   3 10 2 0 453.92 0
46917   4 10 2 0 322.68 0
46922   1 10 2 0 408.02 0
46922   2 10 2 0 427.09 0
46922   3 10 2 0 421.97 0
46922   4 10 2 0 404.12 0
46924   1 10 2 0 622.83 0
46924   2 10 2 0 597.10 0
46924   3 10 2 0 576.01 0
46924   4 10 2 0 581.76 0
46930   1 90 2 0 286.05 206.60
46930   2 90 2 0 250.09 183.12
46930   3 90 2 0 250.09 183.12
46930   4 90 2 0 250.09 183.12
46940   1 10 2 0 211.42 0
46940   2 10 2 0 197.01 0
46940   3 10 2 0 199.09 0
46940   4 10 2 0 233.83 0
46942   1 10 2 0 219.43 0
46942   2 10 2 0 178.03 0
46942   3 10 2 0 207.98 0
46942   4 10 2 0 205.85 0
46945   1 90 2 0 242.63 222.07
46945   2 90 2 0 245.56 226.01
46945   3 90 2 0 246.63 227.18
46945   4 90 2 0 238.01 219.24
46946   1 90 2 0 442.63 0
46946   2 90 2 0 438.02 0
46946   3 90 2 0 331.44 0
46946   4 90 2 0 414.90 0
46947   1 90 2 0 571.31 0
46947   2 90 2 0 508.06 0
46947   3 90 2 0 508.06 0
46947   4 90 2 0 508.06 0
46999     YYY 2 0 * 0
47000   1 0 2 0 277.16 0
47000   2 0 2 0 273.68 0
47000   3 0 2 0 259.44 0
47000   4 0 2 0 256.34 0
47001   1 ZZZ 0 0 296.13 0
47001   2 ZZZ 0 0 318.67 0
47001   3 ZZZ 0 0 277.20 0
47001   4 ZZZ 0 0 276.43 0
47010   1 90 2 0 1,397.46 0
47010   2 90 2 0 1,240.48 0
47010   3 90 2 0 1,240.48 0
47010   4 90 2 0 1,240.48 0
47015   1 90 2 0 1,628.37 0
47015   2 90 2 0 1,624.10 0
47015   3 90 2 0 1,585.58 0
47015   4 90 2 0 1,579.03 0
47100   1 90 2 0 937.18 0
47100   2 90 2 0 981.83 0
47100   3 90 2 0 924.25 0
47100   4 90 2 0 1,009.56 0
47120   1 90 2 0 3,027.41 0
47120   2 90 2 0 2,981.20 0
47120   3 90 2 0 3,048.18 0
47120   4 90 2 0 3,035.36 0
47122   1 90 2 0 4,705.30 0
47122   2 90 2 0 4,636.41 0
47122   3 90 2 0 4,353.13 0
47122   4 90 2 0 4,305.22 0
47125   1 90 2 0 4,669.02 0
47125   2 90 2 0 4,640.61 0
47125   3 90 2 0 4,230.69 0
47125   4 90 2 0 4,504.65 0
47130   1 90 2 0 4,838.40 0
47130   2 90 2 0 4,625.67 0
47130   3 90 2 0 4,600.82 0
47130   4 90 2 0 4,374.19 0