You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page.
Skip Ribbon Commands
Skip to main content
Turn off Animations
Turn on Animations
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 51785-53510
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
51785-53510
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
51785
001
XXX
2
X
272.82
X
51785
26
001
XXX
2
X
229.20
X
51785
TC
001
XXX
2
X
48.83
X
51785
003
XXX
2
X
249.00
X
51785
26
003
XXX
2
X
221.20
X
51785
TC
003
XXX
2
X
43.46
X
51785
002
XXX
2
X
267.35
X
51785
26
002
XXX
2
X
227.58
X
51785
TC
002
XXX
2
X
47.80
X
51785
004
XXX
2
X
244.31
X
51785
26
004
XXX
2
X
219.64
X
51785
TC
004
XXX
2
X
42.87
X
51792
003
0
2
X
280.79
X
51792
26
003
0
2
X
183.26
X
51792
TC
003
0
2
X
150.82
X
51792
002
0
2
X
360.72
X
51792
26
002
0
2
X
192.66
X
51792
TC
002
0
2
X
165.69
X
51792
004
0
2
X
329.72
X
51792
26
004
0
2
X
181.22
X
51792
TC
004
0
2
X
148.51
X
51792
001
0
2
X
364.14
X
51792
26
001
0
2
X
194.95
X
51792
TC
001
0
2
X
169.20
X
51797
002
ZZZ
0
X
258.63
X
51797
26
002
ZZZ
0
X
208.48
X
51797
TC
002
ZZZ
0
X
55.72
X
51797
003
ZZZ
0
X
250.05
X
51797
26
003
ZZZ
0
X
190.91
X
51797
TC
003
ZZZ
0
X
50.61
X
51797
004
ZZZ
0
X
275.14
X
51797
26
004
ZZZ
0
X
225.31
X
51797
TC
004
ZZZ
0
X
49.87
X
51797
001
ZZZ
0
X
260.66
X
51797
26
001
ZZZ
0
X
209.82
X
51797
TC
001
ZZZ
0
X
56.98
X
51798
003
XXX
0
X
40.82
X
51798
002
XXX
0
X
40.82
X
51798
004
XXX
0
X
40.82
X
51798
001
XXX
0
X
50.90
X
51800
001
90
2
X
3,344.67
X
51800
004
90
2
X
3,075.91
X
51800
003
90
2
X
3,112.51
X
51800
002
90
2
X
3,299.54
X
51820
001
90
2
X
2,051.59
X
51820
004
90
2
X
1,914.43
X
51820
002
90
2
X
2,022.61
X
51820
003
90
2
X
1,922.11
X
51840
004
90
2
X
1,875.29
X
51840
001
90
2
X
2,126.04
X
51840
003
90
2
X
1,875.29
X
51840
002
90
2
X
1,875.29
X
51841
004
90
2
X
2,709.80
X
51841
003
90
2
X
2,631.68
X
51841
002
90
2
X
2,733.99
X
51841
001
90
2
X
2,775.23
X
51845
003
90
2
X
2,556.14
X
51845
002
90
2
X
2,604.53
X
51845
001
90
2
X
2,629.95
X
51845
004
90
2
X
2,544.62
X
51860
001
90
2
X
2,206.54
X
51860
004
90
2
X
2,034.09
X
51860
003
90
2
X
2,058.15
X
51860
002
90
2
X
2,177.57
X
51865
002
90
2
X
2,901.37
X
51865
003
90
2
X
2,736.90
X
51865
004
90
2
X
2,704.41
X
51865
001
90
2
X
2,941.07
X
51880
001
90
2
X
1,419.27
X
51880
003
90
2
X
1,327.02
X
51880
002
90
2
X
1,401.37
X
51880
004
90
2
X
1,311.46
X
51900
004
90
2
X
2,545.19
X
51900
001
90
2
X
3,243.78
X
51900
003
90
2
X
2,811.47
X
51900
002
90
2
X
3,143.31
X
51920
002
90
2
X
2,073.70
X
51920
003
90
2
X
1,965.12
X
51920
001
90
2
X
2,099.88
X
51920
004
90
2
X
1,941.89
X
51925
002
90
2
X
2,982.92
X
51925
003
90
2
X
2,771.40
X
51925
004
90
2
X
2,740.32
X
51925
001
90
2
X
3,034.43
X
51940
001
90
2
X
5,177.94
X
51940
004
90
2
X
4,763.80
X
51940
003
90
2
X
4,820.77
X
51940
002
90
2
X
5,108.44
X
51960
004
90
2
X
4,611.30
X
51960
003
90
2
X
4,668.73
X
51960
002
90
2
X
4,964.23
X
51960
001
90
2
X
5,035.39
X
51980
001
90
2
X
2,947.81
X
51980
004
90
2
X
1,924.45
X
51980
002
90
2
X
2,853.57
X
51980
003
90
2
X
1,947.48
X
51990
002
90
2
X
1,654.53
X
51990
003
90
2
X
1,654.53
X
51990
001
90
2
X
1,822.36
X
51990
004
90
2
X
1,654.53
X
51992
001
90
2
X
1,980.49
X
51992
004
90
2
X
1,805.37
X
51992
003
90
2
X
1,805.37
X
51992
002
90
2
X
1,805.37
X
51999
YYY
0
X
#
X
52000
003
0
2
X
362.90
X
52000
002
0
2
X
382.87
X
52000
004
0
2
X
358.63
X
52000
001
0
2
X
387.74
X
52001
004
0
3
X
286.88
X
52001
001
0
3
X
323.27
X
52001
003
0
3
X
286.88
X
52001
002
0
3
X
286.88
X
52005
004
0
3
X
492.75
X
52005
002
0
3
X
528.88
X
52005
003
0
3
X
498.82
X
52005
001
0
3
X
536.14
X
52007
003
0
3
X
615.35
X
52007
002
0
3
X
646.10
X
52007
001
0
3
X
643.43
X
52007
004
0
3
X
597.46
X
52010
002
0
3
X
499.68
X
52010
003
0
3
X
534.73
X
52010
001
0
3
X
570.69
X
52010
004
0
3
X
528.55
X
52204
001
0
3
X
660.30
X
52204
004
0
3
X
627.90
X
52204
002
0
3
X
585.05
X
52204
003
0
3
X
532.49
X
52214
001
0
3
X
817.77
X
52214
002
0
3
X
808.70
X
52214
003
0
3
X
733.09
X
52214
004
0
3
X
796.10
X
52224
002
0
3
X
795.24
X
52224
003
0
3
X
694.62
X
52224
004
0
3
X
741.29
X
52224
001
0
3
X
794.68
X
52234
004
0
3
X
1,126.04
X
52234
001
0
3
X
1,166.16
X
52234
003
0
3
X
1,127.82
X
52234
002
0
3
X
1,159.29
X
52235
002
0
3
X
1,712.06
X
52235
003
0
3
X
1,664.55
X
52235
004
0
3
X
1,753.11
X
52235
001
0
3
X
1,897.94
X
52240
001
0
3
X
2,402.18
X
52240
004
0
3
X
2,262.84
X
52240
003
0
3
X
2,188.35
X
52240
002
0
3
X
2,421.01
X
52250
004
0
3
X
790.14
X
52250
003
0
3
X
639.22
X
52250
002
0
3
X
842.41
X
52250
001
0
3
X
852.81
X
52260
004
0
3
X
550.24
X
52260
001
0
3
X
576.63
X
52260
002
0
3
X
571.13
X
52260
003
0
3
X
554.10
X
52265
001
0
3
X
445.34
X
52265
003
0
3
X
406.40
X
52265
002
0
3
X
431.23
X
52265
004
0
3
X
420.54
X
52270
004
0
3
X
788.17
X
52270
001
0
3
X
857.29
X
52270
003
0
3
X
797.96
X
52270
002
0
3
X
845.82
X
52275
001
0
3
X
944.37
X
52275
003
0
3
X
883.21
X
52275
002
0
3
X
947.28
X
52275
004
0
3
X
872.72
X
52276
001
0
3
X
1,004.82
X
52276
002
0
3
X
990.38
X
52276
003
0
3
X
972.50
X
52276
004
0
3
X
967.54
X
52277
002
0
3
X
1,134.82
X
52277
003
0
3
X
1,059.61
X
52277
004
0
3
X
1,182.16
X
52277
001
0
3
X
1,182.39
X
52281
004
0
3
X
474.43
369.49
52281
002
0
3
X
474.43
369.49
52281
003
0
3
X
474.43
369.49
52281
001
0
3
X
532.83
409.52
52282
001
0
3
X
1,133.77
X
52282
003
0
3
X
1,015.71
X
52282
002
0
3
X
1,015.71
X
52282
004
0
3
X
1,015.71
X
52283
004
0
3
X
560.60
X
52283
002
0
3
X
478.00
X
52283
003
0
3
X
566.74
X
52283
001
0
3
X
599.19
X
52284
004
0
3
X
2,760.57
173.67
52284
003
0
3
X
2,760.57
173.67
52284
002
0
3
X
2,760.57
173.67
52284
001
0
3
X
3,126.28
187.77
52285
004
0
3
X
722.61
X
52285
003
0
3
X
738.22
X
52285
002
0
3
X
781.04
X
52285
001
0
3
X
765.79
X
52287
001
0
3
X
536.80
289.30
52287
004
0
3
X
480.08
266.67
52287
002
0
3
X
480.08
266.67
52287
003
0
3
X
480.08
266.67
52290
002
0
3
X
788.90
X
52290
003
0
3
X
751.24
X
52290
001
0
3
X
797.98
X
52290
004
0
3
X
742.71
X
52300
001
0
3
X
1,101.72
X
52300
004
0
3
X
1,049.85
X
52300
003
0
3
X
959.59
X
52300
002
0
3
X
1,096.43
X
52301
004
0
3
X
943.50
X
52301
002
0
3
X
969.55
X
52301
003
0
3
X
943.50
X
52301
001
0
3
X
1,051.51
X
52305
001
0
3
X
1,021.74
X
52305
002
0
3
X
1,009.22
X
52305
003
0
3
X
957.37
X
52305
004
0
3
X
946.18
X
52310
001
0
3
X
832.06
X
52310
003
0
3
X
788.78
X
52310
002
0
3
X
818.93
X
52310
004
0
3
X
797.76
X
52315
001
0
3
X
1,081.96
X
52315
003
0
3
X
1,022.10
X
52315
002
0
3
X
1,068.09
X
52315
004
0
3
X
998.47
X
52317
004
0
3
X
1,389.70
X
52317
001
0
3
X
1,511.02
X
52317
003
0
3
X
1,406.96
X
52317
002
0
3
X
1,490.78
X
52318
004
0
3
X
1,838.14
X
52318
001
0
3
X
1,996.14
X
52318
002
0
3
X
1,969.81
X
52318
003
0
3
X
1,860.66
X
52320
004
0
3
X
1,031.09
X
52320
001
0
3
X
1,178.86
X
52320
003
0
3
X
1,142.14
X
52320
002
0
3
X
1,108.82
X
52325
001
0
3
X
1,555.10
X
52325
004
0
3
X
1,423.20
X
52325
002
0
3
X
1,532.96
X
52325
003
0
3
X
1,441.25
X
52327
001
0
3
X
1,111.18
X
52327
003
0
3
X
1,026.73
X
52327
002
0
3
X
1,084.51
X
52327
004
0
3
X
1,013.03
X
52330
001
0
3
X
1,122.09
X
52330
003
0
3
X
1,078.98
X
52330
002
0
3
X
1,030.33
X
52330
004
0
3
X
915.12
X
52332
002
0
3
X
781.11
X
52332
003
0
3
X
764.84
X
52332
004
0
3
X
753.04
X
52332
001
0
3
X
786.03
X
52334
003
0
3
X
1,108.17
X
52334
002
0
3
X
1,098.38
X
52334
001
0
3
X
1,163.97
X
52334
004
0
3
X
1,090.76
X
52341
004
0
3
X
748.14
X
52341
002
0
3
X
748.14
X
52341
003
0
3
X
748.14
X
52341
001
0
3
X
818.75
X
52342
004
0
3
X
809.96
X
52342
001
0
3
X
886.00
X
52342
002
0
3
X
809.96
X
52342
003
0
3
X
809.96
X
52343
002
0
3
X
897.20
X
52343
003
0
3
X
897.20
X
52343
001
0
3
X
981.56
X
52343
004
0
3
X
897.20
X
52344
001
0
3
X
1,048.80
X
52344
003
0
3
X
959.06
X
52344
002
0
3
X
959.06
X
52344
004
0
3
X
959.06
X
52345
001
0
3
X
1,118.38
X
52345
004
0
3
X
1,022.12
X
52345
002
0
3
X
1,022.12
X
52345
003
0
3
X
1,022.12
X
52346
002
0
3
X
1,149.86
X
52346
003
0
3
X
1,149.86
X
52346
001
0
3
X
1,257.80
X
52346
004
0
3
X
1,149.86
X
52351
001
0
2
X
836.67
X
52351
002
0
2
X
762.69
X
52351
003
0
2
X
762.69
X
52351
004
0
2
X
762.69
X
52352
003
0
3
X
942.31
X
52352
002
0
3
X
942.31
X
52352
004
0
3
X
942.31
X
52352
001
0
3
X
1,037.40
X
52353
002
0
3
X
1,091.66
X
52353
003
0
3
X
1,091.66
X
52353
001
0
3
X
1,201.83
X
52353
004
0
3
X
1,091.66
X
52354
001
0
3
X
1,049.80
X
52354
002
0
3
X
956.54
X
52354
003
0
3
X
956.54
X
52354
004
0
3
X
956.54
X
52355
001
0
3
X
1,231.91
X
52355
004
0
3
X
1,123.91
X
52355
002
0
3
X
1,123.91
X
52355
003
0
3
X
1,123.91
X
52356
004
0
3
X
668.96
X
52356
001
0
3
X
720.81
X
52356
003
0
3
X
668.96
X
52356
002
0
3
X
668.96
X
52400
003
90
3
X
1,333.94
X
52400
002
90
3
X
1,333.94
X
52400
004
90
3
X
1,333.94
X
52400
001
90
3
X
1,468.96
X
52402
002
0
3
X
566.64
X
52402
003
0
3
X
566.64
X
52402
001
0
3
X
617.91
X
52402
004
0
3
X
566.64
X
52441
003
0
3
X
1,860.71
373.35
52441
002
0
3
X
1,860.71
373.35
52441
001
0
3
X
2,143.78
403.46
52441
004
0
3
X
1,860.71
373.35
52442
003
ZZZ
0
X
1,436.91
129.20
52442
002
ZZZ
0
X
1,436.91
129.20
52442
001
ZZZ
0
X
1,675.61
145.52
52442
004
ZZZ
0
X
1,436.91
129.20
52450
002
90
2
X
1,382.76
X
52450
003
90
2
X
1,310.10
X
52450
004
90
2
X
1,294.66
X
52450
001
90
2
X
1,400.31
X
52500
004
90
2
X
1,733.33
X
52500
002
90
2
X
1,838.39
X
52500
003
90
2
X
1,749.60
X
52500
001
90
2
X
1,789.99
X
52601
004
90
2
X
2,646.38
X
52601
002
90
2
X
2,830.50
X
52601
003
90
2
X
2,684.78
X
52601
001
90
2
X
2,868.70
X
52630
004
90
2
X
2,341.90
X
52630
002
90
2
X
2,470.51
X
52630
003
90
2
X
2,406.34
X
52630
001
90
2
X
2,484.34
X
52640
001
90
2
X
1,640.41
X
52640
003
90
2
X
1,596.10
X
52640
002
90
2
X
1,631.75
X
52640
004
90
2
X
1,589.00
X
52647
001
90
2
X
2,868.70
X
52647
002
90
2
X
2,830.50
X
52647
003
90
2
X
2,684.78
X
52647
004
90
2
X
2,646.38
X
52648
003
90
2
X
2,684.78
X
52648
002
90
2
X
2,830.50
X
52648
004
90
2
X
2,646.38
X
52648
001
90
2
X
2,868.70
X
52649
001
90
2
X
1,927.03
X
52649
004
90
2
X
1,742.73
X
52649
003
90
2
X
1,742.73
X
52649
002
90
2
X
1,742.73
X
52700
002
90
2
X
1,125.89
X
52700
003
90
2
X
1,042.18
X
52700
004
90
2
X
1,081.51
X
52700
001
90
2
X
1,159.27
X
53000
001
10
2
X
463.32
X
53000
003
10
2
X
420.34
X
53000
002
10
2
X
444.46
X
53000
004
10
2
X
405.37
X
53010
002
90
2
X
895.32
X
53010
003
90
2
X
851.69
X
53010
001
90
2
X
776.29
X
53010
004
90
2
X
708.92
X
53020
002
0
2
X
294.89
X
53020
003
0
2
X
301.30
X
53020
004
0
2
X
277.93
X
53020
001
0
2
X
301.86
X
53025
003
0
2
X
209.70
X
53025
002
0
2
X
221.42
X
53025
001
0
2
X
224.18
X
53025
004
0
2
X
207.31
X
53040
001
90
2
X
839.43
X
53040
004
90
2
X
837.69
X
53040
003
90
2
X
813.85
X
53040
002
90
2
X
786.09
X
53060
004
10
2
X
330.35
X
53060
002
10
2
X
315.40
X
53060
003
10
2
X
333.79
X
53060
001
10
2
X
350.15
X
53080
001
90
2
X
1,151.89
X
53080
004
90
2
X
1,063.57
X
53080
002
90
2
X
1,137.19
X
53080
003
90
2
X
1,076.14
X
53085
004
90
2
X
1,768.77
X
53085
002
90
2
X
1,890.02
X
53085
003
90
2
X
1,789.86
X
53085
001
90
2
X
1,914.31
X
53200
003
0
2
X
399.53
X
53200
002
0
2
X
418.67
X
53200
004
0
2
X
395.17
X
53200
001
0
2
X
423.32
X
53210
003
90
2
X
1,871.22
X
53210
002
90
2
X
1,990.71
X
53210
001
90
2
X
1,970.56
X
53210
004
90
2
X
1,967.96
X
53215
001
90
2
X
2,849.67
X
53215
003
90
2
X
2,669.49
X
53215
002
90
2
X
2,814.57
X
53215
004
90
2
X
2,638.10
X
53220
002
90
2
X
1,306.56
X
53220
003
90
2
X
1,236.56
X
53220
004
90
2
X
1,221.92
X
53220
001
90
2
X
1,323.49
X
53230
001
90
2
X
1,988.63
X
53230
003
90
2
X
1,852.06
X
53230
002
90
2
X
1,962.11
X
53230
004
90
2
X
1,829.59
X
53235
001
90
2
X
1,574.81
X
53235
004
90
2
X
1,465.58
X
53235
002
90
2
X
1,425.63
X
53235
003
90
2
X
1,381.68
X
53240
001
90
2
X
1,039.63
X
53240
004
90
2
X
1,115.86
X
53240
003
90
2
X
1,129.22
X
53240
002
90
2
X
1,017.02
X
53250
004
90
2
X
1,045.45
X
53250
002
90
2
X
1,116.56
X
53250
003
90
2
X
699.81
X
53250
001
90
2
X
1,130.58
X
53260
001
10
2
X
522.78
X
53260
004
10
2
X
509.09
X
53260
003
10
2
X
506.45
X
53260
002
10
2
X
489.73
X
53265
003
10
2
X
686.35
X
53265
002
10
2
X
732.63
X
53265
004
10
2
X
660.52
X
53265
001
10
2
X
635.41
X
53270
002
10
2
X
436.68
X
53270
003
10
2
X
336.51
X
53270
001
10
2
X
441.91
X
53270
004
10
2
X
411.03
X
53275
001
10
2
X
757.76
X
53275
004
10
2
X
723.90
X
53275
002
10
2
X
764.95
X
53275
003
10
2
X
732.22
X
53400
004
90
2
X
2,069.02
X
53400
002
90
2
X
2,206.27
X
53400
003
90
2
X
2,093.37
X
53400
001
90
2
X
2,233.61
X
53405
001
90
2
X
2,835.96
X
53405
004
90
2
X
2,609.45
X
53405
003
90
2
X
2,640.64
X
53405
002
90
2
X
2,797.94
X
53410
004
90
2
X
2,586.79
X
53410
001
90
2
X
2,782.25
X
53410
003
90
2
X
2,616.73
X
53410
002
90
2
X
2,749.96
X
53415
003
90
2
X
3,104.54
X
53415
002
90
2
X
3,204.93
X
53415
004
90
2
X
3,257.30
X
53415
001
90
2
X
3,513.95
X
53420
004
90
2
X
1,479.39
X
53420
001
90
2
X
1,634.72
X
53420
002
90
2
X
1,609.62
X
53420
003
90
2
X
2,630.07
X
53425
002
90
2
X
2,785.68
X
53425
003
90
2
X
2,647.49
X
53425
004
90
2
X
2,616.74
X
53425
001
90
2
X
2,819.12
X
53430
001
90
2
X
2,609.99
X
53430
003
90
2
X
2,459.91
X
53430
002
90
2
X
2,580.72
X
53430
004
90
2
X
2,432.50
X
53431
004
90
2
X
2,294.92
X
53431
001
90
2
X
2,521.77
X
53431
003
90
2
X
2,294.92
X
53431
002
90
2
X
2,294.92
X
53440
004
90
2
X
2,847.26
X
53440
003
90
2
X
2,707.83
X
53440
002
90
2
X
2,982.35
X
53440
001
90
2
X
3,074.31
X
53442
001
90
2
X
1,590.20
X
53442
004
90
2
X
1,463.33
X
53442
003
90
2
X
1,480.84
X
53442
002
90
2
X
1,568.98
X
53444
003
90
2
X
1,642.51
X
53444
002
90
2
X
1,642.51
X
53444
004
90
2
X
1,642.51
X
53444
001
90
2
X
1,810.13
X
53445
004
90
2
X
3,468.08
X
53445
002
90
2
X
3,759.00
X
53445
003
90
2
X
3,513.04
X
53445
001
90
2
X
3,818.16
X
53446
004
90
2
X
1,511.28
X
53446
001
90
2
X
1,684.74
X
53446
003
90
2
X
1,511.28
X
53446
002
90
2
X
1,511.28
X
53447
004
90
2
X
2,313.50
X
53447
001
90
2
X
2,503.89
X
53447
003
90
2
X
2,341.35
X
53447
002
90
2
X
2,472.23
X
53448
002
90
2
X
2,733.86
X
53448
003
90
2
X
2,733.86
X
53448
004
90
2
X
2,733.86
X
53448
001
90
2
X
3,024.16
X
53449
001
90
2
X
2,058.54
X
53449
004
90
2
X
1,892.76
X
53449
002
90
2
X
1,932.16
X
53449
003
90
2
X
1,916.22
X
53450
001
90
2
X
969.54
X
53450
004
90
2
X
934.43
X
53450
002
90
2
X
958.82
X
53450
003
90
2
X
914.42
X
53451
10
0
X
#
X
53452
10
0
X
#
X
53453
0
0
X
#
X
53454
0
0
X
*
X
53460
002
90
2
X
1,030.16
X
53460
003
90
2
X
979.71
X
53460
001
90
2
X
1,040.92
X
53460
004
90
2
X
975.19
X
53500
004
90
2
X
1,511.09
X
53500
002
90
2
X
1,511.09
X
53500
003
90
2
X
1,511.09
X
53500
001
90
2
X
1,659.64
X
53502
004
90
2
X
1,316.65
X
53502
003
90
2
X
1,332.27
X
53502
002
90
2
X
1,408.57
X
53502
001
90
2
X
1,560.98
X
53505
004
90
2
X
1,458.26
X
53505
001
90
2
X
1,441.49
X
53505
003
90
2
X
1,348.19
X
53505
002
90
2
X
1,423.30
X
53510
002
90
2
X
1,897.73
X
53510
003
90
2
X
1,798.27
X
53510
001
90
2
X
1,921.64
X
53510
004
90
2
X
1,776.94
X
Return to CPT/HCPC List