Read CMS/Medicare CPT Codes/Values 2004 text version

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M E D I C A R E

F E E

S C H E D U L E

Attached is a 2004 Medicare Fee Schedule (Disclosure Report) for your locality. The fee schedule amounts and the codes that have been added for 2004 are effective for services performed on or after January 1, 2004. The Medicare Fee Schedule report is formatted in three columns and reads from left to right. The 2004 Medicare Fee Schedule includes the following information: PROC/MOD NOTE CPT or HCPCS code along with -TC (Technical component) -26 (Professional component) or -53 (Discontinued procedure) modifiers when applicable. "D" - Deleted/Discontinued Code. This code is "Deleted/Discontinued" effective with the beginning of the year and it is subject to a 90 day grace period. "G" - Not Valid for Medicare Purposes Code. Medicare uses another code for reporting of, and payment for, these services. This code is "Not Valid for Medicare Purposes" effective with the beginning of the year and it is subject to a 90 day grace period. "H" - Deleted/Discontinued Component Code. Either the "TC" or "26" component shown for this code has been "Deleted/Discontinued". This component code is "Deleted/Discontinued" effective with the beginning of the year and it is subject to a 90 day grace period. "F" - Facility Fee. These amounts apply when the service is performed in a facility setting: Inpatient Hospital (Place of Service (POS) 21), Outpatient Hospital (POS 22), Emergency Room of Hospital (POS 23), Ambulatory Surgical Center (POS 24 - Note: ASC is only treated as a facility setting when an ASC list procedure is performed in an ASC), Military Treatment Facility (POS 26), Skilled Nursing Facility (POS 31), Hospice (POS 34), Ambulance via Land (POS 41), Ambulance via Air or Water (POS 42), Inpatient Psychiatric Facility (POS 51), Psychiatric Facility Partial Hospitalization (POS 52), Community Mental Health Center (POS 53), Psychiatric Residential Treatment Facility (POS 56), and Comprehensive Inpatient Rehabilitation Facility (POS 61). "N" - Non-Facility Fee. These amounts apply when the service is performed in a place of service setting other than listed in the "F" - Facility Fee description above. PAR FEE NPAR FEE LC FEE Note: Allowed amount for participating physicians Allowed amount for non-participating physicians The maximum limiting charge amount that can be charged for that service on a non-assigned claim

A fee schedule amount has been given for each procedure code listed in the Medicare Fee Schedule Data Base. However, based on Medicare policy, the specific procedure may not be payable by the Medicare program.

Special Notice: All pricing as listed in the Fee Schedule is effective for the entire year of 2004, with the exception of the codes J2353, J3240, J7320, J9045, J9201, J9206 and Q3025. These codes are listed in the Fee Schedule with pricing for 01/01/2004 - 03/31/2004. The pricing for these services for 04/01/2004 - 12/31/2004 is as follows: Code Drug Description J2353 Octreotide, Depot form for intramuscular injection, 1 mg J3240 Thyrotropin alpha injection, 0.9 mg, provided in 1.1mg vial J7320 Hylan G-F 20, 16 mg, for intra-articular injection J9045 Carboplatin, Paraplatin, 50 mg J9201 Gemcitabine HCl, 200 mg J9206 Irinotecan, 20 mg Q3025 Interferon beta-1a injection, 11 mcg for im use Visit us on the Web at www.TrailBlazerHealth.com. Par$ $77.14 $585.65 $204.03 $137.54 $111.33 $130.24 $80.22 Non-par$ $73.28 $556.37 $193.83 $130.66 $105.76 $123.73 $76.21

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------6.69 38.38 1017.15 1728.83 1017.37 1728.83 1017.37 1728.83 1017.15 1728.83 1017.15 1701.64 1017.15 1728.49 1017.15 1728.83 1017.15 1728.83 1017.15 1728.83 35.78 8.69 363.95 55.90 49.66 59.69 15.27 78.93 58.41 79.04 23.95 136.42 363.95 55.90 15.69 42.35 22.16 87.31 72.42 131.71 138.93 111.82 74.76 74.76 74.76 74.76 74.76 75.49 74.76 75.12 17.96 36.84 27.83 9.05 46.94 7.32 10.90 85.11 657.54 447.61 392.61 245.80 447.61 21.84 8.35 33.06 16.18 10.10 0.89 18.57 1.41 0.16 16.73 0.70 67.83 4.54

M E D I C A R E LC FEE -------7.69 44.14 1169.72 1988.15 1169.98 1988.15 1169.98 1988.15 1169.72 1988.15 1169.72 1956.89 1169.72 1987.76 1169.72 1988.15 1169.72 1988.15 1169.72 1988.15 41.15 9.99 418.54 64.29 57.11 68.64 17.56 90.77 67.17 90.90 27.54 156.88 418.54 64.29 18.04 48.70 25.48 100.41 83.28 151.47 159.77 128.59 85.97 85.97 85.97 85.97 85.97 86.81 85.97 86.39 20.65 42.37 32.00 10.41 53.98 8.42 12.54 97.88 756.17 514.75 451.50 282.67 514.75 25.12 9.60 38.02 18.61 11.62 1.02 21.36 1.62 0.18 19.24 0.81 78.00 5.22

F E E

S C H E D U L E NPAR FEE -------115.61 27.98 941.66 1632.46 941.66 1632.46 941.66 1632.46 941.66 1632.46 941.66 1606.44 941.66 1632.46 941.66 1632.46 941.66 1632.46 941.66 1632.46 22.89 117.75 199.74 136.42 31.26 44.96 108.45 63.46 68.68 54.37 25.63 86.76 199.74 22.16 9.06 31.47 134.67 22.52 120.93 96.57 95.10 76.35 74.76 74.76 74.76 74.76 74.76 75.12 75.49 75.12 62.94 22.85 248.85 96.50 32.95 13.06 10.90 96.50 525.84 357.91 313.77 196.36 392.61 13.08 8.76 63.23 35.27 26.78 5.23 12.92 6.31 13.62 155.04 20.12 14.51 10.14

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------113.72 37.60 77.33 96.54 76.19 97.28 77.29 96.91 76.59 96.18 75.12 96.50 77.70 96.58 78.43 97.65 77.70 96.54 77.70 96.91 20.84 55.90 117.75 86.76 18.00 20.79 88.57 62.82 58.73 43.10 9.06 49.66 117.75 75.45 4.33 10.88 3.97 56.02 127.93 35.14 43.83 35.47 74.76 74.76 75.12 75.12 75.12 74.76 74.76 75.12 45.63 38.86 144.29 96.50 17.63 13.06 398.43 789.69 537.39 471.51 295.25 657.54 245.80 14.90 436.07 2.00 385.03 2.26 8.84 30.43 2.26 1.08 21.58 182.90 3.32 19.89

PAGE 001 LC FEE -------130.78 43.24 88.93 111.02 87.62 111.87 88.88 111.45 88.08 110.61 86.39 110.98 89.36 111.07 90.19 112.30 89.36 111.02 89.36 111.45 23.97 64.29 135.41 99.77 20.70 23.91 101.86 72.24 67.54 49.57 10.42 57.11 135.41 86.77 4.98 12.51 4.57 64.42 147.12 40.41 50.40 40.79 85.97 85.97 86.39 86.39 86.39 85.97 85.97 86.39 52.47 44.69 165.93 110.98 20.27 15.02 458.19 908.14 618.00 542.24 339.54 756.17 282.67 17.14 501.48 2.30 442.78 2.60 10.17 34.99 2.60 1.24 24.82 210.34 3.82 22.87 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------A4643 A9503 G0030 G0031 G0032 G0033 G0034 G0035 G0036 G0037 G0038 G0039 G0040 G0041 G0042 G0043 G0044 G0045 G0046 G0047 G0101 G0102 G0105 G0105 G0106 G0110 G0111 G0113 G0114 G0116 G0117 G0120 G0121 G0121 G0127 G0130 G0141 G0168 G0180 G0202 G0204 G0206 G0210 G0213 G0216 G0220 G0223 G0226 G0229 G0232 G0237 G0246 G0247 G0250 G0268 G0271 G0281 G0289 G0309 G0312 G0315 G0318 G0321 G0324 G0327 J0150 J0200 J0210 J0280 J0287 J0290 J0330 J0390 J0460 J0476 J0520 *** 7.04 40.40 1070.68 1819.82 1070.92 1819.82 1070.92 1819.82 1070.68 1819.82 1070.68 1791.20 1070.68 1819.46 1070.68 1819.82 1070.68 1819.82 1070.68 1819.82 37.66 9.15 383.10 58.84 52.27 62.83 16.07 83.08 61.48 83.20 25.21 143.60 383.10 58.84 16.52 44.58 23.33 91.91 76.23 138.64 146.24 117.71 78.69 78.69 78.69 78.69 78.69 79.46 78.69 79.07 18.91 38.78 29.29 9.53 49.41 7.71 11.47 89.59 692.15 471.17 413.27 258.74 471.17 22.99 8.79 34.80 17.03 10.63 0.94 19.55 1.48 0.17 17.61 0.74 71.40 4.78

PROC MOD NOTE PAR FEE ----- -- ---- -------A9500 A9505 G0030 G0031 G0032 G0033 G0034 G0035 G0036 G0037 G0038 G0039 G0040 G0041 G0042 G0043 G0044 G0045 G0046 G0047 G0101 G0104 G0105 G0106 G0108 G0110 G0112 G0113 G0115 G0116 G0118 G0120 G0121 G0124 G0127 G0130 G0166 G0168 G0181 G0202 G0204 G0206 G0211 G0214 G0217 G0221 G0224 G0227 G0230 G0233 G0245 G0246 G0248 G0253 G0268 G0275 G0283 G0296 G0310 G0313 G0316 G0319 G0322 G0325 G0329 J0152 J0205 J0215 J0282 J0288 J0295 J0360 J0395 J0470 J0500 J0530 TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC F N F F N F N F N TC F F TC N F TC TC TC 26 26 26 26 26 26 26 26 N F 26 F 26 121.69 29.45 991.22 1718.38 991.22 1718.38 991.22 1718.38 991.22 1718.38 991.22 1690.99 991.22 1718.38 991.22 1718.38 991.22 1718.38 991.22 1718.38 24.09 123.95 210.25 143.60 32.90 47.33 114.16 66.80 72.29 57.23 26.98 91.33 210.25 23.33 9.54 33.13 141.76 23.70 127.29 101.65 100.10 80.37 78.69 78.69 78.69 78.69 78.69 79.07 79.46 79.07 66.25 24.05 261.95 101.58 34.68 13.75 11.47 101.58 553.52 376.75 330.28 206.69 413.27 13.77 9.22 66.56 37.13 28.19 5.51 13.60 6.64 14.34 163.20 21.18 15.27 10.67

LC FEE -------132.95 32.18 1082.91 1877.33 1082.91 1877.33 1082.91 1877.33 1082.91 1877.33 1082.91 1847.41 1082.91 1877.33 1082.91 1877.33 1082.91 1877.33 1082.91 1877.33 26.32 135.41 229.70 156.88 35.95 51.70 124.72 72.98 78.98 62.53 29.47 99.77 229.70 25.48 10.42 36.19 154.87 25.90 139.07 111.06 109.37 87.80 85.97 85.97 85.97 85.97 85.97 86.39 86.81 86.39 72.38 26.28 286.18 110.98 37.89 15.02 12.54 110.98 604.72 411.60 360.84 225.81 451.50 15.04 10.07 72.71 40.56 30.80 6.01 14.86 7.26 15.66 178.30 23.14 16.69 11.66

PROC MOD NOTE PAR FEE ----- -- ---- -------A9502 A9510 G0030 G0031 G0032 G0033 G0034 G0035 G0036 G0037 G0038 G0039 G0040 G0041 G0042 G0043 G0044 G0045 G0046 G0047 G0102 G0104 G0105 G0106 G0109 G0111 G0112 G0114 G0115 G0117 G0118 G0120 G0121 G0125 G0128 G0130 G0166 G0179 G0182 G0202 G0204 G0206 G0212 G0215 G0218 G0222 G0225 G0228 G0231 G0234 G0245 G0247 G0249 G0254 G0270 G0278 G0288 G0308 G0311 G0314 G0317 G0320 G0323 G0326 J0130 J0170 J0207 J0256 J0285 J0289 J0300 J0380 J0456 J0475 J0515 J0540 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 N F 53 N TC N F N F N F 26 53 N 26 26 F 26 26 26 26 26 26 26 26 26 26 26 F N 26 119.70 39.58 81.40 101.62 80.20 102.40 81.36 102.01 80.62 101.24 79.07 101.58 81.79 101.66 82.56 102.79 81.79 101.62 81.79 102.01 21.94 58.84 123.95 91.33 18.95 21.88 93.23 66.13 61.82 45.37 9.54 52.27 123.95 79.42 4.56 11.45 4.18 58.97 134.66 36.99 46.14 37.34 78.69 78.69 79.07 79.07 79.07 78.69 78.69 79.07 48.03 40.91 151.88 101.58 18.56 13.75 419.40 831.25 565.67 496.33 310.79 692.15 258.74 15.68 459.02 2.10 405.29 2.38 9.30 32.03 2.38 1.14 22.72 192.53 3.49 20.94

N F N 53 F 26 N F N F N F N 53 F N N

26 26 26 26 26 26 26 26 N F N

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------42.60 33.62 7.47 37.49 32.65 2.85 6.92 5.46 0.91 4.22 46.88 11.64 46.03 71.31 13.28 1.37 3.52 20.92 8.02 34.24 0.73 198.87 37.91 4.85 4.67 10.91 0.46 0.48 150.58 807.50 19.38 48.45 77.52 62.70 29.95 28.62 171.68 7.75 13.34 3.26 4.73 213.65 0.55 8.03 57.13 0.42 0.84 17.69 21.25 31.28 0.46 3.49 0.57 8.84 3.26 128.88 227.69 5.43 225.99 4.27 0.25 2.42 2.94 3.02 0.67 20.74 1.59 100.26 17.47 23.25 6.94 38.72 75.71 0.79 24.99 0.27

M E D I C A R E LC FEE -------48.99 38.66 8.59 43.11 37.55 3.28 7.96 6.28 1.05 4.85 53.91 13.39 52.93 82.01 15.27 1.58 4.05 24.06 9.22 39.38 0.84 228.70 43.60 5.58 5.37 12.55 0.53 0.55 173.17 928.63 22.29 55.72 89.15 72.11 34.44 32.91 197.43 8.91 15.34 3.75 5.44 245.70 0.63 9.23 65.70 0.48 0.97 20.34 24.44 35.97 0.53 4.01 0.66 10.17 3.75 148.21 261.84 6.24 259.89 4.91 0.29 2.78 3.38 3.47 0.77 23.85 1.83 115.30 20.09 26.74 7.98 44.53 87.07 0.91 28.74 0.31

F E E

S C H E D U L E NPAR FEE -------8.41 1.36 0.87 0.86 1.18 1.76 9.08 8.08 2.92 6.14 717.06 0.39 3.55 605.26 1.39 1.62 7.03 3.79 0.61 17.44 1.31 1.36 0.65 4.03 2.04 20.18 0.97 65.41 254.40 11.12 29.10 58.03 87.30 0.68 1.62 11.50 14.84 0.05 5.19 100.94 1.47 55.85 3.52 8.03 31.32 3.03 431.10 3.20 0.84 2.67 3.82 1.08 6.64 1.28 5.94 67.54 4.61 5.30 2.83 8.16 4.14 1.37 0.21 7.62 0.56 87.51 97.39 43.53 0.06 14.72 1.34 39.04 31.19 22.57 7.63 0.80

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------16.82 4.21 3.74 5.27 28.01 1.91 12.68 4.23 5.74 2.27 13.49 6.00 78.99 20.14 0.81 2.28 4.28 4.21 0.10 1.51 7.67 8.91 0.32 13.16 15.35 2.98 52.29 131.89 81.54 9.69 38.76 67.76 96.90 14.07 0.77 38.76 5.80 0.33 7.03 0.29 104.51 15.23 2.38 0.09 2.79 8.72 29.07 7.28 2.70 2.77 4.18 43.84 1.62 2.01 13.38 3.62 1.09 2.51 0.86 1.12 38.11 1.09 3.33 1.18 0.65 27.13 1.23 85.27 3.23 0.42 1.63 0.39 5.39 4.44 15.27 3.73

PAGE 002 LC FEE -------19.34 4.84 4.30 6.06 32.21 2.20 14.58 4.86 6.60 2.61 15.51 6.90 90.84 23.16 0.93 2.62 4.92 4.84 0.12 1.74 8.82 10.25 0.37 15.13 17.65 3.43 60.13 151.67 93.77 11.14 44.57 77.92 111.44 16.18 0.89 44.57 6.67 0.38 8.08 0.33 120.19 17.51 2.74 0.10 3.21 10.03 33.43 8.37 3.11 3.19 4.81 50.42 1.86 2.31 15.39 4.16 1.25 2.89 0.99 1.29 43.83 1.25 3.83 1.36 0.75 31.20 1.41 98.06 3.71 0.48 1.87 0.45 6.20 5.11 17.56 4.29 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------J0550 J0580 J0587 J0600 J0630 J0640 J0692 J0697 J0704 J0715 J0735 J0744 J0770 J0835 J0895 J0970 J1030 J1056 J1080 J1110 J1165 J1190 J1212 J1245 J1270 J1327 J1380 J1435 J1440 J1452 J1470 J1500 J1530 J1563 J1570 J1595 J1620 J1631 J1645 J1655 J1710 J1742 J1756 J1800 J1830 J1850 J1940 J1956 J1990 J2020 J2175 J2210 J2270 J2280 J2320 J2324 J2355 J2400 J2430 J2501 J2540 J2550 J2597 J2675 J2700 J2725 J2765 J2783 J2792 J2820 J2916 J2940 J2995 J3010 J3105 J3140 *** 44.84 35.39 7.86 39.46 34.37 3.00 7.28 5.75 0.96 4.44 49.35 12.25 48.45 75.06 13.98 1.44 3.70 22.02 8.44 36.04 0.77 209.34 39.91 5.10 4.92 11.48 0.48 0.51 158.50 850.00 20.40 51.00 81.60 66.00 31.53 30.13 180.72 8.16 14.04 3.43 4.98 224.89 0.58 8.45 60.14 0.44 0.88 18.62 22.37 32.93 0.48 3.67 0.60 9.30 3.43 135.66 239.67 5.72 237.88 4.49 0.26 2.55 3.09 3.18 0.71 21.83 1.67 105.54 18.39 24.47 7.31 40.76 79.69 0.83 26.30 0.28

PROC MOD NOTE PAR FEE ----- -- ---- -------J0560 J0583 J0592 J0610 J0636 J0670 J0694 J0698 J0706 J0720 J0740 J0745 J0780 J0850 J0900 J1000 J1040 J1060 J1094 J1120 J1170 J1200 J1230 J1250 J1320 J1335 J1390 J1436 J1441 J1455 J1480 J1510 J1540 J1564 J1580 J1600 J1626 J1642 J1650 J1670 J1720 J1745 J1785 J1810 J1835 J1885 J1950 J1960 J2001 J2060 J2180 J2250 J2271 J2300 J2321 J2353 J2360 J2405 J2440 J2510 J2543 J2560 J2650 J2680 J2710 J2730 J2770 J2788 J2795 J2910 J2920 J2941 J2997 J3030 J3120 J3150 8.85 1.43 0.92 0.90 1.24 1.85 9.56 8.51 3.07 6.46 754.80 0.41 3.74 637.12 1.46 1.70 7.40 3.99 0.64 18.36 1.38 1.43 0.68 4.24 2.15 21.24 1.02 68.85 267.79 11.70 30.63 61.08 91.89 0.72 1.70 12.10 15.62 0.05 5.46 106.25 1.55 58.79 3.71 8.45 32.97 3.19 453.79 3.37 0.88 2.81 4.02 1.14 6.99 1.35 6.25 71.09 4.85 5.58 2.98 8.59 4.36 1.44 0.22 8.02 0.59 92.12 102.52 45.82 0.06 15.49 1.41 41.09 32.83 23.76 8.03 0.84

LC FEE -------9.67 1.56 1.00 0.99 1.36 2.02 10.44 9.29 3.36 7.06 824.62 0.45 4.08 696.05 1.60 1.86 8.08 4.36 0.70 20.06 1.51 1.56 0.75 4.63 2.35 23.21 1.12 75.22 292.56 12.79 33.47 66.73 100.40 0.78 1.86 13.23 17.07 0.06 5.97 116.08 1.69 64.23 4.05 9.23 36.02 3.48 495.77 3.68 0.97 3.07 4.39 1.24 7.64 1.47 6.83 77.67 5.30 6.10 3.25 9.38 4.76 1.58 0.24 8.76 0.64 100.64 112.00 50.06 0.07 16.93 1.54 44.90 35.87 25.96 8.77 0.92

PROC MOD NOTE PAR FEE ----- -- ---- -------J0570 J0585 J0595 J0620 J0637 J0690 J0696 J0702 J0713 J0725 J0743 J0760 J0800 J0880 J0945 J1020 J1051 J1070 J1100 J1160 J1180 J1205 J1240 J1260 J1325 J1364 J1410 J1438 J1450 J1460 J1490 J1520 J1550 J1565 J1590 J1610 J1630 J1644 J1652 J1700 J1730 J1750 J1790 J1815 J1840 J1890 J1955 J1980 J2010 J2150 J2185 J2260 J2275 J2310 J2322 J2354 J2370 J2410 J2460 J2515 J2545 J2590 J2670 J2690 J2720 J2760 J2780 J2790 J2800 J2912 J2930 J2950 J3000 J3070 J3130 J3230 17.70 4.43 3.94 5.55 29.48 2.01 13.35 4.45 6.04 2.39 14.20 6.32 83.15 21.20 0.85 2.40 4.50 4.43 0.10 1.59 8.07 9.38 0.34 13.85 16.16 3.14 55.04 138.83 85.83 10.20 40.80 71.33 102.00 14.81 0.81 40.80 6.11 0.35 7.40 0.30 110.01 16.03 2.50 0.09 2.94 9.18 30.60 7.66 2.84 2.92 4.40 46.15 1.70 2.12 14.08 3.81 1.15 2.64 0.91 1.18 40.12 1.15 3.51 1.24 0.68 28.56 1.29 89.76 3.40 0.44 1.72 0.41 5.67 4.67 16.07 3.93

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------524.88 3.79 1.36 121.13 24.04 48.12 57.02 0.45 4.28 0.86 8.45 2.11 9.29 10.57 117.90 4.44 361.34 2.41 24.54 1.52 334.46 31.29 143.08 12.88 4.87 38.87 9.89 79.75 7.27 18.50 12.25 1.45 1.76 357.19 29.88 29.65 198.76 10.20 4.04 79.73 242.25 120.25 49.41 28.88 72.38 18.15 31.77 37.00 23.71 38.03 11.04 383.78 112.10 11.04 58.66 129.64 63.44 89.86 149.44 247.65 63.24 116.95 64.69 44.70 15.57 495.69 426.26 55.94 60.76 290.04 22.50 57.14 44.61 68.56 15.58 73.67

M E D I C A R E LC FEE -------603.61 4.36 1.56 139.30 27.65 55.34 65.57 0.52 4.92 0.99 9.72 2.43 10.68 12.16 135.59 5.11 415.54 2.77 28.22 1.75 384.63 35.98 164.54 14.81 5.60 44.70 11.37 91.71 8.36 21.28 14.09 1.67 2.02 410.77 34.36 34.10 228.57 11.73 4.65 91.69 278.59 138.29 56.82 33.21 83.24 20.87 36.54 42.55 27.27 43.73 12.70 441.35 128.92 12.70 67.46 149.09 72.96 103.34 171.86 284.80 72.73 134.49 74.39 51.41 17.91 570.04 490.20 64.33 69.87 333.55 25.88 65.71 51.30 78.84 17.92 84.72

F E E

S C H E D U L E NPAR FEE -------400.68 1.32 0.29 6.78 80.02 434.78 1.03 0.14 0.19 17.67 5.36 0.07 21.35 0.42 191.18 2.97 1.11 6.06 0.12 5.52 496.85 53.22 120.49 64.40 9.25 77.73 19.43 315.73 11.79 63.10 286.33 14.54 116.28 116.59 356.94 12.64 475.55 357.09 8.03 54.26 305.44 79.54 447.68 57.77 77.49 22.16 117.33 66.60 14.65 18.89 4.03 38.00 72.42 0.40 111.85 68.51 82.27 80.28 161.24 151.91 229.93 94.86 211.05 31.81 417.73 287.30 38.86 44.16 221.32 263.16 46.61 41.68 28.03 57.88 56.61 46.06

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------1.19 4.81 0.86 338.83 0.73 2.45 0.77 1.88 0.07 184.81 8.03 7.69 12.08 105.90 27.84 303.94 23.83 100.98 0.17 7.75 624.29 136.12 115.75 43.61 19.43 4.95 38.87 6.96 9.54 54.91 23.49 302.66 96.81 127.82 3.89 6.68 66.77 0.33 131.37 176.36 405.92 670.86 2.67 144.42 26.25 83.03 33.57 124.10 9.06 12.11 14.25 399.95 4.03 0.59 111.85 144.07 69.75 160.49 87.98 101.90 176.55 74.63 167.97 20.00 255.36 726.32 27.83 79.90 191.86 36.48 32.25 77.38 22.51 17.05 27.89 88.24

PAGE 003 LC FEE -------1.37 5.53 0.99 389.65 0.84 2.82 0.89 2.16 0.08 212.53 9.23 8.84 13.89 121.79 32.02 349.53 27.40 116.13 0.20 8.91 717.93 156.54 133.11 50.15 22.34 5.69 44.70 8.00 10.97 63.15 27.01 348.06 111.33 146.99 4.47 7.68 76.79 0.38 151.08 202.81 466.81 771.49 3.07 166.08 30.19 95.48 38.61 142.72 10.42 13.93 16.39 459.94 4.63 0.68 128.63 165.68 80.21 184.56 101.18 117.19 203.03 85.82 193.17 23.00 293.66 835.27 32.00 91.89 220.64 41.95 37.09 88.99 25.89 19.61 32.07 101.48 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------J3240 J3260 J3301 J3305 J3320 J3364 J3400 J3415 J3465 J3485 J7030 J7050 J7070 J7120 J7317 J7502 J7513 J7517 J7608 J7621 J9001 J9017 J9040 J9060 J9070 J9091 J9094 J9097 J9110 J9140 J9165 J9181 J9190 J9202 J9209 J9213 J9216 J9230 J9260 J9270 J9291 J9320 J9355 J9370 J9390 M0064 P9012 P9019 Q0035 Q0091 Q0136 Q3003 Q3012 Q4055 Q4077 10021 10022 10060 10061 10081 10120 10140 10160 11000 11001 11011 11012 11041 11042 11044 11055 11057 11100 11200 11201 11301 *** 552.50 3.99 1.43 127.50 25.30 50.65 60.02 0.47 4.51 0.91 8.89 2.22 9.78 11.13 124.11 4.67 380.36 2.54 25.83 1.60 352.06 32.94 150.61 13.56 5.13 40.92 10.41 83.95 7.65 19.47 12.89 1.53 1.85 375.99 31.45 31.21 209.22 10.74 4.25 83.93 255.00 126.58 52.01 30.40 76.19 19.10 33.44 38.95 24.96 40.03 11.62 403.98 118.00 11.62 61.75 136.46 66.78 94.59 157.31 260.68 66.57 123.10 68.09 47.05 16.39 521.78 448.69 58.88 63.96 305.31 23.68 60.15 46.96 72.17 16.40 77.55

PROC MOD NOTE PAR FEE ----- -- ---- -------J3245 J3265 J3302 J3310 J3350 J3365 J3410 J3420 J3475 J3486 J7040 J7051 J7100 J7130 J7320 J7507 J7515 J7520 J7618 J8700 J9010 J9020 J9045 J9062 J9080 J9092 J9095 J9098 J9120 J9150 J9170 J9182 J9200 J9206 J9211 J9214 J9217 J9245 J9263 J9280 J9293 J9340 J9357 J9375 J9395 P3001 P9016 P9021 Q0035 TC Q0091 F Q0137 Q3004 Q3025 Q4075 R0070 10021 F 10040 N 10060 F 10080 N 10081 F 10121 N 10140 F 10180 N 11000 F 11010 N 11011 F 11040 N 11041 F 11043 N 11044 F 11056 N 11057 F 11101 N 11200 F 11300 N 11301 F 421.77 1.39 0.31 7.14 84.23 457.66 1.08 0.15 0.20 18.60 5.64 0.07 22.47 0.44 201.24 3.13 1.17 6.38 0.13 5.81 523.00 56.02 126.83 67.79 9.74 81.82 20.45 332.35 12.41 66.42 301.40 15.30 122.40 122.73 375.73 13.31 500.58 375.88 8.45 57.12 321.52 83.73 471.24 60.81 81.57 23.33 123.50 70.11 15.42 19.88 4.24 40.00 76.23 0.42 117.74 72.12 86.60 84.51 169.73 159.91 242.03 99.85 222.16 33.48 439.72 302.42 40.91 46.48 232.97 277.01 49.06 43.87 29.50 60.93 59.59 48.48

LC FEE -------460.78 1.52 0.33 7.80 92.02 500.00 1.18 0.16 0.22 20.32 6.16 0.08 24.55 0.48 219.86 3.42 1.28 6.97 0.14 6.35 571.38 61.20 138.56 74.06 10.64 89.39 22.34 363.09 13.56 72.57 329.28 16.72 133.72 134.08 410.48 14.54 546.88 410.65 9.23 62.40 351.26 91.47 514.83 66.44 89.11 25.48 134.93 76.59 16.85 21.72 4.63 43.70 83.28 0.46 128.63 78.79 94.61 92.32 185.43 174.70 264.42 109.09 242.71 36.58 480.39 330.40 44.69 50.78 254.52 302.63 53.60 47.93 32.23 66.56 65.10 52.97

PROC MOD NOTE PAR FEE ----- -- ---- -------J3250 J3280 J3303 J3315 J3360 J3370 J3411 J3430 J3480 J3487 J7042 J7060 J7110 J7308 J7340 J7511 J7516 J7525 J7619 J9000 J9015 J9031 J9050 J9065 J9090 J9093 J9096 J9100 J9130 J9151 J9178 J9185 J9201 J9208 J9212 J9215 J9218 J9250 J9265 J9290 J9310 J9350 J9360 J9380 M0064 N P9010 P9017 P9022 Q0035 26 Q0092 Q3002 Q3007 Q4054 Q4076 R0075 10022 N 10040 F 10061 N 10080 F 10120 N 10121 F 10160 N 10180 F 11001 N 11010 F 11012 N 11040 F 11042 N 11043 F 11055 N 11056 F 11100 N 11101 F 11201 N 11300 F 11302 N 1.25 5.06 0.90 356.66 0.77 2.58 0.81 1.98 0.07 194.54 8.45 8.09 12.72 111.47 29.30 319.94 25.08 106.29 0.18 8.16 657.15 143.28 121.84 45.90 20.45 5.21 40.92 7.33 10.04 57.80 24.73 318.59 101.90 134.55 4.09 7.03 70.28 0.35 138.28 185.64 427.28 706.17 2.81 152.02 27.63 87.40 35.34 130.63 9.54 12.75 15.00 421.00 4.24 0.62 117.74 151.65 73.42 168.94 92.61 107.26 185.84 78.56 176.81 21.05 268.80 764.55 29.29 84.11 201.96 38.40 33.95 81.45 23.69 17.95 29.36 92.88

F N

N F N F N F N F N F N F N F N F N F N F N

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------56.94 56.84 52.93 107.09 40.24 98.79 88.82 124.39 99.81 182.38 171.35 132.30 113.98 200.09 227.76 146.25 126.07 253.96 276.49 406.36 174.52 318.84 277.55 169.96 122.66 219.74 199.52 168.87 132.81 260.27 257.60 196.83 164.76 333.32 361.78 24.77 28.94 38.46 19.87 218.52 131.90 184.92 233.70 352.57 43.42 43.55 165.04 28.93 102.29 93.18 750.80 260.65 98.06 84.25 217.15 84.89 174.95 158.11 305.82 87.76 192.45 172.24 256.05 168.89 168.86 163.14 329.41 250.12 183.71 156.61 280.13 271.03 214.65 156.59 265.18 252.73

M E D I C A R E LC FEE -------65.48 65.37 60.87 123.15 46.28 113.61 102.14 143.05 114.78 209.74 197.05 152.15 131.08 230.10 261.92 168.19 144.98 292.05 317.96 467.31 200.70 366.67 319.18 195.45 141.06 252.70 229.45 194.20 152.73 299.31 296.24 226.35 189.47 383.32 416.05 28.49 33.28 44.23 22.85 251.30 151.69 212.66 268.76 405.46 49.93 50.08 189.80 33.27 117.63 107.16 863.42 299.75 112.77 96.89 249.72 97.62 201.19 181.83 351.69 100.92 221.32 198.08 294.46 194.22 194.19 187.61 378.82 287.64 211.27 180.10 322.15 311.68 246.85 180.08 304.96 290.64

F E E

S C H E D U L E NPAR FEE -------105.76 35.85 90.76 75.43 85.66 66.02 106.73 86.10 160.20 133.78 103.96 96.96 175.83 155.53 125.64 113.49 199.55 204.26 297.25 252.46 414.80 213.17 148.65 115.10 200.09 145.73 143.19 114.39 226.16 186.27 151.90 140.87 263.60 249.74 15.69 17.03 82.11 30.72 152.06 90.25 108.71 68.94 159.70 543.49 27.59 138.51 114.24 75.07 65.84 164.43 510.63 133.99 77.44 143.93 185.85 149.15 126.72 271.05 231.45 163.39 136.49 287.39 301.65 138.29 113.63 230.72 216.01 424.25 124.80 241.11 224.89 420.59 145.80 239.48 193.76 455.47

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------66.37 78.71 61.30 69.32 57.68 129.31 65.86 142.15 120.07 224.00 73.41 148.22 133.48 279.67 90.66 163.27 157.58 325.46 183.84 291.60 257.58 427.41 87.15 181.20 134.56 286.41 82.07 192.09 160.99 342.29 94.09 227.72 194.01 447.19 9.06 37.04 60.39 46.02 136.96 69.64 201.12 46.11 439.83 421.99 54.60 93.96 33.35 47.46 136.99 108.10 346.81 96.43 123.28 102.32 140.49 107.55 217.76 201.47 148.88 114.06 242.55 212.28 202.03 126.14 238.25 165.92 359.84 290.61 224.35 180.73 411.30 298.36 223.96 176.15 341.10 319.61

PAGE 004 LC FEE -------76.33 90.52 70.50 79.72 66.33 148.71 75.74 163.47 138.08 257.60 84.42 170.45 153.50 321.62 104.26 187.76 181.22 374.28 211.42 335.34 296.22 491.52 100.22 208.38 154.74 329.37 94.38 220.90 185.14 393.63 108.20 261.88 223.11 514.27 10.42 42.60 69.45 52.92 157.50 80.09 231.29 53.03 505.80 485.29 62.79 108.05 38.35 54.58 157.54 124.32 398.83 110.89 141.77 117.67 161.56 123.68 250.42 231.69 171.21 131.17 278.93 244.12 232.33 145.06 273.99 190.81 413.82 334.20 258.00 207.84 473.00 343.11 257.55 202.57 392.27 367.55 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------11302 11305 11306 11308 11310 11312 11313 11401 11402 11404 11406 11421 11422 11424 11426 11441 11442 11444 11446 11451 11462 11470 11471 11601 11602 11604 11606 11621 11622 11624 11626 11641 11642 11644 11646 11720 11721 11732 11740 11752 11760 11762 11770 11771 11900 11901 11921 11922 11951 11952 11960 11971 11980 11981 11983 12001 12004 12005 12007 12011 12014 12015 12017 12020 12031 12032 12035 12036 12041 12042 12045 12046 12051 12052 12054 12055 *** F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F F N F N F N F N F N F F N F N F N F N F N F N F 59.94 59.83 55.72 112.73 42.36 103.99 93.49 130.94 105.06 191.98 180.37 139.26 119.98 210.62 239.75 153.95 132.71 267.33 291.04 427.75 183.71 335.62 292.16 178.90 129.12 231.30 210.02 177.76 139.80 273.97 271.16 207.19 173.43 350.86 380.82 26.07 30.46 40.48 20.92 230.02 138.84 194.65 246.00 371.13 45.71 45.84 173.73 30.45 107.67 98.08 790.32 274.37 103.22 88.68 228.58 89.36 184.16 166.43 321.92 92.38 202.58 181.30 269.53 177.78 177.75 171.73 346.75 263.28 193.38 164.85 294.87 285.29 225.95 164.83 279.14 266.03

PROC MOD NOTE PAR FEE ----- -- ---- -------11303 11305 11307 11308 11311 11312 11400 11401 11403 11404 11420 11421 11423 11424 11440 11441 11443 11444 11450 11451 11463 11470 11600 11601 11603 11604 11620 11621 11623 11624 11640 11641 11643 11644 11719 11720 11730 11732 11750 11755 11760 11765 11770 11772 11900 11920 11921 11950 11951 11954 11970 11976 11980 11982 11983 12002 12004 12006 12007 12013 12014 12016 12018 12021 12031 12034 12035 12037 12041 12044 12045 12047 12051 12053 12054 12056 N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N N F N F N F N F N F N N F N F N F N F N F N N F N F N F N F N F N F N 111.33 37.74 95.54 79.40 90.17 69.49 112.35 90.63 168.63 140.82 109.43 102.06 185.08 163.72 132.25 119.46 210.05 215.01 312.89 265.75 436.63 224.39 156.47 121.16 210.62 153.40 150.73 120.41 238.06 196.07 159.89 148.28 277.47 262.88 16.52 17.93 86.43 32.34 160.06 95.00 114.43 72.57 168.10 572.09 29.04 145.80 120.25 79.02 69.30 173.08 537.50 141.04 81.52 151.51 195.63 157.00 133.39 285.32 243.63 171.99 143.67 302.52 317.53 145.57 119.61 242.86 227.38 446.58 131.37 253.80 236.73 442.73 153.47 252.08 203.96 479.44

LC FEE -------121.62 41.23 104.37 86.74 98.51 75.92 122.74 99.02 184.23 153.85 119.55 111.50 202.20 178.86 144.49 130.51 229.48 234.90 341.84 290.33 477.02 245.15 170.95 132.37 230.10 167.59 164.67 131.55 260.08 214.21 174.69 162.00 303.14 287.20 18.04 19.58 94.43 35.33 174.87 103.79 125.02 79.28 183.66 625.01 31.73 159.29 131.38 86.33 75.72 189.09 587.22 154.09 89.06 165.52 213.73 171.52 145.73 311.71 266.17 187.90 156.96 330.50 346.90 159.03 130.67 265.33 248.41 487.89 143.52 277.28 258.62 483.68 167.67 275.40 222.82 523.79

PROC MOD NOTE PAR FEE ----- -- ---- -------11303 11306 11307 11310 11311 11313 11400 11402 11403 11406 11420 11422 11423 11426 11440 11442 11443 11446 11450 11462 11463 11471 11600 11602 11603 11606 11620 11622 11623 11626 11640 11642 11643 11646 11719 11721 11730 11740 11750 11755 11762 11765 11771 11772 11901 11920 11922 11950 11952 11954 11971 11976 11981 11982 12001 12002 12005 12006 12011 12013 12015 12016 12020 12021 12032 12034 12036 12037 12042 12044 12046 12047 12052 12053 12055 12056 F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F 69.86 82.85 64.53 72.97 60.72 136.12 69.33 149.63 126.39 235.79 77.27 156.02 140.51 294.39 95.43 171.86 165.87 342.59 193.52 306.95 271.14 449.90 91.74 190.74 141.64 301.48 86.39 202.20 169.46 360.30 99.04 239.70 204.22 470.73 9.54 38.99 63.57 48.44 144.17 73.30 211.70 48.54 462.98 444.20 57.47 98.91 35.10 49.96 144.20 113.79 365.06 101.51 129.77 107.71 147.88 113.21 229.22 212.07 156.72 120.06 255.32 223.45 212.66 132.78 250.79 174.65 378.78 305.90 236.16 190.24 432.95 314.06 235.75 185.42 359.05 336.43

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------459.89 186.79 76.11 195.77 88.81 225.60 130.06 245.27 467.93 135.43 419.62 595.74 675.98 835.53 614.05 872.18 299.64 55.60 829.72 130.67 276.22 540.42 701.64 68.33 127.68 705.34 107.23 13.40 75.12 311.31 709.12 602.45 688.81 176.18 392.37 274.35 1369.34 1173.48 1385.65 685.38 2208.20 603.35 208.82 540.13 346.39 124.57 202.96 369.49 294.44 418.88 394.65 383.26 497.58 734.55 747.75 593.70 602.98 2378.60 45.65 123.03 669.58 812.74 940.71 782.84 505.80 845.43 66.21 57.34 53.74 163.59 80.70 9.81 153.16 629.38 795.42 96.82

M E D I C A R E LC FEE -------528.87 214.81 87.53 225.14 102.13 259.44 149.57 282.06 538.12 155.74 482.56 685.10 777.38 960.86 706.16 1003.01 344.59 63.94 954.18 150.27 317.65 621.48 806.89 78.58 146.83 811.14 123.31 15.41 86.39 358.01 815.49 692.82 792.13 202.61 451.23 315.50 1574.74 1349.50 1593.50 788.19 2539.43 693.85 240.14 621.15 398.35 143.26 233.40 424.91 338.61 481.71 453.85 440.75 572.22 844.73 859.91 682.76 693.43 2735.39 52.50 141.48 770.02 934.65 1081.82 900.27 581.67 972.24 76.14 65.94 61.80 188.13 92.81 11.28 176.13 723.79 914.73 111.34

F E E

S C H E D U L E NPAR FEE -------373.73 288.59 69.85 312.53 79.97 400.31 124.17 370.84 388.77 689.25 698.12 478.66 610.20 763.37 903.38 797.80 240.36 393.33 651.89 788.53 176.44 91.71 548.47 732.43 108.17 187.84 60.10 463.99 54.87 85.42 617.43 717.73 579.45 234.88 252.82 404.30 1154.69 1328.12 1157.75 791.57 2209.40 549.34 422.50 383.15 318.77 24.40 163.56 187.67 330.63 635.14 485.20 330.24 802.85 722.98 626.60 505.19 895.42 830.82 102.64 104.99 583.95 971.93 606.23 872.28 725.45 1026.21 44.49 136.36 139.18 123.83 59.13 8.34 356.40 553.17 85.21 56.70

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------250.48 232.26 261.67 251.78 289.66 344.72 351.68 283.58 142.79 544.81 574.77 775.76 559.02 665.23 824.23 653.08 90.58 348.04 210.57 677.71 713.83 76.25 81.23 640.39 752.47 139.97 19.66 339.18 314.25 56.71 680.87 649.99 335.97 209.10 381.49 305.62 1375.98 1072.61 756.44 2159.66 702.40 262.58 327.50 322.67 137.83 18.51 423.99 172.94 447.96 450.24 422.25 554.65 775.76 886.55 626.84 663.00 1502.18 96.45 47.04 527.13 729.79 807.93 814.82 1403.10 747.61 1035.73 58.45 79.52 108.98 203.77 34.84 191.08 300.07 869.06 43.23 65.05

PAGE 005 LC FEE -------288.05 267.10 300.92 289.55 333.11 396.43 404.43 326.12 164.21 626.53 660.99 892.12 642.87 765.01 947.86 751.04 104.17 400.25 242.16 779.37 820.90 87.69 93.41 736.45 865.34 160.97 22.61 390.06 361.39 65.22 783.00 747.49 386.37 240.47 438.71 351.46 1582.38 1233.50 869.91 2483.61 807.76 301.97 376.63 371.07 158.50 21.29 487.59 198.88 515.15 517.78 485.59 637.85 892.12 1019.53 720.87 762.45 1727.51 110.92 54.10 606.20 839.26 929.12 937.04 1613.57 859.75 1191.09 67.22 91.45 125.33 234.34 40.07 219.74 345.08 999.42 49.71 74.81 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------12057 13100 13102 13120 13122 13131 13133 13150 13152 13153 14000 14020 14021 14041 14060 14300 15000 15001 15100 15101 15121 15200 15220 15221 15241 15260 15342 15343 15351 15400 15570 15572 15576 15600 15620 15630 15732 15734 15738 15740 15757 15760 15775 15780 15783 15786 15788 15789 15793 15811 15820 15822 15823 15833 15835 15837 15839 15842 15851 15860 15922 15934 15937 15944 15950 15953 16000 16010 16020 16030 16036 17003 17004 17107 17108 17111 *** N F N F N F N F N F F N F N F N N F N F N F N F N F N F N F N F N F N F N F N F F F N F N F F F N F F F F F N 484.09 196.62 80.12 206.07 93.48 237.47 136.91 258.18 492.56 142.56 441.70 627.09 711.56 879.51 646.37 918.08 315.41 58.53 873.39 137.55 290.76 568.86 738.57 71.93 134.40 742.46 112.87 14.10 79.07 327.69 746.44 634.16 725.06 185.45 413.02 288.79 1441.41 1235.24 1458.58 721.45 2324.42 635.11 219.81 568.56 364.62 131.13 213.64 388.94 309.94 440.93 415.42 403.43 523.77 773.21 787.10 624.95 634.72 2503.79 48.05 129.51 704.82 855.52 990.22 824.04 532.42 889.93 69.69 60.36 56.57 172.20 84.95 10.33 161.22 662.51 837.28 101.92

PROC MOD NOTE PAR FEE ----- -- ---- -------12057 13101 13102 13121 13122 13132 13133 13151 13152 13160 14001 14020 14040 14041 14061 14300 15000 15050 15100 15120 15121 15201 15220 15240 15241 15261 15342 15350 15351 15401 15570 15574 15576 15610 15620 15650 15732 15736 15738 15750 15758 15770 15776 15781 15783 15787 15788 15792 15810 15819 15821 15822 15831 15834 15836 15838 15840 15845 15852 15860 15931 15935 15940 15945 15951 15956 16000 16015 16025 16030 17000 17003 17106 17107 17110 17111 F N F N F N F N F N F N F N F F N F N F N F N F N F N F N F N F N F N F N F N F N F N N F 393.40 303.78 73.53 328.98 84.18 421.38 130.70 390.36 409.23 725.53 734.86 503.85 642.32 803.55 950.93 839.79 253.01 414.03 686.20 830.03 185.73 96.54 577.34 770.98 113.86 197.73 63.26 488.41 57.76 89.92 649.93 755.51 609.95 247.24 266.13 425.58 1215.46 1398.02 1218.68 833.23 2325.68 578.25 444.74 403.32 335.55 25.68 172.17 197.55 348.03 668.57 510.74 347.62 845.10 761.03 659.58 531.78 942.55 874.55 108.04 110.52 614.68 1023.08 638.14 918.19 763.63 1080.22 46.83 143.54 146.50 130.35 62.24 8.78 375.16 582.28 89.69 59.68

LC FEE -------429.79 331.88 80.33 359.41 91.97 460.36 142.80 426.47 447.09 792.64 802.84 550.46 701.73 877.88 1038.89 917.47 276.41 452.33 749.67 906.81 202.91 105.47 630.74 842.29 124.40 216.02 69.12 533.59 63.10 98.23 710.04 825.39 666.37 270.11 290.74 464.95 1327.89 1527.34 1331.41 910.31 2540.81 631.74 485.88 440.62 366.59 28.06 188.09 215.82 380.22 730.41 557.98 379.78 923.28 831.43 720.59 580.97 1029.73 955.44 118.04 120.74 671.54 1117.72 697.16 1003.12 834.27 1180.14 51.16 156.81 160.06 142.40 68.00 9.59 409.86 636.15 97.99 65.21

PROC MOD NOTE PAR FEE ----- -- ---- -------13100 13101 13120 13121 13131 13132 13150 13151 13153 14000 14001 14021 14040 14060 14061 14350 15001 15050 15101 15120 15200 15201 15221 15240 15260 15261 15343 15350 15400 15401 15572 15574 15600 15610 15630 15650 15734 15736 15740 15756 15760 15775 15776 15782 15786 15787 15789 15792 15811 15820 15821 15823 15832 15835 15837 15839 15841 15851 15852 15920 15933 15936 15941 15946 15952 15958 16010 16020 16025 16035 17000 17004 17106 17108 17110 17250 N F N F N F N F N N F N F N F N F N F N F N F N F N F N F N F N F N F N F N N N F N F N F N N F N N N N N F 263.66 244.48 275.44 265.03 304.90 362.86 370.19 298.51 150.31 573.48 605.02 816.59 588.44 700.24 867.61 687.45 95.35 366.36 221.65 713.38 751.40 80.26 85.50 674.09 792.07 147.34 20.69 357.03 330.79 59.69 716.71 684.20 353.65 220.11 401.57 321.71 1448.40 1129.06 796.25 2273.33 739.37 276.40 344.74 339.65 145.08 19.48 446.30 182.04 471.54 473.94 444.47 583.84 816.59 933.21 659.83 697.89 1581.24 101.53 49.52 554.87 768.20 850.45 857.70 1476.95 786.96 1090.24 61.53 83.70 114.72 214.49 36.67 201.14 315.86 914.80 45.51 68.47

N F

N F F N N F N F N

F N F N F N F N F

N N F F N F N F N

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------32.64 104.00 88.58 155.67 125.49 122.18 99.14 193.08 174.85 135.25 114.70 230.11 249.98 248.11 157.54 97.14 40.58 107.81 21.69 182.13 65.42 224.25 185.19 361.29 336.85 155.18 368.03 488.05 947.98 1586.59 88.57 711.77 584.29 370.83 622.43 1244.45 1273.53 1936.25 655.33 170.60 215.09 235.17 222.47 798.84 246.78 51.05 253.17 533.06 265.00 38.05 268.53 55.13 54.51 33.94 49.78 40.57 53.81 157.55 223.09 451.75 129.86 216.96 392.89 338.39 4087.01 2660.91 501.57 474.62 374.30 484.98 171.97 89.09 2401.00 2693.58 2771.08 174.70

M E D I C A R E LC FEE -------37.54 119.60 101.87 179.02 144.31 140.51 114.01 222.04 201.08 155.54 131.91 264.63 287.48 285.33 181.17 111.71 46.67 123.98 24.94 209.45 75.23 257.89 212.97 415.48 387.38 178.46 423.23 561.26 1090.18 1824.58 101.86 818.54 671.93 426.45 715.79 1431.12 1464.56 2226.69 753.63 196.19 247.35 270.45 255.84 918.67 283.80 58.71 291.15 613.02 304.75 43.76 308.81 63.40 62.69 39.03 57.25 46.66 61.88 181.18 256.55 519.51 149.34 249.50 451.82 389.15 4700.06 3060.05 576.81 545.81 430.45 557.73 197.77 102.45 2761.15 3097.62 3186.74 200.91

F E E

S C H E D U L E NPAR FEE -------81.74 66.07 144.34 106.32 113.08 83.51 159.24 142.27 104.00 96.60 194.16 177.83 584.95 157.18 247.01 53.32 107.85 46.32 363.71 76.46 295.77 102.01 387.15 246.41 421.37 475.00 778.99 916.37 1039.88 159.13 31.87 1044.70 416.45 783.36 776.77 1213.03 1651.08 581.40 300.65 142.98 616.81 185.47 366.80 177.26 138.90 222.45 180.99 368.77 191.73 156.78 240.18 55.61 41.99 60.40 39.47 66.52 40.19 181.09 172.64 402.26 102.24 257.68 449.84 2507.50 2680.75 2480.06 445.61 413.14 521.82 410.49 187.62 2512.04 2599.11 2598.73 48.92 52.46

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------50.81 129.45 99.79 182.19 73.68 140.38 114.32 231.18 65.34 157.41 145.92 305.95 418.53 248.85 158.28 42.80 81.71 45.62 244.79 129.11 184.95 584.31 285.53 392.08 365.04 332.51 539.64 936.25 1445.06 63.40 102.32 417.74 530.37 883.48 489.58 2508.91 2057.92 668.30 124.29 260.01 564.89 285.43 333.29 88.53 154.88 147.35 225.91 422.72 140.40 140.57 72.07 38.31 53.10 37.94 54.55 47.01 183.68 163.42 395.64 609.81 318.57 236.88 425.66 3256.28 2369.27 2566.43 567.91 475.63 460.33 113.34 101.98 2565.15 2772.53 2537.98 46.33 36.62

PAGE 006 LC FEE -------58.43 148.87 114.76 209.52 84.73 161.44 131.47 265.86 75.14 181.02 167.81 351.84 481.31 286.18 182.02 49.22 93.97 52.46 281.51 148.48 212.69 671.96 328.36 450.89 419.80 382.39 620.59 1076.69 1661.82 72.91 117.67 480.40 609.93 1016.00 563.02 2885.25 2366.61 768.55 142.93 299.01 649.62 328.24 383.28 101.81 178.11 169.45 259.80 486.13 161.46 161.66 82.88 44.06 61.07 43.63 62.73 54.06 211.23 187.93 454.99 701.28 366.36 272.41 489.51 3744.72 2724.66 2951.39 653.10 546.97 529.38 130.34 117.28 2949.92 3188.41 2918.68 53.28 42.11 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------17250 17261 17262 17264 17266 17271 17272 17274 17276 17281 17282 17284 17286 17305 17306 17310 17340 19000 19001 19030 19100 19102 19103 19112 19120 19126 19160 19182 19240 19272 19291 19316 19325 19340 19350 19357 19366 19369 19380 20000 20005 20101 20102 20150 20205 20206 20225 20245 20500 20501 20525 20526 20551 20552 20600 20605 20612 20615 20660 20662 20665 20670 20692 20694 20808 20824 20900 20910 20920 20924 20937 20950 20957 20970 20973 20975 *** F N F N F N F N F N F N F N F N F N F N F N F N F 34.36 109.47 93.24 163.86 132.09 128.61 104.36 203.24 184.05 142.37 120.74 242.22 263.14 261.17 165.83 102.25 42.72 113.48 22.83 191.72 68.86 236.05 194.94 380.30 354.58 163.35 387.40 513.74 997.87 1670.09 93.23 749.23 615.04 390.35 655.19 1309.95 1340.56 2038.16 689.82 179.58 226.41 247.55 234.18 840.88 259.77 53.74 266.49 561.12 278.95 40.05 282.66 58.03 57.38 35.73 52.40 42.70 56.64 165.84 234.83 475.53 136.69 228.38 413.57 356.20 4302.12 2800.96 527.97 499.60 394.00 510.50 181.02 93.78 2527.37 2835.35 2916.93 183.89

PROC MOD NOTE PAR FEE ----- -- ---- -------17260 17261 17263 17264 17270 17271 17273 17274 17280 17281 17283 17284 17304 17305 17307 17310 17360 19000 19020 19030 19101 19102 19110 19112 19125 19140 19162 19200 19260 19290 19291 19318 19328 19342 19355 19361 19367 19370 19396 20000 20100 20101 20103 20200 20205 20220 20225 20250 20500 20520 20525 20550 20551 20553 20600 20610 20612 20650 20660 20663 20665 20680 20693 20802 20816 20827 20900 20910 20922 20926 20938 20955 20962 20972 20974 20979 N F N F N F N F N F N F N F N F N F N F N F N F N N N F N N F N F N N F N F F N F N F N F N F N F F 86.04 69.55 151.94 111.92 119.03 87.91 167.62 149.76 109.47 101.68 204.38 187.19 615.74 165.45 260.01 56.13 113.53 48.76 382.85 80.48 311.34 107.38 407.53 259.38 443.55 500.00 819.99 964.60 1094.61 167.50 33.55 1099.68 438.37 824.59 817.65 1276.87 1737.98 612.00 316.47 150.51 649.27 195.23 386.10 186.59 146.21 234.16 190.52 388.18 201.82 165.03 252.82 58.54 44.20 63.58 41.55 70.02 42.30 190.62 181.73 423.43 107.62 271.24 473.52 2639.47 2821.84 2610.59 469.06 434.88 549.28 432.09 197.49 2644.25 2735.90 2735.50 51.49 55.22

LC FEE -------94.00 75.98 165.99 122.27 130.04 96.04 183.13 163.61 119.60 111.09 223.28 204.50 672.69 180.76 284.06 61.32 124.03 53.27 418.27 87.93 340.14 117.31 445.22 283.37 484.58 546.25 895.84 1053.83 1195.86 183.00 36.65 1201.41 478.92 900.86 893.29 1394.98 1898.74 668.61 345.75 164.43 709.33 213.29 421.82 203.85 159.74 255.82 208.14 424.09 220.49 180.30 276.21 63.95 48.29 69.46 45.39 76.50 46.22 208.25 198.54 462.60 117.58 296.33 517.32 2883.63 3082.86 2852.07 512.45 475.11 600.09 472.06 215.76 2888.85 2988.98 2988.54 56.26 60.33

PROC MOD NOTE PAR FEE ----- -- ---- -------17260 17262 17263 17266 17270 17272 17273 17276 17280 17282 17283 17286 17304 17306 17307 17340 17360 19001 19020 19100 19101 19103 19110 19120 19125 19140 19180 19220 19271 19290 19295 19324 19330 19350 19355 19364 19368 19371 19396 20005 20100 20102 20103 20200 20206 20220 20240 20251 20501 20520 20526 20550 20552 20553 20605 20610 20615 20650 20661 20664 20670 20690 20694 20805 20822 20838 20902 20912 20922 20931 20950 20956 20969 20972 20974 20979 F N F N F N F N F N F N F N F N F N F N F N F N F F F N F F N F N F F N F N F N F N F N F N F N N 53.48 136.26 105.04 191.78 77.56 147.77 120.34 243.35 68.78 165.69 153.60 322.05 440.56 261.95 166.61 45.05 86.01 48.02 257.67 135.91 194.68 615.06 300.56 412.72 384.25 350.01 568.04 985.53 1521.12 66.74 107.70 439.73 558.28 929.98 515.35 2640.96 2166.23 703.47 130.83 273.69 594.62 300.45 350.83 93.19 163.03 155.10 237.80 444.97 147.79 147.97 75.86 40.33 55.89 39.94 57.42 49.48 193.35 172.02 416.46 641.90 335.34 249.35 448.06 3427.66 2493.97 2701.50 597.80 500.66 484.56 119.30 107.35 2700.16 2918.45 2671.56 48.77 38.55

N F

N F N F N F N N F N F N F N F N F N N F F N N F

F F N

F N F F F

N N N

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------4164.90 415.63 446.65 539.10 297.20 247.89 423.15 1053.60 1006.00 776.82 913.89 1689.11 1737.17 1544.80 1318.14 665.03 1696.65 366.65 407.94 514.84 543.62 847.81 767.79 929.08 1262.78 1410.71 2039.99 2752.74 1450.56 1988.53 1444.86 1159.36 967.28 748.09 908.81 784.42 525.22 1483.42 822.04 1566.80 1299.33 1074.96 1587.47 836.96 452.40 328.55 109.15 106.07 286.45 448.11 475.27 883.87 609.80 863.81 234.99 765.80 1127.17 659.58 192.29 274.08 836.26 743.67 670.56 1634.34 403.09 447.49 514.43 208.39 496.18 903.55 1059.64 375.06 154.52 392.45 297.26 213.90

M E D I C A R E LC FEE -------4789.64 477.97 513.65 619.97 341.78 285.07 486.62 1211.64 1156.90 893.34 1050.97 1942.48 1997.75 1776.52 1515.86 764.78 1951.15 421.65 469.13 592.07 625.16 974.98 882.96 1068.44 1452.20 1622.32 2345.99 3165.65 1668.14 2286.81 1661.59 1333.26 1112.37 860.30 1045.13 902.08 604.00 1705.93 945.35 1801.82 1494.23 1236.20 1825.59 962.50 520.26 377.83 125.52 121.98 329.42 515.33 546.56 1016.45 701.27 993.38 270.24 880.67 1296.25 758.52 221.13 315.19 961.70 855.22 771.14 1879.49 463.55 514.61 591.59 239.65 570.61 1039.08 1218.59 431.32 177.70 451.32 341.85 245.99

F E E

S C H E D U L E NPAR FEE -------396.16 770.53 394.74 438.23 244.18 1138.62 322.63 977.59 1170.83 582.19 2542.73 1515.33 1747.14 1401.57 1712.68 604.65 1869.13 329.83 300.83 384.87 592.32 717.47 650.34 1230.51 1325.25 1475.77 2285.14 1599.33 1588.02 2173.03 1158.64 1259.18 948.20 704.55 751.22 743.16 1021.60 837.16 1034.81 934.70 1155.01 977.31 1223.95 697.05 306.59 117.33 28.51 229.43 408.03 294.84 571.53 1286.22 902.80 1079.53 593.81 482.30 617.10 688.79 132.64 510.75 567.86 589.77 529.91 1166.84 258.02 508.92 403.60 606.35 782.65 717.99 95.86 333.08 454.44 336.11 498.73 143.95

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------654.90 697.25 624.89 345.07 298.71 1056.15 783.05 1233.89 800.42 1007.41 2321.82 1937.83 1557.15 1488.24 1527.49 1869.70 1704.19 458.01 43.83 682.79 753.80 966.98 841.98 1207.94 1407.81 1762.16 2702.06 2079.00 684.36 2377.08 1290.58 955.35 939.91 532.98 926.91 682.43 973.63 1056.57 861.75 798.10 1119.89 1933.40 1480.54 769.08 164.52 39.28 170.87 140.69 587.61 242.55 743.65 743.81 750.01 320.78 282.69 1025.90 637.16 844.89 317.54 601.08 429.43 726.48 561.16 1784.69 601.03 255.25 366.35 471.23 627.28 833.98 31.07 845.47 442.42 324.86 444.87 359.66

PAGE 007 LC FEE -------753.14 801.84 718.62 396.83 343.52 1214.57 900.51 1418.97 920.48 1158.52 2670.09 2228.50 1790.72 1711.48 1756.61 2150.16 1959.82 526.71 50.40 785.21 866.87 1112.03 968.28 1389.13 1618.98 2026.48 3107.37 2390.85 787.01 2733.64 1484.17 1098.65 1080.90 612.93 1065.95 784.79 1119.67 1215.06 991.01 917.82 1287.87 2223.41 1702.62 884.44 189.20 45.17 196.50 161.79 675.75 278.93 855.20 855.38 862.51 368.90 325.09 1179.79 732.73 971.62 365.17 691.24 493.84 835.45 645.33 2052.39 691.18 293.54 421.30 541.91 721.37 959.08 35.73 972.29 508.78 373.59 511.60 413.61 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------20982 21015 21026 21029 21031 21032 21040 21045 21048 21060 21076 21079 21080 21082 21083 21085 21086 21100 21110 21120 21121 21125 21127 21139 21143 21147 21154 21160 21179 21182 21188 21195 21199 21208 21210 21215 21235 21243 21245 21247 21249 21256 21263 21270 21280 21296 21310 21315 21325 21336 21338 21343 21345 21347 21355 21360 21366 21387 21400 21401 21408 21422 21431 21433 21440 21445 21451 21452 21454 21462 21470 21485 21493 21497 21501 21550 *** N N F N F N F N F N F N F N F N F N F 4384.10 437.50 470.16 567.47 312.84 260.94 445.42 1109.05 1058.95 817.70 961.99 1778.01 1828.60 1626.11 1387.52 700.03 1785.95 385.95 429.41 541.94 572.23 892.43 808.20 977.98 1329.24 1484.96 2147.36 2897.62 1526.91 2093.19 1520.90 1220.38 1018.19 787.46 956.64 825.70 552.86 1561.49 865.30 1649.26 1367.72 1131.54 1671.02 881.01 476.21 345.84 114.89 111.65 301.53 471.69 500.28 930.39 641.89 909.27 247.36 806.11 1186.49 694.29 202.41 288.51 880.27 782.81 705.85 1720.36 424.30 471.04 541.50 219.36 522.29 951.11 1115.41 394.80 162.65 413.10 312.90 225.16

PROC MOD NOTE PAR FEE ----- -- ---- -------20982 21025 21026 21030 21031 21034 21040 21046 21049 21070 21077 21079 21081 21082 21084 21085 21087 21100 21116 21120 21122 21125 21137 21141 21145 21150 21155 21172 21180 21183 21193 21196 21206 21209 21210 21230 21240 21244 21246 21248 21249 21260 21267 21270 21282 21300 21310 21320 21330 21337 21339 21344 21346 21348 21356 21360 21385 21390 21400 21406 21421 21422 21431 21435 21440 21450 21451 21453 21461 21462 21480 21485 21494 21497 21502 21550 F N F N F N F N F N F N F N F N F F 417.01 811.08 415.52 461.29 257.03 1198.55 339.61 1029.04 1232.45 612.83 2676.56 1595.08 1839.09 1475.34 1802.82 636.47 1967.51 347.19 316.66 405.13 623.49 755.23 684.57 1295.27 1395.00 1553.44 2405.41 1683.50 1671.60 2287.40 1219.62 1325.45 998.11 741.63 790.76 782.27 1075.37 881.22 1089.27 983.89 1215.80 1028.75 1288.37 733.74 322.73 123.51 30.01 241.50 429.51 310.36 601.61 1353.92 950.32 1136.35 625.06 507.68 649.58 725.04 139.62 537.63 597.75 620.81 557.80 1228.25 271.60 535.71 424.84 638.26 823.84 755.78 100.91 350.61 478.36 353.80 524.98 151.53

LC FEE -------455.58 886.11 453.95 503.96 280.81 1309.41 371.02 1124.23 1346.45 669.52 2924.14 1742.63 2009.21 1611.81 1969.58 695.35 2149.50 379.30 345.95 442.60 681.17 825.09 747.89 1415.09 1524.04 1697.14 2627.91 1839.23 1826.22 2498.98 1332.44 1448.06 1090.43 810.23 863.90 854.63 1174.84 962.73 1190.03 1074.91 1328.26 1123.91 1407.54 801.61 352.58 134.93 32.79 263.84 469.23 339.07 657.26 1479.15 1038.22 1241.46 682.88 554.65 709.67 792.11 152.54 587.36 653.04 678.24 609.40 1341.87 296.72 585.26 464.14 697.30 900.05 825.69 110.24 383.04 522.61 386.53 573.54 165.54

PROC MOD NOTE PAR FEE ----- -- ---- -------21010 21025 21029 21030 21032 21034 21044 21047 21050 21076 21077 21080 21081 21083 21084 21086 21087 21110 21116 21121 21123 21127 21138 21142 21146 21151 21159 21175 21181 21184 21194 21198 21208 21209 21215 21235 21242 21245 21246 21248 21255 21261 21268 21275 21295 21300 21315 21320 21335 21337 21340 21345 21346 21355 21356 21365 21386 21395 21401 21407 21421 21423 21432 21436 21445 21450 21452 21453 21461 21465 21480 21490 21495 21501 21510 21555 F N F N F N F N F N F N F N F N N 689.37 733.95 657.78 363.23 314.43 1111.74 824.26 1298.83 842.55 1060.43 2444.02 2039.82 1639.11 1566.57 1607.88 1968.10 1793.88 482.12 46.14 718.73 793.47 1017.87 886.29 1271.52 1481.90 1854.90 2844.27 2188.42 720.38 2502.19 1358.50 1005.63 989.38 561.03 975.69 718.35 1024.87 1112.18 907.11 840.10 1178.83 2035.16 1558.46 809.56 173.18 41.35 179.86 148.09 618.54 255.32 782.79 782.96 789.48 337.66 297.57 1079.89 670.69 889.36 334.25 632.72 452.03 764.72 590.69 1878.62 632.66 268.68 385.63 496.03 660.29 877.87 32.70 889.97 465.71 341.96 468.28 378.59

F N F F F N N N F

N F N N F F N F N N N N F F N F F F N F N N F N F F F

N F N N N F F

F N F F N F N F N F N F N F F F N N

F F N N F N N N F N F N N N F N

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------290.07 495.07 783.87 1147.39 459.89 438.44 994.37 89.95 149.13 199.99 303.09 1099.52 710.52 884.65 1600.67 372.96 1430.04 173.79 868.38 1605.87 1261.90 4103.10 492.57 1459.33 1266.53 341.97 1109.20 397.85 1233.21 1721.93 2044.78 774.01 1014.35 853.10 662.24 1014.07 330.51 248.58 672.70 144.52 178.93 1050.14 606.59 535.01 481.04 608.61 515.59 694.55 529.85 858.08 1582.47 557.53 50.35 939.66 864.60 951.81 921.93 1036.46 1162.05 923.83 220.32 291.53 188.24 520.40 180.91 534.05 197.99 653.81 445.39 1408.01 396.16 307.31 545.35 580.76 716.95 1070.23

M E D I C A R E LC FEE -------333.58 569.33 901.45 1319.50 528.87 504.21 1143.53 103.44 171.50 229.99 348.55 1264.45 817.10 1017.35 1840.77 428.90 1644.55 199.86 998.64 1846.75 1451.19 4718.57 566.46 1678.23 1456.51 393.27 1275.58 457.53 1418.19 1980.22 2351.50 890.11 1166.50 981.07 761.58 1166.18 380.09 285.87 773.61 166.20 205.77 1207.66 697.58 615.26 553.20 699.90 592.93 798.73 609.33 986.79 1819.84 641.16 57.90 1080.61 994.29 1094.58 1060.22 1191.93 1336.36 1062.40 253.37 335.26 216.48 598.46 208.05 614.16 227.69 751.88 512.20 1619.21 455.58 353.41 627.15 667.87 824.49 1230.76

F E E

S C H E D U L E NPAR FEE -------373.16 934.87 499.74 1153.68 414.97 407.88 669.21 234.49 119.68 134.08 401.96 694.69 144.15 884.90 1301.42 1425.86 373.17 289.06 651.51 1213.03 276.95 521.41 231.15 367.82 1539.25 1382.92 1102.24 1403.44 2009.75 1946.83 2262.41 776.53 745.87 369.75 410.97 353.57 651.00 211.48 535.45 357.88 163.48 459.88 460.62 671.15 657.46 733.48 523.51 665.04 695.44 1007.69 147.16 827.27 1169.36 605.44 919.78 715.47 984.36 1053.40 1382.91 797.41 180.19 549.00 341.54 589.42 298.91 619.86 379.88 332.60 385.38 291.25 330.99 240.66 427.57 530.11 189.82 1250.00

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------555.54 652.75 516.80 891.77 591.25 492.01 115.72 457.05 547.67 423.85 327.59 704.78 889.48 142.95 1321.29 1328.24 203.25 260.71 1445.06 1321.76 113.23 3632.80 1563.96 1714.94 1420.08 1316.72 1408.98 323.34 2351.46 2102.88 751.73 814.39 773.39 1216.50 631.74 368.07 251.52 672.33 191.28 319.96 523.45 430.88 631.46 576.75 589.97 632.60 704.06 740.12 826.13 1177.36 144.59 179.95 1092.32 758.79 709.63 742.49 1061.06 1008.79 789.15 987.44 349.32 222.85 290.37 247.18 257.67 227.44 323.92 262.28 710.38 218.72 549.40 339.11 366.81 474.89 975.80 976.50

PAGE 008 LC FEE -------638.87 750.66 594.32 1025.54 679.94 565.81 133.08 525.61 629.82 487.43 376.73 810.50 1022.90 164.39 1519.48 1527.48 233.74 299.82 1661.82 1520.02 130.21 4177.72 1798.55 1972.18 1633.09 1514.23 1620.33 371.84 2704.18 2418.31 864.49 936.55 889.40 1398.98 726.50 423.28 289.25 773.18 219.97 367.95 601.97 495.51 726.18 663.26 678.47 727.49 809.67 851.14 950.05 1353.96 166.28 206.94 1256.17 872.61 816.07 853.86 1220.22 1160.11 907.52 1135.56 401.72 256.28 333.93 284.26 296.32 261.56 372.51 301.62 816.94 251.53 631.81 389.98 421.83 546.12 1122.17 1122.98 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------21555 21600 21616 21630 21700 21720 21740 21800 21820 21920 21925 21935 22102 22112 22210 22216 22224 22305 22315 22319 22327 22520 22521 22533 22554 22585 22600 22614 22800 22808 22818 22840 22844 22847 22850 22855 23000 23030 23040 23065 23075 23077 23105 23120 23140 23150 23170 23180 23190 23210 23222 23331 23350 23400 23410 23420 23450 23462 23470 23485 23500 23505 23520 23530 23540 23550 23570 23585 23605 23616 23625 23650 23660 23670 23680 23802 *** F N N F N N F 305.34 521.13 825.13 1207.78 484.09 461.52 1046.71 94.68 156.98 210.52 319.04 1157.39 747.92 931.21 1684.92 392.59 1505.30 182.94 914.08 1690.39 1328.32 4319.05 518.49 1536.14 1333.19 359.97 1167.58 418.79 1298.12 1812.56 2152.40 814.75 1067.74 898.00 697.09 1067.44 347.91 261.66 708.10 152.13 188.35 1105.41 638.52 563.17 506.36 640.64 542.73 731.10 557.74 903.24 1665.76 586.87 53.00 989.12 910.11 1001.91 970.45 1091.01 1223.21 972.45 231.92 306.87 198.15 547.79 190.43 562.16 208.41 688.22 468.83 1482.12 417.01 323.48 574.05 611.33 754.68 1126.56

PROC MOD NOTE PAR FEE ----- -- ---- -------21556 21610 21620 21632 21700 21720 21750 21805 21820 21920 21930 22100 22103 22114 22212 22220 22226 22310 22315 22325 22328 22520 22522 22534 22556 22590 22610 22630 22802 22810 22819 22842 22845 22848 22851 22900 23020 23031 23044 23066 23075 23100 23106 23125 23145 23155 23172 23182 23195 23220 23330 23332 23395 23405 23412 23430 23455 23465 23472 23490 23500 23515 23525 23532 23545 23552 23575 23600 23605 23620 23625 23650 23665 23675 23700 23900 392.80 984.07 526.04 1214.40 436.81 429.35 704.43 246.83 125.98 141.14 423.12 731.25 151.74 931.47 1369.92 1500.91 392.81 304.27 685.80 1276.87 291.53 548.85 243.32 387.18 1620.26 1455.70 1160.25 1477.31 2115.53 2049.29 2381.48 817.40 785.13 389.21 432.60 372.18 685.26 222.61 563.63 376.72 172.08 484.08 484.86 706.47 692.06 772.08 551.06 700.04 732.04 1060.73 154.91 870.81 1230.90 637.30 968.19 753.13 1036.17 1108.84 1455.69 839.38 189.67 577.89 359.52 620.44 314.64 652.48 399.87 350.11 405.66 306.58 348.41 253.33 450.07 558.01 199.81 1315.79

LC FEE -------429.13 1075.10 574.70 1326.73 477.22 469.06 769.59 269.66 137.63 154.19 462.25 798.89 165.77 1017.64 1496.63 1639.74 429.15 332.42 749.24 1394.98 318.49 599.62 265.82 422.99 1770.14 1590.36 1267.58 1613.96 2311.21 2238.85 2601.77 893.01 857.75 425.21 472.62 406.61 748.65 243.20 615.77 411.56 188.00 528.86 529.71 771.82 756.08 843.50 602.04 764.80 799.76 1158.84 169.23 951.36 1344.76 696.26 1057.75 822.79 1132.01 1211.41 1590.35 917.02 207.22 631.35 392.77 677.83 343.75 712.84 436.86 382.49 443.19 334.94 380.64 276.76 491.71 609.63 218.29 1437.50

PROC MOD NOTE PAR FEE ----- -- ---- -------21557 21615 21627 21685 21705 21725 21800 21810 21825 21925 21930 22101 22110 22116 22214 22222 22305 22310 22318 22326 22505 22521 22532 22548 22558 22595 22612 22632 22804 22812 22830 22843 22846 22849 22852 23000 23030 23035 23065 23066 23076 23101 23107 23130 23146 23156 23174 23184 23200 23221 23330 23350 23397 23406 23415 23440 23460 23466 23480 23491 23505 23520 23525 23540 23545 23570 23575 23600 23615 23620 23630 23655 23665 23675 23800 23920 584.78 687.11 544.00 938.70 622.37 517.91 121.81 481.10 576.49 446.16 344.83 741.87 936.29 150.47 1390.83 1398.15 213.95 274.43 1521.12 1391.33 119.19 3824.00 1646.27 1805.20 1494.82 1386.02 1483.14 340.36 2475.22 2213.56 791.29 857.25 814.09 1280.53 664.99 387.44 264.76 707.72 201.35 336.80 551.00 453.56 664.69 607.10 621.02 665.89 741.12 779.07 869.61 1239.33 152.20 189.42 1149.81 798.73 746.98 781.57 1116.90 1061.88 830.68 1039.41 367.71 234.58 305.65 260.19 271.23 239.41 340.97 276.08 747.77 230.23 578.32 356.96 386.12 499.88 1027.16 1027.89

F F F F N

N N F

F N N F

N F F

N F N

F F F N

N N N F

N F

N

F N

F

N F F F F N N N

F N N N N F N F F N N

N N F N F N F F F F F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------419.48 162.55 438.47 146.48 344.71 796.16 585.18 664.91 547.92 742.19 730.38 1009.25 700.18 575.06 131.17 430.05 721.70 706.64 542.42 754.48 646.10 462.12 508.03 985.83 654.70 951.15 645.59 331.26 410.00 343.66 522.39 1070.76 498.43 748.38 520.04 688.89 377.39 677.57 118.81 189.97 614.75 216.02 644.08 664.81 696.24 395.77 1097.91 526.42 568.21 376.63 496.00 517.61 317.08 791.27 710.93 456.24 722.15 1030.55 444.48 72.83 680.04 828.62 779.62 777.19 674.62 922.00 854.55 827.35 873.21 1160.44 1171.43 1024.84 1361.53 645.27 903.20 793.82

M E D I C A R E LC FEE -------482.40 186.93 504.24 168.45 396.42 915.58 672.96 764.65 630.11 853.52 839.94 1160.64 805.21 661.32 150.85 494.56 829.96 812.64 623.78 867.65 743.02 531.44 584.23 1133.70 752.91 1093.82 742.43 380.95 471.50 395.21 600.75 1231.37 573.19 860.64 598.05 792.22 434.00 779.21 136.63 218.47 706.96 248.42 740.69 764.53 800.68 455.14 1262.60 605.38 653.44 433.12 570.40 595.25 364.64 909.96 817.57 524.68 830.47 1185.13 511.15 83.75 782.05 952.91 896.56 893.77 775.81 1060.30 982.73 951.45 1004.19 1334.51 1347.14 1178.57 1565.76 742.06 1038.68 912.89

F E E

S C H E D U L E NPAR FEE -------219.13 153.71 670.46 424.83 293.90 368.26 310.02 828.44 593.21 595.84 614.51 923.71 657.28 467.00 396.37 66.28 554.35 684.91 582.72 649.78 990.54 493.83 857.79 1267.08 788.97 893.84 663.57 265.34 830.13 290.28 710.97 301.94 429.21 300.65 451.18 1043.71 301.91 513.38 79.78 431.00 692.22 443.75 781.72 670.55 746.98 290.46 670.09 473.14 179.42 568.71 359.88 574.84 385.08 396.19 797.52 561.74 604.35 498.23 475.32 529.41 357.03 946.23 877.96 789.42 647.22 967.09 804.18 889.94 1101.24 979.70 1306.96 1244.93 1354.70 702.84 764.65 690.52

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------205.87 479.24 158.26 369.97 442.94 470.74 553.62 491.63 479.73 618.15 632.09 1080.36 790.19 142.22 347.03 356.70 456.20 757.75 614.01 995.69 421.73 493.17 971.18 608.78 995.30 948.29 839.01 484.01 821.66 595.65 746.55 233.46 624.27 250.94 808.88 1035.19 417.95 1073.46 256.98 354.78 268.67 373.80 950.32 524.50 935.87 610.39 1053.31 821.71 435.25 863.88 412.70 428.06 894.97 536.16 803.07 484.91 785.84 653.32 425.18 492.93 832.53 711.23 627.42 734.74 829.56 1128.55 963.29 973.65 1158.21 1183.76 734.74 1176.30 1297.62 779.97 745.88 1120.98

PAGE 009 LC FEE -------236.75 551.13 182.00 425.47 509.38 541.35 636.66 565.37 551.69 710.87 726.90 1242.41 908.72 163.55 399.08 410.21 524.63 871.41 706.11 1145.04 484.99 567.15 1116.86 700.10 1144.60 1090.53 964.86 556.61 944.91 685.00 858.53 268.48 717.91 288.58 930.21 1190.47 480.64 1234.48 295.53 408.00 308.97 429.87 1092.87 603.18 1076.25 701.95 1211.31 944.97 500.54 993.46 474.61 492.27 1029.22 616.58 923.53 557.65 903.72 751.32 488.96 566.87 957.41 817.91 721.53 844.95 953.99 1297.83 1107.78 1119.70 1331.94 1361.32 844.95 1352.75 1492.26 896.97 857.76 1289.13 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------23921 23931 24000 24065 24075 24077 24102 24115 24125 24134 24140 24149 24152 24160 24200 24220 24301 24320 24332 24342 24345 24351 24356 24362 24366 24420 24470 24500 24505 24530 24535 24546 24565 24575 24577 24582 24600 24615 24640 24650 24665 24670 24685 24900 24930 25000 25023 25028 25040 25075 25085 25105 25111 25116 25120 25130 25145 25170 25230 25246 25251 25263 25272 25280 25300 25312 25320 25337 25360 25375 25392 25400 25420 25430 25441 25444 *** N F N 441.56 171.11 461.55 154.19 362.85 838.06 615.98 699.90 576.76 781.25 768.82 1062.37 737.03 605.33 138.07 452.68 759.68 743.83 570.97 794.19 680.11 486.44 534.77 1037.72 689.16 1001.21 679.57 348.69 431.58 361.75 549.88 1127.12 524.66 787.77 547.41 725.15 397.25 713.23 125.06 199.97 647.10 227.39 677.98 699.80 732.88 416.60 1155.69 554.13 598.12 396.45 522.10 544.85 333.77 832.92 748.35 480.25 760.16 1084.79 467.87 76.66 715.83 872.23 820.65 818.09 710.13 970.53 899.53 870.89 919.17 1221.52 1233.08 1078.78 1433.19 679.23 950.74 835.60

PROC MOD NOTE PAR FEE ----- -- ---- -------23930 23931 24006 24066 24075 24100 24105 24116 24126 24136 24145 24150 24153 24164 24201 24220 24305 24330 24340 24343 24346 24352 24360 24363 24400 24430 24495 24500 24515 24530 24538 24560 24565 24576 24577 24586 24600 24620 24640 24655 24666 24675 24800 24920 24931 25001 25024 25031 25065 25076 25100 25107 25112 25118 25125 25135 25150 25210 25240 25248 25259 25265 25274 25290 25301 25315 25332 25350 25365 25390 25393 25405 25425 25431 25442 25445 N F N F 230.66 161.80 705.75 447.19 309.37 387.64 326.34 872.04 624.43 627.20 646.85 972.33 691.87 491.58 417.23 69.77 583.53 720.96 613.39 683.98 1042.67 519.82 902.94 1333.77 830.49 940.88 698.49 279.31 873.82 305.56 748.39 317.83 451.80 316.47 474.93 1098.64 317.80 540.40 83.98 453.68 728.65 467.11 822.86 705.84 786.29 305.75 705.36 498.04 188.86 598.64 378.82 605.09 405.35 417.04 839.49 591.30 636.16 524.45 500.34 557.27 375.82 996.03 924.17 830.97 681.28 1017.99 846.51 936.78 1159.20 1031.26 1375.75 1310.45 1426.00 739.83 804.89 726.86

LC FEE -------252.00 176.77 771.03 488.55 337.99 423.50 356.52 952.71 682.19 685.22 706.69 1062.27 755.87 537.05 455.83 76.22 637.50 787.65 670.13 747.25 1139.12 567.90 986.46 1457.14 907.32 1027.92 763.11 305.14 954.65 333.82 817.62 347.23 493.59 345.75 518.86 1200.27 347.20 590.39 91.75 495.65 796.05 510.31 898.98 771.13 859.03 334.03 770.60 544.11 206.33 654.02 413.86 661.07 442.84 455.62 917.15 646.00 695.00 572.96 546.62 608.82 410.58 1088.16 1009.65 907.83 744.30 1112.15 924.81 1023.43 1266.43 1126.66 1503.00 1431.67 1557.91 808.27 879.35 794.10

PROC MOD NOTE PAR FEE ----- -- ---- -------23930 23935 24065 24066 24076 24101 24110 24120 24130 24138 24147 24151 24155 24200 24201 24300 24310 24331 24341 24344 24350 24354 24361 24365 24410 24435 24498 24505 24516 24535 24545 24560 24566 24576 24579 24587 24605 24635 24650 24655 24670 24675 24802 24925 24935 25020 25025 25035 25066 25077 25101 25110 25115 25119 25126 25136 25151 25215 25246 25250 25260 25270 25275 25295 25310 25316 25335 25355 25370 25391 25394 25415 25426 25440 25443 25446 F N F 216.71 504.46 166.59 389.44 466.25 495.52 582.76 517.51 504.98 650.68 665.36 1137.22 831.78 149.70 365.29 375.47 480.21 797.63 646.33 1048.09 443.93 519.13 1022.29 640.82 1047.68 998.20 883.17 509.48 864.90 627.00 785.84 245.75 657.13 264.15 851.45 1089.67 439.95 1129.96 270.50 373.45 282.81 393.47 1000.34 552.11 985.13 642.52 1108.75 864.96 458.16 909.35 434.42 450.59 942.07 564.38 845.34 510.43 827.20 687.70 447.56 518.87 876.35 748.66 660.44 773.41 873.22 1187.95 1013.99 1024.89 1219.17 1246.06 773.41 1238.21 1365.92 821.02 785.14 1179.98

F N

N F

N F

N F N F N N N N F F

F F N F N F F F N N

N N F F

N F N F

N

F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------742.76 803.07 1083.84 481.56 534.29 1041.37 465.07 248.01 429.79 273.36 463.70 278.57 368.54 227.41 549.19 420.94 589.74 361.29 693.45 739.99 597.88 843.46 836.53 572.28 532.97 122.50 397.29 487.48 285.33 253.37 291.18 305.36 330.52 564.06 416.82 479.41 375.84 422.35 517.96 413.13 513.32 319.74 906.79 1014.99 955.25 653.65 946.87 760.43 605.86 728.29 889.95 411.96 630.63 682.66 905.27 909.94 906.77 688.14 693.55 871.71 761.79 351.68 865.59 927.56 3187.07 1373.80 898.22 736.16 885.89 641.15 178.09 455.29 357.99 334.34 327.51 352.50

M E D I C A R E LC FEE -------854.17 923.53 1246.42 553.79 614.43 1197.58 534.83 285.21 494.26 314.36 533.26 320.36 423.82 261.52 631.57 484.08 678.20 415.48 797.47 850.99 687.56 969.98 962.01 658.12 612.92 140.88 456.88 560.60 328.13 291.38 334.86 351.16 380.10 648.67 479.34 551.32 432.22 485.70 595.65 475.10 590.32 367.70 1042.81 1167.24 1098.54 751.70 1088.90 874.49 696.74 837.53 1023.44 473.75 725.22 785.06 1041.06 1046.43 1042.79 791.36 797.58 1002.47 876.06 404.43 995.43 1066.69 3665.13 1579.87 1032.95 846.58 1018.77 737.32 204.80 523.58 411.69 384.49 376.64 405.38

F E E

S C H E D U L E NPAR FEE -------983.54 909.25 246.86 409.02 476.48 239.02 403.22 196.46 554.33 217.03 649.44 222.60 637.73 422.66 303.15 567.70 469.47 604.24 428.32 844.91 722.70 844.21 1431.90 651.26 761.51 423.53 395.32 686.86 435.10 242.66 349.99 291.52 445.28 704.43 521.65 596.83 409.64 568.31 477.62 544.63 591.57 276.94 1027.43 880.37 888.23 772.37 650.16 830.92 692.62 944.02 429.80 665.14 634.81 852.59 846.17 852.40 1184.98 756.07 658.78 878.20 497.91 620.64 736.03 822.42 2607.33 3244.74 1229.11 964.80 1232.04 690.18 311.70 456.61 290.98 486.39 259.04 479.92

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------702.93 961.03 199.74 655.67 875.57 189.68 652.49 504.53 781.57 538.06 623.88 445.12 287.42 317.37 243.87 367.04 430.50 415.89 609.00 800.33 954.99 771.96 650.81 806.29 270.14 174.27 464.04 539.88 646.96 270.85 301.34 649.37 608.40 279.95 473.27 278.35 434.11 408.92 466.55 835.62 427.49 815.95 959.60 996.84 1071.26 784.52 802.87 557.96 680.88 690.07 426.43 655.64 691.06 934.33 830.68 894.61 859.22 782.52 760.32 755.99 583.75 719.58 752.52 1508.41 3696.07 596.74 735.84 1230.16 516.94 231.11 250.21 424.01 405.40 563.87 419.51 520.89

PAGE 010 LC FEE -------808.37 1105.18 229.70 754.02 1006.91 218.13 750.36 580.21 898.81 618.77 717.46 511.89 330.53 364.98 280.45 422.10 495.08 478.27 700.35 920.38 1098.24 887.75 748.43 927.23 310.66 200.41 533.65 620.86 744.00 311.48 346.54 746.78 699.66 321.94 544.26 320.10 499.23 470.26 536.53 960.96 491.61 938.34 1103.54 1146.37 1231.95 902.20 923.30 641.65 783.01 793.58 490.39 753.99 794.72 1074.48 955.28 1028.80 988.10 899.90 874.37 869.39 671.31 827.52 865.40 1734.67 4250.48 686.25 846.22 1414.68 594.48 265.78 287.74 487.61 466.21 648.45 482.44 599.02 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------25447 25455 25492 25505 25520 25526 25535 25560 25565 25600 25605 25622 25624 25630 25645 25651 25670 25675 25685 25800 25820 25900 25909 25922 25929 26010 26020 26034 26040 26055 26075 26105 26115 26121 26130 26145 26170 26200 26215 26236 26260 26320 26352 26358 26373 26410 26416 26426 26433 26440 26449 26460 26476 26479 26485 26492 26497 26500 26508 26517 26525 26535 26541 26546 26551 26555 26561 26567 26587 26593 26600 26607 26641 26645 26670 26675 *** 781.85 845.34 1140.88 506.90 562.41 1096.18 489.55 261.06 452.41 287.75 488.10 293.23 387.94 239.38 578.09 443.09 620.78 380.30 729.95 778.94 629.35 887.85 880.56 602.40 561.02 128.95 418.20 513.14 300.35 266.71 306.51 321.43 347.92 593.75 438.76 504.64 395.62 444.58 545.22 434.87 540.34 336.57 954.52 1068.41 1005.53 688.05 996.70 800.45 637.75 766.62 936.79 433.64 663.82 718.59 952.92 957.83 954.49 724.36 730.05 917.59 801.88 370.19 911.15 976.38 3354.81 1446.11 945.49 774.91 932.52 674.89 187.46 479.25 376.83 351.94 344.75 371.05

PROC MOD NOTE PAR FEE ----- -- ---- -------25449 25490 25500 25505 25520 25530 25535 25560 25574 25600 25611 25622 25628 25635 25650 25652 25671 25676 25690 25805 25825 25905 25915 25924 25931 26011 26025 26035 26045 26060 26080 26110 26116 26123 26135 26160 26180 26205 26230 26250 26261 26340 26356 26370 26390 26412 26418 26428 26434 26442 26450 26471 26477 26480 26489 26494 26498 26502 26510 26518 26530 26536 26542 26548 26553 26556 26562 26568 26590 26596 26605 26608 26641 26650 26670 26676 N F F N F F F F N N 1035.31 957.10 259.85 430.55 501.56 251.60 424.44 206.80 583.51 228.45 683.62 234.32 671.29 444.91 319.11 597.58 494.18 636.04 450.86 889.38 760.74 888.64 1507.26 685.54 801.59 445.82 416.13 723.01 458.00 255.43 368.41 306.86 468.72 741.51 549.10 628.24 431.20 598.22 502.76 573.29 622.70 291.52 1081.51 926.71 934.98 813.02 684.38 874.65 729.07 993.71 452.42 700.15 668.22 897.46 890.70 897.26 1247.35 795.86 693.45 924.42 524.12 653.31 774.77 865.70 2744.56 3415.52 1293.80 1015.58 1296.88 726.50 328.11 480.64 306.29 511.99 272.67 505.18

LC FEE -------1131.07 1045.64 283.89 470.37 547.95 274.87 463.70 225.93 637.48 249.58 746.86 255.99 733.39 486.06 348.62 652.86 539.89 694.88 492.57 971.65 831.11 970.84 1646.69 748.95 875.74 487.06 454.62 789.89 500.37 279.06 402.49 335.25 512.07 810.09 599.90 686.35 471.09 653.56 549.26 626.32 680.31 318.48 1181.54 1012.43 1021.46 888.23 747.68 955.56 796.51 1085.62 494.27 764.91 730.03 980.48 973.10 980.26 1362.73 869.48 757.60 1009.93 572.60 713.74 846.43 945.78 2998.43 3731.45 1413.48 1109.52 1416.85 793.71 358.46 525.10 334.63 559.35 297.90 551.91

PROC MOD NOTE PAR FEE ----- -- ---- -------25450 25491 25500 25515 25525 25530 25545 25565 25575 25605 25620 25624 25630 25635 25650 25660 25675 25680 25695 25810 25830 25907 25920 25927 26010 26011 26030 26037 26055 26070 26100 26115 26117 26125 26140 26160 26185 26210 26235 26255 26262 26350 26357 26372 26392 26415 26420 26432 26437 26445 26455 26474 26478 26483 26490 26496 26499 26504 26516 26520 26531 26540 26545 26550 26554 26560 26565 26580 26591 26600 26605 26615 26645 26665 26675 26685 F F N N N N F F N 739.93 1011.61 210.25 690.18 921.65 199.66 686.83 531.08 822.71 566.38 656.72 468.55 302.55 334.07 256.71 386.36 453.16 437.78 641.05 842.45 1005.25 812.59 685.06 848.73 284.36 183.44 488.46 568.29 681.01 285.11 317.20 683.55 640.42 294.68 498.18 293.00 456.96 430.44 491.11 879.60 449.99 858.89 1010.10 1049.31 1127.64 825.81 845.13 587.33 716.72 726.39 448.87 690.15 727.43 983.50 874.40 941.69 904.44 823.71 800.34 795.78 614.47 757.45 792.13 1587.80 3890.60 628.15 774.57 1294.90 544.15 243.27 263.38 446.33 426.74 593.55 441.59 548.30

N N N N F N F N F F F

F F F

N

N F N N F

N

F N F N F

N F F

N F N N

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------587.96 393.21 447.47 362.00 462.67 372.47 184.78 239.43 282.27 291.81 844.86 781.39 835.80 772.64 579.34 550.60 428.32 692.66 898.09 906.68 645.89 440.61 476.13 415.70 970.60 2078.82 936.41 148.67 783.31 68.38 398.26 630.36 877.83 1026.36 1542.46 1451.41 1339.41 1231.33 1084.81 1028.02 973.97 493.12 677.76 931.85 961.59 460.33 1542.09 413.45 1053.51 1079.96 359.00 702.13 294.61 1041.67 543.02 758.21 1480.58 482.87 368.45 461.26 160.20 325.30 375.78 547.96 340.93 606.15 760.06 1108.33 428.93 764.41 413.74 482.44 588.85 610.43 901.00 705.44

M E D I C A R E LC FEE -------676.15 452.19 514.59 416.30 532.07 428.34 212.50 275.34 324.61 335.58 971.59 898.60 961.17 888.54 666.24 633.19 492.57 796.56 1032.80 1042.68 742.77 506.70 547.55 478.06 1116.19 2390.64 1076.87 170.97 900.81 78.64 458.00 724.91 1009.50 1180.31 1773.83 1669.12 1540.32 1416.03 1247.53 1182.22 1120.07 567.09 779.42 1071.63 1105.83 529.38 1773.40 475.47 1211.54 1241.95 412.85 807.45 338.80 1197.92 624.47 871.94 1702.67 555.30 423.72 530.45 184.23 374.10 432.15 630.15 392.07 697.07 874.07 1274.58 493.27 879.07 475.80 554.81 677.18 701.99 1036.15 811.26

F E E

S C H E D U L E NPAR FEE -------318.35 327.30 211.27 286.52 210.91 300.30 145.74 403.47 214.16 427.22 794.65 864.05 618.52 239.41 707.84 494.28 515.38 697.21 924.44 208.66 541.98 882.08 626.47 447.67 801.74 1458.47 942.70 143.51 1434.86 454.45 66.16 784.38 836.40 999.07 1840.91 855.39 1240.57 1141.67 595.84 809.81 662.69 443.04 187.48 681.72 1265.67 893.31 1779.31 708.21 417.34 1352.46 737.06 897.05 245.28 1419.92 172.85 1487.94 1192.67 611.31 443.96 447.35 360.70 396.04 447.82 634.65 452.95 570.02 291.56 479.27 380.69 603.38 543.79 622.07 803.33 635.78 778.15 705.75

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------256.13 397.90 163.77 452.10 178.88 457.04 304.23 347.12 366.56 350.66 846.75 749.84 106.17 741.65 588.11 940.33 543.61 774.90 1125.02 187.67 484.54 343.62 398.27 743.18 870.20 2423.75 449.80 599.23 500.27 77.43 605.09 830.31 1180.82 1326.22 1392.64 1172.40 1622.01 1220.71 833.34 907.91 945.26 723.79 155.45 992.79 517.40 913.41 467.57 853.40 864.32 405.02 454.03 1203.53 317.18 383.54 942.35 1524.35 536.63 442.09 664.48 170.14 377.95 928.54 605.72 719.10 438.90 684.61 802.35 48.86 565.83 789.45 665.93 834.50 643.44 731.98 706.84 419.87

PAGE 011 LC FEE -------294.55 457.59 188.34 519.92 205.71 525.60 349.86 399.19 421.54 403.26 973.76 862.32 122.10 852.90 676.33 1081.38 625.15 891.14 1293.77 215.82 557.22 395.16 458.01 854.66 1000.73 2787.31 517.27 689.11 575.31 89.04 695.85 954.86 1357.94 1525.15 1601.54 1348.26 1865.31 1403.82 958.34 1044.10 1087.05 832.36 178.77 1141.71 595.01 1050.42 537.71 981.41 993.97 465.77 522.13 1384.06 364.76 441.07 1083.70 1753.00 617.12 508.40 764.15 195.66 434.64 1067.82 696.58 826.97 504.74 787.30 922.70 56.19 650.70 907.87 765.82 959.68 739.96 841.78 812.87 482.85 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------26686 26705 26715 26725 26735 26742 26750 26755 26770 26775 26820 26843 26852 26862 26951 26991 27000 27005 27030 27036 27041 27048 27052 27062 27067 27075 27078 27086 27090 27093 27096 27098 27110 27122 27132 27138 27147 27158 27170 27177 27181 27193 27194 27202 27217 27220 27227 27230 27236 27244 27246 27252 27256 27258 27266 27282 27290 27301 27306 27315 27323 27327 27330 27333 27340 27350 27357 27365 27372 27381 27390 27393 27396 27403 27409 27422 *** N N N N F N F 618.91 413.90 471.02 381.05 487.02 392.07 194.50 252.03 297.13 307.17 889.33 822.52 879.79 813.30 609.83 579.58 450.86 729.12 945.36 954.40 679.88 463.80 501.19 437.58 1021.68 2188.23 985.69 156.49 824.54 71.98 419.22 663.54 924.03 1080.38 1623.64 1527.80 1409.90 1296.14 1141.91 1082.13 1025.23 519.07 713.43 980.89 1012.20 484.56 1623.25 435.21 1108.96 1136.80 377.89 739.08 310.12 1096.49 571.60 798.12 1558.51 508.28 387.84 485.54 168.63 342.42 395.56 576.80 358.87 638.05 800.06 1166.66 451.50 804.64 435.52 507.83 619.84 642.56 948.42 742.57

PROC MOD NOTE PAR FEE ----- -- ---- -------26700 26705 26720 26725 26740 26742 26750 26756 26770 26776 26841 26844 26860 26863 26952 26991 27001 27006 27033 27040 27047 27049 27054 27065 27070 27076 27079 27086 27091 27095 27096 27100 27111 27125 27134 27140 27151 27161 27175 27178 27185 27193 27200 27215 27218 27222 27228 27232 27238 27245 27248 27253 27256 27259 27275 27284 27295 27303 27307 27320 27324 27328 27331 27334 27345 27355 27358 27370 27372 27385 27391 27394 27397 27405 27418 27424 N F N F N F F F 335.10 344.53 222.39 301.60 222.01 316.11 153.41 424.70 225.43 449.70 836.47 909.53 651.07 252.01 745.09 520.29 542.51 733.91 973.09 219.64 570.50 928.51 659.44 471.23 843.94 1535.23 992.32 151.06 1510.38 478.37 69.64 825.66 880.42 1051.65 1937.80 900.41 1305.86 1201.76 627.20 852.43 697.57 466.36 197.35 717.60 1332.28 940.33 1872.96 745.48 439.30 1423.64 775.85 944.26 258.19 1494.65 181.95 1566.25 1255.44 643.48 467.33 470.89 379.68 416.88 471.39 668.05 476.79 600.02 306.91 504.49 400.73 635.14 572.41 654.81 845.61 669.24 819.11 742.89

LC FEE -------366.10 376.40 242.96 329.50 242.55 345.35 167.60 463.99 246.28 491.30 913.85 993.66 711.30 275.32 814.02 568.42 592.69 801.79 1063.11 239.96 623.28 1014.39 720.44 514.82 922.00 1677.24 1084.11 165.04 1650.09 522.62 76.08 902.04 961.86 1148.93 2117.05 983.70 1426.66 1312.92 685.22 931.28 762.09 509.50 215.60 783.98 1455.52 1027.31 2046.21 814.44 479.94 1555.33 847.62 1031.61 282.07 1632.91 198.78 1711.13 1371.57 703.01 510.55 514.45 414.81 455.45 514.99 729.85 520.89 655.52 335.29 551.16 437.79 693.89 625.36 715.38 923.83 731.15 894.87 811.61

PROC MOD NOTE PAR FEE ----- -- ---- -------26700 26706 26720 26727 26740 26746 26755 26765 26775 26785 26842 26850 26861 26910 26990 26992 27003 27025 27035 27040 27047 27050 27060 27066 27071 27077 27080 27087 27093 27095 27097 27105 27120 27130 27137 27146 27156 27165 27176 27179 27187 27194 27200 27216 27220 27226 27230 27235 27240 27246 27250 27254 27257 27265 27280 27286 27301 27305 27310 27323 27327 27329 27332 27335 27347 27356 27360 27370 27380 27386 27392 27395 27400 27407 27420 27425 F F F N N 269.61 418.84 172.39 475.89 188.29 481.09 320.24 365.39 385.85 369.12 891.32 789.30 111.76 780.68 619.06 989.82 572.22 815.68 1184.23 197.55 510.04 361.70 419.23 782.29 916.00 2551.32 473.47 630.77 526.60 81.51 636.94 874.01 1242.97 1396.02 1465.94 1234.10 1707.38 1284.96 877.20 955.69 995.01 761.88 163.63 1045.04 544.63 961.48 492.18 898.32 909.81 426.34 477.93 1266.87 333.87 403.73 991.95 1604.58 564.87 465.36 699.45 179.09 397.84 977.41 637.60 756.95 462.00 720.64 844.58 51.43 595.61 831.00 700.98 878.42 677.31 770.51 744.04 441.97

N

F N N

F F

N F N

F N F

N F

N F F F F N

F N

N F N N N

F

N N N

F F F

N

N F

F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------675.11 696.74 778.44 820.91 1071.95 973.41 926.20 1250.97 623.28 641.04 1082.36 501.05 503.83 455.45 1191.26 438.35 981.21 491.18 636.77 244.32 313.85 851.31 389.79 416.46 1183.75 274.97 139.23 850.13 698.53 416.87 379.56 443.13 297.54 530.72 552.65 540.48 571.30 628.92 575.50 870.48 937.03 48.90 684.49 545.06 498.12 631.77 599.74 569.96 554.38 703.70 584.69 950.92 735.67 989.62 832.15 963.24 644.50 1147.45 701.35 271.50 522.55 317.82 408.15 227.36 533.58 423.08 326.81 397.55 244.70 840.54 257.89 683.05 478.43 352.33 441.96 170.97

M E D I C A R E LC FEE -------776.38 801.25 895.21 944.05 1232.74 1119.42 1065.13 1438.62 716.77 737.20 1244.71 576.21 579.40 523.77 1369.95 504.10 1128.39 564.86 732.29 280.97 360.93 979.01 448.26 478.93 1361.31 316.22 160.11 977.65 803.31 479.40 436.49 509.60 342.17 610.33 635.55 621.55 657.00 723.26 661.83 1001.05 1077.58 56.24 787.16 626.82 572.84 726.54 689.70 655.45 637.54 809.26 672.39 1093.56 846.02 1138.06 956.97 1107.73 741.18 1319.57 806.55 312.23 600.93 365.49 469.37 261.46 613.62 486.54 375.83 457.18 281.41 966.62 296.57 785.51 550.19 405.18 508.25 196.62

F E E

S C H E D U L E NPAR FEE -------992.58 703.96 653.28 771.81 1428.76 1193.16 956.26 1105.98 693.14 1295.60 1071.58 552.60 429.46 740.11 947.30 612.66 1257.15 421.59 1053.91 717.31 592.55 1075.90 893.66 582.24 1222.30 413.10 1351.14 651.35 699.67 496.08 498.88 205.29 573.47 223.67 399.86 360.45 451.73 528.25 718.61 707.92 796.96 680.90 549.90 382.70 605.54 415.64 430.30 474.23 460.18 112.20 647.79 1071.50 366.14 999.12 1199.97 950.87 401.49 680.59 721.06 515.55 820.71 254.50 612.58 415.57 305.12 350.92 250.23 760.63 488.15 958.84 559.37 1054.36 342.90 497.80 699.58 967.23

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------1102.53 614.69 695.41 1188.56 778.40 897.96 1104.32 1208.05 897.85 1658.91 462.22 629.83 525.77 746.00 499.10 644.47 1210.85 693.47 310.96 373.50 535.12 463.06 477.21 1030.36 359.28 852.15 750.19 483.60 406.22 592.74 349.77 541.64 607.52 149.66 898.42 735.15 587.25 361.46 749.43 1045.71 384.68 726.09 331.94 700.62 365.48 513.13 502.72 774.55 601.09 489.36 592.53 503.27 715.90 840.24 1088.79 535.19 577.13 894.27 330.41 445.96 954.51 480.32 290.33 347.08 240.32 573.70 469.71 303.25 413.78 324.89 473.58 1187.47 295.41 327.55 824.14 663.80

PAGE 012 LC FEE -------1267.91 706.89 799.72 1366.84 895.16 1032.65 1269.97 1389.26 1032.53 1907.75 531.55 724.30 604.64 857.90 573.97 741.14 1392.48 797.49 357.60 429.53 615.39 532.52 548.79 1184.91 413.17 979.97 862.72 556.14 467.15 681.65 402.24 622.89 698.65 172.11 1033.18 845.42 675.34 415.68 861.84 1202.57 442.38 835.00 381.73 805.71 420.30 590.10 578.13 890.73 691.25 562.76 681.41 578.76 823.29 966.28 1252.11 615.47 663.70 1028.41 379.97 512.85 1097.69 552.37 333.88 399.14 276.37 659.76 540.17 348.74 475.85 373.62 544.62 1365.59 339.72 376.68 947.76 763.37 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------27427 27430 27438 27442 27446 27450 27457 27468 27475 27485 27488 27497 27500 27501 27506 27508 27511 27516 27517 27520 27530 27535 27538 27550 27557 27560 27570 27591 27596 27601 27603 27605 27606 27612 27614 27618 27619 27626 27635 27640 27646 27648 27654 27658 27659 27665 27676 27685 27686 27691 27696 27702 27705 27712 27722 27727 27732 27740 27742 27750 27756 27760 27762 27780 27784 27788 27808 27810 27816 27822 27824 27826 27829 27831 27842 27860 *** 710.64 733.41 819.41 864.12 1128.37 1024.64 974.95 1316.81 656.08 674.78 1139.33 527.42 530.35 479.42 1253.96 461.42 1032.85 517.03 670.28 257.18 330.37 896.12 410.31 438.38 1246.05 289.44 146.56 894.87 735.29 438.81 399.54 466.45 313.20 558.65 581.74 568.93 601.37 662.02 605.79 916.29 986.35 51.47 720.52 573.75 524.34 665.02 631.30 599.96 583.56 740.74 615.46 1000.97 774.39 1041.71 875.95 1013.94 678.42 1207.84 738.26 285.79 550.05 334.55 429.63 239.33 561.66 445.35 344.01 418.47 257.58 884.78 271.46 719.00 503.61 370.87 465.22 179.97

PROC MOD NOTE PAR FEE ----- -- ---- -------27428 27435 27440 27443 27447 27454 27465 27470 27477 27486 27495 27498 27500 27502 27507 27509 27513 27516 27519 27524 27532 27536 27540 27552 27558 27562 27580 27592 27598 27602 27604 27605 27607 27613 27614 27618 27620 27630 27637 27641 27647 27650 27656 27658 27664 27665 27680 27685 27687 27692 27698 27703 27707 27715 27724 27730 27732 27740 27745 27752 27758 27760 27766 27781 27786 27788 27808 27814 27818 27823 27825 27827 27830 27832 27846 27870 1044.82 741.01 687.66 812.43 1503.96 1255.96 1006.59 1164.19 729.62 1363.79 1127.98 581.68 452.06 779.06 997.16 644.90 1323.32 443.78 1109.38 755.06 623.74 1132.53 940.69 612.88 1286.63 434.84 1422.25 685.63 736.49 522.19 525.14 216.09 603.65 235.44 420.90 379.42 475.51 556.05 756.43 745.18 838.91 716.74 578.84 402.84 637.41 437.52 452.95 499.19 484.40 118.11 681.88 1127.89 385.41 1051.70 1263.13 1000.92 422.62 716.41 759.01 542.68 863.90 267.89 644.82 437.44 321.18 369.39 263.40 800.66 513.84 1009.30 588.81 1109.85 360.95 524.00 736.40 1018.14

LC FEE -------1141.47 809.55 751.27 887.58 1643.07 1372.13 1099.70 1271.88 797.11 1489.94 1232.32 635.49 493.88 851.13 1089.40 704.56 1445.72 484.83 1212.00 824.91 681.43 1237.29 1027.71 669.58 1405.65 475.07 1553.81 749.05 804.62 570.49 573.71 236.08 659.49 257.22 459.84 414.52 519.49 607.49 826.40 814.11 916.50 783.04 632.39 440.11 696.37 477.99 494.85 545.36 529.21 129.03 744.96 1232.23 421.06 1148.99 1379.97 1093.50 461.71 782.68 829.22 592.88 943.82 292.68 704.47 477.91 350.89 403.56 287.76 874.72 561.37 1102.67 643.28 1212.51 394.34 572.47 804.52 1112.31

PROC MOD NOTE PAR FEE ----- -- ---- -------27429 27437 27441 27445 27448 27455 27466 27472 27479 27487 27496 27499 27501 27503 27508 27510 27514 27517 27520 27530 27532 27538 27550 27556 27560 27566 27590 27594 27600 27603 27604 27606 27610 27613 27615 27619 27625 27630 27638 27645 27648 27652 27656 27659 27664 27675 27681 27686 27690 27695 27700 27704 27709 27720 27725 27730 27734 27742 27750 27752 27759 27762 27780 27781 27786 27792 27810 27816 27818 27824 27825 27828 27830 27840 27848 27871 1160.56 647.04 732.01 1251.12 819.37 945.22 1162.44 1271.63 945.11 1746.22 486.55 662.98 553.44 785.26 525.37 678.39 1274.58 729.97 327.33 393.16 563.28 487.43 502.33 1084.59 378.19 897.00 789.67 509.05 427.60 623.94 368.18 570.15 639.49 157.54 945.71 773.84 618.16 380.48 788.87 1100.75 404.93 764.30 349.41 737.49 384.72 540.14 529.18 815.32 632.73 515.12 623.72 529.76 753.58 884.46 1146.09 563.36 607.51 941.34 347.80 469.43 1004.75 505.60 305.61 365.35 252.97 603.89 494.43 319.21 435.56 341.99 498.51 1249.97 310.96 344.79 867.52 698.74

N F F N F F F F F F

F

N N N N N F N N N

F N

F N F N N F

N F N F F N

N F N F N F N F N F N

F N F N N F

N F N F F

N N F F N F F N N F F F

N F F N F N N F F N N N

F N N F N N F F N N F N F F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------757.91 559.53 656.77 721.01 455.24 567.54 313.96 445.88 361.14 406.35 416.35 266.44 759.69 310.11 356.70 364.83 430.85 349.99 548.94 307.51 382.69 412.09 445.63 468.23 371.39 302.38 432.34 369.78 586.35 413.64 541.82 511.45 343.21 587.36 307.73 364.69 663.74 399.42 425.22 383.57 582.13 308.74 393.50 389.62 395.01 316.92 353.76 509.18 486.82 520.09 1188.31 720.15 347.31 382.75 401.55 392.20 494.46 505.27 637.17 596.50 600.91 667.97 874.09 584.88 508.94 453.52 823.88 409.36 408.81 631.51 551.32 533.35 504.74 247.37 357.03 1170.58

M E D I C A R E LC FEE -------871.60 643.46 755.29 829.16 523.53 652.67 361.05 512.76 415.31 467.30 478.80 306.41 873.64 356.63 410.21 419.55 495.48 402.49 631.28 353.64 440.09 473.90 512.47 538.46 427.10 347.74 497.19 425.25 674.30 475.69 623.09 588.17 394.69 675.46 353.89 419.39 763.30 459.33 489.00 441.11 669.45 355.05 452.53 448.06 454.26 364.46 406.82 585.56 559.84 598.10 1366.56 828.17 399.41 440.16 461.78 451.03 568.63 581.06 732.75 685.98 691.05 768.17 1005.20 672.61 585.28 521.55 947.46 470.76 470.13 726.24 634.02 613.35 580.45 284.48 410.58 1346.17

F E E

S C H E D U L E NPAR FEE -------841.31 633.18 517.00 325.37 360.25 593.40 321.97 328.80 417.75 324.98 360.75 420.67 683.11 382.60 266.12 532.29 354.64 367.43 371.85 403.78 282.54 540.97 446.26 496.95 294.80 470.54 335.50 847.59 513.45 452.87 409.28 423.44 275.83 467.33 350.49 296.57 567.26 316.95 325.45 408.38 452.16 522.46 319.87 345.67 330.21 349.95 267.61 387.79 402.88 818.18 1082.27 416.01 269.99 410.73 325.33 623.16 430.39 780.98 542.92 719.69 530.58 879.63 647.28 802.66 400.70 444.10 456.42 340.51 416.35 721.21 453.76 427.32 423.75 199.50 513.20 236.44

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------619.50 679.86 513.15 240.32 627.92 392.38 225.51 466.81 338.23 388.19 358.85 331.94 388.16 293.87 451.73 424.04 427.67 285.33 419.43 312.84 574.09 580.01 361.59 389.44 388.89 360.08 448.94 722.04 509.37 366.72 592.45 349.08 584.28 388.74 265.07 601.71 494.41 205.02 466.05 326.27 391.95 414.59 452.95 265.03 383.55 268.21 615.95 315.63 591.89 760.38 745.55 353.04 483.26 333.04 443.37 521.54 580.74 603.15 682.65 632.42 752.66 657.62 671.76 651.70 684.01 359.04 372.47 444.89 337.18 581.30 617.30 313.55 943.95 393.11 1154.28 182.69

PAGE 013 LC FEE -------712.43 781.84 590.12 276.37 722.11 451.24 259.34 536.83 388.96 446.42 412.68 381.73 446.38 337.95 519.49 487.65 491.82 328.13 482.34 359.77 660.20 667.01 415.83 447.86 447.22 414.09 516.28 830.35 585.78 421.73 681.32 401.44 671.92 447.05 304.83 691.97 568.57 235.77 535.96 375.21 450.74 476.78 520.89 304.78 441.08 308.44 708.34 362.97 680.67 874.44 857.38 406.00 555.75 383.00 509.88 599.77 667.85 693.62 785.05 727.28 865.56 756.26 772.52 749.46 786.61 412.90 428.34 511.62 387.76 668.50 709.90 360.58 1085.54 452.08 1327.42 210.09 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------27880 27884 27889 27894 28002 28003 28008 28011 28020 28024 28035 28043 28046 28050 28054 28060 28070 28072 28086 28088 28092 28100 28103 28106 28108 28110 28112 28113 28116 28118 28120 28122 28126 28140 28150 28160 28173 28175 28192 28193 28202 28208 28220 28222 28226 28230 28234 28238 28250 28260 28262 28264 28272 28280 28286 28288 28290 28292 28294 28296 28298 28299 28302 28304 28306 28307 28309 28312 28313 28320 28340 28341 28345 28400 28405 28420 *** 797.80 588.98 691.34 758.96 479.20 597.41 330.48 469.35 380.15 427.74 438.26 280.46 799.67 326.43 375.47 384.03 453.53 368.41 577.83 323.69 402.83 433.78 469.08 492.87 390.94 318.29 455.09 389.24 617.21 435.41 570.34 538.37 361.27 618.27 323.93 383.88 698.67 420.44 447.60 403.76 612.77 324.99 414.21 410.13 415.80 333.60 372.38 535.98 512.44 547.46 1250.85 758.05 365.59 402.89 422.68 412.84 520.48 531.86 670.70 627.89 632.54 703.13 920.09 615.66 535.73 477.39 867.24 430.90 430.33 664.75 580.34 561.42 531.31 260.39 375.82 1232.19

PROC MOD NOTE PAR FEE ----- -- ---- -------27881 27886 27892 28001 28002 28005 28010 28011 28022 28024 28035 28045 28046 28052 28054 28062 28070 28080 28086 28090 28092 28102 28104 28107 28108 28111 28112 28114 28116 28119 28120 28124 28126 28140 28153 28160 28173 28190 28192 28200 28202 28210 28220 28225 28226 28232 28234 28240 28250 28261 28262 28270 28272 28285 28286 28289 28290 28293 28294 28297 28298 28300 28302 28305 28306 28308 28310 28312 28315 28322 28340 28344 28345 28400 28406 28430 885.59 666.50 544.21 342.49 379.21 624.63 338.92 346.10 439.74 342.08 379.74 442.81 719.06 402.74 280.13 560.31 373.30 386.77 391.42 425.03 297.41 569.44 469.75 523.11 310.32 495.30 353.16 892.20 540.47 476.71 430.82 445.73 290.35 491.93 368.94 312.18 597.12 333.63 342.58 429.87 475.96 549.96 336.70 363.86 347.59 368.37 281.69 408.20 424.08 861.24 1139.23 437.90 284.20 432.35 342.45 655.96 453.04 822.08 571.49 757.57 558.51 925.93 681.35 844.90 421.79 467.47 480.44 358.43 438.26 759.17 477.64 449.81 446.05 210.00 540.21 248.88

LC FEE -------967.51 728.16 594.55 374.18 414.29 682.41 370.27 378.12 480.41 373.73 414.86 483.77 785.58 439.99 306.04 612.13 407.84 422.54 427.63 464.35 324.92 622.12 513.20 571.49 339.02 541.12 385.83 974.73 590.47 520.80 470.67 486.96 317.20 537.43 403.06 341.06 652.35 364.49 374.27 469.64 519.98 600.83 367.85 397.52 379.74 402.44 307.75 445.96 463.31 940.91 1244.61 478.41 310.49 472.34 374.13 716.63 494.95 898.13 624.36 827.64 610.17 1011.57 744.37 923.06 460.81 510.72 524.88 391.59 478.80 829.39 521.82 491.42 487.31 229.43 590.18 271.91

PROC MOD NOTE PAR FEE ----- -- ---- -------27882 27888 27893 28001 28003 28008 28010 28020 28022 28030 28043 28045 28050 28052 28060 28062 28072 28080 28088 28090 28100 28103 28104 28107 28110 28111 28113 28114 28118 28119 28122 28124 28130 28150 28153 28171 28175 28190 28193 28200 28208 28210 28222 28225 28230 28232 28238 28240 28260 28261 28264 28270 28280 28285 28288 28289 28292 28293 28296 28297 28299 28300 28304 28305 28307 28308 28310 28313 28315 28322 28341 28344 28360 28405 28415 28430 652.11 715.64 540.16 252.97 660.97 413.03 237.38 491.38 356.03 408.62 377.74 349.41 408.59 309.34 475.50 446.36 450.18 300.35 441.51 329.30 604.31 610.54 380.62 409.94 409.36 379.03 472.57 760.04 536.18 386.02 623.63 367.45 615.03 409.20 279.02 633.38 520.43 215.81 490.58 343.44 412.58 436.41 476.79 278.98 403.74 282.33 648.37 332.24 623.04 800.40 784.79 371.62 508.69 350.57 466.71 548.99 611.31 634.89 718.58 665.71 792.27 692.23 707.12 686.00 720.01 377.94 392.07 468.31 354.93 611.89 649.79 330.05 993.63 413.80 1215.03 192.30

N F F N F N N F N F N F N F N F N F F N F N F N F N F N N F N N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N N F

N F N F N F F N F N F N F N F N F N N F N F N F N F N F F N F F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N N F N N F N F F N

F N N F N F N F N F N F N F N F N N F F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F F N F F N F N F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------306.91 1022.22 275.24 522.72 272.86 442.47 156.86 230.91 117.66 133.08 120.25 190.73 207.23 685.84 153.35 546.82 574.33 249.72 425.45 109.73 341.91 304.45 139.86 194.00 1222.29 760.91 761.72 547.59 618.93 559.35 330.78 207.14 149.20 204.19 164.53 188.89 156.45 82.51 126.69 82.53 56.85 59.00 54.95 74.01 26.34 52.80 40.18 49.18 32.64 220.31 96.59 131.55 83.91 85.63 83.17 138.47 121.12 60.37 36.78 35.22 29.31 48.24 33.59 110.32 52.07 59.84 64.54 528.00 1002.07 520.31 602.46 648.23 472.02 508.39 453.96 498.49

M E D I C A R E LC FEE -------352.95 1175.55 316.53 601.13 313.79 508.84 180.39 265.55 135.31 153.04 138.29 219.34 238.31 788.72 176.35 628.84 660.48 287.18 489.27 126.19 393.20 350.12 160.84 223.10 1405.63 875.05 875.98 629.73 711.77 643.25 380.40 238.21 171.58 234.82 189.21 217.22 179.92 94.89 145.69 94.91 65.38 67.85 63.19 85.11 30.29 60.72 46.21 56.56 37.54 253.36 111.08 151.28 96.50 98.47 95.65 159.24 139.29 69.43 42.30 40.50 33.71 55.48 38.63 126.87 59.88 68.82 74.22 607.20 1152.38 598.36 692.83 745.46 542.82 584.65 522.05 573.26

F E E

S C H E D U L E NPAR FEE -------275.24 228.57 254.63 224.79 241.20 126.13 140.66 514.94 106.98 480.15 97.42 189.13 424.55 503.60 298.60 375.98 199.16 244.93 618.10 139.87 228.87 108.12 139.13 446.30 905.62 741.70 571.74 449.19 529.82 427.53 438.05 156.70 206.36 134.61 200.70 149.86 221.22 56.73 108.28 63.37 81.08 43.54 60.13 47.13 48.12 38.45 59.36 34.09 202.53 165.82 124.09 98.78 78.85 68.70 47.96 109.38 69.64 46.38 51.75 31.90 46.56 40.88 60.57 81.23 69.09 44.37 90.19 630.50 976.85 568.10 614.19 1046.30 481.76 570.35 474.91 516.96

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------413.86 171.49 266.27 173.61 323.93 108.45 455.14 330.48 145.60 294.22 428.94 181.76 312.26 175.44 286.08 633.61 175.96 794.00 113.42 133.61 383.97 91.55 329.86 260.74 790.38 655.85 782.50 339.83 558.32 492.77 286.37 207.01 153.71 215.71 130.38 228.25 175.19 177.50 79.93 76.36 59.00 79.25 38.41 36.66 30.08 52.33 41.32 49.94 148.04 120.52 103.84 107.84 61.54 104.53 33.59 134.00 44.23 52.25 35.18 34.10 35.88 55.69 45.48 79.32 42.58 87.74 73.26 454.33 563.41 551.52 562.34 432.91 560.55 420.61 540.24 427.51

PAGE 014 LC FEE -------475.94 197.21 306.21 199.65 372.52 124.72 523.41 380.05 167.44 338.35 493.28 209.02 359.10 201.76 328.99 728.65 202.35 913.10 130.43 153.65 441.57 105.28 379.34 299.85 908.94 754.23 899.88 390.80 642.07 566.69 329.33 238.06 176.77 248.07 149.94 262.49 201.47 204.13 91.92 87.81 67.85 91.14 44.17 42.16 34.59 60.18 47.52 57.43 170.25 138.60 119.42 124.02 70.77 120.21 38.63 154.10 50.86 60.09 40.46 39.22 41.26 64.04 52.30 91.22 48.97 100.90 84.25 522.48 647.92 634.25 646.69 497.85 644.63 483.70 621.28 491.64 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------28435 28445 28455 28465 28475 28485 28495 28496 28510 28515 28530 28531 28545 28555 28570 28576 28585 28605 28606 28630 28636 28645 28665 28666 28705 28730 28740 28750 28760 28805 28820 29000 29010 29020 29025 29040 29044 29049 29055 29065 29075 29086 29105 29126 29130 29200 29220 29260 29280 29325 29345 29358 29365 29425 29435 29445 29450 29515 29520 29540 29550 29590 29700 29710 29715 29730 29740 29800 29806 29820 29823 29826 29834 29837 29843 29846 *** N N N N F N F N F N F N F N F F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F 323.06 1076.02 289.73 550.23 287.22 465.76 165.12 243.06 123.85 140.08 126.58 200.77 218.14 721.94 161.42 575.60 604.56 262.86 447.84 115.51 359.90 320.47 147.22 204.21 1286.62 800.96 801.81 576.41 651.50 588.79 348.19 218.04 157.05 214.94 173.19 198.83 164.68 86.85 133.36 86.87 59.84 62.11 57.84 77.91 27.73 55.58 42.29 51.77 34.36 231.91 101.67 138.47 88.33 90.14 87.55 145.76 127.49 63.55 38.72 37.07 30.85 50.78 35.36 116.13 54.81 62.99 67.94 555.79 1054.81 547.69 634.17 682.35 496.86 535.15 477.85 524.73

PROC MOD NOTE PAR FEE ----- -- ---- -------28435 28450 28455 28470 28475 28490 28495 28505 28510 28525 28530 28540 28546 28555 28575 28576 28600 28605 28615 28635 28636 28660 28665 28675 28715 28735 28740 28755 28760 28810 28825 29000 29015 29020 29035 29040 29046 29049 29058 29065 29085 29086 29125 29126 29131 29200 29240 29260 29305 29325 29355 29358 29405 29425 29440 29445 29505 29515 29530 29540 29580 29590 29705 29710 29720 29730 29750 29804 29807 29821 29824 29827 29835 29838 29844 29847 F N F N F N F N F N F N N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N 289.73 240.60 268.03 236.62 253.89 132.77 148.06 542.04 112.61 505.42 102.55 199.08 446.89 530.10 314.32 395.77 209.64 257.82 650.63 147.23 240.92 113.81 146.45 469.79 953.28 780.74 601.83 472.83 557.71 450.03 461.11 164.95 217.22 141.69 211.26 157.75 232.86 59.72 113.98 66.71 85.35 45.83 63.29 49.61 50.65 40.47 62.48 35.88 213.19 174.55 130.62 103.98 83.00 72.32 50.48 115.14 73.31 48.82 54.47 33.58 49.01 43.03 63.76 85.51 72.73 46.71 94.94 663.68 1028.26 598.00 646.52 1101.37 507.12 600.37 499.90 544.17

LC FEE -------316.53 262.86 292.82 258.51 277.38 145.05 161.76 592.18 123.03 552.17 112.03 217.50 488.23 579.14 343.39 432.38 229.03 281.67 710.82 160.85 263.20 124.34 160.00 513.25 1041.46 852.96 657.50 516.57 609.29 491.66 503.76 180.21 237.31 154.80 230.81 172.34 254.40 65.24 124.52 72.88 93.24 50.07 69.15 54.20 55.34 44.22 68.26 39.20 232.91 190.69 142.70 113.60 90.68 79.01 55.15 125.79 80.09 53.34 59.51 36.69 53.54 47.01 69.66 93.41 79.45 51.03 103.72 725.08 1123.38 653.32 706.32 1203.25 554.02 655.90 546.15 594.50

PROC MOD NOTE PAR FEE ----- -- ---- -------28436 28450 28456 28470 28476 28490 28496 28505 28515 28525 28531 28540 28546 28570 28575 28585 28600 28606 28630 28635 28645 28660 28666 28675 28725 28737 28750 28755 28800 28820 28825 29010 29015 29025 29035 29044 29046 29055 29058 29075 29085 29105 29125 29130 29131 29220 29240 29280 29305 29345 29355 29365 29405 29435 29440 29450 29505 29520 29530 29550 29580 29700 29705 29715 29720 29740 29750 29805 29819 29822 29825 29830 29836 29840 29845 29848 F F F N F N F N F F N F N F N N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F N F 435.64 180.52 280.28 182.75 340.98 114.16 479.09 347.87 153.26 309.70 451.52 191.33 328.69 184.67 301.14 666.96 185.22 835.79 119.39 140.64 404.18 96.37 347.22 274.46 831.98 690.37 823.68 357.72 587.70 518.71 301.44 217.90 161.80 227.06 137.24 240.26 184.41 186.84 84.14 80.38 62.10 83.42 40.43 38.59 31.66 55.08 43.49 52.57 155.83 126.86 109.30 113.52 64.78 110.03 35.36 141.05 46.56 55.00 37.03 35.89 37.77 58.62 47.87 83.49 44.82 92.36 77.12 478.24 593.06 580.55 591.94 455.69 590.05 442.75 568.67 450.01

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------511.20 977.91 722.55 483.93 474.50 592.34 617.58 666.91 951.78 655.22 499.49 571.15 479.87 107.66 111.83 121.83 244.12 408.44 260.20 659.28 122.31 116.76 194.42 915.08 858.29 1287.57 508.36 128.79 478.09 505.50 179.24 59.60 208.73 139.84 110.01 195.92 438.53 600.04 321.17 882.64 864.03 374.37 1256.04 77.02 290.64 186.50 637.74 423.98 535.26 1118.49 1049.11 472.55 1494.01 1352.79 1855.19 758.61 34.76 201.40 125.37 136.86 158.56 164.77 167.65 197.73 280.03 360.71 112.36 124.86 267.25 144.09 1303.47 838.53 608.10 227.13 438.81 380.29

M E D I C A R E LC FEE -------587.88 1124.60 830.93 556.52 545.68 681.19 710.22 766.95 1094.55 753.50 574.41 656.82 551.85 123.81 128.60 140.10 280.74 469.71 299.23 758.17 140.66 134.27 223.58 1052.34 987.03 1480.71 584.61 148.11 549.80 581.33 206.13 68.54 240.04 160.82 126.51 225.31 504.31 690.05 369.35 1015.04 993.63 430.53 1444.45 88.57 334.24 214.48 733.40 487.58 615.55 1286.26 1206.48 543.43 1718.11 1555.71 2133.47 872.40 39.97 231.61 144.18 157.39 182.34 189.49 192.80 227.39 322.03 414.82 129.21 143.59 307.34 165.70 1498.99 964.31 699.32 261.20 504.63 437.33

F E E

S C H E D U L E NPAR FEE -------901.35 587.52 721.04 480.52 584.02 620.48 779.98 561.66 1112.89 444.13 489.87 942.93 513.80 178.43 66.55 317.40 644.65 231.75 279.60 93.15 91.02 218.51 342.85 1081.20 1254.56 741.86 761.22 525.72 448.63 122.67 174.45 163.49 105.27 494.48 152.10 266.10 407.97 372.06 622.26 896.51 880.05 576.98 1412.58 250.53 167.68 327.97 166.59 207.19 244.18 1188.76 1209.09 1178.97 1828.44 1350.33 2139.86 110.58 81.55 122.61 204.21 206.41 244.63 196.63 204.89 222.78 329.28 238.47 76.65 234.09 168.22 891.72 385.38 993.04 391.02 186.31 76.50 565.52

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------760.29 648.36 386.73 509.44 549.40 575.04 547.21 663.99 621.02 362.40 512.76 435.15 210.02 109.58 187.37 284.62 410.28 498.37 643.06 58.91 225.75 112.47 724.59 583.75 679.70 411.86 230.41 487.07 446.49 118.99 97.53 78.80 241.46 658.82 96.86 243.63 462.58 494.68 754.64 943.71 687.46 674.16 173.84 140.82 315.00 205.36 287.33 335.54 283.32 967.44 999.02 1590.98 1461.05 1409.23 769.57 80.05 47.31 204.16 132.42 110.31 165.10 145.49 224.61 256.13 358.22 263.00 209.91 154.19 228.03 1483.70 620.70 596.24 265.05 618.59 48.53 178.13

PAGE 015 LC FEE -------874.33 745.61 444.74 585.86 631.81 661.30 629.29 763.59 714.17 416.76 589.67 500.42 241.52 126.02 215.48 327.31 471.82 573.13 739.52 67.75 259.61 129.34 833.28 671.31 781.66 473.64 264.97 560.13 513.46 136.84 112.16 90.62 277.68 757.64 111.39 280.17 531.97 568.88 867.84 1085.27 790.58 775.28 199.92 161.94 362.25 236.16 330.43 385.87 325.82 1112.56 1148.87 1829.63 1680.21 1620.61 885.01 92.06 54.41 234.78 152.28 126.86 189.87 167.31 258.30 294.55 411.95 302.45 241.40 177.32 262.23 1706.26 713.81 685.68 304.81 711.38 55.81 204.85 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------29850 29856 29862 29871 29875 29879 29882 29885 29888 29892 29894 29898 29901 30000 30100 30110 30117 30120 30130 30160 30210 30220 30310 30410 30435 30462 30540 30560 30600 30630 30802 30901 30905 30906 30930 31002 31030 31040 31070 31081 31086 31200 31225 31231 31235 31237 31239 31255 31276 31290 31293 31320 31367 31375 31390 31420 31502 31510 31511 31513 31520 31526 31529 31535 31541 31570 31575 31576 31578 31579 31584 31587 31595 31603 31611 31613 *** 538.10 1029.38 760.58 509.40 499.47 623.52 650.08 702.01 1001.87 689.71 525.78 601.21 505.13 113.33 117.72 128.24 256.97 429.94 273.89 693.98 128.75 122.91 204.65 963.24 903.46 1355.34 535.12 135.57 503.25 532.11 188.67 62.74 219.72 147.20 115.80 206.23 461.61 631.62 338.07 929.09 909.51 394.07 1322.15 81.07 305.94 196.32 671.30 446.29 563.43 1177.36 1104.33 497.42 1572.64 1423.99 1952.83 798.54 36.59 212.00 131.97 144.06 166.90 173.44 176.47 208.14 294.77 379.69 118.27 131.43 281.32 151.67 1372.07 882.66 640.11 239.08 461.91 400.30

PROC MOD NOTE PAR FEE ----- -- ---- -------29851 29860 29863 29873 29876 29880 29883 29886 29889 29893 29895 29899 29902 30020 30100 30115 30118 30124 30140 30200 30210 30300 30320 30420 30450 30465 30545 30580 30600 30801 30802 30903 30905 30915 31000 31020 31030 31050 31075 31084 31087 31201 31230 31233 31235 31238 31240 31256 31287 31291 31294 31360 31368 31380 31395 31500 31505 31510 31512 31515 31525 31527 31530 31536 31560 31570 31575 31577 31578 31580 31585 31588 31600 31605 31612 31614 948.79 618.44 758.99 505.81 614.76 653.14 821.03 591.22 1171.46 467.51 515.65 992.56 540.84 187.82 70.05 334.11 678.58 243.95 294.32 98.05 95.81 230.01 360.89 1138.10 1320.59 780.90 801.28 553.39 472.24 129.13 183.63 172.09 110.81 520.51 160.10 280.10 429.44 391.64 655.01 943.69 926.37 607.35 1486.93 263.72 176.50 345.23 175.36 218.09 257.03 1251.33 1272.73 1241.02 1924.67 1421.40 2252.48 116.40 85.84 129.06 214.96 217.27 257.51 206.98 215.67 234.51 346.61 251.02 80.68 246.41 177.07 938.65 405.66 1045.30 411.60 196.12 80.53 595.28

LC FEE -------1036.55 675.65 829.20 552.60 671.62 713.55 896.98 645.91 1279.82 510.75 563.35 1084.37 590.87 205.19 76.53 365.01 741.35 266.51 321.54 107.12 104.67 251.29 394.28 1243.38 1442.74 853.14 875.40 604.58 515.92 141.07 200.62 188.01 121.06 568.65 174.92 306.02 469.17 427.87 715.60 1030.99 1012.06 663.53 1624.47 288.11 192.83 377.17 191.58 238.27 280.81 1367.07 1390.45 1355.82 2102.71 1552.88 2460.84 127.17 93.78 141.00 234.84 237.37 281.32 226.12 235.62 256.20 378.67 274.24 88.15 269.20 193.45 1025.48 443.19 1142.00 449.67 214.26 87.98 650.35

PROC MOD NOTE PAR FEE ----- -- ---- -------29855 29861 29870 29874 29877 29881 29884 29887 29891 29893 29897 29900 30000 30020 30110 30117 30120 30125 30150 30200 30220 30300 30400 30430 30460 30520 30560 30580 30620 30801 30901 30903 30906 30920 31000 31020 31032 31051 31080 31085 31090 31205 31231 31233 31237 31238 31254 31267 31288 31292 31300 31365 31370 31382 31400 31502 31505 31511 31512 31515 31525 31528 31531 31540 31561 31571 31576 31577 31579 31582 31586 31590 31601 31610 31612 31615 800.31 682.48 407.08 536.25 578.32 605.30 576.01 698.94 653.71 381.47 539.75 458.05 221.07 115.35 197.23 299.60 431.87 524.60 676.90 62.01 237.63 118.39 762.73 614.47 715.47 433.54 242.54 512.70 469.99 125.25 102.66 82.95 254.17 693.49 101.96 256.45 486.93 520.72 794.36 993.38 723.64 709.64 182.99 148.23 331.58 216.17 302.45 353.20 298.23 1018.36 1051.60 1674.72 1537.95 1483.40 810.07 84.26 49.80 214.90 139.39 116.12 173.79 153.15 236.43 269.61 377.07 276.84 220.96 162.31 240.03 1561.79 653.37 627.62 279.00 651.15 51.08 187.51

N N F

F N F N N N F N F

F N F F F N F

N F N

F N N F N F N

N F N F N F N N F

N F F N F N F F

F N F

N F N

N F N F

F N F

N F N N N

N F N F F F

N N F N F

F F N F

N F N

N

F N

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------125.49 295.85 142.72 346.84 206.80 70.90 68.14 271.75 142.89 76.58 64.23 94.09 96.30 937.40 1732.67 1112.56 1440.51 379.35 526.02 173.65 114.53 211.37 541.25 736.18 855.21 572.60 719.35 826.40 86.63 96.72 1618.66 1474.92 1566.03 248.64 1561.19 338.21 394.31 793.89 788.61 843.24 1063.88 1156.63 830.94 1321.45 3149.68 1226.61 136.06 121.75 767.56 1270.54 1248.43 754.80 488.85 178.31 484.83 381.50 355.32 434.80 487.55 846.86 235.68 863.66 1240.30 1448.17 1066.62 1327.80 1230.12 1730.04 1527.77 2224.96 2459.25 1557.12 1235.78 1981.16 1392.43 1665.32

M E D I C A R E LC FEE -------144.31 340.23 164.13 398.87 237.82 81.54 78.36 312.51 164.32 88.07 73.86 108.20 110.75 1078.01 1992.57 1279.44 1656.59 436.25 604.92 199.70 131.71 243.08 622.44 846.61 983.49 658.49 827.25 950.36 99.62 111.23 1861.46 1696.16 1800.93 285.94 1795.37 388.94 453.46 912.97 906.90 969.73 1223.46 1330.12 955.58 1519.67 3622.13 1410.60 156.47 140.01 882.69 1461.12 1435.69 868.02 562.18 205.06 557.55 438.73 408.62 500.02 560.68 973.89 271.03 993.21 1426.35 1665.40 1226.61 1526.97 1414.64 1989.55 1756.94 2558.70 2828.14 1790.69 1421.15 2278.33 1601.29 1915.12

F E E

S C H E D U L E NPAR FEE -------259.83 142.68 325.67 192.57 223.51 54.70 202.65 180.57 116.79 74.73 189.39 52.85 190.89 1144.91 1285.31 1381.86 475.14 357.63 385.94 76.09 328.51 571.84 899.12 787.71 858.22 929.97 1442.20 1417.37 500.10 113.80 1551.27 1270.46 1341.35 1310.31 959.19 426.63 467.96 1141.35 802.46 750.63 833.46 863.63 813.10 2621.81 3386.17 1546.45 92.25 123.22 732.17 879.22 1216.49 663.95 494.48 342.97 303.31 373.40 421.93 471.41 619.71 916.67 1342.96 1220.71 1427.94 317.50 1275.99 978.60 1255.15 1733.02 1700.71 1950.93 2512.45 1750.92 1574.19 2333.58 1530.81 1754.79

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------139.06 267.17 174.35 624.31 244.49 86.93 279.93 163.90 126.64 75.53 112.44 143.79 149.29 1265.82 1404.75 1054.82 800.98 546.27 371.94 205.85 112.02 637.04 1294.93 856.14 870.47 199.63 856.78 128.97 152.32 1483.14 1394.07 1474.05 1322.54 1436.31 311.57 486.22 688.83 785.22 824.32 750.26 1000.42 934.20 1357.05 2945.59 1195.77 1151.87 309.04 454.69 1125.03 1439.90 255.26 429.27 172.47 387.67 381.48 374.86 489.60 249.94 790.43 467.58 869.43 858.91 1781.81 231.59 1114.71 1201.15 1353.60 1472.07 2095.61 2170.07 1772.17 1679.22 1578.24 2008.13 1627.42 1261.41

PAGE 016 LC FEE -------159.92 307.25 200.50 717.96 281.16 99.97 321.92 188.49 145.64 86.86 129.31 165.36 171.68 1455.69 1615.46 1213.04 921.13 628.21 427.73 236.73 128.82 732.60 1489.17 984.56 1001.04 229.57 985.30 148.32 175.17 1705.61 1603.18 1695.16 1520.92 1651.76 358.31 559.15 792.15 903.00 947.97 862.80 1150.48 1074.33 1560.61 3387.43 1375.14 1324.65 355.40 522.89 1293.78 1655.89 293.55 493.66 198.34 445.82 438.70 431.09 563.04 287.43 908.99 537.72 999.84 987.75 2049.08 266.33 1281.92 1381.32 1556.64 1692.88 2409.95 2495.58 2038.00 1931.10 1814.98 2309.35 1871.53 1450.62 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------31615 31623 31624 31628 31629 31632 31633 31641 31646 31700 31715 31720 31725 31750 31766 31780 31786 31820 31825 32000 32002 32020 32095 32120 32141 32160 32215 32310 32400 32405 32442 32482 32488 32501 32525 32602 32605 32651 32654 32657 32660 32663 32800 32820 32853 32905 32960 33010 33020 33031 33130 33200 33207 33211 33214 33217 33222 33225 33234 33237 33241 33245 33250 33261 33300 33315 33322 33335 33403 33406 33412 33415 33420 33426 33460 33465 *** F N F N F N F F N F 132.09 311.42 150.23 365.09 217.68 74.63 71.73 286.05 150.41 80.61 67.61 99.04 101.37 986.74 1823.86 1171.12 1516.33 399.32 553.70 182.79 120.56 222.49 569.74 774.93 900.22 602.74 757.21 869.89 91.19 101.81 1703.85 1552.55 1648.45 261.73 1643.36 356.01 415.06 835.67 830.12 887.62 1119.87 1217.51 874.67 1391.00 3315.45 1291.17 143.22 128.16 807.96 1337.41 1314.14 794.53 514.58 187.69 510.35 401.58 374.02 457.68 513.21 891.43 248.08 909.12 1305.58 1524.39 1122.76 1397.68 1294.86 1821.09 1608.18 2342.06 2588.68 1639.07 1300.82 2085.43 1465.72 1752.97

PROC MOD NOTE PAR FEE ----- -- ---- -------31622 31623 31625 31628 31630 31632 31635 31643 31656 31708 31717 31720 31730 31755 31770 31781 31800 31820 31830 32000 32005 32035 32100 32124 32150 32200 32220 32320 32402 32420 32445 32484 32491 32520 32540 32603 32606 32652 32655 32658 32661 32664 32810 32851 32854 32906 32960 33011 33025 33050 33140 33201 33208 33212 33215 33218 33223 33226 33235 33238 33243 33246 33251 33282 33305 33320 33330 33400 33404 33410 33413 33416 33422 33427 33463 33468 N F N F F 273.50 150.19 342.81 202.70 235.27 57.58 213.32 190.07 122.94 78.66 199.36 55.63 200.94 1205.17 1352.96 1454.59 500.15 376.45 406.25 80.09 345.80 601.94 946.44 829.17 903.39 978.92 1518.11 1491.97 526.42 119.79 1632.92 1337.33 1411.95 1379.27 1009.67 449.08 492.59 1201.42 844.69 790.14 877.33 909.08 855.89 2759.80 3564.39 1627.84 97.10 129.71 770.70 925.49 1280.52 698.89 520.50 361.02 319.27 393.05 444.14 496.22 652.33 964.92 1413.64 1284.96 1503.09 334.21 1343.15 1030.11 1321.21 1824.23 1790.22 2053.61 2644.68 1843.07 1657.04 2456.40 1611.38 1847.15

LC FEE -------298.80 164.08 374.52 221.46 257.04 62.91 233.05 207.66 134.31 85.94 217.80 60.78 219.52 1316.65 1478.11 1589.14 546.41 411.27 443.83 87.50 377.79 657.62 1033.99 905.87 986.95 1069.47 1658.53 1629.98 575.12 130.87 1783.96 1461.03 1542.55 1506.86 1103.07 490.62 538.15 1312.55 922.83 863.22 958.48 993.17 935.07 3015.08 3894.10 1778.42 106.09 141.70 842.00 1011.10 1398.96 763.54 568.65 394.42 348.81 429.41 485.22 542.12 712.67 1054.17 1544.40 1403.82 1642.13 365.13 1467.39 1125.39 1443.42 1992.97 1955.82 2243.57 2889.32 2013.56 1810.32 2683.62 1760.43 2018.01

PROC MOD NOTE PAR FEE ----- -- ---- -------31622 31624 31625 31629 31631 31633 31640 31645 31700 31710 31717 31725 31730 31760 31775 31785 31805 31825 31830 32002 32005 32036 32110 32140 32151 32201 32225 32400 32405 32440 32480 32486 32500 32522 32601 32604 32650 32653 32656 32659 32662 32665 32815 32852 32900 32940 32997 33015 33030 33120 33141 33206 33210 33213 33216 33220 33224 33233 33236 33240 33244 33249 33253 33284 33310 33321 33332 33401 33405 33411 33414 33417 33425 33430 33464 33470 F N F N N N F N F 146.38 281.23 183.53 657.17 257.36 91.50 294.66 172.53 133.31 79.51 118.36 151.36 157.15 1332.44 1478.68 1110.34 843.14 575.02 391.52 216.68 117.92 670.57 1363.08 901.20 916.28 210.14 901.87 135.76 160.34 1561.20 1467.44 1551.63 1392.15 1511.91 327.97 511.81 725.08 826.55 867.71 789.75 1053.07 983.37 1428.47 3100.62 1258.71 1212.49 325.31 478.62 1184.24 1515.68 268.69 451.86 181.55 408.07 401.56 394.59 515.37 263.09 832.03 492.19 915.19 904.12 1875.59 243.78 1173.38 1264.37 1424.84 1549.55 2205.90 2284.28 1865.44 1767.60 1661.30 2113.82 1713.07 1327.80

N F N

N F N F

F N F N

N F N F

F F

N N

N

F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------1285.81 1868.26 1594.85 1271.47 1510.38 1777.81 1973.50 136.88 500.36 311.24 2076.63 2084.34 1609.42 1789.72 1912.44 1234.83 1697.29 1791.23 1188.93 2033.34 1543.30 1626.05 1309.27 1228.47 1445.81 1810.50 1940.03 2421.54 1537.62 1175.71 981.68 1221.60 1405.92 2343.36 1880.03 1164.44 1541.32 1346.07 2535.95 254.63 612.69 1060.11 1326.33 773.46 593.89 949.18 1462.82 948.01 1026.18 1259.51 211.57 500.14 1778.20 627.66 1160.36 997.92 1289.51 2119.42 1706.13 1604.81 1385.45 1295.33 1104.85 1633.09 1538.94 763.78 1097.31 1136.91 1468.73 993.43 1386.53 1077.93 1470.70 1039.53 842.23 170.12

M E D I C A R E LC FEE -------1478.68 2148.50 1834.08 1462.19 1736.94 2044.48 2269.53 157.41 575.41 357.93 2388.12 2396.99 1850.83 2058.18 2199.31 1420.05 1951.88 2059.91 1367.27 2338.34 1774.80 1869.96 1505.66 1412.74 1662.68 2082.08 2231.03 2784.77 1768.26 1352.07 1128.93 1404.84 1616.81 2694.86 2162.03 1339.11 1772.52 1547.98 2916.34 292.82 704.59 1219.13 1525.28 889.48 682.97 1091.56 1682.24 1090.21 1180.11 1448.44 243.31 575.16 2044.93 721.81 1334.41 1147.61 1482.94 2437.33 1962.05 1845.53 1593.27 1489.63 1270.58 1878.05 1769.78 878.35 1261.91 1307.45 1689.04 1142.44 1594.51 1239.62 1691.31 1195.46 968.56 195.64

F E E

S C H E D U L E NPAR FEE -------1361.66 1470.18 1460.36 1206.08 1950.73 1849.54 2026.16 258.26 621.67 1823.11 2163.73 236.35 1760.69 1884.21 2093.74 1463.46 1698.36 1727.38 1778.26 1562.84 1691.92 1189.28 1223.23 1244.59 2060.59 1862.81 2264.14 2012.99 933.95 1262.03 1051.43 1336.04 1864.69 2502.62 2347.30 1476.02 2233.88 296.32 966.76 34.29 515.62 1223.23 2373.05 913.65 1362.00 1346.51 600.92 1548.11 1002.28 1259.88 346.05 695.37 1813.22 294.98 1190.70 1229.85 964.16 1944.85 2201.62 1658.87 1641.04 1265.43 1157.25 1011.35 753.18 689.27 1320.62 958.82 1602.46 845.41 1517.85 1520.10 1423.87 1558.45 1009.38 163.42

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------1349.75 1592.05 1031.45 1451.32 16.23 1948.07 2144.80 378.61 743.00 1963.96 1668.60 1623.39 1812.69 2004.22 2585.71 1683.40 1845.57 1651.52 1926.82 1746.14 1876.09 1397.97 1230.83 1376.26 1898.47 1997.93 1975.31 2215.32 1042.98 1500.91 1180.25 1280.05 2154.74 2474.47 1435.09 1463.74 1811.43 3599.36 587.21 356.15 872.96 1204.38 3157.11 604.12 603.79 704.90 586.82 1097.97 1148.92 1205.32 245.19 211.57 1919.26 939.84 1036.28 1137.26 1564.19 2450.56 1362.89 1917.04 1118.46 1424.16 806.98 859.92 925.64 1306.56 834.62 1364.16 1026.71 1300.20 937.64 905.70 1277.94 1667.21 932.53 546.06

PAGE 017 LC FEE -------1552.21 1830.86 1186.17 1669.02 18.66 2240.28 2466.52 435.40 854.45 2258.55 1918.89 1866.90 2084.59 2304.85 2973.57 1935.91 2122.41 1899.25 2215.84 2008.06 2157.50 1607.67 1415.45 1582.70 2183.24 2297.62 2271.61 2547.62 1199.43 1726.05 1357.29 1472.06 2477.95 2845.64 1650.35 1683.30 2083.14 4139.26 675.29 409.57 1003.90 1385.04 3630.68 694.74 694.36 810.64 674.84 1262.67 1321.26 1386.12 281.97 243.31 2207.15 1080.82 1191.72 1307.85 1798.82 2818.14 1567.32 2204.60 1286.23 1637.78 928.03 988.91 1064.49 1502.54 959.81 1568.78 1180.72 1495.23 1078.29 1041.56 1469.63 1917.29 1072.41 627.97 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------33471 33475 33496 33502 33505 33510 33513 33517 33521 33530 33535 33545 33602 33610 33615 33641 33660 33681 33690 33697 33720 33732 33737 33762 33767 33774 33777 33780 33788 33803 33820 33840 33852 33861 33875 33915 33918 33922 33945 33967 33971 33975 33978 34001 34111 34203 34451 34501 34520 34802 34808 34820 34830 34833 35001 35011 35022 35082 35102 35112 35131 35142 35161 35182 35189 35206 35216 35231 35246 35261 35276 35301 35331 35355 35371 35390 *** 1353.48 1966.59 1678.79 1338.39 1589.87 1871.38 2077.37 144.08 526.69 327.62 2185.93 2194.04 1694.13 1883.92 2013.09 1299.82 1786.62 1885.50 1251.51 2140.36 1624.53 1711.63 1378.18 1293.13 1521.91 1905.79 2042.14 2548.99 1618.55 1237.59 1033.35 1285.89 1479.92 2466.69 1978.98 1225.73 1622.44 1416.92 2669.42 268.03 644.94 1115.91 1396.14 814.17 625.15 999.14 1539.81 997.90 1080.19 1325.80 222.71 526.46 1871.79 660.69 1221.43 1050.44 1357.38 2230.97 1795.93 1689.27 1458.37 1363.50 1163.00 1719.04 1619.94 803.98 1155.06 1196.75 1546.03 1045.72 1459.51 1134.66 1548.10 1094.24 886.56 179.07

PROC MOD NOTE PAR FEE ----- -- ---- -------33472 33476 33500 33503 33506 33511 33514 33518 33522 33533 33536 33572 33606 33611 33617 33645 33665 33684 33692 33702 33722 33735 33750 33764 33770 33775 33778 33781 33800 33813 33822 33845 33853 33863 33877 33916 33919 33924 33960 33968 33973 33976 33979 34051 34151 34401 34471 34502 34530 34804 34812 34825 34831 34834 35002 35013 35045 35091 35103 35121 35132 35151 35162 35184 35190 35207 35221 35236 35251 35266 35281 35311 35341 35361 35372 35400 1433.33 1547.56 1537.22 1269.56 2053.40 1946.88 2132.80 271.85 654.39 1919.06 2277.61 248.79 1853.36 1983.38 2203.94 1540.48 1787.75 1818.29 1871.85 1645.09 1780.97 1251.87 1287.61 1310.09 2169.04 1960.85 2383.31 2118.94 983.10 1328.45 1106.77 1406.36 1962.83 2634.34 2470.84 1553.71 2351.45 311.92 1017.64 36.09 542.76 1287.61 2497.95 961.74 1433.68 1417.38 632.55 1629.59 1055.03 1326.19 364.26 731.97 1908.65 310.50 1253.37 1294.58 1014.91 2047.21 2317.49 1746.18 1727.41 1332.03 1218.16 1064.58 792.82 725.55 1390.13 1009.28 1686.80 889.91 1597.74 1600.10 1498.81 1640.47 1062.50 172.02

LC FEE -------1565.91 1690.71 1679.41 1386.99 2243.34 2126.97 2330.08 297.00 714.92 2096.58 2488.29 271.80 2024.79 2166.84 2407.80 1682.98 1953.11 1986.49 2045.00 1797.27 1945.71 1367.67 1406.71 1431.28 2369.68 2142.23 2603.76 2314.94 1074.04 1451.33 1209.14 1536.45 2144.39 2878.01 2699.40 1697.42 2568.96 340.77 1111.77 39.43 592.96 1406.71 2729.01 1050.70 1566.30 1548.49 691.06 1780.33 1152.62 1448.86 397.96 799.68 2085.20 339.23 1369.31 1414.33 1108.78 2236.58 2531.86 1907.70 1887.20 1455.24 1330.84 1163.05 866.16 792.66 1518.71 1102.64 1842.83 972.22 1745.53 1748.12 1637.45 1792.22 1160.79 187.93

PROC MOD NOTE PAR FEE ----- -- ---- -------33474 33478 33501 33504 33508 33512 33516 33519 33523 33534 33542 33600 33608 33612 33619 33647 33670 33688 33694 33710 33730 33736 33755 33766 33771 33776 33779 33786 33802 33814 33824 33851 33860 33870 33910 33917 33920 33935 33961 33970 33974 33977 33980 34101 34201 34421 34490 34510 34800 34805 34813 34826 34832 34900 35005 35021 35081 35092 35111 35122 35141 35152 35180 35188 35201 35211 35226 35241 35256 35271 35286 35321 35351 35363 35381 35450 1420.79 1675.84 1085.74 1527.71 17.08 2050.60 2257.68 398.54 782.11 2067.33 1756.42 1708.83 1908.09 2109.70 2721.80 1772.00 1942.71 1738.44 2028.23 1838.04 1974.83 1471.55 1295.61 1448.69 1998.39 2103.08 2079.27 2331.92 1097.87 1579.91 1242.37 1347.42 2268.15 2604.71 1510.62 1540.78 1906.77 3788.80 618.12 374.89 918.90 1267.77 3323.27 635.92 635.57 742.00 617.70 1155.76 1209.39 1268.76 258.09 222.71 2020.27 989.31 1090.82 1197.12 1646.52 2579.54 1434.62 2017.94 1177.33 1499.12 849.45 905.18 974.36 1375.33 878.55 1435.96 1080.75 1368.63 986.99 953.37 1345.20 1754.96 981.61 574.80

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------396.99 534.22 473.75 339.43 334.21 383.96 535.08 375.09 525.43 1154.21 1061.86 1251.29 1169.78 1159.64 1539.39 1438.45 1517.18 1757.99 1515.24 1532.74 1406.29 1096.59 1110.95 1853.17 1044.43 1578.55 1381.44 1226.33 1113.19 450.63 1045.62 1096.62 523.61 367.75 591.24 597.70 1030.41 1703.66 8.69 347.91 158.57 151.43 101.01 130.48 265.23 239.12 51.78 264.39 21.50 8.69 152.87 39.17 129.52 59.64 545.14 179.48 91.47 92.21 104.73 134.19 703.08 283.90 1308.20 356.35 1099.50 98.19 1694.47 307.90 418.88 226.88 632.28 309.06 314.94 289.42 369.06 193.01

M E D I C A R E LC FEE -------456.54 614.35 544.81 390.34 384.34 441.55 615.34 431.35 604.24 1327.34 1221.14 1438.98 1345.25 1333.59 1770.30 1654.22 1744.76 2021.69 1742.53 1762.65 1617.23 1261.08 1277.59 2131.15 1201.09 1815.33 1588.66 1410.28 1280.17 518.22 1202.46 1261.11 602.15 422.91 679.93 687.36 1184.97 1959.21 9.99 400.10 182.36 174.14 116.16 150.05 305.01 274.99 59.55 304.05 24.73 9.99 175.80 45.05 148.95 68.59 626.91 206.40 105.19 106.04 120.44 154.32 808.54 326.49 1504.43 409.80 1264.43 112.92 1948.64 354.09 481.71 260.91 727.12 355.42 362.18 332.83 424.42 221.96

F E E

S C H E D U L E NPAR FEE -------349.70 484.50 547.62 388.08 611.51 455.69 595.75 452.09 333.07 1150.06 1275.66 1108.00 1238.94 1632.49 1729.21 1225.80 1245.41 1331.17 1356.78 1285.69 262.69 929.99 1331.74 1616.06 1013.51 1061.66 1112.48 1178.48 84.72 205.92 912.91 160.11 448.06 457.55 375.21 968.99 529.59 1871.76 182.09 47.84 176.40 175.73 100.98 152.87 319.47 267.00 571.65 24.77 14.51 17.90 50.52 51.65 343.60 175.84 369.15 64.25 91.47 65.27 26.58 309.23 298.81 1320.20 342.09 1051.94 366.45 343.28 308.99 167.09 199.81 301.62 211.45 692.67 68.63 171.47 193.43 190.45

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------419.64 343.47 384.70 511.63 436.72 578.02 416.22 558.51 1100.01 1116.50 1181.75 917.11 1214.92 1960.44 1456.09 1338.12 1182.85 1281.58 357.88 1608.11 1034.42 940.87 1561.71 1410.03 1749.67 1407.05 1076.67 1284.41 381.78 170.82 1095.78 163.67 486.55 794.88 1261.41 917.89 601.93 28.94 111.40 123.37 122.50 157.14 101.05 236.22 51.44 317.99 351.59 17.40 17.90 8.69 37.60 113.17 143.58 84.89 183.17 91.47 91.47 1179.82 324.90 121.09 688.16 354.45 1649.04 342.09 378.01 92.18 1523.27 53.32 533.94 67.82 1187.92 311.24 1498.54 142.38 864.95 46.85

PAGE 018 LC FEE -------482.59 394.99 442.41 588.37 502.23 664.72 478.65 642.29 1265.01 1283.98 1359.01 1054.68 1397.16 2254.51 1674.50 1538.84 1360.28 1473.82 411.56 1849.33 1189.58 1082.00 1795.97 1621.53 2012.12 1618.11 1238.17 1477.07 439.05 196.44 1260.15 188.22 559.53 914.11 1450.62 1055.57 692.22 33.28 128.11 141.88 140.88 180.71 116.21 271.65 59.16 365.69 404.33 20.01 20.59 9.99 43.24 130.15 165.12 97.62 210.65 105.19 105.19 1356.79 373.64 139.25 791.38 407.62 1896.40 393.40 434.71 106.01 1751.76 61.32 614.03 77.99 1366.11 357.93 1723.32 163.74 994.69 53.88 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------35452 35458 35470 35473 35476 35482 35485 35492 35495 35506 35509 35512 35518 35525 35533 35546 35551 35560 35566 35582 35587 35606 35621 35631 35642 35647 35654 35663 35671 35683 35691 35695 35701 35761 35840 35875 35881 35905 36000 36005 36011 36014 36120 36160 36216 36245 36248 36262 36405 36406 36420 36430 36455 36470 36481 36510 36512 36515 36522 36555 36557 36558 36561 36563 36566 36568 36570 36571 36576 36578 36581 36582 36584 36585 36590 36595 *** 417.88 562.34 498.68 357.29 351.80 404.17 563.24 394.83 553.08 1214.96 1117.75 1317.15 1231.35 1220.67 1620.41 1514.16 1597.03 1850.52 1594.99 1613.41 1480.30 1154.31 1169.42 1950.70 1099.40 1661.63 1454.15 1290.87 1171.78 474.35 1100.65 1154.34 551.17 387.10 622.36 629.16 1084.64 1793.33 9.15 366.22 166.92 159.40 106.33 137.35 279.19 251.71 54.50 278.30 22.63 9.15 160.92 41.23 136.34 62.78 573.83 188.93 96.28 97.06 110.24 141.25 740.08 298.84 1377.05 375.10 1157.37 103.36 1783.65 324.10 440.93 238.82 665.56 325.33 331.52 304.65 388.48 203.17

PROC MOD NOTE PAR FEE ----- -- ---- -------35454 35459 35471 35474 35480 35483 35490 35493 35500 35507 35510 35515 35521 35526 35536 35548 35556 35563 35571 35583 35600 35612 35623 35636 35645 35650 35656 35665 35681 35685 35693 35697 35721 35800 35860 35876 35901 35907 36002 36005 36012 36015 36140 36200 36217 36246 36260 36400 36405 36410 36420 36440 36460 36471 36481 36510 36513 36516 36550 36556 36557 36560 36561 36565 36566 36569 36570 36575 36576 36580 36581 36583 36584 36589 36590 36596 368.10 510.00 576.44 408.50 643.69 479.67 627.11 475.88 350.60 1210.59 1342.80 1166.32 1304.15 1718.41 1820.22 1290.32 1310.96 1401.23 1428.19 1353.36 276.52 978.94 1401.83 1701.12 1066.85 1117.54 1171.03 1240.51 89.18 216.76 960.96 168.54 471.64 481.63 394.96 1019.99 557.46 1970.27 191.67 50.36 185.68 184.98 106.29 160.92 336.28 281.05 601.74 26.07 15.27 18.84 53.18 54.37 361.68 185.09 388.58 67.63 96.28 68.71 27.98 325.50 314.54 1389.68 360.09 1107.31 385.74 361.35 325.25 175.88 210.33 317.49 222.58 729.13 72.24 180.49 203.61 200.47

LC FEE -------402.16 557.18 629.76 446.29 703.24 524.04 685.11 519.90 383.03 1322.57 1467.01 1274.20 1424.78 1877.36 1988.59 1409.67 1432.22 1530.85 1560.30 1478.54 302.09 1069.49 1531.50 1858.47 1165.54 1220.91 1279.35 1355.25 97.43 236.81 1049.85 184.13 515.27 526.18 431.49 1114.34 609.03 2152.52 209.40 55.02 202.86 202.09 116.13 175.80 367.39 307.05 657.40 28.49 16.69 20.59 58.10 59.40 395.14 202.22 424.52 73.89 105.19 75.06 30.57 355.61 343.63 1518.23 393.40 1209.73 421.42 394.77 355.34 192.15 229.78 346.86 243.17 796.57 78.92 197.19 222.44 219.02

PROC MOD NOTE PAR FEE ----- -- ---- -------35456 35460 35472 35475 35481 35484 35491 35494 35501 35508 35511 35516 35522 35531 35541 35549 35558 35565 35572 35585 35601 35616 35626 35641 35646 35651 35661 35666 35682 35686 35694 35700 35741 35820 35870 35879 35903 36000 36002 36010 36013 36100 36145 36215 36218 36247 36261 36400 36406 36410 36425 36450 36470 36471 36500 36511 36514 36522 36555 36556 36558 36560 36563 36565 36568 36569 36571 36575 36578 36580 36582 36583 36585 36589 36595 36596 441.73 361.55 404.95 538.56 459.70 608.44 438.13 587.91 1157.90 1175.26 1243.95 965.38 1278.86 2063.62 1532.73 1408.55 1245.10 1349.03 376.72 1692.75 1088.86 990.39 1643.90 1484.24 1841.76 1481.11 1133.34 1352.01 401.87 179.81 1153.45 172.28 512.16 836.72 1327.80 966.20 633.61 30.46 117.26 129.86 128.95 165.41 106.37 248.65 54.15 334.73 370.09 18.32 18.84 9.15 39.58 119.13 151.14 89.36 192.81 96.28 96.28 1241.92 342.00 127.46 724.38 373.11 1735.83 360.09 397.91 97.03 1603.44 56.13 562.04 71.39 1250.44 327.62 1577.41 149.87 910.47 49.32

F N

N F

N F

N F N F N N F F N F N F N F N F N F N F N F N F

N F N F N F F N F N F N F N F N F N F N F N F N

F N F N F N N F N F N F N F N F N F N F N F N F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------163.22 15.56 121.98 161.58 804.01 386.34 681.50 676.87 1189.40 151.36 1288.04 1375.56 419.94 283.07 910.52 451.55 110.60 619.15 427.44 189.80 1204.66 478.35 366.39 620.79 260.93 1191.89 850.82 957.15 80.97 205.53 122.35 240.75 392.40 507.12 285.85 73.63 413.33 399.53 632.46 768.81 940.70 737.60 731.55 968.32 36.68 729.95 409.52 4811.37 941.21 825.79 114.61 347.27 455.49 652.00 348.02 362.00 849.60 928.77 87.98 142.42 177.25 121.72 95.63 308.25 268.26 255.47 136.18 230.26 618.16 871.06 1076.76 141.65 108.91 274.35 259.76 168.09

M E D I C A R E LC FEE -------187.70 17.89 140.28 185.82 924.61 444.29 783.73 778.40 1367.81 174.06 1481.25 1581.89 482.93 325.53 1047.10 519.28 127.19 712.02 491.56 218.27 1385.36 550.10 421.35 713.91 300.07 1370.67 978.44 1100.72 93.12 236.36 140.70 276.86 451.26 583.19 328.73 84.67 475.33 459.46 727.33 884.13 1081.81 848.24 841.28 1113.57 42.18 839.44 470.95 5533.08 1082.39 949.66 131.80 399.36 523.81 749.80 400.22 416.30 977.04 1068.09 101.18 163.78 203.84 139.98 109.97 354.49 308.50 293.79 156.61 264.80 710.88 1001.72 1238.27 162.90 125.25 315.50 298.72 193.30

F E E

S C H E D U L E NPAR FEE -------61.97 52.79 70.21 221.48 804.01 1195.33 466.91 578.63 168.44 1925.49 1390.98 1478.32 312.68 332.09 454.38 217.89 83.81 668.13 381.65 381.63 328.57 1141.05 453.39 449.20 344.14 493.56 253.71 133.00 186.97 75.20 122.71 154.22 463.93 784.32 223.99 455.72 362.33 424.56 628.90 911.80 995.76 258.17 1110.69 464.19 292.91 809.34 771.83 953.92 768.08 721.49 68.95 436.15 370.80 455.92 283.59 474.72 1061.54 986.88 215.60 89.78 62.33 77.17 209.88 254.87 282.87 201.72 182.38 210.75 661.14 787.84 1312.71 102.26 288.51 243.06 318.50 351.96

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------29.93 101.83 64.80 148.20 535.10 588.51 600.81 451.92 126.46 311.36 1209.77 904.87 227.60 284.20 211.14 114.11 675.64 760.29 289.95 973.48 622.03 254.03 631.16 545.96 252.08 805.63 874.69 80.97 59.57 287.37 92.26 451.31 391.77 621.91 123.34 376.92 477.95 886.85 515.03 619.69 574.39 258.40 731.61 79.44 422.66 1028.13 922.80 888.50 826.41 1057.37 390.72 361.40 554.19 405.11 408.76 430.53 823.67 127.38 173.63 229.17 46.86 138.70 156.13 324.23 222.86 148.70 161.77 663.07 602.97 1152.97 1229.14 147.57 253.90 298.04 281.30 304.10

PAGE 019 LC FEE -------34.42 117.10 74.52 170.43 615.37 676.79 690.93 519.71 145.43 358.06 1391.24 1040.60 261.74 326.83 242.81 131.23 776.99 874.33 333.44 1119.50 715.33 292.13 725.83 627.85 289.89 926.47 1005.89 93.12 68.51 330.48 106.10 519.01 450.54 715.20 141.84 433.46 549.64 1019.88 592.28 712.64 660.55 297.16 841.35 91.36 486.06 1182.35 1061.22 1021.78 950.37 1215.98 449.33 415.61 637.32 465.88 470.07 495.11 947.22 146.49 199.67 263.55 53.89 159.51 179.55 372.86 256.29 171.01 186.04 762.53 693.42 1325.92 1413.51 169.71 291.99 342.75 323.50 349.72 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------36597 36600 36640 36800 36819 36822 36830 36833 36838 36861 37140 37180 37183 37201 37204 37207 37250 37565 37606 37609 37617 37650 37720 37760 37780 37788 38101 38120 38206 38221 38240 38300 38305 38380 38500 38505 38520 38542 38562 38571 38720 38745 38760 38780 38792 39010 39400 39503 39531 39545 40490 40500 40520 40527 40650 40652 40700 40720 40800 40804 40805 40808 40810 40814 40816 40819 40820 40831 40840 40843 40844 41000 41005 41007 41008 41010 *** N F 171.81 16.38 128.40 170.08 846.33 406.67 717.37 712.49 1252.00 159.33 1355.83 1447.96 442.04 297.97 958.44 475.32 116.42 651.74 449.94 199.79 1268.06 503.53 385.67 653.46 274.66 1254.62 895.60 1007.53 85.23 216.35 128.79 253.42 413.05 533.81 300.89 77.51 435.08 420.56 665.75 809.27 990.21 776.42 770.05 1019.28 38.61 768.37 431.07 5064.60 990.75 869.25 120.64 365.55 479.46 686.32 366.34 381.05 894.32 977.65 92.61 149.92 186.58 128.13 100.66 324.47 282.38 268.92 143.35 242.38 650.69 916.90 1133.43 149.11 114.64 288.79 273.43 176.94

PROC MOD NOTE PAR FEE ----- -- ---- -------36597 36620 36660 36810 36820 36823 36831 36834 36860 36870 37145 37181 37195 37202 37205 37208 37251 37600 37607 37615 37618 37660 37730 37765 37785 37790 38102 38200 38220 38221 38241 38300 38308 38381 38500 38510 38525 38550 38564 38572 38724 38746 38765 38790 38794 39200 39501 39520 39540 39560 40490 40510 40520 40530 40650 40654 40701 40761 40801 40804 40806 40808 40812 40814 40818 40819 40830 40831 40842 40843 40845 41000 41006 41007 41009 41015 F 65.23 55.57 73.90 233.14 846.33 1258.24 491.48 609.08 177.30 2026.83 1464.19 1556.13 329.14 349.57 478.29 229.36 88.22 703.29 401.74 401.72 345.86 1201.10 477.25 472.84 362.25 519.54 267.06 140.00 196.81 79.16 129.17 162.34 488.35 825.60 235.78 479.70 381.40 446.91 662.00 959.79 1048.17 271.76 1169.15 488.62 308.33 851.94 812.45 1004.13 808.50 759.46 72.58 459.10 390.32 479.92 298.52 499.70 1117.41 1038.82 226.95 94.50 65.61 81.23 220.93 268.28 297.76 212.34 191.98 221.84 695.94 829.31 1381.80 107.64 303.69 255.85 335.26 370.48

LC FEE -------71.27 60.71 80.74 254.70 924.61 1374.63 536.95 665.42 193.71 2214.31 1599.63 1700.07 359.58 381.90 522.54 250.57 96.38 768.35 438.90 438.87 377.86 1312.21 521.40 516.58 395.76 567.59 291.77 152.95 215.02 86.48 141.12 177.35 533.52 901.97 257.59 524.08 416.68 488.24 723.24 1048.57 1145.12 296.90 1277.29 533.82 336.85 930.74 887.60 1097.01 883.29 829.71 79.29 501.57 426.42 524.31 326.13 545.93 1220.77 1134.91 247.94 103.25 71.68 88.75 241.36 293.10 325.30 231.98 209.74 242.36 760.31 906.02 1509.62 117.60 331.79 279.52 366.28 404.75

PROC MOD NOTE PAR FEE ----- -- ---- -------36600 36625 36680 36815 36821 36825 36832 36835 36860 36870 37160 37182 37200 37203 37206 37209 37500 37605 37609 37616 37620 37700 37735 37766 37785 38100 38115 38205 38220 38230 38242 38305 38308 38382 38505 38510 38530 38555 38570 38700 38740 38747 38770 38790 39000 39220 39502 39530 39541 39561 40500 40510 40525 40530 40652 40654 40702 40800 40801 40805 40806 40810 40812 40816 40818 40820 40830 40840 40842 40844 40845 41005 41006 41008 41009 41015 N 31.50 107.19 68.21 156.00 563.26 619.48 632.43 475.70 133.12 327.75 1273.44 952.49 239.58 299.16 222.25 120.12 711.20 800.31 305.21 1024.72 654.77 267.40 664.38 574.69 265.35 848.03 920.73 85.23 62.71 302.49 97.12 475.06 412.39 654.64 129.83 396.76 503.10 933.53 542.14 652.31 604.62 272.00 770.12 83.62 444.90 1082.24 971.37 935.26 869.91 1113.02 411.28 380.42 583.36 426.43 430.27 453.19 867.02 134.08 182.77 241.23 49.33 146.00 164.35 341.29 234.59 156.53 170.28 697.97 634.70 1213.65 1293.83 155.34 267.26 313.73 296.11 320.10

N N

F F

N

F

N N F F N F N

F F N F N F

N N F N F

N

F

N F N N F F N F N F N F N F N F N F N F N F

F N F N F N N F N F N F N F N F N F N F N F N N

N F F N F N F N F N F N F N F N F N F N F N F F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------358.92 312.34 157.91 103.62 151.76 206.57 653.97 162.93 660.29 1586.99 1515.04 134.76 269.97 247.21 143.94 134.33 243.82 282.03 232.34 274.79 310.98 231.03 148.66 101.48 219.29 327.22 150.56 168.04 304.98 857.53 477.71 642.40 662.49 183.02 143.22 117.49 236.86 264.20 272.71 336.98 282.25 327.08 613.07 843.71 388.88 321.16 438.79 542.54 402.39 56.34 229.63 126.99 713.75 221.33 114.45 206.95 120.91 476.37 255.31 211.04 589.48 181.67 1018.76 559.10 164.96 344.06 530.22 594.68 1913.48 1852.10 1662.16 1590.05 209.51 127.07 200.14 136.31

M E D I C A R E LC FEE -------412.76 359.19 181.60 119.16 174.52 237.56 752.07 187.37 759.33 1825.04 1742.30 154.97 310.47 284.29 165.53 154.48 280.39 324.33 267.19 316.01 357.63 265.68 170.96 116.70 252.18 376.30 173.14 193.25 350.73 986.16 549.37 738.76 761.86 210.47 164.70 135.11 272.39 303.83 313.62 387.53 324.59 376.14 705.03 970.27 447.21 369.33 504.61 623.92 462.75 64.79 264.07 146.04 820.81 254.53 131.62 237.99 139.05 547.83 293.61 242.70 677.90 208.92 1171.57 642.97 189.70 395.67 609.75 683.88 2200.50 2129.92 1911.48 1828.56 240.94 146.13 230.16 156.76

F E E

S C H E D U L E NPAR FEE -------308.11 411.75 115.94 122.33 107.95 294.14 564.14 250.68 743.24 1876.88 1745.38 221.28 200.75 256.31 99.02 239.62 142.21 171.80 197.00 282.08 261.65 293.46 94.53 165.63 185.78 445.30 556.99 222.58 261.91 961.27 656.89 501.12 134.04 144.73 419.88 221.64 188.63 207.81 252.83 94.99 220.04 240.40 1075.36 1325.73 336.60 495.00 613.09 528.06 354.15 98.06 207.55 397.01 136.41 131.49 213.17 161.29 305.81 280.23 249.48 186.69 928.08 386.75 1447.76 630.43 396.50 425.35 516.19 951.74 2390.69 2189.22 2183.69 747.63 102.37 271.15 200.90 361.96

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------357.26 354.68 145.96 82.56 263.27 234.49 194.59 197.29 1447.19 1470.01 188.15 160.53 277.88 225.02 149.06 221.95 345.35 137.93 339.96 244.16 271.53 242.29 134.99 121.09 396.81 154.60 202.65 176.19 804.23 635.34 680.98 728.39 92.80 184.45 146.95 169.73 317.22 154.79 369.02 57.07 363.53 223.46 1236.34 458.83 368.28 438.30 776.75 62.68 73.27 74.49 164.18 352.09 105.85 194.71 132.53 157.73 251.68 302.39 196.80 239.69 1541.38 848.11 341.52 497.81 489.66 483.25 1209.26 2208.62 2007.53 1852.88 1880.48 956.42 253.36 108.41 146.02 156.51

PAGE 020 LC FEE -------410.85 407.88 167.85 94.94 302.76 269.66 223.78 226.88 1664.27 1690.51 216.37 184.61 319.56 258.77 171.42 255.24 397.15 158.62 390.95 280.78 312.26 278.63 155.24 139.25 456.33 177.79 233.05 202.62 924.86 730.64 783.13 837.65 106.72 212.12 168.99 195.19 364.80 178.01 424.37 65.63 418.06 256.98 1421.79 527.65 423.52 504.05 893.26 72.08 84.26 85.66 188.81 404.90 121.73 223.92 152.41 181.39 289.43 347.75 226.32 275.64 1772.59 975.33 392.75 572.48 563.11 555.74 1390.65 2539.91 2308.66 2130.81 2162.55 1099.88 291.36 124.67 167.92 179.99 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------41016 41017 41100 41105 41110 41112 41114 41115 41120 41140 41153 41250 41252 41510 41800 41805 41822 41823 41826 41827 41830 41872 42000 42100 42106 42107 42140 42160 42182 42205 42220 42227 42260 42281 42300 42310 42325 42326 42335 42340 42405 42408 42410 42425 42450 42500 42507 42510 42600 42650 42665 42700 42725 42802 42804 42808 42809 42815 42825 42831 42842 42860 42892 42950 42960 42970 43020 43100 43108 43116 43121 43124 43200 43201 43204 43216 *** N F N F N F N F F N N F N F N F N F N F N F F F N F N F F N F N F N F N F N F N F N F N F 377.81 328.78 166.22 109.07 159.75 217.44 688.39 171.50 695.04 1670.52 1594.78 141.85 284.18 260.22 151.52 141.40 256.65 296.87 244.57 289.25 327.35 243.19 156.48 106.82 230.83 344.44 158.48 176.88 321.03 902.66 502.85 676.21 697.36 192.65 150.76 123.67 249.33 278.11 287.06 354.72 297.11 344.29 645.34 888.12 409.35 338.06 461.88 571.09 423.57 59.30 241.72 133.67 751.32 232.98 120.47 217.84 127.27 501.44 268.75 222.15 620.50 191.23 1072.38 588.53 173.64 362.17 558.13 625.98 2014.19 1949.58 1749.64 1673.74 220.54 133.76 210.67 143.48

PROC MOD NOTE PAR FEE ----- -- ---- -------41016 41018 41100 41108 41110 41113 41114 41116 41130 41145 41155 41251 41252 41520 41800 41806 41822 41825 41826 41828 41830 41874 42000 42104 42106 42120 42145 42180 42182 42210 42225 42235 42280 42281 42305 42320 42325 42330 42335 42400 42405 42409 42415 42426 42450 42505 42508 42550 42600 42660 42665 42720 42800 42802 42806 42808 42810 42820 42826 42835 42844 42870 42894 42953 42961 42971 43030 43101 43112 43117 43122 43130 43200 43202 43205 43217 F N F N F N F N N F N F N F N F N F N F N F N F N F N F N F N F N F N N F N F N N F N F N 324.33 433.42 122.04 128.77 113.63 309.62 593.83 263.87 782.36 1975.66 1837.24 232.93 211.32 269.80 104.23 252.23 149.69 180.84 207.37 296.93 275.42 308.91 99.51 174.35 195.56 468.74 586.31 234.29 275.69 1011.86 691.46 527.49 141.09 152.35 441.98 233.31 198.56 218.75 266.14 99.99 231.62 253.05 1131.96 1395.51 354.32 521.05 645.36 555.85 372.79 103.22 218.47 417.91 143.59 138.41 224.39 169.78 321.90 294.98 262.61 196.52 976.93 407.11 1523.96 663.61 417.37 447.74 543.36 1001.83 2516.52 2304.44 2298.62 786.98 107.76 285.42 211.47 381.01

LC FEE -------354.33 473.51 133.33 140.68 124.14 338.26 648.76 288.28 854.73 2158.41 2007.19 254.47 230.86 294.76 113.87 275.56 163.54 197.57 226.55 324.39 300.90 337.48 108.71 190.47 213.65 512.10 640.54 255.97 301.20 1105.46 755.42 576.29 154.15 166.44 482.86 254.89 216.92 238.98 290.75 109.24 253.05 276.46 1236.66 1524.59 387.09 569.25 705.05 607.27 407.27 112.77 238.68 456.56 156.87 151.21 245.15 185.48 351.68 322.26 286.90 214.69 1067.29 444.76 1664.92 724.99 455.98 489.15 593.62 1094.50 2749.29 2517.60 2511.24 859.77 117.73 311.82 231.04 416.25

PROC MOD NOTE PAR FEE ----- -- ---- -------41017 41018 41105 41108 41112 41113 41115 41116 41135 41150 41250 41251 41500 41520 41805 41806 41823 41825 41827 41828 41872 41874 42100 42104 42107 42140 42160 42180 42200 42215 42226 42260 42280 42300 42310 42320 42326 42330 42340 42400 42408 42409 42420 42440 42500 42505 42509 42550 42650 42660 42700 42720 42800 42804 42806 42809 42810 42821 42830 42836 42845 42890 42900 42955 42962 42972 43045 43107 43113 43118 43123 43135 43201 43202 43215 43217 N F N F N F N F N F F N F N F N F N F N F N N N F N F N N F N F N F N F N F F N F N F F N F N F 376.06 373.35 153.64 86.91 277.13 246.83 204.83 207.67 1523.36 1547.38 198.05 168.98 292.51 236.86 156.90 233.63 363.53 145.19 357.85 257.01 285.82 255.04 142.09 127.46 417.69 162.74 213.32 185.46 846.56 668.78 716.82 766.73 97.68 194.16 154.68 178.66 333.92 162.94 388.44 60.07 382.66 235.22 1301.41 482.98 387.66 461.37 817.63 65.98 77.13 78.41 172.82 370.62 111.42 204.96 139.51 166.03 264.93 318.30 207.16 252.31 1622.50 892.75 359.49 524.01 515.43 508.68 1272.91 2324.86 2113.19 1950.40 1979.45 1006.76 266.69 114.12 153.70 164.75

N F

F N N

N F F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------158.12 191.41 239.87 277.40 157.76 315.00 141.39 264.78 181.62 172.53 231.59 311.43 377.24 383.90 383.90 604.35 1604.35 1125.40 1131.00 1102.67 1086.23 2230.08 1142.83 828.71 79.50 604.94 166.73 1094.23 589.92 801.53 1649.24 1235.70 108.63 944.18 687.98 34.86 105.84 840.28 483.08 1027.99 1475.45 1408.03 546.49 697.13 777.73 1171.43 792.51 962.72 235.32 1164.59 1210.70 1140.08 1530.58 1760.08 565.51 1376.73 1600.24 1901.23 869.61 1135.48 460.36 140.65 199.30 237.38 187.38 372.50 73.56 105.88 298.64 167.75 482.34 203.20 455.65 31.66 875.23 680.39

M E D I C A R E LC FEE -------181.84 220.12 275.85 319.01 181.42 362.25 162.60 304.50 208.86 198.41 266.33 358.14 433.83 441.49 441.49 695.00 1845.00 1294.21 1300.65 1268.07 1249.16 2564.59 1314.25 953.02 91.43 695.68 191.74 1258.36 678.41 921.76 1896.63 1421.06 124.92 1085.81 791.18 40.09 121.72 966.32 555.54 1182.19 1696.77 1619.23 628.46 801.70 894.39 1347.14 911.39 1107.13 270.62 1339.28 1392.31 1311.09 1760.17 2024.09 650.34 1583.24 1840.28 2186.41 1000.05 1305.80 529.41 161.75 229.20 272.99 215.49 428.38 84.59 121.76 343.44 192.91 554.69 233.68 524.00 36.41 1006.51 782.45

F E E

S C H E D U L E NPAR FEE -------117.13 204.25 269.90 131.23 212.33 154.84 378.29 171.77 169.73 197.56 241.08 327.37 461.48 387.58 384.27 1079.76 2595.50 1136.96 1091.60 1209.60 913.89 1153.18 816.14 1210.72 277.06 141.03 200.37 1259.70 111.39 980.00 1741.14 1262.05 1577.57 958.27 465.99 103.23 756.36 1051.50 863.20 1034.39 1609.05 1354.13 1335.61 137.56 788.13 117.91 934.85 1819.38 803.40 1156.79 1444.08 1395.19 1734.89 1034.40 1213.92 1219.76 1733.17 1776.39 459.93 972.48 857.48 154.43 177.94 255.00 276.80 393.23 158.89 322.41 152.10 396.15 228.67 439.87 234.75 858.78 1079.11 829.96

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------128.39 172.43 111.22 344.05 263.25 359.84 241.15 230.09 156.99 252.81 271.99 384.27 516.33 422.33 963.52 1455.39 2849.76 1116.58 1166.80 929.61 1968.42 1219.91 1415.01 145.40 86.71 358.91 616.90 751.60 666.00 1614.28 1235.37 1368.48 1596.72 584.54 275.60 59.04 803.13 551.86 861.40 1329.28 1335.79 1433.31 891.79 773.98 774.19 660.97 235.30 2080.21 117.00 1309.72 1561.33 1549.14 1592.50 809.72 234.18 1475.57 1537.07 676.46 826.61 800.35 935.66 185.54 233.06 234.68 290.30 61.95 253.89 123.96 359.58 202.85 387.65 255.04 257.29 999.31 879.08 1381.09

PAGE 021 LC FEE -------147.65 198.29 127.90 395.66 302.74 413.82 277.32 264.60 180.54 290.73 312.79 441.91 593.78 485.68 1108.05 1673.70 3277.22 1284.07 1341.82 1069.05 2263.68 1402.90 1627.26 167.21 99.72 412.75 709.44 864.34 765.90 1856.42 1420.68 1573.75 1836.23 672.22 316.94 67.90 923.60 634.64 990.61 1528.67 1536.16 1648.31 1025.56 890.08 890.32 760.12 270.60 2392.24 134.55 1506.18 1795.53 1781.51 1831.38 931.18 269.31 1696.91 1767.63 777.93 950.60 920.40 1076.01 213.37 268.02 269.88 333.85 71.24 291.97 142.55 413.52 233.28 445.80 293.30 295.88 1149.21 1010.94 1588.25 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------43219 43227 43232 43235 43236 43239 43241 43244 43247 43250 43256 43260 43263 43267 43271 43300 43312 43320 43326 43340 43351 43361 43405 43420 43450 43456 43458 43501 43520 43610 43621 43632 43635 43640 43652 43752 43761 43820 43831 43842 43847 43855 43870 44010 44021 44055 44111 44125 44128 44140 44144 44147 44152 44156 44201 44204 44207 44211 44310 44316 44340 44360 44364 44369 44373 44378 44382 44385 44388 44389 44391 44392 44394 44500 44604 44620 *** 166.44 201.48 252.49 292.00 166.06 331.58 148.83 278.72 191.18 181.61 243.78 327.82 397.09 404.11 404.11 636.16 1688.79 1184.63 1190.53 1160.70 1143.40 2347.45 1202.98 872.33 83.68 636.78 175.50 1151.82 620.97 843.72 1736.04 1300.74 114.35 993.87 724.19 36.69 111.41 884.50 508.51 1082.09 1553.11 1482.14 575.25 733.82 818.66 1233.08 834.22 1013.39 247.71 1225.88 1274.42 1200.08 1611.14 1852.72 595.27 1449.19 1684.46 2001.29 915.38 1195.24 484.59 148.05 209.79 249.87 197.24 392.10 77.43 111.45 314.36 176.58 507.73 213.89 479.63 33.33 921.29 716.20

PROC MOD NOTE PAR FEE ----- -- ---- -------43220 43228 43234 43235 43237 43239 43242 43245 43248 43251 43258 43261 43264 43268 43272 43305 43313 43324 43330 43341 43352 43400 43410 43425 43453 43456 43460 43502 43600 43611 43622 43633 43638 43641 43653 43760 43800 43825 43832 43843 43848 43860 43880 44015 44025 44100 44120 44126 44130 44141 44145 44150 44153 44160 44202 44205 44208 44212 44312 44320 44345 44361 44365 44370 44376 44379 44383 44386 44388 44390 44391 44393 44394 44602 44605 44625 N F F 123.29 215.00 284.11 138.14 223.51 162.99 398.20 180.81 178.66 207.96 253.77 344.60 485.77 407.98 404.49 1136.59 2732.10 1196.80 1149.05 1273.26 961.99 1213.87 859.09 1274.44 291.64 148.45 210.92 1326.00 117.25 1031.58 1832.78 1328.47 1660.60 1008.71 490.52 108.66 796.17 1106.84 908.63 1088.83 1693.74 1425.40 1405.91 144.80 829.61 124.12 984.05 1915.14 845.68 1217.67 1520.08 1468.62 1826.20 1088.84 1277.81 1283.96 1824.39 1869.88 484.14 1023.66 902.61 162.56 187.31 268.42 291.37 413.93 167.25 339.38 160.11 417.00 240.70 463.02 247.10 903.98 1135.90 873.64

LC FEE -------134.70 234.89 310.39 150.91 244.18 178.07 435.03 197.54 195.19 227.19 277.24 376.48 530.70 445.72 441.91 1241.72 2984.83 1307.50 1255.34 1391.04 1050.97 1326.16 938.56 1392.33 318.62 162.18 230.43 1448.66 128.10 1127.00 2002.31 1451.36 1814.21 1102.01 535.89 118.71 869.81 1209.23 992.68 1189.55 1850.41 1557.25 1535.95 158.19 906.35 135.60 1075.08 2092.29 923.91 1330.31 1660.69 1604.47 1995.12 1189.56 1396.01 1402.72 1993.15 2042.85 528.92 1118.35 986.10 177.59 204.63 293.25 318.32 452.21 182.72 370.77 174.92 455.57 262.97 505.85 269.96 987.60 1240.98 954.45

PROC MOD NOTE PAR FEE ----- -- ---- -------43226 43231 43234 43236 43238 43240 43243 43246 43249 43255 43259 43262 43265 43269 43280 43310 43314 43325 43331 43350 43360 43401 43415 43450 43453 43458 43500 43510 43605 43620 43631 43634 43639 43651 43750 43760 43810 43830 43840 43846 43850 43865 44005 44020 44050 44110 44121 44127 44139 44143 44146 44151 44155 44200 44203 44206 44210 44300 44314 44322 44346 44363 44366 44372 44377 44380 44385 44386 44389 44390 44392 44393 44397 44603 44615 44626 F N 135.15 181.50 117.07 362.16 277.11 378.78 253.84 242.20 165.25 266.12 286.30 404.49 543.50 444.56 1014.23 1531.99 2999.75 1175.35 1228.21 978.54 2072.02 1284.12 1489.48 153.05 91.27 377.80 649.37 791.16 701.05 1699.24 1300.39 1440.50 1680.76 615.30 290.11 62.15 845.40 580.90 906.74 1399.24 1406.09 1508.75 938.73 814.72 814.94 695.76 247.68 2189.69 123.16 1378.65 1643.51 1630.67 1676.32 852.34 246.51 1553.23 1617.97 712.06 870.12 842.47 984.90 195.30 245.33 247.03 305.58 65.21 267.25 130.48 378.50 213.53 408.05 268.46 270.83 1051.91 925.35 1453.78

N F N

F N F

N F

N F N

N

F

F N F N F N

N F N F N F

N F N F N F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------1158.47 1311.61 159.55 613.09 556.96 505.46 141.56 297.33 1632.86 1339.44 1495.45 889.60 332.86 555.07 719.27 59.36 106.77 111.39 149.87 92.03 117.75 67.49 243.23 182.17 275.89 169.25 143.33 188.90 117.75 247.87 459.70 298.71 425.74 279.76 313.41 52.87 740.48 861.75 1163.38 157.42 294.80 182.42 393.56 142.02 178.26 147.37 224.86 355.45 96.72 213.92 248.26 325.79 418.54 236.19 357.89 418.60 165.65 33.75 173.00 85.01 194.84 128.83 199.08 416.65 890.70 1650.64 3133.08 551.16 146.89 692.68 171.65 122.54 196.54 157.96 221.96 228.37

M E D I C A R E LC FEE -------1332.24 1508.35 183.48 705.05 640.50 581.28 162.79 341.93 1877.79 1540.36 1719.77 1023.04 382.79 638.33 827.16 68.26 122.79 128.10 172.35 105.83 135.41 77.61 279.71 209.50 317.27 194.64 164.83 217.24 135.41 285.05 528.66 343.52 489.60 321.72 360.42 60.80 851.55 991.01 1337.89 181.03 339.02 209.78 452.59 163.32 205.00 169.48 258.59 408.77 111.23 246.01 285.50 374.66 481.32 271.62 411.57 481.39 190.50 38.81 198.95 97.76 224.07 148.15 228.94 479.15 1024.31 1898.24 3603.04 633.83 168.92 796.58 197.40 140.92 226.02 181.65 255.25 262.63

F E E

S C H E D U L E NPAR FEE -------1204.52 850.06 650.15 574.37 81.20 287.91 308.63 1562.97 1657.75 1661.65 899.40 1069.80 842.64 69.86 31.13 150.44 52.28 161.72 87.29 70.66 55.90 248.05 100.75 80.55 129.35 318.51 214.83 363.95 55.90 428.99 222.22 514.13 248.27 676.33 418.29 28.57 1236.99 1312.48 998.24 141.56 163.73 98.54 315.13 79.05 187.42 90.31 284.03 277.03 138.15 149.12 385.52 354.45 441.18 341.16 293.47 141.98 85.76 393.49 48.17 202.64 100.95 162.36 146.80 139.15 1491.51 2045.18 3308.72 465.83 817.99 204.79 113.48 411.26 114.43 321.45 139.49 202.56

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------1126.99 877.24 681.67 170.22 687.52 257.54 234.12 925.30 1484.14 1355.44 2475.28 1556.52 644.76 27.16 135.20 58.40 181.72 82.56 169.71 89.49 151.43 100.42 148.59 130.07 243.63 101.65 155.88 199.74 457.74 234.22 574.47 308.68 486.31 241.14 436.45 887.63 600.00 963.84 1172.00 168.13 197.89 74.98 279.45 348.01 141.03 269.40 185.73 145.69 119.74 336.62 285.01 377.44 320.13 275.25 247.82 95.22 77.93 74.64 222.71 75.62 283.10 110.44 508.85 424.79 1768.24 2773.05 585.67 216.48 756.97 103.54 185.87 114.87 427.83 236.40 309.01 146.97

PAGE 022 LC FEE -------1296.04 1008.83 783.92 195.75 790.65 296.17 269.24 1064.10 1706.76 1558.76 2846.57 1790.00 741.47 31.23 155.48 67.16 208.98 94.94 195.17 102.91 174.14 115.48 170.88 149.58 280.17 116.90 179.26 229.70 526.40 269.35 660.64 354.98 559.26 277.31 501.92 1020.77 690.00 1108.42 1347.80 193.35 227.57 86.23 321.37 400.21 162.18 309.81 213.59 167.54 137.70 387.11 327.76 434.06 368.15 316.54 284.99 109.50 89.62 85.84 256.12 86.96 325.57 127.01 585.18 488.51 2033.48 3189.01 673.52 248.95 870.52 119.07 213.75 132.10 492.00 271.86 355.36 169.02 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------44640 44661 44701 44850 44950 44970 45005 F 45108 45112 45116 45121 45130 45150 45190 45303 N 45305 F 45308 N 45309 F 45317 N 45320 F 45330 N 45331 F 45333 N 45335 N 45338 N 45339 F 45341 45355 45378 53 N 45379 F 45381 N 45382 F 45384 N 45385 F 45387 45520 N 45541 45562 45805 45900 45915 N 46020 F 46040 N 46050 N 46070 46083 N 46200 F 46211 N 46220 F 46230 N 46250 F 46257 46261 46270 F 46280 46288 46500 N 46600 F 46606 N 46608 F 46611 N 46612 F 46615 N 46705 46716 46740 46746 46751 46754 F 46762 46910 N 46916 F 46922 N 46924 F 46935 N 46936 F *** 1219.44 1380.64 167.95 645.36 586.27 532.06 149.01 312.98 1718.80 1409.94 1574.16 936.42 350.38 584.28 757.13 62.48 112.39 117.25 157.76 96.87 123.95 71.04 256.03 191.76 290.41 178.16 150.87 198.84 123.95 260.92 483.89 314.43 448.15 294.48 329.90 55.65 779.45 907.10 1224.61 165.71 310.32 192.02 414.27 149.49 187.64 155.13 236.69 374.16 101.81 225.18 261.33 342.94 440.57 248.62 376.73 440.63 174.37 35.53 182.10 89.48 205.09 135.61 209.56 438.58 937.58 1737.52 3297.98 580.17 154.62 729.14 180.68 128.99 206.88 166.27 233.64 240.39

PROC MOD NOTE PAR FEE ----- -- ---- -------44650 44680 44800 44900 44955 45000 45020 45110 45113 45119 45123 45135 45160 45300 N 45303 F 45307 N 45308 F 45315 N 45317 F 45321 45330 F 45332 N 45333 F 45335 F 45338 F 45340 N 45342 45378 N 45378 53 F 45380 N 45381 F 45383 N 45384 F 45386 N 45500 45520 F 45550 45563 45820 45905 45915 F 46030 N 46040 F 46050 F 46080 N 46083 F 46210 N 46211 F 46221 N 46230 F 46255 N 46258 46262 46275 N 46285 N 46320 N 46500 F 46604 N 46606 F 46610 N 46611 F 46614 N 46615 F 46706 46730 46742 46748 46753 46760 46900 N 46910 F 46917 N 46922 F 46934 N 46935 F 46937 N 1267.92 894.80 684.37 604.60 85.47 303.06 324.87 1645.23 1745.00 1749.10 946.74 1126.10 886.99 73.54 32.77 158.36 55.03 170.23 91.88 74.38 58.84 261.11 106.05 84.79 136.16 335.27 226.14 383.10 58.84 451.57 233.92 541.19 261.34 711.93 440.30 30.07 1302.09 1381.56 1050.78 149.01 172.35 103.73 331.72 83.21 197.28 95.06 298.98 291.61 145.42 156.97 405.81 373.10 464.40 359.12 308.92 149.45 90.27 414.20 50.71 213.31 106.26 170.90 154.53 146.47 1570.01 2152.82 3482.86 490.35 861.04 215.57 119.45 432.91 120.45 338.37 146.83 213.22

LC FEE -------1385.20 977.57 747.67 660.53 93.38 331.10 354.92 1797.42 1906.41 1910.90 1034.31 1230.27 969.04 80.34 35.80 173.01 60.12 185.98 100.38 81.26 64.29 285.26 115.86 92.63 148.75 366.29 247.05 418.54 64.29 493.34 255.55 591.25 285.51 777.78 481.03 32.86 1422.54 1509.35 1147.98 162.79 188.29 113.32 362.40 90.91 215.53 103.86 326.63 318.58 158.87 171.49 443.35 407.62 507.36 392.33 337.49 163.28 98.62 452.51 55.40 233.04 116.09 186.71 168.82 160.02 1715.24 2351.96 3805.03 535.70 940.69 235.51 130.50 472.95 131.59 369.67 160.41 232.94

PROC MOD NOTE PAR FEE ----- -- ---- -------44660 44700 44820 44901 44960 45005 45100 45111 45114 45120 45126 45136 45170 45300 45305 45307 45309 45315 45320 45327 45331 45332 45334 45337 45339 45340 45345 45378 45379 45380 45382 45383 45385 45386 45505 45540 45560 45800 45825 45910 46020 46030 46045 46060 46080 46200 46210 46220 46221 46250 46255 46260 46270 46275 46285 46320 46600 46604 46608 46610 46612 46614 46700 46715 46735 46744 46750 46754 46761 46900 46916 46917 46924 46934 46936 46937 1186.31 923.41 717.55 179.18 723.70 271.09 246.44 974.00 1562.25 1426.78 2605.56 1638.44 678.69 28.59 142.32 61.47 191.28 86.90 178.64 94.20 159.40 105.70 156.41 136.92 256.45 107.00 164.08 210.25 481.83 246.55 604.71 324.93 511.90 253.83 459.42 934.35 631.58 1014.57 1233.68 176.98 208.30 78.93 294.16 366.33 148.45 283.58 195.50 153.36 126.04 354.34 300.01 397.30 336.98 289.74 260.86 100.23 82.03 78.57 234.43 79.60 298.00 116.25 535.63 447.15 1861.31 2919.00 616.49 227.87 796.81 108.99 195.65 120.92 450.35 248.84 325.27 154.70

N

F N F N F N N F N F F N F N F N F

N F F N F N F N F N F F F N F N F N F

N F N F N F N F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------339.63 131.09 203.91 170.47 100.01 859.18 2932.99 4452.66 3607.88 1085.94 1041.81 1211.61 1746.37 1011.79 98.18 481.87 382.11 337.22 447.44 629.91 704.17 1038.73 524.45 1280.43 940.93 1042.69 1387.39 1293.31 1114.10 2227.47 509.89 1267.69 973.72 2633.97 1359.24 837.73 1086.17 2004.79 608.11 169.56 879.77 206.17 68.93 86.57 1828.91 655.69 338.94 393.34 358.23 667.28 352.45 791.89 332.24 443.12 668.46 495.06 626.91 652.65 343.34 393.22 490.37 1047.10 371.06 1370.59 886.26 851.80 1092.71 1221.33 902.30 133.01 1089.55 1378.74 821.83 1838.54 1310.62 207.26

M E D I C A R E LC FEE -------390.57 150.75 234.50 196.04 115.01 988.06 3372.94 5120.56 4149.06 1248.83 1198.08 1393.35 2008.33 1163.56 112.91 554.15 439.43 387.80 514.56 724.40 809.80 1194.54 603.12 1472.49 1082.07 1199.09 1595.50 1487.31 1281.22 2561.59 586.37 1457.84 1119.78 3029.07 1563.13 963.39 1249.10 2305.51 699.33 194.99 1011.74 237.10 79.27 99.56 2103.25 754.04 389.78 452.34 411.96 767.37 405.32 910.67 382.08 509.59 768.73 569.32 720.95 750.55 394.84 452.20 563.93 1204.17 426.72 1576.18 1019.20 979.57 1256.62 1404.53 1037.65 152.96 1252.98 1585.55 945.10 2114.32 1507.21 238.35

F E E

S C H E D U L E NPAR FEE -------283.66 147.24 142.79 192.47 919.64 676.22 2629.92 3769.33 3974.14 1471.17 1047.19 1230.95 1111.31 644.95 124.57 585.77 159.18 481.58 263.60 675.77 765.59 1035.11 896.17 1659.91 907.56 1188.65 1464.05 882.77 1493.98 892.63 267.25 1322.81 2635.63 2434.76 98.14 199.67 1017.76 933.88 711.62 760.48 185.12 68.11 678.64 594.18 844.58 301.35 544.39 126.92 80.18 562.85 426.65 346.52 507.72 546.40 491.45 538.75 650.07 797.85 395.35 369.74 639.56 603.92 481.99 345.97 168.86 1038.77 1351.53 941.55 938.08 639.11 1177.13 1236.41 1240.97 2153.58 98.18 122.69

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------164.23 117.05 255.88 95.64 185.12 1937.56 2845.91 2984.71 852.44 2514.07 1047.56 819.22 1107.38 489.34 38.05 330.24 323.59 398.12 285.14 791.89 822.30 1133.01 1551.61 1055.75 1074.15 1424.95 1713.39 1212.01 1871.26 693.15 881.16 1496.54 2419.65 1417.57 878.93 868.54 1413.90 668.39 1255.27 199.99 656.12 144.41 188.20 856.58 494.82 313.91 101.46 339.88 45.05 51.89 632.95 515.53 451.59 547.06 588.65 517.09 789.18 258.40 259.23 438.36 3905.60 615.37 724.09 627.85 883.03 1026.49 855.37 873.36 1034.23 940.17 1197.47 859.75 740.34 823.22 168.86 38.38

PAGE 023 LC FEE -------188.86 134.61 294.26 109.99 212.89 2228.19 3272.80 3432.42 980.31 2891.18 1204.69 942.10 1273.49 562.74 43.76 379.78 372.13 457.84 327.91 910.67 945.65 1302.96 1784.35 1214.11 1235.27 1638.69 1970.40 1393.81 2151.95 797.12 1013.33 1721.02 2782.60 1630.21 1010.77 998.82 1625.99 768.65 1443.56 229.99 754.54 166.07 216.43 985.07 569.04 361.00 116.68 390.86 51.81 59.67 727.89 592.86 519.33 629.12 676.95 594.65 907.56 297.16 298.11 504.11 4491.44 707.68 832.70 722.03 1015.48 1180.46 983.68 1004.36 1189.36 1081.20 1377.09 988.71 851.39 946.70 194.19 44.14 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------46938 46940 46945 46946 47001 47015 47122 47135 47141 47350 47362 47380 47400 47460 47500 47510 47530 47553 47556 47562 47570 47610 47630 47711 47716 47740 47765 47800 47900 48005 48102 48140 48148 48153 48180 48510 48540 48554 49002 49021 49060 49080 49081 49180 49215 49255 49322 49419 49422 49425 49428 49492 49500 49505 49521 49550 49557 49565 49570 49582 49590 49606 49650 49904 50020 50045 50070 50081 50125 50200 50225 50236 50290 50360 50380 50393 *** N F N F 357.50 137.99 214.64 179.44 105.27 904.40 3087.36 4687.01 3797.77 1143.09 1096.64 1275.38 1838.28 1065.04 103.35 507.23 402.22 354.97 470.99 663.06 741.23 1093.40 552.05 1347.82 990.45 1097.57 1460.41 1361.38 1172.74 2344.71 536.73 1334.41 1024.97 2772.60 1430.78 881.82 1143.34 2110.31 640.12 178.48 926.07 217.02 72.56 91.13 1925.17 690.20 356.78 414.04 377.08 702.40 371.00 833.57 349.73 466.44 703.64 521.12 659.91 687.00 361.41 413.92 516.18 1102.21 390.59 1442.73 932.91 896.63 1150.22 1285.61 949.79 140.01 1146.89 1451.30 865.08 1935.31 1379.60 218.17

PROC MOD NOTE PAR FEE ----- -- ---- -------46938 46942 46945 47000 47010 47100 47125 47136 47142 47360 47370 47381 47420 47480 47505 47511 47550 47554 47560 47563 47600 47612 47700 47712 47720 47741 47780 47801 48000 48020 48102 48145 48150 48154 48400 48511 48545 48556 49010 49040 49061 49080 49085 49200 49220 49320 49323 49420 49423 49426 49429 49495 49501 49507 49525 49553 49560 49566 49572 49585 49600 49610 49651 49905 50021 50060 50075 50100 50130 50205 50230 50240 50320 50365 50390 50394 F N F N 298.59 154.99 150.31 202.60 968.04 711.81 2768.34 3967.72 4183.30 1548.60 1102.30 1295.74 1169.80 678.89 131.13 616.60 167.56 506.93 277.47 711.34 805.88 1089.59 943.34 1747.27 955.33 1251.21 1541.11 929.23 1572.61 939.61 281.32 1392.43 2774.35 2562.90 103.31 210.18 1071.33 983.03 749.07 800.50 194.86 71.69 714.36 625.45 889.03 317.21 573.04 133.60 84.40 592.47 449.11 364.76 534.44 575.16 517.32 567.10 684.28 839.84 416.16 389.20 673.22 635.70 507.36 364.18 177.75 1093.44 1422.66 991.10 987.45 672.75 1239.08 1301.48 1306.28 2266.93 103.35 129.15

LC FEE -------326.21 169.33 164.21 221.34 1057.59 777.65 3024.41 4334.73 4570.26 1691.85 1204.27 1415.59 1278.01 741.69 143.26 673.64 183.06 553.82 303.14 777.14 880.43 1190.38 1030.60 1908.90 1043.69 1366.95 1683.66 1015.19 1718.08 1026.52 307.34 1521.23 3030.97 2799.97 112.86 229.62 1170.42 1073.96 818.36 874.55 212.89 78.33 780.44 683.31 971.27 346.55 626.05 145.96 92.21 647.28 490.65 398.50 583.88 628.36 565.17 619.56 747.58 917.53 454.65 425.20 735.49 694.51 554.29 397.87 194.19 1194.59 1554.26 1082.78 1078.79 734.98 1353.70 1421.87 1427.12 2476.62 112.91 141.09

PROC MOD NOTE PAR FEE ----- -- ---- -------46940 46942 46946 47000 47011 47120 47130 47140 47300 47361 47371 47382 47425 47490 47505 47525 47552 47555 47561 47564 47605 47620 47701 47715 47721 47760 47785 47802 48001 48100 48120 48146 48152 48155 48500 48520 48547 49000 49020 49041 49062 49081 49180 49201 49250 49321 49400 49421 49424 49427 49491 49496 49505 49520 49540 49555 49561 49568 49580 49587 49605 49611 49900 50010 50040 50065 50080 50120 50135 50220 50234 50280 50340 50370 50392 50394 N F N F 172.87 123.21 269.35 100.67 194.86 2039.54 2995.69 3141.80 897.31 2646.39 1102.69 862.34 1165.66 515.09 40.05 347.62 340.62 419.07 300.15 833.57 865.58 1192.64 1633.27 1111.32 1130.68 1499.95 1803.57 1275.80 1969.75 729.63 927.54 1575.30 2547.00 1492.18 925.19 914.25 1488.32 703.57 1321.34 210.52 690.65 152.01 198.10 901.66 520.86 330.43 106.80 357.77 47.42 54.62 666.26 542.66 475.36 575.85 619.63 544.31 830.72 272.00 272.87 461.43 4111.16 647.76 762.20 660.89 929.51 1080.52 900.39 919.33 1088.66 989.65 1260.49 905.00 779.31 866.55 177.75 40.40

N

F

N

F

N F F

F

N N

N

F

N

F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------168.82 72.82 1088.34 1333.43 1076.71 1264.60 1277.07 914.89 329.00 336.71 569.49 555.57 571.09 535.50 885.32 948.16 38.38 109.12 853.23 1031.96 1018.51 1059.09 1141.22 1148.39 1520.03 1132.23 801.59 916.73 421.62 314.12 933.70 1170.37 348.26 257.72 39.06 348.06 412.24 405.16 364.11 769.34 860.92 1305.79 1873.79 2093.74 44.19 103.33 44.16 105.58 77.85 183.88 194.36 272.41 356.53 45.43 74.04 277.39 212.02 230.46 267.94 343.24 282.63 15.89 626.90 687.14 732.68 1561.83 720.13 105.40 311.95 158.24 191.88 279.84 203.50 175.64 321.49 329.08

M E D I C A R E LC FEE -------194.14 83.74 1251.59 1533.44 1238.22 1454.29 1468.63 1052.12 378.35 387.22 654.91 638.91 656.75 615.83 1018.12 1090.38 44.14 125.49 981.21 1186.75 1171.29 1217.95 1312.40 1320.65 1748.03 1302.06 921.83 1054.24 484.86 361.24 1073.76 1345.93 400.50 296.38 44.92 400.27 474.08 465.93 418.73 884.74 990.06 1501.66 2154.86 2407.80 50.82 118.83 50.78 121.42 89.53 211.46 223.51 313.27 410.01 52.24 85.15 319.00 243.82 265.03 308.13 394.73 325.02 18.27 720.94 790.21 842.58 1796.10 828.15 121.21 358.74 181.98 220.66 321.82 234.03 201.99 369.71 378.44

F E E

S C H E D U L E NPAR FEE -------111.32 1037.56 995.26 1086.34 1354.33 1100.69 396.80 302.23 992.75 943.33 480.25 703.86 596.44 869.58 828.36 1057.86 226.21 627.52 1082.90 507.81 1059.50 1001.10 1109.80 1101.65 1684.64 849.51 1040.82 1320.75 293.85 1014.43 341.66 304.04 460.75 344.90 216.97 206.31 275.55 511.71 588.54 696.44 1146.62 1627.30 1733.65 2040.61 422.47 62.10 79.81 29.00 125.41 85.95 141.51 195.72 269.69 14.32 16.49 194.21 134.24 153.02 209.37 265.45 201.57 959.48 746.98 835.72 673.03 1251.77 773.39 400.61 124.92 225.43 163.32 496.27 251.81 242.56 381.90 292.38

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------99.33 1306.26 1239.61 854.02 1178.13 1387.67 281.92 957.13 332.96 381.85 522.14 552.94 746.83 861.80 817.86 595.44 82.25 57.94 943.19 717.01 1008.58 1113.40 819.14 1183.01 1102.21 765.66 810.15 1204.12 925.67 341.02 216.70 360.07 455.30 103.13 52.76 406.02 413.13 505.86 535.55 719.88 1173.49 1669.74 1960.41 248.91 37.72 94.60 26.42 169.17 61.71 292.31 101.75 76.69 86.84 31.10 57.55 83.18 77.79 77.45 58.57 77.79 81.05 1016.08 556.08 448.36 940.00 642.21 201.87 278.74 158.97 125.28 238.23 234.62 154.97 258.50 148.11 195.18

PAGE 024 LC FEE -------114.23 1502.20 1425.55 982.12 1354.85 1595.82 324.21 1100.70 382.90 439.13 600.46 635.88 858.85 991.07 940.54 684.76 94.59 66.63 1084.67 824.56 1159.87 1280.41 942.01 1360.46 1267.54 880.51 931.67 1384.74 1064.52 392.17 249.21 414.08 523.60 118.60 60.67 466.92 475.10 581.74 615.88 827.86 1349.51 1920.20 2254.47 286.25 43.38 108.79 30.38 194.55 70.97 336.16 117.01 88.19 99.87 35.77 66.18 95.66 89.46 89.07 67.36 89.46 93.21 1168.49 639.49 515.61 1081.00 738.54 232.15 320.55 182.82 144.07 273.96 269.81 178.22 297.28 170.33 224.46 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------50395 50398 50500 50526 50542 50545 50548 50553 50555 50559 50562 50574 50578 50590 50610 50650 50684 50688 50700 50725 50740 50770 50783 50810 50825 50845 50920 50945 50951 50953 50957 50961 50972 50978 51000 51010 51030 51050 51080 51525 51550 51570 51585 51596 51600 51610 51700 51702 51703 51710 51715 51725 51726 51736 51741 51772 51784 51785 51792 51795 51797 51798 51840 51860 51900 51940 51990 52000 52005 52010 52214 52235 52260 52270 52277 52282 *** F 177.71 76.65 1145.62 1403.61 1133.38 1331.16 1344.28 963.04 346.32 354.43 599.46 584.81 601.15 563.68 931.92 998.06 40.40 114.86 898.14 1086.27 1072.12 1114.83 1201.28 1208.83 1600.03 1191.82 843.78 964.98 443.81 330.65 982.84 1231.97 366.59 271.28 41.12 366.38 433.94 426.48 383.27 809.83 906.23 1374.52 1972.41 2203.94 46.52 108.77 46.48 111.14 81.95 193.56 204.59 286.75 375.29 47.82 77.94 291.99 223.18 242.59 282.04 361.30 297.50 16.73 659.89 723.31 771.24 1644.03 758.03 110.95 328.37 166.57 201.98 294.57 214.21 184.88 338.41 346.40

PROC MOD NOTE PAR FEE ----- -- ---- -------50396 50400 50520 50540 50543 50546 50551 50553 50557 50561 50570 50575 50580 50600 50620 50660 50686 50690 50715 50727 50750 50780 50785 50815 50830 50860 50930 50947 50951 50955 50957 50961 50974 50980 51005 51010 51040 51060 51500 51530 51555 51575 51590 51597 51605 51610 51701 51702 51705 51710 51720 51725 51726 51736 51741 51772 51784 51785 51792 51795 51797 51800 51841 51865 51920 51960 51992 52001 52005 52204 52224 52240 52265 52275 52281 52283 117.18 1092.17 1047.64 1143.52 1425.61 1158.62 417.68 318.14 1045.00 992.98 505.53 740.91 627.83 915.35 871.96 1113.54 238.12 660.55 1139.89 534.54 1115.26 1053.79 1168.21 1159.63 1773.30 894.22 1095.60 1390.26 309.32 1067.82 359.64 320.04 485.00 363.05 228.39 217.17 290.05 538.64 619.52 733.09 1206.97 1712.95 1824.89 2148.01 444.70 65.37 84.01 30.53 132.01 90.47 148.96 206.02 283.88 15.07 17.36 204.43 141.30 161.07 220.39 279.42 212.18 1009.98 786.29 879.70 708.45 1317.65 814.09 421.69 131.49 237.29 171.92 522.39 265.06 255.33 402.00 307.77

LC FEE -------128.02 1193.19 1144.55 1249.29 1557.48 1265.79 456.32 347.56 1141.66 1084.83 552.29 809.44 685.91 1000.02 952.61 1216.54 260.14 721.65 1245.34 583.98 1218.43 1151.27 1276.27 1266.90 1937.34 976.94 1196.94 1518.86 337.93 1166.59 392.91 349.65 529.86 396.64 249.52 237.26 316.88 588.47 676.82 800.91 1318.61 1871.40 1993.70 2346.70 485.84 71.42 91.78 33.35 144.22 98.84 162.74 225.08 310.14 16.47 18.96 223.34 154.38 175.97 240.78 305.27 231.81 1103.40 859.03 961.08 773.98 1439.54 889.40 460.70 143.66 259.24 187.82 570.71 289.58 278.94 439.19 336.24

PROC MOD NOTE PAR FEE ----- -- ---- -------50398 50405 50525 50541 50544 50547 50551 50555 50557 50561 50572 50576 50590 50605 50630 50684 50686 50690 50722 50728 50760 50782 50800 50820 50840 50900 50940 50948 50953 50955 50959 50970 50976 51000 51005 51020 51045 51065 51520 51535 51565 51580 51595 51600 51605 51700 51701 51703 51705 51715 51720 51725 51726 51736 51741 51772 51784 51785 51792 51795 51797 51820 51845 51880 51925 51980 52000 52001 52007 52204 52234 52250 52265 52276 52281 52283 N 104.56 1375.01 1304.85 898.97 1240.14 1460.70 296.76 1007.50 350.48 401.95 549.62 582.04 786.14 907.16 860.90 626.78 86.58 60.99 992.83 754.75 1061.66 1172.00 862.25 1245.27 1160.22 805.96 852.79 1267.49 974.39 358.97 228.10 379.02 479.26 108.56 55.54 427.39 434.87 532.48 563.74 757.77 1235.25 1757.62 2063.59 262.01 39.70 99.58 27.81 178.07 64.96 307.69 107.10 80.73 91.41 32.74 60.58 87.56 81.88 81.53 61.65 81.88 85.32 1069.56 585.35 471.96 989.47 676.01 212.49 293.41 167.34 131.87 250.77 246.97 163.13 272.11 155.90 205.45

N F

N F N N

F N F F N N F F

F F

N N

N F N N F N

F N F F N F

N F N F

F N F N F N F

N F N F N F N TC TC TC TC TC TC TC TC TC TC

N F N F N F N F 26 26 26 26 26 26 26 26 26 26

F N

N F N N N N

N F F F F F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------290.24 275.15 238.67 342.80 315.28 148.46 337.41 425.40 304.86 381.60 431.08 666.26 387.98 364.62 609.87 250.58 186.05 480.66 678.88 707.04 548.56 351.26 188.66 720.36 1023.12 893.84 642.95 590.54 552.28 698.76 583.96 89.54 51.79 84.72 76.70 38.77 522.65 2331.36 243.25 109.77 76.28 80.24 156.26 206.82 894.10 590.66 1424.95 136.96 190.58 77.15 128.93 131.04 67.09 66.21 112.16 682.61 673.51 900.12 1194.62 977.27 774.30 510.93 668.23 871.46 763.61 372.81 73.21 485.62 490.19 628.13 408.92 380.87 701.06 123.13 304.74 746.58

M E D I C A R E LC FEE -------333.78 316.42 274.47 394.22 362.57 170.73 388.02 489.21 350.59 438.84 495.74 766.20 446.18 419.31 701.35 288.17 213.96 552.76 780.71 813.10 630.84 403.95 216.96 828.41 1176.59 1027.92 739.39 679.12 635.12 803.57 671.55 102.97 59.56 97.43 88.21 44.59 601.05 2681.06 279.74 126.24 87.72 92.28 179.70 237.84 1028.22 679.26 1638.69 157.50 219.17 88.72 148.27 150.70 77.15 76.14 128.98 785.00 774.54 1035.14 1373.81 1123.86 890.45 587.57 768.46 1002.18 878.15 428.73 84.19 558.46 563.72 722.35 470.26 438.00 806.22 141.60 350.45 858.57

F E E

S C H E D U L E NPAR FEE -------188.63 288.34 146.99 468.06 267.85 250.59 373.26 477.82 358.06 456.83 472.00 445.36 365.37 3223.25 380.28 182.53 62.34 157.88 258.69 849.76 575.10 237.94 189.01 797.48 782.67 1071.89 737.16 757.78 362.05 447.10 737.08 62.29 64.75 130.62 39.51 39.07 3806.15 317.39 140.52 86.21 138.53 217.38 178.44 597.57 551.94 770.16 108.20 184.16 164.93 483.48 93.07 111.53 89.91 120.92 613.42 788.18 745.26 877.00 544.34 1382.33 897.62 610.66 704.83 473.44 651.82 84.08 71.36 307.18 681.07 404.25 649.54 726.30 204.90 309.45 367.79 999.94

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------237.88 272.64 268.28 241.46 258.86 313.53 400.42 267.03 413.06 513.15 374.47 446.60 398.29 567.17 145.66 93.06 662.91 471.45 136.82 412.03 384.09 183.45 258.87 899.05 876.20 743.97 809.12 1156.50 415.31 441.03 504.49 85.67 137.74 70.60 77.06 3966.64 553.24 108.70 300.87 105.74 96.92 127.91 102.96 768.41 402.46 1110.89 134.11 190.21 108.81 238.65 74.66 81.82 23.70 8.76 721.79 948.08 933.55 949.73 913.91 687.96 1186.21 740.47 844.13 613.92 583.94 60.51 204.26 549.23 444.47 280.25 310.87 621.79 124.97 321.41 504.02 133.44

PAGE 025 LC FEE -------273.56 313.54 308.52 277.68 297.69 360.56 460.48 307.08 475.02 590.12 430.64 513.59 458.03 652.25 167.51 107.02 762.35 542.17 157.34 473.83 441.70 210.97 297.70 1033.91 1007.63 855.57 930.49 1329.98 477.61 507.18 580.16 98.52 158.40 81.19 88.62 4561.64 636.23 125.01 346.00 121.60 111.46 147.10 118.40 883.67 462.83 1277.52 154.23 218.74 125.13 274.45 85.86 94.09 27.26 10.07 830.06 1090.29 1073.58 1092.19 1051.00 791.15 1364.14 851.54 970.75 706.01 671.53 69.59 234.90 631.61 511.14 322.29 357.50 715.06 143.72 369.62 579.62 153.46 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------52285 N 52300 52310 N 52317 52325 52332 52342 52345 52351 52354 52450 52601 52614 52640 52648 53010 53025 N 53040 F 53085 53210 53230 53250 53265 53400 53415 53430 53442 53446 53449 53500 53510 53600 N 53601 F 53620 F 53660 N 53661 F 53850 F 53853 N 54001 N 54050 N 54055 F 54057 54065 54105 54112 54120 54135 54160 54163 54200 F 54220 F 54231 N 54235 F 54240 26 54250 26 54308 54318 54326 54336 54348 54380 54400 54406 54411 54417 54435 54500 N 54512 54530 54560 54640 54670 54692 54800 F 54840 54900 *** 305.52 289.63 251.23 360.84 331.87 156.27 355.17 447.79 320.90 401.68 453.77 701.33 408.40 383.81 641.97 263.77 195.84 505.96 714.61 744.25 577.43 369.75 198.59 758.27 1076.97 940.88 676.79 621.62 581.35 735.54 614.69 94.25 54.52 89.18 80.74 40.81 550.16 2454.06 256.05 115.55 80.29 84.46 164.48 217.70 941.16 621.75 1499.95 144.17 200.61 81.21 135.72 137.94 70.62 69.69 118.06 718.54 708.96 947.49 1257.49 1028.70 815.05 537.82 703.40 917.33 803.80 392.43 77.06 511.18 515.99 661.19 430.44 400.92 737.96 129.61 320.78 785.87

PROC MOD NOTE PAR FEE ----- -- ---- -------52285 52301 52310 52318 52327 52334 52343 52346 52352 52355 52500 52606 52620 52647 52700 53020 53025 53060 53200 53215 53235 53260 53270 53405 53420 53431 53444 53447 53450 53502 53515 53600 53605 53621 53660 53665 53852 53853 54001 54050 54056 54060 54100 54110 54115 54125 54150 54161 54164 54205 54230 54231 54240 54250 54300 54312 54322 54328 54340 54352 54385 54401 54408 54415 54420 54450 54500 54520 54535 54600 54650 54680 54700 54820 54860 54901 F F 198.56 303.52 154.73 492.69 281.95 263.78 392.90 502.97 376.90 480.87 496.84 468.80 384.60 3392.89 400.29 192.14 65.62 166.19 272.30 894.48 605.37 250.46 198.96 839.45 823.86 1128.31 775.96 797.66 381.10 470.63 775.87 65.57 68.16 137.49 41.59 41.13 4006.47 334.09 147.92 90.75 145.82 228.82 187.83 629.02 580.99 810.69 113.89 193.85 173.61 508.93 97.97 117.40 94.64 127.28 645.70 829.66 784.48 923.16 572.99 1455.08 944.86 642.80 741.93 498.36 686.13 88.50 75.12 323.35 716.92 425.53 683.73 764.53 215.68 325.74 387.15 1052.57

LC FEE -------216.92 331.59 169.04 538.27 308.03 288.18 429.25 549.49 411.77 525.35 542.80 512.16 420.18 3706.74 437.32 209.91 71.69 181.56 297.49 977.22 661.37 273.63 217.36 917.10 900.07 1232.67 847.73 871.45 416.36 514.17 847.64 71.63 74.46 150.21 45.44 44.93 4377.07 365.00 161.60 99.14 159.31 249.99 205.21 687.21 634.73 885.68 124.43 211.78 189.67 556.00 107.03 128.26 103.40 139.06 705.43 906.41 857.05 1008.55 625.99 1589.68 1032.26 702.26 810.55 544.46 749.59 96.69 82.06 353.26 783.23 464.89 746.97 835.25 235.64 355.87 422.96 1149.93

PROC MOD NOTE PAR FEE ----- -- ---- -------52290 52305 52315 52320 52330 52341 52344 52347 52353 52400 52510 52612 52630 52647 F 53000 53020 F 53040 N 53080 53200 F 53220 53240 53260 F 53275 53410 53425 53440 53445 53448 53460 53505 53520 53601 N 53620 N 53621 F 53661 N 53850 N 53852 F 54000 54015 54055 N 54056 F 54060 F 54100 F 54111 54115 F 54130 54152 54162 54200 N 54220 N 54230 F 54235 N 54240 TC 54250 TC 54304 54316 54324 54332 54344 54360 54390 54405 54410 54416 54430 54450 F 54505 54522 54550 54620 54660 54690 54800 N 54830 54861 55000 N 250.40 286.99 282.40 254.17 272.48 330.03 421.49 281.08 434.80 540.16 394.18 470.10 419.25 597.02 153.33 97.96 697.80 496.26 144.02 433.72 404.30 193.10 272.49 946.37 922.32 783.13 851.70 1217.37 437.17 464.24 531.04 90.18 144.99 74.32 81.12 4175.41 582.36 114.42 316.71 111.30 102.02 134.64 108.38 808.85 423.64 1169.36 141.17 200.22 114.54 251.21 78.59 86.13 24.95 9.22 759.78 997.98 982.68 999.72 962.01 724.17 1248.64 779.44 888.56 646.23 614.67 63.69 215.01 578.14 467.86 295.00 327.23 654.52 131.55 338.33 530.55 140.46

N N F N N

F N F N F F F N N N N

N F

N F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------79.69 329.65 337.35 425.73 366.70 229.76 423.88 362.34 448.92 469.91 220.25 439.26 1191.18 782.05 1309.15 792.40 1600.77 1076.75 139.94 145.65 107.38 84.27 30.33 752.03 982.11 1289.60 270.94 250.07 145.07 382.56 157.52 91.79 87.92 116.74 1472.48 1584.80 154.32 63.10 76.00 49.11 264.66 349.63 511.10 715.63 769.77 680.11 461.29 585.56 476.61 132.73 138.83 153.81 109.83 126.48 134.14 158.64 137.03 86.41 143.82 128.32 295.02 1597.77 363.82 255.55 48.50 107.02 200.49 1068.76 890.20 2190.15 933.52 917.32 1064.30 1295.83 68.95 88.68

M E D I C A R E LC FEE -------91.64 379.10 387.95 489.59 421.71 264.22 487.46 416.69 516.26 540.40 253.29 505.15 1369.86 899.36 1505.52 911.26 1840.89 1238.26 160.93 167.50 123.49 96.91 34.88 864.83 1129.43 1483.04 311.58 287.58 166.83 439.94 181.15 105.56 101.11 134.25 1693.35 1822.52 177.47 72.57 87.40 56.48 304.36 402.07 587.77 822.97 885.24 782.13 530.48 673.39 548.10 152.64 159.65 176.88 126.30 145.45 154.26 182.44 157.58 99.37 165.39 147.57 339.27 1837.44 418.39 293.88 55.78 123.07 230.56 1229.07 1023.73 2518.67 1073.55 1054.92 1223.95 1490.20 79.29 101.98

F E E

S C H E D U L E NPAR FEE -------316.61 221.89 409.26 315.28 251.83 182.91 227.27 331.85 378.63 652.33 86.96 504.56 1472.36 851.53 1509.58 1003.23 155.75 106.73 95.75 130.56 201.11 61.07 478.75 980.91 1070.54 164.54 236.01 107.63 112.66 95.25 276.60 189.44 65.09 407.72 842.74 468.55 190.51 30.33 49.86 143.76 333.34 381.99 678.32 873.51 619.77 501.21 782.75 406.60 693.69 143.36 112.72 120.31 81.48 141.79 102.48 367.40 56.39 133.88 126.88 341.80 233.17 720.89 548.35 281.37 122.27 84.56 848.65 890.48 1236.36 765.64 986.14 981.22 1172.43 1144.26 79.62 59.22

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------448.50 141.63 306.91 617.26 461.35 480.45 335.24 381.07 370.70 311.37 260.79 958.20 1619.02 1222.70 699.68 1227.00 139.18 100.10 177.04 127.26 173.86 40.27 535.65 1168.82 1294.89 41.63 1101.78 81.48 182.49 81.99 111.67 166.61 139.19 1304.98 1549.74 177.15 168.06 403.68 91.45 110.99 287.44 353.55 425.88 550.72 724.21 781.84 899.90 463.01 1078.33 101.76 86.57 873.44 154.47 109.38 335.73 187.36 100.04 114.73 145.26 264.12 318.55 769.69 514.14 59.17 109.38 216.69 500.72 1169.52 1647.86 863.10 831.60 1248.96 1243.22 100.24 50.90 17.82

PAGE 026 LC FEE -------515.78 162.87 352.95 709.85 530.55 552.52 385.53 438.23 426.31 358.08 299.91 1101.93 1861.87 1406.11 804.63 1411.05 160.06 115.12 203.60 146.35 199.94 46.31 616.00 1344.14 1489.12 47.87 1267.05 93.70 209.86 94.29 128.42 191.60 160.07 1500.73 1782.20 203.72 193.27 464.23 105.17 127.64 330.56 406.58 489.76 633.33 832.84 899.12 1034.89 532.46 1240.08 117.02 99.56 1004.46 177.64 125.79 386.09 215.46 115.05 131.94 167.05 303.74 366.33 885.14 591.26 68.05 125.79 249.19 575.83 1344.95 1895.04 992.57 956.34 1436.30 1429.70 115.28 58.54 20.49 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------55000 55060 55110 55150 55200 55250 55450 55520 55540 55605 55700 55720 55810 55821 55842 55860 55866 55873 56420 56441 56501 56605 56606 56630 56633 56640 56740 56810 56821 57010 57022 57061 57100 57105 57109 57112 57130 57150 57160 57170 57200 57230 57260 57270 57284 57289 57300 57308 57320 57400 57415 57421 57452 57454 57456 57460 57500 57505 57511 57513 57522 57531 57550 57700 57800 58100 58120 58146 58180 58240 58263 58275 58290 58293 58301 58322 *** F N F N N 83.88 347.00 355.10 448.14 386.00 241.85 446.19 381.41 472.55 494.64 231.84 462.38 1253.87 823.21 1378.05 834.10 1685.02 1133.42 147.30 153.32 113.03 88.70 31.93 791.61 1033.80 1357.47 285.20 263.23 152.70 402.69 165.81 96.62 92.55 122.88 1549.98 1668.21 162.44 66.42 80.00 51.69 278.59 368.03 538.00 753.29 810.28 715.91 485.57 616.38 501.69 139.72 146.14 161.90 115.61 133.14 141.20 166.99 144.24 90.96 151.39 135.07 310.55 1681.86 382.97 269.00 51.05 112.65 211.04 1125.01 937.05 2305.42 982.65 965.60 1120.32 1364.03 72.58 93.35

PROC MOD NOTE PAR FEE ----- -- ---- -------55040 55100 55120 55175 55200 55300 55450 55530 55550 55650 55700 55725 55812 55831 55845 55862 55870 56405 56420 56441 56515 56605 56620 56631 56634 56700 56800 56820 56821 57020 57023 57065 57100 57106 57110 57120 57135 57150 57160 57180 57210 57240 57265 57280 57287 57291 57305 57310 57330 57410 57420 57421 57452 57455 57456 57461 57500 57510 57511 57520 57522 57540 57555 57720 57820 58100 58140 58150 58200 58260 58267 58280 58291 58294 58321 58322 N N F F F 333.27 233.57 430.80 331.87 265.08 192.54 239.23 349.32 398.56 686.66 91.54 531.12 1549.85 896.35 1589.03 1056.03 163.95 112.35 100.79 137.43 211.69 64.28 503.95 1032.54 1126.88 173.20 248.43 113.29 118.59 100.26 291.16 199.41 68.52 429.18 887.09 493.21 200.54 31.93 52.48 151.33 350.88 402.09 714.02 919.48 652.39 527.59 823.95 428.00 730.20 150.91 118.65 126.64 85.77 149.25 107.87 386.74 59.36 140.93 133.56 359.79 245.44 758.83 577.21 296.18 128.71 89.01 893.32 937.35 1301.43 805.94 1038.04 1032.86 1234.14 1204.48 83.81 62.34

LC FEE -------364.10 255.17 470.65 362.57 289.60 210.35 261.36 381.63 435.42 750.18 100.00 580.24 1693.21 979.26 1736.02 1153.71 179.11 122.74 110.11 150.14 231.28 70.23 550.56 1128.05 1231.12 189.22 271.41 123.77 129.56 109.54 318.09 217.86 74.85 468.88 969.15 538.83 219.09 34.88 57.34 165.32 383.34 439.29 780.07 1004.54 712.74 576.39 900.16 467.59 797.74 164.86 129.63 138.36 93.70 163.06 117.85 422.51 64.85 153.96 145.91 393.07 268.15 829.02 630.60 323.58 140.61 97.24 975.95 1024.05 1421.81 880.49 1134.06 1128.40 1348.29 1315.90 91.56 68.10

PROC MOD NOTE PAR FEE ----- -- ---- -------55041 55100 55120 55180 55250 55400 55500 55535 55600 55680 55705 55801 55815 55840 55859 55865 55870 56405 56440 56501 56515 56606 56625 56632 56637 56720 56805 56820 57000 57020 57061 57065 57105 57107 57111 57130 57135 57155 57170 57180 57220 57250 57268 57282 57288 57292 57307 57311 57335 57410 57420 57425 57454 57455 57460 57461 57505 57510 57513 57520 57530 57545 57556 57800 57820 58120 58145 58152 58210 58262 58270 58285 58292 58301 58321 58323 F F N 472.11 149.08 323.06 649.75 485.63 505.74 352.88 401.13 390.21 327.76 274.52 1008.63 1704.23 1287.05 736.51 1291.58 146.51 105.37 186.36 133.96 183.01 42.39 563.84 1230.34 1363.04 43.82 1159.77 85.77 192.09 86.31 117.55 175.38 146.52 1373.66 1631.30 186.47 176.90 424.93 96.26 116.83 302.57 372.16 448.29 579.71 762.33 822.99 947.26 487.38 1135.08 107.12 91.13 919.41 162.60 115.14 353.40 197.22 105.30 120.77 152.90 278.02 335.32 810.20 541.20 62.28 115.14 228.09 527.07 1231.07 1734.59 908.53 875.37 1314.69 1308.65 105.52 53.58 18.76

N N F N F

N N F F N F

F F N F N

N F N F F N N F

N F N N F N F F N

F F N F N N F N F

N N F N F N F N F N F N F

N N F F N F N F N F N F N F

F F N F N F N F N F N F N

F N

N F

N F N

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------12.30 272.44 74.78 400.90 837.32 839.77 1229.65 266.99 556.31 341.68 256.87 686.70 743.65 669.84 854.17 329.08 287.00 635.97 666.16 986.75 1826.43 227.10 221.25 169.80 134.55 38.47 30.88 43.46 463.28 463.28 738.93 815.19 693.54 195.31 183.98 246.78 780.48 93.06 640.60 126.94 1041.90 875.82 1008.89 303.19 208.90 394.36 473.88 411.11 148.88 49.96 604.91 700.83 1187.79 1196.49 555.85 1271.80 1129.99 1105.56 1096.33 114.63 133.62 343.57 1065.46 1013.44 364.04 1440.81 1649.92 88.50 1797.73 1728.53 1231.22 1710.65 1838.26 1671.65 1875.79 1614.24

M E D I C A R E LC FEE -------14.15 313.31 86.00 461.04 962.92 965.74 1414.10 307.04 639.76 392.93 295.40 789.71 855.20 770.32 982.30 378.44 330.05 731.37 766.08 1134.76 2100.39 261.17 254.44 195.27 154.73 44.24 35.51 49.98 532.77 532.77 849.77 937.47 797.57 224.61 211.58 283.80 897.55 107.02 736.69 145.98 1198.19 1007.19 1160.22 348.67 240.24 453.51 544.96 472.78 171.21 57.45 695.65 805.95 1365.96 1375.96 639.23 1462.57 1299.49 1271.39 1260.78 131.82 153.66 395.11 1225.28 1165.46 418.65 1656.93 1897.41 101.78 2067.39 1987.81 1415.90 1967.25 2114.00 1922.40 2157.16 1856.38

F E E

S C H E D U L E NPAR FEE -------259.03 414.22 1478.46 742.14 850.54 931.47 211.45 344.32 290.49 309.90 647.79 345.00 796.79 793.35 776.81 273.86 595.73 371.93 444.77 1285.36 1988.03 196.91 133.65 206.79 60.91 40.38 124.93 387.52 368.75 773.29 799.04 427.79 695.75 78.74 139.79 285.70 873.28 365.03 477.87 1777.11 492.24 963.86 1138.76 320.25 321.72 543.47 571.12 157.13 144.47 110.76 646.40 843.32 1583.38 985.51 928.36 238.32 1365.63 1124.21 97.85 121.37 73.79 712.43 1158.85 1089.39 710.16 1737.18 1516.81 1678.36 1858.68 1676.51 1938.59 1670.11 1639.73 1177.15 2280.85 74.26

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------59.10 95.77 218.90 701.01 1075.43 1066.14 187.89 390.90 344.69 76.14 633.28 346.40 682.38 869.97 817.56 365.75 170.54 644.68 1062.50 1442.96 862.58 251.07 81.73 153.33 22.45 9.50 51.76 287.75 287.75 728.14 867.95 368.52 238.02 45.97 154.04 1568.77 103.97 277.03 137.99 920.94 1656.06 1881.65 262.23 412.48 376.33 396.27 240.61 133.93 92.30 78.00 927.83 926.01 1012.92 407.89 1164.89 989.55 953.79 1293.63 98.93 106.36 373.16 609.79 835.52 393.97 822.03 1642.39 1816.56 1839.41 1454.25 1174.73 1761.57 1770.86 1743.29 981.97 1651.30 2429.79

PAGE 027 LC FEE -------67.97 110.14 251.74 806.16 1236.74 1226.06 216.07 449.54 396.39 87.56 728.27 398.36 784.74 1000.47 940.19 420.61 196.12 741.38 1221.88 1659.40 991.97 288.73 93.99 176.33 25.82 10.93 59.52 330.91 330.91 837.36 998.14 423.80 273.72 52.87 177.15 1804.09 119.57 318.58 158.69 1059.08 1904.47 2163.90 301.56 474.35 432.78 455.71 276.70 154.02 106.15 89.70 1067.00 1064.91 1164.86 469.07 1339.62 1137.98 1096.86 1487.67 113.77 122.31 429.13 701.26 960.85 453.07 945.33 1888.75 2089.04 2115.32 1672.39 1350.94 2025.81 2036.49 2004.78 1129.27 1899.00 2794.26 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------58323 F 58345 58350 F 58400 58540 58550 58554 58558 58561 58600 58615 58662 58672 58720 58752 58800 N 58820 58825 58925 58950 58953 58970 N 58976 F 59001 59015 F 59020 26 59025 26 59051 59072 59076 59121 59136 59150 59160 F 59300 N 59325 59409 59414 59426 N 59430 F 59515 59612 59620 59820 59840 59851 59856 59870 60000 N 60001 F 60200 60220 60252 60270 60281 60505 60521 60545 60650 61020 61055 61107 61140 61154 61215 61304 61313 61316 61322 61332 61340 61440 61460 61490 61510 61516 *** 12.95 286.78 78.72 422.00 881.39 883.97 1294.37 281.04 585.59 359.66 270.39 722.84 782.79 705.09 899.13 346.40 302.10 669.44 701.22 1038.68 1922.56 239.05 232.89 178.74 141.63 40.49 32.51 45.75 487.66 487.66 777.82 858.09 730.04 205.59 193.66 259.77 821.56 97.96 674.32 133.62 1096.74 921.92 1061.99 319.15 219.89 415.12 498.82 432.75 156.72 52.59 636.75 737.72 1250.30 1259.46 585.10 1338.74 1189.46 1163.75 1154.03 120.66 140.65 361.65 1121.54 1066.78 383.20 1516.64 1736.76 93.16 1892.35 1819.50 1296.02 1800.68 1935.01 1759.63 1974.52 1699.20

PROC MOD NOTE PAR FEE ----- -- ---- -------58340 58346 58353 58410 58545 58552 58555 58559 58562 58605 58660 58670 58673 58740 58760 58800 58822 58900 58940 58951 58954 58970 59000 59012 59020 59025 59030 59070 59074 59100 59130 59140 59151 59200 59300 59350 59410 59425 59426 59510 59525 59614 59622 59821 59841 59852 59857 59871 60000 60100 60210 60225 60254 60271 60500 60512 60522 60600 61000 61026 61070 61108 61150 61156 61250 61305 61314 61320 61323 61333 61343 61450 61470 61500 61512 61517 N N N 272.66 436.02 1556.27 781.20 895.30 980.49 222.58 362.44 305.78 326.21 681.88 363.16 838.73 835.11 817.69 288.27 627.08 391.51 468.18 1353.01 2092.66 207.27 140.68 217.67 64.12 42.51 131.50 407.92 388.16 813.99 841.09 450.31 732.37 82.88 147.15 300.74 919.24 384.24 503.02 1870.64 518.15 1014.59 1198.69 337.10 338.65 572.07 601.18 165.40 152.07 116.59 680.42 887.71 1666.72 1037.38 977.22 250.86 1437.50 1183.38 103.00 127.76 77.67 749.93 1219.84 1146.73 747.54 1828.61 1596.64 1766.69 1956.51 1764.75 2040.62 1758.01 1726.03 1239.11 2400.89 78.17

LC FEE -------297.88 476.35 1700.23 853.46 978.12 1071.19 243.17 395.97 334.06 356.39 744.96 396.75 916.31 912.35 893.33 314.94 685.09 427.72 511.49 1478.16 2286.23 226.45 153.70 237.81 70.05 46.44 143.67 445.65 424.06 889.28 918.90 491.96 800.11 90.55 160.76 328.56 1004.27 419.78 549.55 2043.68 566.08 1108.44 1309.57 368.29 369.98 624.99 656.79 180.70 166.14 127.37 743.36 969.82 1820.89 1133.34 1067.61 274.07 1570.47 1292.84 112.53 139.58 84.86 819.29 1332.68 1252.80 816.68 1997.76 1744.33 1930.11 2137.48 1927.99 2229.38 1920.63 1885.69 1353.72 2622.98 85.40

PROC MOD NOTE PAR FEE ----- -- ---- -------58340 F 58350 N 58353 F 58520 58546 58553 58555 F 58560 58563 58611 58661 58671 58700 58750 58770 58805 58823 58920 58943 58952 58960 58976 N 59000 F 59015 N 59020 TC 59025 TC 59050 59070 F 59074 F 59120 59135 59140 F 59160 N 59200 F 59320 59400 59412 59425 F 59430 N 59514 59610 59618 59812 59830 59850 59855 59866 59871 F 60001 N 60100 F 60212 60240 60260 60280 60502 60520 60540 60605 61001 61050 61105 61120 61151 61210 61253 61312 61315 61321 61330 61334 61345 61458 61480 61501 61514 61518 62.21 100.81 230.42 737.91 1132.03 1122.25 197.78 411.47 362.83 80.15 666.61 364.63 718.29 915.76 860.59 385.00 179.52 678.61 1118.42 1518.91 907.98 264.28 86.03 161.40 23.63 10.00 54.48 302.89 302.89 766.46 913.63 387.92 250.55 48.39 162.15 1651.34 109.44 291.61 145.25 969.41 1743.22 1980.68 276.03 434.19 396.14 417.13 253.27 140.98 97.16 82.10 976.66 974.75 1066.23 429.36 1226.20 1041.63 1003.99 1361.72 104.14 111.96 392.80 641.88 879.49 414.70 865.29 1728.83 1912.17 1936.22 1530.79 1236.56 1854.28 1864.06 1835.04 1033.65 1738.21 2557.67

F

F N

N N N N F N F

N F N

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------2659.02 1883.25 2759.02 1371.14 1650.28 1992.12 1906.18 2020.39 1081.02 1553.63 2181.73 1587.08 3174.90 2389.48 2617.00 2882.59 2363.32 1790.84 2604.12 619.68 1641.47 2906.01 535.90 1995.83 4141.87 3272.88 3101.81 1923.09 1115.22 1179.21 684.29 253.42 1279.64 474.80 448.97 367.38 1310.11 1540.16 1348.29 732.42 1056.70 171.43 996.92 1388.00 304.34 866.08 704.23 46.69 675.88 223.51 664.27 61.28 184.00 134.58 391.90 81.82 163.70 475.73 91.87 281.37 89.32 333.65 450.21 36.14 1009.57 1290.35 1006.91 1237.28 1105.04 202.66 319.69 1295.22 198.99 1730.29 267.43 2057.05

M E D I C A R E LC FEE -------3057.87 2165.74 3172.87 1576.81 1897.82 2290.94 2192.11 2323.45 1243.17 1786.67 2508.99 1825.14 3651.14 2747.90 3009.55 3314.98 2717.82 2059.47 2994.74 712.63 1887.69 3341.91 616.29 2295.20 4763.15 3763.81 3567.08 2211.55 1282.50 1356.09 786.93 291.43 1471.59 546.02 516.32 422.49 1506.63 1771.18 1550.53 842.28 1215.21 197.14 1146.46 1596.20 349.99 995.99 809.86 53.69 777.26 257.04 763.91 70.47 211.60 154.77 450.69 94.09 188.26 547.09 105.65 323.58 102.72 383.70 517.74 41.56 1161.01 1483.90 1157.95 1422.87 1270.80 233.06 367.64 1489.50 228.84 1989.83 307.54 2365.61

F E E

S C H E D U L E NPAR FEE -------3506.87 1786.49 980.00 786.27 1750.07 1861.72 1629.32 1396.39 1367.87 2172.71 1976.56 1722.66 2145.46 2506.78 1870.80 2713.62 2486.07 1976.28 2417.48 1699.05 2778.61 1117.42 1029.71 3923.92 1898.18 3135.31 1163.24 1672.43 1354.49 1311.28 978.81 820.69 284.24 969.59 455.91 692.08 1432.00 1751.94 900.04 871.09 1263.28 1222.49 1699.27 748.81 1210.61 872.93 88.23 465.94 326.84 572.39 267.01 189.67 104.46 314.68 119.08 521.91 321.82 668.64 240.18 97.28 420.77 202.92 351.59 1043.25 886.05 1272.65 830.94 1171.48 1060.81 1441.89 1609.74 253.19 1563.22 196.23 1777.91 2057.05

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------2856.48 3244.51 1290.69 2282.31 2080.71 2039.58 2833.17 833.17 1499.34 1712.30 2261.40 2169.14 2233.98 2412.01 2742.04 2019.75 2251.13 1976.70 2835.33 471.49 2184.74 1338.23 838.50 2566.63 3297.35 3260.57 2286.76 2340.82 1198.50 1391.41 1137.03 1362.16 1957.04 958.11 588.91 1002.78 1394.05 1493.97 987.90 1235.55 119.80 1573.24 1327.25 823.02 987.23 390.15 41.52 963.55 453.99 263.12 156.64 77.74 344.81 130.96 239.41 367.31 153.93 251.29 75.97 249.48 694.54 359.70 23.49 1058.49 1036.48 1073.90 195.41 216.04 995.07 1331.05 204.65 1382.22 272.70 2236.29 181.32 239.98

PAGE 028 LC FEE -------3284.95 3731.19 1484.29 2624.66 2392.82 2345.52 3258.15 958.15 1724.24 1969.15 2600.61 2494.51 2569.08 2773.81 3153.35 2322.71 2588.80 2273.21 3260.63 542.21 2512.45 1538.96 964.28 2951.62 3791.95 3749.66 2629.77 2691.94 1378.28 1600.12 1307.58 1566.48 2250.60 1101.83 677.25 1153.20 1603.16 1718.07 1136.09 1420.88 137.77 1809.23 1526.34 946.47 1135.31 448.67 47.75 1108.08 522.09 302.59 180.14 89.40 396.53 150.60 275.32 422.41 177.02 288.98 87.37 286.90 798.72 413.66 27.01 1217.26 1191.95 1234.99 224.72 248.45 1144.33 1530.71 235.35 1589.55 313.61 2571.73 208.52 275.98 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------61519 61522 61530 61534 61537 61540 61543 61546 61552 61558 61564 61570 61576 61582 61585 61591 61596 61600 61606 61609 61612 61616 61623 61680 61686 61697 61702 61708 61720 61751 61790 61795 61863 61868 61880 61888 62010 62116 62121 62142 62146 62160 62163 62180 62194 62220 62230 62252 26 62263 N 62264 F 62269 N 62270 F 62273 N 62280 F 62282 N 62284 F 62290 F 62292 62310 F 62318 N 62319 F 62355 62362 62368 26 63005 63015 63020 63040 63045 63048 63057 63075 63078 63085 63088 63101 *** 2798.97 1982.37 2904.23 1443.31 1737.14 2096.97 2006.50 2126.73 1137.92 1635.40 2296.56 1670.61 3342.00 2515.24 2754.74 3034.31 2487.70 1885.09 2741.18 652.29 1727.86 3058.96 564.10 2100.87 4359.86 3445.14 3265.06 2024.30 1173.92 1241.27 720.31 266.76 1346.99 499.79 472.60 386.72 1379.06 1621.22 1419.25 770.97 1112.32 180.45 1049.39 1461.05 320.36 911.66 741.29 49.15 711.45 235.27 699.23 64.50 193.68 141.66 412.53 86.13 172.32 500.77 96.71 296.18 94.02 351.21 473.90 38.04 1062.70 1358.26 1059.91 1302.40 1163.20 213.33 336.52 1363.39 209.46 1821.36 281.50 2165.32

PROC MOD NOTE PAR FEE ----- -- ---- -------61520 61524 61531 61535 61538 61541 61544 61548 61556 61559 61566 61571 61580 61583 61586 61592 61597 61601 61607 61610 61613 61618 61624 61682 61690 61698 61703 61710 61735 61760 61791 61850 61864 61870 61885 62000 62100 62117 62140 62143 62147 62161 62164 62190 62200 62223 62252 62256 62263 62268 62269 62272 62273 62281 62282 62287 62291 62294 62311 62318 62350 62360 62365 63001 63011 63016 63030 63042 63046 63055 63064 63076 63081 63086 63090 63102 3691.44 1880.52 1031.58 827.65 1842.18 1959.70 1715.07 1469.88 1439.86 2287.06 2080.59 1813.33 2258.38 2638.72 1969.26 2856.44 2616.92 2080.29 2544.72 1788.47 2924.85 1176.23 1083.90 4130.44 1998.08 3300.33 1224.46 1760.45 1425.78 1380.29 1030.33 863.88 299.20 1020.62 479.91 728.50 1507.37 1844.15 947.41 916.94 1329.77 1286.83 1788.71 788.22 1274.33 918.87 92.87 490.46 344.04 602.52 281.06 199.65 109.96 331.24 125.35 549.38 338.76 703.83 252.82 102.40 442.92 213.60 370.09 1098.16 932.68 1339.63 874.67 1233.14 1116.64 1517.78 1694.46 266.52 1645.49 206.56 1871.48 2165.32

LC FEE -------4032.90 2054.46 1127.00 904.21 2012.58 2140.98 1873.72 1605.85 1573.05 2498.62 2273.04 1981.06 2467.28 2882.80 2151.42 3120.66 2858.98 2272.72 2780.10 1953.91 3195.40 1285.03 1184.17 4512.51 2182.91 3605.61 1337.73 1923.29 1557.66 1507.97 1125.63 943.79 326.88 1115.03 524.30 795.89 1646.80 2014.73 1035.05 1001.75 1452.77 1405.86 1954.16 861.13 1392.20 1003.87 101.46 535.83 375.87 658.25 307.06 218.12 120.13 361.88 136.94 600.20 370.09 768.94 276.21 111.87 483.89 233.36 404.33 1199.74 1018.96 1463.55 955.58 1347.20 1219.93 1658.17 1851.20 291.17 1797.70 225.66 2044.60 2365.61

PROC MOD NOTE PAR FEE ----- -- ---- -------61521 61526 61533 61536 61539 61542 61545 61550 61557 61563 61567 61575 61581 61584 61590 61595 61598 61605 61608 61611 61615 61619 61626 61684 61692 61700 61705 61711 61750 61770 61793 61860 61867 61875 61886 62005 62115 62120 62141 62145 62148 62162 62165 62192 62201 62225 62252 TC 62258 62264 N 62268 F 62270 N 62272 F 62280 N 62281 F 62284 N 62290 N 62291 F 62310 N 62311 F 62319 N 62351 62361 62367 26 63003 63012 63017 63035 63043 63047 63056 63066 63077 63082 63087 63091 63103 3006.82 3415.27 1358.62 2402.43 2190.22 2146.93 2982.28 877.02 1578.25 1802.42 2380.42 2283.30 2351.56 2538.96 2886.36 2126.05 2369.61 2080.74 2984.56 496.31 2299.73 1408.66 882.63 2701.72 3470.89 3432.18 2407.12 2464.02 1261.58 1464.64 1196.87 1433.85 2060.04 1008.54 619.91 1055.56 1467.42 1572.60 1039.89 1300.58 126.10 1656.04 1397.11 866.34 1039.19 410.68 43.71 1014.26 477.88 276.97 164.88 81.83 362.96 137.85 252.01 386.64 162.03 264.52 79.97 262.61 731.09 378.63 24.73 1114.20 1091.03 1130.42 205.69 227.41 1047.44 1401.10 215.42 1454.97 287.05 2353.99 190.86 252.61

F N F N F N F N N F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------1315.98 1225.87 1125.06 1232.09 1446.79 2516.25 1422.09 1180.08 1659.63 1537.22 1859.14 1649.62 2380.68 1772.18 1922.93 1931.39 2382.29 381.43 446.06 1121.45 767.76 767.93 418.31 111.98 65.46 149.35 59.66 161.46 169.56 64.07 263.25 84.98 153.44 70.53 149.87 64.39 121.78 72.00 344.86 76.34 154.57 69.86 164.64 116.00 205.92 8.69 200.27 140.27 113.43 309.01 512.15 172.72 446.93 299.42 171.08 111.40 279.15 160.86 373.28 55.25 260.36 147.95 313.95 485.50 445.27 360.70 183.71 343.01 426.83 447.03 373.09 523.77 345.28 221.63 256.24 940.04

M E D I C A R E LC FEE -------1513.38 1409.75 1293.82 1416.90 1663.81 2893.69 1635.40 1357.09 1908.57 1767.80 2138.01 1897.06 2737.78 2038.01 2211.37 2221.10 2739.63 438.64 512.97 1289.67 882.92 883.12 481.06 128.78 75.28 171.75 68.61 185.68 194.99 73.68 302.74 97.73 176.46 81.11 172.35 74.05 140.05 82.80 396.59 87.79 177.76 80.34 189.34 133.40 236.81 9.99 230.31 161.31 130.44 355.36 588.97 198.63 513.97 344.33 196.74 128.11 321.02 184.99 429.27 63.54 299.41 170.14 361.04 558.33 512.06 414.81 211.27 394.46 490.85 514.08 429.05 602.34 397.07 254.87 294.68 1081.05

F E E

S C H E D U L E NPAR FEE -------1175.66 1291.66 1166.71 1492.10 1757.40 2643.00 1471.26 1756.19 1610.47 1375.48 1837.46 2329.94 2417.03 1799.41 2037.76 326.52 417.65 699.62 354.02 1393.44 961.57 516.34 116.52 67.42 112.87 69.45 123.56 71.26 71.25 175.34 81.38 152.52 81.65 164.45 147.66 250.56 61.76 104.81 111.80 350.67 65.09 151.86 60.45 220.09 78.16 190.00 130.68 364.37 522.93 287.80 149.12 465.16 193.61 594.02 114.38 202.60 153.24 127.26 195.81 215.43 165.74 454.83 309.35 655.16 467.36 295.39 320.03 410.61 367.92 744.27 474.25 490.15 183.05 643.73 315.82 183.40

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------1439.82 930.59 1291.49 1395.62 1259.85 2620.46 1196.66 1770.52 1551.58 1359.85 1732.89 2305.50 1601.81 1933.11 1917.00 755.85 1048.92 382.14 1083.04 1561.03 946.06 547.49 56.14 107.07 78.99 145.82 70.17 156.20 148.02 58.63 130.26 75.21 155.94 76.40 95.68 92.24 222.59 47.01 148.13 97.74 97.47 61.66 183.38 67.29 17.90 159.08 189.60 190.38 271.44 702.23 370.07 126.43 540.21 435.33 184.30 124.55 396.14 46.64 141.41 162.05 320.63 211.47 431.80 554.91 364.59 275.42 360.33 380.88 410.90 401.77 546.59 350.93 394.70 1009.96 740.63 556.04

PAGE 029 LC FEE -------1655.79 1070.18 1485.21 1604.96 1448.83 3013.53 1376.16 2036.10 1784.32 1563.83 1992.82 2651.33 1842.08 2223.08 2204.55 869.23 1206.26 439.46 1245.50 1795.18 1087.97 629.61 64.56 123.13 90.84 167.69 80.70 179.63 170.22 67.42 149.80 86.49 179.33 87.86 110.03 106.08 255.98 54.06 170.35 112.40 112.09 70.91 210.89 77.38 20.59 182.94 218.04 218.94 312.16 807.56 425.58 145.39 621.24 500.63 211.95 143.23 455.56 53.64 162.62 186.36 368.72 243.19 496.57 638.15 419.28 316.73 414.38 438.01 472.54 462.04 628.58 403.57 453.91 1161.45 851.72 639.45 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------63170 63180 63190 63195 63198 63250 63265 63268 63272 63276 63280 63283 63287 63301 63304 63307 63610 63650 63685 63702 63707 63740 63746 64402 64405 64410 64412 64415 64417 64418 64421 64425 64435 64445 64448 64450 64472 64475 64479 64480 64484 64505 64510 64517 64530 64550 64555 64560 64565 64577 64585 64590 64600 64605 64612 64613 64620 64622 64626 64627 64640 64680 64702 64712 64716 64721 64727 64736 64742 64752 64761 64771 64776 64783 64787 64792 *** 1385.24 1290.39 1184.27 1296.94 1522.94 2648.68 1496.94 1242.19 1746.98 1618.13 1956.99 1736.44 2505.98 1865.45 2024.14 2033.04 2507.67 401.51 469.54 1180.47 808.17 808.35 440.33 117.87 68.91 157.21 62.80 169.96 178.48 67.44 277.11 89.45 161.52 74.24 157.76 67.78 128.19 75.79 363.01 80.36 162.70 73.54 173.31 122.10 216.76 9.15 210.81 147.65 119.40 325.27 539.11 181.81 470.45 315.18 180.08 117.26 293.84 169.33 392.93 58.16 274.06 155.74 330.47 511.05 468.70 379.68 193.38 361.06 449.29 470.56 392.73 551.34 363.45 233.29 269.73 989.52

PROC MOD NOTE PAR FEE ----- -- ---- -------63172 63182 63191 63196 63199 63251 63266 63270 63273 63277 63281 63285 63290 63302 63305 63308 63610 63655 63688 63704 63709 63741 64400 64402 64408 64410 64413 64415 64417 64420 64421 64430 64435 64446 64449 64470 64472 64476 64479 64483 64484 64508 64510 64520 64530 64553 64555 64561 64573 64580 64585 64595 64600 64610 64612 64614 64620 64623 64626 64630 64640 64681 64704 64713 64718 64722 64732 64738 64744 64755 64763 64772 64778 64784 64788 64795 1237.54 1359.64 1228.12 1570.63 1849.89 2782.10 1548.69 1848.62 1695.23 1447.87 1934.17 2452.57 2544.24 1894.12 2145.01 343.71 439.63 736.44 372.65 1466.78 1012.18 543.52 122.65 70.97 118.81 73.10 130.06 75.01 75.00 184.57 85.66 160.55 85.95 173.10 155.43 263.75 65.01 110.33 117.68 369.13 68.52 159.85 63.63 231.67 82.27 200.00 137.56 383.55 550.45 302.95 156.97 489.64 203.80 625.28 120.40 213.26 161.30 133.96 206.12 226.77 174.46 478.77 325.63 689.64 491.96 310.94 336.87 432.22 387.28 783.44 499.21 515.95 192.68 677.61 332.44 193.05

LC FEE -------1352.01 1485.41 1341.72 1715.92 2021.01 3039.45 1691.95 2019.62 1852.04 1581.80 2113.08 2679.43 2779.58 2069.32 2343.42 375.50 480.30 804.56 407.12 1602.46 1105.81 593.79 134.00 77.53 129.80 79.87 142.09 81.95 81.94 201.64 93.59 175.40 93.90 189.12 169.81 288.14 71.02 120.53 128.57 403.27 74.85 174.64 69.52 253.10 89.88 218.50 150.28 419.03 601.37 330.97 171.49 534.93 222.65 683.12 131.54 232.99 176.23 146.35 225.18 247.74 190.60 523.05 355.75 753.43 537.46 339.70 368.03 472.20 423.11 855.91 545.39 563.67 210.51 740.29 363.19 210.91

PROC MOD NOTE PAR FEE ----- -- ---- -------63173 63185 63194 63197 63200 63252 63267 63271 63275 63278 63282 63286 63300 63303 63306 63600 63615 63660 63700 63706 63710 63744 64400 64405 64408 64412 64413 64416 64418 64420 64425 64430 64445 64447 64450 64470 64475 64476 64480 64483 64505 64508 64517 64520 64550 64553 64560 64565 64575 64581 64590 64595 64605 64610 64613 64614 64622 64623 64627 64630 64680 64681 64708 64714 64719 64726 64734 64740 64746 64760 64766 64774 64782 64786 64790 64802 1515.60 979.57 1359.46 1469.07 1326.16 2758.38 1259.64 1863.71 1633.24 1431.42 1824.09 2426.84 1686.12 2034.85 2017.89 795.63 1104.13 402.25 1140.04 1643.19 995.85 576.30 59.09 112.71 83.15 153.49 73.86 164.42 155.81 61.72 137.12 79.17 164.15 80.42 100.72 97.09 234.30 49.48 155.93 102.88 102.60 64.90 193.03 70.83 18.84 167.45 199.58 200.40 285.73 739.19 389.55 133.08 568.64 458.24 194.00 131.10 416.99 49.09 148.85 170.58 337.51 222.60 454.53 584.12 383.78 289.92 379.29 400.93 432.53 422.92 575.36 369.40 415.47 1063.12 779.61 585.30

N

F

N F N F N N F N F N F F N F N F N F N F N F N F F N F N F N F N F N F N F

N F N F N F F N F N F N F N F N F N F N F N F F N F N F N F N F N F N

F N F N F N F N F N N F N F N F N F N F N F N N N F N F N F N F N F N F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------865.89 683.17 722.57 677.86 377.71 948.24 1228.68 969.09 943.45 184.70 985.10 998.71 1159.19 692.17 602.07 685.89 1252.29 227.91 702.52 592.61 58.99 34.32 552.98 213.12 336.08 589.74 484.32 503.71 434.83 438.48 83.57 350.51 335.67 974.47 1189.13 488.86 983.36 156.05 498.62 741.80 277.41 499.17 837.05 147.49 99.53 676.47 658.71 974.61 760.10 327.71 901.48 505.50 507.67 372.20 349.70 357.65 328.14 408.21 681.70 629.10 699.67 568.35 802.95 440.85 534.76 334.88 313.02 1384.32 646.56 508.93 898.46 448.99 813.80 414.45 450.60 1211.36

M E D I C A R E LC FEE -------995.77 785.65 830.96 779.54 434.37 1090.48 1412.98 1114.45 1084.97 212.41 1132.87 1148.52 1333.07 796.00 692.38 788.77 1440.13 262.10 807.90 681.50 67.84 39.47 635.93 245.09 386.49 678.20 556.97 579.27 500.05 504.25 96.11 403.09 386.02 1120.64 1367.50 562.19 1130.86 179.46 573.41 853.07 319.02 574.05 962.61 169.61 114.46 777.94 757.52 1120.80 874.12 376.87 1036.70 581.33 583.82 428.03 402.16 411.30 377.36 469.44 783.96 723.47 804.62 653.60 923.39 506.98 614.97 385.11 359.97 1591.97 743.54 585.27 1033.23 516.34 935.87 476.62 518.19 1393.06

F E E

S C H E D U L E NPAR FEE -------746.20 626.44 646.32 732.03 810.00 1102.52 1241.70 969.09 121.78 1095.56 919.53 1133.33 1247.93 882.62 631.16 744.79 1300.68 646.83 578.29 49.12 42.79 63.32 834.20 154.58 371.76 942.74 444.01 118.87 405.75 237.80 49.32 389.54 242.89 1057.48 425.19 748.02 156.05 115.92 466.22 337.46 253.84 520.32 637.37 118.40 565.75 673.56 917.20 608.86 507.85 352.41 451.81 480.04 376.95 321.77 378.10 309.05 417.91 235.61 570.16 678.14 631.83 666.86 82.40 545.76 880.92 137.16 289.08 1009.61 582.49 1031.84 672.40 678.32 462.45 384.26 563.05 857.56

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------611.47 623.49 340.31 729.64 904.70 254.73 796.92 890.13 178.16 1288.84 921.76 1219.98 603.47 1212.41 658.68 1069.47 458.77 660.31 755.84 34.03 49.79 45.28 941.54 357.07 412.32 517.46 546.42 79.48 473.46 79.85 373.70 356.77 919.99 1049.85 399.78 1140.45 115.55 479.99 699.07 295.12 449.94 550.76 565.61 128.62 545.14 775.88 1124.10 615.33 464.77 655.58 425.31 427.29 329.46 389.47 335.02 379.69 369.31 231.92 555.68 607.93 875.88 591.73 376.25 782.17 734.01 433.25 792.96 1166.18 573.73 1412.26 1173.11 480.61 434.83 471.59 546.11 820.36

PAGE 030 LC FEE -------703.19 717.01 391.36 839.09 1040.41 292.94 916.46 1023.65 204.88 1482.17 1060.02 1402.98 693.99 1394.27 757.48 1229.89 527.59 759.36 869.22 39.13 57.26 52.07 1082.77 410.63 474.17 595.08 628.38 91.40 544.48 91.83 429.76 410.29 1057.99 1207.33 459.75 1311.52 132.88 551.99 803.93 339.39 517.43 633.37 650.45 147.91 626.91 892.26 1292.72 707.63 534.49 753.92 489.11 491.38 378.88 447.89 385.27 436.64 424.71 266.71 639.03 699.12 1007.26 680.49 432.69 899.50 844.11 498.24 911.90 1341.11 659.79 1624.10 1349.08 552.70 500.05 542.33 628.03 943.41 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------64804 64820 64823 64834 64837 64857 64861 64865 64870 64876 64890 64893 64897 64902 65091 65103 65112 65125 65140 65175 65210 65220 65235 65270 65272 65280 65286 65400 65420 65426 65435 65436 65600 65730 65770 65775 65782 65805 65815 65850 65860 65870 65900 66020 66030 66150 66165 66180 66225 66500 66605 66630 66682 66710 66720 66761 66762 66820 66825 66850 66930 66983 66986 67010 67025 67028 67031 67038 67101 67105 67110 67115 67121 67145 67208 67218 *** 911.46 719.13 760.60 713.54 397.59 998.15 1293.35 1020.09 993.11 194.42 1036.95 1051.27 1220.20 728.60 633.76 721.99 1318.20 239.91 739.49 623.80 62.09 36.13 582.08 224.34 353.77 620.78 509.81 530.22 457.72 461.56 87.97 368.96 353.34 1025.76 1251.72 514.59 1035.12 164.26 524.86 780.84 292.01 525.44 881.11 155.25 104.77 712.07 693.38 1025.91 800.11 344.96 948.93 532.10 534.39 391.79 368.11 376.47 345.41 429.69 717.58 662.21 736.49 598.26 845.21 464.05 562.90 352.50 329.49 1457.18 680.59 535.72 945.75 472.62 856.63 436.26 474.32 1275.12

PROC MOD NOTE PAR FEE ----- -- ---- -------64809 64821 64831 64835 64840 64858 64862 64866 64872 64885 64891 64895 64898 64905 65093 65105 65114 65130 65150 65205 65210 65222 65260 65270 65273 65285 65290 65410 65420 65430 65435 65450 65600 65750 65772 65780 65800 65805 65815 65855 65860 65875 65920 66020 66130 66155 66170 66185 66250 66505 66625 66635 66700 66710 66740 66761 66770 66821 66830 66852 66940 66984 66990 67015 67027 67028 67031 67039 67101 67107 67110 67120 67141 67145 67210 67220 785.47 659.41 680.34 770.56 852.63 1160.55 1307.05 1020.09 128.19 1153.22 967.93 1192.98 1313.61 929.07 664.38 783.99 1369.14 680.87 608.73 51.71 45.04 66.65 878.11 162.72 391.33 992.36 467.38 125.13 427.10 250.32 51.92 410.04 255.67 1113.14 447.57 787.39 164.26 122.02 490.76 355.22 267.20 547.71 670.92 124.63 595.53 709.01 965.47 640.90 534.58 370.96 475.59 505.30 396.79 338.70 398.00 325.32 439.91 248.01 600.17 713.83 665.08 701.96 86.74 574.48 927.28 144.38 304.29 1062.75 613.15 1086.15 707.79 714.02 486.79 404.48 592.68 902.69

LC FEE -------858.13 720.41 743.27 841.83 931.50 1267.90 1427.96 1114.45 140.05 1259.89 1057.46 1303.33 1435.12 1015.01 725.83 856.51 1495.78 743.85 665.03 56.49 49.21 72.82 959.33 177.77 427.52 1084.15 510.61 136.70 466.61 273.47 56.72 447.97 279.32 1216.10 488.97 860.22 179.46 133.31 536.15 388.08 291.92 598.37 732.98 136.16 650.61 774.59 1054.78 700.19 584.03 405.27 519.58 552.05 433.49 370.04 434.82 355.41 480.60 270.95 655.68 779.86 726.60 766.89 94.76 627.62 1013.06 157.73 332.44 1161.05 669.86 1186.62 773.26 780.07 531.82 441.90 647.51 986.19

PROC MOD NOTE PAR FEE ----- -- ---- -------64818 64822 64832 64836 64856 64859 64864 64868 64874 64886 64892 64896 64901 64907 65101 65110 65125 65135 65155 65205 65220 65222 65265 65272 65275 65286 65400 65410 65426 65430 65436 65450 65710 65755 65772 65781 65800 65810 65820 65855 65865 65880 65930 66030 66130 66160 66172 66220 66250 66600 66625 66680 66700 66720 66740 66762 66770 66821 66840 66920 66982 66985 67005 67025 67027 67030 67036 67040 67105 67108 67112 67120 67141 67208 67210 67220 643.65 656.31 358.22 768.04 952.32 268.14 838.86 936.98 187.54 1356.67 970.27 1284.19 635.23 1276.22 693.35 1125.76 482.92 695.06 795.62 35.82 52.41 47.66 991.09 375.86 434.02 544.69 575.18 83.66 498.38 84.05 393.37 375.55 968.41 1105.11 420.82 1200.47 121.63 505.25 735.86 310.65 473.62 579.75 595.38 135.39 573.83 816.72 1183.26 647.72 489.23 690.08 447.69 449.78 346.80 409.97 352.65 399.67 388.75 244.13 584.93 639.93 921.98 622.87 396.05 823.34 772.64 456.05 834.69 1227.56 603.93 1486.59 1234.85 505.90 457.72 496.41 574.85 863.54

N F N F N N N F N F N F F F F N F F F F N F N F F

F N F N F F F N F N F N

N F N F N F N F N F N N F F N F F N N N N F N F N N

N N N N F

N F N F

F N N N F N N F

N F F F F N N F N N

N F N F F N F F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------323.82 25.45 879.22 738.99 551.17 235.55 216.70 547.96 178.07 838.14 95.72 1066.03 60.45 39.08 840.26 229.41 58.10 144.33 105.26 336.76 74.76 92.06 394.00 286.97 74.03 596.88 466.58 661.16 500.57 518.45 429.33 408.62 411.31 410.35 463.80 244.60 553.62 245.93 264.39 464.20 557.48 829.02 261.42 45.72 289.86 131.03 265.15 26.88 513.34 448.72 555.23 370.28 344.03 173.04 796.22 251.50 486.39 938.52 115.09 648.07 177.48 514.73 157.53 421.94 82.59 165.09 150.80 95.05 61.45 304.33 197.88 115.65 46.94 59.61 402.89 118.16

M E D I C A R E LC FEE -------372.39 29.27 1011.10 849.84 633.85 270.88 249.21 630.15 204.78 963.86 110.08 1225.93 69.52 44.94 966.30 263.82 66.82 165.98 121.05 387.27 85.97 105.87 453.10 330.02 85.13 686.41 536.57 760.33 575.66 596.22 493.73 469.91 473.01 471.90 533.37 281.29 636.66 282.82 304.05 533.83 641.10 953.37 300.63 52.58 333.34 150.68 304.92 30.91 590.34 516.03 638.51 425.82 395.63 199.00 915.65 289.23 559.35 1079.30 132.35 745.28 204.10 591.94 181.16 485.23 94.98 189.85 173.42 109.31 70.67 349.98 227.56 133.00 53.98 68.55 463.32 135.88

F E E

S C H E D U L E NPAR FEE -------217.78 483.08 790.49 487.74 667.97 223.93 135.38 273.01 830.87 825.94 1449.83 1124.65 37.26 52.94 855.95 74.03 214.80 77.69 286.17 190.29 47.51 339.61 273.06 133.44 499.20 394.00 500.94 492.54 597.80 402.48 422.12 481.59 215.44 585.07 266.46 640.05 426.60 654.71 71.10 591.49 459.17 823.00 76.96 235.67 118.28 485.48 102.42 443.90 501.69 404.91 333.21 561.25 138.96 217.21 829.52 571.27 243.39 517.96 643.44 212.20 87.65 70.30 105.98 220.17 631.17 107.65 202.22 45.34 283.65 557.04 892.75 51.22 32.58 193.84 728.93 57.04

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------26.92 446.62 709.27 600.77 577.44 244.25 267.88 162.93 709.35 937.34 1105.68 1093.47 65.22 33.06 1082.91 222.32 68.99 268.00 123.79 80.95 110.47 136.00 114.00 310.77 301.48 621.59 505.99 696.45 483.66 549.73 964.94 284.62 634.58 454.00 405.50 439.39 447.32 455.53 526.05 425.81 638.69 601.36 209.57 73.66 294.14 343.36 44.92 401.56 570.56 521.58 407.84 354.13 378.86 53.73 484.20 241.71 761.41 278.57 630.01 110.58 734.53 57.79 175.96 107.64 41.33 191.67 132.63 118.14 245.36 233.60 1345.06 96.80 117.42 129.04 1104.82 72.33

PAGE 031 LC FEE -------30.96 513.61 815.66 690.89 664.06 280.89 308.06 187.37 815.75 1077.94 1271.53 1257.49 75.00 38.02 1245.35 255.67 79.34 308.20 142.36 93.09 127.04 156.40 131.10 357.39 346.70 714.83 581.89 800.92 556.21 632.19 1109.68 327.31 729.77 522.10 466.33 505.30 514.42 523.86 604.96 489.68 734.49 691.56 241.01 84.71 338.26 394.86 51.66 461.79 656.14 599.82 469.02 407.25 435.69 61.79 556.83 277.97 875.62 320.36 724.51 127.17 844.71 66.46 202.35 123.79 47.53 220.42 152.52 135.86 282.16 268.64 1546.82 111.32 135.03 148.40 1270.54 83.18 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------67221 67225 67228 67255 67314 67320 67334 67343 67350 67412 67415 67440 67500 67505 67550 67700 67710 67800 67801 67808 67820 67825 67835 67850 67875 67882 67900 67903 67904 67908 67909 67912 67915 67916 67921 67922 67924 67930 67938 67950 67966 67973 68020 68040 68110 68115 68135 68200 68325 68330 68340 68360 68400 68420 68500 68510 68530 68550 68705 68750 68761 68770 68810 68815 68840 69000 69005 69100 69105 69120 69145 69200 69210 69220 69300 69400 *** N F N 340.86 26.79 925.49 777.88 580.18 247.95 228.10 576.80 187.44 882.25 100.76 1122.14 63.63 41.14 884.48 241.48 61.16 151.93 110.80 354.48 78.69 96.90 414.74 302.07 77.93 628.29 491.14 695.96 526.92 545.74 451.93 430.13 432.96 431.95 488.21 257.47 582.76 258.87 278.31 488.63 586.82 872.65 275.18 48.13 305.12 137.93 279.11 28.29 540.36 472.34 584.45 389.77 362.14 182.15 838.13 264.74 511.99 987.92 121.15 682.18 186.82 541.82 165.82 444.15 86.94 173.78 158.74 100.05 64.68 320.35 208.29 121.74 49.41 62.75 424.09 124.38

PROC MOD NOTE PAR FEE ----- -- ---- -------67221 67227 67228 67311 67316 67331 67335 67345 67400 67413 67420 67445 67500 67515 67560 67700 67715 67800 67805 67810 67820 67830 67840 67850 67880 67882 67901 67903 67906 67908 67911 67914 67915 67917 67921 67923 67924 67935 67938 67961 67966 67974 68020 68100 68110 68130 68135 68320 68326 68330 68340 68362 68400 68440 68505 68520 68530 68700 68720 68760 68761 68801 68810 68815 68850 69000 69020 69100 69110 69140 69150 69200 69210 69222 69310 69400 F N F 229.24 508.50 832.09 513.41 703.13 235.72 142.50 287.38 874.60 869.41 1526.14 1183.84 39.22 55.73 901.00 77.93 226.10 81.78 301.23 200.31 50.01 357.48 287.43 140.46 525.47 414.74 527.31 518.46 629.26 423.66 444.34 506.94 226.78 615.86 280.48 673.74 449.05 689.17 74.84 622.62 483.34 866.32 81.01 248.07 124.51 511.03 107.81 467.26 528.09 426.22 350.75 590.79 146.27 228.64 873.18 601.34 256.20 545.22 677.30 223.37 92.26 74.00 111.56 231.76 664.39 113.32 212.86 47.73 298.58 586.36 939.74 53.92 34.29 204.04 767.29 60.04

LC FEE -------250.45 555.54 909.06 560.90 768.17 257.52 155.69 313.96 955.50 949.83 1667.30 1293.35 42.85 60.88 984.34 85.13 247.02 89.34 329.10 218.83 54.64 390.55 314.02 153.46 574.08 453.10 576.08 566.42 687.47 462.85 485.44 553.83 247.76 672.83 306.43 736.06 490.59 752.92 81.77 680.21 528.05 946.45 88.50 271.02 136.02 558.30 117.78 510.49 576.94 465.65 383.19 645.44 159.80 249.79 953.95 656.96 279.90 595.65 739.96 244.03 100.80 80.85 121.88 253.20 725.85 123.80 232.55 52.14 326.20 640.60 1026.66 58.90 37.47 222.92 838.27 65.60

PROC MOD NOTE PAR FEE ----- -- ---- -------67225 67227 67250 67312 67318 67332 67340 67345 67405 67414 67430 67450 67505 67515 67570 67710 67715 67801 67805 67810 67825 67830 67840 67875 67880 67900 67902 67904 67906 67909 67912 67914 67916 67917 67922 67923 67930 67935 67950 67961 67971 67975 68040 68100 68115 68130 68200 68320 68328 68335 68360 68371 68420 68440 68510 68525 68540 68705 68745 68760 68770 68801 68811 68840 68850 69005 69020 69105 69110 69145 69155 69205 69220 69222 69320 69401 N F 28.34 470.13 746.60 632.39 607.83 257.11 281.98 171.50 746.68 986.67 1163.87 1151.02 68.65 34.80 1139.91 234.02 72.62 282.10 130.31 85.21 116.28 143.16 120.00 327.13 317.35 654.30 532.62 733.10 509.12 578.66 1015.73 299.60 667.98 477.89 426.84 462.52 470.86 479.50 553.74 448.22 672.31 633.01 220.60 77.54 309.62 361.43 47.28 422.69 600.59 549.03 429.30 372.77 398.80 56.56 509.68 254.43 801.48 293.23 663.17 116.40 773.19 60.83 185.22 113.30 43.51 201.76 139.61 124.36 258.27 245.89 1415.85 101.89 123.60 135.83 1162.97 76.14

N

F

N F N F N F N F N F N F N F N F F N F N F N F N F N N F N F N F N N F N F F N F N F N N F N F N F F N N F N

F N F N F N N F N N F N F F N F N F N F N F N F N F F N F N F N F F F N F N F N F F N F N F N F F N F

N F N F N F F N F F N F N N F N N F N F N F N F N F N F N F N F N N F N N F N F N F N F N F N N F N

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------48.40 88.09 110.30 58.13 158.34 613.80 889.87 182.58 1233.52 894.74 1191.33 454.50 854.23 1003.60 1101.54 1069.49 780.24 655.22 651.63 910.72 1174.16 1003.26 863.11 688.45 887.35 1633.26 1853.74 167.06 52.72 15.76 19.81 24.15 24.15 30.74 28.90 24.15 30.74 19.81 36.96 24.15 30.74 24.15 30.74 15.76 24.15 34.75 10.60 15.76 30.74 18.71 32.95 81.28 433.32 14.29 22.31 15.76 50.54 81.28 69.54 25.99 69.54 182.77 218.67 273.63 182.77 218.67 273.63 182.77 218.67 273.63 182.77 218.67 273.63 411.27 411.27 426.72

M E D I C A R E LC FEE -------55.66 101.30 126.85 66.85 182.09 705.87 1023.35 209.97 1418.55 1028.95 1370.03 522.68 982.36 1154.14 1266.77 1229.91 897.28 753.50 749.37 1047.33 1350.28 1153.75 992.58 791.72 1020.45 1878.25 2131.80 192.12 60.63 18.12 22.78 27.77 27.77 35.35 33.24 27.77 35.35 22.78 42.50 27.77 35.35 27.77 35.35 18.12 27.77 39.96 12.19 18.12 35.35 21.52 37.89 93.47 498.32 16.43 25.66 18.12 58.12 93.47 79.97 29.89 79.97 210.19 251.47 314.67 210.19 251.47 314.67 210.19 251.47 314.67 210.19 251.47 314.67 472.96 472.96 490.73

F E E

S C H E D U L E NPAR FEE -------230.64 30.29 144.88 173.11 526.14 822.91 1225.41 118.15 2060.32 921.04 370.74 394.85 816.19 997.07 1007.55 1165.64 1020.80 656.50 535.61 1167.80 956.43 1060.83 908.07 650.69 1350.17 1700.01 214.04 59.76 59.44 8.69 9.05 12.33 9.05 16.69 16.69 9.42 13.06 8.69 14.88 10.52 13.78 8.69 12.33 9.42 11.97 16.69 5.80 9.07 11.24 9.05 11.97 27.58 73.91 9.06 10.52 8.69 15.97 42.38 22.12 8.69 19.21 42.74 56.53 63.40 64.13 68.86 72.12 56.89 64.86 70.67 64.13 68.86 72.12 87.67 87.67 66.74

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------186.83 165.53 111.88 120.46 401.71 856.51 2233.31 734.95 883.98 919.32 292.69 673.15 862.06 843.58 1105.07 649.01 998.64 764.90 698.89 936.33 1608.35 584.16 818.50 737.57 1090.08 1701.96 226.82 112.15 24.45 28.86 36.48 33.20 47.43 45.59 33.57 43.80 28.50 51.83 34.67 44.53 32.84 43.06 25.18 36.12 51.44 16.40 24.82 41.98 27.76 44.92 108.86 507.23 23.35 32.82 24.45 66.51 123.66 91.66 34.68 88.75 225.52 275.20 337.03 246.91 287.53 345.76 239.67 283.52 344.30 246.91 287.53 345.76 498.93 498.93 493.46 592.36

PAGE 032 LC FEE -------214.85 190.36 128.66 138.53 461.97 984.99 2568.31 845.19 1016.58 1057.22 336.59 774.12 991.37 970.12 1270.83 746.36 1148.44 879.64 803.72 1076.78 1849.60 671.78 941.28 848.21 1253.59 1957.25 260.84 128.97 28.12 33.19 41.95 38.18 54.54 52.43 38.61 50.37 32.78 59.60 39.87 51.21 37.77 49.52 28.96 41.54 59.16 18.86 28.54 48.28 31.92 51.66 125.19 583.31 26.85 37.74 28.12 76.49 142.21 105.41 39.88 102.06 259.35 316.48 387.58 283.95 330.66 397.62 275.62 326.05 395.95 283.95 330.66 397.62 573.77 573.77 567.48 681.21 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------69401 69410 69420 69424 69436 69501 69511 69540 69552 69602 69605 69620 69632 69636 69642 69645 69660 69666 69676 69714 69718 69740 69802 69820 69910 69950 69970 70010 70015 70030 70100 70110 70120 70130 70134 70140 70150 70160 70170 70190 70200 70210 70220 70240 70250 70260 70300 70310 70320 70328 70330 70332 70336 70350 70355 70360 70370 70371 70373 70380 70390 70450 70460 70470 70480 70481 70482 70486 70487 70488 70490 70491 70492 70496 70498 70540 *** F N F F N N 50.95 92.73 116.11 61.19 166.67 646.11 936.71 192.19 1298.44 941.83 1254.03 478.42 899.19 1056.42 1159.52 1125.78 821.30 689.70 685.93 958.65 1235.96 1056.06 908.54 724.68 934.05 1719.22 1951.30 175.85 55.49 16.59 20.85 25.42 25.42 32.36 30.42 25.42 32.36 20.85 38.90 25.42 32.36 25.42 32.36 16.59 25.42 36.58 11.16 16.59 32.36 19.69 34.68 85.56 456.13 15.04 23.48 16.59 53.20 85.56 73.20 27.36 73.20 192.39 230.18 288.03 192.39 230.18 288.03 192.39 230.18 288.03 192.39 230.18 288.03 432.92 432.92 449.18

PROC MOD NOTE PAR FEE ----- -- ---- -------69405 69410 69421 69433 69440 69502 69530 69540 69554 69603 69610 69620 69633 69637 69643 69646 69661 69667 69700 69715 69720 69745 69805 69840 69915 69955 69990 70010 70015 70030 70100 70110 70120 70130 70134 70140 70150 70160 70170 70190 70200 70210 70220 70240 70250 70260 70300 70310 70320 70328 70330 70332 70336 70350 70355 70360 70370 70371 70373 70380 70390 70450 70460 70470 70480 70481 70482 70486 70487 70488 70490 70491 70492 70496 70498 70540 N F N F N F 242.78 31.88 152.51 182.22 553.83 866.22 1289.90 124.37 2168.76 969.52 390.25 415.63 859.15 1049.55 1060.58 1226.99 1074.53 691.05 563.80 1229.26 1006.77 1116.66 955.86 684.94 1421.23 1789.48 225.30 62.91 62.57 9.15 9.53 12.98 9.53 17.57 17.57 9.92 13.75 9.15 15.66 11.07 14.51 9.15 12.98 9.92 12.60 17.57 6.10 9.55 11.83 9.53 12.60 29.03 77.80 9.54 11.07 9.15 16.81 44.61 23.28 9.15 20.22 44.99 59.50 66.74 67.51 72.48 75.92 59.88 68.27 74.39 67.51 72.48 75.92 92.28 92.28 70.25

LC FEE -------265.24 34.83 166.61 199.08 605.06 946.35 1409.22 135.87 2369.37 1059.20 426.35 454.08 938.62 1146.63 1158.68 1340.49 1173.92 754.98 615.95 1342.97 1099.89 1219.95 1044.28 748.29 1552.70 1955.01 246.15 68.72 68.36 9.99 10.41 14.18 10.41 19.19 19.19 10.83 15.02 9.99 17.11 12.10 15.85 9.99 14.18 10.83 13.77 19.19 6.67 10.43 12.93 10.41 13.77 31.72 85.00 10.42 12.10 9.99 18.37 48.74 25.44 9.99 22.09 49.15 65.01 72.91 73.75 79.19 82.94 65.42 74.59 81.27 73.75 79.19 82.94 100.82 100.82 76.75

PROC MOD NOTE PAR FEE ----- -- ---- -------69405 69420 69424 69433 69450 69505 69535 69550 69601 69604 69610 69631 69635 69641 69644 69650 69662 69670 69711 69717 69725 69801 69806 69905 69930 69960 70010 70015 70030 70100 70110 70120 70130 70134 70140 70150 70160 70170 70190 70200 70210 70220 70240 70250 70260 70300 70310 70320 70328 70330 70332 70336 70350 70355 70360 70370 70371 70373 70380 70390 70450 70460 70470 70480 70481 70482 70486 70487 70488 70490 70491 70492 70496 70498 70540 70542 F N N F 196.66 174.24 117.77 126.80 422.85 901.59 2350.85 773.63 930.50 967.71 308.09 708.58 907.43 887.98 1163.23 683.17 1051.20 805.16 735.67 985.61 1693.00 614.90 861.58 776.39 1147.45 1791.54 238.76 118.05 25.74 30.38 38.40 34.95 49.93 47.99 35.34 46.10 30.00 54.56 36.49 46.87 34.57 45.33 26.50 38.02 54.15 17.26 26.13 44.19 29.22 47.28 114.59 533.93 24.58 34.55 25.74 70.01 130.17 96.48 36.51 93.42 237.39 289.68 354.77 259.90 302.66 363.96 252.28 298.44 362.42 259.90 302.66 363.96 525.19 525.19 519.43 623.54

F

TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC

26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------512.20 947.46 433.32 433.32 847.53 433.32 433.32 847.53 433.32 519.79 962.99 158.95 17.96 19.81 24.15 28.90 28.90 30.74 30.74 55.66 19.81 56.39 85.66 65.85 22.31 25.99 30.74 34.75 25.25 27.46 228.57 273.63 342.14 470.16 428.70 513.86 942.18 433.32 39.90 15.76 23.41 34.75 43.59 18.71 25.25 28.90 35.48 25.99 25.99 25.99 35.48 45.80 34.75 228.57 273.63 342.14 228.57 273.63 342.14 228.57 273.63 342.14 433.32 519.79 480.62 519.79 480.62 519.79 962.99 962.99 962.99 19.81 25.99 457.27 228.57 264.83

M E D I C A R E LC FEE -------589.03 1089.58 498.32 498.32 974.66 498.32 498.32 974.66 498.32 597.76 1107.44 182.79 20.65 22.78 27.77 33.24 33.24 35.35 35.35 64.01 22.78 64.85 98.51 75.73 25.66 29.89 35.35 39.96 29.04 31.58 262.86 314.67 393.46 540.68 493.01 590.94 1083.51 498.32 45.89 18.12 26.92 39.96 50.13 21.52 29.04 33.24 40.80 29.89 29.89 29.89 40.80 52.67 39.96 262.86 314.67 393.46 262.86 314.67 393.46 262.86 314.67 393.46 498.32 597.76 552.71 597.76 552.71 597.76 1107.44 1107.44 1107.44 22.78 29.89 525.86 262.86 304.55

F E E

S C H E D U L E NPAR FEE -------80.16 106.65 59.80 59.80 90.21 59.80 59.80 90.21 74.28 89.49 118.15 159.62 9.05 10.52 10.88 13.42 15.57 19.21 15.24 23.21 9.05 29.32 37.33 27.95 10.88 13.42 13.42 15.97 10.15 10.88 57.98 61.62 68.86 95.04 72.20 85.95 112.39 90.94 23.14 7.60 10.88 15.57 18.12 11.57 10.88 10.88 10.88 11.20 14.12 11.20 15.57 18.77 11.20 57.98 60.52 63.40 57.98 60.52 63.40 57.98 61.22 63.77 80.10 97.10 79.73 96.73 74.28 90.18 128.66 128.66 118.48 8.69 10.52 89.96 54.71 57.98

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------1054.11 493.13 493.13 937.75 493.13 493.13 937.75 507.60 609.28 1081.14 143.74 27.03 30.31 35.03 42.32 44.47 49.95 45.98 78.87 28.86 85.72 122.99 93.80 33.18 39.42 44.16 50.72 35.41 38.33 286.55 335.25 411.00 565.20 500.90 599.80 1054.58 524.27 63.04 23.36 34.29 50.32 61.70 30.28 36.13 39.77 46.36 37.19 40.10 37.19 51.05 64.57 45.95 286.55 334.15 405.54 286.55 334.15 405.54 286.55 334.85 405.91 513.43 616.89 560.36 616.53 554.91 609.99 1091.65 1091.65 1081.46 28.50 36.50 547.23 283.28 322.81 388.79

PAGE 033 LC FEE -------1212.23 567.10 567.10 1078.41 567.10 567.10 1078.41 583.74 700.67 1243.31 165.30 31.08 34.86 40.28 48.67 51.14 57.44 52.88 90.70 33.19 98.58 141.44 107.87 38.16 45.33 50.78 58.33 40.72 44.08 329.53 385.54 472.65 649.98 576.04 689.77 1212.77 602.91 72.50 26.86 39.43 57.87 70.96 34.82 41.55 45.74 53.31 42.77 46.12 42.77 58.71 74.26 52.84 329.53 384.27 466.37 329.53 384.27 466.37 329.53 385.08 466.80 590.44 709.42 644.41 709.01 638.15 701.49 1255.40 1255.40 1243.68 32.78 41.98 629.31 325.77 371.23 447.11 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------70542 70543 70544 70545 70546 70547 70548 70549 70551 70552 70553 70558 71010 71015 71020 71021 71022 71023 71030 71034 71035 71040 71060 71090 71100 71101 71110 71111 71120 71130 71250 71260 71270 71275 71550 71551 71552 71555 72010 72020 72040 72050 72052 72069 72070 72072 72074 72080 72090 72100 72110 72114 72120 72125 72126 72127 72128 72129 72130 72131 72132 72133 72141 72142 72146 72147 72148 72149 72156 72157 72158 72170 72190 72191 72192 72193 *** TC TC TC TC TC TC TC TC TC TC TC 26 TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC 539.16 997.33 456.13 456.13 892.14 456.13 456.13 892.14 456.13 547.15 1013.67 167.32 18.91 20.85 25.42 30.42 30.42 32.36 32.36 58.59 20.85 59.36 90.17 69.32 23.48 27.36 32.36 36.58 26.58 28.91 240.60 288.03 360.15 494.91 451.26 540.90 991.77 456.13 42.00 16.59 24.64 36.58 45.88 19.69 26.58 30.42 37.35 27.36 27.36 27.36 37.35 48.21 36.58 240.60 288.03 360.15 240.60 288.03 360.15 240.60 288.03 360.15 456.13 547.15 505.92 547.15 505.92 547.15 1013.67 1013.67 1013.67 20.85 27.36 481.34 240.60 278.77

PROC MOD NOTE PAR FEE ----- -- ---- -------70542 70543 70544 70545 70546 70547 70548 70549 70551 70552 70553 70559 71010 71015 71020 71021 71022 71023 71030 71034 71035 71040 71060 71090 71100 71101 71110 71111 71120 71130 71250 71260 71270 71275 71550 71551 71552 71555 72010 72020 72040 72050 72052 72069 72070 72072 72074 72080 72090 72100 72110 72114 72120 72125 72126 72127 72128 72129 72130 72131 72132 72133 72141 72142 72146 72147 72148 72149 72156 72157 72158 72170 72190 72191 72192 72193 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 84.38 112.26 62.95 62.95 94.96 62.95 62.95 94.96 78.19 94.20 124.37 168.02 9.53 11.07 11.45 14.13 16.39 20.22 16.04 24.43 9.53 30.86 39.29 29.42 11.45 14.13 14.13 16.81 10.68 11.45 61.03 64.86 72.48 100.04 76.00 90.47 118.31 95.73 24.36 8.00 11.45 16.39 19.07 12.18 11.45 11.45 11.45 11.79 14.86 11.79 16.39 19.76 11.79 61.03 63.71 66.74 61.03 63.71 66.74 61.03 64.44 67.13 84.32 102.21 83.93 101.82 78.19 94.93 135.43 135.43 124.72 9.15 11.07 94.69 57.59 61.03

LC FEE -------92.18 122.65 68.77 68.77 103.74 68.77 68.77 103.74 85.42 102.91 135.87 183.56 10.41 12.10 12.51 15.43 17.91 22.09 17.53 26.69 10.41 33.72 42.93 32.14 12.51 15.43 15.43 18.37 11.67 12.51 66.68 70.86 79.19 109.30 83.03 98.84 129.25 104.58 26.61 8.74 12.51 17.91 20.84 13.31 12.51 12.51 12.51 12.88 16.24 12.88 17.91 21.59 12.88 66.68 69.60 72.91 66.68 69.60 72.91 66.68 70.40 73.34 92.12 111.67 91.69 111.24 85.42 103.71 147.96 147.96 136.25 9.99 12.10 103.45 62.92 66.68

PROC MOD NOTE PAR FEE ----- -- ---- -------70543 70544 70545 70546 70547 70548 70549 70551 70552 70553 70557 26 71010 71015 71020 71021 71022 71023 71030 71034 71035 71040 71060 71090 71100 71101 71110 71111 71120 71130 71250 71260 71270 71275 71550 71551 71552 71555 72010 72020 72040 72050 72052 72069 72070 72072 72074 72080 72090 72100 72110 72114 72120 72125 72126 72127 72128 72129 72130 72131 72132 72133 72141 72142 72146 72147 72148 72149 72156 72157 72158 72170 72190 72191 72192 72193 72194 1109.59 519.08 519.08 987.10 519.08 519.08 987.10 534.32 641.35 1138.04 151.31 28.45 31.91 36.87 44.55 46.81 52.58 48.40 83.02 30.38 90.23 129.46 98.74 34.93 41.49 46.48 53.39 37.27 40.35 301.63 352.89 432.63 594.95 527.26 631.37 1110.08 551.86 66.36 24.59 36.09 52.97 64.95 31.87 38.03 41.86 48.80 39.15 42.21 39.15 53.74 67.97 48.37 301.63 351.74 426.88 301.63 351.74 426.88 301.63 352.47 427.27 540.45 649.36 589.85 648.98 584.12 642.09 1149.10 1149.10 1138.38 30.00 38.42 576.03 298.19 339.80 409.25

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------327.89 428.70 513.86 950.10 433.32 19.81 24.15 22.31 183.88 167.06 157.85 236.23 84.59 323.85 303.34 19.81 19.81 17.96 22.31 81.28 25.99 22.31 19.81 22.31 81.28 19.81 18.71 18.71 20.18 61.47 18.71 20.18 15.76 191.24 228.57 287.18 417.89 426.72 512.20 947.46 426.72 512.20 947.46 17.96 22.31 25.99 81.28 19.81 22.31 81.28 22.31 19.81 22.31 24.15 18.71 101.09 19.81 18.71 18.71 20.18 81.28 18.71 20.18 17.96 15.76 191.24 228.57 287.18 417.89 426.72 512.20 947.46 426.72 512.20 947.46 433.32

M E D I C A R E LC FEE -------377.07 493.01 590.94 1092.62 498.32 22.78 27.77 25.66 211.46 192.12 181.53 271.66 97.28 372.43 348.84 22.78 22.78 20.65 25.66 93.47 29.89 25.66 22.78 25.66 93.47 22.78 21.52 21.52 23.21 70.69 21.52 23.21 18.12 219.93 262.86 330.26 480.57 490.73 589.03 1089.58 490.73 589.03 1089.58 20.65 25.66 29.89 93.47 22.78 25.66 93.47 25.66 22.78 25.66 27.77 21.52 116.25 22.78 21.52 21.52 23.21 93.47 21.52 23.21 20.65 18.12 219.93 262.86 330.26 480.57 490.73 589.03 1089.58 490.73 589.03 1089.58 498.32

F E E

S C H E D U L E NPAR FEE -------60.90 72.53 85.62 112.39 93.53 8.69 9.42 8.69 45.29 44.92 41.29 65.90 36.20 57.58 41.65 7.96 8.69 7.60 9.05 27.50 10.48 8.69 7.60 8.69 27.87 7.96 7.96 8.66 8.69 27.87 7.96 8.69 6.51 54.71 57.98 61.22 89.59 66.74 80.16 107.30 66.74 80.16 106.65 8.69 10.84 13.39 27.50 14.52 10.48 28.58 8.69 9.03 9.39 11.57 9.03 27.50 8.69 8.33 7.96 8.69 27.87 7.96 8.69 7.96 6.51 54.71 57.98 60.90 93.95 66.74 80.16 107.30 66.74 80.49 106.65 91.30

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------501.23 599.47 1062.50 526.85 28.50 33.57 31.01 229.17 211.97 199.14 302.13 120.79 381.42 344.99 27.77 28.50 25.56 31.37 108.78 36.47 31.01 27.41 31.01 109.16 27.77 26.67 27.37 28.87 89.35 26.67 28.87 22.27 245.96 286.55 348.39 507.46 493.46 592.36 1054.77 493.46 592.36 1054.11 26.66 33.16 39.38 108.78 34.32 32.78 109.86 31.01 28.83 31.69 35.72 27.73 128.59 28.50 27.04 26.67 28.87 109.16 26.67 28.87 25.94 22.27 245.96 286.55 348.07 511.83 493.46 592.36 1054.77 493.46 592.70 1054.11 524.63 28.86

PAGE 034 LC FEE -------576.41 689.39 1221.88 605.88 32.78 38.61 35.66 263.55 243.77 229.01 347.45 138.91 438.63 396.74 31.94 32.78 29.39 36.08 125.10 41.94 35.66 31.52 35.66 125.53 31.94 30.67 31.48 33.20 102.75 30.67 33.20 25.61 282.85 329.53 400.65 583.58 567.48 681.21 1212.99 567.48 681.21 1212.23 30.66 38.13 45.29 125.10 39.47 37.70 126.34 35.66 33.15 36.44 41.08 31.89 147.88 32.78 31.10 30.67 33.20 125.53 30.67 33.20 29.83 25.61 282.85 329.53 400.28 588.60 567.48 681.21 1212.99 567.48 681.61 1212.23 603.32 33.19 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------72194 72195 72196 72197 72198 72200 72202 72220 72240 72255 72265 72270 72275 72285 72295 73000 73010 73020 73030 73040 73050 73060 73070 73080 73085 73090 73092 73100 73110 73115 73120 73130 73140 73200 73201 73202 73206 73218 73219 73220 73221 73222 73223 73500 73510 73520 73525 73530 73540 73542 73550 73560 73562 73564 73565 73580 73590 73592 73600 73610 73615 73620 73630 73650 73660 73700 73701 73702 73706 73718 73719 73720 73721 73722 73723 73725 *** TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC 345.15 451.26 540.90 1000.11 456.13 20.85 25.42 23.48 193.56 175.85 166.16 248.66 89.04 340.89 319.30 20.85 20.85 18.91 23.48 85.56 27.36 23.48 20.85 23.48 85.56 20.85 19.69 19.69 21.24 64.71 19.69 21.24 16.59 201.31 240.60 302.29 439.88 449.18 539.16 997.33 449.18 539.16 997.33 18.91 23.48 27.36 85.56 20.85 23.48 85.56 23.48 20.85 23.48 25.42 19.69 106.41 20.85 19.69 19.69 21.24 85.56 19.69 21.24 18.91 16.59 201.31 240.60 302.29 439.88 449.18 539.16 997.33 449.18 539.16 997.33 456.13

PROC MOD NOTE PAR FEE ----- -- ---- -------72194 72195 72196 72197 72198 72200 72202 72220 72240 72255 72265 72270 72275 72285 72295 73000 73010 73020 73030 73040 73050 73060 73070 73080 73085 73090 73092 73100 73110 73115 73120 73130 73140 73200 73201 73202 73206 73218 73219 73220 73221 73222 73223 73500 73510 73520 73525 73530 73540 73542 73550 73560 73562 73564 73565 73580 73590 73592 73600 73610 73615 73620 73630 73650 73660 73700 73701 73702 73706 73718 73719 73720 73721 73722 73723 73725 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 64.10 76.35 90.13 118.31 98.45 9.15 9.92 9.15 47.67 47.28 43.46 69.37 38.11 60.61 43.84 8.38 9.15 8.00 9.53 28.95 11.03 9.15 8.00 9.15 29.34 8.38 8.38 9.12 9.15 29.34 8.38 9.15 6.85 57.59 61.03 64.44 94.30 70.25 84.38 112.95 70.25 84.38 112.26 9.15 11.41 14.09 28.95 15.28 11.03 30.08 9.15 9.50 9.88 12.18 9.50 28.95 9.15 8.77 8.38 9.15 29.34 8.38 9.15 8.38 6.85 57.59 61.03 64.10 98.89 70.25 84.38 112.95 70.25 84.73 112.26 96.11

LC FEE -------70.04 83.41 98.46 129.25 107.56 9.99 10.83 9.99 52.08 51.66 47.48 75.79 41.63 66.22 47.90 9.15 9.99 8.74 10.41 31.63 12.05 9.99 8.74 9.99 32.05 9.15 9.15 9.96 9.99 32.05 9.15 9.99 7.49 62.92 66.68 70.40 103.03 76.75 92.18 123.40 76.75 92.18 122.65 9.99 12.47 15.40 31.63 16.70 12.05 32.87 9.99 10.38 10.80 13.31 10.38 31.63 9.99 9.58 9.15 9.99 32.05 9.15 9.99 9.15 7.49 62.92 66.68 70.04 108.04 76.75 92.18 123.40 76.75 92.56 122.65 105.00

PROC MOD NOTE PAR FEE ----- -- ---- -------72195 72196 72197 72198 72200 72202 72220 72240 72255 72265 72270 72275 72285 72295 73000 73010 73020 73030 73040 73050 73060 73070 73080 73085 73090 73092 73100 73110 73115 73120 73130 73140 73200 73201 73202 73206 73218 73219 73220 73221 73222 73223 73500 73510 73520 73525 73530 73540 73542 73550 73560 73562 73564 73565 73580 73590 73592 73600 73610 73615 73620 73630 73650 73660 73700 73701 73702 73706 73718 73719 73720 73721 73722 73723 73725 74000 527.61 631.02 1118.42 554.58 30.00 35.34 32.64 241.23 223.13 209.62 318.03 127.15 401.49 363.15 29.23 30.00 26.91 33.02 114.51 38.39 32.64 28.85 32.64 114.90 29.23 28.07 28.81 30.39 94.05 28.07 30.39 23.44 258.90 301.63 366.73 534.17 519.43 623.54 1110.28 519.43 623.54 1109.59 28.06 34.90 41.45 114.51 36.13 34.51 115.64 32.64 30.35 33.36 37.60 29.19 135.36 30.00 28.46 28.07 30.39 114.90 28.07 30.39 27.30 23.44 258.90 301.63 366.39 538.77 519.43 623.54 1110.28 519.43 623.89 1109.59 552.24 30.38

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------19.81 22.31 24.15 28.90 218.67 264.83 327.89 457.27 428.70 513.86 950.10 433.32 50.54 45.80 45.80 50.54 101.09 56.39 57.50 92.29 64.05 65.85 99.99 50.54 50.54 57.50 66.60 86.76 99.62 28.90 15.76 10.52 21.02 26.85 35.14 35.14 35.14 45.29 26.85 38.05 38.05 27.21 44.19 24.30 24.30 24.30 18.12 18.12 16.30 18.84 56.89 16.66 16.66 26.85 26.85 26.85 27.50 17.02 19.21 30.12 31.50 80.10 100.00 92.48 89.22 25.40 57.63 57.26 90.58 120.00 74.64 67.06 65.96 85.14 65.92 83.67

M E D I C A R E LC FEE -------22.78 25.66 27.77 33.24 251.47 304.55 377.07 525.86 493.01 590.94 1092.62 498.32 58.12 52.67 52.67 58.12 116.25 64.85 66.13 106.13 73.66 75.73 114.99 58.12 58.12 66.13 76.59 99.77 114.56 33.24 18.12 12.10 24.17 30.88 40.41 40.41 40.41 52.08 30.88 43.76 43.76 31.29 50.82 27.95 27.95 27.95 20.84 20.84 18.75 21.67 65.42 19.16 19.16 30.88 30.88 30.88 31.63 19.57 22.09 34.64 36.23 92.12 115.00 106.35 102.60 29.21 66.27 65.85 104.17 138.00 85.84 77.12 75.85 97.91 75.81 96.22

F E E

S C H E D U L E NPAR FEE -------9.05 11.61 13.42 15.97 59.44 63.40 69.58 93.95 72.86 85.59 112.39 90.21 23.93 18.12 22.84 26.49 59.44 34.78 34.78 45.66 34.78 34.78 45.66 23.57 34.78 25.02 34.78 49.66 101.09 15.97 10.15 51.77 149.17 103.94 157.47 157.47 167.62 127.93 160.38 139.14 149.54 280.42 90.16 100.09 106.31 119.21 68.66 57.30 62.42 100.47 73.06 78.14 75.18 184.70 184.70 149.83 58.04 69.75 152.45 87.90 513.43 533.32 525.81 522.55 512.25 544.47 544.10 598.27 720.87 561.50 553.91 552.81 572.00 552.77 570.52 553.14

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------33.92 37.57 44.87 278.10 328.23 397.47 551.23 501.56 599.43 1062.50 523.54 74.48 63.92 68.64 77.03 160.52 91.17 92.28 137.94 98.83 100.63 145.64 74.12 85.32 82.53 101.37 136.42 200.71 44.87 25.91 18.12 30.74 122.33 68.80 122.33 122.33 122.33 101.09 122.33 101.09 122.33 236.23 65.85 75.80 82.01 101.09 50.54 41.01 43.59 43.59 56.39 61.47 48.34 157.85 157.85 122.33 41.01 50.54 122.33 56.39 433.32 433.32 433.32 433.32 486.85 486.85 486.85 507.68 600.87 486.85 486.85 486.85 486.85 486.85 486.85 486.85

PAGE 035 LC FEE -------39.01 43.21 51.60 319.82 377.46 457.09 633.91 576.79 689.34 1221.88 602.07 85.65 73.51 78.94 88.58 184.60 104.85 106.12 158.63 113.65 115.72 167.49 85.24 98.12 94.91 116.58 156.88 230.82 51.60 29.80 20.84 35.35 140.68 79.12 140.68 140.68 140.68 116.25 140.68 116.25 140.68 271.66 75.73 87.17 94.31 116.25 58.12 47.16 50.13 50.13 64.85 70.69 55.59 181.53 181.53 140.68 47.16 58.12 140.68 64.85 498.32 498.32 498.32 498.32 559.88 559.88 559.88 583.83 691.00 559.88 559.88 559.88 559.88 559.88 559.88 559.88 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------74000 74010 74020 74022 74150 74160 74170 74175 74181 74182 74183 74185 74190 74210 74220 74230 74235 74240 74241 74245 74246 74247 74249 74250 74251 74260 74270 74280 74283 74290 74291 74301 74305 74320 74327 74328 74329 74330 74340 74350 74355 74360 74363 74400 74410 74415 74420 74425 74430 74440 74445 74450 74455 74470 74475 74480 74485 74710 74740 74742 74775 75552 75553 75554 75555 75600 75605 75625 75630 75635 75650 75658 75660 75662 75665 75671 *** TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 20.85 23.48 25.42 30.42 230.18 278.77 345.15 481.34 451.26 540.90 1000.11 456.13 53.20 48.21 48.21 53.20 106.41 59.36 60.53 97.15 67.42 69.32 105.25 53.20 53.20 60.53 70.10 91.33 104.86 30.42 16.59 11.07 22.13 28.26 36.99 36.99 36.99 47.67 28.26 40.05 40.05 28.64 46.52 25.58 25.58 25.58 19.07 19.07 17.16 19.83 59.88 17.54 17.54 28.26 28.26 28.26 28.95 17.92 20.22 31.70 33.16 84.32 105.26 97.35 93.92 26.74 60.66 60.27 95.35 126.32 78.57 70.59 69.43 89.62 69.39 88.07

PROC MOD NOTE PAR FEE ----- -- ---- -------74000 74010 74020 74022 74150 74160 74170 74175 74181 74182 74183 74185 74190 74210 74220 74230 74235 74240 74241 74245 74246 74247 74249 74250 74251 74260 74270 74280 74283 74290 74291 74305 74320 74327 74328 74329 74330 74340 74350 74355 74360 74363 74400 74410 74415 74420 74425 74430 74440 74445 74450 74455 74470 74475 74480 74485 74710 74740 74742 74775 75552 75553 75554 75555 75600 75605 75625 75630 75635 75650 75658 75660 75662 75665 75671 75676 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 9.53 12.22 14.13 16.81 62.57 66.74 73.24 98.89 76.69 90.09 118.31 94.96 25.19 19.07 24.04 27.88 62.57 36.61 36.61 48.06 36.61 36.61 48.06 24.81 36.61 26.34 36.61 52.27 106.41 16.81 10.68 54.49 157.02 109.41 165.76 165.76 176.44 134.66 168.82 146.46 157.41 295.18 94.90 105.36 111.91 125.48 72.27 60.32 65.71 105.76 76.90 82.25 79.14 194.42 194.42 157.72 61.09 73.42 160.47 92.53 540.45 561.39 553.48 550.05 539.21 573.13 572.74 629.76 758.81 591.05 583.06 581.90 602.10 581.86 600.55 582.25

LC FEE -------10.41 13.35 15.43 18.37 68.36 72.91 80.02 108.04 83.79 98.43 129.25 103.74 27.52 20.84 26.27 30.46 68.36 40.00 40.00 52.51 40.00 40.00 52.51 27.11 40.00 28.77 40.00 57.11 116.25 18.37 11.67 59.54 171.55 119.53 181.09 181.09 192.76 147.12 184.44 160.01 171.97 322.48 103.68 115.10 122.26 137.09 78.96 65.90 71.78 115.54 84.02 89.86 86.46 212.41 212.41 172.30 66.75 80.21 175.32 101.09 590.44 613.32 604.68 600.93 589.09 626.14 625.72 688.01 829.00 645.73 637.00 635.73 657.80 635.69 656.10 636.11

PROC MOD NOTE PAR FEE ----- -- ---- -------74010 74020 74022 74150 74160 74170 74175 74181 74182 74183 74185 74190 74210 74220 74230 74235 74240 74241 74245 74246 74247 74249 74250 74251 74260 74270 74280 74283 74290 74291 74300 74305 74320 74327 74328 74329 74330 74340 74350 74355 74360 74363 74400 74410 74415 74420 74425 74430 74440 74445 74450 74455 74470 74475 74480 74485 74710 74740 74742 74775 75552 75553 75554 75555 75600 75605 75625 75630 75635 75650 75658 75660 75662 75665 75671 75676 35.70 39.55 47.23 292.74 345.51 418.39 580.24 527.96 630.98 1118.42 551.09 78.40 67.28 72.25 81.08 168.97 95.97 97.14 145.20 104.03 105.93 153.30 78.02 89.81 86.87 106.71 143.60 211.27 47.23 27.27 19.07 32.36 128.77 72.42 128.77 128.77 128.77 106.41 128.77 106.41 128.77 248.66 69.32 79.79 86.33 106.41 53.20 43.17 45.88 45.88 59.36 64.71 50.88 166.16 166.16 128.77 43.17 53.20 128.77 59.36 456.13 456.13 456.13 456.13 512.47 512.47 512.47 534.40 632.49 512.47 512.47 512.47 512.47 512.47 512.47 512.47

26 TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------66.28 83.67 65.59 110.12 57.59 65.59 58.00 76.56 56.89 56.89 65.59 56.89 65.59 82.64 56.89 59.14 18.49 92.36 41.26 58.35 40.93 58.35 23.57 57.22 35.14 53.26 57.22 56.89 56.89 74.64 57.55 74.27 57.96 57.96 56.89 35.14 71.76 71.76 56.89 56.89 26.85 65.92 66.32 82.65 24.30 24.30 19.57 27.50 20.96 20.96 125.87 42.03 212.36 27.87 18.12 66.69 18.15 42.39 26.85 71.76 71.40 36.23 59.07 27.21 18.53 66.69 67.06 17.78 20.20 8.33 33.69 27.13 28.94 19.81 86.43 9.42

M E D I C A R E LC FEE -------76.22 96.22 75.43 126.64 66.23 75.43 66.70 88.04 65.42 65.42 75.43 65.42 75.43 95.04 65.42 68.01 21.26 106.21 47.45 67.10 47.07 67.10 27.11 65.80 40.41 61.25 65.80 65.42 65.42 85.84 66.18 85.41 66.65 66.65 65.42 40.41 82.52 82.52 65.42 65.42 30.88 75.81 76.27 95.05 27.95 27.95 22.51 31.63 24.10 24.10 144.75 48.33 244.21 32.05 20.84 76.69 20.87 48.75 30.88 82.52 82.11 41.66 67.93 31.29 21.31 76.69 77.12 20.45 23.23 9.58 38.74 31.20 33.28 22.78 99.39 10.83

F E E

S C H E D U L E NPAR FEE -------570.52 552.43 596.97 544.44 552.43 544.84 563.41 543.74 543.74 552.43 543.74 552.43 569.49 543.74 545.98 505.33 145.07 251.12 268.21 277.15 294.57 54.31 544.07 72.10 110.39 544.07 543.74 543.74 561.50 544.40 561.13 544.81 544.81 543.74 72.10 558.62 558.62 543.74 543.74 513.69 999.60 878.05 123.65 835.61 99.94 95.21 514.36 197.51 109.93 244.91 617.89 618.59 637.01 342.32 675.83 342.36 488.93 635.99 281.64 307.63 112.03 181.39 636.35 342.73 675.83 676.20 342.00 71.73 58.87 134.78 77.68 79.49 23.49 9.05 29.22 45.15

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------486.85 486.85 486.85 486.85 486.85 486.85 486.85 486.85 486.85 486.85 486.85 486.85 486.85 486.85 486.85 486.85 52.72 209.86 209.86 236.23 236.23 30.74 486.85 36.96 57.13 486.85 486.85 486.85 486.85 486.85 486.85 486.85 486.85 486.85 36.96 486.85 486.85 486.85 486.85 486.85 933.68 811.72 41.01 811.32 75.64 75.64 486.85 176.56 88.98 92.90 575.86 406.23 609.14 324.21 609.14 324.21 446.54 609.14 209.86 236.23 75.80 122.33 609.14 324.21 609.14 609.14 324.21 51.54 50.54 101.09 50.54 50.54 28.86 73.63 19.81 30.74

PAGE 036 LC FEE -------559.88 559.88 559.88 559.88 559.88 559.88 559.88 559.88 559.88 559.88 559.88 559.88 559.88 559.88 559.88 559.88 60.63 241.34 241.34 271.66 271.66 35.35 559.88 42.50 65.70 559.88 559.88 559.88 559.88 559.88 559.88 559.88 559.88 559.88 42.50 559.88 559.88 559.88 559.88 559.88 1073.73 933.48 47.16 933.02 86.99 86.99 559.88 203.04 102.33 106.84 662.24 467.16 700.51 372.84 700.51 372.84 513.52 700.51 241.34 271.66 87.17 140.68 700.51 372.84 700.51 700.51 372.84 59.27 58.12 116.25 58.12 58.12 33.19 84.67 22.78 35.35 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------75676 75680 75685 75705 75710 75716 75722 75724 75726 75731 75733 75736 75741 75743 75746 75756 75774 75790 75801 75803 75805 75807 75809 75810 75820 75822 75825 75827 75831 75833 75840 75842 75860 75870 75872 75880 75885 75887 75889 75891 75893 75894 75896 75898 75900 75901 75902 75940 75945 75946 75954 75960 75961 75962 75964 75966 75968 75970 75978 75980 75982 75984 75989 75992 75993 75994 75995 75996 75998 76000 76001 76003 76005 76010 76013 76020 *** 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 TC 26 26 69.77 88.07 69.04 115.92 60.62 69.04 61.05 80.59 59.88 59.88 69.04 59.88 69.04 86.99 59.88 62.25 19.46 97.22 43.43 61.42 43.08 61.42 24.81 60.23 36.99 56.06 60.23 59.88 59.88 78.57 60.58 78.18 61.01 61.01 59.88 36.99 75.54 75.54 59.88 59.88 28.26 69.39 69.81 87.00 25.58 25.58 20.60 28.95 22.06 22.06 132.49 44.24 223.54 29.34 19.07 70.20 19.11 44.62 28.26 75.54 75.16 38.14 62.18 28.64 19.50 70.20 70.59 18.72 21.26 8.77 35.46 28.56 30.46 20.85 90.98 9.92

PROC MOD NOTE PAR FEE ----- -- ---- -------75680 75685 75705 75710 75716 75722 75724 75726 75731 75733 75736 75741 75743 75746 75756 75774 75790 75801 75803 75805 75807 75809 75810 75820 75822 75825 75827 75831 75833 75840 75842 75860 75870 75872 75880 75885 75887 75889 75891 75893 75894 75896 75898 75900 75901 75902 75940 75945 75946 75952 26 75960 75961 75962 75964 75966 75968 75970 75978 75980 75982 75984 75989 75992 75993 75994 75995 75996 75998 76000 76001 76003 76005 76006 76010 26 76020 76040 600.55 581.51 628.39 573.09 581.51 573.52 593.06 572.36 572.36 581.51 572.36 581.51 599.46 572.36 574.72 531.93 152.71 264.34 282.33 291.74 310.07 57.17 572.70 75.89 116.20 572.70 572.36 572.36 591.05 573.05 590.66 573.48 573.48 572.36 75.89 588.02 588.02 572.36 572.36 540.73 1052.21 924.26 130.16 879.59 105.20 100.22 541.43 207.91 115.72 257.80 650.41 651.15 670.54 360.34 711.40 360.38 514.66 669.46 296.46 323.82 117.93 190.94 669.84 360.77 711.40 711.79 360.00 75.51 61.97 141.87 81.77 83.67 24.73 9.53 30.76 47.53

LC FEE -------656.10 635.29 686.52 626.11 635.29 626.57 647.92 625.30 625.30 635.29 625.30 635.29 654.91 625.30 627.88 581.13 166.83 288.79 308.44 318.72 338.76 62.46 625.68 82.92 126.95 625.68 625.30 625.30 645.73 626.06 645.30 626.53 626.53 625.30 82.92 642.41 642.41 625.30 625.30 590.74 1149.54 1009.76 142.20 960.95 114.93 109.49 591.51 227.14 126.42 281.65 710.57 711.38 732.56 393.67 777.20 393.71 562.27 731.39 323.89 353.77 128.83 208.60 731.80 394.14 777.20 777.63 393.30 82.49 67.70 155.00 89.33 91.41 27.01 10.41 33.60 51.92

PROC MOD NOTE PAR FEE ----- -- ---- -------75680 75685 75705 75710 75716 75722 75724 75726 75731 75733 75736 75741 75743 75746 75756 75774 75790 75801 75803 75805 75807 75809 75810 75820 75822 75825 75827 75831 75833 75840 75842 75860 75870 75872 75880 75885 75887 75889 75891 75893 75894 75896 75898 75900 75901 75902 75940 75945 75946 75953 75960 75961 75962 75964 75966 75968 75970 75978 75980 75982 75984 75989 75992 75993 75994 75995 75996 75998 76000 76001 76003 76005 76010 76012 76020 76040 TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC 26 TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC 26 TC TC 512.47 512.47 512.47 512.47 512.47 512.47 512.47 512.47 512.47 512.47 512.47 512.47 512.47 512.47 512.47 512.47 55.49 220.91 220.91 248.66 248.66 32.36 512.47 38.90 60.14 512.47 512.47 512.47 512.47 512.47 512.47 512.47 512.47 512.47 38.90 512.47 512.47 512.47 512.47 512.47 982.82 854.44 43.17 854.02 79.62 79.62 512.47 185.85 93.66 97.79 606.17 427.61 641.20 341.27 641.20 341.27 470.04 641.20 220.91 248.66 79.79 128.77 641.20 341.27 641.20 641.20 341.27 54.25 53.20 106.41 53.20 53.20 30.38 77.50 20.85 32.36

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------14.41 22.48 26.85 34.51 15.94 12.33 10.88 14.88 11.24 10.15 26.85 3.24 3.24 18.12 22.48 35.14 43.51 35.14 81.19 81.19 80.36 28.60 7.96 29.32 29.32 29.69 19.21 13.42 319.10 319.10 353.44 114.27 136.65 135.18 432.00 465.36 433.32 55.29 54.96 56.69 60.00 2.54 46.49 49.81 44.98 55.29 50.54 41.01 76.53 55.29 76.53 55.29 76.53 55.29 81.28 42.99 81.28 46.29 144.53 52.56 55.29 43.22 57.95 62.95 62.95 76.53 27.79 67.66 43.88 59.27 59.27 59.27 59.78 59.27 71.78 82.60

M E D I C A R E LC FEE -------16.57 25.85 30.88 39.69 18.33 14.18 12.51 17.11 12.93 11.67 30.88 3.73 3.73 20.84 25.85 40.41 50.04 40.41 93.37 93.37 92.41 32.89 9.15 33.72 33.72 34.14 22.09 15.43 366.97 366.97 406.46 131.41 157.15 155.46 496.80 535.16 498.32 63.58 63.20 65.19 69.00 2.92 53.46 57.28 51.73 63.58 58.12 47.16 88.01 63.58 88.01 63.58 88.01 63.58 93.47 49.44 93.47 53.23 166.21 60.44 63.58 49.70 66.64 72.39 72.39 88.01 31.96 77.81 50.46 68.16 68.16 68.16 68.75 68.16 82.55 94.99

F E E

S C H E D U L E NPAR FEE -------61.28 82.51 63.41 59.16 126.60 121.51 135.00 40.88 39.79 67.85 18.67 18.67 119.21 164.25 76.15 94.05 82.74 762.52 1005.41 357.30 79.14 23.72 77.65 84.62 97.38 60.22 44.16 15.76 60.86 57.62 199.63 42.74 7.96 49.30 75.37 212.33 79.73 33.35 49.43 35.27 35.27 9.43 29.09 29.09 30.18 27.94 27.21 27.50 40.93 30.05 37.33 29.32 37.33 55.46 50.39 42.39 50.39 51.02 99.06 92.28 32.67 43.23 38.13 53.67 38.86 84.88 42.06 29.76 29.04 34.78 36.31 34.78 19.21 32.23 35.11 77.47

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------38.80 55.66 28.90 43.22 114.27 110.64 120.12 29.63 29.63 41.01 15.43 15.43 101.09 141.77 41.01 50.54 47.60 681.33 924.23 276.94 50.54 15.76 48.34 55.29 67.70 41.01 30.74 379.95 376.71 553.07 157.01 144.62 184.47 507.38 677.68 513.06 88.64 104.40 91.97 95.29 11.97 75.58 78.90 75.16 83.23 77.75 68.51 117.46 85.35 113.86 84.62 113.86 110.75 131.67 85.38 131.67 97.31 243.59 144.85 87.96 86.44 96.07 116.61 101.80 161.41 69.85 97.42 72.92 94.04 95.57 94.04 78.99 91.49 106.89 160.08 85.35

PAGE 037 LC FEE -------44.62 64.01 33.24 49.70 131.41 127.24 138.14 34.07 34.07 47.16 17.74 17.74 116.25 163.04 47.16 58.12 54.74 783.53 1062.86 318.48 58.12 18.12 55.59 63.58 77.86 47.16 35.35 436.94 433.22 636.03 180.56 166.31 212.14 583.49 779.33 590.02 101.94 120.06 105.77 109.58 13.77 86.92 90.74 86.43 95.71 89.41 78.79 135.08 98.15 130.94 97.31 130.94 127.36 151.42 98.19 151.42 111.91 280.13 166.58 101.15 99.41 110.48 134.10 117.07 185.62 80.33 112.03 83.86 108.15 109.91 108.15 90.84 105.21 122.92 184.09 98.15 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------76040 76061 76062 76065 76066 76070 76071 76075 76076 76078 76080 76082 76083 76086 76088 76090 76091 76092 76093 76094 76095 76096 76098 76100 76101 76102 76120 76125 76355 76360 76362 76370 76375 76380 76393 76394 76400 76506 76511 76512 76513 76514 76516 76519 76529 76536 76604 76645 76700 76705 76770 76775 76778 76800 76801 76802 76805 76810 76811 76812 76815 76816 76817 76818 76819 76825 76826 76827 76828 76830 76831 76856 76857 76870 76872 76873 *** 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC 15.17 23.66 28.26 36.33 16.78 12.98 11.45 15.66 11.83 10.68 28.26 3.41 3.41 19.07 23.66 36.99 45.80 36.99 85.46 85.46 84.59 30.10 8.38 30.86 30.86 31.25 20.22 14.13 335.89 335.89 372.04 120.28 143.84 142.29 454.74 489.85 456.13 58.20 57.85 59.67 63.16 2.67 48.94 52.43 47.35 58.20 53.20 43.17 80.56 58.20 80.56 58.20 80.56 58.20 85.56 45.25 85.56 48.73 152.14 55.33 58.20 45.49 61.00 66.26 66.26 80.56 29.25 71.22 46.19 62.39 62.39 62.39 62.93 62.39 75.56 86.95

PROC MOD NOTE PAR FEE ----- -- ---- -------76061 76062 76065 76066 76070 76071 76075 76076 76078 76080 76082 76083 76086 76088 76090 76091 76092 76093 76094 76095 76096 76098 76100 76101 76102 76120 76125 76150 76355 76360 76362 76370 76375 76380 76393 76394 76400 76506 76511 76512 76513 76514 76516 76519 76529 76536 76604 76645 76700 76705 76770 76775 76778 76800 76801 76802 76805 76810 76811 76812 76815 76816 76817 76818 76819 76825 76826 76827 76828 76830 76831 76856 76857 76870 76872 76873 64.51 86.85 66.75 62.27 133.26 127.90 142.10 43.03 41.88 71.42 19.65 19.65 125.48 172.89 80.16 99.00 87.09 802.65 1058.33 376.11 83.31 24.97 81.74 89.07 102.51 63.39 46.48 16.59 64.06 60.65 210.14 44.99 8.38 51.89 79.34 223.50 83.93 35.10 52.03 37.13 37.13 9.93 30.62 30.62 31.77 29.41 28.64 28.95 43.08 31.63 39.29 30.86 39.29 58.38 53.04 44.62 53.04 53.70 104.27 97.14 34.39 45.50 40.14 56.49 40.90 89.35 44.27 31.33 30.57 36.61 38.22 36.61 20.22 33.93 36.96 81.55

LC FEE -------70.47 94.89 72.92 68.03 145.59 139.74 155.25 47.01 45.76 78.03 21.47 21.47 137.09 188.89 87.57 108.16 95.15 876.90 1156.22 410.90 91.01 27.28 89.30 97.31 111.99 69.25 50.78 18.12 69.99 66.26 229.57 49.15 9.15 56.70 86.68 244.18 91.69 38.35 56.84 40.56 40.56 10.84 33.45 33.45 34.71 32.13 31.29 31.63 47.07 34.56 42.93 33.72 42.93 63.78 57.95 48.75 57.95 58.67 113.92 106.12 37.57 49.71 43.85 61.72 44.69 97.61 48.37 34.22 33.40 40.00 41.76 40.00 22.09 37.06 40.38 89.09

PROC MOD NOTE PAR FEE ----- -- ---- -------76061 76062 76065 76066 76070 76071 76075 76076 76078 76080 76082 76083 76086 76088 76090 76091 76092 76093 76094 76095 76096 76098 76100 76101 76102 76120 76125 76355 76360 76362 76370 76375 76380 76393 76394 76400 76506 76511 76512 76513 76514 76516 76519 76529 76536 76604 76645 76700 76705 76770 76775 76778 76800 76801 76802 76805 76810 76811 76812 76815 76816 76817 76818 76819 76825 76826 76827 76828 76830 76831 76856 76857 76870 76872 76873 76880 TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC 40.84 58.59 30.42 45.49 120.28 116.46 126.44 31.19 31.19 43.17 16.24 16.24 106.41 149.23 43.17 53.20 50.10 717.19 972.87 291.52 53.20 16.59 50.88 58.20 71.26 43.17 32.36 399.95 396.54 582.18 165.27 152.23 194.18 534.08 713.35 540.06 93.30 109.89 96.81 100.30 12.60 79.56 83.05 79.12 87.61 81.84 72.12 123.64 89.84 119.85 89.07 119.85 116.58 138.60 89.87 138.60 102.43 256.41 152.47 92.59 90.99 101.13 122.75 107.16 169.91 73.53 102.55 76.76 98.99 100.60 98.99 83.15 96.31 112.52 168.50 89.84

26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------55.29 59.27 55.29 59.27 59.27 243.92 16.93 65.54 58.98 96.82 58.98 59.27 59.27 50.54 215.39 41.01 59.27 32.21 101.09 107.66 134.07 215.73 251.98 1080.89 52.01 1080.89 72.49 90.45 102.56 156.42 91.55 134.07 191.24 19.07 52.01 73.59 125.64 134.81 69.17 80.91 80.91 90.45 668.87 407.18 103.63 77.84 105.27 77.55 103.63 77.59 242.19 184.40 283.08 423.69 213.32 370.30 553.69 82.27 123.60 184.11 277.26 55.51 52.19 9.79 13.06 16.33 24.66 25.02 19.57 22.48 34.06 41.70 43.51 30.12 41.33 38.06

M E D I C A R E LC FEE -------63.58 68.16 63.58 68.16 68.16 280.51 19.47 75.37 67.83 111.34 67.83 68.16 68.16 58.12 247.70 47.16 68.16 37.04 116.25 123.81 154.18 248.09 289.78 1243.02 59.81 1243.02 83.36 104.02 117.94 179.88 105.28 154.18 219.93 21.93 59.81 84.63 144.49 155.03 79.55 93.05 93.05 104.02 769.20 468.26 119.17 89.52 121.06 89.18 119.17 89.23 278.52 212.06 325.54 487.24 245.32 425.85 636.74 94.61 142.14 211.73 318.85 63.84 60.02 11.26 15.02 18.78 28.36 28.77 22.51 25.85 39.17 47.96 50.04 34.64 47.53 43.77

F E E

S C H E D U L E NPAR FEE -------30.05 37.33 31.50 34.49 34.49 100.66 16.20 100.65 68.14 34.02 34.06 19.25 19.21 29.32 66.63 19.93 40.96 2.88 60.83 160.24 34.77 52.19 76.85 225.80 31.14 390.15 35.14 52.19 76.85 47.47 46.38 68.85 103.63 43.47 26.48 42.01 61.25 69.17 69.17 80.91 90.45 90.45 164.15 535.11 195.79 262.76 195.49 261.11 195.53 293.84 281.80 422.65 596.97 297.88 534.04 752.22 867.64 908.96 969.48 1062.62 72.73 71.27 47.48 63.60 54.03 116.95 125.01 90.58 115.87 134.04 176.14 253.75 82.97 112.34 248.30 107.02

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------96.59 86.80 93.77 93.77 344.58 33.13 166.19 127.12 130.83 93.02 78.52 78.48 79.87 282.03 60.94 100.23 35.08 161.92 71.43 168.84 267.92 328.83 1306.69 83.15 1471.04 107.63 142.64 179.41 203.89 137.93 202.92 294.87 62.54 78.49 115.60 186.89 115.37 69.17 69.17 80.91 90.45 23.05 93.23 431.48 117.95 157.48 117.95 157.48 117.95 51.65 97.40 139.56 173.28 84.56 163.74 198.53 785.37 785.37 785.37 785.37 17.23 19.07 37.70 50.54 37.70 92.29 99.99 71.01 93.39 99.99 134.44 210.24 52.86 71.01 210.24 79.07

PAGE 038 LC FEE -------111.08 99.82 107.84 107.84 396.27 38.10 191.12 146.19 150.45 106.97 90.30 90.25 91.85 324.33 70.08 115.26 40.34 186.21 82.14 194.17 308.11 378.15 1502.69 95.62 1691.70 123.77 164.04 206.32 234.47 158.62 233.36 339.10 71.92 90.26 132.94 214.92 132.68 79.55 79.55 93.05 104.02 26.51 107.21 496.20 135.64 181.10 135.64 181.10 135.64 59.40 112.01 160.49 199.27 97.24 188.30 228.31 903.18 903.18 903.18 903.18 19.81 21.93 43.36 58.12 43.36 106.13 114.99 81.66 107.40 114.99 154.61 241.78 60.79 81.66 241.78 90.93 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------76880 76885 76886 76930 76932 76936 76937 76940 76941 76942 76945 76946 76948 76950 76965 76970 76975 76977 76986 77262 77280 77285 77290 77295 77300 77301 77305 77310 77315 77321 77326 77327 77328 77331 77332 77333 77334 77370 77403 77407 77411 77414 77418 77432 77470 77600 77605 77610 77615 77620 77750 77761 77762 77763 77776 77777 77778 77781 77782 77783 77784 77789 77790 78000 78001 78003 78006 78007 78010 78011 78015 78016 78018 78020 78070 78075 *** TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC 58.20 62.39 58.20 62.39 62.39 256.76 17.82 68.99 62.08 101.92 62.08 62.39 62.39 53.20 226.73 43.17 62.39 33.91 106.41 113.33 141.13 227.08 265.24 1137.78 54.75 1137.78 76.30 95.21 107.96 164.65 96.37 141.13 201.31 20.07 54.75 77.46 132.25 141.90 72.81 85.17 85.17 95.21 704.07 428.61 109.08 81.94 110.81 81.63 109.08 81.67 254.94 194.10 297.98 445.99 224.55 389.79 582.83 86.60 130.10 193.80 291.85 58.43 54.94 10.30 13.75 17.19 25.96 26.34 20.60 23.66 35.85 43.89 45.80 31.71 43.50 40.06

PROC MOD NOTE PAR FEE ----- -- ---- -------76880 76885 76886 76930 76932 76936 76937 76940 76941 76942 76945 76946 76948 76950 76965 76970 76975 76977 76986 77263 77280 77285 77290 77295 77300 77301 77305 77310 77315 77321 77326 77327 77328 77331 77332 77333 77334 77401 77404 77408 77412 77416 77427 77470 77600 77605 77610 77615 77620 77750 77761 77762 77763 77776 77777 77778 77781 77782 77783 77784 77789 77790 78000 78001 78003 78006 78007 78010 78011 78015 78016 78018 78020 78070 78075 78102 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 31.63 39.29 33.16 36.31 36.31 105.96 17.05 105.95 71.73 35.81 35.85 20.26 20.22 30.86 70.14 20.98 43.12 3.03 64.03 168.67 36.60 54.94 80.89 237.68 32.78 410.68 36.99 54.94 80.89 49.97 48.82 72.47 109.08 45.76 27.87 44.22 64.47 72.81 72.81 85.17 95.21 95.21 172.79 563.27 206.09 276.59 205.78 274.85 205.82 309.31 296.63 444.89 628.39 313.56 562.15 791.81 913.30 956.80 1020.50 1118.55 76.56 75.02 49.98 66.95 56.87 123.11 131.59 95.35 121.97 141.09 185.41 267.10 87.34 118.25 261.37 112.65

LC FEE -------34.56 42.93 36.23 39.66 39.66 115.76 18.63 115.75 78.36 39.12 39.17 22.14 22.09 33.72 76.62 22.92 47.10 3.31 69.95 184.28 39.99 60.02 88.38 259.67 35.81 448.67 40.41 60.02 88.38 54.59 53.34 79.18 119.17 49.99 30.45 48.31 70.44 79.55 79.55 93.05 104.02 104.02 188.77 615.38 225.16 302.17 224.81 300.28 224.86 337.92 324.07 486.05 686.52 342.56 614.15 865.05 997.79 1045.30 1114.90 1222.01 83.64 81.96 54.60 73.14 62.13 134.49 143.76 104.17 133.25 154.15 202.56 291.81 95.42 129.19 285.55 123.07

PROC MOD NOTE PAR FEE ----- -- ---- -------76885 76886 76930 76932 76936 76937 76940 76941 76942 76945 76946 76948 76950 76965 76970 76975 76977 76986 77261 77280 77285 77290 77295 77300 77301 77305 77310 77315 77321 77326 77327 77328 77331 77332 77333 77334 77336 77402 77406 77409 77413 77417 77431 77470 77600 77605 77610 77615 77620 77750 77761 77762 77763 77776 77777 77778 77781 77782 77783 77784 77789 77790 78000 78001 78003 78006 78007 78010 78011 78015 78016 78018 78020 78070 78075 78102 101.67 91.37 98.70 98.70 362.72 34.87 174.94 133.81 137.72 97.92 82.65 82.61 84.07 296.87 64.15 105.51 36.93 170.44 75.19 177.73 282.02 346.14 1375.46 87.53 1548.46 113.29 150.15 188.85 214.62 145.19 213.60 310.39 65.83 82.62 121.68 196.73 121.44 72.81 72.81 85.17 95.21 24.26 98.14 454.19 124.16 165.77 124.16 165.77 124.16 54.37 102.53 146.90 182.40 89.01 172.36 208.98 826.70 826.70 826.70 826.70 18.14 20.07 39.68 53.20 39.68 97.15 105.25 74.75 98.31 105.25 141.52 221.30 55.64 74.75 221.30 83.23

26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26

TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------27.94 38.06 40.23 9.79 11.24 11.61 15.97 22.85 31.14 32.59 30.78 17.69 23.63 21.65 91.55 220.88 283.20 157.85 91.55 111.03 228.57 221.97 113.24 134.44 143.97 141.77 84.56 122.69 136.65 111.03 158.59 164.48 159.70 60.37 64.05 90.08 188.30 152.36 163.25 128.17 183.45 208.69 236.46 281.50 40.51 22.85 40.61 24.66 36.96 50.75 38.78 46.07 91.55 182.77 273.63 456.04 101.09 141.77 202.18 213.51 319.10 60.74 60.74 202.18 304.04 271.32 271.32 132.60 123.80 217.93 100.35 108.08 124.13 109.92 133.33 191.98

M E D I C A R E LC FEE -------32.13 43.77 46.26 11.26 12.93 13.35 18.37 26.28 35.81 37.48 35.40 20.34 27.17 24.90 105.28 254.01 325.68 181.53 105.28 127.68 262.86 255.27 130.23 154.61 165.57 163.04 97.24 141.09 157.15 127.68 182.38 189.15 183.66 69.43 73.66 103.59 216.55 175.21 187.74 147.40 210.97 239.99 271.93 323.73 46.59 26.28 46.70 28.36 42.50 58.36 44.60 52.98 105.28 210.19 314.67 524.45 116.25 163.04 232.51 245.54 366.97 69.85 69.85 232.51 349.65 312.02 312.02 152.49 142.37 250.62 115.40 124.29 142.75 126.41 153.33 220.78

F E E

S C H E D U L E NPAR FEE -------160.75 198.08 46.75 111.23 79.31 128.10 200.88 141.07 220.89 183.14 159.46 147.42 227.15 26.49 20.30 56.15 30.78 60.53 22.12 25.75 36.24 48.93 24.66 28.67 24.66 42.38 22.48 26.49 23.61 37.33 35.51 34.78 39.51 10.15 10.15 13.79 50.03 117.95 118.68 96.67 141.77 165.21 184.98 228.57 29.63 128.12 97.15 191.17 207.60 141.34 201.74 76.96 43.51 62.36 55.12 74.01 35.51 40.60 46.42 50.03 74.00 31.58 31.58 50.44 75.10 59.84 25.39 37.33 49.66 55.08 19.93 24.66 55.08 20.30 24.66 26.49

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------122.69 157.85 36.96 99.99 67.70 112.13 178.03 109.92 188.30 152.37 141.77 123.80 205.49 111.85 277.02 313.98 218.39 113.67 136.79 264.81 270.90 137.90 163.11 168.64 184.15 107.04 149.19 160.26 148.35 194.10 199.26 199.21 70.52 74.20 103.87 238.32 19.21 34.42 44.56 31.50 41.69 43.47 51.48 52.93 10.88 87.50 72.49 154.20 156.85 102.56 155.68 135.06 245.14 328.75 530.03 136.60 182.37 248.60 263.54 393.09 92.32 92.32 252.61 379.14 331.16 296.71 169.93 173.45 273.01 120.28 132.74 179.21 130.23 158.00 218.46 337.07

PAGE 039 LC FEE -------141.09 181.53 42.50 114.99 77.86 128.95 204.73 126.41 216.55 175.23 163.04 142.37 236.31 128.63 318.57 361.08 251.15 130.72 157.31 304.53 311.54 158.59 187.58 193.94 211.77 123.10 171.57 184.30 170.60 223.22 229.15 229.09 81.10 85.33 119.45 274.07 22.09 39.58 51.24 36.23 47.94 49.99 59.20 60.87 12.51 100.63 83.36 177.33 180.38 117.94 179.03 155.32 281.91 378.06 609.53 157.09 209.73 285.89 303.07 452.05 106.17 106.17 290.50 436.01 380.83 341.22 195.42 199.47 313.96 138.32 152.65 206.09 149.76 181.70 251.23 387.63 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------78102 78103 78104 78110 78111 78120 78121 78122 78130 78135 78140 78160 78162 78170 78185 78190 78191 78195 78201 78202 78205 78206 78215 78216 78220 78223 78230 78231 78232 78258 78261 78262 78264 78270 78271 78272 78278 78290 78291 78300 78305 78306 78315 78320 78350 78414 78428 78445 78455 78456 78457 78458 78460 78461 78464 78465 78466 78468 78469 78472 78473 78478 78480 78481 78483 78494 78496 78580 78584 78585 78586 78587 78588 78591 78593 78594 *** 26 26 26 26 26 26 26 26 26 26 26 26 26 26 TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC 29.41 40.06 42.35 10.30 11.83 12.22 16.81 24.05 32.78 34.31 32.40 18.62 24.87 22.79 96.37 232.50 298.11 166.16 96.37 116.87 240.60 233.65 119.20 141.52 151.55 149.23 89.01 129.15 143.84 116.87 166.94 173.14 168.10 63.55 67.42 94.82 198.21 160.38 171.84 134.92 193.11 219.67 248.91 296.32 42.64 24.05 42.75 25.96 38.91 53.42 40.82 48.49 96.37 192.39 288.03 480.04 106.41 149.23 212.82 224.75 335.89 63.94 63.94 212.82 320.04 285.60 285.60 139.58 130.32 229.40 105.63 113.77 130.66 115.71 140.35 202.08

PROC MOD NOTE PAR FEE ----- -- ---- -------78103 78104 78110 78111 78120 78121 78122 78130 78135 78140 78160 78162 78170 78172 78185 78190 78191 78195 78201 78202 78205 78206 78215 78216 78220 78223 78230 78231 78232 78258 78261 78262 78264 78270 78271 78272 78278 78290 78291 78300 78305 78306 78315 78320 78350 78428 78445 78455 78456 78457 78458 78459 78460 78461 78464 78465 78466 78468 78469 78472 78473 78478 78480 78481 78483 78494 78496 78580 78584 78585 78586 78587 78588 78591 78593 78594 169.21 208.51 49.21 117.08 83.48 134.84 211.45 148.49 232.52 192.78 167.85 155.18 239.10 27.88 21.37 59.10 32.40 63.72 23.28 27.11 38.15 51.51 25.96 30.18 25.96 44.61 23.66 27.88 24.85 39.29 37.38 36.61 41.59 10.68 10.68 14.52 52.66 124.16 124.93 101.76 149.23 173.91 194.72 240.60 31.19 134.86 102.26 201.23 218.53 148.78 212.36 81.01 45.80 65.64 58.02 77.90 37.38 42.74 48.86 52.66 77.89 33.24 33.24 53.09 79.05 62.99 26.73 39.29 52.27 57.98 20.98 25.96 57.98 21.37 25.96 27.88

LC FEE -------184.86 227.79 53.76 127.91 91.21 147.32 231.01 162.23 254.02 210.61 183.38 169.53 261.22 30.46 23.35 64.57 35.40 69.61 25.44 29.61 41.68 56.27 28.36 32.97 28.36 48.74 25.85 30.46 27.15 42.93 40.84 40.00 45.44 11.67 11.67 15.86 57.53 135.64 136.48 111.17 163.04 189.99 212.73 262.86 34.07 147.34 111.72 219.85 238.74 162.54 232.00 88.50 50.04 71.71 63.39 85.11 40.84 46.69 53.38 57.53 85.10 36.32 36.32 58.01 86.37 68.82 29.20 42.93 57.11 63.34 22.92 28.36 63.34 23.35 28.36 30.46

PROC MOD NOTE PAR FEE ----- -- ---- -------78103 78104 78110 78111 78120 78121 78122 78130 78135 78140 78160 78162 78170 78185 78190 78191 78195 78201 78202 78205 78206 78215 78216 78220 78223 78230 78231 78232 78258 78261 78262 78264 78270 78271 78272 78278 78282 78290 78291 78300 78305 78306 78315 78320 78350 78428 78445 78455 78456 78457 78458 78460 78461 78464 78465 78466 78468 78469 78472 78473 78478 78480 78481 78483 78494 78496 78580 78584 78585 78586 78587 78588 78591 78593 78594 78596 TC TC TC TC TC TC TC TC TC TC TC TC TC 129.15 166.16 38.90 105.25 71.26 118.03 187.40 115.71 198.21 160.39 149.23 130.32 216.30 117.74 291.60 330.50 229.88 119.65 143.99 278.75 285.16 145.16 171.69 177.52 193.84 112.67 157.04 168.69 156.16 204.32 209.75 209.69 74.23 78.11 109.34 250.86 20.22 36.23 46.91 33.16 43.88 45.76 54.19 55.72 11.45 92.11 76.30 162.32 165.11 107.96 163.87 142.17 258.04 346.05 557.93 143.79 191.97 261.68 277.41 413.78 97.18 97.18 265.91 399.09 348.59 312.33 178.87 182.58 287.38 126.61 139.73 188.64 137.08 166.32 229.96 354.81

26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 TC TC TC TC TC TC TC TC

26 26 26 26 26 26 26 TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC

26 26 26 26 26 26 26 26 26 TC TC TC TC TC TC

26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------273.63 111.03 131.50 131.50 149.79 253.82 61.47 149.06 194.85 98.88 132.60 228.57 179.50 82.01 117.95 137.39 153.10 172.54 172.54 172.54 228.57 61.47 69.54 56.39 82.01 103.29 123.80 131.50 163.37 214.25 253.82 418.59 131.50 249.03 253.82 101.09 50.54 101.09 101.09 101.09 101.09 101.09 200.04 280.50 75.04 101.88 72.98 19.26 19.99 99.80 20.98 52.30 50.09 19.99 19.62 19.62 10.23 19.99 19.07 14.29 24.23 21.28 54.79 5.48 53.30 51.83 54.54 47.35 117.41 66.68 89.07 29.80 4.70 7.25 11.98 40.34

M E D I C A R E LC FEE -------314.67 127.68 151.23 151.23 172.26 291.89 70.69 171.42 224.08 113.71 152.49 262.86 206.43 94.31 135.64 158.00 176.07 198.42 198.42 198.42 262.86 70.69 79.97 64.85 94.31 118.78 142.37 151.23 187.88 246.39 291.89 481.38 151.23 286.38 291.89 116.25 58.12 116.25 116.25 116.25 116.25 116.25 230.05 322.58 86.30 117.16 83.93 22.15 22.99 114.77 24.13 60.15 57.60 22.99 22.56 22.56 11.76 22.99 21.93 16.43 27.86 24.47 63.01 6.30 61.30 59.60 62.72 54.45 135.02 76.68 102.43 34.27 5.41 8.34 13.78 46.39

F E E

S C H E D U L E NPAR FEE -------63.44 22.12 25.39 26.85 32.59 62.36 15.25 21.76 34.42 31.59 28.67 45.70 30.49 26.49 22.48 24.66 37.33 48.56 60.90 70.68 33.33 15.25 18.88 18.49 28.30 33.33 35.87 33.33 39.87 43.51 55.12 53.69 36.96 43.51 55.49 89.92 52.93 90.28 105.50 127.30 66.72 100.11 101.09 162.57 202.97 21.83 71.51 19.62 19.62 50.45 19.99 50.45 53.41 19.62 19.62 11.33 8.07 19.62 30.14 30.14 41.36 30.14 63.49 14.16 26.43 24.96 13.18 15.02 43.00 47.42 47.35 13.87 31.10 40.99 93.20 159.45

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------133.14 156.88 158.35 182.39 316.18 76.72 170.82 229.26 130.46 161.26 274.27 209.98 108.50 140.43 162.05 190.43 221.11 233.44 243.22 261.90 76.72 88.42 74.88 110.31 136.62 159.68 164.82 203.24 257.76 308.94 472.28 168.45 292.55 309.31 191.01 103.47 191.37 206.59 228.38 167.81 201.20 81.21 98.95 117.92 101.09 19.62 19.62 18.89 24.32 19.26 19.62 53.41 50.45 19.62 22.53 12.45 18.15 49.22 44.43 65.59 51.42 118.28 19.65 22.16 26.87 26.87 41.36 32.33 74.41 19.26 41.72 9.17 23.85 29.01 52.87 74.15

PAGE 040 LC FEE -------153.11 180.41 182.10 209.75 363.61 88.23 196.44 263.65 150.03 185.45 315.41 241.48 124.78 161.49 186.36 218.99 254.28 268.46 279.70 301.19 88.23 101.68 86.11 126.86 157.11 183.63 189.54 233.73 296.42 355.28 543.12 193.72 336.43 355.71 219.66 118.99 220.08 237.58 262.64 192.98 231.38 93.39 113.79 135.61 116.25 22.56 22.56 21.72 27.97 22.15 22.56 61.42 58.02 22.56 25.91 14.32 20.87 56.60 51.09 75.43 59.13 136.02 22.60 25.48 30.90 30.90 47.56 37.18 85.57 22.15 47.98 10.55 27.43 33.36 60.80 85.27 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------78596 78600 78601 78605 78606 78607 78610 78615 78630 78635 78645 78647 78650 78660 78700 78701 78704 78707 78708 78709 78710 78715 78725 78730 78740 78760 78761 78800 78801 78802 78803 78804 78805 78806 78807 79000 79001 79020 79030 79035 79100 79200 79400 79403 79420 79440 80502 83912 84182 85097 85396 86077 86078 86255 86320 86334 86580 87207 88104 88106 88107 88108 88112 88125 88160 88161 88162 88172 88173 88180 88182 88291 88300 88302 88304 88305 *** TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC 26 26 N 26 26 N N N F 26 N 26 26 26 N TC TC TC TC TC TC 288.03 116.87 138.42 138.42 157.67 267.18 64.71 156.90 205.10 104.08 139.58 240.60 188.95 86.33 124.16 144.62 161.16 181.62 181.62 181.62 240.60 64.71 73.20 59.36 86.33 108.73 130.32 138.42 171.97 225.53 267.18 440.62 138.42 262.14 267.18 106.41 53.20 106.41 106.41 106.41 106.41 106.41 210.57 295.26 78.99 107.24 76.82 20.27 21.04 105.05 22.08 55.05 52.73 21.04 20.65 20.65 10.77 21.04 20.07 15.04 25.50 22.40 57.67 5.77 56.11 54.56 57.41 49.84 123.59 70.19 93.76 31.37 4.95 7.63 12.61 42.46

PROC MOD NOTE PAR FEE ----- -- ---- -------78596 78600 78601 78605 78606 78607 78610 78615 78630 78635 78645 78647 78650 78660 78700 78701 78704 78707 78708 78709 78710 78715 78725 78730 78740 78760 78761 78800 78801 78802 78803 78804 78805 78806 78807 79000 79001 79020 79030 79035 79100 79200 79400 79403 79440 80500 80502 84165 84182 85097 85576 86077 86079 86255 86325 86490 86585 87207 88104 88106 88107 88108 88112 88125 88160 88161 88162 88172 88173 88180 88182 88300 88302 88304 88305 88307 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 TC TC N F 26 26 F F 26 N F N 26 F 26 26 F 26 26 26 26 26 26 TC TC TC TC TC TC TC 66.78 23.28 26.73 28.26 34.31 65.64 16.05 22.91 36.23 33.25 30.18 48.10 32.09 27.88 23.66 25.96 39.29 51.12 64.10 74.40 35.08 16.05 19.87 19.46 29.79 35.08 37.76 35.08 41.97 45.80 58.02 56.52 38.91 45.80 58.41 94.65 55.72 95.03 111.05 134.00 70.23 105.38 106.41 171.13 213.65 22.98 75.27 20.65 20.65 53.11 21.04 53.11 56.22 20.65 20.65 11.93 8.49 20.65 31.73 31.73 43.54 31.73 66.83 14.91 27.82 26.27 13.87 15.81 45.26 49.92 49.84 14.60 32.74 43.15 98.11 167.84

LC FEE -------72.96 25.44 29.20 30.88 37.48 71.71 17.54 25.02 39.58 36.33 32.97 52.56 35.06 30.46 25.85 28.36 42.93 55.84 70.04 81.28 38.33 17.54 21.71 21.26 32.55 38.33 41.25 38.33 45.85 50.04 63.39 61.74 42.50 50.04 63.81 103.41 60.87 103.82 121.33 146.40 76.73 115.13 116.25 186.96 233.42 25.10 82.24 22.56 22.56 58.02 22.99 58.02 61.42 22.56 22.56 13.03 9.28 22.56 34.66 34.66 47.56 34.66 73.01 16.28 30.39 28.70 15.16 17.27 49.45 54.53 54.45 15.95 35.77 47.14 107.18 183.37

PROC MOD NOTE PAR FEE ----- -- ---- -------78600 78601 78605 78606 78607 78610 78615 78630 78635 78645 78647 78650 78660 78700 78701 78704 78707 78708 78709 78710 78715 78725 78730 78740 78760 78761 78800 78801 78802 78803 78804 78805 78806 78807 79000 79001 79020 79030 79035 79100 79200 79300 79400 79403 79440 80500 83020 84181 85060 85390 85576 86078 86079 86256 86327 86510 87164 88104 88106 88107 88108 88112 88125 88141 88160 88161 88162 88172 88173 88180 88182 88300 88302 88304 88305 88307 140.15 165.14 166.68 191.99 332.82 80.76 179.81 241.33 137.33 169.75 288.70 221.03 114.21 147.82 170.58 200.45 232.75 245.73 256.02 275.68 80.76 93.07 78.82 116.12 143.81 168.08 173.49 213.94 271.33 325.20 497.14 177.32 307.95 325.59 201.06 108.92 201.44 217.46 240.40 176.64 211.79 85.48 104.16 124.13 106.41 20.65 20.65 19.88 25.60 20.27 20.65 56.22 53.11 20.65 23.72 13.10 19.10 51.81 46.77 69.04 54.13 124.50 20.68 23.33 28.28 28.28 43.54 34.03 78.33 20.27 43.92 9.65 25.11 30.54 55.65 78.05

26 26 26 TC F 26 26 26 26 F N F 26 26 26

26 26 26 26

26 26 26 26 26 26 26 TC TC TC TC TC

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------85.30 122.69 13.07 29.05 13.07 24.32 22.53 28.32 104.55 190.48 35.97 63.90 31.60 45.72 46.08 45.72 80.60 41.36 99.09 160.09 53.83 53.11 115.47 50.09 19.99 30.49 81.03 9.42 66.84 45.68 15.39 61.92 112.81 151.91 25.33 9.79 24.11 21.68 155.83 59.13 94.78 98.33 146.30 64.59 102.41 103.79 152.12 68.95 141.99 74.41 148.51 86.73 110.00 30.90 33.05 164.04 119.59 20.66 70.18 117.72 3.28 85.93 100.28 106.50 92.19 76.87 137.85 140.23 70.98 77.98 6.56 70.24 17.38 180.35 90.16 67.88

M E D I C A R E LC FEE -------98.10 141.09 15.03 33.41 15.03 27.97 25.91 32.57 120.23 219.05 41.37 73.49 36.34 52.58 52.99 52.58 92.69 47.56 113.95 184.10 61.90 61.08 132.79 57.60 22.99 35.06 93.18 10.83 76.87 52.53 17.70 71.21 129.73 174.70 29.13 11.26 27.73 24.93 179.20 68.00 109.00 113.08 168.25 74.28 117.77 119.36 174.94 79.29 163.29 85.57 170.79 99.74 126.50 35.54 38.01 188.65 137.53 23.76 80.71 135.38 3.77 98.82 115.32 122.48 106.02 88.40 158.53 161.26 81.63 89.68 7.54 80.78 19.99 207.40 103.68 78.06

F E E

S C H E D U L E NPAR FEE -------207.52 16.72 70.25 49.49 50.39 45.32 90.10 78.93 31.96 119.42 82.15 41.10 82.47 86.15 97.93 370.83 398.64 167.35 221.31 61.29 135.68 245.21 117.03 18.52 19.62 101.24 21.75 88.47 11.25 132.25 16.86 66.40 8.07 59.79 115.74 115.67 24.56 146.79 147.73 69.34 91.11 141.61 143.35 75.91 96.89 148.53 148.44 95.50 145.90 101.32 151.36 91.86 31.64 30.16 49.79 138.26 106.69 93.16 114.81 120.54 36.96 63.08 75.82 73.97 72.13 46.43 60.90 65.63 40.24 45.64 22.12 10.15 912.77 293.83 27.15 45.42

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------84.83 3.65 41.20 36.41 26.07 22.79 61.78 69.35 72.60 48.12 18.26 9.50 36.75 40.05 52.20 290.23 357.28 68.26 61.22 7.47 82.57 129.74 66.94 19.99 81.30 25.02 61.70 39.14 111.21 44.62 552.33 30.52 5.48 25.33 12.22 32.22 48.75 138.32 63.18 66.40 100.91 137.19 67.54 71.86 107.47 144.12 63.53 100.16 68.25 105.61 87.83 112.20 30.53 34.52 46.84 98.82 39.81 45.30 73.78 40.24 149.01 176.10 180.47 164.32 123.30 198.74 205.86 111.23 123.61 28.66 80.40 52.10 732.42 203.67 34.06 123.65

PAGE 041 LC FEE -------97.55 4.20 47.38 41.87 29.98 26.21 71.05 79.75 83.49 55.34 21.00 10.93 42.26 46.06 60.03 333.76 410.87 78.50 70.40 8.59 94.96 149.20 76.98 22.99 93.50 28.77 70.96 45.01 127.89 51.31 635.18 35.10 6.30 29.13 14.05 37.05 56.06 159.07 72.66 76.36 116.05 157.77 77.67 82.64 123.59 165.74 73.06 115.18 78.49 121.45 101.00 129.03 35.11 39.70 53.87 113.64 45.78 52.10 84.85 46.28 171.36 202.52 207.54 188.97 141.80 228.55 236.74 127.91 142.15 32.96 92.46 59.92 842.28 234.22 39.17 142.20 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------88307 88309 88311 88312 88313 88314 88318 88319 88323 88325 88329 88331 88332 88342 88346 88347 88348 88349 88355 88356 88358 88361 88362 88365 89060 89100 89130 89132 89136 89140 89220 90375 90396 90586 90634 90718 90782 90788 90802 90804 90806 90807 90809 90810 90812 90813 90815 90817 90821 90824 90828 90845 90847 90853 90857 90865 90880 90901 90935 90947 91000 91010 91011 91012 91020 91030 91032 91033 91052 91055 91060 91065 91105 91110 91122 92002 *** 26 26 26 26 26 26 26 26 N F 26 26 26 26 26 26 26 26 26 26 26 26 26 26 N F N F N F 89.79 129.15 13.76 30.58 13.76 25.60 23.72 29.81 110.05 200.50 37.86 67.26 33.26 48.13 48.51 48.13 84.84 43.54 104.31 168.52 56.66 55.90 121.55 52.73 21.04 32.09 85.29 9.92 70.36 48.08 16.20 65.18 118.75 159.91 26.66 10.31 25.38 22.82 164.03 62.24 99.77 103.51 154.00 67.99 107.80 109.25 160.13 72.58 149.46 78.33 156.33 91.29 115.79 32.53 34.79 172.67 125.88 21.75 73.87 123.92 3.45 90.45 105.56 112.11 97.04 80.92 145.10 147.61 74.72 82.08 6.90 73.94 18.29 189.84 94.90 71.45

PROC MOD NOTE PAR FEE ----- -- ---- -------88309 88311 88312 88313 88314 88318 88319 88321 88323 88325 88331 88332 88342 88346 88347 88348 88349 88355 88356 88358 88361 88362 88365 88371 89060 89105 89130 89135 89136 89141 89230 90376 90471 90632 90675 90780 90783 90801 90802 90805 90806 90808 90809 90811 90812 90814 90815 90818 90822 90826 90829 90846 90849 90853 90862 90865 90880 90911 90937 90997 91000 91010 91011 91012 91020 91030 91032 91033 91052 91055 91060 91065 91110 91122 91132 92002 218.44 17.60 73.95 52.09 53.04 47.71 94.84 83.08 33.64 125.70 86.47 43.26 86.81 90.68 103.08 390.35 419.62 176.16 232.96 64.52 142.82 258.12 123.19 19.49 20.65 106.57 22.89 93.13 11.84 139.21 17.75 69.89 8.49 62.94 121.83 121.76 25.85 154.52 155.51 72.99 95.90 149.06 150.89 79.90 101.99 156.35 156.25 100.53 153.58 106.65 159.33 96.69 33.30 31.75 52.41 145.54 112.31 98.06 120.85 126.88 38.91 66.40 79.81 77.86 75.93 48.87 64.10 69.08 42.36 48.04 23.28 10.68 960.81 309.29 28.58 47.81

LC FEE -------238.65 19.23 80.79 56.91 57.95 52.12 103.62 90.77 36.75 137.33 94.47 47.27 94.84 99.07 112.62 426.45 458.44 192.45 254.51 70.48 156.03 281.99 134.58 21.30 22.56 116.43 25.01 101.74 12.94 152.09 19.39 76.36 9.28 68.76 133.10 133.02 28.24 168.81 169.89 79.74 104.78 162.85 164.85 87.30 111.42 170.81 170.71 109.83 167.79 116.52 174.06 105.64 36.39 34.68 57.26 159.00 122.69 107.13 132.03 138.62 42.50 72.54 87.19 85.07 82.95 53.39 70.04 75.47 46.28 52.49 25.44 11.67 1049.69 337.90 31.22 52.23

PROC MOD NOTE PAR FEE ----- -- ---- -------88309 88311 88312 88313 88314 88318 88319 88321 88323 88329 88331 88332 88342 88346 88347 88348 88349 88355 88356 88358 88361 88362 88365 88372 89100 89105 89132 89135 89140 89141 90371 90385 90472 90633 90703 90781 90784 90801 90804 90805 90807 90808 90810 90811 90813 90814 90816 90819 90823 90827 90845 90847 90849 90857 90862 90870 90901 90911 90945 91000 91010 91011 91012 91020 91030 91032 91033 91052 91055 91060 91065 91100 91110 91122 91133 92004 TC TC TC TC TC TC TC F 26 N TC TC TC TC TC TC TC TC TC TC TC TC TC 26 N F N F N F 89.29 3.84 43.37 38.33 27.44 23.99 65.03 73.00 76.42 50.65 19.22 10.00 38.68 42.16 54.95 305.51 376.08 71.85 64.44 7.86 86.92 136.57 70.46 21.04 85.58 26.34 64.95 41.20 117.06 46.97 581.40 32.13 5.77 26.66 12.86 33.92 51.32 145.60 66.51 69.89 106.22 144.41 71.09 75.64 113.13 151.70 66.87 105.43 71.84 111.17 92.45 118.11 32.14 36.34 49.31 104.02 41.90 47.68 77.66 42.36 156.85 185.37 189.97 172.97 129.79 209.20 216.69 117.08 130.12 30.17 84.63 54.84 770.97 214.39 35.85 130.16

N TC F

26 26 F N F N F N

N F N F N F N F N

N F N F N F N F N F

F N F N F N F N F

F F N F N N F TC TC TC TC TC TC TC TC TC TC TC TC 26 26 N

N F N F F N 26 26 26 26 26 26 26 26 26 26 26 26 26 F

N N F N F N F

TC TC 26 N

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------86.84 91.30 69.38 52.16 33.94 65.45 26.11 35.67 41.20 47.60 75.28 23.16 57.54 26.17 20.02 29.75 43.61 58.54 23.63 99.87 88.75 108.96 37.37 94.40 47.30 148.97 129.04 53.32 76.68 22.52 55.29 62.37 53.82 24.89 47.53 28.89 60.83 49.00 42.84 51.52 51.97 23.80 41.33 38.41 77.77 44.33 28.34 14.94 28.49 18.95 14.94 3.65 17.85 28.86 99.98 73.10 7.62 19.63 95.02 89.21 120.20 129.30 73.30 71.10 106.44 17.13 250.12 170.91 312.68 93.64 74.42 585.25 1310.09 171.47 25.93 228.32

M E D I C A R E LC FEE -------99.87 105.00 79.79 59.98 39.03 75.27 30.03 41.02 47.38 54.74 86.57 26.63 66.17 30.10 23.02 34.21 50.15 67.32 27.17 114.85 102.06 125.30 42.98 108.56 54.40 171.32 148.40 61.32 88.18 25.90 63.58 71.73 61.89 28.62 54.66 33.22 69.95 56.35 49.27 59.25 59.77 27.37 47.53 44.17 89.44 50.98 32.59 17.18 32.76 21.79 17.18 4.20 20.53 33.19 114.98 84.07 8.76 22.57 109.27 102.59 138.23 148.70 84.30 81.77 122.41 19.70 287.64 196.55 359.58 107.69 85.58 673.04 1506.60 197.19 29.82 262.57

F E E

S C H E D U L E NPAR FEE -------62.15 57.44 25.88 16.16 14.69 37.46 18.89 23.26 26.53 68.29 43.61 18.90 29.09 22.19 17.80 139.86 301.31 80.29 18.25 59.57 45.58 56.26 28.31 82.07 36.41 113.70 41.41 89.66 44.66 61.78 22.15 80.53 22.89 10.17 61.09 14.16 60.34 24.33 81.70 29.38 33.80 18.00 27.17 25.70 62.15 140.51 17.52 22.97 16.05 15.68 16.05 14.21 28.82 35.41 73.10 59.48 78.04 21.50 49.36 84.42 26.32 129.30 41.72 37.72 46.46 330.00 173.45 157.71 270.20 163.39 788.60 155.89 1017.44 637.53 17.23 26.49

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------35.27 131.62 19.62 36.00 19.26 44.99 58.94 67.74 80.37 41.78 42.06 86.63 53.05 19.98 83.88 96.24 242.77 56.66 10.89 40.31 43.18 52.71 9.06 12.33 10.89 35.27 83.88 64.99 51.60 36.01 14.69 52.92 98.60 128.90 28.33 147.35 27.21 47.25 27.94 22.14 18.17 5.80 14.16 12.71 15.62 112.17 26.28 47.78 14.94 21.13 15.31 11.70 28.86 98.61 26.87 51.86 58.42 23.70 127.86 56.43 60.23 148.41 137.37 191.86 181.59 127.86 97.71 374.58 176.56 88.98 218.97 1261.48 643.60 310.52 8.69 104.36

PAGE 042 LC FEE -------40.56 151.36 22.56 41.40 22.15 51.74 67.78 77.90 92.43 48.05 48.37 99.62 61.01 22.98 96.46 110.68 279.19 65.16 12.52 46.36 49.66 60.62 10.42 14.18 12.52 40.56 96.46 74.74 59.34 41.41 16.89 60.86 113.39 148.24 32.58 169.45 31.29 54.34 32.13 25.46 20.90 6.67 16.28 14.62 17.96 129.00 30.22 54.95 17.18 24.30 17.61 13.46 33.19 113.40 30.90 59.64 67.18 27.26 147.04 64.89 69.26 170.67 157.98 220.64 208.83 147.04 112.37 430.77 203.04 102.33 251.82 1450.70 740.14 357.10 9.99 120.01 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------92004 92014 92019 92060 92065 92070 92081 92082 92083 92100 92130 92135 92136 92140 92226 92230 92235 92240 92250 92265 92270 92275 92283 92284 92285 92286 92287 92311 92313 92315 92317 92326 92335 92504 92506 92508 92511 92516 92520 92541 92542 92543 92544 92545 92546 92547 92548 92555 92561 92564 92568 92572 92576 92582 92585 92586 92587 92588 92597 92602 92607 92610 92612 92614 92616 92953 92961 92973 92977 92978 92979 92982 92987 92996 93000 93012 *** F N N TC TC TC F N TC TC F N F 26 26 26 91.41 96.11 73.03 54.90 35.73 68.89 27.48 37.55 43.37 50.11 79.24 24.38 60.57 27.55 21.07 31.32 45.91 61.62 24.87 105.13 93.42 114.69 39.34 99.37 49.79 156.81 135.83 56.13 80.72 23.70 58.20 65.65 56.65 26.20 50.03 30.41 64.03 51.58 45.09 54.23 54.70 25.05 43.51 40.43 81.86 46.66 29.83 15.73 29.99 19.95 15.73 3.84 18.79 30.38 105.24 76.95 8.02 20.66 100.02 93.90 126.53 136.10 77.16 74.84 112.04 18.03 263.28 179.90 329.14 98.57 78.34 616.05 1379.04 180.49 27.29 240.34

PROC MOD NOTE PAR FEE ----- -- ---- -------92012 92014 92020 92060 92065 92070 92081 92082 92083 92120 92130 92135 92136 92225 92226 92235 92240 92250 92260 92265 92270 92275 92283 92284 92285 92286 92287 92312 92313 92316 92317 92330 92335 92504 92507 92508 92512 92516 92526 92541 92542 92543 92544 92545 92546 92548 92552 92556 92562 92565 92569 92573 92577 92583 92585 92587 92588 92589 92597 92603 92608 92611 92613 92615 92617 92960 92970 92974 92978 92979 92980 92984 92990 92997 93005 93014 N F N TC TC F 26 26 26 N F 26 26 N F N TC TC TC TC TC TC TC F N F N F N F F N F N F N TC TC TC TC TC TC 65.42 60.46 27.24 17.01 15.46 39.43 19.88 24.48 27.93 71.88 45.91 19.89 30.62 23.36 18.74 147.22 317.17 84.52 19.21 62.71 47.98 59.22 29.80 86.39 38.33 119.68 43.59 94.38 47.01 65.03 23.32 84.77 24.09 10.70 64.31 14.91 63.52 25.61 86.00 30.93 35.58 18.95 28.60 27.05 65.42 147.91 18.44 24.18 16.89 16.51 16.89 14.96 30.34 37.27 76.95 62.61 82.15 22.63 51.96 88.86 27.70 136.10 43.92 39.71 48.91 347.37 182.58 166.01 284.42 171.99 830.11 164.09 1070.99 671.08 18.14 27.88

LC FEE -------71.47 66.06 29.76 18.58 16.89 43.08 21.72 26.75 30.51 78.53 50.15 21.74 33.45 25.52 20.47 160.84 346.51 92.33 20.99 68.51 52.42 64.70 32.56 94.38 41.87 130.76 47.62 103.11 51.36 71.05 25.47 92.61 26.32 11.70 70.25 16.28 69.39 27.98 93.96 33.79 38.87 20.70 31.25 29.56 71.47 161.59 20.15 26.42 18.46 18.03 18.46 16.34 33.14 40.72 84.07 68.40 89.75 24.73 56.76 97.08 30.27 148.70 47.98 43.38 53.43 379.50 199.47 181.37 310.73 187.90 906.89 179.27 1170.06 733.16 19.81 30.46

PROC MOD NOTE PAR FEE ----- -- ---- -------92012 92018 92020 92060 92065 92081 92082 92083 92100 92120 92135 92136 92140 92225 92230 92235 92240 92250 92260 92265 92270 92275 92283 92284 92285 92286 92311 92312 92315 92316 92325 92330 92502 92506 92507 92511 92512 92520 92526 92541 92542 92543 92544 92545 92546 92548 92553 92557 92563 92567 92571 92575 92579 92584 92585 92587 92588 92596 92601 92604 92609 92612 92614 92616 92950 92960 92971 92975 92978 92979 92981 92986 92995 92998 93010 93015 F F 26 26 N F N F N TC TC TC F 26 26 26 26 26 26 26 N F N F F N F N F N F 26 26 26 26 26 26 TC 37.13 138.55 20.65 37.89 20.27 47.36 62.04 71.30 84.60 43.98 44.27 91.19 55.84 21.03 88.29 101.30 255.55 59.64 11.46 42.43 45.45 55.48 9.54 12.98 11.46 37.13 88.29 68.41 54.32 37.90 15.46 55.70 103.79 135.68 29.82 155.11 28.64 49.74 29.41 23.31 19.13 6.10 14.91 13.38 16.44 118.07 27.66 50.29 15.73 22.24 16.12 12.32 30.38 103.80 28.28 54.59 61.49 24.95 134.59 59.40 63.40 156.22 144.60 201.96 191.15 134.59 102.85 394.29 185.85 93.66 230.49 1327.87 677.47 326.86 9.15 109.85

N F N F N N N F N F N F

26

TC F

26 26 N F F F

26 TC TC

N N N F TC TC

N

26 26

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------22.89 104.47 332.63 13.82 160.41 26.86 84.56 101.09 48.30 59.04 216.49 114.22 197.98 103.67 261.18 44.12 64.23 93.25 67.29 43.88 114.08 69.46 659.11 308.28 720.18 1686.81 1685.03 1788.21 2216.46 2216.57 2234.56 2327.00 2101.17 892.95 2336.33 2373.29 2196.39 20.71 14.89 20.71 42.44 43.53 24.66 7.96 94.52 77.49 188.09 155.51 177.12 379.08 212.39 222.29 375.57 47.11 71.73 224.68 397.75 183.57 77.56 247.65 278.96 278.96 278.96 855.59 62.88 44.37 36.45 409.15 28.18 23.59 47.89 9.06 19.62 38.80 7.97 41.41

M E D I C A R E LC FEE -------26.32 120.14 382.52 15.89 184.47 30.89 97.24 116.25 55.55 67.90 248.96 131.35 227.68 119.22 300.36 50.74 73.86 107.24 77.38 50.46 131.19 79.88 757.98 354.52 828.21 1939.83 1937.78 2056.44 2548.93 2549.06 2569.74 2676.05 2416.35 1026.89 2686.78 2729.28 2525.85 23.82 17.12 23.82 48.81 50.06 28.36 9.15 108.70 89.11 216.30 178.84 203.69 435.94 244.25 255.63 431.91 54.18 82.49 258.38 457.41 211.11 89.19 284.80 320.80 320.80 320.80 983.93 72.31 51.03 41.92 470.52 32.41 27.13 55.07 10.42 22.56 44.62 9.17 47.62

F E E

S C H E D U L E NPAR FEE -------65.85 43.88 294.13 5.85 48.30 171.01 26.86 22.89 228.32 45.97 150.08 76.09 150.08 76.09 149.12 213.34 142.20 99.29 19.62 7.97 3.97 75.25 157.99 78.56 486.85 1441.18 1402.79 1402.79 1833.48 1883.95 1833.48 1833.48 1833.48 659.11 1883.95 1833.48 1833.48 22.16 15.25 285.62 425.98 45.79 21.07 271.07 166.47 961.50 76.46 43.55 65.85 105.76 53.37 63.28 59.56 84.18 379.15 698.24 621.73 150.39 264.75 403.65 184.45 312.04 264.75 930.27 98.00 35.31 28.12 154.46 42.95 67.99 37.92 33.16 56.32 33.15 67.40 72.87

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------15.61 60.59 38.50 7.96 85.25 59.59 123.98 303.12 26.49 13.06 66.41 38.13 47.89 27.59 112.06 149.12 45.22 86.91 51.85 118.05 144.70 817.10 136.70 229.73 233.33 245.63 282.25 385.42 382.98 332.61 401.08 493.52 267.69 233.83 452.38 539.81 362.91 14.89 13.06 243.18 382.45 21.13 13.10 176.56 88.98 1284.20 111.63 111.96 111.26 273.32 159.01 159.01 12.45 12.45 154.46 300.49 112.19 342.30 651.29 463.42 591.00 543.70 565.54 160.89 158.45 9.06 8.33 254.69 19.36 20.10 28.86 13.55 17.52 25.18 25.99 25.99

PAGE 043 LC FEE -------17.95 69.68 44.28 9.15 98.04 68.53 142.58 348.59 30.46 15.02 76.37 43.85 55.07 31.73 128.87 171.49 52.00 99.95 59.63 135.76 166.41 939.67 157.21 264.19 268.33 282.47 324.59 443.23 440.43 382.50 461.24 567.55 307.84 268.90 520.24 620.78 417.35 17.12 15.02 279.66 439.82 24.30 15.07 203.04 102.33 1476.83 128.37 128.75 127.95 314.32 182.86 182.86 14.32 14.32 177.63 345.56 129.02 393.65 748.98 532.93 679.65 625.26 650.37 185.02 182.22 10.42 9.58 292.89 22.26 23.12 33.19 15.58 20.15 28.96 29.89 29.89 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------93016 93024 93025 93040 93224 93227 93232 93236 93270 93278 93303 93304 93307 93308 93312 93313 93314 93317 93320 93321 93325 93350 93501 93505 93508 93510 93511 93514 93524 93526 93527 93528 93529 93530 93531 93532 93533 93539 93542 93545 93555 93556 93561 93562 93571 93572 93600 93602 93603 93609 93610 93612 93613 93615 93616 93618 93619 93622 93624 93631 93640 93641 93642 93651 93660 93701 93720 93724 93727 93731 93732 93733 93734 93735 93736 93741 *** 24.09 109.97 350.14 14.55 168.85 28.27 89.01 106.41 50.84 62.15 227.88 120.23 208.40 109.13 274.93 46.44 67.61 98.16 70.83 46.19 120.08 73.12 693.80 324.51 758.08 1775.59 1773.72 1882.33 2333.12 2333.23 2352.17 2449.47 2211.76 939.95 2459.29 2498.20 2311.99 21.80 15.67 21.80 44.67 45.82 25.96 8.38 99.49 81.57 197.99 163.69 186.44 399.03 223.57 233.99 395.34 49.59 75.51 236.51 418.68 193.23 81.64 260.68 293.64 293.64 293.64 900.62 66.19 46.71 38.37 430.68 29.66 24.83 50.41 9.54 20.65 40.84 8.39 43.59

PROC MOD NOTE PAR FEE ----- -- ---- -------93017 93024 93025 93041 93225 93230 93233 93237 93271 93278 93303 93304 93307 93308 93312 93314 93315 93318 93320 93321 93325 93350 93501 93505 93508 93510 93511 93514 93524 93526 93527 93528 93529 93530 93531 93532 93533 93540 93543 93555 93556 93561 93562 93571 93572 93580 93600 93602 93603 93609 93610 93612 93615 93616 93618 93619 93620 93623 93624 93631 93640 93641 93642 93652 93660 93701 93721 93724 93731 93732 93733 93734 93735 93736 93741 93742 TC TC 69.32 46.19 309.61 6.16 50.84 180.01 28.27 24.09 240.34 48.39 157.98 80.09 157.98 80.09 156.97 224.57 149.68 104.52 20.65 8.39 4.18 79.21 166.30 82.69 512.47 1517.03 1476.62 1476.62 1929.98 1983.11 1929.98 1929.98 1929.98 693.80 1983.11 1929.98 1929.98 23.33 16.05 300.65 448.40 48.20 22.18 285.34 175.23 1012.10 80.48 45.84 69.32 111.33 56.18 66.61 62.69 88.61 399.10 734.99 654.45 158.31 278.68 424.89 194.16 328.46 278.68 979.23 103.16 37.17 29.60 162.59 45.21 71.57 39.92 34.91 59.28 34.89 70.95 76.70

LC FEE -------75.73 50.46 338.25 6.73 55.55 196.66 30.89 26.32 262.57 52.87 172.59 87.50 172.59 87.50 171.49 245.34 163.53 114.18 22.56 9.17 4.57 86.54 181.69 90.34 559.88 1657.36 1613.21 1613.21 2108.50 2166.54 2108.50 2108.50 2108.50 757.98 2166.54 2108.50 2108.50 25.48 17.54 328.46 489.88 52.66 24.23 311.73 191.44 1105.73 87.93 50.08 75.73 121.62 61.38 72.77 68.49 96.81 436.02 802.98 714.99 172.95 304.46 464.20 212.12 358.85 304.46 1069.81 112.70 40.61 32.34 177.63 49.39 78.19 43.61 38.13 64.77 38.12 77.51 83.80

PROC MOD NOTE PAR FEE ----- -- ---- -------93018 93024 93025 93042 93226 93231 93235 93268 93272 93278 93303 93304 93307 93308 93312 93314 93316 93320 93321 93325 93350 93501 93503 93505 93508 93510 93511 93514 93524 93526 93527 93528 93529 93530 93531 93532 93533 93541 93544 93555 93556 93561 93562 93571 93572 93581 93600 93602 93603 93609 93610 93612 93615 93616 93618 93619 93621 93624 93631 93640 93641 93642 93650 93660 93662 93701 93722 93724 93731 93732 93733 93734 93735 93736 93741 93742 26 26 16.43 63.78 40.53 8.38 89.74 62.73 130.50 319.07 27.88 13.75 69.90 40.14 50.41 29.04 117.96 156.97 47.60 91.48 54.58 124.26 152.32 860.11 143.89 241.82 245.61 258.56 297.10 405.71 403.14 350.12 422.19 519.49 281.78 246.14 476.19 568.22 382.01 15.67 13.75 255.98 402.58 22.24 13.79 185.85 93.66 1351.79 117.50 117.85 117.12 287.70 167.38 167.38 13.10 13.10 162.59 316.31 118.09 360.32 685.57 487.81 622.10 572.32 595.30 169.36 166.79 9.54 8.77 268.09 20.38 21.16 30.38 14.26 18.44 26.50 27.36 27.36

TC TC TC TC TC TC 26 26 26 26 26 26 26 TC TC TC TC TC TC TC TC TC TC TC TC TC TC

26 26 26 26 26 26 TC

26 26 TC TC TC TC TC

26 26 26 26 26 26 26 26 26 26 26 26 26 26 TC TC TC TC TC TC 26 26 26 26 26 26 TC TC TC TC 26

26 26 26 26 26 26

TC TC TC TC TC TC

26 26 26 26 26 TC TC TC TC TC TC

26 26 26 26 26 26 26 26 TC TC

26 26 26 TC TC TC TC TC TC TC TC

26 26 26 26 26 26 26

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------46.87 53.35 60.99 19.10 9.42 73.05 188.84 134.23 213.48 144.21 85.06 135.67 166.78 213.52 151.53 171.95 123.64 85.79 185.98 131.83 297.97 183.44 169.55 123.08 235.13 196.56 143.23 31.82 48.17 54.78 135.78 21.18 37.17 28.58 27.34 38.68 37.14 36.92 34.68 47.73 40.84 116.24 132.55 12.45 58.27 53.14 13.10 81.31 108.00 76.72 48.55 121.22 59.69 2.14 69.56 4.01 11.29 5.85 9.90 8.07 66.28 14.65 3.24 18.71 3.24 32.33 3.24 130.41 680.30 212.94 505.64 588.80 772.62 836.04 188.36 250.12

M E D I C A R E LC FEE -------53.90 61.35 70.14 21.97 10.83 84.01 217.17 154.36 245.50 165.84 97.82 156.02 191.80 245.55 174.26 197.74 142.19 98.66 213.88 151.60 342.67 210.96 194.98 141.54 270.40 226.04 164.71 36.59 55.40 63.00 156.15 24.36 42.75 32.87 31.44 44.48 42.71 42.46 39.88 54.89 46.97 133.68 152.43 14.32 67.01 61.11 15.07 93.51 124.20 88.23 55.83 139.40 68.64 2.46 79.99 4.61 12.98 6.73 11.39 9.28 76.22 16.85 3.73 21.52 3.73 37.18 3.73 149.97 782.35 244.88 581.49 677.12 888.51 961.45 216.61 287.64

F E E

S C H E D U L E NPAR FEE -------81.92 86.98 71.82 18.88 28.51 61.81 157.73 112.94 163.84 111.64 72.04 112.20 140.44 183.50 131.31 148.08 107.70 68.03 150.91 108.69 206.39 122.57 135.93 99.97 172.12 174.45 130.20 23.48 22.42 39.54 106.39 15.76 24.48 23.16 20.83 25.99 24.44 24.23 19.44 28.49 21.28 85.03 63.32 10.57 68.20 37.68 21.54 68.62 97.85 73.12 35.85 108.53 48.45 4.56 62.33 17.92 7.97 9.17 6.95 84.98 49.71 19.07 14.65 3.61 23.85 3.61 7.66 104.63 585.60 131.01 424.02 454.96 597.08 646.74 131.02 159.37

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------28.57 25.99 33.84 20.47 14.52 11.24 31.11 21.29 49.65 32.58 13.02 23.47 26.34 30.02 20.24 23.87 15.94 17.76 35.07 23.14 91.57 60.86 33.62 23.10 63.00 22.12 13.02 8.33 25.75 15.24 29.38 5.42 12.69 5.42 6.51 12.69 12.69 12.69 15.24 19.24 19.56 31.20 69.24 89.94 40.58 37.02 17.59 12.69 10.15 3.60 12.69 12.69 11.24 18.03 7.24 7.97 5.85 8.07 13.55 108.54 10.23 9.50 3.24 17.96 3.61 9.87 3.24 140.98 94.70 81.95 81.61 133.85 175.55 189.30 57.33 90.73

PAGE 044 LC FEE -------32.86 29.89 38.92 23.54 16.70 12.93 35.78 24.48 57.10 37.47 14.97 26.99 30.29 34.52 23.28 27.45 18.33 20.42 40.33 26.61 105.31 69.99 38.66 26.57 72.45 25.44 14.97 9.58 29.61 17.53 33.79 6.23 14.59 6.23 7.49 14.59 14.59 14.59 17.53 22.13 22.49 35.88 79.63 103.43 46.67 42.57 20.23 14.59 11.67 4.14 14.59 14.59 12.93 20.73 8.33 9.17 6.73 9.28 15.58 124.82 11.76 10.93 3.73 20.65 4.15 11.35 3.73 162.13 108.91 94.24 93.85 153.93 201.88 217.70 65.93 104.34 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------93742 26 93743 26 93744 26 93788 93797 F 93875 93880 93882 93886 93888 93922 93923 93924 93925 93926 93930 93931 93965 93970 93971 93975 93976 93978 93979 93980 93981 93990 94010 94014 94060 94070 94200 94240 94250 94260 94350 94360 94370 94375 94400 94450 94620 94621 94640 94656 F 94660 N 94664 94680 94681 94690 94720 94725 94750 94760 94770 95004 95015 N 95027 95052 95065 95075 N 95115 95144 F 95146 N 95147 F 95149 N 95165 F 95180 N 95805 95806 95807 95808 95810 95811 95812 95813 *** 49.34 56.16 64.20 20.11 9.92 76.89 198.78 141.29 224.72 151.80 89.54 142.81 175.56 224.76 159.51 181.00 130.15 90.30 195.77 138.77 313.65 193.09 178.47 129.56 247.51 206.91 150.77 33.49 50.71 57.66 142.93 22.29 39.13 30.08 28.78 40.72 39.09 38.86 36.50 50.24 42.99 122.36 139.53 13.10 61.34 55.94 13.79 85.59 113.68 80.76 51.10 127.60 62.83 2.25 73.22 4.22 11.88 6.16 10.42 8.49 69.77 15.42 3.41 19.69 3.41 34.03 3.41 137.27 716.10 224.15 532.25 619.79 813.28 880.04 198.27 263.28

PROC MOD NOTE PAR FEE ----- -- ---- -------93743 93744 93784 93790 93798 93875 93880 93882 93886 93888 93922 93923 93924 93925 93926 93930 93931 93965 93970 93971 93975 93976 93978 93979 93980 93981 93990 94010 94015 94060 94070 94200 94240 94250 94260 94350 94360 94370 94375 94400 94450 94620 94621 94642 94657 94660 94667 94680 94681 94690 94720 94725 94750 94761 94770 95010 95015 95028 95056 95070 95075 95117 95145 95146 95148 95149 95170 95180 95805 95806 95807 95808 95810 95811 95812 95813 86.23 91.56 75.60 19.87 30.01 65.06 166.03 118.88 172.46 117.52 75.83 118.10 147.83 193.16 138.22 155.87 113.37 71.61 158.85 114.41 217.25 129.02 143.08 105.23 181.18 183.63 137.05 24.72 23.60 41.62 111.99 16.59 25.77 24.38 21.93 27.36 25.73 25.50 20.46 29.99 22.40 89.51 66.65 11.13 71.79 39.66 22.67 72.23 103.00 76.97 37.74 114.24 51.00 4.80 65.61 18.86 8.39 9.65 7.32 89.45 52.33 20.07 15.42 3.80 25.11 3.80 8.06 110.14 616.42 137.90 446.34 478.90 628.50 680.78 137.92 167.76

LC FEE -------94.21 100.03 82.59 21.71 32.79 71.08 181.39 129.88 188.42 128.39 82.85 129.03 161.51 211.03 151.01 170.29 123.86 78.23 173.55 124.99 237.35 140.96 156.32 114.97 197.94 200.62 149.73 27.00 25.78 45.47 122.35 18.12 28.15 26.63 23.95 29.89 28.11 27.86 22.36 32.76 24.47 97.78 72.82 12.16 78.43 43.33 24.77 78.91 112.53 84.09 41.23 124.81 55.72 5.24 71.68 20.61 9.17 10.55 7.99 97.73 57.17 21.93 16.85 4.15 27.43 4.15 8.81 120.32 673.44 150.66 487.62 523.20 686.64 743.75 150.67 183.28

PROC MOD NOTE PAR FEE ----- -- ---- -------93743 93744 93786 93797 93798 93875 93880 93882 93886 93888 93922 93923 93924 93925 93926 93930 93931 93965 93970 93971 93975 93976 93978 93979 93980 93981 93990 94010 94016 94060 94070 94200 94240 94250 94260 94350 94360 94370 94375 94400 94450 94620 94621 94656 94657 94662 94668 94680 94681 94690 94720 94725 94750 94762 94770 95010 95024 95044 95060 95071 95078 95144 95145 95147 95148 95165 95170 95250 95805 95806 95807 95808 95810 95811 95812 95813 TC TC N F 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 N F 26 26 26 26 26 26 26 F 30.07 27.36 35.62 21.55 15.28 11.83 32.75 22.41 52.26 34.29 13.71 24.71 27.73 31.60 21.30 25.13 16.78 18.69 36.92 24.36 96.39 64.06 35.39 24.32 66.32 23.28 13.71 8.77 27.11 16.04 30.93 5.70 13.36 5.70 6.85 13.36 13.36 13.36 16.04 20.25 20.59 32.84 72.88 94.67 42.72 38.97 18.52 13.36 10.68 3.79 13.36 13.36 11.83 18.98 7.62 8.39 6.16 8.49 14.26 114.25 10.77 10.00 3.41 18.91 3.80 10.39 3.41 148.40 99.68 86.26 85.91 140.89 184.79 199.26 60.35 95.51

N TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC N F TC TC TC TC TC TC TC N F F N F N F N F TC TC TC TC TC TC TC TC

N F N F N F 26 26 26 26 26 26 26 26

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------159.68 179.93 205.22 40.57 55.16 322.54 22.99 15.25 40.80 9.07 42.31 15.68 38.58 29.23 36.59 69.86 22.68 27.43 8.76 8.76 23.74 38.80 41.16 35.63 36.01 50.54 14.29 14.29 63.62 35.48 35.48 35.48 47.46 31.07 8.76 8.76 13.18 155.21 1374.63 248.00 121.28 78.15 486.95 66.92 68.72 50.54 50.54 214.14 23.14 82.98 48.85 57.21 86.10 19.87 71.12 71.12 25.39 23.58 23.22 106.02 40.68 47.14 263.85 400.46 126.13 202.24 77.71 27.94 50.99 65.90 394.54 62.01 77.10 29.75 6.56 5.81

M E D I C A R E LC FEE -------183.63 206.92 236.00 46.66 63.43 370.92 26.44 17.54 46.92 10.43 48.66 18.03 44.37 33.61 42.08 80.34 26.08 31.54 10.07 10.07 27.30 44.62 47.33 40.97 41.41 58.12 16.43 16.43 73.16 40.80 40.80 40.80 54.58 35.73 10.07 10.07 15.16 178.49 1580.82 285.20 139.47 89.87 559.99 76.96 79.03 58.12 58.12 246.26 26.61 95.43 56.18 65.79 99.02 22.85 81.79 81.79 29.20 27.12 26.70 121.92 46.78 54.21 303.43 460.53 145.05 232.58 89.37 32.13 58.64 75.79 453.72 71.31 88.67 34.21 7.54 6.68

F E E

S C H E D U L E NPAR FEE -------101.97 122.23 147.89 144.47 1389.83 188.29 15.26 33.92 32.70 13.89 28.32 82.81 51.55 82.79 99.85 106.41 42.82 63.17 19.62 19.62 79.17 58.43 22.53 31.96 18.16 116.64 46.07 50.82 47.54 28.68 29.05 30.09 18.53 30.87 27.23 29.41 34.14 81.55 319.48 163.00 131.35 51.81 163.70 105.64 225.25 163.43 174.36 180.64 40.87 79.30 162.09 82.52 102.83 115.78 12.94 71.12 24.67 23.21 22.85 28.33 152.17 265.31 104.25 136.11 340.27 149.74 37.40 18.34 68.84 330.98 120.62 38.22 60.16 14.54 4.71 4.71

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------57.70 57.70 57.33 89.31 1067.29 91.09 20.04 25.82 19.75 6.16 98.50 90.14 112.01 136.45 176.28 65.49 90.58 28.39 28.39 102.91 97.22 63.70 67.60 54.17 167.18 60.34 65.09 111.16 64.17 64.54 65.57 65.99 61.93 36.00 38.18 47.32 236.77 1698.56 411.00 252.62 129.96 650.65 172.57 293.98 213.97 224.90 427.50 23.87 39.03 50.32 91.09 36.86 21.03 71.12 139.50 25.76 24.30 5.42 63.00 143.77 213.80 148.18 241.50 396.75 111.25 216.51 55.11 40.72 327.67 66.99 72.31 31.23 44.48 13.84 14.58 5.80

PAGE 045 LC FEE -------66.36 66.36 65.93 102.71 1227.38 104.75 23.05 29.69 22.71 7.08 113.28 103.66 128.81 156.92 202.72 75.31 104.17 32.65 32.65 118.35 111.80 73.26 77.74 62.30 192.26 69.39 74.85 127.83 73.80 74.22 75.41 75.89 71.22 41.40 43.91 54.42 272.29 1953.34 472.65 290.51 149.45 748.25 198.46 338.08 246.07 258.64 491.63 27.45 44.88 57.87 104.75 42.39 24.18 81.79 160.43 29.62 27.95 6.23 72.45 165.34 245.87 170.41 277.73 456.26 127.94 248.99 63.38 46.83 376.82 77.04 83.16 35.91 51.15 15.92 16.77 6.67 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------95816 95819 95822 95824 95827 95829 95831 95832 95834 95851 95857 95858 95860 95861 95863 95864 95867 95868 95869 95870 95872 95875 95900 95903 95904 95920 95921 95922 95923 95925 95926 95927 95930 95933 95934 95936 95937 95950 95951 95953 95954 95955 95956 95957 95958 95961 95962 95966 95970 95972 95973 95990 96000 96003 96105 96115 96150 96152 96154 96405 96406 96412 96422 96440 96445 96520 96542 96571 96912 96920 96922 97001 97003 97004 97018 97024 *** 168.08 189.40 216.02 42.70 58.06 339.52 24.20 16.05 42.95 9.55 44.54 16.51 40.61 30.77 38.52 73.54 23.87 28.87 9.22 9.22 24.99 40.84 43.33 37.51 37.90 53.20 15.04 15.04 66.97 37.35 37.35 37.35 49.96 32.70 9.22 9.22 13.87 163.38 1446.98 261.05 127.66 82.26 512.58 70.44 72.34 53.20 53.20 225.41 24.36 87.35 51.42 60.22 90.63 20.92 74.86 74.86 26.73 24.82 24.44 111.60 42.82 49.62 277.74 421.54 132.77 212.88 81.80 29.41 53.67 69.37 415.31 65.27 81.16 31.32 6.90 6.12

PROC MOD NOTE PAR FEE ----- -- ---- -------95816 95819 95822 95827 95829 95830 95831 95833 95834 95852 95857 95858 95860 95861 95863 95864 95867 95868 95869 95870 95872 95875 95900 95903 95904 95920 95921 95922 95923 95925 95926 95927 95930 95933 95934 95936 95937 95950 95951 95953 95954 95955 95956 95957 95958 95961 95962 95967 95971 95972 95974 95991 96001 96004 96110 96117 96151 96152 96154 96405 96408 96414 96423 96440 96450 96530 96567 96900 96913 96921 96922 97002 97003 97012 97020 97026 TC TC TC N F N F N F 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 N F N 107.34 128.66 155.67 152.07 1462.98 198.20 16.06 35.71 34.42 14.62 29.81 87.17 54.26 87.15 105.11 112.01 45.07 66.49 20.65 20.65 83.34 61.50 23.72 33.64 19.12 122.78 48.49 53.49 50.04 30.19 30.58 31.67 19.50 32.49 28.66 30.96 35.94 85.84 336.29 171.58 138.26 54.54 172.32 111.20 237.11 172.03 183.54 190.15 43.02 83.47 170.62 86.86 108.24 121.87 13.62 74.86 25.97 24.43 24.05 29.82 160.18 279.27 109.74 143.27 358.18 157.62 39.37 19.30 72.46 348.40 126.97 40.23 63.33 15.30 4.96 4.96

LC FEE -------117.27 140.56 170.07 166.14 1598.30 216.53 17.55 39.01 37.61 15.97 32.57 95.23 59.28 95.21 114.83 122.37 49.24 72.65 22.56 22.56 91.05 67.19 25.91 36.75 20.88 134.14 52.98 58.44 54.67 32.98 33.41 34.60 21.31 35.50 31.31 33.82 39.26 93.78 367.40 187.45 151.05 59.58 188.26 121.49 259.04 187.94 200.51 207.74 47.00 91.20 186.40 94.90 118.25 133.15 14.88 81.79 28.37 26.69 26.28 32.58 175.00 305.11 119.89 156.53 391.31 172.20 43.01 21.09 79.17 380.63 138.71 43.95 69.18 16.72 5.42 5.42

PROC MOD NOTE PAR FEE ----- -- ---- -------95816 95819 95822 95827 95829 95830 95832 95833 95851 95852 95858 95860 95861 95863 95864 95867 95868 95869 95870 95872 95875 95900 95903 95904 95920 95921 95922 95923 95925 95926 95927 95930 95933 95934 95936 95937 95950 95951 95953 95954 95955 95956 95957 95958 95961 95962 95965 95970 95971 95973 95975 95991 96002 96100 96111 96150 96151 96153 96400 96406 96410 96420 96425 96445 96450 96542 96570 96910 96920 96921 97001 97002 97004 97016 97022 97028 26 26 26 TC TC F N F N F 60.74 60.74 60.35 94.01 1123.46 95.88 21.09 27.18 20.79 6.48 103.68 94.88 117.91 143.63 185.56 68.94 95.35 29.88 29.88 108.33 102.34 67.05 71.16 57.02 175.98 63.52 68.52 117.01 67.55 67.94 69.02 69.46 65.19 37.89 40.19 49.81 249.23 1787.96 432.63 265.92 136.80 684.89 181.65 309.45 225.23 236.74 450.00 25.13 41.08 52.97 95.88 38.80 22.14 74.86 146.84 27.12 25.58 5.71 66.32 151.34 225.05 155.98 254.21 417.63 117.11 227.91 58.01 42.86 344.92 70.52 76.12 32.87 46.82 14.57 15.35 6.11

26 26 26 N F N F N TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC TC 26 F N F

26 N F N F N F N N F N N F N F N

F N N N F N F F F N F N F

N F F F F N

N F N F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

MFSJ04FS

FSY-2004

"STATE MD" NPAR FEE -------15.28 11.99 27.93 23.99 25.80 27.27 25.10 26.93 28.01 17.63 21.78 51.60 51.51 25.46 30.83 129.34 264.25 80.77 22.85 93.43 102.53 20.84 22.85 80.15 90.68 107.31 108.05 53.33 176.27 92.61 89.01 89.45 214.44 69.51 187.47 64.21 62.93 61.94 148.00 26.76 144.92 236.27 98.64 894.73 129.48 95.27 99.77 61.47 70.39 89.44 54.83 44.28 82.06 194.53 113.76 90.72 87.07 81.08 74.72

M E D I C A R E LC FEE -------17.57 13.79 32.12 27.59 29.67 31.36 28.87 30.97 32.21 20.27 25.05 59.34 59.24 29.28 35.45 148.74 303.89 92.89 26.28 107.44 117.91 23.97 26.28 92.17 104.28 123.41 124.26 61.33 202.71 106.50 102.36 102.87 246.61 79.94 215.59 73.84 72.37 71.23 170.20 30.77 166.66 271.71 113.44 1028.94 148.90 109.56 114.74 70.69 80.95 102.86 63.05 50.92 94.37 223.71 130.82 104.33 100.13 93.24 85.93

F E E

S C H E D U L E NPAR FEE -------20.39 22.62 28.01 21.47 17.06 28.38 29.11 37.80 33.79 7.32 39.66 43.87 69.79 21.04 46.08 85.17 115.88 16.86 62.94 69.50 167.59 8.69 51.36 56.21 67.85 150.50 150.54 75.81 219.75 48.76 67.29 166.10 175.79 94.58 21.76 37.87 44.15 116.36 118.55 59.62 249.41 197.24 789.08 392.49 69.78 80.17 39.69 50.06 68.34 75.08 68.26 54.10 119.83 43.21 165.24 93.29 87.44 62.67 73.25

"LOCALITY 01"

JUNE 10, 2004 NPAR FEE -------13.82 11.26 31.99 15.30 29.76 24.00 26.57 24.81 17.63 28.78 33.40 60.71 58.37 35.25 41.67 54.84 24.88 35.37 45.63 131.99 136.30 36.84 34.42 116.08 64.17 64.90 32.31 133.83 67.89 32.93 117.43 132.59 34.76 136.35 43.52 23.51 86.24 89.85 15.92 92.55 120.12 104.90 390.29 137.80 59.84 117.81 29.75 84.01 56.20 39.26 34.17 56.23 157.14 73.43 94.03 89.24 58.02 30.48 145.02

PAGE 046 LC FEE -------15.89 12.95 36.79 17.60 34.22 27.60 30.56 28.53 20.27 33.10 38.41 69.82 67.13 40.54 47.92 63.07 28.61 40.68 52.47 151.79 156.75 42.37 39.58 133.49 73.80 74.64 37.16 153.90 78.07 37.87 135.04 152.48 39.97 156.80 50.05 27.04 99.18 103.33 18.31 106.43 138.14 120.64 448.83 158.47 68.82 135.48 34.21 96.61 64.63 45.15 39.30 64.66 180.71 84.44 108.13 102.63 66.72 35.05 166.77 ***

PROC MOD NOTE PAR FEE ----- -- ---- -------97032 97035 97110 97116 97140 97520 97533 97542 97750 97803 98925 98927 98928 98940 98941 99170 99183 99186 99201 99203 99204 99211 99212 99214 99215 99219 99222 99232 99235 99239 99242 99243 99245 99252 99255 99263 99272 99273 99275 99282 99285 99291 99292 99295 99299 99302 99303 99312 99313 99316 99322 99332 99342 99345 99349 99354 99356 99432 99435 *** 16.08 12.62 29.40 25.25 27.16 28.70 26.42 28.35 29.48 18.56 22.93 54.32 54.22 26.80 32.45 136.15 278.16 85.02 24.05 98.35 107.93 21.94 24.05 84.37 95.45 112.96 113.74 56.14 185.55 97.48 93.69 94.16 225.73 73.17 197.34 67.59 66.24 65.20 155.79 28.17 152.55 248.70 103.83 941.82 136.29 100.28 105.02 64.70 74.09 94.15 57.72 46.61 86.38 204.77 119.75 95.49 91.65 85.35 78.65

PROC MOD NOTE PAR FEE ----- -- ---- -------97033 97036 97112 97124 97150 97530 97535 97601 97755 97804 98926 98927 98929 98940 98942 99170 99183 99195 99202 99203 99205 99211 99213 99214 99217 99220 99223 99233 99236 99241 99242 99244 99245 99253 99261 99271 99272 99274 99275 99283 99289 99291 99293 99296 99301 99302 99311 99312 99315 99316 99323 99333 99343 99347 99350 99355 99357 99432 99436 21.46 23.81 29.48 22.60 17.96 29.87 30.64 39.79 35.57 7.71 41.75 46.18 73.46 22.15 48.51 89.65 121.98 17.75 66.25 73.16 176.41 9.15 54.06 59.17 71.42 158.42 158.46 79.80 231.32 51.33 70.83 174.84 185.04 99.56 22.91 39.86 46.47 122.48 124.79 62.76 262.54 207.62 830.61 413.15 73.45 84.39 41.78 52.69 71.94 79.03 71.85 56.95 126.14 45.48 173.94 98.20 92.04 65.97 77.10

LC FEE -------23.45 26.01 32.21 24.69 19.62 32.64 33.48 43.47 38.86 8.42 45.61 50.45 80.26 24.20 52.99 97.95 133.26 19.39 72.38 79.93 192.73 9.99 59.06 64.64 78.03 173.08 173.12 87.18 252.71 56.07 77.38 191.02 202.16 108.77 25.02 43.55 50.77 133.81 136.33 68.56 286.82 226.83 907.44 451.36 80.25 92.20 45.64 57.57 78.59 86.34 78.50 62.22 137.80 49.69 190.03 107.28 100.56 72.07 84.24

PROC MOD NOTE PAR FEE ----- -- ---- -------97034 97039 97113 97139 97504 97532 97537 97703 97802 98925 98926 98928 98929 98941 98942 99175 99185 99201 99202 99204 99205 99212 99213 99215 99218 99221 99231 99234 99238 99241 99243 99244 99251 99254 99262 99271 99273 99274 99281 99284 99290 99292 99294 99298 99301 99303 99311 99313 99315 99321 99331 99341 99344 99348 99354 99355 99431 99433 99440 14.55 11.85 33.67 16.10 31.33 25.26 27.97 26.12 18.56 30.29 35.16 63.91 61.44 37.10 43.86 57.73 26.19 37.23 48.03 138.94 143.47 38.78 36.23 122.19 67.55 68.32 34.01 140.87 71.46 34.66 123.61 139.57 36.59 143.53 45.81 24.75 90.78 94.58 16.76 97.42 126.44 110.42 410.83 145.05 62.99 124.01 31.32 88.43 59.16 41.33 35.97 59.19 165.41 77.29 98.98 93.94 61.07 32.08 152.65

F N F N F N N F N F N F N F

N F N F N F F N F N F N F

N F N F N F N F N F N F N

N F N N F N N F N F N F N

N F N F N F N F F N F N F N F

F N F F N F N F N F N F

F N

N F

N F

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

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