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 90849-92134
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
90849-92134
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
90849
002
XXX
0
X
78.14
X
90849
003
XXX
0
X
78.14
X
90849
004
XXX
0
X
78.14
X
90849
001
XXX
0
X
85.83
X
90853
004
XXX
0
X
78.14
X
90853
003
XXX
0
X
78.14
X
90853
002
XXX
0
X
78.14
X
90853
001
XXX
0
X
85.83
X
90863
XXX
9
X
*
X
90865
003
XXX
0
X
302.72
X
90865
002
XXX
0
X
302.72
X
90865
004
XXX
0
X
302.72
X
90865
001
XXX
0
X
323.52
X
90867
0
0
X
*
X
90868
0
0
X
*
X
90869
002
0
0
X
731.08
194.64
90869
001
0
0
X
825.24
203.07
90869
003
0
0
X
731.08
194.64
90869
004
0
0
X
731.08
194.64
90870
002
0
0
X
258.69
X
90870
003
0
0
X
247.43
X
90870
004
0
0
X
244.71
X
90870
001
0
0
X
261.46
X
90875
XXX
9
X
*
X
90876
002
XXX
9
X
201.24
X
90876
001
XXX
9
X
213.63
X
90876
004
XXX
9
X
195.79
X
90876
003
XXX
9
X
195.79
X
90880
002
XXX
0
X
257.60
X
90880
004
XXX
0
X
257.60
X
90880
003
XXX
0
X
257.60
X
90880
001
XXX
0
X
278.62
X
90882
XXX
9
X
*
X
90885
XXX
9
X
*
X
90887
003
XXX
9
X
173.68
X
90887
002
XXX
9
X
166.87
X
90887
004
XXX
9
X
146.72
X
90887
001
XXX
9
X
178.61
X
90899
XXX
0
X
#
X
90901
001
0
0
X
67.00
X
90901
002
0
0
X
61.90
X
90901
003
0
0
X
60.29
X
90901
004
0
0
X
60.29
X
90912
003
0
0
X
108.90
61.59
90912
002
0
0
X
108.90
61.59
90912
004
0
0
X
108.90
61.59
90912
001
0
0
X
120.39
65.92
90913
001
ZZZ
0
X
48.50
36.65
90913
003
ZZZ
0
X
44.53
34.22
90913
004
ZZZ
0
X
44.53
34.22
90913
002
ZZZ
0
X
44.53
34.22
90935
004
0
0
X
311.52
X
90935
003
0
0
X
319.81
X
90935
002
0
0
X
327.51
X
90935
001
0
0
X
324.44
X
90937
002
0
0
X
661.09
X
90937
003
0
0
X
652.79
X
90937
004
0
0
X
649.84
X
90937
001
0
0
X
674.84
X
90940
XXX
9
X
*
X
90945
002
0
0
X
259.26
X
90945
003
0
0
X
245.74
X
90945
004
0
0
X
242.66
X
90945
001
0
0
X
243.26
X
90947
003
0
0
X
451.69
X
90947
002
0
0
X
491.98
X
90947
001
0
0
X
480.02
X
90947
004
0
0
X
477.29
X
90951
002
XXX
0
X
1,688.51
X
90951
003
XXX
0
X
1,688.51
X
90951
001
XXX
0
X
1,813.09
X
90951
004
XXX
0
X
1,688.51
X
90952
XXX
0
X
*
X
90953
XXX
0
X
*
X
90954
001
XXX
0
X
1,482.98
X
90954
004
XXX
0
X
1,388.12
X
90954
003
XXX
0
X
1,388.12
X
90954
002
XXX
0
X
1,388.12
X
90955
004
XXX
0
X
785.72
X
90955
003
XXX
0
X
785.72
X
90955
002
XXX
0
X
785.72
X
90955
001
XXX
0
X
842.09
X
90956
003
XXX
0
X
531.94
X
90956
001
XXX
0
X
569.90
X
90956
004
XXX
0
X
531.94
X
90956
002
XXX
0
X
531.94
X
90957
004
XXX
0
X
1,113.00
X
90957
003
XXX
0
X
1,113.00
X
90957
002
XXX
0
X
1,113.00
X
90957
001
XXX
0
X
1,191.42
X
90958
002
XXX
0
X
750.98
X
90958
003
XXX
0
X
750.98
X
90958
004
XXX
0
X
750.98
X
90958
001
XXX
0
X
805.17
X
90959
002
XXX
0
X
492.42
X
90959
001
XXX
0
X
527.32
X
90959
004
XXX
0
X
492.42
X
90959
003
XXX
0
X
492.42
X
90960
003
XXX
0
X
493.27
X
90960
002
XXX
0
X
493.27
X
90960
001
XXX
0
X
531.85
X
90960
004
XXX
0
X
493.27
X
90961
001
XXX
0
X
428.69
X
90961
004
XXX
0
X
398.31
X
90961
002
XXX
0
X
398.31
X
90961
003
XXX
0
X
398.31
X
90962
003
XXX
0
X
288.02
X
90962
002
XXX
0
X
288.02
X
90962
004
XXX
0
X
288.02
X
90962
001
XXX
0
X
309.17
X
90963
004
XXX
0
X
954.28
X
90963
002
XXX
0
X
954.28
X
90963
003
XXX
0
X
954.28
X
90963
001
XXX
0
X
1,023.61
X
90964
002
XXX
0
X
797.19
X
90964
003
XXX
0
X
797.19
X
90964
004
XXX
0
X
797.19
X
90964
001
XXX
0
X
852.25
X
90965
001
XXX
0
X
809.34
X
90965
004
XXX
0
X
757.57
X
90965
003
XXX
0
X
757.57
X
90965
002
XXX
0
X
757.57
X
90966
004
XXX
0
X
394.15
X
90966
002
XXX
0
X
394.15
X
90966
003
XXX
0
X
394.15
X
90966
001
XXX
0
X
423.72
X
90967
001
XXX
0
X
36.76
X
90967
004
XXX
0
X
34.08
X
90967
003
XXX
0
X
34.08
X
90967
002
XXX
0
X
34.08
X
90968
001
XXX
0
X
28.53
X
90968
004
XXX
0
X
26.59
X
90968
002
XXX
0
X
26.59
X
90968
003
XXX
0
X
26.59
X
90969
002
XXX
0
X
26.03
X
90969
004
XXX
0
X
26.03
X
90969
003
XXX
0
X
26.03
X
90969
001
XXX
0
X
27.86
X
90970
001
XXX
0
X
15.19
X
90970
002
XXX
0
X
13.90
X
90970
003
XXX
0
X
13.90
X
90970
004
XXX
0
X
13.90
X
90989
XXX
9
X
1,517.07
X
90993
XXX
9
X
60.70
X
90997
001
0
0
X
666.63
X
90997
002
0
0
X
696.19
X
90997
003
0
0
X
422.99
X
90997
004
0
0
X
613.61
X
90999
XXX
0
X
#
X
91010
004
0
0
X
248.90
X
91010
26
004
0
0
X
353.23
X
91010
TC
004
0
0
X
79.20
X
91010
002
0
0
X
329.60
X
91010
26
002
0
0
X
349.42
X
91010
TC
002
0
0
X
87.55
X
91010
003
0
0
X
321.69
X
91010
26
003
0
0
X
278.53
X
91010
TC
003
0
0
X
80.41
X
91010
001
0
0
X
374.75
X
91010
26
001
0
0
X
340.01
X
91010
TC
001
0
0
X
89.23
X
91013
004
ZZZ
0
X
39.22
X
91013
26
004
ZZZ
0
X
17.00
X
91013
TC
004
ZZZ
0
X
22.22
X
91013
003
ZZZ
0
X
39.22
X
91013
26
003
ZZZ
0
X
17.00
X
91013
TC
003
ZZZ
0
X
22.22
X
91013
002
ZZZ
0
X
39.22
X
91013
26
002
ZZZ
0
X
17.00
X
91013
TC
002
ZZZ
0
X
22.22
X
91013
001
ZZZ
0
X
43.61
X
91013
26
001
ZZZ
0
X
18.21
X
91013
TC
001
ZZZ
0
X
25.39
X
91020
003
0
0
X
350.15
X
91020
26
003
0
0
X
279.70
X
91020
002
0
0
X
350.15
X
91020
26
002
0
0
X
279.70
X
91020
004
0
0
X
350.15
X
91020
26
004
0
0
X
279.70
X
91020
001
0
0
X
401.49
X
91020
26
001
0
0
X
316.08
X
91020
TC
001
0
0
X
85.37
X
91020
TC
002
0
0
X
70.41
X
91020
TC
003
0
0
X
70.41
X
91020
TC
004
0
0
X
70.41
X
91022
004
0
0
X
401.55
X
91022
26
004
0
0
X
142.27
X
91022
TC
004
0
0
X
259.32
X
91022
003
0
0
X
401.55
X
91022
26
003
0
0
X
142.27
X
91022
TC
003
0
0
X
259.32
X
91022
002
0
0
X
401.55
X
91022
26
002
0
0
X
142.27
X
91022
TC
002
0
0
X
259.32
X
91022
001
0
0
X
473.50
X
91022
26
001
0
0
X
154.41
X
91022
TC
001
0
0
X
319.13
X
91030
001
0
0
X
173.39
X
91030
26
001
0
0
X
144.68
X
91030
TC
001
0
0
X
24.34
X
91030
004
0
0
X
174.65
X
91030
26
004
0
0
X
137.64
X
91030
TC
004
0
0
X
21.49
X
91030
003
0
0
X
176.63
X
91030
26
003
0
0
X
136.96
X
91030
TC
003
0
0
X
21.77
X
91030
002
0
0
X
184.95
X
91030
26
002
0
0
X
142.05
X
91030
TC
002
0
0
X
23.83
X
91034
004
0
0
X
464.97
X
91034
26
004
0
0
X
105.40
X
91034
TC
004
0
0
X
359.55
X
91034
003
0
0
X
464.97
X
91034
26
003
0
0
X
105.40
X
91034
TC
003
0
0
X
359.55
X
91034
002
0
0
X
464.97
X
91034
26
002
0
0
X
105.40
X
91034
TC
002
0
0
X
359.55
X
91034
001
0
0
X
547.58
X
91034
26
001
0
0
X
114.62
X
91034
TC
001
0
0
X
433.04
X
91035
003
0
0
X
917.74
X
91035
26
003
0
0
X
170.50
X
91035
TC
003
0
0
X
747.26
X
91035
002
0
0
X
917.74
X
91035
26
002
0
0
X
170.50
X
91035
TC
002
0
0
X
747.26
X
91035
001
0
0
X
1,081.59
X
91035
26
001
0
0
X
183.88
X
91035
TC
001
0
0
X
897.70
X
91035
004
0
0
X
917.74
X
91035
26
004
0
0
X
170.50
X
91035
TC
004
0
0
X
747.26
X
91037
001
0
0
X
346.59
X
91037
26
001
0
0
X
114.62
X
91037
TC
001
0
0
X
232.00
X
91037
002
0
0
X
297.27
X
91037
26
002
0
0
X
105.40
X
91037
TC
002
0
0
X
191.87
X
91037
003
0
0
X
297.27
X
91037
26
003
0
0
X
105.40
X
91037
TC
003
0
0
X
191.87
X
91037
004
0
0
X
297.27
X
91037
26
004
0
0
X
105.40
X
91037
TC
004
0
0
X
191.87
X
91038
004
0
0
X
256.00
X
91038
26
004
0
0
X
119.35
X
91038
TC
004
0
0
X
136.69
X
91038
001
0
0
X
295.30
X
91038
26
001
0
0
X
129.44
X
91038
TC
001
0
0
X
165.85
X
91038
003
0
0
X
256.00
X
91038
26
003
0
0
X
119.35
X
91038
TC
003
0
0
X
136.69
X
91038
002
0
0
X
256.00
X
91038
26
002
0
0
X
119.35
X
91038
TC
002
0
0
X
136.69
X
91040
004
0
0
X
892.56
X
91040
26
004
0
0
X
105.40
X
91040
TC
004
0
0
X
787.22
X
91040
002
0
0
X
892.56
X
91040
26
002
0
0
X
105.40
X
91040
TC
002
0
0
X
787.22
X
91040
003
0
0
X
892.56
X
91040
26
003
0
0
X
105.40
X
91040
TC
003
0
0
X
787.22
X
91040
001
0
0
X
1,060.18
X
91040
26
001
0
0
X
114.62
X
91040
TC
001
0
0
X
945.61
X
91065
004
0
0
X
160.78
X
91065
26
004
0
0
X
93.11
X
91065
TC
004
0
0
X
33.50
X
91065
003
0
0
X
161.46
X
91065
26
003
0
0
X
94.33
X
91065
TC
003
0
0
X
34.07
X
91065
002
0
0
X
164.85
X
91065
26
002
0
0
X
99.58
X
91065
TC
002
0
0
X
36.88
X
91065
001
0
0
X
165.69
X
91065
26
001
0
0
X
100.84
X
91065
TC
001
0
0
X
37.58
X
91110
004
XXX
0
X
1,891.85
X
91110
26
004
XXX
0
X
394.21
X
91110
TC
004
XXX
0
X
1,497.65
X
91110
002
XXX
0
X
1,891.85
X
91110
26
002
XXX
0
X
394.21
X
91110
TC
002
XXX
0
X
1,497.65
X
91110
003
XXX
0
X
1,891.85
X
91110
26
003
XXX
0
X
394.21
X
91110
TC
003
XXX
0
X
1,497.65
X
91110
001
XXX
0
X
2,182.23
X
91110
26
001
XXX
0
X
419.12
X
91110
TC
001
XXX
0
X
1,763.10
X
91111
004
XXX
0
X
1,230.26
X
91111
26
004
XXX
0
X
92.15
X
91111
TC
004
XXX
0
X
1,138.12
X
91111
003
XXX
0
X
1,230.26
X
91111
26
003
XXX
0
X
92.15
X
91111
TC
003
XXX
0
X
1,138.12
X
91111
002
XXX
0
X
1,230.26
X
91111
26
002
XXX
0
X
92.15
X
91111
TC
002
XXX
0
X
1,138.12
X
91111
001
XXX
0
X
1,494.22
X
91111
26
001
XXX
0
X
101.21
X
91111
TC
001
XXX
0
X
1,393.00
X
91112
002
XXX
0
X
1,779.88
X
91112
26
002
XXX
0
X
177.96
X
91112
TC
002
XXX
0
X
1,601.92
X
91112
004
XXX
0
X
1,779.88
X
91112
26
004
XXX
0
X
177.96
X
91112
TC
004
XXX
0
X
1,601.92
X
91112
003
XXX
0
X
1,779.88
X
91112
26
003
XXX
0
X
177.96
X
91112
TC
003
XXX
0
X
1,601.92
X
91112
001
XXX
0
X
2,049.31
X
91112
26
001
XXX
0
X
191.04
X
91112
TC
001
XXX
0
X
1,858.27
X
91113
004
XXX
0
X
1,090.33
X
91113
26
004
XXX
0
X
145.08
X
91113
TC
004
XXX
0
X
945.22
X
91113
001
XXX
0
X
1,244.96
X
91113
26
001
XXX
0
X
154.71
X
91113
TC
001
XXX
0
X
1,090.25
X
91113
002
XXX
0
X
1,090.33
X
91113
26
002
XXX
0
X
145.08
X
91113
TC
002
XXX
0
X
945.22
X
91113
003
XXX
0
X
1,090.33
X
91113
26
003
XXX
0
X
145.08
X
91113
TC
003
XXX
0
X
945.22
X
91117
004
0
0
X
247.26
262.62
91117
002
0
0
X
247.26
262.62
91117
003
0
0
X
247.26
262.62
91117
001
0
0
X
271.28
288.62
91120
003
XXX
0
X
881.04
X
91120
26
003
XXX
0
X
106.03
X
91120
TC
003
XXX
0
X
775.04
X
91120
002
XXX
0
X
881.04
X
91120
26
002
XXX
0
X
106.03
X
91120
TC
002
XXX
0
X
775.04
X
91120
001
XXX
0
X
1,046.02
X
91120
26
001
XXX
0
X
115.70
X
91120
TC
001
XXX
0
X
930.33
X
91120
004
XXX
0
X
881.04
X
91120
26
004
XXX
0
X
106.03
X
91120
TC
004
XXX
0
X
775.04
X
91122
004
0
0
X
382.77
X
91122
26
004
0
0
X
305.90
X
91122
TC
004
0
0
X
76.87
X
91122
003
0
0
X
377.86
X
91122
26
003
0
0
X
309.46
X
91122
TC
003
0
0
X
78.00
X
91122
002
0
0
X
383.58
X
91122
26
002
0
0
X
366.94
X
91122
TC
002
0
0
X
86.46
X
91122
001
0
0
X
398.53
X
91122
26
001
0
0
X
368.67
X
91122
TC
001
0
0
X
88.45
X
91132
XXX
0
X
*
X
91133
XXX
0
X
*
X
91200
003
XXX
0
X
54.71
X
91200
26
003
XXX
0
X
23.23
X
91200
TC
003
XXX
0
X
31.45
X
91200
001
XXX
0
X
61.67
X
91200
26
001
XXX
0
X
24.82
X
91200
TC
001
XXX
0
X
36.86
X
91200
002
XXX
0
X
54.71
X
91200
26
002
XXX
0
X
23.23
X
91200
TC
002
XXX
0
X
31.45
X
91200
004
XXX
0
X
54.71
X
91200
26
004
XXX
0
X
23.23
X
91200
TC
004
XXX
0
X
31.45
X
91299
XXX
0
X
#
X
91300
XXX
9
X
0.01
X
91301
XXX
9
X
0.01
X
91302
XXX
9
X
0.01
X
91303
XXX
9
X
0.01
X
91304
XXX
9
X
0.01
X
91305
XXX
9
X
0.01
X
91306
XXX
9
X
0.01
X
91307
XXX
9
X
0.01
X
91308
XXX
9
X
0.01
X
91309
XXX
9
X
0.01
X
91310
XXX
9
X
0.01
X
91311
XXX
9
X
0.01
X
91312
XXX
9
X
0.01
X
91313
XXX
9
X
0.01
X
91314
X
#
X
91315
X
#
X
91316
X
#
X
91317
X
#
X
92002
003
XXX
0
X
137.28
115.71
92002
004
XXX
0
X
135.98
114.39
92002
002
XXX
0
X
145.84
122.05
92002
001
XXX
0
X
145.61
122.47
92004
001
XXX
0
X
210.97
184.09
92004
002
XXX
0
X
205.33
178.57
92004
003
XXX
0
X
190.94
166.74
92004
004
XXX
0
X
190.73
166.87
92012
003
XXX
0
X
114.67
95.69
92012
004
XXX
0
X
116.14
96.88
92012
001
XXX
0
X
123.40
102.66
92012
002
XXX
0
X
123.83
102.77
92014
004
XXX
0
X
152.33
127.63
92014
002
XXX
0
X
161.98
135.36
92014
003
XXX
0
X
144.99
121.49
92014
001
XXX
0
X
168.51
139.97
92015
XXX
9
X
*
X
92018
004
XXX
0
X
194.04
172.47
92018
003
XXX
0
X
189.28
167.86
92018
002
XXX
0
X
206.25
182.25
92018
001
XXX
0
X
248.04
218.83
92019
001
XXX
0
X
186.90
X
92019
002
XXX
0
X
149.54
X
92019
003
XXX
0
X
145.43
X
92019
004
XXX
0
X
175.97
X
92020
001
XXX
0
X
62.68
49.21
92020
003
XXX
0
X
64.71
51.06
92020
004
XXX
0
X
50.98
40.09
92020
002
XXX
0
X
67.65
53.20
92025
002
XXX
7
X
49.87
X
92025
26
002
XXX
7
X
29.30
X
92025
TC
002
XXX
7
X
20.58
X
92025
001
XXX
7
X
57.34
X
92025
26
001
XXX
7
X
31.91
X
92025
TC
001
XXX
7
X
25.42
X
92025
004
XXX
7
X
49.87
X
92025
26
004
XXX
7
X
29.30
X
92025
TC
004
XXX
7
X
20.58
X
92025
003
XXX
7
X
49.87
X
92025
26
003
XXX
7
X
29.30
X
92025
TC
003
XXX
7
X
20.58
X
92060
004
XXX
7
X
87.79
X
92060
26
004
XXX
7
X
70.10
X
92060
TC
004
XXX
7
X
17.69
X
92060
003
XXX
7
X
88.93
X
92060
26
003
XXX
7
X
70.91
X
92060
TC
003
XXX
7
X
17.91
X
92060
002
XXX
7
X
93.16
X
92060
26
002
XXX
7
X
73.79
X
92060
TC
002
XXX
7
X
19.34
X
92060
001
XXX
7
X
94.20
X
92060
26
001
XXX
7
X
74.42
X
92060
TC
001
XXX
7
X
19.79
X
92065
004
XXX
0
X
70.41
X
92065
26
004
XXX
0
X
55.61
X
92065
TC
004
XXX
0
X
14.82
X
92065
003
XXX
0
X
70.00
X
92065
26
003
XXX
0
X
54.28
X
92065
TC
003
XXX
0
X
15.11
X
92065
002
XXX
0
X
83.32
X
92065
26
002
XXX
0
X
64.41
X
92065
TC
002
XXX
0
X
16.00
X
92065
001
XXX
0
X
75.44
X
92065
26
001
XXX
0
X
59.23
X
92065
TC
001
XXX
0
X
16.18
X
92066
003
XXX
0
X
28.60
X
92066
004
XXX
0
X
28.60
X
92066
001
XXX
0
X
32.80
X
92066
002
XXX
0
X
28.60
X
92071
001
XXX
0
X
66.23
58.96
92071
003
XXX
0
X
61.06
54.74
92071
002
XXX
0
X
61.06
54.74
92071
004
XXX
0
X
61.06
54.74
92072
002
XXX
0
X
195.01
158.35
92072
003
XXX
0
X
195.01
158.35
92072
004
XXX
0
X
195.01
158.35
92072
001
XXX
0
X
211.76
169.20
92081
004
XXX
7
X
65.73
X
92081
26
004
XXX
7
X
51.81
X
92081
TC
004
XXX
7
X
14.02
X
92081
002
XXX
7
X
69.65
X
92081
26
002
XXX
7
X
54.66
X
92081
TC
002
XXX
7
X
15.00
X
92081
003
XXX
7
X
66.54
X
92081
26
003
XXX
7
X
52.38
X
92081
TC
003
XXX
7
X
14.16
X
92081
001
XXX
7
X
71.93
X
92081
26
001
XXX
7
X
55.96
X
92081
TC
001
XXX
7
X
15.17
X
92082
002
XXX
7
X
96.18
X
92082
26
002
XXX
7
X
75.72
X
92082
TC
002
XXX
7
X
20.40
X
92082
003
XXX
7
X
88.26
X
92082
26
003
XXX
7
X
68.06
X
92082
TC
003
XXX
7
X
18.90
X
92082
004
XXX
7
X
89.21
X
92082
26
004
XXX
7
X
69.04
X
92082
TC
004
XXX
7
X
18.64
X
92082
001
XXX
7
X
97.27
X
92082
26
001
XXX
7
X
76.46
X
92082
TC
001
XXX
7
X
20.78
X
92083
001
XXX
7
X
151.80
X
92083
26
001
XXX
7
X
113.04
X
92083
TC
001
XXX
7
X
29.89
X
92083
002
XXX
7
X
152.33
X
92083
26
002
XXX
7
X
113.20
X
92083
TC
002
XXX
7
X
29.40
X
92083
003
XXX
7
X
145.27
X
92083
26
003
XXX
7
X
108.25
X
92083
TC
003
XXX
7
X
27.40
X
92083
004
XXX
7
X
138.10
X
92083
26
004
XXX
7
X
103.12
X
92083
TC
004
XXX
7
X
26.97
X
92100
004
XXX
0
X
88.32
77.20
92100
003
XXX
0
X
86.94
75.99
92100
002
XXX
0
X
85.03
74.28
92100
001
XXX
0
X
93.40
81.07
92132
001
XXX
7
X
68.62
X
92132
26
001
XXX
7
X
39.36
X
92132
TC
001
XXX
7
X
29.26
X
92132
004
XXX
7
X
61.97
X
92132
26
004
XXX
7
X
36.34
X
92132
TC
004
XXX
7
X
25.64
X
92132
002
XXX
7
X
61.97
X
92132
26
002
XXX
7
X
36.34
X
92132
TC
002
XXX
7
X
25.64
X
92132
003
XXX
7
X
61.97
X
92132
26
003
XXX
7
X
36.34
X
92132
TC
003
XXX
7
X
25.64
X
92133
001
XXX
7
X
83.39
X
92133
26
001
XXX
7
X
54.17
X
92133
TC
001
XXX
7
X
29.26
X
92133
002
XXX
7
X
75.96
X
92133
26
002
XXX
7
X
50.33
X
92133
TC
002
XXX
7
X
25.64
X
92133
003
XXX
7
X
75.96
X
92133
26
003
XXX
7
X
50.33
X
92133
TC
003
XXX
7
X
25.64
X
92133
004
XXX
7
X
75.96
X
92133
26
004
XXX
7
X
50.33
X
92133
TC
004
XXX
7
X
25.64
X
92134
001
XXX
7
X
83.39
X
92134
26
001
XXX
7
X
54.17
X
92134
TC
001
XXX
7
X
29.26
X
92134
003
XXX
7
X
75.96
X
92134
26
003
XXX
7
X
50.33
X
92134
TC
003
XXX
7
X
25.64
X
92134
002
XXX
7
X
75.96
X
92134
26
002
XXX
7
X
50.33
X
92134
TC
002
XXX
7
X
25.64
X
92134
004
XXX
7
X
75.96
X
92134
26
004
XXX
7
X
50.33
X
92134
TC
004
XXX
7
X
25.64
X
Return to CPT/HCPC List