0¾¨qIDICODEC COSTN DOLLARSN FLATRATEN# INFORMALL-ISDOLLARSL.NAMEC/úNAME2C)úPERCOMC#TYPEC7UNITNL UNITTYPECVSCUTCWISNOTBILLL\ISTAXL]TAXN^ IDMODIFIhIDMODIF2IlISCANCELVSLp ÙY 97001 0.00 0.00 0.00FFPT EVALUATION + 1.00 FF 0.00F ÚY 97002 0.00 0.00 0.00FFPT RE-EVALUATION + 1.00 FF 0.00F ÛY 97003 0.00 0.00 0.00FFOT EVALUATION + 1.00 FF 0.00F ÜY 97004 0.00 0.00 0.00FFOT RE-EVALUATION + 1.00 FF 0.00F ÝY 97005 0.00 0.00 0.00FFATHLETIC TRAIN EVAL + 1.00 FF 0.00F ÞY 97006 0.00 0.00 0.00FFATHLETIC TRAIN REEVAL + 1.00 FF 0.00F ßY 97010 0.00 0.00 0.00FFHOT OR COLD PACKS THERAPY + 1.00 FF 0.00F àY 97012 0.00 0.00 0.00FFMECHANICAL TRACTION THERAPY + 1.00 FF 0.00F áY 97014 0.00 0.00 0.00FFELECTRIC STIMULATION THERAPY + 1.00 FF 0.00F âY 97016 0.00 0.00 0.00FFVASOPNEUMATIC DEVICE THERAPY + 1.00 FF 0.00F ãY 97018 0.00 0.00 0.00FFPARAFFIN BATH THERAPY + 1.00 FF 0.00F äY 97022 0.00 0.00 0.00FFWHIRLPOOL THERAPY + 1.00 FF 0.00F åY 97024 0.00 0.00 0.00FFDIATHERMY EG, MICROWAVE + 1.00 FF 0.00F æY 97026 0.00 0.00 0.00FFINFRARED THERAPY + 1.00 FF 0.00F çY 97028 0.00 0.00 0.00FFULTRAVIOLET THERAPY + 1.00 FF 0.00F èY 97032 0.00 0.00 0.00FFELECTRICAL STIMULATION + 1.00 FF 0.00F éY 97033 0.00 0.00 0.00FFELECTRIC CURRENT THERAPY + 1.00 FF 0.00F êY 97034 0.00 0.00 0.00FFCONTRAST BATH THERAPY + 1.00 FF 0.00F ëY 97035 0.00 0.00 0.00FFULTRASOUND THERAPY + 1.00 FF 0.00F ìY 97036 0.00 0.00 0.00FFHYDROTHERAPY + 1.00 FF 0.00F íY 97039 0.00 0.00 0.00FFPHYSICAL THERAPY TREATMENT + 1.00 FF 0.00F îY 97110 0.00 0.00 0.00FFTHERAPEUTIC EXERCISES + 1.00 FF 0.00F ïY 97112 0.00 0.00 0.00FFNEUROMUSCULAR REEDUCATION + 1.00 FF 0.00F ðY 97113 0.00 0.00 0.00FFAQUATIC THERAPY/EXERCISES + 1.00 FF 0.00F ñY 97116 0.00 0.00 0.00FFGAIT TRAINING THERAPY + 1.00 FF 0.00F òY 97124 0.00 0.00 0.00FFMASSAGE THERAPY + 1.00 FF 0.00F óY 97139 0.00 0.00 0.00FFPHYSICAL MEDICINE PROCEDURE + 1.00 FF 0.00F ôY 97140 0.00 0.00 0.00FFMANUAL THERAPY + 1.00 FF 0.00F õY 97150 0.00 0.00 0.00FFGROUP THERAPEUTIC PROCEDURES + 1.00 FF 0.00F öY 97530 0.00 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0.00 0.00FFOSTEOPATHIC MANIPULATION + 1.00 FF 0.00F Z 98940 0.00 0.00 0.00FFCHIROPRACTIC MANIPULATION + 1.00 FF 0.00F Z 98941 0.00 0.00 0.00FFCHIROPRACTIC MANIPULATION + 1.00 FF 0.00F Z 98942 0.00 0.00 0.00FFCHIROPRACTIC MANIPULATION + 1.00 FF 0.00F Z 98943 0.00 0.00 0.00FFCHIROPRACTIC MANIPULATION + 1.00 FF 0.00F FZ 99201 0.00 0.00 0.00FFOFFICE VISIT, NEW PAT + 1.00 FF 0.00F GZ 99202 0.00 0.00 0.00FFOFFICE VISIT, NEW PAT + 1.00 FF 0.00F HZ 99203 0.00 0.00 0.00FFOFFICE VISIT, NEW PAT + 1.00 FF 0.00F IZ 99204 0.00 0.00 0.00FFOFFICE VISIT, NEW PAT + 1.00 FF 0.00F JZ 99205 0.00 0.00 0.00FFOFFICE VISIT, NEW PAT + 1.00 FF 0.00F KZ 99211 0.00 0.00 0.00FFOFFICE VISIT, EST PAT + 1.00 FF 0.00F LZ 99212 0.00 0.00 0.00FFOFFICE VISIT, EST PAT + 1.00 FF 0.00F MZ 99213 0.00 0.00 0.00FFOFFICE VISIT, EST PAT + 1.00 FF 0.00F NZ 99214 0.00 0.00 0.00FFOFFICE VISIT, EST PAT + 1.00 FF 0.00F OZ 99215 0.00 0.00 0.00FFOFFICE VISIT, EST PAT + 1.00 FF 0.00F çO 72010 0.00 0.00 0.00FFX-RAY SPINE + 1.00 FF 0.00F èO 72020 0.00 0.00 0.00FFX-RAY SPINE + 1.00 FF 0.00F éO 72040 0.00 0.00 0.00FFX-RAY NECK SPINE + 1.00 FF 0.00F êO 72050 0.00 0.00 0.00FFX-RAY NECK SPINE + 1.00 FF 0.00F ëO 72052 0.00 0.00 0.00FFX-RAY NECK SPINE + 1.00 FF 0.00F ìO 72069 0.00 0.00 0.00FFX-RAY TRUNK SPINE + 1.00 FF 0.00F íO 72070 0.00 0.00 0.00FFX-RAY THORACIC SPINE + 1.00 FF 0.00F îO 72072 0.00 0.00 0.00FFX-RAY THORACIC SPINE + 1.00 FF 0.00F ïO 72074 0.00 0.00 0.00FFX-RAY THORACIC SPINE + 1.00 FF 0.00F ðO 72080 0.00 0.00 0.00FFX-RAY TRUNK SPINE + 1.00 FF 0.00F ñO 72090 0.00 0.00 0.00FFX-RAY TRUNK SPINE + 1.00 FF 0.00F òO 72100 0.00 0.00 0.00FFX-RAY LOWER SPINE + 1.00 FF 0.00F óO 72110 0.00 0.00 0.00FFX-RAY LOWER SPINE + 1.00 FF 0.00F ôO 72114 0.00 0.00 0.00FFX-RAY LOWER SPINE + 1.00 FF 0.00F õO 72120 0.00 0.00 0.00FFX-RAY LOWER SPINE + 1.00 FF 0.00F öO 72125 0.00 0.00 0.00FFCT NECK SPINE W/O DYE + 1.00 FF 0.00F ÷O 72126 0.00 0.00 0.00FFCT NECK SPINE W/DYE + 1.00 FF 0.00F øO 72127 0.00 0.00 0.00FFCT NECK SPINE W/O & W/DYE + 1.00 FF 0.00F ùO 72128 0.00 0.00 0.00FFCT CHEST SPINE W/O DYE + 1.00 FF 0.00F úO 72129 0.00 0.00 0.00FFCT CHEST SPINE W/DYE + 1.00 FF 0.00F ûO 72130 0.00 0.00 0.00FFCT CHEST SPINE W/O & W/DYE + 1.00 FF 0.00F üO 72131 0.00 0.00 0.00FFCT LUMBAR SPINE W/O DYE + 1.00 FF 0.00F ýO 72132 0.00 0.00 0.00FFCT LUMBAR SPINE W/DYE + 1.00 FF 0.00F þO 72133 0.00 0.00 0.00FFCT LUMBAR SPINE W/O & W/DYE + 1.00 FF 0.00F ÿO 72141 0.00 0.00 0.00FFMRI NECK SPINE W/O DYE + 1.00 FF 0.00F P 72142 0.00 0.00 0.00FFMRI NECK SPINE W/DYE + 1.00 FF 0.00F P 72146 0.00 0.00 0.00FFMRI CHEST SPINE W/O DYE + 1.00 FF 0.00F P 72147 0.00 0.00 0.00FFMRI CHEST SPINE W/DYE + 1.00 FF 0.00F P 72148 0.00 0.00 0.00FFMRI LUMBAR SPINE W/O DYE + 1.00 FF 0.00F P 72149 0.00 0.00 0.00FFMRI LUMBAR SPINE W/DYE + 1.00 FF 0.00F P 72156 0.00 0.00 0.00FFMRI NECK SPINE W/O & W/DYE + 1.00 FF 0.00F P 72157 0.00 0.00 0.00FFMRI CHEST SPINE W/O & W/DYE + 1.00 FF 0.00F P 72158 0.00 0.00 0.00FFMRI LUMBAR SPINE W/O & W/DYE + 1.00 FF 0.00F P 72159 0.00 0.00 0.00FFMR ANGIO SPINE W/O&W/DYE + 1.00 FF 0.00F P 72170 0.00 0.00 0.00FFX-RAY PELVIS + 1.00 FF 0.00F P 72190 0.00 0.00 0.00FFX-RAY PELVIS + 1.00 FF 0.00F P 72191 0.00 0.00 0.00FFCT ANGIOGRAPH PELVIC W/O&W/DYE + 1.00 FF 0.00F P 72192 0.00 0.00 0.00FFCT PELVIS W/O DYE + 1.00 FF 0.00F P 72193 0.00 0.00 0.00FFCT PELVIS W/DYE + 1.00 FF 0.00F P 72194 0.00 0.00 0.00FFCT PELVIS W/O & W/DYE + 1.00 FF 0.00F P 72195 0.00 0.00 0.00FFMRI PELVIS W/O DYE + 1.00 FF 0.00F P 72196 0.00 0.00 0.00FFMRI PELVIS W/DYE + 1.00 FF 0.00F P 72197 0.00 0.00 0.00FFMRI PELVIS W/O & W/DYE + 1.00 FF 0.00F P 72198 0.00 0.00 0.00FFMR ANGIO PELVIS W/O & W/DYE + 1.00 FF 0.00F P 72200 0.00 0.00 0.00FFX-RAY EXAM SACROILIAC JOINTS + 1.00 FF 0.00F P 72202 0.00 0.00 0.00FFX-RAY EXAM SACROILIAC JOINTS + 1.00 FF 0.00F P 72220 0.00 0.00 0.00FFX-RAY TAILBONE + 1.00 FF 0.00F P 72240 0.00 0.00 0.00FFCONTRAST X-RAY NECK SPINE + 1.00 FF 0.00F P 72255 0.00 0.00 0.00FFCONTRAST X-RAY, THORAX SPINE + 1.00 FF 0.00F P 72265 0.00 0.00 0.00FFCONTRAST X-RAY, LOWER SPINE + 1.00 FF 0.00F P 72270 0.00 0.00 0.00FFCONTRAST X-RAY, SPINE + 1.00 FF 0.00F P 72275 0.00 0.00 0.00FFEPIDUROGRAPHY + 1.00 FF 0.00F P 72285 0.00 0.00 0.00FFX-RAY C/T SPINE DISK + 1.00 FF 0.00F P 72295 0.00 0.00 0.00FFX-RAY LOWER SPINE DISK + 1.00 FF 0.00F P 73000 0.00 0.00 0.00FFX-RAY COLLAR BONE + 1.00 FF 0.00F P 73010 0.00 0.00 0.00FFX-RAY SHOULDER BLADE + 1.00 FF 0.00F P 73020 0.00 0.00 0.00FFX-RAY SHOULDER + 1.00 FF 0.00F P 73030 0.00 0.00 0.00FFX-RAY SHOULDER + 1.00 FF 0.00F !P 73040 0.00 0.00 0.00FFCONTRAST X-RAY SHOULDER + 1.00 FF 0.00F "P 73050 0.00 0.00 0.00FFX-RAY SHOULDERS + 1.00 FF 0.00F #P 73060 0.00 0.00 0.00FFX-RAY HUMERUS + 1.00 FF 0.00F $P 73070 0.00 0.00 0.00FFX-RAY ELBOW + 1.00 FF 0.00F %P 73080 0.00 0.00 0.00FFX-RAY ELBOW + 1.00 FF 0.00F &P 73085 0.00 0.00 0.00FFCONTRAST X-RAY ELBOW + 1.00 FF 0.00F 'P 73090 0.00 0.00 0.00FFX-RAY FOREARM + 1.00 FF 0.00F (P 73092 0.00 0.00 0.00FFX-RAY ARM, INFANT + 1.00 FF 0.00F )P 73100 0.00 0.00 0.00FFX-RAY WRIST + 1.00 FF 0.00F *P 73110 0.00 0.00 0.00FFX-RAY WRIST + 1.00 FF 0.00F +P 73115 0.00 0.00 0.00FFCONTRAST X-RAY WRIST + 1.00 FF 0.00F ,P 73120 0.00 0.00 0.00FFX-RAY HAND + 1.00 FF 0.00F -P 73130 0.00 0.00 0.00FFX-RAY HAND + 1.00 FF 0.00F .P 73140 0.00 0.00 0.00FFX-RAY FINGER(S) + 1.00 FF 0.00F /P 73200 0.00 0.00 0.00FFCT UPPER EXTREMITY W/O DYE + 1.00 FF 0.00F 0P 73201 0.00 0.00 0.00FFCT UPPER EXTREMITY W/DYE + 1.00 FF 0.00F 1P 73202 0.00 0.00 0.00FFCT UPPER EXTREMITY W/O&W/DYE + 1.00 FF 0.00F 2P 73206 0.00 0.00 0.00FFCT ANGIO UPPER EXTRM W/O&W/DYE + 1.00 FF 0.00F 3P 73218 0.00 0.00 0.00FFMRI UPPER EXTREMITY W/O DYE + 1.00 FF 0.00F 4P 73219 0.00 0.00 0.00FFMRI UPPER EXTREMITY W/DYE + 1.00 FF 0.00F 5P 73220 0.00 0.00 0.00FFMRI UPPER EXTREMITY W/O&W/DYE + 1.00 FF 0.00F 6P 73221 0.00 0.00 0.00FFMRI JOINT UPPER EXTREM W/O DYE + 1.00 FF 0.00F 7P 73222 0.00 0.00 0.00FFMRI JOINT UPPER EXTREM W/DYE + 1.00 FF 0.00F 8P 73223 0.00 0.00 0.00FFMRI JOINT UPPER EXTR W/O&W/DYE + 1.00 FF 0.00F 9P 73225 0.00 0.00 0.00FFMR ANGIO UPR EXTR W/O&W/DYE + 1.00 FF 0.00F :P 73500 0.00 0.00 0.00FFX-RAY HIP + 1.00 FF 0.00F ;P 73510 0.00 0.00 0.00FFX-RAY HIP + 1.00 FF 0.00F P 73530 0.00 0.00 0.00FFX-RAY HIP + 1.00 FF 0.00F ?P 73540 0.00 0.00 0.00FFX-RAY PELVIS & HIPS + 1.00 FF 0.00F @P 73542 0.00 0.00 0.00FFX-RAY EXAM, SACROILIAC JOINT + 1.00 FF 0.00F AP 73550 0.00 0.00 0.00FFX-RAY THIGH + 1.00 FF 0.00F BP 73560 0.00 0.00 0.00FFX-RAY KNEE, 1 OR 2 + 1.00 FF 0.00F CP 73562 0.00 0.00 0.00FFX-RAY KNEE, 3 + 1.00 FF 0.00F DP 73564 0.00 0.00 0.00FFX-RAY EXAM, KNEE, 4 OR MORE + 1.00 FF 0.00F EP 73565 0.00 0.00 0.00FFX-RAY KNEES + 1.00 FF 0.00F FP 73580 0.00 0.00 0.00FFCONTRAST X-RAY KNEE JOINT + 1.00 FF 0.00F GP 73590 0.00 0.00 0.00FFX-RAY LOWER LEG + 1.00 FF 0.00F HP 73592 0.00 0.00 0.00FFX-RAY LEG, INFANT + 1.00 FF 0.00F IP 73600 0.00 0.00 0.00FFX-RAY ANKLE + 1.00 FF 0.00F JP 73610 0.00 0.00 0.00FFX-RAY ANKLE + 1.00 FF 0.00F KP 73615 0.00 0.00 0.00FFCONTRAST X-RAY ANKLE + 1.00 FF 0.00F LP 73620 0.00 0.00 0.00FFX-RAY FOOT + 1.00 FF 0.00F MP 73630 0.00 0.00 0.00FFX-RAY FOOT + 1.00 FF 0.00F NP 73650 0.00 0.00 0.00FFX-RAY HEEL + 1.00 FF 0.00F OP 73660 0.00 0.00 0.00FFX-RAY TOE(S) + 1.00 FF 0.00F PP 73700 0.00 0.00 0.00FFCT LOWER EXTREMITY W/O DYE + 1.00 FF 0.00F QP 73701 0.00 0.00 0.00FFCT LOWER EXTREMITY W/DYE + 1.00 FF 0.00F RP 73702 0.00 0.00 0.00FFCT LOWER EXTREMITY W/O&W/DYE + 1.00 FF 0.00F SP 73706 0.00 0.00 0.00FFCT ANGIO LOWER EXTR W/O&W/DYE + 1.00 FF 0.00F TP 73718 0.00 0.00 0.00FFMRI LOWER EXTREMITY W/O DYE + 1.00 FF 0.00F UP 73719 0.00 0.00 0.00FFMRI LOWER EXTREMITY W/DYE + 1.00 FF 0.00F VP 73720 0.00 0.00 0.00FFMRI LOWER EXTREMITY W/O&W/DYE + 1.00 FF 0.00F WP 73721 0.00 0.00 0.00FFMRI JOINT LOWER EXTRE W/O DYE + 1.00 FF 0.00F XP 73722 0.00 0.00 0.00FFMRI JOINT LOWER EXTR W/DYE + 1.00 FF 0.00F YP 73723 0.00 0.00 0.00FFMRI JOINT LOWER EXTR W/O&W/DYE + 1.00 FF 0.00F ZP 73725 0.00 0.00 0.00FFMR ANG LOWER EXT W OR W/O DYE + 1.00 FF 0.00F