rhode island workers’ compensation fee schedule · rhode island workers’ compensation fee...

Rhode Island Workers’ Compensation Fee Schedule

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CPT codes & descriptions only are copyright 2019 AMA

Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 10004 $98.34 $0.00 $0.00 0 N1 $0.00 10005 $236.94 $0.00 $0.00 0 P3 $71.35 10006 $112.86 $0.00 $0.00 0 N1 $0.00 10007 $533.94 $0.00 $0.00 0 P3 $219.46 10008 $300.96 $0.00 $0.00 0 N1 $0.00 10009 $873.84 $0.00 $0.00 0 P2 $298.44 10010 $526.68 $0.00 $0.00 0 N1 $0.00 10011 BR $0.00 $0.00 0 R2 $298.44 10012 BR $0.00 $0.00 0 N1 $0.00 10021 $307.34 $0.00 $0.00 0 P3 $58.02 10030 $1,523.36 $0.00 $0.00 0 G2 $298.44 10035 $1,032.56 $0.00 $0.00 0 N1 $0.00 10036 $900.24 $0.00 $0.00 0 N1 $0.00 10040 $205.55 $0.00 $0.00 1 N1 $0.00 10060 $259.91 $0.00 $0.00 1 P3 $72.79 10061 $415.64 $0.00 $0.00 1 P3 $112.43 10080 $376.56 $0.00 $0.00 1 P3 $138.38 10081 $569.15 $0.00 $0.00 1 P3 $180.18 10120 $344.79 $0.00 $0.00 1 P3 $106.67 10121 $562.23 $0.00 $0.00 1 A2 $547.17 10140 $336.93 $0.00 $0.00 1 P3 $107.75 10160 $265.26 $0.00 $0.00 1 P3 $82.88 10180 $512.16 $0.00 $0.00 1 A2 $1,078.70 11000 $110.58 $0.00 $0.00 1 P3 $33.15 11001 $43.23 $0.00 $0.00 1 N1 $0.00 11004 $1,150.64 $0.00 $0.00 1 $0.00 11005 $1,564.71 $0.00 $0.00 0 $0.00 11006 $1,403.10 $0.00 $0.00 1 $0.00 11008 $549.79 $0.00 $0.00 0 $0.00 11010 $1,122.50 $0.00 $0.00 1 A2 $298.44 11011 $1,097.12 $0.00 $0.00 1 A2 $298.44 11012 $1,604.70 $0.00 $0.00 1 A2 $1,078.70 11042 $265.05 $0.00 $0.00 1 A2 $161.80 11043 $517.41 $0.00 $0.00 1 A2 $248.76 11044 $711.90 $0.00 $0.00 1 A2 $547.17 11045 $94.87 $0.00 $0.00 0 N1 $0.00 11046 $163.63 $0.00 $0.00 0 N1 $0.00 11047 $249.80 $0.00 $0.00 0 N1 $0.00 11055 $97.75 $0.00 $0.00 1 N1 $0.00 11056 $118.97 $0.00 $0.00 1 N1 $0.00 11057 $133.28 $0.00 $0.00 1 P3 $51.17


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Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 11102 $184.80 $0.00 $0.00 1 P3 $73.87 11103 $99.66 $0.00 $0.00 1 N1 $0.00 11104 $232.32 $0.00 $0.00 1 P2 $90.90 11105 $114.18 $0.00 $0.00 1 N1 $0.00 11106 $281.16 $0.00 $0.00 1 P3 $112.07 11107 $134.64 $0.00 $0.00 1 N1 $0.00 11200 $178.08 $0.00 $0.00 1 N1 $0.00 11201 $37.79 $0.00 $0.00 1 N1 $0.00 11300 $200.10 $0.00 $0.00 0 N1 $0.00 11301 $245.37 $0.00 $0.00 0 N1 $0.00 11302 $289.45 $0.00 $0.00 0 N1 $0.00 11303 $318.59 $0.00 $0.00 0 N1 $0.00 11305 $203.08 $0.00 $0.00 0 N1 $0.00 11306 $247.17 $0.00 $0.00 0 N1 $0.00 11307 $292.58 $0.00 $0.00 0 P2 $90.90 11308 $312.63 $0.00 $0.00 0 N1 $0.00 11310 $232.57 $0.00 $0.00 0 P3 $83.60 11311 $230.22 $0.00 $0.00 0 P2 $90.90 11312 $329.55 $0.00 $0.00 0 P3 $109.19 11313 $379.99 $0.00 $0.00 0 P3 $121.44 11400 $252.84 $0.00 $0.00 1 P3 $90.09 11401 $308.08 $0.00 $0.00 1 P3 $101.98 11402 $341.54 $0.00 $0.00 1 P3 $111.71 11403 $393.95 $0.00 $0.00 1 P3 $121.44 11404 $447.24 $0.00 $0.00 1 A2 $547.17 11406 $638.14 $0.00 $0.00 1 A2 $547.17 11420 $253.94 $0.00 $0.00 1 P3 $86.12 11421 $323.51 $0.00 $0.00 1 P3 $101.62 11422 $360.34 $0.00 $0.00 1 P3 $112.79 11423 $415.53 $0.00 $0.00 1 P3 $122.16 11424 $476.09 $0.00 $0.00 1 A2 $547.17 11426 $674.79 $0.00 $0.00 1 A2 $1,078.70 11440 $281.63 $0.00 $0.00 1 P3 $98.38 11441 $346.86 $0.00 $0.00 1 P3 $110.99 11442 $386.39 $0.00 $0.00 1 P3 $120.72 11443 $459.80 $0.00 $0.00 1 P3 $133.69 11444 $573.29 $0.00 $0.00 1 A2 $547.17 11446 $788.84 $0.00 $0.00 1 A2 $1,078.70 11450 $793.75 $0.00 $0.00 1 A2 $1,078.70 11451 $1,010.73 $0.00 $0.00 0 A2 $1,078.70 11462 $777.88 $0.00 $0.00 0 A2 $1,078.70


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Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 11463 $1,008.47 $0.00 $0.00 0 A2 $1,078.70 11470 $862.36 $0.00 $0.00 1 A2 $1,078.70 11471 $1,064.87 $0.00 $0.00 0 A2 $1,078.70 11600 $395.99 $0.00 $0.00 1 P3 $131.89 11601 $467.17 $0.00 $0.00 1 P3 $149.19 11602 $506.62 $0.00 $0.00 1 P3 $160.36 11603 $573.74 $0.00 $0.00 1 P3 $173.69 11604 $640.14 $0.00 $0.00 1 A2 $298.44 11606 $916.20 $0.00 $0.00 1 A2 $547.17 11620 $401.44 $0.00 $0.00 1 P3 $132.61 11621 $470.57 $0.00 $0.00 1 P3 $149.55 11622 $523.67 $0.00 $0.00 1 P3 $162.88 11623 $610.60 $0.00 $0.00 1 P3 $178.74 11624 $689.16 $0.00 $0.00 1 A2 $547.17 11626 $832.36 $0.00 $0.00 1 A2 $1,078.70 11640 $413.68 $0.00 $0.00 1 P3 $137.66 11641 $487.66 $0.00 $0.00 1 P3 $154.23 11642 $554.18 $0.00 $0.00 1 P3 $169.37 11643 $650.71 $0.00 $0.00 1 P3 $185.22 11644 $801.25 $0.00 $0.00 1 A2 $547.17 11646 $1,043.42 $0.00 $0.00 1 A2 $1,078.70 11719 $27.04 $0.00 $0.00 1 N1 $0.00 11720 $65.20 $0.00 $0.00 1 N1 $0.00 11721 $89.42 $0.00 $0.00 1 N1 $0.00 11730 $219.07 $0.00 $0.00 1 N1 $0.00 11732 $72.01 $0.00 $0.00 1 N1 $0.00 11740 $111.02 $0.00 $0.00 1 N1 $0.00 11750 $455.89 $0.00 $0.00 1 P3 $97.66 11755 $272.26 $0.00 $0.00 0 P3 $76.76 11760 $531.83 $0.00 $0.00 1 G2 $248.76 11762 $586.98 $0.00 $0.00 1 P3 $177.66 11765 $342.05 $0.00 $0.00 1 N1 $0.00 11770 $578.40 $0.00 $0.00 1 A2 $1,078.70 11771 $1,183.83 $0.00 $0.00 1 A2 $1,078.70 11772 $1,439.42 $0.00 $0.00 1 A2 $1,078.70 11900 $113.09 $0.00 $0.00 1 N1 $0.00 11901 $140.70 $0.00 $0.00 1 N1 $0.00 11920 $358.64 $0.00 $0.00 0 P3 $116.39 11921 $413.86 $0.00 $0.00 0 P3 $130.09 11922 $126.17 $0.00 $0.00 0 N1 $0.00 11950 $145.29 $0.00 $0.00 0 P3 $36.04


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Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 11951 $215.14 $0.00 $0.00 0 P3 $51.17 11952 $285.77 $0.00 $0.00 0 P3 $66.31 11954 $321.44 $0.00 $0.00 0 P3 $81.08 11960 $1,914.61 $0.00 $0.00 1 A2 $1,424.94 11970 $1,245.74 $0.00 $0.00 1 A2 $2,744.32 11971 $986.64 $0.00 $0.00 0 A2 $1,078.70 11976 $294.77 $0.00 $0.00 0 P3 $76.76 11980 $206.22 $0.00 $0.00 1 N1 $0.00 11981 $277.10 $0.00 $0.00 0 N1 $0.00 11982 $310.43 $0.00 $0.00 0 N1 $0.00 11983 $432.96 $0.00 $0.00 0 N1 $0.00 12001 $204.47 $0.00 $0.00 1 N1 $0.00 12002 $247.20 $0.00 $0.00 1 N1 $0.00 12004 $289.94 $0.00 $0.00 1 N1 $0.00 12005 $344.11 $0.00 $0.00 1 A2 $161.80 12006 $413.57 $0.00 $0.00 1 A2 $161.80 12007 $468.46 $0.00 $0.00 1 A2 $90.90 12011 $249.64 $0.00 $0.00 1 N1 $0.00 12013 $272.74 $0.00 $0.00 1 N1 $0.00 12014 $290.19 $0.00 $0.00 1 N1 $0.00 12015 $355.01 $0.00 $0.00 1 G2 $90.90 12016 $441.52 $0.00 $0.00 1 A2 $161.80 12017 $305.30 $0.00 $0.00 0 A2 $161.80 12018 $405.07 $0.00 $0.00 2 A2 $90.90 12020 $584.42 $0.00 $0.00 1 A2 $248.76 12021 $353.14 $0.00 $0.00 1 A2 $161.80 12031 $495.71 $0.00 $0.00 1 P2 $161.80 12032 $689.20 $0.00 $0.00 1 P2 $161.80 12034 $648.18 $0.00 $0.00 1 A2 $161.80 12035 $803.17 $0.00 $0.00 1 A2 $161.80 12036 $871.74 $0.00 $0.00 1 A2 $248.76 12037 $953.87 $0.00 $0.00 0 A2 $797.93 12041 $547.82 $0.00 $0.00 1 P2 $161.80 12042 $651.09 $0.00 $0.00 1 P2 $161.80 12044 $748.32 $0.00 $0.00 1 A2 $248.76 12045 $829.71 $0.00 $0.00 1 A2 $248.76 12046 $1,109.53 $0.00 $0.00 0 A2 $161.80 12047 $1,212.57 $0.00 $0.00 2 A2 $797.93 12051 $537.56 $0.00 $0.00 1 P2 $161.80 12052 $608.91 $0.00 $0.00 1 P2 $161.80 12053 $719.77 $0.00 $0.00 1 P2 $161.80


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Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 12054 $768.32 $0.00 $0.00 1 A2 $161.80 12055 $981.35 $0.00 $0.00 1 A2 $161.80 12056 $1,126.01 $0.00 $0.00 0 A2 $161.80 12057 $1,133.71 $0.00 $0.00 2 A2 $161.80 13100 $693.29 $0.00 $0.00 1 A2 $248.76 13101 $822.08 $0.00 $0.00 1 A2 $248.76 13102 $248.81 $0.00 $0.00 1 N1 $0.00 13120 $725.15 $0.00 $0.00 1 A2 $248.76 13121 $882.34 $0.00 $0.00 1 A2 $248.76 13122 $272.56 $0.00 $0.00 1 N1 $0.00 13131 $796.43 $0.00 $0.00 1 A2 $161.80 13132 $1,073.01 $0.00 $0.00 1 A2 $248.76 13133 $359.76 $0.00 $0.00 1 N1 $0.00 13151 $869.64 $0.00 $0.00 1 A2 $248.76 13152 $981.48 $0.00 $0.00 1 A2 $248.76 13153 $391.85 $0.00 $0.00 1 N1 $0.00 13160 $1,637.03 $0.00 $0.00 1 A2 $797.93 14000 $1,283.58 $0.00 $0.00 1 A2 $797.93 14001 $1,630.00 $0.00 $0.00 1 A2 $797.93 14020 $1,432.02 $0.00 $0.00 1 A2 $797.93 14021 $1,777.23 $0.00 $0.00 1 A2 $797.93 14040 $1,718.17 $0.00 $0.00 1 A2 $797.93 14041 $1,910.42 $0.00 $0.00 1 A2 $797.93 14060 $1,580.20 $0.00 $0.00 1 A2 $797.93 14061 $2,053.01 $0.00 $0.00 1 A2 $797.93 14301 $2,204.98 $0.00 $0.00 2 G2 $1,424.94 14302 $438.06 $0.00 $0.00 2 N1 $0.00 14350 $1,425.23 $0.00 $0.00 0 A2 $797.93 15002 $787.05 $0.00 $0.00 0 A2 $797.93 15003 $172.32 $0.00 $0.00 0 N1 $0.00 15004 $902.60 $0.00 $0.00 0 A2 $248.76 15005 $252.25 $0.00 $0.00 0 N1 $0.00 15040 $539.11 $0.00 $0.00 1 A2 $797.93 15050 $1,182.72 $0.00 $0.00 1 A2 $248.76 15100 $1,767.17 $0.00 $0.00 1 A2 $797.93 15101 $423.73 $0.00 $0.00 1 N1 $0.00 15110 $1,783.05 $0.00 $0.00 1 A2 $797.93 15111 $229.84 $0.00 $0.00 1 N1 $0.00 15115 $1,777.01 $0.00 $0.00 1 A2 $797.93 15116 $314.40 $0.00 $0.00 1 N1 $0.00 15120 $1,741.50 $0.00 $0.00 1 A2 $1,424.94


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Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 15121 $429.75 $0.00 $0.00 1 N1 $0.00 15130 $1,397.71 $0.00 $0.00 1 A2 $797.93 15131 $188.47 $0.00 $0.00 1 N1 $0.00 15135 $1,808.63 $0.00 $0.00 1 A2 $1,424.94 15136 $186.32 $0.00 $0.00 1 N1 $0.00 15150 $1,417.67 $0.00 $0.00 1 A2 $797.93 15151 $238.01 $0.00 $0.00 1 N1 $0.00 15152 $310.98 $0.00 $0.00 1 N1 $0.00 15155 $1,540.98 $0.00 $0.00 1 A2 $1,424.94 15156 $321.74 $0.00 $0.00 1 N1 $0.00 15157 $366.45 $0.00 $0.00 1 N1 $0.00 15200 $1,705.20 $0.00 $0.00 1 A2 $797.93 15201 $304.85 $0.00 $0.00 1 N1 $0.00 15220 $1,587.02 $0.00 $0.00 1 A2 $797.93 15221 $283.10 $0.00 $0.00 1 N1 $0.00 15240 $1,914.11 $0.00 $0.00 1 A2 $797.93 15241 $378.17 $0.00 $0.00 1 N1 $0.00 15260 $2,067.58 $0.00 $0.00 1 A2 $797.93 15261 $441.21 $0.00 $0.00 1 N1 $0.00 15271 $277.97 $0.00 $0.00 1 G2 $797.93 15272 $51.22 $0.00 $0.00 1 N1 $0.00 15273 $574.31 $0.00 $0.00 1 G2 $1,424.94 15274 $136.27 $0.00 $0.00 1 N1 $0.00 15275 $313.78 $0.00 $0.00 1 G2 $797.93 15276 $68.13 $0.00 $0.00 1 N1 $0.00 15277 $628.47 $0.00 $0.00 1 G2 $797.93 15278 $162.72 $0.00 $0.00 1 N1 $0.00 15570 $1,872.26 $0.00 $0.00 1 A2 $797.93 15572 $1,790.95 $0.00 $0.00 1 A2 $1,424.94 15574 $1,857.86 $0.00 $0.00 1 A2 $797.93 15576 $1,655.51 $0.00 $0.00 1 A2 $797.93 15600 $679.67 $0.00 $0.00 0 A2 $1,424.94 15610 $736.29 $0.00 $0.00 0 A2 $797.93 15620 $914.47 $0.00 $0.00 1 A2 $797.93 15630 $953.50 $0.00 $0.00 1 A2 $797.93 15650 $1,052.06 $0.00 $0.00 0 A2 $797.93 15730 $2,905.24 $0.00 $0.00 1 G2 $1,424.94 15731 $2,311.46 $0.00 $0.00 0 A2 $1,424.94 15733 $1,977.98 $0.00 $0.00 1 A2 $1,424.94 15734 $3,049.01 $0.00 $0.00 2 A2 $1,424.94 15736 $2,690.73 $0.00 $0.00 1 A2 $797.93


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Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 15738 $2,852.51 $0.00 $0.00 2 A2 $1,424.94 15740 $2,060.02 $0.00 $0.00 1 A2 $797.93 15750 $1,863.53 $0.00 $0.00 2 A2 $1,424.94 15756 $4,725.90 $0.00 $0.00 2 $0.00 15757 $4,690.02 $0.00 $0.00 2 $0.00 15758 $4,679.86 $0.00 $0.00 2 $0.00 15760 $1,751.98 $0.00 $0.00 1 A2 $797.93 15770 $1,384.57 $0.00 $0.00 2 A2 $1,424.94 15775 $591.26 $0.00 $0.00 0 A2 $161.80 15776 $954.44 $0.00 $0.00 0 A2 $161.80 15777 $412.50 $0.00 $0.00 1 N1 $0.00 15780 $1,866.96 $0.00 $0.00 0 P3 $580.89 15781 $1,133.13 $0.00 $0.00 1 P2 $298.44 15782 $1,213.09 $0.00 $0.00 0 P3 $405.76 15783 $992.51 $0.00 $0.00 0 P2 $161.80 15786 $507.89 $0.00 $0.00 1 N1 $0.00 15787 $102.37 $0.00 $0.00 1 N1 $0.00 15788 $976.93 $0.00 $0.00 1 N1 $0.00 15789 $1,123.15 $0.00 $0.00 1 P2 $248.76 15792 $917.14 $0.00 $0.00 0 N1 $0.00 15793 $1,018.42 $0.00 $0.00 0 N1 $0.00 15819 $1,502.16 $0.00 $0.00 0 G2 $797.93 15820 $1,215.98 $0.00 $0.00 0 A2 $797.93 15821 $1,271.04 $0.00 $0.00 0 A2 $797.93 15822 $931.64 $0.00 $0.00 1 A2 $797.93 15823 $1,281.49 $0.00 $0.00 1 A2 $797.93 15824 BR $0.00 $0.00 0 A2 $797.93 15825 BR $0.00 $0.00 0 A2 $1,424.94 15826 BR $0.00 $0.00 0 A2 $1,424.94 15828 BR $0.00 $0.00 0 A2 $1,424.94 15829 BR $0.00 $0.00 0 A2 $1,424.94 15830 $2,376.39 $0.00 $0.00 2 A2 $2,094.06 15832 $1,923.01 $0.00 $0.00 2 A2 $1,078.70 15833 $1,781.07 $0.00 $0.00 0 A2 $1,078.70 15834 $1,822.36 $0.00 $0.00 0 A2 $1,078.70 15835 $1,914.59 $0.00 $0.00 0 A2 $1,078.70 15836 $1,617.12 $0.00 $0.00 0 A2 $1,078.70 15837 $1,819.29 $0.00 $0.00 0 G2 $1,078.70 15838 $1,193.24 $0.00 $0.00 0 G2 $1,078.70 15839 $1,788.01 $0.00 $0.00 0 A2 $1,078.70 15840 $2,081.29 $0.00 $0.00 1 A2 $1,424.94


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Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 15841 $3,316.12 $0.00 $0.00 2 A2 $1,424.94 15842 $5,328.24 $0.00 $0.00 2 G2 $797.93 15845 $2,075.64 $0.00 $0.00 2 A2 $1,424.94 15847 BR $0.00 $0.00 2 N1 $0.00 15850 $168.96 $0.00 $0.00 G2 $248.76 15851 $205.72 $0.00 $0.00 1 P3 $68.47 15852 $92.50 $0.00 $0.00 1 N1 $0.00 15860 $223.48 $0.00 $0.00 0 N1 $0.00 15876 BR $0.00 $0.00 0 A2 $1,424.94 15877 BR $0.00 $0.00 0 A2 $1,424.94 15878 BR $0.00 $0.00 0 A2 $797.93 15879 BR $0.00 $0.00 0 A2 $1,424.94 15920 $1,257.78 $0.00 $0.00 0 A2 $1,078.70 15922 $1,607.21 $0.00 $0.00 2 A2 $1,424.94 15931 $1,394.87 $0.00 $0.00 1 A2 $547.17 15933 $1,751.63 $0.00 $0.00 0 A2 $1,078.70 15934 $1,895.06 $0.00 $0.00 1 A2 $1,424.94 15935 $2,270.62 $0.00 $0.00 2 A2 $1,424.94 15936 $1,831.08 $0.00 $0.00 1 A2 $797.93 15937 $2,128.28 $0.00 $0.00 1 A2 $797.93 15940 $1,424.04 $0.00 $0.00 1 A2 $1,078.70 15941 $1,870.38 $0.00 $0.00 0 A2 $1,078.70 15944 $1,866.32 $0.00 $0.00 0 A2 $1,424.94 15945 $2,034.33 $0.00 $0.00 0 A2 $797.93 15946 $3,327.77 $0.00 $0.00 1 A2 $797.93 15950 $1,205.34 $0.00 $0.00 1 A2 $547.17 15951 $1,674.91 $0.00 $0.00 0 A2 $1,078.70 15952 $1,869.21 $0.00 $0.00 2 A2 $797.93 15953 $2,046.16 $0.00 $0.00 1 A2 $1,424.94 15956 $2,373.52 $0.00 $0.00 1 A2 $797.93 15958 $2,414.85 $0.00 $0.00 1 A2 $1,424.94 15999 BR $0.00 $0.00 0 $0.00 16000 $141.06 $0.00 $0.00 1 N1 $0.00 16020 $184.02 $0.00 $0.00 1 N1 $0.00 16025 $303.05 $0.00 $0.00 1 A2 $90.90 16030 $378.90 $0.00 $0.00 1 A2 $161.80 16035 $401.34 $0.00 $0.00 1 G2 $161.80 16036 $161.74 $0.00 $0.00 1 $0.00 17000 $165.95 $0.00 $0.00 1 N1 $0.00 17003 $13.78 $0.00 $0.00 1 N1 $0.00 17004 $350.10 $0.00 $0.00 1 P3 $99.10


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Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 17106 $684.26 $0.00 $0.00 1 P2 $161.80 17107 $904.25 $0.00 $0.00 1 P2 $248.76 17108 $1,299.28 $0.00 $0.00 0 P3 $350.99 17110 $227.79 $0.00 $0.00 1 N1 $0.00 17111 $269.71 $0.00 $0.00 1 N1 $0.00 17250 $166.43 $0.00 $0.00 1 N1 $0.00 17260 $191.04 $0.00 $0.00 1 N1 $0.00 17261 $295.64 $0.00 $0.00 1 N1 $0.00 17262 $358.78 $0.00 $0.00 1 N1 $0.00 17263 $392.12 $0.00 $0.00 1 N1 $0.00 17264 $419.33 $0.00 $0.00 1 P3 $129.37 17266 $477.17 $0.00 $0.00 1 P3 $141.62 17270 $307.60 $0.00 $0.00 1 P2 $90.90 17271 $335.74 $0.00 $0.00 1 P2 $90.90 17272 $381.20 $0.00 $0.00 1 N1 $0.00 17273 $426.11 $0.00 $0.00 1 P3 $127.57 17274 $500.69 $0.00 $0.00 1 P3 $143.78 17276 $579.61 $0.00 $0.00 1 P3 $158.92 17280 $288.04 $0.00 $0.00 1 N1 $0.00 17281 $364.21 $0.00 $0.00 1 P3 $110.27 17282 $417.89 $0.00 $0.00 1 P3 $124.32 17283 $498.60 $0.00 $0.00 1 P3 $140.90 17284 $564.23 $0.00 $0.00 1 P3 $155.67 17286 $733.82 $0.00 $0.00 1 P3 $184.14 17311 $1,340.59 $0.00 $0.00 1 P2 $248.76 17312 $806.34 $0.00 $0.00 1 N1 $0.00 17313 $1,223.35 $0.00 $0.00 1 P2 $248.76 17314 $747.72 $0.00 $0.00 1 N1 $0.00 17315 $156.88 $0.00 $0.00 1 N1 $0.00 17340 $102.58 $0.00 $0.00 1 N1 $0.00 17360 $261.98 $0.00 $0.00 1 N1 $0.00 17380 BR $0.00 $0.00 0 R2 $248.76 17999 BR $0.00 $0.00 0 $0.00 19000 $227.04 $0.00 $0.00 1 P3 $78.20 19001 $52.84 $0.00 $0.00 1 N1 $0.00 19020 $977.31 $0.00 $0.00 1 A2 $547.17 19030 $328.14 $0.00 $0.00 1 N1 $0.00 19081 $1,334.59 $0.00 $0.00 0 G2 $547.17 19082 $1,107.59 $0.00 $0.00 0 N1 $0.00 19083 $1,291.43 $0.00 $0.00 0 G2 $547.17 19084 $1,065.72 $0.00 $0.00 0 N1 $0.00


45


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 19085 $1,988.18 $0.00 $0.00 0 G2 $547.17 19086 $1,580.00 $0.00 $0.00 0 N1 $0.00 19100 $314.14 $0.00 $0.00 1 A2 $547.17 19101 $701.52 $0.00 $0.00 1 A2 $1,057.44 19105 $4,470.18 $0.00 $0.00 1 J8 $1,562.46 19110 $1,013.18 $0.00 $0.00 1 A2 $1,057.44 19112 $961.31 $0.00 $0.00 0 A2 $1,057.44 19120 $1,015.60 $0.00 $0.00 1 A2 $1,057.44 19125 $1,127.59 $0.00 $0.00 1 A2 $1,057.44 19126 $322.37 $0.00 $0.00 1 N1 $0.00 19260 $2,459.92 $0.00 $0.00 2 $0.00 19271 $3,322.37 $0.00 $0.00 2 $0.00 19272 $3,676.77 $0.00 $0.00 2 $0.00 19281 $465.08 $0.00 $0.00 0 N1 $0.00 19282 $327.77 $0.00 $0.00 0 N1 $0.00 19283 $518.94 $0.00 $0.00 0 N1 $0.00 19284 $396.73 $0.00 $0.00 0 N1 $0.00 19285 $994.23 $0.00 $0.00 0 N1 $0.00 19286 $875.60 $0.00 $0.00 0 N1 $0.00 19287 $1,663.26 $0.00 $0.00 0 N1 $0.00 19288 $1,344.69 $0.00 $0.00 0 N1 $0.00 19294 $309.30 $0.00 $0.00 0 N1 $0.00 19296 $8,676.11 $0.00 $0.00 0 J8 $3,829.92 19297 $187.94 $0.00 $0.00 0 N1 $0.00 19298 $2,332.05 $0.00 $0.00 0 G2 $2,094.06 19300 $1,084.20 $0.00 $0.00 1 A2 $1,057.44 19301 $1,319.42 $0.00 $0.00 0 A2 $1,057.44 19302 $1,815.83 $0.00 $0.00 2 A2 $2,094.06 19303 $2,037.57 $0.00 $0.00 2 A2 $2,094.06 19304 $1,181.58 $0.00 $0.00 2 A2 $1,057.44 19305 $2,291.43 $0.00 $0.00 2 $0.00 19306 $2,429.83 $0.00 $0.00 2 $0.00 19307 $2,422.15 $0.00 $0.00 2 $0.00 19316 $1,567.88 $0.00 $0.00 2 A2 $2,094.06 19318 $2,251.53 $0.00 $0.00 2 A2 $2,094.06 19324 $1,000.15 $0.00 $0.00 0 A2 $2,466.33 19325 $1,323.48 $0.00 $0.00 0 G2 $2,466.33 19328 $1,017.73 $0.00 $0.00 1 A2 $1,057.44 19330 $1,292.49 $0.00 $0.00 1 A2 $1,057.44 19340 $2,044.84 $0.00 $0.00 1 A2 $2,094.06 19342 $1,891.39 $0.00 $0.00 0 A2 $2,466.33


46


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 19350 $1,697.39 $0.00 $0.00 1 A2 $1,057.44 19355 $1,433.61 $0.00 $0.00 0 A2 $1,057.44 19357 $3,093.10 $0.00 $0.00 2 J8 $4,336.89 19361 $3,217.28 $0.00 $0.00 2 $0.00 19364 $5,606.80 $0.00 $0.00 2 $0.00 19366 $2,811.69 $0.00 $0.00 2 A2 $2,094.06 19367 $3,638.47 $0.00 $0.00 2 $0.00 19368 $4,485.56 $0.00 $0.00 2 $0.00 19369 $4,164.11 $0.00 $0.00 2 $0.00 19370 $1,405.96 $0.00 $0.00 1 A2 $1,057.44 19371 $1,610.31 $0.00 $0.00 1 A2 $1,057.44 19380 $1,586.47 $0.00 $0.00 1 A2 $2,094.06 19396 $607.43 $0.00 $0.00 0 G2 $1,057.44 19499 BR $0.00 $0.00 0 $0.00 20100 $1,838.08 $0.00 $0.00 2 $0.00 20101 $1,445.09 $0.00 $0.00 1 $0.00 20102 $1,549.56 $0.00 $0.00 1 $0.00 20103 $2,009.53 $0.00 $0.00 0 G2 $298.44 20150 $3,080.36 $0.00 $0.00 2 G2 $1,256.79 20200 $657.82 $0.00 $0.00 1 A2 $547.17 20205 $918.01 $0.00 $0.00 1 A2 $1,078.70 20206 $731.67 $0.00 $0.00 1 A2 $547.17 20220 $517.38 $0.00 $0.00 1 A2 $547.17 20225 $1,655.19 $0.00 $0.00 1 A2 $547.17 20240 $676.17 $0.00 $0.00 1 A2 $1,078.70 20245 $1,907.95 $0.00 $0.00 1 A2 $1,078.70 20250 $1,211.84 $0.00 $0.00 1 A2 $1,256.79 20251 $1,305.82 $0.00 $0.00 2 A2 $2,744.32 20500 $327.81 $0.00 $0.00 1 P3 $60.54 20501 $363.60 $0.00 $0.00 1 N1 $0.00 20520 $633.80 $0.00 $0.00 1 P3 $133.69 20525 $1,509.93 $0.00 $0.00 1 A2 $1,078.70 20526 $255.69 $0.00 $0.00 1 P3 $39.64 20527 $239.80 $0.00 $0.00 1 P3 $43.60 20550 $194.95 $0.00 $0.00 1 P3 $24.14 20551 $201.79 $0.00 $0.00 1 P3 $25.22 20552 $185.98 $0.00 $0.00 1 P3 $30.27 20553 $216.51 $0.00 $0.00 1 P3 $35.31 20555 $1,011.80 $0.00 $0.00 0 R2 $1,256.79 20600 $157.42 $0.00 $0.00 1 P3 $23.06 20604 $210.78 $0.00 $0.00 1 P3 $40.00


47


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 20605 $218.65 $0.00 $0.00 1 P3 $24.50 20606 $233.08 $0.00 $0.00 1 P3 $43.24 20610 $202.23 $0.00 $0.00 1 P3 $28.83 20611 $266.07 $0.00 $0.00 1 P3 $49.01 20612 $183.22 $0.00 $0.00 1 P3 $33.15 20615 $757.94 $0.00 $0.00 1 P3 $155.31 20650 $636.47 $0.00 $0.00 1 A2 $1,256.79 20660 $738.07 $0.00 $0.00 1 $0.00 20661 $1,584.36 $0.00 $0.00 1 $0.00 20662 $1,329.85 $0.00 $0.00 0 R2 $705.07 20663 $1,450.50 $0.00 $0.00 0 R2 $1,256.79 20664 $2,723.48 $0.00 $0.00 1 $0.00 20665 $317.96 $0.00 $0.00 0 G2 $179.35 20670 $1,206.30 $0.00 $0.00 1 A2 $547.17 20680 $2,140.83 $0.00 $0.00 0 A2 $1,078.70 20690 $1,811.10 $0.00 $0.00 1 J8 $3,683.25 20692 $3,429.14 $0.00 $0.00 2 J8 $7,917.89 20693 $1,397.65 $0.00 $0.00 1 A2 $2,744.32 20694 $1,319.82 $0.00 $0.00 1 A2 $705.07 20696 $3,468.28 $0.00 $0.00 2 J8 $10,034.77 20697 $6,657.03 $0.00 $0.00 2 P2 $705.07 20802 $7,969.00 $0.00 $0.00 2 $0.00 20805 $9,489.00 $0.00 $0.00 2 $0.00 20808 $11,561.26 $0.00 $0.00 2 $0.00 20816 $6,043.58 $0.00 $0.00 2 $0.00 20822 $5,587.60 $0.00 $0.00 2 G2 $705.07 20824 $6,533.08 $0.00 $0.00 2 $0.00 20827 $5,713.55 $0.00 $0.00 2 $0.00 20838 $7,968.38 $0.00 $0.00 2 $0.00 20900 $1,320.04 $0.00 $0.00 2 A2 $2,744.32 20902 $933.21 $0.00 $0.00 2 A2 $2,744.32 20910 $1,389.36 $0.00 $0.00 0 A2 $248.76 20912 $1,496.89 $0.00 $0.00 0 A2 $1,424.94 20920 $1,231.93 $0.00 $0.00 1 A2 $797.93 20922 $1,908.02 $0.00 $0.00 2 A2 $797.93 20924 $1,549.36 $0.00 $0.00 2 A2 $2,744.32 20926 $1,352.63 $0.00 $0.00 1 A2 $1,424.94 20930 BR $0.00 $0.00 N1 $0.00 20931 $378.56 $0.00 $0.00 1 N1 $0.00 20932 $2,054.00 $0.00 $0.00 2 N1 $0.00 20933 $1,884.00 $0.00 $0.00 2 N1 $0.00


48


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 20934 $2,053.00 $0.00 $0.00 2 N1 $0.00 20936 BR $0.00 $0.00 N1 $0.00 20937 $508.24 $0.00 $0.00 2 N1 $0.00 20938 $562.30 $0.00 $0.00 2 N1 $0.00 20939 $192.06 $0.00 $0.00 0 N1 $0.00 20950 $818.56 $0.00 $0.00 0 G2 $298.44 20955 $7,701.47 $0.00 $0.00 2 $0.00 20956 $8,032.75 $0.00 $0.00 2 $0.00 20957 $7,292.76 $0.00 $0.00 2 $0.00 20962 $6,820.81 $0.00 $0.00 2 $0.00 20969 $8,545.66 $0.00 $0.00 2 $0.00 20970 $8,337.34 $0.00 $0.00 2 $0.00 20972 $7,113.89 $0.00 $0.00 2 G2 $2,744.32 20973 $8,731.00 $0.00 $0.00 2 R2 $2,744.32 20974 $240.89 $0.00 $0.00 1 $0.00 20975 $542.94 $0.00 $0.00 2 N1 $0.00 20979 $163.72 $0.00 $0.00 1 N1 $0.00 20982 $11,079.33 $0.00 $0.00 1 G2 $2,744.32 20983 $21,367.89 $0.00 $0.00 1 G2 $2,744.32 20985 $444.51 $0.00 $0.00 0 N1 $0.00 20999 BR $0.00 $0.00 0 $0.00 21010 $2,338.52 $0.00 $0.00 0 A2 $968.88 21011 $1,099.97 $0.00 $0.00 2 P3 $237.83 21012 $1,031.56 $0.00 $0.00 2 R2 $547.17 21013 $1,630.50 $0.00 $0.00 2 P3 $312.07 21014 $1,592.91 $0.00 $0.00 2 R2 $1,078.70 21015 $2,176.00 $0.00 $0.00 1 G2 $1,078.70 21016 $3,172.65 $0.00 $0.00 2 G2 $1,078.70 21025 $2,737.72 $0.00 $0.00 1 A2 $2,176.10 21026 $1,924.78 $0.00 $0.00 1 A2 $2,176.10 21029 $2,433.49 $0.00 $0.00 0 A2 $968.88 21030 $1,612.06 $0.00 $0.00 1 P3 $321.08 21031 $1,214.93 $0.00 $0.00 1 P3 $268.82 21032 $1,240.72 $0.00 $0.00 1 P3 $269.91 21034 $4,103.17 $0.00 $0.00 2 A2 $2,176.10 21040 $1,621.23 $0.00 $0.00 1 A2 $968.88 21044 $2,729.48 $0.00 $0.00 2 A2 $2,176.10 21045 $3,760.12 $0.00 $0.00 2 $0.00 21046 $3,387.30 $0.00 $0.00 0 A2 $2,176.10 21047 $3,970.58 $0.00 $0.00 2 A2 $2,176.10 21048 $3,475.19 $0.00 $0.00 0 R2 $2,176.10


49


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 21049 $3,758.47 $0.00 $0.00 2 $0.00 21050 $2,678.21 $0.00 $0.00 0 A2 $2,176.10 21060 $2,546.41 $0.00 $0.00 2 A2 $2,176.10 21070 $1,958.54 $0.00 $0.00 0 A2 $2,176.10 21073 $1,219.90 $0.00 $0.00 0 P3 $252.25 21076 $3,016.27 $0.00 $0.00 0 P3 $430.62 21077 $7,566.79 $0.00 $0.00 0 P3 $1,058.72 21079 $5,111.88 $0.00 $0.00 1 P3 $741.25 21080 $5,739.28 $0.00 $0.00 1 P3 $846.83 21081 $5,294.62 $0.00 $0.00 0 P3 $786.29 21082 $5,030.76 $0.00 $0.00 0 P3 $756.39 21083 $4,676.59 $0.00 $0.00 0 P3 $744.49 21084 $5,476.71 $0.00 $0.00 0 P3 $837.10 21085 $2,576.86 $0.00 $0.00 0 P2 $106.19 21086 $5,639.49 $0.00 $0.00 0 P3 $792.42 21087 $5,583.79 $0.00 $0.00 0 P3 $792.42 21088 BR $0.00 $0.00 0 R2 $968.88 21089 BR $0.00 $0.00 1 $0.00 21100 $3,011.27 $0.00 $0.00 0 A2 $2,176.10 21110 $2,550.76 $0.00 $0.00 1 P2 $564.34 21116 $480.74 $0.00 $0.00 1 N1 $0.00 21120 $1,958.16 $0.00 $0.00 1 G2 $2,176.10 21121 $2,370.47 $0.00 $0.00 2 A2 $968.88 21122 $2,196.43 $0.00 $0.00 2 A2 $2,176.10 21123 $2,714.00 $0.00 $0.00 2 A2 $968.88 21125 $10,905.63 $0.00 $0.00 2 A2 $2,176.10 21127 $13,281.84 $0.00 $0.00 2 A2 $2,176.10 21137 $2,167.34 $0.00 $0.00 2 G2 $968.88 21138 $2,641.00 $0.00 $0.00 2 G2 $2,176.10 21139 $3,176.82 $0.00 $0.00 2 G2 $2,176.10 21141 $4,214.70 $0.00 $0.00 2 $0.00 21142 $4,331.35 $0.00 $0.00 2 $0.00 21143 $4,562.49 $0.00 $0.00 2 $0.00 21145 $4,624.00 $0.00 $0.00 2 $0.00 21146 $4,957.75 $0.00 $0.00 2 $0.00 21147 $5,295.70 $0.00 $0.00 2 $0.00 21150 $5,001.52 $0.00 $0.00 2 G2 $2,176.10 21151 $5,975.92 $0.00 $0.00 2 $0.00 21154 $6,131.03 $0.00 $0.00 2 $0.00 21155 $6,555.77 $0.00 $0.00 2 $0.00 21159 $7,851.75 $0.00 $0.00 2 $0.00


50


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 21160 $9,236.14 $0.00 $0.00 2 $0.00 21172 $6,059.00 $0.00 $0.00 2 $0.00 21175 $7,502.74 $0.00 $0.00 2 $0.00 21179 $4,360.00 $0.00 $0.00 2 $0.00 21180 $4,802.96 $0.00 $0.00 2 $0.00 21181 $2,132.60 $0.00 $0.00 0 A2 $2,176.10 21182 $6,404.21 $0.00 $0.00 2 $0.00 21183 $7,291.49 $0.00 $0.00 2 $0.00 21184 $7,825.02 $0.00 $0.00 2 $0.00 21188 $4,834.71 $0.00 $0.00 2 $0.00 21193 $3,830.11 $0.00 $0.00 2 $0.00 21194 $4,273.82 $0.00 $0.00 2 $0.00 21195 $4,112.34 $0.00 $0.00 2 $0.00 21196 $4,497.69 $0.00 $0.00 2 $0.00 21198 $3,554.99 $0.00 $0.00 2 G2 $2,176.10 21199 $3,095.00 $0.00 $0.00 2 G2 $2,176.10 21206 $3,876.78 $0.00 $0.00 2 A2 $2,176.10 21208 $6,071.10 $0.00 $0.00 0 A2 $2,176.10 21209 $2,667.21 $0.00 $0.00 2 A2 $2,176.10 21210 $7,228.64 $0.00 $0.00 1 A2 $2,176.10 21215 $13,219.88 $0.00 $0.00 1 A2 $2,176.10 21230 $2,274.82 $0.00 $0.00 0 A2 $2,176.10 21235 $2,302.80 $0.00 $0.00 1 A2 $2,176.10 21240 $3,359.31 $0.00 $0.00 2 A2 $2,176.10 21242 $3,082.55 $0.00 $0.00 2 A2 $2,176.10 21243 $5,074.06 $0.00 $0.00 2 J8 $12,046.61 21244 $3,286.64 $0.00 $0.00 2 J8 $3,112.55 21245 $3,500.45 $0.00 $0.00 2 A2 $2,176.10 21246 $2,545.24 $0.00 $0.00 2 A2 $2,176.10 21247 $4,854.90 $0.00 $0.00 2 $0.00 21248 $3,390.87 $0.00 $0.00 1 A2 $2,176.10 21249 $4,667.94 $0.00 $0.00 0 A2 $2,176.10 21255 $4,079.50 $0.00 $0.00 2 $0.00 21256 $3,755.69 $0.00 $0.00 2 $0.00 21260 $4,038.71 $0.00 $0.00 2 G2 $2,176.10 21261 $6,803.81 $0.00 $0.00 2 $0.00 21263 $5,818.09 $0.00 $0.00 2 $0.00 21267 $5,130.35 $0.00 $0.00 2 A2 $2,176.10 21268 $5,621.33 $0.00 $0.00 2 $0.00 21270 $3,025.32 $0.00 $0.00 2 A2 $2,176.10 21275 $2,610.10 $0.00 $0.00 2 G2 $2,176.10


51


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 21280 $1,837.17 $0.00 $0.00 0 A2 $968.88 21282 $1,219.04 $0.00 $0.00 1 A2 $968.88 21295 $619.81 $0.00 $0.00 0 A2 $564.34 21296 $1,368.23 $0.00 $0.00 0 A2 $968.88 21299 BR $0.00 $0.00 0 $0.00 21310 $422.10 $0.00 $0.00 1 A2 $115.95 21315 $902.92 $0.00 $0.00 1 A2 $564.34 21320 $821.28 $0.00 $0.00 1 A2 $968.88 21325 $1,473.37 $0.00 $0.00 0 A2 $968.88 21330 $1,769.26 $0.00 $0.00 0 A2 $2,176.10 21335 $2,255.65 $0.00 $0.00 1 A2 $968.88 21336 $2,028.74 $0.00 $0.00 0 A2 $1,256.79 21337 $1,302.11 $0.00 $0.00 0 A2 $968.88 21338 $2,379.31 $0.00 $0.00 0 J8 $3,138.36 21339 $2,677.06 $0.00 $0.00 2 A2 $2,176.10 21340 $2,549.43 $0.00 $0.00 0 A2 $968.88 21343 $3,833.15 $0.00 $0.00 2 $0.00 21344 $4,885.69 $0.00 $0.00 2 $0.00 21345 $2,641.10 $0.00 $0.00 0 A2 $564.34 21346 $2,863.66 $0.00 $0.00 1 $0.00 21347 $3,476.29 $0.00 $0.00 2 $0.00 21348 $3,662.26 $0.00 $0.00 2 $0.00 21355 $1,369.31 $0.00 $0.00 0 A2 $968.88 21356 $1,573.20 $0.00 $0.00 0 A2 $2,176.10 21360 $1,632.00 $0.00 $0.00 2 G2 $2,176.10 21365 $3,424.12 $0.00 $0.00 2 $0.00 21366 $3,945.81 $0.00 $0.00 2 $0.00 21385 $2,159.30 $0.00 $0.00 2 $0.00 21386 $2,159.60 $0.00 $0.00 2 $0.00 21387 $2,280.54 $0.00 $0.00 2 $0.00 21390 $2,502.15 $0.00 $0.00 2 G2 $2,176.10 21395 $3,015.85 $0.00 $0.00 2 $0.00 21400 $621.96 $0.00 $0.00 0 A2 $250.94 21401 $1,477.58 $0.00 $0.00 2 A2 $564.34 21406 $1,732.19 $0.00 $0.00 2 G2 $2,176.10 21407 $2,035.16 $0.00 $0.00 2 G2 $2,176.10 21408 $2,757.46 $0.00 $0.00 2 $0.00 21421 $2,534.60 $0.00 $0.00 0 A2 $968.88 21422 $2,040.01 $0.00 $0.00 2 $0.00 21423 $2,560.64 $0.00 $0.00 2 $0.00 21431 $2,311.14 $0.00 $0.00 2 $0.00


52


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 21432 $2,218.54 $0.00 $0.00 2 $0.00 21433 $5,402.32 $0.00 $0.00 2 $0.00 21435 $4,189.67 $0.00 $0.00 2 $0.00 21436 $5,946.35 $0.00 $0.00 2 $0.00 21440 $1,874.01 $0.00 $0.00 0 P3 $479.99 21445 $2,412.15 $0.00 $0.00 2 A2 $2,176.10 21450 $1,980.92 $0.00 $0.00 0 A2 $250.94 21451 $2,426.49 $0.00 $0.00 0 A2 $564.34 21452 $1,853.79 $0.00 $0.00 0 A2 $2,176.10 21453 $2,933.46 $0.00 $0.00 0 A2 $2,176.10 21454 $1,721.31 $0.00 $0.00 0 J8 $2,988.01 21461 $6,825.99 $0.00 $0.00 1 J8 $2,846.07 21462 $7,168.95 $0.00 $0.00 2 J8 $2,998.87 21465 $2,889.80 $0.00 $0.00 2 A2 $2,176.10 21470 $3,704.33 $0.00 $0.00 2 $0.00 21480 $315.20 $0.00 $0.00 1 A2 $115.95 21485 $2,253.93 $0.00 $0.00 0 A2 $564.34 21490 $2,852.87 $0.00 $0.00 2 A2 $968.88 21497 $2,394.64 $0.00 $0.00 0 A2 $564.34 21499 BR $0.00 $0.00 0 $0.00 21501 $1,456.42 $0.00 $0.00 1 A2 $1,078.70 21502 $1,553.02 $0.00 $0.00 2 A2 $1,256.79 21510 $1,386.82 $0.00 $0.00 0 $0.00 21550 $819.47 $0.00 $0.00 1 G2 $547.17 21552 $1,368.74 $0.00 $0.00 2 G2 $1,078.70 21554 $2,232.89 $0.00 $0.00 2 G2 $1,078.70 21555 $1,325.69 $0.00 $0.00 1 G2 $547.17 21556 $1,650.08 $0.00 $0.00 1 G2 $1,078.70 21557 $2,953.46 $0.00 $0.00 2 G2 $1,078.70 21558 $4,108.67 $0.00 $0.00 2 G2 $1,078.70 21600 $1,744.81 $0.00 $0.00 2 A2 $2,744.32 21610 $3,500.11 $0.00 $0.00 2 A2 $1,256.79 21615 $1,970.27 $0.00 $0.00 2 $0.00 21616 $2,576.95 $0.00 $0.00 2 $0.00 21620 $1,586.12 $0.00 $0.00 2 $0.00 21627 $1,694.12 $0.00 $0.00 2 $0.00 21630 $3,771.31 $0.00 $0.00 2 $0.00 21632 $3,783.83 $0.00 $0.00 2 $0.00 21685 $3,073.62 $0.00 $0.00 2 G2 $2,176.10 21700 $1,145.82 $0.00 $0.00 2 A2 $1,256.79 21705 $1,703.44 $0.00 $0.00 2 $0.00


53


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 21720 $1,628.40 $0.00 $0.00 2 A2 $1,256.79 21725 $1,558.00 $0.00 $0.00 2 A2 $298.44 21740 $3,711.61 $0.00 $0.00 2 $0.00 21742 BR $0.00 $0.00 2 $0.00 21743 BR $0.00 $0.00 2 $0.00 21750 $2,129.45 $0.00 $0.00 2 $0.00 21811 $1,740.46 $0.00 $0.00 2 $0.00 21812 $2,107.00 $0.00 $0.00 2 $0.00 21813 $2,826.67 $0.00 $0.00 2 $0.00 21820 $446.51 $0.00 $0.00 1 A2 $115.95 21825 $1,707.82 $0.00 $0.00 2 $0.00 21899 BR $0.00 $0.00 0 $0.00 21920 $813.90 $0.00 $0.00 1 P3 $175.49 21925 $1,417.73 $0.00 $0.00 1 A2 $547.17 21930 $1,500.79 $0.00 $0.00 1 G2 $547.17 21931 $1,444.94 $0.00 $0.00 2 G2 $547.17 21932 $2,028.03 $0.00 $0.00 2 G2 $1,078.70 21933 $2,262.39 $0.00 $0.00 2 G2 $1,078.70 21935 $3,165.90 $0.00 $0.00 1 G2 $1,078.70 21936 $4,313.19 $0.00 $0.00 2 G2 $1,078.70 22010 $2,942.32 $0.00 $0.00 0 $0.00 22015 $2,786.95 $0.00 $0.00 1 $0.00 22100 $2,872.93 $0.00 $0.00 2 $0.00 22101 $2,708.83 $0.00 $0.00 2 $0.00 22102 $2,513.57 $0.00 $0.00 2 G2 $2,744.32 22103 $431.55 $0.00 $0.00 2 N1 $0.00 22110 $3,356.30 $0.00 $0.00 2 $0.00 22112 $3,297.50 $0.00 $0.00 2 $0.00 22114 $3,134.68 $0.00 $0.00 2 $0.00 22116 $423.83 $0.00 $0.00 2 $0.00 22206 $7,240.98 $0.00 $0.00 2 $0.00 22207 $7,334.03 $0.00 $0.00 2 $0.00 22208 $1,791.86 $0.00 $0.00 2 $0.00 22210 $5,454.28 $0.00 $0.00 2 $0.00 22212 $4,543.27 $0.00 $0.00 2 $0.00 22214 $4,575.35 $0.00 $0.00 2 $0.00 22216 $1,110.21 $0.00 $0.00 2 $0.00 22220 $5,069.80 $0.00 $0.00 2 $0.00 22222 $4,580.99 $0.00 $0.00 2 $0.00 22224 $4,871.83 $0.00 $0.00 2 $0.00 22226 $1,112.14 $0.00 $0.00 2 $0.00


54


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 22310 $939.41 $0.00 $0.00 1 A2 $115.95 22315 $2,727.40 $0.00 $0.00 1 A2 $1,256.79 22318 $5,059.28 $0.00 $0.00 2 $0.00 22319 $5,623.35 $0.00 $0.00 2 $0.00 22325 $4,470.00 $0.00 $0.00 2 $0.00 22326 $4,601.83 $0.00 $0.00 2 $0.00 22327 $4,611.96 $0.00 $0.00 2 $0.00 22328 $866.51 $0.00 $0.00 2 $0.00 22505 $379.10 $0.00 $0.00 1 A2 $705.07 22510 $5,266.89 $0.00 $0.00 1 G2 $1,256.79 22511 $5,215.24 $0.00 $0.00 1 G2 $1,256.79 22512 $2,869.91 $0.00 $0.00 1 N1 $0.00 22513 $21,566.97 $0.00 $0.00 1 G2 $2,744.32 22514 $21,546.06 $0.00 $0.00 1 G2 $2,744.32 22515 $13,052.93 $0.00 $0.00 1 N1 $0.00 22526 $6,625.71 $0.00 $0.00 $0.00 22527 $5,596.88 $0.00 $0.00 $0.00 22532 $5,532.05 $0.00 $0.00 2 $0.00 22533 $5,152.83 $0.00 $0.00 2 $0.00 22534 $1,108.29 $0.00 $0.00 2 $0.00 22548 $6,043.09 $0.00 $0.00 2 $0.00 22551 $5,840.19 $0.00 $0.00 2 J8 $7,668.83 22552 $1,330.85 $0.00 $0.00 2 N1 $0.00 22554 $3,928.95 $0.00 $0.00 2 J8 $7,569.91 22556 $5,137.07 $0.00 $0.00 2 $0.00 22558 $5,223.34 $0.00 $0.00 2 $0.00 22585 $1,131.75 $0.00 $0.00 2 N1 $0.00 22586 $5,736.82 $0.00 $0.00 2 $0.00 22590 $4,895.74 $0.00 $0.00 2 $0.00 22595 $4,660.01 $0.00 $0.00 2 $0.00 22600 $3,997.50 $0.00 $0.00 2 $0.00 22610 $3,906.91 $0.00 $0.00 2 $0.00 22612 $5,415.73 $0.00 $0.00 2 G2 $5,281.63 22614 $1,320.66 $0.00 $0.00 2 N1 $0.00 22630 $4,771.11 $0.00 $0.00 2 $0.00 22632 $977.09 $0.00 $0.00 2 $0.00 22633 $6,238.03 $0.00 $0.00 2 $0.00 22634 $1,516.85 $0.00 $0.00 2 $0.00 22800 $4,191.24 $0.00 $0.00 2 $0.00 22802 $6,423.50 $0.00 $0.00 2 $0.00 22804 $7,405.29 $0.00 $0.00 2 $0.00


55


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 22808 $5,594.66 $0.00 $0.00 2 $0.00 22810 $6,318.53 $0.00 $0.00 2 $0.00 22812 $6,780.63 $0.00 $0.00 2 $0.00 22818 $6,682.21 $0.00 $0.00 2 $0.00 22819 $8,433.07 $0.00 $0.00 2 $0.00 22830 $2,765.08 $0.00 $0.00 2 $0.00 22840 $2,576.62 $0.00 $0.00 2 N1 $0.00 22841 BR $0.00 $0.00 $0.00 22842 $2,578.15 $0.00 $0.00 2 N1 $0.00 22843 $2,483.17 $0.00 $0.00 2 $0.00 22844 $2,978.05 $0.00 $0.00 2 $0.00 22845 $2,494.57 $0.00 $0.00 2 N1 $0.00 22846 $2,344.21 $0.00 $0.00 2 $0.00 22847 $2,672.33 $0.00 $0.00 2 $0.00 22848 $1,089.05 $0.00 $0.00 2 $0.00 22849 $4,003.41 $0.00 $0.00 2 $0.00 22850 $2,243.64 $0.00 $0.00 2 $0.00 22852 $2,148.22 $0.00 $0.00 2 $0.00 22853 $770.06 $0.00 $0.00 2 N1 $0.00 22854 $996.85 $0.00 $0.00 2 N1 $0.00 22855 $3,464.67 $0.00 $0.00 2 $0.00 22856 $5,156.43 $0.00 $0.00 2 J8 $11,340.70 22857 $5,644.73 $0.00 $0.00 2 $0.00 22858 $1,493.00 $0.00 $0.00 2 N1 $0.00 22859 $996.85 $0.00 $0.00 2 N1 $0.00 22861 $6,817.80 $0.00 $0.00 2 $0.00 22862 $6,286.46 $0.00 $0.00 2 $0.00 22864 $6,089.12 $0.00 $0.00 2 $0.00 22865 $6,361.56 $0.00 $0.00 2 $0.00 22867 $2,877.65 $0.00 $0.00 2 J8 $11,556.01 22868 $719.67 $0.00 $0.00 2 N1 $0.00 22869 $1,554.34 $0.00 $0.00 2 J8 $12,597.93 22870 $411.85 $0.00 $0.00 2 N1 $0.00 22899 BR $0.00 $0.00 2 $0.00 22900 $1,722.50 $0.00 $0.00 2 G2 $1,078.70 22901 $2,030.40 $0.00 $0.00 2 G2 $1,078.70 22902 $1,366.17 $0.00 $0.00 2 G2 $547.17 22903 $1,335.04 $0.00 $0.00 2 G2 $1,078.70 22904 $3,237.83 $0.00 $0.00 2 G2 $1,078.70 22905 $4,070.91 $0.00 $0.00 2 G2 $1,078.70 22999 BR $0.00 $0.00 0 $0.00


56


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 23000 $1,832.42 $0.00 $0.00 2 A2 $1,078.70 23020 $2,115.09 $0.00 $0.00 2 A2 $1,256.79 23030 $1,383.96 $0.00 $0.00 1 A2 $1,078.70 23031 $1,327.58 $0.00 $0.00 1 A2 $547.17 23035 $2,081.32 $0.00 $0.00 2 A2 $705.07 23040 $2,208.47 $0.00 $0.00 2 A2 $1,256.79 23044 $1,748.31 $0.00 $0.00 1 A2 $1,256.79 23065 $688.90 $0.00 $0.00 1 P3 $132.61 23066 $1,741.12 $0.00 $0.00 1 A2 $1,078.70 23071 $1,286.90 $0.00 $0.00 2 G2 $547.17 23073 $2,120.80 $0.00 $0.00 2 G2 $1,078.70 23075 $1,491.76 $0.00 $0.00 1 G2 $547.17 23076 $1,661.04 $0.00 $0.00 1 G2 $1,078.70 23077 $3,472.78 $0.00 $0.00 2 G2 $1,078.70 23078 $4,396.80 $0.00 $0.00 2 G2 $1,078.70 23100 $1,537.83 $0.00 $0.00 2 A2 $1,256.79 23101 $1,369.46 $0.00 $0.00 1 A2 $1,256.79 23105 $1,957.57 $0.00 $0.00 2 A2 $2,744.32 23106 $1,530.83 $0.00 $0.00 1 A2 $1,256.79 23107 $2,027.40 $0.00 $0.00 2 A2 $2,744.32 23120 $1,990.36 $0.00 $0.00 2 A2 $1,256.79 23125 $2,159.34 $0.00 $0.00 2 A2 $1,256.79 23130 $2,065.23 $0.00 $0.00 1 A2 $1,256.79 23140 $1,652.90 $0.00 $0.00 1 A2 $1,256.79 23145 $2,117.36 $0.00 $0.00 2 A2 $1,256.79 23146 $1,895.74 $0.00 $0.00 0 A2 $2,744.32 23150 $2,016.13 $0.00 $0.00 2 A2 $1,256.79 23155 $2,416.25 $0.00 $0.00 2 A2 $2,744.32 23156 $2,072.24 $0.00 $0.00 2 A2 $2,744.32 23170 $1,722.61 $0.00 $0.00 1 A2 $1,256.79 23172 $1,732.91 $0.00 $0.00 2 A2 $1,256.79 23174 $2,325.29 $0.00 $0.00 2 A2 $1,256.79 23180 $2,071.71 $0.00 $0.00 1 A2 $1,256.79 23182 $2,044.02 $0.00 $0.00 2 A2 $1,256.79 23184 $2,263.20 $0.00 $0.00 2 A2 $2,744.32 23190 $1,746.23 $0.00 $0.00 2 A2 $1,256.79 23195 $2,301.02 $0.00 $0.00 2 A2 $2,744.32 23200 $4,610.05 $0.00 $0.00 2 $0.00 23210 $5,407.23 $0.00 $0.00 2 $0.00 23220 $5,940.64 $0.00 $0.00 2 $0.00 23330 $863.08 $0.00 $0.00 0 A2 $298.44


57


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 23333 $1,332.31 $0.00 $0.00 0 G2 $547.17 23334 $3,088.00 $0.00 $0.00 1 G2 $1,078.70 23335 $3,686.00 $0.00 $0.00 1 $0.00 23350 $436.63 $0.00 $0.00 1 N1 $0.00 23395 $3,942.57 $0.00 $0.00 2 A2 $2,744.32 23397 $3,475.21 $0.00 $0.00 2 A2 $2,744.32 23400 $2,953.12 $0.00 $0.00 2 A2 $2,744.32 23405 $1,921.00 $0.00 $0.00 2 A2 $2,744.32 23406 $2,367.11 $0.00 $0.00 2 A2 $1,256.79 23410 $2,780.76 $0.00 $0.00 2 A2 $2,744.32 23412 $2,884.06 $0.00 $0.00 2 A2 $2,744.32 23415 $2,143.78 $0.00 $0.00 1 A2 $2,744.32 23420 $3,279.57 $0.00 $0.00 2 A2 $2,744.32 23430 $2,537.11 $0.00 $0.00 2 A2 $2,744.32 23440 $2,317.35 $0.00 $0.00 2 A2 $1,256.79 23450 $2,885.28 $0.00 $0.00 2 A2 $2,744.32 23455 $3,068.43 $0.00 $0.00 2 A2 $2,744.32 23460 $3,313.51 $0.00 $0.00 2 A2 $2,744.32 23462 $3,247.74 $0.00 $0.00 2 A2 $2,744.32 23465 $3,407.06 $0.00 $0.00 2 G2 $2,744.32 23466 $3,426.88 $0.00 $0.00 2 A2 $2,744.32 23470 $3,689.79 $0.00 $0.00 2 $0.00 23472 $4,463.94 $0.00 $0.00 2 $0.00 23473 $4,969.22 $0.00 $0.00 2 $0.00 23474 $5,370.07 $0.00 $0.00 2 $0.00 23480 $2,512.70 $0.00 $0.00 1 A2 $2,744.32 23485 $2,942.01 $0.00 $0.00 2 J8 $7,430.71 23490 $2,623.53 $0.00 $0.00 2 A2 $2,744.32 23491 $3,101.09 $0.00 $0.00 2 A2 $5,281.63 23500 $678.53 $0.00 $0.00 1 A2 $115.95 23505 $1,097.14 $0.00 $0.00 1 A2 $705.07 23515 $2,215.61 $0.00 $0.00 2 J8 $3,700.04 23520 $721.53 $0.00 $0.00 0 A2 $705.07 23525 $1,176.08 $0.00 $0.00 0 A2 $115.95 23530 $1,747.86 $0.00 $0.00 2 A2 $2,744.32 23532 $1,903.83 $0.00 $0.00 2 A2 $2,744.32 23540 $706.02 $0.00 $0.00 1 A2 $115.95 23545 $1,092.12 $0.00 $0.00 0 A2 $115.95 23550 $1,770.48 $0.00 $0.00 2 A2 $2,744.32 23552 $2,017.11 $0.00 $0.00 2 J8 $3,630.30 23570 $716.41 $0.00 $0.00 1 A2 $115.95


58


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 23575 $1,240.04 $0.00 $0.00 0 A2 $705.07 23585 $3,009.46 $0.00 $0.00 2 A2 $2,744.32 23600 $1,022.33 $0.00 $0.00 1 P2 $115.95 23605 $1,446.70 $0.00 $0.00 1 A2 $705.07 23615 $2,706.19 $0.00 $0.00 2 J8 $7,542.07 23616 $3,777.15 $0.00 $0.00 2 J8 $11,134.58 23620 $799.20 $0.00 $0.00 1 P2 $115.95 23625 $1,188.45 $0.00 $0.00 1 A2 $705.07 23630 $2,411.00 $0.00 $0.00 2 A2 $2,744.32 23650 $1,079.21 $0.00 $0.00 1 A2 $115.95 23655 $1,239.02 $0.00 $0.00 1 A2 $705.07 23660 $1,793.57 $0.00 $0.00 2 A2 $2,744.32 23665 $1,323.46 $0.00 $0.00 1 A2 $705.07 23670 $2,698.61 $0.00 $0.00 2 A2 $2,744.32 23675 $1,700.31 $0.00 $0.00 1 A2 $705.07 23680 $2,844.81 $0.00 $0.00 2 J8 $7,680.76 23700 $662.71 $0.00 $0.00 1 A2 $705.07 23800 $3,127.96 $0.00 $0.00 2 G2 $2,744.32 23802 $3,906.05 $0.00 $0.00 2 G2 $5,281.63 23900 $4,223.37 $0.00 $0.00 2 $0.00 23920 $3,437.28 $0.00 $0.00 2 $0.00 23921 $1,468.93 $0.00 $0.00 1 A2 $797.93 23929 BR $0.00 $0.00 2 $0.00 23930 $1,108.31 $0.00 $0.00 1 A2 $547.17 23931 $896.29 $0.00 $0.00 1 A2 $547.17 23935 $1,573.17 $0.00 $0.00 0 A2 $1,256.79 24000 $1,465.15 $0.00 $0.00 0 A2 $1,256.79 24006 $2,194.20 $0.00 $0.00 2 A2 $1,256.79 24065 $814.11 $0.00 $0.00 1 P3 $178.02 24066 $1,976.78 $0.00 $0.00 1 A2 $1,078.70 24071 $1,245.50 $0.00 $0.00 2 G2 $1,078.70 24073 $2,111.04 $0.00 $0.00 2 G2 $1,078.70 24075 $1,564.85 $0.00 $0.00 1 G2 $547.17 24076 $1,668.81 $0.00 $0.00 1 G2 $1,078.70 24077 $3,182.06 $0.00 $0.00 1 G2 $1,078.70 24079 $4,043.04 $0.00 $0.00 2 G2 $1,078.70 24100 $1,282.88 $0.00 $0.00 2 A2 $1,256.79 24101 $1,540.66 $0.00 $0.00 2 A2 $1,256.79 24102 $1,888.66 $0.00 $0.00 2 A2 $1,256.79 24105 $1,089.01 $0.00 $0.00 1 A2 $1,256.79 24110 $1,803.15 $0.00 $0.00 1 A2 $1,256.79


59


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 24115 $2,245.65 $0.00 $0.00 2 J8 $4,212.26 24116 $2,629.21 $0.00 $0.00 2 A2 $2,744.32 24120 $1,625.83 $0.00 $0.00 0 A2 $1,256.79 24125 $1,905.13 $0.00 $0.00 2 A2 $1,256.79 24126 $1,978.74 $0.00 $0.00 2 J8 $4,126.25 24130 $1,562.95 $0.00 $0.00 1 A2 $1,256.79 24134 $2,282.50 $0.00 $0.00 2 A2 $2,744.32 24136 $1,936.14 $0.00 $0.00 1 A2 $1,256.79 24138 $2,079.00 $0.00 $0.00 2 A2 $2,744.32 24140 $2,147.29 $0.00 $0.00 2 A2 $1,256.79 24145 $1,817.51 $0.00 $0.00 1 A2 $2,744.32 24147 $1,913.42 $0.00 $0.00 1 A2 $1,256.79 24149 $3,585.92 $0.00 $0.00 2 G2 $2,744.32 24150 $4,732.85 $0.00 $0.00 2 $0.00 24152 $4,106.88 $0.00 $0.00 2 G2 $2,744.32 24155 $2,595.64 $0.00 $0.00 2 A2 $1,256.79 24160 $3,646.00 $0.00 $0.00 1 A2 $1,256.79 24164 $2,089.50 $0.00 $0.00 1 A2 $1,256.79 24200 $647.65 $0.00 $0.00 0 P3 $141.98 24201 $1,751.80 $0.00 $0.00 1 A2 $1,078.70 24220 $500.92 $0.00 $0.00 0 N1 $0.00 24300 $1,299.87 $0.00 $0.00 1 G2 $705.07 24301 $2,288.72 $0.00 $0.00 2 A2 $2,744.32 24305 $1,767.04 $0.00 $0.00 0 A2 $1,256.79 24310 $1,463.90 $0.00 $0.00 0 A2 $1,256.79 24320 $2,377.07 $0.00 $0.00 2 A2 $2,744.32 24330 $2,191.71 $0.00 $0.00 2 A2 $1,256.79 24331 $2,393.53 $0.00 $0.00 2 A2 $2,744.32 24332 $1,882.61 $0.00 $0.00 1 G2 $1,256.79 24340 $1,886.38 $0.00 $0.00 2 A2 $2,744.32 24341 $2,303.86 $0.00 $0.00 2 A2 $2,744.32 24342 $2,625.10 $0.00 $0.00 2 A2 $2,744.32 24343 $2,173.37 $0.00 $0.00 2 G2 $1,256.79 24344 $3,343.94 $0.00 $0.00 2 J8 $3,688.42 24345 $2,156.64 $0.00 $0.00 2 A2 $2,744.32 24346 $3,357.45 $0.00 $0.00 2 G2 $5,281.63 24357 $1,348.81 $0.00 $0.00 0 G2 $1,256.79 24358 $1,609.33 $0.00 $0.00 0 G2 $1,256.79 24359 $2,021.43 $0.00 $0.00 0 G2 $1,256.79 24360 $2,748.98 $0.00 $0.00 2 A2 $2,744.32 24361 $3,075.25 $0.00 $0.00 2 J8 $11,831.31


60


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 24362 $3,242.70 $0.00 $0.00 2 J8 $8,178.88 24363 $4,434.50 $0.00 $0.00 2 J8 $12,037.44 24365 $1,954.42 $0.00 $0.00 2 G2 $5,281.63 24366 $2,083.67 $0.00 $0.00 2 J8 $8,209.70 24370 $4,722.59 $0.00 $0.00 2 J8 $7,689.21 24371 $5,392.82 $0.00 $0.00 2 J8 $11,296.23 24400 $2,532.52 $0.00 $0.00 2 A2 $2,744.32 24410 $3,313.39 $0.00 $0.00 2 G2 $5,281.63 24420 $3,032.13 $0.00 $0.00 2 A2 $2,744.32 24430 $3,236.45 $0.00 $0.00 2 J8 $7,316.87 24435 $3,306.69 $0.00 $0.00 2 J8 $7,316.87 24470 $1,935.00 $0.00 $0.00 2 A2 $1,256.79 24495 $2,042.09 $0.00 $0.00 0 A2 $2,744.32 24498 $2,657.19 $0.00 $0.00 2 J8 $7,533.61 24500 $1,108.31 $0.00 $0.00 1 A2 $115.95 24505 $1,557.34 $0.00 $0.00 1 A2 $705.07 24515 $2,692.16 $0.00 $0.00 2 J8 $7,171.21 24516 $2,636.38 $0.00 $0.00 2 J8 $7,275.60 24530 $1,175.04 $0.00 $0.00 1 A2 $115.95 24535 $1,896.29 $0.00 $0.00 1 A2 $705.07 24538 $2,295.88 $0.00 $0.00 1 A2 $2,744.32 24545 $2,846.83 $0.00 $0.00 2 J8 $7,628.07 24546 $3,186.23 $0.00 $0.00 2 J8 $10,650.32 24560 $1,014.22 $0.00 $0.00 1 A2 $115.95 24565 $1,647.12 $0.00 $0.00 1 A2 $705.07 24566 $2,211.56 $0.00 $0.00 1 A2 $705.07 24575 $2,247.37 $0.00 $0.00 2 A2 $5,281.63 24576 $1,068.01 $0.00 $0.00 1 A2 $115.95 24577 $1,694.54 $0.00 $0.00 1 A2 $705.07 24579 $2,564.00 $0.00 $0.00 2 J8 $6,855.04 24582 $2,494.39 $0.00 $0.00 1 A2 $1,256.79 24586 $3,306.44 $0.00 $0.00 2 G2 $5,281.63 24587 $3,294.48 $0.00 $0.00 2 J8 $8,030.74 24600 $1,145.81 $0.00 $0.00 1 A2 $115.95 24605 $1,458.63 $0.00 $0.00 1 A2 $705.07 24615 $2,181.38 $0.00 $0.00 2 A2 $2,744.32 24620 $1,708.50 $0.00 $0.00 0 A2 $705.07 24635 $2,065.55 $0.00 $0.00 2 J8 $3,784.77 24640 $448.53 $0.00 $0.00 0 P3 $55.13 24650 $813.23 $0.00 $0.00 1 P2 $115.95 24655 $1,372.23 $0.00 $0.00 1 A2 $705.07


61


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 24665 $2,000.65 $0.00 $0.00 2 A2 $2,744.32 24666 $2,247.83 $0.00 $0.00 2 J8 $8,204.73 24670 $903.75 $0.00 $0.00 1 A2 $115.95 24675 $1,425.00 $0.00 $0.00 1 A2 $705.07 24685 $2,013.46 $0.00 $0.00 2 J8 $3,553.33 24800 $2,526.16 $0.00 $0.00 2 A2 $2,744.32 24802 $3,066.17 $0.00 $0.00 2 G2 $5,281.63 24900 $2,237.12 $0.00 $0.00 2 $0.00 24920 $2,116.00 $0.00 $0.00 2 $0.00 24925 $1,756.47 $0.00 $0.00 2 A2 $1,256.79 24930 $2,360.99 $0.00 $0.00 2 $0.00 24931 $2,385.52 $0.00 $0.00 2 $0.00 24935 $3,344.69 $0.00 $0.00 0 $0.00 24940 BR $0.00 $0.00 2 $0.00 24999 BR $0.00 $0.00 0 $0.00 25000 $1,144.71 $0.00 $0.00 1 A2 $705.07 25001 $1,061.19 $0.00 $0.00 1 G2 $1,256.79 25020 $1,772.37 $0.00 $0.00 1 A2 $705.07 25023 $3,414.59 $0.00 $0.00 0 A2 $1,256.79 25024 $2,426.98 $0.00 $0.00 1 A2 $1,256.79 25025 $3,726.72 $0.00 $0.00 0 A2 $705.07 25028 $1,630.52 $0.00 $0.00 1 A2 $1,256.79 25031 $1,067.70 $0.00 $0.00 0 A2 $705.07 25035 $1,790.24 $0.00 $0.00 0 A2 $2,744.32 25040 $1,715.50 $0.00 $0.00 0 A2 $1,256.79 25065 $809.18 $0.00 $0.00 1 P3 $179.46 25066 $1,100.59 $0.00 $0.00 1 A2 $1,078.70 25071 $1,305.02 $0.00 $0.00 2 G2 $547.17 25073 $1,629.81 $0.00 $0.00 2 G2 $1,078.70 25075 $1,525.93 $0.00 $0.00 1 G2 $547.17 25076 $1,581.35 $0.00 $0.00 1 G2 $547.17 25077 $2,698.83 $0.00 $0.00 1 G2 $547.17 25078 $3,586.40 $0.00 $0.00 2 G2 $1,078.70 25085 $1,383.78 $0.00 $0.00 2 A2 $1,256.79 25100 $1,068.12 $0.00 $0.00 0 A2 $1,256.79 25101 $1,247.28 $0.00 $0.00 0 A2 $1,256.79 25105 $1,486.30 $0.00 $0.00 0 A2 $1,256.79 25107 $1,880.62 $0.00 $0.00 2 A2 $1,256.79 25109 $1,642.32 $0.00 $0.00 1 G2 $1,256.79 25110 $1,049.05 $0.00 $0.00 1 A2 $705.07 25111 $988.52 $0.00 $0.00 1 A2 $705.07


62


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 25112 $1,190.38 $0.00 $0.00 1 A2 $705.07 25115 $2,311.40 $0.00 $0.00 1 A2 $705.07 25116 $1,838.28 $0.00 $0.00 0 A2 $1,256.79 25118 $1,168.15 $0.00 $0.00 1 A2 $705.07 25119 $1,516.76 $0.00 $0.00 2 A2 $1,256.79 25120 $1,529.83 $0.00 $0.00 0 A2 $1,256.79 25125 $1,817.73 $0.00 $0.00 0 A2 $705.07 25126 $1,824.49 $0.00 $0.00 2 J8 $1,750.43 25130 $1,372.73 $0.00 $0.00 0 A2 $1,256.79 25135 $1,703.74 $0.00 $0.00 2 A2 $1,256.79 25136 $1,507.61 $0.00 $0.00 2 A2 $2,744.32 25145 $1,583.03 $0.00 $0.00 2 A2 $1,256.79 25150 $1,725.27 $0.00 $0.00 1 A2 $1,256.79 25151 $1,789.37 $0.00 $0.00 2 A2 $1,256.79 25170 $4,495.35 $0.00 $0.00 2 $0.00 25210 $1,495.92 $0.00 $0.00 0 A2 $1,256.79 25215 $1,879.73 $0.00 $0.00 2 A2 $1,256.79 25230 $1,317.88 $0.00 $0.00 1 A2 $1,256.79 25240 $1,310.95 $0.00 $0.00 0 A2 $1,256.79 25246 $498.60 $0.00 $0.00 1 N1 $0.00 25248 $1,272.52 $0.00 $0.00 1 A2 $705.07 25250 $1,621.08 $0.00 $0.00 2 A2 $705.07 25251 $2,196.95 $0.00 $0.00 2 A2 $1,256.79 25259 $1,294.45 $0.00 $0.00 1 G2 $705.07 25260 $2,132.20 $0.00 $0.00 1 A2 $1,256.79 25263 $1,929.04 $0.00 $0.00 2 A2 $1,256.79 25265 $2,278.43 $0.00 $0.00 2 A2 $1,256.79 25270 $1,501.90 $0.00 $0.00 0 A2 $1,256.79 25272 $1,687.89 $0.00 $0.00 0 A2 $1,256.79 25274 $2,037.45 $0.00 $0.00 0 A2 $1,256.79 25275 $2,064.04 $0.00 $0.00 0 A2 $1,256.79 25280 $1,722.15 $0.00 $0.00 0 A2 $1,256.79 25290 $1,335.24 $0.00 $0.00 1 A2 $1,256.79 25295 $1,760.16 $0.00 $0.00 1 A2 $1,256.79 25300 $2,101.25 $0.00 $0.00 2 A2 $1,256.79 25301 $1,965.38 $0.00 $0.00 2 A2 $1,256.79 25310 $1,884.91 $0.00 $0.00 2 A2 $1,256.79 25312 $2,195.06 $0.00 $0.00 2 A2 $1,256.79 25315 $2,349.58 $0.00 $0.00 2 A2 $2,744.32 25316 $2,726.21 $0.00 $0.00 2 A2 $2,744.32 25320 $3,015.00 $0.00 $0.00 2 A2 $2,744.32


63


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 25332 $2,578.21 $0.00 $0.00 2 A2 $1,256.79 25335 $2,754.97 $0.00 $0.00 2 A2 $1,256.79 25337 $2,706.40 $0.00 $0.00 1 A2 $2,744.32 25350 $2,054.36 $0.00 $0.00 2 A2 $2,744.32 25355 $2,331.90 $0.00 $0.00 2 A2 $1,256.79 25360 $2,007.53 $0.00 $0.00 2 A2 $2,744.32 25365 $2,785.08 $0.00 $0.00 2 A2 $5,281.63 25370 $3,088.21 $0.00 $0.00 2 A2 $1,256.79 25375 $2,753.30 $0.00 $0.00 2 A2 $1,256.79 25390 $2,340.46 $0.00 $0.00 2 J8 $3,685.83 25391 $3,045.56 $0.00 $0.00 2 J8 $7,449.60 25392 $3,081.70 $0.00 $0.00 2 A2 $1,256.79 25393 $3,432.58 $0.00 $0.00 2 A2 $1,256.79 25394 $2,387.77 $0.00 $0.00 2 G2 $1,256.79 25400 $2,448.78 $0.00 $0.00 2 J8 $3,797.68 25405 $3,162.10 $0.00 $0.00 2 J8 $3,718.64 25415 $2,948.12 $0.00 $0.00 2 J8 $3,749.89 25420 $3,556.01 $0.00 $0.00 2 J8 $3,818.09 25425 $2,934.79 $0.00 $0.00 2 A2 $2,744.32 25426 $3,433.20 $0.00 $0.00 2 G2 $1,256.79 25430 $2,160.91 $0.00 $0.00 1 G2 $1,256.79 25431 $2,405.42 $0.00 $0.00 2 G2 $2,744.32 25440 $2,341.72 $0.00 $0.00 2 A2 $2,744.32 25441 $2,782.42 $0.00 $0.00 2 J8 $8,472.68 25442 $2,392.63 $0.00 $0.00 2 J8 $11,625.19 25443 $2,378.25 $0.00 $0.00 2 A2 $2,744.32 25444 $2,377.72 $0.00 $0.00 2 J8 $9,025.49 25445 $2,200.32 $0.00 $0.00 1 J8 $3,819.89 25446 $3,548.66 $0.00 $0.00 2 J8 $12,343.10 25447 $2,523.48 $0.00 $0.00 2 A2 $1,256.79 25449 $3,178.53 $0.00 $0.00 2 A2 $2,744.32 25450 $1,890.77 $0.00 $0.00 1 A2 $1,256.79 25455 $2,094.00 $0.00 $0.00 1 A2 $1,256.79 25490 $2,123.02 $0.00 $0.00 2 A2 $2,744.32 25491 $2,266.25 $0.00 $0.00 2 A2 $5,281.63 25492 $2,611.00 $0.00 $0.00 2 A2 $1,256.79 25500 $848.99 $0.00 $0.00 1 P2 $115.95 25505 $1,564.17 $0.00 $0.00 1 A2 $705.07 25515 $2,055.19 $0.00 $0.00 2 J8 $3,636.76 25520 $1,743.74 $0.00 $0.00 1 A2 $705.07 25525 $2,407.31 $0.00 $0.00 2 J8 $3,558.49


64


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 25526 $2,919.79 $0.00 $0.00 2 A2 $2,744.32 25530 $814.39 $0.00 $0.00 1 P2 $115.95 25535 $1,527.30 $0.00 $0.00 1 A2 $115.95 25545 $1,917.25 $0.00 $0.00 2 A2 $2,744.32 25560 $874.42 $0.00 $0.00 1 P2 $115.95 25565 $1,607.16 $0.00 $0.00 1 A2 $705.07 25574 $2,072.20 $0.00 $0.00 2 J8 $3,782.44 25575 $2,762.01 $0.00 $0.00 2 J8 $3,812.92 25600 $1,131.04 $0.00 $0.00 1 P2 $115.95 25605 $1,874.27 $0.00 $0.00 1 A2 $705.07 25606 $2,035.35 $0.00 $0.00 1 A2 $1,256.79 25607 $2,257.68 $0.00 $0.00 2 J8 $3,883.95 25608 $2,780.93 $0.00 $0.00 2 J8 $3,884.47 25609 $3,531.88 $0.00 $0.00 2 J8 $3,915.73 25622 $945.92 $0.00 $0.00 1 P2 $115.95 25624 $1,479.37 $0.00 $0.00 0 A2 $705.07 25628 $2,198.19 $0.00 $0.00 2 A2 $2,744.32 25630 $943.59 $0.00 $0.00 1 P2 $115.95 25635 $1,410.73 $0.00 $0.00 0 A2 $705.07 25645 $1,741.03 $0.00 $0.00 2 A2 $1,256.79 25650 $1,001.21 $0.00 $0.00 1 P2 $115.95 25651 $1,492.08 $0.00 $0.00 0 G2 $1,256.79 25652 $1,903.74 $0.00 $0.00 1 G2 $2,744.32 25660 $1,260.01 $0.00 $0.00 0 A2 $115.95 25670 $1,851.32 $0.00 $0.00 2 A2 $1,256.79 25671 $1,625.86 $0.00 $0.00 1 A2 $1,256.79 25675 $1,385.16 $0.00 $0.00 0 A2 $115.95 25676 $1,926.62 $0.00 $0.00 2 A2 $2,744.32 25680 $1,493.00 $0.00 $0.00 0 A2 $115.95 25685 $2,248.45 $0.00 $0.00 2 A2 $1,256.79 25690 $1,487.91 $0.00 $0.00 0 A2 $705.07 25695 $1,934.70 $0.00 $0.00 2 A2 $2,744.32 25800 $2,227.63 $0.00 $0.00 2 G2 $2,744.32 25805 $2,581.93 $0.00 $0.00 2 J8 $3,594.14 25810 $2,645.09 $0.00 $0.00 2 J8 $7,283.56 25820 $1,897.91 $0.00 $0.00 2 J8 $3,834.10 25825 $2,327.26 $0.00 $0.00 2 J8 $3,653.55 25830 $2,932.90 $0.00 $0.00 2 J8 $3,736.46 25900 $2,187.45 $0.00 $0.00 0 $0.00 25905 $2,135.92 $0.00 $0.00 2 $0.00 25907 $1,867.85 $0.00 $0.00 2 A2 $1,256.79


65


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 25909 $2,091.82 $0.00 $0.00 2 $0.00 25915 $3,389.34 $0.00 $0.00 2 $0.00 25920 $2,155.81 $0.00 $0.00 0 $0.00 25922 $1,780.21 $0.00 $0.00 2 A2 $705.07 25924 $2,088.67 $0.00 $0.00 2 $0.00 25927 $2,496.20 $0.00 $0.00 0 $0.00 25929 $1,832.00 $0.00 $0.00 2 A2 $797.93 25931 $2,270.37 $0.00 $0.00 1 G2 $1,256.79 25999 BR $0.00 $0.00 0 $0.00 26010 $845.24 $0.00 $0.00 1 P2 $90.90 26011 $1,242.46 $0.00 $0.00 1 A2 $547.17 26020 $1,340.11 $0.00 $0.00 1 A2 $1,256.79 26025 $1,298.26 $0.00 $0.00 0 A2 $1,256.79 26030 $1,501.41 $0.00 $0.00 0 A2 $1,256.79 26034 $1,659.87 $0.00 $0.00 1 A2 $705.07 26035 $2,632.05 $0.00 $0.00 0 G2 $1,256.79 26037 $1,746.43 $0.00 $0.00 0 G2 $1,256.79 26040 $953.07 $0.00 $0.00 1 A2 $705.07 26045 $1,444.76 $0.00 $0.00 1 A2 $1,256.79 26055 $1,940.84 $0.00 $0.00 1 A2 $705.07 26060 $814.85 $0.00 $0.00 0 A2 $705.07 26070 $952.02 $0.00 $0.00 1 A2 $705.07 26075 $1,009.00 $0.00 $0.00 1 A2 $1,256.79 26080 $1,202.39 $0.00 $0.00 1 A2 $705.07 26100 $1,032.97 $0.00 $0.00 0 A2 $1,256.79 26105 $1,039.24 $0.00 $0.00 0 A2 $1,256.79 26110 $989.80 $0.00 $0.00 1 A2 $705.07 26111 $1,273.15 $0.00 $0.00 2 G2 $547.17 26113 $1,667.62 $0.00 $0.00 2 G2 $547.17 26115 $1,592.42 $0.00 $0.00 1 G2 $547.17 26116 $1,606.13 $0.00 $0.00 1 G2 $547.17 26117 $2,282.75 $0.00 $0.00 1 G2 $1,078.70 26118 $3,243.88 $0.00 $0.00 2 G2 $1,078.70 26121 $1,823.08 $0.00 $0.00 1 A2 $1,256.79 26123 $2,545.64 $0.00 $0.00 1 A2 $1,256.79 26125 $823.02 $0.00 $0.00 1 N1 $0.00 26130 $1,401.02 $0.00 $0.00 1 A2 $1,256.79 26135 $1,680.42 $0.00 $0.00 0 A2 $1,256.79 26140 $1,548.95 $0.00 $0.00 1 A2 $705.07 26145 $1,726.75 $0.00 $0.00 1 A2 $705.07 26160 $1,824.97 $0.00 $0.00 1 A2 $705.07


66


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 26170 $1,241.15 $0.00 $0.00 0 A2 $705.07 26180 $1,360.51 $0.00 $0.00 0 A2 $705.07 26185 $1,689.86 $0.00 $0.00 2 A2 $705.07 26200 $1,378.74 $0.00 $0.00 0 A2 $705.07 26205 $1,850.72 $0.00 $0.00 1 A2 $2,744.32 26210 $1,357.10 $0.00 $0.00 1 A2 $705.07 26215 $1,739.37 $0.00 $0.00 1 A2 $1,256.79 26230 $1,520.09 $0.00 $0.00 0 A2 $1,256.79 26235 $1,501.64 $0.00 $0.00 0 A2 $705.07 26236 $1,349.68 $0.00 $0.00 1 A2 $705.07 26250 $3,271.53 $0.00 $0.00 0 A2 $1,256.79 26260 $2,447.45 $0.00 $0.00 2 A2 $1,256.79 26262 $1,934.60 $0.00 $0.00 2 A2 $705.07 26320 $1,063.81 $0.00 $0.00 1 A2 $547.17 26340 $1,151.55 $0.00 $0.00 1 G2 $705.07 26341 $307.35 $0.00 $0.00 1 P3 $65.58 26350 $2,417.54 $0.00 $0.00 1 A2 $1,256.79 26352 $2,500.17 $0.00 $0.00 2 A2 $1,256.79 26356 $3,702.94 $0.00 $0.00 1 A2 $1,256.79 26357 $2,669.24 $0.00 $0.00 2 A2 $1,256.79 26358 $2,821.00 $0.00 $0.00 2 A2 $1,256.79 26370 $2,312.00 $0.00 $0.00 0 A2 $1,256.79 26372 $2,703.44 $0.00 $0.00 2 A2 $2,744.32 26373 $2,595.52 $0.00 $0.00 2 A2 $1,256.79 26390 $2,527.77 $0.00 $0.00 2 A2 $2,744.32 26392 $2,940.36 $0.00 $0.00 2 A2 $2,744.32 26410 $1,917.35 $0.00 $0.00 1 A2 $705.07 26412 $2,106.91 $0.00 $0.00 0 A2 $1,256.79 26415 $2,423.41 $0.00 $0.00 0 A2 $1,256.79 26416 $2,491.32 $0.00 $0.00 1 A2 $1,256.79 26418 $1,971.49 $0.00 $0.00 1 A2 $705.07 26420 $2,163.80 $0.00 $0.00 2 A2 $1,256.79 26426 $1,535.44 $0.00 $0.00 1 A2 $1,256.79 26428 $2,277.99 $0.00 $0.00 0 A2 $1,256.79 26432 $1,527.62 $0.00 $0.00 1 A2 $705.07 26433 $1,623.38 $0.00 $0.00 1 A2 $1,256.79 26434 $1,978.79 $0.00 $0.00 2 A2 $1,256.79 26437 $1,892.25 $0.00 $0.00 1 A2 $1,256.79 26440 $2,093.50 $0.00 $0.00 1 A2 $705.07 26442 $2,934.46 $0.00 $0.00 1 A2 $1,256.79 26445 $1,958.40 $0.00 $0.00 1 A2 $1,256.79


67


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 26449 $2,148.81 $0.00 $0.00 0 A2 $1,256.79 26450 $1,224.07 $0.00 $0.00 0 A2 $1,256.79 26455 $1,238.73 $0.00 $0.00 0 A2 $705.07 26460 $1,201.43 $0.00 $0.00 1 A2 $705.07 26471 $1,870.02 $0.00 $0.00 0 A2 $1,256.79 26474 $1,804.04 $0.00 $0.00 2 A2 $705.07 26476 $1,782.06 $0.00 $0.00 1 A2 $1,256.79 26477 $1,771.87 $0.00 $0.00 1 A2 $1,256.79 26478 $1,894.30 $0.00 $0.00 0 A2 $1,256.79 26479 $1,882.14 $0.00 $0.00 2 A2 $1,256.79 26480 $2,296.89 $0.00 $0.00 0 A2 $1,256.79 26483 $2,564.33 $0.00 $0.00 2 A2 $1,256.79 26485 $2,456.87 $0.00 $0.00 2 A2 $1,256.79 26489 $2,853.07 $0.00 $0.00 0 A2 $1,256.79 26490 $2,407.73 $0.00 $0.00 0 A2 $1,256.79 26492 $2,687.87 $0.00 $0.00 2 A2 $1,256.79 26494 $2,433.31 $0.00 $0.00 2 A2 $1,256.79 26496 $2,586.71 $0.00 $0.00 0 A2 $1,256.79 26497 $2,615.41 $0.00 $0.00 2 A2 $1,256.79 26498 $3,469.95 $0.00 $0.00 2 A2 $1,256.79 26499 $2,507.40 $0.00 $0.00 2 A2 $1,256.79 26500 $1,902.66 $0.00 $0.00 0 A2 $2,744.32 26502 $2,167.84 $0.00 $0.00 2 A2 $1,256.79 26508 $1,951.44 $0.00 $0.00 0 A2 $1,256.79 26510 $1,816.78 $0.00 $0.00 0 A2 $1,256.79 26516 $2,126.38 $0.00 $0.00 0 A2 $1,256.79 26517 $2,492.10 $0.00 $0.00 2 A2 $1,256.79 26518 $2,543.26 $0.00 $0.00 2 A2 $1,256.79 26520 $1,990.58 $0.00 $0.00 1 A2 $1,256.79 26525 $2,208.41 $0.00 $0.00 1 A2 $705.07 26530 $1,636.02 $0.00 $0.00 2 A2 $1,256.79 26531 $1,901.45 $0.00 $0.00 2 J8 $3,934.84 26535 $1,287.85 $0.00 $0.00 1 A2 $1,256.79 26536 $2,177.74 $0.00 $0.00 0 J8 $3,679.64 26540 $2,000.54 $0.00 $0.00 0 A2 $1,256.79 26541 $2,420.22 $0.00 $0.00 2 A2 $1,256.79 26542 $2,069.18 $0.00 $0.00 0 A2 $1,256.79 26545 $2,160.56 $0.00 $0.00 0 A2 $1,256.79 26546 $3,022.31 $0.00 $0.00 2 A2 $2,744.32 26548 $2,313.72 $0.00 $0.00 0 A2 $1,256.79 26550 $5,014.58 $0.00 $0.00 2 A2 $1,256.79


68


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 26551 $9,518.06 $0.00 $0.00 2 $0.00 26553 $9,399.00 $0.00 $0.00 2 $0.00 26554 $9,771.80 $0.00 $0.00 2 $0.00 26555 $4,164.92 $0.00 $0.00 2 A2 $2,744.32 26556 $9,769.00 $0.00 $0.00 2 $0.00 26560 $1,808.19 $0.00 $0.00 2 A2 $705.07 26561 $2,872.93 $0.00 $0.00 2 A2 $1,256.79 26562 $3,835.32 $0.00 $0.00 2 A2 $1,256.79 26565 $2,071.99 $0.00 $0.00 2 A2 $1,256.79 26567 $2,066.73 $0.00 $0.00 0 A2 $1,256.79 26568 $2,748.47 $0.00 $0.00 2 A2 $2,744.32 26580 $4,590.71 $0.00 $0.00 2 A2 $1,256.79 26587 $3,212.33 $0.00 $0.00 2 A2 $1,256.79 26590 $3,997.82 $0.00 $0.00 2 A2 $705.07 26591 $1,349.81 $0.00 $0.00 0 A2 $1,256.79 26593 $1,821.12 $0.00 $0.00 1 A2 $1,256.79 26596 $2,313.63 $0.00 $0.00 2 A2 $1,256.79 26600 $914.32 $0.00 $0.00 1 P2 $115.95 26605 $1,004.43 $0.00 $0.00 1 A2 $115.95 26607 $1,421.78 $0.00 $0.00 0 A2 $1,256.79 26608 $1,475.75 $0.00 $0.00 0 A2 $1,256.79 26615 $1,950.23 $0.00 $0.00 1 A2 $1,256.79 26641 $1,132.69 $0.00 $0.00 0 P2 $115.95 26645 $1,319.34 $0.00 $0.00 0 A2 $705.07 26650 $1,478.39 $0.00 $0.00 1 A2 $1,256.79 26665 $1,927.90 $0.00 $0.00 1 A2 $1,256.79 26670 $1,030.00 $0.00 $0.00 0 P2 $115.95 26675 $1,409.73 $0.00 $0.00 0 A2 $705.07 26676 $1,550.08 $0.00 $0.00 1 A2 $1,256.79 26685 $1,774.19 $0.00 $0.00 1 A2 $1,256.79 26686 $1,906.10 $0.00 $0.00 2 A2 $1,256.79 26700 $1,017.82 $0.00 $0.00 1 P2 $115.95 26705 $1,295.95 $0.00 $0.00 0 A2 $705.07 26706 $1,360.44 $0.00 $0.00 1 A2 $1,256.79 26715 $1,762.07 $0.00 $0.00 0 A2 $1,256.79 26720 $616.99 $0.00 $0.00 1 P2 $115.95 26725 $1,049.54 $0.00 $0.00 1 P2 $115.95 26727 $1,447.57 $0.00 $0.00 1 A2 $1,256.79 26735 $2,019.78 $0.00 $0.00 1 A2 $1,256.79 26740 $706.93 $0.00 $0.00 1 P2 $115.95 26742 $1,136.85 $0.00 $0.00 1 A2 $705.07


69


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 26746 $2,264.55 $0.00 $0.00 1 A2 $1,256.79 26750 $633.59 $0.00 $0.00 1 P3 $114.59 26755 $977.01 $0.00 $0.00 1 G2 $115.95 26756 $1,294.98 $0.00 $0.00 0 A2 $1,256.79 26765 $1,702.67 $0.00 $0.00 1 A2 $1,256.79 26770 $863.92 $0.00 $0.00 1 G2 $115.95 26775 $1,201.34 $0.00 $0.00 1 P2 $121.36 26776 $1,360.74 $0.00 $0.00 1 A2 $1,256.79 26785 $1,679.40 $0.00 $0.00 1 A2 $1,256.79 26820 $2,397.55 $0.00 $0.00 2 J8 $4,000.97 26841 $2,225.02 $0.00 $0.00 0 A2 $2,744.32 26842 $2,392.44 $0.00 $0.00 2 A2 $2,744.32 26843 $2,249.77 $0.00 $0.00 2 A2 $2,744.32 26844 $2,473.60 $0.00 $0.00 2 J8 $3,778.56 26850 $2,096.42 $0.00 $0.00 0 A2 $2,744.32 26852 $2,398.27 $0.00 $0.00 2 A2 $2,744.32 26860 $1,719.43 $0.00 $0.00 1 A2 $1,256.79 26861 $312.11 $0.00 $0.00 1 N1 $0.00 26862 $2,195.93 $0.00 $0.00 2 A2 $1,256.79 26863 $712.53 $0.00 $0.00 2 N1 $0.00 26910 $2,176.35 $0.00 $0.00 1 A2 $1,256.79 26951 $2,211.41 $0.00 $0.00 1 A2 $1,256.79 26952 $2,175.32 $0.00 $0.00 1 A2 $1,256.79 26989 BR $0.00 $0.00 1 $0.00 26990 $1,950.30 $0.00 $0.00 1 A2 $1,256.79 26991 $2,189.58 $0.00 $0.00 0 A2 $705.07 26992 $2,980.81 $0.00 $0.00 0 $0.00 27000 $1,293.82 $0.00 $0.00 1 A2 $705.07 27001 $1,663.31 $0.00 $0.00 2 A2 $1,256.79 27003 $1,820.36 $0.00 $0.00 2 A2 $2,744.32 27005 $2,225.75 $0.00 $0.00 2 $0.00 27006 $2,251.46 $0.00 $0.00 2 $0.00 27025 $2,813.31 $0.00 $0.00 0 $0.00 27027 $2,598.07 $0.00 $0.00 0 $0.00 27030 $2,770.85 $0.00 $0.00 2 $0.00 27033 $2,985.52 $0.00 $0.00 2 A2 $1,256.79 27035 $3,290.16 $0.00 $0.00 2 A2 $1,256.79 27036 $3,093.38 $0.00 $0.00 2 $0.00 27040 $1,051.12 $0.00 $0.00 1 A2 $547.17 27041 $2,101.04 $0.00 $0.00 1 A2 $547.17 27043 $1,445.98 $0.00 $0.00 1 G2 $1,078.70


70


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 27045 $2,269.47 $0.00 $0.00 2 G2 $1,078.70 27047 $1,478.77 $0.00 $0.00 1 G2 $1,078.70 27048 $1,873.47 $0.00 $0.00 2 G2 $1,078.70 27049 $4,127.03 $0.00 $0.00 2 G2 $1,078.70 27050 $1,241.71 $0.00 $0.00 0 A2 $705.07 27052 $1,772.67 $0.00 $0.00 2 A2 $705.07 27054 $2,110.68 $0.00 $0.00 2 $0.00 27057 $2,914.00 $0.00 $0.00 0 $0.00 27059 $5,497.08 $0.00 $0.00 2 G2 $1,078.70 27060 $1,429.54 $0.00 $0.00 1 A2 $1,256.79 27062 $1,405.65 $0.00 $0.00 1 A2 $1,256.79 27065 $1,589.30 $0.00 $0.00 2 A2 $1,256.79 27066 $2,480.59 $0.00 $0.00 2 A2 $1,256.79 27067 $3,168.47 $0.00 $0.00 2 A2 $2,744.32 27070 $2,635.61 $0.00 $0.00 2 $0.00 27071 $2,845.60 $0.00 $0.00 2 $0.00 27075 $6,377.85 $0.00 $0.00 2 $0.00 27076 $7,711.60 $0.00 $0.00 2 $0.00 27077 $8,633.25 $0.00 $0.00 2 $0.00 27078 $6,289.11 $0.00 $0.00 2 $0.00 27080 $1,578.50 $0.00 $0.00 2 A2 $1,256.79 27086 $861.00 $0.00 $0.00 0 A2 $547.17 27087 $1,941.07 $0.00 $0.00 2 A2 $1,256.79 27090 $2,549.96 $0.00 $0.00 2 $0.00 27091 $4,886.72 $0.00 $0.00 2 $0.00 27093 $600.96 $0.00 $0.00 1 N1 $0.00 27095 $754.07 $0.00 $0.00 1 N1 $0.00 27096 $570.12 $0.00 $0.00 1 $0.00 27097 $2,078.34 $0.00 $0.00 2 A2 $1,256.79 27098 $2,131.36 $0.00 $0.00 2 A2 $1,256.79 27100 $2,514.75 $0.00 $0.00 2 A2 $2,744.32 27105 $2,641.44 $0.00 $0.00 2 A2 $1,256.79 27110 $2,948.04 $0.00 $0.00 2 A2 $2,744.32 27111 $2,755.29 $0.00 $0.00 2 A2 $1,256.79 27120 $3,925.18 $0.00 $0.00 2 $0.00 27122 $3,371.23 $0.00 $0.00 2 $0.00 27125 $3,470.27 $0.00 $0.00 2 $0.00 27130 $4,404.20 $0.00 $0.00 2 $0.00 27132 $5,125.94 $0.00 $0.00 2 $0.00 27134 $5,849.46 $0.00 $0.00 2 $0.00 27137 $4,502.30 $0.00 $0.00 2 $0.00


71


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 27138 $4,679.86 $0.00 $0.00 2 $0.00 27140 $2,739.61 $0.00 $0.00 2 $0.00 27146 $3,911.69 $0.00 $0.00 2 $0.00 27147 $4,466.06 $0.00 $0.00 2 $0.00 27151 $4,850.63 $0.00 $0.00 2 $0.00 27156 $5,206.06 $0.00 $0.00 2 $0.00 27158 $4,055.93 $0.00 $0.00 2 $0.00 27161 $3,716.74 $0.00 $0.00 2 $0.00 27165 $4,200.61 $0.00 $0.00 2 $0.00 27170 $3,589.43 $0.00 $0.00 2 $0.00 27175 $2,041.04 $0.00 $0.00 0 $0.00 27176 $2,802.88 $0.00 $0.00 2 $0.00 27177 $3,388.39 $0.00 $0.00 2 $0.00 27178 $2,817.74 $0.00 $0.00 2 $0.00 27179 $2,968.39 $0.00 $0.00 2 $0.00 27181 $3,647.25 $0.00 $0.00 2 $0.00 27185 $2,071.00 $0.00 $0.00 1 $0.00 27187 $3,047.55 $0.00 $0.00 2 $0.00 27197 $347.16 $0.00 $0.00 1 G2 $115.95 27198 $867.00 $0.00 $0.00 0 G2 $115.95 27200 $560.84 $0.00 $0.00 1 P3 $107.75 27202 $1,625.46 $0.00 $0.00 2 A2 $1,256.79 27215 $1,800.00 $0.00 $0.00 $0.00 27216 $2,672.00 $0.00 $0.00 $0.00 27217 $2,507.00 $0.00 $0.00 $0.00 27218 $3,463.00 $0.00 $0.00 $0.00 27220 $1,633.65 $0.00 $0.00 1 G2 $115.95 27222 $2,960.20 $0.00 $0.00 1 $0.00 27226 $3,244.69 $0.00 $0.00 2 $0.00 27227 $5,073.47 $0.00 $0.00 2 $0.00 27228 $5,762.24 $0.00 $0.00 2 $0.00 27230 $1,476.28 $0.00 $0.00 1 A2 $115.95 27232 $2,329.49 $0.00 $0.00 1 $0.00 27235 $2,785.23 $0.00 $0.00 1 $0.00 27236 $3,665.31 $0.00 $0.00 2 $0.00 27238 $1,427.56 $0.00 $0.00 1 A2 $705.07 27240 $2,940.47 $0.00 $0.00 1 $0.00 27244 $3,767.25 $0.00 $0.00 2 $0.00 27245 $3,766.18 $0.00 $0.00 2 $0.00 27246 $1,189.70 $0.00 $0.00 1 A2 $115.95 27248 $2,279.28 $0.00 $0.00 2 $0.00


72


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 27250 $551.16 $0.00 $0.00 1 A2 $115.95 27252 $2,327.31 $0.00 $0.00 1 A2 $705.07 27253 $2,897.97 $0.00 $0.00 2 $0.00 27254 $3,836.96 $0.00 $0.00 2 $0.00 27256 $943.44 $0.00 $0.00 0 G2 $115.95 27257 $1,046.00 $0.00 $0.00 0 A2 $705.07 27258 $3,383.67 $0.00 $0.00 2 $0.00 27259 $4,731.87 $0.00 $0.00 2 $0.00 27265 $1,251.70 $0.00 $0.00 1 A2 $115.95 27266 $1,788.40 $0.00 $0.00 1 A2 $705.07 27267 $1,351.10 $0.00 $0.00 2 G2 $1,256.79 27268 $1,646.88 $0.00 $0.00 2 $0.00 27269 $3,791.35 $0.00 $0.00 2 $0.00 27275 $564.07 $0.00 $0.00 1 A2 $705.07 27279 $1,999.00 $0.00 $0.00 2 J8 $12,481.45 27280 $3,922.00 $0.00 $0.00 2 $0.00 27282 $2,621.18 $0.00 $0.00 2 $0.00 27284 $4,911.38 $0.00 $0.00 2 $0.00 27286 $5,038.41 $0.00 $0.00 2 $0.00 27290 $4,952.95 $0.00 $0.00 2 $0.00 27295 $3,839.93 $0.00 $0.00 2 $0.00 27299 BR $0.00 $0.00 2 $0.00 27301 $2,097.64 $0.00 $0.00 1 A2 $1,078.70 27303 $1,966.01 $0.00 $0.00 2 $0.00 27305 $1,494.75 $0.00 $0.00 2 A2 $1,256.79 27306 $1,112.75 $0.00 $0.00 2 A2 $1,256.79 27307 $1,495.13 $0.00 $0.00 0 A2 $1,256.79 27310 $2,245.60 $0.00 $0.00 2 A2 $1,256.79 27323 $866.60 $0.00 $0.00 1 A2 $547.17 27324 $1,222.65 $0.00 $0.00 1 A2 $1,078.70 27325 $1,705.91 $0.00 $0.00 2 A2 $781.71 27326 $1,575.87 $0.00 $0.00 2 A2 $781.71 27327 $1,462.43 $0.00 $0.00 1 G2 $547.17 27328 $1,919.19 $0.00 $0.00 1 G2 $1,078.70 27329 $3,164.36 $0.00 $0.00 2 G2 $1,078.70 27330 $1,275.98 $0.00 $0.00 1 A2 $1,256.79 27331 $1,470.79 $0.00 $0.00 2 A2 $1,256.79 27332 $1,961.58 $0.00 $0.00 2 A2 $1,256.79 27333 $1,802.35 $0.00 $0.00 2 A2 $1,256.79 27334 $2,106.56 $0.00 $0.00 2 A2 $1,256.79 27335 $2,347.81 $0.00 $0.00 2 A2 $2,744.32


73


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 27337 $1,288.97 $0.00 $0.00 2 G2 $1,078.70 27339 $2,304.74 $0.00 $0.00 2 G2 $1,078.70 27340 $1,148.70 $0.00 $0.00 1 A2 $1,256.79 27345 $1,481.08 $0.00 $0.00 2 A2 $1,256.79 27347 $1,626.48 $0.00 $0.00 2 A2 $1,256.79 27350 $2,001.89 $0.00 $0.00 2 A2 $1,256.79 27355 $1,856.83 $0.00 $0.00 2 A2 $1,256.79 27356 $2,257.67 $0.00 $0.00 2 G2 $5,281.63 27357 $2,492.34 $0.00 $0.00 2 A2 $2,744.32 27358 $839.31 $0.00 $0.00 2 N1 $0.00 27360 $2,650.60 $0.00 $0.00 2 A2 $1,256.79 27364 $4,754.84 $0.00 $0.00 2 G2 $1,078.70 27365 $6,308.27 $0.00 $0.00 2 $0.00 27369 $406.00 $0.00 $0.00 0 N1 $0.00 27372 $1,903.80 $0.00 $0.00 0 A2 $1,078.70 27380 $1,847.30 $0.00 $0.00 2 A2 $2,744.32 27381 $2,459.81 $0.00 $0.00 2 A2 $2,744.32 27385 $1,791.59 $0.00 $0.00 2 A2 $2,744.32 27386 $2,575.80 $0.00 $0.00 2 A2 $2,744.32 27390 $1,374.60 $0.00 $0.00 2 A2 $1,256.79 27391 $1,771.16 $0.00 $0.00 0 A2 $1,256.79 27392 $2,170.99 $0.00 $0.00 2 A2 $1,256.79 27393 $1,570.80 $0.00 $0.00 2 A2 $1,256.79 27394 $2,001.83 $0.00 $0.00 2 A2 $2,744.32 27395 $2,682.01 $0.00 $0.00 2 A2 $1,256.79 27396 $1,879.14 $0.00 $0.00 2 J8 $4,470.05 27397 $2,794.35 $0.00 $0.00 2 G2 $2,744.32 27400 $2,117.48 $0.00 $0.00 2 A2 $2,744.32 27403 $1,973.10 $0.00 $0.00 2 J8 $1,779.17 27405 $2,087.18 $0.00 $0.00 2 A2 $2,744.32 27407 $2,414.24 $0.00 $0.00 2 A2 $2,744.32 27409 $2,936.79 $0.00 $0.00 2 A2 $2,744.32 27412 $5,028.20 $0.00 $0.00 2 $0.00 27415 $4,181.08 $0.00 $0.00 2 J8 $8,576.09 27416 $2,981.67 $0.00 $0.00 0 J8 $3,763.07 27418 $2,564.69 $0.00 $0.00 2 A2 $2,744.32 27420 $2,233.81 $0.00 $0.00 2 A2 $2,744.32 27422 $2,284.69 $0.00 $0.00 2 A2 $2,744.32 27424 $2,284.53 $0.00 $0.00 2 A2 $2,744.32 27425 $1,386.40 $0.00 $0.00 1 A2 $1,256.79 27427 $2,208.75 $0.00 $0.00 2 A2 $2,744.32


74


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 27428 $3,401.71 $0.00 $0.00 2 A2 $5,281.63 27429 $3,853.94 $0.00 $0.00 2 J8 $7,043.45 27430 $2,275.46 $0.00 $0.00 2 A2 $2,744.32 27435 $2,492.84 $0.00 $0.00 2 A2 $1,256.79 27437 $2,023.87 $0.00 $0.00 1 A2 $2,744.32 27438 $2,582.89 $0.00 $0.00 2 J8 $7,240.31 27440 $2,432.05 $0.00 $0.00 2 J8 $7,393.43 27441 $2,517.71 $0.00 $0.00 2 G2 $5,281.63 27442 $2,665.28 $0.00 $0.00 2 J8 $7,612.16 27443 $2,497.34 $0.00 $0.00 2 A2 $5,281.63 27445 $3,833.65 $0.00 $0.00 2 $0.00 27446 $3,381.47 $0.00 $0.00 2 J8 $7,694.68 27447 $5,195.84 $0.00 $0.00 2 $0.00 27448 $2,522.23 $0.00 $0.00 2 $0.00 27450 $3,153.48 $0.00 $0.00 2 $0.00 27454 $3,951.78 $0.00 $0.00 2 $0.00 27455 $2,866.81 $0.00 $0.00 2 $0.00 27457 $2,968.68 $0.00 $0.00 2 $0.00 27465 $3,873.09 $0.00 $0.00 2 $0.00 27466 $3,596.08 $0.00 $0.00 2 $0.00 27468 $4,100.67 $0.00 $0.00 2 $0.00 27470 $3,610.00 $0.00 $0.00 2 $0.00 27472 $3,874.95 $0.00 $0.00 2 $0.00 27475 $2,032.28 $0.00 $0.00 1 G2 $2,744.32 27477 $2,247.64 $0.00 $0.00 1 $0.00 27479 $2,657.00 $0.00 $0.00 2 G2 $2,744.32 27485 $2,060.16 $0.00 $0.00 1 $0.00 27486 $4,304.61 $0.00 $0.00 2 $0.00 27487 $5,376.55 $0.00 $0.00 2 $0.00 27488 $3,682.94 $0.00 $0.00 2 $0.00 27495 $3,461.08 $0.00 $0.00 2 $0.00 27496 $1,672.08 $0.00 $0.00 1 A2 $1,256.79 27497 $1,778.99 $0.00 $0.00 0 A2 $1,256.79 27498 $2,002.95 $0.00 $0.00 2 A2 $705.07 27499 $2,139.23 $0.00 $0.00 2 A2 $1,256.79 27500 $1,593.55 $0.00 $0.00 1 A2 $115.95 27501 $1,549.11 $0.00 $0.00 0 A2 $115.95 27502 $2,364.20 $0.00 $0.00 1 A2 $705.07 27503 $2,458.75 $0.00 $0.00 0 A2 $705.07 27506 $4,099.89 $0.00 $0.00 2 $0.00 27507 $2,977.84 $0.00 $0.00 2 $0.00


75


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 27508 $1,620.29 $0.00 $0.00 1 A2 $115.95 27509 $2,007.30 $0.00 $0.00 0 J8 $3,569.08 27510 $2,105.27 $0.00 $0.00 1 A2 $705.07 27511 $3,050.90 $0.00 $0.00 2 $0.00 27513 $3,791.56 $0.00 $0.00 2 $0.00 27514 $2,963.16 $0.00 $0.00 2 $0.00 27516 $1,576.96 $0.00 $0.00 1 A2 $115.95 27517 $2,091.89 $0.00 $0.00 0 A2 $705.07 27519 $2,718.61 $0.00 $0.00 2 $0.00 27520 $1,006.86 $0.00 $0.00 1 A2 $115.95 27524 $2,313.64 $0.00 $0.00 2 G2 $2,744.32 27530 $940.11 $0.00 $0.00 1 A2 $115.95 27532 $1,899.48 $0.00 $0.00 1 A2 $1,256.79 27535 $2,750.64 $0.00 $0.00 2 $0.00 27536 $3,644.76 $0.00 $0.00 2 $0.00 27538 $1,476.79 $0.00 $0.00 0 A2 $115.95 27540 $2,508.37 $0.00 $0.00 2 $0.00 27550 $1,562.30 $0.00 $0.00 0 A2 $115.95 27552 $1,940.93 $0.00 $0.00 0 A2 $705.07 27556 $2,672.26 $0.00 $0.00 2 $0.00 27557 $3,179.33 $0.00 $0.00 2 $0.00 27558 $3,620.53 $0.00 $0.00 2 $0.00 27560 $1,143.89 $0.00 $0.00 1 A2 $115.95 27562 $1,485.22 $0.00 $0.00 0 A2 $115.95 27566 $2,720.82 $0.00 $0.00 2 A2 $2,744.32 27570 $465.74 $0.00 $0.00 1 A2 $705.07 27580 $4,423.37 $0.00 $0.00 2 $0.00 27590 $2,499.02 $0.00 $0.00 2 $0.00 27591 $2,964.59 $0.00 $0.00 2 $0.00 27592 $2,146.68 $0.00 $0.00 2 $0.00 27594 $1,585.55 $0.00 $0.00 1 A2 $1,256.79 27596 $2,258.01 $0.00 $0.00 1 $0.00 27598 $2,256.68 $0.00 $0.00 2 $0.00 27599 BR $0.00 $0.00 2 $0.00 27600 $1,290.63 $0.00 $0.00 1 A2 $1,256.79 27601 $1,363.77 $0.00 $0.00 1 A2 $1,256.79 27602 $1,541.84 $0.00 $0.00 2 A2 $1,256.79 27603 $1,693.54 $0.00 $0.00 1 A2 $1,078.70 27604 $1,505.16 $0.00 $0.00 0 A2 $1,256.79 27605 $1,068.91 $0.00 $0.00 0 A2 $705.07 27606 $872.67 $0.00 $0.00 1 A2 $1,256.79


76


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 27607 $1,877.66 $0.00 $0.00 1 A2 $1,256.79 27610 $2,000.76 $0.00 $0.00 1 A2 $1,256.79 27612 $1,728.71 $0.00 $0.00 2 A2 $1,256.79 27613 $795.61 $0.00 $0.00 1 P3 $168.29 27614 $1,816.75 $0.00 $0.00 1 A2 $1,078.70 27615 $3,137.87 $0.00 $0.00 0 G2 $1,078.70 27616 $3,845.56 $0.00 $0.00 0 G2 $1,078.70 27618 $1,414.25 $0.00 $0.00 1 G2 $547.17 27619 $1,463.70 $0.00 $0.00 1 G2 $1,078.70 27620 $1,405.73 $0.00 $0.00 2 A2 $1,256.79 27625 $1,761.20 $0.00 $0.00 2 A2 $1,256.79 27626 $1,922.40 $0.00 $0.00 2 A2 $1,256.79 27630 $1,747.32 $0.00 $0.00 1 A2 $1,256.79 27632 $1,278.54 $0.00 $0.00 2 G2 $1,078.70 27634 $2,082.11 $0.00 $0.00 2 G2 $1,078.70 27635 $1,802.95 $0.00 $0.00 1 A2 $1,256.79 27637 $2,319.48 $0.00 $0.00 2 A2 $2,744.32 27638 $2,370.71 $0.00 $0.00 2 A2 $2,744.32 27640 $2,559.15 $0.00 $0.00 1 A2 $1,256.79 27641 $2,025.45 $0.00 $0.00 1 A2 $1,256.79 27645 $5,415.67 $0.00 $0.00 2 $0.00 27646 $4,693.06 $0.00 $0.00 2 $0.00 27647 $3,118.76 $0.00 $0.00 2 A2 $1,256.79 27648 $520.02 $0.00 $0.00 0 N1 $0.00 27650 $2,044.25 $0.00 $0.00 2 A2 $1,256.79 27652 $2,072.05 $0.00 $0.00 1 A2 $2,744.32 27654 $2,163.17 $0.00 $0.00 2 A2 $2,744.32 27656 $1,993.54 $0.00 $0.00 2 A2 $1,256.79 27658 $1,164.88 $0.00 $0.00 2 A2 $1,256.79 27659 $1,486.90 $0.00 $0.00 2 A2 $2,744.32 27664 $1,122.20 $0.00 $0.00 0 A2 $2,744.32 27665 $1,284.97 $0.00 $0.00 2 A2 $2,744.32 27675 $1,505.47 $0.00 $0.00 2 A2 $1,256.79 27676 $1,908.36 $0.00 $0.00 2 A2 $2,744.32 27680 $1,327.21 $0.00 $0.00 1 A2 $1,256.79 27681 $1,682.40 $0.00 $0.00 1 A2 $1,256.79 27685 $2,063.42 $0.00 $0.00 2 A2 $1,256.79 27686 $1,684.60 $0.00 $0.00 1 A2 $1,256.79 27687 $1,412.07 $0.00 $0.00 2 A2 $1,256.79 27690 $1,950.00 $0.00 $0.00 2 A2 $2,744.32 27691 $2,312.40 $0.00 $0.00 2 A2 $2,744.32


77


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 27692 $323.47 $0.00 $0.00 2 N1 $0.00 27695 $1,473.96 $0.00 $0.00 1 A2 $2,744.32 27696 $1,705.80 $0.00 $0.00 1 J8 $3,862.51 27698 $1,961.59 $0.00 $0.00 2 A2 $2,744.32 27700 $1,808.91 $0.00 $0.00 2 A2 $2,744.32 27702 $2,985.77 $0.00 $0.00 2 $0.00 27703 $3,475.58 $0.00 $0.00 2 $0.00 27704 $1,813.35 $0.00 $0.00 1 A2 $1,256.79 27705 $2,317.61 $0.00 $0.00 2 J8 $3,739.82 27707 $1,258.03 $0.00 $0.00 1 A2 $1,256.79 27709 $3,577.43 $0.00 $0.00 2 J8 $7,391.44 27712 $3,366.07 $0.00 $0.00 2 $0.00 27715 $3,252.86 $0.00 $0.00 2 $0.00 27720 $2,701.51 $0.00 $0.00 2 J8 $3,803.88 27722 $2,717.96 $0.00 $0.00 2 $0.00 27724 $3,877.31 $0.00 $0.00 2 $0.00 27725 $3,721.25 $0.00 $0.00 2 $0.00 27726 $2,989.72 $0.00 $0.00 1 J8 $3,612.48 27727 $3,155.59 $0.00 $0.00 2 $0.00 27730 $1,801.05 $0.00 $0.00 1 A2 $1,256.79 27732 $1,382.25 $0.00 $0.00 1 A2 $1,256.79 27734 $1,893.00 $0.00 $0.00 1 A2 $1,256.79 27740 $2,043.00 $0.00 $0.00 2 G2 $1,256.79 27742 $2,244.00 $0.00 $0.00 2 A2 $1,256.79 27745 $2,324.63 $0.00 $0.00 2 J8 $3,757.13 27750 $1,074.44 $0.00 $0.00 1 A2 $115.95 27752 $1,663.94 $0.00 $0.00 1 A2 $705.07 27756 $1,775.97 $0.00 $0.00 2 J8 $3,876.46 27758 $2,740.91 $0.00 $0.00 2 J8 $7,247.27 27759 $3,062.73 $0.00 $0.00 2 J8 $7,313.88 27760 $1,041.31 $0.00 $0.00 1 A2 $115.95 27762 $1,496.12 $0.00 $0.00 1 A2 $705.07 27766 $1,877.83 $0.00 $0.00 1 A2 $2,744.32 27767 $883.75 $0.00 $0.00 1 P2 $115.95 27768 $1,360.68 $0.00 $0.00 1 G2 $705.07 27769 $2,248.43 $0.00 $0.00 1 G2 $2,744.32 27780 $955.20 $0.00 $0.00 1 A2 $115.95 27781 $1,299.46 $0.00 $0.00 1 A2 $705.07 27784 $2,215.00 $0.00 $0.00 1 A2 $2,744.32 27786 $985.62 $0.00 $0.00 1 A2 $115.95 27788 $1,316.66 $0.00 $0.00 1 A2 $115.95


78


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 27792 $2,224.73 $0.00 $0.00 1 J8 $3,568.05 27808 $1,042.58 $0.00 $0.00 1 A2 $115.95 27810 $1,466.86 $0.00 $0.00 1 A2 $705.07 27814 $2,621.01 $0.00 $0.00 2 J8 $3,621.77 27816 $998.85 $0.00 $0.00 1 A2 $115.95 27818 $1,509.61 $0.00 $0.00 1 A2 $705.07 27822 $2,596.40 $0.00 $0.00 2 J8 $3,631.34 27823 $2,941.02 $0.00 $0.00 2 J8 $3,661.29 27824 $971.91 $0.00 $0.00 1 A2 $115.95 27825 $1,677.96 $0.00 $0.00 0 A2 $705.07 27826 $2,574.57 $0.00 $0.00 2 A2 $2,744.32 27827 $3,349.53 $0.00 $0.00 2 J8 $7,335.26 27828 $3,983.38 $0.00 $0.00 2 J8 $7,277.10 27829 $2,115.53 $0.00 $0.00 2 A2 $2,744.32 27830 $1,174.56 $0.00 $0.00 0 A2 $115.95 27831 $1,238.54 $0.00 $0.00 0 A2 $1,256.79 27832 $2,309.34 $0.00 $0.00 2 A2 $2,744.32 27840 $1,167.12 $0.00 $0.00 1 A2 $115.95 27842 $1,519.91 $0.00 $0.00 1 A2 $705.07 27846 $2,252.87 $0.00 $0.00 2 A2 $2,744.32 27848 $2,480.84 $0.00 $0.00 2 A2 $2,744.32 27860 $547.59 $0.00 $0.00 0 A2 $1,256.79 27870 $3,167.33 $0.00 $0.00 2 J8 $7,650.94 27871 $2,127.95 $0.00 $0.00 2 J8 $7,046.43 27880 $2,837.08 $0.00 $0.00 2 $0.00 27881 $2,734.41 $0.00 $0.00 2 $0.00 27882 $1,892.11 $0.00 $0.00 0 $0.00 27884 $1,796.96 $0.00 $0.00 1 A2 $1,256.79 27886 $2,054.66 $0.00 $0.00 1 $0.00 27888 $2,081.06 $0.00 $0.00 2 $0.00 27889 $2,015.61 $0.00 $0.00 1 A2 $2,744.32 27892 $1,691.54 $0.00 $0.00 0 A2 $1,256.79 27893 $1,885.14 $0.00 $0.00 0 A2 $2,744.32 27894 $2,702.72 $0.00 $0.00 2 A2 $1,256.79 27899 BR $0.00 $0.00 0 $0.00 28001 $863.24 $0.00 $0.00 1 P3 $180.90 28002 $1,401.61 $0.00 $0.00 1 A2 $705.07 28003 $2,264.78 $0.00 $0.00 1 A2 $1,256.79 28005 $1,774.08 $0.00 $0.00 1 A2 $1,256.79 28008 $1,345.17 $0.00 $0.00 1 A2 $1,256.79 28010 $719.91 $0.00 $0.00 1 P3 $125.40


79


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 28011 $1,000.23 $0.00 $0.00 1 A2 $705.07 28020 $1,693.50 $0.00 $0.00 1 A2 $1,256.79 28022 $1,543.66 $0.00 $0.00 1 A2 $1,256.79 28024 $1,435.66 $0.00 $0.00 1 A2 $705.07 28035 $1,652.89 $0.00 $0.00 1 A2 $781.71 28039 $1,614.63 $0.00 $0.00 2 G2 $1,078.70 28041 $1,406.73 $0.00 $0.00 0 G2 $1,078.70 28043 $1,252.62 $0.00 $0.00 1 G2 $547.17 28045 $1,545.69 $0.00 $0.00 0 G2 $1,078.70 28046 $2,228.36 $0.00 $0.00 1 G2 $1,078.70 28047 $3,071.98 $0.00 $0.00 2 G2 $1,078.70 28050 $1,364.15 $0.00 $0.00 1 A2 $1,256.79 28052 $1,385.60 $0.00 $0.00 1 A2 $1,256.79 28054 $1,173.67 $0.00 $0.00 0 A2 $1,256.79 28055 $1,148.15 $0.00 $0.00 0 A2 $781.71 28060 $1,623.99 $0.00 $0.00 1 A2 $1,256.79 28062 $1,814.79 $0.00 $0.00 1 A2 $1,256.79 28070 $1,663.98 $0.00 $0.00 1 A2 $1,256.79 28072 $1,595.67 $0.00 $0.00 1 A2 $1,256.79 28080 $1,657.15 $0.00 $0.00 0 A2 $705.07 28086 $1,720.86 $0.00 $0.00 2 A2 $1,256.79 28088 $1,542.57 $0.00 $0.00 0 A2 $1,256.79 28090 $1,477.68 $0.00 $0.00 1 A2 $705.07 28092 $1,348.96 $0.00 $0.00 1 A2 $705.07 28100 $1,920.43 $0.00 $0.00 2 A2 $1,256.79 28102 $1,747.84 $0.00 $0.00 2 J8 $3,617.64 28103 $1,184.74 $0.00 $0.00 2 A2 $2,744.32 28104 $1,638.08 $0.00 $0.00 2 A2 $1,256.79 28106 $1,382.41 $0.00 $0.00 2 A2 $2,744.32 28107 $1,645.73 $0.00 $0.00 2 A2 $2,744.32 28108 $1,375.77 $0.00 $0.00 1 A2 $705.07 28110 $1,459.40 $0.00 $0.00 1 A2 $1,256.79 28111 $1,576.26 $0.00 $0.00 1 A2 $1,256.79 28112 $1,550.39 $0.00 $0.00 1 A2 $1,256.79 28113 $1,854.50 $0.00 $0.00 0 A2 $1,256.79 28114 $3,335.93 $0.00 $0.00 2 A2 $1,256.79 28116 $2,375.46 $0.00 $0.00 1 A2 $1,256.79 28118 $1,869.85 $0.00 $0.00 2 A2 $1,256.79 28119 $1,641.66 $0.00 $0.00 1 A2 $1,256.79 28120 $2,130.31 $0.00 $0.00 1 A2 $1,256.79 28122 $1,870.03 $0.00 $0.00 2 A2 $1,256.79


80


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 28124 $1,488.99 $0.00 $0.00 1 P3 $303.78 28126 $1,241.58 $0.00 $0.00 1 A2 $1,256.79 28130 $2,228.51 $0.00 $0.00 2 A2 $1,256.79 28140 $1,864.05 $0.00 $0.00 1 A2 $1,256.79 28150 $1,342.22 $0.00 $0.00 1 A2 $1,256.79 28153 $1,307.98 $0.00 $0.00 1 A2 $1,256.79 28160 $1,317.97 $0.00 $0.00 1 A2 $1,256.79 28171 $2,613.20 $0.00 $0.00 2 A2 $1,256.79 28173 $2,334.49 $0.00 $0.00 1 A2 $1,256.79 28175 $1,487.70 $0.00 $0.00 1 A2 $705.07 28190 $807.24 $0.00 $0.00 1 P3 $185.94 28192 $1,484.32 $0.00 $0.00 1 A2 $547.17 28193 $1,674.36 $0.00 $0.00 1 A2 $547.17 28200 $1,518.17 $0.00 $0.00 1 A2 $1,256.79 28202 $1,863.42 $0.00 $0.00 2 A2 $2,744.32 28208 $1,472.91 $0.00 $0.00 1 A2 $1,256.79 28210 $1,802.61 $0.00 $0.00 2 A2 $2,744.32 28220 $1,406.19 $0.00 $0.00 1 P3 $289.00 28222 $1,611.45 $0.00 $0.00 1 A2 $1,256.79 28225 $1,311.07 $0.00 $0.00 1 A2 $1,256.79 28226 $1,869.40 $0.00 $0.00 1 A2 $1,256.79 28230 $1,349.83 $0.00 $0.00 1 P3 $282.88 28232 $1,228.71 $0.00 $0.00 1 P3 $265.94 28234 $1,300.58 $0.00 $0.00 1 A2 $705.07 28238 $2,069.92 $0.00 $0.00 2 A2 $2,744.32 28240 $1,358.75 $0.00 $0.00 1 A2 $1,256.79 28250 $1,803.00 $0.00 $0.00 2 A2 $1,256.79 28260 $2,101.55 $0.00 $0.00 2 A2 $1,256.79 28261 $2,999.14 $0.00 $0.00 0 A2 $705.07 28262 $4,502.24 $0.00 $0.00 2 J8 $3,707.02 28264 $2,990.94 $0.00 $0.00 2 A2 $705.07 28270 $1,545.08 $0.00 $0.00 1 A2 $1,256.79 28272 $1,226.78 $0.00 $0.00 1 P3 $257.65 28280 $1,628.11 $0.00 $0.00 0 A2 $1,256.79 28285 $1,666.52 $0.00 $0.00 1 A2 $1,256.79 28286 $1,408.88 $0.00 $0.00 1 A2 $1,256.79 28288 $1,906.81 $0.00 $0.00 1 A2 $1,256.79 28289 $2,291.45 $0.00 $0.00 2 A2 $1,256.79 28291 $2,103.43 $0.00 $0.00 2 J8 $4,001.74 28292 $2,443.79 $0.00 $0.00 2 A2 $1,256.79 28295 $2,755.36 $0.00 $0.00 2 G2 $1,256.79


81


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 28296 $2,632.00 $0.00 $0.00 2 A2 $1,256.79 28297 $3,027.00 $0.00 $0.00 2 J8 $3,798.97 28298 $2,455.66 $0.00 $0.00 2 A2 $2,744.32 28299 $2,919.00 $0.00 $0.00 2 A2 $1,256.79 28300 $2,017.94 $0.00 $0.00 2 J8 $3,571.15 28302 $2,186.68 $0.00 $0.00 2 A2 $2,744.32 28304 $2,516.16 $0.00 $0.00 2 A2 $2,744.32 28305 $1,967.04 $0.00 $0.00 2 G2 $2,744.32 28306 $1,930.97 $0.00 $0.00 2 A2 $2,744.32 28307 $2,211.54 $0.00 $0.00 0 A2 $1,256.79 28308 $1,768.62 $0.00 $0.00 2 A2 $1,256.79 28309 $2,713.73 $0.00 $0.00 0 A2 $2,744.32 28310 $1,694.54 $0.00 $0.00 1 A2 $1,256.79 28312 $1,599.07 $0.00 $0.00 1 A2 $1,256.79 28313 $1,641.85 $0.00 $0.00 1 A2 $1,256.79 28315 $1,501.02 $0.00 $0.00 1 A2 $1,256.79 28320 $1,881.61 $0.00 $0.00 2 J8 $7,493.85 28322 $2,457.59 $0.00 $0.00 2 J8 $3,722.00 28340 $1,788.67 $0.00 $0.00 1 A2 $1,256.79 28341 $2,070.99 $0.00 $0.00 1 A2 $1,256.79 28344 $1,594.93 $0.00 $0.00 1 A2 $1,256.79 28345 $1,620.22 $0.00 $0.00 0 A2 $705.07 28360 $3,367.52 $0.00 $0.00 2 $0.00 28400 $782.70 $0.00 $0.00 1 A2 $115.95 28405 $1,173.68 $0.00 $0.00 0 A2 $115.95 28406 $1,647.30 $0.00 $0.00 0 A2 $2,744.32 28415 $3,403.56 $0.00 $0.00 2 J8 $3,757.39 28420 $3,865.83 $0.00 $0.00 2 J8 $7,222.41 28430 $743.37 $0.00 $0.00 1 P2 $115.95 28435 $1,123.51 $0.00 $0.00 0 A2 $705.07 28436 $1,400.50 $0.00 $0.00 1 G2 $2,744.32 28445 $3,252.71 $0.00 $0.00 2 A2 $2,744.32 28446 $3,728.22 $0.00 $0.00 2 G2 $2,744.32 28450 $674.46 $0.00 $0.00 1 P2 $115.95 28455 $845.59 $0.00 $0.00 0 P3 $168.29 28456 $1,005.13 $0.00 $0.00 1 A2 $2,744.32 28465 $1,859.18 $0.00 $0.00 1 J8 $3,694.10 28470 $764.14 $0.00 $0.00 1 P2 $115.95 28475 $791.71 $0.00 $0.00 1 P2 $115.95 28476 $1,079.77 $0.00 $0.00 0 A2 $1,256.79 28485 $1,782.65 $0.00 $0.00 1 J8 $3,572.70


82


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 28490 $457.97 $0.00 $0.00 1 P3 $100.90 28495 $558.58 $0.00 $0.00 1 P2 $115.95 28496 $1,434.52 $0.00 $0.00 1 A2 $1,256.79 28505 $2,071.70 $0.00 $0.00 1 A2 $1,256.79 28510 $384.50 $0.00 $0.00 1 P3 $79.64 28515 $505.88 $0.00 $0.00 1 P3 $106.30 28525 $1,786.02 $0.00 $0.00 0 A2 $1,256.79 28530 $356.16 $0.00 $0.00 0 P3 $76.40 28531 $1,111.40 $0.00 $0.00 1 A2 $2,744.32 28540 $610.50 $0.00 $0.00 0 P2 $115.95 28545 $927.30 $0.00 $0.00 0 G2 $1,256.79 28546 $1,814.54 $0.00 $0.00 0 A2 $705.07 28555 $2,743.34 $0.00 $0.00 2 J8 $4,051.33 28570 $654.00 $0.00 $0.00 0 P2 $115.95 28575 $1,142.26 $0.00 $0.00 0 A2 $1,256.79 28576 $1,217.99 $0.00 $0.00 0 A2 $1,256.79 28585 $2,738.67 $0.00 $0.00 2 J8 $4,064.77 28600 $638.24 $0.00 $0.00 0 P2 $115.95 28605 $1,027.69 $0.00 $0.00 0 A2 $115.95 28606 $1,216.55 $0.00 $0.00 1 A2 $1,256.79 28615 $2,442.84 $0.00 $0.00 2 J8 $3,684.03 28630 $487.84 $0.00 $0.00 0 P3 $91.17 28635 $535.47 $0.00 $0.00 0 A2 $705.07 28636 $995.97 $0.00 $0.00 1 A2 $1,256.79 28645 $2,062.23 $0.00 $0.00 1 A2 $1,256.79 28660 $369.47 $0.00 $0.00 1 P3 $69.91 28665 $478.97 $0.00 $0.00 0 A2 $121.36 28666 $594.77 $0.00 $0.00 1 A2 $1,256.79 28675 $1,807.47 $0.00 $0.00 1 A2 $1,256.79 28705 $3,914.89 $0.00 $0.00 2 J8 $11,466.35 28715 $2,878.58 $0.00 $0.00 2 J8 $7,784.16 28725 $2,382.38 $0.00 $0.00 2 J8 $7,434.19 28730 $2,250.30 $0.00 $0.00 2 J8 $7,872.66 28735 $2,386.54 $0.00 $0.00 2 J8 $7,663.36 28737 $2,107.56 $0.00 $0.00 2 J8 $8,043.67 28740 $2,643.32 $0.00 $0.00 2 J8 $3,951.11 28750 $2,567.79 $0.00 $0.00 0 J8 $3,893.25 28755 $1,593.16 $0.00 $0.00 1 A2 $2,744.32 28760 $2,422.16 $0.00 $0.00 2 A2 $2,744.32 28800 $1,682.17 $0.00 $0.00 2 $0.00 28805 $2,276.56 $0.00 $0.00 0 $0.00


83


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 28810 $1,351.21 $0.00 $0.00 0 A2 $1,256.79 28820 $1,795.74 $0.00 $0.00 1 A2 $1,256.79 28825 $1,706.23 $0.00 $0.00 1 A2 $1,256.79 28890 $1,013.59 $0.00 $0.00 1 P3 $201.80 28899 BR $0.00 $0.00 0 $0.00 29000 $883.95 $0.00 $0.00 0 G2 $121.36 29010 $765.56 $0.00 $0.00 0 P2 $121.36 29015 $911.75 $0.00 $0.00 0 P2 $121.36 29035 $733.32 $0.00 $0.00 0 P2 $121.36 29040 $730.43 $0.00 $0.00 0 G2 $121.36 29044 $900.38 $0.00 $0.00 0 P2 $69.35 29046 $850.36 $0.00 $0.00 0 G2 $121.36 29049 $308.65 $0.00 $0.00 0 P3 $63.06 29055 $696.59 $0.00 $0.00 0 P2 $121.36 29058 $380.07 $0.00 $0.00 0 P3 $70.63 29065 $300.21 $0.00 $0.00 1 P3 $61.26 29075 $299.77 $0.00 $0.00 1 P3 $56.22 29085 $295.84 $0.00 $0.00 1 P3 $60.90 29086 $245.36 $0.00 $0.00 1 P3 $55.86 29105 $302.80 $0.00 $0.00 1 P3 $51.17 29125 $225.60 $0.00 $0.00 1 N1 $0.00 29126 $240.26 $0.00 $0.00 1 N1 $0.00 29130 $139.73 $0.00 $0.00 1 N1 $0.00 29131 $161.07 $0.00 $0.00 1 N1 $0.00 29200 $180.03 $0.00 $0.00 1 P3 $18.02 29240 $194.66 $0.00 $0.00 1 N1 $0.00 29260 $176.97 $0.00 $0.00 1 N1 $0.00 29280 $173.56 $0.00 $0.00 1 N1 $0.00 29305 $772.55 $0.00 $0.00 0 P2 $121.36 29325 $853.83 $0.00 $0.00 0 P2 $121.36 29345 $424.61 $0.00 $0.00 1 P3 $79.28 29355 $444.26 $0.00 $0.00 1 P3 $80.36 29358 $501.09 $0.00 $0.00 1 P3 $102.34 29365 $384.62 $0.00 $0.00 1 P3 $75.31 29405 $280.92 $0.00 $0.00 1 P3 $49.73 29425 $242.94 $0.00 $0.00 1 P3 $46.85 29435 $373.30 $0.00 $0.00 1 P3 $70.63 29440 $137.27 $0.00 $0.00 1 P3 $22.70 29445 $420.81 $0.00 $0.00 1 P3 $63.06 29450 $441.23 $0.00 $0.00 1 P3 $67.39 29505 $289.36 $0.00 $0.00 1 P3 $59.46


84


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 29515 $247.90 $0.00 $0.00 1 P3 $43.60 29520 $151.93 $0.00 $0.00 0 N1 $0.00 29530 $179.17 $0.00 $0.00 1 N1 $0.00 29540 $125.83 $0.00 $0.00 1 P3 $14.41 29550 $98.99 $0.00 $0.00 1 N1 $0.00 29580 $170.62 $0.00 $0.00 1 P3 $41.80 29581 $215.26 $0.00 $0.00 0 P3 $66.67 29584 $227.93 $0.00 $0.00 0 P2 $69.35 29700 $205.58 $0.00 $0.00 1 P3 $42.16 29705 $205.20 $0.00 $0.00 1 P3 $34.95 29710 $382.54 $0.00 $0.00 0 P3 $65.94 29720 $260.14 $0.00 $0.00 1 P3 $57.30 29730 $200.97 $0.00 $0.00 1 P3 $33.51 29740 $288.28 $0.00 $0.00 1 P3 $53.33 29750 $332.16 $0.00 $0.00 0 P3 $55.86 29799 BR $0.00 $0.00 0 $0.00 29800 $1,579.63 $0.00 $0.00 0 A2 $1,256.79 29804 $1,997.60 $0.00 $0.00 2 A2 $1,256.79 29805 $1,452.90 $0.00 $0.00 1 A2 $1,256.79 29806 $3,591.53 $0.00 $0.00 1 A2 $2,744.32 29807 $3,501.41 $0.00 $0.00 1 A2 $2,744.32 29819 $1,810.16 $0.00 $0.00 1 A2 $1,256.79 29820 $1,660.04 $0.00 $0.00 2 A2 $2,744.32 29821 $2,000.05 $0.00 $0.00 2 A2 $1,256.79 29822 $1,954.69 $0.00 $0.00 2 A2 $1,256.79 29823 $2,132.04 $0.00 $0.00 2 A2 $1,256.79 29824 $2,303.20 $0.00 $0.00 2 A2 $1,256.79 29825 $1,989.69 $0.00 $0.00 2 A2 $1,256.79 29826 $590.54 $0.00 $0.00 2 N1 $0.00 29827 $3,635.90 $0.00 $0.00 2 A2 $2,744.32 29828 $3,129.24 $0.00 $0.00 2 G2 $2,744.32 29830 $1,392.49 $0.00 $0.00 1 A2 $1,256.79 29834 $1,506.96 $0.00 $0.00 2 A2 $1,256.79 29835 $1,552.37 $0.00 $0.00 2 A2 $1,256.79 29836 $1,761.99 $0.00 $0.00 2 A2 $2,744.32 29837 $1,630.28 $0.00 $0.00 2 A2 $1,256.79 29838 $1,813.52 $0.00 $0.00 0 A2 $1,256.79 29840 $1,387.47 $0.00 $0.00 0 A2 $1,256.79 29843 $1,482.83 $0.00 $0.00 2 A2 $1,256.79 29844 $1,525.87 $0.00 $0.00 2 A2 $1,256.79 29845 $1,776.25 $0.00 $0.00 2 A2 $1,256.79


85


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 29846 $1,758.98 $0.00 $0.00 0 A2 $1,256.79 29847 $1,661.32 $0.00 $0.00 2 A2 $2,744.32 29848 $1,730.42 $0.00 $0.00 1 A2 $705.07 29850 $1,908.96 $0.00 $0.00 0 A2 $705.07 29851 $2,840.08 $0.00 $0.00 2 A2 $705.07 29855 $2,417.07 $0.00 $0.00 2 J8 $3,989.08 29856 $3,036.43 $0.00 $0.00 2 J8 $7,510.75 29860 $2,039.44 $0.00 $0.00 2 A2 $2,744.32 29861 $2,222.74 $0.00 $0.00 2 A2 $1,256.79 29862 $2,511.68 $0.00 $0.00 2 A2 $2,744.32 29863 $2,521.48 $0.00 $0.00 2 A2 $1,256.79 29866 $3,221.43 $0.00 $0.00 0 G2 $2,744.32 29867 $3,895.85 $0.00 $0.00 0 $0.00 29868 $5,113.06 $0.00 $0.00 0 $0.00 29870 $2,021.99 $0.00 $0.00 1 A2 $1,256.79 29871 $1,581.90 $0.00 $0.00 1 A2 $1,256.79 29873 $1,623.82 $0.00 $0.00 1 A2 $1,256.79 29874 $1,656.01 $0.00 $0.00 0 A2 $1,256.79 29875 $1,685.94 $0.00 $0.00 0 A2 $1,256.79 29876 $2,228.88 $0.00 $0.00 1 A2 $1,256.79 29877 $2,117.26 $0.00 $0.00 0 A2 $1,256.79 29879 $2,254.01 $0.00 $0.00 0 A2 $1,256.79 29880 $1,918.19 $0.00 $0.00 0 A2 $1,256.79 29881 $1,846.35 $0.00 $0.00 0 A2 $1,256.79 29882 $2,147.33 $0.00 $0.00 1 A2 $1,256.79 29883 $2,586.05 $0.00 $0.00 0 A2 $1,256.79 29884 $1,910.01 $0.00 $0.00 2 A2 $1,256.79 29885 $2,299.09 $0.00 $0.00 2 A2 $2,744.32 29886 $1,952.39 $0.00 $0.00 1 A2 $1,256.79 29887 $2,290.87 $0.00 $0.00 2 A2 $2,744.32 29888 $3,347.47 $0.00 $0.00 2 J8 $3,696.68 29889 $3,735.62 $0.00 $0.00 2 A2 $5,281.63 29891 $2,089.18 $0.00 $0.00 2 A2 $1,256.79 29892 $1,934.34 $0.00 $0.00 2 A2 $2,744.32 29893 $1,929.89 $0.00 $0.00 1 A2 $1,256.79 29894 $1,604.09 $0.00 $0.00 2 A2 $1,256.79 29895 $1,474.20 $0.00 $0.00 2 A2 $1,256.79 29897 $1,582.08 $0.00 $0.00 2 A2 $1,256.79 29898 $1,915.09 $0.00 $0.00 2 A2 $1,256.79 29899 $3,225.65 $0.00 $0.00 2 J8 $3,520.26 29900 $1,416.44 $0.00 $0.00 0 A2 $1,256.79


86


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 29901 $1,636.01 $0.00 $0.00 0 A2 $1,256.79 29902 $1,884.38 $0.00 $0.00 0 A2 $705.07 29904 $1,947.68 $0.00 $0.00 2 G2 $1,256.79 29905 $2,112.44 $0.00 $0.00 2 G2 $1,256.79 29906 $2,160.35 $0.00 $0.00 2 G2 $1,256.79 29907 $2,676.79 $0.00 $0.00 2 J8 $6,817.26 29914 $3,102.33 $0.00 $0.00 2 G2 $2,744.32 29915 $3,182.40 $0.00 $0.00 2 G2 $2,744.32 29916 $3,156.14 $0.00 $0.00 2 G2 $2,744.32 29999 BR $0.00 $0.00 0 $0.00 30000 $493.93 $0.00 $0.00 0 P2 $106.19 30020 $501.38 $0.00 $0.00 1 P3 $187.74 30100 $302.97 $0.00 $0.00 1 P3 $105.58 30110 $492.16 $0.00 $0.00 1 P3 $170.45 30115 $901.00 $0.00 $0.00 1 A2 $968.88 30117 $1,898.01 $0.00 $0.00 1 A2 $968.88 30118 $1,576.79 $0.00 $0.00 1 A2 $968.88 30120 $1,067.65 $0.00 $0.00 1 A2 $968.88 30124 $596.27 $0.00 $0.00 1 R2 $564.34 30125 $1,262.13 $0.00 $0.00 2 A2 $2,176.10 30130 $797.53 $0.00 $0.00 1 A2 $968.88 30140 $931.81 $0.00 $0.00 1 A2 $968.88 30150 $1,590.39 $0.00 $0.00 1 A2 $2,176.10 30160 $1,598.53 $0.00 $0.00 2 A2 $2,176.10 30200 $243.51 $0.00 $0.00 1 P3 $82.52 30210 $318.34 $0.00 $0.00 1 P3 $106.67 30220 $657.18 $0.00 $0.00 1 A2 $564.34 30300 $501.05 $0.00 $0.00 1 N1 $0.00 30310 $433.47 $0.00 $0.00 0 A2 $968.88 30320 $945.23 $0.00 $0.00 0 A2 $564.34 30400 $2,106.06 $0.00 $0.00 0 A2 $2,176.10 30410 $2,457.20 $0.00 $0.00 2 A2 $2,176.10 30420 $2,841.77 $0.00 $0.00 1 A2 $2,176.10 30430 $1,872.96 $0.00 $0.00 2 A2 $2,176.10 30435 $2,374.23 $0.00 $0.00 2 A2 $2,176.10 30450 $3,087.97 $0.00 $0.00 2 A2 $2,176.10 30460 $1,682.81 $0.00 $0.00 2 A2 $2,176.10 30462 $2,993.46 $0.00 $0.00 2 A2 $2,176.10 30465 $2,034.34 $0.00 $0.00 0 A2 $2,176.10 30520 $1,302.02 $0.00 $0.00 1 A2 $968.88 30540 $1,429.86 $0.00 $0.00 2 A2 $2,176.10


87


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 30545 $1,760.37 $0.00 $0.00 2 A2 $2,176.10 30560 $581.96 $0.00 $0.00 1 A2 $250.94 30580 $1,310.22 $0.00 $0.00 1 A2 $2,176.10 30600 $1,173.59 $0.00 $0.00 0 A2 $2,176.10 30620 $1,318.34 $0.00 $0.00 1 A2 $2,176.10 30630 $1,304.25 $0.00 $0.00 0 A2 $968.88 30801 $484.54 $0.00 $0.00 1 A2 $564.34 30802 $606.06 $0.00 $0.00 1 A2 $564.34 30901 $204.17 $0.00 $0.00 1 N1 $0.00 30903 $439.15 $0.00 $0.00 1 A2 $54.85 30905 $561.54 $0.00 $0.00 1 A2 $54.85 30906 $682.37 $0.00 $0.00 1 A2 $106.19 30915 $1,193.74 $0.00 $0.00 1 A2 $1,306.09 30920 $1,724.27 $0.00 $0.00 1 A2 $1,306.09 30930 $255.16 $0.00 $0.00 1 A2 $968.88 30999 BR $0.00 $0.00 0 $0.00 31000 $382.99 $0.00 $0.00 1 P2 $106.19 31002 $421.13 $0.00 $0.00 0 R2 $564.34 31020 $1,020.00 $0.00 $0.00 1 A2 $968.88 31030 $1,415.94 $0.00 $0.00 1 A2 $2,176.10 31032 $1,186.79 $0.00 $0.00 1 A2 $2,176.10 31040 $1,568.83 $0.00 $0.00 1 R2 $2,176.10 31050 $1,007.31 $0.00 $0.00 1 A2 $2,176.10 31051 $1,341.05 $0.00 $0.00 1 A2 $2,176.10 31070 $921.43 $0.00 $0.00 1 A2 $2,176.10 31075 $1,617.80 $0.00 $0.00 2 A2 $2,176.10 31080 $2,130.87 $0.00 $0.00 2 A2 $2,176.10 31081 $3,091.08 $0.00 $0.00 2 A2 $2,176.10 31084 $2,377.78 $0.00 $0.00 2 A2 $2,176.10 31085 $3,277.52 $0.00 $0.00 2 A2 $2,176.10 31086 $2,312.70 $0.00 $0.00 2 A2 $2,176.10 31087 $2,222.24 $0.00 $0.00 2 A2 $2,176.10 31090 $2,130.30 $0.00 $0.00 1 A2 $2,176.10 31200 $1,200.88 $0.00 $0.00 1 A2 $2,176.10 31201 $1,544.36 $0.00 $0.00 1 A2 $968.88 31205 $1,882.61 $0.00 $0.00 2 A2 $968.88 31225 $3,783.89 $0.00 $0.00 2 $0.00 31230 $4,198.69 $0.00 $0.00 2 $0.00 31231 $436.16 $0.00 $0.00 1 P2 $84.47 31233 $559.06 $0.00 $0.00 0 A2 $199.10 31235 $631.46 $0.00 $0.00 0 A2 $603.92


88


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 31237 $668.93 $0.00 $0.00 1 A2 $603.92 31238 $683.54 $0.00 $0.00 0 A2 $603.92 31239 $1,406.93 $0.00 $0.00 0 A2 $1,180.61 31240 $326.09 $0.00 $0.00 0 A2 $603.92 31241 $847.44 $0.00 $0.00 0 $0.00 31253 $953.04 $0.00 $0.00 1 G2 $1,791.49 31254 $570.77 $0.00 $0.00 1 A2 $1,791.49 31255 $804.48 $0.00 $0.00 1 A2 $1,791.49 31256 $399.14 $0.00 $0.00 1 A2 $1,180.61 31257 $850.08 $0.00 $0.00 1 G2 $1,791.49 31259 $900.24 $0.00 $0.00 1 G2 $1,791.49 31267 $638.40 $0.00 $0.00 1 A2 $1,791.49 31276 $1,016.87 $0.00 $0.00 1 A2 $1,791.49 31287 $468.35 $0.00 $0.00 0 A2 $1,791.49 31288 $543.09 $0.00 $0.00 0 A2 $1,791.49 31290 $2,338.06 $0.00 $0.00 0 $0.00 31291 $2,476.61 $0.00 $0.00 0 $0.00 31292 $2,026.74 $0.00 $0.00 0 $0.00 31293 $2,202.18 $0.00 $0.00 0 $0.00 31294 $2,517.83 $0.00 $0.00 0 $0.00 31295 $4,457.18 $0.00 $0.00 2 P2 $1,791.49 31296 $4,523.84 $0.00 $0.00 2 P2 $1,791.49 31297 $4,464.04 $0.00 $0.00 0 P2 $1,791.49 31298 $7,213.19 $0.00 $0.00 0 G2 $1,791.49 31299 BR $0.00 $0.00 0 $0.00 31300 $2,559.26 $0.00 $0.00 2 A2 $968.88 31360 $4,219.41 $0.00 $0.00 2 $0.00 31365 $5,221.28 $0.00 $0.00 2 $0.00 31367 $4,485.73 $0.00 $0.00 2 $0.00 31368 $4,957.69 $0.00 $0.00 2 $0.00 31370 $4,219.96 $0.00 $0.00 2 $0.00 31375 $4,004.87 $0.00 $0.00 2 $0.00 31380 $3,954.99 $0.00 $0.00 2 $0.00 31382 $4,331.15 $0.00 $0.00 2 $0.00 31390 $5,791.42 $0.00 $0.00 2 $0.00 31395 $6,065.89 $0.00 $0.00 2 $0.00 31400 $2,058.80 $0.00 $0.00 2 A2 $2,176.10 31420 $1,709.06 $0.00 $0.00 2 A2 $2,176.10 31500 $268.62 $0.00 $0.00 1 G2 $106.19 31502 $70.27 $0.00 $0.00 1 G2 $106.19 31505 $176.58 $0.00 $0.00 1 P3 $61.62


89


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 31510 $446.31 $0.00 $0.00 0 A2 $1,180.61 31511 $449.54 $0.00 $0.00 1 A2 $84.47 31512 $436.90 $0.00 $0.00 0 A2 $1,180.61 31513 $269.19 $0.00 $0.00 0 A2 $199.10 31515 $435.12 $0.00 $0.00 1 A2 $199.10 31520 $295.68 $0.00 $0.00 0 G2 $199.10 31525 $520.96 $0.00 $0.00 1 A2 $603.92 31526 $320.62 $0.00 $0.00 1 A2 $603.92 31527 $396.31 $0.00 $0.00 0 A2 $1,180.61 31528 $294.90 $0.00 $0.00 0 A2 $1,180.61 31529 $329.34 $0.00 $0.00 0 A2 $1,180.61 31530 $399.02 $0.00 $0.00 1 A2 $603.92 31531 $430.17 $0.00 $0.00 0 A2 $1,180.61 31535 $384.21 $0.00 $0.00 1 A2 $1,180.61 31536 $428.89 $0.00 $0.00 1 A2 $1,180.61 31540 $491.21 $0.00 $0.00 1 A2 $1,180.61 31541 $536.67 $0.00 $0.00 1 A2 $1,180.61 31545 $736.97 $0.00 $0.00 1 A2 $1,180.61 31546 $1,116.15 $0.00 $0.00 1 A2 $1,791.49 31551 $2,719.20 $0.00 $0.00 0 G2 $2,176.10 31552 $2,737.02 $0.00 $0.00 0 G2 $2,176.10 31553 $2,987.16 $0.00 $0.00 0 G2 $2,176.10 31554 $3,125.76 $0.00 $0.00 0 G2 $2,176.10 31560 $635.31 $0.00 $0.00 0 A2 $1,791.49 31561 $695.62 $0.00 $0.00 0 A2 $1,791.49 31570 $709.82 $0.00 $0.00 1 A2 $1,180.61 31571 $506.03 $0.00 $0.00 1 A2 $1,180.61 31572 $941.31 $0.00 $0.00 0 G2 $1,180.61 31573 $500.92 $0.00 $0.00 0 P3 $174.05 31574 $1,914.27 $0.00 $0.00 0 G2 $603.92 31575 $238.95 $0.00 $0.00 1 P3 $80.72 31576 $497.80 $0.00 $0.00 1 A2 $603.92 31577 $520.16 $0.00 $0.00 0 A2 $199.10 31578 $586.17 $0.00 $0.00 0 A2 $1,180.61 31579 $441.56 $0.00 $0.00 1 P3 $111.35 31580 $2,531.25 $0.00 $0.00 0 A2 $2,176.10 31584 $3,106.49 $0.00 $0.00 0 $0.00 31587 $2,213.91 $0.00 $0.00 0 $0.00 31590 $1,865.96 $0.00 $0.00 2 A2 $2,176.10 31591 $1,985.73 $0.00 $0.00 0 G2 $2,176.10 31592 $3,218.54 $0.00 $0.00 0 G2 $2,176.10


90


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 31599 BR $0.00 $0.00 0 $0.00 31600 $794.48 $0.00 $0.00 1 $0.00 31601 $539.03 $0.00 $0.00 2 $0.00 31603 $462.65 $0.00 $0.00 1 A2 $564.34 31605 $377.70 $0.00 $0.00 1 G2 $106.19 31610 $1,520.15 $0.00 $0.00 1 $0.00 31611 $1,118.48 $0.00 $0.00 2 A2 $968.88 31612 $175.51 $0.00 $0.00 0 A2 $968.88 31613 $938.86 $0.00 $0.00 1 A2 $968.88 31614 $1,554.64 $0.00 $0.00 1 A2 $2,176.10 31615 $379.25 $0.00 $0.00 1 A2 $250.94 31622 $651.36 $0.00 $0.00 1 A2 $603.92 31623 $687.17 $0.00 $0.00 1 A2 $603.92 31624 $646.35 $0.00 $0.00 1 A2 $603.92 31625 $773.29 $0.00 $0.00 1 A2 $603.92 31626 $1,755.08 $0.00 $0.00 0 G2 $1,791.49 31627 $2,811.40 $0.00 $0.00 0 N1 $0.00 31628 $814.33 $0.00 $0.00 1 A2 $1,180.61 31629 $1,284.37 $0.00 $0.00 1 A2 $1,180.61 31630 $402.62 $0.00 $0.00 1 A2 $1,180.61 31631 $460.42 $0.00 $0.00 1 A2 $1,791.49 31632 $144.60 $0.00 $0.00 1 N1 $0.00 31633 $177.54 $0.00 $0.00 1 N1 $0.00 31634 $4,117.88 $0.00 $0.00 2 G2 $1,791.49 31635 $720.69 $0.00 $0.00 1 A2 $603.92 31636 $445.81 $0.00 $0.00 1 J8 $2,564.45 31637 $149.07 $0.00 $0.00 1 N1 $0.00 31638 $512.36 $0.00 $0.00 1 A2 $1,791.49 31640 $515.49 $0.00 $0.00 1 A2 $1,180.61 31641 $516.26 $0.00 $0.00 1 A2 $1,180.61 31643 $351.62 $0.00 $0.00 1 A2 $603.92 31645 $664.43 $0.00 $0.00 1 A2 $603.92 31646 $599.34 $0.00 $0.00 1 A2 $199.10 31647 $446.95 $0.00 $0.00 1 G2 $1,791.49 31648 $476.14 $0.00 $0.00 1 G2 $1,180.61 31649 $145.96 $0.00 $0.00 1 G2 $603.92 31651 $154.63 $0.00 $0.00 1 N1 $0.00 31652 $1,773.93 $0.00 $0.00 1 G2 $1,180.61 31653 $1,884.85 $0.00 $0.00 1 G2 $1,180.61 31654 $275.39 $0.00 $0.00 1 N1 $0.00 31660 $449.87 $0.00 $0.00 1 $0.00


91


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 31661 $473.47 $0.00 $0.00 1 $0.00 31717 $559.12 $0.00 $0.00 1 A2 $199.10 31720 $98.83 $0.00 $0.00 1 N1 $0.00 31725 $184.14 $0.00 $0.00 1 $0.00 31730 $2,583.53 $0.00 $0.00 1 A2 $603.92 31750 $2,820.10 $0.00 $0.00 2 A2 $2,176.10 31755 $3,553.00 $0.00 $0.00 2 A2 $2,176.10 31760 $2,795.40 $0.00 $0.00 2 $0.00 31766 $3,622.78 $0.00 $0.00 2 $0.00 31770 $2,697.83 $0.00 $0.00 2 $0.00 31775 $2,788.58 $0.00 $0.00 2 $0.00 31780 $2,416.74 $0.00 $0.00 2 $0.00 31781 $3,106.40 $0.00 $0.00 2 $0.00 31785 $2,206.33 $0.00 $0.00 2 $0.00 31786 $2,940.35 $0.00 $0.00 2 $0.00 31800 $1,492.94 $0.00 $0.00 0 $0.00 31805 $1,660.43 $0.00 $0.00 2 $0.00 31820 $915.97 $0.00 $0.00 0 A2 $968.88 31825 $1,260.42 $0.00 $0.00 0 A2 $968.88 31830 $937.93 $0.00 $0.00 0 A2 $968.88 31899 BR $0.00 $0.00 0 $0.00 32035 $1,476.37 $0.00 $0.00 2 $0.00 32036 $1,603.65 $0.00 $0.00 2 $0.00 32096 $1,655.51 $0.00 $0.00 2 $0.00 32097 $1,656.22 $0.00 $0.00 2 $0.00 32098 $1,602.74 $0.00 $0.00 2 $0.00 32100 $1,675.38 $0.00 $0.00 2 $0.00 32110 $2,997.75 $0.00 $0.00 2 $0.00 32120 $1,789.12 $0.00 $0.00 2 $0.00 32124 $1,902.47 $0.00 $0.00 2 $0.00 32140 $2,020.48 $0.00 $0.00 2 $0.00 32141 $3,116.70 $0.00 $0.00 2 $0.00 32150 $2,058.49 $0.00 $0.00 2 $0.00 32151 $2,048.83 $0.00 $0.00 2 $0.00 32160 $1,625.28 $0.00 $0.00 2 $0.00 32200 $2,305.61 $0.00 $0.00 2 $0.00 32215 $1,633.78 $0.00 $0.00 2 $0.00 32220 $3,261.52 $0.00 $0.00 2 $0.00 32225 $2,037.20 $0.00 $0.00 2 $0.00 32310 $1,878.56 $0.00 $0.00 2 $0.00 32320 $3,274.67 $0.00 $0.00 2 $0.00


92


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 32400 $307.25 $0.00 $0.00 1 A2 $547.17 32405 $928.34 $0.00 $0.00 1 A2 $547.17 32440 $3,198.14 $0.00 $0.00 2 $0.00 32442 $6,241.30 $0.00 $0.00 2 $0.00 32445 $7,204.74 $0.00 $0.00 2 $0.00 32480 $3,025.07 $0.00 $0.00 2 $0.00 32482 $3,235.82 $0.00 $0.00 2 $0.00 32484 $2,926.75 $0.00 $0.00 2 $0.00 32486 $4,797.83 $0.00 $0.00 2 $0.00 32488 $4,837.68 $0.00 $0.00 2 $0.00 32491 $3,043.34 $0.00 $0.00 2 $0.00 32501 $495.45 $0.00 $0.00 2 $0.00 32503 $3,686.75 $0.00 $0.00 2 $0.00 32504 $4,167.86 $0.00 $0.00 2 $0.00 32505 $1,960.95 $0.00 $0.00 2 $0.00 32506 $336.59 $0.00 $0.00 2 $0.00 32507 $335.85 $0.00 $0.00 2 $0.00 32540 $3,509.75 $0.00 $0.00 2 $0.00 32550 $1,682.23 $0.00 $0.00 1 G2 $1,343.39 32551 $355.85 $0.00 $0.00 1 $0.00 32552 $395.58 $0.00 $0.00 0 G2 $319.39 32553 $1,203.77 $0.00 $0.00 2 G2 $614.00 32554 $1,150.91 $0.00 $0.00 1 G2 $319.39 32555 $1,327.07 $0.00 $0.00 1 G2 $319.39 32556 $1,212.41 $0.00 $0.00 1 G2 $642.73 32557 $1,972.86 $0.00 $0.00 1 G2 $563.37 32560 $524.73 $0.00 $0.00 1 $0.00 32561 $193.19 $0.00 $0.00 2 $0.00 32562 $174.25 $0.00 $0.00 2 $0.00 32601 $629.28 $0.00 $0.00 0 $0.00 32604 $975.94 $0.00 $0.00 0 $0.00 32606 $940.97 $0.00 $0.00 0 $0.00 32607 $652.48 $0.00 $0.00 0 $0.00 32608 $804.12 $0.00 $0.00 0 $0.00 32609 $553.21 $0.00 $0.00 0 $0.00 32650 $1,365.66 $0.00 $0.00 2 $0.00 32651 $2,236.40 $0.00 $0.00 2 $0.00 32652 $3,389.27 $0.00 $0.00 2 $0.00 32653 $2,158.94 $0.00 $0.00 2 $0.00 32654 $2,405.79 $0.00 $0.00 2 $0.00 32655 $1,959.19 $0.00 $0.00 2 $0.00


93


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 32656 $1,632.26 $0.00 $0.00 2 $0.00 32658 $1,456.89 $0.00 $0.00 2 $0.00 32659 $1,494.66 $0.00 $0.00 2 $0.00 32661 $1,625.68 $0.00 $0.00 2 $0.00 32662 $1,825.64 $0.00 $0.00 2 $0.00 32663 $2,858.05 $0.00 $0.00 2 $0.00 32664 $1,730.69 $0.00 $0.00 2 $0.00 32665 $2,468.58 $0.00 $0.00 2 $0.00 32666 $1,824.25 $0.00 $0.00 2 $0.00 32667 $336.59 $0.00 $0.00 2 $0.00 32668 $338.14 $0.00 $0.00 2 $0.00 32669 $2,740.56 $0.00 $0.00 2 $0.00 32670 $3,265.43 $0.00 $0.00 2 $0.00 32671 $3,607.92 $0.00 $0.00 2 $0.00 32672 $3,098.02 $0.00 $0.00 2 $0.00 32673 $2,428.55 $0.00 $0.00 2 $0.00 32674 $438.85 $0.00 $0.00 2 $0.00 32701 $448.41 $0.00 $0.00 0 $0.00 32800 $1,920.54 $0.00 $0.00 2 $0.00 32810 $1,836.30 $0.00 $0.00 2 $0.00 32815 $5,763.92 $0.00 $0.00 2 $0.00 32820 $2,874.74 $0.00 $0.00 2 $0.00 32850 BR $0.00 $0.00 $0.00 32851 $6,709.39 $0.00 $0.00 2 $0.00 32852 $7,324.40 $0.00 $0.00 2 $0.00 32853 $9,426.39 $0.00 $0.00 2 $0.00 32854 $10,023.42 $0.00 $0.00 2 $0.00 32855 BR $0.00 $0.00 2 $0.00 32856 BR $0.00 $0.00 2 $0.00 32900 $2,832.96 $0.00 $0.00 2 $0.00 32905 $2,712.17 $0.00 $0.00 2 $0.00 32906 $3,351.52 $0.00 $0.00 2 $0.00 32940 $2,508.67 $0.00 $0.00 2 $0.00 32960 $309.83 $0.00 $0.00 1 G2 $319.39 32994 $11,503.41 $0.00 $0.00 2 G2 $2,129.56 32997 $710.13 $0.00 $0.00 1 $0.00 32998 $6,343.24 $0.00 $0.00 2 G2 $2,129.56 32999 BR $0.00 $0.00 1 $0.00 33010 $236.78 $0.00 $0.00 1 A2 $563.37 33011 $240.56 $0.00 $0.00 0 A2 $563.37 33015 $1,021.87 $0.00 $0.00 1 $0.00


94


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 33020 $1,788.64 $0.00 $0.00 2 $0.00 33025 $1,636.68 $0.00 $0.00 2 $0.00 33030 $4,089.94 $0.00 $0.00 2 $0.00 33031 $5,081.57 $0.00 $0.00 2 $0.00 33050 $2,038.54 $0.00 $0.00 2 $0.00 33120 $4,301.64 $0.00 $0.00 2 $0.00 33130 $2,839.42 $0.00 $0.00 2 $0.00 33140 $3,229.53 $0.00 $0.00 2 $0.00 33141 $269.04 $0.00 $0.00 2 $0.00 33202 $1,584.97 $0.00 $0.00 1 $0.00 33203 $1,644.70 $0.00 $0.00 1 $0.00 33206 $922.85 $0.00 $0.00 1 J8 $7,940.39 33207 $975.27 $0.00 $0.00 1 J8 $7,920.93 33208 $1,054.99 $0.00 $0.00 1 J8 $8,065.52 33210 $354.93 $0.00 $0.00 1 G2 $3,703.18 33211 $365.58 $0.00 $0.00 1 J8 $5,635.93 33212 $671.18 $0.00 $0.00 1 J8 $5,878.17 33213 $700.60 $0.00 $0.00 1 J8 $8,088.69 33214 $973.11 $0.00 $0.00 0 J8 $7,884.32 33215 $612.49 $0.00 $0.00 1 G2 $1,306.09 33216 $756.41 $0.00 $0.00 1 J8 $5,326.76 33217 $754.51 $0.00 $0.00 1 J8 $5,898.39 33218 $791.83 $0.00 $0.00 1 G2 $1,612.65 33220 $796.48 $0.00 $0.00 1 G2 $1,612.65 33221 $729.25 $0.00 $0.00 1 J8 $12,778.00 33222 $700.88 $0.00 $0.00 1 A2 $797.93 33223 $835.77 $0.00 $0.00 0 A2 $797.93 33224 $1,018.03 $0.00 $0.00 1 J8 $7,919.54 33225 $914.20 $0.00 $0.00 1 N1 $0.00 33226 $979.84 $0.00 $0.00 1 G2 $1,306.09 33227 $698.68 $0.00 $0.00 1 J8 $5,831.46 33228 $727.27 $0.00 $0.00 1 J8 $7,875.51 33229 $757.30 $0.00 $0.00 1 J8 $12,784.59 33230 $790.01 $0.00 $0.00 1 J8 $19,844.38 33231 $819.35 $0.00 $0.00 1 J8 $27,063.77 33233 $479.55 $0.00 $0.00 1 G2 $3,703.18 33234 $982.18 $0.00 $0.00 1 G2 $1,612.65 33235 $1,281.80 $0.00 $0.00 1 G2 $1,612.65 33236 $1,620.68 $0.00 $0.00 0 $0.00 33237 $1,721.56 $0.00 $0.00 0 $0.00 33238 $1,920.56 $0.00 $0.00 0 $0.00


95


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 33240 $760.00 $0.00 $0.00 1 J8 $19,902.43 33241 $449.43 $0.00 $0.00 1 G2 $1,612.65 33243 $2,796.80 $0.00 $0.00 2 $0.00 33244 $1,726.51 $0.00 $0.00 1 $0.00 33249 $1,824.89 $0.00 $0.00 1 J8 $27,057.89 33250 $3,015.28 $0.00 $0.00 2 $0.00 33251 $3,335.41 $0.00 $0.00 2 $0.00 33254 $2,805.25 $0.00 $0.00 2 $0.00 33255 $3,377.31 $0.00 $0.00 2 $0.00 33256 $4,009.84 $0.00 $0.00 2 $0.00 33257 $1,202.03 $0.00 $0.00 2 $0.00 33258 $1,348.25 $0.00 $0.00 2 $0.00 33259 $1,746.75 $0.00 $0.00 2 $0.00 33261 $3,339.51 $0.00 $0.00 2 $0.00 33262 $762.07 $0.00 $0.00 1 J8 $19,281.19 33263 $790.67 $0.00 $0.00 1 J8 $19,564.94 33264 $821.37 $0.00 $0.00 1 J8 $27,121.05 33265 $2,790.25 $0.00 $0.00 2 $0.00 33266 $3,812.26 $0.00 $0.00 2 $0.00 33270 $1,122.20 $0.00 $0.00 1 J8 $27,007.95 33271 $942.05 $0.00 $0.00 1 J8 $6,297.48 33272 $666.55 $0.00 $0.00 1 $0.00 33273 $775.56 $0.00 $0.00 1 G2 $1,612.65 33274 $937.86 $0.00 $0.00 1 J8 $10,618.29 33275 $996.60 $0.00 $0.00 1 G2 $1,306.09 33285 $9,640.62 $0.00 $0.00 1 J8 $6,374.86 33286 $250.80 $0.00 $0.00 1 G2 $298.44 33289 $627.66 $0.00 $0.00 0 $0.00 33300 $5,023.45 $0.00 $0.00 2 $0.00 33305 $8,418.85 $0.00 $0.00 2 $0.00 33310 $2,383.28 $0.00 $0.00 2 $0.00 33315 $3,940.20 $0.00 $0.00 2 $0.00 33320 $2,158.88 $0.00 $0.00 2 $0.00 33321 $2,439.90 $0.00 $0.00 2 $0.00 33322 $2,852.43 $0.00 $0.00 2 $0.00 33330 $3,123.77 $0.00 $0.00 2 $0.00 33335 $3,853.91 $0.00 $0.00 2 $0.00 33340 $1,519.57 $0.00 $0.00 0 $0.00 33361 $2,712.15 $0.00 $0.00 0 $0.00 33362 $2,967.17 $0.00 $0.00 0 $0.00 33363 $3,068.08 $0.00 $0.00 0 $0.00


96


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 33364 $3,251.04 $0.00 $0.00 0 $0.00 33365 $3,592.60 $0.00 $0.00 0 $0.00 33366 $3,697.98 $0.00 $0.00 0 $0.00 33367 $1,261.85 $0.00 $0.00 0 $0.00 33368 $1,528.26 $0.00 $0.00 0 $0.00 33369 $2,017.16 $0.00 $0.00 0 $0.00 33390 $3,683.42 $0.00 $0.00 2 $0.00 33391 $4,364.62 $0.00 $0.00 2 $0.00 33404 $3,603.68 $0.00 $0.00 2 $0.00 33405 $4,650.26 $0.00 $0.00 2 $0.00 33406 $5,927.35 $0.00 $0.00 2 $0.00 33410 $5,223.97 $0.00 $0.00 2 $0.00 33411 $6,924.16 $0.00 $0.00 2 $0.00 33412 $6,516.99 $0.00 $0.00 2 $0.00 33413 $6,596.26 $0.00 $0.00 2 $0.00 33414 $4,406.68 $0.00 $0.00 2 $0.00 33415 $4,189.61 $0.00 $0.00 2 $0.00 33416 $4,177.76 $0.00 $0.00 2 $0.00 33417 $3,406.14 $0.00 $0.00 2 $0.00 33418 $3,457.74 $0.00 $0.00 2 $0.00 33419 $816.42 $0.00 $0.00 2 N1 $0.00 33420 $2,920.27 $0.00 $0.00 1 $0.00 33422 $3,453.26 $0.00 $0.00 2 $0.00 33425 $5,621.03 $0.00 $0.00 2 $0.00 33426 $4,907.28 $0.00 $0.00 2 $0.00 33427 $5,028.04 $0.00 $0.00 2 $0.00 33430 $5,742.14 $0.00 $0.00 2 $0.00 33440 $6,474.60 $0.00 $0.00 2 $0.00 33460 $4,969.71 $0.00 $0.00 2 $0.00 33463 $6,357.95 $0.00 $0.00 2 $0.00 33464 $5,035.03 $0.00 $0.00 2 $0.00 33465 $5,682.02 $0.00 $0.00 2 $0.00 33468 $5,022.95 $0.00 $0.00 2 $0.00 33470 $2,673.69 $0.00 $0.00 2 $0.00 33471 $2,829.00 $0.00 $0.00 2 $0.00 33474 $4,446.11 $0.00 $0.00 2 $0.00 33475 $4,826.21 $0.00 $0.00 2 $0.00 33476 $3,128.30 $0.00 $0.00 2 $0.00 33477 $2,571.57 $0.00 $0.00 0 $0.00 33478 $3,231.74 $0.00 $0.00 2 $0.00 33496 $3,415.82 $0.00 $0.00 2 $0.00


97


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 33500 $3,232.97 $0.00 $0.00 2 $0.00 33501 $2,315.07 $0.00 $0.00 2 $0.00 33502 $2,629.17 $0.00 $0.00 2 $0.00 33503 $2,691.57 $0.00 $0.00 0 $0.00 33504 $3,013.36 $0.00 $0.00 2 $0.00 33505 $4,227.80 $0.00 $0.00 2 $0.00 33506 $4,167.55 $0.00 $0.00 2 $0.00 33507 $3,495.81 $0.00 $0.00 2 $0.00 33508 $32.73 $0.00 $0.00 2 N1 $0.00 33510 $3,985.28 $0.00 $0.00 2 $0.00 33511 $4,373.84 $0.00 $0.00 2 $0.00 33512 $4,975.93 $0.00 $0.00 2 $0.00 33513 $5,123.98 $0.00 $0.00 2 $0.00 33514 $5,359.32 $0.00 $0.00 2 $0.00 33516 $5,593.98 $0.00 $0.00 2 $0.00 33517 $382.29 $0.00 $0.00 2 $0.00 33518 $844.09 $0.00 $0.00 2 $0.00 33519 $1,116.54 $0.00 $0.00 2 $0.00 33521 $1,343.55 $0.00 $0.00 2 $0.00 33522 $1,507.47 $0.00 $0.00 2 $0.00 33523 $1,702.14 $0.00 $0.00 2 $0.00 33530 $1,077.50 $0.00 $0.00 2 $0.00 33533 $3,828.89 $0.00 $0.00 2 $0.00 33534 $4,525.30 $0.00 $0.00 2 $0.00 33535 $5,048.66 $0.00 $0.00 2 $0.00 33536 $5,397.12 $0.00 $0.00 2 $0.00 33542 $5,430.94 $0.00 $0.00 2 $0.00 33545 $6,327.33 $0.00 $0.00 2 $0.00 33548 $6,072.68 $0.00 $0.00 2 $0.00 33572 $473.35 $0.00 $0.00 2 $0.00 33600 $3,495.24 $0.00 $0.00 2 $0.00 33602 $3,347.28 $0.00 $0.00 2 $0.00 33606 $3,579.39 $0.00 $0.00 2 $0.00 33608 $3,680.86 $0.00 $0.00 2 $0.00 33610 $3,769.92 $0.00 $0.00 2 $0.00 33611 $4,022.95 $0.00 $0.00 2 $0.00 33612 $4,042.03 $0.00 $0.00 2 $0.00 33615 $4,076.82 $0.00 $0.00 2 $0.00 33617 $4,389.80 $0.00 $0.00 2 $0.00 33619 $5,582.52 $0.00 $0.00 2 $0.00 33620 $3,148.86 $0.00 $0.00 2 $0.00


98


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 33621 $1,782.00 $0.00 $0.00 2 $0.00 33622 $7,021.06 $0.00 $0.00 2 $0.00 33641 $3,348.21 $0.00 $0.00 2 $0.00 33645 $3,553.92 $0.00 $0.00 2 $0.00 33647 $3,728.71 $0.00 $0.00 2 $0.00 33660 $3,604.97 $0.00 $0.00 2 $0.00 33665 $3,948.65 $0.00 $0.00 2 $0.00 33670 $4,073.03 $0.00 $0.00 2 $0.00 33675 $4,044.87 $0.00 $0.00 2 $0.00 33676 $4,376.20 $0.00 $0.00 2 $0.00 33677 $4,349.48 $0.00 $0.00 2 $0.00 33681 $3,758.26 $0.00 $0.00 2 $0.00 33684 $3,899.27 $0.00 $0.00 2 $0.00 33688 $3,887.72 $0.00 $0.00 2 $0.00 33690 $2,455.57 $0.00 $0.00 2 $0.00 33692 $4,236.49 $0.00 $0.00 2 $0.00 33694 $4,206.93 $0.00 $0.00 2 $0.00 33697 $4,191.34 $0.00 $0.00 2 $0.00 33702 $3,179.98 $0.00 $0.00 2 $0.00 33710 $4,380.78 $0.00 $0.00 2 $0.00 33720 $3,148.29 $0.00 $0.00 2 $0.00 33722 $3,355.17 $0.00 $0.00 2 $0.00 33724 $3,125.60 $0.00 $0.00 2 $0.00 33726 $4,385.31 $0.00 $0.00 2 $0.00 33730 $4,115.15 $0.00 $0.00 2 $0.00 33732 $3,390.14 $0.00 $0.00 2 $0.00 33735 $2,646.61 $0.00 $0.00 2 $0.00 33736 $2,891.59 $0.00 $0.00 2 $0.00 33737 $2,747.27 $0.00 $0.00 2 $0.00 33750 $2,942.70 $0.00 $0.00 2 $0.00 33755 $2,754.96 $0.00 $0.00 2 $0.00 33762 $2,753.79 $0.00 $0.00 2 $0.00 33764 $2,656.98 $0.00 $0.00 2 $0.00 33766 $2,800.49 $0.00 $0.00 2 $0.00 33767 $2,935.58 $0.00 $0.00 2 $0.00 33768 $899.35 $0.00 $0.00 2 $0.00 33770 $4,530.59 $0.00 $0.00 2 $0.00 33771 $4,730.24 $0.00 $0.00 2 $0.00 33774 $3,719.52 $0.00 $0.00 2 $0.00 33775 $3,985.32 $0.00 $0.00 2 $0.00 33776 $4,186.87 $0.00 $0.00 2 $0.00


99


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 33777 $4,078.54 $0.00 $0.00 2 $0.00 33778 $4,865.24 $0.00 $0.00 2 $0.00 33779 $5,051.22 $0.00 $0.00 2 $0.00 33780 $5,105.33 $0.00 $0.00 2 $0.00 33781 $5,027.34 $0.00 $0.00 2 $0.00 33782 $6,592.93 $0.00 $0.00 2 $0.00 33783 $7,130.33 $0.00 $0.00 2 $0.00 33786 $4,704.34 $0.00 $0.00 2 $0.00 33788 $3,341.77 $0.00 $0.00 2 $0.00 33800 $1,882.10 $0.00 $0.00 2 $0.00 33802 $2,377.23 $0.00 $0.00 2 $0.00 33803 $2,374.42 $0.00 $0.00 2 $0.00 33813 $2,611.38 $0.00 $0.00 2 $0.00 33814 $3,148.72 $0.00 $0.00 2 $0.00 33820 $1,994.73 $0.00 $0.00 2 $0.00 33822 $2,184.42 $0.00 $0.00 2 $0.00 33824 $2,413.30 $0.00 $0.00 2 $0.00 33840 $2,561.07 $0.00 $0.00 2 $0.00 33845 $2,744.78 $0.00 $0.00 2 $0.00 33851 $2,630.57 $0.00 $0.00 2 $0.00 33852 $2,875.31 $0.00 $0.00 2 $0.00 33853 $3,764.93 $0.00 $0.00 2 $0.00 33860 $6,615.24 $0.00 $0.00 2 $0.00 33863 $6,473.43 $0.00 $0.00 2 $0.00 33864 $6,612.92 $0.00 $0.00 2 $0.00 33866 $1,970.10 $0.00 $0.00 0 N1 $0.00 33870 $5,197.54 $0.00 $0.00 2 $0.00 33875 $5,655.98 $0.00 $0.00 2 $0.00 33877 $7,505.05 $0.00 $0.00 2 $0.00 33880 $3,713.42 $0.00 $0.00 2 $0.00 33881 $3,185.57 $0.00 $0.00 2 $0.00 33883 $2,304.41 $0.00 $0.00 2 $0.00 33884 $840.00 $0.00 $0.00 2 $0.00 33886 $2,010.99 $0.00 $0.00 2 $0.00 33889 $1,632.98 $0.00 $0.00 2 $0.00 33891 $2,008.55 $0.00 $0.00 2 $0.00 33910 $5,426.43 $0.00 $0.00 2 $0.00 33915 $2,792.10 $0.00 $0.00 2 $0.00 33916 $8,677.92 $0.00 $0.00 2 $0.00 33917 $2,969.16 $0.00 $0.00 2 $0.00 33920 $3,734.59 $0.00 $0.00 2 $0.00


100


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 33922 $2,858.39 $0.00 $0.00 2 $0.00 33924 $577.21 $0.00 $0.00 2 $0.00 33925 $3,505.13 $0.00 $0.00 2 $0.00 33926 $4,982.52 $0.00 $0.00 2 $0.00 33927 $4,901.82 $0.00 $0.00 2 $0.00 33928 BR $0.00 $0.00 2 $0.00 33929 BR $0.00 $0.00 2 $0.00 33930 BR $0.00 $0.00 $0.00 33933 BR $0.00 $0.00 2 $0.00 33935 $10,357.26 $0.00 $0.00 2 $0.00 33940 BR $0.00 $0.00 $0.00 33944 BR $0.00 $0.00 2 $0.00 33945 $10,027.77 $0.00 $0.00 2 $0.00 33946 $593.34 $0.00 $0.00 1 $0.00 33947 $658.02 $0.00 $0.00 1 $0.00 33948 $456.20 $0.00 $0.00 1 $0.00 33949 $445.89 $0.00 $0.00 1 $0.00 33951 $818.25 $0.00 $0.00 0 $0.00 33952 $820.38 $0.00 $0.00 0 $0.00 33953 $914.13 $0.00 $0.00 0 $0.00 33954 $916.08 $0.00 $0.00 0 $0.00 33955 $1,604.33 $0.00 $0.00 0 $0.00 33956 $1,598.52 $0.00 $0.00 0 $0.00 33957 $355.94 $0.00 $0.00 0 $0.00 33958 $354.62 $0.00 $0.00 0 $0.00 33959 $452.61 $0.00 $0.00 0 $0.00 33962 $450.50 $0.00 $0.00 0 $0.00 33963 $905.55 $0.00 $0.00 0 $0.00 33964 $947.62 $0.00 $0.00 0 $0.00 33965 $355.94 $0.00 $0.00 0 $0.00 33966 $456.06 $0.00 $0.00 0 $0.00 33967 $523.08 $0.00 $0.00 0 $0.00 33968 $68.16 $0.00 $0.00 1 $0.00 33969 $527.99 $0.00 $0.00 0 $0.00 33970 $719.29 $0.00 $0.00 2 $0.00 33971 $1,462.97 $0.00 $0.00 1 $0.00 33973 $1,048.20 $0.00 $0.00 2 $0.00 33974 $1,859.21 $0.00 $0.00 1 $0.00 33975 $2,701.72 $0.00 $0.00 2 $0.00 33976 $3,279.47 $0.00 $0.00 2 $0.00 33977 $2,318.20 $0.00 $0.00 2 $0.00


101


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 33978 $2,766.67 $0.00 $0.00 2 $0.00 33979 $3,996.09 $0.00 $0.00 2 $0.00 33980 $3,662.82 $0.00 $0.00 2 $0.00 33981 $1,724.98 $0.00 $0.00 2 $0.00 33982 $4,223.39 $0.00 $0.00 2 $0.00 33983 $4,728.79 $0.00 $0.00 2 $0.00 33984 $546.36 $0.00 $0.00 0 $0.00 33985 $993.68 $0.00 $0.00 0 $0.00 33986 $1,000.26 $0.00 $0.00 0 $0.00 33987 $400.62 $0.00 $0.00 0 $0.00 33988 $1,493.06 $0.00 $0.00 0 $0.00 33989 $947.62 $0.00 $0.00 0 $0.00 33990 $882.50 $0.00 $0.00 2 $0.00 33991 $1,279.18 $0.00 $0.00 2 $0.00 33992 $417.91 $0.00 $0.00 2 $0.00 33993 $368.19 $0.00 $0.00 2 $0.00 33999 BR $0.00 $0.00 2 $0.00 34001 $2,046.49 $0.00 $0.00 2 $0.00 34051 $2,054.19 $0.00 $0.00 2 $0.00 34101 $1,252.33 $0.00 $0.00 2 $0.00 34111 $1,256.97 $0.00 $0.00 2 $0.00 34151 $2,911.60 $0.00 $0.00 2 $0.00 34201 $2,151.63 $0.00 $0.00 2 $0.00 34203 $1,996.23 $0.00 $0.00 2 $0.00 34401 $2,981.71 $0.00 $0.00 2 $0.00 34421 $1,521.44 $0.00 $0.00 2 $0.00 34451 $3,399.36 $0.00 $0.00 2 $0.00 34471 $2,216.19 $0.00 $0.00 1 $0.00 34490 $1,308.63 $0.00 $0.00 1 G2 $1,306.09 34501 $1,873.03 $0.00 $0.00 2 $0.00 34502 $3,138.48 $0.00 $0.00 2 $0.00 34510 $2,406.41 $0.00 $0.00 2 $0.00 34520 $2,069.22 $0.00 $0.00 2 $0.00 34530 $2,085.02 $0.00 $0.00 2 $0.00 34701 $2,366.10 $0.00 $0.00 2 $0.00 34702 $3,533.64 $0.00 $0.00 2 $0.00 34703 $2,663.76 $0.00 $0.00 2 $0.00 34704 $4,439.16 $0.00 $0.00 2 $0.00 34705 $2,929.74 $0.00 $0.00 2 $0.00 34706 $4,414.08 $0.00 $0.00 2 $0.00 34707 $2,207.04 $0.00 $0.00 2 $0.00


102


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 34708 $3,542.88 $0.00 $0.00 2 $0.00 34709 $619.08 $0.00 $0.00 2 $0.00 34710 $1,533.84 $0.00 $0.00 2 $0.00 34711 $571.56 $0.00 $0.00 2 $0.00 34712 $1,310.10 $0.00 $0.00 2 $0.00 34713 $246.18 $0.00 $0.00 2 N1 $0.00 34714 $517.44 $0.00 $0.00 2 N1 $0.00 34715 $580.14 $0.00 $0.00 2 N1 $0.00 34716 $717.42 $0.00 $0.00 2 N1 $0.00 34808 $429.51 $0.00 $0.00 2 $0.00 34812 $696.32 $0.00 $0.00 2 $0.00 34813 $490.43 $0.00 $0.00 2 $0.00 34820 $1,008.94 $0.00 $0.00 2 $0.00 34830 $3,679.72 $0.00 $0.00 2 $0.00 34831 $3,966.19 $0.00 $0.00 2 $0.00 34832 $3,956.23 $0.00 $0.00 2 $0.00 34833 $1,258.28 $0.00 $0.00 2 $0.00 34834 $568.35 $0.00 $0.00 2 $0.00 34839 BR $0.00 $0.00 0 $0.00 34841 BR $0.00 $0.00 2 $0.00 34842 BR $0.00 $0.00 2 $0.00 34843 BR $0.00 $0.00 2 $0.00 34844 BR $0.00 $0.00 2 $0.00 34845 BR $0.00 $0.00 2 $0.00 34846 BR $0.00 $0.00 2 $0.00 34847 BR $0.00 $0.00 2 $0.00 34848 BR $0.00 $0.00 2 $0.00 35001 $2,362.57 $0.00 $0.00 2 $0.00 35002 $2,333.55 $0.00 $0.00 2 $0.00 35005 $2,385.41 $0.00 $0.00 2 $0.00 35011 $2,073.14 $0.00 $0.00 2 $0.00 35013 $2,593.85 $0.00 $0.00 2 $0.00 35021 $2,580.58 $0.00 $0.00 2 $0.00 35022 $2,948.60 $0.00 $0.00 2 $0.00 35045 $2,048.69 $0.00 $0.00 2 $0.00 35081 $3,649.82 $0.00 $0.00 2 $0.00 35082 $4,545.27 $0.00 $0.00 2 $0.00 35091 $3,726.45 $0.00 $0.00 2 $0.00 35092 $5,431.66 $0.00 $0.00 2 $0.00 35102 $3,944.01 $0.00 $0.00 2 $0.00 35103 $4,672.78 $0.00 $0.00 2 $0.00


103


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 35111 $2,901.19 $0.00 $0.00 2 $0.00 35112 $3,799.24 $0.00 $0.00 2 $0.00 35121 $3,450.07 $0.00 $0.00 2 $0.00 35122 $4,381.64 $0.00 $0.00 2 $0.00 35131 $2,885.79 $0.00 $0.00 2 $0.00 35132 $3,390.52 $0.00 $0.00 2 $0.00 35141 $2,314.10 $0.00 $0.00 2 $0.00 35142 $2,765.15 $0.00 $0.00 2 $0.00 35151 $2,595.08 $0.00 $0.00 2 $0.00 35152 $2,919.71 $0.00 $0.00 2 $0.00 35180 $1,905.07 $0.00 $0.00 2 $0.00 35182 $3,601.27 $0.00 $0.00 2 $0.00 35184 $2,165.36 $0.00 $0.00 2 $0.00 35188 $2,281.18 $0.00 $0.00 2 A2 $2,248.51 35189 $3,182.53 $0.00 $0.00 2 $0.00 35190 $1,575.18 $0.00 $0.00 2 $0.00 35201 $1,962.25 $0.00 $0.00 2 $0.00 35206 $1,614.18 $0.00 $0.00 2 $0.00 35207 $1,521.97 $0.00 $0.00 1 A2 $1,306.09 35211 $2,841.91 $0.00 $0.00 2 $0.00 35216 $4,212.14 $0.00 $0.00 2 $0.00 35221 $2,980.22 $0.00 $0.00 2 $0.00 35226 $1,739.09 $0.00 $0.00 2 $0.00 35231 $2,465.59 $0.00 $0.00 2 $0.00 35236 $2,053.53 $0.00 $0.00 2 $0.00 35241 $2,960.17 $0.00 $0.00 2 $0.00 35246 $2,993.90 $0.00 $0.00 2 $0.00 35251 $3,490.24 $0.00 $0.00 2 $0.00 35256 $2,125.17 $0.00 $0.00 2 $0.00 35261 $2,178.71 $0.00 $0.00 2 $0.00 35266 $1,792.44 $0.00 $0.00 2 $0.00 35271 $2,861.50 $0.00 $0.00 2 $0.00 35276 $2,993.85 $0.00 $0.00 2 $0.00 35281 $3,378.68 $0.00 $0.00 2 $0.00 35286 $1,943.13 $0.00 $0.00 2 $0.00 35301 $2,188.12 $0.00 $0.00 2 $0.00 35302 $2,352.78 $0.00 $0.00 2 $0.00 35303 $2,596.36 $0.00 $0.00 2 $0.00 35304 $2,674.28 $0.00 $0.00 2 $0.00 35305 $2,570.50 $0.00 $0.00 2 $0.00 35306 $928.47 $0.00 $0.00 2 $0.00


104


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 35311 $3,184.10 $0.00 $0.00 2 $0.00 35321 $1,856.15 $0.00 $0.00 2 $0.00 35331 $3,056.40 $0.00 $0.00 2 $0.00 35341 $2,874.02 $0.00 $0.00 2 $0.00 35351 $2,669.49 $0.00 $0.00 2 $0.00 35355 $2,161.00 $0.00 $0.00 2 $0.00 35361 $3,179.93 $0.00 $0.00 2 $0.00 35363 $3,577.25 $0.00 $0.00 2 $0.00 35371 $1,713.07 $0.00 $0.00 2 $0.00 35372 $2,046.28 $0.00 $0.00 2 $0.00 35390 $329.89 $0.00 $0.00 2 $0.00 35400 $308.11 $0.00 $0.00 0 $0.00 35500 $665.28 $0.00 $0.00 2 $0.00 35501 $3,196.24 $0.00 $0.00 2 $0.00 35506 $2,792.24 $0.00 $0.00 2 $0.00 35508 $2,805.09 $0.00 $0.00 2 $0.00 35509 $2,955.66 $0.00 $0.00 2 $0.00 35510 $2,571.09 $0.00 $0.00 2 $0.00 35511 $2,660.16 $0.00 $0.00 2 $0.00 35512 $2,630.00 $0.00 $0.00 2 $0.00 35515 $2,782.60 $0.00 $0.00 2 $0.00 35516 $2,550.73 $0.00 $0.00 2 $0.00 35518 $2,709.00 $0.00 $0.00 2 $0.00 35521 $2,923.76 $0.00 $0.00 2 $0.00 35522 $2,589.65 $0.00 $0.00 2 $0.00 35523 $2,675.05 $0.00 $0.00 2 $0.00 35525 $2,377.54 $0.00 $0.00 2 $0.00 35526 $3,604.03 $0.00 $0.00 2 $0.00 35531 $4,205.88 $0.00 $0.00 2 $0.00 35533 $3,146.52 $0.00 $0.00 2 $0.00 35535 $3,670.24 $0.00 $0.00 2 $0.00 35536 $4,193.05 $0.00 $0.00 2 $0.00 35537 $4,551.05 $0.00 $0.00 2 $0.00 35538 $4,872.47 $0.00 $0.00 2 $0.00 35539 $4,577.80 $0.00 $0.00 2 $0.00 35540 $5,343.54 $0.00 $0.00 1 $0.00 35556 $2,930.25 $0.00 $0.00 2 $0.00 35558 $2,587.12 $0.00 $0.00 2 $0.00 35560 $3,559.53 $0.00 $0.00 2 $0.00 35563 $2,869.81 $0.00 $0.00 2 $0.00 35565 $2,748.05 $0.00 $0.00 2 $0.00


105


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 35566 $3,494.29 $0.00 $0.00 2 $0.00 35570 $2,904.58 $0.00 $0.00 2 $0.00 35571 $2,775.01 $0.00 $0.00 2 $0.00 35572 $714.44 $0.00 $0.00 2 N1 $0.00 35583 $3,013.62 $0.00 $0.00 2 $0.00 35585 $3,503.63 $0.00 $0.00 2 $0.00 35587 $2,851.66 $0.00 $0.00 2 $0.00 35600 $529.44 $0.00 $0.00 2 $0.00 35601 $2,948.67 $0.00 $0.00 2 $0.00 35606 $2,456.56 $0.00 $0.00 2 $0.00 35612 $2,186.16 $0.00 $0.00 2 $0.00 35616 $2,263.53 $0.00 $0.00 2 $0.00 35621 $2,295.81 $0.00 $0.00 2 $0.00 35623 $2,744.30 $0.00 $0.00 2 $0.00 35626 $3,274.49 $0.00 $0.00 2 $0.00 35631 $3,848.79 $0.00 $0.00 2 $0.00 35632 $3,457.88 $0.00 $0.00 2 $0.00 35633 $3,843.40 $0.00 $0.00 2 $0.00 35634 $3,452.65 $0.00 $0.00 2 $0.00 35636 $3,330.65 $0.00 $0.00 2 $0.00 35637 $3,613.12 $0.00 $0.00 2 $0.00 35638 $3,680.81 $0.00 $0.00 2 $0.00 35642 $2,100.08 $0.00 $0.00 2 $0.00 35645 $2,285.81 $0.00 $0.00 2 $0.00 35646 $3,580.08 $0.00 $0.00 2 $0.00 35647 $3,253.25 $0.00 $0.00 2 $0.00 35650 $2,219.89 $0.00 $0.00 2 $0.00 35654 $2,849.05 $0.00 $0.00 2 $0.00 35656 $2,264.38 $0.00 $0.00 2 $0.00 35661 $2,272.73 $0.00 $0.00 2 $0.00 35663 $2,630.00 $0.00 $0.00 2 $0.00 35665 $2,454.94 $0.00 $0.00 2 $0.00 35666 $2,660.28 $0.00 $0.00 2 $0.00 35671 $2,350.74 $0.00 $0.00 2 $0.00 35681 $166.50 $0.00 $0.00 2 $0.00 35682 $731.83 $0.00 $0.00 0 $0.00 35683 $850.96 $0.00 $0.00 0 $0.00 35685 $414.73 $0.00 $0.00 2 $0.00 35686 $341.97 $0.00 $0.00 2 $0.00 35691 $1,977.53 $0.00 $0.00 2 $0.00 35693 $1,751.47 $0.00 $0.00 2 $0.00


106


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 35694 $2,064.42 $0.00 $0.00 2 $0.00 35695 $2,143.24 $0.00 $0.00 2 $0.00 35697 $306.96 $0.00 $0.00 2 $0.00 35700 $317.72 $0.00 $0.00 2 $0.00 35701 $1,181.13 $0.00 $0.00 2 $0.00 35721 $946.38 $0.00 $0.00 2 $0.00 35741 $1,068.90 $0.00 $0.00 2 $0.00 35761 $811.73 $0.00 $0.00 2 G2 $1,306.09 35800 $1,484.71 $0.00 $0.00 2 $0.00 35820 $4,130.79 $0.00 $0.00 2 $0.00 35840 $2,422.52 $0.00 $0.00 2 $0.00 35860 $1,748.24 $0.00 $0.00 2 $0.00 35870 $2,601.72 $0.00 $0.00 2 $0.00 35875 $1,246.51 $0.00 $0.00 1 A2 $2,248.51 35876 $1,977.01 $0.00 $0.00 2 A2 $2,248.51 35879 $1,939.22 $0.00 $0.00 2 $0.00 35881 $2,138.42 $0.00 $0.00 2 $0.00 35883 $2,526.50 $0.00 $0.00 2 $0.00 35884 $2,592.12 $0.00 $0.00 2 $0.00 35901 $1,043.69 $0.00 $0.00 2 $0.00 35903 $1,189.74 $0.00 $0.00 2 $0.00 35905 $3,508.59 $0.00 $0.00 2 $0.00 35907 $3,985.40 $0.00 $0.00 2 $0.00 36000 $49.93 $0.00 $0.00 N1 $0.00 36002 $329.60 $0.00 $0.00 1 G2 $319.39 36005 $674.17 $0.00 $0.00 0 N1 $0.00 36010 $1,064.49 $0.00 $0.00 1 N1 $0.00 36011 $1,796.02 $0.00 $0.00 1 N1 $0.00 36012 $1,840.20 $0.00 $0.00 1 N1 $0.00 36013 $1,714.28 $0.00 $0.00 1 N1 $0.00 36014 $1,730.87 $0.00 $0.00 1 N1 $0.00 36015 $1,861.73 $0.00 $0.00 1 N1 $0.00 36100 $1,095.07 $0.00 $0.00 1 N1 $0.00 36140 $942.50 $0.00 $0.00 1 N1 $0.00 36160 $1,089.50 $0.00 $0.00 1 N1 $0.00 36200 $1,350.13 $0.00 $0.00 1 N1 $0.00 36215 $2,349.44 $0.00 $0.00 1 N1 $0.00 36216 $2,617.85 $0.00 $0.00 1 N1 $0.00 36217 $4,479.44 $0.00 $0.00 1 N1 $0.00 36218 $420.29 $0.00 $0.00 1 N1 $0.00 36221 $2,357.82 $0.00 $0.00 1 N1 $0.00


107


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 36222 $2,936.42 $0.00 $0.00 1 N1 $0.00 36223 $3,212.50 $0.00 $0.00 1 N1 $0.00 36224 $3,647.77 $0.00 $0.00 1 N1 $0.00 36225 $3,188.85 $0.00 $0.00 1 N1 $0.00 36226 $3,614.78 $0.00 $0.00 1 N1 $0.00 36227 $501.75 $0.00 $0.00 1 N1 $0.00 36228 $2,482.32 $0.00 $0.00 1 N1 $0.00 36245 $2,680.66 $0.00 $0.00 1 N1 $0.00 36246 $1,899.83 $0.00 $0.00 1 N1 $0.00 36247 $3,357.95 $0.00 $0.00 1 N1 $0.00 36248 $318.28 $0.00 $0.00 1 N1 $0.00 36251 $3,053.11 $0.00 $0.00 1 N1 $0.00 36252 $3,339.47 $0.00 $0.00 1 N1 $0.00 36253 $4,654.07 $0.00 $0.00 1 N1 $0.00 36254 $4,811.67 $0.00 $0.00 1 N1 $0.00 36260 $1,316.90 $0.00 $0.00 1 J8 $3,969.54 36261 $830.71 $0.00 $0.00 2 J8 $2,764.72 36262 $635.35 $0.00 $0.00 1 G2 $1,612.65 36299 BR $0.00 $0.00 0 $0.00 36400 $49.50 $0.00 $0.00 1 N1 $0.00 36405 $43.56 $0.00 $0.00 1 N1 $0.00 36406 $31.02 $0.00 $0.00 1 N1 $0.00 36410 $35.20 $0.00 $0.00 1 N1 $0.00 36415 $3.26 $0.00 $0.00 $0.00 36416 BR $0.00 $0.00 N1 $0.00 36420 $89.10 $0.00 $0.00 0 N1 $0.00 36425 $76.56 $0.00 $0.00 1 N1 $0.00 36430 $69.49 $0.00 $0.00 1 P3 $34.95 36440 $96.36 $0.00 $0.00 0 R2 $197.24 36450 $326.04 $0.00 $0.00 0 R2 $197.24 36455 $243.64 $0.00 $0.00 1 G2 $197.24 36456 $205.55 $0.00 $0.00 0 $0.00 36460 $731.62 $0.00 $0.00 2 $0.00 36465 $2,963.03 $0.00 $0.00 1 G2 $797.93 36466 $3,095.68 $0.00 $0.00 1 G2 $797.93 36468 BR $0.00 $0.00 0 N1 $0.00 36470 $321.65 $0.00 $0.00 1 P3 $76.76 36471 $368.41 $0.00 $0.00 1 P3 $133.69 36473 $2,811.99 $0.00 $0.00 1 P2 $1,306.09 36474 $519.42 $0.00 $0.00 1 N1 $0.00 36475 $3,622.41 $0.00 $0.00 1 A2 $1,306.09


108


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 36476 $818.94 $0.00 $0.00 1 N1 $0.00 36478 $2,835.51 $0.00 $0.00 1 A2 $1,306.09 36479 $830.79 $0.00 $0.00 1 N1 $0.00 36481 $4,375.23 $0.00 $0.00 1 N1 $0.00 36482 $3,944.14 $0.00 $0.00 1 G2 $2,248.51 36483 $272.78 $0.00 $0.00 1 N1 $0.00 36500 $359.17 $0.00 $0.00 1 N1 $0.00 36510 $154.44 $0.00 $0.00 0 N1 $0.00 36511 $197.09 $0.00 $0.00 1 G2 $642.37 36512 $189.09 $0.00 $0.00 1 G2 $642.37 36513 $203.31 $0.00 $0.00 1 R2 $197.24 36514 $1,133.27 $0.00 $0.00 1 G2 $642.37 36516 $4,354.37 $0.00 $0.00 1 P3 $1,961.77 36522 $2,992.91 $0.00 $0.00 1 G2 $2,020.62 36555 $351.78 $0.00 $0.00 1 A2 $563.37 36556 $482.89 $0.00 $0.00 1 A2 $563.37 36557 $1,969.76 $0.00 $0.00 0 A2 $2,248.51 36558 $1,663.63 $0.00 $0.00 0 A2 $1,306.09 36560 $2,895.92 $0.00 $0.00 0 G2 $1,306.09 36561 $2,500.99 $0.00 $0.00 0 A2 $1,306.09 36563 $2,848.08 $0.00 $0.00 0 A2 $2,248.51 36565 $2,109.29 $0.00 $0.00 0 A2 $1,306.09 36566 $11,788.64 $0.00 $0.00 0 A2 $2,248.51 36568 $600.18 $0.00 $0.00 1 A2 $319.39 36569 $503.77 $0.00 $0.00 1 A2 $563.37 36570 $2,592.54 $0.00 $0.00 0 A2 $1,306.09 36571 $2,801.40 $0.00 $0.00 0 A2 $1,306.09 36573 $739.20 $0.00 $0.00 1 G2 $563.37 36575 $353.24 $0.00 $0.00 0 A2 $319.39 36576 $816.47 $0.00 $0.00 0 A2 $563.37 36578 $1,106.50 $0.00 $0.00 0 A2 $1,306.09 36580 $448.66 $0.00 $0.00 1 J8 $736.50 36581 $1,632.40 $0.00 $0.00 0 J8 $1,735.62 36582 $2,326.65 $0.00 $0.00 0 A2 $1,306.09 36583 $2,927.44 $0.00 $0.00 0 A2 $2,248.51 36584 $422.92 $0.00 $0.00 1 A2 $563.37 36585 $2,589.51 $0.00 $0.00 0 A2 $1,306.09 36589 $342.23 $0.00 $0.00 0 A2 $319.39 36590 $608.96 $0.00 $0.00 0 A2 $319.39 36591 $48.59 $0.00 $0.00 0 N1 $0.00 36592 $56.21 $0.00 $0.00 0 N1 $0.00


109


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 36593 $63.38 $0.00 $0.00 0 P3 $31.35 36595 $1,191.05 $0.00 $0.00 1 J8 $1,701.32 36596 $277.52 $0.00 $0.00 1 G2 $563.37 36597 $259.39 $0.00 $0.00 1 G2 $563.37 36598 $228.25 $0.00 $0.00 0 P3 $89.73 36600 $63.50 $0.00 $0.00 1 N1 $0.00 36620 $110.50 $0.00 $0.00 1 N1 $0.00 36625 $214.35 $0.00 $0.00 1 N1 $0.00 36640 $266.34 $0.00 $0.00 1 A2 $1,306.09 36660 $148.89 $0.00 $0.00 0 $0.00 36680 $119.59 $0.00 $0.00 0 N1 $0.00 36800 $335.09 $0.00 $0.00 1 G2 $2,248.51 36810 $433.64 $0.00 $0.00 1 A2 $1,306.09 36815 $305.21 $0.00 $0.00 1 A2 $2,248.51 36818 $1,387.98 $0.00 $0.00 2 A2 $2,248.51 36819 $1,524.88 $0.00 $0.00 2 A2 $2,248.51 36820 $1,668.29 $0.00 $0.00 2 A2 $2,248.51 36821 $1,436.83 $0.00 $0.00 2 A2 $1,306.09 36823 $2,730.90 $0.00 $0.00 1 $0.00 36825 $1,645.91 $0.00 $0.00 2 A2 $2,248.51 36830 $1,358.74 $0.00 $0.00 2 A2 $2,248.51 36831 $1,180.72 $0.00 $0.00 2 A2 $2,248.51 36832 $1,448.62 $0.00 $0.00 2 A2 $2,248.51 36833 $1,555.02 $0.00 $0.00 2 A2 $2,248.51 36835 $946.78 $0.00 $0.00 1 A2 $1,306.09 36838 $2,380.01 $0.00 $0.00 2 $0.00 36860 $433.47 $0.00 $0.00 1 A2 $319.39 36861 $325.41 $0.00 $0.00 1 A2 $2,248.51 36901 $1,106.64 $0.00 $0.00 1 P3 $522.51 36902 $2,353.50 $0.00 $0.00 1 G2 $2,003.24 36903 $10,444.16 $0.00 $0.00 1 J8 $6,002.75 36904 $3,431.41 $0.00 $0.00 1 G2 $2,003.24 36905 $4,352.46 $0.00 $0.00 1 G2 $4,058.15 36906 $12,675.62 $0.00 $0.00 1 J8 $9,725.70 36907 $1,383.24 $0.00 $0.00 1 N1 $0.00 36908 $5,040.17 $0.00 $0.00 1 N1 $0.00 36909 $3,663.07 $0.00 $0.00 1 N1 $0.00 37140 $4,661.60 $0.00 $0.00 1 $0.00 37145 $4,336.08 $0.00 $0.00 2 $0.00 37160 $4,444.46 $0.00 $0.00 2 $0.00 37180 $4,271.19 $0.00 $0.00 2 $0.00


110


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 37181 $4,660.82 $0.00 $0.00 2 $0.00 37182 $1,655.95 $0.00 $0.00 0 $0.00 37183 $12,545.27 $0.00 $0.00 0 $0.00 37184 $4,796.82 $0.00 $0.00 1 J8 $2,913.00 37185 $1,528.43 $0.00 $0.00 1 N1 $0.00 37186 $2,952.73 $0.00 $0.00 1 N1 $0.00 37187 $4,430.82 $0.00 $0.00 1 J8 $2,721.81 37188 $3,716.32 $0.00 $0.00 1 G2 $1,306.09 37191 $5,588.01 $0.00 $0.00 1 $0.00 37192 $3,639.79 $0.00 $0.00 1 $0.00 37193 $3,537.96 $0.00 $0.00 1 $0.00 37195 BR $0.00 $0.00 0 $0.00 37197 $3,217.17 $0.00 $0.00 1 G2 $1,306.09 37200 $438.59 $0.00 $0.00 1 G2 $2,248.51 37211 $811.32 $0.00 $0.00 1 G2 $2,248.51 37212 $715.58 $0.00 $0.00 1 G2 $1,306.09 37213 $498.12 $0.00 $0.00 1 $0.00 37214 $294.95 $0.00 $0.00 1 $0.00 37215 $2,202.75 $0.00 $0.00 0 $0.00 37216 $1,924.79 $0.00 $0.00 $0.00 37217 $2,099.95 $0.00 $0.00 0 $0.00 37218 $1,573.95 $0.00 $0.00 0 $0.00 37220 $6,847.11 $0.00 $0.00 1 G2 $2,003.24 37221 $10,014.77 $0.00 $0.00 0 J8 $5,834.69 37222 $1,925.46 $0.00 $0.00 0 N1 $0.00 37223 $5,589.68 $0.00 $0.00 0 N1 $0.00 37224 $8,246.95 $0.00 $0.00 0 J8 $2,887.73 37225 $24,113.50 $0.00 $0.00 0 J8 $6,411.46 37226 $19,808.29 $0.00 $0.00 0 J8 $6,223.53 37227 $32,580.45 $0.00 $0.00 0 J8 $10,355.48 37228 $11,761.32 $0.00 $0.00 0 J8 $5,485.57 37229 $23,749.12 $0.00 $0.00 0 J8 $9,788.93 37230 $18,098.31 $0.00 $0.00 0 J8 $9,605.45 37231 $28,897.00 $0.00 $0.00 0 J8 $9,852.78 37232 $2,608.64 $0.00 $0.00 0 N1 $0.00 37233 $3,119.56 $0.00 $0.00 0 N1 $0.00 37234 $8,448.52 $0.00 $0.00 0 N1 $0.00 37235 $8,767.26 $0.00 $0.00 0 N1 $0.00 37236 $7,987.47 $0.00 $0.00 0 J8 $5,741.87 37237 $4,779.08 $0.00 $0.00 0 N1 $0.00 37238 $8,162.66 $0.00 $0.00 0 J8 $5,873.65


111


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 37239 $3,947.49 $0.00 $0.00 0 N1 $0.00 37241 $9,443.84 $0.00 $0.00 1 P2 $4,058.15 37242 $15,196.37 $0.00 $0.00 1 J8 $5,788.09 37243 $18,965.12 $0.00 $0.00 1 G2 $4,058.15 37244 $13,428.97 $0.00 $0.00 1 $0.00 37246 $3,980.26 $0.00 $0.00 1 G2 $2,003.24 37247 $1,608.26 $0.00 $0.00 1 N1 $0.00 37248 $2,797.08 $0.00 $0.00 1 G2 $2,003.24 37249 $1,181.40 $0.00 $0.00 1 N1 $0.00 37252 $2,714.83 $0.00 $0.00 0 N1 $0.00 37253 $414.56 $0.00 $0.00 0 N1 $0.00 37500 $1,446.03 $0.00 $0.00 1 A2 $2,248.51 37501 BR $0.00 $0.00 1 $0.00 37565 $1,567.88 $0.00 $0.00 0 $0.00 37600 $1,470.43 $0.00 $0.00 2 $0.00 37605 $1,667.99 $0.00 $0.00 2 $0.00 37606 $1,209.63 $0.00 $0.00 2 $0.00 37607 $783.84 $0.00 $0.00 1 A2 $1,306.09 37609 $660.31 $0.00 $0.00 1 A2 $547.17 37615 $1,063.75 $0.00 $0.00 2 $0.00 37616 $2,221.26 $0.00 $0.00 2 $0.00 37617 $2,739.46 $0.00 $0.00 2 $0.00 37618 $805.66 $0.00 $0.00 2 $0.00 37619 $3,472.92 $0.00 $0.00 2 $0.00 37650 $965.99 $0.00 $0.00 1 A2 $1,306.09 37660 $2,512.62 $0.00 $0.00 2 $0.00 37700 $523.39 $0.00 $0.00 1 A2 $1,306.09 37718 $912.22 $0.00 $0.00 1 A2 $1,306.09 37722 $1,001.19 $0.00 $0.00 1 A2 $1,306.09 37735 $1,324.01 $0.00 $0.00 1 A2 $1,306.09 37760 $1,270.07 $0.00 $0.00 1 A2 $1,306.09 37761 $1,134.31 $0.00 $0.00 2 R2 $563.37 37765 $1,372.53 $0.00 $0.00 1 P3 $332.97 37766 $1,631.68 $0.00 $0.00 1 P3 $374.77 37780 $528.07 $0.00 $0.00 1 A2 $563.37 37785 $750.09 $0.00 $0.00 1 A2 $1,306.09 37788 $2,825.18 $0.00 $0.00 2 $0.00 37790 $954.63 $0.00 $0.00 0 A2 $1,368.77 37799 BR $0.00 $0.00 0 $0.00 38100 $2,320.93 $0.00 $0.00 2 $0.00 38101 $2,329.03 $0.00 $0.00 2 $0.00


112


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 38102 $522.39 $0.00 $0.00 2 $0.00 38115 $2,556.16 $0.00 $0.00 2 $0.00 38120 $2,128.25 $0.00 $0.00 2 $0.00 38129 BR $0.00 $0.00 2 $0.00 38200 $288.83 $0.00 $0.00 0 N1 $0.00 38204 $199.98 $0.00 $0.00 N1 $0.00 38205 $158.26 $0.00 $0.00 0 $0.00 38206 $161.71 $0.00 $0.00 0 G2 $642.37 38207 $89.31 $0.00 $0.00 $0.00 38208 $56.76 $0.00 $0.00 $0.00 38209 $23.76 $0.00 $0.00 $0.00 38210 $158.40 $0.00 $0.00 $0.00 38211 $142.56 $0.00 $0.00 $0.00 38212 $94.56 $0.00 $0.00 $0.00 38213 $23.76 $0.00 $0.00 $0.00 38214 $81.43 $0.00 $0.00 $0.00 38215 $94.56 $0.00 $0.00 $0.00 38220 $364.27 $0.00 $0.00 0 P3 $120.72 38221 $337.07 $0.00 $0.00 0 P3 $108.83 38222 $321.42 $0.00 $0.00 0 P3 $120.00 38230 $416.16 $0.00 $0.00 0 G2 $642.37 38232 $416.83 $0.00 $0.00 0 G2 $2,020.62 38240 $430.98 $0.00 $0.00 0 $0.00 38241 $325.20 $0.00 $0.00 0 G2 $642.37 38242 $228.10 $0.00 $0.00 0 R2 $642.37 38243 $233.10 $0.00 $0.00 0 R2 $642.37 38300 $604.40 $0.00 $0.00 1 A2 $547.17 38305 $947.14 $0.00 $0.00 1 A2 $547.17 38308 $928.59 $0.00 $0.00 2 A2 $1,057.44 38380 $1,175.56 $0.00 $0.00 2 $0.00 38381 $1,638.68 $0.00 $0.00 2 $0.00 38382 $1,364.19 $0.00 $0.00 2 $0.00 38500 $687.20 $0.00 $0.00 1 A2 $1,057.44 38505 $256.40 $0.00 $0.00 1 A2 $547.17 38510 $1,077.20 $0.00 $0.00 1 A2 $1,057.44 38520 $948.64 $0.00 $0.00 1 A2 $1,057.44 38525 $887.17 $0.00 $0.00 1 A2 $1,057.44 38530 $1,120.06 $0.00 $0.00 2 A2 $1,057.44 38531 $831.60 $0.00 $0.00 0 $0.00 38542 $1,058.71 $0.00 $0.00 2 A2 $2,129.56 38550 $1,043.84 $0.00 $0.00 0 A2 $1,057.44


113


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 38555 $1,931.39 $0.00 $0.00 2 A2 $2,094.06 38562 $1,414.73 $0.00 $0.00 2 $0.00 38564 $1,417.27 $0.00 $0.00 2 $0.00 38570 $1,062.10 $0.00 $0.00 2 A2 $2,129.56 38571 $1,533.90 $0.00 $0.00 2 A2 $3,428.14 38572 $1,892.70 $0.00 $0.00 2 A2 $3,428.14 38573 $2,228.82 $0.00 $0.00 2 G2 $3,428.14 38589 BR $0.00 $0.00 2 $0.00 38700 $1,647.56 $0.00 $0.00 2 G2 $2,094.06 38720 $2,737.39 $0.00 $0.00 2 $0.00 38724 $2,961.15 $0.00 $0.00 2 $0.00 38740 $1,405.92 $0.00 $0.00 2 A2 $2,129.56 38745 $1,776.17 $0.00 $0.00 2 A2 $2,129.56 38746 $438.15 $0.00 $0.00 2 $0.00 38747 $533.48 $0.00 $0.00 2 $0.00 38760 $1,699.33 $0.00 $0.00 2 A2 $2,094.06 38765 $2,594.63 $0.00 $0.00 2 $0.00 38770 $1,584.67 $0.00 $0.00 2 $0.00 38780 $2,042.29 $0.00 $0.00 2 $0.00 38790 $167.40 $0.00 $0.00 1 N1 $0.00 38792 $83.35 $0.00 $0.00 1 N1 $0.00 38794 $585.28 $0.00 $0.00 0 N1 $0.00 38900 $275.29 $0.00 $0.00 2 N1 $0.00 38999 BR $0.00 $0.00 0 $0.00 39000 $1,027.56 $0.00 $0.00 2 $0.00 39010 $1,623.25 $0.00 $0.00 2 $0.00 39200 $1,778.39 $0.00 $0.00 2 $0.00 39220 $2,324.49 $0.00 $0.00 2 $0.00 39401 $591.36 $0.00 $0.00 1 $0.00 39402 $774.18 $0.00 $0.00 1 $0.00 39499 BR $0.00 $0.00 2 $0.00 39501 $1,727.39 $0.00 $0.00 2 $0.00 39503 $12,462.78 $0.00 $0.00 2 $0.00 39540 $1,759.67 $0.00 $0.00 2 $0.00 39541 $1,913.46 $0.00 $0.00 2 $0.00 39545 $1,826.80 $0.00 $0.00 2 $0.00 39560 $1,604.85 $0.00 $0.00 2 $0.00 39561 $2,535.95 $0.00 $0.00 2 $0.00 39599 BR $0.00 $0.00 2 $0.00 40490 $265.58 $0.00 $0.00 1 P3 $79.28 40500 $1,073.72 $0.00 $0.00 1 A2 $968.88


114


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 40510 $1,015.05 $0.00 $0.00 1 A2 $968.88 40520 $1,033.35 $0.00 $0.00 1 A2 $968.88 40525 $1,139.99 $0.00 $0.00 1 A2 $968.88 40527 $1,275.09 $0.00 $0.00 0 A2 $2,176.10 40530 $1,137.39 $0.00 $0.00 1 A2 $968.88 40650 $942.11 $0.00 $0.00 0 A2 $250.94 40652 $1,042.41 $0.00 $0.00 0 A2 $250.94 40654 $1,194.34 $0.00 $0.00 1 A2 $564.34 40700 $1,999.33 $0.00 $0.00 0 A2 $2,176.10 40701 $2,274.36 $0.00 $0.00 2 A2 $2,176.10 40702 $1,923.17 $0.00 $0.00 2 R2 $2,176.10 40720 $2,118.24 $0.00 $0.00 0 A2 $968.88 40761 $2,231.82 $0.00 $0.00 1 A2 $2,176.10 40799 BR $0.00 $0.00 2 $0.00 40800 $447.94 $0.00 $0.00 1 P3 $167.57 40801 $657.40 $0.00 $0.00 1 A2 $250.94 40804 $466.79 $0.00 $0.00 0 N1 $0.00 40805 $829.03 $0.00 $0.00 0 P3 $203.60 40806 $243.28 $0.00 $0.00 0 P3 $91.17 40808 $400.36 $0.00 $0.00 1 P3 $151.35 40810 $444.09 $0.00 $0.00 1 P3 $159.28 40812 $604.69 $0.00 $0.00 1 P3 $199.64 40814 $804.56 $0.00 $0.00 1 A2 $968.88 40816 $842.63 $0.00 $0.00 1 A2 $968.88 40818 $743.89 $0.00 $0.00 0 A2 $250.94 40819 $647.79 $0.00 $0.00 0 A2 $564.34 40820 $568.83 $0.00 $0.00 1 P3 $215.85 40830 $569.10 $0.00 $0.00 0 G2 $106.19 40831 $727.38 $0.00 $0.00 0 A2 $250.94 40840 $1,690.10 $0.00 $0.00 2 A2 $2,176.10 40842 $1,671.20 $0.00 $0.00 0 A2 $2,176.10 40843 $2,257.88 $0.00 $0.00 2 A2 $2,176.10 40844 $2,809.30 $0.00 $0.00 2 A2 $2,176.10 40845 $3,035.40 $0.00 $0.00 0 A2 $2,176.10 40899 BR $0.00 $0.00 0 $0.00 41000 $339.76 $0.00 $0.00 1 P3 $111.35 41005 $489.77 $0.00 $0.00 0 A2 $106.19 41006 $750.82 $0.00 $0.00 0 A2 $564.34 41007 $740.85 $0.00 $0.00 0 A2 $564.34 41008 $795.25 $0.00 $0.00 0 A2 $968.88 41009 $845.84 $0.00 $0.00 0 A2 $250.94


115


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 41010 $445.57 $0.00 $0.00 0 A2 $564.34 41015 $928.32 $0.00 $0.00 0 A2 $250.94 41016 $907.02 $0.00 $0.00 0 A2 $2,176.10 41017 $926.24 $0.00 $0.00 0 A2 $968.88 41018 $1,070.17 $0.00 $0.00 0 A2 $564.34 41019 $915.49 $0.00 $0.00 0 G2 $2,176.10 41100 $360.17 $0.00 $0.00 1 P3 $119.28 41105 $364.91 $0.00 $0.00 1 P3 $119.64 41108 $318.12 $0.00 $0.00 1 P3 $111.71 41110 $459.80 $0.00 $0.00 1 P3 $159.28 41112 $705.48 $0.00 $0.00 1 A2 $968.88 41113 $763.47 $0.00 $0.00 1 A2 $968.88 41114 $1,293.47 $0.00 $0.00 0 A2 $968.88 41115 $537.66 $0.00 $0.00 0 P3 $184.50 41116 $705.37 $0.00 $0.00 1 A2 $968.88 41120 $2,173.27 $0.00 $0.00 2 A2 $2,176.10 41130 $2,682.52 $0.00 $0.00 2 $0.00 41135 $4,415.66 $0.00 $0.00 2 $0.00 41140 $4,472.60 $0.00 $0.00 2 $0.00 41145 $5,642.83 $0.00 $0.00 2 $0.00 41150 $4,487.97 $0.00 $0.00 2 $0.00 41153 $4,864.41 $0.00 $0.00 2 $0.00 41155 $6,096.67 $0.00 $0.00 2 $0.00 41250 $578.32 $0.00 $0.00 0 N1 $0.00 41251 $632.67 $0.00 $0.00 0 A2 $106.19 41252 $670.71 $0.00 $0.00 0 A2 $106.19 41510 $916.67 $0.00 $0.00 0 A2 $968.88 41512 $1,306.71 $0.00 $0.00 0 G2 $2,176.10 41520 $745.56 $0.00 $0.00 0 A2 $968.88 41530 $7,037.41 $0.00 $0.00 0 P3 $845.03 41599 BR $0.00 $0.00 0 $0.00 41800 $594.88 $0.00 $0.00 1 N1 $0.00 41805 $541.55 $0.00 $0.00 0 P3 $241.80 41806 $760.21 $0.00 $0.00 0 P3 $292.25 41820 BR $0.00 $0.00 0 R2 $968.88 41821 BR $0.00 $0.00 0 G2 $564.34 41822 $604.29 $0.00 $0.00 0 P3 $193.15 41823 $886.49 $0.00 $0.00 0 P3 $296.21 41825 $455.11 $0.00 $0.00 1 P3 $163.96 41826 $657.82 $0.00 $0.00 1 P3 $226.30 41827 $932.58 $0.00 $0.00 1 A2 $2,176.10


116


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 41828 $629.20 $0.00 $0.00 0 P3 $193.15 41830 $813.37 $0.00 $0.00 0 P3 $267.02 41850 BR $0.00 $0.00 0 R2 $564.34 41870 BR $0.00 $0.00 0 G2 $968.88 41872 $813.89 $0.00 $0.00 0 P3 $279.28 41874 $784.97 $0.00 $0.00 0 P3 $269.19 41899 BR $0.00 $0.00 0 $0.00 42000 $432.19 $0.00 $0.00 0 A2 $106.19 42100 $315.10 $0.00 $0.00 1 P3 $97.66 42104 $460.77 $0.00 $0.00 1 P3 $153.15 42106 $572.73 $0.00 $0.00 1 P3 $190.63 42107 $974.68 $0.00 $0.00 1 A2 $2,176.10 42120 $2,063.29 $0.00 $0.00 2 A2 $2,176.10 42140 $553.11 $0.00 $0.00 1 A2 $968.88 42145 $1,450.08 $0.00 $0.00 1 A2 $2,176.10 42160 $497.67 $0.00 $0.00 0 P3 $164.68 42180 $520.16 $0.00 $0.00 0 A2 $250.94 42182 $675.12 $0.00 $0.00 0 A2 $2,176.10 42200 $1,784.88 $0.00 $0.00 2 A2 $2,176.10 42205 $1,857.16 $0.00 $0.00 2 A2 $968.88 42210 $2,100.78 $0.00 $0.00 2 A2 $2,176.10 42215 $1,495.78 $0.00 $0.00 2 A2 $2,176.10 42220 $1,090.54 $0.00 $0.00 2 A2 $2,176.10 42225 $1,872.03 $0.00 $0.00 2 G2 $2,176.10 42226 $1,855.13 $0.00 $0.00 2 A2 $2,176.10 42227 $1,744.62 $0.00 $0.00 2 G2 $2,176.10 42235 $1,532.45 $0.00 $0.00 2 A2 $2,176.10 42260 $1,762.49 $0.00 $0.00 2 A2 $2,176.10 42280 $354.09 $0.00 $0.00 0 P3 $116.76 42281 $437.48 $0.00 $0.00 0 G2 $2,176.10 42299 BR $0.00 $0.00 2 $0.00 42300 $446.94 $0.00 $0.00 1 A2 $564.34 42305 $878.21 $0.00 $0.00 0 A2 $968.88 42310 $343.67 $0.00 $0.00 0 A2 $250.94 42320 $534.86 $0.00 $0.00 0 A2 $250.94 42330 $492.21 $0.00 $0.00 1 P3 $146.30 42335 $800.96 $0.00 $0.00 1 P3 $260.90 42340 $991.55 $0.00 $0.00 0 A2 $968.88 42400 $222.82 $0.00 $0.00 1 P3 $75.31 42405 $626.42 $0.00 $0.00 1 A2 $968.88 42408 $964.58 $0.00 $0.00 0 A2 $968.88


117


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 42409 $717.84 $0.00 $0.00 2 A2 $968.88 42410 $1,284.73 $0.00 $0.00 2 A2 $2,176.10 42415 $2,164.28 $0.00 $0.00 2 A2 $2,176.10 42420 $2,428.71 $0.00 $0.00 2 A2 $2,176.10 42425 $1,712.99 $0.00 $0.00 2 A2 $2,176.10 42426 $2,762.52 $0.00 $0.00 2 $0.00 42440 $851.24 $0.00 $0.00 2 A2 $2,176.10 42450 $956.89 $0.00 $0.00 0 A2 $2,176.10 42500 $920.61 $0.00 $0.00 0 A2 $2,176.10 42505 $1,173.32 $0.00 $0.00 1 A2 $2,176.10 42507 $1,064.00 $0.00 $0.00 2 A2 $2,176.10 42509 $1,666.30 $0.00 $0.00 0 A2 $2,176.10 42510 $1,296.51 $0.00 $0.00 2 A2 $968.88 42550 $273.15 $0.00 $0.00 1 N1 $0.00 42600 $1,021.81 $0.00 $0.00 0 A2 $968.88 42650 $175.38 $0.00 $0.00 1 P3 $51.53 42660 $254.55 $0.00 $0.00 0 P3 $77.48 42665 $677.34 $0.00 $0.00 0 A2 $968.88 42699 BR $0.00 $0.00 2 $0.00 42700 $405.43 $0.00 $0.00 1 A2 $106.19 42720 $940.46 $0.00 $0.00 0 A2 $968.88 42725 $1,655.30 $0.00 $0.00 2 A2 $2,176.10 42800 $337.79 $0.00 $0.00 1 P3 $102.70 42804 $425.25 $0.00 $0.00 1 A2 $968.88 42806 $475.58 $0.00 $0.00 1 A2 $968.88 42808 $483.63 $0.00 $0.00 1 A2 $968.88 42809 $394.24 $0.00 $0.00 1 N1 $0.00 42810 $826.51 $0.00 $0.00 2 A2 $968.88 42815 $1,152.59 $0.00 $0.00 2 A2 $2,176.10 42820 $599.17 $0.00 $0.00 0 A2 $2,176.10 42821 $623.79 $0.00 $0.00 0 A2 $968.88 42825 $546.03 $0.00 $0.00 0 A2 $2,176.10 42826 $522.18 $0.00 $0.00 1 A2 $968.88 42830 $435.67 $0.00 $0.00 0 A2 $968.88 42831 $469.61 $0.00 $0.00 0 A2 $968.88 42835 $405.15 $0.00 $0.00 0 A2 $968.88 42836 $500.43 $0.00 $0.00 0 A2 $968.88 42842 $2,060.43 $0.00 $0.00 0 $0.00 42844 $2,812.24 $0.00 $0.00 2 $0.00 42845 $4,530.00 $0.00 $0.00 2 $0.00 42860 $396.41 $0.00 $0.00 0 A2 $968.88


118


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 42870 $1,212.26 $0.00 $0.00 0 A2 $2,176.10 42890 $2,903.78 $0.00 $0.00 2 A2 $2,176.10 42892 $3,847.27 $0.00 $0.00 2 A2 $2,176.10 42894 $4,856.38 $0.00 $0.00 2 $0.00 42900 $692.97 $0.00 $0.00 0 A2 $564.34 42950 $1,649.69 $0.00 $0.00 2 A2 $2,176.10 42953 $1,975.85 $0.00 $0.00 2 $0.00 42955 $1,565.71 $0.00 $0.00 2 A2 $564.34 42960 $349.51 $0.00 $0.00 0 A2 $250.94 42961 $872.12 $0.00 $0.00 2 $0.00 42962 $1,068.16 $0.00 $0.00 1 A2 $968.88 42970 $843.61 $0.00 $0.00 1 R2 $106.19 42971 $943.21 $0.00 $0.00 2 $0.00 42972 $1,054.38 $0.00 $0.00 2 A2 $968.88 42999 BR $0.00 $0.00 0 $0.00 43020 $1,081.40 $0.00 $0.00 2 $0.00 43030 $1,071.10 $0.00 $0.00 2 G2 $2,176.10 43045 $2,664.71 $0.00 $0.00 2 $0.00 43100 $1,291.68 $0.00 $0.00 2 $0.00 43101 $2,054.17 $0.00 $0.00 2 $0.00 43107 $5,315.36 $0.00 $0.00 2 $0.00 43108 $9,492.38 $0.00 $0.00 2 $0.00 43112 $5,619.73 $0.00 $0.00 2 $0.00 43113 $8,798.58 $0.00 $0.00 2 $0.00 43116 $10,652.73 $0.00 $0.00 2 $0.00 43117 $5,154.21 $0.00 $0.00 2 $0.00 43118 $7,720.67 $0.00 $0.00 2 $0.00 43121 $5,797.01 $0.00 $0.00 2 $0.00 43122 $5,180.88 $0.00 $0.00 2 $0.00 43123 $9,019.44 $0.00 $0.00 2 $0.00 43124 $7,778.32 $0.00 $0.00 2 $0.00 43130 $1,616.60 $0.00 $0.00 2 G2 $2,176.10 43135 $3,009.72 $0.00 $0.00 2 $0.00 43180 $1,062.33 $0.00 $0.00 1 G2 $2,176.10 43191 $297.43 $0.00 $0.00 1 G2 $642.73 43192 $329.28 $0.00 $0.00 1 G2 $642.73 43193 $326.15 $0.00 $0.00 1 G2 $642.73 43194 $369.07 $0.00 $0.00 1 G2 $642.73 43195 $353.27 $0.00 $0.00 1 G2 $1,246.09 43196 $378.44 $0.00 $0.00 1 G2 $1,246.09 43197 $362.91 $0.00 $0.00 1 P3 $128.65


119


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 43198 $402.43 $0.00 $0.00 1 P3 $136.57 43200 $531.87 $0.00 $0.00 1 A2 $392.30 43201 $663.67 $0.00 $0.00 1 A2 $642.73 43202 $709.60 $0.00 $0.00 1 A2 $642.73 43204 $455.10 $0.00 $0.00 1 A2 $642.73 43205 $451.01 $0.00 $0.00 1 A2 $642.73 43206 $643.66 $0.00 $0.00 1 G2 $642.73 43210 $848.49 $0.00 $0.00 1 G2 $3,428.14 43211 $464.96 $0.00 $0.00 1 G2 $642.73 43212 $374.28 $0.00 $0.00 1 J8 $2,960.83 43213 $2,399.90 $0.00 $0.00 1 G2 $642.73 43214 $379.66 $0.00 $0.00 1 G2 $642.73 43215 $816.92 $0.00 $0.00 1 A2 $642.73 43216 $808.71 $0.00 $0.00 1 A2 $642.73 43217 $870.66 $0.00 $0.00 1 A2 $642.73 43220 $2,191.05 $0.00 $0.00 1 A2 $642.73 43226 $742.34 $0.00 $0.00 1 A2 $642.73 43227 $1,336.86 $0.00 $0.00 1 A2 $642.73 43229 $1,411.94 $0.00 $0.00 1 G2 $1,246.09 43231 $780.72 $0.00 $0.00 1 A2 $642.73 43232 $931.07 $0.00 $0.00 1 A2 $642.73 43233 $449.02 $0.00 $0.00 1 G2 $642.73 43235 $632.43 $0.00 $0.00 1 A2 $392.30 43236 $810.40 $0.00 $0.00 1 A2 $392.30 43237 $470.57 $0.00 $0.00 1 A2 $642.73 43238 $584.89 $0.00 $0.00 1 A2 $642.73 43239 $774.49 $0.00 $0.00 1 A2 $392.30 43240 $797.75 $0.00 $0.00 1 J8 $1,860.67 43241 $315.50 $0.00 $0.00 1 A2 $642.73 43242 $849.02 $0.00 $0.00 1 A2 $642.73 43243 $537.70 $0.00 $0.00 1 A2 $642.73 43244 $591.79 $0.00 $0.00 1 A2 $642.73 43245 $1,198.30 $0.00 $0.00 1 A2 $642.73 43246 $507.47 $0.00 $0.00 0 A2 $642.73 43247 $808.51 $0.00 $0.00 1 A2 $392.30 43248 $794.75 $0.00 $0.00 1 A2 $392.30 43249 $2,110.15 $0.00 $0.00 1 A2 $642.73 43250 $886.47 $0.00 $0.00 1 A2 $642.73 43251 $970.27 $0.00 $0.00 1 A2 $642.73 43252 $712.32 $0.00 $0.00 1 G2 $1,246.09 43253 $518.17 $0.00 $0.00 1 G2 $642.73


120


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 43254 $532.77 $0.00 $0.00 1 G2 $642.73 43255 $1,401.47 $0.00 $0.00 1 A2 $642.73 43257 $650.96 $0.00 $0.00 1 A2 $1,246.09 43259 $609.63 $0.00 $0.00 1 A2 $642.73 43260 $694.94 $0.00 $0.00 1 A2 $1,246.09 43261 $729.44 $0.00 $0.00 1 A2 $1,246.09 43262 $858.12 $0.00 $0.00 1 A2 $1,246.09 43263 $848.72 $0.00 $0.00 1 A2 $1,246.09 43264 $1,027.44 $0.00 $0.00 1 A2 $1,246.09 43265 $1,154.79 $0.00 $0.00 1 A2 $1,929.12 43266 $446.69 $0.00 $0.00 1 J8 $3,050.71 43270 $1,467.23 $0.00 $0.00 1 G2 $642.73 43273 $252.33 $0.00 $0.00 0 N1 $0.00 43274 $905.09 $0.00 $0.00 1 G2 $1,929.12 43275 $738.81 $0.00 $0.00 1 G2 $1,246.09 43276 $942.63 $0.00 $0.00 1 G2 $1,929.12 43277 $742.19 $0.00 $0.00 1 G2 $1,246.09 43278 $846.36 $0.00 $0.00 1 G2 $1,246.09 43279 $2,603.83 $0.00 $0.00 2 $0.00 43280 $2,181.97 $0.00 $0.00 2 $0.00 43281 $3,110.80 $0.00 $0.00 2 $0.00 43282 $3,494.91 $0.00 $0.00 2 $0.00 43283 $314.53 $0.00 $0.00 2 $0.00 43284 $1,236.57 $0.00 $0.00 2 J8 $5,148.28 43285 $1,206.12 $0.00 $0.00 2 G2 $2,129.56 43286 $6,005.34 $0.00 $0.00 2 $0.00 43287 $6,873.24 $0.00 $0.00 2 $0.00 43288 $7,157.70 $0.00 $0.00 2 $0.00 43289 BR $0.00 $0.00 2 $0.00 43300 $1,269.51 $0.00 $0.00 2 $0.00 43305 $2,230.71 $0.00 $0.00 2 $0.00 43310 $3,021.91 $0.00 $0.00 2 $0.00 43312 $3,240.13 $0.00 $0.00 2 $0.00 43313 $6,307.84 $0.00 $0.00 2 $0.00 43314 $5,843.74 $0.00 $0.00 2 $0.00 43320 $2,808.55 $0.00 $0.00 2 $0.00 43325 $2,704.90 $0.00 $0.00 2 $0.00 43327 $1,643.54 $0.00 $0.00 2 $0.00 43328 $2,350.88 $0.00 $0.00 2 $0.00 43330 $2,688.97 $0.00 $0.00 2 $0.00 43331 $2,732.54 $0.00 $0.00 2 $0.00


121


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 43332 $2,343.48 $0.00 $0.00 2 $0.00 43333 $2,544.97 $0.00 $0.00 2 $0.00 43334 $2,526.46 $0.00 $0.00 2 $0.00 43335 $2,684.75 $0.00 $0.00 2 $0.00 43336 $3,098.33 $0.00 $0.00 2 $0.00 43337 $3,302.96 $0.00 $0.00 2 $0.00 43338 $234.64 $0.00 $0.00 2 $0.00 43340 $2,766.10 $0.00 $0.00 2 $0.00 43341 $3,032.98 $0.00 $0.00 2 $0.00 43351 $2,678.49 $0.00 $0.00 2 $0.00 43352 $2,184.65 $0.00 $0.00 2 $0.00 43360 $4,593.40 $0.00 $0.00 2 $0.00 43361 $5,169.12 $0.00 $0.00 2 $0.00 43400 $3,150.07 $0.00 $0.00 2 $0.00 43401 $3,141.61 $0.00 $0.00 2 $0.00 43405 $2,928.82 $0.00 $0.00 2 $0.00 43410 $2,243.12 $0.00 $0.00 2 $0.00 43415 $5,221.23 $0.00 $0.00 2 $0.00 43420 $2,082.51 $0.00 $0.00 0 $0.00 43425 $2,898.63 $0.00 $0.00 2 $0.00 43450 $412.55 $0.00 $0.00 1 A2 $392.30 43453 $1,873.26 $0.00 $0.00 1 A2 $642.73 43460 $451.42 $0.00 $0.00 1 $0.00 43496 BR $0.00 $0.00 2 $0.00 43499 BR $0.00 $0.00 1 $0.00 43500 $1,589.03 $0.00 $0.00 2 $0.00 43501 $2,717.60 $0.00 $0.00 2 $0.00 43502 $3,049.38 $0.00 $0.00 2 $0.00 43510 $1,835.72 $0.00 $0.00 2 $0.00 43520 $1,402.10 $0.00 $0.00 2 $0.00 43605 $1,693.06 $0.00 $0.00 2 $0.00 43610 $1,987.84 $0.00 $0.00 2 $0.00 43611 $2,466.03 $0.00 $0.00 2 $0.00 43620 $3,918.83 $0.00 $0.00 2 $0.00 43621 $4,560.39 $0.00 $0.00 2 $0.00 43622 $4,602.70 $0.00 $0.00 2 $0.00 43631 $2,928.30 $0.00 $0.00 2 $0.00 43632 $4,088.39 $0.00 $0.00 2 $0.00 43633 $3,867.62 $0.00 $0.00 2 $0.00 43634 $4,250.86 $0.00 $0.00 2 $0.00 43635 $222.90 $0.00 $0.00 2 $0.00


122


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 43640 $2,378.03 $0.00 $0.00 2 $0.00 43641 $2,407.91 $0.00 $0.00 2 $0.00 43644 $3,489.65 $0.00 $0.00 2 $0.00 43645 $3,740.70 $0.00 $0.00 2 $0.00 43647 BR $0.00 $0.00 2 $0.00 43648 BR $0.00 $0.00 2 $0.00 43651 $1,320.63 $0.00 $0.00 2 $0.00 43652 $1,548.46 $0.00 $0.00 2 $0.00 43653 $1,169.66 $0.00 $0.00 2 A2 $2,129.56 43659 BR $0.00 $0.00 2 $0.00 43752 $79.85 $0.00 $0.00 1 G2 $179.35 43753 $41.58 $0.00 $0.00 2 N1 $0.00 43754 $238.02 $0.00 $0.00 2 N1 $0.00 43755 $304.78 $0.00 $0.00 2 G2 $70.04 43756 $469.81 $0.00 $0.00 2 G2 $392.30 43757 $658.77 $0.00 $0.00 2 G2 $392.30 43761 $235.15 $0.00 $0.00 1 A2 $119.21 43762 $416.46 $0.00 $0.00 1 G2 $119.21 43763 $618.42 $0.00 $0.00 1 G2 $119.21 43770 $2,267.48 $0.00 $0.00 2 $0.00 43771 $2,552.91 $0.00 $0.00 2 $0.00 43772 $1,912.23 $0.00 $0.00 2 $0.00 43773 $2,549.17 $0.00 $0.00 2 $0.00 43774 $1,939.53 $0.00 $0.00 2 $0.00 43775 $2,135.76 $0.00 $0.00 2 $0.00 43800 $1,881.79 $0.00 $0.00 2 $0.00 43810 $2,040.78 $0.00 $0.00 2 $0.00 43820 $2,702.48 $0.00 $0.00 2 $0.00 43825 $2,596.39 $0.00 $0.00 2 $0.00 43830 $1,419.67 $0.00 $0.00 2 $0.00 43831 $1,223.92 $0.00 $0.00 2 $0.00 43832 $2,113.08 $0.00 $0.00 2 $0.00 43840 $2,739.26 $0.00 $0.00 2 $0.00 43842 $2,282.94 $0.00 $0.00 $0.00 43843 $2,564.57 $0.00 $0.00 2 $0.00 43845 $3,929.97 $0.00 $0.00 2 $0.00 43846 $3,281.31 $0.00 $0.00 2 $0.00 43847 $3,611.84 $0.00 $0.00 2 $0.00 43848 $3,887.18 $0.00 $0.00 2 $0.00 43850 $3,256.16 $0.00 $0.00 2 $0.00 43855 $3,376.79 $0.00 $0.00 2 $0.00


123


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 43860 $3,285.52 $0.00 $0.00 2 $0.00 43865 $3,422.23 $0.00 $0.00 2 $0.00 43870 $1,443.30 $0.00 $0.00 2 A2 $1,246.09 43880 $3,196.53 $0.00 $0.00 2 $0.00 43881 BR $0.00 $0.00 2 $0.00 43882 BR $0.00 $0.00 2 $0.00 43886 $744.98 $0.00 $0.00 2 G2 $1,424.94 43887 $669.06 $0.00 $0.00 2 G2 $797.93 43888 $935.03 $0.00 $0.00 2 G2 $1,424.94 43999 BR $0.00 $0.00 0 $0.00 44005 $2,204.34 $0.00 $0.00 2 $0.00 44010 $1,757.95 $0.00 $0.00 2 $0.00 44015 $284.84 $0.00 $0.00 2 $0.00 44020 $1,968.31 $0.00 $0.00 2 $0.00 44021 $1,973.94 $0.00 $0.00 2 $0.00 44025 $2,001.47 $0.00 $0.00 2 $0.00 44050 $1,889.82 $0.00 $0.00 2 $0.00 44055 $3,026.31 $0.00 $0.00 2 $0.00 44100 $226.82 $0.00 $0.00 1 A2 $392.30 44110 $1,716.42 $0.00 $0.00 2 $0.00 44111 $1,993.98 $0.00 $0.00 2 $0.00 44120 $2,461.09 $0.00 $0.00 2 $0.00 44121 $483.40 $0.00 $0.00 2 $0.00 44125 $2,380.59 $0.00 $0.00 2 $0.00 44126 $4,938.02 $0.00 $0.00 2 $0.00 44127 $5,739.90 $0.00 $0.00 2 $0.00 44128 $486.40 $0.00 $0.00 2 $0.00 44130 $2,653.14 $0.00 $0.00 2 $0.00 44132 BR $0.00 $0.00 0 $0.00 44133 BR $0.00 $0.00 0 $0.00 44135 BR $0.00 $0.00 0 $0.00 44136 BR $0.00 $0.00 0 $0.00 44137 BR $0.00 $0.00 2 $0.00 44139 $240.39 $0.00 $0.00 2 $0.00 44140 $2,704.68 $0.00 $0.00 2 $0.00 44141 $3,688.43 $0.00 $0.00 2 $0.00 44143 $3,360.45 $0.00 $0.00 2 $0.00 44144 $3,577.72 $0.00 $0.00 2 $0.00 44145 $3,340.84 $0.00 $0.00 2 $0.00 44146 $4,273.07 $0.00 $0.00 2 $0.00 44147 $3,911.57 $0.00 $0.00 2 $0.00


124


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 44150 $3,785.63 $0.00 $0.00 2 $0.00 44151 $4,341.29 $0.00 $0.00 2 $0.00 44155 $4,195.40 $0.00 $0.00 2 $0.00 44156 $4,650.13 $0.00 $0.00 2 $0.00 44157 $4,393.76 $0.00 $0.00 2 $0.00 44158 $4,515.13 $0.00 $0.00 2 $0.00 44160 $2,504.81 $0.00 $0.00 2 $0.00 44180 $1,855.54 $0.00 $0.00 2 $0.00 44186 $1,322.81 $0.00 $0.00 2 $0.00 44187 $2,246.97 $0.00 $0.00 2 $0.00 44188 $2,488.74 $0.00 $0.00 2 $0.00 44202 $2,794.95 $0.00 $0.00 2 $0.00 44203 $481.25 $0.00 $0.00 2 $0.00 44204 $3,106.03 $0.00 $0.00 2 $0.00 44205 $2,701.20 $0.00 $0.00 2 $0.00 44206 $3,541.87 $0.00 $0.00 2 $0.00 44207 $3,677.60 $0.00 $0.00 2 $0.00 44208 $4,011.21 $0.00 $0.00 2 $0.00 44210 $3,624.99 $0.00 $0.00 2 $0.00 44211 $4,597.94 $0.00 $0.00 2 $0.00 44212 $4,176.48 $0.00 $0.00 2 $0.00 44213 $376.81 $0.00 $0.00 2 $0.00 44227 $3,367.62 $0.00 $0.00 2 $0.00 44238 BR $0.00 $0.00 2 $0.00 44300 $1,706.25 $0.00 $0.00 2 $0.00 44310 $2,105.79 $0.00 $0.00 2 $0.00 44312 $1,193.21 $0.00 $0.00 0 A2 $1,424.94 44314 $2,033.29 $0.00 $0.00 2 $0.00 44316 $2,850.94 $0.00 $0.00 2 $0.00 44320 $2,432.88 $0.00 $0.00 2 $0.00 44322 $2,053.96 $0.00 $0.00 2 $0.00 44340 $1,272.31 $0.00 $0.00 1 A2 $1,424.94 44345 $2,128.30 $0.00 $0.00 2 $0.00 44346 $2,392.09 $0.00 $0.00 2 $0.00 44360 $316.72 $0.00 $0.00 1 A2 $642.73 44361 $348.57 $0.00 $0.00 1 A2 $642.73 44363 $415.16 $0.00 $0.00 0 A2 $642.73 44364 $442.72 $0.00 $0.00 0 A2 $642.73 44365 $396.13 $0.00 $0.00 0 A2 $642.73 44366 $521.67 $0.00 $0.00 1 A2 $642.73 44369 $533.54 $0.00 $0.00 0 A2 $642.73


125


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 44370 $577.72 $0.00 $0.00 0 J8 $2,820.11 44372 $518.44 $0.00 $0.00 1 A2 $642.73 44373 $414.57 $0.00 $0.00 1 A2 $642.73 44376 $609.98 $0.00 $0.00 0 A2 $642.73 44377 $644.87 $0.00 $0.00 0 A2 $642.73 44378 $828.66 $0.00 $0.00 0 A2 $642.73 44379 $882.89 $0.00 $0.00 0 A2 $1,929.12 44380 $431.80 $0.00 $0.00 1 A2 $392.30 44381 $1,969.85 $0.00 $0.00 1 G2 $642.73 44382 $626.26 $0.00 $0.00 1 A2 $392.30 44384 $301.76 $0.00 $0.00 1 G2 $1,246.09 44385 $562.11 $0.00 $0.00 1 A2 $383.72 44386 $767.80 $0.00 $0.00 1 A2 $383.72 44388 $756.86 $0.00 $0.00 1 A2 $383.72 44389 $865.83 $0.00 $0.00 1 A2 $504.73 44390 $1,007.04 $0.00 $0.00 1 A2 $504.73 44391 $1,471.00 $0.00 $0.00 1 A2 $504.73 44392 $946.02 $0.00 $0.00 1 A2 $504.73 44394 $1,065.71 $0.00 $0.00 1 A2 $504.73 44401 $6,304.02 $0.00 $0.00 1 G2 $504.73 44402 $515.35 $0.00 $0.00 1 J8 $2,905.27 44403 $592.31 $0.00 $0.00 1 G2 $504.73 44404 $828.31 $0.00 $0.00 1 G2 $504.73 44405 $1,193.92 $0.00 $0.00 1 G2 $504.73 44406 $451.93 $0.00 $0.00 1 G2 $504.73 44407 $541.08 $0.00 $0.00 1 G2 $504.73 44408 $456.47 $0.00 $0.00 1 G2 $383.72 44500 $47.80 $0.00 $0.00 0 G2 $392.30 44602 $2,835.19 $0.00 $0.00 2 $0.00 44603 $3,255.83 $0.00 $0.00 2 $0.00 44604 $2,128.05 $0.00 $0.00 2 $0.00 44605 $2,626.44 $0.00 $0.00 2 $0.00 44615 $2,167.06 $0.00 $0.00 2 $0.00 44620 $1,752.52 $0.00 $0.00 2 $0.00 44625 $2,058.42 $0.00 $0.00 2 $0.00 44626 $3,229.19 $0.00 $0.00 2 $0.00 44640 $2,827.02 $0.00 $0.00 2 $0.00 44650 $2,921.41 $0.00 $0.00 2 $0.00 44660 $2,659.13 $0.00 $0.00 2 $0.00 44661 $3,110.28 $0.00 $0.00 2 $0.00 44680 $2,180.04 $0.00 $0.00 2 $0.00


126


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 44700 $2,046.06 $0.00 $0.00 2 $0.00 44701 $333.29 $0.00 $0.00 2 N1 $0.00 44705 $213.43 $0.00 $0.00 $0.00 44715 BR $0.00 $0.00 2 $0.00 44720 $579.21 $0.00 $0.00 2 $0.00 44721 $767.37 $0.00 $0.00 2 $0.00 44799 BR $0.00 $0.00 1 $0.00 44800 $1,554.29 $0.00 $0.00 2 $0.00 44820 $1,686.81 $0.00 $0.00 2 $0.00 44850 $1,523.94 $0.00 $0.00 2 $0.00 44899 BR $0.00 $0.00 2 $0.00 44900 $1,562.15 $0.00 $0.00 2 $0.00 44950 $1,296.40 $0.00 $0.00 2 $0.00 44955 $168.18 $0.00 $0.00 2 $0.00 44960 $1,766.96 $0.00 $0.00 2 $0.00 44970 $1,215.99 $0.00 $0.00 2 $0.00 44979 BR $0.00 $0.00 2 $0.00 45000 $856.92 $0.00 $0.00 1 A2 $504.73 45005 $575.87 $0.00 $0.00 1 A2 $504.73 45020 $1,155.35 $0.00 $0.00 1 A2 $1,139.74 45100 $614.00 $0.00 $0.00 1 A2 $1,139.74 45108 $755.08 $0.00 $0.00 1 A2 $1,139.74 45110 $3,739.92 $0.00 $0.00 2 $0.00 45111 $2,206.25 $0.00 $0.00 2 $0.00 45112 $3,790.56 $0.00 $0.00 2 $0.00 45113 $4,010.62 $0.00 $0.00 2 $0.00 45114 $3,644.62 $0.00 $0.00 2 $0.00 45116 $3,150.44 $0.00 $0.00 2 $0.00 45119 $3,992.86 $0.00 $0.00 2 $0.00 45120 $3,186.08 $0.00 $0.00 2 $0.00 45121 $3,478.02 $0.00 $0.00 2 $0.00 45123 $2,265.85 $0.00 $0.00 2 $0.00 45126 $5,844.87 $0.00 $0.00 2 $0.00 45130 $2,204.69 $0.00 $0.00 2 $0.00 45135 $2,753.39 $0.00 $0.00 2 $0.00 45136 $3,724.80 $0.00 $0.00 2 $0.00 45150 $802.37 $0.00 $0.00 0 A2 $504.73 45160 $2,070.66 $0.00 $0.00 2 A2 $1,139.74 45171 $1,233.46 $0.00 $0.00 2 G2 $1,139.74 45172 $1,656.69 $0.00 $0.00 2 G2 $1,139.74 45190 $1,404.34 $0.00 $0.00 1 A2 $1,139.74


127


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 45300 $258.52 $0.00 $0.00 1 P3 $91.53 45303 $2,094.02 $0.00 $0.00 1 P2 $504.73 45305 $422.49 $0.00 $0.00 1 A2 $504.73 45307 $495.79 $0.00 $0.00 0 A2 $1,139.74 45308 $453.59 $0.00 $0.00 1 A2 $1,139.74 45309 $464.54 $0.00 $0.00 1 A2 $504.73 45315 $490.02 $0.00 $0.00 1 A2 $504.73 45317 $520.73 $0.00 $0.00 1 A2 $504.73 45320 $518.98 $0.00 $0.00 1 A2 $1,139.74 45321 $220.52 $0.00 $0.00 1 A2 $1,139.74 45327 $261.15 $0.00 $0.00 1 A2 $1,929.12 45330 $326.31 $0.00 $0.00 1 P3 $141.26 45331 $501.46 $0.00 $0.00 1 A2 $383.72 45332 $636.57 $0.00 $0.00 1 A2 $504.73 45333 $681.78 $0.00 $0.00 1 A2 $383.72 45334 $1,174.11 $0.00 $0.00 1 A2 $504.73 45335 $602.15 $0.00 $0.00 1 A2 $383.72 45337 $289.85 $0.00 $0.00 1 A2 $504.73 45338 $690.56 $0.00 $0.00 1 A2 $504.73 45340 $1,077.77 $0.00 $0.00 1 A2 $504.73 45341 $317.31 $0.00 $0.00 1 A2 $504.73 45342 $481.29 $0.00 $0.00 1 A2 $504.73 45346 $6,041.85 $0.00 $0.00 1 G2 $504.73 45347 $308.99 $0.00 $0.00 1 J8 $3,160.57 45349 $391.28 $0.00 $0.00 1 G2 $504.73 45350 $1,145.50 $0.00 $0.00 1 G2 $504.73 45378 $833.01 $0.00 $0.00 1 A2 $383.72 45379 $1,070.92 $0.00 $0.00 1 A2 $504.73 45380 $992.05 $0.00 $0.00 1 A2 $504.73 45381 $999.88 $0.00 $0.00 1 A2 $504.73 45382 $1,520.30 $0.00 $0.00 1 A2 $504.73 45384 $997.50 $0.00 $0.00 1 A2 $504.73 45385 $1,115.92 $0.00 $0.00 1 A2 $504.73 45386 $1,450.15 $0.00 $0.00 1 A2 $504.73 45388 $6,338.45 $0.00 $0.00 1 G2 $504.73 45389 $569.52 $0.00 $0.00 1 J8 $3,069.06 45390 $648.87 $0.00 $0.00 1 G2 $504.73 45391 $595.02 $0.00 $0.00 1 A2 $504.73 45392 $763.51 $0.00 $0.00 1 A2 $504.73 45393 $497.26 $0.00 $0.00 1 G2 $504.73 45395 $4,010.48 $0.00 $0.00 2 $0.00


128


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 45397 $4,335.79 $0.00 $0.00 2 $0.00 45398 $1,427.37 $0.00 $0.00 1 G2 $504.73 45399 BR $0.00 $0.00 1 $0.00 45400 $2,329.39 $0.00 $0.00 2 $0.00 45402 $3,079.25 $0.00 $0.00 2 $0.00 45499 BR $0.00 $0.00 2 $0.00 45500 $1,086.51 $0.00 $0.00 0 A2 $1,139.74 45505 $1,213.81 $0.00 $0.00 1 A2 $1,139.74 45520 $334.87 $0.00 $0.00 1 N1 $0.00 45540 $2,138.56 $0.00 $0.00 2 $0.00 45541 $1,889.71 $0.00 $0.00 2 G2 $1,139.74 45550 $2,972.01 $0.00 $0.00 2 $0.00 45560 $1,403.29 $0.00 $0.00 2 A2 $1,139.74 45562 $2,271.42 $0.00 $0.00 2 $0.00 45563 $3,320.86 $0.00 $0.00 2 $0.00 45800 $2,420.36 $0.00 $0.00 2 $0.00 45805 $2,962.65 $0.00 $0.00 2 $0.00 45820 $2,341.71 $0.00 $0.00 2 $0.00 45825 $2,964.63 $0.00 $0.00 2 $0.00 45900 $413.24 $0.00 $0.00 0 A2 $383.72 45905 $343.60 $0.00 $0.00 1 A2 $504.73 45910 $396.53 $0.00 $0.00 1 A2 $504.73 45915 $689.75 $0.00 $0.00 1 A2 $504.73 45990 $214.74 $0.00 $0.00 0 A2 $1,139.74 45999 BR $0.00 $0.00 0 $0.00 46020 $576.76 $0.00 $0.00 1 A2 $1,139.74 46030 $293.34 $0.00 $0.00 0 A2 $504.73 46040 $1,106.53 $0.00 $0.00 1 A2 $504.73 46045 $893.10 $0.00 $0.00 1 A2 $1,139.74 46050 $432.99 $0.00 $0.00 1 A2 $383.72 46060 $980.96 $0.00 $0.00 1 A2 $1,139.74 46070 $462.51 $0.00 $0.00 0 G2 $1,139.74 46080 $523.72 $0.00 $0.00 1 A2 $1,139.74 46083 $372.25 $0.00 $0.00 1 P2 $119.21 46200 $936.26 $0.00 $0.00 1 A2 $1,139.74 46220 $438.22 $0.00 $0.00 1 A2 $504.73 46221 $566.83 $0.00 $0.00 1 P3 $181.98 46230 $577.45 $0.00 $0.00 1 A2 $1,139.74 46250 $965.63 $0.00 $0.00 1 A2 $1,139.74 46255 $1,057.63 $0.00 $0.00 1 A2 $1,139.74 46257 $858.78 $0.00 $0.00 1 A2 $1,139.74


129


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 46258 $958.65 $0.00 $0.00 0 A2 $1,139.74 46260 $971.22 $0.00 $0.00 1 A2 $1,139.74 46261 $1,064.82 $0.00 $0.00 1 A2 $1,139.74 46262 $1,135.58 $0.00 $0.00 1 A2 $1,139.74 46270 $1,060.16 $0.00 $0.00 1 A2 $1,139.74 46275 $1,120.33 $0.00 $0.00 1 A2 $1,139.74 46280 $967.47 $0.00 $0.00 1 A2 $1,139.74 46285 $1,113.53 $0.00 $0.00 1 A2 $1,139.74 46288 $1,116.31 $0.00 $0.00 1 A2 $1,139.74 46320 $387.58 $0.00 $0.00 1 P3 $125.76 46500 $506.54 $0.00 $0.00 1 P3 $223.78 46505 $602.77 $0.00 $0.00 1 G2 $504.73 46600 $188.60 $0.00 $0.00 1 N1 $0.00 46601 $266.21 $0.00 $0.00 1 N1 $0.00 46604 $1,361.18 $0.00 $0.00 1 P2 $504.73 46606 $486.36 $0.00 $0.00 1 P3 $197.83 46607 $371.96 $0.00 $0.00 1 G2 $504.73 46608 $499.37 $0.00 $0.00 1 A2 $383.72 46610 $488.33 $0.00 $0.00 1 A2 $1,139.74 46611 $371.10 $0.00 $0.00 1 A2 $383.72 46612 $593.75 $0.00 $0.00 1 A2 $1,139.74 46614 $270.55 $0.00 $0.00 1 P3 $100.90 46615 $303.97 $0.00 $0.00 1 A2 $1,139.74 46700 $1,333.30 $0.00 $0.00 1 A2 $1,139.74 46705 $1,063.26 $0.00 $0.00 2 $0.00 46706 $346.26 $0.00 $0.00 1 A2 $1,139.74 46707 $954.94 $0.00 $0.00 0 G2 $1,139.74 46710 $2,242.19 $0.00 $0.00 2 $0.00 46712 $4,191.80 $0.00 $0.00 2 $0.00 46715 $1,040.82 $0.00 $0.00 2 $0.00 46716 $2,303.23 $0.00 $0.00 2 $0.00 46730 $3,744.76 $0.00 $0.00 2 $0.00 46735 $4,171.89 $0.00 $0.00 2 $0.00 46740 $4,115.10 $0.00 $0.00 2 $0.00 46742 $5,192.01 $0.00 $0.00 2 $0.00 46744 $6,716.87 $0.00 $0.00 2 $0.00 46746 $7,208.70 $0.00 $0.00 2 $0.00 46748 $7,931.72 $0.00 $0.00 2 $0.00 46750 $1,537.19 $0.00 $0.00 2 A2 $1,139.74 46751 $1,254.66 $0.00 $0.00 2 $0.00 46753 $1,203.56 $0.00 $0.00 1 A2 $1,139.74


130


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 46754 $628.67 $0.00 $0.00 0 A2 $1,139.74 46760 $2,215.06 $0.00 $0.00 2 A2 $1,139.74 46761 $1,873.33 $0.00 $0.00 2 A2 $1,139.74 46900 $501.22 $0.00 $0.00 1 P2 $161.80 46910 $532.77 $0.00 $0.00 1 P3 $186.30 46916 $482.99 $0.00 $0.00 1 P2 $90.90 46917 $957.43 $0.00 $0.00 1 A2 $1,139.74 46922 $568.92 $0.00 $0.00 1 A2 $1,139.74 46924 $1,138.41 $0.00 $0.00 1 A2 $1,139.74 46930 $431.76 $0.00 $0.00 0 P3 $150.63 46940 $482.18 $0.00 $0.00 1 P3 $147.02 46942 $456.84 $0.00 $0.00 0 P3 $147.39 46945 $653.02 $0.00 $0.00 1 P3 $232.79 46946 $660.21 $0.00 $0.00 1 A2 $1,139.74 46947 $782.84 $0.00 $0.00 1 A2 $1,139.74 46999 BR $0.00 $0.00 0 $0.00 47000 $752.69 $0.00 $0.00 1 A2 $547.17 47001 $204.90 $0.00 $0.00 1 N1 $0.00 47010 $2,448.47 $0.00 $0.00 2 $0.00 47015 $2,354.93 $0.00 $0.00 2 $0.00 47100 $1,717.25 $0.00 $0.00 2 $0.00 47120 $4,701.99 $0.00 $0.00 2 $0.00 47122 $6,902.56 $0.00 $0.00 2 $0.00 47125 $6,193.08 $0.00 $0.00 2 $0.00 47130 $6,636.91 $0.00 $0.00 2 $0.00 47133 BR $0.00 $0.00 $0.00 47135 $10,315.80 $0.00 $0.00 2 $0.00 47140 $7,204.52 $0.00 $0.00 2 $0.00 47141 $8,189.94 $0.00 $0.00 2 $0.00 47142 $9,491.35 $0.00 $0.00 2 $0.00 47143 BR $0.00 $0.00 2 $0.00 47144 BR $0.00 $0.00 2 $0.00 47145 BR $0.00 $0.00 2 $0.00 47146 $654.32 $0.00 $0.00 2 $0.00 47147 $765.13 $0.00 $0.00 2 $0.00 47300 $2,295.45 $0.00 $0.00 2 $0.00 47350 $2,765.66 $0.00 $0.00 2 $0.00 47360 $3,780.59 $0.00 $0.00 2 $0.00 47361 $6,094.00 $0.00 $0.00 2 $0.00 47362 $2,925.45 $0.00 $0.00 2 $0.00 47370 $2,500.59 $0.00 $0.00 2 $0.00


131


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 47371 $2,515.80 $0.00 $0.00 2 $0.00 47379 BR $0.00 $0.00 2 $0.00 47380 $2,893.14 $0.00 $0.00 2 $0.00 47381 $2,961.27 $0.00 $0.00 2 $0.00 47382 $10,360.05 $0.00 $0.00 1 G2 $2,129.56 47383 $14,794.67 $0.00 $0.00 1 J8 $2,921.31 47399 BR $0.00 $0.00 1 $0.00 47400 $4,338.72 $0.00 $0.00 2 $0.00 47420 $2,722.11 $0.00 $0.00 2 $0.00 47425 $2,760.44 $0.00 $0.00 2 $0.00 47460 $2,555.08 $0.00 $0.00 2 $0.00 47480 $1,781.28 $0.00 $0.00 2 $0.00 47490 $668.85 $0.00 $0.00 1 $0.00 47531 $731.12 $0.00 $0.00 1 N1 $0.00 47532 $1,607.40 $0.00 $0.00 1 N1 $0.00 47533 $2,607.87 $0.00 $0.00 1 G2 $1,343.39 47534 $3,174.60 $0.00 $0.00 1 G2 $1,343.39 47535 $2,132.25 $0.00 $0.00 1 G2 $1,343.39 47536 $1,585.44 $0.00 $0.00 1 G2 $1,343.39 47537 $791.02 $0.00 $0.00 1 G2 $392.30 47538 $8,740.64 $0.00 $0.00 1 J8 $3,137.59 47539 $9,545.10 $0.00 $0.00 1 J8 $3,050.19 47540 $9,918.67 $0.00 $0.00 1 J8 $3,182.48 47541 $2,317.70 $0.00 $0.00 1 G2 $1,343.39 47542 $1,007.96 $0.00 $0.00 1 N1 $0.00 47543 $2,560.83 $0.00 $0.00 1 N1 $0.00 47544 $2,016.44 $0.00 $0.00 1 N1 $0.00 47550 $330.37 $0.00 $0.00 2 $0.00 47552 $625.22 $0.00 $0.00 1 A2 $1,343.39 47553 $625.31 $0.00 $0.00 1 A2 $1,343.39 47554 $988.68 $0.00 $0.00 1 A2 $2,129.56 47555 $733.48 $0.00 $0.00 1 A2 $1,343.39 47556 $833.99 $0.00 $0.00 1 J8 $3,048.79 47562 $1,330.69 $0.00 $0.00 2 G2 $2,129.56 47563 $1,448.08 $0.00 $0.00 2 G2 $2,129.56 47564 $2,251.93 $0.00 $0.00 2 G2 $2,129.56 47570 $1,565.26 $0.00 $0.00 2 $0.00 47579 BR $0.00 $0.00 2 $0.00 47600 $2,159.57 $0.00 $0.00 2 $0.00 47605 $2,271.49 $0.00 $0.00 2 $0.00 47610 $2,531.07 $0.00 $0.00 2 $0.00


132


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 47612 $2,538.15 $0.00 $0.00 2 $0.00 47620 $2,760.01 $0.00 $0.00 2 $0.00 47700 $2,138.44 $0.00 $0.00 2 $0.00 47701 $3,472.66 $0.00 $0.00 0 $0.00 47711 $3,125.88 $0.00 $0.00 2 $0.00 47712 $4,011.47 $0.00 $0.00 2 $0.00 47715 $2,677.13 $0.00 $0.00 2 $0.00 47720 $2,328.72 $0.00 $0.00 2 $0.00 47721 $2,738.80 $0.00 $0.00 2 $0.00 47740 $2,633.93 $0.00 $0.00 2 $0.00 47741 $2,972.91 $0.00 $0.00 2 $0.00 47760 $4,528.93 $0.00 $0.00 2 $0.00 47765 $6,090.67 $0.00 $0.00 2 $0.00 47780 $4,975.57 $0.00 $0.00 2 $0.00 47785 $6,550.92 $0.00 $0.00 2 $0.00 47800 $3,175.19 $0.00 $0.00 2 $0.00 47801 $2,070.59 $0.00 $0.00 2 $0.00 47802 $3,084.31 $0.00 $0.00 2 $0.00 47900 $2,767.82 $0.00 $0.00 2 $0.00 47999 BR $0.00 $0.00 1 $0.00 48000 $3,712.54 $0.00 $0.00 2 $0.00 48001 $4,614.27 $0.00 $0.00 2 $0.00 48020 $2,380.15 $0.00 $0.00 2 $0.00 48100 $1,797.13 $0.00 $0.00 2 $0.00 48102 $1,078.09 $0.00 $0.00 1 A2 $547.17 48105 $5,726.35 $0.00 $0.00 2 $0.00 48120 $2,244.91 $0.00 $0.00 2 $0.00 48140 $3,149.81 $0.00 $0.00 2 $0.00 48145 $3,282.77 $0.00 $0.00 2 $0.00 48146 $3,763.74 $0.00 $0.00 2 $0.00 48148 $2,514.09 $0.00 $0.00 2 $0.00 48150 $6,266.34 $0.00 $0.00 2 $0.00 48152 $5,818.18 $0.00 $0.00 2 $0.00 48153 $6,245.14 $0.00 $0.00 2 $0.00 48154 $5,854.51 $0.00 $0.00 2 $0.00 48155 $3,666.39 $0.00 $0.00 2 $0.00 48160 BR $0.00 $0.00 $0.00 48400 $220.65 $0.00 $0.00 0 $0.00 48500 $2,331.88 $0.00 $0.00 2 $0.00 48510 $2,185.16 $0.00 $0.00 2 $0.00 48520 $2,200.17 $0.00 $0.00 2 $0.00


133


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 48540 $2,624.84 $0.00 $0.00 2 $0.00 48545 $2,702.20 $0.00 $0.00 2 $0.00 48547 $3,593.31 $0.00 $0.00 2 $0.00 48548 $3,351.64 $0.00 $0.00 2 $0.00 48550 BR $0.00 $0.00 $0.00 48551 BR $0.00 $0.00 2 $0.00 48552 $470.73 $0.00 $0.00 2 $0.00 48554 $5,215.25 $0.00 $0.00 2 $0.00 48556 $2,586.42 $0.00 $0.00 2 $0.00 48999 BR $0.00 $0.00 2 $0.00 49000 $1,556.92 $0.00 $0.00 2 $0.00 49002 $2,109.62 $0.00 $0.00 2 $0.00 49010 $1,876.41 $0.00 $0.00 2 $0.00 49020 $3,206.39 $0.00 $0.00 2 $0.00 49040 $2,022.09 $0.00 $0.00 2 $0.00 49060 $2,211.05 $0.00 $0.00 1 $0.00 49062 $1,480.11 $0.00 $0.00 2 $0.00 49082 $374.90 $0.00 $0.00 1 G2 $392.30 49083 $654.68 $0.00 $0.00 1 G2 $392.30 49084 $206.86 $0.00 $0.00 1 G2 $392.30 49180 $330.64 $0.00 $0.00 1 A2 $547.17 49185 $1,960.91 $0.00 $0.00 1 $0.00 49203 $2,398.30 $0.00 $0.00 2 $0.00 49204 $3,054.04 $0.00 $0.00 2 $0.00 49205 $3,515.68 $0.00 $0.00 2 $0.00 49215 $4,425.15 $0.00 $0.00 2 $0.00 49220 $1,919.13 $0.00 $0.00 2 $0.00 49250 $1,188.58 $0.00 $0.00 1 A2 $1,343.39 49255 $1,603.19 $0.00 $0.00 2 $0.00 49320 $662.84 $0.00 $0.00 2 A2 $2,129.56 49321 $702.00 $0.00 $0.00 2 A2 $2,129.56 49322 $750.23 $0.00 $0.00 2 A2 $2,129.56 49323 $1,303.51 $0.00 $0.00 2 $0.00 49324 $793.29 $0.00 $0.00 2 G2 $2,129.56 49325 $850.26 $0.00 $0.00 2 G2 $2,129.56 49326 $376.65 $0.00 $0.00 2 N1 $0.00 49327 $257.41 $0.00 $0.00 2 N1 $0.00 49329 BR $0.00 $0.00 2 $0.00 49400 $277.02 $0.00 $0.00 1 N1 $0.00 49402 $1,726.57 $0.00 $0.00 1 A2 $1,343.39 49405 $1,720.28 $0.00 $0.00 1 $0.00


134


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 49406 $1,720.98 $0.00 $0.00 1 G2 $547.17 49407 $1,431.37 $0.00 $0.00 1 G2 $547.17 49411 $1,106.73 $0.00 $0.00 0 P3 $355.67 49412 $163.37 $0.00 $0.00 0 $0.00 49418 $2,999.87 $0.00 $0.00 0 G2 $1,343.39 49419 $875.92 $0.00 $0.00 1 A2 $2,248.51 49421 $460.05 $0.00 $0.00 1 G2 $1,343.39 49422 $767.39 $0.00 $0.00 1 A2 $1,306.09 49423 $1,157.52 $0.00 $0.00 0 G2 $642.73 49424 $305.11 $0.00 $0.00 0 N1 $0.00 49425 $1,535.42 $0.00 $0.00 2 $0.00 49426 $1,271.70 $0.00 $0.00 1 A2 $1,343.39 49427 $88.69 $0.00 $0.00 0 N1 $0.00 49428 $872.75 $0.00 $0.00 1 $0.00 49429 $891.65 $0.00 $0.00 1 G2 $1,306.09 49435 $238.21 $0.00 $0.00 2 N1 $0.00 49436 $380.59 $0.00 $0.00 2 G2 $642.73 49440 $2,177.89 $0.00 $0.00 0 G2 $642.73 49441 $2,445.88 $0.00 $0.00 0 G2 $642.73 49442 $1,942.56 $0.00 $0.00 0 G2 $504.73 49446 $2,068.13 $0.00 $0.00 0 G2 $642.73 49450 $1,394.44 $0.00 $0.00 0 G2 $392.30 49451 $1,520.63 $0.00 $0.00 0 G2 $392.30 49452 $1,865.99 $0.00 $0.00 0 G2 $392.30 49460 $1,538.75 $0.00 $0.00 0 G2 $392.30 49465 $342.01 $0.00 $0.00 0 G2 $118.77 49491 $1,607.81 $0.00 $0.00 2 $0.00 49492 $1,884.85 $0.00 $0.00 2 $0.00 49495 $797.02 $0.00 $0.00 2 A2 $1,343.39 49496 $1,174.14 $0.00 $0.00 2 A2 $1,343.39 49500 $773.50 $0.00 $0.00 2 A2 $1,343.39 49501 $1,226.66 $0.00 $0.00 2 A2 $1,343.39 49505 $1,161.75 $0.00 $0.00 2 A2 $1,343.39 49507 $1,186.29 $0.00 $0.00 2 A2 $1,343.39 49520 $1,278.87 $0.00 $0.00 2 A2 $1,343.39 49521 $1,447.84 $0.00 $0.00 2 A2 $1,343.39 49525 $1,161.57 $0.00 $0.00 2 A2 $1,343.39 49540 $1,371.02 $0.00 $0.00 2 A2 $2,129.56 49550 $1,167.14 $0.00 $0.00 2 A2 $1,343.39 49553 $1,278.36 $0.00 $0.00 2 A2 $1,343.39 49555 $1,207.24 $0.00 $0.00 2 A2 $1,343.39


135


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 49557 $1,460.17 $0.00 $0.00 2 A2 $1,343.39 49560 $1,489.16 $0.00 $0.00 2 A2 $1,343.39 49561 $1,875.75 $0.00 $0.00 2 A2 $1,343.39 49565 $1,552.81 $0.00 $0.00 2 A2 $2,129.56 49566 $1,895.69 $0.00 $0.00 2 A2 $2,129.56 49568 $589.22 $0.00 $0.00 2 N1 $0.00 49570 $847.63 $0.00 $0.00 2 A2 $1,343.39 49572 $1,048.59 $0.00 $0.00 2 A2 $1,343.39 49580 $631.09 $0.00 $0.00 2 A2 $1,343.39 49582 $916.10 $0.00 $0.00 2 A2 $1,343.39 49585 $994.13 $0.00 $0.00 2 A2 $1,343.39 49587 $966.17 $0.00 $0.00 2 A2 $1,343.39 49590 $1,161.10 $0.00 $0.00 2 A2 $1,343.39 49600 $1,466.97 $0.00 $0.00 2 A2 $1,343.39 49605 $9,867.82 $0.00 $0.00 2 $0.00 49606 $2,282.39 $0.00 $0.00 2 $0.00 49610 $1,319.34 $0.00 $0.00 2 $0.00 49611 $1,161.60 $0.00 $0.00 2 $0.00 49650 $958.11 $0.00 $0.00 2 A2 $2,129.56 49651 $1,136.89 $0.00 $0.00 2 A2 $2,129.56 49652 $1,422.30 $0.00 $0.00 2 G2 $2,129.56 49653 $1,776.06 $0.00 $0.00 2 G2 $2,129.56 49654 $1,616.34 $0.00 $0.00 2 G2 $3,428.14 49655 $1,974.06 $0.00 $0.00 2 G2 $3,428.14 49656 $1,752.96 $0.00 $0.00 2 G2 $3,428.14 49657 $2,523.84 $0.00 $0.00 2 G2 $3,428.14 49659 BR $0.00 $0.00 2 $0.00 49900 $1,658.33 $0.00 $0.00 2 $0.00 49904 $2,943.30 $0.00 $0.00 1 $0.00 49905 $703.22 $0.00 $0.00 2 $0.00 49906 BR $0.00 $0.00 1 $0.00 49999 BR $0.00 $0.00 1 $0.00 50010 $1,461.79 $0.00 $0.00 2 $0.00 50020 $2,108.38 $0.00 $0.00 1 $0.00 50040 $1,810.55 $0.00 $0.00 1 $0.00 50045 $1,822.03 $0.00 $0.00 2 $0.00 50060 $2,214.78 $0.00 $0.00 2 $0.00 50065 $2,347.77 $0.00 $0.00 2 $0.00 50070 $2,346.88 $0.00 $0.00 2 $0.00 50075 $2,828.06 $0.00 $0.00 2 $0.00 50080 $1,693.20 $0.00 $0.00 1 G2 $3,847.27


136


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 50081 $2,485.18 $0.00 $0.00 2 G2 $3,847.27 50100 $2,076.56 $0.00 $0.00 2 $0.00 50120 $1,846.10 $0.00 $0.00 2 $0.00 50125 $2,050.12 $0.00 $0.00 2 $0.00 50130 $2,007.31 $0.00 $0.00 2 $0.00 50135 $2,180.54 $0.00 $0.00 2 $0.00 50200 $1,216.90 $0.00 $0.00 1 A2 $547.17 50205 $1,511.50 $0.00 $0.00 2 $0.00 50220 $2,047.61 $0.00 $0.00 2 $0.00 50225 $2,347.79 $0.00 $0.00 2 $0.00 50230 $2,493.23 $0.00 $0.00 2 $0.00 50234 $2,534.27 $0.00 $0.00 2 $0.00 50236 $2,843.61 $0.00 $0.00 2 $0.00 50240 $2,578.90 $0.00 $0.00 2 $0.00 50250 $2,370.71 $0.00 $0.00 2 $0.00 50280 $1,874.71 $0.00 $0.00 2 $0.00 50290 $1,747.87 $0.00 $0.00 2 $0.00 50300 BR $0.00 $0.00 $0.00 50320 $2,893.34 $0.00 $0.00 2 $0.00 50323 BR $0.00 $0.00 2 $0.00 50325 BR $0.00 $0.00 2 $0.00 50327 $430.01 $0.00 $0.00 2 $0.00 50328 $374.77 $0.00 $0.00 2 $0.00 50329 $346.73 $0.00 $0.00 2 $0.00 50340 $1,930.89 $0.00 $0.00 2 $0.00 50360 $5,189.30 $0.00 $0.00 2 $0.00 50365 $5,781.72 $0.00 $0.00 2 $0.00 50370 $2,420.13 $0.00 $0.00 2 $0.00 50380 $4,055.84 $0.00 $0.00 2 $0.00 50382 $2,437.94 $0.00 $0.00 1 G2 $785.68 50384 $1,977.06 $0.00 $0.00 1 G2 $785.68 50385 $2,349.64 $0.00 $0.00 0 G2 $785.68 50386 $1,547.83 $0.00 $0.00 0 P3 $610.44 50387 $1,159.77 $0.00 $0.00 0 G2 $785.68 50389 $628.16 $0.00 $0.00 1 G2 $289.63 50390 $190.00 $0.00 $0.00 1 A2 $298.44 50391 $241.47 $0.00 $0.00 1 P3 $49.37 50396 $226.27 $0.00 $0.00 0 A2 $289.63 50400 $2,254.50 $0.00 $0.00 2 $0.00 50405 $2,709.98 $0.00 $0.00 2 $0.00 50430 $1,021.03 $0.00 $0.00 0 N1 $0.00


137


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 50431 $317.11 $0.00 $0.00 1 N1 $0.00 50432 $1,658.96 $0.00 $0.00 1 G2 $785.68 50433 $2,234.05 $0.00 $0.00 1 G2 $785.68 50434 $1,768.38 $0.00 $0.00 1 J8 $1,043.85 50435 $929.21 $0.00 $0.00 1 G2 $785.68 50436 $288.42 $0.00 $0.00 1 G2 $785.68 50437 $481.14 $0.00 $0.00 1 G2 $1,368.77 50500 $2,548.01 $0.00 $0.00 2 $0.00 50520 $2,196.15 $0.00 $0.00 2 $0.00 50525 $3,019.36 $0.00 $0.00 2 $0.00 50526 $2,906.54 $0.00 $0.00 2 $0.00 50540 $2,222.54 $0.00 $0.00 2 $0.00 50541 $1,790.46 $0.00 $0.00 2 $0.00 50542 $2,271.38 $0.00 $0.00 2 $0.00 50543 $2,898.49 $0.00 $0.00 2 $0.00 50544 $2,420.57 $0.00 $0.00 2 $0.00 50545 $2,608.25 $0.00 $0.00 2 $0.00 50546 $2,345.16 $0.00 $0.00 2 $0.00 50547 $3,211.35 $0.00 $0.00 2 $0.00 50548 $2,616.70 $0.00 $0.00 2 $0.00 50549 BR $0.00 $0.00 2 $0.00 50551 $702.66 $0.00 $0.00 0 A2 $1,913.25 50553 $755.43 $0.00 $0.00 1 A2 $1,913.25 50555 $801.91 $0.00 $0.00 0 A2 $1,913.25 50557 $816.84 $0.00 $0.00 0 A2 $3,847.27 50561 $925.72 $0.00 $0.00 0 A2 $1,913.25 50562 $1,127.48 $0.00 $0.00 2 G2 $3,847.27 50570 $950.75 $0.00 $0.00 0 G2 $1,368.77 50572 $1,030.51 $0.00 $0.00 0 G2 $289.63 50574 $1,096.63 $0.00 $0.00 0 G2 $785.68 50575 $1,384.42 $0.00 $0.00 1 G2 $1,913.25 50576 $1,092.43 $0.00 $0.00 0 G2 $1,913.25 50580 $1,177.52 $0.00 $0.00 0 G2 $1,913.25 50590 $1,568.30 $0.00 $0.00 1 G2 $1,368.77 50592 $6,428.75 $0.00 $0.00 1 G2 $2,129.56 50593 $9,503.48 $0.00 $0.00 2 J8 $4,540.38 50600 $1,824.98 $0.00 $0.00 2 $0.00 50605 $1,945.93 $0.00 $0.00 2 $0.00 50606 $1,308.80 $0.00 $0.00 1 N1 $0.00 50610 $1,847.62 $0.00 $0.00 2 $0.00 50620 $1,753.63 $0.00 $0.00 2 $0.00


138


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 50630 $1,736.10 $0.00 $0.00 2 $0.00 50650 $2,020.86 $0.00 $0.00 2 $0.00 50660 $2,218.98 $0.00 $0.00 2 $0.00 50684 $216.43 $0.00 $0.00 1 N1 $0.00 50686 $299.97 $0.00 $0.00 0 P2 $70.04 50688 $158.18 $0.00 $0.00 1 A2 $785.68 50690 $195.90 $0.00 $0.00 1 N1 $0.00 50693 $2,082.11 $0.00 $0.00 1 G2 $785.68 50694 $2,289.71 $0.00 $0.00 1 G2 $1,368.77 50695 $2,790.71 $0.00 $0.00 1 G2 $1,368.77 50700 $1,801.09 $0.00 $0.00 2 $0.00 50705 $3,671.17 $0.00 $0.00 1 N1 $0.00 50706 $1,851.13 $0.00 $0.00 1 N1 $0.00 50715 $2,379.49 $0.00 $0.00 2 $0.00 50722 $2,107.07 $0.00 $0.00 2 $0.00 50725 $2,142.09 $0.00 $0.00 2 $0.00 50727 $991.92 $0.00 $0.00 2 G2 $1,368.77 50728 $1,381.98 $0.00 $0.00 2 $0.00 50740 $2,465.23 $0.00 $0.00 2 $0.00 50750 $2,241.13 $0.00 $0.00 2 $0.00 50760 $2,230.02 $0.00 $0.00 2 $0.00 50770 $2,238.44 $0.00 $0.00 2 $0.00 50780 $2,160.92 $0.00 $0.00 2 $0.00 50782 $2,407.55 $0.00 $0.00 2 $0.00 50783 $2,190.67 $0.00 $0.00 2 $0.00 50785 $2,358.25 $0.00 $0.00 2 $0.00 50800 $1,821.85 $0.00 $0.00 2 $0.00 50810 $2,677.62 $0.00 $0.00 2 $0.00 50815 $2,377.29 $0.00 $0.00 2 $0.00 50820 $2,575.09 $0.00 $0.00 2 $0.00 50825 $3,253.82 $0.00 $0.00 2 $0.00 50830 $3,499.16 $0.00 $0.00 2 $0.00 50840 $2,390.85 $0.00 $0.00 2 $0.00 50845 $2,440.57 $0.00 $0.00 2 $0.00 50860 $1,838.10 $0.00 $0.00 2 $0.00 50900 $1,653.75 $0.00 $0.00 2 $0.00 50920 $1,728.29 $0.00 $0.00 2 $0.00 50930 $2,322.46 $0.00 $0.00 2 $0.00 50940 $1,724.97 $0.00 $0.00 2 $0.00 50945 $1,886.88 $0.00 $0.00 2 $0.00 50947 $2,697.72 $0.00 $0.00 2 A2 $2,129.56


139


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 50948 $2,472.83 $0.00 $0.00 2 A2 $3,428.14 50949 BR $0.00 $0.00 2 $0.00 50951 $734.43 $0.00 $0.00 0 A2 $785.68 50953 $775.20 $0.00 $0.00 0 A2 $1,368.77 50955 $828.94 $0.00 $0.00 0 A2 $1,913.25 50957 $835.70 $0.00 $0.00 0 A2 $1,913.25 50961 $752.73 $0.00 $0.00 0 A2 $1,913.25 50970 $716.86 $0.00 $0.00 0 A2 $785.68 50972 $694.76 $0.00 $0.00 0 A2 $1,368.77 50974 $915.77 $0.00 $0.00 0 A2 $1,913.25 50976 $904.32 $0.00 $0.00 0 A2 $1,913.25 50980 $688.55 $0.00 $0.00 0 A2 $1,913.25 51020 $916.97 $0.00 $0.00 2 A2 $785.68 51030 $919.70 $0.00 $0.00 0 A2 $1,368.77 51040 $567.49 $0.00 $0.00 2 A2 $785.68 51045 $975.07 $0.00 $0.00 2 A2 $785.68 51050 $922.35 $0.00 $0.00 2 A2 $1,913.25 51060 $1,136.39 $0.00 $0.00 2 $0.00 51065 $1,131.60 $0.00 $0.00 0 A2 $1,368.77 51080 $798.90 $0.00 $0.00 2 A2 $1,078.70 51100 $125.01 $0.00 $0.00 1 P3 $34.95 51101 $257.84 $0.00 $0.00 1 P3 $95.49 51102 $459.87 $0.00 $0.00 1 A2 $785.68 51500 $1,240.14 $0.00 $0.00 2 A2 $2,129.56 51520 $1,160.51 $0.00 $0.00 2 A2 $785.68 51525 $1,676.99 $0.00 $0.00 2 $0.00 51530 $1,546.57 $0.00 $0.00 2 $0.00 51535 $1,514.24 $0.00 $0.00 2 G2 $1,368.77 51550 $1,898.78 $0.00 $0.00 2 $0.00 51555 $2,488.40 $0.00 $0.00 2 $0.00 51565 $2,540.97 $0.00 $0.00 2 $0.00 51570 $2,872.47 $0.00 $0.00 2 $0.00 51575 $3,535.66 $0.00 $0.00 2 $0.00 51580 $3,674.79 $0.00 $0.00 2 $0.00 51585 $4,094.06 $0.00 $0.00 2 $0.00 51590 $3,751.86 $0.00 $0.00 2 $0.00 51595 $4,253.16 $0.00 $0.00 2 $0.00 51596 $4,573.31 $0.00 $0.00 2 $0.00 51597 $4,455.29 $0.00 $0.00 2 $0.00 51600 $374.89 $0.00 $0.00 1 N1 $0.00 51605 $74.53 $0.00 $0.00 1 N1 $0.00


140


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 51610 $215.33 $0.00 $0.00 1 N1 $0.00 51700 $166.37 $0.00 $0.00 1 P3 $52.61 51701 $109.55 $0.00 $0.00 1 N1 $0.00 51702 $142.22 $0.00 $0.00 1 N1 $0.00 51703 $261.14 $0.00 $0.00 1 P2 $70.04 51705 $184.40 $0.00 $0.00 1 P3 $60.18 51710 $244.85 $0.00 $0.00 1 A2 $289.63 51715 $581.71 $0.00 $0.00 0 J8 $1,799.72 51720 $213.06 $0.00 $0.00 1 P3 $51.89 51725 $384.98 $238.69 $146.29 0 P2 $119.21 51726 $543.54 $375.04 $168.50 1 A2 $119.21 51727 $650.53 $435.85 $214.67 0 P3 $227.02 51728 $646.72 $439.77 $206.95 0 P3 $234.95 51729 $703.83 $453.60 $250.24 0 P3 $236.39 51736 $30.98 $12.39 $18.59 0 N1 $0.00 51741 $31.66 $13.13 $18.53 1 N1 $0.00 51784 $393.95 $173.50 $220.45 1 P3 $30.27 51785 $526.27 $373.61 $152.66 0 A2 $119.21 51792 $438.41 $332.31 $106.10 0 N1 $0.00 51797 $230.10 $162.53 $67.57 0 N1 $0.00 51798 $39.57 $0.00 $0.00 0 N1 $0.00 51800 $2,055.92 $0.00 $0.00 2 $0.00 51820 $2,226.05 $0.00 $0.00 2 $0.00 51840 $1,333.35 $0.00 $0.00 2 $0.00 51841 $1,584.60 $0.00 $0.00 2 $0.00 51845 $1,154.24 $0.00 $0.00 2 $0.00 51860 $1,482.68 $0.00 $0.00 2 $0.00 51865 $1,770.13 $0.00 $0.00 2 $0.00 51880 $925.75 $0.00 $0.00 2 A2 $1,368.77 51900 $1,619.33 $0.00 $0.00 2 $0.00 51920 $1,622.33 $0.00 $0.00 2 $0.00 51925 $2,132.44 $0.00 $0.00 2 $0.00 51940 $3,196.37 $0.00 $0.00 2 $0.00 51960 $2,709.57 $0.00 $0.00 2 $0.00 51980 $1,387.70 $0.00 $0.00 2 $0.00 51990 $1,502.06 $0.00 $0.00 2 $0.00 51992 $1,707.67 $0.00 $0.00 2 J8 $2,833.12 51999 BR $0.00 $0.00 0 $0.00 52000 $409.14 $0.00 $0.00 1 A2 $289.63 52001 $735.61 $0.00 $0.00 1 A2 $1,368.77 52005 $535.70 $0.00 $0.00 1 A2 $785.68


141


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 52007 $904.73 $0.00 $0.00 1 A2 $1,368.77 52010 $742.59 $0.00 $0.00 1 A2 $289.63 52204 $750.17 $0.00 $0.00 1 A2 $785.68 52214 $1,351.47 $0.00 $0.00 1 A2 $785.68 52224 $1,411.08 $0.00 $0.00 1 A2 $785.68 52234 $476.28 $0.00 $0.00 1 A2 $1,368.77 52235 $559.33 $0.00 $0.00 1 A2 $1,368.77 52240 $760.21 $0.00 $0.00 1 A2 $1,913.25 52250 $471.50 $0.00 $0.00 1 A2 $1,368.77 52260 $409.00 $0.00 $0.00 1 A2 $785.68 52265 $748.77 $0.00 $0.00 1 P3 $265.22 52270 $715.74 $0.00 $0.00 1 A2 $785.68 52275 $965.26 $0.00 $0.00 1 A2 $785.68 52276 $515.51 $0.00 $0.00 1 A2 $785.68 52277 $632.82 $0.00 $0.00 0 A2 $1,368.77 52281 $547.74 $0.00 $0.00 1 A2 $785.68 52282 $655.31 $0.00 $0.00 1 A2 $1,368.77 52283 $548.98 $0.00 $0.00 1 A2 $785.68 52285 $557.60 $0.00 $0.00 1 A2 $289.63 52287 $625.36 $0.00 $0.00 1 G2 $785.68 52290 $474.30 $0.00 $0.00 1 A2 $785.68 52300 $555.01 $0.00 $0.00 0 A2 $1,368.77 52301 $567.23 $0.00 $0.00 0 A2 $1,368.77 52305 $541.07 $0.00 $0.00 1 A2 $1,913.25 52310 $485.95 $0.00 $0.00 1 A2 $785.68 52315 $821.80 $0.00 $0.00 1 A2 $785.68 52317 $1,628.90 $0.00 $0.00 1 A2 $1,368.77 52318 $917.09 $0.00 $0.00 1 A2 $1,368.77 52320 $477.17 $0.00 $0.00 1 A2 $1,368.77 52325 $621.49 $0.00 $0.00 1 A2 $1,913.25 52327 $508.52 $0.00 $0.00 1 J8 $2,638.80 52330 $992.54 $0.00 $0.00 1 A2 $1,368.77 52332 $1,021.64 $0.00 $0.00 1 A2 $1,368.77 52334 $498.23 $0.00 $0.00 1 A2 $1,368.77 52341 $560.76 $0.00 $0.00 1 A2 $785.68 52342 $609.22 $0.00 $0.00 1 A2 $1,368.77 52343 $678.09 $0.00 $0.00 1 A2 $785.68 52344 $736.79 $0.00 $0.00 1 A2 $1,368.77 52345 $785.94 $0.00 $0.00 0 A2 $1,368.77 52346 $887.83 $0.00 $0.00 0 A2 $1,913.25 52351 $598.83 $0.00 $0.00 1 A2 $785.68


142


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 52352 $704.48 $0.00 $0.00 1 A2 $1,368.77 52353 $776.49 $0.00 $0.00 1 A2 $1,913.25 52354 $825.72 $0.00 $0.00 1 A2 $1,913.25 52355 $923.59 $0.00 $0.00 1 A2 $1,913.25 52356 $795.30 $0.00 $0.00 1 G2 $1,913.25 52400 $930.13 $0.00 $0.00 1 A2 $1,368.77 52402 $515.66 $0.00 $0.00 1 A2 $1,368.77 52441 $2,424.93 $0.00 $0.00 1 $0.00 52442 $1,834.45 $0.00 $0.00 1 $0.00 52450 $919.09 $0.00 $0.00 1 A2 $1,368.77 52500 $954.76 $0.00 $0.00 1 A2 $1,368.77 52601 $1,644.67 $0.00 $0.00 1 A2 $1,913.25 52630 $784.80 $0.00 $0.00 1 A2 $1,913.25 52640 $619.56 $0.00 $0.00 1 A2 $1,368.77 52647 $3,576.59 $0.00 $0.00 1 A2 $1,913.25 52648 $3,680.32 $0.00 $0.00 1 A2 $1,913.25 52649 $1,589.31 $0.00 $0.00 0 G2 $1,913.25 52700 $860.66 $0.00 $0.00 0 A2 $1,368.77 53000 $290.91 $0.00 $0.00 1 A2 $785.68 53010 $576.99 $0.00 $0.00 1 A2 $1,913.25 53020 $188.81 $0.00 $0.00 1 A2 $785.68 53025 $145.72 $0.00 $0.00 0 R2 $785.68 53040 $767.71 $0.00 $0.00 0 A2 $785.68 53060 $369.15 $0.00 $0.00 1 P3 $81.08 53080 $821.84 $0.00 $0.00 1 A2 $289.63 53085 $1,295.77 $0.00 $0.00 2 G2 $785.68 53200 $306.30 $0.00 $0.00 1 A2 $785.68 53210 $1,513.14 $0.00 $0.00 2 A2 $1,368.77 53215 $1,804.23 $0.00 $0.00 2 A2 $1,913.25 53220 $888.47 $0.00 $0.00 0 A2 $1,368.77 53230 $1,196.44 $0.00 $0.00 2 A2 $1,913.25 53235 $1,231.90 $0.00 $0.00 2 A2 $1,913.25 53240 $829.10 $0.00 $0.00 1 A2 $785.68 53250 $834.65 $0.00 $0.00 1 A2 $1,368.77 53260 $401.77 $0.00 $0.00 1 A2 $785.68 53265 $435.55 $0.00 $0.00 1 A2 $785.68 53270 $422.30 $0.00 $0.00 1 A2 $785.68 53275 $512.01 $0.00 $0.00 1 A2 $785.68 53400 $1,569.86 $0.00 $0.00 2 A2 $1,913.25 53405 $1,699.97 $0.00 $0.00 2 A2 $1,913.25 53410 $1,907.69 $0.00 $0.00 2 A2 $1,913.25


143


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 53415 $2,196.52 $0.00 $0.00 2 $0.00 53420 $1,636.45 $0.00 $0.00 1 A2 $1,913.25 53425 $1,821.68 $0.00 $0.00 2 A2 $1,913.25 53430 $1,894.15 $0.00 $0.00 2 A2 $1,913.25 53431 $2,240.56 $0.00 $0.00 2 A2 $1,913.25 53440 $1,467.39 $0.00 $0.00 2 J8 $6,160.11 53442 $1,526.59 $0.00 $0.00 2 A2 $1,913.25 53444 $1,543.33 $0.00 $0.00 2 J8 $13,004.17 53445 $1,468.64 $0.00 $0.00 2 J8 $13,783.70 53446 $1,254.64 $0.00 $0.00 2 A2 $1,913.25 53447 $1,574.17 $0.00 $0.00 2 J8 $13,523.85 53448 $2,483.63 $0.00 $0.00 2 $0.00 53449 $1,194.46 $0.00 $0.00 2 A2 $1,913.25 53450 $797.40 $0.00 $0.00 1 A2 $785.68 53460 $890.97 $0.00 $0.00 0 A2 $785.68 53500 $1,473.91 $0.00 $0.00 2 $0.00 53502 $949.89 $0.00 $0.00 1 A2 $1,368.77 53505 $949.21 $0.00 $0.00 2 A2 $1,913.25 53510 $1,229.90 $0.00 $0.00 2 A2 $1,913.25 53515 $1,548.03 $0.00 $0.00 2 A2 $1,913.25 53520 $1,087.59 $0.00 $0.00 1 A2 $1,913.25 53600 $163.04 $0.00 $0.00 1 P3 $37.84 53601 $158.40 $0.00 $0.00 1 N1 $0.00 53605 $124.05 $0.00 $0.00 1 A2 $785.68 53620 $231.19 $0.00 $0.00 1 P3 $71.71 53621 $218.28 $0.00 $0.00 1 P3 $74.23 53660 $139.89 $0.00 $0.00 1 P3 $43.24 53661 $137.12 $0.00 $0.00 1 N1 $0.00 53665 $75.57 $0.00 $0.00 1 A2 $785.68 53850 $4,189.50 $0.00 $0.00 1 P2 $1,368.77 53852 $3,850.19 $0.00 $0.00 1 P3 $1,347.37 53854 $3,435.30 $0.00 $0.00 1 G2 $785.68 53855 $1,587.42 $0.00 $0.00 0 P3 $719.27 53860 $3,279.62 $0.00 $0.00 0 P2 $785.68 53899 BR $0.00 $0.00 0 $0.00 54000 $297.59 $0.00 $0.00 0 A2 $785.68 54001 $371.70 $0.00 $0.00 1 A2 $785.68 54015 $606.22 $0.00 $0.00 0 A2 $547.17 54050 $267.30 $0.00 $0.00 1 N1 $0.00 54055 $242.93 $0.00 $0.00 1 P3 $74.95 54056 $290.60 $0.00 $0.00 1 N1 $0.00


144


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 54057 $270.34 $0.00 $0.00 1 A2 $797.93 54060 $362.53 $0.00 $0.00 1 A2 $797.93 54065 $445.10 $0.00 $0.00 1 A2 $797.93 54100 $399.30 $0.00 $0.00 1 A2 $547.17 54105 $520.96 $0.00 $0.00 1 A2 $1,078.70 54110 $1,216.31 $0.00 $0.00 2 A2 $1,368.77 54111 $1,554.05 $0.00 $0.00 2 A2 $1,913.25 54112 $1,824.43 $0.00 $0.00 2 A2 $3,847.27 54115 $886.73 $0.00 $0.00 2 A2 $1,078.70 54120 $1,232.09 $0.00 $0.00 2 A2 $1,368.77 54125 $1,587.83 $0.00 $0.00 2 $0.00 54130 $2,321.09 $0.00 $0.00 2 $0.00 54135 $2,936.64 $0.00 $0.00 2 $0.00 54150 $307.36 $0.00 $0.00 0 A2 $785.68 54160 $434.09 $0.00 $0.00 1 A2 $289.63 54161 $386.65 $0.00 $0.00 1 A2 $785.68 54162 $508.31 $0.00 $0.00 1 A2 $785.68 54163 $428.30 $0.00 $0.00 1 A2 $785.68 54164 $381.88 $0.00 $0.00 1 A2 $785.68 54200 $214.48 $0.00 $0.00 1 P3 $68.47 54205 $1,039.77 $0.00 $0.00 2 A2 $1,913.25 54220 $406.46 $0.00 $0.00 1 A2 $119.21 54230 $189.51 $0.00 $0.00 1 N1 $0.00 54231 $275.48 $0.00 $0.00 1 P3 $65.22 54235 $177.24 $0.00 $0.00 1 P3 $44.68 54240 $203.25 $71.17 $132.08 0 P3 $37.12 54250 $236.63 $22.99 $213.64 0 P3 $11.89 54300 $1,254.83 $0.00 $0.00 2 A2 $1,368.77 54304 $1,457.10 $0.00 $0.00 2 A2 $1,368.77 54308 $1,393.05 $0.00 $0.00 2 A2 $1,913.25 54312 $1,630.67 $0.00 $0.00 2 A2 $1,368.77 54316 $1,984.95 $0.00 $0.00 2 A2 $1,913.25 54318 $1,416.64 $0.00 $0.00 2 A2 $1,368.77 54322 $1,521.11 $0.00 $0.00 2 A2 $1,368.77 54324 $1,898.67 $0.00 $0.00 2 A2 $1,368.77 54326 $1,840.28 $0.00 $0.00 2 A2 $785.68 54328 $1,827.42 $0.00 $0.00 2 A2 $1,368.77 54332 $2,026.24 $0.00 $0.00 2 $0.00 54336 $2,417.00 $0.00 $0.00 2 $0.00 54340 $1,111.22 $0.00 $0.00 2 A2 $1,368.77 54344 $1,949.20 $0.00 $0.00 2 A2 $1,913.25


145


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 54348 $1,936.44 $0.00 $0.00 2 A2 $1,913.25 54352 $2,756.94 $0.00 $0.00 2 A2 $1,913.25 54360 $1,403.81 $0.00 $0.00 2 A2 $1,368.77 54380 $1,792.56 $0.00 $0.00 2 A2 $785.68 54385 $1,954.63 $0.00 $0.00 2 A2 $785.68 54390 $2,519.97 $0.00 $0.00 2 $0.00 54400 $1,034.01 $0.00 $0.00 1 J8 $13,423.19 54401 $1,287.57 $0.00 $0.00 1 J8 $13,752.48 54405 $1,575.13 $0.00 $0.00 2 J8 $13,839.88 54406 $1,421.45 $0.00 $0.00 2 A2 $1,368.77 54408 $1,541.88 $0.00 $0.00 2 A2 $1,913.25 54410 $1,676.74 $0.00 $0.00 2 J8 $13,630.76 54411 $1,999.77 $0.00 $0.00 2 $0.00 54415 $1,033.80 $0.00 $0.00 2 A2 $1,368.77 54416 $1,391.83 $0.00 $0.00 2 J8 $13,612.81 54417 $1,748.01 $0.00 $0.00 2 $0.00 54420 $1,371.64 $0.00 $0.00 2 A2 $785.68 54430 $1,249.68 $0.00 $0.00 2 $0.00 54435 $813.05 $0.00 $0.00 1 A2 $785.68 54437 $1,292.46 $0.00 $0.00 2 G2 $1,368.77 54438 $2,599.06 $0.00 $0.00 2 $0.00 54440 BR $0.00 $0.00 2 A2 $1,368.77 54450 $135.13 $0.00 $0.00 1 A2 $119.21 54500 $144.39 $0.00 $0.00 0 A2 $1,078.70 54505 $410.88 $0.00 $0.00 0 A2 $1,368.77 54512 $1,051.24 $0.00 $0.00 1 A2 $1,368.77 54520 $643.74 $0.00 $0.00 1 A2 $785.68 54522 $1,178.31 $0.00 $0.00 2 A2 $785.68 54530 $991.77 $0.00 $0.00 2 A2 $1,343.39 54535 $1,446.35 $0.00 $0.00 2 $0.00 54550 $961.36 $0.00 $0.00 2 A2 $1,343.39 54560 $1,359.91 $0.00 $0.00 2 G2 $785.68 54600 $882.34 $0.00 $0.00 1 A2 $785.68 54620 $583.50 $0.00 $0.00 1 A2 $1,368.77 54640 $946.91 $0.00 $0.00 0 A2 $1,343.39 54650 $1,386.65 $0.00 $0.00 2 $0.00 54660 $698.91 $0.00 $0.00 0 J8 $2,736.41 54670 $794.15 $0.00 $0.00 0 A2 $785.68 54680 $1,533.30 $0.00 $0.00 2 A2 $785.68 54690 $1,483.92 $0.00 $0.00 2 A2 $2,129.56 54692 $1,599.44 $0.00 $0.00 1 G2 $2,129.56


146


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 54699 BR $0.00 $0.00 2 $0.00 54700 $420.95 $0.00 $0.00 1 A2 $785.68 54800 $252.12 $0.00 $0.00 0 A2 $547.17 54830 $733.28 $0.00 $0.00 0 A2 $785.68 54840 $628.66 $0.00 $0.00 1 A2 $785.68 54860 $819.14 $0.00 $0.00 1 A2 $785.68 54861 $1,104.39 $0.00 $0.00 0 A2 $1,368.77 54865 $702.44 $0.00 $0.00 0 A2 $785.68 54900 $1,595.61 $0.00 $0.00 0 A2 $785.68 54901 $2,103.98 $0.00 $0.00 0 A2 $1,368.77 55000 $231.41 $0.00 $0.00 1 P3 $62.70 55040 $667.34 $0.00 $0.00 1 A2 $1,343.39 55041 $1,002.78 $0.00 $0.00 1 A2 $1,343.39 55060 $749.73 $0.00 $0.00 0 A2 $785.68 55100 $437.59 $0.00 $0.00 1 A2 $547.17 55110 $761.72 $0.00 $0.00 1 A2 $1,368.77 55120 $707.73 $0.00 $0.00 0 A2 $785.68 55150 $967.08 $0.00 $0.00 2 A2 $785.68 55175 $713.50 $0.00 $0.00 0 A2 $1,368.77 55180 $1,360.64 $0.00 $0.00 0 A2 $1,913.25 55200 $865.31 $0.00 $0.00 0 A2 $785.68 55250 $766.99 $0.00 $0.00 1 A2 $785.68 55300 $364.37 $0.00 $0.00 0 N1 $0.00 55400 $969.91 $0.00 $0.00 2 A2 $1,368.77 55500 $790.36 $0.00 $0.00 0 A2 $785.68 55520 $921.55 $0.00 $0.00 2 A2 $785.68 55530 $693.51 $0.00 $0.00 1 A2 $1,368.77 55535 $840.56 $0.00 $0.00 2 A2 $1,343.39 55540 $1,091.28 $0.00 $0.00 1 A2 $1,343.39 55550 $836.44 $0.00 $0.00 2 A2 $2,129.56 55559 BR $0.00 $0.00 2 $0.00 55600 $823.78 $0.00 $0.00 0 R2 $785.68 55605 $1,043.55 $0.00 $0.00 0 $0.00 55650 $1,397.78 $0.00 $0.00 2 $0.00 55680 $686.74 $0.00 $0.00 0 A2 $1,368.77 55700 $469.92 $0.00 $0.00 1 A2 $785.68 55705 $518.77 $0.00 $0.00 1 A2 $785.68 55706 $715.95 $0.00 $0.00 2 G2 $785.68 55720 $879.39 $0.00 $0.00 2 A2 $785.68 55725 $1,239.06 $0.00 $0.00 2 A2 $1,368.77 55801 $2,127.03 $0.00 $0.00 2 $0.00


147


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 55810 $2,569.63 $0.00 $0.00 2 $0.00 55812 $3,133.64 $0.00 $0.00 2 $0.00 55815 $3,413.58 $0.00 $0.00 2 $0.00 55821 $1,702.05 $0.00 $0.00 2 $0.00 55831 $1,839.27 $0.00 $0.00 2 $0.00 55840 $2,599.82 $0.00 $0.00 2 $0.00 55842 $2,785.92 $0.00 $0.00 2 $0.00 55845 $3,177.60 $0.00 $0.00 2 $0.00 55860 $1,704.33 $0.00 $0.00 1 G2 $1,913.25 55862 $2,181.46 $0.00 $0.00 2 $0.00 55865 $2,584.56 $0.00 $0.00 2 $0.00 55866 $3,375.67 $0.00 $0.00 2 $0.00 55870 $344.18 $0.00 $0.00 1 P3 $78.56 55873 $14,074.34 $0.00 $0.00 1 J8 $5,841.08 55874 $6,926.87 $0.00 $0.00 1 G2 $1,913.25 55875 $1,488.81 $0.00 $0.00 0 A2 $1,913.25 55876 $271.10 $0.00 $0.00 1 P3 $77.12 55899 BR $0.00 $0.00 0 $0.00 55920 $872.41 $0.00 $0.00 0 G2 $1,846.53 55970 BR $0.00 $0.00 $0.00 55980 BR $0.00 $0.00 $0.00 56405 $227.51 $0.00 $0.00 1 P3 $56.58 56420 $253.78 $0.00 $0.00 1 P3 $80.72 56440 $371.81 $0.00 $0.00 1 A2 $1,157.19 56441 $294.46 $0.00 $0.00 0 A2 $1,157.19 56442 $97.43 $0.00 $0.00 0 A2 $1,157.19 56501 $271.74 $0.00 $0.00 1 P3 $83.60 56515 $462.94 $0.00 $0.00 1 A2 $797.93 56605 $170.19 $0.00 $0.00 1 P3 $42.88 56606 $76.07 $0.00 $0.00 1 N1 $0.00 56620 $1,050.53 $0.00 $0.00 2 A2 $1,157.19 56625 $1,254.47 $0.00 $0.00 2 A2 $1,157.19 56630 $1,842.70 $0.00 $0.00 2 $0.00 56631 $2,321.81 $0.00 $0.00 2 $0.00 56632 $2,724.80 $0.00 $0.00 2 $0.00 56633 $2,391.70 $0.00 $0.00 2 $0.00 56634 $2,512.93 $0.00 $0.00 2 $0.00 56637 $2,909.50 $0.00 $0.00 2 $0.00 56640 $2,910.49 $0.00 $0.00 2 $0.00 56700 $387.79 $0.00 $0.00 2 A2 $1,157.19 56740 $614.85 $0.00 $0.00 1 A2 $1,157.19


148


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 56800 $494.10 $0.00 $0.00 2 A2 $1,157.19 56805 $2,396.01 $0.00 $0.00 2 G2 $1,157.19 56810 $533.90 $0.00 $0.00 2 A2 $1,157.19 56820 $229.58 $0.00 $0.00 1 P3 $55.49 56821 $303.16 $0.00 $0.00 1 P3 $72.43 57000 $391.02 $0.00 $0.00 0 A2 $1,157.19 57010 $899.41 $0.00 $0.00 0 A2 $1,157.19 57020 $193.54 $0.00 $0.00 0 A2 $1,157.19 57022 $346.90 $0.00 $0.00 0 R2 $547.17 57023 $639.82 $0.00 $0.00 0 A2 $1,078.70 57061 $236.61 $0.00 $0.00 1 P3 $73.87 57065 $398.24 $0.00 $0.00 1 A2 $1,157.19 57100 $181.92 $0.00 $0.00 1 P3 $45.04 57105 $280.54 $0.00 $0.00 1 A2 $1,157.19 57106 $998.79 $0.00 $0.00 2 $0.00 57107 $2,893.79 $0.00 $0.00 2 $0.00 57109 $3,364.67 $0.00 $0.00 2 $0.00 57110 $1,834.82 $0.00 $0.00 2 $0.00 57111 $3,364.68 $0.00 $0.00 2 $0.00 57112 $3,595.40 $0.00 $0.00 2 $0.00 57120 $1,051.68 $0.00 $0.00 2 G2 $1,846.53 57130 $367.27 $0.00 $0.00 2 A2 $1,157.19 57135 $395.38 $0.00 $0.00 1 A2 $1,157.19 57150 $93.67 $0.00 $0.00 1 N1 $0.00 57155 $896.68 $0.00 $0.00 1 A2 $1,157.19 57156 $390.77 $0.00 $0.00 0 G2 $140.63 57160 $155.74 $0.00 $0.00 1 P3 $28.83 57170 $124.55 $0.00 $0.00 0 P3 $29.91 57180 $293.11 $0.00 $0.00 1 A2 $85.47 57200 $617.60 $0.00 $0.00 2 A2 $1,157.19 57210 $754.29 $0.00 $0.00 2 A2 $1,157.19 57220 $661.06 $0.00 $0.00 2 A2 $1,846.53 57230 $817.31 $0.00 $0.00 2 A2 $1,157.19 57240 $1,359.83 $0.00 $0.00 2 A2 $1,846.53 57250 $1,388.74 $0.00 $0.00 2 A2 $1,846.53 57260 $1,702.08 $0.00 $0.00 2 A2 $1,846.53 57265 $1,862.51 $0.00 $0.00 2 A2 $1,846.53 57267 $511.09 $0.00 $0.00 2 N1 $0.00 57268 $994.57 $0.00 $0.00 2 A2 $1,157.19 57270 $1,636.18 $0.00 $0.00 2 $0.00 57280 $1,938.72 $0.00 $0.00 2 $0.00


149


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 57282 $1,027.77 $0.00 $0.00 2 $0.00 57283 $1,411.46 $0.00 $0.00 2 $0.00 57284 $1,655.72 $0.00 $0.00 2 $0.00 57285 $1,374.31 $0.00 $0.00 2 $0.00 57287 $1,375.84 $0.00 $0.00 2 G2 $1,157.19 57288 $1,438.69 $0.00 $0.00 2 J8 $2,474.82 57289 $1,441.34 $0.00 $0.00 2 A2 $2,455.85 57291 $1,171.18 $0.00 $0.00 2 A2 $1,157.19 57292 $1,671.01 $0.00 $0.00 2 $0.00 57295 $978.56 $0.00 $0.00 2 G2 $1,157.19 57296 $1,948.72 $0.00 $0.00 2 $0.00 57300 $1,151.89 $0.00 $0.00 2 A2 $1,157.19 57305 $1,915.06 $0.00 $0.00 2 $0.00 57307 $2,188.00 $0.00 $0.00 2 $0.00 57308 $1,304.90 $0.00 $0.00 2 $0.00 57310 $913.11 $0.00 $0.00 2 G2 $2,455.85 57311 $1,038.17 $0.00 $0.00 2 $0.00 57320 $1,064.16 $0.00 $0.00 2 G2 $1,846.53 57330 $1,454.20 $0.00 $0.00 2 $0.00 57335 $2,375.07 $0.00 $0.00 2 $0.00 57400 $271.84 $0.00 $0.00 0 A2 $1,157.19 57410 $217.02 $0.00 $0.00 1 A2 $1,157.19 57415 $327.35 $0.00 $0.00 0 A2 $1,157.19 57420 $239.74 $0.00 $0.00 1 P3 $57.30 57421 $322.48 $0.00 $0.00 1 P3 $75.31 57423 $1,881.46 $0.00 $0.00 2 $0.00 57425 $1,973.47 $0.00 $0.00 2 $0.00 57426 $1,745.52 $0.00 $0.00 2 G2 $2,455.85 57452 $224.54 $0.00 $0.00 1 P3 $55.49 57454 $316.03 $0.00 $0.00 1 P3 $66.67 57455 $295.57 $0.00 $0.00 1 P3 $70.63 57456 $279.10 $0.00 $0.00 1 P3 $67.39 57460 $592.90 $0.00 $0.00 1 P3 $184.50 57461 $668.71 $0.00 $0.00 1 P3 $197.83 57500 $267.83 $0.00 $0.00 1 P3 $88.29 57505 $212.43 $0.00 $0.00 1 P3 $66.31 57510 $271.35 $0.00 $0.00 1 P3 $63.78 57511 $301.90 $0.00 $0.00 1 P3 $81.08 57513 $298.44 $0.00 $0.00 1 A2 $1,157.19 57520 $631.23 $0.00 $0.00 1 A2 $1,157.19 57522 $545.88 $0.00 $0.00 1 A2 $1,157.19


150


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 57530 $711.99 $0.00 $0.00 2 A2 $1,157.19 57531 $3,556.88 $0.00 $0.00 2 $0.00 57540 $1,590.76 $0.00 $0.00 2 $0.00 57545 $1,684.78 $0.00 $0.00 2 $0.00 57550 $844.42 $0.00 $0.00 2 A2 $1,157.19 57555 $1,238.92 $0.00 $0.00 2 $0.00 57556 $1,161.03 $0.00 $0.00 2 A2 $1,846.53 57558 $259.12 $0.00 $0.00 1 A2 $1,157.19 57700 $645.57 $0.00 $0.00 0 A2 $1,157.19 57720 $636.32 $0.00 $0.00 2 A2 $1,157.19 57800 $124.71 $0.00 $0.00 1 P3 $35.31 58100 $222.02 $0.00 $0.00 1 P3 $46.13 58110 $98.37 $0.00 $0.00 0 N1 $0.00 58120 $534.12 $0.00 $0.00 1 A2 $1,157.19 58140 $1,885.34 $0.00 $0.00 2 $0.00 58145 $1,122.65 $0.00 $0.00 2 A2 $1,157.19 58146 $2,355.01 $0.00 $0.00 2 $0.00 58150 $2,041.28 $0.00 $0.00 2 $0.00 58152 $2,545.78 $0.00 $0.00 2 $0.00 58180 $1,952.73 $0.00 $0.00 2 $0.00 58200 $2,696.82 $0.00 $0.00 2 $0.00 58210 $3,609.65 $0.00 $0.00 2 $0.00 58240 $5,791.49 $0.00 $0.00 2 $0.00 58260 $1,694.44 $0.00 $0.00 2 G2 $1,846.53 58262 $1,884.45 $0.00 $0.00 2 G2 $1,846.53 58263 $2,024.44 $0.00 $0.00 2 $0.00 58267 $2,159.36 $0.00 $0.00 2 $0.00 58270 $1,804.33 $0.00 $0.00 2 $0.00 58275 $2,010.28 $0.00 $0.00 2 $0.00 58280 $2,154.86 $0.00 $0.00 2 $0.00 58285 $2,762.76 $0.00 $0.00 2 $0.00 58290 $2,342.96 $0.00 $0.00 2 $0.00 58291 $2,565.94 $0.00 $0.00 2 $0.00 58292 $2,675.79 $0.00 $0.00 2 $0.00 58293 $2,788.27 $0.00 $0.00 2 $0.00 58294 $2,489.06 $0.00 $0.00 2 $0.00 58300 $139.73 $0.00 $0.00 $0.00 58301 $195.33 $0.00 $0.00 0 P3 $46.13 58321 $152.13 $0.00 $0.00 0 P3 $42.16 58322 $177.70 $0.00 $0.00 0 P3 $44.68 58323 $31.81 $0.00 $0.00 0 P3 $6.13


151


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 58340 $247.08 $0.00 $0.00 1 N1 $0.00 58345 $574.49 $0.00 $0.00 2 R2 $1,157.19 58346 $874.32 $0.00 $0.00 1 A2 $1,157.19 58350 $201.47 $0.00 $0.00 1 A2 $1,846.53 58353 $2,103.43 $0.00 $0.00 1 A2 $1,846.53 58356 $3,927.07 $0.00 $0.00 2 P3 $1,621.24 58400 $899.39 $0.00 $0.00 2 $0.00 58410 $1,648.18 $0.00 $0.00 2 $0.00 58520 $1,663.38 $0.00 $0.00 2 $0.00 58540 $1,861.60 $0.00 $0.00 2 $0.00 58541 $1,767.79 $0.00 $0.00 2 G2 $2,129.56 58542 $1,981.22 $0.00 $0.00 2 G2 $3,428.14 58543 $2,006.59 $0.00 $0.00 2 G2 $3,428.14 58544 $2,169.76 $0.00 $0.00 2 G2 $3,428.14 58545 $1,823.93 $0.00 $0.00 2 A2 $2,129.56 58546 $2,288.59 $0.00 $0.00 2 A2 $3,428.14 58548 $3,719.79 $0.00 $0.00 2 $0.00 58550 $1,797.97 $0.00 $0.00 2 A2 $2,129.56 58552 $1,999.05 $0.00 $0.00 2 G2 $3,428.14 58553 $2,305.49 $0.00 $0.00 2 G2 $3,428.14 58554 $2,674.62 $0.00 $0.00 2 G2 $3,428.14 58555 $631.27 $0.00 $0.00 0 A2 $1,157.19 58558 $2,565.42 $0.00 $0.00 1 A2 $1,157.19 58559 $692.78 $0.00 $0.00 1 A2 $1,846.53 58560 $781.17 $0.00 $0.00 2 A2 $1,846.53 58561 $1,105.20 $0.00 $0.00 0 A2 $1,846.53 58562 $850.72 $0.00 $0.00 1 A2 $1,157.19 58563 $3,529.36 $0.00 $0.00 0 A2 $1,846.53 58565 $3,923.11 $0.00 $0.00 1 J8 $2,472.04 58570 $1,915.50 $0.00 $0.00 2 G2 $3,428.14 58571 $2,132.14 $0.00 $0.00 2 G2 $3,428.14 58572 $2,373.80 $0.00 $0.00 2 G2 $3,428.14 58573 $2,722.25 $0.00 $0.00 2 G2 $3,428.14 58575 $3,584.93 $0.00 $0.00 2 $0.00 58578 BR $0.00 $0.00 2 $0.00 58579 BR $0.00 $0.00 2 $0.00 58600 $750.17 $0.00 $0.00 2 G2 $1,157.19 58605 $677.25 $0.00 $0.00 2 $0.00 58611 $156.09 $0.00 $0.00 2 $0.00 58615 $504.03 $0.00 $0.00 2 G2 $1,157.19 58660 $1,376.26 $0.00 $0.00 2 A2 $2,129.56


152


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 58661 $1,313.44 $0.00 $0.00 2 A2 $2,129.56 58662 $1,438.64 $0.00 $0.00 2 A2 $2,129.56 58670 $749.34 $0.00 $0.00 1 A2 $2,129.56 58671 $751.53 $0.00 $0.00 1 A2 $2,129.56 58672 $1,497.33 $0.00 $0.00 2 A2 $2,129.56 58673 $1,621.86 $0.00 $0.00 2 A2 $2,129.56 58674 $1,518.66 $0.00 $0.00 2 G2 $3,428.14 58679 BR $0.00 $0.00 2 $0.00 58700 $1,601.11 $0.00 $0.00 2 $0.00 58720 $1,493.88 $0.00 $0.00 2 $0.00 58740 $1,807.94 $0.00 $0.00 2 $0.00 58750 $1,886.51 $0.00 $0.00 2 $0.00 58752 $1,741.69 $0.00 $0.00 2 $0.00 58760 $1,659.77 $0.00 $0.00 2 $0.00 58770 $1,745.95 $0.00 $0.00 2 $0.00 58800 $657.77 $0.00 $0.00 1 A2 $1,157.19 58805 $833.24 $0.00 $0.00 2 G2 $1,157.19 58820 $646.68 $0.00 $0.00 2 A2 $1,157.19 58822 $1,530.52 $0.00 $0.00 2 $0.00 58825 $1,426.59 $0.00 $0.00 2 $0.00 58900 $877.87 $0.00 $0.00 2 A2 $1,157.19 58920 $1,436.23 $0.00 $0.00 2 $0.00 58925 $1,525.36 $0.00 $0.00 2 $0.00 58940 $1,075.59 $0.00 $0.00 2 $0.00 58943 $2,337.22 $0.00 $0.00 2 $0.00 58950 $2,241.58 $0.00 $0.00 2 $0.00 58951 $2,854.64 $0.00 $0.00 2 $0.00 58952 $3,237.56 $0.00 $0.00 2 $0.00 58953 $3,981.08 $0.00 $0.00 2 $0.00 58954 $4,306.12 $0.00 $0.00 2 $0.00 58956 $2,718.91 $0.00 $0.00 2 $0.00 58957 $3,144.17 $0.00 $0.00 2 $0.00 58958 $3,451.89 $0.00 $0.00 2 $0.00 58960 $1,918.99 $0.00 $0.00 2 $0.00 58970 $433.47 $0.00 $0.00 0 A2 $287.47 58974 BR $0.00 $0.00 2 A2 $287.47 58976 $488.96 $0.00 $0.00 2 A2 $140.63 58999 BR $0.00 $0.00 1 $0.00 59000 $260.26 $0.00 $0.00 1 P3 $68.11 59001 $369.57 $0.00 $0.00 1 R2 $140.63 59012 $418.01 $0.00 $0.00 0 G2 $140.63


153


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 59015 $321.24 $0.00 $0.00 0 P3 $61.62 59020 $148.95 $69.61 $79.34 0 P3 $33.15 59025 $100.39 $38.10 $62.28 0 P3 $18.38 59030 $214.50 $0.00 $0.00 0 $0.00 59050 $104.39 $0.00 $0.00 0 $0.00 59051 $87.35 $0.00 $0.00 0 $0.00 59070 $846.55 $0.00 $0.00 2 G2 $140.63 59072 $1,070.45 $0.00 $0.00 1 G2 $140.63 59074 $826.14 $0.00 $0.00 2 G2 $140.63 59076 $1,070.45 $0.00 $0.00 2 G2 $140.63 59100 $1,742.66 $0.00 $0.00 2 R2 $1,157.19 59120 $1,658.54 $0.00 $0.00 2 $0.00 59121 $1,659.13 $0.00 $0.00 2 $0.00 59130 $1,777.77 $0.00 $0.00 0 $0.00 59135 $1,702.01 $0.00 $0.00 0 $0.00 59136 $1,903.50 $0.00 $0.00 2 $0.00 59140 $769.25 $0.00 $0.00 2 $0.00 59150 $1,604.91 $0.00 $0.00 2 G2 $2,129.56 59151 $1,564.01 $0.00 $0.00 2 G2 $2,129.56 59160 $426.67 $0.00 $0.00 0 A2 $1,157.19 59200 $151.96 $0.00 $0.00 1 P3 $44.68 59300 $405.81 $0.00 $0.00 0 P3 $98.74 59320 $312.78 $0.00 $0.00 0 A2 $1,157.19 59325 $460.01 $0.00 $0.00 0 $0.00 59350 $577.67 $0.00 $0.00 2 $0.00 59400 $4,365.60 $0.00 $0.00 1 $0.00 59409 $1,678.37 $0.00 $0.00 0 $0.00 59410 $2,146.34 $0.00 $0.00 1 $0.00 59412 $212.74 $0.00 $0.00 0 G2 $1,157.19 59414 $189.14 $0.00 $0.00 0 G2 $1,157.19 59425 $956.39 $0.00 $0.00 0 $0.00 59426 $1,707.87 $0.00 $0.00 0 $0.00 59430 $388.26 $0.00 $0.00 1 $0.00 59510 $4,825.69 $0.00 $0.00 1 $0.00 59514 $1,890.92 $0.00 $0.00 2 $0.00 59515 $2,606.47 $0.00 $0.00 1 $0.00 59525 $998.37 $0.00 $0.00 2 $0.00 59610 $4,563.47 $0.00 $0.00 0 $0.00 59612 $1,885.97 $0.00 $0.00 0 $0.00 59614 $2,341.05 $0.00 $0.00 0 $0.00 59618 $4,892.46 $0.00 $0.00 0 $0.00


154


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 59620 $1,948.42 $0.00 $0.00 2 $0.00 59622 $2,690.70 $0.00 $0.00 0 $0.00 59812 $666.71 $0.00 $0.00 1 A2 $1,157.19 59820 $798.67 $0.00 $0.00 1 A2 $1,157.19 59821 $803.64 $0.00 $0.00 0 A2 $1,157.19 59830 $914.78 $0.00 $0.00 0 $0.00 59840 $451.92 $0.00 $0.00 0 A2 $1,157.19 59841 $800.92 $0.00 $0.00 0 A2 $1,157.19 59850 $718.10 $0.00 $0.00 0 $0.00 59851 $820.72 $0.00 $0.00 0 $0.00 59852 $1,017.94 $0.00 $0.00 0 $0.00 59855 $864.32 $0.00 $0.00 0 $0.00 59856 $1,013.01 $0.00 $0.00 0 $0.00 59857 $1,031.63 $0.00 $0.00 0 $0.00 59866 $426.41 $0.00 $0.00 2 G2 $140.63 59870 $991.74 $0.00 $0.00 2 A2 $1,157.19 59871 $276.12 $0.00 $0.00 0 A2 $1,157.19 59897 BR $0.00 $0.00 1 $0.00 59898 BR $0.00 $0.00 2 $0.00 59899 BR $0.00 $0.00 2 $0.00 60000 $547.77 $0.00 $0.00 0 A2 $564.34 60100 $337.03 $0.00 $0.00 1 P3 $53.69 60200 $2,051.00 $0.00 $0.00 2 A2 $2,129.56 60210 $2,188.26 $0.00 $0.00 2 G2 $2,129.56 60212 $3,078.50 $0.00 $0.00 2 G2 $2,129.56 60220 $2,188.89 $0.00 $0.00 2 G2 $2,129.56 60225 $2,873.81 $0.00 $0.00 2 G2 $2,129.56 60240 $2,830.73 $0.00 $0.00 2 G2 $2,129.56 60252 $4,050.95 $0.00 $0.00 2 $0.00 60254 $5,133.53 $0.00 $0.00 2 $0.00 60260 $3,357.52 $0.00 $0.00 2 $0.00 60270 $4,214.20 $0.00 $0.00 2 $0.00 60271 $3,248.33 $0.00 $0.00 2 $0.00 60280 $1,388.77 $0.00 $0.00 2 A2 $2,129.56 60281 $1,835.58 $0.00 $0.00 2 A2 $2,129.56 60300 $363.13 $0.00 $0.00 1 P3 $78.92 60500 $2,973.28 $0.00 $0.00 2 G2 $2,176.10 60502 $3,966.47 $0.00 $0.00 2 $0.00 60505 $4,719.77 $0.00 $0.00 2 $0.00 60512 $738.79 $0.00 $0.00 2 $0.00 60520 $3,178.77 $0.00 $0.00 2 $0.00


155


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 60521 $3,482.57 $0.00 $0.00 2 $0.00 60522 $4,240.88 $0.00 $0.00 2 $0.00 60540 $3,217.88 $0.00 $0.00 2 $0.00 60545 $3,696.38 $0.00 $0.00 2 $0.00 60600 $4,240.63 $0.00 $0.00 2 $0.00 60605 $5,537.53 $0.00 $0.00 2 $0.00 60650 $3,604.30 $0.00 $0.00 2 $0.00 60659 BR $0.00 $0.00 2 $0.00 60699 BR $0.00 $0.00 2 $0.00 61000 $353.19 $0.00 $0.00 1 R2 $308.47 61001 $346.95 $0.00 $0.00 1 R2 $308.47 61020 $434.62 $0.00 $0.00 1 A2 $394.00 61026 $402.64 $0.00 $0.00 1 A2 $308.47 61050 $326.37 $0.00 $0.00 0 A2 $127.48 61055 $420.97 $0.00 $0.00 1 A2 $127.48 61070 $266.65 $0.00 $0.00 1 A2 $308.47 61105 $1,447.06 $0.00 $0.00 0 $0.00 61107 $968.12 $0.00 $0.00 1 $0.00 61108 $2,821.64 $0.00 $0.00 1 $0.00 61120 $2,320.49 $0.00 $0.00 0 $0.00 61140 $3,929.87 $0.00 $0.00 2 $0.00 61150 $4,203.42 $0.00 $0.00 1 $0.00 61151 $3,092.75 $0.00 $0.00 1 $0.00 61154 $3,959.32 $0.00 $0.00 2 $0.00 61156 $3,851.09 $0.00 $0.00 2 $0.00 61210 $1,132.96 $0.00 $0.00 1 $0.00 61215 $1,593.20 $0.00 $0.00 1 A2 $1,920.83 61250 $2,684.66 $0.00 $0.00 2 $0.00 61253 $2,424.99 $0.00 $0.00 2 $0.00 61304 $5,110.50 $0.00 $0.00 2 $0.00 61305 $6,187.36 $0.00 $0.00 2 $0.00 61312 $6,450.36 $0.00 $0.00 2 $0.00 61313 $6,167.64 $0.00 $0.00 2 $0.00 61314 $5,645.17 $0.00 $0.00 2 $0.00 61315 $6,409.76 $0.00 $0.00 2 $0.00 61316 $270.14 $0.00 $0.00 1 $0.00 61320 $5,888.42 $0.00 $0.00 2 $0.00 61321 $6,555.01 $0.00 $0.00 2 $0.00 61322 $7,392.93 $0.00 $0.00 2 $0.00 61323 $7,329.30 $0.00 $0.00 2 $0.00 61330 $5,690.19 $0.00 $0.00 2 G2 $968.88


156


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 61333 $6,534.05 $0.00 $0.00 2 $0.00 61340 $4,460.49 $0.00 $0.00 2 $0.00 61343 $6,795.61 $0.00 $0.00 2 $0.00 61345 $6,287.23 $0.00 $0.00 2 $0.00 61450 $5,915.96 $0.00 $0.00 2 $0.00 61458 $6,231.20 $0.00 $0.00 2 $0.00 61460 $6,502.32 $0.00 $0.00 2 $0.00 61500 $4,112.13 $0.00 $0.00 2 $0.00 61501 $3,562.91 $0.00 $0.00 2 $0.00 61510 $6,810.07 $0.00 $0.00 2 $0.00 61512 $7,936.92 $0.00 $0.00 2 $0.00 61514 $5,951.82 $0.00 $0.00 2 $0.00 61516 $5,744.28 $0.00 $0.00 2 $0.00 61517 $268.08 $0.00 $0.00 1 $0.00 61518 $8,619.51 $0.00 $0.00 2 $0.00 61519 $9,221.03 $0.00 $0.00 2 $0.00 61520 $11,661.56 $0.00 $0.00 2 $0.00 61521 $9,882.12 $0.00 $0.00 2 $0.00 61522 $6,726.31 $0.00 $0.00 2 $0.00 61524 $6,416.75 $0.00 $0.00 2 $0.00 61526 $11,203.26 $0.00 $0.00 1 $0.00 61530 $9,598.37 $0.00 $0.00 1 $0.00 61531 $3,780.07 $0.00 $0.00 2 $0.00 61533 $4,718.34 $0.00 $0.00 2 $0.00 61534 $5,072.53 $0.00 $0.00 2 $0.00 61535 $3,096.27 $0.00 $0.00 2 $0.00 61536 $7,924.39 $0.00 $0.00 2 $0.00 61537 $7,659.85 $0.00 $0.00 2 $0.00 61538 $8,238.31 $0.00 $0.00 2 $0.00 61539 $7,334.33 $0.00 $0.00 2 $0.00 61540 $6,714.82 $0.00 $0.00 2 $0.00 61541 $6,610.13 $0.00 $0.00 2 $0.00 61543 $6,680.56 $0.00 $0.00 2 $0.00 61544 $5,600.00 $0.00 $0.00 2 $0.00 61545 $9,822.11 $0.00 $0.00 2 $0.00 61546 $7,103.03 $0.00 $0.00 2 $0.00 61548 $4,794.84 $0.00 $0.00 2 $0.00 61550 $3,454.64 $0.00 $0.00 2 $0.00 61552 $3,458.76 $0.00 $0.00 2 $0.00 61556 $5,294.76 $0.00 $0.00 2 $0.00 61557 $5,226.21 $0.00 $0.00 2 $0.00


157


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 61558 $5,528.00 $0.00 $0.00 2 $0.00 61559 $6,817.79 $0.00 $0.00 2 $0.00 61563 $6,092.27 $0.00 $0.00 2 $0.00 61564 $6,937.38 $0.00 $0.00 2 $0.00 61566 $6,912.00 $0.00 $0.00 2 $0.00 61567 $7,883.49 $0.00 $0.00 2 $0.00 61570 $5,750.37 $0.00 $0.00 2 $0.00 61571 $6,119.90 $0.00 $0.00 2 $0.00 61575 $7,753.57 $0.00 $0.00 2 $0.00 61576 $10,725.66 $0.00 $0.00 2 $0.00 61580 $7,661.96 $0.00 $0.00 1 $0.00 61581 $8,377.68 $0.00 $0.00 1 $0.00 61582 $9,667.24 $0.00 $0.00 2 $0.00 61583 $9,106.54 $0.00 $0.00 2 $0.00 61584 $8,975.10 $0.00 $0.00 2 $0.00 61585 $10,210.55 $0.00 $0.00 2 $0.00 61586 $7,707.57 $0.00 $0.00 2 $0.00 61590 $9,449.68 $0.00 $0.00 2 $0.00 61591 $9,626.37 $0.00 $0.00 2 $0.00 61592 $9,962.19 $0.00 $0.00 2 $0.00 61595 $7,416.10 $0.00 $0.00 1 $0.00 61596 $7,595.93 $0.00 $0.00 2 $0.00 61597 $8,937.01 $0.00 $0.00 2 $0.00 61598 $8,846.72 $0.00 $0.00 2 $0.00 61600 $6,659.02 $0.00 $0.00 2 $0.00 61601 $7,529.16 $0.00 $0.00 2 $0.00 61605 $6,766.09 $0.00 $0.00 2 $0.00 61606 $9,329.92 $0.00 $0.00 2 $0.00 61607 $8,896.83 $0.00 $0.00 2 $0.00 61608 $10,203.62 $0.00 $0.00 2 $0.00 61611 $1,153.03 $0.00 $0.00 2 $0.00 61613 $10,305.44 $0.00 $0.00 2 $0.00 61615 $7,347.61 $0.00 $0.00 2 $0.00 61616 $10,384.94 $0.00 $0.00 2 $0.00 61618 $4,045.63 $0.00 $0.00 2 $0.00 61619 $4,530.67 $0.00 $0.00 2 $0.00 61623 $1,671.60 $0.00 $0.00 1 $0.00 61624 $3,371.00 $0.00 $0.00 1 $0.00 61626 $2,578.48 $0.00 $0.00 1 $0.00 61630 $4,032.75 $0.00 $0.00 2 $0.00 61635 $4,261.00 $0.00 $0.00 2 $0.00


158


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 61640 $1,401.00 $0.00 $0.00 $0.00 61641 $492.00 $0.00 $0.00 $0.00 61642 $984.00 $0.00 $0.00 $0.00 61645 $2,357.47 $0.00 $0.00 0 $0.00 61650 $1,586.36 $0.00 $0.00 1 $0.00 61651 $673.65 $0.00 $0.00 1 $0.00 61680 $7,067.09 $0.00 $0.00 2 $0.00 61682 $13,065.57 $0.00 $0.00 2 $0.00 61684 $8,765.94 $0.00 $0.00 2 $0.00 61686 $14,055.89 $0.00 $0.00 2 $0.00 61690 $6,728.27 $0.00 $0.00 2 $0.00 61692 $11,438.19 $0.00 $0.00 2 $0.00 61697 $13,194.62 $0.00 $0.00 2 $0.00 61698 $14,474.27 $0.00 $0.00 2 $0.00 61700 $10,681.78 $0.00 $0.00 2 $0.00 61702 $12,531.98 $0.00 $0.00 2 $0.00 61703 $4,192.61 $0.00 $0.00 2 $0.00 61705 $7,998.18 $0.00 $0.00 2 $0.00 61708 $6,995.58 $0.00 $0.00 2 $0.00 61710 $6,339.00 $0.00 $0.00 0 $0.00 61711 $8,023.00 $0.00 $0.00 2 $0.00 61720 $3,945.97 $0.00 $0.00 1 $0.00 61735 $4,942.01 $0.00 $0.00 1 $0.00 61750 $4,363.60 $0.00 $0.00 1 $0.00 61751 $4,275.38 $0.00 $0.00 1 $0.00 61760 $4,871.81 $0.00 $0.00 1 $0.00 61770 $5,019.95 $0.00 $0.00 1 G2 $1,920.83 61781 $717.70 $0.00 $0.00 0 N1 $0.00 61782 $586.25 $0.00 $0.00 0 N1 $0.00 61783 $718.72 $0.00 $0.00 0 N1 $0.00 61790 $2,717.95 $0.00 $0.00 1 A2 $781.71 61791 $3,456.60 $0.00 $0.00 0 A2 $781.71 61796 $3,115.25 $0.00 $0.00 2 $0.00 61797 $664.36 $0.00 $0.00 2 $0.00 61798 $4,251.70 $0.00 $0.00 2 $0.00 61799 $923.75 $0.00 $0.00 2 $0.00 61800 $468.29 $0.00 $0.00 2 $0.00 61850 $3,034.80 $0.00 $0.00 2 $0.00 61860 $4,828.37 $0.00 $0.00 2 $0.00 61863 $4,672.97 $0.00 $0.00 2 $0.00 61864 $873.32 $0.00 $0.00 2 $0.00


159


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 61867 $7,075.13 $0.00 $0.00 2 $0.00 61868 $1,539.03 $0.00 $0.00 2 $0.00 61870 $3,680.07 $0.00 $0.00 2 $0.00 61880 $1,801.09 $0.00 $0.00 2 G2 $1,483.49 61885 $1,629.68 $0.00 $0.00 0 J8 $16,949.65 61886 $2,677.75 $0.00 $0.00 0 J8 $22,650.55 61888 $1,216.12 $0.00 $0.00 1 J8 $4,536.23 62000 $3,207.43 $0.00 $0.00 1 $0.00 62005 $3,919.88 $0.00 $0.00 2 $0.00 62010 $4,722.39 $0.00 $0.00 2 $0.00 62100 $4,973.45 $0.00 $0.00 2 $0.00 62115 $3,912.89 $0.00 $0.00 2 $0.00 62117 $5,784.00 $0.00 $0.00 2 $0.00 62120 $5,270.33 $0.00 $0.00 2 $0.00 62121 $5,119.00 $0.00 $0.00 2 $0.00 62140 $3,225.90 $0.00 $0.00 2 $0.00 62141 $3,558.70 $0.00 $0.00 2 $0.00 62142 $2,756.50 $0.00 $0.00 2 $0.00 62143 $3,254.52 $0.00 $0.00 2 $0.00 62145 $4,383.86 $0.00 $0.00 2 $0.00 62146 $3,852.47 $0.00 $0.00 2 $0.00 62147 $4,488.64 $0.00 $0.00 2 $0.00 62148 $388.03 $0.00 $0.00 1 $0.00 62160 $584.34 $0.00 $0.00 1 N1 $0.00 62161 $4,681.43 $0.00 $0.00 2 $0.00 62162 $5,838.49 $0.00 $0.00 2 $0.00 62163 $3,783.15 $0.00 $0.00 2 $0.00 62164 $6,449.24 $0.00 $0.00 2 $0.00 62165 $4,778.35 $0.00 $0.00 0 $0.00 62180 $4,968.17 $0.00 $0.00 2 $0.00 62190 $2,882.75 $0.00 $0.00 1 $0.00 62192 $3,034.42 $0.00 $0.00 2 $0.00 62194 $1,362.43 $0.00 $0.00 0 A2 $781.71 62200 $4,253.56 $0.00 $0.00 2 $0.00 62201 $3,759.32 $0.00 $0.00 1 $0.00 62220 $3,183.13 $0.00 $0.00 2 $0.00 62223 $3,281.29 $0.00 $0.00 2 $0.00 62225 $1,668.98 $0.00 $0.00 1 A2 $1,920.83 62230 $2,632.25 $0.00 $0.00 2 A2 $1,920.83 62252 $273.73 $115.81 $157.92 0 P3 $35.31 62256 $1,884.53 $0.00 $0.00 2 $0.00


160


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 62258 $3,496.13 $0.00 $0.00 2 $0.00 62263 $2,209.60 $0.00 $0.00 1 A2 $394.00 62264 $1,356.08 $0.00 $0.00 1 A2 $394.00 62267 $761.98 $0.00 $0.00 0 G2 $298.44 62268 $788.83 $0.00 $0.00 1 A2 $394.00 62269 $809.91 $0.00 $0.00 0 A2 $547.17 62270 $494.33 $0.00 $0.00 1 A2 $308.47 62272 $636.95 $0.00 $0.00 1 A2 $308.47 62273 $537.13 $0.00 $0.00 1 A2 $308.47 62280 $1,063.08 $0.00 $0.00 1 A2 $394.00 62281 $836.33 $0.00 $0.00 1 A2 $394.00 62282 $904.88 $0.00 $0.00 1 A2 $394.00 62284 $655.23 $0.00 $0.00 1 N1 $0.00 62287 $1,737.38 $0.00 $0.00 1 A2 $1,920.83 62290 $1,164.71 $0.00 $0.00 1 N1 $0.00 62291 $1,000.05 $0.00 $0.00 1 N1 $0.00 62292 $1,806.86 $0.00 $0.00 0 R2 $781.71 62294 $2,785.00 $0.00 $0.00 1 A2 $394.00 62302 $713.26 $0.00 $0.00 1 N1 $0.00 62303 $741.77 $0.00 $0.00 1 N1 $0.00 62304 $705.98 $0.00 $0.00 1 N1 $0.00 62305 $770.09 $0.00 $0.00 1 N1 $0.00 62320 $470.64 $0.00 $0.00 1 G2 $308.47 62321 $714.17 $0.00 $0.00 1 G2 $308.47 62322 $441.78 $0.00 $0.00 1 G2 $308.47 62323 $705.05 $0.00 $0.00 1 G2 $308.47 62324 $412.00 $0.00 $0.00 1 G2 $394.00 62325 $635.15 $0.00 $0.00 1 G2 $394.00 62326 $433.82 $0.00 $0.00 1 G2 $394.00 62327 $647.31 $0.00 $0.00 1 G2 $394.00 62350 $1,238.70 $0.00 $0.00 1 J8 $2,480.75 62351 $2,733.64 $0.00 $0.00 2 $0.00 62355 $813.39 $0.00 $0.00 0 A2 $781.71 62360 $974.97 $0.00 $0.00 0 J8 $13,318.99 62361 $1,246.00 $0.00 $0.00 0 J8 $12,912.20 62362 $1,196.51 $0.00 $0.00 0 J8 $13,537.75 62365 $905.04 $0.00 $0.00 0 A2 $1,920.83 62367 $128.95 $0.00 $0.00 1 P3 $21.98 62368 $191.21 $0.00 $0.00 1 P3 $29.91 62369 $389.03 $0.00 $0.00 1 P3 $93.69 62370 $448.98 $0.00 $0.00 1 P3 $89.73


161


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 62380 BR $0.00 $0.00 2 G2 $2,744.32 63001 $3,831.64 $0.00 $0.00 2 G2 $2,744.32 63003 $3,815.56 $0.00 $0.00 2 G2 $2,744.32 63005 $3,661.99 $0.00 $0.00 2 G2 $2,744.32 63011 $3,367.51 $0.00 $0.00 2 $0.00 63012 $3,690.71 $0.00 $0.00 2 $0.00 63015 $4,605.02 $0.00 $0.00 2 $0.00 63016 $4,665.95 $0.00 $0.00 2 $0.00 63017 $3,898.72 $0.00 $0.00 2 $0.00 63020 $3,626.13 $0.00 $0.00 2 G2 $2,744.32 63030 $3,301.12 $0.00 $0.00 2 G2 $2,744.32 63035 $587.37 $0.00 $0.00 2 $0.00 63040 $4,314.48 $0.00 $0.00 2 $0.00 63042 $4,429.97 $0.00 $0.00 2 G2 $2,744.32 63043 BR $0.00 $0.00 2 $0.00 63044 BR $0.00 $0.00 2 N1 $0.00 63045 $3,945.00 $0.00 $0.00 2 G2 $2,744.32 63046 $3,752.08 $0.00 $0.00 2 G2 $2,744.32 63047 $3,767.13 $0.00 $0.00 2 G2 $2,744.32 63048 $719.50 $0.00 $0.00 2 $0.00 63050 $4,794.99 $0.00 $0.00 2 $0.00 63051 $5,292.63 $0.00 $0.00 2 $0.00 63055 $5,041.89 $0.00 $0.00 2 G2 $2,744.32 63056 $4,576.11 $0.00 $0.00 2 G2 $2,744.32 63057 $982.26 $0.00 $0.00 2 $0.00 63064 $5,459.10 $0.00 $0.00 2 $0.00 63066 $632.26 $0.00 $0.00 2 $0.00 63075 $4,239.78 $0.00 $0.00 2 $0.00 63076 $765.38 $0.00 $0.00 2 $0.00 63077 $4,618.15 $0.00 $0.00 2 $0.00 63078 $600.79 $0.00 $0.00 2 $0.00 63081 $5,464.86 $0.00 $0.00 2 $0.00 63082 $821.03 $0.00 $0.00 2 $0.00 63085 $5,859.38 $0.00 $0.00 2 $0.00 63086 $581.93 $0.00 $0.00 2 $0.00 63087 $7,334.98 $0.00 $0.00 2 $0.00 63088 $795.98 $0.00 $0.00 2 $0.00 63090 $6,024.48 $0.00 $0.00 2 $0.00 63091 $541.59 $0.00 $0.00 2 $0.00 63101 $7,177.84 $0.00 $0.00 2 $0.00 63102 $6,896.59 $0.00 $0.00 2 $0.00


162


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 63103 $891.75 $0.00 $0.00 2 $0.00 63170 $4,912.76 $0.00 $0.00 2 $0.00 63172 $4,333.92 $0.00 $0.00 2 $0.00 63173 $5,320.98 $0.00 $0.00 2 $0.00 63180 $4,584.49 $0.00 $0.00 2 $0.00 63182 $5,029.98 $0.00 $0.00 2 $0.00 63185 $3,736.71 $0.00 $0.00 2 $0.00 63190 $3,841.31 $0.00 $0.00 2 $0.00 63191 $4,041.68 $0.00 $0.00 2 $0.00 63194 $4,695.00 $0.00 $0.00 2 $0.00 63195 $4,763.62 $0.00 $0.00 2 $0.00 63196 $4,209.18 $0.00 $0.00 2 $0.00 63197 $5,276.23 $0.00 $0.00 2 $0.00 63198 $4,957.83 $0.00 $0.00 2 $0.00 63199 $5,899.10 $0.00 $0.00 2 $0.00 63200 $4,759.63 $0.00 $0.00 2 $0.00 63250 $9,115.28 $0.00 $0.00 2 $0.00 63251 $9,432.66 $0.00 $0.00 2 $0.00 63252 $9,377.89 $0.00 $0.00 2 $0.00 63265 $5,173.57 $0.00 $0.00 2 $0.00 63266 $5,349.53 $0.00 $0.00 2 $0.00 63267 $4,272.36 $0.00 $0.00 2 $0.00 63268 $4,493.25 $0.00 $0.00 2 $0.00 63270 $6,390.14 $0.00 $0.00 2 $0.00 63271 $6,405.80 $0.00 $0.00 2 $0.00 63272 $5,898.37 $0.00 $0.00 2 $0.00 63273 $5,745.65 $0.00 $0.00 2 $0.00 63275 $5,589.25 $0.00 $0.00 2 $0.00 63276 $5,556.62 $0.00 $0.00 2 $0.00 63277 $4,824.74 $0.00 $0.00 2 $0.00 63278 $4,901.36 $0.00 $0.00 2 $0.00 63280 $6,584.57 $0.00 $0.00 2 $0.00 63281 $6,500.22 $0.00 $0.00 2 $0.00 63282 $6,138.80 $0.00 $0.00 2 $0.00 63283 $5,853.82 $0.00 $0.00 2 $0.00 63285 $8,098.61 $0.00 $0.00 2 $0.00 63286 $7,937.15 $0.00 $0.00 2 $0.00 63287 $8,447.80 $0.00 $0.00 2 $0.00 63290 $8,581.29 $0.00 $0.00 2 $0.00 63295 $1,017.37 $0.00 $0.00 2 $0.00 63300 $5,696.45 $0.00 $0.00 2 $0.00


163


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 63301 $6,587.28 $0.00 $0.00 2 $0.00 63302 $6,704.01 $0.00 $0.00 2 $0.00 63303 $7,114.44 $0.00 $0.00 2 $0.00 63304 $7,227.29 $0.00 $0.00 2 $0.00 63305 $7,306.10 $0.00 $0.00 2 $0.00 63306 $6,792.91 $0.00 $0.00 2 $0.00 63307 $7,480.58 $0.00 $0.00 2 $0.00 63308 $991.52 $0.00 $0.00 2 $0.00 63600 $2,936.80 $0.00 $0.00 0 A2 $781.71 63610 $1,358.69 $0.00 $0.00 0 J8 $1,140.84 63620 $3,435.09 $0.00 $0.00 2 $0.00 63621 $763.39 $0.00 $0.00 2 $0.00 63650 $1,456.81 $0.00 $0.00 1 J8 $4,449.98 63655 $2,576.91 $0.00 $0.00 2 J8 $15,742.69 63661 $1,841.52 $0.00 $0.00 2 G2 $781.71 63662 $2,440.00 $0.00 $0.00 2 G2 $1,483.49 63663 $2,585.79 $0.00 $0.00 2 J8 $4,091.75 63664 $2,529.00 $0.00 $0.00 2 J8 $14,143.70 63685 $1,240.05 $0.00 $0.00 2 J8 $22,581.16 63688 $1,135.03 $0.00 $0.00 1 A2 $1,483.49 63700 $3,897.82 $0.00 $0.00 2 $0.00 63702 $4,428.29 $0.00 $0.00 2 $0.00 63704 $5,093.25 $0.00 $0.00 2 $0.00 63706 $5,662.59 $0.00 $0.00 2 $0.00 63707 $2,851.04 $0.00 $0.00 2 $0.00 63709 $3,423.94 $0.00 $0.00 2 $0.00 63710 $3,435.30 $0.00 $0.00 2 $0.00 63740 $2,949.96 $0.00 $0.00 2 $0.00 63741 $1,991.61 $0.00 $0.00 2 $0.00 63744 $2,158.90 $0.00 $0.00 2 J8 $2,598.27 63746 $1,867.73 $0.00 $0.00 0 A2 $781.71 64400 $388.01 $0.00 $0.00 1 P3 $90.81 64402 $394.83 $0.00 $0.00 1 N1 $0.00 64405 $347.87 $0.00 $0.00 1 P3 $44.32 64408 $340.37 $0.00 $0.00 0 P3 $65.94 64410 $413.51 $0.00 $0.00 0 A2 $394.00 64413 $387.62 $0.00 $0.00 1 P3 $71.35 64415 $402.93 $0.00 $0.00 1 A2 $394.00 64416 $258.09 $0.00 $0.00 1 G2 $394.00 64417 $440.81 $0.00 $0.00 1 A2 $394.00 64418 $437.34 $0.00 $0.00 1 P3 $53.69


164


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 64420 $353.28 $0.00 $0.00 1 A2 $308.47 64421 $488.13 $0.00 $0.00 1 A2 $394.00 64425 $423.84 $0.00 $0.00 1 P3 $72.43 64430 $428.24 $0.00 $0.00 1 A2 $394.00 64435 $427.54 $0.00 $0.00 1 P3 $85.76 64445 $464.25 $0.00 $0.00 1 P3 $81.44 64446 $236.04 $0.00 $0.00 1 G2 $394.00 64447 $404.02 $0.00 $0.00 1 P3 $66.31 64448 $210.49 $0.00 $0.00 1 G2 $394.00 64449 $247.40 $0.00 $0.00 1 G2 $394.00 64450 $271.25 $0.00 $0.00 1 P3 $49.37 64455 $145.63 $0.00 $0.00 0 P3 $19.82 64461 $427.77 $0.00 $0.00 1 G2 $308.47 64462 $241.64 $0.00 $0.00 1 N1 $0.00 64463 $475.75 $0.00 $0.00 1 G2 $308.47 64479 $833.17 $0.00 $0.00 1 A2 $394.00 64480 $362.51 $0.00 $0.00 1 N1 $0.00 64483 $779.31 $0.00 $0.00 1 A2 $394.00 64484 $303.73 $0.00 $0.00 1 N1 $0.00 64486 $359.84 $0.00 $0.00 1 N1 $0.00 64487 $451.42 $0.00 $0.00 1 N1 $0.00 64488 $446.01 $0.00 $0.00 1 N1 $0.00 64489 $631.19 $0.00 $0.00 1 N1 $0.00 64490 $677.30 $0.00 $0.00 2 G2 $394.00 64491 $326.43 $0.00 $0.00 2 N1 $0.00 64492 $327.55 $0.00 $0.00 2 N1 $0.00 64493 $612.41 $0.00 $0.00 2 G2 $394.00 64494 $299.16 $0.00 $0.00 2 N1 $0.00 64495 $300.31 $0.00 $0.00 2 N1 $0.00 64505 $320.98 $0.00 $0.00 1 P3 $63.06 64510 $443.78 $0.00 $0.00 1 A2 $394.00 64517 $561.65 $0.00 $0.00 1 A2 $394.00 64520 $651.51 $0.00 $0.00 1 A2 $394.00 64530 $618.89 $0.00 $0.00 1 A2 $394.00 64553 $741.51 $0.00 $0.00 0 J8 $4,577.94 64555 $641.79 $0.00 $0.00 1 J8 $4,543.84 64561 $2,451.20 $0.00 $0.00 1 J8 $4,587.25 64566 $373.94 $0.00 $0.00 0 P3 $106.67 64568 $1,871.16 $0.00 $0.00 0 J8 $22,750.51 64569 $2,395.25 $0.00 $0.00 0 J8 $5,272.43 64570 $2,137.26 $0.00 $0.00 0 G2 $1,920.83


165


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 64575 $976.24 $0.00 $0.00 1 J8 $14,829.11 64580 $947.72 $0.00 $0.00 2 G2 $9,359.93 64581 $1,987.24 $0.00 $0.00 1 J8 $4,822.88 64585 $771.65 $0.00 $0.00 1 A2 $1,483.49 64590 $807.81 $0.00 $0.00 1 J8 $16,957.58 64595 $764.98 $0.00 $0.00 1 J8 $1,970.38 64600 $1,241.02 $0.00 $0.00 1 A2 $394.00 64605 $2,182.63 $0.00 $0.00 0 A2 $781.71 64610 $2,345.87 $0.00 $0.00 1 A2 $781.71 64611 $349.55 $0.00 $0.00 0 P3 $72.79 64612 $429.42 $0.00 $0.00 1 P3 $76.40 64615 $445.66 $0.00 $0.00 1 P3 $65.22 64616 $378.25 $0.00 $0.00 1 P3 $63.06 64617 $566.75 $0.00 $0.00 1 P3 $87.93 64620 $650.32 $0.00 $0.00 1 A2 $394.00 64630 $678.16 $0.00 $0.00 0 A2 $394.00 64632 $260.33 $0.00 $0.00 0 P3 $41.08 64633 $1,389.42 $0.00 $0.00 1 G2 $781.71 64634 $629.88 $0.00 $0.00 1 N1 $0.00 64635 $1,364.35 $0.00 $0.00 1 G2 $781.71 64636 $567.35 $0.00 $0.00 1 N1 $0.00 64640 $424.43 $0.00 $0.00 1 P3 $91.17 64642 $415.00 $0.00 $0.00 1 P3 $76.40 64643 $266.00 $0.00 $0.00 1 N1 $0.00 64644 $477.12 $0.00 $0.00 1 P3 $93.33 64645 $331.56 $0.00 $0.00 1 N1 $0.00 64646 $435.22 $0.00 $0.00 1 P3 $76.40 64647 $512.00 $0.00 $0.00 1 P3 $86.12 64650 $391.13 $0.00 $0.00 0 P3 $51.17 64653 $472.00 $0.00 $0.00 0 P3 $59.82 64680 $1,002.48 $0.00 $0.00 1 A2 $394.00 64681 $1,503.84 $0.00 $0.00 1 A2 $394.00 64702 $1,548.26 $0.00 $0.00 1 A2 $781.71 64704 $973.54 $0.00 $0.00 2 A2 $781.71 64708 $1,692.64 $0.00 $0.00 2 G2 $781.71 64712 $1,755.86 $0.00 $0.00 2 G2 $781.71 64713 $2,294.90 $0.00 $0.00 2 G2 $781.71 64714 $2,072.60 $0.00 $0.00 2 G2 $781.71 64716 $1,645.92 $0.00 $0.00 2 A2 $781.71 64718 $2,019.71 $0.00 $0.00 0 A2 $781.71 64719 $1,231.67 $0.00 $0.00 1 A2 $781.71


166


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 64721 $1,460.96 $0.00 $0.00 1 A2 $781.71 64722 $1,235.42 $0.00 $0.00 2 A2 $781.71 64726 $831.97 $0.00 $0.00 1 A2 $781.71 64727 $554.79 $0.00 $0.00 1 N1 $0.00 64732 $1,392.51 $0.00 $0.00 2 A2 $781.71 64734 $1,457.00 $0.00 $0.00 0 A2 $781.71 64736 $1,332.93 $0.00 $0.00 2 A2 $781.71 64738 $1,549.61 $0.00 $0.00 2 A2 $781.71 64740 $1,410.91 $0.00 $0.00 2 A2 $781.71 64742 $1,539.12 $0.00 $0.00 2 A2 $781.71 64744 $1,536.53 $0.00 $0.00 0 A2 $781.71 64746 $1,343.11 $0.00 $0.00 2 A2 $781.71 64755 $2,788.25 $0.00 $0.00 2 $0.00 64760 $1,572.30 $0.00 $0.00 2 $0.00 64763 $1,721.55 $0.00 $0.00 2 G2 $781.71 64766 $1,801.95 $0.00 $0.00 2 G2 $1,920.83 64771 $1,763.11 $0.00 $0.00 2 A2 $781.71 64772 $1,778.31 $0.00 $0.00 2 A2 $781.71 64774 $1,284.95 $0.00 $0.00 1 A2 $781.71 64776 $1,179.77 $0.00 $0.00 0 A2 $781.71 64778 $478.01 $0.00 $0.00 1 N1 $0.00 64782 $1,385.50 $0.00 $0.00 1 A2 $781.71 64783 $649.19 $0.00 $0.00 1 N1 $0.00 64784 $2,261.53 $0.00 $0.00 0 A2 $781.71 64786 $3,308.64 $0.00 $0.00 2 A2 $1,920.83 64787 $734.15 $0.00 $0.00 0 N1 $0.00 64788 $1,255.98 $0.00 $0.00 1 A2 $781.71 64790 $2,530.61 $0.00 $0.00 0 A2 $781.71 64792 $3,677.23 $0.00 $0.00 2 A2 $1,920.83 64795 $598.46 $0.00 $0.00 1 A2 $781.71 64802 $1,993.80 $0.00 $0.00 2 A2 $781.71 64804 $2,896.87 $0.00 $0.00 2 $0.00 64809 $2,954.24 $0.00 $0.00 2 $0.00 64818 $1,988.11 $0.00 $0.00 2 $0.00 64820 $2,298.93 $0.00 $0.00 1 G2 $781.71 64821 $2,146.95 $0.00 $0.00 1 A2 $1,256.79 64822 $2,146.95 $0.00 $0.00 1 G2 $1,256.79 64823 $2,440.78 $0.00 $0.00 1 G2 $1,256.79 64831 $2,317.63 $0.00 $0.00 1 A2 $1,920.83 64832 $1,018.92 $0.00 $0.00 0 N1 $0.00 64834 $2,277.77 $0.00 $0.00 0 A2 $1,920.83


167


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 64835 $2,485.44 $0.00 $0.00 2 A2 $1,920.83 64836 $2,548.62 $0.00 $0.00 2 A2 $1,920.83 64837 $1,119.08 $0.00 $0.00 2 N1 $0.00 64840 $2,898.98 $0.00 $0.00 2 A2 $1,920.83 64856 $3,101.96 $0.00 $0.00 1 A2 $1,920.83 64857 $3,207.89 $0.00 $0.00 2 A2 $1,920.83 64858 $3,704.57 $0.00 $0.00 2 A2 $1,920.83 64859 $779.01 $0.00 $0.00 2 N1 $0.00 64861 $4,121.62 $0.00 $0.00 2 A2 $1,920.83 64862 $4,338.43 $0.00 $0.00 2 A2 $1,920.83 64864 $2,663.57 $0.00 $0.00 2 A2 $1,920.83 64865 $3,434.04 $0.00 $0.00 2 A2 $1,920.83 64866 $3,640.22 $0.00 $0.00 2 $0.00 64868 $3,155.13 $0.00 $0.00 2 $0.00 64872 $351.00 $0.00 $0.00 2 N1 $0.00 64874 $533.94 $0.00 $0.00 2 N1 $0.00 64876 $568.17 $0.00 $0.00 2 N1 $0.00 64885 $3,455.01 $0.00 $0.00 2 J8 $3,575.47 64886 $4,004.40 $0.00 $0.00 2 J8 $3,172.29 64890 $3,294.36 $0.00 $0.00 2 J8 $3,075.21 64891 $3,612.12 $0.00 $0.00 2 G2 $1,920.83 64892 $3,295.11 $0.00 $0.00 2 A2 $1,920.83 64893 $3,429.01 $0.00 $0.00 2 G2 $1,920.83 64895 $4,116.15 $0.00 $0.00 2 A2 $1,920.83 64896 $4,598.26 $0.00 $0.00 2 A2 $1,920.83 64897 $3,930.16 $0.00 $0.00 2 G2 $1,920.83 64898 $4,323.91 $0.00 $0.00 2 A2 $1,920.83 64901 $1,919.79 $0.00 $0.00 2 N1 $0.00 64902 $2,059.55 $0.00 $0.00 2 N1 $0.00 64905 $3,209.24 $0.00 $0.00 2 A2 $1,920.83 64907 $3,908.12 $0.00 $0.00 2 A2 $1,920.83 64910 $2,504.98 $0.00 $0.00 2 J8 $2,613.64 64911 $3,157.94 $0.00 $0.00 2 $0.00 64912 $2,232.00 $0.00 $0.00 2 G2 $1,920.83 64913 $451.73 $0.00 $0.00 2 N1 $0.00 64999 BR $0.00 $0.00 0 $0.00 65091 $2,071.55 $0.00 $0.00 0 A2 $1,303.47 65093 $2,046.44 $0.00 $0.00 1 A2 $1,303.47 65101 $2,405.35 $0.00 $0.00 1 A2 $1,303.47 65103 $2,510.97 $0.00 $0.00 1 A2 $1,303.47 65105 $2,765.65 $0.00 $0.00 2 A2 $1,303.47


168


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 65110 $3,833.25 $0.00 $0.00 2 A2 $1,303.47 65112 $4,433.21 $0.00 $0.00 2 A2 $1,303.47 65114 $4,644.90 $0.00 $0.00 2 A2 $1,303.47 65125 $1,467.39 $0.00 $0.00 1 G2 $805.14 65130 $2,384.21 $0.00 $0.00 1 A2 $1,303.47 65135 $2,417.44 $0.00 $0.00 1 A2 $1,303.47 65140 $2,555.34 $0.00 $0.00 1 A2 $1,303.47 65150 $1,786.06 $0.00 $0.00 0 A2 $1,303.47 65155 $2,753.89 $0.00 $0.00 1 A2 $1,303.47 65175 $2,079.14 $0.00 $0.00 1 A2 $1,303.47 65205 $193.09 $0.00 $0.00 1 N1 $0.00 65210 $215.23 $0.00 $0.00 1 N1 $0.00 65220 $198.97 $0.00 $0.00 1 N1 $0.00 65222 $234.20 $0.00 $0.00 1 N1 $0.00 65235 $2,231.22 $0.00 $0.00 0 A2 $977.33 65260 $2,903.35 $0.00 $0.00 2 A2 $977.33 65265 $3,513.71 $0.00 $0.00 2 A2 $977.33 65270 $857.63 $0.00 $0.00 0 A2 $805.14 65272 $1,569.25 $0.00 $0.00 1 A2 $805.14 65273 $1,151.94 $0.00 $0.00 1 $0.00 65275 $1,770.25 $0.00 $0.00 0 A2 $1,303.47 65280 $2,157.97 $0.00 $0.00 0 A2 $1,771.76 65285 $3,530.10 $0.00 $0.00 1 A2 $1,771.76 65286 $2,213.72 $0.00 $0.00 1 P3 $467.02 65290 $1,575.64 $0.00 $0.00 1 A2 $1,303.47 65400 $2,140.48 $0.00 $0.00 1 A2 $415.87 65410 $461.25 $0.00 $0.00 0 A2 $805.14 65420 $1,634.90 $0.00 $0.00 1 A2 $805.14 65426 $2,073.06 $0.00 $0.00 1 A2 $805.14 65430 $362.70 $0.00 $0.00 1 N1 $0.00 65435 $254.94 $0.00 $0.00 1 P3 $48.29 65436 $1,232.77 $0.00 $0.00 1 P3 $211.89 65450 $1,022.36 $0.00 $0.00 1 G2 $146.05 65600 $1,258.70 $0.00 $0.00 1 P3 $247.92 65710 $3,491.12 $0.00 $0.00 2 A2 $1,771.76 65730 $3,856.37 $0.00 $0.00 2 A2 $1,771.76 65750 $3,856.61 $0.00 $0.00 2 A2 $1,771.76 65755 $3,853.55 $0.00 $0.00 2 A2 $1,771.76 65756 $3,556.75 $0.00 $0.00 2 G2 $1,771.76 65757 BR $0.00 $0.00 0 N1 $0.00 65760 BR $0.00 $0.00 $0.00


169


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 65765 BR $0.00 $0.00 $0.00 65767 BR $0.00 $0.00 $0.00 65770 $4,880.47 $0.00 $0.00 2 J8 $7,734.39 65771 BR $0.00 $0.00 $0.00 65772 $1,411.88 $0.00 $0.00 1 A2 $415.87 65775 $1,685.63 $0.00 $0.00 1 A2 $805.14 65778 $4,459.59 $0.00 $0.00 0 N1 $0.00 65779 $3,934.45 $0.00 $0.00 0 N1 $0.00 65780 $2,772.19 $0.00 $0.00 1 A2 $1,303.47 65781 $4,016.54 $0.00 $0.00 2 A2 $1,771.76 65782 $3,696.32 $0.00 $0.00 1 A2 $1,303.47 65785 $6,346.01 $0.00 $0.00 1 P2 $1,771.76 65800 $373.82 $0.00 $0.00 1 A2 $977.33 65810 $1,457.21 $0.00 $0.00 1 A2 $977.33 65815 $2,043.46 $0.00 $0.00 1 A2 $977.33 65820 $2,302.69 $0.00 $0.00 0 A2 $1,771.76 65850 $2,669.77 $0.00 $0.00 1 A2 $977.33 65855 $1,071.84 $0.00 $0.00 1 P3 $136.57 65860 $1,062.89 $0.00 $0.00 0 P3 $178.74 65865 $1,433.98 $0.00 $0.00 1 A2 $977.33 65870 $1,879.32 $0.00 $0.00 1 A2 $977.33 65875 $1,970.59 $0.00 $0.00 1 A2 $977.33 65880 $2,009.12 $0.00 $0.00 1 A2 $1,771.76 65900 $2,935.93 $0.00 $0.00 2 A2 $977.33 65920 $2,455.02 $0.00 $0.00 1 A2 $977.33 65930 $2,025.46 $0.00 $0.00 1 A2 $977.33 66020 $582.57 $0.00 $0.00 1 A2 $977.33 66030 $531.16 $0.00 $0.00 1 A2 $977.33 66130 $2,262.24 $0.00 $0.00 0 A2 $805.14 66150 $2,661.40 $0.00 $0.00 1 A2 $1,771.76 66155 $2,659.37 $0.00 $0.00 1 A2 $1,771.76 66160 $2,993.67 $0.00 $0.00 1 A2 $977.33 66170 $3,738.67 $0.00 $0.00 2 A2 $977.33 66172 $4,719.42 $0.00 $0.00 2 A2 $977.33 66174 $3,014.42 $0.00 $0.00 2 A2 $1,771.76 66175 $3,445.86 $0.00 $0.00 2 A2 $1,771.76 66179 $3,101.93 $0.00 $0.00 2 G2 $1,771.76 66180 $3,619.27 $0.00 $0.00 2 J8 $2,363.77 66183 $2,965.42 $0.00 $0.00 2 J8 $2,361.93 66184 $2,262.61 $0.00 $0.00 2 G2 $977.33 66185 $2,437.79 $0.00 $0.00 2 A2 $977.33


170


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 66225 $2,991.87 $0.00 $0.00 1 A2 $1,771.76 66250 $2,415.21 $0.00 $0.00 1 A2 $805.14 66500 $1,097.62 $0.00 $0.00 1 A2 $977.33 66505 $1,199.21 $0.00 $0.00 1 A2 $977.33 66600 $2,559.36 $0.00 $0.00 1 A2 $1,771.76 66605 $3,220.19 $0.00 $0.00 1 A2 $977.33 66625 $1,341.34 $0.00 $0.00 1 A2 $977.33 66630 $1,803.15 $0.00 $0.00 1 A2 $977.33 66635 $1,736.84 $0.00 $0.00 1 A2 $977.33 66680 $1,674.45 $0.00 $0.00 1 A2 $977.33 66682 $2,077.93 $0.00 $0.00 1 A2 $977.33 66700 $1,385.63 $0.00 $0.00 0 A2 $977.33 66710 $1,417.63 $0.00 $0.00 1 A2 $805.14 66711 $1,945.84 $0.00 $0.00 1 A2 $977.33 66720 $1,488.31 $0.00 $0.00 1 A2 $805.14 66740 $1,329.94 $0.00 $0.00 1 A2 $805.14 66761 $939.86 $0.00 $0.00 1 P3 $190.27 66762 $1,482.71 $0.00 $0.00 1 P2 $255.60 66770 $1,606.24 $0.00 $0.00 1 P2 $255.60 66820 $1,268.39 $0.00 $0.00 1 G2 $977.33 66821 $1,048.28 $0.00 $0.00 1 A2 $255.60 66825 $2,398.23 $0.00 $0.00 0 A2 $977.33 66830 $2,144.82 $0.00 $0.00 1 A2 $977.33 66840 $2,237.41 $0.00 $0.00 1 A2 $977.33 66850 $2,472.77 $0.00 $0.00 1 A2 $977.33 66852 $2,682.02 $0.00 $0.00 0 A2 $1,771.76 66920 $2,270.77 $0.00 $0.00 0 A2 $977.33 66930 $2,580.08 $0.00 $0.00 0 A2 $1,771.76 66940 $2,475.00 $0.00 $0.00 0 A2 $977.33 66982 $2,498.10 $0.00 $0.00 1 A2 $977.33 66983 $2,265.32 $0.00 $0.00 1 A2 $977.33 66984 $2,014.94 $0.00 $0.00 1 A2 $977.33 66985 $2,394.65 $0.00 $0.00 1 A2 $977.33 66986 $2,820.79 $0.00 $0.00 1 A2 $977.33 66990 $266.60 $0.00 $0.00 1 N1 $0.00 66999 BR $0.00 $0.00 0 $0.00 67005 $1,528.61 $0.00 $0.00 1 A2 $977.33 67010 $1,694.12 $0.00 $0.00 1 A2 $977.33 67015 $1,825.13 $0.00 $0.00 1 A2 $977.33 67025 $2,333.19 $0.00 $0.00 1 A2 $977.33 67027 $2,706.66 $0.00 $0.00 2 A2 $1,614.05


171


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 67028 $316.81 $0.00 $0.00 1 P3 $48.29 67030 $1,625.05 $0.00 $0.00 1 A2 $977.33 67031 $1,216.29 $0.00 $0.00 1 A2 $255.60 67036 $2,985.63 $0.00 $0.00 2 A2 $1,771.76 67039 $3,923.82 $0.00 $0.00 2 A2 $1,771.76 67040 $4,420.15 $0.00 $0.00 2 A2 $1,771.76 67041 $4,117.94 $0.00 $0.00 2 G2 $1,771.76 67042 $4,700.99 $0.00 $0.00 2 G2 $1,771.76 67043 $5,044.44 $0.00 $0.00 2 G2 $1,771.76 67101 $2,511.93 $0.00 $0.00 1 P3 $203.24 67105 $2,254.00 $0.00 $0.00 1 P3 $173.33 67107 $3,864.36 $0.00 $0.00 2 G2 $1,771.76 67108 $4,991.02 $0.00 $0.00 2 G2 $1,771.76 67110 $2,725.66 $0.00 $0.00 1 P3 $508.10 67113 $5,422.36 $0.00 $0.00 2 G2 $1,771.76 67115 $1,552.74 $0.00 $0.00 1 A2 $1,771.76 67120 $2,135.55 $0.00 $0.00 1 A2 $977.33 67121 $2,888.51 $0.00 $0.00 2 A2 $977.33 67141 $1,667.63 $0.00 $0.00 1 A2 $146.05 67145 $1,646.44 $0.00 $0.00 1 P2 $255.60 67208 $1,814.88 $0.00 $0.00 1 P2 $146.05 67210 $1,626.54 $0.00 $0.00 1 P2 $255.60 67218 $4,152.40 $0.00 $0.00 1 A2 $1,303.47 67220 $1,700.50 $0.00 $0.00 1 P2 $255.60 67221 $895.71 $0.00 $0.00 1 P3 $157.48 67225 $88.50 $0.00 $0.00 1 N1 $0.00 67227 $1,861.40 $0.00 $0.00 1 P3 $165.04 67228 $3,139.72 $0.00 $0.00 1 P3 $180.90 67229 $3,507.45 $0.00 $0.00 1 R2 $255.60 67250 $2,516.10 $0.00 $0.00 1 A2 $805.14 67255 $2,700.92 $0.00 $0.00 2 A2 $977.33 67299 BR $0.00 $0.00 0 $0.00 67311 $1,892.70 $0.00 $0.00 1 A2 $805.14 67312 $2,288.17 $0.00 $0.00 1 A2 $1,303.47 67314 $2,134.04 $0.00 $0.00 1 A2 $805.14 67316 $2,568.74 $0.00 $0.00 0 A2 $805.14 67318 $2,120.88 $0.00 $0.00 1 A2 $805.14 67320 $956.38 $0.00 $0.00 1 N1 $0.00 67331 $964.55 $0.00 $0.00 1 N1 $0.00 67332 $1,048.97 $0.00 $0.00 1 N1 $0.00 67334 $896.08 $0.00 $0.00 1 N1 $0.00


172


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 67335 $468.24 $0.00 $0.00 1 N1 $0.00 67340 $1,062.61 $0.00 $0.00 2 N1 $0.00 67343 $2,096.27 $0.00 $0.00 1 A2 $805.14 67345 $782.50 $0.00 $0.00 1 P3 $127.21 67346 $648.85 $0.00 $0.00 0 A2 $1,303.47 67399 BR $0.00 $0.00 2 $0.00 67400 $3,007.03 $0.00 $0.00 1 A2 $1,303.47 67405 $2,499.03 $0.00 $0.00 1 A2 $805.14 67412 $2,751.03 $0.00 $0.00 1 A2 $805.14 67413 $2,780.42 $0.00 $0.00 2 A2 $805.14 67414 $4,161.55 $0.00 $0.00 2 G2 $1,303.47 67415 $322.97 $0.00 $0.00 0 A2 $805.14 67420 $5,195.44 $0.00 $0.00 2 A2 $1,303.47 67430 $3,834.67 $0.00 $0.00 2 A2 $1,303.47 67440 $3,809.98 $0.00 $0.00 2 A2 $1,303.47 67445 $4,554.07 $0.00 $0.00 2 A2 $1,303.47 67450 $3,959.08 $0.00 $0.00 2 A2 $1,303.47 67500 $237.78 $0.00 $0.00 1 G2 $146.05 67505 $286.76 $0.00 $0.00 1 P3 $40.00 67515 $309.00 $0.00 $0.00 1 P3 $51.89 67550 $3,129.90 $0.00 $0.00 1 A2 $1,303.47 67560 $3,116.61 $0.00 $0.00 0 A2 $1,303.47 67570 $3,999.95 $0.00 $0.00 2 A2 $1,303.47 67599 BR $0.00 $0.00 2 $0.00 67700 $865.31 $0.00 $0.00 1 P2 $146.05 67710 $729.87 $0.00 $0.00 1 P3 $194.95 67715 $773.81 $0.00 $0.00 1 A2 $805.14 67800 $403.52 $0.00 $0.00 1 P3 $76.76 67801 $520.63 $0.00 $0.00 1 P3 $93.33 67805 $646.64 $0.00 $0.00 1 P3 $119.64 67808 $1,179.85 $0.00 $0.00 1 A2 $805.14 67810 $549.43 $0.00 $0.00 1 P3 $132.25 67820 $157.81 $0.00 $0.00 1 N1 $0.00 67825 $417.50 $0.00 $0.00 1 P3 $78.56 67830 $857.75 $0.00 $0.00 1 A2 $415.87 67835 $1,410.59 $0.00 $0.00 0 A2 $805.14 67840 $880.55 $0.00 $0.00 1 P3 $203.96 67850 $674.99 $0.00 $0.00 1 P3 $151.71 67875 $551.10 $0.00 $0.00 1 G2 $415.87 67880 $1,468.99 $0.00 $0.00 1 A2 $805.14 67882 $1,811.49 $0.00 $0.00 1 A2 $805.14


173


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 67900 $2,040.74 $0.00 $0.00 1 A2 $805.14 67901 $2,460.66 $0.00 $0.00 1 A2 $805.14 67902 $2,313.52 $0.00 $0.00 1 A2 $1,303.47 67903 $1,910.04 $0.00 $0.00 1 A2 $805.14 67904 $2,350.73 $0.00 $0.00 1 A2 $805.14 67906 $1,530.73 $0.00 $0.00 1 A2 $1,303.47 67908 $1,597.60 $0.00 $0.00 1 A2 $805.14 67909 $1,724.39 $0.00 $0.00 1 A2 $805.14 67911 $1,793.34 $0.00 $0.00 1 A2 $805.14 67912 $2,833.09 $0.00 $0.00 1 A2 $805.14 67914 $1,374.54 $0.00 $0.00 1 A2 $805.14 67915 $1,122.12 $0.00 $0.00 1 P3 $228.47 67916 $1,731.26 $0.00 $0.00 1 A2 $805.14 67917 $1,891.37 $0.00 $0.00 1 A2 $805.14 67921 $1,349.16 $0.00 $0.00 1 A2 $805.14 67922 $1,090.17 $0.00 $0.00 1 P3 $223.06 67923 $1,837.45 $0.00 $0.00 1 A2 $805.14 67924 $1,895.27 $0.00 $0.00 1 A2 $805.14 67930 $1,173.32 $0.00 $0.00 1 P3 $234.23 67935 $1,903.72 $0.00 $0.00 1 A2 $805.14 67938 $781.28 $0.00 $0.00 1 P2 $146.05 67950 $1,832.87 $0.00 $0.00 1 A2 $805.14 67961 $1,846.79 $0.00 $0.00 0 A2 $805.14 67966 $2,464.80 $0.00 $0.00 1 A2 $805.14 67971 $2,320.69 $0.00 $0.00 1 A2 $805.14 67973 $2,986.53 $0.00 $0.00 2 A2 $805.14 67974 $2,983.62 $0.00 $0.00 2 A2 $1,303.47 67975 $2,195.99 $0.00 $0.00 1 A2 $805.14 67999 BR $0.00 $0.00 0 $0.00 68020 $376.01 $0.00 $0.00 1 P3 $69.19 68040 $206.46 $0.00 $0.00 1 P3 $31.71 68100 $544.91 $0.00 $0.00 1 P3 $126.84 68110 $733.21 $0.00 $0.00 1 P3 $166.12 68115 $994.10 $0.00 $0.00 1 A2 $805.14 68130 $1,668.42 $0.00 $0.00 1 A2 $805.14 68135 $490.20 $0.00 $0.00 1 P3 $88.65 68200 $129.94 $0.00 $0.00 1 N1 $0.00 68320 $2,343.86 $0.00 $0.00 1 A2 $805.14 68325 $2,109.24 $0.00 $0.00 1 A2 $1,303.47 68326 $2,071.08 $0.00 $0.00 1 A2 $1,303.47 68328 $2,268.10 $0.00 $0.00 0 A2 $805.14


174


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 68330 $1,958.20 $0.00 $0.00 0 A2 $977.33 68335 $2,078.24 $0.00 $0.00 1 A2 $1,303.47 68340 $1,776.38 $0.00 $0.00 0 A2 $805.14 68360 $1,725.76 $0.00 $0.00 1 A2 $1,303.47 68362 $2,110.51 $0.00 $0.00 1 A2 $805.14 68371 $1,252.33 $0.00 $0.00 1 A2 $805.14 68399 BR $0.00 $0.00 0 $0.00 68400 $926.49 $0.00 $0.00 1 P3 $229.55 68420 $1,023.52 $0.00 $0.00 1 P3 $243.24 68440 $330.97 $0.00 $0.00 1 P3 $67.03 68500 $3,205.96 $0.00 $0.00 1 A2 $1,303.47 68505 $3,133.05 $0.00 $0.00 1 A2 $1,303.47 68510 $1,452.41 $0.00 $0.00 0 A2 $805.14 68520 $2,144.59 $0.00 $0.00 0 A2 $1,303.47 68525 $846.91 $0.00 $0.00 1 A2 $805.14 68530 $1,377.79 $0.00 $0.00 1 P2 $146.05 68540 $2,900.45 $0.00 $0.00 1 A2 $805.14 68550 $3,554.26 $0.00 $0.00 1 A2 $1,303.47 68700 $1,936.89 $0.00 $0.00 1 A2 $805.14 68705 $768.70 $0.00 $0.00 1 P2 $146.05 68720 $2,400.45 $0.00 $0.00 2 A2 $1,303.47 68745 $2,451.13 $0.00 $0.00 2 A2 $1,303.47 68750 $2,534.05 $0.00 $0.00 2 A2 $1,303.47 68760 $654.46 $0.00 $0.00 1 P3 $144.50 68761 $468.48 $0.00 $0.00 0 P3 $98.02 68770 $2,018.36 $0.00 $0.00 0 A2 $805.14 68801 $402.81 $0.00 $0.00 1 N1 $0.00 68810 $785.06 $0.00 $0.00 1 A2 $146.05 68811 $660.95 $0.00 $0.00 1 A2 $805.14 68815 $1,428.70 $0.00 $0.00 1 A2 $805.14 68816 $2,420.28 $0.00 $0.00 1 G2 $805.14 68840 $412.28 $0.00 $0.00 1 P3 $82.16 68850 $180.55 $0.00 $0.00 1 N1 $0.00 68899 BR $0.00 $0.00 0 $0.00 69000 $595.60 $0.00 $0.00 1 P3 $129.73 69005 $687.10 $0.00 $0.00 1 P3 $131.53 69020 $754.55 $0.00 $0.00 1 P3 $173.69 69090 BR $0.00 $0.00 $0.00 69100 $313.18 $0.00 $0.00 1 P3 $67.39 69105 $457.13 $0.00 $0.00 1 P3 $108.83 69110 $1,460.28 $0.00 $0.00 1 A2 $1,078.70


175


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 69120 $1,283.67 $0.00 $0.00 1 A2 $2,176.10 69140 $2,801.88 $0.00 $0.00 0 A2 $2,176.10 69145 $1,279.65 $0.00 $0.00 1 A2 $1,078.70 69150 $3,240.91 $0.00 $0.00 1 A2 $2,176.10 69155 $5,173.59 $0.00 $0.00 2 $0.00 69200 $391.82 $0.00 $0.00 1 N1 $0.00 69205 $315.54 $0.00 $0.00 1 A2 $547.17 69209 $38.29 $0.00 $0.00 1 N1 $0.00 69210 $159.69 $0.00 $0.00 1 N1 $0.00 69220 $440.82 $0.00 $0.00 1 N1 $0.00 69222 $705.08 $0.00 $0.00 1 P3 $160.72 69300 $2,351.27 $0.00 $0.00 0 A2 $968.88 69310 $3,474.06 $0.00 $0.00 1 A2 $2,176.10 69320 $4,835.67 $0.00 $0.00 2 A2 $2,176.10 69399 BR $0.00 $0.00 0 $0.00 69420 $610.13 $0.00 $0.00 1 P2 $106.19 69421 $468.59 $0.00 $0.00 1 A2 $968.88 69424 $414.27 $0.00 $0.00 1 P3 $95.85 69433 $647.05 $0.00 $0.00 1 P3 $139.46 69436 $500.10 $0.00 $0.00 1 A2 $564.34 69440 $2,192.07 $0.00 $0.00 1 A2 $968.88 69450 $1,730.39 $0.00 $0.00 0 A2 $968.88 69501 $2,284.23 $0.00 $0.00 1 A2 $2,176.10 69502 $3,026.31 $0.00 $0.00 0 A2 $2,176.10 69505 $3,816.28 $0.00 $0.00 0 A2 $2,176.10 69511 $3,907.71 $0.00 $0.00 0 A2 $2,176.10 69530 $5,205.24 $0.00 $0.00 2 A2 $2,176.10 69535 $8,310.11 $0.00 $0.00 1 $0.00 69540 $674.63 $0.00 $0.00 1 P3 $160.00 69550 $3,305.45 $0.00 $0.00 2 A2 $2,176.10 69552 $4,933.38 $0.00 $0.00 2 A2 $2,176.10 69554 $7,849.71 $0.00 $0.00 2 $0.00 69601 $3,264.40 $0.00 $0.00 0 A2 $2,176.10 69602 $3,431.89 $0.00 $0.00 0 A2 $2,176.10 69603 $3,990.61 $0.00 $0.00 0 A2 $2,176.10 69604 $3,506.81 $0.00 $0.00 1 A2 $2,176.10 69605 $4,920.07 $0.00 $0.00 2 A2 $2,176.10 69610 $1,203.87 $0.00 $0.00 1 P3 $206.12 69620 $2,227.29 $0.00 $0.00 1 A2 $968.88 69631 $2,806.93 $0.00 $0.00 1 A2 $2,176.10 69632 $3,410.58 $0.00 $0.00 1 A2 $2,176.10


176


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 69633 $3,299.69 $0.00 $0.00 1 A2 $2,176.10 69635 $3,905.09 $0.00 $0.00 1 A2 $2,176.10 69636 $4,369.96 $0.00 $0.00 0 A2 $2,176.10 69637 $4,391.93 $0.00 $0.00 0 A2 $2,176.10 69641 $3,287.40 $0.00 $0.00 1 A2 $2,176.10 69642 $4,220.75 $0.00 $0.00 1 A2 $2,176.10 69643 $3,850.36 $0.00 $0.00 1 A2 $2,176.10 69644 $4,678.33 $0.00 $0.00 1 A2 $2,176.10 69645 $4,597.36 $0.00 $0.00 1 A2 $2,176.10 69646 $4,865.43 $0.00 $0.00 0 A2 $2,176.10 69650 $2,536.35 $0.00 $0.00 1 A2 $968.88 69660 $2,913.16 $0.00 $0.00 1 A2 $2,176.10 69661 $3,792.09 $0.00 $0.00 0 A2 $2,176.10 69662 $3,629.28 $0.00 $0.00 1 A2 $2,176.10 69666 $2,538.79 $0.00 $0.00 0 A2 $968.88 69667 $2,547.44 $0.00 $0.00 0 A2 $968.88 69670 $2,959.26 $0.00 $0.00 2 A2 $2,176.10 69676 $2,632.09 $0.00 $0.00 1 A2 $968.88 69700 $2,144.84 $0.00 $0.00 1 A2 $564.34 69710 BR $0.00 $0.00 $0.00 69711 $2,699.45 $0.00 $0.00 2 A2 $968.88 69714 $3,354.34 $0.00 $0.00 1 J8 $8,646.68 69715 $4,125.97 $0.00 $0.00 1 J8 $12,225.21 69717 $3,514.17 $0.00 $0.00 1 J8 $4,500.53 69718 $4,165.79 $0.00 $0.00 1 G2 $5,281.63 69720 $3,708.22 $0.00 $0.00 0 A2 $2,176.10 69725 $5,857.94 $0.00 $0.00 2 $0.00 69740 $3,649.77 $0.00 $0.00 2 A2 $2,176.10 69745 $4,049.30 $0.00 $0.00 2 A2 $2,176.10 69799 BR $0.00 $0.00 0 $0.00 69801 $625.25 $0.00 $0.00 0 P3 $125.04 69805 $3,276.19 $0.00 $0.00 2 A2 $2,176.10 69806 $2,935.41 $0.00 $0.00 1 A2 $2,176.10 69905 $2,896.99 $0.00 $0.00 1 A2 $2,176.10 69910 $3,161.31 $0.00 $0.00 0 A2 $2,176.10 69915 $4,769.87 $0.00 $0.00 2 A2 $968.88 69930 $3,818.32 $0.00 $0.00 0 J8 $30,080.35 69949 BR $0.00 $0.00 0 $0.00 69950 $5,505.26 $0.00 $0.00 2 $0.00 69955 $6,141.09 $0.00 $0.00 2 $0.00 69960 $5,950.84 $0.00 $0.00 2 $0.00


177


Code Rate TC (27) PC(26) Asst Surg ASC Ind ASC Rate 69970 $6,656.91 $0.00 $0.00 2 $0.00 69979 BR $0.00 $0.00 0 $0.00 69990 $732.01 $0.00 $0.00 2 N1 $0.00

rhode island workers’ compensation fee schedule · rhode island workers’ compensation fee...

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