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
Individuals
Individuals
Unemployment Benefits
Disability Services
Find A Job
Workers' Compensation Services
Workforce Development
PennSERVE
Individual Services
Uniform Construction Code
Labor Management Relations
Misclassified Workers
Businesses
Businesses
Employer UC Info
Finding Skilled Workers
Disability Services
Workforce Development
Workers' Compensation Services
Labor-Management Relations
Pennsylvania Business One-Stop
State Workers' Insurance Fund
Employer Services
About L&I
About L&I
Equal Opportunity
Guide to Services
Boards
Councils and Committees
LI Directory
Right to Know
Search
Search
Menu
Department of Labor & Industry
Menu
Individuals
Individuals
Unemployment Benefits
Disability Services
Find A Job
Workers' Compensation Services
Workforce Development
PennSERVE
Individual Services
Uniform Construction Code
Labor Management Relations
Misclassified Workers
Businesses
Businesses
Employer UC Info
Finding Skilled Workers
Disability Services
Workforce Development
Workers' Compensation Services
Labor-Management Relations
Pennsylvania Business One-Stop
State Workers' Insurance Fund
Employer Services
About L&I
About L&I
Equal Opportunity
Guide to Services
Boards
Councils and Committees
LI Directory
Right to Know
Find a Job
Find Services
Individual Services
Disability Services
Employer Services
Unemployment
Publications
DLI
>
Businesses
>
Workers' Compensation Services
>
Workers' Compensation
>
Health Care Services Review
>
Medical Fee Review
>
Fee Schedule
>
Fee Schedule 93313-93619
Begin Main Content Area
Page Content
2021 Workers' Compensation Part B Fee Schedule
93313-93619
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
93313
4
XXX
0
X
138.61
X
93313
3
XXX
0
X
140.26
X
93313
2
XXX
0
X
147.80
X
93313
1
XXX
0
X
149.60
X
93314
26
4
XXX
0
X
138.61
X
93314
26
3
XXX
0
X
140.26
X
93314
26
2
XXX
0
X
147.80
X
93314
26
1
XXX
0
X
149.60
X
93314
TC
4
XXX
0
X
315.87
X
93314
TC
3
XXX
0
X
320.82
X
93314
TC
2
XXX
0
X
350.95
X
93314
TC
1
XXX
0
X
358.05
X
93314
4
XXX
0
X
454.42
X
93314
3
XXX
0
X
461.07
X
93314
2
XXX
0
X
498.73
X
93314
1
XXX
0
X
507.77
X
93315
TC
3
XXX
0
X
280.22
X
93315
TC
4
XXX
0
X
280.22
X
93315
TC
2
XXX
0
X
287.92
X
93315
26
3
XXX
0
X
303.05
X
93315
26
4
XXX
0
X
303.05
X
93315
26
2
XXX
0
X
311.35
X
93315
26
1
XXX
0
X
333.38
X
93315
TC
1
XXX
0
X
342.65
X
93315
3
XXX
0
X
583.27
X
93315
4
XXX
0
X
583.27
X
93315
2
XXX
0
X
599.33
X
93315
1
XXX
0
X
676.04
X
93316
3
XXX
0
X
119.75
X
93316
4
XXX
0
X
119.75
X
93316
2
XXX
0
X
123.09
X
93316
1
XXX
0
X
133.77
X
93317
26
3
XXX
0
X
182.51
X
93317
26
4
XXX
0
X
182.51
X
93317
26
2
XXX
0
X
187.56
X
93317
26
1
XXX
0
X
198.76
X
93317
TC
3
XXX
0
X
280.22
X
93317
TC
4
XXX
0
X
280.22
X
93317
TC
2
XXX
0
X
287.92
X
93317
TC
1
XXX
0
X
342.65
X
93317
3
XXX
0
X
462.77
X
93317
4
XXX
0
X
462.77
X
93317
2
XXX
0
X
475.47
X
93317
1
XXX
0
X
541.40
X
93318
XXX
0
X
*
X
93320
26
2
ZZZ
0
X
64.29
X
93320
26
3
ZZZ
0
X
64.29
X
93320
26
4
ZZZ
0
X
64.29
X
93320
26
1
ZZZ
0
X
73.39
X
93320
TC
2
ZZZ
0
X
133.91
X
93320
TC
3
ZZZ
0
X
133.91
X
93320
TC
4
ZZZ
0
X
133.91
X
93320
TC
1
ZZZ
0
X
162.25
X
93320
2
ZZZ
0
X
198.19
X
93320
3
ZZZ
0
X
198.19
X
93320
4
ZZZ
0
X
198.19
X
93320
1
ZZZ
0
X
235.62
X
93321
26
1
ZZZ
0
X
71.09
X
93321
26
2
ZZZ
0
X
71.88
X
93321
26
3
ZZZ
0
X
77.54
X
93321
TC
4
ZZZ
0
X
92.26
X
93321
TC
3
ZZZ
0
X
93.67
X
93321
26
4
ZZZ
0
X
95.01
X
93321
TC
2
ZZZ
0
X
102.33
X
93321
TC
1
ZZZ
0
X
104.34
X
93321
4
ZZZ
0
X
126.18
X
93321
3
ZZZ
0
X
165.02
X
93321
2
ZZZ
0
X
180.46
X
93321
1
ZZZ
0
X
186.07
X
93325
26
2
ZZZ
0
X
9.00
X
93325
26
3
ZZZ
0
X
9.00
X
93325
26
4
ZZZ
0
X
9.00
X
93325
26
1
ZZZ
0
X
10.17
X
93325
TC
2
ZZZ
0
X
227.88
X
93325
TC
3
ZZZ
0
X
227.88
X
93325
TC
4
ZZZ
0
X
227.88
X
93325
2
ZZZ
0
X
236.87
X
93325
3
ZZZ
0
X
236.87
X
93325
4
ZZZ
0
X
236.87
X
93325
TC
1
ZZZ
0
X
276.73
X
93325
1
ZZZ
0
X
286.97
X
93350
TC
4
XXX
0
X
284.63
X
93350
TC
3
XXX
0
X
289.10
X
93350
TC
1
XXX
0
X
321.23
X
93350
26
4
XXX
0
X
477.66
X
93350
26
3
XXX
0
X
479.50
X
93350
26
2
XXX
0
X
488.28
X
93350
26
1
XXX
0
X
490.41
X
93350
TC
2
XXX
0
X
621.24
X
93350
4
XXX
0
X
911.09
X
93350
3
XXX
0
X
914.82
X
93350
2
XXX
0
X
934.47
X
93350
1
XXX
0
X
939.19
X
93351
2
XXX
0
X
401.53
X
93351
3
XXX
0
X
401.53
X
93351
4
XXX
0
X
401.53
X
93351
1
XXX
0
X
465.89
X
93352
2
XXX
0
X
55.67
X
93352
3
XXX
0
X
55.67
X
93352
4
XXX
0
X
55.67
X
93352
1
XXX
0
X
64.98
X
93355
2
XXX
6
X
302.46
X
93355
3
XXX
6
X
302.46
X
93355
4
XXX
6
X
302.46
X
93355
1
XXX
6
X
321.41
X
93356
2
ZZZ
0
X
45.75
14.18
93356
3
ZZZ
0
X
45.75
14.18
93356
4
ZZZ
0
X
45.75
14.18
93356
1
ZZZ
0
X
51.61
15.25
93451
26
2
0
2
X
221.83
X
93451
26
3
0
2
X
221.83
X
93451
26
4
0
2
X
221.83
X
93451
26
1
0
2
X
246.11
X
93451
TC
2
0
2
X
877.37
X
93451
TC
3
0
2
X
877.37
X
93451
TC
4
0
2
X
877.37
X
93451
TC
1
0
2
X
993.32
X
93451
2
0
2
X
1,099.20
X
93451
3
0
2
X
1,099.20
X
93451
4
0
2
X
1,099.20
X
93451
1
0
2
X
1,239.43
X
93452
26
2
0
2
X
388.97
X
93452
26
3
0
2
X
388.97
X
93452
26
4
0
2
X
388.97
X
93452
26
1
0
2
X
432.14
X
93452
TC
2
0
2
X
838.11
X
93452
TC
3
0
2
X
838.11
X
93452
TC
4
0
2
X
838.11
X
93452
TC
1
0
2
X
948.91
X
93452
2
0
2
X
1,227.07
X
93452
3
0
2
X
1,227.07
X
93452
4
0
2
X
1,227.07
X
93452
1
0
2
X
1,381.07
X
93453
26
2
0
2
X
509.73
X
93453
26
3
0
2
X
509.73
X
93453
26
4
0
2
X
509.73
X
93453
26
1
0
2
X
565.85
X
93453
TC
2
0
2
X
1,096.01
X
93453
TC
3
0
2
X
1,096.01
X
93453
TC
4
0
2
X
1,096.01
X
93453
TC
1
0
2
X
1,240.89
X
93453
2
0
2
X
1,605.71
X
93453
3
0
2
X
1,605.71
X
93453
4
0
2
X
1,605.71
X
93453
1
0
2
X
1,806.76
X
93454
26
2
0
2
X
391.98
X
93454
26
3
0
2
X
391.98
X
93454
26
4
0
2
X
391.98
X
93454
26
1
0
2
X
435.28
X
93454
TC
2
0
2
X
872.99
X
93454
TC
3
0
2
X
872.99
X
93454
TC
4
0
2
X
872.99
X
93454
TC
1
0
2
X
988.39
X
93454
2
0
2
X
1,264.97
X
93454
3
0
2
X
1,264.97
X
93454
4
0
2
X
1,264.97
X
93454
1
0
2
X
1,423.68
X
93455
26
2
0
2
X
452.31
X
93455
26
3
0
2
X
452.31
X
93455
26
4
0
2
X
452.31
X
93455
26
1
0
2
X
502.00
X
93455
TC
2
0
2
X
1,023.31
X
93455
TC
3
0
2
X
1,023.31
X
93455
TC
4
0
2
X
1,023.31
X
93455
TC
1
0
2
X
1,158.68
X
93455
2
0
2
X
1,475.62
X
93455
3
0
2
X
1,475.62
X
93455
4
0
2
X
1,475.62
X
93455
1
0
2
X
1,660.64
X
93456
26
2
0
2
X
501.50
X
93456
26
3
0
2
X
501.50
X
93456
26
4
0
2
X
501.50
X
93456
26
1
0
2
X
556.29
X
93456
TC
2
0
2
X
1,081.96
X
93456
TC
3
0
2
X
1,081.96
X
93456
TC
4
0
2
X
1,081.96
X
93456
TC
1
0
2
X
1,224.99
X
93456
2
0
2
X
1,583.43
X
93456
3
0
2
X
1,583.43
X
93456
4
0
2
X
1,583.43
X
93456
1
0
2
X
1,781.30
X
93457
26
2
0
2
X
562.44
X
93457
26
3
0
2
X
562.44
X
93457
26
4
0
2
X
562.44
X
93457
26
1
0
2
X
624.11
X
93457
TC
2
0
2
X
1,231.71
X
93457
TC
3
0
2
X
1,231.71
X
93457
TC
4
0
2
X
1,231.71
X
93457
TC
1
0
2
X
1,394.43
X
93457
2
0
2
X
1,794.12
X
93457
3
0
2
X
1,794.12
X
93457
4
0
2
X
1,794.12
X
93457
1
0
2
X
2,018.55
X
93458
26
2
0
2
X
478.27
X
93458
26
3
0
2
X
478.27
X
93458
26
4
0
2
X
478.27
X
93458
26
1
0
2
X
531.05
X
93458
TC
2
0
2
X
1,048.50
X
93458
TC
3
0
2
X
1,048.50
X
93458
TC
4
0
2
X
1,048.50
X
93458
TC
1
0
2
X
1,187.17
X
93458
2
0
2
X
1,526.77
X
93458
3
0
2
X
1,526.77
X
93458
4
0
2
X
1,526.77
X
93458
1
0
2
X
1,718.21
X
93459
26
2
0
2
X
538.07
X
93459
26
3
0
2
X
538.07
X
93459
26
4
0
2
X
538.07
X
93459
26
1
0
2
X
596.91
X
93459
TC
2
0
2
X
1,148.33
X
93459
TC
3
0
2
X
1,148.33
X
93459
TC
4
0
2
X
1,148.33
X
93459
TC
1
0
2
X
1,300.14
X
93459
2
0
2
X
1,686.42
X
93459
3
0
2
X
1,686.42
X
93459
4
0
2
X
1,686.42
X
93459
1
0
2
X
1,897.04
X
93460
26
2
0
2
X
599.44
X
93460
26
3
0
2
X
599.44
X
93460
26
4
0
2
X
599.44
X
93460
26
1
0
2
X
664.96
X
93460
TC
2
0
2
X
1,206.49
X
93460
TC
3
0
2
X
1,206.49
X
93460
TC
4
0
2
X
1,206.49
X
93460
TC
1
0
2
X
1,365.92
X
93460
2
0
2
X
1,805.94
X
93460
3
0
2
X
1,805.94
X
93460
4
0
2
X
1,805.94
X
93460
1
0
2
X
2,030.92
X
93461
26
2
0
2
X
661.47
X
93461
26
3
0
2
X
661.47
X
93461
26
4
0
2
X
661.47
X
93461
26
1
0
2
X
734.10
X
93461
TC
2
0
2
X
1,406.73
X
93461
TC
3
0
2
X
1,406.73
X
93461
TC
4
0
2
X
1,406.73
X
93461
TC
1
0
2
X
1,592.67
X
93461
2
0
2
X
2,068.16
X
93461
3
0
2
X
2,068.16
X
93461
4
0
2
X
2,068.16
X
93461
1
0
2
X
2,326.82
X
93462
2
ZZZ
0
X
304.49
X
93462
3
ZZZ
0
X
304.49
X
93462
4
ZZZ
0
X
304.49
X
93462
1
ZZZ
0
X
337.64
X
93463
2
ZZZ
0
X
161.18
X
93463
3
ZZZ
0
X
161.18
X
93463
4
ZZZ
0
X
161.18
X
93463
1
ZZZ
0
X
177.96
X
93464
26
2
ZZZ
0
X
142.03
X
93464
26
3
ZZZ
0
X
142.03
X
93464
26
4
ZZZ
0
X
142.03
X
93464
26
1
ZZZ
0
X
156.73
X
93464
TC
2
ZZZ
0
X
223.97
X
93464
TC
3
ZZZ
0
X
223.97
X
93464
TC
4
ZZZ
0
X
223.97
X
93464
TC
1
ZZZ
0
X
253.60
X
93464
2
ZZZ
0
X
366.01
X
93464
3
ZZZ
0
X
366.01
X
93464
4
ZZZ
0
X
366.01
X
93464
1
ZZZ
0
X
410.37
X
93503
3
0
0
X
531.96
X
93503
4
0
0
X
542.95
X
93503
1
0
0
X
569.97
X
93503
2
0
0
X
592.25
X
93505
TC
4
0
2
X
166.30
X
93505
TC
3
0
2
X
168.87
X
93505
TC
2
0
2
X
184.95
X
93505
TC
1
0
2
X
188.86
X
93505
26
3
0
2
X
699.75
X
93505
26
4
0
2
X
730.24
X
93505
26
2
0
2
X
746.45
X
93505
26
1
0
2
X
751.67
X
93505
4
0
2
X
815.01
X
93505
3
0
2
X
825.27
X
93505
2
0
2
X
876.24
X
93505
1
0
2
X
888.48
X
93530
26
2
0
2
X
620.54
X
93530
26
3
0
2
X
620.54
X
93530
26
4
0
2
X
620.54
X
93530
26
1
0
2
X
697.08
X
93530
TC
2
0
2
X
1,318.56
X
93530
TC
3
0
2
X
1,318.56
X
93530
TC
4
0
2
X
1,318.56
X
93530
TC
1
0
2
X
1,594.27
X
93530
2
0
2
X
1,939.09
X
93530
3
0
2
X
1,939.09
X
93530
4
0
2
X
1,939.09
X
93530
1
0
2
X
2,291.37
X
93531
26
2
0
2
X
1,078.80
X
93531
26
3
0
2
X
1,078.80
X
93531
26
4
0
2
X
1,078.80
X
93531
26
1
0
2
X
1,193.67
X
93531
TC
2
0
2
X
3,768.05
X
93531
TC
3
0
2
X
3,768.05
X
93531
TC
4
0
2
X
3,768.05
X
93531
TC
1
0
2
X
4,556.40
X
93531
2
0
2
X
4,846.84
X
93531
3
0
2
X
4,846.84
X
93531
4
0
2
X
4,846.84
X
93531
1
0
2
X
5,750.10
X
93532
26
2
0
2
X
1,341.39
X
93532
26
3
0
2
X
1,341.39
X
93532
26
4
0
2
X
1,341.39
X
93532
26
1
0
2
X
1,488.91
X
93532
TC
2
0
2
X
3,667.50
X
93532
TC
3
0
2
X
3,667.50
X
93532
TC
4
0
2
X
3,667.50
X
93532
TC
1
0
2
X
4,434.84
X
93532
2
0
2
X
5,008.84
X
93532
3
0
2
X
5,008.84
X
93532
4
0
2
X
5,008.84
X
93532
1
0
2
X
5,923.75
X
93533
26
2
0
2
X
748.34
X
93533
26
3
0
2
X
748.34
X
93533
26
4
0
2
X
748.34
X
93533
26
1
0
2
X
816.54
X
93533
TC
2
0
2
X
3,667.50
X
93533
TC
3
0
2
X
3,667.50
X
93533
TC
4
0
2
X
3,667.50
X
93533
2
0
2
X
4,415.82
X
93533
3
0
2
X
4,415.82
X
93533
4
0
2
X
4,415.82
X
93533
TC
1
0
2
X
4,434.86
X
93533
1
0
2
X
5,251.40
X
93561
TC
4
0
0
X
46.26
X
93561
TC
2
0
0
X
52.10
X
93561
TC
1
0
0
X
53.31
X
93561
TC
3
0
0
X
62.55
X
93561
26
3
0
0
X
157.14
X
93561
26
4
0
0
X
164.08
X
93561
26
2
0
0
X
175.48
X
93561
26
1
0
0
X
177.78
X
93561
3
0
0
X
185.01
X
93561
2
0
0
X
203.20
X
93561
4
0
0
X
210.35
X
93561
1
0
0
X
231.08
X
93562
TC
4
0
0
X
27.12
X
93562
TC
3
0
0
X
27.49
X
93562
TC
2
0
0
X
30.51
X
93562
TC
1
0
0
X
31.20
X
93562
4
0
0
X
100.07
X
93562
26
2
0
0
X
101.22
X
93562
3
0
0
X
104.16
X
93562
1
0
0
X
111.70
X
93562
2
0
0
X
116.94
X
93562
26
3
0
0
X
119.25
X
93562
26
1
0
0
X
120.50
X
93562
26
4
0
0
X
134.51
X
93563
2
ZZZ
0
X
83.05
X
93563
3
ZZZ
0
X
83.05
X
93563
4
ZZZ
0
X
83.05
X
93563
1
ZZZ
0
X
89.32
X
93564
2
ZZZ
0
X
84.60
X
93564
3
ZZZ
0
X
84.60
X
93564
4
ZZZ
0
X
84.60
X
93564
1
ZZZ
0
X
91.15
X
93565
2
ZZZ
0
X
63.94
X
93565
3
ZZZ
0
X
63.94
X
93565
4
ZZZ
0
X
63.94
X
93565
1
ZZZ
0
X
68.80
X
93566
2
ZZZ
0
X
243.73
63.94
93566
3
ZZZ
0
X
243.73
63.94
93566
4
ZZZ
0
X
243.73
63.94
93566
1
ZZZ
0
X
272.24
68.80
93567
2
ZZZ
0
X
201.82
71.93
93567
3
ZZZ
0
X
201.82
71.93
93567
4
ZZZ
0
X
201.82
71.93
93567
1
ZZZ
0
X
224.15
77.19
93568
2
ZZZ
0
X
220.54
65.45
93568
3
ZZZ
0
X
220.54
65.45
93568
4
ZZZ
0
X
220.54
65.45
93568
1
ZZZ
0
X
245.86
70.39
93571
26
2
ZZZ
0
X
185.11
X
93571
26
3
ZZZ
0
X
185.11
X
93571
26
4
ZZZ
0
X
185.11
X
93571
26
1
ZZZ
0
X
200.57
X
93571
TC
2
ZZZ
0
X
343.10
X
93571
TC
3
ZZZ
0
X
343.10
X
93571
TC
4
ZZZ
0
X
343.10
X
93571
TC
1
ZZZ
0
X
409.00
X
93571
2
ZZZ
0
X
528.17
X
93571
3
ZZZ
0
X
528.17
X
93571
4
ZZZ
0
X
528.17
X
93571
1
ZZZ
0
X
609.53
X
93572
26
2
ZZZ
0
X
148.61
X
93572
26
3
ZZZ
0
X
148.61
X
93572
26
4
ZZZ
0
X
148.61
X
93572
26
1
ZZZ
0
X
161.14
X
93572
TC
2
ZZZ
0
X
337.81
X
93572
TC
3
ZZZ
0
X
337.81
X
93572
TC
4
ZZZ
0
X
337.81
X
93572
TC
1
ZZZ
0
X
398.97
X
93572
2
ZZZ
0
X
486.37
X
93572
3
ZZZ
0
X
486.37
X
93572
4
ZZZ
0
X
486.37
X
93572
1
ZZZ
0
X
560.06
X
93580
2
ZZZ
0
X
1,776.17
X
93580
3
ZZZ
0
X
1,776.17
X
93580
4
ZZZ
0
X
1,776.17
X
93580
1
ZZZ
0
X
1,952.85
X
93581
2
0
2
X
2,380.81
X
93581
3
0
2
X
2,380.81
X
93581
4
0
2
X
2,380.81
X
93581
1
0
2
X
2,601.09
X
93582
2
0
2
X
946.40
X
93582
3
0
2
X
946.40
X
93582
4
0
2
X
946.40
X
93582
1
0
2
X
1,039.56
X
93583
2
0
2
X
1,053.45
X
93583
3
0
2
X
1,053.45
X
93583
4
0
2
X
1,053.45
X
93583
1
0
2
X
1,157.04
X
93590
2
0
2
X
1,576.85
X
93590
3
0
2
X
1,576.85
X
93590
4
0
2
X
1,576.85
X
93590
1
0
2
X
1,725.69
X
93591
2
0
2
X
1,308.62
X
93591
3
0
2
X
1,308.62
X
93591
4
0
2
X
1,308.62
X
93591
1
0
2
X
1,432.37
X
93592
2
ZZZ
0
X
576.94
X
93592
3
ZZZ
0
X
576.94
X
93592
4
ZZZ
0
X
576.94
X
93592
1
ZZZ
0
X
631.17
X
93600
TC
4
0
0
X
160.58
X
93600
TC
3
0
0
X
163.12
X
93600
TC
2
0
0
X
177.53
X
93600
TC
1
0
0
X
180.92
X
93600
26
4
0
0
X
567.44
X
93600
26
3
0
0
X
568.01
X
93600
26
2
0
0
X
581.03
X
93600
4
0
0
X
595.92
X
93600
26
1
0
0
X
598.00
X
93600
3
0
0
X
604.21
X
93600
2
0
0
X
646.56
X
93600
1
0
0
X
656.69
X
93602
TC
4
0
0
X
91.42
X
93602
TC
3
0
0
X
92.87
X
93602
TC
2
0
0
X
101.03
X
93602
TC
1
0
0
X
103.03
X
93602
26
1
0
0
X
358.01
X
93602
26
4
0
0
X
359.63
X
93602
26
3
0
0
X
361.39
X
93602
26
2
0
0
X
361.70
X
93602
4
0
0
X
422.68
X
93602
3
0
0
X
428.15
X
93602
2
0
0
X
454.71
X
93602
1
0
0
X
461.06
X
93603
TC
4
0
0
X
138.23
X
93603
TC
3
0
0
X
140.54
X
93603
TC
2
0
0
X
152.88
X
93603
TC
1
0
0
X
155.81
X
93603
4
0
0
X
504.42
X
93603
3
0
0
X
511.27
X
93603
1
0
0
X
552.75
X
93603
26
2
0
0
X
575.46
X
93603
26
1
0
0
X
580.53
X
93603
26
4
0
0
X
592.03
X
93603
26
3
0
0
X
613.68
X
93603
2
0
0
X
639.60
X
93609
TC
4
0
0
X
223.35
X
93609
TC
3
0
0
X
226.93
X
93609
TC
2
0
0
X
246.77
X
93609
TC
1
0
0
X
251.47
X
93609
26
2
0
0
X
1,239.53
X
93609
4
0
0
X
1,399.62
X
93609
3
0
0
X
1,416.33
X
93609
2
0
0
X
1,486.29
X
93609
1
0
0
X
1,503.21
X
93609
26
4
0
0
X
1,592.90
X
93609
26
3
0
0
X
1,598.37
X
93609
26
1
0
0
X
1,624.50
X
93610
TC
4
0
0
X
111.26
X
93610
TC
3
0
0
X
113.08
X
93610
TC
2
0
0
X
123.12
X
93610
TC
1
0
0
X
125.53
X
93610
3
0
0
X
571.46
X
93610
26
3
0
0
X
657.94
X
93610
26
4
0
0
X
661.11
X
93610
26
2
0
0
X
673.43
X
93610
26
1
0
0
X
675.83
X
93610
4
0
0
X
707.84
X
93610
2
0
0
X
725.20
X
93610
1
0
0
X
728.55
X
93612
TC
4
0
0
X
133.60
X
93612
TC
3
0
0
X
135.68
X
93612
TC
2
0
0
X
147.79
X
93612
TC
1
0
0
X
150.66
X
93612
4
0
0
X
588.75
X
93612
26
3
0
0
X
649.30
X
93612
26
4
0
0
X
662.15
X
93612
26
2
0
0
X
669.89
X
93612
26
1
0
0
X
676.95
X
93612
3
0
0
X
706.19
X
93612
2
0
0
X
731.92
X
93612
1
0
0
X
740.17
X
93613
26
2
XXX
0
X
693.28
X
93613
26
3
XXX
0
X
693.28
X
93613
26
4
XXX
0
X
693.28
X
93613
26
1
XXX
0
X
764.91
X
93615
TC
4
0
0
X
25.45
X
93615
TC
3
0
0
X
25.85
X
93615
TC
2
0
0
X
28.04
X
93615
TC
1
0
0
X
28.52
X
93615
26
4
0
0
X
112.47
X
93615
26
3
0
0
X
113.72
X
93615
2
0
0
X
117.24
X
93615
26
2
0
0
X
118.16
X
93615
26
1
0
0
X
119.34
X
93615
1
0
0
X
120.49
X
93615
4
0
0
X
137.86
X
93615
3
0
0
X
139.54
X
93616
TC
4
0
0
X
25.45
X
93616
TC
3
0
0
X
25.85
X
93616
TC
2
0
0
X
28.04
X
93616
TC
1
0
0
X
28.52
X
93616
26
4
0
0
X
241.39
X
93616
26
3
0
0
X
244.43
X
93616
26
2
0
0
X
257.17
X
93616
26
1
0
0
X
260.28
X
93616
4
0
0
X
266.80
X
93616
3
0
0
X
270.27
X
93616
2
0
0
X
285.23
X
93616
1
0
0
X
288.77
X
93618
TC
4
0
0
X
325.89
X
93618
TC
3
0
0
X
331.04
X
93618
TC
2
0
0
X
360.16
X
93618
TC
1
0
0
X
367.08
X
93618
3
0
0
X
1,187.53
X
93618
26
4
0
0
X
1,834.56
X
93618
26
3
0
0
X
1,839.34
X
93618
26
2
0
0
X
1,861.98
X
93618
26
1
0
0
X
1,867.44
X
93618
4
0
0
X
1,971.24
X
93618
2
0
0
X
2,013.05
X
93618
1
0
0
X
2,021.41
X
93619
TC
4
0
0
X
633.54
X
93619
TC
3
0
0
X
643.61
X
93619
TC
2
0
0
X
700.30
X
93619
TC
1
0
0
X
713.77
X
93619
26
4
0
0
X
2,170.01
X
93619
26
3
0
0
X
2,179.18
X
93619
4
0
0
X
2,179.26
X
93619
3
0
0
X
2,209.85
X
93619
26
2
0
0
X
2,223.71
X
93619
26
1
0
0
X
2,234.37
X
93619
2
0
0
X
2,367.07
X
93619
1
0
0
X
2,404.56
X
Return to CPT/HCPC List