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 27179-27468
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
27179-27468
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
27179
001
90
2
X
2,803.93
X
27179
003
90
2
X
2,571.41
X
27179
002
90
2
X
2,758.62
X
27179
004
90
2
X
2,540.90
X
27181
001
90
2
X
3,307.47
X
27181
002
90
2
X
3,254.05
X
27181
003
90
2
X
3,033.39
X
27181
004
90
2
X
2,997.36
X
27185
003
90
2
X
1,255.58
X
27185
002
90
2
X
1,336.37
X
27185
004
90
2
X
1,242.71
X
27185
001
90
2
X
1,356.05
X
27187
004
90
2
X
3,234.83
X
27187
001
90
2
X
4,175.20
X
27187
002
90
2
X
3,540.15
X
27187
003
90
2
X
3,274.88
X
27197
001
0
2
X
193.41
X
27197
004
0
2
X
175.22
X
27197
003
0
2
X
175.22
X
27197
002
0
2
X
175.22
X
27198
002
0
2
X
450.54
X
27198
003
0
2
X
450.54
X
27198
001
0
2
X
493.02
X
27198
004
0
2
X
450.54
X
27200
002
90
2
X
392.19
X
27200
003
90
2
X
362.27
X
27200
004
90
2
X
377.41
X
27200
001
90
2
X
384.04
X
27202
001
90
2
X
1,534.68
X
27202
004
90
2
X
1,396.49
X
27202
002
90
2
X
1,511.07
X
27202
003
90
2
X
1,413.42
X
27215
001
90
9
X
2,866.75
X
27215
003
90
9
X
2,595.26
X
27215
002
90
9
X
2,813.90
X
27215
004
90
9
X
2,563.27
X
27216
001
90
9
X
1,772.31
X
27216
003
90
9
X
1,583.18
X
27216
002
90
9
X
1,773.20
X
27216
004
90
9
X
1,661.99
X
27217
004
90
9
X
3,093.58
X
27217
001
90
9
X
3,424.95
X
27217
002
90
9
X
3,367.79
X
27217
003
90
9
X
3,131.44
X
27218
002
90
9
X
3,980.71
X
27218
003
90
9
X
3,729.77
X
27218
004
90
9
X
3,686.38
X
27218
001
90
9
X
4,041.47
X
27220
003
90
2
X
1,061.30
X
27220
002
90
2
X
1,447.72
X
27220
001
90
2
X
1,465.58
X
27220
004
90
2
X
1,340.87
X
27222
004
90
2
X
1,898.99
X
27222
002
90
2
X
1,993.93
X
27222
003
90
2
X
1,892.00
X
27222
001
90
2
X
2,033.66
X
27226
003
90
2
X
3,355.12
X
27226
002
90
2
X
3,610.04
X
27226
004
90
2
X
3,314.37
X
27226
001
90
2
X
3,671.62
X
27227
004
90
2
X
3,933.33
X
27227
001
90
2
X
4,632.04
X
27227
003
90
2
X
3,982.25
X
27227
002
90
2
X
4,298.04
X
27228
004
90
2
X
4,222.29
X
27228
002
90
2
X
4,597.86
X
27228
003
90
2
X
4,274.06
X
27228
001
90
2
X
4,775.33
X
27230
001
90
2
X
794.77
X
27230
004
90
2
X
894.24
X
27230
002
90
2
X
1,028.77
X
27230
003
90
2
X
964.79
X
27232
001
90
2
X
2,507.13
X
27232
004
90
2
X
2,158.06
X
27232
002
90
2
X
2,270.54
X
27232
003
90
2
X
2,330.19
X
27235
001
90
2
X
3,278.18
X
27235
004
90
2
X
2,935.76
X
27235
003
90
2
X
2,972.26
X
27235
002
90
2
X
3,218.62
X
27236
002
90
2
X
3,784.60
X
27236
003
90
2
X
3,513.13
X
27236
001
90
2
X
4,244.01
X
27236
004
90
2
X
3,470.24
X
27238
004
90
2
X
757.93
X
27238
001
90
2
X
819.87
X
27238
003
90
2
X
1,111.23
X
27238
002
90
2
X
1,190.81
X
27240
001
90
2
X
2,505.53
X
27240
004
90
2
X
2,277.22
X
27240
002
90
2
X
2,466.35
X
27240
003
90
2
X
2,423.56
X
27244
002
90
2
X
3,727.10
X
27244
003
90
2
X
3,463.17
X
27244
004
90
2
X
3,421.10
X
27244
001
90
2
X
4,209.80
X
27245
001
90
2
X
4,443.21
X
27245
004
90
2
X
3,880.82
X
27245
003
90
2
X
3,927.18
X
27245
002
90
2
X
4,202.41
X
27246
004
90
2
X
916.12
X
27246
002
90
2
X
957.60
X
27246
003
90
2
X
920.99
X
27246
001
90
2
X
947.17
X
27248
001
90
2
X
2,512.52
X
27248
004
90
2
X
2,348.28
X
27248
002
90
2
X
2,484.10
X
27248
003
90
2
X
2,366.24
X
27250
004
0
2
X
1,248.36
X
27250
001
0
2
X
1,150.66
X
27250
003
0
2
X
1,074.22
X
27250
002
0
2
X
1,281.08
X
27252
003
90
2
X
1,434.85
X
27252
002
90
2
X
1,604.92
X
27252
001
90
2
X
1,640.54
X
27252
004
90
2
X
1,504.07
X
27253
003
90
2
X
2,957.02
X
27253
002
90
2
X
3,048.54
X
27253
004
90
2
X
2,942.68
X
27253
001
90
2
X
3,100.17
X
27254
003
90
2
X
3,449.84
X
27254
002
90
2
X
3,687.30
X
27254
004
90
2
X
3,409.83
X
27254
001
90
2
X
3,744.86
X
27256
004
10
2
X
611.98
X
27256
001
10
2
X
663.60
X
27256
002
10
2
X
964.92
X
27256
003
10
2
X
618.81
X
27257
001
10
2
X
1,154.46
X
27257
003
10
2
X
1,059.78
X
27257
002
10
2
X
1,136.03
X
27257
004
10
2
X
1,047.16
X
27258
004
90
2
X
3,169.57
X
27258
002
90
2
X
3,396.50
X
27258
003
90
2
X
3,166.35
X
27258
001
90
2
X
3,452.21
X
27259
004
90
2
X
3,919.24
X
27259
001
90
2
X
4,324.90
X
27259
003
90
2
X
3,966.48
X
27259
002
90
2
X
4,255.01
X
27265
001
90
2
X
1,197.56
X
27265
003
90
2
X
1,002.73
X
27265
002
90
2
X
1,266.14
X
27265
004
90
2
X
1,235.35
X
27266
004
90
2
X
1,443.83
X
27266
003
90
2
X
1,303.54
X
27266
002
90
2
X
1,482.54
X
27266
001
90
2
X
1,451.93
X
27267
001
90
2
X
776.56
X
27267
004
90
2
X
677.93
X
27267
003
90
2
X
677.93
X
27267
002
90
2
X
677.93
X
27268
004
90
2
X
836.17
X
27268
002
90
2
X
836.17
X
27268
003
90
2
X
836.17
X
27268
001
90
2
X
955.19
X
27269
003
90
2
X
1,999.04
X
27269
002
90
2
X
1,999.04
X
27269
004
90
2
X
1,999.04
X
27269
001
90
2
X
2,263.74
X
27275
001
10
2
X
460.39
X
27275
003
10
2
X
438.31
X
27275
002
10
2
X
455.99
X
27275
004
10
2
X
429.92
X
27278
001
90
2
X
14,198.83
541.87
27278
004
90
2
X
12,521.70
498.91
27278
003
90
2
X
12,521.70
498.91
27278
002
90
2
X
12,521.70
498.91
27279
001
90
2
X
959.68
X
27279
004
90
2
X
879.27
X
27279
003
90
2
X
879.27
X
27279
002
90
2
X
879.27
X
27280
002
90
2
X
2,644.87
X
27280
003
90
2
X
2,466.87
X
27280
001
90
2
X
2,688.02
X
27280
004
90
2
X
2,438.09
X
27282
004
90
2
X
2,194.55
X
27282
001
90
2
X
2,893.17
X
27282
002
90
2
X
2,384.93
X
27282
003
90
2
X
2,788.38
X
27284
002
90
2
X
4,146.20
X
27284
003
90
2
X
3,390.92
X
27284
004
90
2
X
3,350.71
X
27284
001
90
2
X
4,144.31
X
27286
002
90
2
X
4,390.90
X
27286
003
90
2
X
3,450.98
X
27286
004
90
2
X
3,409.50
X
27286
001
90
2
X
3,752.90
X
27290
001
90
2
X
5,775.90
X
27290
002
90
2
X
5,696.38
X
27290
003
90
2
X
5,389.40
X
27290
004
90
2
X
5,324.51
X
27295
001
90
2
X
4,196.06
X
27295
004
90
2
X
3,855.01
X
27295
003
90
2
X
3,837.05
X
27295
002
90
2
X
4,126.02
X
27299
YYY
2
X
#
X
27301
004
90
2
X
797.30
X
27301
001
90
2
X
852.89
X
27301
003
90
2
X
805.75
X
27301
002
90
2
X
842.72
X
27303
001
90
2
X
1,643.61
X
27303
004
90
2
X
1,465.48
X
27303
003
90
2
X
1,516.54
X
27303
002
90
2
X
1,618.84
X
27305
001
90
2
X
1,122.40
X
27305
004
90
2
X
1,023.07
X
27305
002
90
2
X
1,105.28
X
27305
003
90
2
X
1,034.92
X
27306
003
90
2
X
695.31
X
27306
002
90
2
X
728.35
X
27306
004
90
2
X
682.17
X
27306
001
90
2
X
737.71
X
27307
001
90
2
X
989.80
X
27307
004
90
2
X
910.32
X
27307
003
90
2
X
920.62
X
27307
002
90
2
X
976.27
X
27310
001
90
2
X
2,340.09
X
27310
004
90
2
X
2,072.90
X
27310
002
90
2
X
2,169.78
X
27310
003
90
2
X
2,016.29
X
27323
001
10
2
X
311.17
X
27323
004
10
2
X
319.78
X
27323
002
10
2
X
309.10
X
27323
003
10
2
X
389.82
X
27324
002
90
2
X
567.03
X
27324
003
90
2
X
528.34
X
27324
004
90
2
X
524.69
X
27324
001
90
2
X
581.14
X
27325
001
90
2
X
939.53
X
27325
004
90
2
X
814.93
X
27325
002
90
2
X
814.93
X
27325
003
90
2
X
814.93
X
27326
002
90
2
X
770.55
X
27326
003
90
2
X
770.55
X
27326
004
90
2
X
770.55
X
27326
001
90
2
X
893.36
X
27327
003
90
2
X
768.45
X
27327
002
90
2
X
779.08
X
27327
004
90
2
X
726.50
X
27327
001
90
2
X
789.88
X
27328
004
90
2
X
819.33
X
27328
001
90
2
X
1,011.62
X
27328
003
90
2
X
820.56
X
27328
002
90
2
X
1,017.18
X
27329
002
90
2
X
2,870.39
X
27329
003
90
2
X
2,664.77
X
27329
004
90
2
X
2,633.20
X
27329
001
90
2
X
2,939.85
X
27330
003
90
2
X
1,347.68
X
27330
002
90
2
X
1,607.17
X
27330
001
90
2
X
1,714.00
X
27330
004
90
2
X
1,576.11
X
27331
003
90
2
X
1,773.35
X
27331
002
90
2
X
1,970.57
X
27331
004
90
2
X
1,909.45
X
27331
001
90
2
X
2,137.92
X
27332
002
90
2
X
2,355.00
X
27332
003
90
2
X
2,057.88
X
27332
004
90
2
X
2,032.64
X
27332
001
90
2
X
2,372.00
X
27333
003
90
2
X
2,423.55
X
27333
002
90
2
X
2,583.80
X
27333
001
90
2
X
2,637.51
X
27333
004
90
2
X
2,331.65
X
27334
004
90
2
X
2,511.00
X
27334
002
90
2
X
2,632.29
X
27334
003
90
2
X
2,550.05
X
27334
001
90
2
X
2,654.08
X
27335
004
90
2
X
2,618.29
X
27335
001
90
2
X
2,797.70
X
27335
003
90
2
X
2,695.15
X
27335
002
90
2
X
2,777.82
X
27337
004
90
2
X
702.67
X
27337
002
90
2
X
702.67
X
27337
003
90
2
X
702.67
X
27337
001
90
2
X
790.48
X
27339
002
90
2
X
1,268.45
X
27339
003
90
2
X
1,268.45
X
27339
001
90
2
X
1,423.81
X
27339
004
90
2
X
1,268.45
X
27340
001
90
2
X
1,136.69
X
27340
004
90
2
X
1,003.49
X
27340
002
90
2
X
1,092.59
X
27340
003
90
2
X
888.31
X
27345
001
90
2
X
1,466.80
X
27345
004
90
2
X
1,281.04
X
27345
002
90
2
X
1,400.41
X
27345
003
90
2
X
1,271.90
X
27347
004
90
2
X
748.54
780.67
27347
001
90
2
X
837.82
875.42
27347
002
90
2
X
748.54
780.67
27347
003
90
2
X
748.54
780.67
27350
001
90
2
X
2,108.03
X
27350
004
90
2
X
1,895.49
X
27350
002
90
2
X
2,071.23
X
27350
003
90
2
X
1,919.16
X
27355
002
90
2
X
1,982.32
X
27355
003
90
2
X
1,797.76
X
27355
004
90
2
X
1,632.21
X
27355
001
90
2
X
2,117.95
X
27356
004
90
2
X
1,868.43
X
27356
002
90
2
X
2,028.09
X
27356
003
90
2
X
1,890.97
X
27356
001
90
2
X
2,061.37
X
27357
002
90
2
X
2,220.47
X
27357
003
90
2
X
2,072.11
X
27357
004
90
2
X
2,047.60
X
27357
001
90
2
X
2,256.33
X
27358
002
ZZZ
0
X
1,987.15
X
27358
003
ZZZ
0
X
1,955.58
X
27358
004
ZZZ
0
X
1,895.90
X
27358
001
ZZZ
0
X
2,010.30
X
27360
003
90
2
X
2,001.77
X
27360
002
90
2
X
2,146.12
X
27360
001
90
2
X
2,181.07
X
27360
004
90
2
X
1,977.94
X
27364
001
90
2
X
2,972.92
X
27364
004
90
2
X
2,656.57
X
27364
002
90
2
X
2,656.57
X
27364
003
90
2
X
2,656.57
X
27365
001
90
2
X
3,444.73
X
27365
003
90
2
X
2,907.76
X
27365
002
90
2
X
3,100.54
X
27365
004
90
2
X
3,110.18
X
27369
001
0
2
X
217.02
62.10
27369
003
0
2
X
192.60
57.55
27369
002
0
2
X
192.60
57.55
27369
004
0
2
X
192.60
57.55
27372
001
90
2
X
932.26
X
27372
004
90
2
X
857.95
X
27372
002
90
2
X
908.75
X
27372
003
90
2
X
853.96
X
27380
004
90
2
X
1,697.86
X
27380
002
90
2
X
1,805.52
X
27380
003
90
2
X
1,680.65
X
27380
001
90
2
X
1,848.45
X
27381
004
90
2
X
2,339.51
X
27381
003
90
2
X
2,368.33
X
27381
002
90
2
X
2,550.58
X
27381
001
90
2
X
2,594.56
X
27385
003
90
2
X
1,813.76
X
27385
002
90
2
X
1,955.51
X
27385
004
90
2
X
1,833.96
X
27385
001
90
2
X
1,989.67
X
27386
004
90
2
X
2,559.35
X
27386
001
90
2
X
2,761.81
X
27386
002
90
2
X
2,713.74
X
27386
003
90
2
X
2,514.65
X
27390
004
90
2
X
1,026.54
X
27390
002
90
2
X
1,222.49
X
27390
003
90
2
X
1,038.82
X
27390
001
90
2
X
1,218.16
X
27391
001
90
2
X
1,472.49
X
27391
004
90
2
X
1,339.79
X
27391
002
90
2
X
1,449.72
X
27391
003
90
2
X
1,355.67
X
27392
004
90
2
X
1,800.23
X
27392
002
90
2
X
1,952.66
X
27392
003
90
2
X
1,821.77
X
27392
001
90
2
X
1,984.33
X
27393
001
90
2
X
1,426.61
X
27393
004
90
2
X
1,292.88
X
27393
002
90
2
X
1,403.56
X
27393
003
90
2
X
1,308.42
X
27394
001
90
2
X
1,655.46
X
27394
003
90
2
X
1,529.67
X
27394
002
90
2
X
1,630.93
X
27394
004
90
2
X
1,512.06
X
27395
003
90
2
X
2,407.29
X
27395
002
90
2
X
2,579.82
X
27395
004
90
2
X
2,378.56
X
27395
001
90
2
X
2,621.64
X
27396
001
90
2
X
1,759.35
X
27396
003
90
2
X
1,615.40
X
27396
002
90
2
X
2,471.13
X
27396
004
90
2
X
1,596.14
X
27397
004
90
2
X
2,025.42
X
27397
001
90
2
X
2,234.80
X
27397
002
90
2
X
2,198.76
X
27397
003
90
2
X
2,049.76
X
27400
003
90
2
X
1,834.52
X
27400
002
90
2
X
1,964.60
X
27400
004
90
2
X
1,812.57
X
27400
001
90
2
X
2,600.18
X
27403
002
90
2
X
2,262.35
X
27403
003
90
2
X
2,025.06
X
27403
001
90
2
X
2,056.82
X
27403
004
90
2
X
1,855.29
X
27405
003
90
2
X
2,708.12
X
27405
002
90
2
X
2,776.86
X
27405
001
90
2
X
2,793.45
X
27405
004
90
2
X
2,697.49
X
27407
004
90
2
X
2,033.70
X
27407
001
90
2
X
2,241.77
X
27407
003
90
2
X
2,058.19
X
27407
002
90
2
X
2,205.93
X
27409
001
90
2
X
3,357.81
X
27409
003
90
2
X
3,055.67
X
27409
002
90
2
X
3,299.06
X
27409
004
90
2
X
3,018.20
X
27412
001
90
2
X
3,641.58
X
27412
004
90
2
X
3,192.22
X
27412
003
90
2
X
3,192.22
X
27412
002
90
2
X
3,192.22
X
27415
001
90
2
X
3,062.58
X
27415
004
90
2
X
2,653.19
X
27415
003
90
2
X
2,653.19
X
27415
002
90
2
X
2,653.19
X
27416
003
90
2
X
1,566.49
X
27416
002
90
2
X
1,566.49
X
27416
004
90
2
X
1,566.49
X
27416
001
90
2
X
1,782.64
X
27418
004
90
2
X
2,455.38
X
27418
002
90
2
X
2,781.40
X
27418
003
90
2
X
2,486.08
X
27418
001
90
2
X
2,721.85
X
27420
001
90
2
X
2,312.10
X
27420
004
90
2
X
2,248.26
X
27420
003
90
2
X
2,276.11
X
27420
002
90
2
X
2,512.68
X
27422
004
90
2
X
2,497.53
X
27422
002
90
2
X
2,619.10
X
27422
003
90
2
X
2,327.72
X
27422
001
90
2
X
2,708.86
X
27424
001
90
2
X
2,592.14
X
27424
004
90
2
X
2,331.30
X
27424
002
90
2
X
2,546.99
X
27424
003
90
2
X
2,360.34
X
27425
003
90
2
X
1,984.68
X
27425
001
90
2
X
2,041.49
X
27425
002
90
2
X
1,817.70
X
27425
004
90
2
X
1,979.83
X
27427
001
90
2
X
2,719.86
X
27427
003
90
2
X
2,459.83
X
27427
002
90
2
X
3,099.73
X
27427
004
90
2
X
2,429.38
X
27428
001
90
2
X
3,268.27
X
27428
003
90
2
X
2,956.23
X
27428
002
90
2
X
3,207.43
X
27428
004
90
2
X
2,919.87
X
27429
002
90
2
X
3,928.93
X
27429
003
90
2
X
2,602.43
X
27429
004
90
2
X
2,571.39
X
27429
001
90
2
X
2,836.37
X
27430
004
90
2
X
2,172.79
X
27430
002
90
2
X
2,247.42
X
27430
003
90
2
X
2,094.36
X
27430
001
90
2
X
2,300.05
X
27435
001
90
2
X
2,622.19
X
27435
004
90
2
X
1,743.96
X
27435
002
90
2
X
2,609.93
X
27435
003
90
2
X
2,559.40
X
27437
004
90
2
X
1,972.52
X
27437
002
90
2
X
2,324.85
X
27437
003
90
2
X
2,155.29
X
27437
001
90
2
X
2,318.82
X
27438
003
90
2
X
5,394.69
X
27438
002
90
2
X
5,558.31
X
27438
004
90
2
X
2,624.98
X
27438
001
90
2
X
5,372.12
X
27440
002
90
2
X
2,758.01
X
27440
003
90
2
X
2,436.44
X
27440
004
90
2
X
2,406.81
X
27440
001
90
2
X
2,683.19
X
27441
001
90
2
X
2,325.87
X
27441
004
90
2
X
2,108.45
X
27441
002
90
2
X
2,288.41
X
27441
003
90
2
X
2,133.75
X
27442
001
90
2
X
3,576.58
X
27442
004
90
2
X
3,188.80
X
27442
003
90
2
X
3,228.75
X
27442
002
90
2
X
3,508.85
X
27443
001
90
2
X
3,621.90
X
27443
002
90
2
X
3,549.94
X
27443
003
90
2
X
3,252.22
X
27443
004
90
2
X
3,211.64
X
27445
004
90
2
X
6,325.94
X
27445
001
90
2
X
6,639.43
X
27445
002
90
2
X
6,571.40
X
27445
003
90
2
X
6,393.75
X
27446
003
90
2
X
5,018.74
X
27446
002
90
2
X
5,172.07
X
27446
004
90
2
X
4,918.86
X
27446
001
90
2
X
4,715.64
X
27447
001
90
2
X
6,865.02
X
27447
004
90
2
X
6,553.66
X
27447
003
90
2
X
6,555.52
X
27447
002
90
2
X
6,810.13
X
27448
004
90
2
X
2,588.79
X
27448
002
90
2
X
3,260.47
X
27448
003
90
2
X
2,758.89
X
27448
001
90
2
X
2,877.27
X
27450
001
90
2
X
3,449.40
X
27450
004
90
2
X
3,114.00
X
27450
003
90
2
X
3,152.27
X
27450
002
90
2
X
3,497.18
X
27454
001
90
2
X
3,779.54
X
27454
004
90
2
X
3,205.85
X
27454
003
90
2
X
3,245.59
X
27454
002
90
2
X
3,728.56
X
27455
001
90
2
X
2,952.59
X
27455
003
90
2
X
2,705.33
X
27455
002
90
2
X
2,904.39
X
27455
004
90
2
X
2,672.96
X
27457
001
90
2
X
3,104.87
X
27457
003
90
2
X
2,920.41
X
27457
002
90
2
X
3,137.98
X
27457
004
90
2
X
2,885.18
X
27465
004
90
2
X
2,789.45
X
27465
002
90
2
X
3,453.16
X
27465
003
90
2
X
2,822.99
X
27465
001
90
2
X
3,496.31
X
27466
004
90
2
X
3,173.87
X
27466
001
90
2
X
3,499.37
X
27466
003
90
2
X
3,211.74
X
27466
002
90
2
X
3,443.33
X
27468
004
90
2
X
3,836.66
X
27468
002
90
2
X
4,165.05
X
27468
003
90
2
X
3,882.91
X
27468
001
90
2
X
4,233.28
X
Return to CPT/HCPC List