CPT Codes and Fees: Evaluation & Management, Medicine, Physical Therapy

Evaluation & Management, Medicine, Physical Therapy

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)	Units Required
90281	BR
90283	BR
90284	BR
90287	BR
90288	BR
90291	BR
90296	BR
90371	BR
90375	BR
90376	BR
90378	BR
90384	BR
90385	BR
90386	BR
90389	BR
90393	BR
90396	BR
90399	BR
90460		$45.96
90461		$23.05
90471	BR
90472	BR
90473	BR
90474	BR
90476	BR
90477	BR
90581	BR
90585	BR
90586	BR
90630	BR
90632	BR
90633	BR
90634	BR
90636	BR
90644	BR
90645	BR
90646	BR
90647	BR
90648	BR
90649	BR
90650	BR
90651	BR
90653	BR
90654	BR
90655	BR
90656	BR
90657	BR
90658	BR
90659	BR
90660	BR
90661	BR
90662	BR
90664	BR
90666	BR
90667	BR
90668	BR
90669	BR
90670	BR
90672	BR
90673	BR
90675	BR
90676	BR
90680	BR
90681	BR
90685	BR
90686	BR
90687	BR
90688	BR
90690	BR
90691	BR
90692	BR
90693	BR
90696	BR
90698	BR
90700	$25.15
90702	$13.67
90703	$12.58
90704	$22.97
90705	$20.78
90706	$21.88
90707	$28.44
90708	$25.15
90710	$34.46
90712	$13.67
90713	$26.26
90714	$24.19
90715	BR
90716	$34.46
90717	$33.37
90719	$20.78
90720	$37.75
90721	BR
90723	BR
90725	$14.77
90727	$20.78
90732	$18.04
90733	$39.93
90734	BR
90735	$16.40
90736	BR
90738	BR
90739	BR
90740	BR
90743	BR
90744	BR
90746	BR
90747	BR
90748	BR
90749	BR
90780	$54.70
90781	$27.35
90782	$5.47
90783	$20.24
90784	$23.51
90785		$7.28	$7.28
90788	$5.47
90791		$230.38	$181.04
90792		$192.13	$187.15
90799	BR
90832		$95.97	$76.05
90833		$64.15	$63.64
90834		$124.65	$114.19
90836		$104.20	$104.20
90837		$182.65	$172.19
90838		$168.25	$167.26
90839	BR
90840	BR
90845	$115.96
90846	$129.07
90847	$146.58
90849	$44.86
90853	$36.64
90863	BR
90865	$175.16
90867	BR
90868	BR
90869		$899.83	$234.24
90870	$129.07
90871	$188.70
90875	$71.19					YES
90876	$110.74					YES
90880	$149.86
90882	$98.45
90885	BR
90887	$95.72
90889	$80.41
90899	BR
90901	$78.00
90911	$124.00
90935	$141.11
90937	$247.76
90939	BR
90940	BR
90945	$132.91
90947	$221.50
90951	$1,922.58
90952	BR
90953	BR
90954	$1,578.58
90955	$893.77
90956	$605.43
90957	$1,267.02
90958	$854.82
90959	$560.96
90960	$561.93
90961	$453.67
90962	$328.10
90963	$1,086.05
90964	$906.30
90965	$862.05
90966	$448.87
90967	$38.85
90968	$30.32
90969	$29.58
90970	$15.68
90989	$526.69
90993	$88.05
90997	$218.23
90999	PA
91010	$204.55			$40.91	$163.64
91013	$45.77			$26.00	$19.78
91020	$228.61			$45.72	$182.89
91022	$334.14			$217.14	$117.00
91030	$92.43			$9.24	$83.19
91034	$352.90			$273.70	$79.20
91035	$697.98			$569.46	$128.51
91037	$224.96			$145.75	$79.20
91038	$193.42			$103.66	$89.75
91040	$679.14			$599.92	$79.20
91065	$66.19			$13.24	$52.95
91110	$1,378.53
91111	$1,085.40			$1,004.97	$80.42
91112	$1,745.63			$1,574.56	$171.07
91117		$280.51	$298.66
91120	$670.44			$590.85	$79.60
91122	$210.66			$42.13	$168.53
91132	BR
91133	BR
91200	$67.07			$38.98	$28.09
91299	BR
92002	$82.21
92004	$120.14
92012	$65.63
92014	$83.68
92015	$36.64
92018	$103.92
92019	$93.52
92020	$34.46
92025	$43.61			$18.04	$25.56
92060	$56.98			$9.88	$47.10
92065	$38.60			$8.55	$30.05
92071		$74.14	$66.33
92072		$236.45	$190.94
92081	$35.94			$8.01	$27.93
92082	$49.40			$10.41	$38.99
92083	$71.20			$15.22	$55.98
92100	$61.26
92132	$72.06			$30.03	$42.02
92133	$88.60			$30.03	$58.57
92134	$88.60			$30.03	$58.57
92136	$113.27			$71.26	$42.01
92140	$41.57
92145	$29.28			$12.27	$17.01
92225	$53.59
92226	$47.04
92227		$22.64
92228	$59.55			$24.66	$34.90
92230	$67.28
92235	$128.60			$54.48	$74.12
92240	$132.02			$49.99	$82.03
92250	$45.67			$9.35	$36.32
92260	$54.15
92265	$57.84			$12.29	$45.55
92270	$78.92			$16.56	$62.36
92275	$101.53			$21.36	$80.17
92283	$24.52			$6.40	$18.12
92284	$36.95			$9.35	$27.60
92285	$26.09			$5.88	$20.21
92286	$101.09			$21.36	$79.73
92287	$120.33
92310	$127.98
92311	$102.83
92312	$125.25
92313	$93.52
92314	$75.48
92315	$57.43
92316	$84.23
92317	$43.75
92325	$19.15
92326	$78.76
92341	$51.41
92342	$57.97
92352	$35.00
92353	$46.48
92354	$422.24
92355	$205.65
92358	$47.04
92370	$35.00
92371	$30.08
92499	BR
92502	$138.38
92504	$22.97
92507	$44.86
92508	$22.97
92511	$100.96
92512	$53.59
92516	$43.21
92520	$67.81
92521		$174.32	$174.32
92522		$141.88	$141.88
92523		$294.16	$294.16
92524		$147.10	$147.10
92526	$52.43
92531	$25.15
92532	$36.64
92533	$57.43
92534	$28.44
92540	$185.21			$31.42	$153.80
92541	$56.33			$11.27	$45.06
92542	$49.22			$9.84	$39.38
92543	$62.90			$12.58	$50.32
92544	$38.28			$7.66	$30.62
92545	$32.82			$6.56	$26.26
92546	$42.66			$8.53	$34.13
92547	$27.89			$5.58	$22.31
92548	$119.05			$71.98	$47.07
92551	$16.40
92552	$21.88
92553	$32.82
92555	$18.60
92556	$28.44
92557	$59.08
92558	BR
92559	$48.13
92560	$28.44
92561	$35.55
92562	$20.24
92563	$18.60
92564	$23.51
92565	$19.69
92567	$26.26
92568	$18.60
92570	$61.31	$57.87
92571	$19.15
92572	$4.38
92575	$15.31
92576	$21.88
92577	$35.55
92579	$36.33
92582	$36.10
92583	$44.30
92584	$123.07
92585	$195.26			$97.63	$97.63
92586	$107.06
92587	$82.29			$69.44	$12.85
92588	$113.67			$78.53	$35.14
92589	$26.80
92590	$74.39
92591	$97.36
92592	$27.35
92593	$51.41
92594	$27.35
92595	$51.41
92596	$28.99
92597	$112.33
92601	$191.46
92602	$134.11
92603	$128.69
92604	$87.56
92605	BR
92606	BR
92607	$159.93
92608	$31.14
92609	$86.54
92610	$60.86
92611	$66.27
92612		$255.83	$101.07			YES
92613	BR
92614		$197.93	$101.07			YES
92615	BR
92616		$271.82	$147.90			YES
92617	BR
92618	BR
92620	$65.44
92621	$16.14
92625	$64.33
92626	$123.49
92627	$31.06
92630	BR
92633	BR
92640	$77.67
92700	BR
92920		$809.13	$809.13
92921	BR
92924		$961.81	$961.81
92925	BR
92928		$898.45	$898.45
92929	BR
92933		$1,004.71	$1,004.71
92934	BR
92937		$897.42	$897.42
92938	BR
92941		$1,006.65	$1,006.65
92943		$1,006.65	$1,006.65
92944	BR
92950	$318.32
92953	$70.55
92960	$216.59
92961	$349.35
92970	$368.63
92971	$150.95
92973	$260.70
92974	$273.69
92975	$678.20
92977	$394.34
92978	$359.67			$220.06	$139.61
92979	$221.96			$110.27	$111.69
92986	$1,698.23
92987	$1,733.64
92990	$1,353.67
92992	$3,429.18
92993	$2,402.67
92997	$1,357.01
92998	$524.43
93000	$39.37			$23.62	$15.75
93005	$21.88
93010	$16.95			$0.00	$16.95
93015	$161.89			$80.94	$80.95
93016	$43.75
93017	$82.03
93018	$35.55
93024	$194.70			$77.88	$116.82
93025	$387.21
93040	$21.88			$7.66	$14.22
93041	$7.11
93042	$14.77
93224	$230.81			$138.49	$92.32
93225	$60.70			$60.70	$0.00
93226	$107.20
93227	$63.44
93228	$51.25
93229	BR
93260	$126.89			$40.94	$85.95
93261	$226.43			$135.86	$90.57
93268	$226.43			$135.86	$90.57
93270	$60.70
93271	$117.05
93272	$48.68			$0.00	$48.68
93278	$104.47			$62.68	$41.79
93279	$108.85			$36.94	$71.91
93280	$128.98			$42.64	$86.33
93281	$150.79			$50.00	$100.80
93282	$139.30			$45.18	$94.12
93283	$169.76			$51.38	$118.39
93284	$199.04			$58.24	$140.80
93285	$93.69			$34.88	$58.81
93286	$53.02			$22.93	$30.10
93287	$70.14			$25.94	$44.21
93288	$83.78			$35.56	$48.22
93289	$129.72			$42.64	$87.08
93290	$62.27			$19.76	$42.52
93291	$80.36			$31.66	$48.70
93292	$72.78			$24.56	$48.22
93293	$113.07			$79.41	$33.66
93294	$73.07
93295	$132.11
93296	$69.20
93297	$51.25
93298	$58.81
93299	BR
93303	$300.01			$186.93	$113.08
93304	$164.33			$94.07	$70.26
93306	$509.19			$366.04	$143.15
93307	$336.93			$237.62	$99.31
93308	$162.22			$102.54	$59.68
93312	$339.65			$186.81	$152.84
93313	$85.32			$0.00	$85.32
93314	$271.82			$163.09	$108.73
93315	$385.83			$184.40	$201.43
93316	$79.52
93317	$305.82			$184.40	$121.42
93318	BR
93320	$131.80			$79.08	$52.72
93321	$73.83			$44.30	$29.53
93325	$148.77			$89.26	$59.51
93350	$227.52			$136.51	$91.01
93351	$530.43
93352	$73.73
93355		$223.62	$223.62
93451	$1,504.56			$1,215.54	$289.02
93452	$1,667.14			$1,161.12	$506.02
93453	$2,182.08			$1,518.38	$663.69
93454	$1,719.69			$1,209.51	$510.18
93455	$2,006.71			$1,417.59	$589.12
93456	$2,152.41			$1,498.90	$653.51
93457	$2,439.20			$1,706.50	$732.70
93458	$2,075.12			$1,452.53	$622.59
93459	$2,292.02			$1,590.94	$701.08
93460	$2,452.74			$1,671.57	$781.17
93461	$2,810.38			$1,948.86	$861.51
93462		$397.02	$397.02
93463		$211.19	$211.19
93464	$496.13			$310.22	$185.92
93503	$254.87			$114.69	$140.18
93505	$497.16			$223.72	$273.44
93530	$1,312.71			$892.48	$420.23
93531	$3,282.77			$2,550.31	$732.46
93532	$3,393.03			$2,482.21	$910.82
93533	$2,990.39			$2,482.21	$508.18
93561	$126.89			$76.13	$50.76
93562	$59.61			$35.77	$23.84
93565		$86.09	$86.09
93566		$335.37	$86.09
93567		$277.21	$97.15
93568		$303.17	$88.15
93571	$377.76			$245.83	$131.93
93572	$348.74			$242.83	$105.91
93580	$1,451.39
93581	$1,949.18
93582		$1,045.03	$1,045.03
93583		$1,163.15	$1,163.15
93600	$348.39			$156.78	$191.61
93602	$258.16			$116.17	$141.99
93603	$307.37			$138.32	$169.05
93609	$864.70			$389.11	$475.59
93610	$345.66			$155.55	$190.11
93612	$359.88			$161.95	$197.93
93613	$554.61			$0.00	$554.61
93615	$85.87			$38.64	$47.23
93616	$164.08			$73.84	$90.24
93618	$701.71			$315.77	$385.94
93619	$1,261.77			$567.80	$693.97
93620	$1,748.00			$786.60	$961.40
93621	$2,432.76			$1,094.74	$1,338.02
93622	$2,432.76			$1,094.74	$1,338.02
93623	$551.86			$248.34	$303.52
93624	$505.92			$227.66	$278.26
93631	$1,011.83			$455.32	$556.51
93640	$841.18			$378.53	$462.65
93641	$1,028.23			$462.70	$565.53
93642	$947.29			$426.28	$521.01
93644	$560.87			$194.65	$366.23
93650	$1,292.41			$581.58	$710.83
93651	$1,779.17			$800.63	$978.54
93652	$1,855.19			$834.84	$1,020.35
93653		$1,223.01	$1,223.01
93654		$1,632.19	$1,632.19
93655		$1,611.57	$1,611.57
93656		$1,632.77	$1,632.77
93657		$1,611.95	$1,611.95
93660	BR			BR	BR
93662	$456.76			$220.60	$236.16
93668	BR
93701	$51.63			$38.14	$13.49
93702		$106.35	$106.35
93724	$602.17			$481.74	$120.43
93740	$31.73			$25.38	$6.35
93745	BR
93750	$101.35	$88.99
93770	$19.15			$11.49	$7.66
93784	$306.28			$183.77	$122.51
93786	$45.95
93788	$137.82
93790	$122.51			$0.00	$122.51
93797	$25.15
93798	$39.37			$0.00	$39.37
93799	BR
93880	$237.92			$142.75	$95.17
93882	$158.06			$94.84	$63.22
93886	$282.22			$169.33	$112.89
93888	$187.59			$112.55	$75.04
93890	$348.51			$264.19	$84.32
93892	$371.90			$275.26	$96.63
93893	$364.69			$268.06	$96.63
93895	BR
93922	$86.41			$51.85	$34.56
93923	$162.44			$97.46	$64.98
93924	$177.21			$106.33	$70.88
93925	$237.36			$142.42	$94.94
93926	$158.62			$95.17	$63.45
93930	$242.85			$145.71	$97.14
93931	$161.89			$97.13	$64.76
93965	$96.81			$58.09	$38.72
93970	$263.07			$157.84	$105.23
93971	$175.02			$105.01	$70.01
93975	$351.68			$211.01	$140.67
93976	$235.18			$141.11	$94.07
93978	$247.21			$148.33	$98.88
93979	$164.62			$98.77	$65.85
93980	$312.84			$187.70	$125.14
93981	$215.50			$129.30	$86.20
93982		$78.84
93990	$147.67			$88.60	$59.07
93998	BR
94002	$129.35
94003	$94.14
94004	$68.65
94005	BR
94010	$43.75			$26.25	$17.50
94011			$189.97
94012			$292.17
94013			$61.47
94014	$60.72			$22.35	$38.37
94015	BR
94016	$38.92
94060	$81.50			$48.90	$32.60
94070	$123.07			$73.84	$49.23
94150	$16.40			$9.84	$6.56
94200	$25.15			$17.60	$7.55
94250	$19.69			$13.78	$5.91
94375	$50.86			$35.60	$15.26
94400	$63.99			$44.79	$19.20
94450	$52.50			$36.75	$15.75
94452	$76.58			$52.28	$24.31
94453	$109.11			$77.75	$31.36
94610	$91.40
94620	$152.04			$106.43	$45.61
94621	$138.34			$76.72	$61.62
94640	$20.24
94642	$112.12
94644	$51.54
94645	$19.53
94660	$77.12
94662	$55.79
94664	$25.71
94667	$28.44
94668	$17.51
94669		$51.95	$51.95
94680	$56.88			$34.13	$22.75
94681	$96.25			$57.75	$38.50
94690	$32.26			$19.36	$12.90
94726	$103.56			$78.98	$24.58
94727	$81.62			$57.04	$24.58
94728	$81.62			$57.04	$24.58
94729	$102.61			$86.29	$16.32
94750	$54.70			$32.82	$21.88
94760	$13.13
94761	$33.37
94762	$55.79
94770	$32.82			$19.69	$13.13
94772	BR
94774	BR
94775	BR
94776	BR
94777	BR
94780			$46.82
94781			$16.32
94799	BR
95004	$4.93					YES
95012	$26.88
95017		$31.11	$5.62
95018		$32.31	$10.89
95024	$7.11					YES
95027	$7.11					YES
95028	$10.93					YES
95044	$9.84					YES
95052	$12.04					YES
95056	$8.75
95060	$16.95
95065	$9.84
95070	$108.29
95071	$138.91
95076		$176.69	$110.41
95079		$125.39	$101.47
95115	$18.60
95117	$24.06
95120	$12.58
95125	$15.31
95130	$21.88
95131	$27.35
95132	$33.37
95133	$39.93
95134	$48.13
95144	$9.84
95145	$20.78
95146	$34.46
95147	$49.22
95148	$49.22
95149	$60.70
95165	$8.20
95170	$21.33
95180	$113.76
95199	BR
95250	$77.03
95251	$42.38
95782	$1,537.43			$1,341.61	$195.83
95783	$1,640.99			$1,427.07	$213.92
95800	$408.42			$291.41	$117.01
95801	$193.27			$89.84	$103.43
95803	BR
95805	$383.94			$230.36	$153.58
95806	SC			SC	SC
95807	$538.18			$322.91	$215.27
95808	$591.24			$354.74	$236.50
95810	$637.72			$382.63	$255.09
95811	$705.66			$366.92	$338.74
95812	$152.60			$91.56	$61.04
95813	$187.06			$112.24	$74.82
95816	$136.73			$82.04	$54.69
95819	$149.86			$89.92	$59.94
95822	$175.02			$105.01	$70.01
95824	$89.70			$53.82	$35.88
95827	$214.94			$128.96	$85.98
95829	$353.37			$8.01	$345.36
95830	$130.71			$0.00	$130.71
95831	$31.58
95832	$29.86
95833	$47.10
95834	$66.61
95851	$28.72
95852	$18.94
95857	$54.15
95860	$107.20			$64.32	$42.88
95861	$183.22			$109.93	$73.29
95863	$217.68			$130.61	$87.07
95864	$283.31			$169.99	$113.32
95865	$178.10			$38.62	$139.50
95866	$120.55			$12.17	$108.37
95867	$91.34			$54.80	$36.54
95868	$178.30			$106.98	$71.32
95869	$47.04			$28.22	$18.82
95870	$48.75			$11.22	$37.53
95872	$144.40			$86.64	$57.76
95873	$43.51			$11.79	$31.74
95874	$44.07			$11.79	$32.28
95875	$103.36			$62.02	$41.34
95885	$108.07			$72.64	$35.43
95886	$171.10			$76.53	$94.57
95887	$152.09			$77.83	$74.26
95905	$152.06			$146.33	$5.73
95907	$141.71			$79.30	$62.41
95908	$174.95			$99.59	$75.37
95909	$209.57			$119.01	$90.57
95910	$275.95			$116.86	$159.09
95911	$334.34			$198.80	$135.55
95912	$391.75			$238.39	$153.35
95913	$454.36			$282.82	$171.54
95921	$55.98			$18.38	$37.60
95922	$58.62			$18.38	$40.24
95923	$55.98			$18.38	$37.60
95924	$221.94			$89.08	$132.86
95925	$160.80			$96.48	$64.32
95926	$107.41			$45.37	$62.04
95927	$107.41			$45.37	$62.04
95928	$260.54			$132.41	$128.12
95929	$271.06			$142.94	$128.12
95930	$61.48			$12.80	$48.68
95933	$95.72			$57.43	$38.29
95937	$71.65			$42.99	$28.66	YES
95938	$568.11			$481.15	$86.95
95939	$893.07			$664.29	$228.78
95940		$48.82	$48.82
95941	BR
95943	BR
95950	$454.50			$272.70	$181.80	YES
95951	$655.23			$393.14	$262.09	YES
95953	$537.64			$322.58	$215.06	YES
95954	$257.87			$25.64	$232.23
95955	$215.05			$104.96	$110.09
95956	$552.40			$331.44	$220.96	YES
95957	$227.18			$90.00	$137.18
95958	$494.46			$92.40	$402.06
95961	$301.25			$68.37	$232.88
95962	$313.63			$68.37	$245.26	YES
95965	$620.50			$0.00	$620.50
95966	$313.24			$0.00	$313.24
95967	$274.51			$0.00	$274.51
95970	$32.48
95971	$54.62
95972	$102.57
95973	$64.10
95974	$210.82
95975	$124.38
95978		$323.36	$288.47
95979		$149.45	$139.48
95980			$76.49
95981		$53.25	$30.08
95982		$81.25	$60.23
95990	$82.35
95991		$126.15	$58.05
95992	BR
95999	BR
96000	$138.88
96001	$165.76
96002	$31.95
96003	$29.53
96004	$140.92
96020	$250.95
96040	BR
96101		$149.09	$148.00
96102		$66.68	$39.69
96103		$42.87	$40.67
96105	$89.15					YES
96110	BR
96111	$89.15					YES
96116		$163.99	$153.53
96118		$194.85	$152.98
96119		$96.02	$50.29
96120		$72.06	$40.67
96125		$180.66	$152.42
96127		$7.79	$7.79
96150		$39.59	$39.07			YES
96151		$38.49	$37.43			YES
96152		$36.85	$35.79			YES
96153	$8.01					YES
96154		$35.76	$35.23			YES
96155	$34.68					YES
96360	$107.33
96361	$31.25
96365	$130.91
96366	$42.07
96367	$66.17
96368	$39.26
96369	$285.08
96370	$30.39
96371	$137.92
96372	$40.58
96374	$103.91
96375	$45.05
96376	BR
96379	BR
96401	$77.40
96402	$67.40
96405	$53.59
96406	$81.02
96409	$178.08
96411	$102.97
96413	$251.20
96415	$56.47
96416	$165.45
96417	$122.67
96420	$61.26
96422	$60.17
96423	$23.51					YES
96425	$69.46
96440	$167.35
96446		$349.66	$41.92
96450	$144.93
96521	$222.56
96522	$160.86
96523	$40.80
96542	$132.36
96549	BR
96567	$87.82					YES
96570	$107.72
96571	$55.49					YES
96900	$19.69
96902	BR
96904	$101.96
96910	$28.44
96912	$32.26
96913	$66.19
96920		$223.79	$92.30			YES
96921		$229.24	$93.96			YES
96922		$316.55	$168.30			YES
96999	BR
97001	$73.52
97002	$31.88
97003	$75.71
97004	$32.21
97005	BR
97006	BR
97010	$14.65
97012	$19.85
97014	$17.01
97016	$19.37
97018	$16.07
97022	$19.85
97024	$14.65
97026	$13.70
97028	$17.48
97032	$17.48					YES
97033	$18.43					YES
97034	$14.16					YES
97035	$14.65					YES
97036	$26.93					YES
97039	$24.10
97110	$26.45					YES
97112	$26.45					YES
97113	$29.30					YES
97116	$23.15					YES
97124	$20.79					YES
97139	$17.01					YES
97140	$28.13					YES
97150	$21.26
97530	$27.88					YES
97532		$33.71	$26.44			YES
97533		$36.61	$26.44			YES
97535	$22.93					YES
97537	$22.93					YES
97542	$19.27					YES
97545	Per Agm
97546	Per Agm
97597	$63.23
97598	$80.83
97602	BR
97605	BR
97606		$78.07	$46.55
97607	BR
97608	BR
97610	BR
97750	$31.66					YES
97755	$45.99
97760		$49.17	$41.07
97761		$45.29	$40.08
97762		$40.81	$27.51
97799	BR
97802	BR
97803	BR
97804	BR
97810	BR
97811	BR
97813	BR
97814	BR
98925	$30.15
98926	$45.45
98927	$54.00
98928	$63.00
98929	$68.41
98940	$35.83
98941	$45.36
98942	$55.80
98943	$32.95
98960	BR
98961	BR
98962	BR
98966	BR
98967	BR
98968	BR
98969	BR
99000	$8.75
99001	$9.84
99002	$14.22
99024	NA
99026	BR
99027	BR
99050	$26.26
99051	BR
99053	BR
99056	$34.46
99058	$35.55
99060	BR
99070	SC
99071	NA
99075	SC
99078	$15.00
99080	$165.00
99082	BR
99090	NA
99091	BR
99100	NA
99116	$100.00
99135	NA
99140	NA
99143	BR
99144	$38.11
99145	BR
99148	BR
99149	BR
99150	BR
99170	$198.65
99172	BR
99173	BR
99174	BR
99175	$68.37
99183	$209.48			$0.00	$209.48
99184		$361.93	$361.93
99188	BR
99190	$699.53			$419.72	$279.81
99191	$524.51			$314.71	$209.80
99192	$349.50			$209.70	$139.80
99195	$21.33
99199	BR
99201	$53.82
99202	$86.68
99203	$119.56
99204	$179.36
99205	$225.67
99211	$26.14
99212	$47.07
99213	$66.51
99214	$103.13
99215	$162.90
99217	$84.77
99218	$92.43
99219	$147.13
99220	$186.50
99221	$90.79
99222	$151.51
99223	$194.17
99224			$55.79
99225			$99.00
99226			$148.00
99231	$46.48
99232	$70.01
99233	$97.36
99234	$170.06
99235	$233.43
99236	$283.67
99238	$82.59
99239	$119.55
99241	$62.35
99242	$98.99
99243	$128.53
99244	$182.13
99245	$244.47
99251	$63.99
99252	$99.54
99253	$132.36
99254	$182.68
99255	$247.76
99281	$30.46
99282	$46.56
99283	$86.22
99284	$131.63
99285	$207.52
99288	BR
99291	$266.91
99292	$129.62
99304	$100.76
99305	$133.79
99306	$165.13
99307	$51.95
99308	$86.20
99309	$121.49
99310	$152.01
99315	$86.63
99316	$105.73
99318	$100.76
99324	$89.38
99325	$131.16
99326	$190.44
99327	$250.87
99328	$310.69
99334	$69.08
99335	$109.70
99336	$169.58
99337	$249.77
99339	BR
99340	BR
99341	$91.40
99342	$120.71
99343	$158.08
99344	$204.20
99345	$243.43
99347	$64.34
99348	$94.41
99349	$138.17
99350	$198.86
99354	$125.31
99355	$125.31
99356	$120.33
99357	$120.33
99358	$153.13
99359	$76.57
99360	$90.79
99366	BR
99367	BR
99368	BR
99374	BR
99375	$86.81
99377	BR
99378	$117.60
99379	BR
99380	BR
99381	$132.78
99382	$151.76
99383	$151.76
99384	$170.72
99385	$160.39
99386	$197.17
99387	$215.56
99391	$113.82
99392	$132.78
99393	$132.78
99394	$151.76
99395	$143.13
99396	$160.39
99397	$179.35
99401	$51.16
99402	$102.32
99403	$153.48
99404	$204.64
99406		$24.21	$22.76
99407		$48.06	$45.88
99408	BR
99409	BR
99411	$56.91
99412	$73.01
99420	BR
99429	BR
99441	$45.00
99442	$60.00
99443	$75.00
99444	BR
99446	BR
99447	BR
99448	BR
99449	BR
99450	BR
99455	$125.31
99456	$182.13
99460	$112.64
99461	$166.32
99462	$60.07
99463			$150.69
99464	$141.77
99465	$290.01
99466	$463.40
99467	$231.38
99468	$1,736.81
99469	$760.59
99471	$1,547.22
99472	$766.71
99475	$1,067.55
99476	$636.23
99477	$642.56
99479	$242.07
99480	$232.80
99485	BR
99486	BR
99487	BR
99489	BR
99495		$246.73	$203.87
99496		$348.33	$299.00
99499	BR
99500	BR
99501	BR
99502	BR
99503	BR
99504	BR
99505	BR
99506	BR
99507	BR
99509	BR
99510	BR
99511	BR
99512	BR
99551	BR
99552	BR
99553	BR
99554	BR
99555	BR
99556	BR
99557	BR
99558	BR
99559	BR
99560	BR
99561	BR
99562	BR
99563	BR
99564	BR
99565	BR
99566	BR
99567	BR
99568	BR
99569	BR
99600	BR
99601	In Full
99602	In Full
99605	BR
99606	BR
99607	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//