You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page.
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 33212-33676
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
33212-33676
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
33212
003
90
2
X
1,287.68
X
33212
002
90
2
X
1,284.29
X
33212
004
90
2
X
1,271.08
X
33212
001
90
2
X
1,305.88
X
33213
003
90
2
X
1,320.57
X
33213
002
90
2
X
1,386.47
X
33213
004
90
2
X
1,303.71
X
33213
001
90
2
X
1,408.58
X
33214
001
90
2
X
1,580.16
X
33214
004
90
2
X
1,434.76
X
33214
003
90
2
X
1,451.27
X
33214
002
90
2
X
1,554.97
X
33215
004
90
2
X
645.76
X
33215
002
90
2
X
645.76
X
33215
003
90
2
X
645.76
X
33215
001
90
2
X
719.62
X
33216
004
90
2
X
1,155.80
X
33216
001
90
2
X
1,171.04
X
33216
003
90
2
X
1,160.11
X
33216
002
90
2
X
1,184.93
X
33217
001
90
2
X
1,183.02
X
33217
003
90
2
X
1,171.83
X
33217
002
90
2
X
1,196.84
X
33217
004
90
2
X
1,167.38
X
33218
003
90
2
X
1,067.35
X
33218
002
90
2
X
1,138.45
X
33218
004
90
2
X
1,054.47
X
33218
001
90
2
X
1,155.74
X
33220
002
90
2
X
1,147.11
X
33220
003
90
2
X
1,075.68
X
33220
001
90
2
X
1,164.42
X
33220
004
90
2
X
1,062.84
X
33221
001
90
2
X
666.07
X
33221
002
90
2
X
595.60
X
33221
003
90
2
X
595.60
X
33221
004
90
2
X
595.60
X
33222
002
90
2
X
1,775.98
X
33222
003
90
2
X
1,589.48
X
33222
004
90
2
X
1,736.50
X
33222
001
90
2
X
1,748.55
X
33223
001
90
2
X
1,804.61
X
33223
002
90
2
X
1,831.66
X
33223
003
90
2
X
1,643.93
X
33223
004
90
2
X
1,790.40
X
33224
001
0
2
X
1,146.44
X
33224
004
0
2
X
1,050.44
X
33224
002
0
2
X
1,050.44
X
33224
003
0
2
X
1,050.44
X
33225
002
ZZZ
0
X
931.67
X
33225
003
ZZZ
0
X
931.67
X
33225
001
ZZZ
0
X
1,015.00
X
33225
004
ZZZ
0
X
931.67
X
33226
003
0
2
X
1,011.49
X
33226
002
0
2
X
1,011.49
X
33226
004
0
2
X
1,011.49
X
33226
001
0
2
X
1,104.80
X
33227
003
90
2
X
568.24
X
33227
001
90
2
X
635.72
X
33227
002
90
2
X
568.24
X
33227
004
90
2
X
568.24
X
33228
004
90
2
X
592.83
X
33228
002
90
2
X
592.83
X
33228
003
90
2
X
592.83
X
33228
001
90
2
X
663.11
X
33229
001
90
2
X
690.48
X
33229
004
90
2
X
617.42
X
33229
003
90
2
X
617.42
X
33229
002
90
2
X
617.42
X
33230
001
90
2
X
717.23
X
33230
004
90
2
X
641.54
X
33230
003
90
2
X
641.54
X
33230
002
90
2
X
641.54
X
33231
001
90
2
X
744.61
X
33231
004
90
2
X
666.13
X
33231
003
90
2
X
666.13
X
33231
002
90
2
X
666.13
X
33233
001
90
2
X
964.78
X
33233
004
90
2
X
962.99
X
33233
002
90
2
X
980.92
X
33233
003
90
2
X
966.42
X
33234
002
90
2
X
1,098.79
X
33234
003
90
2
X
1,069.20
X
33234
001
90
2
X
1,164.34
X
33234
004
90
2
X
1,069.20
X
33235
003
90
2
X
1,019.36
X
33235
002
90
2
X
1,047.56
X
33235
001
90
2
X
1,111.64
X
33235
004
90
2
X
1,019.36
X
33236
002
90
2
X
1,799.21
X
33236
003
90
2
X
1,714.35
X
33236
001
90
2
X
1,819.88
X
33236
004
90
2
X
1,696.15
X
33237
002
90
2
X
2,657.01
X
33237
003
90
2
X
2,479.87
X
33237
004
90
2
X
2,451.59
X
33237
001
90
2
X
2,699.98
X
33238
002
90
2
X
2,961.17
X
33238
003
90
2
X
2,764.05
X
33238
004
90
2
X
2,732.62
X
33238
001
90
2
X
3,009.00
X
33240
004
90
2
X
1,340.13
X
33240
001
90
2
X
1,523.27
X
33240
003
90
2
X
1,357.32
X
33240
002
90
2
X
1,500.37
X
33241
001
90
2
X
598.50
X
33241
003
90
2
X
549.91
X
33241
002
90
2
X
588.96
X
33241
004
90
2
X
543.61
X
33243
002
90
2
X
2,693.67
X
33243
003
90
2
X
2,573.37
X
33243
001
90
2
X
2,673.88
X
33243
004
90
2
X
3,325.98
X
33244
001
90
2
X
2,199.85
X
33244
004
90
2
X
1,944.70
X
33244
003
90
2
X
2,113.36
X
33244
002
90
2
X
2,222.46
X
33249
004
90
2
X
3,249.32
X
33249
001
90
2
X
3,994.03
X
33249
003
90
2
X
4,425.40
X
33249
002
90
2
X
3,920.82
X
33250
001
90
2
X
3,546.02
X
33250
004
90
2
X
3,305.28
X
33250
002
90
2
X
3,506.68
X
33250
003
90
2
X
3,344.18
X
33251
003
90
2
X
4,409.70
X
33251
002
90
2
X
4,724.65
X
33251
004
90
2
X
4,359.45
X
33251
001
90
2
X
4,801.07
X
33254
002
90
2
X
2,259.91
X
33254
003
90
2
X
2,259.91
X
33254
004
90
2
X
2,259.91
X
33254
001
90
2
X
2,566.20
X
33255
002
90
2
X
2,722.72
X
33255
003
90
2
X
2,722.72
X
33255
004
90
2
X
2,722.72
X
33255
001
90
2
X
3,083.04
X
33256
001
90
2
X
3,686.18
X
33256
004
90
2
X
3,252.13
X
33256
002
90
2
X
3,252.13
X
33256
003
90
2
X
3,252.13
X
33257
002
ZZZ
0
X
1,011.18
X
33257
003
ZZZ
0
X
1,011.18
X
33257
004
ZZZ
0
X
1,011.18
X
33257
001
ZZZ
0
X
1,128.29
X
33258
002
ZZZ
0
X
1,143.52
X
33258
003
ZZZ
0
X
1,143.52
X
33258
001
ZZZ
0
X
1,276.66
X
33258
004
ZZZ
0
X
1,143.52
X
33259
003
ZZZ
0
X
1,501.07
X
33259
002
ZZZ
0
X
1,501.07
X
33259
004
ZZZ
0
X
1,501.07
X
33259
001
ZZZ
0
X
1,688.43
X
33261
004
90
2
X
4,063.13
X
33261
001
90
2
X
8,638.17
X
33261
002
90
2
X
4,385.62
X
33261
003
90
2
X
8,493.12
X
33262
001
90
2
X
691.02
X
33262
003
90
2
X
618.04
X
33262
002
90
2
X
618.04
X
33262
004
90
2
X
618.04
X
33263
004
90
2
X
642.63
X
33263
002
90
2
X
642.63
X
33263
003
90
2
X
642.63
X
33263
001
90
2
X
718.40
X
33264
001
90
2
X
745.76
X
33264
004
90
2
X
667.24
X
33264
003
90
2
X
667.24
X
33264
002
90
2
X
667.24
X
33265
001
90
2
X
2,566.20
X
33265
004
90
2
X
2,259.91
X
33265
003
90
2
X
2,259.91
X
33265
002
90
2
X
2,259.91
X
33266
003
90
2
X
3,093.69
X
33266
002
90
2
X
3,093.69
X
33266
004
90
2
X
3,093.69
X
33266
001
90
2
X
3,511.13
X
33267
002
90
2
X
1,243.89
X
33267
003
90
2
X
1,243.89
X
33267
004
90
2
X
1,243.89
X
33267
001
90
2
X
1,364.30
X
33268
004
ZZZ
0
X
155.64
X
33268
001
ZZZ
0
X
169.96
X
33268
002
ZZZ
0
X
155.64
X
33268
003
ZZZ
0
X
155.64
X
33269
002
90
2
X
983.25
X
33269
003
90
2
X
983.25
X
33269
001
90
2
X
1,079.75
X
33269
004
90
2
X
983.25
X
33270
001
90
2
X
1,123.94
X
33270
003
90
2
X
1,008.38
X
33270
002
90
2
X
1,008.38
X
33270
004
90
2
X
1,008.38
X
33271
001
90
2
X
839.81
X
33271
004
90
2
X
764.83
X
33271
003
90
2
X
764.83
X
33271
002
90
2
X
764.83
X
33272
004
90
2
X
682.80
X
33272
002
90
2
X
682.80
X
33272
003
90
2
X
682.80
X
33272
001
90
2
X
772.46
X
33273
001
90
2
X
674.74
X
33273
004
90
2
X
617.69
X
33273
002
90
2
X
617.69
X
33273
003
90
2
X
617.69
X
33274
001
90
2
X
769.12
X
33274
004
90
2
X
697.61
X
33274
003
90
2
X
697.61
X
33274
002
90
2
X
697.61
X
33275
002
90
2
X
742.80
X
33275
003
90
2
X
742.80
X
33275
001
90
2
X
818.14
X
33275
004
90
2
X
742.80
X
33276
002
90
2
X
606.10
X
33276
003
90
2
X
606.10
X
33276
001
90
2
X
664.02
X
33276
004
90
2
X
606.10
X
33277
004
ZZZ
0
X
318.12
X
33277
003
ZZZ
0
X
318.12
X
33277
002
ZZZ
0
X
318.12
X
33277
001
ZZZ
0
X
347.45
X
33278
002
90
2
X
603.47
X
33278
003
90
2
X
603.47
X
33278
004
90
2
X
603.47
X
33278
001
90
2
X
661.07
X
33279
002
90
2
X
364.05
X
33279
003
90
2
X
364.05
X
33279
004
90
2
X
364.05
X
33279
001
90
2
X
399.67
X
33280
001
90
2
X
238.55
X
33280
004
90
2
X
218.47
X
33280
003
90
2
X
218.47
X
33280
002
90
2
X
218.47
X
33281
001
90
2
X
431.98
X
33281
004
90
2
X
393.83
X
33281
003
90
2
X
393.83
X
33281
002
90
2
X
393.83
X
33285
003
0
2
X
6,831.38
127.64
33285
002
0
2
X
6,831.38
127.64
33285
004
0
2
X
6,831.38
127.64
33285
001
0
2
X
7,832.46
140.37
33286
004
0
2
X
184.04
125.16
33286
003
0
2
X
184.04
125.16
33286
002
0
2
X
184.04
125.16
33286
001
0
2
X
205.17
137.61
33287
002
90
2
X
405.94
X
33287
003
90
2
X
405.94
X
33287
004
90
2
X
405.94
X
33287
001
90
2
X
445.62
X
33288
001
90
2
X
587.41
X
33288
004
90
2
X
536.31
X
33288
002
90
2
X
536.31
X
33288
003
90
2
X
536.31
X
33289
003
0
2
X
469.68
X
33289
002
0
2
X
469.68
X
33289
001
0
2
X
513.76
X
33289
004
0
2
X
469.68
X
33300
004
90
2
X
3,418.22
X
33300
001
90
2
X
3,776.85
X
33300
003
90
2
X
3,458.76
X
33300
002
90
2
X
3,714.81
X
33305
004
90
2
X
4,090.22
X
33305
001
90
2
X
4,517.67
X
33305
003
90
2
X
4,138.90
X
33305
002
90
2
X
4,158.52
X
33310
002
90
2
X
3,379.30
X
33310
003
90
2
X
3,360.01
X
33310
004
90
2
X
3,136.31
X
33310
001
90
2
X
3,429.52
X
33315
001
90
2
X
4,217.50
X
33315
002
90
2
X
4,153.14
X
33315
003
90
2
X
3,887.52
X
33315
004
90
2
X
3,843.03
X
33320
001
90
2
X
3,989.93
X
33320
002
90
2
X
3,964.66
X
33320
003
90
2
X
3,860.46
X
33320
004
90
2
X
3,302.75
X
33321
002
90
2
X
4,908.96
X
33321
003
90
2
X
4,553.15
X
33321
001
90
2
X
5,255.35
X
33321
004
90
2
X
4,497.75
X
33322
001
90
2
X
5,255.35
X
33322
004
90
2
X
4,497.75
X
33322
002
90
2
X
4,908.96
X
33322
003
90
2
X
4,553.15
X
33330
003
90
2
X
3,528.71
X
33330
002
90
2
X
3,749.20
X
33330
001
90
2
X
3,802.68
X
33330
004
90
2
X
3,488.26
X
33335
004
90
2
X
4,674.02
X
33335
001
90
2
X
5,074.65
X
33335
003
90
2
X
4,726.91
X
33335
002
90
2
X
5,006.76
X
33340
004
0
2
X
1,233.38
X
33340
003
0
2
X
1,233.38
X
33340
002
0
2
X
1,233.38
X
33340
001
0
2
X
1,350.96
X
33361
004
0
2
X
2,201.70
X
33361
002
0
2
X
2,201.70
X
33361
003
0
2
X
2,201.70
X
33361
001
0
2
X
2,450.31
X
33362
004
0
2
X
2,409.00
X
33362
002
0
2
X
2,409.00
X
33362
003
0
2
X
2,409.00
X
33362
001
0
2
X
2,680.86
X
33363
002
0
2
X
2,494.39
X
33363
003
0
2
X
2,494.39
X
33363
004
0
2
X
2,494.39
X
33363
001
0
2
X
2,775.88
X
33364
001
0
2
X
2,952.13
X
33364
003
0
2
X
2,651.57
X
33364
002
0
2
X
2,651.57
X
33364
004
0
2
X
2,651.57
X
33365
002
0
2
X
2,915.67
X
33365
003
0
2
X
2,915.67
X
33365
001
0
2
X
3,255.15
X
33365
004
0
2
X
2,915.67
X
33366
003
0
2
X
3,177.47
X
33366
002
0
2
X
3,177.47
X
33366
004
0
2
X
3,177.47
X
33366
001
0
2
X
3,499.80
X
33367
002
ZZZ
0
X
1,025.72
X
33367
003
ZZZ
0
X
1,025.72
X
33367
004
ZZZ
0
X
1,025.72
X
33367
001
ZZZ
0
X
1,144.19
X
33368
004
ZZZ
0
X
1,243.16
X
33368
001
ZZZ
0
X
1,386.96
X
33368
003
ZZZ
0
X
1,243.16
X
33368
002
ZZZ
0
X
1,243.16
X
33369
001
ZZZ
0
X
1,830.90
X
33369
004
ZZZ
0
X
1,641.16
X
33369
002
ZZZ
0
X
1,641.16
X
33369
003
ZZZ
0
X
1,641.16
X
33370
004
ZZZ
0
X
158.14
X
33370
001
ZZZ
0
X
172.33
X
33370
003
ZZZ
0
X
158.14
X
33370
002
ZZZ
0
X
158.14
X
33390
004
90
2
X
2,946.78
X
33390
001
90
2
X
3,215.87
X
33390
003
90
2
X
2,946.78
X
33390
002
90
2
X
2,946.78
X
33391
001
90
2
X
3,810.48
X
33391
004
90
2
X
3,491.82
X
33391
003
90
2
X
3,491.82
X
33391
002
90
2
X
3,491.82
X
33404
003
90
2
X
5,200.47
X
33404
002
90
2
X
5,571.29
X
33404
001
90
2
X
5,661.34
X
33404
004
90
2
X
5,141.19
X
33405
004
90
2
X
7,299.96
X
33405
001
90
2
X
7,829.52
X
33405
002
90
2
X
7,741.96
X
33405
003
90
2
X
7,258.79
X
33406
002
90
2
X
7,214.81
X
33406
003
90
2
X
6,696.02
X
33406
004
90
2
X
6,615.74
X
33406
001
90
2
X
7,340.44
X
33410
001
90
2
X
5,709.77
X
33410
002
90
2
X
5,062.87
X
33410
003
90
2
X
5,062.87
X
33410
004
90
2
X
5,062.87
X
33411
002
90
2
X
8,632.04
X
33411
003
90
2
X
7,955.34
X
33411
001
90
2
X
8,795.89
X
33411
004
90
2
X
7,859.14
X
33412
002
90
2
X
6,592.34
X
33412
003
90
2
X
6,221.19
X
33412
001
90
2
X
6,682.03
X
33412
004
90
2
X
6,147.56
X
33413
003
90
2
X
6,696.02
X
33413
002
90
2
X
7,214.81
X
33413
004
90
2
X
6,615.74
X
33413
001
90
2
X
7,340.44
X
33414
001
90
2
X
6,068.47
X
33414
004
90
2
X
6,068.47
X
33414
003
90
2
X
6,068.47
X
33414
002
90
2
X
6,068.47
X
33415
004
90
2
X
4,755.98
X
33415
001
90
2
X
5,169.35
X
33415
003
90
2
X
4,812.83
X
33415
002
90
2
X
5,099.89
X
33416
001
90
2
X
6,997.43
X
33416
002
90
2
X
6,879.44
X
33416
003
90
2
X
6,391.91
X
33416
004
90
2
X
6,315.99
X
33417
002
90
2
X
9,212.33
X
33417
003
90
2
X
9,212.33
X
33417
001
90
2
X
9,212.33
X
33417
004
90
2
X
9,212.33
X
33418
002
90
2
X
2,745.64
2,867.14
33418
003
90
2
X
2,745.64
2,867.14
33418
004
90
2
X
2,745.64
2,867.14
33418
001
90
2
X
2,972.18
3,114.39
33419
003
ZZZ
0
X
882.82
X
33419
002
ZZZ
0
X
882.82
X
33419
004
ZZZ
0
X
882.82
X
33419
001
ZZZ
0
X
997.00
X
33420
003
90
2
X
6,820.48
X
33420
002
90
2
X
7,279.23
X
33420
004
90
2
X
7,039.38
X
33420
001
90
2
X
4,841.21
X
33422
002
90
2
X
9,261.99
X
33422
003
90
2
X
8,664.73
X
33422
004
90
2
X
6,368.08
X
33422
001
90
2
X
9,204.02
X
33425
001
90
2
X
8,953.62
X
33425
004
90
2
X
8,370.92
X
33425
002
90
2
X
9,239.76
X
33425
003
90
2
X
8,811.36
X
33426
004
90
2
X
6,561.12
X
33426
003
90
2
X
6,641.59
X
33426
002
90
2
X
9,480.03
X
33426
001
90
2
X
8,320.79
X
33427
004
90
2
X
7,521.58
X
33427
002
90
2
X
8,213.86
X
33427
003
90
2
X
7,612.61
X
33427
001
90
2
X
8,359.36
X
33430
001
90
2
X
9,458.94
X
33430
004
90
2
X
9,124.73
X
33430
003
90
2
X
9,142.74
X
33430
002
90
2
X
9,675.26
X
33440
003
90
2
X
4,856.10
X
33440
002
90
2
X
4,856.10
X
33440
004
90
2
X
4,856.10
X
33440
001
90
2
X
5,307.48
X
33460
003
90
2
X
7,018.70
X
33460
002
90
2
X
6,944.08
X
33460
004
90
2
X
5,386.70
X
33460
001
90
2
X
7,193.02
X
33463
004
90
2
X
4,667.07
X
33463
003
90
2
X
4,720.84
X
33463
002
90
2
X
5,057.52
X
33463
001
90
2
X
5,139.32
X
33464
004
90
2
X
4,996.14
X
33464
003
90
2
X
5,053.65
X
33464
002
90
2
X
5,413.93
X
33464
001
90
2
X
5,501.34
X
33465
003
90
2
X
7,495.13
X
33465
002
90
2
X
7,555.27
X
33465
004
90
2
X
6,701.31
X
33465
001
90
2
X
7,815.61
X
33468
004
90
2
X
5,349.19
X
33468
001
90
2
X
5,871.09
X
33468
002
90
2
X
5,781.26
X
33468
003
90
2
X
5,410.95
X
33471
001
90
2
X
7,340.44
X
33471
003
90
2
X
6,696.02
X
33471
002
90
2
X
7,214.81
X
33471
004
90
2
X
6,615.74
X
33474
002
90
2
X
3,965.63
X
33474
003
90
2
X
3,751.49
X
33474
004
90
2
X
3,708.12
X
33474
001
90
2
X
4,017.45
X
33475
004
90
2
X
6,615.74
X
33475
003
90
2
X
6,696.02
X
33475
002
90
2
X
7,214.81
X
33475
001
90
2
X
7,340.44
X
33476
001
90
2
X
7,039.26
X
33476
004
90
2
X
6,233.56
X
33476
002
90
2
X
6,808.60
X
33476
003
90
2
X
6,322.48
X
33477
004
0
2
X
2,021.51
X
33477
001
0
2
X
2,183.64
X
33477
003
0
2
X
2,021.51
X
33477
002
0
2
X
2,021.51
X
33478
001
90
2
X
7,595.80
X
33478
004
90
2
X
6,717.41
X
33478
003
90
2
X
6,814.14
X
33478
002
90
2
X
7,344.85
X
33496
001
90
2
X
6,368.03
X
33496
004
90
2
X
5,506.98
X
33496
003
90
2
X
5,506.98
X
33496
002
90
2
X
5,506.98
X
33500
001
90
2
X
4,798.20
X
33500
004
90
2
X
4,373.71
X
33500
002
90
2
X
6,296.07
X
33500
003
90
2
X
4,423.48
X
33501
002
90
2
X
5,875.89
X
33501
003
90
2
X
3,598.37
X
33501
001
90
2
X
3,948.01
X
33501
004
90
2
X
3,556.28
X
33502
004
90
2
X
5,120.38
X
33502
001
90
2
X
3,930.63
X
33502
003
90
2
X
3,654.13
X
33502
002
90
2
X
3,876.77
X
33503
003
90
2
X
3,631.64
X
33503
002
90
2
X
4,484.51
X
33503
001
90
2
X
3,859.06
X
33503
004
90
2
X
5,492.16
X
33504
004
90
2
X
4,062.39
X
33504
001
90
2
X
4,442.60
X
33504
003
90
2
X
4,108.14
X
33504
002
90
2
X
4,377.25
X
33505
002
90
2
X
4,377.25
X
33505
003
90
2
X
4,108.14
X
33505
004
90
2
X
4,062.39
X
33505
001
90
2
X
4,442.60
X
33506
004
90
2
X
4,062.39
X
33506
001
90
2
X
4,442.60
X
33506
003
90
2
X
4,108.14
X
33506
002
90
2
X
4,377.25
X
33507
004
90
2
X
3,316.04
X
33507
002
90
2
X
3,316.04
X
33507
003
90
2
X
3,316.04
X
33507
001
90
2
X
3,722.69
X
33508
001
ZZZ
0
X
39.12
X
33508
003
ZZZ
0
X
35.26
X
33508
002
ZZZ
0
X
35.26
X
33508
004
ZZZ
0
X
35.26
X
33509
002
ZZZ
0
X
205.54
X
33509
003
ZZZ
0
X
205.54
X
33509
001
ZZZ
0
X
224.44
X
33509
004
ZZZ
0
X
205.54
X
33510
001
90
2
X
7,084.74
X
33510
003
90
2
X
6,521.70
X
33510
002
90
2
X
6,956.76
X
33510
004
90
2
X
6,514.51
X
33511
001
90
2
X
8,156.23
X
33511
004
90
2
X
7,469.02
X
33511
003
90
2
X
7,549.72
X
33511
002
90
2
X
8,041.54
X
33512
002
90
2
X
8,658.88
X
33512
003
90
2
X
8,102.23
X
33512
004
90
2
X
8,056.81
X
33512
001
90
2
X
8,762.83
X
33513
002
90
2
X
9,244.82
X
33513
003
90
2
X
8,620.03
X
33513
001
90
2
X
9,350.49
X
33513
004
90
2
X
8,584.93
X
33514
001
90
2
X
9,686.82
X
33514
004
90
2
X
9,010.94
X
33514
002
90
2
X
9,618.63
X
33514
003
90
2
X
9,077.81
X
33516
003
90
2
X
9,671.49
X
33516
002
90
2
X
9,962.84
X
33516
004
90
2
X
9,627.60
X
33516
001
90
2
X
9,882.14
X
33517
002
ZZZ
0
X
731.71
X
33517
003
ZZZ
0
X
674.41
X
33517
004
ZZZ
0
X
672.11
X
33517
001
ZZZ
0
X
720.77
X
33518
001
ZZZ
0
X
1,386.65
X
33518
004
ZZZ
0
X
1,289.12
X
33518
003
ZZZ
0
X
1,282.83
X
33518
002
ZZZ
0
X
1,403.68
X
33519
002
ZZZ
0
X
1,873.39
X
33519
003
ZZZ
0
X
1,768.54
X
33519
004
ZZZ
0
X
1,764.20
X
33519
001
ZZZ
0
X
1,835.05
X
33521
001
ZZZ
0
X
2,183.45
X
33521
003
ZZZ
0
X
2,331.23
X
33521
002
ZZZ
0
X
2,301.94
X
33521
004
ZZZ
0
X
2,313.15
X
33522
004
ZZZ
0
X
2,996.38
X
33522
001
ZZZ
0
X
2,661.13
X
33522
003
ZZZ
0
X
3,031.43
X
33522
002
ZZZ
0
X
2,873.23
X
33523
002
ZZZ
0
X
3,116.58
X
33523
003
ZZZ
0
X
3,258.17
X
33523
001
ZZZ
0
X
2,908.47
X
33523
004
ZZZ
0
X
3,220.40
X
33530
004
ZZZ
0
X
1,888.78
X
33530
001
ZZZ
0
X
2,141.53
X
33530
003
ZZZ
0
X
1,912.41
X
33530
002
ZZZ
0
X
2,096.84
X
33533
001
90
2
X
7,546.43
X
33533
004
90
2
X
6,878.07
X
33533
002
90
2
X
7,408.13
X
33533
003
90
2
X
6,925.07
X
33534
002
90
2
X
8,212.79
X
33534
003
90
2
X
7,698.08
X
33534
004
90
2
X
7,643.19
X
33534
001
90
2
X
8,333.47
X
33535
001
90
2
X
9,041.87
X
33535
002
90
2
X
8,932.66
X
33535
003
90
2
X
8,370.08
X
33535
004
90
2
X
8,320.95
X
33536
001
90
2
X
9,731.51
X
33536
004
90
2
X
8,982.46
X
33536
002
90
2
X
9,633.60
X
33536
003
90
2
X
9,032.00
X
33542
003
90
2
X
10,612.07
X
33542
002
90
2
X
11,428.28
X
33542
004
90
2
X
10,879.20
X
33542
001
90
2
X
10,760.74
X
33545
004
90
2
X
7,738.95
X
33545
001
90
2
X
8,406.86
X
33545
003
90
2
X
8,107.15
X
33545
002
90
2
X
8,464.39
X
33548
004
90
2
X
4,352.98
X
33548
002
90
2
X
4,352.98
X
33548
003
90
2
X
4,352.98
X
33548
001
90
2
X
4,913.80
X
33572
002
ZZZ
0
X
981.91
X
33572
003
ZZZ
0
X
919.53
X
33572
004
ZZZ
0
X
907.35
X
33572
001
ZZZ
0
X
1,012.16
X
33600
001
90
2
X
5,804.48
X
33600
004
90
2
X
5,188.02
X
33600
003
90
2
X
5,251.72
X
33600
002
90
2
X
5,696.71
X
33602
004
90
2
X
4,525.00
X
33602
001
90
2
X
4,983.22
X
33602
003
90
2
X
4,577.18
X
33602
002
90
2
X
4,903.96
X
33606
001
90
2
X
9,261.55
X
33606
004
90
2
X
8,140.82
X
33606
003
90
2
X
8,258.82
X
33606
002
90
2
X
8,937.72
X
33608
004
90
2
X
8,224.41
X
33608
002
90
2
X
9,024.14
X
33608
003
90
2
X
8,343.26
X
33608
001
90
2
X
9,349.10
X
33610
001
90
2
X
9,261.55
X
33610
004
90
2
X
8,140.82
X
33610
003
90
2
X
8,258.82
X
33610
002
90
2
X
8,937.72
X
33611
001
90
2
X
9,492.24
X
33611
003
90
2
X
8,481.37
X
33611
002
90
2
X
9,165.47
X
33611
004
90
2
X
8,361.13
X
33612
002
90
2
X
9,262.43
X
33612
003
90
2
X
8,576.09
X
33612
004
90
2
X
8,454.87
X
33612
001
90
2
X
9,590.40
X
33615
003
90
2
X
8,398.01
X
33615
002
90
2
X
9,080.21
X
33615
004
90
2
X
8,278.72
X
33615
001
90
2
X
9,405.90
X
33617
002
90
2
X
9,279.91
X
33617
003
90
2
X
8,593.14
X
33617
001
90
2
X
9,608.18
X
33617
004
90
2
X
8,471.86
X
33619
003
90
2
X
9,625.08
X
33619
002
90
2
X
10,389.18
X
33619
004
90
2
X
9,488.29
X
33619
001
90
2
X
10,751.93
X
33620
001
90
2
X
3,385.86
X
33620
004
90
2
X
3,028.80
X
33620
003
90
2
X
3,028.80
X
33620
002
90
2
X
3,028.80
X
33621
004
90
2
X
1,624.19
X
33621
002
90
2
X
1,624.19
X
33621
003
90
2
X
1,624.19
X
33621
001
90
2
X
1,809.23
X
33622
004
90
2
X
6,372.93
X
33622
001
90
2
X
7,100.43
X
33622
003
90
2
X
6,372.93
X
33622
002
90
2
X
6,372.93
X
33641
004
90
2
X
5,188.02
X
33641
003
90
2
X
5,251.72
X
33641
002
90
2
X
5,696.71
X
33641
001
90
2
X
5,804.48
X
33645
002
90
2
X
4,654.25
X
33645
003
90
2
X
4,392.13
X
33645
004
90
2
X
4,340.21
X
33645
001
90
2
X
4,717.52
X
33647
90
2
X
*
X
33660
001
90
2
X
7,481.04
X
33660
004
90
2
X
6,607.84
X
33660
002
90
2
X
7,231.58
X
33660
003
90
2
X
6,703.38
X
33665
001
90
2
X
7,827.60
X
33665
002
90
2
X
7,573.78
X
33665
003
90
2
X
7,037.86
X
33665
004
90
2
X
6,938.78
X
33670
001
90
2
X
9,492.24
X
33670
003
90
2
X
8,481.37
X
33670
002
90
2
X
9,165.47
X
33670
004
90
2
X
8,361.13
X
33675
003
90
2
X
3,598.18
X
33675
002
90
2
X
3,598.18
X
33675
004
90
2
X
3,598.18
X
33675
001
90
2
X
4,096.06
X
33676
001
90
2
X
4,232.26
X
33676
003
90
2
X
3,708.64
X
33676
002
90
2
X
3,708.64
X
33676
004
90
2
X
3,708.64
X
Return to CPT/HCPC List