CPT Codes and Fees: Pathology and Laboratory

Pathology and Laboratory

Effective January 1, 2015

ABBREVIATIONS: BR = by report (i.e., report is needed to establish fee), CPT = Current Procedural Terminology, FAC = services were performed in a facility setting, FUD = follow-up days (i.e., number of days in global period), NA = no allowance, OFF = services were performed in physician office setting, PC (26) = professional component, PER AGM = per agreement, SC = special consideration (see Guides or contact Industrial Commission), TBA = to be assigned, TC (27) = technical component, Total = total fee, and Units = requires time or number of units.

CPT Code	Total	OFF	FAC	TC (27)	PC (26)
80047	BR			BR	BR
80048	$17.70
80050	$47.07
80051	$15.07
80053	$18.64
80055	$53.73
80061	$34.34
80069	BR			BR	BR
80074	$102.87
80076	BR			BR	BR
80150	$38.77
80155	BR			BR	BR
80156	$34.34
80157	BR			BR	BR
80158	$51.50
80159	BR			BR	BR
80162	$32.67
80163	BR
80165	BR
80164	$34.34
80168	$38.77
80169	BR			BR	BR
80170	$34.34
80171	BR			BR	BR
80173	BR			BR	BR
80175	BR			BR	BR
80176	$34.34
80177	BR			BR	BR
80178	$19.94
80180	BR			BR	BR
80183	BR			BR	BR
80184	$34.34
80185	$32.67
80186	$34.34
80188	$38.77
80190	$38.77
80192	$51.50
80194	$34.34
80195	BR			BR	BR
80197	BR			BR	BR
80198	$32.67
80199	BR			BR	BR
80200	$38.77
80201	BR			BR	BR
80202	$34.34
80203	BR			BR	BR
80299	BR			BR	BR
80300	BR			BR	BR
80301	BR			BR	BR
80302	BR			BR	BR
80303	BR			BR	BR
80304	BR			BR	BR
80320	BR			BR	BR
80321	BR			BR	BR
80322	BR			BR	BR
80323	BR			BR	BR
80324	BR			BR	BR
80325	BR			BR	BR
80326	BR			BR	BR
80327	BR			BR	BR
80328	BR			BR	BR
80329	BR			BR	BR
80330	BR			BR	BR
80331	BR			BR	BR
80332	BR			BR	BR
80333	BR			BR	BR
80334	BR			BR	BR
80335	BR			BR	BR
80336	BR			BR	BR
80337	BR			BR	BR
80338	BR			BR	BR
80339	BR			BR	BR
80340	BR			BR	BR
80341	BR			BR	BR
80342	BR			BR	BR
80343	BR			BR	BR
80344	BR			BR	BR
80345	BR			BR	BR
80346	BR			BR	BR
80347	BR			BR	BR
80348	BR			BR	BR
80349	BR			BR	BR
80350	BR			BR	BR
80351	BR			BR	BR
80353	BR			BR	BR
80353	BR			BR	BR
80354	BR			BR	BR
80355	BR			BR	BR
80356	BR			BR	BR
80357	BR			BR	BR
80358	BR			BR	BR
80359	BR			BR	BR
80360	BR			BR	BR
80361	BR			BR	BR
80362	BR			BR	BR
80363	BR			BR	BR
80364	BR			BR	BR
80365	BR			BR	BR
80366	BR			BR	BR
80367	BR			BR	BR
80368	BR			BR	BR
80369	BR			BR	BR
80370	BR			BR	BR
80371	BR			BR	BR
80372	BR			BR	BR
80373	BR			BR	BR
80374	BR			BR	BR
80375	BR			BR	BR
80376	BR			BR	BR
80377	BR			BR	BR
80360	BR			BR	BR
80360	BR			BR	BR
80360	BR			BR	BR
80400	$80.30
80402	$148.43
80406	$137.90
80408	$184.99
80410	$165.60
80412	$411.52
80414	$60.93
80415	$60.93
80416	BR			BR	BR
80417	BR			BR	BR
80418	$1,145.38
80420	$145.66
80422	$90.83
80424	$88.06
80426	$214.34
80428	$106.90
80430	$130.16
80432	$232.06
80434	$153.97
80435	$163.39
80436	$150.66
80438	$76.99
80439	$96.93
80500	$29.90
80502	$88.62
81000	$9.97
81001	$7.76
81002	$7.76
81003	$7.76
81005	$6.64
81007	$10.53
81015	$7.76
81020	$7.76
81025	$14.40
81050	$6.64
81099	BR			BR	BR
81200	BR			BR	BR
81201	BR			BR	BR
81202	BR			BR	BR
81203	BR			BR	BR
81205	BR			BR	BR
81206	BR			BR	BR
81207	BR			BR	BR
81208	BR			BR	BR
81209	BR			BR	BR
81210	BR			BR	BR
81211	BR			BR	BR
81212	BR			BR	BR
81213	BR			BR	BR
81214	BR			BR	BR
81215	BR			BR	BR
81216	BR			BR	BR
81217	BR			BR	BR
81220	BR			BR	BR
81221	BR			BR	BR
81222	BR			BR	BR
81223	BR			BR	BR
81224	BR			BR	BR
81225	BR			BR	BR
81226	BR			BR	BR
81227	BR			BR	BR
81228	BR			BR	BR
81229	BR			BR	BR
81235	BR			BR	BR
81240	BR			BR	BR
81241	BR			BR	BR
81242	BR			BR	BR
81243	BR			BR	BR
81244	BR			BR	BR
81245	BR			BR	BR
81246	BR			BR	BR
81250	BR			BR	BR
81251	BR			BR	BR
81252	BR			BR	BR
81253	BR			BR	BR
81254	BR			BR	BR
81255	BR			BR	BR
81256	BR			BR	BR
81257	BR			BR	BR
81260	BR			BR	BR
81261	BR			BR	BR
81262	BR			BR	BR
81263	BR			BR	BR
81264	BR			BR	BR
81265	BR			BR	BR
81266	BR			BR	BR
81267	BR			BR	BR
81268	BR			BR	BR
81270	BR			BR	BR
81275	BR			BR	BR
81280	BR			BR	BR
81281	BR			BR	BR
81282	BR			BR	BR
81287	BR			BR	BR
81288	BR			BR	BR
81290	BR			BR	BR
81291	BR			BR	BR
81292	BR			BR	BR
81293	BR			BR	BR
81294	BR			BR	BR
81295	BR			BR	BR
81296	BR			BR	BR
81297	BR			BR	BR
81298	BR			BR	BR
81299	BR			BR	BR
81300	BR			BR	BR
81301	BR			BR	BR
81302	BR			BR	BR
81303	BR			BR	BR
81304	BR			BR	BR
81310	BR			BR	BR
81313	BR			BR	BR
81315	BR			BR	BR
81316	BR			BR	BR
81317	BR			BR	BR
81318	BR			BR	BR
81319	BR			BR	BR
81321	BR			BR	BR
81322	BR			BR	BR
81323	BR			BR	BR
81324	BR			BR	BR
81325	BR			BR	BR
81326	BR			BR	BR
81330	BR			BR	BR
81331	BR			BR	BR
81332	BR			BR	BR
81340	BR			BR	BR
81341	BR			BR	BR
81342	BR			BR	BR
81350	BR			BR	BR
81355	BR			BR	BR
81370	BR			BR	BR
81371	BR			BR	BR
81372	BR			BR	BR
81373	BR			BR	BR
81374	BR			BR	BR
81375	BR			BR	BR
81376	BR			BR	BR
81377	BR			BR	BR
81378	BR			BR	BR
81379	BR			BR	BR
81380	BR			BR	BR
81381	BR			BR	BR
81382	BR			BR	BR
81383	BR			BR	BR
81400	BR			BR	BR
81401	BR			BR	BR
81402	BR			BR	BR
81403	BR			BR	BR
81404	BR			BR	BR
81405	BR			BR	BR
81406	BR			BR	BR
81407	BR			BR	BR
81408	BR			BR	BR
81410	BR			BR	BR
81411	BR			BR	BR
81415	BR			BR	BR
81416	BR			BR	BR
81417	BR			BR	BR
81420	BR			BR	BR
81425	BR			BR	BR
81426	BR			BR	BR
81427	BR			BR	BR
81430	BR			BR	BR
81431	BR			BR	BR
81435	BR			BR	BR
81436	BR			BR	BR
81440	BR			BR	BR
81445	BR			BR	BR
81450	BR			BR	BR
81455	BR			BR	BR
81460	BR			BR	BR
81465	BR			BR	BR
81460	BR			BR	BR
81465	BR			BR	BR
81470	BR			BR	BR
81471	BR			BR	BR
81479	BR			BR	BR
81500	BR			BR	BR
81503	BR			BR	BR
81504	BR			BR	BR
81506	BR			BR	BR
81507	BR			BR	BR
81508	BR			BR	BR
81509	BR			BR	BR
81510	BR			BR	BR
81511	BR			BR	BR
81512	BR			BR	BR
81519	BR			BR	BR
81599	BR			BR	BR
82777	BR			BR	BR
87389	BR			BR	BR
82009	$9.41
82010	$20.50
82013	$34.34
82016	BR			BR	BR
82017	BR			BR	BR
82024	$76.99
82030	$59.82
82040	$11.07
82042	$13.84
82043	$29.90
82044	$15.50
82045	BR			BR	BR
82075	$24.93
82085	$25.47
82088	$68.67
82103	$34.34
82104	$47.07
82105	$40.43
82106	$40.43
82107	BR			BR	BR
82108	$51.50
82120	BR			BR	BR
82127	BR			BR	BR
82128	$24.93
82131	$153.97
82135	$37.66
82136	BR			BR	BR
82139	BR			BR	BR
82140	$25.47
82143	$27.70
82150	$13.84
82154	$55.94
82157	$51.50
82160	$55.94
82163	$51.50
82164	$42.64
82172	$28.24
82175	$47.07
82180	$28.24
82190	$51.50
82232	$47.07
82239	$27.70
82240	$60.93
82247	BR			BR	BR
82248	BR			BR	BR
82252	$7.76
82261	BR			BR	BR
82270	$8.30			$8.30	$0.00
82271	BR			BR	BR
82272	BR			BR	BR
82274	BR			BR	BR
82286	$51.50
82300	$51.50
82306	$64.24
82308	$65.90
82310	$12.19
82330	$31.57
82331	$34.34
82340	$12.19
82355	$26.59
82360	$32.67
82365	$32.67
82370	$32.67
82373	BR			BR	BR
82374	$11.07
82375	$29.36
82376	$10.53
82378	$44.30
82379	BR			BR	BR
82380	$25.47
82382	$44.30
82383	$64.24
82384	$64.24
82387	$51.50
82390	$27.70
82397	$38.77
82415	$42.64
82435	$11.07
82436	$12.19
82438	$12.19
82441	$31.01
82465	$11.63
82480	$20.50
82482	$31.01
82485	$51.50
82486	$48.19
82487	$37.66
82488	$59.82
82489	$37.66
82491	$42.64
82492	BR			BR	BR
82495	$51.50
82507	$64.24
82523	BR			BR	BR
82525	$34.34
82528	$51.50
82530	$47.07
82533	$40.43
82540	$12.19
82541	BR			BR	BR
82542	$39.86
82543	BR			BR	BR
82544	BR			BR	BR
82550	$12.74
82552	$34.34
82553	$16.06
82554	$29.90
82565	$11.07
82570	$12.19
82575	$23.26
82585	$29.36
82595	$15.50
82600	$34.34
82607	$34.34
82608	$39.33
82610	BR			BR	BR
82615	$25.47
82626	$59.82
82627	$51.50
82633	$68.67
82634	$59.82
82638	$23.81
82652	$68.67
82656	BR			BR	BR
82657	BR			BR	BR
82658	BR			BR	BR
82664	$31.57
82668	$55.94
82670	$40.43
82671	$72.00
82672	$51.50
82677	$37.10
82679	$55.94
82693	$31.01
82696	$59.82
82705	$12.74
82710	$48.19
82715	$20.50
82725	$20.50
82726	BR			BR	BR
82728	$31.57
82731	BR			BR	BR
82735	$45.97
82746	$34.90
82747	$42.10
82757	$22.16
82759	$27.70
82760	$28.24
82775	$36.00
82776	$11.63
82784	$29.36
82785	$37.10
82787	$91.94
82800	$25.47
82803	$46.53
82805	$54.83
82810	$25.47
82820	$29.90
82930	BR			BR	BR
82938	$42.10
82941	$42.10
82943	$50.40
82945	BR			BR	BR
82946	$28.24
82947	$11.07
82948	$8.30
82950	$14.40
82951	$31.57
82952	$8.30
82955	$32.67
82960	$17.17
82962	$8.30
82963	$42.64
82965	$12.19
82977	$12.74
82978	$29.90
82979	$21.60
82985	$20.50
83001	$42.64
83002	$42.64
83003	$42.64
83006	BR			BR	BR
83009	BR			BR	BR
83010	$31.57
83012	$48.74
83013	BR			BR	BR
83014	BR			BR	BR
83015	$59.82
83018	$59.82
83020	$32.13			$22.49	$9.64
83021	BR			BR	BR
83026	$7.76
83030	$22.16
83033	$12.74
83036	$24.93
83037	BR			BR	BR
83045	$8.30
83050	$12.19
83051	$11.07
83060	$23.81
83065	$6.64
83068	$9.41
83069	$6.64
83070	$10.53
83080	BR			BR	BR
83088	$65.90
83090	BR			BR	BR
83150	$42.64
83491	$50.40
83497	$40.43
83498	$58.16
83499	$45.97
83500	$42.64
83505	$55.94
83516	$27.70
83518	$17.17
83519	$36.00
83520	$36.00
83525	$33.23
83527	$33.23
83528	$44.30
83540	$12.19
83550	$16.61
83570	$20.50
83582	$34.90
83586	$34.34
83593	$75.33
83605	$27.70
83615	$11.63
83625	$34.34
83630	BR			BR	BR
83631	BR			BR	BR
83632	$54.83
83633	$10.53
83655	$22.16
83661	$73.66
83662	$21.60
83663	BR			BR	BR
83664	BR			BR	BR
83670	$31.01
83690	$19.94
83695	BR			BR	BR
83698	BR			BR	BR
83700	BR			BR	BR
83701	BR			BR	BR
83704	BR			BR	BR
83718	$17.17
83719	$17.73
83721	$17.17
83727	$47.07
83735	$12.74
83775	$19.94
83785	$51.50
83788	BR			BR	BR
83789	BR			BR	BR
83825	$44.30
83835	$44.30
83857	$25.47
83861	BR			BR	BR
83864	$25.47
83872	$9.41
83873	$47.07
83874	$38.77
83876	BR			BR	BR
83880	$74.94
83883	$31.57
83885	$45.97
83915	$27.70
83916	$40.99
83918	$64.24
83919	BR			BR	BR
83921	BR			BR	BR
83930	$8.30
83935	$21.60
83937	$61.47
83945	$31.01
83950	$140.64
83951	BR			BR	BR
83970	$68.67
83986	$7.90
83987	BR			BR	BR
83992	$32.45
83993	BR			BR	BR
84030	$12.19
84035	$8.30
84060	$21.60
84061	$23.81
84066	$28.24
84075	$11.63
84078	$21.04
84080	$37.10
84081	$51.50
84085	$22.16
84087	$23.81
84100	$11.07
84105	$12.19
84106	$16.06
84110	$21.60
84112	BR			BR	BR
84119	$22.16
84120	$34.34
84126	$38.77
84132	$11.07
84133	$12.19
84134	$25.47
84135	$42.64
84138	$42.64
84140	$51.50
84143	$51.50
84144	$42.64
84145	BR			BR	BR
84146	$42.64
84150	$47.07
84152	BR			BR	BR
84153	$42.64
84154	BR			BR	BR
84155	$13.84
84156	$8.09
84157	$8.09
84160	$8.30
84163	BR			BR	BR
84165	$31.01			$24.81	$6.20
84166	$37.57			$0.00	$37.57
84181	$47.07			$32.95	$14.12
84182	$68.67			$48.07	$20.60
84202	$27.70
84203	$14.96
84206	$64.24
84207	$64.24
84210	$37.10
84220	$21.60
84228	$34.34
84233	$68.67
84234	$68.67
84235	$68.67
84238	$85.84
84244	$54.83
84252	$36.00
84255	$42.64
84260	$78.64
84270	$45.42
84275	$27.70
84285	$58.16
84295	$11.07
84300	$12.19
84302	$6.79
84305	$64.24
84307	$47.07
84311	$15.44
84315	$6.10
84375	$34.34
84376	BR			BR	BR
84377	BR			BR	BR
84378	BR			BR	BR
84379	BR			BR	BR
84392	BR			BR	BR
84402	$48.74
84403	$40.43
84425	$47.07
84430	$29.90
84431	BR			BR	BR
84432	$42.64
84436	$17.17
84437	$17.17
84439	$25.47
84442	$29.90
84443	$38.77
84445	$111.33
84446	$34.34
84449	$40.99
84450	$12.19
84460	$12.19
84466	$29.90
84478	$12.19
84479	$15.50
84480	$34.34
84481	$45.42
84482	$38.77
84484	BR			BR	BR
84485	$17.17
84488	$11.07
84490	$12.74
84510	$22.16
84512	BR			BR	BR
84520	$11.63
84525	$8.30
84540	$12.19
84545	$17.17
84550	$11.63
84560	$12.19
84577	$17.17
84578	$7.76
84580	$16.06
84583	$7.76
84585	$42.64
84586	$65.90
84588	$70.34
84590	$34.34
84591	BR			BR	BR
84597	$39.33
84600	$29.90
84620	$34.34
84630	$34.34
84681	$51.50
84702	$34.34
84703	$19.94
84704	BR			BR	BR
84830	$21.60
84999	BR			BR	BR
85002	$17.73
85004	$9.04
85007	$9.97
85008	$6.64
85009	$10.53
85013	$7.76
85014	$7.76
85018	$7.76
85025	$16.06
85027	$14.96
85032	$6.01
85041	$7.20
85044	$12.74
85045	$12.19
85046	BR			BR	BR
85048	$8.30
85049	$6.25
85055	$59.11
85060	$35.44
85097	$75.33			$15.07	$60.26
85130	$25.47
85170	$8.86
85175	$17.17
85210	$25.47
85220	$51.50
85230	$51.50
85240	$55.94
85244	$68.67
85245	$42.64
85246	$68.67
85247	$68.67
85250	$55.94
85260	$51.50
85270	$55.94
85280	$55.94
85290	$42.64
85291	$24.93
85292	$51.50
85293	$51.50
85300	$41.54
85301	$42.64
85302	$47.07
85303	$51.50
85305	$55.94
85306	$55.94
85307	BR			BR	BR
85335	$23.26
85337	$42.64
85345	$8.30
85347	$8.30
85348	$13.84
85360	$27.70
85362	$18.83
85366	$27.70
85370	$27.70
85378	$22.16
85379	$25.47
85380	$12.87
85384	$17.17
85385	$21.60
85390	$21.60			$10.80	$10.80
85396	$32.63
85397	BR			BR	BR
85400	$40.99
85410	$40.99
85415	$31.57
85420	$40.99
85421	$51.50
85441	$7.76
85445	$12.19
85460	$23.26
85461	$23.26
85475	$29.36
85520	$34.34
85525	$34.34
85530	$34.34
85536	BR			BR	BR
85540	$21.60
85547	$19.94
85549	$43.76
85555	$16.06
85557	$42.64
85576	$42.64			$34.11	$8.53
85597	$29.90
85598	BR			BR	BR
85610	$12.19
85611	$12.74
85612	$23.81
85613	$28.24
85635	$17.17
85651	$10.53
85652	BR			BR	BR
85660	$12.19
85670	$15.50
85675	$17.73
85705	$32.67
85730	$14.40
85732	$17.17
85810	$19.94
85999	BR			BR	BR
86000	$19.94			$19.94	$0.00
86001	BR			BR	BR
86003	$111.33
86005	$42.64
86021	$51.50
86022	$78.10
86023	$42.64
86038	$29.90
86039	$29.90
86060	$20.50
86063	$15.50
86077	$35.44
86078	$68.13
86079	$37.10
86140	$16.06
86141	$28.27
86146	BR			BR	BR
86147	$59.82
86148	BR			BR	BR
86152	BR			BR	BR
86153	BR			BR	BR
86155	$23.26
86156	$15.50
86157	$19.94
86160	$37.66
86161	$37.66
86162	$53.17
86171	$24.93
86185	$23.81
86215	$33.23
86225	$37.10
86226	$37.10
86235	$32.67
86243	$40.43
86255	$29.90
86256	$37.10
86277	$29.90
86280	$24.93
86294	BR			BR	BR
86300	BR			BR	BR
86301	BR			BR	BR
86304	BR			BR	BR
86305	BR			BR	BR
86308	$14.40
86309	$20.50
86310	$21.60
86316	$44.30
86317	$20.50
86318	$20.50
86320	$53.73			$42.98	$10.75
86325	$55.94			$44.75	$11.19
86327	$42.64			$34.11	$8.53
86329	$40.99
86331	$38.77
86332	$48.74
86334	$46.53			$37.22	$9.31
86335	$37.57
86336	BR			BR	BR
86337	$53.73
86340	$37.66
86341	$29.90
86343	$37.10
86344	$21.60
86352	BR			BR	BR
86353	$120.19
86356	BR			BR	BR
86357	BR			BR	BR
86359	$64.24
86360	$95.82
86361	BR			BR	BR
86367	BR			BR	BR
86376	$36.00
86378	$38.77
86382	$39.33
86384	$29.90
86403	$13.84
86406	$16.06
86430	$16.06
86431	$18.83
86480	BR			BR	BR
86481	BR			BR	BR
86485	$12.74
86486	$7.98
86490	$14.40
86510	$15.50
86580	$12.74
86590	$15.50
86592	$11.07
86593	$12.19
86602	$34.34
86603	$34.34
86606	$37.66
86609	BR			BR	BR
86611	BR			BR	BR
86612	$37.66
86615	$42.64
86617	$45.42
86618	$42.64
86619	$34.34
86622	$25.47
86625	$34.34
86628	$40.99
86631	$29.90
86632	$33.23
86635	$40.99
86638	$34.34
86641	$25.47
86644	$39.33
86645	$43.76
86648	$37.66
86651	$34.34
86652	$34.34
86653	$34.34
86654	$34.34
86658	$34.34
86663	$40.99
86664	$40.99
86665	$44.30
86666	BR			BR	BR
86668	$25.47
86671	$34.34
86674	$34.34
86677	$46.53
86682	$42.64
86684	$42.64
86687	$34.34
86688	$32.67
86689	$45.42
86692	$42.64
86694	$37.66
86695	$37.66
86696	BR			BR	BR
86698	$34.34
86701	$19.61
86702	$42.64
86703	$29.36
86704	$25.41
86705	$25.71
86706	$23.45
86707	$25.25
86708	$27.05
86709	$24.57
86710	$28.24
86386	BR			BR	BR
86711	BR			BR	BR
86713	$40.99
86717	$34.34
86720	$34.34
86723	$34.34
86727	$34.34
86729	$34.34
86732	$34.34
86735	$34.34
86738	$34.34
86741	$34.34
86744	$34.34
86747	$42.64
86750	$34.34
86753	$34.34
86756	$34.34
86757	$42.74
86759	$34.34
86762	$19.94
86765	$42.64
86768	$34.34
86771	$34.34
86774	$42.64
86777	$32.67
86778	$40.43
86780	BR			BR	BR
86784	$34.34
86787	$37.66
86788	BR			BR	BR
86789	BR			BR	BR
86790	$34.34
86793	$34.34
86800	$40.99
86803	$31.17
86804	$25.85
86805	$126.83
86806	$42.10
86807	$42.10
86808	$47.07
86812	$59.82
86813	$85.84
86816	$81.42
86817	$233.73
86821	$182.77
86822	$59.82
86825	BR			BR	BR
86826	BR			BR	BR
86828	BR			BR	BR
86829	BR			BR	BR
86830	BR			BR	BR
86831	BR			BR	BR
86832	BR			BR	BR
86833	BR			BR	BR
86834	BR			BR	BR
86835	BR			BR	BR
86849	BR			BR	BR
86850	$17.17
86860	$17.17
86870	$29.90
86880	$9.41
86885	$12.19
86886	$15.50
86890	$68.67
86891	$106.90
86900	$9.41
86901	$8.30
86902	BR			BR	BR
86904	$12.74
86905	$10.53
86906	$14.40
86910	$18.83
86911	$14.40
86920	$20.50
86921	$17.17
86922	$10.53
86923	BR			BR	BR
86927	$12.19
86930	$85.84
86931	$94.16
86932	$103.02
86940	$17.73
86941	$18.83
86945	$25.47
86950	$47.07
86960	BR			BR	BR
86965	$12.19
86970	$12.74
86971	$13.84
86972	$12.74
86975	$8.30
86976	$6.64
86977	$8.30
86978	$18.83
86985	$17.73
86999	BR			BR	BR
87003	$34.34
87015	$17.73
87040	$23.81
87045	$28.24
87046	BR			BR	BR
87070	$23.26
87071	BR			BR	BR
87073	BR			BR	BR
87075	$23.81
87076	$26.59
87077	$17.84
87081	$13.84
87084	$17.17
87086	$21.60
87088	$20.50
87101	$17.73
87102	$22.16
87103	$25.47
87106	$23.26
87107	BR			BR	BR
87109	$49.30
87110	$34.34
87116	$27.70
87118	$22.16
87140	$12.74
87143	$32.67
87147	$12.19
87149	BR			BR	BR
87150	BR			BR	BR
87152	BR			BR	BR
87153	BR			BR	BR
87158	$11.63
87164	$25.47			$5.09	$20.38
87166	$21.60
87168	BR			BR	BR
87169	BR			BR	BR
87172	BR			BR	BR
87176	$15.50
87177	$25.47
87181	$16.06
87184	$17.17
87185	BR			BR	BR
87186	$19.94
87187	$19.94
87188	$19.94
87190	$12.74
87197	$27.70
87205	$10.53
87206	$19.94
87207	$17.73
87209	BR			BR	BR
87210	$10.53
87220	$12.74
87230	$38.77
87250	$46.53
87252	$42.64
87253	$42.64
87254	BR			BR	BR
87255	$34.14
87260	$25.03
87265	$25.03
87267	$16.01
87269	$25.30
87270	$25.03
87271	$16.01
87272	$25.03
87273	BR			BR	BR
87274	$25.03
87275	BR			BR	BR
87276	$25.03
87277	BR			BR	BR
87278	$25.03
87279	BR			BR	BR
87280	$25.03
87281	BR			BR	BR
87283	BR			BR	BR
87285	$25.03
87290	$25.03
87299	$25.03
87300	BR			BR	BR
87301	$25.03
87305	BR			BR	BR
87320	$25.03
87324	$25.03
87327	BR			BR	BR
87328	$25.03
87329	$25.30
87332	$25.03
87335	$25.03
87336	BR			BR	BR
87337	BR			BR	BR
87338	BR			BR	BR
87339	BR			BR	BR
87340	$20.32
87341	BR			BR	BR
87350	$24.16
87380	$35.85
87385	$25.03
87390	$38.52
87391	$38.52
87400	BR			BR	BR
87420	$25.03
87425	$25.03
87427	BR			BR	BR
87430	$25.03
87449	$25.03
87450	$16.68
87451	BR			BR	BR
87470	$43.78
87471	$53.55
87472	BR			BR	BR
87475	$43.78
87476	$53.55
87477	BR			BR	BR
87480	$43.78
87481	$53.55
87482	BR			BR	BR
87485	$43.78
87486	$53.55
87487	BR			BR	BR
87490	$43.78
87491	$53.55
87492	BR			BR	BR
87493	BR			BR	BR
87495	$43.78
87496	$53.55
87497	BR			BR	BR
87498	BR			BR	BR
87500	BR			BR	BR
87501	BR			BR	BR
87502	BR			BR	BR
87503	BR			BR	BR
87505	BR			BR	BR
87506	BR			BR	BR
87507	BR			BR	BR
87510	$43.78
87511	$53.55
87512	BR			BR	BR
87515	$43.78
87516	$53.55
87517	BR			BR	BR
87520	$43.78
87521	$53.55
87522	$71.89
87525	$43.78
87526	$53.55
87527	BR			BR	BR
87528	$43.78
87529	$53.55
87530	BR			BR	BR
87531	$43.78
87532	$53.55
87533	BR			BR	BR
87534	$43.78
87535	$53.55
87536	BR			BR	BR
87537	$43.78
87538	$53.55
87539	BR			BR	BR
87540	$43.78
87541	$53.55
87542	BR			BR	BR
87550	$43.78
87551	$53.55
87552	BR			BR	BR
87555	$43.78
87556	$53.55
87557	BR			BR	BR
87560	$43.78
87561	$53.55
87562	BR			BR	BR
87580	$43.78
87581	$53.55
87582	BR			BR	BR
87590	$43.78
87591	$53.55
87592	BR			BR	BR
87623	BR			BR	BR
87624	BR			BR	BR
87625	BR			BR	BR
87631	BR			BR	BR
87632	BR			BR	BR
87633	BR			BR	BR
87640	BR			BR	BR
87641	BR			BR	BR
87650	$43.78
87651	$53.55
87652	BR			BR	BR
87653	BR			BR	BR
87660	$44.27
87661	BR			BR	BR
87797	$43.78
87798	$53.55
87799	BR			BR	BR
87800	BR			BR	BR
87801	BR			BR	BR
87802	$25.03
87803	$25.03
87804	$25.03
87806	BR			BR	BR
87807	BR			BR	BR
87808	BR			BR	BR
87809	BR			BR	BR
87810	$25.03
87850	$25.03
87880	$25.03
87899	$25.03
87900	BR			BR	BR
87901	BR			BR	BR
87902	$170.42
87903	BR			BR	BR
87904	BR			BR	BR
87905	BR			BR	BR
87906	BR			BR	BR
87910	BR			BR	BR
87912	BR			BR	BR
87999	BR			BR	BR
88000	$216.00
88005	$239.82
88007	$263.63
88012	$198.83
88014	$198.83
88016	$241.49
88020	$310.16
88025	$333.97
88027	$358.35
88028	$198.83
88029	$198.83
88036	$128.50
88037	$94.16
88040	$513.98
88045	$42.64
88099	BR			BR	BR
88104	$53.17			$10.63	$42.54
88106	$49.30			$9.86	$39.44
88108	$54.83			$10.97	$43.86
88112	$181.27			$81.46	$99.81
88120	$693.75			$612.28	$81.46
88121	$585.91			$513.64	$72.27
88125	$19.39			$1.94	$17.45
88130	$21.60			$19.44	$2.16
88140	$17.17
88141	BR			BR	BR
88142	BR			BR	BR
88143	BR			BR	BR
88147	BR			BR	BR
88148	BR			BR	BR
88150	$14.40
88152	$11.30
88153	BR			BR	BR
88154	BR			BR	BR
88155	$16.06			$12.85	$3.21
88160	$44.30			$13.29	$31.01
88161	$47.07			$18.83	$28.24
88162	$81.97			$32.79	$49.18
88164	BR			BR	BR
88165	BR			BR	BR
88166	BR			BR	BR
88167	BR			BR	BR
88172	$69.23
88173	$103.02			$15.45	$87.57
88174	$29.85
88175	$36.31
88177	$42.85			$9.64	$33.21
88182	$88.06			$70.45	$17.61
88184	$91.64
88185	$44.92
88187	$132.41
88188	$165.16
88189	$217.65
88199	BR			BR	BR
88230	$92.50
88233	$34.90
88235	$197.17
88237	$151.76
88239	$59.82
88240	BR			BR	BR
88241	BR			BR	BR
88245	$128.50			$115.65	$12.85
88248	$256.99			$231.29	$25.70
88249	BR			BR	BR
88261	$248.69			$223.82	$24.87
88262	$299.63			$269.67	$29.96
88263	$308.50			$277.65	$30.85
88264	BR			BR	BR
88267	$338.40			$304.56	$33.84
88269	$297.42			$267.68	$29.74
88271	BR			BR	BR
88272	BR			BR	BR
88273	BR			BR	BR
88274	BR			BR	BR
88275	BR			BR	BR
88280	$97.47			$87.72	$9.75
88283	$76.99			$69.29	$7.70
88285	$89.73			$80.76	$8.97
88289	$64.24			$57.82	$6.42
88291	$38.60
88299	BR			BR	BR
88300	$14.40			$4.32	$10.08
88302	$29.36			$11.74	$17.62
88304	$43.76			$17.50	$26.26
88305	$94.16			$28.25	$65.91
88307	$164.50			$41.12	$123.38
88309	$222.10			$55.52	$166.58
88311	$23.81			$4.76	$19.05
88312	$42.10			$8.42	$33.68
88313	$23.81			$4.76	$19.05
88314	$56.50			$16.95	$39.55
88318	$34.90			$6.98	$27.92
88319	$54.27			$10.85	$43.42
88321	$91.39
88323	$110.22			$22.04	$88.18
88325	$144.00
88329	$55.39
88331	$121.30			$30.32	$90.98
88332	$60.93			$15.23	$45.70
88333	$166.76			$39.49	$127.26
88334	$86.73			$24.19	$62.54
88341	$125.01			$83.30	$41.71
88342	$78.64			$15.73	$62.91
88344	$216.66			$140.00	$76.66
88346	$76.43			$15.29	$61.14
88347	$68.13			$13.63	$54.50
88348	$199.39			$59.82	$139.57
88355	$189.97			$47.49	$142.48
88356	$300.19			$75.05	$225.14
88358	$271.94			$67.98	$203.96
88360	$204.36			$87.51	$116.85
88361	$204.63			$122.28	$82.35
88362	$218.77			$54.69	$164.08
88363		$58.03	$26.09
88364	$179.65			$127.64	$52.02
88365	$88.62			$17.72	$70.90
88366	$278.28			$157.60	$120.68
88367	$384.65			$248.13	$136.51
88368	$350.17			$202.11	$148.05
88369	$136.61			$88.51	$48.10
88371	$45.42			$36.34	$9.08
88372	$55.94			$44.75	$11.19
88373	$112.03			$71.58	$40.45
88374	$377.14			$290.57	$86.57
88375	BR			BR	BR
88377	$396.39			$270.36	$126.03
88380	BR			BR	BR
88381	$313.90			$231.26	$82.63
88384	BR			BR	BR
88385	$602.31			$443.63	$158.68
88386	$629.02			$429.53	$199.49
88387	$58.82			$11.44	$47.38
88388	$35.16			$5.64	$29.51
88399	BR			BR	BR
88720	BR			BR	BR
88738	BR			BR	BR
88740	BR			BR	BR
88741	BR			BR	BR
88749	BR			BR	BR
89049	$350.11			$125.30	$125.30
89050	$13.84
89051	$16.06
89055	$59.96
89060	$16.06
89125	$12.74
89160	$7.76
89190	$12.19
89220	BR			BR	BR
89230	$12.15
89240	BR			BR	BR
89250	BR			BR	BR
89251	BR			BR	BR
89252	BR			BR	BR
89253	BR			BR	BR
89254	BR			BR	BR
89255	BR			BR	BR
89256	BR			BR	BR
89257	BR			BR	BR
89258	BR			BR	BR
89259	BR			BR	BR
89260	BR			BR	BR
89261	BR			BR	BR
89264	BR			BR	BR
89268	BR			BR	BR
89272	BR			BR	BR
89280	BR			BR	BR
89281	BR			BR	BR
89290	BR			BR	BR
89291	BR			BR	BR
89300	$29.90
89310	$28.24
89320	$42.64
89321	BR			BR	BR
89322	BR			BR	BR
89325	$72.56
89329	$192.74
89330	$48.74
89331	BR
89335	BR			BR	BR
89337	BR			BR	BR
89342	BR			BR	BR
89343	BR			BR	BR
89344	BR			BR	BR
89346	BR			BR	BR
89350	$20.50
89352	BR			BR	BR
89353	BR			BR	BR
89354	BR			BR	BR
89355	$8.30
89356	BR			BR	BR
89360	$22.16
89365	$20.50
89398	BR			BR	BR
89399	BR			BR	BR

N.C. Industrial Commission · Medical Fees Section
4337 Mail Service Center · Raleigh, NC 27699-4337
Telephone: (919) 807-2503 · Fax: (919) 715-0280
NCIC Home Page: http://www.ic.nc.gov//