Statutes, codes, and regulations
Arizona Administrative Code
Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCEChapter 05 - INDUSTRIAL COMMISSION OF ARIZONA
Article 6 - OCCUPATIONAL SAFETY AND HEALTH STANDARDS
Appendix A - Arizona Physicians' and Pharmaceutical Fee Schedule 2024/2025

Ariz. Admin. Code § tit. 20, ch. 05, art. 6, app A

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Current through Register Vol. 30, No. 21, May 24, 2024
Appendix A - Arizona Physicians' and Pharmaceutical Fee Schedule 2024/2025

Arizona Physicians' and Pharmaceutical Fee Schedule 2024/2025

Adopted by The Industrial Commission of Arizona Medical

Resource Office

Phone (602) 542-4308 / Fax (602) 542-4797

mro@azica.gov

Effective May 1, 2024

INTRODUCTION

Since 1925, when the Arizona Legislature passed the state's first Workers' Compensation Act ("Act"), the Industrial Commission of Arizona ("Commission") has administered the workers' compensation laws of that Act. The Act includes the authority of the Commission to set a schedule of fees to be charged by healthcare providers attending injured employees (also referred to in this document as "injured worker" or "claimant." A.R.S. § 23-908(B). In 2004, the Act was amended to include the setting of fees for prescription medicines required to treat an injured employee. A.R.S. § 23-908(C). This fee schedule is referred to as the Arizona Physicians' and Pharmaceutical Fee Schedule (Fee Schedule).

Any reference to "healthcare providers" in the Fee Schedule is intended to include all licensed professionals whose scope of practice allows them to legally provide services to injured workers. Any reference to "physician" in relation to workers' compensation cases includes the following: doctors of medicine, doctors of osteopathy, doctors of podiatric medicine, doctors of chiropractic, doctors of naturopathic medicine, certified registered nurse anesthesiologists, physician assistants and nurse practitioners. Healthcare providers treating employees under industrial coverage are entitled by law to charge according to the schedule of fees adopted by the Commission. Accurate calculation of fees based upon this schedule, the filing of reports and bills for payment, and the use of forms prescribed are essential to timely and correct payment for a provider's services and can be vital in the award of benefits to the injured worker and their dependents.

This Fee Schedule has been updated to incorporate by reference the following:

1. The 2024 Edition of the American Medical Association's Current Procedural Terminology (CPT®) publication, including the general guidelines, identifiers, modifiers, and terminology associated with the incorporated codes.

2. The 2024 Healthcare Common Procedure Coding System (HCPCS) codes that include procedures, supplies, products, and services published by the Centers for Medicare & Medicaid Services (CMS).

3. The unit values and guidance for consultative, diagnostic, and therapeutic services published in the most recent edition of Relative Value Guide, American Society of Anesthesiologists (ASA) https://www.asahq.org.

4. The 2024 Clinical Diagnostic Laboratory Fee Schedule, CMS Clinical Laboratory Fee Schedule https://www.cms.gov.

5. The National Correct Coding Initiative Edits, CMS; https://www.cms.gov/ncci-medicare/medicare-ncci-policy-manual

The codes listed herein are CPT only copyright 2023 American Medical Association. All rights reserved.

6. Physicians as Assistants at Surgery: 2023 Update https://www.facs.org/for-medical-professionals/practice-management/coding-and-billing/physicians-as-assistants-at-surgery-report/

7. Surgical global periods published by CMS, 2024 Update

8. FAIR Health data, copyright 2024, FAIR Health, Inc.

Codes that are unique to Arizona are preceded by an AZ identifier and numbered in the following format: AZxxx. To the extent that a conflict may exist between an incorporated portion of the CPT® publication or HCPCS codes and a code, guideline, identifier, or modifier unique to Arizona, then the Arizona code, guideline, identifier, or modifier shall control.

Except as otherwise noted, unit values assigned to the service codes listed in this document are the product of the Industrial Commission of Arizona and are not associated in any way with the American Medical Association, the American Society of Anesthesiologists, the Centers for Medicare and Medicaid Services, or any other entity or organization.

A. GENERAL GUIDANCE

1. Reimbursements and billing associated with Pharmaceuticals are found in the Pharmaceutical Fee Schedule Section and HCPCS Guidelines of this document.

2. A CPT code shall be billed when a CPT code exists that accurately describes the service provided. If no CPT code exists that accurately describes the service, a HCPCS code shall be billed. A miscellaneous or unlisted code shall not be used when a specific CPT or HCPCS code exists that describes the service. Reimbursement values for unlisted codes are By Report and the bill must be accompanied by documentation to support the amount billed. Exceptions apply to the following services for which HCPCS codes should be used in place of CPT codes:

* Drug testing: CPT codes 80320-80377 may not be used to bill for drug testing. HCPCS codes G0480 -G0483 shall be used for definitive drug testing.

3. Except when governed by a separate contract or network that governs fees pursuant to A.R.S. § 23-908(J)(1), this Fee Schedule establishes the maximum reimbursement values for services performed by healthcare providers to injured workers under Arizona's workers' compensation law.

4. If a healthcare provider or insurance carrier is referring an injured worker to a medical specialist for evaluation and/or treatment, the medical specialist's diagnosis becomes the foundational diagnosis for billing purposes.

5. Routine progress and routine final reports filed by the attending healthcare provider do not ordinarily command a fee.

6. Payment will be made for only one professional visit in any one day except when the submitted report clearly demonstrates the need for the additional visit and fee.

7. Fees for hospital, office, or home visits, subsequent to the initial visit, are not to be added to coded surgical procedures performed on the same day.

8. Routine office treatment principally by injection of drugs, other than antibiotics, requires authorization by the carrier or self-insured employer for each series of 10 after the first series of 10.

9. Except in emergencies, a carrier must be given notice regarding a consultation and the consultant must provide his/her report to the carrier and the attending healthcare provider within a reasonable period of time to facilitate processing of the claim.

10. The Commission requests that carriers notify attending healthcare providers at the same time the claimant is notified that their claim is closed with or without supportive care. If a claim is approved for reopening, the carrier should also notify the attending healthcare provider of that approval.

11. Missed individual appointments for consultants, without prior notification, will be compensated at 50% of the consultation fee.

12. The Commission will investigate an injured worker's complaint of bad faith/unfair claims processing practices, and if appropriate, impose penalties under A.R.S. § 23-930, in those circumstances where a "peer to peer" review was not conducted by a healthcare provider with appropriate skill, training, and knowledge or where the individual performing the "peer to peer" review was not licensed. The Commission will also investigate an injured workers' complaint of bad faith/unfair claims processing practice, and if appropriate, impose penalties under A.R.S. § 23- 930, for a denial of treatment based on the failure of the treating doctor to participate in a "peer to peer" review, when the treating doctor has not been given reasonable time or opportunity to participate in the "peer to peer" review.

13. As authorized under A.A.C. R20-5-128, the fee for the reproduction of medical records for workers' compensation purposes shall be 25¢ per page and $10.00 per hour per person for reasonable clerical costs associated with locating and reproducing the documents.

14. Reimbursement values for telehealth services are governed by the Fee Schedule and no reductions are justified unless specified by the Fee Schedule. The performance of telehealth services is governed by Arizona Revised Statutes, Title 36, Chapter 36. Bills for telehealth services shall include modifier -95 and place of service (POS) code according to the incorporated AMA/CMS guidelines. Reimbursement for telehealth services shall be based on the non-facility (NF) rate regardless of the POS code.

B. PAYMENT AND REVIEW OF BILLINGS

1. Under Arizona workers' compensation law, an insurance carrier, self-insured employer, or their representative is not responsible for payment of a billing for medical, surgical, and hospital benefits that the insurance carrier, employer, or representative received more than 24 months from the date that the medical service was rendered, or from the date on which the provider knew or should have known that the service was rendered, whichever occurs later. A subsequent billing or corrective billing does not restart the limitations period. See A.R.S. § 23-1062.01.

2. It is incumbent upon the insurance carrier, self-insured employer, and third party processing service to inform all parties, including the Commission, regarding changes in addresses for bill processing locations.

3. Under Arizona workers' compensation law, a healthcare provider is entitled to timely payment for services rendered. An insurance carrier, self-insured employer, or claims processing representative shall make a determination whether to deny or pay a medical bill on an accepted claim, in whole or in part, including the decision as to the amount to pay, within thirty days from the date the claim is accepted, if the billing is received before the date of acceptance, or within thirty days from the date of the receipt of the billing if the billing is received after the date of acceptance. All billing denials shall be based on reasonable justification. The insurance carrier, self-insured employer, or claims processing representative shall pay the approved portion of the billing within thirty days after the determination for payment is made. If the billing is not paid within the applicable time period, the insurance carrier, self-insured employer, or claims processing representative shall pay interest to the health provider on the billing at a rate that is equal to the legal rate. Interest shall be calculated beginning on the date that the payment to the healthcare provider is due. See A.R.S. § 23-1062.01.

To ensure timely and accurate payment of a medical billing, a billing must contain the information required under A.R.S. § 23- 1062.01. A billing must contain at least the following information: Correct demographic patient information including claim number, if known; Correct provider information, including name, address, telephone number, and federal taxpayer identification number; Appropriate medical coding with dollar amounts and units clearly stated with all descriptions and dates of services clearly printed; and legible medical reports required for each date of service if the billing is for direct treatment of the injured worker.

4. Payment of a workers' compensation medical billing is governed by A.R.S. § 23-1062.01, which includes:

a. Timeframes for processing and payment of medical bills;

b. Criteria for billing denials;

c. A provision that the injured worker is not responsible for payment of any portion of a medical bill on an accepted claim or payment of any portion of a medical billing that is being disputed;

d. A provision that the insurance carrier or self-insured employer may establish an internal system for resolving payment disputes;

e. A provision that A.R.S. § 23-1062.01 does not apply to written contracts entered into between medical providers and insurance carriers and self-insured employers or their representatives that specify payment periods or contractual remedies for untimely payments; and

f. A provision that the Industrial Commission does not have jurisdiction over contract disputes between the parties.

5. Health care providers shall bill the code that most accurately describes the service performed. If an insurance carrier, self-insured employer, or claims processing representative determines that the documentation submitted does not support the procedure code billed, the payment to the health care provider may be appropriately adjusted based on Fee Schedule reimbursement values. See A.R.S. § 23-1062.01. The payer shall provide documentation justifying the adjustment and clearly outline the process a health care provider may follow to appeal the determination. Payers shall not downcode medical billings under the Arizona Physicians' & Pharmaceutical Fee Schedule. Downcoding is defined as a payer changing a code in a payment remittance to a code at a lower service level than was billed by the healthcare provider. As applicable, the health care provider may resubmit the bill with documentation that addresses the reason for the adjustment.

6. "Reasonable justification" to deny a bill does not include the payment/billing policies of other private or public entities (publications) unless the publication has been incorporated by reference in the Fee Schedule.

7. Excluding bundling and unbundling issues, it is not the Commission's intent to restrict an insurance carrier's, self-insured employer's, or third party processing service's ability to address issues not addressed by the Fee Schedule. This includes evaluating unlisted procedures, establishing values for unlisted procedures, establishing values for codes that are listed as "BR" or "RNE", or new CPT® codes that have not been incorporated by the Industrial Commission, or managing issues outside the jurisdiction of the Fee Schedule, such as hospital billings.

8. Healthcare providers shall provide legible medical documentation and reports that are sufficient for insurance carriers/self-insured employers to determine if treatment is being directed towards injuries sustained in an industrial accident or incident. The healthcare provider shall ensure that their patients' medical files include the information required by A.R.S. § 32-1401.2. The healthcare provider is not required to provide copies of documents or reports that they did not author and that are not in their possession (i.e., Employers' First Report of Injury).

9. Treating physicians shall submit a narrative that justifies the billing of a level 4 or 5 E/M service.

10. The Commission has incorporated by reference the Centers for Medicare and Medicaid Services, Evaluation and Management Services Guide, and the most current American Medical Association, Evaluation and Management Code and Guideline Changes. Medical billings shall be prepared and reviewed consistent with how these guidelines are used and interpreted by CMS. Additionally, payers are required to disclose any additional guideline(s) utilized in their Explanation of Reviews (or other similar document.

11. A payer's Explanation of Review (or other similar document) shall contain sufficient information to allow the healthcare provider to determine whether the amount of payment is correct and whom to contact regarding any questions related to the payment. Information in the Explanation of Review (or other similar document) shall include the following:

a. The name of the injured worker;

b. The name of the payer and the name of the third party administrator ("TPA"), if applicable;

c. If applicable, the name, telephone number, and address of all entities that reviewed the medical billing on behalf of the payer;

d. If applicable, the name, telephone number, and address of the party that has a written contract signed by the healthcare provider that allows the contracting party or other third party to access and pay rates that are different from those provided under this Fee Schedule;

e. The amount billed by the healthcare provider;

f. The amount of any reduction due to a written contract with the healthcare provider; and

g. The amount of payment.

12. Nothing in this Fee Schedule precludes a healthcare provider from entering into a separate contract that governs fees. In this instance, reimbursement shall be made according to the applicable contracted charge. In the absence of a separate contract that governs a healthcare provider's fees, reimbursement shall be made according to this Fee Schedule. A payer shall demonstrate that it is entitled to pay the contracted rate in the event of a dispute by providing a valid copy of the governing contract to the healthcare provider. If a payer fails to provide evidence that it is entitled to pay a contracted rate, then the payer shall be required to make payment as provided in this Fee Schedule.

13. Billing and reimbursement guidelines for Pharmaceuticals are found in the Pharmaceutical Fee Schedule Section of this document.

14. The Fee Schedule does not apply to ambulance service providers. Service fees for ground ambulance transportation are set and mandated by the Arizona Department of Health Services through its Arizona Ground Ambulance Service Rate Schedule. A.R.S. § 36-2239(D) states "an ambulance service shall not charge, demand or collect any remuneration for any service greater or less than or different from the rate or charge determined and fixed by the department as the rate or charge for that service." Service fees published in the Arizona Ground Ambulance Service Rate Schedule are applicable in the workers' compensation setting.

C. REIMBURSEMENT OF MID-LEVEL MEDICAL PROVIDERS

1. Certified Registered Nurse Anesthetists ("CRNAs") are reimbursed at 85% of the fee schedule.

a. Physician Assistants and Nurse Practitioners are reimbursed at 85% of the fee schedule except if services are provided "incident to" a physician's professional services. In that instance, reimbursement is required to be at 100% of the fee schedule. The following criteria are identified as establishing the "incident to" exception:

b. The Physician Assistant and Nurse Practitioner must work under the direct supervision of an appropriately licensed physician,

c. The Physician must initially see that patient and establish a plan of care for that patient ("treatment plan"),

d. Subsequent service provided by the Physician Assistant and Nurse Practitioner must be a part of the documented treatment plan, and

e. The Physician must always be involved in the patient's treatment plan and see the patient often enough to demonstrate that the Physician is actively participating in and managing the patient's care.

2. For purposes of the Fee Schedule, the Commission recognizes that direct supervision of a Physician Assistant or Nurse Practitioner by a Physician can be accomplished through the use of modern technology and telecommunications (telemedicine) and may not require the on-site presence of the Physician when the Physician Assistant or Nurse Practitioner sees the patient. In all instances, however, and regardless of the extent to which telemedicine is used, the Physician must actively participate in and manage the patient's care if services provided by a Physician Assistant or Nurse Practitioner are billed at 100% of the fee schedule under the "incident to" exception.

3. It is the responsibility of the Physician to document if the services provided by a Physician Assistant and Nurse Practitioner are "incident to" the Physician's professional service. If either the incident to criteria is not met, or the documentation submitted fails to support the "incident to" criteria, the reimbursement should be made at 85% of the fee schedule.

D. DIRECTED CARE AND USE OF NETWORKS

The Arizona Workers' Compensation Act only permits private self-insured employers to direct medical care. A.R.S. § 23-1070(A); See also Southwest Gas Corp. v. Industrial Commission of Arizona, 200 Ariz. 292, 25 P.3d 1164 (2001). This limitation on the scope of directed care means that employees of private self-insured employers do not have an unrestricted right to choose their own medical providers, while employees of all other employers do (including public self-insured employers).1 Notwithstanding an employee's right to choose, many workers' compensation insurance carriers ("carriers") and public self-insured employers ("employers") have taken advantage of "networks" to reduce their costs. This is done by either creating their own network of "preferred providers" or by contracting with a third party to access private healthcare networks.

Actions or conduct that impair or limit the right of an employee to choose their medical provider may rise to the level of bad faith and/or unfair claims processing practices under A.R.S. § 23-930. The Commission will investigate a complaint of bad faith/unfair claims processing practices, and if appropriate, impose penalties under A.R.S. § 23-930, in those circumstances where a carrier, employer, or TPA has engaged in conduct that results in directing a claimant to a "network" provider. The following are examples of conduct that the Commission would consider appropriate for investigation under A.R.S. § 23-930.

* A claimant is told that they must see a healthcare provider that is "in the network;"

* A claimant is told that care from a "non-network" healthcare provider is not authorized;

* A "network" healthcare provider is told that referrals are required to be made to another "network" healthcare provider;

* A "network" healthcare provider is told that they may not recommend a "non-network" healthcare provider to a patient;

* A "non-network" healthcare provider is told that care will only be authorized if provided by a "network" provider; and

* A "non-network" healthcare provider is told that reimbursement will be made according to "network" discounts.

E. TREATMENT OF INDUSTRIAL INJURIES AND DISEASES

1. An employee who sustains an injury arising out of, or in the course of, employment is entitled, under Arizona law, to select a healthcare provider of his/her own choice unless that employee is employed by a private self-insured employer as described in A.R.S. § 23-1070. Employers described in A.R.S. § 23-1070, excluding the State or Political Subdivisions thereof, are allowed to direct medical care.

2. The attending healthcare provider's promptness and professional exactness in the completion and filing of workers' compensation forms are extremely important to the employee being treated. The injured or disabled employee's claim to medical benefits and compensation can rest on the conscientious attention of the healthcare provider in processing the required reports. Rules addressing the completion of these forms are found in Title 20, Chapter 5, Article 1 of the Arizona Administrative Code, which can be obtained at: http://apps.azsos.gov/public_services/Title_20/20-05.pdf

3. The Commission, the employer, and the insurance carrier may, at any time, designate a healthcare provider or healthcare providers to examine an employee. Additionally, upon application of the employer, employee, or insurance carrier, the Commission may order a change of healthcare provider or a change of conditions of treatment when there are reasonable grounds or a belief that the employee's health or progress can thus be improved.

4. A claimant may not change doctors without the written authorization of the insurance carrier, the Commission, or the attending physician. A claimant may not transfer from one hospital to another without the written authorization of the insurance carrier or the Commission. If the patient's employment requires leaving the locale in which he/she is receiving treatment, the attending physician should arrange for continued treatment and notify the carrier of such arrangement. It is the responsibility of the physician or the hospital to which a patient has transferred to ascertain whether such a change has been authorized.

5. Treatment of conditions unrelated to the injuries sustained in the industrial accident may be denied as unauthorized if the treatment seems directed principally toward the non-industrial condition or if the treatment does not seem necessary for the patient's physical rehabilitation from the industrial injury.

6. If the patient refuses to submit to a medical examination or to cooperate with the healthcare provider's treatments, the carrier or self-insured employer should be notified.

7. If an employee is capable of some form of gainful employment, it is proper for the healthcare provider to release the employee to light work and make a specific report to the carrier or self-insured employer as to the date of such release. It can be to the employee's economic advantage to be released to light work since he/she can receive compensation based on 66 2/3% of the difference between one's earnings and one's established wage. On the other hand, it would not be to the employee's economic advantage to be released to light work if, in fact, the employee is not capable of performing such work. The healthcare provider's judgment in such matters is extremely important.

8. If the employee no longer requires active medical care for the industrial injury and is discharged from treatment, the healthcare provider is required to provide a signed report with the date of discharge to the carrier or self-insured employer, even if, as a private patient, the employee may require further medical care for conditions unrelated to the industrial accident. This final report and discharge date are necessary for closing the claim file.

9. When a healthcare provider discharges a claimant from treatment, the healthcare provider shall determine whether the employee has suffered any impairment of function, or disfigurement about the head or face, including injury to or loss of teeth, and include this information in the final signed report provided to the carrier or self-insured employer. The Rules of Procedure Before the Industrial Commission of Arizona require that any rating of the percentage of functional impairment should be made in accordance with the standards of evaluation published in the most recent edition of the American Medical Association Guides to the Evaluation of Permanent Impairment. Additional guidance on appropriate billing and reimbursement for impairment evaluations is found in the Evaluation and Management Section of this document.

10. Once an exposure to a blood-borne pathogen occurs, the workers' compensation insurance carrier/self-insured employer is responsible for payment of the accepted treatment protocol which includes the HBIG vaccination (Hepatitis B Immune Globulin), and, if necessary, the three (3) Hepatitis B vaccinations.

11. When a work-related incident occurs that may have exposed an employee to Hepatitis, the insurance carrier/self-insured employer is responsible for paying for the testing and/or treatment of Hepatitis B or C. As to the treatment of HIV, if a bona fide claim exists under A.R.S. § 23-1043.02, then the insurance carrier/self-insured employer is responsible for paying for the treatment.

12. It is the employer's responsibility, in accordance with existing OSHA standards, to pay for HIV testing. The insurance carrier may seek reimbursement from the employer for the costs associated with providing the series of three (3) Hepatitis B vaccinations if the employer failed to provide them in violation of federal and state laws.

F. REOPENING OF CLAIMS

1. Whether or not the employee has suffered a permanent disability, on a claim that has been previously accepted, the claim may be reopened on the basis of a new, additional, or previously undiscovered disability or condition, but:

a. The claimant should use the form of petition prescribed by the Commission;

b. The petition must be personally signed by the worker or his authorized representative and must be filed at any office of the Industrial Commission of Arizona;

c. The petition, in order to be considered, must be accompanied by the healthcare provider's medical report.

2. If the claim is reopened, the payment for such reasonable and necessary medical, hospital and laboratory work expenses shall be paid by the insurance carrier if such expenses are incurred within 15 days of the filing of the petition to reopen.

3. No monetary compensation is payable for any period prior to the date of filing of the petition to reopen. Surgical benefits are not payable for any period prior to the date of filing of a petition to reopen, except that surgical benefits are payable for a period prior to the date of filing not to exceed seven (7) days if a bona fide medical emergency precludes the employee from filing a petition to reopen prior to the surgery. Other information relative to reopening rights may be found at A.R.S. § 23-1061(H).

4. If a claim is approved for reopening, the carrier must notify the attending healthcare provider of that approval.

G. NO-INSURANCE CLAIMS

"No-Insurance" claims are workers' compensation claims involving injuries to employees of employers who do not have workers' compensation insurance coverage as required by Arizona law. In such cases, all claims and reports are to be addressed to the No-Insurance Section of the Special Fund of The Industrial Commission of Arizona.

H. CONSULTATIONS

Workers' compensation cases can present additional medical and legal problems that justify consultation sooner and more frequently than the average private patient. In complex cases and cases requiring an estimate of general or unscheduled disability, consultation with specialists in the appropriate field may be requested by any interested party. The Industrial Commission continues to recognize the necessity for consultations in workers' compensation and establishes relative value units and rates for consultation codes.

I. WITNESS FEES

1. Insurance providers, self-insured employers, and the Special Fund of the Commission are responsible for paying $150.00 for the first hour of testimony (or any portion thereof) and $50.00 for each 20 minute increment following the initial hour (or any portion thereof) to a healthcare provider who testifies at hearing at their request.

2. The Commission is responsible for paying $150.00 for the first hour of testimony (or any portion thereof) and $50.00 for each 20 minute increment following the initial hour (or any portion thereof) to a healthcare provider who testifies at hearing on request of a workers' compensation claimant.

J. DEFINITIONS OF SELECT UNIT VALUES

1. BY REPORT "BR" ITEMS: "BR" in the value column indicates that the value of this service is to be determined "by report" because the service is too unusual or variable to be assigned a unit relativity. Pertinent information concerning the nature, intent, and need for the procedure or service, the time, the skill and equipment necessary, etc., is to be furnished. A detailed clinical record is not necessary.

2. RELATIVITY NOT ESTABLISHED "RNE" ITEMS: "RNE" in the value column indicates new or infrequently performed services for which sufficient data has not been collected to allow the establishment of relativity. "RNE" items are clearly definable and not inherently variable as are BR procedures. A report may be necessary.

3. MATERIALS AND SUPPLIES: A healthcare provider is not entitled to be reimbursed for supplies and materials normally necessary to perform a billable service. Examples of those items that are not reimbursable are listed below. Billing and reimbursement guidelines for materials and supplies that are reimbursable are found in the HCPCS Section of the Fee Schedule.

Drugs that are administered to patients in a clinical setting shall be billed using the appropriate HCPCS code and reimbursed according to the Pharmaceutical Fee Schedule Guidelines. The provisions in this subsection do not apply to hospitals, ambulatory surgery centers, and ambulance service providers.

Examples of supplies that are usually not separately reimbursable include:

Applied hot or cold packs

Eye patches, injections, or debridement trays

Steristrips

Needles

Syringes

Eye/ear trays

Drapes

Sterile gloves

Applied eye wash or eye drops

Creams (massage)

Fluorescein

Ultrasound pads and gel

Tissues

Urine collection kits

Gauze

Cotton balls/fluff

Sterile water

Band-Aids and dressings for simple wound occlusion

Head sheets

Aspiration trays

Sterile trays for laceration repair and more complex surgeries Tape for dressings

4. MODIFIERS: A two-digit (numeric or alpha) sequence that provides the means by which the reporting healthcare provider can specify that a procedure performed has been altered under a special circumstance. This allows defining the modifying circumstance of the service or procedure without creating a separate procedure or listing.

Modifier Examples

Professional Component (PC): Certain procedures are a combination of a physician, or Professional component and a technical component. When modifier 26 is added to an appropriate code, a PC allowable amount will be paid.

Technical Component (TC): The TC component reflects the technical portion of the procedure code. When the technical component is provided by a healthcare provider other than the one providing the professional component, the healthcare provider bills for the technical component by adding modifier TC to the applicable code.

K. LIST OF ACRONYMS

AMA

American Medical Association

AS

Assistant Surgeon

AWP

Average Wholesale Price

BR

By Report

CCI

Current Coding Initiative (National)

CF

Conversion Factor

CMS

Centers for Medicare & Medicaid Services

CPT

Current Procedural Terminology

CRNA

Certified Registered Nurse Anesthetist

DME

Durable Medical Equipment

E/M

Evaluation and management services

FCE

Functional Capacity Evaluation

FUD

Follow-up day(s)

HCPCS

Healthcare Common Procedure Coding System

ICD-10-CM

International Classification of Diseases, Tenth Revision, Clinical Modification

IME

Independent medical examination

MPFS

Medicare physician fee schedule

MRI

Magnetic resonance imaging

NCCI

(see CCI)

NP

Nurse Practitioner

OTC

Over-the-counter

PA

Physician Assistant

RBRVS

Resource Based Relative Value Scale

RVU

Relative value unit

PHARMACEUTICAL FEE SCHEDULE

A. GENERAL PROVISIONS AND APPLICABILITY OF THE PHARMACEUTICAL FEE SCHEDULE

1. The Pharmaceutical Fee Schedule (PFS) applies to prescription and over-the-counter (OTC) medications required to treat an injured employee, whether administered by a medical practitioner or dispensed by a pharmacy (including online or mail order pharmacies) or by a medical practitioner

2. Medications are not reimbursable unless "reasonably required" at the time of injury or during the period of disability. See A.R.S. § 23-1062(A); A.A.C. R20-5-1303(A). The Industrial Commission of Arizona has adopted the Official Disability Guidelines (ODG), including ODG's Drug Formulary Appendix A (ODG Formulary), as the standard reference for evidence-based medicine used in treating injured employees within the context of Arizona's workers' compensation system. Effective October 1, 2018, ODG applies to all body parts and conditions. See A.A.C. R20-5-1301(B), (E). ODG is to be used as a tool to support clinical decision-making and quality health care delivery to injured employees. The ODG Formulary sets forth pharmaceutical guidelines that are generally considered reasonable and are presumed correct if the guidelines provide recommendations related to a particular medication. See A.A.C. R20-5-1301(H). Medical practitioners are encouraged to consult the ODG Formulary before dispensing, administering, or prescribing medications to injured employees.

3. Generic drugs must be dispensed or administered to injured employees when appropriate, consistent with A.R.S. § 32-1963.01(A)1, (B), and (D) through (L)2. See A.R.S. § 23-908(C). For purposes of this subsection, the definitions in A.R.S. § 32- 1963.01(L) apply3. Whenever possible: (1) medical practitioners should prescribe less costly drugs; (2) pharmacies and medical practitioners (under Section VII) should dispense generic drugs with lower AWP values; and (3) medical practitioners (under Section VI) should administer generic drugs with lower AWP values.

B. DEFINITIONS.

1. "Administer" has the meaning set forth in A.R.S. 32-1901(1).

2. "Average Wholesale Price" or "AWP" means the wholesale price charged on a specific commodity that is assigned by the drug manufacturer and is listed in a nationally recognized drug pricing file.

3. "Commercially available" means a drug product is widely available for purchase in pharmacies accessible to the general public, including in brick and mortar pharmacies accessible to the general public.

4. "Compound medication" means a pharmaceutical product created by virtue of mixing or combining drugs and/or components to meet the unique needs of an individual patient when the finished product does not recreate a commercially available product.

5. "Dispense" or "dispensing" means to deliver to an ultimate user by or pursuant to the lawful order of a medical practitioner, including the prescribing, administering, packaging, labeling, or compounding necessary to prepare for that delivery. See A.R.S. § 32-1901(27).

6. "Drug" has the meaning set forth in A.R.S. § 32-1901(31).

7. "Hospital" means any institution for the care and treatment of the sick and injured that is approved and licensed as a hospital by: (1) the Arizona Department of Health Services; or (2) an equivalent regulatory agency in another U.S. state, territory, or district. See A.R.S. § 32-1901(42).

8. "Medical practitioner" means any person who is permitted/licensed and authorized by law to use and prescribe prescription medications, acting within the scope of such authority, for the treatment of sick and injured human beings or for the diagnosis or prevention of sickness in human beings in the State of Arizona or any U.S. state, territory or district. See A.R.S. § 32-1901(53).

9. "Non-traditional strength" medication means a finished drug product in a strength (i.e., dosage) that is not commercially available in pharmacies accessible to the general public.

10. "Over-the-counter medication" or "OTC medication" means a finished drug product, including label and container according to context, which does not require a prescription order.

11. "Pharmacy" has the meaning set forth in A.R.S. § 32-1901(71).

12. "Pharmacy accessible to the general public" means a pharmacy that is readily accessible and provides pharmaceutical services (including prescription medication services) to all segments of the general public without restricting services to a defined or exclusive group of consumers, including but not limited to consumers who have access to services because they are treated by or have an affiliation with a specific entity or medical practitioner. This definition includes mail order pharmacies delivering pharmaceutical services to workers' compensation claimants if both of the following apply:

a. The pharmacy does not limit or restrict access to claimants with an affiliation to a medical provider or other entity.

b. Any medical provider or other entity referring a claimant to the pharmacy does not receive or accept any rebate, refund, commission, preference, or other consideration as compensation for the referral.

13. "Pharmacy not accessible to the general public" means a pharmacy that provides pharmaceutical services (including prescription medication services) only to a defined or exclusive group of consumers, including but not limited to consumers who have access to services because they are treated by or have an affiliation with a specific entity or medical practitioner. "Pharmacy not accessible to the general public" does not include a hospital pharmacy. This definition does not include mail order pharmacies delivering pharmaceutical services to workers' compensation claimants if both of the following apply:

a. The pharmacy does not limit or restrict access to claimants with an affiliation to a medical provider or other entity.

b. Any medical provider or other entity referring a claimant to the pharmacy does not receive or accept any rebate, refund, commission, preference, or other consideration as compensation for the referral.

14. "Prescription" means either a prescription order or a prescription medication. See A.R.S. § 32-1901(80).

15. "Prescription medication" means any drug, including label and container according to context, which is dispensed pursuant to a prescription order. See A.R.S. § 32-1901(81).

16. "Prescription order" shall have the meaning set forth in A.R.S. § 32-1901(84).

17. "Repackaged medication" means a finished drug product removed from the container in which it was distributed by the original manufacturer and placed into a different container without further manipulation of the drug. The term also includes the act of placing the contents of multiple containers of the same finished drug product into one container. The term also includes "co-pack drug" products which contain two or more separate finished medications that are contained in a single package or unit. The term does not include a drug that is manipulated in any other way, including if the drug is reconstituted, diluted, mixed, or combined with another ingredient.

18. "Therapeutically-similar" medication means a medication that is expected to produce a clinical effect comparable to the original product. Key considerations for determining the "most therapeutically-similar" medications are: (1) the similarity of the clinical effects; (2) the extent to which active ingredients overlap; (3) the similarity of the dosage profiles; and (4) the similarity of the mode of administration; and (5) the similarity of the intended strength.

19. "Traditional strength" medication means a finished drug product in a formulation that is commercially available in pharmacies accessible to the general public.

20. "Ultimate user" means a person who lawfully possesses a prescription medication for that person's own use or for the use of a member of that person's household. See A.R.S. § 32-1901(95).

C. GENERAL GUIDELINES FOR BILLING AND REIMBURSEMENT OF PRESCRIPTION MEDICATIONS.

1. Except as permitted in Sections VI and VII of the current PFS, an insurance carrier, self-insured employer, or the Special Fund of the Commission is responsible for the payment of prescription medications only if all of the following apply:

a. The prescription medication is dispensed by an individual who is currently licensed to practice the profession of pharmacy by either: (i) the Arizona State Board of Pharmacy; or (ii) an equivalent regulatory agency in another U.S. state, territory, or district; and

b. The prescription medication is dispensed by a pharmacy accessible to the general public, including online or mail-order pharmacies that are accessible to the general public.

2. Subject to Sections III(G), IV, V, and VI(B), reimbursement for prescription medications shall be based on the actual medication dispensed or administered, including a substituted medication that is dispensed or administered pursuant to A.R.S. § 32-1963.01.

3. Except as specified in Sections IV and V of the current PFS, a pharmaceutical bill submitted for a prescription medication must include the National Drug Code (NDC) of the original manufacturer registered with the U.S. Food & Drug Administration (FDA), the quantity dispensed, and the reimbursement value of the medication. Under no circumstance shall an NDC other than the original manufacturer's NDC be used.

4. The reimbursement value for prescription medications shall be based on the current PFS reimbursement methodology in the absence of a contractual agreement between the pharmacy or medical practitioner and payer governing reimbursement. Network discounts may not be applied in the absence of a contractual agreement with the pharmacy or medical practitioner authorizing such discounts.

5. The reimbursement value for a prescription medication shall be determined on the date a drug is dispensed from pricing published in the most recent issue, as updated in the most recent update, of a nationally recognized pharmaceutical publication designated by the Commission. For purposes of determining AWP, the Commission has selected Medi-Span®.

6. The reimbursement value for a prescription medication shall be determined by reference to the original manufacturer's NDC and shall be calculated on a per unit basis as follows:

a. Generic drugs:

* (75% of AWP per unit) x (number of units dispensed).

b. Brand name drugs:

* (85% of AWP per unit) x (number of units dispensed).

7. Reimbursement for non-traditional strength prescription medications shall be calculated on a per unit basis, as of the date of dispensing or administering, based on the original manufacturer's NDC and corresponding AWP of the most therapeutically-similar traditional strength form of the same medication. Under no circumstance shall the NDC of the non-traditional strength medication be used.

8. The reimbursement value for OTC medications shall be calculated on a per unit basis, as of the date of dispensing, based on the retail price (per unit) of the OTC medication in settings where the medication is commercially available.

9. Subject to Section III(J), the reimbursement value for OTC medications that are not commercially available in pharmacies accessible to the general public shall be calculated on a per unit basis, as of the date of dispensing, based on the retail price (per unit) of the most therapeutically-similar OTC medication commercially available in pharmacies accessible to the general public. Under no circumstance shall the NDC or AWP of the non-commercially available OTC medication be used.

10. The reimbursement value for OTC medications that are not commercially available may not exceed:

a. Thirty dollars ($30.00) for a thirty-day supply (or a pro-rated amount if the supply is greater or less than thirty days) for a topical cream or lotion.

b. Seventy-five dollars ($75.00) for a thirty-day supply (or a pro-rated amount if the supply is greater or less than thirty days) for topical patches.

D. BILLING AND REIMBURSEMENT FOR REPACKAGED MEDICATIONS.

1. A pharmaceutical bill submitted for a repackaged medication must identify the NDC of the repackaged medication, the NDC of the original manufacturer registered with the U.S. FDA, the quantity dispensed, and the reimbursement value of the repackaged medication. Under no circumstances shall the reimbursement value of a repackaged medication be based upon an NDC other than the original manufacturer's NDC. A repackaged NDC shall not be used for calculating the reimbursement value of a repackaged medication and shall not be considered the original manufacturer's NDC.

2. If a pharmaceutical bill for a repackaged medication is submitted without the original manufacturer's NDC, the payer has the discretion to determine the appropriate NDC (and corresponding AWP) to use or, alternatively, may deny coverage until the appropriate NDC is furnished.

3. The reimbursement value for a repackaged medication shall be based on the current PFS reimbursement methodology contained in Section III of the PFS, utilizing the NDC(s) and corresponding AWP(s) of the original manufacturer(s).

4. Any component of a co-pack drug product for which there is no NDC shall not be reimbursed.

E. BILLING AND REIMBURSEMENT FOR COMPOUND MEDICATIONS.

1. A pharmaceutical bill submitted for a compound medication must identify each reimbursable component ingredient, the applicable NDC of each reimbursable component ingredient, the corresponding quantity of each component ingredient, and the calculated reimbursement value of each component ingredient. All component ingredients of a compound medication must be billed on a single bill.

2. The reimbursement value for a compound medication shall be calculated at the component ingredient level. The reimbursement value for a compound medication shall be based on the sum of the reimbursement values of each component ingredient and the corresponding component ingredient's NDC, based on the current PFS reimbursement methodology set forth in Section III.

3. Any component ingredient in a compound medication for which there is no NDC shall not be reimbursed.

4. Any component ingredient in a topical compound medication that is not FDA approved for topical use shall not be reimbursed.

5. If any component ingredient in a compound medication is a repackaged medication, the reimbursement value for the repackaged medication ingredient shall be determined based on the current PFS reimbursement methodology set forth in Section III, using the AWP corresponding to the NDC of the original manufacturer. See Section IV.

6. The maximum reimbursement value for a topical compound medication shall be the lesser of:

a. Two hundred dollars ($200.00) for a thirty-day supply (or a pro-rated amount if the supply is greater or less than thirty days), or

b. The reimbursement value of the compound medication as calculated under this section.

F. BILLING AND REIMBURSEMENT FOR MEDICATIONS ADMINISTERED BY A MEDICAL PRACTITIONER.

1. A pharmaceutical bill submitted for a medication administered by a medical practitioner must comply with billing procedures outlined in Sections III, IV, and V of the current PFS, as applicable.

2. The reimbursement value for a medication administered by a medical practitioner shall be based on the current PFS reimbursement methodology contained in Sections III, IV, and V of the PFS, as applicable.

G. REIMBURSEMENT FOR MEDICATIONS DISPENSED BY A MEDICAL PRACTITIONER OR IN A PHARMACY NOT ACCESSIBLE TO THE GENERAL PUBLIC.4,5

1. An insurance carrier, self-insured employer, or the Special Fund of the Commission is responsible for the payment of prescription medications that are dispensed by a medical practitioner or in a pharmacy not accessible to the general public if all of the following apply:

a. The prescription medication is dispensed by a medical practitioner or a pharmacy not accessible to the general public to the injured employee within seven days of the date of the industrial injury;

b. The prescription medication is limited to no more than a one-time, ten-day supply;

c. The prescription medication conforms to dosages and formulations that are commercially available in pharmacies accessible to the general public.

2. An insurance carrier, self-insured employer, or the Special Fund of the Commission is responsible for the payment of prescription medications that are dispensed by a medical practitioner or in a pharmacy not accessible to the general public if all of the following apply:

a. The injured employee does not have access to a pharmacy accessible to the general public within 20 miles of the injured employee's home address, work address, or the address of the prescribing medical practitioner;

b. The injured employee cannot reasonably acquire the prescription medication from an online or mail order pharmacy accessible to the general public; and

c. The prescription medication conforms to dosages and formulations which are commercially available in pharmacies accessible to the general public.

3. An insurance carrier, self-insured employer, or the Special Fund of the Commission is responsible for the payment of prescription medications that are dispensed by a medical practitioner or in a pharmacy not accessible to the general public if the dispensing of a prescription medication for an individual claim and specified duration has been preapproved in writing by the insurance carrier, self-insured employer, or the Special Fund of the Commission. Nothing in this section requires an insurance carrier, self-insured employer, or the Special Fund of the Commission to preapprove the dispensing of prescription medications under this subsection.

4. An insurance carrier, self-insured employer, or the Special Fund of the Commission is responsible for the payment of prescription medications that are dispensed by a pharmacy not accessible to the general public if all of the following apply:

a. The prescription medication was dispensed to an injured employee whose workers' compensation claim was initially denied by the carrier, self-insured employer, or the Special Fund of the Commission;

b. The injured employee protested the claim denial by filing a timely request for hearing;

c. The workers' compensation claim was either: (a) subsequently accepted by the carrier, self-insured employer, or the Special Fund of the Commission; or (b) the claim was found to be compensable by the Commission's Administrative Law Judge Division, the Arizona Court of Appeals, or the Arizona Supreme Court;

d. The prescription medication was dispensed during the time period between: (a) the initial claim denial and (b) the subsequent acceptance of the claim or the compensability determination by the Commission's Administrative Law Judge Division, the Arizona Court of Appeals, or the Arizona Supreme Court; and

e. The prescription medication conforms to dosages and formulations that are commercially available in pharmacies accessible to the general public.

5. The guidelines in Section III(A) and this section do not apply to prescription medications dispensed during inpatient hospital care or upon discharge from in-patient hospital care.

6. Subject to the limitations in this section, medications that have been provided as free samples to a medical practitioner may be dispensed to an injured employee when appropriate, but are not reimbursable.

H. DISPENSING FEE.

1. If a prescription medication is dispensed by a pharmacy accessible to the general public pursuant to a prescription order, a dispensing fee of up to seven dollars ($7.00) per prescription medication, repackaged medication, or compound medication may be charged. The dispensing fee does not apply to OTC medications that are not prescribed by a medical practitioner.

2. If a prescription medication is dispensed by a medical practitioner or in a pharmacy not accessible to the general public pursuant to Section VII(A), (B), or (C), a dispensing fee of up to seven dollars ($7.00) per prescription medication, repackaged medication, or compound medication may be charged. If an OTC medication is dispensed by a medical practitioner or by a pharmacy not accessible to the general public, a dispensing fee is not permitted.

3. If a prescription or OTC medication is administered by a medical practitioner, a dispensing fee is not permitted.

I. ADDITIONAL BILLING GUIDELINES.

1. Paper billing by a medical practitioner:

The following is an example of how to report both the repackaged NDC and original NDC on the CMS 1500 form using the shaded area of line 24. The information is reported in the following order: qualifier (N4), NDC code, one space, unit/basis of measurement qualifier, quantity, one space, ORIG, qualifier (N4), NDC code."

Click here to view

If a physician does not bill using the CMS 1500 form or is not able to include all the required information on the CMS 1500 form (due to software/system limitations), then the physician may provide the required information (in the required order) separately or as an attachment to the CMS 1500 form.

2. Paper billing by non-physician entities.

A non-physician entity using paper billing to bill for medications shall use the most recent version of the Workers' Compensation/Property & Casualty Universal Claim Form (WC/PC UCF) adopted by the National Council for Prescription Drug Programs.

X. SEVERABILITY CLAUSE.

If any provision of the Pharmaceutical Fee Schedule or the application thereof to any person or circumstances is held invalid, such invalidity shall not affect other provisions or application of the Pharmaceutical Fee Schedule which can be given effect without the invalid provisions or application, and to this end the provisions of this Pharmaceutical Fee Schedule are severable.

ANESTHESIA GUIDELINES

Information regarding publications incorporated by reference is found in the Introduction Section of the Fee Schedule.

The following Commission guidelines are in addition to the CPT® guidelines and represent additional guidance from the Commission relative to unit values for anesthesia services. To the extent that a conflict may exist between an incorporated portion of the CPT®, the most recent edition of Relative Value Guide, or the American Society of Anesthesiologists, and a code, guideline, identifier, or modifier unique to Arizona, then the Arizona code, guideline, identifier or modifier shall control. Codes that are unique to Arizona are preceded by an AZ identifier and numbered in the following format: AZxxx.

A. CERTIFIED REGISTERED NURSE ANESTHETISTS: Are reimbursed at 85% of the fee schedule when billed with modifier QZ.

B. ANESTHESIA MODIFIERS: Anesthesia modifiers, which may include physical status and other optional modifiers, may be added to the basic values. Unit values for physical status modifiers are as follows:

Unit Values

P1 A normal healthy patient

0

P2 A patient with mild systemic disease

0

P3 A patient with severe systemic disease

1

P4 A patient with severe systemic disease that is a constant threat to life

2

P5 A moribund patient who is not expected to survive without the operation

3

P6 A declared brain-dead patient whose organs are being removed for donor purposes

0

AA Anesthesia services personally performed by an anesthesiologist are reimbursed at 100% of the lesser of billed charges or the fee schedule calculation.

AD Medical supervision by a physician: more than four (4) concurrent anesthesia procedures reimbursed at 50% of the lesser of billed charges or fee schedule calculation.

QK Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals reimbursed at 50% of the lesser of billed charges or fee schedule calculation.

QX Qualified nonphysician anesthetist with medical direction by a physician reimbursed at 50% of fee schedule calculation.

QZ CRNA without medical direction by a physician is reimbursed at 85% of the lesser of billed charges or fee schedule calculation.

C. REPORTING OF TIME: Time reporting is described in the Anesthesia Guidelines of the CPT® publication. In Arizona, time units will be added to the basic value and modifying units as is customary in the local area using the following unit values:

1 unit value is equal to Fifteen (15) minutes or any Seven (7) minute portion thereof.

Show the elapsed time (minutes) in item 24G of the CMS 1500 form. Convert hours into minutes and enter the total minutes required for this procedure.

D. UNIT VALUES FOR OTHER QUALIFYING CIRCUMSTANCES: (more than one may be selected)

Qualifying circumstances are described in the Anesthesia Guidelines of the CPT® book. The unit values for these procedures, which are reported as an additional service and may be added to the basic unit values, are as follows:

Code

Unit Value

99100

1

99116

5

99135

5

99140

2

Note: Healthcare providers who provide additional services that are billed using CPT® codes 62320-62327 or 64400-64530 shall follow the Surgery Guidelines in this Fee Schedule.

ARIZONA PHYSICIANS' FEE SCHEDULE

Anesthesia Codes 2024

Anesthesia Conversion Factor $61.00

Code

Category

Base Unit

RBRVS Rate

00100

Anesthesia

5

305.00

00102

Anesthesia

6

366.00

00103

Anesthesia

5

305.00

00104

Anesthesia

4

244.00

00120

Anesthesia

5

305.00

00124

Anesthesia

4

244.00

00126

Anesthesia

4

244.00

00140

Anesthesia

5

305.00

00142

Anesthesia

4

244.00

00144

Anesthesia

6

366.00

00145

Anesthesia

6

366.00

00147

Anesthesia

4

244.00

00148

Anesthesia

4

244.00

00160

Anesthesia

5

305.00

00162

Anesthesia

7

427.00

00164

Anesthesia

4

244.00

00170

Anesthesia

5

305.00

00172

Anesthesia

6

366.00

00174

Anesthesia

6

366.00

00176

Anesthesia

7

427.00

00190

Anesthesia

5

305.00

00192

Anesthesia

7

427.00

00210

Anesthesia

11

671.00

00211

Anesthesia

10

610.00

00212

Anesthesia

5

305.00

00214

Anesthesia

9

549.00

00215

Anesthesia

9

549.00

00216

Anesthesia

15

915.00

00218

Anesthesia

13

793.00

00220

Anesthesia

10

610.00

00222

Anesthesia

6

366.00

00300

Anesthesia

5

305.00

00320

Anesthesia

6

366.00

00322

Anesthesia

3

183.00

00326

Anesthesia

7

427.00

00350

Anesthesia

10

610.00

00352

Anesthesia

5

305.00

00400

Anesthesia

3

183.00

00402

Anesthesia

5

305.00

00404

Anesthesia

5

305.00

00406

Anesthesia

13

793.00

00410

Anesthesia

4

244.00

00450

Anesthesia

5

305.00

00454

Anesthesia

3

183.00

00470

Anesthesia

6

366.00

00472

Anesthesia

10

610.00

00474

Anesthesia

13

793.00

00500

Anesthesia

15

915.00

00520

Anesthesia

6

366.00

00522

Anesthesia

4

244.00

00524

Anesthesia

4

244.00

00528

Anesthesia

8

488.00

00529

Anesthesia

11

671.00

00530

Anesthesia

4

244.00

00532

Anesthesia

4

244.00

00534

Anesthesia

7

427.00

00537

Anesthesia

10

610.00

00539

Anesthesia

18

1098.00

00540

Anesthesia

12

732.00

00541

Anesthesia

15

915.00

00542

Anesthesia

15

915.00

00546

Anesthesia

15

915.00

00548

Anesthesia

17

1037.00

00550

Anesthesia

10

610.00

00560

Anesthesia

15

915.00

00561

Anesthesia

25

1525.00

00562

Anesthesia

20

1220.00

00563

Anesthesia

25

1525.00

00566

Anesthesia

25

1525.00

00567

Anesthesia

18

1098.00

00580

Anesthesia

20

1220.00

00600

Anesthesia

10

610.00

00604

Anesthesia

13

793.00

00620

Anesthesia

10

610.00

00625

Anesthesia

13

793.00

00626

Anesthesia

15

915.00

00630

Anesthesia

8

488.00

00632

Anesthesia

7

427.00

00635

Anesthesia

4

244.00

00640

Anesthesia

3

183.00

00670

Anesthesia

13

793.00

00700

Anesthesia

4

244.00

00702

Anesthesia

4

244.00

00730

Anesthesia

5

305.00

00731

Anesthesia

5

305.00

00732

Anesthesia

6

366.00

00750

Anesthesia

4

244.00

00752

Anesthesia

6

366.00

00754

Anesthesia

7

427.00

00756

Anesthesia

7

427.00

00770

Anesthesia

15

915.00

00790

Anesthesia

7

427.00

00792

Anesthesia

13

793.00

00794

Anesthesia

8

488.00

00796

Anesthesia

30

1830.00

00797

Anesthesia

11

671.00

00800

Anesthesia

4

244.00

00802

Anesthesia

5

305.00

00811

Anesthesia

4

244.00

00812

Anesthesia

3

183.00

00813

Anesthesia

5

305.00

00820

Anesthesia

5

305.00

00830

Anesthesia

4

244.00

00832

Anesthesia

6

366.00

00834

Anesthesia

5

305.00

00836

Anesthesia

6

366.00

00840

Anesthesia

6

366.00

00842

Anesthesia

4

244.00

00844

Anesthesia

7

427.00

00846

Anesthesia

8

488.00

00848

Anesthesia

8

488.00

00851

Anesthesia

6

366.00

00860

Anesthesia

6

366.00

00862

Anesthesia

7

427.00

00864

Anesthesia

8

488.00

00865

Anesthesia

7

427.00

00866

Anesthesia

10

610.00

00868

Anesthesia

10

610.00

00870

Anesthesia

5

305.00

00872

Anesthesia

7

427.00

00873

Anesthesia

5

305.00

00880

Anesthesia

15

915.00

00882

Anesthesia

10

610.00

00902

Anesthesia

5

305.00

00904

Anesthesia

7

427.00

00906

Anesthesia

4

244.00

00908

Anesthesia

6

366.00

00910

Anesthesia

3

183.00

00912

Anesthesia

5

305.00

00914

Anesthesia

5

305.00

00916

Anesthesia

5

305.00

00918

Anesthesia

5

305.00

00920

Anesthesia

3

183.00

00921

Anesthesia

3

183.00

00922

Anesthesia

6

366.00

00924

Anesthesia

4

244.00

00926

Anesthesia

4

244.00

00928

Anesthesia

6

366.00

00930

Anesthesia

4

244.00

00932

Anesthesia

4

244.00

00934

Anesthesia

6

366.00

00936

Anesthesia

8

488.00

00938

Anesthesia

4

244.00

00940

Anesthesia

3

183.00

00942

Anesthesia

4

244.00

00944

Anesthesia

6

366.00

00948

Anesthesia

4

244.00

00950

Anesthesia

5

305.00

00952

Anesthesia

4

244.00

01112

Anesthesia

5

305.00

01120

Anesthesia

6

366.00

01130

Anesthesia

3

183.00

01140

Anesthesia

15

915.00

01150

Anesthesia

10

610.00

01160

Anesthesia

4

244.00

01170

Anesthesia

8

488.00

01173

Anesthesia

12

732.00

01200

Anesthesia

4

244.00

01202

Anesthesia

4

244.00

01210

Anesthesia

6

366.00

01212

Anesthesia

10

610.00

01214

Anesthesia

8

488.00

01215

Anesthesia

10

610.00

01220

Anesthesia

4

244.00

01230

Anesthesia

6

366.00

01232

Anesthesia

5

305.00

01234

Anesthesia

8

488.00

01250

Anesthesia

4

244.00

01260

Anesthesia

3

183.00

01270

Anesthesia

8

488.00

01272

Anesthesia

4

244.00

01274

Anesthesia

6

366.00

01320

Anesthesia

4

244.00

01340

Anesthesia

4

244.00

01360

Anesthesia

5

305.00

01380

Anesthesia

3

183.00

01382

Anesthesia

3

183.00

01390

Anesthesia

3

183.00

01392

Anesthesia

4

244.00

01400

Anesthesia

4

244.00

01402

Anesthesia

7

427.00

01404

Anesthesia

5

305.00

01420

Anesthesia

3

183.00

01430

Anesthesia

3

183.00

01432

Anesthesia

6

366.00

01440

Anesthesia

8

488.00

01442

Anesthesia

8

488.00

01444

Anesthesia

8

488.00

01462

Anesthesia

3

183.00

01464

Anesthesia

3

183.00

01470

Anesthesia

3

183.00

01472

Anesthesia

5

305.00

01474

Anesthesia

5

305.00

01480

Anesthesia

3

183.00

01482

Anesthesia

4

244.00

01484

Anesthesia

4

244.00

01486

Anesthesia

7

427.00

01490

Anesthesia

3

183.00

01500

Anesthesia

8

488.00

01502

Anesthesia

6

366.00

01520

Anesthesia

3

183.00

01522

Anesthesia

5

305.00

01610

Anesthesia

5

305.00

01620

Anesthesia

4

244.00

01622

Anesthesia

4

244.00

01630

Anesthesia

5

305.00

01634

Anesthesia

9

549.00

01636

Anesthesia

15

915.00

01638

Anesthesia

10

610.00

01650

Anesthesia

6

366.00

01652

Anesthesia

10

610.00

01654

Anesthesia

8

488.00

01656

Anesthesia

10

610.00

01670

Anesthesia

4

244.00

01680

Anesthesia

3

183.00

01710

Anesthesia

3

183.00

01712

Anesthesia

5

305.00

01714

Anesthesia

5

305.00

01716

Anesthesia

5

305.00

01730

Anesthesia

3

183.00

01732

Anesthesia

3

183.00

01740

Anesthesia

4

244.00

01742

Anesthesia

5

305.00

01744

Anesthesia

5

305.00

01756

Anesthesia

6

366.00

01758

Anesthesia

5

305.00

01760

Anesthesia

7

427.00

01770

Anesthesia

6

366.00

01772

Anesthesia

6

366.00

01780

Anesthesia

3

183.00

01782

Anesthesia

4

244.00

01810

Anesthesia

3

183.00

01820

Anesthesia

3

183.00

01829

Anesthesia

3

183.00

01830

Anesthesia

3

183.00

01832

Anesthesia

6

366.00

01840

Anesthesia

6

366.00

01842

Anesthesia

6

366.00

01844

Anesthesia

6

366.00

01850

Anesthesia

3

183.00

01852

Anesthesia

4

244.00

01860

Anesthesia

3

183.00

01916

Anesthesia

5

305.00

01920

Anesthesia

7

427.00

01922

Anesthesia

7

427.00

01924

Anesthesia

5

305.00

01925

Anesthesia

7

427.00

01926

Anesthesia

8

488.00

01930

Anesthesia

5

305.00

01931

Anesthesia

7

427.00

01932

Anesthesia

6

366.00

01933

Anesthesia

7

427.00

01937

Anesthesia

4

244.00

01938

Anesthesia

4

244.00

01939

Anesthesia

4

244.00

01940

Anesthesia

4

244.00

01941

Anesthesia

5

305.00

01942

Anesthesia

5

305.00

01951

Anesthesia

3

183.00

01952

Anesthesia

5

305.00

01953

Anesthesia

1

61.00

01958

Anesthesia

5

305.00

01960

Anesthesia

5

305.00

01961

Anesthesia

7

427.00

01962

Anesthesia

8

488.00

01963

Anesthesia

8

488.00

01965

Anesthesia

4

244.00

01966

Anesthesia

4

244.00

01967

Anesthesia

5

305.00

01968

Anesthesia

2

122.00

01969

Anesthesia

5

305.00

01990

Anesthesia

7

427.00

01991

Anesthesia

3

183.00

01992

Anesthesia

5

305.00

01996

Anesthesia

3

183.00

99100

Anesthesia

1

61.00

99116

Anesthesia

5

305.00

99135

Anesthesia

5

305.00

99140

Anesthesia

2

122.00

SURGERY GUIDELINES

Information regarding publications incorporated by reference is found in the Introduction Section of the Fee Schedule.

The following Commission guidelines are in addition to the CPT® guidelines and represent additional guidance from the Commission relative to unit values for surgical services. To the extent that a conflict may exist between CMS, an incorporated portion of the CPT®, and a code, guideline, identifier, or modifier unique to Arizona, then the Arizona code, guideline, identifier, or modifier shall control. Codes that are unique to Arizona are preceded by an AZ identifier and numbered in the following format: AZxxx.

A. MATERIALS AND SUPPLIES: A healthcare provider may charge for materials and supplies as described in the HCPCS Section of this Fee Schedule.

B. MULTIPLE PROCEDURES: It is appropriate to designate multiple procedures that are rendered on the same date by separate entries. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). Note: This modifier should not be appended to designated "add-on" codes.

C. SPECIAL REPORT: A typical request for more detailed information from an insurance carrier regarding a billing does not constitute a "special report", which is defined in the CPT® book.

D. MODIFIERS: Listed services and procedures may be modified under certain circumstances. When applicable, the modifying circumstance should be identified by the addition of the appropriate modifier code, which may be reported in either of two ways. The modifier may be reported by a two-digit number placed after the usual procedure number from which it is separated by a hyphen. Or the modifier may be reported by a separate five-digit code that is used in addition to the procedure code. If more than one modifier is used, the "Multiple Modifiers" code placed first after the procedure code indicates that one or more additional modifier codes will follow.

Modifiers either unique to Arizona or containing explanatory language specific to Arizona are as follows:

22 Increased Procedural Services: Use of this modifier will result in a twenty-five percent (25%) increase in the listed value for the listed procedure.

25 Separately Identifiable Evaluation and Management Service by the same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service. It may be necessary to indicate that on the day a procedure or service identified by a CPT® code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed (see Evaluation and Management Services Guidelines for instructions on determining level of E/M service). As such, different diagnoses are not required for reporting of the E/M services on the same date. The circumstance may be reported by adding modifier 25 to the appropriate level of E/M service.

47 Anesthesia by Surgeon: Used to report anesthesia by the attending or assistant surgeon (does not include local anesthesia). Reimbursement shall be fifty percent (50%) of the base unit as indicated in the Anesthesia section of the Fee Schedule. This modifier shall be allowed no more than once per surgical encounter.

50 Bilateral Procedure: Unless otherwise identified in the listings, when bilateral procedures which add significant time or complexity to patient care are provided at the same operative session, identify and value the first or major procedure as listed. Identify the secondary or lesser procedure(s) by adding this modifier 50 to the usual procedure number(s) and value at fifty percent (50%) of the listed value(s). If, however, the procedures are independently complex and involve different parts of the body, including digits, the bilateral procedure rule would not apply. In such cases, independent procedures would be billed at one hundred percent (100%) of their listed value.

51 Multiple Procedures: When multiple procedures are performed during the same operative session*, the procedures should be valued at the appropriate percent of its listed value, as shown below:

100% (full value) for the first or major procedure 50% for the second and multiple procedure(s) Sixth and subsequent procedures - by report.

*Multiple Procedure Guidelines do not apply to codes specifically identified as "Add-on/Additional Procedures, Global indicator ZZZ".

The major or primary procedure is defined as the procedure with the highest value and is the code that determines the followup days when a surgery has multiple procedures. The second procedure is the procedure with the next highest value, the third the next highest value, and so on. If, however, the procedures are independently complex such as digits, tendons, nerves, or artery repair, the multiple procedure rule would not apply. In such cases, independent procedures would be billed at one hundred percent (100%) of their listed value.

When performing multiple procedures with different global period values during the same operative session, the global period value for the session is the largest global period value.

57 Decision for Surgery: An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service.

59 Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.

Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.

Note: If an epidural or peripheral nerve block injection (62320-62327 or 64400-64530) for postoperative pain management is reported separately on the same date of service as an anesthesia 0XXXX code, modifier 59 shall be appended to the epidural or peripheral nerve block injection code (62320-62327 or 64400-64530) to indicate that it was administered for postoperative pain management. An epidural or peripheral nerve block injection (6232062327 or 64400-64530) for postoperative pain management in patients receiving general anesthesia, spinal (subarachnoid injection) anesthesia, or postoperative pain management in patients receiving general anesthesia, spinal (subarachnoid injection) anesthesia, or regional anesthesia by epidural injection as described above may be administered preoperatively, intraoperatively, or postoperatively.

62 Two Surgeons: By prior agreement, the total value of services performed by two surgeons working together as primary surgeons may be apportioned in relation to the responsibility and work done, provided the patient is made aware of the fee distribution according to medical ethics. If no apportionment is listed, the fee should be split evenly between the co-surgeons. The total value may be increased by twenty-five percent (25%) in lieu of the usual assistant's charge. Under these circumstances, the services of each surgeon should be identified by adding this modifier 62 to the joint procedure number(s) and valued as agreed upon. (Usual charges for surgical assistance may be warranted if still another physician is required as part of the surgical team.) The value of the procedure should be 125% of the customary value listed. Payment of 125% of the maximum allowable would be divided between the participating surgeons.

Two Surgeons - When 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on codes(s) for that procedure as long as both surgeons continue to work together as primary surgeons. Each surgeon should report the co-surgery once using the same procedure code. If additional procedure(s) (including add-on procedure(s)) are performed during the same surgical session, separate code(s) may be reported with modifier 62 added.

Note: If a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80, 81, or 82 added, as appropriate.

80 Assistant Surgeon: These services are valued at twenty percent (20%) of the listed value of the surgical procedure(s).

81 Minimum Assistant Surgeon: These services are valued at sixteen percent (16%) of the listed value of the surgical procedure(s).

82 Assistant Surgeon (when qualified resident surgeon not available): These services are valued at sixteen percent (16%) of the listed value of the surgical procedure(s).

AS Use the modifier AS for assistant at surgery services when services are provided by a Physician Assistant (PA), Nurse Practitioner (NP), or Clinical Nurse Specialist (CNS). These services are valued at fourteen percent (14%) of the listed value of the surgical procedure(s). No further adjustment for mid-level medical providers as mentioned in section C of the Introduction shall be applied.

Note: A Medical Doctor or Doctor of Osteopathic Medicine should not submit the AS modifier. This modifier is only valid for use by a PA, NP, and CNS when billing under their own provider number.

ARIZONA PHYSICIANS' FEE SCHEDULE

Surgery Codes 2024

Surgery Conversion Factor $72.00

Code

Category

FY24 NF RVU

FY24 FAC RVU

FY24 NF RBRVS Rate

FY24 FAC RBRVS Rate

10004 00

Surgery

1.57

1.29

113.04

92.88

10005 00

Surgery

4.03

2.16

290.16

155.52

10006 00

Surgery

1.80

1.48

129.60

106.56

10007 00

Surgery

9.11

2.65

655.92

190.80

10008 00

Surgery

4.23

1.52

304.56

109.44

10009 00

Surgery

12.79

3.20

920.88

230.40

10010 00

Surgery

7.05

2.13

507.60

153.36

10011 00

Surgery

-

-

1224.72

600.48

10012 00

Surgery

-

-

740.16

362.88

10021 00

Surgery

3.04

1.63

218.88

117.36

10030 00

Surgery

18.99

3.97

1367.28

285.84

10035 00

Surgery

10.82

2.47

779.04

177.84

10036 00

Surgery

8.85

1.25

637.20

90.00

10040 00

Surgery

3.50

1.55

252.00

111.60

10060 00

Surgery

3.83

3.22

275.76

231.84

10061 00

Surgery

6.47

5.56

465.84

400.32

10080 00

Surgery

7.54

3.18

542.88

228.96

10081 00

Surgery

10.35

5.15

745.20

370.80

10120 00

Surgery

4.59

3.19

330.48

229.68

10121 00

Surgery

7.97

5.52

573.84

397.44

10140 00

Surgery

5.12

3.57

368.64

257.04

10160 00

Surgery

3.91

2.91

281.52

209.52

10180 00

Surgery

7.92

5.39

570.24

388.08

11000 00

Surgery

1.78

0.82

128.16

59.04

11001 00

Surgery

0.82

0.44

59.04

31.68

11004 00

Surgery

16.84

16.84

1212.48

1212.48

11005 00

Surgery

22.95

22.95

1652.40

1652.40

11006 00

Surgery

20.76

20.76

1494.72

1494.72

11008 00

Surgery

8.08

8.08

581.76

581.76

11010 00

Surgery

13.44

8.26

967.68

594.72

11011 00

Surgery

15.01

8.88

1080.72

639.36

11012 00

Surgery

19.54

12.40

1406.88

892.80

11042 00

Surgery

3.90

1.81

280.80

130.32

11043 00

Surgery

6.99

4.58

503.28

329.76

11044 00

Surgery

9.35

6.72

673.20

483.84

11045 00

Surgery

1.20

0.75

86.40

54.00

11046 00

Surgery

2.19

1.63

157.68

117.36

11047 00

Surgery

3.62

2.88

260.64

207.36

11055 00

Surgery

2.14

0.46

154.08

33.12

11056 00

Surgery

2.48

0.65

178.56

46.80

11057 00

Surgery

2.71

0.85

195.12

61.20

11102 00

Surgery

3.02

1.12

217.44

80.64

11103 00

Surgery

1.51

0.65

108.72

46.80

11104 00

Surgery

3.76

1.39

270.72

100.08

11105 00

Surgery

1.79

0.76

128.88

54.72

11106 00

Surgery

4.67

1.68

336.24

120.96

11107 00

Surgery

2.14

0.91

154.08

65.52

11200 00

Surgery

2.79

2.31

200.88

166.32

11201 00

Surgery

0.55

0.48

39.60

34.56

11300 00

Surgery

3.02

1.01

217.44

72.72

11301 00

Surgery

3.65

1.52

262.80

109.44

11302 00

Surgery

4.12

1.77

296.64

127.44

11303 00

Surgery

4.56

2.11

328.32

151.92

11305 00

Surgery

3.16

1.11

227.52

79.92

11306 00

Surgery

3.68

1.45

264.96

104.40

11307 00

Surgery

4.16

1.85

299.52

133.20

11308 00

Surgery

4.38

2.07

315.36

149.04

11310 00

Surgery

3.48

1.35

250.56

97.20

11311 00

Surgery

4.11

1.86

295.92

133.92

11312 00

Surgery

4.67

2.20

336.24

158.40

11313 00

Surgery

5.44

2.85

391.68

205.20

11400 00

Surgery

3.87

2.55

278.64

183.60

11401 00

Surgery

4.71

3.19

339.12

229.68

11402 00

Surgery

5.19

3.49

373.68

251.28

11403 00

Surgery

5.98

4.52

430.56

325.44

11404 00

Surgery

6.77

4.97

487.44

357.84

11406 00

Surgery

9.63

7.49

693.36

539.28

11420 00

Surgery

3.82

2.48

275.04

178.56

11421 00

Surgery

4.82

3.29

347.04

236.88

11422 00

Surgery

5.41

4.10

389.52

295.20

11423 00

Surgery

6.20

4.74

446.40

341.28

11424 00

Surgery

7.18

5.46

516.96

393.12

11426 00

Surgery

9.89

8.06

712.08

580.32

11440 00

Surgery

4.33

3.24

311.76

233.28

11441 00

Surgery

5.26

4.03

378.72

290.16

11442 00

Surgery

5.84

4.44

420.48

319.68

11443 00

Surgery

6.88

5.40

495.36

388.80

11444 00

Surgery

8.54

6.79

614.88

488.88

11446 00

Surgery

11.57

9.53

833.04

686.16

11450 00

Surgery

12.98

7.94

934.56

571.68

11451 00

Surgery

15.81

10.02

1138.32

721.44

11462 00

Surgery

12.62

7.56

908.64

544.32

11463 00

Surgery

16.01

10.07

1152.72

725.04

11470 00

Surgery

13.72

8.68

987.84

624.96

11471 00

Surgery

16.45

10.62

1184.40

764.64

11600 00

Surgery

5.95

3.68

428.40

264.96

11601 00

Surgery

6.89

4.45

496.08

320.40

11602 00

Surgery

7.37

4.83

530.64

347.76

11603 00

Surgery

8.39

5.77

604.08

415.44

11604 00

Surgery

9.35

6.35

673.20

457.20

11606 00

Surgery

13.49

9.46

971.28

681.12

11620 00

Surgery

5.98

3.71

430.56

267.12

11621 00

Surgery

6.91

4.47

497.52

321.84

11622 00

Surgery

7.63

5.07

549.36

365.04

11623 00

Surgery

8.91

6.25

641.52

450.00

11624 00

Surgery

10.15

7.11

730.80

511.92

11626 00

Surgery

12.21

8.69

879.12

625.68

11640 00

Surgery

6.13

3.81

441.36

274.32

11641 00

Surgery

7.14

4.66

514.08

335.52

11642 00

Surgery

8.08

5.45

581.76

392.40

11643 00

Surgery

9.48

6.79

682.56

488.88

11644 00

Surgery

11.70

8.41

842.40

605.52

11646 00

Surgery

15.17

11.61

1092.24

835.92

11719 00

Surgery

0.43

0.22

30.96

15.84

11720 00

Surgery

0.99

0.42

71.28

30.24

11721 00

Surgery

1.34

0.70

96.48

50.40

11730 00

Surgery

3.46

1.60

249.12

115.20

11732 00

Surgery

0.99

0.50

71.28

36.00

11740 00

Surgery

1.74

0.97

125.28

69.84

11750 00

Surgery

4.84

3.06

348.48

220.32

11755 00

Surgery

3.67

1.80

264.24

129.60

11760 00

Surgery

5.56

3.29

400.32

236.88

11762 00

Surgery

8.66

5.61

623.52

403.92

11765 00

Surgery

5.00

2.80

360.00

201.60

11770 00

Surgery

10.67

5.60

768.24

403.20

11771 00

Surgery

19.00

13.62

1368.00

980.64

11772 00

Surgery

23.27

17.51

1675.44

1260.72

11900 00

Surgery

1.73

0.89

124.56

64.08

11901 00

Surgery

2.11

1.35

151.92

97.20

11920 00

Surgery

6.04

3.41

434.88

245.52

11921 00

Surgery

6.67

3.91

480.24

281.52

11922 00

Surgery

1.84

0.86

132.48

61.92

11950 00

Surgery

2.46

1.55

177.12

111.60

11951 00

Surgery

3.27

2.17

235.44

156.24

11952 00

Surgery

4.37

3.05

314.64

219.60

11954 00

Surgery

4.81

3.33

346.32

239.76

11960 00

Surgery

30.59

30.59

2202.48

2202.48

11970 00

Surgery

16.95

16.95

1220.40

1220.40

11971 00

Surgery

16.70

16.70

1202.40

1202.40

11976 00

Surgery

4.37

2.77

314.64

199.44

11980 00

Surgery

2.83

1.65

203.76

118.80

11981 00

Surgery

3.03

1.87

218.16

134.64

11982 00

Surgery

3.34

2.18

240.48

156.96

11983 00

Surgery

4.27

3.08

307.44

221.76

12001 00

Surgery

2.84

1.34

204.48

96.48

12002 00

Surgery

3.44

1.76

247.68

126.72

12004 00

Surgery

4.01

2.20

288.72

158.40

12005 00

Surgery

5.34

2.83

384.48

203.76

12006 00

Surgery

6.16

3.46

443.52

249.12

12007 00

Surgery

6.99

4.30

503.28

309.60

12011 00

Surgery

3.38

1.66

243.36

119.52

12013 00

Surgery

3.52

1.73

253.44

124.56

12014 00

Surgery

4.30

2.24

309.60

161.28

12015 00

Surgery

5.19

2.81

373.68

202.32

12016 00

Surgery

6.58

3.81

473.76

274.32

12017 00

Surgery

4.60

4.60

331.20

331.20

12018 00

Surgery

5.18

5.18

372.96

372.96

12020 00

Surgery

9.03

5.66

650.16

407.52

12021 00

Surgery

5.35

4.25

385.20

306.00

12031 00

Surgery

7.91

4.54

569.52

326.88

12032 00

Surgery

9.14

5.70

658.08

410.40

12034 00

Surgery

10.07

6.15

725.04

442.80

12035 00

Surgery

11.71

7.24

843.12

521.28

12036 00

Surgery

13.05

8.47

939.60

609.84

12037 00

Surgery

14.66

9.84

1055.52

708.48

12041 00

Surgery

7.93

4.35

570.96

313.20

12042 00

Surgery

9.33

5.86

671.76

421.92

12044 00

Surgery

11.52

6.42

829.44

462.24

12045 00

Surgery

12.44

8.22

895.68

591.84

12046 00

Surgery

15.07

9.58

1085.04

689.76

12047 00

Surgery

16.50

10.62

1188.00

764.64

12051 00

Surgery

8.53

5.08

614.16

365.76

12052 00

Surgery

9.49

5.97

683.28

429.84

12053 00

Surgery

10.93

6.44

786.96

463.68

12054 00

Surgery

11.51

6.59

828.72

474.48

12055 00

Surgery

15.13

9.05

1089.36

651.60

12056 00

Surgery

17.42

11.52

1254.24

829.44

12057 00

Surgery

18.23

12.57

1312.56

905.04

13100 00

Surgery

10.23

5.98

736.56

430.56

13101 00

Surgery

11.91

7.36

857.52

529.92

13102 00

Surgery

3.49

2.13

251.28

153.36

13120 00

Surgery

10.66

6.91

767.52

497.52

13121 00

Surgery

12.76

7.68

918.72

552.96

13122 00

Surgery

3.80

2.45

273.60

176.40

13131 00

Surgery

11.65

7.21

838.80

519.12

13132 00

Surgery

14.12

9.00

1016.64

648.00

13133 00

Surgery

5.04

3.72

362.88

267.84

13151 00

Surgery

12.69

8.28

913.68

596.16

13152 00

Surgery

14.90

9.98

1072.80

718.56

13153 00

Surgery

5.54

4.05

398.88

291.60

13160 00

Surgery

23.89

23.89

1720.08

1720.08

14000 00

Surgery

19.23

15.20

1384.56

1094.40

14001 00

Surgery

24.48

19.66

1762.56

1415.52

14020 00

Surgery

21.24

17.06

1529.28

1228.32

14021 00

Surgery

26.15

21.27

1882.80

1531.44

14040 00

Surgery

22.92

18.73

1650.24

1348.56

14041 00

Surgery

27.82

22.84

2003.04

1644.48

14060 00

Surgery

23.16

19.95

1667.52

1436.40

14061 00

Surgery

30.03

24.53

2162.16

1766.16

14301 00

Surgery

32.59

26.05

2346.48

1875.60

14302 00

Surgery

6.40

6.40

460.80

460.80

14350 00

Surgery

20.29

20.29

1460.88

1460.88

15002 00

Surgery

10.30

6.53

741.60

470.16

15003 00

Surgery

2.08

1.34

149.76

96.48

15004 00

Surgery

11.76

7.71

846.72

555.12

15005 00

Surgery

3.48

2.66

250.56

191.52

15040 00

Surgery

7.84

3.74

564.48

269.28

15050 00

Surgery

17.67

13.78

1272.24

992.16

15100 00

Surgery

26.13

21.51

1881.36

1548.72

15101 00

Surgery

5.56

3.30

400.32

237.60

15110 00

Surgery

25.07

21.48

1805.04

1546.56

15111 00

Surgery

3.39

3.02

244.08

217.44

15115 00

Surgery

24.32

20.90

1751.04

1504.80

15116 00

Surgery

4.59

4.11

330.48

295.92

15120 00

Surgery

25.46

20.73

1833.12

1492.56

15121 00

Surgery

6.20

3.92

446.40

282.24

15130 00

Surgery

21.66

17.97

1559.52

1293.84

15131 00

Surgery

2.91

2.65

209.52

190.80

15135 00

Surgery

26.22

22.73

1887.84

1636.56

15136 00

Surgery

2.87

2.65

206.64

190.80

15150 00

Surgery

21.23

19.25

1528.56

1386.00

15151 00

Surgery

3.54

3.24

254.88

233.28

15152 00

Surgery

4.41

4.13

317.52

297.36

15155 00

Surgery

23.87

21.86

1718.64

1573.92

15156 00

Surgery

4.77

4.47

343.44

321.84

15157 00

Surgery

5.30

4.87

381.60

350.64

15200 00

Surgery

25.32

20.25

1823.04

1458.00

15201 00

Surgery

4.19

2.27

301.68

163.44

15220 00

Surgery

23.21

18.34

1671.12

1320.48

15221 00

Surgery

3.87

2.05

278.64

147.60

15240 00

Surgery

28.01

23.92

2016.72

1722.24

15241 00

Surgery

5.23

3.18

376.56

228.96

15260 00

Surgery

30.11

25.35

2167.92

1825.20

15261 00

Surgery

6.14

4.02

442.08

289.44

15271 00

Surgery

4.63

2.50

333.36

180.00

15272 00

Surgery

0.74

0.50

53.28

36.00

15273 00

Surgery

9.26

5.80

666.72

417.60

15274 00

Surgery

2.43

1.32

174.96

95.04

15275 00

Surgery

4.77

2.77

343.44

199.44

15276 00

Surgery

0.97

0.74

69.84

53.28

15277 00

Surgery

10.22

6.61

735.84

475.92

15278 00

Surgery

2.84

1.65

204.48

118.80

15570 00

Surgery

27.28

21.90

1964.16

1576.80

15572 00

Surgery

26.57

22.15

1913.04

1594.80

15574 00

Surgery

26.67

22.23

1920.24

1600.56

15576 00

Surgery

23.49

19.42

1691.28

1398.24

15600 00

Surgery

10.22

6.43

735.84

462.96

15610 00

Surgery

11.12

7.40

800.64

532.80

15620 00

Surgery

13.51

9.87

972.72

710.64

15630 00

Surgery

13.97

10.38

1005.84

747.36

15650 00

Surgery

16.36

12.20

1177.92

878.40

15730 00

Surgery

42.67

27.39

3072.24

1972.08

15731 00

Surgery

33.77

29.92

2431.44

2154.24

15733 00

Surgery

30.85

30.85

2221.20

2221.20

15734 00

Surgery

45.01

45.01

3240.72

3240.72

15736 00

Surgery

36.57

36.57

2633.04

2633.04

15738 00

Surgery

37.99

37.99

2735.28

2735.28

15740 00

Surgery

30.54

25.30

2198.88

1821.60

15750 00

Surgery

28.10

28.10

2023.20

2023.20

15756 00

Surgery

68.22

68.22

4911.84

4911.84

15757 00

Surgery

67.77

67.77

4879.44

4879.44

15758 00

Surgery

67.49

67.49

4859.28

4859.28

15760 00

Surgery

25.48

20.97

1834.56

1509.84

15769 00

Surgery

14.48

14.48

1042.56

1042.56

15770 00

Surgery

20.31

20.31

1462.32

1462.32

15771 00

Surgery

18.43

15.44

1326.96

1111.68

15772 00

Surgery

5.75

4.41

414.00

317.52

15773 00

Surgery

17.98

15.11

1294.56

1087.92

15774 00

Surgery

5.59

4.26

402.48

306.72

15775 00

Surgery

11.30

7.61

813.60

547.92

15776 00

Surgery

15.28

10.43

1100.16

750.96

15777 00

Surgery

6.37

6.37

458.64

458.64

15778 00

Surgery

11.49

11.49

827.28

827.28

15780 00

Surgery

25.50

19.93

1836.00

1434.96

15781 00

Surgery

16.13

12.85

1161.36

925.20

15782 00

Surgery

14.64

11.14

1054.08

802.08

15783 00

Surgery

13.58

10.70

977.76

770.40

15786 00

Surgery

6.90

4.04

496.80

290.88

15787 00

Surgery

0.90

0.49

64.80

35.28

15788 00

Surgery

11.73

6.54

844.56

470.88

15789 00

Surgery

16.06

12.36

1156.32

889.92

15792 00

Surgery

10.11

6.36

727.92

457.92

15793 00

Surgery

14.33

10.77

1031.76

775.44

15819 00

Surgery

24.08

24.08

1733.76

1733.76

15820 00

Surgery

17.44

15.48

1255.68

1114.56

15821 00

Surgery

18.67

16.51

1344.24

1188.72

15822 00

Surgery

13.91

11.99

1001.52

863.28

15823 00

Surgery

18.70

16.52

1346.40

1189.44

15824 00

Surgery

-

-

4861.44

3451.68

15825 00

Surgery

-

-

8507.52

6040.08

15826 00

Surgery

0.00

0.00

BR

BR

15828 00

Surgery

-

-

6886.80

4889.52

15829 00

Surgery

-

-

8223.84

5839.20

15830 00

Surgery

35.19

35.19

2533.68

2533.68

15832 00

Surgery

27.73

27.73

1996.56

1996.56

15833 00

Surgery

26.39

26.39

1900.08

1900.08

15834 00

Surgery

26.86

26.86

1933.92

1933.92

15835 00

Surgery

27.99

27.99

2015.28

2015.28

15836 00

Surgery

24.00

24.00

1728.00

1728.00

15837 00

Surgery

26.14

21.57

1882.08

1553.04

15838 00

Surgery

19.58

19.58

1409.76

1409.76

15839 00

Surgery

26.91

22.26

1937.52

1602.72

15840 00

Surgery

30.38

30.38

2187.36

2187.36

15841 00

Surgery

53.29

53.29

3836.88

3836.88

15842 00

Surgery

80.61

80.61

5803.92

5803.92

15845 00

Surgery

31.94

31.94

2299.68

2299.68

15847 00

Surgery

-

-

1519.20

1078.56

15851 00

Surgery

1.70

1.95

122.40

140.40

15852 00

Surgery

1.33

1.33

95.76

95.76

15853 00

Surgery

0.35

0.35

25.20

25.20

15854 00

Surgery

0.48

0.48

34.56

34.56

15860 00

Surgery

3.16

3.16

227.52

227.52

15876 00

Surgery

-

-

1880.64

1335.60

15877 00

Surgery

-

-

2458.08

1745.28

15878 00

Surgery

0.00

0.00

BR

BR

15879 00

Surgery

-

-

3458.88

2455.92

15920 00

Surgery

19.05

19.05

1371.60

1371.60

15922 00

Surgery

24.02

24.02

1729.44

1729.44

15931 00

Surgery

21.25

21.25

1530.00

1530.00

15933 00

Surgery

26.31

26.31

1894.32

1894.32

15934 00

Surgery

29.62

29.62

2132.64

2132.64

15935 00

Surgery

34.73

34.73

2500.56

2500.56

15936 00

Surgery

27.01

27.01

1944.72

1944.72

15937 00

Surgery

31.15

31.15

2242.80

2242.80

15940 00

Surgery

21.38

21.38

1539.36

1539.36

15941 00

Surgery

27.94

27.94

2011.68

2011.68

15944 00

Surgery

28.12

28.12

2024.64

2024.64

15945 00

Surgery

30.70

30.70

2210.40

2210.40

15946 00

Surgery

48.34

48.34

3480.48

3480.48

15950 00

Surgery

19.21

19.21

1383.12

1383.12

15951 00

Surgery

27.07

27.07

1949.04

1949.04

15952 00

Surgery

27.58

27.58

1985.76

1985.76

15953 00

Surgery

30.37

30.37

2186.64

2186.64

15956 00

Surgery

35.69

35.69

2569.68

2569.68

15958 00

Surgery

35.30

35.30

2541.60

2541.60

15999 00

Surgery

0.00

0.00

BR

BR

16000 00

Surgery

2.40

1.36

172.80

97.92

16020 00

Surgery

2.59

1.68

186.48

120.96

16025 00

Surgery

4.74

3.34

341.28

240.48

16030 00

Surgery

5.94

3.95

427.68

284.40

16035 00

Surgery

5.83

5.83

419.76

419.76

16036 00

Surgery

2.45

2.45

176.40

176.40

17000 00

Surgery

2.04

1.66

146.88

119.52

17003 00

Surgery

0.20

0.06

14.40

4.32

17004 00

Surgery

5.04

2.95

362.88

212.40

17106 00

Surgery

10.40

8.31

748.80

598.32

17107 00

Surgery

13.49

10.81

971.28

778.32

17108 00

Surgery

19.17

15.86

1380.24

1141.92

17110 00

Surgery

3.43

2.07

246.96

149.04

17111 00

Surgery

4.01

2.51

288.72

180.72

17250 00

Surgery

2.62

1.13

188.64

81.36

17260 00

Surgery

3.01

2.12

216.72

152.64

17261 00

Surgery

4.48

2.62

322.56

188.64

17262 00

Surgery

5.38

3.31

387.36

238.32

17263 00

Surgery

5.82

3.66

419.04

263.52

17264 00

Surgery

6.24

3.91

449.28

281.52

17266 00

Surgery

7.09

4.58

510.48

329.76

17270 00

Surgery

4.52

2.87

325.44

206.64

17271 00

Surgery

5.02

3.15

361.44

226.80

17272 00

Surgery

5.69

3.63

409.68

261.36

17273 00

Surgery

6.31

4.10

454.32

295.20

17274 00

Surgery

7.37

5.00

530.64

360.00

17276 00

Surgery

8.55

6.03

615.60

434.16

17280 00

Surgery

4.25

2.61

306.00

187.92

17281 00

Surgery

5.43

3.54

390.96

254.88

17282 00

Surgery

6.20

4.08

446.40

293.76

17283 00

Surgery

7.33

5.10

527.76

367.20

17284 00

Surgery

8.32

5.93

599.04

426.96

17286 00

Surgery

10.67

8.05

768.24

579.60

17311 00

Surgery

20.45

10.52

1472.40

757.44

17312 00

Surgery

12.41

5.60

893.52

403.20

17313 00

Surgery

19.22

9.44

1383.84

679.68

17314 00

Surgery

11.89

5.19

856.08

373.68

17315 00

Surgery

2.40

1.48

172.80

106.56

17340 00

Surgery

1.58

1.47

113.76

105.84

17360 00

Surgery

3.71

2.79

267.12

200.88

17380 00

Surgery

-

-

97.20

69.12

17999 00

Surgery

0.00

0.00

BR

BR

19000 00

Surgery

3.01

1.25

216.72

90.00

19001 00

Surgery

0.79

0.62

56.88

44.64

19020 00

Surgery

14.18

9.52

1020.96

685.44

19030 00

Surgery

4.91

2.23

353.52

160.56

19081 00

Surgery

14.85

4.79

1069.20

344.88

19082 00

Surgery

11.41

2.40

821.52

172.80

19083 00

Surgery

14.80

4.53

1065.60

326.16

19084 00

Surgery

11.23

2.26

808.56

162.72

19085 00

Surgery

22.67

5.26

1632.24

378.72

19086 00

Surgery

17.53

2.62

1262.16

188.64

19100 00

Surgery

4.48

2.06

322.56

148.32

19101 00

Surgery

9.88

6.74

711.36

485.28

19105 00

Surgery

68.01

6.27

4896.72

451.44

19110 00

Surgery

14.71

10.70

1059.12

770.40

19112 00

Surgery

13.93

9.82

1002.96

707.04

19120 00

Surgery

15.73

12.66

1132.56

911.52

19125 00

Surgery

17.33

14.00

1247.76

1008.00

19126 00

Surgery

4.77

4.77

343.44

343.44

19281 00

Surgery

7.21

2.89

519.12

208.08

19282 00

Surgery

5.10

1.45

367.20

104.40

19283 00

Surgery

7.73

2.92

556.56

210.24

19284 00

Surgery

5.65

1.46

406.80

105.12

19285 00

Surgery

10.91

2.47

785.52

177.84

19286 00

Surgery

8.91

1.24

641.52

89.28

19287 00

Surgery

18.82

3.69

1355.04

265.68

19288 00

Surgery

14.49

1.84

1043.28

132.48

19294 00

Surgery

4.89

4.89

352.08

352.08

19296 00

Surgery

107.75

6.28

7758.00

452.16

19297 00

Surgery

2.79

2.79

200.88

200.88

19298 00

Surgery

26.05

9.45

1875.60

680.40

19300 00

Surgery

17.41

13.07

1253.52

941.04

19301 00

Surgery

19.93

19.93

1434.96

1434.96

19302 00

Surgery

27.36

27.36

1969.92

1969.92

19303 00

Surgery

28.88

28.88

2079.36

2079.36

19305 00

Surgery

34.63

34.63

2493.36

2493.36

19306 00

Surgery

36.80

36.80

2649.60

2649.60

19307 00

Surgery

35.55

35.55

2559.60

2559.60

19316 00

Surgery

23.86

23.86

1717.92

1717.92

19318 00

Surgery

32.83

32.83

2363.76

2363.76

19325 00

Surgery

18.56

18.56

1336.32

1336.32

19328 00

Surgery

16.71

16.71

1203.12

1203.12

19330 00

Surgery

19.46

19.46

1401.12

1401.12

19340 00

Surgery

22.87

22.87

1646.64

1646.64

19342 00

Surgery

22.93

22.93

1650.96

1650.96

19350 00

Surgery

25.05

20.29

1803.60

1460.88

19355 00

Surgery

22.76

18.59

1638.72

1338.48

19357 00

Surgery

34.91

34.91

2513.52

2513.52

19361 00

Surgery

46.68

46.68

3360.96

3360.96

19364 00

Surgery

81.23

81.23

5848.56

5848.56

19367 00

Surgery

52.99

52.99

3815.28

3815.28

19368 00

Surgery

64.81

64.81

4666.32

4666.32

19369 00

Surgery

60.23

60.23

4336.56

4336.56

19370 00

Surgery

20.25

20.25

1458.00

1458.00

19371 00

Surgery

21.43

21.43

1542.96

1542.96

19380 00

Surgery

24.31

24.31

1750.32

1750.32

19396 00

Surgery

8.17

4.27

588.24

307.44

19499 00

Surgery

0.00

0.00

BR

BR

20100 00

Surgery

17.99

17.99

1295.28

1295.28

20101 00

Surgery

17.25

6.30

1242.00

453.60

20102 00

Surgery

18.40

7.71

1324.80

555.12

20103 00

Surgery

16.96

10.38

1221.12

747.36

20150 00

Surgery

30.28

30.28

2180.16

2180.16

20200 00

Surgery

6.50

2.86

468.00

205.92

20205 00

Surgery

9.15

4.66

658.80

335.52

20206 00

Surgery

6.55

1.69

471.60

121.68

20220 00

Surgery

6.93

2.57

498.96

185.04

20225 00

Surgery

11.32

3.81

815.04

274.32

20240 00

Surgery

4.18

4.18

300.96

300.96

20245 00

Surgery

10.25

10.25

738.00

738.00

20250 00

Surgery

11.84

11.84

852.48

852.48

20251 00

Surgery

12.66

12.66

911.52

911.52

20500 00

Surgery

3.73

2.69

268.56

193.68

20501 00

Surgery

4.23

1.07

304.56

77.04

20520 00

Surgery

6.58

4.47

473.76

321.84

20525 00

Surgery

13.95

7.45

1004.40

536.40

20526 00

Surgery

2.48

1.70

178.56

122.40

20527 00

Surgery

2.64

1.97

190.08

141.84

20550 00

Surgery

1.74

1.16

125.28

83.52

20551 00

Surgery

1.73

1.15

124.56

82.80

20552 00

Surgery

1.58

1.10

113.76

79.20

20553 00

Surgery

1.82

1.25

131.04

90.00

20555 00

Surgery

10.00

10.00

720.00

720.00

20560 00

Surgery

0.77

0.44

55.44

31.68

20561 00

Surgery

1.11

0.66

79.92

47.52

20600 00

Surgery

1.62

1.07

116.64

77.04

20604 00

Surgery

2.49

1.36

179.28

97.92

20605 00

Surgery

1.66

1.10

119.52

79.20

20606 00

Surgery

2.71

1.55

195.12

111.60

20610 00

Surgery

1.96

1.36

141.12

97.92

20611 00

Surgery

2.99

1.76

215.28

126.72

20612 00

Surgery

1.96

1.23

141.12

88.56

20615 00

Surgery

7.67

4.90

552.24

352.80

20650 00

Surgery

7.01

5.06

504.72

364.32

20660 00

Surgery

7.20

7.20

518.40

518.40

20661 00

Surgery

16.06

16.06

1156.32

1156.32

20662 00

Surgery

15.92

15.92

1146.24

1146.24

20663 00

Surgery

14.71

14.71

1059.12

1059.12

20664 00

Surgery

27.23

27.23

1960.56

1960.56

20665 00

Surgery

3.55

2.94

255.60

211.68

20670 00

Surgery

10.68

4.38

768.96

315.36

20680 00

Surgery

18.11

12.71

1303.92

915.12

20690 00

Surgery

18.04

18.04

1298.88

1298.88

20692 00

Surgery

34.09

34.09

2454.48

2454.48

20693 00

Surgery

13.58

13.58

977.76

977.76

20694 00

Surgery

13.10

10.42

943.20

750.24

20696 00

Surgery

35.09

35.09

2526.48

2526.48

20697 00

Surgery

53.10

53.10

3823.20

3823.20

20700 00

Surgery

2.52

2.52

181.44

181.44

20701 00

Surgery

1.91

1.91

137.52

137.52

20702 00

Surgery

4.24

4.24

305.28

305.28

20703 00

Surgery

3.10

3.10

223.20

223.20

20704 00

Surgery

4.46

4.46

321.12

321.12

20705 00

Surgery

3.69

3.69

265.68

265.68

20802 00

Surgery

82.20

82.20

5918.40

5918.40

20805 00

Surgery

97.57

97.57

7025.04

7025.04

20808 00

Surgery

117.64

117.64

8470.08

8470.08

20816 00

Surgery

61.54

61.54

4430.88

4430.88

20822 00

Surgery

53.24

53.24

3833.28

3833.28

20824 00

Surgery

61.66

61.66

4439.52

4439.52

20827 00

Surgery

54.65

54.65

3934.80

3934.80

20838 00

Surgery

83.42

83.42

6006.24

6006.24

20900 00

Surgery

11.56

5.39

832.32

388.08

20902 00

Surgery

8.22

8.22

591.84

591.84

20910 00

Surgery

14.55

14.55

1047.60

1047.60

20912 00

Surgery

14.62

14.62

1052.64

1052.64

20920 00

Surgery

12.13

12.13

873.36

873.36

20922 00

Surgery

18.63

15.11

1341.36

1087.92

20924 00

Surgery

15.32

15.32

1103.04

1103.04

20930 00

Surgery

-

-

534.96

491.76

20931 00

Surgery

3.30

3.30

237.60

237.60

20932 00

Surgery

22.43

22.43

1614.96

1614.96

20933 00

Surgery

20.57

20.57

1481.04

1481.04

20934 00

Surgery

22.41

22.41

1613.52

1613.52

20936 00

Surgery

-

-

707.04

650.88

20937 00

Surgery

4.98

4.98

358.56

358.56

20938 00

Surgery

5.49

5.49

395.28

395.28

20939 00

Surgery

2.08

2.08

149.76

149.76

20950 00

Surgery

7.96

2.66

573.12

191.52

20955 00

Surgery

73.00

73.00

5256.00

5256.00

20956 00

Surgery

79.03

79.03

5690.16

5690.16

20957 00

Surgery

82.35

82.35

5929.20

5929.20

20962 00

Surgery

80.13

80.13

5769.36

5769.36

20969 00

Surgery

81.12

81.12

5840.64

5840.64

20970 00

Surgery

85.25

85.25

6138.00

6138.00

20972 00

Surgery

85.00

85.00

6120.00

6120.00

20973 00

Surgery

89.77

89.77

6463.44

6463.44

20974 00

Surgery

2.53

1.54

182.16

110.88

20975 00

Surgery

5.29

5.29

380.88

380.88

20979 00

Surgery

1.72

0.95

123.84

68.40

20982 00

Surgery

102.91

10.82

7409.52

779.04

20983 00

Surgery

149.77

10.06

10783.44

724.32

20985 00

Surgery

4.30

4.30

309.60

309.60

20999 00

Surgery

0.00

0.00

BR

BR

21010 00

Surgery

22.21

22.21

1599.12

1599.12

21011 00

Surgery

11.30

7.91

813.60

569.52

21012 00

Surgery

10.29

10.29

740.88

740.88

21013 00

Surgery

16.16

12.17

1163.52

876.24

21014 00

Surgery

15.78

15.78

1136.16

1136.16

21015 00

Surgery

21.04

21.04

1514.88

1514.88

21016 00

Surgery

30.30

30.30

2181.60

2181.60

21025 00

Surgery

23.85

19.89

1717.20

1432.08

21026 00

Surgery

16.12

12.91

1160.64

929.52

21029 00

Surgery

23.31

18.87

1678.32

1358.64

21030 00

Surgery

13.77

10.84

991.44

780.48

21031 00

Surgery

11.52

8.20

829.44

590.40

21032 00

Surgery

11.20

7.85

806.40

565.20

21034 00

Surgery

39.00

33.79

2808.00

2432.88

21040 00

Surgery

13.91

10.88

1001.52

783.36

21044 00

Surgery

25.95

25.95

1868.40

1868.40

21045 00

Surgery

36.00

36.00

2592.00

2592.00

21046 00

Surgery

29.57

29.57

2129.04

2129.04

21047 00

Surgery

36.22

36.22

2607.84

2607.84

21048 00

Surgery

29.83

29.83

2147.76

2147.76

21049 00

Surgery

34.42

34.42

2478.24

2478.24

21050 00

Surgery

25.86

25.86

1861.92

1861.92

21060 00

Surgery

23.44

23.44

1687.68

1687.68

21070 00

Surgery

18.46

18.46

1329.12

1329.12

21073 00

Surgery

11.45

7.21

824.40

519.12

21076 00

Surgery

25.95

21.07

1868.40

1517.04

21077 00

Surgery

63.47

51.84

4569.84

3732.48

21079 00

Surgery

43.54

34.85

3134.88

2509.20

21080 00

Surgery

49.67

39.32

3576.24

2831.04

21081 00

Surgery

45.96

36.10

3309.12

2599.20

21082 00

Surgery

42.93

33.30

3090.96

2397.60

21083 00

Surgery

40.79

30.78

2936.88

2216.16

21084 00

Surgery

46.54

35.61

3350.88

2563.92

21085 00

Surgery

20.42

14.46

1470.24

1041.12

21086 00

Surgery

47.13

38.20

3393.36

2750.40

21087 00

Surgery

47.13

38.20

3393.36

2750.40

21088 00

Surgery

-

-

2025.36

1863.36

21089 00

Surgery

0.00

0.00

BR

BR

21100 00

Surgery

18.59

10.72

1338.48

771.84

21110 00

Surgery

25.71

21.32

1851.12

1535.04

21116 00

Surgery

6.36

1.32

457.92

95.04

21120 00

Surgery

19.94

15.31

1435.68

1102.32

21121 00

Surgery

19.00

15.90

1368.00

1144.80

21122 00

Surgery

22.51

22.51

1620.72

1620.72

21123 00

Surgery

25.28

25.28

1820.16

1820.16

21125 00

Surgery

77.47

20.01

5577.84

1440.72

21127 00

Surgery

119.93

23.18

8634.96

1668.96

21137 00

Surgery

22.61

22.61

1627.92

1627.92

21138 00

Surgery

27.49

27.49

1979.28

1979.28

21139 00

Surgery

32.70

32.70

2354.40

2354.40

21141 00

Surgery

39.75

39.75

2862.00

2862.00

21142 00

Surgery

40.80

40.80

2937.60

2937.60

21143 00

Surgery

42.04

42.04

3026.88

3026.88

21145 00

Surgery

46.17

46.17

3324.24

3324.24

21146 00

Surgery

48.22

48.22

3471.84

3471.84

21147 00

Surgery

50.72

50.72

3651.84

3651.84

21150 00

Surgery

49.26

49.26

3546.72

3546.72

21151 00

Surgery

54.20

54.20

3902.40

3902.40

21154 00

Surgery

58.34

58.34

4200.48

4200.48

21155 00

Surgery

64.70

64.70

4658.40

4658.40

21159 00

Surgery

77.46

77.46

5577.12

5577.12

21160 00

Surgery

83.99

83.99

6047.28

6047.28

21172 00

Surgery

64.35

64.35

4633.20

4633.20

21175 00

Surgery

66.01

66.01

4752.72

4752.72

21179 00

Surgery

45.49

45.49

3275.28

3275.28

21180 00

Surgery

50.77

50.77

3655.44

3655.44

21181 00

Surgery

22.30

22.30

1605.60

1605.60

21182 00

Surgery

63.19

63.19

4549.68

4549.68

21183 00

Surgery

68.72

68.72

4947.84

4947.84

21184 00

Surgery

73.91

73.91

5321.52

5321.52

21188 00

Surgery

47.05

47.05

3387.60

3387.60

21193 00

Surgery

36.70

36.70

2642.40

2642.40

21194 00

Surgery

42.42

42.42

3054.24

3054.24

21195 00

Surgery

39.94

39.94

2875.68

2875.68

21196 00

Surgery

42.66

42.66

3071.52

3071.52

21198 00

Surgery

30.20

30.20

2174.40

2174.40

21199 00

Surgery

30.31

30.31

2182.32

2182.32

21206 00

Surgery

29.00

29.00

2088.00

2088.00

21208 00

Surgery

48.96

22.09

3525.12

1590.48

21209 00

Surgery

23.87

18.21

1718.64

1311.12

21210 00

Surgery

52.64

22.74

3790.08

1637.28

21215 00

Surgery

121.58

23.63

8753.76

1701.36

21230 00

Surgery

22.49

22.49

1619.28

1619.28

21235 00

Surgery

22.25

17.24

1602.00

1241.28

21240 00

Surgery

31.29

31.29

2252.88

2252.88

21242 00

Surgery

30.25

30.25

2178.00

2178.00

21243 00

Surgery

50.05

50.05

3603.60

3603.60

21244 00

Surgery

30.22

30.22

2175.84

2175.84

21245 00

Surgery

36.56

28.28

2632.32

2036.16

21246 00

Surgery

25.36

25.36

1825.92

1825.92

21247 00

Surgery

47.09

47.09

3390.48

3390.48

21248 00

Surgery

29.42

23.74

2118.24

1709.28

21249 00

Surgery

39.86

33.14

2869.92

2386.08

21255 00

Surgery

39.85

39.85

2869.20

2869.20

21256 00

Surgery

37.24

37.24

2681.28

2681.28

21260 00

Surgery

41.00

41.00

2952.00

2952.00

21261 00

Surgery

72.54

72.54

5222.88

5222.88

21263 00

Surgery

67.12

67.12

4832.64

4832.64

21267 00

Surgery

47.94

47.94

3451.68

3451.68

21268 00

Surgery

60.14

60.14

4330.08

4330.08

21270 00

Surgery

30.65

22.49

2206.80

1619.28

21275 00

Surgery

25.37

25.37

1826.64

1826.64

21280 00

Surgery

17.70

17.70

1274.40

1274.40

21282 00

Surgery

12.06

12.06

868.32

868.32

21295 00

Surgery

6.01

6.01

432.72

432.72

21296 00

Surgery

12.36

12.36

889.92

889.92

21299 00

Surgery

0.00

0.00

BR

BR

21315 00

Surgery

4.60

1.79

331.20

128.88

21320 00

Surgery

6.52

2.85

469.44

205.20

21325 00

Surgery

13.45

13.45

968.40

968.40

21330 00

Surgery

16.16

16.16

1163.52

1163.52

21335 00

Surgery

21.64

21.64

1558.08

1558.08

21336 00

Surgery

19.23

19.23

1384.56

1384.56

21337 00

Surgery

12.62

9.14

908.64

658.08

21338 00

Surgery

20.24

20.24

1457.28

1457.28

21339 00

Surgery

22.85

22.85

1645.20

1645.20

21340 00

Surgery

22.74

22.74

1637.28

1637.28

21343 00

Surgery

32.76

32.76

2358.72

2358.72

21344 00

Surgery

41.84

41.84

3012.48

3012.48

21345 00

Surgery

24.33

19.40

1751.76

1396.80

21346 00

Surgery

30.73

30.73

2212.56

2212.56

21347 00

Surgery

31.20

31.20

2246.40

2246.40

21348 00

Surgery

32.94

32.94

2371.68

2371.68

21355 00

Surgery

13.59

9.97

978.48

717.84

21356 00

Surgery

16.49

12.20

1187.28

878.40

21360 00

Surgery

15.93

15.93

1146.96

1146.96

21365 00

Surgery

32.40

32.40

2332.80

2332.80

21366 00

Surgery

38.28

38.28

2756.16

2756.16

21385 00

Surgery

22.06

22.06

1588.32

1588.32

21386 00

Surgery

20.85

20.85

1501.20

1501.20

21387 00

Surgery

23.02

23.02

1657.44

1657.44

21390 00

Surgery

24.14

24.14

1738.08

1738.08

21395 00

Surgery

30.23

30.23

2176.56

2176.56

21400 00

Surgery

6.62

5.18

476.64

372.96

21401 00

Surgery

15.39

10.02

1108.08

721.44

21406 00

Surgery

17.63

17.63

1269.36

1269.36

21407 00

Surgery

19.32

19.32

1391.04

1391.04

21408 00

Surgery

27.12

27.12

1952.64

1952.64

21421 00

Surgery

19.36

16.35

1393.92

1177.20

21422 00

Surgery

18.75

18.75

1350.00

1350.00

21423 00

Surgery

23.95

23.95

1724.40

1724.40

21431 00

Surgery

20.77

20.77

1495.44

1495.44

21432 00

Surgery

21.42

21.42

1542.24

1542.24

21433 00

Surgery

51.86

51.86

3733.92

3733.92

21435 00

Surgery

42.22

42.22

3039.84

3039.84

21436 00

Surgery

60.99

60.99

4391.28

4391.28

21440 00

Surgery

22.82

18.24

1643.04

1313.28

21445 00

Surgery

23.31

18.88

1678.32

1359.36

21450 00

Surgery

17.72

14.42

1275.84

1038.24

21451 00

Surgery

23.05

19.22

1659.60

1383.84

21452 00

Surgery

21.96

13.74

1581.12

989.28

21453 00

Surgery

32.82

27.93

2363.04

2010.96

21454 00

Surgery

14.71

14.71

1059.12

1059.12

21461 00

Surgery

55.01

31.92

3960.72

2298.24

21462 00

Surgery

58.62

34.80

4220.64

2505.60

21465 00

Surgery

23.93

23.93

1722.96

1722.96

21470 00

Surgery

34.98

34.98

2518.56

2518.56

21480 00

Surgery

4.25

0.93

306.00

66.96

21485 00

Surgery

28.73

23.47

2068.56

1689.84

21490 00

Surgery

23.59

23.59

1698.48

1698.48

21497 00

Surgery

21.23

17.65

1528.56

1270.80

21499 00

Surgery

0.00

0.00

BR

BR

21501 00

Surgery

14.77

10.25

1063.44

738.00

21502 00

Surgery

15.31

15.31

1102.32

1102.32

21510 00

Surgery

13.68

13.68

984.96

984.96

21550 00

Surgery

8.04

4.70

578.88

338.40

21552 00

Surgery

13.56

13.56

976.32

976.32

21554 00

Surgery

22.10

22.10

1591.20

1591.20

21555 00

Surgery

13.12

9.34

944.64

672.48

21556 00

Surgery

16.04

16.04

1154.88

1154.88

21557 00

Surgery

28.88

28.88

2079.36

2079.36

21558 00

Surgery

40.25

40.25

2898.00

2898.00

21600 00

Surgery

17.19

17.19

1237.68

1237.68

21601 00

Surgery

34.46

34.46

2481.12

2481.12

21602 00

Surgery

45.89

45.89

3304.08

3304.08

21603 00

Surgery

50.30

50.30

3621.60

3621.60

21610 00

Surgery

36.87

36.87

2654.64

2654.64

21615 00

Surgery

18.66

18.66

1343.52

1343.52

21616 00

Surgery

21.32

21.32

1535.04

1535.04

21620 00

Surgery

15.16

15.16

1091.52

1091.52

21627 00

Surgery

16.55

16.55

1191.60

1191.60

21630 00

Surgery

39.43

39.43

2838.96

2838.96

21632 00

Surgery

36.27

36.27

2611.44

2611.44

21685 00

Surgery

29.60

29.60

2131.20

2131.20

21700 00

Surgery

10.63

10.63

765.36

765.36

21705 00

Surgery

15.85

15.85

1141.20

1141.20

21720 00

Surgery

16.36

16.36

1177.92

1177.92

21725 00

Surgery

16.54

16.54

1190.88

1190.88

21740 00

Surgery

30.59

30.59

2202.48

2202.48

21742 00

Surgery

-

-

3044.88

2801.52

21743 00

Surgery

-

-

5196.24

4780.08

21750 00

Surgery

20.19

20.19

1453.68

1453.68

21811 00

Surgery

17.66

17.66

1271.52

1271.52

21812 00

Surgery

21.31

21.31

1534.32

1534.32

21813 00

Surgery

29.20

29.20

2102.40

2102.40

21820 00

Surgery

4.67

4.61

336.24

331.92

21825 00

Surgery

16.68

16.68

1200.96

1200.96

21899 00

Surgery

0.00

0.00

BR

BR

21920 00

Surgery

7.74

4.67

557.28

336.24

21925 00

Surgery

15.01

11.53

1080.72

830.16

21930 00

Surgery

15.23

11.10

1096.56

799.20

21931 00

Surgery

14.24

14.24

1025.28

1025.28

21932 00

Surgery

20.04

20.04

1442.88

1442.88

21933 00

Surgery

22.29

22.29

1604.88

1604.88

21935 00

Surgery

30.78

30.78

2216.16

2216.16

21936 00

Surgery

42.54

42.54

3062.88

3062.88

22010 00

Surgery

29.55

29.55

2127.60

2127.60

22015 00

Surgery

28.83

28.83

2075.76

2075.76

22100 00

Surgery

28.97

28.97

2085.84

2085.84

22101 00

Surgery

26.72

26.72

1923.84

1923.84

22102 00

Surgery

23.36

23.36

1681.92

1681.92

22103 00

Surgery

4.01

4.01

288.72

288.72

22110 00

Surgery

32.27

32.27

2323.44

2323.44

22112 00

Surgery

34.81

34.81

2506.32

2506.32

22114 00

Surgery

34.81

34.81

2506.32

2506.32

22116 00

Surgery

4.21

4.21

303.12

303.12

22206 00

Surgery

74.06

74.06

5332.32

5332.32

22207 00

Surgery

72.45

72.45

5216.40

5216.40

22208 00

Surgery

17.63

17.63

1269.36

1269.36

22210 00

Surgery

54.26

54.26

3906.72

3906.72

22212 00

Surgery

45.91

45.91

3305.52

3305.52

22214 00

Surgery

45.92

45.92

3306.24

3306.24

22216 00

Surgery

10.81

10.81

778.32

778.32

22220 00

Surgery

49.07

49.07

3533.04

3533.04

22222 00

Surgery

53.80

53.80

3873.60

3873.60

22224 00

Surgery

47.84

47.84

3444.48

3444.48

22226 00

Surgery

10.70

10.70

770.40

770.40

22310 00

Surgery

9.53

9.10

686.16

655.20

22315 00

Surgery

27.36

23.70

1969.92

1706.40

22318 00

Surgery

50.42

50.42

3630.24

3630.24

22319 00

Surgery

55.91

55.91

4025.52

4025.52

22325 00

Surgery

44.95

44.95

3236.40

3236.40

22326 00

Surgery

45.99

45.99

3311.28

3311.28

22327 00

Surgery

46.84

46.84

3372.48

3372.48

22328 00

Surgery

8.42

8.42

606.24

606.24

22505 00

Surgery

3.93

3.93

282.96

282.96

22510 00

Surgery

53.41

12.83

3845.52

923.76

22511 00

Surgery

53.35

12.08

3841.20

869.76

22512 00

Surgery

21.66

6.13

1559.52

441.36

22513 00

Surgery

168.31

15.21

12118.32

1095.12

22514 00

Surgery

167.57

14.18

12065.04

1020.96

22515 00

Surgery

86.20

6.45

6206.40

464.40

22526 00

Surgery

58.60

9.78

4219.20

704.16

22527 00

Surgery

48.10

4.52

3463.20

325.44

22532 00

Surgery

54.33

54.33

3911.76

3911.76

22533 00

Surgery

50.17

50.17

3612.24

3612.24

22534 00

Surgery

10.77

10.77

775.44

775.44

22548 00

Surgery

59.93

59.93

4314.96

4314.96

22551 00

Surgery

51.50

51.50

3708.00

3708.00

22552 00

Surgery

11.85

11.85

853.20

853.20

22554 00

Surgery

38.35

38.35

2761.20

2761.20

22556 00

Surgery

51.05

51.05

3675.60

3675.60

22558 00

Surgery

46.05

46.05

3315.60

3315.60

22585 00

Surgery

9.69

9.69

697.68

697.68

22586 00

Surgery

61.98

61.98

4462.56

4462.56

22590 00

Surgery

48.43

48.43

3486.96

3486.96

22595 00

Surgery

46.30

46.30

3333.60

3333.60

22600 00

Surgery

39.70

39.70

2858.40

2858.40

22610 00

Surgery

39.00

39.00

2808.00

2808.00

22612 00

Surgery

47.79

47.79

3440.88

3440.88

22614 00

Surgery

11.70

11.70

842.40

842.40

22630 00

Surgery

47.39

47.39

3412.08

3412.08

22632 00

Surgery

9.62

9.62

692.64

692.64

22633 00

Surgery

54.69

54.69

3937.68

3937.68

22634 00

Surgery

14.49

14.49

1043.28

1043.28

22800 00

Surgery

41.41

41.41

2981.52

2981.52

22802 00

Surgery

63.92

63.92

4602.24

4602.24

22804 00

Surgery

73.31

73.31

5278.32

5278.32

22808 00

Surgery

55.28

55.28

3980.16

3980.16

22810 00

Surgery

60.23

60.23

4336.56

4336.56

22812 00

Surgery

66.01

66.01

4752.72

4752.72

22818 00

Surgery

64.41

64.41

4637.52

4637.52

22819 00

Surgery

74.14

74.14

5338.08

5338.08

22830 00

Surgery

25.02

25.02

1801.44

1801.44

22836 00

Surgery

51.36

51.36

3697.92

3697.92

22837 00

Surgery

56.57

56.57

4073.04

4073.04

22838 00

Surgery

57.32

57.32

4127.04

4127.04

22840 00

Surgery

22.60

22.60

1627.20

1627.20

22841 00

Surgery

-

-

2187.36

2012.40

22842 00

Surgery

22.81

22.81

1642.32

1642.32

22843 00

Surgery

24.43

24.43

1758.96

1758.96

22844 00

Surgery

29.35

29.35

2113.20

2113.20

22845 00

Surgery

21.72

21.72

1563.84

1563.84

22846 00

Surgery

22.61

22.61

1627.92

1627.92

22847 00

Surgery

23.73

23.73

1708.56

1708.56

22848 00

Surgery

10.74

10.74

773.28

773.28

22849 00

Surgery

39.53

39.53

2846.16

2846.16

22850 00

Surgery

22.38

22.38

1611.36

1611.36

22852 00

Surgery

21.58

21.58

1553.76

1553.76

22853 00

Surgery

7.70

7.70

554.40

554.40

22854 00

Surgery

10.03

10.03

722.16

722.16

22855 00

Surgery

33.62

33.62

2420.64

2420.64

22856 00

Surgery

49.12

49.12

3536.64

3536.64

22857 00

Surgery

52.42

52.42

3774.24

3774.24

22858 00

Surgery

15.11

15.11

1087.92

1087.92

22859 00

Surgery

9.96

9.96

717.12

717.12

22860 00

Surgery

10.25

10.25

738.00

738.00

22861 00

Surgery

70.49

70.49

5075.28

5075.28

22862 00

Surgery

70.54

70.54

5078.88

5078.88

22864 00

Surgery

62.98

62.98

4534.56

4534.56

22865 00

Surgery

68.85

68.85

4957.20

4957.20

22867 00

Surgery

32.47

32.47

2337.84

2337.84

22868 00

Surgery

7.25

7.25

522.00

522.00

22869 00

Surgery

13.01

13.01

936.72

936.72

22870 00

Surgery

3.49

3.49

251.28

251.28

22899 00

Surgery

0.00

0.00

BR

BR

22900 00

Surgery

17.15

17.15

1234.80

1234.80

22901 00

Surgery

20.15

20.15

1450.80

1450.80

22902 00

Surgery

14.28

10.16

1028.16

731.52

22903 00

Surgery

13.35

13.35

961.20

961.20

22904 00

Surgery

31.55

31.55

2271.60

2271.60

22905 00

Surgery

39.96

39.96

2877.12

2877.12

22999 00

Surgery

0.00

0.00

BR

BR

23000 00

Surgery

16.69

10.94

1201.68

787.68

23020 00

Surgery

21.00

21.00

1512.00

1512.00

23030 00

Surgery

13.26

7.73

954.72

556.56

23031 00

Surgery

13.04

6.77

938.88

487.44

23035 00

Surgery

20.61

20.61

1483.92

1483.92

23040 00

Surgery

21.81

21.81

1570.32

1570.32

23044 00

Surgery

17.23

17.23

1240.56

1240.56

23065 00

Surgery

6.81

4.83

490.32

347.76

23066 00

Surgery

17.34

11.28

1248.48

812.16

23071 00

Surgery

12.76

12.76

918.72

918.72

23073 00

Surgery

21.10

21.10

1519.20

1519.20

23075 00

Surgery

15.57

10.04

1121.04

722.88

23076 00

Surgery

16.51

16.51

1188.72

1188.72

23077 00

Surgery

34.05

34.05

2451.60

2451.60

23078 00

Surgery

43.16

43.16

3107.52

3107.52

23100 00

Surgery

15.53

15.53

1118.16

1118.16

23101 00

Surgery

14.05

14.05

1011.60

1011.60

23105 00

Surgery

19.57

19.57

1409.04

1409.04

23106 00

Surgery

15.41

15.41

1109.52

1109.52

23107 00

Surgery

20.27

20.27

1459.44

1459.44

23120 00

Surgery

18.00

18.00

1296.00

1296.00

23125 00

Surgery

21.63

21.63

1557.36

1557.36

23130 00

Surgery

18.89

18.89

1360.08

1360.08

23140 00

Surgery

17.00

17.00

1224.00

1224.00

23145 00

Surgery

21.20

21.20

1526.40

1526.40

23146 00

Surgery

19.07

19.07

1373.04

1373.04

23150 00

Surgery

20.35

20.35

1465.20

1465.20

23155 00

Surgery

24.26

24.26

1746.72

1746.72

23156 00

Surgery

20.70

20.70

1490.40

1490.40

23170 00

Surgery

17.29

17.29

1244.88

1244.88

23172 00

Surgery

17.46

17.46

1257.12

1257.12

23174 00

Surgery

23.30

23.30

1677.60

1677.60

23180 00

Surgery

20.12

20.12

1448.64

1448.64

23182 00

Surgery

20.51

20.51

1476.72

1476.72

23184 00

Surgery

22.57

22.57

1625.04

1625.04

23190 00

Surgery

17.59

17.59

1266.48

1266.48

23195 00

Surgery

22.73

22.73

1636.56

1636.56

23200 00

Surgery

45.25

45.25

3258.00

3258.00

23210 00

Surgery

53.03

53.03

3818.16

3818.16

23220 00

Surgery

58.02

58.02

4177.44

4177.44

23330 00

Surgery

9.10

5.11

655.20

367.92

23333 00

Surgery

14.49

14.49

1043.28

1043.28

23334 00

Surgery

31.97

31.97

2301.84

2301.84

23335 00

Surgery

38.17

38.17

2748.24

2748.24

23350 00

Surgery

4.85

1.47

349.20

105.84

23395 00

Surgery

38.76

38.76

2790.72

2790.72

23397 00

Surgery

34.45

34.45

2480.40

2480.40

23400 00

Surgery

29.44

29.44

2119.68

2119.68

23405 00

Surgery

18.71

18.71

1347.12

1347.12

23406 00

Surgery

22.13

22.13

1593.36

1593.36

23410 00

Surgery

24.86

24.86

1789.92

1789.92

23412 00

Surgery

25.84

25.84

1860.48

1860.48

23415 00

Surgery

21.26

21.26

1530.72

1530.72

23420 00

Surgery

29.53

29.53

2126.16

2126.16

23430 00

Surgery

22.63

22.63

1629.36

1629.36

23440 00

Surgery

23.01

23.01

1656.72

1656.72

23450 00

Surgery

28.61

28.61

2059.92

2059.92

23455 00

Surgery

29.80

29.80

2145.60

2145.60

23460 00

Surgery

32.95

32.95

2372.40

2372.40

23462 00

Surgery

32.24

32.24

2321.28

2321.28

23465 00

Surgery

33.78

33.78

2432.16

2432.16

23466 00

Surgery

33.97

33.97

2445.84

2445.84

23470 00

Surgery

36.10

36.10

2599.20

2599.20

23472 00

Surgery

43.43

43.43

3126.96

3126.96

23473 00

Surgery

48.29

48.29

3476.88

3476.88

23474 00

Surgery

52.12

52.12

3752.64

3752.64

23480 00

Surgery

24.89

24.89

1792.08

1792.08

23485 00

Surgery

28.85

28.85

2077.20

2077.20

23490 00

Surgery

26.10

26.10

1879.20

1879.20

23491 00

Surgery

30.73

30.73

2212.56

2212.56

23500 00

Surgery

7.02

7.18

505.44

516.96

23505 00

Surgery

11.24

10.43

809.28

750.96

23515 00

Surgery

21.93

21.93

1578.96

1578.96

23520 00

Surgery

7.56

7.50

544.32

540.00

23525 00

Surgery

12.41

11.33

893.52

815.76

23530 00

Surgery

17.60

17.60

1267.20

1267.20

23532 00

Surgery

19.14

19.14

1378.08

1378.08

23540 00

Surgery

7.49

7.43

539.28

534.96

23545 00

Surgery

11.30

10.13

813.60

729.36

23550 00

Surgery

17.47

17.47

1257.84

1257.84

23552 00

Surgery

19.79

19.79

1424.88

1424.88

23570 00

Surgery

7.38

7.62

531.36

548.64

23575 00

Surgery

12.81

11.82

922.32

851.04

23585 00

Surgery

29.50

29.50

2124.00

2124.00

23600 00

Surgery

10.45

9.91

752.40

713.52

23605 00

Surgery

14.62

13.26

1052.64

954.72

23615 00

Surgery

26.79

26.79

1928.88

1928.88

23616 00

Surgery

37.29

37.29

2684.88

2684.88

23620 00

Surgery

8.51

8.15

612.72

586.80

23625 00

Surgery

12.06

11.01

868.32

792.72

23630 00

Surgery

23.76

23.76

1710.72

1710.72

23650 00

Surgery

10.42

9.40

750.24

676.80

23655 00

Surgery

12.60

12.60

907.20

907.20

23660 00

Surgery

17.88

17.88

1287.36

1287.36

23665 00

Surgery

13.57

12.46

977.04

897.12

23670 00

Surgery

26.47

26.47

1905.84

1905.84

23675 00

Surgery

17.17

15.52

1236.24

1117.44

23680 00

Surgery

27.90

27.90

2008.80

2008.80

23700 00

Surgery

5.96

5.96

429.12

429.12

23800 00

Surgery

31.07

31.07

2237.04

2237.04

23802 00

Surgery

38.75

38.75

2790.00

2790.00

23900 00

Surgery

41.69

41.69

3001.68

3001.68

23920 00

Surgery

33.95

33.95

2444.40

2444.40

23921 00

Surgery

14.47

14.47

1041.84

1041.84

23929 00

Surgery

0.00

0.00

BR

BR

23930 00

Surgery

10.84

6.53

780.48

470.16

23931 00

Surgery

9.16

4.92

659.52

354.24

23935 00

Surgery

15.74

15.74

1133.28

1133.28

24000 00

Surgery

14.67

14.67

1056.24

1056.24

24006 00

Surgery

21.74

21.74

1565.28

1565.28

24065 00

Surgery

7.83

4.93

563.76

354.96

24066 00

Surgery

18.98

12.91

1366.56

929.52

24071 00

Surgery

12.32

12.32

887.04

887.04

24073 00

Surgery

20.98

20.98

1510.56

1510.56

24075 00

Surgery

16.02

10.05

1153.44

723.60

24076 00

Surgery

16.64

16.64

1198.08

1198.08

24077 00

Surgery

30.98

30.98

2230.56

2230.56

24079 00

Surgery

39.89

39.89

2872.08

2872.08

24100 00

Surgery

12.93

12.93

930.96

930.96

24101 00

Surgery

15.42

15.42

1110.24

1110.24

24102 00

Surgery

18.84

18.84

1356.48

1356.48

24105 00

Surgery

11.12

11.12

800.64

800.64

24110 00

Surgery

18.07

18.07

1301.04

1301.04

24115 00

Surgery

22.45

22.45

1616.40

1616.40

24116 00

Surgery

26.09

26.09

1878.48

1878.48

24120 00

Surgery

16.31

16.31

1174.32

1174.32

24125 00

Surgery

19.04

19.04

1370.88

1370.88

24126 00

Surgery

19.86

19.86

1429.92

1429.92

24130 00

Surgery

15.65

15.65

1126.80

1126.80

24134 00

Surgery

22.75

22.75

1638.00

1638.00

24136 00

Surgery

19.31

19.31

1390.32

1390.32

24138 00

Surgery

21.02

21.02

1513.44

1513.44

24140 00

Surgery

21.40

21.40

1540.80

1540.80

24145 00

Surgery

18.17

18.17

1308.24

1308.24

24147 00

Surgery

19.19

19.19

1381.68

1381.68

24149 00

Surgery

35.78

35.78

2576.16

2576.16

24150 00

Surgery

46.43

46.43

3342.96

3342.96

24152 00

Surgery

40.46

40.46

2913.12

2913.12

24155 00

Surgery

25.83

25.83

1859.76

1859.76

24160 00

Surgery

37.88

37.88

2727.36

2727.36

24164 00

Surgery

22.05

22.05

1587.60

1587.60

24200 00

Surgery

6.65

4.30

478.80

309.60

24201 00

Surgery

18.67

12.27

1344.24

883.44

24220 00

Surgery

5.67

1.96

408.24

141.12

24300 00

Surgery

13.59

13.59

978.48

978.48

24301 00

Surgery

22.82

22.82

1643.04

1643.04

24305 00

Surgery

17.72

17.72

1275.84

1275.84

24310 00

Surgery

14.53

14.53

1046.16

1046.16

24320 00

Surgery

23.71

23.71

1707.12

1707.12

24330 00

Surgery

21.87

21.87

1574.64

1574.64

24331 00

Surgery

23.86

23.86

1717.92

1717.92

24332 00

Surgery

18.83

18.83

1355.76

1355.76

24340 00

Surgery

18.23

18.23

1312.56

1312.56

24341 00

Surgery

22.89

22.89

1648.08

1648.08

24342 00

Surgery

23.51

23.51

1692.72

1692.72

24343 00

Surgery

21.81

21.81

1570.32

1570.32

24344 00

Surgery

33.49

33.49

2411.28

2411.28

24345 00

Surgery

21.71

21.71

1563.12

1563.12

24346 00

Surgery

33.49

33.49

2411.28

2411.28

24357 00

Surgery

12.72

12.72

915.84

915.84

24358 00

Surgery

16.23

16.23

1168.56

1168.56

24359 00

Surgery

20.24

20.24

1457.28

1457.28

24360 00

Surgery

27.38

27.38

1971.36

1971.36

24361 00

Surgery

30.48

30.48

2194.56

2194.56

24362 00

Surgery

32.08

32.08

2309.76

2309.76

24363 00

Surgery

43.61

43.61

3139.92

3139.92

24365 00

Surgery

19.55

19.55

1407.60

1407.60

24366 00

Surgery

20.70

20.70

1490.40

1490.40

24370 00

Surgery

46.19

46.19

3325.68

3325.68

24371 00

Surgery

53.07

53.07

3821.04

3821.04

24400 00

Surgery

25.13

25.13

1809.36

1809.36

24410 00

Surgery

32.01

32.01

2304.72

2304.72

24420 00

Surgery

32.21

32.21

2319.12

2319.12

24430 00

Surgery

31.91

31.91

2297.52

2297.52

24435 00

Surgery

32.74

32.74

2357.28

2357.28

24470 00

Surgery

20.51

20.51

1476.72

1476.72

24495 00

Surgery

27.89

27.89

2008.08

2008.08

24498 00

Surgery

26.29

26.29

1892.88

1892.88

24500 00

Surgery

11.38

10.48

819.36

754.56

24505 00

Surgery

15.70

14.03

1130.40

1010.16

24515 00

Surgery

26.72

26.72

1923.84

1923.84

24516 00

Surgery

26.03

26.03

1874.16

1874.16

24530 00

Surgery

12.00

10.99

864.00

791.28

24535 00

Surgery

19.28

17.68

1388.16

1272.96

24538 00

Surgery

24.05

24.05

1731.60

1731.60

24545 00

Surgery

28.14

28.14

2026.08

2026.08

24546 00

Surgery

31.37

31.37

2258.64

2258.64

24560 00

Surgery

10.43

9.24

750.96

665.28

24565 00

Surgery

16.82

15.34

1211.04

1104.48

24566 00

Surgery

22.03

22.03

1586.16

1586.16

24575 00

Surgery

22.34

22.34

1608.48

1608.48

24576 00

Surgery

11.06

9.85

796.32

709.20

24577 00

Surgery

17.27

15.72

1243.44

1131.84

24579 00

Surgery

25.37

25.37

1826.64

1826.64

24582 00

Surgery

24.93

24.93

1794.96

1794.96

24586 00

Surgery

32.83

32.83

2363.76

2363.76

24587 00

Surgery

32.90

32.90

2368.80

2368.80

24600 00

Surgery

11.78

10.66

848.16

767.52

24605 00

Surgery

14.74

14.74

1061.28

1061.28

24615 00

Surgery

21.71

21.71

1563.12

1563.12

24620 00

Surgery

18.09

18.09

1302.48

1302.48

24635 00

Surgery

20.61

20.61

1483.92

1483.92

24640 00

Surgery

3.16

2.42

227.52

174.24

24650 00

Surgery

8.31

7.74

598.32

557.28

24655 00

Surgery

14.06

12.66

1012.32

911.52

24665 00

Surgery

20.08

20.08

1445.76

1445.76

24666 00

Surgery

22.29

22.29

1604.88

1604.88

24670 00

Surgery

9.19

8.40

661.68

604.80

24675 00

Surgery

14.33

12.97

1031.76

933.84

24685 00

Surgery

19.97

19.97

1437.84

1437.84

24800 00

Surgery

25.34

25.34

1824.48

1824.48

24802 00

Surgery

30.34

30.34

2184.48

2184.48

24900 00

Surgery

22.47

22.47

1617.84

1617.84

24920 00

Surgery

22.29

22.29

1604.88

1604.88

24925 00

Surgery

17.42

17.42

1254.24

1254.24

24930 00

Surgery

23.49

23.49

1691.28

1691.28

24931 00

Surgery

28.16

28.16

2027.52

2027.52

24935 00

Surgery

36.93

36.93

2658.96

2658.96

24940 00

Surgery

0.00

0.00

BR

BR

24999 00

Surgery

0.00

0.00

BR

BR

25000 00

Surgery

10.68

10.68

768.96

768.96

25001 00

Surgery

10.73

10.73

772.56

772.56

25020 00

Surgery

22.42

22.42

1614.24

1614.24

25023 00

Surgery

39.56

39.56

2848.32

2848.32

25024 00

Surgery

23.69

23.69

1705.68

1705.68

25025 00

Surgery

37.04

37.04

2666.88

2666.88

25028 00

Surgery

21.00

21.00

1512.00

1512.00

25031 00

Surgery

11.35

11.35

817.20

817.20

25035 00

Surgery

18.03

18.03

1298.16

1298.16

25040 00

Surgery

17.06

17.06

1228.32

1228.32

25065 00

Surgery

7.73

4.78

556.56

344.16

25066 00

Surgery

11.28

11.28

812.16

812.16

25071 00

Surgery

12.91

12.91

929.52

929.52

25073 00

Surgery

16.33

16.33

1175.76

1175.76

25075 00

Surgery

15.65

9.65

1126.80

694.80

25076 00

Surgery

15.84

15.84

1140.48

1140.48

25077 00

Surgery

25.96

25.96

1869.12

1869.12

25078 00

Surgery

35.16

35.16

2531.52

2531.52

25085 00

Surgery

13.78

13.78

992.16

992.16

25100 00

Surgery

10.79

10.79

776.88

776.88

25101 00

Surgery

12.50

12.50

900.00

900.00

25105 00

Surgery

14.95

14.95

1076.40

1076.40

25107 00

Surgery

18.92

18.92

1362.24

1362.24

25109 00

Surgery

16.41

16.41

1181.52

1181.52

25110 00

Surgery

10.66

10.66

767.52

767.52

25111 00

Surgery

10.04

10.04

722.88

722.88

25112 00

Surgery

12.04

12.04

866.88

866.88

25115 00

Surgery

23.06

23.06

1660.32

1660.32

25116 00

Surgery

18.51

18.51

1332.72

1332.72

25118 00

Surgery

11.80

11.80

849.60

849.60

25119 00

Surgery

15.41

15.41

1109.52

1109.52

25120 00

Surgery

15.39

15.39

1108.08

1108.08

25125 00

Surgery

18.23

18.23

1312.56

1312.56

25126 00

Surgery

18.36

18.36

1321.92

1321.92

25130 00

Surgery

13.87

13.87

998.64

998.64

25135 00

Surgery

17.22

17.22

1239.84

1239.84

25136 00

Surgery

15.28

15.28

1100.16

1100.16

25145 00

Surgery

15.99

15.99

1151.28

1151.28

25150 00

Surgery

17.33

17.33

1247.76

1247.76

25151 00

Surgery

17.86

17.86

1285.92

1285.92

25170 00

Surgery

44.14

44.14

3178.08

3178.08

25210 00

Surgery

15.14

15.14

1090.08

1090.08

25215 00

Surgery

18.93

18.93

1362.96

1362.96

25230 00

Surgery

13.31

13.31

958.32

958.32

25240 00

Surgery

13.23

13.23

952.56

952.56

25246 00

Surgery

5.84

2.16

420.48

155.52

25248 00

Surgery

13.02

13.02

937.44

937.44

25250 00

Surgery

16.36

16.36

1177.92

1177.92

25251 00

Surgery

21.92

21.92

1578.24

1578.24

25259 00

Surgery

13.36

13.36

961.92

961.92

25260 00

Surgery

19.40

19.40

1396.80

1396.80

25263 00

Surgery

19.40

19.40

1396.80

1396.80

25265 00

Surgery

22.96

22.96

1653.12

1653.12

25270 00

Surgery

15.16

15.16

1091.52

1091.52

25272 00

Surgery

17.15

17.15

1234.80

1234.80

25274 00

Surgery

20.27

20.27

1459.44

1459.44

25275 00

Surgery

20.51

20.51

1476.72

1476.72

25280 00

Surgery

17.32

17.32

1247.04

1247.04

25290 00

Surgery

13.40

13.40

964.80

964.80

25295 00

Surgery

16.14

16.14

1162.08

1162.08

25300 00

Surgery

21.07

21.07

1517.04

1517.04

25301 00

Surgery

19.65

19.65

1414.80

1414.80

25310 00

Surgery

18.99

18.99

1367.28

1367.28

25312 00

Surgery

21.84

21.84

1572.48

1572.48

25315 00

Surgery

23.41

23.41

1685.52

1685.52

25316 00

Surgery

27.79

27.79

2000.88

2000.88

25320 00

Surgery

30.13

30.13

2169.36

2169.36

25332 00

Surgery

25.67

25.67

1848.24

1848.24

25335 00

Surgery

28.61

28.61

2059.92

2059.92

25337 00

Surgery

27.02

27.02

1945.44

1945.44

25350 00

Surgery

20.56

20.56

1480.32

1480.32

25355 00

Surgery

23.28

23.28

1676.16

1676.16

25360 00

Surgery

20.03

20.03

1442.16

1442.16

25365 00

Surgery

27.81

27.81

2002.32

2002.32

25370 00

Surgery

30.67

30.67

2208.24

2208.24

25375 00

Surgery

28.89

28.89

2080.08

2080.08

25390 00

Surgery

23.36

23.36

1681.92

1681.92

25391 00

Surgery

30.14

30.14

2170.08

2170.08

25392 00

Surgery

30.66

30.66

2207.52

2207.52

25393 00

Surgery

34.10

34.10

2455.20

2455.20

25394 00

Surgery

23.86

23.86

1717.92

1717.92

25400 00

Surgery

24.35

24.35

1753.20

1753.20

25405 00

Surgery

31.34

31.34

2256.48

2256.48

25415 00

Surgery

29.31

29.31

2110.32

2110.32

25420 00

Surgery

35.22

35.22

2535.84

2535.84

25425 00

Surgery

29.18

29.18

2100.96

2100.96

25426 00

Surgery

33.91

33.91

2441.52

2441.52

25430 00

Surgery

22.32

22.32

1607.04

1607.04

25431 00

Surgery

23.96

23.96

1725.12

1725.12

25440 00

Surgery

23.37

23.37

1682.64

1682.64

25441 00

Surgery

28.43

28.43

2046.96

2046.96

25442 00

Surgery

24.58

24.58

1769.76

1769.76

25443 00

Surgery

23.91

23.91

1721.52

1721.52

25444 00

Surgery

24.98

24.98

1798.56

1798.56

25445 00

Surgery

21.93

21.93

1578.96

1578.96

25446 00

Surgery

35.39

35.39

2548.08

2548.08

25447 00

Surgery

25.32

25.32

1823.04

1823.04

25449 00

Surgery

31.23

31.23

2248.56

2248.56

25450 00

Surgery

18.89

18.89

1360.08

1360.08

25455 00

Surgery

22.27

22.27

1603.44

1603.44

25490 00

Surgery

21.91

21.91

1577.52

1577.52

25491 00

Surgery

22.51

22.51

1620.72

1620.72

25492 00

Surgery

27.51

27.51

1980.72

1980.72

25500 00

Surgery

8.96

8.11

645.12

583.92

25505 00

Surgery

15.84

14.33

1140.48

1031.76

25515 00

Surgery

20.49

20.49

1475.28

1475.28

25520 00

Surgery

17.87

16.84

1286.64

1212.48

25525 00

Surgery

24.08

24.08

1733.76

1733.76

25526 00

Surgery

29.05

29.05

2091.60

2091.60

25530 00

Surgery

8.34

7.65

600.48

550.80

25535 00

Surgery

15.40

14.20

1108.80

1022.40

25545 00

Surgery

19.12

19.12

1376.64

1376.64

25560 00

Surgery

9.13

8.15

657.36

586.80

25565 00

Surgery

16.14

14.41

1162.08

1037.52

25574 00

Surgery

20.62

20.62

1484.64

1484.64

25575 00

Surgery

27.48

27.48

1978.56

1978.56

25600 00

Surgery

10.64

10.18

766.08

732.96

25605 00

Surgery

16.77

15.82

1207.44

1139.04

25606 00

Surgery

20.48

20.48

1474.56

1474.56

25607 00

Surgery

22.60

22.60

1627.20

1627.20

25608 00

Surgery

25.23

25.23

1816.56

1816.56

25609 00

Surgery

31.95

31.95

2300.40

2300.40

25622 00

Surgery

9.67

8.92

696.24

642.24

25624 00

Surgery

15.32

13.86

1103.04

997.92

25628 00

Surgery

21.91

21.91

1577.52

1577.52

25630 00

Surgery

9.59

8.91

690.48

641.52

25635 00

Surgery

14.54

13.18

1046.88

948.96

25645 00

Surgery

17.49

17.49

1259.28

1259.28

25650 00

Surgery

10.34

9.58

744.48

689.76

25651 00

Surgery

15.11

15.11

1087.92

1087.92

25652 00

Surgery

19.06

19.06

1372.32

1372.32

25660 00

Surgery

13.93

13.93

1002.96

1002.96

25670 00

Surgery

18.56

18.56

1336.32

1336.32

25671 00

Surgery

16.46

16.46

1185.12

1185.12

25675 00

Surgery

14.25

12.85

1026.00

925.20

25676 00

Surgery

19.29

19.29

1388.88

1388.88

25680 00

Surgery

16.37

16.37

1178.64

1178.64

25685 00

Surgery

22.39

22.39

1612.08

1612.08

25690 00

Surgery

15.22

15.22

1095.84

1095.84

25695 00

Surgery

19.37

19.37

1394.64

1394.64

25800 00

Surgery

22.23

22.23

1600.56

1600.56

25805 00

Surgery

25.75

25.75

1854.00

1854.00

25810 00

Surgery

26.34

26.34

1896.48

1896.48

25820 00

Surgery

19.79

19.79

1424.88

1424.88

25825 00

Surgery

24.14

24.14

1738.08

1738.08

25830 00

Surgery

31.22

31.22

2247.84

2247.84

25900 00

Surgery

21.83

21.83

1571.76

1571.76

25905 00

Surgery

21.38

21.38

1539.36

1539.36

25907 00

Surgery

18.79

18.79

1352.88

1352.88

25909 00

Surgery

20.87

20.87

1502.64

1502.64

25915 00

Surgery

35.19

35.19

2533.68

2533.68

25920 00

Surgery

22.21

22.21

1599.12

1599.12

25922 00

Surgery

19.71

19.71

1419.12

1419.12

25924 00

Surgery

21.70

21.70

1562.40

1562.40

25927 00

Surgery

26.18

26.18

1884.96

1884.96

25929 00

Surgery

18.31

18.31

1318.32

1318.32

25931 00

Surgery

24.25

24.25

1746.00

1746.00

25999 00

Surgery

0.00

0.00

BR

BR

26010 00

Surgery

10.36

4.30

745.92

309.60

26011 00

Surgery

14.33

5.63

1031.76

405.36

26020 00

Surgery

17.01

17.01

1224.72

1224.72

26025 00

Surgery

12.84

12.84

924.48

924.48

26030 00

Surgery

15.04

15.04

1082.88

1082.88

26034 00

Surgery

16.88

16.88

1215.36

1215.36

26035 00

Surgery

26.20

26.20

1886.40

1886.40

26037 00

Surgery

17.13

17.13

1233.36

1233.36

26040 00

Surgery

9.76

9.76

702.72

702.72

26045 00

Surgery

14.51

14.51

1044.72

1044.72

26055 00

Surgery

17.81

8.98

1282.32

646.56

26060 00

Surgery

7.87

7.87

566.64

566.64

26070 00

Surgery

9.96

9.96

717.12

717.12

26075 00

Surgery

10.43

10.43

750.96

750.96

26080 00

Surgery

12.29

12.29

884.88

884.88

26100 00

Surgery

10.49

10.49

755.28

755.28

26105 00

Surgery

10.55

10.55

759.60

759.60

26110 00

Surgery

10.04

10.04

722.88

722.88

26111 00

Surgery

12.71

12.71

915.12

915.12

26113 00

Surgery

16.71

16.71

1203.12

1203.12

26115 00

Surgery

16.65

10.20

1198.80

734.40

26116 00

Surgery

16.05

16.05

1155.60

1155.60

26117 00

Surgery

22.61

22.61

1627.92

1627.92

26118 00

Surgery

31.71

31.71

2283.12

2283.12

26121 00

Surgery

18.33

18.33

1319.76

1319.76

26123 00

Surgery

25.54

25.54

1838.88

1838.88

26125 00

Surgery

8.00

8.00

576.00

576.00

26130 00

Surgery

14.43

14.43

1038.96

1038.96

26135 00

Surgery

16.94

16.94

1219.68

1219.68

26140 00

Surgery

15.59

15.59

1122.48

1122.48

26145 00

Surgery

15.82

15.82

1139.04

1139.04

26160 00

Surgery

18.60

9.74

1339.20

701.28

26170 00

Surgery

12.56

12.56

904.32

904.32

26180 00

Surgery

13.84

13.84

996.48

996.48

26185 00

Surgery

17.13

17.13

1233.36

1233.36

26200 00

Surgery

13.84

13.84

996.48

996.48

26205 00

Surgery

18.49

18.49

1331.28

1331.28

26210 00

Surgery

13.78

13.78

992.16

992.16

26215 00

Surgery

17.37

17.37

1250.64

1250.64

26230 00

Surgery

15.31

15.31

1102.32

1102.32

26235 00

Surgery

15.11

15.11

1087.92

1087.92

26236 00

Surgery

13.57

13.57

977.04

977.04

26250 00

Surgery

32.23

32.23

2320.56

2320.56

26260 00

Surgery

24.18

24.18

1740.96

1740.96

26262 00

Surgery

19.25

19.25

1386.00

1386.00

26320 00

Surgery

10.74

10.74

773.28

773.28

26340 00

Surgery

11.05

11.05

795.60

795.60

26341 00

Surgery

3.56

2.38

256.32

171.36

26350 00

Surgery

22.72

22.72

1635.84

1635.84

26352 00

Surgery

25.26

25.26

1818.72

1818.72

26356 00

Surgery

24.25

24.25

1746.00

1746.00

26357 00

Surgery

27.15

27.15

1954.80

1954.80

26358 00

Surgery

29.92

29.92

2154.24

2154.24

26370 00

Surgery

23.80

23.80

1713.60

1713.60

26372 00

Surgery

27.77

27.77

1999.44

1999.44

26373 00

Surgery

26.73

26.73

1924.56

1924.56

26390 00

Surgery

26.64

26.64

1918.08

1918.08

26392 00

Surgery

30.36

30.36

2185.92

2185.92

26410 00

Surgery

18.31

18.31

1318.32

1318.32

26412 00

Surgery

21.77

21.77

1567.44

1567.44

26415 00

Surgery

25.83

25.83

1859.76

1859.76

26416 00

Surgery

27.95

27.95

2012.40

2012.40

26418 00

Surgery

19.04

19.04

1370.88

1370.88

26420 00

Surgery

22.58

22.58

1625.76

1625.76

26426 00

Surgery

15.45

15.45

1112.40

1112.40

26428 00

Surgery

24.22

24.22

1743.84

1743.84

26432 00

Surgery

16.57

16.57

1193.04

1193.04

26433 00

Surgery

17.41

17.41

1253.52

1253.52

26434 00

Surgery

21.18

21.18

1524.96

1524.96

26437 00

Surgery

20.30

20.30

1461.60

1461.60

26440 00

Surgery

19.78

19.78

1424.16

1424.16

26442 00

Surgery

30.07

30.07

2165.04

2165.04

26445 00

Surgery

18.38

18.38

1323.36

1323.36

26449 00

Surgery

21.40

21.40

1540.80

1540.80

26450 00

Surgery

14.17

14.17

1020.24

1020.24

26455 00

Surgery

14.08

14.08

1013.76

1013.76

26460 00

Surgery

13.79

13.79

992.88

992.88

26471 00

Surgery

20.10

20.10

1447.20

1447.20

26474 00

Surgery

19.87

19.87

1430.64

1430.64

26476 00

Surgery

19.63

19.63

1413.36

1413.36

26477 00

Surgery

19.17

19.17

1380.24

1380.24

26478 00

Surgery

20.03

20.03

1442.16

1442.16

26479 00

Surgery

20.59

20.59

1482.48

1482.48

26480 00

Surgery

23.87

23.87

1718.64

1718.64

26483 00

Surgery

26.46

26.46

1905.12

1905.12

26485 00

Surgery

25.40

25.40

1828.80

1828.80

26489 00

Surgery

29.26

29.26

2106.72

2106.72

26490 00

Surgery

25.49

25.49

1835.28

1835.28

26492 00

Surgery

28.19

28.19

2029.68

2029.68

26494 00

Surgery

25.60

25.60

1843.20

1843.20

26496 00

Surgery

27.54

27.54

1982.88

1982.88

26497 00

Surgery

27.50

27.50

1980.00

1980.00

26498 00

Surgery

35.70

35.70

2570.40

2570.40

26499 00

Surgery

26.48

26.48

1906.56

1906.56

26500 00

Surgery

20.95

20.95

1508.40

1508.40

26502 00

Surgery

23.00

23.00

1656.00

1656.00

26508 00

Surgery

20.62

20.62

1484.64

1484.64

26510 00

Surgery

19.51

19.51

1404.72

1404.72

26516 00

Surgery

22.61

22.61

1627.92

1627.92

26517 00

Surgery

26.32

26.32

1895.04

1895.04

26518 00

Surgery

26.65

26.65

1918.80

1918.80

26520 00

Surgery

20.73

20.73

1492.56

1492.56

26525 00

Surgery

20.85

20.85

1501.20

1501.20

26530 00

Surgery

16.61

16.61

1195.92

1195.92

26531 00

Surgery

19.30

19.30

1389.60

1389.60

26535 00

Surgery

13.46

13.46

969.12

969.12

26536 00

Surgery

22.79

22.79

1640.88

1640.88

26540 00

Surgery

21.28

21.28

1532.16

1532.16

26541 00

Surgery

25.39

25.39

1828.08

1828.08

26542 00

Surgery

21.97

21.97

1581.84

1581.84

26545 00

Surgery

22.36

22.36

1609.92

1609.92

26546 00

Surgery

31.52

31.52

2269.44

2269.44

26548 00

Surgery

24.31

24.31

1750.32

1750.32

26550 00

Surgery

49.81

49.81

3586.32

3586.32

26551 00

Surgery

98.83

98.83

7115.76

7115.76

26553 00

Surgery

98.17

98.17

7068.24

7068.24

26554 00

Surgery

114.23

114.23

8224.56

8224.56

26555 00

Surgery

41.90

41.90

3016.80

3016.80

26556 00

Surgery

102.14

102.14

7354.08

7354.08

26560 00

Surgery

19.38

19.38

1395.36

1395.36

26561 00

Surgery

29.81

29.81

2146.32

2146.32

26562 00

Surgery

41.69

41.69

3001.68

3001.68

26565 00

Surgery

21.62

21.62

1556.64

1556.64

26567 00

Surgery

21.88

21.88

1575.36

1575.36

26568 00

Surgery

28.22

28.22

2031.84

2031.84

26580 00

Surgery

46.59

46.59

3354.48

3354.48

26587 00

Surgery

31.64

31.64

2278.08

2278.08

26590 00

Surgery

43.26

43.26

3114.72

3114.72

26591 00

Surgery

14.91

14.91

1073.52

1073.52

26593 00

Surgery

19.63

19.63

1413.36

1413.36

26596 00

Surgery

24.87

24.87

1790.64

1790.64

26600 00

Surgery

9.47

9.02

681.84

649.44

26605 00

Surgery

10.34

9.32

744.48

671.04

26607 00

Surgery

15.58

15.58

1121.76

1121.76

26608 00

Surgery

14.84

14.84

1068.48

1068.48

26615 00

Surgery

17.63

17.63

1269.36

1269.36

26641 00

Surgery

13.10

11.92

943.20

858.24

26645 00

Surgery

13.51

12.29

972.72

884.88

26650 00

Surgery

14.83

14.83

1067.76

1067.76

26665 00

Surgery

19.16

19.16

1379.52

1379.52

26670 00

Surgery

10.98

9.80

790.56

705.60

26675 00

Surgery

14.40

13.13

1036.80

945.36

26676 00

Surgery

15.71

15.71

1131.12

1131.12

26685 00

Surgery

17.65

17.65

1270.80

1270.80

26686 00

Surgery

19.02

19.02

1369.44

1369.44

26700 00

Surgery

10.64

9.80

766.08

705.60

26705 00

Surgery

13.65

12.35

982.80

889.20

26706 00

Surgery

13.78

13.78

992.16

992.16

26715 00

Surgery

17.57

17.57

1265.04

1265.04

26720 00

Surgery

6.35

5.97

457.20

429.84

26725 00

Surgery

10.71

9.53

771.12

686.16

26727 00

Surgery

14.63

14.63

1053.36

1053.36

26735 00

Surgery

18.22

18.22

1311.84

1311.84

26740 00

Surgery

7.34

6.94

528.48

499.68

26742 00

Surgery

11.65

10.44

838.80

751.68

26746 00

Surgery

22.59

22.59

1626.48

1626.48

26750 00

Surgery

5.93

6.00

426.96

432.00

26755 00

Surgery

10.01

8.57

720.72

617.04

26756 00

Surgery

13.10

13.10

943.20

943.20

26765 00

Surgery

15.48

15.48

1114.56

1114.56

26770 00

Surgery

9.08

8.25

653.76

594.00

26775 00

Surgery

12.36

11.09

889.92

798.48

26776 00

Surgery

13.87

13.87

998.64

998.64

26785 00

Surgery

16.79

16.79

1208.88

1208.88

26820 00

Surgery

25.23

25.23

1816.56

1816.56

26841 00

Surgery

23.59

23.59

1698.48

1698.48

26842 00

Surgery

25.30

25.30

1821.60

1821.60

26843 00

Surgery

23.80

23.80

1713.60

1713.60

26844 00

Surgery

26.15

26.15

1882.80

1882.80

26850 00

Surgery

22.34

22.34

1608.48

1608.48

26852 00

Surgery

25.35

25.35

1825.20

1825.20

26860 00

Surgery

18.67

18.67

1344.24

1344.24

26861 00

Surgery

3.03

3.03

218.16

218.16

26862 00

Surgery

23.34

23.34

1680.48

1680.48

26863 00

Surgery

6.76

6.76

486.72

486.72

26910 00

Surgery

23.15

23.15

1666.80

1666.80

26951 00

Surgery

21.40

21.40

1540.80

1540.80

26952 00

Surgery

20.81

20.81

1498.32

1498.32

26989 00

Surgery

0.00

0.00

BR

BR

26990 00

Surgery

20.68

20.68

1488.96

1488.96

26991 00

Surgery

21.45

16.06

1544.40

1156.32

26992 00

Surgery

30.59

30.59

2202.48

2202.48

27000 00

Surgery

11.87

11.87

854.64

854.64

27001 00

Surgery

16.47

16.47

1185.84

1185.84

27003 00

Surgery

18.31

18.31

1318.32

1318.32

27005 00

Surgery

21.88

21.88

1575.36

1575.36

27006 00

Surgery

21.69

21.69

1561.68

1561.68

27025 00

Surgery

28.12

28.12

2024.64

2024.64

27027 00

Surgery

26.78

26.78

1928.16

1928.16

27030 00

Surgery

28.30

28.30

2037.60

2037.60

27033 00

Surgery

29.36

29.36

2113.92

2113.92

27035 00

Surgery

33.90

33.90

2440.80

2440.80

27036 00

Surgery

30.82

30.82

2219.04

2219.04

27040 00

Surgery

10.20

5.99

734.40

431.28

27041 00

Surgery

21.46

21.46

1545.12

1545.12

27043 00

Surgery

14.23

14.23

1024.56

1024.56

27045 00

Surgery

22.16

22.16

1595.52

1595.52

27047 00

Surgery

15.00

11.01

1080.00

792.72

27048 00

Surgery

18.57

18.57

1337.04

1337.04

27049 00

Surgery

42.88

42.88

3087.36

3087.36

27050 00

Surgery

12.48

12.48

898.56

898.56

27052 00

Surgery

17.71

17.71

1275.12

1275.12

27054 00

Surgery

20.96

20.96

1509.12

1509.12

27057 00

Surgery

30.42

30.42

2190.24

2190.24

27059 00

Surgery

54.36

54.36

3913.92

3913.92

27060 00

Surgery

14.30

14.30

1029.60

1029.60

27062 00

Surgery

13.90

13.90

1000.80

1000.80

27065 00

Surgery

15.99

15.99

1151.28

1151.28

27066 00

Surgery

24.76

24.76

1782.72

1782.72

27067 00

Surgery

31.34

31.34

2256.48

2256.48

27070 00

Surgery

26.77

26.77

1927.44

1927.44

27071 00

Surgery

29.42

29.42

2118.24

2118.24

27075 00

Surgery

62.38

62.38

4491.36

4491.36

27076 00

Surgery

75.30

75.30

5421.60

5421.60

27077 00

Surgery

83.94

83.94

6043.68

6043.68

27078 00

Surgery

61.52

61.52

4429.44

4429.44

27080 00

Surgery

15.48

15.48

1114.56

1114.56

27086 00

Surgery

9.40

5.15

676.80

370.80

27087 00

Surgery

18.68

18.68

1344.96

1344.96

27090 00

Surgery

25.13

25.13

1809.36

1809.36

27091 00

Surgery

47.84

47.84

3444.48

3444.48

27093 00

Surgery

6.90

2.01

496.80

144.72

27095 00

Surgery

9.16

2.43

659.52

174.96

27096 00

Surgery

4.93

2.47

354.96

177.84

27097 00

Surgery

20.80

20.80

1497.60

1497.60

27098 00

Surgery

21.18

21.18

1524.96

1524.96

27100 00

Surgery

25.23

25.23

1816.56

1816.56

27105 00

Surgery

26.42

26.42

1902.24

1902.24

27110 00

Surgery

29.39

29.39

2116.08

2116.08

27111 00

Surgery

27.39

27.39

1972.08

1972.08

27120 00

Surgery

39.13

39.13

2817.36

2817.36

27122 00

Surgery

33.31

33.31

2398.32

2398.32

27125 00

Surgery

34.13

34.13

2457.36

2457.36

27130 00

Surgery

38.63

38.63

2781.36

2781.36

27132 00

Surgery

50.16

50.16

3611.52

3611.52

27134 00

Surgery

57.04

57.04

4106.88

4106.88

27137 00

Surgery

43.99

43.99

3167.28

3167.28

27138 00

Surgery

45.68

45.68

3288.96

3288.96

27140 00

Surgery

27.16

27.16

1955.52

1955.52

27146 00

Surgery

38.55

38.55

2775.60

2775.60

27147 00

Surgery

44.00

44.00

3168.00

3168.00

27151 00

Surgery

47.51

47.51

3420.72

3420.72

27156 00

Surgery

51.16

51.16

3683.52

3683.52

27158 00

Surgery

42.10

42.10

3031.20

3031.20

27161 00

Surgery

36.80

36.80

2649.60

2649.60

27165 00

Surgery

41.32

41.32

2975.04

2975.04

27170 00

Surgery

35.23

35.23

2536.56

2536.56

27175 00

Surgery

20.26

20.26

1458.72

1458.72

27176 00

Surgery

27.94

27.94

2011.68

2011.68

27177 00

Surgery

33.71

33.71

2427.12

2427.12

27178 00

Surgery

27.94

27.94

2011.68

2011.68

27179 00

Surgery

29.60

29.60

2131.20

2131.20

27181 00

Surgery

33.85

33.85

2437.20

2437.20

27185 00

Surgery

21.87

21.87

1574.64

1574.64

27187 00

Surgery

30.13

30.13

2169.36

2169.36

27197 00

Surgery

4.04

4.04

290.88

290.88

27198 00

Surgery

9.50

9.50

684.00

684.00

27200 00

Surgery

5.91

5.98

425.52

430.56

27202 00

Surgery

16.07

16.07

1157.04

1157.04

27215 00

Surgery

18.18

18.18

1308.96

1308.96

27216 00

Surgery

26.84

26.84

1932.48

1932.48

27217 00

Surgery

25.24

25.24

1817.28

1817.28

27218 00

Surgery

34.59

34.59

2490.48

2490.48

27220 00

Surgery

12.80

12.63

921.60

909.36

27222 00

Surgery

29.64

29.64

2134.08

2134.08

27226 00

Surgery

31.94

31.94

2299.68

2299.68

27227 00

Surgery

49.58

49.58

3569.76

3569.76

27228 00

Surgery

56.31

56.31

4054.32

4054.32

27230 00

Surgery

15.01

14.73

1080.72

1060.56

27232 00

Surgery

21.96

21.96

1581.12

1581.12

27235 00

Surgery

27.43

27.43

1974.96

1974.96

27236 00

Surgery

35.99

35.99

2591.28

2591.28

27238 00

Surgery

14.39

14.39

1036.08

1036.08

27240 00

Surgery

28.82

28.82

2075.04

2075.04

27244 00

Surgery

37.00

37.00

2664.00

2664.00

27245 00

Surgery

36.95

36.95

2660.40

2660.40

27246 00

Surgery

12.04

11.92

866.88

858.24

27248 00

Surgery

22.54

22.54

1622.88

1622.88

27250 00

Surgery

5.37

5.37

386.64

386.64

27252 00

Surgery

22.70

22.70

1634.40

1634.40

27253 00

Surgery

28.40

28.40

2044.80

2044.80

27254 00

Surgery

38.31

38.31

2758.32

2758.32

27256 00

Surgery

9.62

7.27

692.64

523.44

27257 00

Surgery

10.92

10.92

786.24

786.24

27258 00

Surgery

33.57

33.57

2417.04

2417.04

27259 00

Surgery

46.41

46.41

3341.52

3341.52

27265 00

Surgery

12.90

12.90

928.80

928.80

27266 00

Surgery

17.79

17.79

1280.88

1280.88

27267 00

Surgery

13.61

13.61

979.92

979.92

27268 00

Surgery

16.66

16.66

1199.52

1199.52

27269 00

Surgery

37.30

37.30

2685.60

2685.60

27275 00

Surgery

5.61

5.61

403.92

403.92

27278 00

Surgery

BR

BR

BR

BR

27279 00

Surgery

24.16

24.16

1739.52

1739.52

27280 00

Surgery

41.14

41.14

2962.08

2962.08

27282 00

Surgery

26.09

26.09

1878.48

1878.48

27284 00

Surgery

48.11

48.11

3463.92

3463.92

27286 00

Surgery

49.33

49.33

3551.76

3551.76

27290 00

Surgery

48.82

48.82

3515.04

3515.04

27295 00

Surgery

37.94

37.94

2731.68

2731.68

27299 00

Surgery

0.00

0.00

BR

BR

27301 00

Surgery

20.42

15.49

1470.24

1115.28

27303 00

Surgery

19.53

19.53

1406.16

1406.16

27305 00

Surgery

14.78

14.78

1064.16

1064.16

27306 00

Surgery

10.48

10.48

754.56

754.56

27307 00

Surgery

12.43

12.43

894.96

894.96

27310 00

Surgery

22.29

22.29

1604.88

1604.88

27323 00

Surgery

8.28

5.29

596.16

380.88

27324 00

Surgery

12.55

12.55

903.60

903.60

27325 00

Surgery

17.27

17.27

1243.44

1243.44

27326 00

Surgery

16.01

16.01

1152.72

1152.72

27327 00

Surgery

15.13

9.62

1089.36

692.64

27328 00

Surgery

18.94

18.94

1363.68

1363.68

27329 00

Surgery

31.38

31.38

2259.36

2259.36

27330 00

Surgery

13.00

13.00

936.00

936.00

27331 00

Surgery

14.62

14.62

1052.64

1052.64

27332 00

Surgery

19.71

19.71

1419.12

1419.12

27333 00

Surgery

18.03

18.03

1298.16

1298.16

27334 00

Surgery

20.92

20.92

1506.24

1506.24

27335 00

Surgery

23.30

23.30

1677.60

1677.60

27337 00

Surgery

12.74

12.74

917.28

917.28

27339 00

Surgery

22.87

22.87

1646.64

1646.64

27340 00

Surgery

11.55

11.55

831.60

831.60

27345 00

Surgery

14.90

14.90

1072.80

1072.80

27347 00

Surgery

16.14

16.14

1162.08

1162.08

27350 00

Surgery

19.96

19.96

1437.12

1437.12

27355 00

Surgery

18.55

18.55

1335.60

1335.60

27356 00

Surgery

22.53

22.53

1622.16

1622.16

27357 00

Surgery

24.86

24.86

1789.92

1789.92

27358 00

Surgery

8.15

8.15

586.80

586.80

27360 00

Surgery

27.38

27.38

1971.36

1971.36

27364 00

Surgery

46.97

46.97

3381.84

3381.84

27365 00

Surgery

61.50

61.50

4428.00

4428.00

27369 00

Surgery

5.49

1.19

395.28

85.68

27372 00

Surgery

17.73

12.19

1276.56

877.68

27380 00

Surgery

18.99

18.99

1367.28

1367.28

27381 00

Surgery

24.91

24.91

1793.52

1793.52

27385 00

Surgery

18.53

18.53

1334.16

1334.16

27386 00

Surgery

26.00

26.00

1872.00

1872.00

27390 00

Surgery

13.84

13.84

996.48

996.48

27391 00

Surgery

17.70

17.70

1274.40

1274.40

27392 00

Surgery

21.74

21.74

1565.28

1565.28

27393 00

Surgery

15.33

15.33

1103.76

1103.76

27394 00

Surgery

19.98

19.98

1438.56

1438.56

27395 00

Surgery

26.78

26.78

1928.16

1928.16

27396 00

Surgery

18.88

18.88

1359.36

1359.36

27397 00

Surgery

27.78

27.78

2000.16

2000.16

27400 00

Surgery

21.20

21.20

1526.40

1526.40

27403 00

Surgery

19.69

19.69

1417.68

1417.68

27405 00

Surgery

20.61

20.61

1483.92

1483.92

27407 00

Surgery

24.23

24.23

1744.56

1744.56

27409 00

Surgery

29.28

29.28

2108.16

2108.16

27412 00

Surgery

49.57

49.57

3569.04

3569.04

27415 00

Surgery

41.40

41.40

2980.80

2980.80

27416 00

Surgery

29.65

29.65

2134.80

2134.80

27418 00

Surgery

24.93

24.93

1794.96

1794.96

27420 00

Surgery

22.82

22.82

1643.04

1643.04

27422 00

Surgery

22.56

22.56

1624.32

1624.32

27424 00

Surgery

22.78

22.78

1640.16

1640.16

27425 00

Surgery

13.96

13.96

1005.12

1005.12

27427 00

Surgery

21.55

21.55

1551.60

1551.60

27428 00

Surgery

33.84

33.84

2436.48

2436.48

27429 00

Surgery

38.14

38.14

2746.08

2746.08

27430 00

Surgery

22.59

22.59

1626.48

1626.48

27435 00

Surgery

24.54

24.54

1766.88

1766.88

27437 00

Surgery

20.16

20.16

1451.52

1451.52

27438 00

Surgery

25.50

25.50

1836.00

1836.00

27440 00

Surgery

24.23

24.23

1744.56

1744.56

27441 00

Surgery

25.00

25.00

1800.00

1800.00

27442 00

Surgery

26.32

26.32

1895.04

1895.04

27443 00

Surgery

24.79

24.79

1784.88

1784.88

27445 00

Surgery

37.79

37.79

2720.88

2720.88

27446 00

Surgery

34.59

34.59

2490.48

2490.48

27447 00

Surgery

38.57

38.57

2777.04

2777.04

27448 00

Surgery

25.12

25.12

1808.64

1808.64

27450 00

Surgery

30.51

30.51

2196.72

2196.72

27454 00

Surgery

38.99

38.99

2807.28

2807.28

27455 00

Surgery

29.08

29.08

2093.76

2093.76

27457 00

Surgery

28.53

28.53

2054.16

2054.16

27465 00

Surgery

37.59

37.59

2706.48

2706.48

27466 00

Surgery

35.76

35.76

2574.72

2574.72

27468 00

Surgery

40.38

40.38

2907.36

2907.36

27470 00

Surgery

35.66

35.66

2567.52

2567.52

27472 00

Surgery

38.13

38.13

2745.36

2745.36

27475 00

Surgery

20.22

20.22

1455.84

1455.84

27477 00

Surgery

22.31

22.31

1606.32

1606.32

27479 00

Surgery

27.81

27.81

2002.32

2002.32

27485 00

Surgery

20.46

20.46

1473.12

1473.12

27486 00

Surgery

42.25

42.25

3042.00

3042.00

27487 00

Surgery

52.61

52.61

3787.92

3787.92

27488 00

Surgery

36.21

36.21

2607.12

2607.12

27495 00

Surgery

34.10

34.10

2455.20

2455.20

27496 00

Surgery

16.82

16.82

1211.04

1211.04

27497 00

Surgery

17.73

17.73

1276.56

1276.56

27498 00

Surgery

20.05

20.05

1443.60

1443.60

27499 00

Surgery

21.39

21.39

1540.08

1540.08

27500 00

Surgery

16.07

14.74

1157.04

1061.28

27501 00

Surgery

15.48

15.25

1114.56

1098.00

27502 00

Surgery

22.85

22.85

1645.20

1645.20

27503 00

Surgery

24.27

24.27

1747.44

1747.44

27506 00

Surgery

40.34

40.34

2904.48

2904.48

27507 00

Surgery

29.17

29.17

2100.24

2100.24

27508 00

Surgery

16.20

15.33

1166.40

1103.76

27509 00

Surgery

20.57

20.57

1481.04

1481.04

27510 00

Surgery

20.76

20.76

1494.72

1494.72

27511 00

Surgery

29.99

29.99

2159.28

2159.28

27513 00

Surgery

37.09

37.09

2670.48

2670.48

27514 00

Surgery

29.08

29.08

2093.76

2093.76

27516 00

Surgery

16.06

15.01

1156.32

1080.72

27517 00

Surgery

21.06

21.06

1516.32

1516.32

27519 00

Surgery

26.85

26.85

1933.20

1933.20

27520 00

Surgery

10.21

9.42

735.12

678.24

27524 00

Surgery

22.89

22.89

1648.08

1648.08

27530 00

Surgery

9.65

9.06

694.80

652.32

27532 00

Surgery

19.08

17.78

1373.76

1280.16

27535 00

Surgery

27.04

27.04

1946.88

1946.88

27536 00

Surgery

35.84

35.84

2580.48

2580.48

27538 00

Surgery

14.99

13.93

1079.28

1002.96

27540 00

Surgery

24.69

24.69

1777.68

1777.68

27550 00

Surgery

15.82

14.51

1139.04

1044.72

27552 00

Surgery

19.41

19.41

1397.52

1397.52

27556 00

Surgery

26.43

26.43

1902.96

1902.96

27557 00

Surgery

31.43

31.43

2262.96

2262.96

27558 00

Surgery

35.71

35.71

2571.12

2571.12

27560 00

Surgery

11.67

10.64

840.24

766.08

27562 00

Surgery

15.10

15.10

1087.20

1087.20

27566 00

Surgery

27.06

27.06

1948.32

1948.32

27570 00

Surgery

4.70

4.70

338.40

338.40

27580 00

Surgery

44.50

44.50

3204.00

3204.00

27590 00

Surgery

23.44

23.44

1687.68

1687.68

27591 00

Surgery

29.14

29.14

2098.08

2098.08

27592 00

Surgery

20.07

20.07

1445.04

1445.04

27594 00

Surgery

15.22

15.22

1095.84

1095.84

27596 00

Surgery

21.33

21.33

1535.76

1535.76

27598 00

Surgery

20.79

20.79

1496.88

1496.88

27599 00

Surgery

0.00

0.00

BR

BR

27600 00

Surgery

12.06

12.06

868.32

868.32

27601 00

Surgery

13.41

13.41

965.52

965.52

27602 00

Surgery

14.28

14.28

1028.16

1028.16

27603 00

Surgery

15.84

11.82

1140.48

851.04

27604 00

Surgery

13.57

9.80

977.04

705.60

27605 00

Surgery

9.89

5.52

712.08

397.44

27606 00

Surgery

8.14

8.14

586.08

586.08

27607 00

Surgery

18.16

18.16

1307.52

1307.52

27610 00

Surgery

19.58

19.58

1409.76

1409.76

27612 00

Surgery

17.37

17.37

1250.64

1250.64

27613 00

Surgery

7.66

4.89

551.52

352.08

27614 00

Surgery

17.81

12.63

1282.32

909.36

27615 00

Surgery

30.54

30.54

2198.88

2198.88

27616 00

Surgery

37.89

37.89

2728.08

2728.08

27618 00

Surgery

14.69

9.32

1057.68

671.04

27619 00

Surgery

14.29

14.29

1028.88

1028.88

27620 00

Surgery

13.64

13.64

982.08

982.08

27625 00

Surgery

17.38

17.38

1251.36

1251.36

27626 00

Surgery

18.79

18.79

1352.88

1352.88

27630 00

Surgery

16.26

10.88

1170.72

783.36

27632 00

Surgery

12.39

12.39

892.08

892.08

27634 00

Surgery

20.34

20.34

1464.48

1464.48

27635 00

Surgery

17.61

17.61

1267.92

1267.92

27637 00

Surgery

22.68

22.68

1632.96

1632.96

27638 00

Surgery

22.49

22.49

1619.28

1619.28

27640 00

Surgery

25.16

25.16

1811.52

1811.52

27641 00

Surgery

19.76

19.76

1422.72

1422.72

27645 00

Surgery

53.03

53.03

3818.16

3818.16

27646 00

Surgery

46.12

46.12

3320.64

3320.64

27647 00

Surgery

29.78

29.78

2144.16

2144.16

27648 00

Surgery

6.33

1.53

455.76

110.16

27650 00

Surgery

19.94

19.94

1435.68

1435.68

27652 00

Surgery

20.32

20.32

1463.04

1463.04

27654 00

Surgery

21.69

21.69

1561.68

1561.68

27656 00

Surgery

15.91

10.39

1145.52

748.08

27658 00

Surgery

11.24

11.24

809.28

809.28

27659 00

Surgery

14.35

14.35

1033.20

1033.20

27664 00

Surgery

11.04

11.04

794.88

794.88

27665 00

Surgery

12.92

12.92

930.24

930.24

27675 00

Surgery

15.05

15.05

1083.60

1083.60

27676 00

Surgery

18.50

18.50

1332.00

1332.00

27680 00

Surgery

12.80

12.80

921.60

921.60

27681 00

Surgery

15.44

15.44

1111.68

1111.68

27685 00

Surgery

19.83

14.17

1427.76

1020.24

27686 00

Surgery

16.16

16.16

1163.52

1163.52

27687 00

Surgery

13.81

13.81

994.32

994.32

27690 00

Surgery

19.34

19.34

1392.48

1392.48

27691 00

Surgery

22.52

22.52

1621.44

1621.44

27692 00

Surgery

3.03

3.03

218.16

218.16

27695 00

Surgery

14.79

14.79

1064.88

1064.88

27696 00

Surgery

16.61

16.61

1195.92

1195.92

27698 00

Surgery

19.31

19.31

1390.32

1390.32

27700 00

Surgery

21.65

21.65

1558.80

1558.80

27702 00

Surgery

29.04

29.04

2090.88

2090.88

27703 00

Surgery

33.47

33.47

2409.84

2409.84

27704 00

Surgery

17.22

17.22

1239.84

1239.84

27705 00

Surgery

22.70

22.70

1634.40

1634.40

27707 00

Surgery

12.40

12.40

892.80

892.80

27709 00

Surgery

34.53

34.53

2486.16

2486.16

27712 00

Surgery

33.32

33.32

2399.04

2399.04

27715 00

Surgery

32.41

32.41

2333.52

2333.52

27720 00

Surgery

26.42

26.42

1902.24

1902.24

27722 00

Surgery

27.14

27.14

1954.08

1954.08

27724 00

Surgery

37.74

37.74

2717.28

2717.28

27725 00

Surgery

36.75

36.75

2646.00

2646.00

27726 00

Surgery

28.85

28.85

2077.20

2077.20

27727 00

Surgery

31.42

31.42

2262.24

2262.24

27730 00

Surgery

17.98

17.98

1294.56

1294.56

27732 00

Surgery

13.94

13.94

1003.68

1003.68

27734 00

Surgery

20.06

20.06

1444.32

1444.32

27740 00

Surgery

21.57

21.57

1553.04

1553.04

27742 00

Surgery

23.65

23.65

1702.80

1702.80

27745 00

Surgery

22.61

22.61

1627.92

1627.92

27750 00

Surgery

10.88

10.10

783.36

727.20

27752 00

Surgery

16.55

15.10

1191.60

1087.20

27756 00

Surgery

17.65

17.65

1270.80

1270.80

27758 00

Surgery

27.17

27.17

1956.24

1956.24

27759 00

Surgery

30.13

30.13

2169.36

2169.36

27760 00

Surgery

10.43

9.62

750.96

692.64

27762 00

Surgery

15.17

13.66

1092.24

983.52

27766 00

Surgery

18.42

18.42

1326.24

1326.24

27767 00

Surgery

9.07

9.06

653.04

652.32

27768 00

Surgery

13.88

13.88

999.36

999.36

27769 00

Surgery

22.05

22.05

1587.60

1587.60

27780 00

Surgery

9.69

8.92

697.68

642.24

27781 00

Surgery

13.64

12.54

982.08

902.88

27784 00

Surgery

21.76

21.76

1566.72

1566.72

27786 00

Surgery

9.80

8.97

705.60

645.84

27788 00

Surgery

13.24

11.95

953.28

860.40

27792 00

Surgery

19.62

19.62

1412.64

1412.64

27808 00

Surgery

10.52

9.57

757.44

689.04

27810 00

Surgery

14.76

13.27

1062.72

955.44

27814 00

Surgery

23.19

23.19

1669.68

1669.68

27816 00

Surgery

10.38

9.21

747.36

663.12

27818 00

Surgery

15.31

13.63

1102.32

981.36

27822 00

Surgery

26.48

26.48

1906.56

1906.56

27823 00

Surgery

29.81

29.81

2146.32

2146.32

27824 00

Surgery

9.85

9.51

709.20

684.72

27825 00

Surgery

16.82

15.13

1211.04

1089.36

27826 00

Surgery

25.88

25.88

1863.36

1863.36

27827 00

Surgery

33.89

33.89

2440.08

2440.08

27828 00

Surgery

40.05

40.05

2883.60

2883.60

27829 00

Surgery

21.48

21.48

1546.56

1546.56

27830 00

Surgery

12.15

11.21

874.80

807.12

27831 00

Surgery

12.65

12.65

910.80

910.80

27832 00

Surgery

23.08

23.08

1661.76

1661.76

27840 00

Surgery

12.00

12.00

864.00

864.00

27842 00

Surgery

15.11

15.11

1087.92

1087.92

27846 00

Surgery

22.08

22.08

1589.76

1589.76

27848 00

Surgery

23.90

23.90

1720.80

1720.80

27860 00

Surgery

4.95

4.95

356.40

356.40

27870 00

Surgery

30.43

30.43

2190.96

2190.96

27871 00

Surgery

20.98

20.98

1510.56

1510.56

27880 00

Surgery

26.84

26.84

1932.48

1932.48

27881 00

Surgery

25.21

25.21

1815.12

1815.12

27882 00

Surgery

17.70

17.70

1274.40

1274.40

27884 00

Surgery

17.39

17.39

1252.08

1252.08

27886 00

Surgery

19.47

19.47

1401.84

1401.84

27888 00

Surgery

17.12

17.12

1232.64

1232.64

27889 00

Surgery

19.18

19.18

1380.96

1380.96

27892 00

Surgery

16.21

16.21

1167.12

1167.12

27893 00

Surgery

18.75

18.75

1350.00

1350.00

27894 00

Surgery

24.51

24.51

1764.72

1764.72

27899 00

Surgery

0.00

0.00

BR

BR

28001 00

Surgery

5.13

2.86

369.36

205.92

28002 00

Surgery

7.36

4.19

529.92

301.68

28003 00

Surgery

11.31

7.71

814.32

555.12

28005 00

Surgery

17.23

17.23

1240.56

1240.56

28008 00

Surgery

12.83

8.91

923.76

641.52

28010 00

Surgery

7.09

6.32

510.48

455.04

28011 00

Surgery

9.55

8.47

687.60

609.84

28020 00

Surgery

16.29

11.08

1172.88

797.76

28022 00

Surgery

14.63

9.93

1053.36

714.96

28024 00

Surgery

13.88

9.35

999.36

673.20

28035 00

Surgery

15.87

10.87

1142.64

782.64

28039 00

Surgery

14.33

10.23

1031.76

736.56

28041 00

Surgery

13.63

13.63

981.36

981.36

28043 00

Surgery

11.51

7.91

828.72

569.52

28045 00

Surgery

14.42

10.50

1038.24

756.00

28046 00

Surgery

21.04

21.04

1514.88

1514.88

28047 00

Surgery

31.12

31.12

2240.64

2240.64

28050 00

Surgery

12.48

8.45

898.56

608.40

28052 00

Surgery

11.69

7.75

841.68

558.00

28054 00

Surgery

10.99

7.09

791.28

510.48

28055 00

Surgery

11.77

11.77

847.44

847.44

28060 00

Surgery

15.57

10.92

1121.04

786.24

28062 00

Surgery

17.33

12.22

1247.76

879.84

28070 00

Surgery

15.23

10.38

1096.56

747.36

28072 00

Surgery

14.75

9.87

1062.00

710.64

28080 00

Surgery

16.04

11.50

1154.88

828.00

28086 00

Surgery

15.75

10.62

1134.00

764.64

28088 00

Surgery

13.95

8.93

1004.40

642.96

28090 00

Surgery

14.00

9.36

1008.00

673.92

28092 00

Surgery

12.71

8.28

915.12

596.16

28100 00

Surgery

18.40

12.67

1324.80

912.24

28102 00

Surgery

18.65

18.65

1342.80

1342.80

28103 00

Surgery

11.69

11.69

841.68

841.68

28104 00

Surgery

15.78

10.75

1136.16

774.00

28106 00

Surgery

12.85

12.85

925.20

925.20

28107 00

Surgery

15.21

10.46

1095.12

753.12

28108 00

Surgery

13.03

8.75

938.16

630.00

28110 00

Surgery

13.90

8.91

1000.80

641.52

28111 00

Surgery

14.25

9.64

1026.00

694.08

28112 00

Surgery

14.47

9.49

1041.84

683.28

28113 00

Surgery

17.56

12.93

1264.32

930.96

28114 00

Surgery

32.06

25.31

2308.32

1822.32

28116 00

Surgery

23.12

17.60

1664.64

1267.20

28118 00

Surgery

18.20

12.82

1310.40

923.04

28119 00

Surgery

15.81

11.05

1138.32

795.60

28120 00

Surgery

20.15

15.01

1450.80

1080.72

28122 00

Surgery

17.80

13.30

1281.60

957.60

28124 00

Surgery

14.34

10.14

1032.48

730.08

28126 00

Surgery

11.76

7.61

846.72

547.92

28130 00

Surgery

18.71

18.71

1347.12

1347.12

28140 00

Surgery

17.06

12.84

1228.32

924.48

28150 00

Surgery

12.57

8.47

905.04

609.84

28153 00

Surgery

12.15

8.01

874.80

576.72

28160 00

Surgery

12.26

8.10

882.72

583.20

28171 00

Surgery

33.38

33.38

2403.36

2403.36

28173 00

Surgery

21.75

21.75

1566.00

1566.00

28175 00

Surgery

14.14

14.14

1018.08

1018.08

28190 00

Surgery

7.22

4.00

519.84

288.00

28192 00

Surgery

13.76

9.38

990.72

675.36

28193 00

Surgery

15.61

11.04

1123.92

794.88

28200 00

Surgery

14.84

9.91

1068.48

713.52

28202 00

Surgery

17.92

12.94

1290.24

931.68

28208 00

Surgery

14.57

9.75

1049.04

702.00

28210 00

Surgery

17.83

12.84

1283.76

924.48

28220 00

Surgery

13.54

9.26

974.88

666.72

28222 00

Surgery

16.16

11.22

1163.52

807.84

28225 00

Surgery

12.41

8.04

893.52

578.88

28226 00

Surgery

18.62

12.22

1340.64

879.84

28230 00

Surgery

12.97

8.63

933.84

621.36

28232 00

Surgery

11.32

7.32

815.04

527.04

28234 00

Surgery

12.32

8.20

887.04

590.40

28238 00

Surgery

20.17

14.79

1452.24

1064.88

28240 00

Surgery

13.30

8.90

957.60

640.80

28250 00

Surgery

17.70

12.50

1274.40

900.00

28260 00

Surgery

21.95

16.37

1580.40

1178.64

28261 00

Surgery

32.29

25.47

2324.88

1833.84

28262 00

Surgery

41.32

33.39

2975.04

2404.08

28264 00

Surgery

26.18

20.24

1884.96

1457.28

28270 00

Surgery

14.61

10.13

1051.92

729.36

28272 00

Surgery

11.48

7.61

826.56

547.92

28280 00

Surgery

15.16

10.44

1091.52

751.68

28285 00

Surgery

16.23

11.73

1168.56

844.56

28286 00

Surgery

13.30

9.02

957.60

649.44

28288 00

Surgery

18.15

13.21

1306.80

951.12

28289 00

Surgery

20.68

13.98

1488.96

1006.56

28291 00

Surgery

20.67

14.52

1488.24

1045.44

28292 00

Surgery

21.02

14.72

1513.44

1059.84

28295 00

Surgery

31.44

18.23

2263.68

1312.56

28296 00

Surgery

26.52

15.53

1909.44

1118.16

28297 00

Surgery

30.67

18.19

2208.24

1309.68

28298 00

Surgery

25.08

15.38

1805.76

1107.36

28299 00

Surgery

30.37

18.01

2186.64

1296.72

28300 00

Surgery

19.70

19.70

1418.40

1418.40

28302 00

Surgery

21.78

21.78

1568.16

1568.16

28304 00

Surgery

24.92

18.58

1794.24

1337.76

28305 00

Surgery

20.40

20.40

1468.80

1468.80

28306 00

Surgery

18.36

12.36

1321.92

889.92

28307 00

Surgery

23.66

15.79

1703.52

1136.88

28308 00

Surgery

17.19

11.78

1237.68

848.16

28309 00

Surgery

27.34

27.34

1968.48

1968.48

28310 00

Surgery

16.43

11.03

1182.96

794.16

28312 00

Surgery

16.37

10.48

1178.64

754.56

28313 00

Surgery

15.89

10.98

1144.08

790.56

28315 00

Surgery

14.35

9.87

1033.20

710.64

28320 00

Surgery

18.68

18.68

1344.96

1344.96

28322 00

Surgery

23.69

17.53

1705.68

1262.16

28340 00

Surgery

17.02

12.32

1225.44

887.04

28341 00

Surgery

19.75

14.64

1422.00

1054.08

28344 00

Surgery

12.58

8.46

905.76

609.12

28345 00

Surgery

15.39

10.94

1108.08

787.68

28360 00

Surgery

33.27

33.27

2395.44

2395.44

28400 00

Surgery

7.70

7.15

554.40

514.80

28405 00

Surgery

14.00

12.56

1008.00

904.32

28406 00

Surgery

18.07

18.07

1301.04

1301.04

28415 00

Surgery

33.87

33.87

2438.64

2438.64

28420 00

Surgery

39.20

39.20

2822.40

2822.40

28430 00

Surgery

7.46

6.55

537.12

471.60

28435 00

Surgery

11.51

10.20

828.72

734.40

28436 00

Surgery

15.24

15.24

1097.28

1097.28

28445 00

Surgery

31.70

31.70

2282.40

2282.40

28446 00

Surgery

36.98

36.98

2662.56

2662.56

28450 00

Surgery

6.56

5.94

472.32

427.68

28455 00

Surgery

7.84

7.02

564.48

505.44

28456 00

Surgery

11.40

11.40

820.80

820.80

28465 00

Surgery

19.48

19.48

1402.56

1402.56

28470 00

Surgery

6.77

6.38

487.44

459.36

28475 00

Surgery

8.04

7.08

578.88

509.76

28476 00

Surgery

11.85

11.85

853.20

853.20

28485 00

Surgery

17.14

17.14

1234.08

1234.08

28490 00

Surgery

4.40

3.87

316.80

278.64

28495 00

Surgery

5.56

4.62

400.32

332.64

28496 00

Surgery

15.27

8.43

1099.44

606.96

28505 00

Surgery

19.63

15.05

1413.36

1083.60

28510 00

Surgery

3.76

3.75

270.72

270.00

28515 00

Surgery

5.10

4.45

367.20

320.40

28525 00

Surgery

17.17

12.39

1236.24

892.08

28530 00

Surgery

3.62

3.16

260.64

227.52

28531 00

Surgery

9.92

5.52

714.24

397.44

28540 00

Surgery

6.05

5.43

435.60

390.96

28545 00

Surgery

9.63

8.44

693.36

607.68

28546 00

Surgery

17.79

10.88

1280.88

783.36

28555 00

Surgery

26.03

20.10

1874.16

1447.20

28570 00

Surgery

7.36

6.17

529.92

444.24

28575 00

Surgery

11.76

10.54

846.72

758.88

28576 00

Surgery

11.96

11.96

861.12

861.12

28585 00

Surgery

27.08

21.41

1949.76

1541.52

28600 00

Surgery

5.77

4.95

415.44

356.40

28605 00

Surgery

10.65

9.50

766.80

684.00

28606 00

Surgery

12.00

12.00

864.00

864.00

28615 00

Surgery

25.14

25.14

1810.08

1810.08

28630 00

Surgery

4.73

3.37

340.56

242.64

28635 00

Surgery

5.21

3.97

375.12

285.84

28636 00

Surgery

10.73

6.80

772.56

489.60

28645 00

Surgery

19.64

14.77

1414.08

1063.44

28660 00

Surgery

3.86

2.88

277.92

207.36

28665 00

Surgery

4.61

3.84

331.92

276.48

28666 00

Surgery

5.30

5.30

381.60

381.60

28675 00

Surgery

17.39

12.59

1252.08

906.48

28705 00

Surgery

36.72

36.72

2643.84

2643.84

28715 00

Surgery

28.39

28.39

2044.08

2044.08

28725 00

Surgery

23.56

23.56

1696.32

1696.32

28730 00

Surgery

21.93

21.93

1578.96

1578.96

28735 00

Surgery

23.43

23.43

1686.96

1686.96

28737 00

Surgery

20.89

20.89

1504.08

1504.08

28740 00

Surgery

24.84

18.65

1788.48

1342.80

28750 00

Surgery

23.44

17.43

1687.68

1254.96

28755 00

Surgery

15.16

10.15

1091.52

730.80

28760 00

Surgery

23.19

17.31

1669.68

1246.32

28800 00

Surgery

15.88

15.88

1143.36

1143.36

28805 00

Surgery

21.17

21.17

1524.24

1524.24

28810 00

Surgery

12.74

12.74

917.28

917.28

28820 00

Surgery

8.89

5.30

640.08

381.60

28825 00

Surgery

8.75

5.17

630.00

372.24

28890 00

Surgery

9.41

6.76

677.52

486.72

28899 00

Surgery

0.00

0.00

BR

BR

29000 00

Surgery

11.08

6.05

797.76

435.60

29010 00

Surgery

8.52

4.84

613.44

348.48

29015 00

Surgery

9.12

5.44

656.64

391.68

29035 00

Surgery

8.03

4.35

578.16

313.20

29040 00

Surgery

9.13

5.23

657.36

376.56

29044 00

Surgery

8.96

5.05

645.12

363.60

29046 00

Surgery

9.79

5.67

704.88

408.24

29049 00

Surgery

3.07

2.11

221.04

151.92

29055 00

Surgery

6.94

4.16

499.68

299.52

29058 00

Surgery

3.79

2.82

272.88

203.04

29065 00

Surgery

2.98

2.06

214.56

148.32

29075 00

Surgery

2.69

1.89

193.68

136.08

29085 00

Surgery

2.95

2.04

212.40

146.88

29086 00

Surgery

2.36

1.49

169.92

107.28

29105 00

Surgery

2.54

1.25

182.88

90.00

29125 00

Surgery

2.05

1.22

147.60

87.84

29126 00

Surgery

2.40

1.49

172.80

107.28

29130 00

Surgery

1.28

0.87

92.16

62.64

29131 00

Surgery

1.65

1.04

118.80

74.88

29200 00

Surgery

0.96

0.54

69.12

38.88

29240 00

Surgery

0.89

0.53

64.08

38.16

29260 00

Surgery

0.87

0.56

62.64

40.32

29280 00

Surgery

0.90

0.60

64.80

43.20

29305 00

Surgery

7.67

4.78

552.24

344.16

29325 00

Surgery

8.47

5.35

609.84

385.20

29345 00

Surgery

4.13

2.98

297.36

214.56

29355 00

Surgery

4.33

3.20

311.76

230.40

29358 00

Surgery

4.98

3.11

358.56

223.92

29365 00

Surgery

3.82

2.65

275.04

190.80

29405 00

Surgery

2.46

1.77

177.12

127.44

29425 00

Surgery

2.30

1.63

165.60

117.36

29435 00

Surgery

3.80

2.61

273.60

187.92

29440 00

Surgery

1.31

0.84

94.32

60.48

29445 00

Surgery

3.88

2.95

279.36

212.40

29450 00

Surgery

4.41

3.37

317.52

242.64

29505 00

Surgery

2.75

1.58

198.00

113.76

29515 00

Surgery

2.21

1.50

159.12

108.00

29520 00

Surgery

1.04

0.54

74.88

38.88

29530 00

Surgery

0.88

0.53

63.36

38.16

29540 00

Surgery

0.84

0.51

60.48

36.72

29550 00

Surgery

0.58

0.33

41.76

23.76

29580 00

Surgery

1.92

0.78

138.24

56.16

29581 00

Surgery

2.64

0.79

190.08

56.88

29584 00

Surgery

2.40

0.46

172.80

33.12

29700 00

Surgery

1.95

0.99

140.40

71.28

29705 00

Surgery

1.92

1.33

138.24

95.76

29710 00

Surgery

3.74

2.46

269.28

177.12

29720 00

Surgery

2.65

1.31

190.80

94.32

29730 00

Surgery

1.98

1.34

142.56

96.48

29740 00

Surgery

3.02

2.06

217.44

148.32

29750 00

Surgery

3.25

2.30

234.00

165.60

29799 00

Surgery

0.00

0.00

BR

BR

29800 00

Surgery

16.21

16.21

1167.12

1167.12

29804 00

Surgery

17.87

17.87

1286.64

1286.64

29805 00

Surgery

14.26

14.26

1026.72

1026.72

29806 00

Surgery

32.02

32.02

2305.44

2305.44

29807 00

Surgery

31.27

31.27

2251.44

2251.44

29819 00

Surgery

17.87

17.87

1286.64

1286.64

29820 00

Surgery

16.23

16.23

1168.56

1168.56

29821 00

Surgery

18.03

18.03

1298.16

1298.16

29822 00

Surgery

16.50

16.50

1188.00

1188.00

29823 00

Surgery

18.04

18.04

1298.88

1298.88

29824 00

Surgery

20.59

20.59

1482.48

1482.48

29825 00

Surgery

17.83

17.83

1283.76

1283.76

29826 00

Surgery

5.10

5.10

367.20

367.20

29827 00

Surgery

32.26

32.26

2322.72

2322.72

29828 00

Surgery

27.71

27.71

1995.12

1995.12

29830 00

Surgery

13.93

13.93

1002.96

1002.96

29834 00

Surgery

14.99

14.99

1079.28

1079.28

29835 00

Surgery

15.56

15.56

1120.32

1120.32

29836 00

Surgery

17.80

17.80

1281.60

1281.60

29837 00

Surgery

16.00

16.00

1152.00

1152.00

29838 00

Surgery

18.13

18.13

1305.36

1305.36

29840 00

Surgery

13.77

13.77

991.44

991.44

29843 00

Surgery

14.89

14.89

1072.08

1072.08

29844 00

Surgery

15.23

15.23

1096.56

1096.56

29845 00

Surgery

17.88

17.88

1287.36

1287.36

29846 00

Surgery

15.94

15.94

1147.68

1147.68

29847 00

Surgery

16.61

16.61

1195.92

1195.92

29848 00

Surgery

15.68

15.68

1128.96

1128.96

29850 00

Surgery

19.03

19.03

1370.16

1370.16

29851 00

Surgery

28.14

28.14

2026.08

2026.08

29855 00

Surgery

23.66

23.66

1703.52

1703.52

29856 00

Surgery

30.01

30.01

2160.72

2160.72

29860 00

Surgery

19.92

19.92

1434.24

1434.24

29861 00

Surgery

21.66

21.66

1559.52

1559.52

29862 00

Surgery

24.73

24.73

1780.56

1780.56

29863 00

Surgery

24.71

24.71

1779.12

1779.12

29866 00

Surgery

31.87

31.87

2294.64

2294.64

29867 00

Surgery

38.62

38.62

2780.64

2780.64

29868 00

Surgery

50.20

50.20

3614.40

3614.40

29870 00

Surgery

16.80

12.54

1209.60

902.88

29871 00

Surgery

15.72

15.72

1131.84

1131.84

29873 00

Surgery

16.44

16.44

1183.68

1183.68

29874 00

Surgery

16.40

16.40

1180.80

1180.80

29875 00

Surgery

15.15

15.15

1090.80

1090.80

29876 00

Surgery

19.85

19.85

1429.20

1429.20

29877 00

Surgery

18.89

18.89

1360.08

1360.08

29879 00

Surgery

20.12

20.12

1448.64

1448.64

29880 00

Surgery

17.12

17.12

1232.64

1232.64

29881 00

Surgery

16.50

16.50

1188.00

1188.00

29882 00

Surgery

20.90

20.90

1504.80

1504.80

29883 00

Surgery

25.56

25.56

1840.32

1840.32

29884 00

Surgery

18.86

18.86

1357.92

1357.92

29885 00

Surgery

23.00

23.00

1656.00

1656.00

29886 00

Surgery

19.40

19.40

1396.80

1396.80

29887 00

Surgery

22.92

22.92

1650.24

1650.24

29888 00

Surgery

29.42

29.42

2118.24

2118.24

29889 00

Surgery

37.04

37.04

2666.88

2666.88

29891 00

Surgery

20.44

20.44

1471.68

1471.68

29892 00

Surgery

19.41

19.41

1397.52

1397.52

29893 00

Surgery

20.02

13.29

1441.44

956.88

29894 00

Surgery

15.30

15.30

1101.60

1101.60

29895 00

Surgery

14.03

14.03

1010.16

1010.16

29897 00

Surgery

15.02

15.02

1081.44

1081.44

29898 00

Surgery

16.96

16.96

1221.12

1221.12

29899 00

Surgery

30.32

30.32

2183.04

2183.04

29900 00

Surgery

15.47

15.47

1113.84

1113.84

29901 00

Surgery

16.56

16.56

1192.32

1192.32

29902 00

Surgery

17.55

17.55

1263.60

1263.60

29904 00

Surgery

19.47

19.47

1401.84

1401.84

29905 00

Surgery

15.52

15.52

1117.44

1117.44

29906 00

Surgery

19.79

19.79

1424.88

1424.88

29907 00

Surgery

26.61

26.61

1915.92

1915.92

29914 00

Surgery

29.98

29.98

2158.56

2158.56

29915 00

Surgery

30.73

30.73

2212.56

2212.56

29916 00

Surgery

30.60

30.60

2203.20

2203.20

29999 00

Surgery

0.00

0.00

BR

BR

30000 00

Surgery

7.99

3.67

575.28

264.24

30020 00

Surgery

8.14

3.72

586.08

267.84

30100 00

Surgery

4.24

2.06

305.28

148.32

30110 00

Surgery

7.52

4.03

541.44

290.16

30115 00

Surgery

14.11

14.11

1015.92

1015.92

30117 00

Surgery

29.73

12.50

2140.56

900.00

30118 00

Surgery

21.44

21.44

1543.68

1543.68

30120 00

Surgery

15.42

12.68

1110.24

912.96

30124 00

Surgery

9.25

9.25

666.00

666.00

30125 00

Surgery

19.81

19.81

1426.32

1426.32

30130 00

Surgery

12.60

12.60

907.20

907.20

30140 00

Surgery

8.91

5.33

641.52

383.76

30150 00

Surgery

24.16

24.16

1739.52

1739.52

30160 00

Surgery

24.64

24.64

1774.08

1774.08

30200 00

Surgery

3.33

1.80

239.76

129.60

30210 00

Surgery

4.57

3.12

329.04

224.64

30220 00

Surgery

9.16

3.89

659.52

280.08

30300 00

Surgery

6.34

3.72

456.48

267.84

30310 00

Surgery

6.30

6.30

453.60

453.60

30320 00

Surgery

14.79

14.79

1064.88

1064.88

30400 00

Surgery

37.04

37.04

2666.88

2666.88

30410 00

Surgery

42.60

42.60

3067.20

3067.20

30420 00

Surgery

43.81

43.81

3154.32

3154.32

30430 00

Surgery

32.40

32.40

2332.80

2332.80

30435 00

Surgery

40.34

40.34

2904.48

2904.48

30450 00

Surgery

52.62

52.62

3788.64

3788.64

30460 00

Surgery

24.95

24.95

1796.40

1796.40

30462 00

Surgery

47.91

47.91

3449.52

3449.52

30465 00

Surgery

31.00

31.00

2232.00

2232.00

30468 00

Surgery

74.99

5.06

5399.28

364.32

30469 00

Surgery

73.29

4.51

5276.88

324.72

30520 00

Surgery

20.43

20.43

1470.96

1470.96

30540 00

Surgery

22.36

22.36

1609.92

1609.92

30545 00

Surgery

30.27

30.27

2179.44

2179.44

30560 00

Surgery

9.70

4.58

698.40

329.76

30580 00

Surgery

18.30

13.84

1317.60

996.48

30600 00

Surgery

15.55

11.56

1119.60

832.32

30620 00

Surgery

20.42

20.42

1470.24

1470.24

30630 00

Surgery

20.24

20.24

1457.28

1457.28

30801 00

Surgery

6.59

4.60

474.48

331.20

30802 00

Surgery

8.38

6.12

603.36

440.64

30901 00

Surgery

4.70

1.69

338.40

121.68

30903 00

Surgery

7.32

2.30

527.04

165.60

30905 00

Surgery

10.51

3.16

756.72

227.52

30906 00

Surgery

11.28

3.96

812.16

285.12

30915 00

Surgery

18.26

18.26

1314.72

1314.72

30920 00

Surgery

26.34

26.34

1896.48

1896.48

30930 00

Surgery

3.59

3.59

258.48

258.48

30999 00

Surgery

0.00

0.00

BR

BR

31000 00

Surgery

5.61

3.35

403.92

241.20

31002 00

Surgery

5.71

5.71

411.12

411.12

31020 00

Surgery

12.65

10.31

910.80

742.32

31030 00

Surgery

19.33

15.50

1391.76

1116.00

31032 00

Surgery

17.96

17.96

1293.12

1293.12

31040 00

Surgery

24.35

24.35

1753.20

1753.20

31050 00

Surgery

15.64

15.64

1126.08

1126.08

31051 00

Surgery

20.98

20.98

1510.56

1510.56

31070 00

Surgery

14.40

14.40

1036.80

1036.80

31075 00

Surgery

25.01

25.01

1800.72

1800.72

31080 00

Surgery

32.90

32.90

2368.80

2368.80

31081 00

Surgery

35.25

35.25

2538.00

2538.00

31084 00

Surgery

36.48

36.48

2626.56

2626.56

31085 00

Surgery

37.58

37.58

2705.76

2705.76

31086 00

Surgery

35.52

35.52

2557.44

2557.44

31087 00

Surgery

33.82

33.82

2435.04

2435.04

31090 00

Surgery

33.46

33.46

2409.12

2409.12

31200 00

Surgery

18.90

18.90

1360.80

1360.80

31201 00

Surgery

23.55

23.55

1695.60

1695.60

31205 00

Surgery

28.33

28.33

2039.76

2039.76

31225 00

Surgery

54.07

54.07

3893.04

3893.04

31230 00

Surgery

60.32

60.32

4343.04

4343.04

31231 00

Surgery

5.63

1.93

405.36

138.96

31233 00

Surgery

8.25

4.06

594.00

292.32

31235 00

Surgery

9.38

4.78

675.36

344.16

31237 00

Surgery

7.74

4.79

557.28

344.88

31238 00

Surgery

7.54

5.01

542.88

360.72

31239 00

Surgery

18.18

18.18

1308.96

1308.96

31240 00

Surgery

4.76

4.76

342.72

342.72

31241 00

Surgery

13.27

13.27

955.44

955.44

31242 00

Surgery

75.08

4.72

5405.76

339.84

31243 00

Surgery

72.88

4.72

5247.36

339.84

31253 00

Surgery

14.88

14.88

1071.36

1071.36

31254 00

Surgery

13.13

7.25

945.36

522.00

31255 00

Surgery

9.63

9.63

693.36

693.36

31256 00

Surgery

5.37

5.37

386.64

386.64

31257 00

Surgery

13.28

13.28

956.16

956.16

31259 00

Surgery

14.03

14.03

1010.16

1010.16

31267 00

Surgery

7.92

7.92

570.24

570.24

31276 00

Surgery

11.27

11.27

811.44

811.44

31287 00

Surgery

6.00

6.00

432.00

432.00

31288 00

Surgery

6.98

6.98

502.56

502.56

31290 00

Surgery

34.24

34.24

2465.28

2465.28

31291 00

Surgery

36.73

36.73

2644.56

2644.56

31292 00

Surgery

29.67

29.67

2136.24

2136.24

31293 00

Surgery

32.22

32.22

2319.84

2319.84

31294 00

Surgery

36.78

36.78

2648.16

2648.16

31295 00

Surgery

49.29

4.71

3548.88

339.12

31296 00

Surgery

50.05

5.35

3603.60

385.20

31297 00

Surgery

48.86

4.30

3517.92

309.60

31298 00

Surgery

92.68

7.63

6672.96

549.36

31299 00

Surgery

0.00

0.00

BR

BR

31300 00

Surgery

37.62

37.62

2708.64

2708.64

31360 00

Surgery

61.66

61.66

4439.52

4439.52

31365 00

Surgery

76.00

76.00

5472.00

5472.00

31367 00

Surgery

65.18

65.18

4692.96

4692.96

31368 00

Surgery

72.03

72.03

5186.16

5186.16

31370 00

Surgery

61.18

61.18

4404.96

4404.96

31375 00

Surgery

58.16

58.16

4187.52

4187.52

31380 00

Surgery

57.36

57.36

4129.92

4129.92

31382 00

Surgery

62.79

62.79

4520.88

4520.88

31390 00

Surgery

83.83

83.83

6035.76

6035.76

31395 00

Surgery

87.94

87.94

6331.68

6331.68

31400 00

Surgery

30.49

30.49

2195.28

2195.28

31420 00

Surgery

25.09

25.09

1806.48

1806.48

31500 00

Surgery

4.17

4.17

300.24

300.24

31502 00

Surgery

1.04

1.04

74.88

74.88

31505 00

Surgery

2.70

1.49

194.40

107.28

31510 00

Surgery

6.50

3.63

468.00

261.36

31511 00

Surgery

6.35

4.03

457.20

290.16

31512 00

Surgery

6.54

3.88

470.88

279.36

31513 00

Surgery

3.93

3.93

282.96

282.96

31515 00

Surgery

6.40

3.32

460.80

239.04

31520 00

Surgery

4.68

4.68

336.96

336.96

31525 00

Surgery

7.54

4.79

542.88

344.88

31526 00

Surgery

4.69

4.69

337.68

337.68

31527 00

Surgery

5.81

5.81

418.32

418.32

31528 00

Surgery

4.31

4.31

310.32

310.32

31529 00

Surgery

4.81

4.81

346.32

346.32

31530 00

Surgery

5.93

5.93

426.96

426.96

31531 00

Surgery

6.29

6.29

452.88

452.88

31535 00

Surgery

5.64

5.64

406.08

406.08

31536 00

Surgery

6.26

6.26

450.72

450.72

31540 00

Surgery

7.18

7.18

516.96

516.96

31541 00

Surgery

7.83

7.83

563.76

563.76

31545 00

Surgery

10.76

10.76

774.72

774.72

31546 00

Surgery

16.30

16.30

1173.60

1173.60

31551 00

Surgery

46.42

46.42

3342.24

3342.24

31552 00

Surgery

44.81

44.81

3226.32

3226.32

31553 00

Surgery

50.55

50.55

3639.60

3639.60

31554 00

Surgery

50.57

50.57

3641.04

3641.04

31560 00

Surgery

9.28

9.28

668.16

668.16

31561 00

Surgery

10.15

10.15

730.80

730.80

31570 00

Surgery

10.34

6.83

744.48

491.76

31571 00

Surgery

7.41

7.41

533.52

533.52

31572 00

Surgery

15.71

5.39

1131.12

388.08

31573 00

Surgery

8.66

4.45

623.52

320.40

31574 00

Surgery

28.02

4.47

2017.44

321.84

31575 00

Surgery

3.88

2.06

279.36

148.32

31576 00

Surgery

8.14

3.58

586.08

257.76

31577 00

Surgery

8.23

3.99

592.56

287.28

31578 00

Surgery

9.22

4.47

663.84

321.84

31579 00

Surgery

5.95

3.58

428.40

257.76

31580 00

Surgery

38.63

38.63

2781.36

2781.36

31584 00

Surgery

42.45

42.45

3056.40

3056.40

31587 00

Surgery

36.38

36.38

2619.36

2619.36

31590 00

Surgery

27.91

27.91

2009.52

2009.52

31591 00

Surgery

33.19

33.19

2389.68

2389.68

31592 00

Surgery

52.08

52.08

3749.76

3749.76

31599 00

Surgery

0.00

0.00

BR

BR

31600 00

Surgery

9.07

9.07

653.04

653.04

31601 00

Surgery

13.41

13.41

965.52

965.52

31603 00

Surgery

9.51

9.51

684.72

684.72

31605 00

Surgery

9.79

9.79

704.88

704.88

31610 00

Surgery

28.81

28.81

2074.32

2074.32

31611 00

Surgery

16.21

16.21

1167.12

1167.12

31612 00

Surgery

2.80

1.43

201.60

102.96

31613 00

Surgery

12.80

12.80

921.60

921.60

31614 00

Surgery

21.48

21.48

1546.56

1546.56

31615 00

Surgery

5.18

3.46

372.96

249.12

31622 00

Surgery

7.48

3.90

538.56

280.80

31623 00

Surgery

8.21

3.87

591.12

278.64

31624 00

Surgery

7.64

3.92

550.08

282.24

31625 00

Surgery

10.43

4.58

750.96

329.76

31626 00

Surgery

23.44

5.78

1687.68

416.16

31627 00

Surgery

31.81

2.82

2290.32

203.04

31628 00

Surgery

11.11

5.15

799.92

370.80

31629 00

Surgery

13.52

5.47

973.44

393.84

31630 00

Surgery

5.82

5.82

419.04

419.04

31631 00

Surgery

6.63

6.63

477.36

477.36

31632 00

Surgery

1.93

1.43

138.96

102.96

31633 00

Surgery

2.40

1.84

172.80

132.48

31634 00

Surgery

43.82

5.51

3155.04

396.72

31635 00

Surgery

8.77

5.15

631.44

370.80

31636 00

Surgery

6.34

6.34

456.48

456.48

31637 00

Surgery

2.22

2.22

159.84

159.84

31638 00

Surgery

7.20

7.20

518.40

518.40

31640 00

Surgery

7.24

7.24

521.28

521.28

31641 00

Surgery

7.44

7.44

535.68

535.68

31643 00

Surgery

4.96

4.96

357.12

357.12

31645 00

Surgery

8.21

4.32

591.12

311.04

31646 00

Surgery

4.17

4.17

300.24

300.24

31647 00

Surgery

6.01

6.01

432.72

432.72

31648 00

Surgery

5.80

5.80

417.60

417.60

31649 00

Surgery

1.95

1.95

140.40

140.40

31651 00

Surgery

2.22

2.22

159.84

159.84

31652 00

Surgery

37.10

6.45

2671.20

464.40

31653 00

Surgery

38.51

7.15

2772.72

514.80

31654 00

Surgery

3.60

1.96

259.20

141.12

31660 00

Surgery

5.55

5.55

399.60

399.60

31661 00

Surgery

5.86

5.86

421.92

421.92

31717 00

Surgery

8.55

3.12

615.60

224.64

31720 00

Surgery

1.43

1.43

102.96

102.96

31725 00

Surgery

2.32

2.32

167.04

167.04

31730 00

Surgery

31.41

4.39

2261.52

316.08

31750 00

Surgery

40.58

40.58

2921.76

2921.76

31755 00

Surgery

52.03

52.03

3746.16

3746.16

31760 00

Surgery

40.77

40.77

2935.44

2935.44

31766 00

Surgery

52.43

52.43

3774.96

3774.96

31770 00

Surgery

39.24

39.24

2825.28

2825.28

31775 00

Surgery

41.35

41.35

2977.20

2977.20

31780 00

Surgery

35.98

35.98

2590.56

2590.56

31781 00

Surgery

43.08

43.08

3101.76

3101.76

31785 00

Surgery

32.22

32.22

2319.84

2319.84

31786 00

Surgery

42.61

42.61

3067.92

3067.92

31800 00

Surgery

21.29

21.29

1532.88

1532.88

31805 00

Surgery

24.35

24.35

1753.20

1753.20

31820 00

Surgery

13.45

10.06

968.40

724.32

31825 00

Surgery

18.59

14.70

1338.48

1058.40

31830 00

Surgery

15.00

11.15

1080.00

802.80

31899 00

Surgery

0.00

0.00

BR

BR

32035 00

Surgery

21.92

21.92

1578.24

1578.24

32036 00

Surgery

23.61

23.61

1699.92

1699.92

32096 00

Surgery

23.72

23.72

1707.84

1707.84

32097 00

Surgery

23.76

23.76

1710.72

1710.72

32098 00

Surgery

22.47

22.47

1617.84

1617.84

32100 00

Surgery

24.07

24.07

1733.04

1733.04

32110 00

Surgery

43.81

43.81

3154.32

3154.32

32120 00

Surgery

25.94

25.94

1867.68

1867.68

32124 00

Surgery

27.39

27.39

1972.08

1972.08

32140 00

Surgery

29.41

29.41

2117.52

2117.52

32141 00

Surgery

44.92

44.92

3234.24

3234.24

32150 00

Surgery

30.22

30.22

2175.84

2175.84

32151 00

Surgery

29.84

29.84

2148.48

2148.48

32160 00

Surgery

23.73

23.73

1708.56

1708.56

32200 00

Surgery

33.89

33.89

2440.08

2440.08

32215 00

Surgery

23.89

23.89

1720.08

1720.08

32220 00

Surgery

47.42

47.42

3414.24

3414.24

32225 00

Surgery

29.52

29.52

2125.44

2125.44

32310 00

Surgery

27.29

27.29

1964.88

1964.88

32320 00

Surgery

47.56

47.56

3424.32

3424.32

32400 00

Surgery

5.04

2.46

362.88

177.12

32408 00

Surgery

25.18

4.46

1812.96

321.12

32440 00

Surgery

46.40

46.40

3340.80

3340.80

32442 00

Surgery

89.83

89.83

6467.76

6467.76

32445 00

Surgery

104.02

104.02

7489.44

7489.44

32480 00

Surgery

43.74

43.74

3149.28

3149.28

32482 00

Surgery

46.75

46.75

3366.00

3366.00

32484 00

Surgery

42.34

42.34

3048.48

3048.48

32486 00

Surgery

68.94

68.94

4963.68

4963.68

32488 00

Surgery

70.52

70.52

5077.44

5077.44

32491 00

Surgery

43.63

43.63

3141.36

3141.36

32501 00

Surgery

7.14

7.14

514.08

514.08

32503 00

Surgery

53.00

53.00

3816.00

3816.00

32504 00

Surgery

60.35

60.35

4345.20

4345.20

32505 00

Surgery

27.61

27.61

1987.92

1987.92

32506 00

Surgery

4.58

4.58

329.76

329.76

32507 00

Surgery

4.57

4.57

329.04

329.04

32540 00

Surgery

51.08

51.08

3677.76

3677.76

32550 00

Surgery

23.04

6.00

1658.88

432.00

32551 00

Surgery

4.59

4.59

330.48

330.48

32552 00

Surgery

5.46

4.66

393.12

335.52

32553 00

Surgery

15.04

5.13

1082.88

369.36

32554 00

Surgery

7.01

2.61

504.72

187.92

32555 00

Surgery

9.35

3.20

673.20

230.40

32556 00

Surgery

22.10

3.66

1591.20

263.52

32557 00

Surgery

19.60

4.37

1411.20

314.64

32560 00

Surgery

7.56

2.24

544.32

161.28

32561 00

Surgery

2.84

1.98

204.48

142.56

32562 00

Surgery

2.54

1.77

182.88

127.44

32601 00

Surgery

9.09

9.09

654.48

654.48

32604 00

Surgery

14.12

14.12

1016.64

1016.64

32606 00

Surgery

13.59

13.59

978.48

978.48

32607 00

Surgery

9.07

9.07

653.04

653.04

32608 00

Surgery

11.15

11.15

802.80

802.80

32609 00

Surgery

7.55

7.55

543.60

543.60

32650 00

Surgery

19.89

19.89

1432.08

1432.08

32651 00

Surgery

32.44

32.44

2335.68

2335.68

32652 00

Surgery

49.13

49.13

3537.36

3537.36

32653 00

Surgery

31.34

31.34

2256.48

2256.48

32654 00

Surgery

35.01

35.01

2520.72

2520.72

32655 00

Surgery

28.37

28.37

2042.64

2042.64

32656 00

Surgery

23.86

23.86

1717.92

1717.92

32658 00

Surgery

21.25

21.25

1530.00

1530.00

32659 00

Surgery

21.84

21.84

1572.48

1572.48

32661 00

Surgery

23.72

23.72

1707.84

1707.84

32662 00

Surgery

26.53

26.53

1910.16

1910.16

32663 00

Surgery

41.29

41.29

2972.88

2972.88

32664 00

Surgery

25.17

25.17

1812.24

1812.24

32665 00

Surgery

36.40

36.40

2620.80

2620.80

32666 00

Surgery

25.82

25.82

1859.04

1859.04

32667 00

Surgery

4.59

4.59

330.48

330.48

32668 00

Surgery

4.59

4.59

330.48

330.48

32669 00

Surgery

39.65

39.65

2854.80

2854.80

32670 00

Surgery

47.21

47.21

3399.12

3399.12

32671 00

Surgery

52.25

52.25

3762.00

3762.00

32672 00

Surgery

44.80

44.80

3225.60

3225.60

32673 00

Surgery

35.94

35.94

2587.68

2587.68

32674 00

Surgery

6.31

6.31

454.32

454.32

32701 00

Surgery

6.16

6.16

443.52

443.52

32800 00

Surgery

27.97

27.97

2013.84

2013.84

32810 00

Surgery

26.80

26.80

1929.60

1929.60

32815 00

Surgery

82.63

82.63

5949.36

5949.36

32820 00

Surgery

39.52

39.52

2845.44

2845.44

32850 00

Surgery

0.00

0.00

BR

BR

32851 00

Surgery

96.40

96.40

6940.80

6940.80

32852 00

Surgery

103.74

103.74

7469.28

7469.28

32853 00

Surgery

134.66

134.66

9695.52

9695.52

32854 00

Surgery

142.56

142.56

10264.32

10264.32

32855 00

Surgery

-

-

1803.60

1514.88

32856 00

Surgery

-

-

1998.72

1679.04

32900 00

Surgery

40.28

40.28

2900.16

2900.16

32905 00

Surgery

39.48

39.48

2842.56

2842.56

32906 00

Surgery

48.65

48.65

3502.80

3502.80

32940 00

Surgery

36.50

36.50

2628.00

2628.00

32960 00

Surgery

3.79

2.67

272.88

192.24

32994 00

Surgery

142.37

12.77

10250.64

919.44

32997 00

Surgery

9.88

9.88

711.36

711.36

32998 00

Surgery

90.90

12.79

6544.80

920.88

32999 00

Surgery

0.00

0.00

BR

BR

33016 00

Surgery

6.87

6.87

494.64

494.64

33017 00

Surgery

7.25

7.25

522.00

522.00

33018 00

Surgery

8.47

8.47

609.84

609.84

33019 00

Surgery

6.15

6.15

442.80

442.80

33020 00

Surgery

24.37

24.37

1754.64

1754.64

33025 00

Surgery

22.81

22.81

1642.32

1642.32

33030 00

Surgery

58.92

58.92

4242.24

4242.24

33031 00

Surgery

72.75

72.75

5238.00

5238.00

33050 00

Surgery

29.87

29.87

2150.64

2150.64

33120 00

Surgery

61.46

61.46

4425.12

4425.12

33130 00

Surgery

40.18

40.18

2892.96

2892.96

33140 00

Surgery

45.64

45.64

3286.08

3286.08

33141 00

Surgery

3.86

3.86

277.92

277.92

33202 00

Surgery

22.81

22.81

1642.32

1642.32

33203 00

Surgery

23.97

23.97

1725.84

1725.84

33206 00

Surgery

13.41

13.41

965.52

965.52

33207 00

Surgery

14.09

14.09

1014.48

1014.48

33208 00

Surgery

15.25

15.25

1098.00

1098.00

33210 00

Surgery

4.72

4.72

339.84

339.84

33211 00

Surgery

4.94

4.94

355.68

355.68

33212 00

Surgery

9.55

9.55

687.60

687.60

33213 00

Surgery

10.00

10.00

720.00

720.00

33214 00

Surgery

14.13

14.13

1017.36

1017.36

33215 00

Surgery

9.17

9.17

660.24

660.24

33216 00

Surgery

10.98

10.98

790.56

790.56

33217 00

Surgery

10.90

10.90

784.80

784.80

33218 00

Surgery

11.52

11.52

829.44

829.44

33220 00

Surgery

11.26

11.26

810.72

810.72

33221 00

Surgery

10.56

10.56

760.32

760.32

33222 00

Surgery

10.18

10.18

732.96

732.96

33223 00

Surgery

12.09

12.09

870.48

870.48

33224 00

Surgery

14.99

14.99

1079.28

1079.28

33225 00

Surgery

13.51

13.51

972.72

972.72

33226 00

Surgery

14.35

14.35

1033.20

1033.20

33227 00

Surgery

10.03

10.03

722.16

722.16

33228 00

Surgery

10.47

10.47

753.84

753.84

33229 00

Surgery

11.01

11.01

792.72

792.72

33230 00

Surgery

11.05

11.05

795.60

795.60

33231 00

Surgery

11.84

11.84

852.48

852.48

33233 00

Surgery

6.92

6.92

498.24

498.24

33234 00

Surgery

14.28

14.28

1028.16

1028.16

33235 00

Surgery

18.77

18.77

1351.44

1351.44

33236 00

Surgery

23.20

23.20

1670.40

1670.40

33237 00

Surgery

24.89

24.89

1792.08

1792.08

33238 00

Surgery

28.16

28.16

2027.52

2027.52

33240 00

Surgery

10.88

10.88

783.36

783.36

33241 00

Surgery

6.37

6.37

458.64

458.64

33243 00

Surgery

40.65

40.65

2926.80

2926.80

33244 00

Surgery

25.44

25.44

1831.68

1831.68

33249 00

Surgery

26.85

26.85

1933.20

1933.20

33250 00

Surgery

42.78

42.78

3080.16

3080.16

33251 00

Surgery

48.07

48.07

3461.04

3461.04

33254 00

Surgery

40.21

40.21

2895.12

2895.12

33255 00

Surgery

47.73

47.73

3436.56

3436.56

33256 00

Surgery

56.51

56.51

4068.72

4068.72

33257 00

Surgery

17.25

17.25

1242.00

1242.00

33258 00

Surgery

19.16

19.16

1379.52

1379.52

33259 00

Surgery

25.06

25.06

1804.32

1804.32

33261 00

Surgery

47.29

47.29

3404.88

3404.88

33262 00

Surgery

10.99

10.99

791.28

791.28

33263 00

Surgery

11.42

11.42

822.24

822.24

33264 00

Surgery

11.91

11.91

857.52

857.52

33265 00

Surgery

40.18

40.18

2892.96

2892.96

33266 00

Surgery

54.20

54.20

3902.40

3902.40

33267 00

Surgery

30.80

30.80

2217.60

2217.60

33268 00

Surgery

3.79

3.79

272.88

272.88

33269 00

Surgery

24.50

24.50

1764.00

1764.00

33270 00

Surgery

16.50

16.50

1188.00

1188.00

33271 00

Surgery

13.43

13.43

966.96

966.96

33272 00

Surgery

10.26

10.26

738.72

738.72

33273 00

Surgery

11.89

11.89

856.08

856.08

33274 00

Surgery

14.08

14.08

1013.76

1013.76

33275 00

Surgery

14.88

14.88

1071.36

1071.36

33276 00

Surgery

17.05

17.05

1227.60

1227.60

33277 00

Surgery

8.92

8.92

642.24

642.24

33278 00

Surgery

16.97

16.97

1221.84

1221.84

33279 00

Surgery

10.26

10.26

738.72

738.72

33280 00

Surgery

6.17

6.17

444.24

444.24

33281 00

Surgery

11.09

11.09

798.48

798.48

33285 00

Surgery

124.35

2.57

8953.20

185.04

33286 00

Surgery

3.87

2.52

278.64

181.44

33287 00

Surgery

11.44

11.44

823.68

823.68

33288 00

Surgery

15.08

15.08

1085.76

1085.76

33289 00

Surgery

9.79

9.79

704.88

704.88

33300 00

Surgery

71.80

71.80

5169.60

5169.60

33305 00

Surgery

120.18

120.18

8652.96

8652.96

33310 00

Surgery

34.42

34.42

2478.24

2478.24

33315 00

Surgery

56.40

56.40

4060.80

4060.80

33320 00

Surgery

31.63

31.63

2277.36

2277.36

33321 00

Surgery

34.95

34.95

2516.40

2516.40

33322 00

Surgery

41.26

41.26

2970.72

2970.72

33330 00

Surgery

41.86

41.86

3013.92

3013.92

33335 00

Surgery

54.77

54.77

3943.44

3943.44

33340 00

Surgery

22.84

22.84

1644.48

1644.48

33361 00

Surgery

35.42

35.42

2550.24

2550.24

33362 00

Surgery

38.60

38.60

2779.20

2779.20

33363 00

Surgery

40.06

40.06

2884.32

2884.32

33364 00

Surgery

39.88

39.88

2871.36

2871.36

33365 00

Surgery

41.73

41.73

3004.56

3004.56

33366 00

Surgery

45.92

45.92

3306.24

3306.24

33367 00

Surgery

17.79

17.79

1280.88

1280.88

33368 00

Surgery

21.56

21.56

1552.32

1552.32

33369 00

Surgery

28.46

28.46

2049.12

2049.12

33370 00

Surgery

3.90

3.90

280.80

280.80

33390 00

Surgery

56.48

56.48

4066.56

4066.56

33391 00

Surgery

66.94

66.94

4819.68

4819.68

33404 00

Surgery

51.33

51.33

3695.76

3695.76

33405 00

Surgery

66.76

66.76

4806.72

4806.72

33406 00

Surgery

84.81

84.81

6106.32

6106.32

33410 00

Surgery

74.68

74.68

5376.96

5376.96

33411 00

Surgery

98.41

98.41

7085.52

7085.52

33412 00

Surgery

91.94

91.94

6619.68

6619.68

33413 00

Surgery

94.25

94.25

6786.00

6786.00

33414 00

Surgery

63.21

63.21

4551.12

4551.12

33415 00

Surgery

59.62

59.62

4292.64

4292.64

33416 00

Surgery

59.56

59.56

4288.32

4288.32

33417 00

Surgery

49.33

49.33

3551.76

3551.76

33418 00

Surgery

52.84

52.84

3804.48

3804.48

33419 00

Surgery

12.38

12.38

891.36

891.36

33420 00

Surgery

42.63

42.63

3069.36

3069.36

33422 00

Surgery

48.85

48.85

3517.20

3517.20

33425 00

Surgery

80.23

80.23

5776.56

5776.56

33426 00

Surgery

70.08

70.08

5045.76

5045.76

33427 00

Surgery

71.66

71.66

5159.52

5159.52

33430 00

Surgery

82.37

82.37

5930.64

5930.64

33440 00

Surgery

99.41

99.41

7157.52

7157.52

33460 00

Surgery

70.17

70.17

5052.24

5052.24

33463 00

Surgery

90.29

90.29

6500.88

6500.88

33464 00

Surgery

71.63

71.63

5157.36

5157.36

33465 00

Surgery

80.89

80.89

5824.08

5824.08

33468 00

Surgery

72.07

72.07

5189.04

5189.04

33471 00

Surgery

39.22

39.22

2823.84

2823.84

33474 00

Surgery

64.23

64.23

4624.56

4624.56

33475 00

Surgery

68.21

68.21

4911.12

4911.12

33476 00

Surgery

45.09

45.09

3246.48

3246.48

33477 00

Surgery

38.37

38.37

2762.64

2762.64

33478 00

Surgery

46.55

46.55

3351.60

3351.60

33496 00

Surgery

48.87

48.87

3518.64

3518.64

33500 00

Surgery

45.83

45.83

3299.76

3299.76

33501 00

Surgery

32.84

32.84

2364.48

2364.48

33502 00

Surgery

37.90

37.90

2728.80

2728.80

33503 00

Surgery

39.40

39.40

2836.80

2836.80

33504 00

Surgery

43.42

43.42

3126.24

3126.24

33505 00

Surgery

60.51

60.51

4356.72

4356.72

33506 00

Surgery

60.35

60.35

4345.20

4345.20

33507 00

Surgery

50.66

50.66

3647.52

3647.52

33508 00

Surgery

0.47

0.47

33.84

33.84

33509 00

Surgery

5.05

5.05

363.60

363.60

33510 00

Surgery

56.88

56.88

4095.36

4095.36

33511 00

Surgery

62.46

62.46

4497.12

4497.12

33512 00

Surgery

71.15

71.15

5122.80

5122.80

33513 00

Surgery

72.65

72.65

5230.80

5230.80

33514 00

Surgery

76.38

76.38

5499.36

5499.36

33516 00

Surgery

79.05

79.05

5691.60

5691.60

33517 00

Surgery

5.48

5.48

394.56

394.56

33518 00

Surgery

12.00

12.00

864.00

864.00

33519 00

Surgery

15.88

15.88

1143.36

1143.36

33521 00

Surgery

19.03

19.03

1370.16

1370.16

33522 00

Surgery

21.39

21.39

1540.08

1540.08

33523 00

Surgery

24.07

24.07

1733.04

1733.04

33530 00

Surgery

15.32

15.32

1103.04

1103.04

33533 00

Surgery

55.09

55.09

3966.48

3966.48

33534 00

Surgery

64.69

64.69

4657.68

4657.68

33535 00

Surgery

71.87

71.87

5174.64

5174.64

33536 00

Surgery

77.44

77.44

5575.68

5575.68

33542 00

Surgery

77.04

77.04

5546.88

5546.88

33545 00

Surgery

89.68

89.68

6456.96

6456.96

33548 00

Surgery

86.37

86.37

6218.64

6218.64

33572 00

Surgery

6.75

6.75

486.00

486.00

33600 00

Surgery

50.82

50.82

3659.04

3659.04

33602 00

Surgery

49.34

49.34

3552.48

3552.48

33606 00

Surgery

52.52

52.52

3781.44

3781.44

33608 00

Surgery

53.19

53.19

3829.68

3829.68

33610 00

Surgery

52.46

52.46

3777.12

3777.12

33611 00

Surgery

57.40

57.40

4132.80

4132.80

33612 00

Surgery

58.94

58.94

4243.68

4243.68

33615 00

Surgery

58.91

58.91

4241.52

4241.52

33617 00

Surgery

63.79

63.79

4592.88

4592.88

33619 00

Surgery

81.02

81.02

5833.44

5833.44

33620 00

Surgery

48.54

48.54

3494.88

3494.88

33621 00

Surgery

27.48

27.48

1978.56

1978.56

33622 00

Surgery

100.70

100.70

7250.40

7250.40

33641 00

Surgery

48.30

48.30

3477.60

3477.60

33645 00

Surgery

51.00

51.00

3672.00

3672.00

33647 00

Surgery

53.48

53.48

3850.56

3850.56

33660 00

Surgery

51.71

51.71

3723.12

3723.12

33665 00

Surgery

56.31

56.31

4054.32

4054.32

33670 00

Surgery

57.92

57.92

4170.24

4170.24

33675 00

Surgery

58.00

58.00

4176.00

4176.00

33676 00

Surgery

59.54

59.54

4286.88

4286.88

33677 00

Surgery

61.82

61.82

4451.04

4451.04

33681 00

Surgery

54.50

54.50

3924.00

3924.00

33684 00

Surgery

55.57

55.57

4001.04

4001.04

33688 00

Surgery

55.33

55.33

3983.76

3983.76

33690 00

Surgery

35.66

35.66

2567.52

2567.52

33692 00

Surgery

57.46

57.46

4137.12

4137.12

33694 00

Surgery

57.40

57.40

4132.80

4132.80

33697 00

Surgery

60.46

60.46

4353.12

4353.12

33702 00

Surgery

45.73

45.73

3292.56

3292.56

33710 00

Surgery

60.33

60.33

4343.76

4343.76

33720 00

Surgery

45.76

45.76

3294.72

3294.72

33724 00

Surgery

45.31

45.31

3262.32

3262.32

33726 00

Surgery

59.78

59.78

4304.16

4304.16

33730 00

Surgery

59.16

59.16

4259.52

4259.52

33732 00

Surgery

48.76

48.76

3510.72

3510.72

33735 00

Surgery

38.46

38.46

2769.12

2769.12

33736 00

Surgery

41.69

41.69

3001.68

3001.68

33737 00

Surgery

38.47

38.47

2769.84

2769.84

33741 00

Surgery

21.99

21.99

1583.28

1583.28

33745 00

Surgery

31.42

31.42

2262.24

2262.24

33746 00

Surgery

12.56

12.56

904.32

904.32

33750 00

Surgery

37.30

37.30

2685.60

2685.60

33755 00

Surgery

39.07

39.07

2813.04

2813.04

33762 00

Surgery

37.89

37.89

2728.08

2728.08

33764 00

Surgery

39.07

39.07

2813.04

2813.04

33766 00

Surgery

39.35

39.35

2833.20

2833.20

33767 00

Surgery

41.99

41.99

3023.28

3023.28

33768 00

Surgery

12.18

12.18

876.96

876.96

33770 00

Surgery

62.19

62.19

4477.68

4477.68

33771 00

Surgery

63.91

63.91

4601.52

4601.52

33774 00

Surgery

53.20

53.20

3830.40

3830.40

33775 00

Surgery

54.73

54.73

3940.56

3940.56

33776 00

Surgery

57.91

57.91

4169.52

4169.52

33777 00

Surgery

55.74

55.74

4013.28

4013.28

33778 00

Surgery

69.24

69.24

4985.28

4985.28

33779 00

Surgery

68.24

68.24

4913.28

4913.28

33780 00

Surgery

69.55

69.55

5007.60

5007.60

33781 00

Surgery

67.83

67.83

4883.76

4883.76

33782 00

Surgery

94.71

94.71

6819.12

6819.12

33783 00

Surgery

102.35

102.35

7369.20

7369.20

33786 00

Surgery

66.96

66.96

4821.12

4821.12

33788 00

Surgery

45.22

45.22

3255.84

3255.84

33800 00

Surgery

29.16

29.16

2099.52

2099.52

33802 00

Surgery

32.24

32.24

2321.28

2321.28

33803 00

Surgery

34.01

34.01

2448.72

2448.72

33813 00

Surgery

36.77

36.77

2647.44

2647.44

33814 00

Surgery

45.12

45.12

3248.64

3248.64

33820 00

Surgery

28.66

28.66

2063.52

2063.52

33822 00

Surgery

30.21

30.21

2175.12

2175.12

33824 00

Surgery

35.03

35.03

2522.16

2522.16

33840 00

Surgery

36.73

36.73

2644.56

2644.56

33845 00

Surgery

39.57

39.57

2849.04

2849.04

33851 00

Surgery

37.72

37.72

2715.84

2715.84

33852 00

Surgery

41.43

41.43

2982.96

2982.96

33853 00

Surgery

54.16

54.16

3899.52

3899.52

33858 00

Surgery

99.45

99.45

7160.40

7160.40

33859 00

Surgery

71.49

71.49

5147.28

5147.28

33863 00

Surgery

92.18

92.18

6636.96

6636.96

33864 00

Surgery

94.14

94.14

6778.08

6778.08

33866 00

Surgery

26.88

26.88

1935.36

1935.36

33871 00

Surgery

95.42

95.42

6870.24

6870.24

33875 00

Surgery

80.54

80.54

5798.88

5798.88

33877 00

Surgery

105.63

105.63

7605.36

7605.36

33880 00

Surgery

52.26

52.26

3762.72

3762.72

33881 00

Surgery

44.89

44.89

3232.08

3232.08

33883 00

Surgery

32.58

32.58

2345.76

2345.76

33884 00

Surgery

11.52

11.52

829.44

829.44

33886 00

Surgery

28.13

28.13

2025.36

2025.36

33889 00

Surgery

23.22

23.22

1671.84

1671.84

33891 00

Surgery

28.08

28.08

2021.76

2021.76

33894 00

Surgery

28.71

28.71

2067.12

2067.12

33895 00

Surgery

22.85

22.85

1645.20

1645.20

33897 00

Surgery

16.98

16.98

1222.56

1222.56

33900 00

Surgery

16.96

16.96

1221.12

1221.12

33901 00

Surgery

22.29

22.29

1604.88

1604.88

33902 00

Surgery

21.52

21.52

1549.44

1549.44

33903 00

Surgery

25.36

25.36

1825.92

1825.92

33904 00

Surgery

8.52

8.52

613.44

613.44

33910 00

Surgery

76.53

76.53

5510.16

5510.16

33915 00

Surgery

40.34

40.34

2904.48

2904.48

33916 00

Surgery

122.14

122.14

8794.08

8794.08

33917 00

Surgery

43.18

43.18

3108.96

3108.96

33920 00

Surgery

53.31

53.31

3838.32

3838.32

33922 00

Surgery

41.15

41.15

2962.80

2962.80

33924 00

Surgery

8.34

8.34

600.48

600.48

33925 00

Surgery

50.51

50.51

3636.72

3636.72

33926 00

Surgery

70.98

70.98

5110.56

5110.56

33927 00

Surgery

74.60

74.60

5371.20

5371.20

33928 00

Surgery

0.00

0.00

BR

BR

33929 00

Surgery

0.00

0.00

BR

BR

33930 00

Surgery

0.00

0.00

BR

BR

33933 00

Surgery

0.00

0.00

BR

BR

33935 00

Surgery

144.09

144.09

10374.48

10374.48

33940 00

Surgery

0.00

0.00

BR

BR

33944 00

Surgery

-

-

1205.28

1036.80

33945 00

Surgery

142.73

142.73

10276.56

10276.56

33946 00

Surgery

9.07

9.07

653.04

653.04

33947 00

Surgery

10.04

10.04

722.88

722.88

33948 00

Surgery

6.97

6.97

501.84

501.84

33949 00

Surgery

6.81

6.81

490.32

490.32

33951 00

Surgery

12.31

12.31

886.32

886.32

33952 00

Surgery

12.50

12.50

900.00

900.00

33953 00

Surgery

13.75

13.75

990.00

990.00

33954 00

Surgery

13.92

13.92

1002.24

1002.24

33955 00

Surgery

24.08

24.08

1733.76

1733.76

33956 00

Surgery

24.46

24.46

1761.12

1761.12

33957 00

Surgery

5.36

5.36

385.92

385.92

33958 00

Surgery

5.36

5.36

385.92

385.92

33959 00

Surgery

6.83

6.83

491.76

491.76

33962 00

Surgery

6.83

6.83

491.76

491.76

33963 00

Surgery

13.59

13.59

978.48

978.48

33964 00

Surgery

14.35

14.35

1033.20

1033.20

33965 00

Surgery

5.36

5.36

385.92

385.92

33966 00

Surgery

6.94

6.94

499.68

499.68

33967 00

Surgery

7.57

7.57

545.04

545.04

33968 00

Surgery

0.99

0.99

71.28

71.28

33969 00

Surgery

7.93

7.93

570.96

570.96

33970 00

Surgery

10.32

10.32

743.04

743.04

33971 00

Surgery

20.94

20.94

1507.68

1507.68

33973 00

Surgery

14.59

14.59

1050.48

1050.48

33974 00

Surgery

26.31

26.31

1894.32

1894.32

33975 00

Surgery

38.16

38.16

2747.52

2747.52

33976 00

Surgery

46.07

46.07

3317.04

3317.04

33977 00

Surgery

32.92

32.92

2370.24

2370.24

33978 00

Surgery

38.80

38.80

2793.60

2793.60

33979 00

Surgery

56.86

56.86

4093.92

4093.92

33980 00

Surgery

52.24

52.24

3761.28

3761.28

33981 00

Surgery

24.12

24.12

1736.64

1736.64

33982 00

Surgery

56.72

56.72

4083.84

4083.84

33983 00

Surgery

66.75

66.75

4806.00

4806.00

33984 00

Surgery

8.30

8.30

597.60

597.60

33985 00

Surgery

14.92

14.92

1074.24

1074.24

33986 00

Surgery

15.32

15.32

1103.04

1103.04

33987 00

Surgery

6.06

6.06

436.32

436.32

33988 00

Surgery

22.58

22.58

1625.76

1625.76

33989 00

Surgery

14.35

14.35

1033.20

1033.20

33990 00

Surgery

10.55

10.55

759.60

759.60

33991 00

Surgery

13.24

13.24

953.28

953.28

33992 00

Surgery

5.50

5.50

396.00

396.00

33993 00

Surgery

4.86

4.86

349.92

349.92

33995 00

Surgery

10.38

10.38

747.36

747.36

33997 00

Surgery

4.72

4.72

339.84

339.84

33999 00

Surgery

0.00

0.00

BR

BR

34001 00

Surgery

26.83

26.83

1931.76

1931.76

34051 00

Surgery

29.30

29.30

2109.60

2109.60

34101 00

Surgery

17.50

17.50

1260.00

1260.00

34111 00

Surgery

17.48

17.48

1258.56

1258.56

34151 00

Surgery

40.77

40.77

2935.44

2935.44

34201 00

Surgery

29.93

29.93

2154.96

2154.96

34203 00

Surgery

27.81

27.81

2002.32

2002.32

34401 00

Surgery

44.04

44.04

3170.88

3170.88

34421 00

Surgery

20.42

20.42

1470.24

1470.24

34451 00

Surgery

42.08

42.08

3029.76

3029.76

34471 00

Surgery

31.66

31.66

2279.52

2279.52

34490 00

Surgery

16.92

16.92

1218.24

1218.24

34501 00

Surgery

26.33

26.33

1895.76

1895.76

34502 00

Surgery

45.58

45.58

3281.76

3281.76

34510 00

Surgery

29.97

29.97

2157.84

2157.84

34520 00

Surgery

29.03

29.03

2090.16

2090.16

34530 00

Surgery

27.66

27.66

1991.52

1991.52

34701 00

Surgery

36.11

36.11

2599.92

2599.92

34702 00

Surgery

53.93

53.93

3882.96

3882.96

34703 00

Surgery

40.11

40.11

2887.92

2887.92

34704 00

Surgery

66.86

66.86

4813.92

4813.92

34705 00

Surgery

44.60

44.60

3211.20

3211.20

34706 00

Surgery

66.47

66.47

4785.84

4785.84

34707 00

Surgery

33.92

33.92

2442.24

2442.24

34708 00

Surgery

53.17

53.17

3828.24

3828.24

34709 00

Surgery

9.39

9.39

676.08

676.08

34710 00

Surgery

23.30

23.30

1677.60

1677.60

34711 00

Surgery

8.58

8.58

617.76

617.76

34712 00

Surgery

19.20

19.20

1382.40

1382.40

34713 00

Surgery

3.59

3.59

258.48

258.48

34714 00

Surgery

7.87

7.87

566.64

566.64

34715 00

Surgery

8.71

8.71

627.12

627.12

34716 00

Surgery

10.87

10.87

782.64

782.64

34717 00

Surgery

12.91

12.91

929.52

929.52

34718 00

Surgery

36.18

36.18

2604.96

2604.96

34808 00

Surgery

5.91

5.91

425.52

425.52

34812 00

Surgery

6.01

6.01

432.72

432.72

34813 00

Surgery

6.85

6.85

493.20

493.20

34820 00

Surgery

9.82

9.82

707.04

707.04

34830 00

Surgery

51.60

51.60

3715.20

3715.20

34831 00

Surgery

56.43

56.43

4062.96

4062.96

34832 00

Surgery

55.47

55.47

3993.84

3993.84

34833 00

Surgery

11.46

11.46

825.12

825.12

34834 00

Surgery

3.77

3.77

271.44

271.44

34839 00

Surgery

0.00

0.00

Bundled Code

Bundled Code

34841 00

Surgery

0.00

0.00

BR

BR

34842 00

Surgery

0.00

0.00

BR

BR

34843 00

Surgery

-

-

5652.00

4860.72

34844 00

Surgery

-

-

6176.16

5311.44

34845 00

Surgery

0.00

0.00

BR

BR

34846 00

Surgery

-

-

6033.60

5189.04

34847 00

Surgery

-

-

6742.80

5798.88

34848 00

Surgery

-

-

8928.00

7678.08

35001 00

Surgery

32.93

32.93

2370.96

2370.96

35002 00

Surgery

33.39

33.39

2404.08

2404.08

35005 00

Surgery

29.24

29.24

2105.28

2105.28

35011 00

Surgery

29.68

29.68

2136.96

2136.96

35013 00

Surgery

37.25

37.25

2682.00

2682.00

35021 00

Surgery

37.06

37.06

2668.32

2668.32

35022 00

Surgery

42.37

42.37

3050.64

3050.64

35045 00

Surgery

28.49

28.49

2051.28

2051.28

35081 00

Surgery

50.67

50.67

3648.24

3648.24

35082 00

Surgery

63.25

63.25

4554.00

4554.00

35091 00

Surgery

52.04

52.04

3746.88

3746.88

35092 00

Surgery

75.93

75.93

5466.96

5466.96

35102 00

Surgery

55.09

55.09

3966.48

3966.48

35103 00

Surgery

64.85

64.85

4669.20

4669.20

35111 00

Surgery

38.94

38.94

2803.68

2803.68

35112 00

Surgery

47.85

47.85

3445.20

3445.20

35121 00

Surgery

46.28

46.28

3332.16

3332.16

35122 00

Surgery

55.35

55.35

3985.20

3985.20

35131 00

Surgery

40.48

40.48

2914.56

2914.56

35132 00

Surgery

47.85

47.85

3445.20

3445.20

35141 00

Surgery

32.00

32.00

2304.00

2304.00

35142 00

Surgery

38.65

38.65

2782.80

2782.80

35151 00

Surgery

36.38

36.38

2619.36

2619.36

35152 00

Surgery

40.94

40.94

2947.68

2947.68

35180 00

Surgery

23.06

23.06

1660.32

1660.32

35182 00

Surgery

52.91

52.91

3809.52

3809.52

35184 00

Surgery

28.30

28.30

2037.60

2037.60

35188 00

Surgery

39.12

39.12

2816.64

2816.64

35189 00

Surgery

44.23

44.23

3184.56

3184.56

35190 00

Surgery

22.29

22.29

1604.88

1604.88

35201 00

Surgery

27.52

27.52

1981.44

1981.44

35206 00

Surgery

23.38

23.38

1683.36

1683.36

35207 00

Surgery

22.75

22.75

1638.00

1638.00

35211 00

Surgery

41.09

41.09

2958.48

2958.48

35216 00

Surgery

62.15

62.15

4474.80

4474.80

35221 00

Surgery

43.51

43.51

3132.72

3132.72

35226 00

Surgery

24.35

24.35

1753.20

1753.20

35231 00

Surgery

37.04

37.04

2666.88

2666.88

35236 00

Surgery

29.44

29.44

2119.68

2119.68

35241 00

Surgery

42.19

42.19

3037.68

3037.68

35246 00

Surgery

45.87

45.87

3302.64

3302.64

35251 00

Surgery

51.25

51.25

3690.00

3690.00

35256 00

Surgery

29.69

29.69

2137.68

2137.68

35261 00

Surgery

28.79

28.79

2072.88

2072.88

35266 00

Surgery

25.46

25.46

1833.12

1833.12

35271 00

Surgery

40.87

40.87

2942.64

2942.64

35276 00

Surgery

42.87

42.87

3086.64

3086.64

35281 00

Surgery

47.61

47.61

3427.92

3427.92

35286 00

Surgery

27.20

27.20

1958.40

1958.40

35301 00

Surgery

33.10

33.10

2383.20

2383.20

35302 00

Surgery

32.73

32.73

2356.56

2356.56

35303 00

Surgery

35.88

35.88

2583.36

2583.36

35304 00

Surgery

37.35

37.35

2689.20

2689.20

35305 00

Surgery

35.93

35.93

2586.96

2586.96

35306 00

Surgery

12.97

12.97

933.84

933.84

35311 00

Surgery

45.54

45.54

3278.88

3278.88

35321 00

Surgery

26.38

26.38

1899.36

1899.36

35331 00

Surgery

42.60

42.60

3067.20

3067.20

35341 00

Surgery

40.63

40.63

2925.36

2925.36

35351 00

Surgery

37.64

37.64

2710.08

2710.08

35355 00

Surgery

30.11

30.11

2167.92

2167.92

35361 00

Surgery

44.60

44.60

3211.20

3211.20

35363 00

Surgery

47.54

47.54

3422.88

3422.88

35371 00

Surgery

23.87

23.87

1718.64

1718.64

35372 00

Surgery

28.60

28.60

2059.20

2059.20

35390 00

Surgery

4.63

4.63

333.36

333.36

35400 00

Surgery

4.31

4.31

310.32

310.32

35500 00

Surgery

9.28

9.28

668.16

668.16

35501 00

Surgery

42.72

42.72

3075.84

3075.84

35506 00

Surgery

37.30

37.30

2685.60

2685.60

35508 00

Surgery

38.95

38.95

2804.40

2804.40

35509 00

Surgery

41.31

41.31

2974.32

2974.32

35510 00

Surgery

36.02

36.02

2593.44

2593.44

35511 00

Surgery

32.82

32.82

2363.04

2363.04

35512 00

Surgery

35.32

35.32

2543.04

2543.04

35515 00

Surgery

38.95

38.95

2804.40

2804.40

35516 00

Surgery

35.74

35.74

2573.28

2573.28

35518 00

Surgery

33.45

33.45

2408.40

2408.40

35521 00

Surgery

36.00

36.00

2592.00

2592.00

35522 00

Surgery

34.26

34.26

2466.72

2466.72

35523 00

Surgery

36.05

36.05

2595.60

2595.60

35525 00

Surgery

33.18

33.18

2388.96

2388.96

35526 00

Surgery

50.72

50.72

3651.84

3651.84

35531 00

Surgery

57.07

57.07

4109.04

4109.04

35533 00

Surgery

44.15

44.15

3178.80

3178.80

35535 00

Surgery

55.70

55.70

4010.40

4010.40

35536 00

Surgery

49.47

49.47

3561.84

3561.84

35537 00

Surgery

61.00

61.00

4392.00

4392.00

35538 00

Surgery

68.31

68.31

4918.32

4918.32

35539 00

Surgery

64.12

64.12

4616.64

4616.64

35540 00

Surgery

71.44

71.44

5143.68

5143.68

35556 00

Surgery

40.76

40.76

2934.72

2934.72

35558 00

Surgery

36.30

36.30

2613.60

2613.60

35560 00

Surgery

49.91

49.91

3593.52

3593.52

35563 00

Surgery

38.80

38.80

2793.60

2793.60

35565 00

Surgery

38.42

38.42

2766.24

2766.24

35566 00

Surgery

48.60

48.60

3499.20

3499.20

35570 00

Surgery

43.18

43.18

3108.96

3108.96

35571 00

Surgery

38.73

38.73

2788.56

2788.56

35572 00

Surgery

10.01

10.01

720.72

720.72

35583 00

Surgery

42.18

42.18

3036.96

3036.96

35585 00

Surgery

48.84

48.84

3516.48

3516.48

35587 00

Surgery

39.05

39.05

2811.60

2811.60

35600 00

Surgery

5.44

5.44

391.68

391.68

35601 00

Surgery

41.00

41.00

2952.00

2952.00

35606 00

Surgery

34.45

34.45

2480.40

2480.40

35612 00

Surgery

30.68

30.68

2208.96

2208.96

35616 00

Surgery

32.28

32.28

2324.16

2324.16

35621 00

Surgery

32.10

32.10

2311.20

2311.20

35623 00

Surgery

38.51

38.51

2772.72

2772.72

35626 00

Surgery

46.54

46.54

3350.88

3350.88

35631 00

Surgery

54.22

54.22

3903.84

3903.84

35632 00

Surgery

52.88

52.88

3807.36

3807.36

35633 00

Surgery

58.00

58.00

4176.00

4176.00

35634 00

Surgery

51.75

51.75

3726.00

3726.00

35636 00

Surgery

46.70

46.70

3362.40

3362.40

35637 00

Surgery

48.55

48.55

3495.60

3495.60

35638 00

Surgery

50.75

50.75

3654.00

3654.00

35642 00

Surgery

29.02

29.02

2089.44

2089.44

35645 00

Surgery

27.80

27.80

2001.60

2001.60

35646 00

Surgery

49.88

49.88

3591.36

3591.36

35647 00

Surgery

45.37

45.37

3266.64

3266.64

35650 00

Surgery

29.94

29.94

2155.68

2155.68

35654 00

Surgery

39.91

39.91

2873.52

2873.52

35656 00

Surgery

31.40

31.40

2260.80

2260.80

35661 00

Surgery

31.71

31.71

2283.12

2283.12

35663 00

Surgery

35.73

35.73

2572.56

2572.56

35665 00

Surgery

34.38

34.38

2475.36

2475.36

35666 00

Surgery

37.71

37.71

2715.12

2715.12

35671 00

Surgery

33.20

33.20

2390.40

2390.40

35681 00

Surgery

2.33

2.33

167.76

167.76

35682 00

Surgery

10.29

10.29

740.88

740.88

35683 00

Surgery

11.92

11.92

858.24

858.24

35685 00

Surgery

5.77

5.77

415.44

415.44

35686 00

Surgery

4.68

4.68

336.96

336.96

35691 00

Surgery

27.76

27.76

1998.72

1998.72

35693 00

Surgery

24.62

24.62

1772.64

1772.64

35694 00

Surgery

28.99

28.99

2087.28

2087.28

35695 00

Surgery

30.08

30.08

2165.76

2165.76

35697 00

Surgery

4.27

4.27

307.44

307.44

35700 00

Surgery

4.42

4.42

318.24

318.24

35701 00

Surgery

13.01

13.01

936.72

936.72

35702 00

Surgery

12.10

12.10

871.20

871.20

35703 00

Surgery

12.24

12.24

881.28

881.28

35800 00

Surgery

21.86

21.86

1573.92

1573.92

35820 00

Surgery

59.21

59.21

4263.12

4263.12

35840 00

Surgery

36.20

36.20

2606.40

2606.40

35860 00

Surgery

24.80

24.80

1785.60

1785.60

35870 00

Surgery

36.58

36.58

2633.76

2633.76

35875 00

Surgery

17.37

17.37

1250.64

1250.64

35876 00

Surgery

27.61

27.61

1987.92

1987.92

35879 00

Surgery

26.99

26.99

1943.28

1943.28

35881 00

Surgery

30.17

30.17

2172.24

2172.24

35883 00

Surgery

35.00

35.00

2520.00

2520.00

35884 00

Surgery

36.29

36.29

2612.88

2612.88

35901 00

Surgery

14.07

14.07

1013.04

1013.04

35903 00

Surgery

16.64

16.64

1198.08

1198.08

35905 00

Surgery

49.19

49.19

3541.68

3541.68

35907 00

Surgery

55.88

55.88

4023.36

4023.36

36000 00

Surgery

0.00

0.00

Bundled Code

Bundled Code

36002 00

Surgery

4.59

3.06

330.48

220.32

36005 00

Surgery

7.48

1.39

538.56

100.08

36010 00

Surgery

15.90

3.17

1144.80

228.24

36011 00

Surgery

23.52

4.55

1693.44

327.60

36012 00

Surgery

24.56

5.07

1768.32

365.04

36013 00

Surgery

22.99

3.67

1655.28

264.24

36014 00

Surgery

23.10

4.41

1663.20

317.52

36015 00

Surgery

24.81

4.99

1786.32

359.28

36100 00

Surgery

15.81

4.45

1138.32

320.40

36140 00

Surgery

15.09

2.60

1086.48

187.20

36160 00

Surgery

16.28

3.59

1172.16

258.48

36200 00

Surgery

17.47

4.07

1257.84

293.04

36215 00

Surgery

30.53

6.21

2198.16

447.12

36216 00

Surgery

31.46

7.97

2265.12

573.84

36217 00

Surgery

53.47

9.78

3849.84

704.16

36218 00

Surgery

6.22

1.54

447.84

110.88

36221 00

Surgery

29.12

5.85

2096.64

421.20

36222 00

Surgery

36.52

8.42

2629.44

606.24

36223 00

Surgery

49.64

9.73

3574.08

700.56

36224 00

Surgery

61.29

10.93

4412.88

786.96

36225 00

Surgery

47.14

9.65

3394.08

694.80

36226 00

Surgery

59.72

10.86

4299.84

781.92

36227 00

Surgery

7.28

3.58

524.16

257.76

36228 00

Surgery

38.52

7.38

2773.44

531.36

36245 00

Surgery

36.50

6.88

2628.00

495.36

36246 00

Surgery

24.58

7.38

1769.76

531.36

36247 00

Surgery

41.76

8.69

3006.72

625.68

36248 00

Surgery

3.43

1.40

246.96

100.80

36251 00

Surgery

37.83

7.46

2723.76

537.12

36252 00

Surgery

41.04

10.43

2954.88

750.96

36253 00

Surgery

59.02

10.29

4249.44

740.88

36254 00

Surgery

58.18

12.16

4188.96

875.52

36260 00

Surgery

19.79

19.79

1424.88

1424.88

36261 00

Surgery

12.47

12.47

897.84

897.84

36262 00

Surgery

9.54

9.54

686.88

686.88

36299 00

Surgery

0.00

0.00

BR

BR

36400 00

Surgery

0.82

0.55

59.04

39.60

36405 00

Surgery

0.72

0.44

51.84

31.68

36406 00

Surgery

0.53

0.26

38.16

18.72

36410 00

Surgery

0.53

0.27

38.16

19.44

36415 00

Surgery

0.27

0.27

19.42

19.42

36416 00

Surgery

0.00

0.00

Bundled Code

Bundled Code

36420 00

Surgery

1.41

1.41

101.52

101.52

36425 00

Surgery

1.17

1.17

84.24

84.24

36430 00

Surgery

1.27

1.27

91.44

91.44

36440 00

Surgery

1.48

1.48

106.56

106.56

36450 00

Surgery

5.03

5.03

362.16

362.16

36455 00

Surgery

3.69

3.69

265.68

265.68

36456 00

Surgery

2.87

2.87

206.64

206.64

36460 00

Surgery

10.24

10.24

737.28

737.28

36465 00

Surgery

38.22

3.49

2751.84

251.28

36466 00

Surgery

40.36

4.45

2905.92

320.40

36468 00

Surgery

-

-

243.36

208.80

36470 00

Surgery

3.46

1.12

249.12

80.64

36471 00

Surgery

5.99

2.23

431.28

160.56

36473 00

Surgery

35.64

5.32

2566.08

383.04

36474 00

Surgery

7.47

2.60

537.84

187.20

36475 00

Surgery

31.71

8.15

2283.12

586.80

36476 00

Surgery

8.35

3.90

601.20

280.80

36478 00

Surgery

28.96

8.15

2085.12

586.80

36479 00

Surgery

8.98

3.98

646.56

286.56

36481 00

Surgery

50.76

9.47

3654.72

681.84

36482 00

Surgery

49.27

5.26

3547.44

378.72

36483 00

Surgery

4.09

2.59

294.48

186.48

36500 00

Surgery

5.33

5.33

383.76

383.76

36510 00

Surgery

2.58

1.57

185.76

113.04

36511 00

Surgery

3.28

3.28

236.16

236.16

36512 00

Surgery

3.12

3.12

224.64

224.64

36513 00

Surgery

3.13

3.13

225.36

225.36

36514 00

Surgery

19.94

2.75

1435.68

198.00

36516 00

Surgery

53.26

2.54

3834.72

182.88

36522 00

Surgery

39.91

2.82

2873.52

203.04

36555 00

Surgery

5.60

2.48

403.20

178.56

36556 00

Surgery

6.35

2.49

457.20

179.28

36557 00

Surgery

34.14

9.60

2458.08

691.20

36558 00

Surgery

24.30

7.63

1749.60

549.36

36560 00

Surgery

36.43

11.47

2622.96

825.84

36561 00

Surgery

28.74

9.81

2069.28

706.32

36563 00

Surgery

32.31

10.72

2326.32

771.84

36565 00

Surgery

24.49

9.98

1763.28

718.56

36566 00

Surgery

123.98

10.55

8926.56

759.60

36568 00

Surgery

2.70

2.70

194.40

194.40

36569 00

Surgery

2.79

2.79

200.88

200.88

36570 00

Surgery

42.84

9.96

3084.48

717.12

36571 00

Surgery

36.92

9.29

2658.24

668.88

36572 00

Surgery

11.02

2.38

793.44

171.36

36573 00

Surgery

11.26

2.44

810.72

175.68

36575 00

Surgery

4.28

0.98

308.16

70.56

36576 00

Surgery

10.22

5.43

735.84

390.96

36578 00

Surgery

12.74

6.04

917.28

434.88

36580 00

Surgery

5.58

1.91

401.76

137.52

36581 00

Surgery

22.79

5.38

1640.88

387.36

36582 00

Surgery

25.73

8.48

1852.56

610.56

36583 00

Surgery

33.88

9.84

2439.36

708.48

36584 00

Surgery

9.57

1.71

689.04

123.12

36585 00

Surgery

33.54

8.25

2414.88

594.00

36589 00

Surgery

4.91

4.03

353.52

290.16

36590 00

Surgery

6.64

5.62

478.08

404.64

36591 00

Surgery

0.83

0.83

59.76

59.76

36592 00

Surgery

0.90

0.90

64.80

64.80

36593 00

Surgery

1.04

1.04

74.88

74.88

36595 00

Surgery

17.48

5.29

1258.56

380.88

36596 00

Surgery

3.44

1.33

247.68

95.76

36597 00

Surgery

3.29

1.76

236.88

126.72

36598 00

Surgery

3.55

1.04

255.60

74.88

36600 00

Surgery

0.82

0.44

59.04

31.68

36620 00

Surgery

1.30

1.30

93.60

93.60

36625 00

Surgery

3.10

3.10

223.20

223.20

36640 00

Surgery

3.50

3.50

252.00

252.00

36660 00

Surgery

2.01

2.01

144.72

144.72

36680 00

Surgery

1.77

1.77

127.44

127.44

36800 00

Surgery

3.56

3.56

256.32

256.32

36810 00

Surgery

6.19

6.19

445.68

445.68

36815 00

Surgery

3.97

3.97

285.84

285.84

36818 00

Surgery

20.26

20.26

1458.72

1458.72

36819 00

Surgery

21.45

21.45

1544.40

1544.40

36820 00

Surgery

21.34

21.34

1536.48

1536.48

36821 00

Surgery

19.39

19.39

1396.08

1396.08

36823 00

Surgery

42.08

42.08

3029.76

3029.76

36825 00

Surgery

23.32

23.32

1679.04

1679.04

36830 00

Surgery

19.58

19.58

1409.76

1409.76

36831 00

Surgery

18.14

18.14

1306.08

1306.08

36832 00

Surgery

22.23

22.23

1600.56

1600.56

36833 00

Surgery

23.71

23.71

1707.12

1707.12

36835 00

Surgery

14.41

14.41

1037.52

1037.52

36836 00

Surgery

240.53

10.40

17318.16

748.80

36837 00

Surgery

286.30

13.45

20613.60

968.40

36838 00

Surgery

33.40

33.40

2404.80

2404.80

36860 00

Surgery

6.97

3.26

501.84

234.72

36861 00

Surgery

4.09

4.09

294.48

294.48

36901 00

Surgery

20.79

4.90

1496.88

352.80

36902 00

Surgery

35.53

6.99

2558.16

503.28

36903 00

Surgery

124.51

9.19

8964.72

661.68

36904 00

Surgery

53.16

10.72

3827.52

771.84

36905 00

Surgery

66.85

12.87

4813.20

926.64

36906 00

Surgery

158.48

14.86

11410.56

1069.92

36907 00

Surgery

17.33

4.25

1247.76

306.00

36908 00

Surgery

41.53

6.03

2990.16

434.16

36909 00

Surgery

55.54

5.85

3998.88

421.20

37140 00

Surgery

69.30

69.30

4989.60

4989.60

37145 00

Surgery

64.31

64.31

4630.32

4630.32

37160 00

Surgery

66.05

66.05

4755.60

4755.60

37180 00

Surgery

63.49

63.49

4571.28

4571.28

37181 00

Surgery

69.30

69.30

4989.60

4989.60

37182 00

Surgery

23.63

23.63

1701.36

1701.36

37183 00

Surgery

170.20

10.85

12254.40

781.20

37184 00

Surgery

50.25

12.55

3618.00

903.60

37185 00

Surgery

13.95

4.74

1004.40

341.28

37186 00

Surgery

34.83

7.10

2507.76

511.20

37187 00

Surgery

49.67

11.45

3576.24

824.40

37188 00

Surgery

42.55

8.19

3063.60

589.68

37191 00

Surgery

59.20

6.42

4262.40

462.24

37192 00

Surgery

37.71

10.05

2715.12

723.60

37193 00

Surgery

44.00

10.09

3168.00

726.48

37195 00

Surgery

-

-

1504.80

1293.84

37197 00

Surgery

45.94

8.76

3307.68

630.72

37200 00

Surgery

6.23

6.23

448.56

448.56

37211 00

Surgery

11.28

11.28

812.16

812.16

37212 00

Surgery

9.83

9.83

707.76

707.76

37213 00

Surgery

6.72

6.72

483.84

483.84

37214 00

Surgery

3.55

3.55

255.60

255.60

37215 00

Surgery

29.04

29.04

2090.88

2090.88

37216 00

Surgery

29.18

29.18

2100.96

2100.96

37217 00

Surgery

31.58

31.58

2273.76

2273.76

37218 00

Surgery

24.30

24.30

1749.60

1749.60

37220 00

Surgery

73.65

11.64

5302.80

838.08

37221 00

Surgery

90.41

14.34

6509.52

1032.48

37222 00

Surgery

18.18

5.38

1308.96

387.36

37223 00

Surgery

37.29

6.16

2684.88

443.52

37224 00

Surgery

85.63

12.94

6165.36

931.68

37225 00

Surgery

256.71

17.41

18483.12

1253.52

37226 00

Surgery

237.79

15.09

17120.88

1086.48

37227 00

Surgery

327.81

20.83

23602.32

1499.76

37228 00

Surgery

121.34

15.73

8736.48

1132.56

37229 00

Surgery

261.20

20.15

18806.40

1450.80

37230 00

Surgery

261.62

20.16

18836.64

1451.52

37231 00

Surgery

345.41

21.35

24869.52

1537.20

37232 00

Surgery

24.14

5.79

1738.08

416.88

37233 00

Surgery

31.01

9.36

2232.72

673.92

37234 00

Surgery

106.68

8.18

7680.96

588.96

37235 00

Surgery

115.88

10.69

8343.36

769.68

37236 00

Surgery

80.69

12.84

5809.68

924.48

37237 00

Surgery

37.94

6.15

2731.68

442.80

37238 00

Surgery

101.29

8.94

7292.88

643.68

37239 00

Surgery

50.62

4.38

3644.64

315.36

37241 00

Surgery

135.66

12.43

9767.52

894.96

37242 00

Surgery

207.36

13.84

14929.92

996.48

37243 00

Surgery

251.28

16.26

18092.16

1170.72

37244 00

Surgery

191.96

19.17

13821.12

1380.24

37246 00

Surgery

53.33

10.14

3839.76

730.08

37247 00

Surgery

17.34

5.05

1248.48

363.60

37248 00

Surgery

39.77

8.65

2863.44

622.80

37249 00

Surgery

13.01

4.24

936.72

305.28

37252 00

Surgery

27.85

2.59

2005.20

186.48

37253 00

Surgery

5.12

2.06

368.64

148.32

37500 00

Surgery

18.57

18.57

1337.04

1337.04

37501 00

Surgery

0.00

0.00

BR

BR

37565 00

Surgery

21.73

21.73

1564.56

1564.56

37600 00

Surgery

22.35

22.35

1609.20

1609.20

37605 00

Surgery

21.71

21.71

1563.12

1563.12

37606 00

Surgery

22.38

22.38

1611.36

1611.36

37607 00

Surgery

11.07

11.07

797.04

797.04

37609 00

Surgery

9.34

6.11

672.48

439.92

37615 00

Surgery

15.45

15.45

1112.40

1112.40

37616 00

Surgery

33.50

33.50

2412.00

2412.00

37617 00

Surgery

39.31

39.31

2830.32

2830.32

37618 00

Surgery

11.73

11.73

844.56

844.56

37619 00

Surgery

51.51

51.51

3708.72

3708.72

37650 00

Surgery

13.56

13.56

976.32

976.32

37660 00

Surgery

39.32

39.32

2831.04

2831.04

37700 00

Surgery

7.26

7.26

522.72

522.72

37718 00

Surgery

11.61

11.61

835.92

835.92

37722 00

Surgery

13.63

13.63

981.36

981.36

37735 00

Surgery

17.17

17.17

1236.24

1236.24

37760 00

Surgery

17.00

17.00

1224.00

1224.00

37761 00

Surgery

15.90

15.90

1144.80

1144.80

37765 00

Surgery

12.55

7.98

903.60

574.56

37766 00

Surgery

14.76

9.78

1062.72

704.16

37780 00

Surgery

7.01

7.01

504.72

504.72

37785 00

Surgery

10.45

7.58

752.40

545.76

37788 00

Surgery

37.50

37.50

2700.00

2700.00

37790 00

Surgery

14.54

14.54

1046.88

1046.88

37799 00

Surgery

0.00

0.00

BR

BR

38100 00

Surgery

34.45

34.45

2480.40

2480.40

38101 00

Surgery

34.89

34.89

2512.08

2512.08

38102 00

Surgery

7.79

7.79

560.88

560.88

38115 00

Surgery

38.69

38.69

2785.68

2785.68

38120 00

Surgery

31.84

31.84

2292.48

2292.48

38129 00

Surgery

0.00

0.00

BR

BR

38200 00

Surgery

3.82

3.82

275.04

275.04

38204 00

Surgery

0.00

0.00

Bundled Code

Bundled Code

38205 00

Surgery

2.49

2.49

179.28

179.28

38206 00

Surgery

2.44

2.44

175.68

175.68

38207 00

Surgery

1.33

1.33

95.76

95.76

38208 00

Surgery

0.84

0.84

60.48

60.48

38209 00

Surgery

0.35

0.35

25.20

25.20

38210 00

Surgery

2.34

2.34

168.48

168.48

38211 00

Surgery

2.12

2.12

152.64

152.64

38212 00

Surgery

1.40

1.40

100.80

100.80

38213 00

Surgery

0.35

0.35

25.20

25.20

38214 00

Surgery

1.20

1.20

86.40

86.40

38215 00

Surgery

1.40

1.40

100.80

100.80

38220 00

Surgery

4.72

1.99

339.84

143.28

38221 00

Surgery

4.88

2.08

351.36

149.76

38222 00

Surgery

5.26

2.22

378.72

159.84

38230 00

Surgery

6.04

6.04

434.88

434.88

38232 00

Surgery

5.61

5.61

403.92

403.92

38240 00

Surgery

7.16

7.16

515.52

515.52

38241 00

Surgery

5.29

5.29

380.88

380.88

38242 00

Surgery

3.74

3.74

269.28

269.28

38243 00

Surgery

3.67

3.67

264.24

264.24

38300 00

Surgery

10.19

6.36

733.68

457.92

38305 00

Surgery

15.00

15.00

1080.00

1080.00

38308 00

Surgery

14.20

14.20

1022.40

1022.40

38380 00

Surgery

17.45

17.45

1256.40

1256.40

38381 00

Surgery

23.98

23.98

1726.56

1726.56

38382 00

Surgery

20.44

20.44

1471.68

1471.68

38500 00

Surgery

10.15

7.70

730.80

554.40

38505 00

Surgery

5.21

2.53

375.12

182.16

38510 00

Surgery

15.91

12.58

1145.52

905.76

38520 00

Surgery

14.11

14.11

1015.92

1015.92

38525 00

Surgery

13.34

13.34

960.48

960.48

38530 00

Surgery

17.07

17.07

1229.04

1229.04

38531 00

Surgery

13.52

13.52

973.44

973.44

38542 00

Surgery

15.81

15.81

1138.32

1138.32

38550 00

Surgery

15.83

15.83

1139.76

1139.76

38555 00

Surgery

30.91

30.91

2225.52

2225.52

38562 00

Surgery

21.28

21.28

1532.16

1532.16

38564 00

Surgery

21.06

21.06

1516.32

1516.32

38570 00

Surgery

15.53

15.53

1118.16

1118.16

38571 00

Surgery

19.77

19.77

1423.44

1423.44

38572 00

Surgery

26.92

26.92

1938.24

1938.24

38573 00

Surgery

35.32

35.32

2543.04

2543.04

38589 00

Surgery

0.00

0.00

BR

BR

38700 00

Surgery

24.27

24.27

1747.44

1747.44

38720 00

Surgery

40.40

40.40

2908.80

2908.80

38724 00

Surgery

43.60

43.60

3139.20

3139.20

38740 00

Surgery

21.20

21.20

1526.40

1526.40

38745 00

Surgery

26.62

26.62

1916.64

1916.64

38746 00

Surgery

6.29

6.29

452.88

452.88

38747 00

Surgery

7.92

7.92

570.24

570.24

38760 00

Surgery

25.17

25.17

1812.24

1812.24

38765 00

Surgery

39.25

39.25

2826.00

2826.00

38770 00

Surgery

24.18

24.18

1740.96

1740.96

38780 00

Surgery

31.55

31.55

2271.60

2271.60

38790 00

Surgery

2.44

2.44

175.68

175.68

38792 00

Surgery

2.47

0.95

177.84

68.40

38794 00

Surgery

8.36

8.36

601.92

601.92

38900 00

Surgery

4.09

4.09

294.48

294.48

38999 00

Surgery

0.00

0.00

BR

BR

39000 00

Surgery

15.15

15.15

1090.80

1090.80

39010 00

Surgery

23.47

23.47

1689.84

1689.84

39200 00

Surgery

25.80

25.80

1857.60

1857.60

39220 00

Surgery

33.71

33.71

2427.12

2427.12

39401 00

Surgery

9.11

9.11

655.92

655.92

39402 00

Surgery

11.89

11.89

856.08

856.08

39499 00

Surgery

0.00

0.00

BR

BR

39501 00

Surgery

25.55

25.55

1839.60

1839.60

39503 00

Surgery

171.00

171.00

12312.00

12312.00

39540 00

Surgery

25.95

25.95

1868.40

1868.40

39541 00

Surgery

27.88

27.88

2007.36

2007.36

39545 00

Surgery

26.67

26.67

1920.24

1920.24

39560 00

Surgery

24.05

24.05

1731.60

1731.60

39561 00

Surgery

37.54

37.54

2702.88

2702.88

39599 00

Surgery

0.00

0.00

BR

BR

40490 00

Surgery

3.68

2.06

264.96

148.32

40500 00

Surgery

16.00

11.23

1152.00

808.56

40510 00

Surgery

14.79

10.57

1064.88

761.04

40520 00

Surgery

15.19

10.81

1093.68

778.32

40525 00

Surgery

16.68

16.68

1200.96

1200.96

40527 00

Surgery

19.00

19.00

1368.00

1368.00

40530 00

Surgery

16.85

12.28

1213.20

884.16

40650 00

Surgery

14.58

9.62

1049.76

692.64

40652 00

Surgery

15.66

10.96

1127.52

789.12

40654 00

Surgery

17.74

12.92

1277.28

930.24

40700 00

Surgery

30.29

30.29

2180.88

2180.88

40701 00

Surgery

35.71

35.71

2571.12

2571.12

40702 00

Surgery

30.02

30.02

2161.44

2161.44

40720 00

Surgery

30.80

30.80

2217.60

2217.60

40761 00

Surgery

32.33

32.33

2327.76

2327.76

40799 00

Surgery

0.00

0.00

BR

BR

40800 00

Surgery

6.08

3.58

437.76

257.76

40801 00

Surgery

8.77

5.98

631.44

430.56

40804 00

Surgery

5.70

3.44

410.40

247.68

40805 00

Surgery

8.55

5.94

615.60

427.68

40806 00

Surgery

3.00

0.89

216.00

64.08

40808 00

Surgery

5.10

2.69

367.20

193.68

40810 00

Surgery

6.53

3.70

470.16

266.40

40812 00

Surgery

8.33

5.48

599.76

394.56

40814 00

Surgery

11.17

8.52

804.24

613.44

40816 00

Surgery

12.16

9.17

875.52

660.24

40818 00

Surgery

10.94

7.99

787.68

575.28

40819 00

Surgery

8.12

6.01

584.64

432.72

40820 00

Surgery

7.79

5.01

560.88

360.72

40830 00

Surgery

6.73

4.37

484.56

314.64

40831 00

Surgery

8.85

6.03

637.20

434.16

40840 00

Surgery

26.07

19.08

1877.04

1373.76

40842 00

Surgery

28.06

20.42

2020.32

1470.24

40843 00

Surgery

36.11

26.16

2599.92

1883.52

40844 00

Surgery

45.33

35.40

3263.76

2548.80

40845 00

Surgery

44.52

36.23

3205.44

2608.56

40899 00

Surgery

0.00

0.00

BR

BR

41000 00

Surgery

4.37

3.14

314.64

226.08

41005 00

Surgery

6.85

3.50

493.20

252.00

41006 00

Surgery

10.18

6.95

732.96

500.40

41007 00

Surgery

9.87

6.66

710.64

479.52

41008 00

Surgery

11.82

7.77

851.04

559.44

41009 00

Surgery

12.75

8.61

918.00

619.92

41010 00

Surgery

6.52

3.33

469.44

239.76

41015 00

Surgery

11.99

8.99

863.28

647.28

41016 00

Surgery

13.98

10.36

1006.56

745.92

41017 00

Surgery

13.97

10.30

1005.84

741.60

41018 00

Surgery

15.75

12.01

1134.00

864.72

41019 00

Surgery

14.56

14.56

1048.32

1048.32

41100 00

Surgery

5.65

3.24

406.80

233.28

41105 00

Surgery

5.67

3.33

408.24

239.76

41108 00

Surgery

5.07

2.76

365.04

198.72

41110 00

Surgery

6.93

3.93

498.96

282.96

41112 00

Surgery

10.21

7.33

735.12

527.76

41113 00

Surgery

10.89

7.95

784.08

572.40

41114 00

Surgery

18.73

18.73

1348.56

1348.56

41115 00

Surgery

7.87

4.42

566.64

318.24

41116 00

Surgery

10.07

6.54

725.04

470.88

41120 00

Surgery

31.70

31.70

2282.40

2282.40

41130 00

Surgery

39.21

39.21

2823.12

2823.12

41135 00

Surgery

64.62

64.62

4652.64

4652.64

41140 00

Surgery

65.08

65.08

4685.76

4685.76

41145 00

Surgery

81.94

81.94

5899.68

5899.68

41150 00

Surgery

65.57

65.57

4721.04

4721.04

41153 00

Surgery

71.33

71.33

5135.76

5135.76

41155 00

Surgery

88.88

88.88

6399.36

6399.36

41250 00

Surgery

8.53

4.64

614.16

334.08

41251 00

Surgery

9.43

5.54

678.96

398.88

41252 00

Surgery

9.82

6.29

707.04

452.88

41510 00

Surgery

13.68

13.68

984.96

984.96

41512 00

Surgery

20.02

20.02

1441.44

1441.44

41520 00

Surgery

11.06

7.61

796.32

547.92

41530 00

Surgery

27.32

11.34

1967.04

816.48

41599 00

Surgery

0.00

0.00

BR

BR

41800 00

Surgery

8.76

4.66

630.72

335.52

41805 00

Surgery

9.22

5.86

663.84

421.92

41806 00

Surgery

12.24

8.29

881.28

596.88

41820 00

Surgery

-

-

882.00

740.88

41821 00

Surgery

-

-

223.92

187.92

41822 00

Surgery

10.68

6.08

768.96

437.76

41823 00

Surgery

15.97

11.12

1149.84

800.64

41825 00

Surgery

6.64

3.67

478.08

264.24

41826 00

Surgery

8.96

5.86

645.12

421.92

41827 00

Surgery

12.99

8.68

935.28

624.96

41828 00

Surgery

10.62

6.68

764.64

480.96

41830 00

Surgery

14.11

9.45

1015.92

680.40

41850 00

Surgery

-

-

396.72

333.36

41870 00

Surgery

-

-

731.52

614.88

41872 00

Surgery

14.21

9.22

1023.12

663.84

41874 00

Surgery

11.53

7.34

830.16

528.48

41899 00

Surgery

0.00

0.00

BR

BR

42000 00

Surgery

4.86

3.31

349.92

238.32

42100 00

Surgery

4.41

3.33

317.52

239.76

42104 00

Surgery

6.56

4.08

472.32

293.76

42106 00

Surgery

7.54

4.83

542.88

347.76

42107 00

Surgery

13.36

9.74

961.92

701.28

42120 00

Surgery

30.07

30.07

2165.04

2165.04

42140 00

Surgery

9.38

4.95

675.36

356.40

42145 00

Surgery

20.79

20.79

1496.88

1496.88

42160 00

Surgery

6.82

4.25

491.04

306.00

42180 00

Surgery

7.70

5.67

554.40

408.24

42182 00

Surgery

9.96

7.80

717.12

561.60

42200 00

Surgery

27.84

27.84

2004.48

2004.48

42205 00

Surgery

28.95

28.95

2084.40

2084.40

42210 00

Surgery

32.31

32.31

2326.32

2326.32

42215 00

Surgery

21.15

21.15

1522.80

1522.80

42220 00

Surgery

17.44

17.44

1255.68

1255.68

42225 00

Surgery

29.48

29.48

2122.56

2122.56

42226 00

Surgery

27.27

27.27

1963.44

1963.44

42227 00

Surgery

25.41

25.41

1829.52

1829.52

42235 00

Surgery

22.37

22.37

1610.64

1610.64

42260 00

Surgery

26.03

20.26

1874.16

1458.72

42280 00

Surgery

5.30

3.26

381.60

234.72

42281 00

Surgery

6.74

4.84

485.28

348.48

42299 00

Surgery

0.00

0.00

BR

BR

42300 00

Surgery

6.51

4.74

468.72

341.28

42305 00

Surgery

13.13

13.13

945.36

945.36

42310 00

Surgery

5.15

4.07

370.80

293.04

42320 00

Surgery

7.89

5.43

568.08

390.96

42330 00

Surgery

7.08

5.01

509.76

360.72

42335 00

Surgery

13.09

7.99

942.48

575.28

42340 00

Surgery

16.12

10.47

1160.64

753.84

42400 00

Surgery

2.87

1.58

206.64

113.76

42405 00

Surgery

9.21

6.86

663.12

493.92

42408 00

Surgery

16.28

10.49

1172.16

755.28

42409 00

Surgery

11.95

7.06

860.40

508.32

42410 00

Surgery

19.05

19.05

1371.60

1371.60

42415 00

Surgery

31.90

31.90

2296.80

2296.80

42420 00

Surgery

35.67

35.67

2568.24

2568.24

42425 00

Surgery

25.31

25.31

1822.32

1822.32

42426 00

Surgery

40.54

40.54

2918.88

2918.88

42440 00

Surgery

12.61

12.61

907.92

907.92

42450 00

Surgery

14.32

11.05

1031.04

795.60

42500 00

Surgery

13.60

10.47

979.20

753.84

42505 00

Surgery

17.43

13.90

1254.96

1000.80

42507 00

Surgery

14.98

14.98

1078.56

1078.56

42509 00

Surgery

24.66

24.66

1775.52

1775.52

42510 00

Surgery

18.37

18.37

1322.64

1322.64

42550 00

Surgery

4.59

1.80

330.48

129.60

42600 00

Surgery

16.51

10.82

1188.72

779.04

42650 00

Surgery

2.25

1.78

162.00

128.16

42660 00

Surgery

3.37

2.60

242.64

187.20

42665 00

Surgery

11.38

6.62

819.36

476.64

42699 00

Surgery

0.00

0.00

BR

BR

42700 00

Surgery

5.82

4.12

419.04

296.64

42720 00

Surgery

13.49

11.60

971.28

835.20

42725 00

Surgery

24.08

24.08

1733.76

1733.76

42800 00

Surgery

4.80

3.55

345.60

255.60

42804 00

Surgery

6.53

3.74

470.16

269.28

42806 00

Surgery

7.29

4.30

524.88

309.60

42808 00

Surgery

7.04

5.03

506.88

362.16

42809 00

Surgery

6.26

3.84

450.72

276.48

42810 00

Surgery

11.82

8.60

851.04

619.20

42815 00

Surgery

16.29

16.29

1172.88

1172.88

42820 00

Surgery

8.85

8.85

637.20

637.20

42821 00

Surgery

9.24

9.24

665.28

665.28

42825 00

Surgery

8.17

8.17

588.24

588.24

42826 00

Surgery

7.78

7.78

560.16

560.16

42830 00

Surgery

6.49

6.49

467.28

467.28

42831 00

Surgery

7.05

7.05

507.60

507.60

42835 00

Surgery

6.06

6.06

436.32

436.32

42836 00

Surgery

7.47

7.47

537.84

537.84

42842 00

Surgery

30.35

30.35

2185.20

2185.20

42844 00

Surgery

41.27

41.27

2971.44

2971.44

42845 00

Surgery

65.83

65.83

4739.76

4739.76

42860 00

Surgery

5.93

5.93

426.96

426.96

42870 00

Surgery

17.73

17.73

1276.56

1276.56

42890 00

Surgery

42.44

42.44

3055.68

3055.68

42892 00

Surgery

55.74

55.74

4013.28

4013.28

42894 00

Surgery

70.67

70.67

5088.24

5088.24

42900 00

Surgery

10.00

10.00

720.00

720.00

42950 00

Surgery

23.96

23.96

1725.12

1725.12

42953 00

Surgery

28.72

28.72

2067.84

2067.84

42955 00

Surgery

22.82

22.82

1643.04

1643.04

42960 00

Surgery

4.87

4.87

350.64

350.64

42961 00

Surgery

12.73

12.73

916.56

916.56

42962 00

Surgery

15.66

15.66

1127.52

1127.52

42970 00

Surgery

12.47

12.47

897.84

897.84

42971 00

Surgery

13.73

13.73

988.56

988.56

42972 00

Surgery

15.34

15.34

1104.48

1104.48

42975 00

Surgery

2.91

2.91

209.52

209.52

42999 00

Surgery

0.00

0.00

BR

BR

43020 00

Surgery

17.11

17.11

1231.92

1231.92

43030 00

Surgery

15.85

15.85

1141.20

1141.20

43045 00

Surgery

38.80

38.80

2793.60

2793.60

43100 00

Surgery

19.25

19.25

1386.00

1386.00

43101 00

Surgery

29.92

29.92

2154.24

2154.24

43107 00

Surgery

88.17

88.17

6348.24

6348.24

43108 00

Surgery

130.75

130.75

9414.00

9414.00

43112 00

Surgery

102.16

102.16

7355.52

7355.52

43113 00

Surgery

127.96

127.96

9213.12

9213.12

43116 00

Surgery

146.15

146.15

10522.80

10522.80

43117 00

Surgery

96.33

96.33

6935.76

6935.76

43118 00

Surgery

106.72

106.72

7683.84

7683.84

43121 00

Surgery

84.39

84.39

6076.08

6076.08

43122 00

Surgery

76.43

76.43

5502.96

5502.96

43123 00

Surgery

132.61

132.61

9547.92

9547.92

43124 00

Surgery

112.29

112.29

8084.88

8084.88

43130 00

Surgery

23.91

23.91

1721.52

1721.52

43135 00

Surgery

43.50

43.50

3132.00

3132.00

43180 00

Surgery

16.45

16.45

1184.40

1184.40

43191 00

Surgery

4.66

4.66

335.52

335.52

43192 00

Surgery

5.09

5.09

366.48

366.48

43193 00

Surgery

5.07

5.07

365.04

365.04

43194 00

Surgery

5.68

5.68

408.96

408.96

43195 00

Surgery

5.54

5.54

398.88

398.88

43196 00

Surgery

5.86

5.86

421.92

421.92

43197 00

Surgery

5.72

2.44

411.84

175.68

43198 00

Surgery

6.34

2.91

456.48

209.52

43200 00

Surgery

7.90

2.62

568.80

188.64

43201 00

Surgery

7.79

3.08

560.88

221.76

43202 00

Surgery

10.66

3.06

767.52

220.32

43204 00

Surgery

3.99

3.99

287.28

287.28

43205 00

Surgery

4.17

4.17

300.24

300.24

43206 00

Surgery

9.09

3.92

654.48

282.24

43210 00

Surgery

12.72

12.72

915.84

915.84

43211 00

Surgery

6.92

6.92

498.24

498.24

43212 00

Surgery

5.58

5.58

401.76

401.76

43213 00

Surgery

36.37

7.68

2618.64

552.96

43214 00

Surgery

5.75

5.75

414.00

414.00

43215 00

Surgery

11.75

4.19

846.00

301.68

43216 00

Surgery

12.22

3.95

879.84

284.40

43217 00

Surgery

12.59

4.73

906.48

340.56

43220 00

Surgery

26.70

3.50

1922.40

252.00

43226 00

Surgery

11.55

3.87

831.60

278.64

43227 00

Surgery

17.74

4.88

1277.28

351.36

43229 00

Surgery

21.16

5.81

1523.52

418.32

43231 00

Surgery

4.64

4.64

334.08

334.08

43232 00

Surgery

5.87

5.87

422.64

422.64

43233 00

Surgery

6.77

6.77

487.44

487.44

43235 00

Surgery

8.63

3.63

621.36

261.36

43236 00

Surgery

12.02

4.10

865.44

295.20

43237 00

Surgery

5.77

5.77

415.44

415.44

43238 00

Surgery

6.84

6.84

492.48

492.48

43239 00

Surgery

11.28

4.10

812.16

295.20

43240 00

Surgery

11.54

11.54

830.88

830.88

43241 00

Surgery

4.21

4.21

303.12

303.12

43242 00

Surgery

7.74

7.74

557.28

557.28

43243 00

Surgery

7.01

7.01

504.72

504.72

43244 00

Surgery

7.22

7.22

519.84

519.84

43245 00

Surgery

17.72

5.19

1275.84

373.68

43246 00

Surgery

5.92

5.92

426.24

426.24

43247 00

Surgery

11.49

5.22

827.28

375.84

43248 00

Surgery

12.38

4.91

891.36

353.52

43249 00

Surgery

32.04

4.54

2306.88

326.88

43250 00

Surgery

13.45

5.03

968.40

362.16

43251 00

Surgery

14.79

5.78

1064.88

416.16

43252 00

Surgery

10.18

4.97

732.96

357.84

43253 00

Surgery

7.73

7.73

556.56

556.56

43254 00

Surgery

7.95

7.95

572.40

572.40

43255 00

Surgery

18.68

5.90

1344.96

424.80

43257 00

Surgery

6.91

6.91

497.52

497.52

43259 00

Surgery

6.65

6.65

478.80

478.80

43260 00

Surgery

9.50

9.50

684.00

684.00

43261 00

Surgery

9.97

9.97

717.84

717.84

43262 00

Surgery

10.50

10.50

756.00

756.00

43263 00

Surgery

10.52

10.52

757.44

757.44

43264 00

Surgery

10.71

10.71

771.12

771.12

43265 00

Surgery

12.74

12.74

917.28

917.28

43266 00

Surgery

6.42

6.42

462.24

462.24

43270 00

Surgery

21.77

6.61

1567.44

475.92

43273 00

Surgery

3.50

3.50

252.00

252.00

43274 00

Surgery

13.61

13.61

979.92

979.92

43275 00

Surgery

11.07

11.07

797.04

797.04

43276 00

Surgery

14.17

14.17

1020.24

1020.24

43277 00

Surgery

11.13

11.13

801.36

801.36

43278 00

Surgery

12.74

12.74

917.28

917.28

43279 00

Surgery

38.38

38.38

2763.36

2763.36

43280 00

Surgery

32.32

32.32

2327.04

2327.04

43281 00

Surgery

45.94

45.94

3307.68

3307.68

43282 00

Surgery

51.74

51.74

3725.28

3725.28

43283 00

Surgery

4.67

4.67

336.24

336.24

43284 00

Surgery

19.68

19.68

1416.96

1416.96

43285 00

Surgery

20.23

20.23

1456.56

1456.56

43286 00

Surgery

94.05

94.05

6771.60

6771.60

43287 00

Surgery

105.10

105.10

7567.20

7567.20

43288 00

Surgery

110.84

110.84

7980.48

7980.48

43289 00

Surgery

0.00

0.00

BR

BR

43290 00

Surgery

78.00

5.38

5616.00

387.36

43291 00

Surgery

13.76

4.74

990.72

341.28

43300 00

Surgery

18.95

18.95

1364.40

1364.40

43305 00

Surgery

32.94

32.94

2371.68

2371.68

43310 00

Surgery

43.89

43.89

3160.08

3160.08

43312 00

Surgery

46.86

46.86

3373.92

3373.92

43313 00

Surgery

86.92

86.92

6258.24

6258.24

43314 00

Surgery

92.99

92.99

6695.28

6695.28

43320 00

Surgery

41.93

41.93

3018.96

3018.96

43325 00

Surgery

40.76

40.76

2934.72

2934.72

43327 00

Surgery

24.50

24.50

1764.00

1764.00

43328 00

Surgery

33.23

33.23

2392.56

2392.56

43330 00

Surgery

40.11

40.11

2887.92

2887.92

43331 00

Surgery

39.77

39.77

2863.44

2863.44

43332 00

Surgery

34.37

34.37

2474.64

2474.64

43333 00

Surgery

37.65

37.65

2710.80

2710.80

43334 00

Surgery

36.72

36.72

2643.84

2643.84

43335 00

Surgery

39.44

39.44

2839.68

2839.68

43336 00

Surgery

42.84

42.84

3084.48

3084.48

43337 00

Surgery

45.63

45.63

3285.36

3285.36

43338 00

Surgery

3.36

3.36

241.92

241.92

43340 00

Surgery

41.42

41.42

2982.24

2982.24

43341 00

Surgery

41.58

41.58

2993.76

2993.76

43351 00

Surgery

39.27

39.27

2827.44

2827.44

43352 00

Surgery

31.78

31.78

2288.16

2288.16

43360 00

Surgery

66.57

66.57

4793.04

4793.04

43361 00

Surgery

80.75

80.75

5814.00

5814.00

43400 00

Surgery

45.66

45.66

3287.52

3287.52

43405 00

Surgery

43.34

43.34

3120.48

3120.48

43410 00

Surgery

31.15

31.15

2242.80

2242.80

43415 00

Surgery

76.54

76.54

5510.88

5510.88

43420 00

Surgery

30.62

30.62

2204.64

2204.64

43425 00

Surgery

42.79

42.79

3080.88

3080.88

43450 00

Surgery

5.62

2.37

404.64

170.64

43453 00

Surgery

23.73

2.58

1708.56

185.76

43460 00

Surgery

6.26

6.26

450.72

450.72

43496 00

Surgery

0.00

0.00

BR

BR

43497 00

Surgery

23.49

23.49

1691.28

1691.28

43499 00

Surgery

0.00

0.00

BR

BR

43500 00

Surgery

23.68

23.68

1704.96

1704.96

43501 00

Surgery

40.58

40.58

2921.76

2921.76

43502 00

Surgery

45.77

45.77

3295.44

3295.44

43510 00

Surgery

28.62

28.62

2060.64

2060.64

43520 00

Surgery

20.80

20.80

1497.60

1497.60

43605 00

Surgery

25.14

25.14

1810.08

1810.08

43610 00

Surgery

29.36

29.36

2113.92

2113.92

43611 00

Surgery

36.89

36.89

2656.08

2656.08

43620 00

Surgery

59.33

59.33

4271.76

4271.76

43621 00

Surgery

67.98

67.98

4894.56

4894.56

43622 00

Surgery

69.08

69.08

4973.76

4973.76

43631 00

Surgery

43.47

43.47

3129.84

3129.84

43632 00

Surgery

60.90

60.90

4384.80

4384.80

43633 00

Surgery

57.62

57.62

4148.64

4148.64

43634 00

Surgery

63.57

63.57

4577.04

4577.04

43635 00

Surgery

3.34

3.34

240.48

240.48

43640 00

Surgery

35.81

35.81

2578.32

2578.32

43641 00

Surgery

36.22

36.22

2607.84

2607.84

43644 00

Surgery

52.09

52.09

3750.48

3750.48

43645 00

Surgery

55.34

55.34

3984.48

3984.48

43647 00

Surgery

-

-

1288.08

1082.16

43648 00

Surgery

-

-

1215.36

1020.96

43651 00

Surgery

19.86

19.86

1429.92

1429.92

43652 00

Surgery

23.11

23.11

1663.92

1663.92

43653 00

Surgery

17.48

17.48

1258.56

1258.56

43659 00

Surgery

0.00

0.00

BR

BR

43752 00

Surgery

1.18

1.18

84.96

84.96

43753 00

Surgery

0.64

0.64

46.08

46.08

43754 00

Surgery

7.03

1.14

506.16

82.08

43755 00

Surgery

6.09

1.78

438.48

128.16

43756 00

Surgery

8.26

1.52

594.72

109.44

43757 00

Surgery

11.09

2.29

798.48

164.88

43761 00

Surgery

3.70

3.09

266.40

222.48

43762 00

Surgery

6.76

1.11

486.72

79.92

43763 00

Surgery

10.00

2.61

720.00

187.92

43770 00

Surgery

33.88

33.88

2439.36

2439.36

43771 00

Surgery

38.42

38.42

2766.24

2766.24

43772 00

Surgery

28.57

28.57

2057.04

2057.04

43773 00

Surgery

38.42

38.42

2766.24

2766.24

43774 00

Surgery

28.90

28.90

2080.80

2080.80

43775 00

Surgery

33.03

33.03

2378.16

2378.16

43800 00

Surgery

27.95

27.95

2012.40

2012.40

43810 00

Surgery

30.56

30.56

2200.32

2200.32

43820 00

Surgery

40.38

40.38

2907.36

2907.36

43825 00

Surgery

39.39

39.39

2836.08

2836.08

43830 00

Surgery

21.19

21.19

1525.68

1525.68

43831 00

Surgery

18.45

18.45

1328.40

1328.40

43832 00

Surgery

31.46

31.46

2265.12

2265.12

43840 00

Surgery

40.80

40.80

2937.60

2937.60

43842 00

Surgery

34.50

34.50

2484.00

2484.00

43843 00

Surgery

38.59

38.59

2778.48

2778.48

43845 00

Surgery

58.74

58.74

4229.28

4229.28

43846 00

Surgery

49.59

49.59

3570.48

3570.48

43847 00

Surgery

54.24

54.24

3905.28

3905.28

43848 00

Surgery

58.07

58.07

4181.04

4181.04

43860 00

Surgery

49.01

49.01

3528.72

3528.72

43865 00

Surgery

51.24

51.24

3689.28

3689.28

43870 00

Surgery

21.34

21.34

1536.48

1536.48

43880 00

Surgery

48.17

48.17

3468.24

3468.24

43881 00

Surgery

-

-

2037.60

1711.44

43882 00

Surgery

0.00

0.00

BR

BR

43886 00

Surgery

11.20

11.20

806.40

806.40

43887 00

Surgery

10.12

10.12

728.64

728.64

43888 00

Surgery

14.10

14.10

1015.20

1015.20

43999 00

Surgery

0.00

0.00

BR

BR

44005 00

Surgery

32.71

32.71

2355.12

2355.12

44010 00

Surgery

25.46

25.46

1833.12

1833.12

44015 00

Surgery

4.19

4.19

301.68

301.68

44020 00

Surgery

29.20

29.20

2102.40

2102.40

44021 00

Surgery

29.12

29.12

2096.64

2096.64

44025 00

Surgery

29.44

29.44

2119.68

2119.68

44050 00

Surgery

28.12

28.12

2024.64

2024.64

44055 00

Surgery

44.58

44.58

3209.76

3209.76

44100 00

Surgery

3.15

3.15

226.80

226.80

44110 00

Surgery

25.53

25.53

1838.16

1838.16

44111 00

Surgery

29.31

29.31

2110.32

2110.32

44120 00

Surgery

36.59

36.59

2634.48

2634.48

44121 00

Surgery

7.15

7.15

514.80

514.80

44125 00

Surgery

35.20

35.20

2534.40

2534.40

44126 00

Surgery

73.86

73.86

5317.92

5317.92

44127 00

Surgery

85.25

85.25

6138.00

6138.00

44128 00

Surgery

7.22

7.22

519.84

519.84

44130 00

Surgery

39.42

39.42

2838.24

2838.24

44132 00

Surgery

0.00

0.00

BR

BR

44133 00

Surgery

0.00

0.00

BR

BR

44135 00

Surgery

0.00

0.00

BR

BR

44136 00

Surgery

0.00

0.00

BR

BR

44137 00

Surgery

0.00

0.00

BR

BR

44139 00

Surgery

3.56

3.56

256.32

256.32

44140 00

Surgery

40.18

40.18

2892.96

2892.96

44141 00

Surgery

54.17

54.17

3900.24

3900.24

44143 00

Surgery

49.34

49.34

3552.48

3552.48

44144 00

Surgery

52.66

52.66

3791.52

3791.52

44145 00

Surgery

49.22

49.22

3543.84

3543.84

44146 00

Surgery

62.57

62.57

4505.04

4505.04

44147 00

Surgery

57.64

57.64

4150.08

4150.08

44150 00

Surgery

55.28

55.28

3980.16

3980.16

44151 00

Surgery

64.29

64.29

4628.88

4628.88

44155 00

Surgery

61.61

61.61

4435.92

4435.92

44156 00

Surgery

68.72

68.72

4947.84

4947.84

44157 00

Surgery

65.35

65.35

4705.20

4705.20

44158 00

Surgery

66.98

66.98

4822.56

4822.56

44160 00

Surgery

37.17

37.17

2676.24

2676.24

44180 00

Surgery

27.62

27.62

1988.64

1988.64

44186 00

Surgery

19.62

19.62

1412.64

1412.64

44187 00

Surgery

32.58

32.58

2345.76

2345.76

44188 00

Surgery

36.28

36.28

2612.16

2612.16

44202 00

Surgery

41.50

41.50

2988.00

2988.00

44203 00

Surgery

7.12

7.12

512.64

512.64

44204 00

Surgery

45.80

45.80

3297.60

3297.60

44205 00

Surgery

39.76

39.76

2862.72

2862.72

44206 00

Surgery

51.88

51.88

3735.36

3735.36

44207 00

Surgery

53.84

53.84

3876.48

3876.48

44208 00

Surgery

58.62

58.62

4220.64

4220.64

44210 00

Surgery

52.66

52.66

3791.52

3791.52

44211 00

Surgery

62.70

62.70

4514.40

4514.40

44212 00

Surgery

60.13

60.13

4329.36

4329.36

44213 00

Surgery

5.51

5.51

396.72

396.72

44227 00

Surgery

49.37

49.37

3554.64

3554.64

44238 00

Surgery

0.00

0.00

BR

BR

44300 00

Surgery

25.30

25.30

1821.60

1821.60

44310 00

Surgery

31.10

31.10

2239.20

2239.20

44312 00

Surgery

17.98

17.98

1294.56

1294.56

44314 00

Surgery

30.08

30.08

2165.76

2165.76

44316 00

Surgery

42.46

42.46

3057.12

3057.12

44320 00

Surgery

35.95

35.95

2588.40

2588.40

44322 00

Surgery

30.22

30.22

2175.84

2175.84

44340 00

Surgery

19.00

19.00

1368.00

1368.00

44345 00

Surgery

31.48

31.48

2266.56

2266.56

44346 00

Surgery

35.40

35.40

2548.80

2548.80

44360 00

Surgery

4.25

4.25

306.00

306.00

44361 00

Surgery

4.68

4.68

336.96

336.96

44363 00

Surgery

5.65

5.65

406.80

406.80

44364 00

Surgery

6.02

6.02

433.44

433.44

44365 00

Surgery

5.38

5.38

387.36

387.36

44366 00

Surgery

7.06

7.06

508.32

508.32

44369 00

Surgery

7.23

7.23

520.56

520.56

44370 00

Surgery

7.87

7.87

566.64

566.64

44372 00

Surgery

7.06

7.06

508.32

508.32

44373 00

Surgery

5.64

5.64

406.08

406.08

44376 00

Surgery

8.35

8.35

601.20

601.20

44377 00

Surgery

8.81

8.81

634.32

634.32

44378 00

Surgery

11.31

11.31

814.32

814.32

44379 00

Surgery

12.06

12.06

868.32

868.32

44380 00

Surgery

5.91

1.71

425.52

123.12

44381 00

Surgery

29.13

2.52

2097.36

181.44

44382 00

Surgery

8.93

2.20

642.96

158.40

44384 00

Surgery

4.50

4.50

324.00

324.00

44385 00

Surgery

6.49

2.17

467.28

156.24

44386 00

Surgery

9.30

2.65

669.60

190.80

44388 00

Surgery

9.48

4.62

682.56

332.64

44389 00

Surgery

12.33

5.07

887.76

365.04

44390 00

Surgery

12.12

6.20

872.64

446.40

44391 00

Surgery

19.08

6.80

1373.76

489.60

44392 00

Surgery

11.68

5.91

840.96

425.52

44394 00

Surgery

13.13

6.65

945.36

478.80

44401 00

Surgery

70.18

7.14

5052.96

514.08

44402 00

Surgery

7.70

7.70

554.40

554.40

44403 00

Surgery

8.96

8.96

645.12

645.12

44404 00

Surgery

12.60

5.07

907.20

365.04

44405 00

Surgery

16.59

5.41

1194.48

389.52

44406 00

Surgery

6.76

6.76

486.72

486.72

44407 00

Surgery

8.10

8.10

583.20

583.20

44408 00

Surgery

6.82

6.82

491.04

491.04

44500 00

Surgery

0.56

0.56

40.32

40.32

44602 00

Surgery

42.01

42.01

3024.72

3024.72

44603 00

Surgery

48.27

48.27

3475.44

3475.44

44604 00

Surgery

31.53

31.53

2270.16

2270.16

44605 00

Surgery

38.47

38.47

2769.84

2769.84

44615 00

Surgery

31.94

31.94

2299.68

2299.68

44620 00

Surgery

25.86

25.86

1861.92

1861.92

44625 00

Surgery

30.18

30.18

2172.96

2172.96

44626 00

Surgery

47.40

47.40

3412.80

3412.80

44640 00

Surgery

41.65

41.65

2998.80

2998.80

44650 00

Surgery

42.94

42.94

3091.68

3091.68

44660 00

Surgery

40.02

40.02

2881.44

2881.44

44661 00

Surgery

45.92

45.92

3306.24

3306.24

44680 00

Surgery

32.31

32.31

2326.32

2326.32

44700 00

Surgery

29.92

29.92

2154.24

2154.24

44701 00

Surgery

5.03

5.03

362.16

362.16

44705 00

Surgery

3.37

2.12

242.64

152.64

44715 00

Surgery

0.00

0.00

BR

BR

44720 00

Surgery

8.11

8.11

583.92

583.92

44721 00

Surgery

11.35

11.35

817.20

817.20

44799 00

Surgery

0.00

0.00

BR

BR

44800 00

Surgery

23.42

23.42

1686.24

1686.24

44820 00

Surgery

25.64

25.64

1846.08

1846.08

44850 00

Surgery

22.51

22.51

1620.72

1620.72

44899 00

Surgery

0.00

0.00

BR

BR

44900 00

Surgery

23.61

23.61

1699.92

1699.92

44950 00

Surgery

19.32

19.32

1391.04

1391.04

44955 00

Surgery

2.48

2.48

178.56

178.56

44960 00

Surgery

26.35

26.35

1897.20

1897.20

44970 00

Surgery

18.18

18.18

1308.96

1308.96

44979 00

Surgery

0.00

0.00

BR

BR

45000 00

Surgery

12.95

12.95

932.40

932.40

45005 00

Surgery

9.48

5.00

682.56

360.00

45020 00

Surgery

17.13

17.13

1233.36

1233.36

45100 00

Surgery

9.18

9.18

660.96

660.96

45108 00

Surgery

11.36

11.36

817.92

817.92

45110 00

Surgery

54.09

54.09

3894.48

3894.48

45111 00

Surgery

32.55

32.55

2343.60

2343.60

45112 00

Surgery

53.83

53.83

3875.76

3875.76

45113 00

Surgery

55.34

55.34

3984.48

3984.48

45114 00

Surgery

54.40

54.40

3916.80

3916.80

45116 00

Surgery

45.91

45.91

3305.52

3305.52

45119 00

Surgery

55.75

55.75

4014.00

4014.00

45120 00

Surgery

48.01

48.01

3456.72

3456.72

45121 00

Surgery

52.39

52.39

3772.08

3772.08

45123 00

Surgery

33.22

33.22

2391.84

2391.84

45126 00

Surgery

81.59

81.59

5874.48

5874.48

45130 00

Surgery

32.36

32.36

2329.92

2329.92

45135 00

Surgery

38.65

38.65

2782.80

2782.80

45136 00

Surgery

53.02

53.02

3817.44

3817.44

45150 00

Surgery

12.85

12.85

925.20

925.20

45160 00

Surgery

30.90

30.90

2224.80

2224.80

45171 00

Surgery

18.60

18.60

1339.20

1339.20

45172 00

Surgery

24.75

24.75

1782.00

1782.00

45190 00

Surgery

20.97

20.97

1509.84

1509.84

45300 00

Surgery

3.85

1.44

277.20

103.68

45303 00

Surgery

28.07

2.56

2021.04

184.32

45305 00

Surgery

5.44

2.18

391.68

156.96

45307 00

Surgery

6.41

3.01

461.52

216.72

45308 00

Surgery

6.14

2.54

442.08

182.88

45309 00

Surgery

6.33

2.69

455.76

193.68

45315 00

Surgery

6.83

3.17

491.76

228.24

45317 00

Surgery

6.63

3.31

477.36

238.32

45320 00

Surgery

6.68

3.14

480.96

226.08

45321 00

Surgery

3.10

3.10

223.20

223.20

45327 00

Surgery

3.50

3.50

252.00

252.00

45330 00

Surgery

5.59

1.69

402.48

121.68

45331 00

Surgery

8.58

2.15

617.76

154.80

45332 00

Surgery

8.32

3.13

599.04

225.36

45333 00

Surgery

9.83

2.80

707.76

201.60

45334 00

Surgery

14.68

3.48

1056.96

250.56

45335 00

Surgery

8.71

1.99

627.12

143.28

45337 00

Surgery

3.38

3.38

243.36

243.36

45338 00

Surgery

8.97

3.56

645.84

256.32

45340 00

Surgery

13.61

2.33

979.92

167.76

45341 00

Surgery

3.67

3.67

264.24

264.24

45342 00

Surgery

5.04

5.04

362.88

362.88

45346 00

Surgery

67.85

4.74

4885.20

341.28

45347 00

Surgery

4.55

4.55

327.60

327.60

45349 00

Surgery

5.84

5.84

420.48

420.48

45350 00

Surgery

19.98

3.00

1438.56

216.00

45378 00

Surgery

10.19

5.45

733.68

392.40

45379 00

Surgery

13.01

7.03

936.72

506.16

45380 00

Surgery

12.99

5.92

935.28

426.24

45381 00

Surgery

13.26

5.91

954.72

425.52

45382 00

Surgery

19.87

7.62

1430.64

548.64

45384 00

Surgery

14.62

6.74

1052.64

485.28

45385 00

Surgery

13.60

7.49

979.20

539.28

45386 00

Surgery

18.20

6.25

1310.40

450.00

45388 00

Surgery

72.50

7.97

5220.00

573.84

45389 00

Surgery

8.53

8.53

614.16

614.16

45390 00

Surgery

9.79

9.79

704.88

704.88

45391 00

Surgery

7.59

7.59

546.48

546.48

45392 00

Surgery

8.96

8.96

645.12

645.12

45393 00

Surgery

7.41

7.41

533.52

533.52

45395 00

Surgery

58.20

58.20

4190.40

4190.40

45397 00

Surgery

62.97

62.97

4533.84

4533.84

45398 00

Surgery

24.52

6.95

1765.44

500.40

45399 00

Surgery

0.00

0.00

BR

BR

45400 00

Surgery

33.77

33.77

2431.44

2431.44

45402 00

Surgery

45.15

45.15

3250.80

3250.80

45499 00

Surgery

0.00

0.00

BR

BR

45500 00

Surgery

17.22

17.22

1239.84

1239.84

45505 00

Surgery

18.15

18.15

1306.80

1306.80

45520 00

Surgery

4.86

1.22

349.92

87.84

45540 00

Surgery

31.33

31.33

2255.76

2255.76

45541 00

Surgery

28.11

28.11

2023.92

2023.92

45550 00

Surgery

43.29

43.29

3116.88

3116.88

45560 00

Surgery

20.77

20.77

1495.44

1495.44

45562 00

Surgery

35.12

35.12

2528.64

2528.64

45563 00

Surgery

49.68

49.68

3576.96

3576.96

45800 00

Surgery

38.15

38.15

2746.80

2746.80

45805 00

Surgery

44.01

44.01

3168.72

3168.72

45820 00

Surgery

38.25

38.25

2754.00

2754.00

45825 00

Surgery

46.09

46.09

3318.48

3318.48

45900 00

Surgery

6.42

6.42

462.24

462.24

45905 00

Surgery

5.14

5.14

370.08

370.08

45910 00

Surgery

5.82

5.82

419.04

419.04

45915 00

Surgery

10.63

6.89

765.36

496.08

45990 00

Surgery

3.16

3.16

227.52

227.52

45999 00

Surgery

0.00

0.00

BR

BR

46020 00

Surgery

3.50

3.50

252.00

252.00

46030 00

Surgery

7.61

2.59

547.92

186.48

46040 00

Surgery

16.75

12.90

1206.00

928.80

46045 00

Surgery

13.31

13.31

958.32

958.32

46050 00

Surgery

7.12

3.07

512.64

221.04

46060 00

Surgery

14.72

14.72

1059.84

1059.84

46070 00

Surgery

8.22

8.22

591.84

591.84

46080 00

Surgery

8.65

4.75

622.80

342.00

46083 00

Surgery

6.27

3.33

451.44

239.76

46200 00

Surgery

14.33

10.26

1031.76

738.72

46220 00

Surgery

7.56

3.68

544.32

264.96

46221 00

Surgery

8.53

5.80

614.16

417.60

46230 00

Surgery

9.43

5.24

678.96

377.28

46250 00

Surgery

14.41

9.63

1037.52

693.36

46255 00

Surgery

15.65

10.72

1126.80

771.84

46257 00

Surgery

12.58

12.58

905.76

905.76

46258 00

Surgery

14.63

14.63

1053.36

1053.36

46260 00

Surgery

14.56

14.56

1048.32

1048.32

46261 00

Surgery

16.11

16.11

1159.92

1159.92

46262 00

Surgery

17.73

17.73

1276.56

1276.56

46270 00

Surgery

16.10

12.15

1159.20

874.80

46275 00

Surgery

17.01

12.79

1224.72

920.88

46280 00

Surgery

14.53

14.53

1046.16

1046.16

46285 00

Surgery

17.00

12.83

1224.00

923.76

46288 00

Surgery

16.88

16.88

1215.36

1215.36

46320 00

Surgery

6.44

3.43

463.68

246.96

46500 00

Surgery

9.38

5.54

675.36

398.88

46505 00

Surgery

9.48

7.55

682.56

543.60

46600 00

Surgery

3.54

1.24

254.88

89.28

46601 00

Surgery

4.50

2.80

324.00

201.60

46604 00

Surgery

19.21

1.98

1383.12

142.56

46606 00

Surgery

8.40

2.26

604.80

162.72

46607 00

Surgery

6.23

3.72

448.56

267.84

46608 00

Surgery

8.69

2.54

625.68

182.88

46610 00

Surgery

8.22

2.40

591.84

172.80

46611 00

Surgery

6.69

2.41

481.68

173.52

46612 00

Surgery

9.92

2.86

714.24

205.92

46614 00

Surgery

5.05

1.93

363.60

138.96

46615 00

Surgery

5.32

2.71

383.04

195.12

46700 00

Surgery

19.66

19.66

1415.52

1415.52

46705 00

Surgery

17.29

17.29

1244.88

1244.88

46706 00

Surgery

5.45

5.45

392.40

392.40

46707 00

Surgery

15.26

15.26

1098.72

1098.72

46710 00

Surgery

33.38

33.38

2403.36

2403.36

46712 00

Surgery

66.32

66.32

4775.04

4775.04

46715 00

Surgery

16.78

16.78

1208.16

1208.16

46716 00

Surgery

37.26

37.26

2682.72

2682.72

46730 00

Surgery

59.79

59.79

4304.88

4304.88

46735 00

Surgery

68.72

68.72

4947.84

4947.84

46740 00

Surgery

65.19

65.19

4693.68

4693.68

46742 00

Surgery

75.23

75.23

5416.56

5416.56

46744 00

Surgery

105.87

105.87

7622.64

7622.64

46746 00

Surgery

116.56

116.56

8392.32

8392.32

46748 00

Surgery

126.27

126.27

9091.44

9091.44

46750 00

Surgery

22.49

22.49

1619.28

1619.28

46751 00

Surgery

20.22

20.22

1455.84

1455.84

46753 00

Surgery

18.71

18.71

1347.12

1347.12

46754 00

Surgery

10.53

7.33

758.16

527.76

46760 00

Surgery

33.05

33.05

2379.60

2379.60

46761 00

Surgery

27.37

27.37

1970.64

1970.64

46900 00

Surgery

7.25

4.15

522.00

298.80

46910 00

Surgery

7.97

4.09

573.84

294.48

46916 00

Surgery

7.86

4.28

565.92

308.16

46917 00

Surgery

13.32

3.90

959.04

280.80

46922 00

Surgery

9.45

4.17

680.40

300.24

46924 00

Surgery

16.70

5.46

1202.40

393.12

46930 00

Surgery

6.52

4.58

469.44

329.76

46940 00

Surgery

8.04

4.36

578.88

313.92

46942 00

Surgery

7.66

3.92

551.52

282.24

46945 00

Surgery

10.28

10.28

740.16

740.16

46946 00

Surgery

11.48

11.48

826.56

826.56

46947 00

Surgery

11.78

11.78

848.16

848.16

46948 00

Surgery

13.40

13.40

964.80

964.80

46999 00

Surgery

0.00

0.00

BR

BR

47000 00

Surgery

8.93

2.58

642.96

185.76

47001 00

Surgery

3.07

3.07

221.04

221.04

47010 00

Surgery

36.42

36.42

2622.24

2622.24

47015 00

Surgery

34.99

34.99

2519.28

2519.28

47100 00

Surgery

25.59

25.59

1842.48

1842.48

47120 00

Surgery

69.91

69.91

5033.52

5033.52

47122 00

Surgery

102.01

102.01

7344.72

7344.72

47125 00

Surgery

91.90

91.90

6616.80

6616.80

47130 00

Surgery

98.60

98.60

7099.20

7099.20

47133 00

Surgery

-

-

11963.52

10049.76

47135 00

Surgery

161.52

161.52

11629.44

11629.44

47140 00

Surgery

107.03

107.03

7706.16

7706.16

47141 00

Surgery

127.84

127.84

9204.48

9204.48

47142 00

Surgery

140.71

140.71

10131.12

10131.12

47143 00

Surgery

-

-

1620.72

1361.52

47144 00

Surgery

0.00

0.00

BR

BR

47145 00

Surgery

0.00

0.00

BR

BR

47146 00

Surgery

9.71

9.71

699.12

699.12

47147 00

Surgery

11.34

11.34

816.48

816.48

47300 00

Surgery

34.15

34.15

2458.80

2458.80

47350 00

Surgery

40.86

40.86

2941.92

2941.92

47360 00

Surgery

56.10

56.10

4039.20

4039.20

47361 00

Surgery

89.71

89.71

6459.12

6459.12

47362 00

Surgery

43.49

43.49

3131.28

3131.28

47370 00

Surgery

37.66

37.66

2711.52

2711.52

47371 00

Surgery

37.82

37.82

2723.04

2723.04

47379 00

Surgery

0.00

0.00

BR

BR

47380 00

Surgery

43.38

43.38

3123.36

3123.36

47381 00

Surgery

44.43

44.43

3198.96

3198.96

47382 00

Surgery

107.26

21.51

7722.72

1548.72

47383 00

Surgery

172.75

13.11

12438.00

943.92

47399 00

Surgery

0.00

0.00

BR

BR

47400 00

Surgery

64.32

64.32

4631.04

4631.04

47420 00

Surgery

40.17

40.17

2892.24

2892.24

47425 00

Surgery

41.02

41.02

2953.44

2953.44

47460 00

Surgery

38.11

38.11

2743.92

2743.92

47480 00

Surgery

26.36

26.36

1897.92

1897.92

47490 00

Surgery

9.79

9.79

704.88

704.88

47531 00

Surgery

12.48

2.06

898.56

148.32

47532 00

Surgery

24.76

6.14

1782.72

442.08

47533 00

Surgery

34.25

7.64

2466.00

550.08

47534 00

Surgery

37.62

10.69

2708.64

769.68

47535 00

Surgery

26.08

5.68

1877.76

408.96

47536 00

Surgery

18.68

3.83

1344.96

275.76

47537 00

Surgery

14.46

2.81

1041.12

202.32

47538 00

Surgery

109.95

6.80

7916.40

489.60

47539 00

Surgery

123.64

12.35

8902.08

889.20

47540 00

Surgery

123.38

12.72

8883.36

915.84

47541 00

Surgery

34.28

9.74

2468.16

701.28

47542 00

Surgery

14.65

3.93

1054.80

282.96

47543 00

Surgery

11.55

4.15

831.60

298.80

47544 00

Surgery

24.56

4.53

1768.32

326.16

47550 00

Surgery

4.85

4.85

349.20

349.20

47552 00

Surgery

8.14

8.14

586.08

586.08

47553 00

Surgery

8.15

8.15

586.80

586.80

47554 00

Surgery

13.14

13.14

946.08

946.08

47555 00

Surgery

9.71

9.71

699.12

699.12

47556 00

Surgery

11.00

11.00

792.00

792.00

47562 00

Surgery

19.92

19.92

1434.24

1434.24

47563 00

Surgery

21.65

21.65

1558.80

1558.80

47564 00

Surgery

33.65

33.65

2422.80

2422.80

47570 00

Surgery

23.37

23.37

1682.64

1682.64

47579 00

Surgery

0.00

0.00

BR

BR

47600 00

Surgery

32.18

32.18

2316.96

2316.96

47605 00

Surgery

33.87

33.87

2438.64

2438.64

47610 00

Surgery

37.47

37.47

2697.84

2697.84

47612 00

Surgery

38.20

38.20

2750.40

2750.40

47620 00

Surgery

41.23

41.23

2968.56

2968.56

47700 00

Surgery

31.88

31.88

2295.36

2295.36

47701 00

Surgery

52.04

52.04

3746.88

3746.88

47711 00

Surgery

46.73

46.73

3364.56

3364.56

47712 00

Surgery

59.73

59.73

4300.56

4300.56

47715 00

Surgery

39.96

39.96

2877.12

2877.12

47720 00

Surgery

34.73

34.73

2500.56

2500.56

47721 00

Surgery

40.68

40.68

2928.96

2928.96

47740 00

Surgery

39.45

39.45

2840.40

2840.40

47741 00

Surgery

44.28

44.28

3188.16

3188.16

47760 00

Surgery

67.41

67.41

4853.52

4853.52

47765 00

Surgery

90.54

90.54

6518.88

6518.88

47780 00

Surgery

74.07

74.07

5333.04

5333.04

47785 00

Surgery

96.70

96.70

6962.40

6962.40

47800 00

Surgery

46.59

46.59

3354.48

3354.48

47801 00

Surgery

33.54

33.54

2414.88

2414.88

47802 00

Surgery

45.74

45.74

3293.28

3293.28

47900 00

Surgery

41.40

41.40

2980.80

2980.80

47999 00

Surgery

0.00

0.00

BR

BR

48000 00

Surgery

56.35

56.35

4057.20

4057.20

48001 00

Surgery

68.94

68.94

4963.68

4963.68

48020 00

Surgery

35.47

35.47

2553.84

2553.84

48100 00

Surgery

26.83

26.83

1931.76

1931.76

48102 00

Surgery

15.19

6.91

1093.68

497.52

48105 00

Surgery

84.12

84.12

6056.64

6056.64

48120 00

Surgery

33.45

33.45

2408.40

2408.40

48140 00

Surgery

46.98

46.98

3382.56

3382.56

48145 00

Surgery

48.96

48.96

3525.12

3525.12

48146 00

Surgery

56.47

56.47

4065.84

4065.84

48148 00

Surgery

37.57

37.57

2705.04

2705.04

48150 00

Surgery

93.20

93.20

6710.40

6710.40

48152 00

Surgery

86.27

86.27

6211.44

6211.44

48153 00

Surgery

92.81

92.81

6682.32

6682.32

48154 00

Surgery

86.65

86.65

6238.80

6238.80

48155 00

Surgery

54.53

54.53

3926.16

3926.16

48160 00

Surgery

-

-

7514.64

6312.24

48400 00

Surgery

3.16

3.16

227.52

227.52

48500 00

Surgery

34.56

34.56

2488.32

2488.32

48510 00

Surgery

32.98

32.98

2374.56

2374.56

48520 00

Surgery

33.03

33.03

2378.16

2378.16

48540 00

Surgery

39.20

39.20

2822.40

2822.40

48545 00

Surgery

40.43

40.43

2910.96

2910.96

48547 00

Surgery

53.66

53.66

3863.52

3863.52

48548 00

Surgery

50.10

50.10

3607.20

3607.20

48550 00

Surgery

0.00

0.00

BR

BR

48551 00

Surgery

-

-

1364.40

1146.24

48552 00

Surgery

6.99

6.99

503.28

503.28

48554 00

Surgery

79.11

79.11

5695.92

5695.92

48556 00

Surgery

38.86

38.86

2797.92

2797.92

48999 00

Surgery

0.00

0.00

BR

BR

49000 00

Surgery

23.10

23.10

1663.20

1663.20

49002 00

Surgery

31.24

31.24

2249.28

2249.28

49010 00

Surgery

27.61

27.61

1987.92

1987.92

49013 00

Surgery

13.56

13.56

976.32

976.32

49014 00

Surgery

11.29

11.29

812.88

812.88

49020 00

Surgery

47.79

47.79

3440.88

3440.88

49040 00

Surgery

30.11

30.11

2167.92

2167.92

49060 00

Surgery

32.81

32.81

2362.32

2362.32

49062 00

Surgery

23.18

23.18

1668.96

1668.96

49082 00

Surgery

6.35

2.18

457.20

156.96

49083 00

Surgery

8.71

3.12

627.12

224.64

49084 00

Surgery

3.17

3.17

228.24

228.24

49180 00

Surgery

5.19

2.42

373.68

174.24

49185 00

Surgery

37.11

3.49

2671.92

251.28

49203 00

Surgery

35.85

35.85

2581.20

2581.20

49204 00

Surgery

45.67

45.67

3288.24

3288.24

49205 00

Surgery

52.39

52.39

3772.08

3772.08

49215 00

Surgery

66.43

66.43

4782.96

4782.96

49250 00

Surgery

17.96

17.96

1293.12

1293.12

49255 00

Surgery

23.88

23.88

1719.36

1719.36

49320 00

Surgery

9.94

9.94

715.68

715.68

49321 00

Surgery

10.39

10.39

748.08

748.08

49322 00

Surgery

11.30

11.30

813.60

813.60

49323 00

Surgery

19.25

19.25

1386.00

1386.00

49324 00

Surgery

11.63

11.63

837.36

837.36

49325 00

Surgery

12.40

12.40

892.80

892.80

49326 00

Surgery

5.59

5.59

402.48

402.48

49327 00

Surgery

3.86

3.86

277.92

277.92

49329 00

Surgery

0.00

0.00

BR

BR

49400 00

Surgery

4.45

2.64

320.40

190.08

49402 00

Surgery

25.68

25.68

1848.96

1848.96

49405 00

Surgery

26.10

5.67

1879.20

408.24

49406 00

Surgery

26.11

5.67

1879.92

408.24

49407 00

Surgery

22.28

6.01

1604.16

432.72

49411 00

Surgery

14.33

5.44

1031.76

391.68

49412 00

Surgery

2.44

2.44

175.68

175.68

49418 00

Surgery

28.92

5.85

2082.24

421.20

49419 00

Surgery

12.48

12.48

898.56

898.56

49421 00

Surgery

6.73

6.73

484.56

484.56

49422 00

Surgery

6.58

6.58

473.76

473.76

49423 00

Surgery

17.24

2.06

1241.28

148.32

49424 00

Surgery

5.35

1.09

385.20

78.48

49425 00

Surgery

23.54

23.54

1694.88

1694.88

49426 00

Surgery

20.23

20.23

1456.56

1456.56

49427 00

Surgery

1.14

1.14

82.08

82.08

49428 00

Surgery

12.97

12.97

933.84

933.84

49429 00

Surgery

13.75

13.75

990.00

990.00

49435 00

Surgery

3.49

3.49

251.28

251.28

49436 00

Surgery

16.08

5.61

1157.76

403.92

49440 00

Surgery

24.48

5.93

1762.56

426.96

49441 00

Surgery

28.33

7.07

2039.76

509.04

49442 00

Surgery

23.38

6.06

1683.36

436.32

49446 00

Surgery

23.51

4.26

1692.72

306.72

49450 00

Surgery

17.52

1.91

1261.44

137.52

49451 00

Surgery

18.73

2.58

1348.56

185.76

49452 00

Surgery

22.74

3.97

1637.28

285.84

49460 00

Surgery

21.57

1.49

1553.04

107.28

49465 00

Surgery

4.07

0.89

293.04

64.08

49491 00

Surgery

24.10

24.10

1735.20

1735.20

49492 00

Surgery

28.93

28.93

2082.96

2082.96

49495 00

Surgery

12.38

12.38

891.36

891.36

49496 00

Surgery

18.63

18.63

1341.36

1341.36

49500 00

Surgery

12.64

12.64

910.08

910.08

49501 00

Surgery

18.35

18.35

1321.20

1321.20

49505 00

Surgery

15.82

15.82

1139.04

1139.04

49507 00

Surgery

17.77

17.77

1279.44

1279.44

49520 00

Surgery

19.14

19.14

1378.08

1378.08

49521 00

Surgery

21.62

21.62

1556.64

1556.64

49525 00

Surgery

17.34

17.34

1248.48

1248.48

49540 00

Surgery

20.26

20.26

1458.72

1458.72

49550 00

Surgery

17.47

17.47

1257.84

1257.84

49553 00

Surgery

19.10

19.10

1375.20

1375.20

49555 00

Surgery

18.28

18.28

1316.16

1316.16

49557 00

Surgery

21.80

21.80

1569.60

1569.60

49591 00

Surgery

10.25

10.25

738.00

738.00

49592 00

Surgery

14.24

14.24

1025.28

1025.28

49593 00

Surgery

17.15

17.15

1234.80

1234.80

49594 00

Surgery

22.32

22.32

1607.04

1607.04

49595 00

Surgery

23.07

23.07

1661.04

1661.04

49596 00

Surgery

30.60

30.60

2203.20

2203.20

49600 00

Surgery

22.18

22.18

1596.96

1596.96

49605 00

Surgery

146.66

146.66

10559.52

10559.52

49606 00

Surgery

34.10

34.10

2455.20

2455.20

49610 00

Surgery

20.96

20.96

1509.12

1509.12

49611 00

Surgery

18.49

18.49

1331.28

1331.28

49613 00

Surgery

12.63

12.63

909.36

909.36

49614 00

Surgery

17.10

17.10

1231.20

1231.20

49615 00

Surgery

19.12

19.12

1376.64

1376.64

49616 00

Surgery

25.69

25.69

1849.68

1849.68

49617 00

Surgery

26.47

26.47

1905.84

1905.84

49618 00

Surgery

37.08

37.08

2669.76

2669.76

49621 00

Surgery

22.19

22.19

1597.68

1597.68

49622 00

Surgery

27.36

27.36

1969.92

1969.92

49623 00

Surgery

5.88

5.88

423.36

423.36

49650 00

Surgery

13.12

13.12

944.64

944.64

49651 00

Surgery

17.12

17.12

1232.64

1232.64

49659 00

Surgery

0.00

0.00

BR

BR

49900 00

Surgery

24.85

24.85

1789.20

1789.20

49904 00

Surgery

41.70

41.70

3002.40

3002.40

49905 00

Surgery

10.47

10.47

753.84

753.84

49906 00

Surgery

-

-

11741.76

9863.28

49999 00

Surgery

0.00

0.00

BR

BR

50010 00

Surgery

21.11

21.11

1519.92

1519.92

50020 00

Surgery

30.29

30.29

2180.88

2180.88

50040 00

Surgery

27.59

27.59

1986.48

1986.48

50045 00

Surgery

27.80

27.80

2001.60

2001.60

50060 00

Surgery

33.88

33.88

2439.36

2439.36

50065 00

Surgery

35.89

35.89

2584.08

2584.08

50070 00

Surgery

35.21

35.21

2535.12

2535.12

50075 00

Surgery

43.25

43.25

3114.00

3114.00

50080 00

Surgery

20.79

20.79

1496.88

1496.88

50081 00

Surgery

33.44

33.44

2407.68

2407.68

50100 00

Surgery

32.54

32.54

2342.88

2342.88

50120 00

Surgery

28.29

28.29

2036.88

2036.88

50125 00

Surgery

29.27

29.27

2107.44

2107.44

50130 00

Surgery

30.73

30.73

2212.56

2212.56

50135 00

Surgery

33.33

33.33

2399.76

2399.76

50200 00

Surgery

15.20

3.72

1094.40

267.84

50205 00

Surgery

22.71

22.71

1635.12

1635.12

50220 00

Surgery

31.41

31.41

2261.52

2261.52

50225 00

Surgery

36.08

36.08

2597.76

2597.76

50230 00

Surgery

38.02

38.02

2737.44

2737.44

50234 00

Surgery

38.65

38.65

2782.80

2782.80

50236 00

Surgery

43.47

43.47

3129.84

3129.84

50240 00

Surgery

39.53

39.53

2846.16

2846.16

50250 00

Surgery

36.18

36.18

2604.96

2604.96

50280 00

Surgery

28.19

28.19

2029.68

2029.68

50290 00

Surgery

26.82

26.82

1931.04

1931.04

50300 00

Surgery

0.00

0.00

BR

BR

50320 00

Surgery

45.95

45.95

3308.40

3308.40

50323 00

Surgery

-

-

1042.56

897.12

50325 00

Surgery

-

-

809.28

696.24

50327 00

Surgery

6.42

6.42

462.24

462.24

50328 00

Surgery

5.63

5.63

405.36

405.36

50329 00

Surgery

5.33

5.33

383.76

383.76

50340 00

Surgery

29.01

29.01

2088.72

2088.72

50360 00

Surgery

73.11

73.11

5263.92

5263.92

50365 00

Surgery

87.30

87.30

6285.60

6285.60

50370 00

Surgery

36.66

36.66

2639.52

2639.52

50380 00

Surgery

61.53

61.53

4430.16

4430.16

50382 00

Surgery

29.46

7.32

2121.12

527.04

50384 00

Surgery

25.26

6.61

1818.72

475.92

50385 00

Surgery

29.92

6.31

2154.24

454.32

50386 00

Surgery

22.34

4.79

1608.48

344.88

50387 00

Surgery

16.25

2.42

1170.00

174.24

50389 00

Surgery

12.22

1.56

879.84

112.32

50390 00

Surgery

2.76

2.76

198.72

198.72

50391 00

Surgery

3.75

2.90

270.00

208.80

50396 00

Surgery

3.41

3.41

245.52

245.52

50400 00

Surgery

34.35

34.35

2473.20

2473.20

50405 00

Surgery

41.43

41.43

2982.96

2982.96

50430 00

Surgery

18.73

4.50

1348.56

324.00

50431 00

Surgery

9.53

1.95

686.16

140.40

50432 00

Surgery

26.73

5.96

1924.56

429.12

50433 00

Surgery

33.28

7.40

2396.16

532.80

50434 00

Surgery

26.72

5.56

1923.84

400.32

50435 00

Surgery

17.60

2.92

1267.20

210.24

50436 00

Surgery

4.38

4.38

315.36

315.36

50437 00

Surgery

7.25

7.25

522.00

522.00

50500 00

Surgery

38.69

38.69

2785.68

2785.68

50520 00

Surgery

34.87

34.87

2510.64

2510.64

50525 00

Surgery

44.16

44.16

3179.52

3179.52

50526 00

Surgery

47.28

47.28

3404.16

3404.16

50540 00

Surgery

34.10

34.10

2455.20

2455.20

50541 00

Surgery

27.29

27.29

1964.88

1964.88

50542 00

Surgery

34.52

34.52

2485.44

2485.44

50543 00

Surgery

44.27

44.27

3187.44

3187.44

50544 00

Surgery

36.81

36.81

2650.32

2650.32

50545 00

Surgery

39.61

39.61

2851.92

2851.92

50546 00

Surgery

35.81

35.81

2578.32

2578.32

50547 00

Surgery

48.70

48.70

3506.40

3506.40

50548 00

Surgery

39.82

39.82

2867.04

2867.04

50549 00

Surgery

0.00

0.00

BR

BR

50551 00

Surgery

10.80

8.66

777.60

623.52

50553 00

Surgery

11.59

9.26

834.48

666.72

50555 00

Surgery

12.35

10.05

889.20

723.60

50557 00

Surgery

12.56

10.18

904.32

732.96

50561 00

Surgery

14.27

11.63

1027.44

837.36

50562 00

Surgery

17.08

17.08

1229.76

1229.76

50570 00

Surgery

14.47

14.47

1041.84

1041.84

50572 00

Surgery

15.63

15.63

1125.36

1125.36

50574 00

Surgery

16.61

16.61

1195.92

1195.92

50575 00

Surgery

20.97

20.97

1509.84

1509.84

50576 00

Surgery

16.56

16.56

1192.32

1192.32

50580 00

Surgery

17.85

17.85

1285.20

1285.20

50590 00

Surgery

22.26

17.15

1602.72

1234.80

50592 00

Surgery

82.56

10.04

5944.32

722.88

50593 00

Surgery

110.40

13.39

7948.80

964.08

50600 00

Surgery

27.91

27.91

2009.52

2009.52

50605 00

Surgery

30.22

30.22

2175.84

2175.84

50606 00

Surgery

14.27

4.06

1027.44

292.32

50610 00

Surgery

28.11

28.11

2023.92

2023.92

50620 00

Surgery

26.90

26.90

1936.80

1936.80

50630 00

Surgery

26.59

26.59

1914.48

1914.48

50650 00

Surgery

30.95

30.95

2228.40

2228.40

50660 00

Surgery

33.99

33.99

2447.28

2447.28

50684 00

Surgery

3.82

1.52

275.04

109.44

50686 00

Surgery

4.31

2.64

310.32

190.08

50688 00

Surgery

2.31

2.31

166.32

166.32

50690 00

Surgery

3.55

2.07

255.60

149.04

50693 00

Surgery

29.27

5.93

2107.44

426.96

50694 00

Surgery

32.82

7.74

2363.04

557.28

50695 00

Surgery

39.42

9.93

2838.24

714.96

50700 00

Surgery

27.61

27.61

1987.92

1987.92

50705 00

Surgery

53.71

5.17

3867.12

372.24

50706 00

Surgery

24.65

5.25

1774.80

378.00

50715 00

Surgery

36.16

36.16

2603.52

2603.52

50722 00

Surgery

30.63

30.63

2205.36

2205.36

50725 00

Surgery

32.77

32.77

2359.44

2359.44

50727 00

Surgery

15.40

15.40

1108.80

1108.80

50728 00

Surgery

20.96

20.96

1509.12

1509.12

50740 00

Surgery

36.83

36.83

2651.76

2651.76

50750 00

Surgery

34.28

34.28

2468.16

2468.16

50760 00

Surgery

33.72

33.72

2427.84

2427.84

50770 00

Surgery

34.28

34.28

2468.16

2468.16

50780 00

Surgery

33.18

33.18

2388.96

2388.96

50782 00

Surgery

31.97

31.97

2301.84

2301.84

50783 00

Surgery

33.51

33.51

2412.72

2412.72

50785 00

Surgery

36.06

36.06

2596.32

2596.32

50800 00

Surgery

27.51

27.51

1980.72

1980.72

50810 00

Surgery

42.28

42.28

3044.16

3044.16

50815 00

Surgery

36.44

36.44

2623.68

2623.68

50820 00

Surgery

39.03

39.03

2810.16

2810.16

50825 00

Surgery

48.85

48.85

3517.20

3517.20

50830 00

Surgery

53.40

53.40

3844.80

3844.80

50840 00

Surgery

36.63

36.63

2637.36

2637.36

50845 00

Surgery

37.37

37.37

2690.64

2690.64

50860 00

Surgery

28.18

28.18

2028.96

2028.96

50900 00

Surgery

25.16

25.16

1811.52

1811.52

50920 00

Surgery

26.30

26.30

1893.60

1893.60

50930 00

Surgery

32.74

32.74

2357.28

2357.28

50940 00

Surgery

26.47

26.47

1905.84

1905.84

50945 00

Surgery

28.85

28.85

2077.20

2077.20

50947 00

Surgery

41.10

41.10

2959.20

2959.20

50948 00

Surgery

37.69

37.69

2713.68

2713.68

50949 00

Surgery

0.00

0.00

BR

BR

50951 00

Surgery

11.34

9.05

816.48

651.60

50953 00

Surgery

11.98

9.62

862.56

692.64

50955 00

Surgery

12.78

10.38

920.16

747.36

50957 00

Surgery

12.90

10.43

928.80

750.96

50961 00

Surgery

11.65

9.35

838.80

673.20

50970 00

Surgery

10.91

10.91

785.52

785.52

50972 00

Surgery

10.53

10.53

758.16

758.16

50974 00

Surgery

13.92

13.92

1002.24

1002.24

50976 00

Surgery

13.73

13.73

988.56

988.56

50980 00

Surgery

10.48

10.48

754.56

754.56

51020 00

Surgery

14.16

14.16

1019.52

1019.52

51030 00

Surgery

14.26

14.26

1026.72

1026.72

51040 00

Surgery

8.80

8.80

633.60

633.60

51045 00

Surgery

14.98

14.98

1078.56

1078.56

51050 00

Surgery

14.18

14.18

1020.96

1020.96

51060 00

Surgery

17.49

17.49

1259.28

1259.28

51065 00

Surgery

17.41

17.41

1253.52

1253.52

51080 00

Surgery

12.31

12.31

886.32

886.32

51100 00

Surgery

2.22

1.16

159.84

83.52

51101 00

Surgery

4.62

1.51

332.64

108.72

51102 00

Surgery

7.16

4.22

515.52

303.84

51500 00

Surgery

19.09

19.09

1374.48

1374.48

51520 00

Surgery

17.86

17.86

1285.92

1285.92

51525 00

Surgery

25.58

25.58

1841.76

1841.76

51530 00

Surgery

23.00

23.00

1656.00

1656.00

51535 00

Surgery

23.28

23.28

1676.16

1676.16

51550 00

Surgery

28.75

28.75

2070.00

2070.00

51555 00

Surgery

37.51

37.51

2700.72

2700.72

51565 00

Surgery

38.29

38.29

2756.88

2756.88

51570 00

Surgery

43.72

43.72

3147.84

3147.84

51575 00

Surgery

53.82

53.82

3875.04

3875.04

51580 00

Surgery

56.22

56.22

4047.84

4047.84

51585 00

Surgery

62.49

62.49

4499.28

4499.28

51590 00

Surgery

57.18

57.18

4116.96

4116.96

51595 00

Surgery

64.73

64.73

4660.56

4660.56

51596 00

Surgery

69.76

69.76

5022.72

5022.72

51597 00

Surgery

68.16

68.16

4907.52

4907.52

51600 00

Surgery

6.29

1.28

452.88

92.16

51605 00

Surgery

1.15

1.15

82.80

82.80

51610 00

Surgery

3.86

1.91

277.92

137.52

51700 00

Surgery

2.30

0.89

165.60

64.08

51701 00

Surgery

1.34

0.76

96.48

54.72

51702 00

Surgery

1.87

0.75

134.64

54.00

51703 00

Surgery

4.49

2.26

323.28

162.72

51705 00

Surgery

2.93

1.54

210.96

110.88

51710 00

Surgery

4.09

2.39

294.48

172.08

51715 00

Surgery

11.10

5.92

799.20

426.24

51720 00

Surgery

2.66

1.29

191.52

92.88

51725 00

Surgery

6.83

6.83

491.76

491.76

51725 26

Surgery

2.24

2.24

161.28

161.28

51725 TC

Surgery

4.59

4.59

330.48

330.48

51726 00

Surgery

9.01

9.01

648.72

648.72

51726 26

Surgery

2.48

2.48

178.56

178.56

51726 TC

Surgery

6.53

6.53

470.16

470.16

51727 00

Surgery

10.98

10.98

790.56

790.56

51727 26

Surgery

3.13

3.13

225.36

225.36

51727 TC

Surgery

7.85

7.85

565.20

565.20

51728 00

Surgery

10.91

10.91

785.52

785.52

51728 26

Surgery

3.05

3.05

219.60

219.60

51728 TC

Surgery

7.86

7.86

565.92

565.92

51729 00

Surgery

11.51

11.51

828.72

828.72

51729 26

Surgery

3.70

3.70

266.40

266.40

51729 TC

Surgery

7.81

7.81

562.32

562.32

51736 00

Surgery

0.41

0.41

29.52

29.52

51736 26

Surgery

0.24

0.24

17.28

17.28

51736 TC

Surgery

0.17

0.17

12.24

12.24

51741 00

Surgery

0.43

0.43

30.96

30.96

51741 26

Surgery

0.25

0.25

18.00

18.00

51741 TC

Surgery

0.18

0.18

12.96

12.96

51784 00

Surgery

1.93

1.93

138.96

138.96

51784 26

Surgery

1.09

1.09

78.48

78.48

51784 TC

Surgery

0.84

0.84

60.48

60.48

51785 00

Surgery

13.12

13.12

944.64

944.64

51785 26

Surgery

2.75

2.75

198.00

198.00

51785 TC

Surgery

10.37

10.37

746.64

746.64

51792 00

Surgery

8.22

8.22

591.84

591.84

51792 26

Surgery

1.64

1.64

118.08

118.08

51792 TC

Surgery

6.58

6.58

473.76

473.76

51797 00

Surgery

5.67

5.67

408.24

408.24

51797 26

Surgery

1.17

1.17

84.24

84.24

51797 TC

Surgery

4.50

4.50

324.00

324.00

51798 00

Surgery

0.34

0.34

24.48

24.48

51800 00

Surgery

30.90

30.90

2224.80

2224.80

51820 00

Surgery

32.32

32.32

2327.04

2327.04

51840 00

Surgery

20.87

20.87

1502.64

1502.64

51841 00

Surgery

24.09

24.09

1734.48

1734.48

51845 00

Surgery

17.45

17.45

1256.40

1256.40

51860 00

Surgery

22.34

22.34

1608.48

1608.48

51865 00

Surgery

26.75

26.75

1926.00

1926.00

51880 00

Surgery

14.00

14.00

1008.00

1008.00

51900 00

Surgery

24.61

24.61

1771.92

1771.92

51920 00

Surgery

22.83

22.83

1643.76

1643.76

51925 00

Surgery

32.42

32.42

2334.24

2334.24

51940 00

Surgery

48.66

48.66

3503.52

3503.52

51960 00

Surgery

41.15

41.15

2962.80

2962.80

51980 00

Surgery

21.34

21.34

1536.48

1536.48

51990 00

Surgery

22.22

22.22

1599.84

1599.84

51992 00

Surgery

25.06

25.06

1804.32

1804.32

51999 00

Surgery

0.00

0.00

BR

BR

52000 00

Surgery

7.19

2.38

517.68

171.36

52001 00

Surgery

13.15

8.47

946.80

609.84

52005 00

Surgery

9.10

3.95

655.20

284.40

52007 00

Surgery

13.47

4.92

969.84

354.24

52010 00

Surgery

11.45

4.89

824.40

352.08

52204 00

Surgery

11.31

4.19

814.32

301.68

52214 00

Surgery

22.31

5.15

1606.32

370.80

52224 00

Surgery

23.31

5.96

1678.32

429.12

52234 00

Surgery

7.25

7.25

522.00

522.00

52235 00

Surgery

8.51

8.51

612.72

612.72

52240 00

Surgery

11.55

11.55

831.60

831.60

52250 00

Surgery

7.05

7.05

507.60

507.60

52260 00

Surgery

6.22

6.22

447.84

447.84

52265 00

Surgery

11.17

4.81

804.24

346.32

52270 00

Surgery

12.58

5.36

905.76

385.92

52275 00

Surgery

16.14

7.32

1162.08

527.04

52276 00

Surgery

7.79

7.79

560.88

560.88

52277 00

Surgery

9.52

9.52

685.44

685.44

52281 00

Surgery

9.79

4.50

704.88

324.00

52282 00

Surgery

9.94

9.94

715.68

715.68

52283 00

Surgery

10.61

5.95

763.92

428.40

52284 00

Surgery

80.28

4.86

5780.16

349.92

52285 00

Surgery

10.51

5.80

756.72

417.60

52287 00

Surgery

11.62

4.99

836.64

359.28

52290 00

Surgery

7.18

7.18

516.96

516.96

52300 00

Surgery

8.25

8.25

594.00

594.00

52301 00

Surgery

8.55

8.55

615.60

615.60

52305 00

Surgery

8.19

8.19

589.68

589.68

52310 00

Surgery

9.58

4.48

689.76

322.56

52315 00

Surgery

14.08

8.09

1013.76

582.48

52317 00

Surgery

26.43

10.20

1902.96

734.40

52318 00

Surgery

13.94

13.94

1003.68

1003.68

52320 00

Surgery

7.25

7.25

522.00

522.00

52325 00

Surgery

9.42

9.42

678.24

678.24

52327 00

Surgery

7.62

7.62

548.64

548.64

52330 00

Surgery

18.04

7.76

1298.88

558.72

52332 00

Surgery

11.99

4.60

863.28

331.20

52334 00

Surgery

5.39

5.39

388.08

388.08

52341 00

Surgery

8.38

8.38

603.36

603.36

52342 00

Surgery

9.12

9.12

656.64

656.64

52343 00

Surgery

10.13

10.13

729.36

729.36

52344 00

Surgery

10.89

10.89

784.08

784.08

52345 00

Surgery

11.62

11.62

836.64

836.64

52346 00

Surgery

13.14

13.14

946.08

946.08

52351 00

Surgery

8.93

8.93

642.96

642.96

52352 00

Surgery

10.43

10.43

750.96

750.96

52353 00

Surgery

11.54

11.54

830.88

830.88

52354 00

Surgery

12.28

12.28

884.16

884.16

52355 00

Surgery

13.76

13.76

990.72

990.72

52356 00

Surgery

12.24

12.24

881.28

881.28

52400 00

Surgery

14.23

14.23

1024.56

1024.56

52402 00

Surgery

7.81

7.81

562.32

562.32

52441 00

Surgery

37.72

6.18

2715.84

444.96

52442 00

Surgery

25.64

1.49

1846.08

107.28

52450 00

Surgery

14.28

14.28

1028.16

1028.16

52500 00

Surgery

14.82

14.82

1067.04

1067.04

52601 00

Surgery

21.73

21.73

1564.56

1564.56

52630 00

Surgery

12.20

12.20

878.40

878.40

52640 00

Surgery

9.74

9.74

701.28

701.28

52647 00

Surgery

46.75

19.45

3366.00

1400.40

52648 00

Surgery

48.21

20.72

3471.12

1491.84

52649 00

Surgery

24.64

24.64

1774.08

1774.08

52700 00

Surgery

13.29

13.29

956.88

956.88

53000 00

Surgery

4.47

4.47

321.84

321.84

53010 00

Surgery

8.98

8.98

646.56

646.56

53020 00

Surgery

2.87

2.87

206.64

206.64

53025 00

Surgery

2.05

2.05

147.60

147.60

53040 00

Surgery

11.79

11.79

848.88

848.88

53060 00

Surgery

5.72

5.00

411.84

360.00

53080 00

Surgery

12.66

12.66

911.52

911.52

53085 00

Surgery

19.41

19.41

1397.52

1397.52

53200 00

Surgery

4.78

4.23

344.16

304.56

53210 00

Surgery

23.20

23.20

1670.40

1670.40

53215 00

Surgery

27.60

27.60

1987.20

1987.20

53220 00

Surgery

13.58

13.58

977.76

977.76

53230 00

Surgery

18.30

18.30

1317.60

1317.60

53235 00

Surgery

19.00

19.00

1368.00

1368.00

53240 00

Surgery

12.78

12.78

920.16

920.16

53250 00

Surgery

11.92

11.92

858.24

858.24

53260 00

Surgery

6.25

5.45

450.00

392.40

53265 00

Surgery

6.92

5.67

498.24

408.24

53270 00

Surgery

6.39

5.55

460.08

399.60

53275 00

Surgery

7.87

7.87

566.64

566.64

53400 00

Surgery

23.90

23.90

1720.80

1720.80

53405 00

Surgery

26.05

26.05

1875.60

1875.60

53410 00

Surgery

29.20

29.20

2102.40

2102.40

53415 00

Surgery

33.61

33.61

2419.92

2419.92

53420 00

Surgery

25.07

25.07

1805.04

1805.04

53425 00

Surgery

27.88

27.88

2007.36

2007.36

53430 00

Surgery

29.08

29.08

2093.76

2093.76

53431 00

Surgery

34.28

34.28

2468.16

2468.16

53440 00

Surgery

22.50

22.50

1620.00

1620.00

53442 00

Surgery

23.53

23.53

1694.16

1694.16

53444 00

Surgery

23.69

23.69

1705.68

1705.68

53445 00

Surgery

22.66

22.66

1631.52

1631.52

53446 00

Surgery

19.26

19.26

1386.72

1386.72

53447 00

Surgery

24.08

24.08

1733.76

1733.76

53448 00

Surgery

37.93

37.93

2730.96

2730.96

53449 00

Surgery

18.36

18.36

1321.92

1321.92

53450 00

Surgery

12.30

12.30

885.60

885.60

53451 00

Surgery

0.00

0.00

BR

BR

53452 00

Surgery

0.00

0.00

BR

BR

53453 00

Surgery

0.00

0.00

BR

BR

53454 00

Surgery

-

-

154.08

132.48

53460 00

Surgery

13.76

13.76

990.72

990.72

53500 00

Surgery

22.42

22.42

1614.24

1614.24

53502 00

Surgery

14.61

14.61

1051.92

1051.92

53505 00

Surgery

14.60

14.60

1051.20

1051.20

53510 00

Surgery

18.95

18.95

1364.40

1364.40

53515 00

Surgery

23.74

23.74

1709.28

1709.28

53520 00

Surgery

16.79

16.79

1208.88

1208.88

53600 00

Surgery

2.66

1.88

191.52

135.36

53601 00

Surgery

2.58

1.58

185.76

113.76

53605 00

Surgery

1.89

1.89

136.08

136.08

53620 00

Surgery

5.10

2.58

367.20

185.76

53621 00

Surgery

4.89

2.13

352.08

153.36

53660 00

Surgery

2.29

1.24

164.88

89.28

53661 00

Surgery

2.25

1.20

162.00

86.40

53665 00

Surgery

1.12

1.12

80.64

80.64

53850 00

Surgery

42.19

10.72

3037.68

771.84

53852 00

Surgery

41.19

11.48

2965.68

826.56

53854 00

Surgery

49.70

11.48

3578.40

826.56

53855 00

Surgery

19.40

2.42

1396.80

174.24

53860 00

Surgery

70.89

6.66

5104.08

479.52

53899 00

Surgery

0.00

0.00

BR

BR

54000 00

Surgery

4.94

3.35

355.68

241.20

54001 00

Surgery

6.00

4.23

432.00

304.56

54015 00

Surgery

9.12

9.12

656.64

656.64

54050 00

Surgery

4.37

3.23

314.64

232.56

54055 00

Surgery

4.17

2.90

300.24

208.80

54056 00

Surgery

4.38

3.38

315.36

243.36

54057 00

Surgery

4.31

2.96

310.32

213.12

54060 00

Surgery

5.93

3.97

426.96

285.84

54065 00

Surgery

6.72

5.17

483.84

372.24

54100 00

Surgery

6.10

3.63

439.20

261.36

54105 00

Surgery

8.34

6.39

600.48

460.08

54110 00

Surgery

18.70

18.70

1346.40

1346.40

54111 00

Surgery

23.85

23.85

1717.20

1717.20

54112 00

Surgery

27.95

27.95

2012.40

2012.40

54115 00

Surgery

13.81

12.85

994.32

925.20

54120 00

Surgery

18.96

18.96

1365.12

1365.12

54125 00

Surgery

24.58

24.58

1769.76

1769.76

54130 00

Surgery

35.52

35.52

2557.44

2557.44

54135 00

Surgery

44.84

44.84

3228.48

3228.48

54150 00

Surgery

4.46

2.85

321.12

205.20

54160 00

Surgery

6.66

4.36

479.52

313.92

54161 00

Surgery

5.92

5.92

426.24

426.24

54162 00

Surgery

7.74

6.02

557.28

433.44

54163 00

Surgery

6.61

6.61

475.92

475.92

54164 00

Surgery

5.87

5.87

422.64

422.64

54200 00

Surgery

3.53

2.64

254.16

190.08

54205 00

Surgery

15.99

15.99

1151.28

1151.28

54220 00

Surgery

6.71

4.02

483.12

289.44

54230 00

Surgery

3.21

2.38

231.12

171.36

54231 00

Surgery

4.32

3.45

311.04

248.40

54235 00

Surgery

2.72

2.21

195.84

159.12

54240 00

Surgery

3.22

3.22

231.84

231.84

54240 26

Surgery

1.90

1.90

136.80

136.80

54240 TC

Surgery

1.32

1.32

95.04

95.04

54250 00

Surgery

3.63

3.63

261.36

261.36

54250 26

Surgery

3.19

3.19

229.68

229.68

54250 TC

Surgery

0.44

0.44

31.68

31.68

54300 00

Surgery

19.32

19.32

1391.04

1391.04

54304 00

Surgery

22.34

22.34

1608.48

1608.48

54308 00

Surgery

21.42

21.42

1542.24

1542.24

54312 00

Surgery

24.45

24.45

1760.40

1760.40

54316 00

Surgery

29.63

29.63

2133.36

2133.36

54318 00

Surgery

21.31

21.31

1534.32

1534.32

54322 00

Surgery

23.32

23.32

1679.04

1679.04

54324 00

Surgery

28.86

28.86

2077.92

2077.92

54326 00

Surgery

28.11

28.11

2023.92

2023.92

54328 00

Surgery

27.92

27.92

2010.24

2010.24

54332 00

Surgery

30.09

30.09

2166.48

2166.48

54336 00

Surgery

35.37

35.37

2546.64

2546.64

54340 00

Surgery

17.09

17.09

1230.48

1230.48

54344 00

Surgery

28.16

28.16

2027.52

2027.52

54348 00

Surgery

30.10

30.10

2167.20

2167.20

54352 00

Surgery

42.01

42.01

3024.72

3024.72

54360 00

Surgery

21.56

21.56

1552.32

1552.32

54380 00

Surgery

23.88

23.88

1719.36

1719.36

54385 00

Surgery

27.79

27.79

2000.88

2000.88

54390 00

Surgery

36.93

36.93

2658.96

2658.96

54400 00

Surgery

15.96

15.96

1149.12

1149.12

54401 00

Surgery

20.01

20.01

1440.72

1440.72

54405 00

Surgery

24.12

24.12

1736.64

1736.64

54406 00

Surgery

21.88

21.88

1575.36

1575.36

54408 00

Surgery

23.66

23.66

1703.52

1703.52

54410 00

Surgery

25.81

25.81

1858.32

1858.32

54411 00

Surgery

30.70

30.70

2210.40

2210.40

54415 00

Surgery

16.00

16.00

1152.00

1152.00

54416 00

Surgery

21.52

21.52

1549.44

1549.44

54417 00

Surgery

26.84

26.84

1932.48

1932.48

54420 00

Surgery

21.02

21.02

1513.44

1513.44

54430 00

Surgery

19.14

19.14

1378.08

1378.08

54435 00

Surgery

12.47

12.47

897.84

897.84

54437 00

Surgery

20.36

20.36

1465.92

1465.92

54438 00

Surgery

39.75

39.75

2862.00

2862.00

54440 00

Surgery

-

-

1899.36

1784.88

54450 00

Surgery

2.07

1.69

149.04

121.68

54500 00

Surgery

2.22

2.22

159.84

159.84

54505 00

Surgery

6.28

6.28

452.16

452.16

54512 00

Surgery

16.13

16.13

1161.36

1161.36

54520 00

Surgery

9.89

9.89

712.08

712.08

54522 00

Surgery

17.60

17.60

1267.20

1267.20

54530 00

Surgery

15.30

15.30

1101.60

1101.60

54535 00

Surgery

22.26

22.26

1602.72

1602.72

54550 00

Surgery

14.77

14.77

1063.44

1063.44

54560 00

Surgery

20.57

20.57

1481.04

1481.04

54600 00

Surgery

13.62

13.62

980.64

980.64

54620 00

Surgery

8.93

8.93

642.96

642.96

54640 00

Surgery

12.92

12.92

930.24

930.24

54650 00

Surgery

21.34

21.34

1536.48

1536.48

54660 00

Surgery

10.81

10.81

778.32

778.32

54670 00

Surgery

12.32

12.32

887.04

887.04

54680 00

Surgery

23.52

23.52

1693.44

1693.44

54690 00

Surgery

19.60

19.60

1411.20

1411.20

54692 00

Surgery

22.54

22.54

1622.88

1622.88

54699 00

Surgery

0.00

0.00

BR

BR

54700 00

Surgery

6.41

6.41

461.52

461.52

54800 00

Surgery

3.73

3.73

268.56

268.56

54830 00

Surgery

11.23

11.23

808.56

808.56

54840 00

Surgery

9.70

9.70

698.40

698.40

54860 00

Surgery

12.61

12.61

907.92

907.92

54861 00

Surgery

17.07

17.07

1229.04

1229.04

54865 00

Surgery

10.86

10.86

781.92

781.92

54900 00

Surgery

23.91

23.91

1721.52

1721.52

54901 00

Surgery

31.53

31.53

2270.16

2270.16

55000 00

Surgery

3.62

2.53

260.64

182.16

55040 00

Surgery

10.21

10.21

735.12

735.12

55041 00

Surgery

15.39

15.39

1108.08

1108.08

55060 00

Surgery

11.44

11.44

823.68

823.68

55100 00

Surgery

6.98

5.07

502.56

365.04

55110 00

Surgery

11.69

11.69

841.68

841.68

55120 00

Surgery

10.72

10.72

771.84

771.84

55150 00

Surgery

14.83

14.83

1067.76

1067.76

55175 00

Surgery

11.00

11.00

792.00

792.00

55180 00

Surgery

20.64

20.64

1486.08

1486.08

55200 00

Surgery

11.53

8.36

830.16

601.92

55250 00

Surgery

10.09

6.93

726.48

498.96

55300 00

Surgery

5.51

5.51

396.72

396.72

55400 00

Surgery

15.01

15.01

1080.72

1080.72

55500 00

Surgery

11.81

11.81

850.32

850.32

55520 00

Surgery

13.88

13.88

999.36

999.36

55530 00

Surgery

10.61

10.61

763.92

763.92

55535 00

Surgery

12.95

12.95

932.40

932.40

55540 00

Surgery

16.79

16.79

1208.88

1208.88

55550 00

Surgery

12.93

12.93

930.96

930.96

55559 00

Surgery

0.00

0.00

BR

BR

55600 00

Surgery

12.70

12.70

914.40

914.40

55605 00

Surgery

15.76

15.76

1134.72

1134.72

55650 00

Surgery

21.49

21.49

1547.28

1547.28

55680 00

Surgery

10.46

10.46

753.12

753.12

55700 00

Surgery

7.23

3.86

520.56

277.92

55705 00

Surgery

7.92

7.92

570.24

570.24

55706 00

Surgery

11.26

11.26

810.72

810.72

55720 00

Surgery

13.58

13.58

977.76

977.76

55725 00

Surgery

17.89

17.89

1288.08

1288.08

55801 00

Surgery

32.62

32.62

2348.64

2348.64

55810 00

Surgery

38.82

38.82

2795.04

2795.04

55812 00

Surgery

47.72

47.72

3435.84

3435.84

55815 00

Surgery

52.22

52.22

3759.84

3759.84

55821 00

Surgery

25.02

25.02

1801.44

1801.44

55831 00

Surgery

25.65

25.65

1846.80

1846.80

55840 00

Surgery

34.83

34.83

2507.76

2507.76

55842 00

Surgery

34.81

34.81

2506.32

2506.32

55845 00

Surgery

40.47

40.47

2913.84

2913.84

55860 00

Surgery

26.07

26.07

1877.04

1877.04

55862 00

Surgery

32.59

32.59

2346.48

2346.48

55865 00

Surgery

39.66

39.66

2855.52

2855.52

55866 00

Surgery

35.53

35.53

2558.16

2558.16

55867 00

Surgery

31.21

31.21

2247.12

2247.12

55870 00

Surgery

5.36

4.22

385.92

303.84

55873 00

Surgery

170.19

22.84

12253.68

1644.48

55874 00

Surgery

85.22

4.87

6135.84

350.64

55875 00

Surgery

23.31

23.31

1678.32

1678.32

55876 00

Surgery

4.55

3.05

327.60

219.60

55880 00

Surgery

29.21

29.21

2103.12

2103.12

55899 00

Surgery

0.00

0.00

BR

BR

55920 00

Surgery

13.72

13.72

987.84

987.84

55970 00

Surgery

0.00

0.00

BR

BR

55980 00

Surgery

0.00

0.00

BR

BR

56405 00

Surgery

4.44

3.85

319.68

277.20

56420 00

Surgery

5.63

3.35

405.36

241.20

56440 00

Surgery

5.49

5.49

395.28

395.28

56441 00

Surgery

5.56

4.71

400.32

339.12

56442 00

Surgery

1.43

1.43

102.96

102.96

56501 00

Surgery

5.82

4.05

419.04

291.60

56515 00

Surgery

8.39

6.43

604.08

462.96

56605 00

Surgery

2.91

1.77

209.52

127.44

56606 00

Surgery

1.14

0.87

82.08

62.64

56620 00

Surgery

17.81

17.81

1282.32

1282.32

56625 00

Surgery

20.26

20.26

1458.72

1458.72

56630 00

Surgery

29.08

29.08

2093.76

2093.76

56631 00

Surgery

35.88

35.88

2583.36

2583.36

56632 00

Surgery

43.39

43.39

3124.08

3124.08

56633 00

Surgery

37.46

37.46

2697.12

2697.12

56634 00

Surgery

39.18

39.18

2820.96

2820.96

56637 00

Surgery

45.87

45.87

3302.64

3302.64

56640 00

Surgery

46.11

46.11

3319.92

3319.92

56700 00

Surgery

6.15

6.15

442.80

442.80

56740 00

Surgery

9.52

9.52

685.44

685.44

56800 00

Surgery

7.66

7.66

551.52

551.52

56805 00

Surgery

35.11

35.11

2527.92

2527.92

56810 00

Surgery

8.26

8.26

594.72

594.72

56820 00

Surgery

3.79

2.52

272.88

181.44

56821 00

Surgery

5.08

3.40

365.76

244.80

57000 00

Surgery

6.11

6.11

439.92

439.92

57010 00

Surgery

13.87

13.87

998.64

998.64

57020 00

Surgery

3.77

2.37

271.44

170.64

57022 00

Surgery

5.48

5.48

394.56

394.56

57023 00

Surgery

9.67

9.67

696.24

696.24

57061 00

Surgery

5.07

3.50

365.04

252.00

57065 00

Surgery

7.47

5.63

537.84

405.36

57100 00

Surgery

3.13

1.96

225.36

141.12

57105 00

Surgery

5.37

4.45

386.64

320.40

57106 00

Surgery

16.28

16.28

1172.16

1172.16

57107 00

Surgery

43.96

43.96

3165.12

3165.12

57109 00

Surgery

52.25

52.25

3762.00

3762.00

57110 00

Surgery

27.22

27.22

1959.84

1959.84

57111 00

Surgery

52.25

52.25

3762.00

3762.00

57120 00

Surgery

16.06

16.06

1156.32

1156.32

57130 00

Surgery

6.97

5.24

501.84

377.28

57135 00

Surgery

7.49

5.69

539.28

409.68

57150 00

Surgery

1.74

0.77

125.28

55.44

57155 00

Surgery

11.97

8.48

861.84

610.56

57156 00

Surgery

6.89

4.52

496.08

325.44

57160 00

Surgery

2.24

1.37

161.28

98.64

57170 00

Surgery

2.34

1.41

168.48

101.52

57180 00

Surgery

5.99

3.66

431.28

263.52

57200 00

Surgery

10.09

10.09

726.48

726.48

57210 00

Surgery

11.92

11.92

858.24

858.24

57220 00

Surgery

10.49

10.49

755.28

755.28

57230 00

Surgery

12.70

12.70

914.40

914.40

57240 00

Surgery

18.51

18.51

1332.72

1332.72

57250 00

Surgery

18.59

18.59

1338.48

1338.48

57260 00

Surgery

23.47

23.47

1689.84

1689.84

57265 00

Surgery

26.24

26.24

1889.28

1889.28

57267 00

Surgery

7.46

7.46

537.12

537.12

57268 00

Surgery

15.33

15.33

1103.76

1103.76

57270 00

Surgery

24.52

24.52

1765.44

1765.44

57280 00

Surgery

29.04

29.04

2090.88

2090.88

57282 00

Surgery

20.92

20.92

1506.24

1506.24

57283 00

Surgery

21.07

21.07

1517.04

1517.04

57284 00

Surgery

25.06

25.06

1804.32

1804.32

57285 00

Surgery

20.87

20.87

1502.64

1502.64

57287 00

Surgery

22.41

22.41

1613.52

1613.52

57288 00

Surgery

22.42

22.42

1614.24

1614.24

57289 00

Surgery

23.97

23.97

1725.84

1725.84

57291 00

Surgery

16.64

16.64

1198.08

1198.08

57292 00

Surgery

24.97

24.97

1797.84

1797.84

57295 00

Surgery

15.16

15.16

1091.52

1091.52

57296 00

Surgery

28.86

28.86

2077.92

2077.92

57300 00

Surgery

18.55

18.55

1335.60

1335.60

57305 00

Surgery

29.46

29.46

2121.12

2121.12

57307 00

Surgery

32.45

32.45

2336.40

2336.40

57308 00

Surgery

20.01

20.01

1440.72

1440.72

57310 00

Surgery

14.88

14.88

1071.36

1071.36

57311 00

Surgery

16.75

16.75

1206.00

1206.00

57320 00

Surgery

17.09

17.09

1230.48

1230.48

57330 00

Surgery

23.01

23.01

1656.72

1656.72

57335 00

Surgery

35.47

35.47

2553.84

2553.84

57400 00

Surgery

3.91

3.91

281.52

281.52

57410 00

Surgery

3.19

3.19

229.68

229.68

57415 00

Surgery

5.32

5.32

383.04

383.04

57420 00

Surgery

4.02

2.69

289.44

193.68

57421 00

Surgery

5.38

3.65

387.36

262.80

57423 00

Surgery

27.93

27.93

2010.96

2010.96

57425 00

Surgery

29.26

29.26

2106.72

2106.72

57426 00

Surgery

26.33

26.33

1895.76

1895.76

57452 00

Surgery

3.83

2.73

275.76

196.56

57454 00

Surgery

5.10

4.01

367.20

288.72

57455 00

Surgery

4.89

3.25

352.08

234.00

57456 00

Surgery

4.61

3.03

331.92

218.16

57460 00

Surgery

9.45

4.78

680.40

344.16

57461 00

Surgery

10.53

5.47

758.16

393.84

57465 00

Surgery

1.65

1.27

118.80

91.44

57500 00

Surgery

4.63

2.26

333.36

162.72

57505 00

Surgery

4.69

3.33

337.68

239.76

57510 00

Surgery

5.06

3.41

364.32

245.52

57511 00

Surgery

6.04

4.47

434.88

321.84

57513 00

Surgery

6.23

4.45

448.56

320.40

57520 00

Surgery

10.72

9.00

771.84

648.00

57522 00

Surgery

9.19

7.74

661.68

557.28

57530 00

Surgery

11.36

11.36

817.92

817.92

57531 00

Surgery

55.23

55.23

3976.56

3976.56

57540 00

Surgery

23.87

23.87

1718.64

1718.64

57545 00

Surgery

25.14

25.14

1810.08

1810.08

57550 00

Surgery

13.10

13.10

943.20

943.20

57555 00

Surgery

18.71

18.71

1347.12

1347.12

57556 00

Surgery

17.77

17.77

1279.44

1279.44

57558 00

Surgery

4.80

3.91

345.60

281.52

57700 00

Surgery

10.84

10.84

780.48

780.48

57720 00

Surgery

10.14

10.14

730.08

730.08

57800 00

Surgery

2.35

1.45

169.20

104.40

58100 00

Surgery

3.06

1.89

220.32

136.08

58110 00

Surgery

1.51

1.20

108.72

86.40

58120 00

Surgery

9.02

7.06

649.44

508.32

58140 00

Surgery

27.78

27.78

2000.16

2000.16

58145 00

Surgery

17.22

17.22

1239.84

1239.84

58146 00

Surgery

34.75

34.75

2502.00

2502.00

58150 00

Surgery

30.62

30.62

2204.64

2204.64

58152 00

Surgery

37.24

37.24

2681.28

2681.28

58180 00

Surgery

28.96

28.96

2085.12

2085.12

58200 00

Surgery

40.60

40.60

2923.20

2923.20

58210 00

Surgery

54.83

54.83

3947.76

3947.76

58240 00

Surgery

87.85

87.85

6325.20

6325.20

58260 00

Surgery

25.31

25.31

1822.32

1822.32

58262 00

Surgery

27.96

27.96

2013.12

2013.12

58263 00

Surgery

29.96

29.96

2157.12

2157.12

58267 00

Surgery

32.23

32.23

2320.56

2320.56

58270 00

Surgery

26.95

26.95

1940.40

1940.40

58275 00

Surgery

29.86

29.86

2149.92

2149.92

58280 00

Surgery

31.94

31.94

2299.68

2299.68

58285 00

Surgery

42.91

42.91

3089.52

3089.52

58290 00

Surgery

34.64

34.64

2494.08

2494.08

58291 00

Surgery

37.41

37.41

2693.52

2693.52

58292 00

Surgery

39.42

39.42

2838.24

2838.24

58294 00

Surgery

36.61

36.61

2635.92

2635.92

58300 00

Surgery

3.31

1.50

238.32

108.00

58301 00

Surgery

3.33

1.98

239.76

142.56

58321 00

Surgery

2.48

1.44

178.56

103.68

58322 00

Surgery

2.76

1.72

198.72

123.84

58323 00

Surgery

0.45

0.36

32.40

25.92

58340 00

Surgery

7.26

1.73

522.72

124.56

58345 00

Surgery

8.73

8.73

628.56

628.56

58346 00

Surgery

14.94

14.94

1075.68

1075.68

58350 00

Surgery

4.65

2.88

334.80

207.36

58353 00

Surgery

27.64

6.97

1990.08

501.84

58356 00

Surgery

49.90

10.63

3592.80

765.36

58400 00

Surgery

14.03

14.03

1010.16

1010.16

58410 00

Surgery

24.60

24.60

1771.20

1771.20

58520 00

Surgery

24.09

24.09

1734.48

1734.48

58540 00

Surgery

27.65

27.65

1990.80

1990.80

58541 00

Surgery

22.05

22.05

1587.60

1587.60

58542 00

Surgery

25.02

25.02

1801.44

1801.44

58543 00

Surgery

25.41

25.41

1829.52

1829.52

58544 00

Surgery

27.30

27.30

1965.60

1965.60

58545 00

Surgery

27.19

27.19

1957.68

1957.68

58546 00

Surgery

33.50

33.50

2412.00

2412.00

58548 00

Surgery

56.72

56.72

4083.84

4083.84

58550 00

Surgery

26.60

26.60

1915.20

1915.20

58552 00

Surgery

29.54

29.54

2126.88

2126.88

58553 00

Surgery

33.69

33.69

2425.68

2425.68

58554 00

Surgery

39.26

39.26

2826.72

2826.72

58555 00

Surgery

10.84

4.53

780.48

326.16

58558 00

Surgery

39.55

6.92

2847.60

498.24

58559 00

Surgery

8.49

8.49

611.28

611.28

58560 00

Surgery

9.35

9.35

673.20

673.20

58561 00

Surgery

10.70

10.70

770.40

770.40

58562 00

Surgery

12.96

6.63

933.12

477.36

58563 00

Surgery

62.67

7.35

4512.24

529.20

58565 00

Surgery

49.71

13.84

3579.12

996.48

58570 00

Surgery

24.36

24.36

1753.92

1753.92

58571 00

Surgery

27.43

27.43

1974.96

1974.96

58572 00

Surgery

30.56

30.56

2200.32

2200.32

58573 00

Surgery

36.72

36.72

2643.84

2643.84

58575 00

Surgery

58.21

58.21

4191.12

4191.12

58578 00

Surgery

0.00

0.00

BR

BR

58579 00

Surgery

0.00

0.00

BR

BR

58580 00

Surgery

93.09

11.96

6702.48

861.12

58600 00

Surgery

11.23

11.23

808.56

808.56

58605 00

Surgery

10.21

10.21

735.12

735.12

58611 00

Surgery

2.25

2.25

162.00

162.00

58615 00

Surgery

7.67

7.67

552.24

552.24

58660 00

Surgery

20.65

20.65

1486.80

1486.80

58661 00

Surgery

19.65

19.65

1414.80

1414.80

58662 00

Surgery

21.51

21.51

1548.72

1548.72

58670 00

Surgery

11.25

11.25

810.00

810.00

58671 00

Surgery

11.25

11.25

810.00

810.00

58672 00

Surgery

22.00

22.00

1584.00

1584.00

58673 00

Surgery

23.87

23.87

1718.64

1718.64

58674 00

Surgery

24.49

24.49

1763.28

1763.28

58679 00

Surgery

0.00

0.00

BR

BR

58700 00

Surgery

24.18

24.18

1740.96

1740.96

58720 00

Surgery

22.96

22.96

1653.12

1653.12

58740 00

Surgery

27.20

27.20

1958.40

1958.40

58750 00

Surgery

27.42

27.42

1974.24

1974.24

58752 00

Surgery

27.35

27.35

1969.20

1969.20

58760 00

Surgery

24.75

24.75

1782.00

1782.00

58770 00

Surgery

25.98

25.98

1870.56

1870.56

58800 00

Surgery

10.98

9.57

790.56

689.04

58805 00

Surgery

12.98

12.98

934.56

934.56

58820 00

Surgery

10.29

10.29

740.88

740.88

58822 00

Surgery

21.58

21.58

1553.76

1553.76

58825 00

Surgery

21.42

21.42

1542.24

1542.24

58900 00

Surgery

13.25

13.25

954.00

954.00

58920 00

Surgery

21.56

21.56

1552.32

1552.32

58925 00

Surgery

23.16

23.16

1667.52

1667.52

58940 00

Surgery

16.80

16.80

1209.60

1209.60

58943 00

Surgery

36.23

36.23

2608.56

2608.56

58950 00

Surgery

34.73

34.73

2500.56

2500.56

58951 00

Surgery

43.47

43.47

3129.84

3129.84

58952 00

Surgery

49.67

49.67

3576.24

3576.24

58953 00

Surgery

60.28

60.28

4340.16

4340.16

58954 00

Surgery

65.23

65.23

4696.56

4696.56

58956 00

Surgery

41.03

41.03

2954.16

2954.16

58957 00

Surgery

47.95

47.95

3452.40

3452.40

58958 00

Surgery

49.81

49.81

3586.32

3586.32

58960 00

Surgery

30.12

30.12

2168.64

2168.64

58970 00

Surgery

7.25

5.87

522.00

422.64

58974 00

Surgery

-

-

1020.96

918.72

58976 00

Surgery

7.78

6.33

560.16

455.76

58999 00

Surgery

0.00

0.00

BR

BR

59000 00

Surgery

3.57

2.43

257.04

174.96

59001 00

Surgery

5.35

5.35

385.20

385.20

59012 00

Surgery

6.05

6.05

435.60

435.60

59015 00

Surgery

4.78

3.95

344.16

284.40

59020 00

Surgery

2.15

2.15

154.80

154.80

59020 26

Surgery

1.10

1.10

79.20

79.20

59020 TC

Surgery

1.05

1.05

75.60

75.60

59025 00

Surgery

1.48

1.48

106.56

106.56

59025 26

Surgery

0.87

0.87

62.64

62.64

59025 TC

Surgery

0.61

0.61

43.92

43.92

59030 00

Surgery

3.36

3.36

241.92

241.92

59050 00

Surgery

1.49

1.49

107.28

107.28

59051 00

Surgery

1.26

1.26

90.72

90.72

59070 00

Surgery

12.03

9.26

866.16

666.72

59072 00

Surgery

15.61

15.61

1123.92

1123.92

59074 00

Surgery

11.57

9.26

833.04

666.72

59076 00

Surgery

15.61

15.61

1123.92

1123.92

59100 00

Surgery

25.95

25.95

1868.40

1868.40

59120 00

Surgery

24.76

24.76

1782.72

1782.72

59121 00

Surgery

24.77

24.77

1783.44

1783.44

59130 00

Surgery

28.73

28.73

2068.56

2068.56

59136 00

Surgery

27.26

27.26

1962.72

1962.72

59140 00

Surgery

12.69

12.69

913.68

913.68

59150 00

Surgery

24.02

24.02

1729.44

1729.44

59151 00

Surgery

23.50

23.50

1692.00

1692.00

59160 00

Surgery

8.28

5.72

596.16

411.84

59200 00

Surgery

3.16

1.33

227.52

95.76

59300 00

Surgery

6.96

4.45

501.12

320.40

59320 00

Surgery

4.56

4.56

328.32

328.32

59325 00

Surgery

7.23

7.23

520.56

520.56

59350 00

Surgery

8.36

8.36

601.92

601.92

59400 00

Surgery

73.00

73.00

5256.00

5256.00

59409 00

Surgery

24.01

24.01

1728.72

1728.72

59410 00

Surgery

32.51

32.51

2340.72

2340.72

59412 00

Surgery

3.09

3.09

222.48

222.48

59414 00

Surgery

2.72

2.72

195.84

195.84

59425 00

Surgery

17.00

13.02

1224.00

937.44

59426 00

Surgery

31.10

23.91

2239.20

1721.52

59430 00

Surgery

7.99

5.39

575.28

388.08

59510 00

Surgery

81.17

81.17

5844.24

5844.24

59514 00

Surgery

27.23

27.23

1960.56

1960.56

59515 00

Surgery

40.37

40.37

2906.64

2906.64

59525 00

Surgery

14.44

14.44

1039.68

1039.68

59610 00

Surgery

76.53

76.53

5510.16

5510.16

59612 00

Surgery

27.21

27.21

1959.12

1959.12

59614 00

Surgery

35.15

35.15

2530.80

2530.80

59618 00

Surgery

82.04

82.04

5906.88

5906.88

59620 00

Surgery

28.19

28.19

2029.68

2029.68

59622 00

Surgery

41.85

41.85

3013.20

3013.20

59812 00

Surgery

11.02

9.35

793.44

673.20

59820 00

Surgery

13.37

11.77

962.64

847.44

59821 00

Surgery

13.17

11.50

948.24

828.00

59830 00

Surgery

14.11

14.11

1015.92

1015.92

59840 00

Surgery

7.61

6.76

547.92

486.72

59841 00

Surgery

12.96

11.31

933.12

814.32

59850 00

Surgery

11.90

11.90

856.80

856.80

59851 00

Surgery

13.03

13.03

938.16

938.16

59852 00

Surgery

17.90

17.90

1288.80

1288.80

59855 00

Surgery

12.92

12.92

930.24

930.24

59856 00

Surgery

15.10

15.10

1087.20

1087.20

59857 00

Surgery

17.57

17.57

1265.04

1265.04

59866 00

Surgery

7.16

7.16

515.52

515.52

59870 00

Surgery

16.32

16.32

1175.04

1175.04

59871 00

Surgery

4.02

4.02

289.44

289.44

59897 00

Surgery

0.00

0.00

BR

BR

59898 00

Surgery

0.00

0.00

BR

BR

59899 00

Surgery

0.00

0.00

BR

BR

60000 00

Surgery

5.65

4.80

406.80

345.60

60100 00

Surgery

3.29

2.26

236.88

162.72

60200 00

Surgery

20.21

20.21

1455.12

1455.12

60210 00

Surgery

21.33

21.33

1535.76

1535.76

60212 00

Surgery

30.87

30.87

2222.64

2222.64

60220 00

Surgery

21.31

21.31

1534.32

1534.32

60225 00

Surgery

28.26

28.26

2034.72

2034.72

60240 00

Surgery

27.59

27.59

1986.48

1986.48

60252 00

Surgery

39.64

39.64

2854.08

2854.08

60254 00

Surgery

50.01

50.01

3600.72

3600.72

60260 00

Surgery

32.69

32.69

2353.68

2353.68

60270 00

Surgery

40.88

40.88

2943.36

2943.36

60271 00

Surgery

31.69

31.69

2281.68

2281.68

60280 00

Surgery

13.78

13.78

992.16

992.16

60281 00

Surgery

18.03

18.03

1298.16

1298.16

60300 00

Surgery

3.21

1.43

231.12

102.96

60500 00

Surgery

29.20

29.20

2102.40

2102.40

60502 00

Surgery

39.20

39.20

2822.40

2822.40

60505 00

Surgery

42.10

42.10

3031.20

3031.20

60512 00

Surgery

7.19

7.19

517.68

517.68

60520 00

Surgery

31.52

31.52

2269.44

2269.44

60521 00

Surgery

33.43

33.43

2406.96

2406.96

60522 00

Surgery

40.46

40.46

2913.12

2913.12

60540 00

Surgery

32.37

32.37

2330.64

2330.64

60545 00

Surgery

37.51

37.51

2700.72

2700.72

60600 00

Surgery

40.65

40.65

2926.80

2926.80

60605 00

Surgery

48.32

48.32

3479.04

3479.04

60650 00

Surgery

35.68

35.68

2568.96

2568.96

60659 00

Surgery

0.00

0.00

BR

BR

60699 00

Surgery

0.00

0.00

BR

BR

61000 00

Surgery

3.45

3.45

248.40

248.40

61001 00

Surgery

3.27

3.27

235.44

235.44

61020 00

Surgery

3.24

3.24

233.28

233.28

61026 00

Surgery

3.31

3.31

238.32

238.32

61050 00

Surgery

2.37

2.37

170.64

170.64

61055 00

Surgery

3.49

3.49

251.28

251.28

61070 00

Surgery

1.68

1.68

120.96

120.96

61105 00

Surgery

14.29

14.29

1028.88

1028.88

61107 00

Surgery

9.41

9.41

677.52

677.52

61108 00

Surgery

27.74

27.74

1997.28

1997.28

61120 00

Surgery

23.03

23.03

1658.16

1658.16

61140 00

Surgery

38.92

38.92

2802.24

2802.24

61150 00

Surgery

41.23

41.23

2968.56

2968.56

61151 00

Surgery

30.41

30.41

2189.52

2189.52

61154 00

Surgery

39.11

39.11

2815.92

2815.92

61156 00

Surgery

37.85

37.85

2725.20

2725.20

61210 00

Surgery

11.03

11.03

794.16

794.16

61215 00

Surgery

15.91

15.91

1145.52

1145.52

61250 00

Surgery

26.60

26.60

1915.20

1915.20

61253 00

Surgery

30.41

30.41

2189.52

2189.52

61304 00

Surgery

49.99

49.99

3599.28

3599.28

61305 00

Surgery

61.09

61.09

4398.48

4398.48

61312 00

Surgery

62.99

62.99

4535.28

4535.28

61313 00

Surgery

60.53

60.53

4358.16

4358.16

61314 00

Surgery

55.63

55.63

4005.36

4005.36

61315 00

Surgery

63.03

63.03

4538.16

4538.16

61316 00

Surgery

2.63

2.63

189.36

189.36

61320 00

Surgery

57.64

57.64

4150.08

4150.08

61321 00

Surgery

64.68

64.68

4656.96

4656.96

61322 00

Surgery

72.54

72.54

5222.88

5222.88

61323 00

Surgery

72.70

72.70

5234.40

5234.40

61330 00

Surgery

54.72

54.72

3939.84

3939.84

61333 00

Surgery

61.37

61.37

4418.64

4418.64

61340 00

Surgery

43.97

43.97

3165.84

3165.84

61343 00

Surgery

66.69

66.69

4801.68

4801.68

61345 00

Surgery

62.22

62.22

4479.84

4479.84

61450 00

Surgery

58.47

58.47

4209.84

4209.84

61458 00

Surgery

61.24

61.24

4409.28

4409.28

61460 00

Surgery

64.14

64.14

4618.08

4618.08

61500 00

Surgery

39.44

39.44

2839.68

2839.68

61501 00

Surgery

34.32

34.32

2471.04

2471.04

61510 00

Surgery

67.11

67.11

4831.92

4831.92

61512 00

Surgery

77.60

77.60

5587.20

5587.20

61514 00

Surgery

58.32

58.32

4199.04

4199.04

61516 00

Surgery

57.14

57.14

4114.08

4114.08

61517 00

Surgery

2.62

2.62

188.64

188.64

61518 00

Surgery

84.27

84.27

6067.44

6067.44

61519 00

Surgery

89.31

89.31

6430.32

6430.32

61520 00

Surgery

112.51

112.51

8100.72

8100.72

61521 00

Surgery

96.47

96.47

6945.84

6945.84

61522 00

Surgery

66.60

66.60

4795.20

4795.20

61524 00

Surgery

63.48

63.48

4570.56

4570.56

61526 00

Surgery

100.64

100.64

7246.08

7246.08

61530 00

Surgery

93.20

93.20

6710.40

6710.40

61531 00

Surgery

37.55

37.55

2703.60

2703.60

61533 00

Surgery

46.62

46.62

3356.64

3356.64

61534 00

Surgery

50.42

50.42

3630.24

3630.24

61535 00

Surgery

30.86

30.86

2221.92

2221.92

61536 00

Surgery

78.32

78.32

5639.04

5639.04

61537 00

Surgery

74.61

74.61

5371.92

5371.92

61538 00

Surgery

80.76

80.76

5814.72

5814.72

61539 00

Surgery

71.78

71.78

5168.16

5168.16

61540 00

Surgery

66.25

66.25

4770.00

4770.00

61541 00

Surgery

65.46

65.46

4713.12

4713.12

61543 00

Surgery

66.17

66.17

4764.24

4764.24

61544 00

Surgery

57.83

57.83

4163.76

4163.76

61545 00

Surgery

96.81

96.81

6970.32

6970.32

61546 00

Surgery

70.22

70.22

5055.84

5055.84

61548 00

Surgery

47.63

47.63

3429.36

3429.36

61550 00

Surgery

36.72

36.72

2643.84

2643.84

61552 00

Surgery

45.45

45.45

3272.40

3272.40

61556 00

Surgery

52.13

52.13

3753.36

3753.36

61557 00

Surgery

51.54

51.54

3710.88

3710.88

61558 00

Surgery

57.44

57.44

4135.68

4135.68

61559 00

Surgery

73.08

73.08

5261.76

5261.76

61563 00

Surgery

60.39

60.39

4348.08

4348.08

61564 00

Surgery

73.22

73.22

5271.84

5271.84

61566 00

Surgery

68.17

68.17

4908.24

4908.24

61567 00

Surgery

77.64

77.64

5590.08

5590.08

61570 00

Surgery

57.08

57.08

4109.76

4109.76

61571 00

Surgery

60.69

60.69

4369.68

4369.68

61575 00

Surgery

76.12

76.12

5480.64

5480.64

61576 00

Surgery

126.52

126.52

9109.44

9109.44

61580 00

Surgery

74.81

74.81

5386.32

5386.32

61581 00

Surgery

81.47

81.47

5865.84

5865.84

61582 00

Surgery

90.93

90.93

6546.96

6546.96

61583 00

Surgery

88.47

88.47

6369.84

6369.84

61584 00

Surgery

87.23

87.23

6280.56

6280.56

61585 00

Surgery

99.41

99.41

7157.52

7157.52

61586 00

Surgery

76.79

76.79

5528.88

5528.88

61590 00

Surgery

90.73

90.73

6532.56

6532.56

61591 00

Surgery

92.37

92.37

6650.64

6650.64

61592 00

Surgery

96.07

96.07

6917.04

6917.04

61595 00

Surgery

72.16

72.16

5195.52

5195.52

61596 00

Surgery

73.10

73.10

5263.20

5263.20

61597 00

Surgery

89.90

89.90

6472.80

6472.80

61598 00

Surgery

86.57

86.57

6233.04

6233.04

61600 00

Surgery

63.91

63.91

4601.52

4601.52

61601 00

Surgery

73.79

73.79

5312.88

5312.88

61605 00

Surgery

65.06

65.06

4684.32

4684.32

61606 00

Surgery

87.83

87.83

6323.76

6323.76

61607 00

Surgery

92.14

92.14

6634.08

6634.08

61608 00

Surgery

99.41

99.41

7157.52

7157.52

61611 00

Surgery

14.04

14.04

1010.88

1010.88

61613 00

Surgery

99.60

99.60

7171.20

7171.20

61615 00

Surgery

85.42

85.42

6150.24

6150.24

61616 00

Surgery

101.15

101.15

7282.80

7282.80

61618 00

Surgery

39.07

39.07

2813.04

2813.04

61619 00

Surgery

43.34

43.34

3120.48

3120.48

61623 00

Surgery

17.24

17.24

1241.28

1241.28

61624 00

Surgery

34.77

34.77

2503.44

2503.44

61626 00

Surgery

26.95

26.95

1940.40

1940.40

61630 00

Surgery

40.93

40.93

2946.96

2946.96

61635 00

Surgery

44.45

44.45

3200.40

3200.40

61640 00

Surgery

14.01

14.01

1008.72

1008.72

61641 00

Surgery

4.92

4.92

354.24

354.24

61642 00

Surgery

9.84

9.84

708.48

708.48

61645 00

Surgery

25.17

25.17

1812.24

1812.24

61650 00

Surgery

17.42

17.42

1254.24

1254.24

61651 00

Surgery

7.44

7.44

535.68

535.68

61680 00

Surgery

69.09

69.09

4974.48

4974.48

61682 00

Surgery

126.19

126.19

9085.68

9085.68

61684 00

Surgery

86.31

86.31

6214.32

6214.32

61686 00

Surgery

135.88

135.88

9783.36

9783.36

61690 00

Surgery

66.43

66.43

4782.96

4782.96

61692 00

Surgery

110.50

110.50

7956.00

7956.00

61697 00

Surgery

127.86

127.86

9205.92

9205.92

61698 00

Surgery

139.91

139.91

10073.52

10073.52

61700 00

Surgery

103.44

103.44

7447.68

7447.68

61702 00

Surgery

121.71

121.71

8763.12

8763.12

61703 00

Surgery

41.57

41.57

2993.04

2993.04

61705 00

Surgery

79.04

79.04

5690.88

5690.88

61708 00

Surgery

77.36

77.36

5569.92

5569.92

61710 00

Surgery

65.27

65.27

4699.44

4699.44

61711 00

Surgery

79.20

79.20

5702.40

5702.40

61720 00

Surgery

38.89

38.89

2800.08

2800.08

61735 00

Surgery

48.73

48.73

3508.56

3508.56

61736 00

Surgery

36.47

36.47

2625.84

2625.84

61737 00

Surgery

43.94

43.94

3163.68

3163.68

61750 00

Surgery

42.96

42.96

3093.12

3093.12

61751 00

Surgery

42.44

42.44

3055.68

3055.68

61760 00

Surgery

48.10

48.10

3463.20

3463.20

61770 00

Surgery

49.46

49.46

3561.12

3561.12

61781 00

Surgery

7.08

7.08

509.76

509.76

61782 00

Surgery

5.13

5.13

369.36

369.36

61783 00

Surgery

6.93

6.93

498.96

498.96

61790 00

Surgery

27.01

27.01

1944.72

1944.72

61791 00

Surgery

34.49

34.49

2483.28

2483.28

61796 00

Surgery

31.15

31.15

2242.80

2242.80

61797 00

Surgery

6.60

6.60

475.20

475.20

61798 00

Surgery

42.10

42.10

3031.20

3031.20

61799 00

Surgery

9.12

9.12

656.64

656.64

61800 00

Surgery

4.54

4.54

326.88

326.88

61850 00

Surgery

30.21

30.21

2175.12

2175.12

61860 00

Surgery

47.68

47.68

3432.96

3432.96

61863 00

Surgery

46.01

46.01

3312.72

3312.72

61864 00

Surgery

8.49

8.49

611.28

611.28

61867 00

Surgery

69.39

69.39

4996.08

4996.08

61868 00

Surgery

15.00

15.00

1080.00

1080.00

61880 00

Surgery

18.04

18.04

1298.88

1298.88

61885 00

Surgery

16.20

16.20

1166.40

1166.40

61886 00

Surgery

27.03

27.03

1946.16

1946.16

61888 00

Surgery

12.17

12.17

876.24

876.24

61889 00

Surgery

37.92

37.92

2730.24

2730.24

61891 00

Surgery

17.99

17.99

1295.28

1295.28

61892 00

Surgery

24.82

24.82

1787.04

1787.04

62000 00

Surgery

31.69

31.69

2281.68

2281.68

62005 00

Surgery

38.92

38.92

2802.24

2802.24

62010 00

Surgery

46.97

46.97

3381.84

3381.84

62100 00

Surgery

47.81

47.81

3442.32

3442.32

62115 00

Surgery

51.57

51.57

3713.04

3713.04

62117 00

Surgery

59.82

59.82

4307.04

4307.04

62120 00

Surgery

63.21

63.21

4551.12

4551.12

62121 00

Surgery

47.10

47.10

3391.20

3391.20

62140 00

Surgery

31.15

31.15

2242.80

2242.80

62141 00

Surgery

34.88

34.88

2511.36

2511.36

62142 00

Surgery

27.32

27.32

1967.04

1967.04

62143 00

Surgery

31.92

31.92

2298.24

2298.24

62145 00

Surgery

43.36

43.36

3121.92

3121.92

62146 00

Surgery

38.24

38.24

2753.28

2753.28

62147 00

Surgery

43.14

43.14

3106.08

3106.08

62148 00

Surgery

3.78

3.78

272.16

272.16

62160 00

Surgery

5.65

5.65

406.80

406.80

62161 00

Surgery

46.59

46.59

3354.48

3354.48

62162 00

Surgery

57.62

57.62

4148.64

4148.64

62164 00

Surgery

63.88

63.88

4599.36

4599.36

62165 00

Surgery

45.95

45.95

3308.40

3308.40

62180 00

Surgery

48.83

48.83

3515.76

3515.76

62190 00

Surgery

28.54

28.54

2054.88

2054.88

62192 00

Surgery

30.45

30.45

2192.40

2192.40

62194 00

Surgery

15.21

15.21

1095.12

1095.12

62200 00

Surgery

42.05

42.05

3027.60

3027.60

62201 00

Surgery

37.20

37.20

2678.40

2678.40

62220 00

Surgery

29.74

29.74

2141.28

2141.28

62223 00

Surgery

31.56

31.56

2272.32

2272.32

62225 00

Surgery

16.50

16.50

1188.00

1188.00

62230 00

Surgery

25.72

25.72

1851.84

1851.84

62252 00

Surgery

2.59

2.59

186.48

186.48

62252 26

Surgery

1.37

1.37

98.64

98.64

62252 TC

Surgery

1.22

1.22

87.84

87.84

62256 00

Surgery

18.82

18.82

1355.04

1355.04

62258 00

Surgery

34.03

34.03

2450.16

2450.16

62263 00

Surgery

19.42

9.72

1398.24

699.84

62264 00

Surgery

13.17

7.29

948.24

524.88

62267 00

Surgery

7.89

4.55

568.08

327.60

62268 00

Surgery

9.96

9.96

717.12

717.12

62269 00

Surgery

7.65

7.65

550.80

550.80

62270 00

Surgery

4.39

1.90

316.08

136.80

62272 00

Surgery

5.56

2.75

400.32

198.00

62273 00

Surgery

5.04

3.37

362.88

242.64

62280 00

Surgery

9.86

4.78

709.92

344.16

62281 00

Surgery

7.21

4.64

519.12

334.08

62282 00

Surgery

9.33

4.24

671.76

305.28

62284 00

Surgery

5.60

2.46

403.20

177.12

62287 00

Surgery

18.09

18.09

1302.48

1302.48

62290 00

Surgery

10.28

4.63

740.16

333.36

62291 00

Surgery

9.25

4.22

666.00

303.84

62292 00

Surgery

17.46

17.46

1257.12

1257.12

62294 00

Surgery

29.21

29.21

2103.12

2103.12

62302 00

Surgery

7.59

3.51

546.48

252.72

62303 00

Surgery

7.72

3.51

555.84

252.72

62304 00

Surgery

7.55

3.47

543.60

249.84

62305 00

Surgery

8.22

3.60

591.84

259.20

62320 00

Surgery

4.92

2.98

354.24

214.56

62321 00

Surgery

7.89

3.20

568.08

230.40

62322 00

Surgery

4.06

2.36

292.32

169.92

62323 00

Surgery

7.76

2.96

558.72

213.12

62324 00

Surgery

4.11

2.64

295.92

190.08

62325 00

Surgery

7.50

3.28

540.00

236.16

62326 00

Surgery

4.12

2.53

296.64

182.16

62327 00

Surgery

8.19

3.20

589.68

230.40

62328 00

Surgery

6.64

2.52

478.08

181.44

62329 00

Surgery

7.83

3.09

563.76

222.48

62350 00

Surgery

12.04

12.04

866.88

866.88

62351 00

Surgery

27.87

27.87

2006.64

2006.64

62355 00

Surgery

8.38

8.38

603.36

603.36

62360 00

Surgery

9.41

9.41

677.52

677.52

62361 00

Surgery

13.36

13.36

961.92

961.92

62362 00

Surgery

11.68

11.68

840.96

840.96

62365 00

Surgery

9.06

9.06

652.32

652.32

62367 00

Surgery

0.96

0.74

69.12

53.28

62368 00

Surgery

1.33

1.02

95.76

73.44

62369 00

Surgery

2.77

1.04

199.44

74.88

62370 00

Surgery

2.77

1.36

199.44

97.92

62380 00

Surgery

-

-

5215.68

4693.68

63001 00

Surgery

37.44

37.44

2695.68

2695.68

63003 00

Surgery

37.58

37.58

2705.76

2705.76

63005 00

Surgery

36.60

36.60

2635.20

2635.20

63011 00

Surgery

33.01

33.01

2376.72

2376.72

63012 00

Surgery

36.31

36.31

2614.32

2614.32

63015 00

Surgery

45.13

45.13

3249.36

3249.36

63016 00

Surgery

46.40

46.40

3340.80

3340.80

63017 00

Surgery

38.59

38.59

2778.48

2778.48

63020 00

Surgery

33.40

33.40

2404.80

2404.80

63030 00

Surgery

27.85

27.85

2005.20

2005.20

63035 00

Surgery

6.98

6.98

502.56

502.56

63040 00

Surgery

41.74

41.74

3005.28

3005.28

63042 00

Surgery

39.29

39.29

2828.88

2828.88

63043 00

Surgery

-

-

1950.48

1755.36

63044 00

Surgery

-

-

1417.68

1275.84

63045 00

Surgery

39.21

39.21

2823.12

2823.12

63046 00

Surgery

37.40

37.40

2692.80

2692.80

63047 00

Surgery

33.61

33.61

2419.92

2419.92

63048 00

Surgery

6.30

6.30

453.60

453.60

63050 00

Surgery

44.38

44.38

3195.36

3195.36

63051 00

Surgery

51.16

51.16

3683.52

3683.52

63052 00

Surgery

7.72

7.72

555.84

555.84

63053 00

Surgery

6.86

6.86

493.92

493.92

63055 00

Surgery

49.38

49.38

3555.36

3555.36

63056 00

Surgery

45.18

45.18

3252.96

3252.96

63057 00

Surgery

9.62

9.62

692.64

692.64

63064 00

Surgery

53.91

53.91

3881.52

3881.52

63066 00

Surgery

6.17

6.17

444.24

444.24

63075 00

Surgery

41.04

41.04

2954.88

2954.88

63076 00

Surgery

7.22

7.22

519.84

519.84

63077 00

Surgery

43.91

43.91

3161.52

3161.52

63078 00

Surgery

6.21

6.21

447.12

447.12

63081 00

Surgery

53.41

53.41

3845.52

3845.52

63082 00

Surgery

7.96

7.96

573.12

573.12

63085 00

Surgery

58.81

58.81

4234.32

4234.32

63086 00

Surgery

5.73

5.73

412.56

412.56

63087 00

Surgery

73.11

73.11

5263.92

5263.92

63088 00

Surgery

7.75

7.75

558.00

558.00

63090 00

Surgery

58.66

58.66

4223.52

4223.52

63091 00

Surgery

5.23

5.23

376.56

376.56

63101 00

Surgery

70.51

70.51

5076.72

5076.72

63102 00

Surgery

69.17

69.17

4980.24

4980.24

63103 00

Surgery

8.78

8.78

632.16

632.16

63170 00

Surgery

48.70

48.70

3506.40

3506.40

63172 00

Surgery

43.19

43.19

3109.68

3109.68

63173 00

Surgery

52.71

52.71

3795.12

3795.12

63185 00

Surgery

37.65

37.65

2710.80

2710.80

63190 00

Surgery

37.36

37.36

2689.92

2689.92

63191 00

Surgery

42.27

42.27

3043.44

3043.44

63197 00

Surgery

52.26

52.26

3762.72

3762.72

63200 00

Surgery

46.77

46.77

3367.44

3367.44

63250 00

Surgery

89.96

89.96

6477.12

6477.12

63251 00

Surgery

91.98

91.98

6622.56

6622.56

63252 00

Surgery

91.97

91.97

6621.84

6621.84

63265 00

Surgery

50.86

50.86

3661.92

3661.92

63266 00

Surgery

52.20

52.20

3758.40

3758.40

63267 00

Surgery

41.74

41.74

3005.28

3005.28

63268 00

Surgery

44.74

44.74

3221.28

3221.28

63270 00

Surgery

63.30

63.30

4557.60

4557.60

63271 00

Surgery

63.11

63.11

4543.92

4543.92

63272 00

Surgery

56.91

56.91

4097.52

4097.52

63273 00

Surgery

57.00

57.00

4104.00

4104.00

63275 00

Surgery

54.78

54.78

3944.16

3944.16

63276 00

Surgery

54.44

54.44

3919.68

3919.68

63277 00

Surgery

47.48

47.48

3418.56

3418.56

63278 00

Surgery

48.73

48.73

3508.56

3508.56

63280 00

Surgery

64.57

64.57

4649.04

4649.04

63281 00

Surgery

64.04

64.04

4610.88

4610.88

63282 00

Surgery

60.36

60.36

4345.92

4345.92

63283 00

Surgery

58.10

58.10

4183.20

4183.20

63285 00

Surgery

79.51

79.51

5724.72

5724.72

63286 00

Surgery

78.21

78.21

5631.12

5631.12

63287 00

Surgery

83.35

83.35

6001.20

6001.20

63290 00

Surgery

84.75

84.75

6102.00

6102.00

63295 00

Surgery

9.88

9.88

711.36

711.36

63300 00

Surgery

54.95

54.95

3956.40

3956.40

63301 00

Surgery

67.22

67.22

4839.84

4839.84

63302 00

Surgery

66.42

66.42

4782.24

4782.24

63303 00

Surgery

70.42

70.42

5070.24

5070.24

63304 00

Surgery

71.52

71.52

5149.44

5149.44

63305 00

Surgery

76.07

76.07

5477.04

5477.04

63306 00

Surgery

74.75

74.75

5382.00

5382.00

63307 00

Surgery

73.18

73.18

5268.96

5268.96

63308 00

Surgery

9.61

9.61

691.92

691.92

63600 00

Surgery

33.47

33.47

2409.84

2409.84

63610 00

Surgery

17.52

17.52

1261.44

1261.44

63620 00

Surgery

34.42

34.42

2478.24

2478.24

63621 00

Surgery

7.58

7.58

545.76

545.76

63650 00

Surgery

68.30

12.42

4917.60

894.24

63655 00

Surgery

25.60

25.60

1843.20

1843.20

63661 00

Surgery

20.62

9.95

1484.64

716.40

63662 00

Surgery

25.99

25.99

1871.28

1871.28

63663 00

Surgery

27.15

13.56

1954.80

976.32

63664 00

Surgery

27.05

27.05

1947.60

1947.60

63685 00

Surgery

10.28

10.28

740.16

740.16

63688 00

Surgery

9.09

9.09

654.48

654.48

63700 00

Surgery

40.21

40.21

2895.12

2895.12

63702 00

Surgery

43.88

43.88

3159.36

3159.36

63704 00

Surgery

51.04

51.04

3674.88

3674.88

63706 00

Surgery

56.59

56.59

4074.48

4074.48

63707 00

Surgery

28.59

28.59

2058.48

2058.48

63709 00

Surgery

33.90

33.90

2440.80

2440.80

63710 00

Surgery

32.91

32.91

2369.52

2369.52

63740 00

Surgery

30.26

30.26

2178.72

2178.72

63741 00

Surgery

20.88

20.88

1503.36

1503.36

63744 00

Surgery

20.97

20.97

1509.84

1509.84

63746 00

Surgery

18.81

18.81

1354.32

1354.32

64400 00

Surgery

3.42

1.55

246.24

111.60

64405 00

Surgery

2.27

1.58

163.44

113.76

64408 00

Surgery

2.45

1.34

176.40

96.48

64415 00

Surgery

4.02

2.06

289.44

148.32

64416 00

Surgery

2.28

2.28

164.16

164.16

64417 00

Surgery

4.81

1.90

346.32

136.80

64418 00

Surgery

2.59

1.65

186.48

118.80

64420 00

Surgery

2.94

1.73

211.68

124.56

64421 00

Surgery

1.00

0.74

72.00

53.28

64425 00

Surgery

3.32

1.62

239.04

116.64

64430 00

Surgery

2.95

1.63

212.40

117.36

64435 00

Surgery

2.42

1.31

174.24

94.32

64445 00

Surgery

4.76

2.14

342.72

154.08

64446 00

Surgery

2.23

2.23

160.56

160.56

64447 00

Surgery

3.48

1.87

250.56

134.64

64448 00

Surgery

2.13

2.13

153.36

153.36

64449 00

Surgery

1.89

1.89

136.08

136.08

64450 00

Surgery

2.26

1.25

162.72

90.00

64451 00

Surgery

6.84

2.43

492.48

174.96

64454 00

Surgery

6.66

2.45

479.52

176.40

64455 00

Surgery

1.50

0.99

108.00

71.28

64461 00

Surgery

4.02

2.31

289.44

166.32

64462 00

Surgery

2.13

1.43

153.36

102.96

64463 00

Surgery

6.83

2.41

491.76

173.52

64479 00

Surgery

7.98

3.89

574.56

280.08

64480 00

Surgery

4.04

1.81

290.88

130.32

64483 00

Surgery

7.40

3.32

532.80

239.04

64484 00

Surgery

3.34

1.53

240.48

110.16

64486 00

Surgery

3.34

1.63

240.48

117.36

64487 00

Surgery

6.39

1.87

460.08

134.64

64488 00

Surgery

4.12

2.03

296.64

146.16

64489 00

Surgery

10.36

2.28

745.92

164.16

64490 00

Surgery

5.79

3.14

416.88

226.08

64491 00

Surgery

2.92

1.76

210.24

126.72

64492 00

Surgery

2.93

1.79

210.96

128.88

64493 00

Surgery

5.33

2.70

383.76

194.40

64494 00

Surgery

2.73

1.51

196.56

108.72

64495 00

Surgery

2.73

1.54

196.56

110.88

64505 00

Surgery

4.37

3.17

314.64

228.24

64510 00

Surgery

4.40

2.30

316.80

165.60

64517 00

Surgery

5.84

3.76

420.48

270.72

64520 00

Surgery

6.92

2.54

498.24

182.88

64530 00

Surgery

6.86

2.82

493.92

203.04

64553 00

Surgery

116.06

13.74

8356.32

989.28

64555 00

Surgery

63.67

9.68

4584.24

696.96

64561 00

Surgery

22.00

9.06

1584.00

652.32

64566 00

Surgery

3.50

0.90

252.00

64.80

64568 00

Surgery

18.23

18.23

1312.56

1312.56

64569 00

Surgery

23.48

23.48

1690.56

1690.56

64570 00

Surgery

22.60

22.60

1627.20

1627.20

64575 00

Surgery

9.48

9.48

682.56

682.56

64580 00

Surgery

9.54

9.54

686.88

686.88

64581 00

Surgery

19.62

19.62

1412.64

1412.64

64582 00

Surgery

25.13

25.13

1809.36

1809.36

64583 00

Surgery

25.94

25.94

1867.68

1867.68

64584 00

Surgery

21.89

21.89

1576.08

1576.08

64585 00

Surgery

7.28

4.33

524.16

311.76

64590 00

Surgery

13.27

8.83

955.44

635.76

64595 00

Surgery

10.94

6.89

787.68

496.08

64596 00

Surgery

0.00

0.00

BR

BR

64597 00

Surgery

0.00

0.00

BR

BR

64598 00

Surgery

0.00

0.00

BR

BR

64600 00

Surgery

14.38

7.15

1035.36

514.80

64605 00

Surgery

27.30

12.92

1965.60

930.24

64610 00

Surgery

23.29

14.54

1676.88

1046.88

64611 00

Surgery

4.01

3.43

288.72

246.96

64612 00

Surgery

4.16

3.60

299.52

259.20

64615 00

Surgery

4.64

3.70

334.08

266.40

64616 00

Surgery

4.19

3.31

301.68

238.32

64617 00

Surgery

4.87

3.24

350.64

233.28

64620 00

Surgery

6.32

5.32

455.04

383.04

64624 00

Surgery

11.66

4.36

839.52

313.92

64625 00

Surgery

14.19

5.84

1021.68

420.48

64628 00

Surgery

12.37

12.37

890.64

890.64

64629 00

Surgery

5.85

5.85

421.20

421.20

64630 00

Surgery

7.71

5.74

555.12

413.28

64632 00

Surgery

2.73

2.01

196.56

144.72

64633 00

Surgery

13.15

5.74

946.80

413.28

64634 00

Surgery

7.67

1.99

552.24

143.28

64635 00

Surgery

13.26

5.75

954.72

414.00

64636 00

Surgery

7.20

1.74

518.40

125.28

64640 00

Surgery

7.46

3.56

537.12

256.32

64642 00

Surgery

4.62

3.22

332.64

231.84

64643 00

Surgery

2.81

2.09

202.32

150.48

64644 00

Surgery

5.36

3.48

385.92

250.56

64645 00

Surgery

3.63

2.43

261.36

174.96

64646 00

Surgery

4.87

3.49

350.64

251.28

64647 00

Surgery

5.55

4.02

399.60

289.44

64650 00

Surgery

2.67

1.22

192.24

87.84

64653 00

Surgery

3.14

1.55

226.08

111.60

64680 00

Surgery

10.23

4.79

736.56

344.88

64681 00

Surgery

13.55

6.52

975.60

469.44

64702 00

Surgery

15.67

15.67

1128.24

1128.24

64704 00

Surgery

9.84

9.84

708.48

708.48

64708 00

Surgery

15.47

15.47

1113.84

1113.84

64712 00

Surgery

18.06

18.06

1300.32

1300.32

64713 00

Surgery

24.29

24.29

1748.88

1748.88

64714 00

Surgery

23.22

23.22

1671.84

1671.84

64716 00

Surgery

15.49

15.49

1115.28

1115.28

64718 00

Surgery

18.41

18.41

1325.52

1325.52

64719 00

Surgery

12.46

12.46

897.12

897.12

64721 00

Surgery

13.61

13.37

979.92

962.64

64722 00

Surgery

11.30

11.30

813.60

813.60

64726 00

Surgery

8.13

8.13

585.36

585.36

64727 00

Surgery

5.32

5.32

383.04

383.04

64732 00

Surgery

14.00

14.00

1008.00

1008.00

64734 00

Surgery

15.80

15.80

1137.60

1137.60

64736 00

Surgery

9.97

9.97

717.84

717.84

64738 00

Surgery

13.50

13.50

972.00

972.00

64740 00

Surgery

13.78

13.78

992.16

992.16

64742 00

Surgery

14.83

14.83

1067.76

1067.76

64744 00

Surgery

15.57

15.57

1121.04

1121.04

64746 00

Surgery

12.98

12.98

934.56

934.56

64755 00

Surgery

27.71

27.71

1995.12

1995.12

64760 00

Surgery

15.77

15.77

1135.44

1135.44

64763 00

Surgery

15.60

15.60

1123.20

1123.20

64766 00

Surgery

19.24

19.24

1385.28

1385.28

64771 00

Surgery

17.51

17.51

1260.72

1260.72

64772 00

Surgery

16.93

16.93

1218.96

1218.96

64774 00

Surgery

13.01

13.01

936.72

936.72

64776 00

Surgery

12.31

12.31

886.32

886.32

64778 00

Surgery

5.35

5.35

385.20

385.20

64782 00

Surgery

13.79

13.79

992.88

992.88

64783 00

Surgery

6.38

6.38

459.36

459.36

64784 00

Surgery

21.89

21.89

1576.08

1576.08

64786 00

Surgery

30.25

30.25

2178.00

2178.00

64787 00

Surgery

6.94

6.94

499.68

499.68

64788 00

Surgery

12.44

12.44

895.68

895.68

64790 00

Surgery

25.76

25.76

1854.72

1854.72

64792 00

Surgery

32.54

32.54

2342.88

2342.88

64795 00

Surgery

5.86

5.86

421.92

421.92

64802 00

Surgery

25.99

25.99

1871.28

1871.28

64804 00

Surgery

36.50

36.50

2628.00

2628.00

64809 00

Surgery

33.36

33.36

2401.92

2401.92

64818 00

Surgery

23.52

23.52

1693.44

1693.44

64820 00

Surgery

23.23

23.23

1672.56

1672.56

64821 00

Surgery

21.24

21.24

1529.28

1529.28

64822 00

Surgery

21.24

21.24

1529.28

1529.28

64823 00

Surgery

24.02

24.02

1729.44

1729.44

64831 00

Surgery

21.05

21.05

1515.60

1515.60

64832 00

Surgery

9.87

9.87

710.64

710.64

64834 00

Surgery

22.51

22.51

1620.72

1620.72

64835 00

Surgery

24.69

24.69

1777.68

1777.68

64836 00

Surgery

24.69

24.69

1777.68

1777.68

64837 00

Surgery

10.77

10.77

775.44

775.44

64840 00

Surgery

29.04

29.04

2090.88

2090.88

64856 00

Surgery

30.30

30.30

2181.60

2181.60

64857 00

Surgery

31.67

31.67

2280.24

2280.24

64858 00

Surgery

35.34

35.34

2544.48

2544.48

64859 00

Surgery

7.32

7.32

527.04

527.04

64861 00

Surgery

46.49

46.49

3347.28

3347.28

64862 00

Surgery

41.23

41.23

2968.56

2968.56

64864 00

Surgery

25.79

25.79

1856.88

1856.88

64865 00

Surgery

32.60

32.60

2347.20

2347.20

64866 00

Surgery

37.27

37.27

2683.44

2683.44

64868 00

Surgery

29.90

29.90

2152.80

2152.80

64872 00

Surgery

3.42

3.42

246.24

246.24

64874 00

Surgery

5.13

5.13

369.36

369.36

64876 00

Surgery

5.81

5.81

418.32

418.32

64885 00

Surgery

32.25

32.25

2322.00

2322.00

64886 00

Surgery

38.60

38.60

2779.20

2779.20

64890 00

Surgery

32.47

32.47

2337.84

2337.84

64891 00

Surgery

34.52

34.52

2485.44

2485.44

64892 00

Surgery

31.62

31.62

2276.64

2276.64

64893 00

Surgery

33.69

33.69

2425.68

2425.68

64895 00

Surgery

39.74

39.74

2861.28

2861.28

64896 00

Surgery

42.87

42.87

3086.64

3086.64

64897 00

Surgery

38.02

38.02

2737.44

2737.44

64898 00

Surgery

41.16

41.16

2963.52

2963.52

64901 00

Surgery

17.58

17.58

1265.76

1265.76

64902 00

Surgery

20.34

20.34

1464.48

1464.48

64905 00

Surgery

30.11

30.11

2167.92

2167.92

64907 00

Surgery

39.00

39.00

2808.00

2808.00

64910 00

Surgery

22.98

22.98

1654.56

1654.56

64911 00

Surgery

30.83

30.83

2219.76

2219.76

64912 00

Surgery

26.96

26.96

1941.12

1941.12

64913 00

Surgery

5.12

5.12

368.64

368.64

64999 00

Surgery

0.00

0.00

BR

BR

65091 00

Surgery

22.23

22.23

1600.56

1600.56

65093 00

Surgery

22.05

22.05

1587.60

1587.60

65101 00

Surgery

25.45

25.45

1832.40

1832.40

65103 00

Surgery

26.27

26.27

1891.44

1891.44

65105 00

Surgery

28.56

28.56

2056.32

2056.32

65110 00

Surgery

39.37

39.37

2834.64

2834.64

65112 00

Surgery

45.09

45.09

3246.48

3246.48

65114 00

Surgery

47.04

47.04

3386.88

3386.88

65125 00

Surgery

13.61

8.79

979.92

632.88

65130 00

Surgery

25.54

25.54

1838.88

1838.88

65135 00

Surgery

25.85

25.85

1861.20

1861.20

65140 00

Surgery

27.76

27.76

1998.72

1998.72

65150 00

Surgery

20.99

20.99

1511.28

1511.28

65155 00

Surgery

28.86

28.86

2077.92

2077.92

65175 00

Surgery

23.33

23.33

1679.76

1679.76

65205 00

Surgery

0.85

0.86

61.20

61.92

65210 00

Surgery

1.14

1.06

82.08

76.32

65220 00

Surgery

1.82

1.23

131.04

88.56

65222 00

Surgery

2.03

1.49

146.16

107.28

65235 00

Surgery

21.81

21.81

1570.32

1570.32

65260 00

Surgery

29.17

29.17

2100.24

2100.24

65265 00

Surgery

32.83

32.83

2363.76

2363.76

65270 00

Surgery

8.50

4.17

612.00

300.24

65272 00

Surgery

15.78

10.49

1136.16

755.28

65273 00

Surgery

11.27

11.27

811.44

811.44

65275 00

Surgery

17.60

13.67

1267.20

984.24

65280 00

Surgery

19.90

19.90

1432.80

1432.80

65285 00

Surgery

32.78

32.78

2360.16

2360.16

65286 00

Surgery

20.82

14.71

1499.04

1059.12

65290 00

Surgery

14.55

14.55

1047.60

1047.60

65400 00

Surgery

20.70

17.94

1490.40

1291.68

65410 00

Surgery

4.28

3.04

308.16

218.88

65420 00

Surgery

16.12

11.35

1160.64

817.20

65426 00

Surgery

20.00

14.24

1440.00

1025.28

65430 00

Surgery

3.43

3.00

246.96

216.00

65435 00

Surgery

2.46

2.07

177.12

149.04

65436 00

Surgery

11.57

11.00

833.04

792.00

65450 00

Surgery

9.87

9.66

710.64

695.52

65600 00

Surgery

13.08

10.16

941.76

731.52

65710 00

Surgery

33.85

33.85

2437.20

2437.20

65730 00

Surgery

37.19

37.19

2677.68

2677.68

65750 00

Surgery

37.40

37.40

2692.80

2692.80

65755 00

Surgery

37.29

37.29

2684.88

2684.88

65756 00

Surgery

35.01

35.01

2520.72

2520.72

65757 00

Surgery

-

-

567.36

498.96

65760 00

Surgery

-

-

2025.36

1782.72

65765 00

Surgery

0.00

0.00

BR

BR

65767 00

Surgery

0.00

0.00

BR

BR

65770 00

Surgery

41.72

41.72

3003.84

3003.84

65771 00

Surgery

0.00

0.00

BR

BR

65772 00

Surgery

13.63

12.07

981.36

869.04

65775 00

Surgery

17.10

17.10

1231.20

1231.20

65778 00

Surgery

32.64

1.30

2350.08

93.60

65779 00

Surgery

34.67

3.49

2496.24

251.28

65780 00

Surgery

17.61

17.61

1267.92

1267.92

65781 00

Surgery

39.33

39.33

2831.76

2831.76

65782 00

Surgery

33.98

33.98

2446.56

2446.56

65785 00

Surgery

63.55

13.21

4575.60

951.12

65800 00

Surgery

3.56

2.63

256.32

189.36

65810 00

Surgery

13.82

13.82

995.04

995.04

65815 00

Surgery

19.17

14.18

1380.24

1020.96

65820 00

Surgery

24.54

24.54

1766.88

1766.88

65850 00

Surgery

25.04

25.04

1802.88

1802.88

65855 00

Surgery

7.31

6.09

526.32

438.48

65860 00

Surgery

9.18

7.38

660.96

531.36

65865 00

Surgery

14.25

14.25

1026.00

1026.00

65870 00

Surgery

17.69

17.69

1273.68

1273.68

65875 00

Surgery

18.89

18.89

1360.08

1360.08

65880 00

Surgery

19.84

19.84

1428.48

1428.48

65900 00

Surgery

29.46

29.46

2121.12

2121.12

65920 00

Surgery

23.55

23.55

1695.60

1695.60

65930 00

Surgery

19.09

19.09

1374.48

1374.48

66020 00

Surgery

5.90

3.91

424.80

281.52

66030 00

Surgery

5.32

3.32

383.04

239.04

66130 00

Surgery

21.02

16.76

1513.44

1206.72

66150 00

Surgery

26.14

26.14

1882.08

1882.08

66155 00

Surgery

26.12

26.12

1880.64

1880.64

66160 00

Surgery

29.34

29.34

2112.48

2112.48

66170 00

Surgery

32.54

32.54

2342.88

2342.88

66172 00

Surgery

35.54

35.54

2558.88

2558.88

66174 00

Surgery

18.57

18.57

1337.04

1337.04

66175 00

Surgery

21.56

21.56

1552.32

1552.32

66179 00

Surgery

32.13

32.13

2313.36

2313.36

66180 00

Surgery

33.84

33.84

2436.48

2436.48

66183 00

Surgery

30.62

30.62

2204.64

2204.64

66184 00

Surgery

23.58

23.58

1697.76

1697.76

66185 00

Surgery

25.31

25.31

1822.32

1822.32

66225 00

Surgery

27.79

27.79

2000.88

2000.88

66250 00

Surgery

22.44

16.55

1615.68

1191.60

66500 00

Surgery

11.79

11.79

848.88

848.88

66505 00

Surgery

12.82

12.82

923.04

923.04

66600 00

Surgery

26.96

26.96

1941.12

1941.12

66605 00

Surgery

32.35

32.35

2329.20

2329.20

66625 00

Surgery

12.77

12.77

919.44

919.44

66630 00

Surgery

16.87

16.87

1214.64

1214.64

66635 00

Surgery

17.02

17.02

1225.44

1225.44

66680 00

Surgery

15.52

15.52

1117.44

1117.44

66682 00

Surgery

21.24

21.24

1529.28

1529.28

66700 00

Surgery

13.52

11.65

973.44

838.80

66710 00

Surgery

13.21

11.64

951.12

838.08

66711 00

Surgery

15.10

15.10

1087.20

1087.20

66720 00

Surgery

14.01

12.27

1008.72

883.44

66740 00

Surgery

13.13

11.65

945.36

838.80

66761 00

Surgery

8.93

7.03

642.96

506.16

66762 00

Surgery

14.25

12.63

1026.00

909.36

66770 00

Surgery

15.81

14.32

1138.32

1031.04

66820 00

Surgery

14.01

14.01

1008.72

1008.72

66821 00

Surgery

9.98

9.29

718.56

668.88

66825 00

Surgery

24.82

24.82

1787.04

1787.04

66830 00

Surgery

21.08

21.08

1517.76

1517.76

66840 00

Surgery

20.58

20.58

1481.76

1481.76

66850 00

Surgery

23.40

23.40

1684.80

1684.80

66852 00

Surgery

24.89

24.89

1792.08

1792.08

66920 00

Surgery

22.22

22.22

1599.84

1599.84

66930 00

Surgery

25.44

25.44

1831.68

1831.68

66940 00

Surgery

23.30

23.30

1677.60

1677.60

66982 00

Surgery

22.11

22.11

1591.92

1591.92

66983 00

Surgery

-

-

1215.36

1069.20

66984 00

Surgery

16.14

16.14

1162.08

1162.08

66985 00

Surgery

22.85

22.85

1645.20

1645.20

66986 00

Surgery

26.77

26.77

1927.44

1927.44

66987 00

Surgery

-

-

2228.40

1960.56

66988 00

Surgery

-

-

2268.72

1996.56

66989 00

Surgery

25.37

25.37

1826.64

1826.64

66990 00

Surgery

2.60

2.60

187.20

187.20

66991 00

Surgery

20.28

20.28

1460.16

1460.16

66999 00

Surgery

0.00

0.00

BR

BR

67005 00

Surgery

14.21

14.21

1023.12

1023.12

67010 00

Surgery

16.24

16.24

1169.28

1169.28

67015 00

Surgery

18.00

18.00

1296.00

1296.00

67025 00

Surgery

22.08

18.74

1589.76

1349.28

67027 00

Surgery

25.13

25.13

1809.36

1809.36

67028 00

Surgery

3.37

2.71

242.64

195.12

67030 00

Surgery

16.63

16.63

1197.36

1197.36

67031 00

Surgery

11.58

10.51

833.76

756.72

67036 00

Surgery

26.59

26.59

1914.48

1914.48

67039 00

Surgery

28.44

28.44

2047.68

2047.68

67040 00

Surgery

30.68

30.68

2208.96

2208.96

67041 00

Surgery

33.81

33.81

2434.32

2434.32

67042 00

Surgery

33.81

33.81

2434.32

2434.32

67043 00

Surgery

35.65

35.65

2566.80

2566.80

67101 00

Surgery

10.00

8.47

720.00

609.84

67105 00

Surgery

8.84

8.17

636.48

588.24

67107 00

Surgery

33.24

33.24

2393.28

2393.28

67108 00

Surgery

35.18

35.18

2532.96

2532.96

67110 00

Surgery

26.51

24.17

1908.72

1740.24

67113 00

Surgery

39.33

39.33

2831.76

2831.76

67115 00

Surgery

14.85

14.85

1069.20

1069.20

67120 00

Surgery

19.99

16.50

1439.28

1188.00

67121 00

Surgery

26.80

26.80

1929.60

1929.60

67141 00

Surgery

8.07

6.45

581.04

464.40

67145 00

Surgery

7.27

6.45

523.44

464.40

67208 00

Surgery

17.92

17.13

1290.24

1233.36

67210 00

Surgery

15.34

14.81

1104.48

1066.32

67218 00

Surgery

41.14

41.14

2962.08

2962.08

67220 00

Surgery

15.79

14.81

1136.88

1066.32

67221 00

Surgery

8.08

6.14

581.76

442.08

67225 00

Surgery

0.86

0.81

61.92

58.32

67227 00

Surgery

8.80

7.55

633.60

543.60

67228 00

Surgery

10.11

8.98

727.92

646.56

67229 00

Surgery

34.28

34.28

2468.16

2468.16

67250 00

Surgery

26.98

26.98

1942.56

1942.56

67255 00

Surgery

20.51

20.51

1476.72

1476.72

67299 00

Surgery

0.00

0.00

BR

BR

67311 00

Surgery

13.55

13.55

975.60

975.60

67312 00

Surgery

19.71

19.71

1419.12

1419.12

67314 00

Surgery

13.55

13.55

975.60

975.60

67316 00

Surgery

21.13

21.13

1521.36

1521.36

67318 00

Surgery

20.44

20.44

1471.68

1471.68

67320 00

Surgery

5.14

5.14

370.08

370.08

67331 00

Surgery

4.61

4.61

331.92

331.92

67332 00

Surgery

5.99

5.99

431.28

431.28

67334 00

Surgery

4.54

4.54

326.88

326.88

67335 00

Surgery

5.50

5.50

396.00

396.00

67340 00

Surgery

8.60

8.60

619.20

619.20

67343 00

Surgery

20.04

20.04

1442.88

1442.88

67345 00

Surgery

7.26

6.44

522.72

463.68

67346 00

Surgery

5.70

5.70

410.40

410.40

67399 00

Surgery

0.00

0.00

BR

BR

67400 00

Surgery

30.94

30.94

2227.68

2227.68

67405 00

Surgery

27.05

27.05

1947.60

1947.60

67412 00

Surgery

29.52

29.52

2125.44

2125.44

67413 00

Surgery

28.76

28.76

2070.72

2070.72

67414 00

Surgery

43.29

43.29

3116.88

3116.88

67415 00

Surgery

3.03

3.03

218.16

218.16

67420 00

Surgery

51.72

51.72

3723.84

3723.84

67430 00

Surgery

41.34

41.34

2976.48

2976.48

67440 00

Surgery

40.11

40.11

2887.92

2887.92

67445 00

Surgery

45.50

45.50

3276.00

3276.00

67450 00

Surgery

41.54

41.54

2990.88

2990.88

67500 00

Surgery

2.31

1.91

166.32

137.52

67505 00

Surgery

2.56

2.13

184.32

153.36

67515 00

Surgery

1.53

1.39

110.16

100.08

67516 00

Surgery

3.58

2.87

257.76

206.64

67550 00

Surgery

32.36

32.36

2329.92

2329.92

67560 00

Surgery

33.09

33.09

2382.48

2382.48

67570 00

Surgery

37.95

37.95

2732.40

2732.40

67599 00

Surgery

0.00

0.00

BR

BR

67700 00

Surgery

8.48

3.47

610.56

249.84

67710 00

Surgery

7.25

2.93

522.00

210.96

67715 00

Surgery

7.80

3.21

561.60

231.12

67800 00

Surgery

3.86

3.04

277.92

218.88

67801 00

Surgery

4.88

3.90

351.36

280.80

67805 00

Surgery

6.10

4.85

439.20

349.20

67808 00

Surgery

10.96

10.96

789.12

789.12

67810 00

Surgery

5.51

2.01

396.72

144.72

67820 00

Surgery

0.56

0.66

40.32

47.52

67825 00

Surgery

4.03

3.64

290.16

262.08

67830 00

Surgery

8.06

4.09

580.32

294.48

67835 00

Surgery

13.12

13.12

944.64

944.64

67840 00

Surgery

8.37

4.67

602.64

336.24

67850 00

Surgery

6.47

3.91

465.84

281.52

67875 00

Surgery

5.44

2.84

391.68

204.48

67880 00

Surgery

13.99

10.96

1007.28

789.12

67882 00

Surgery

17.08

14.00

1229.76

1008.00

67900 00

Surgery

19.47

15.02

1401.84

1081.44

67901 00

Surgery

23.75

17.52

1710.00

1261.44

67902 00

Surgery

21.54

21.54

1550.88

1550.88

67903 00

Surgery

18.03

14.26

1298.16

1026.72

67904 00

Surgery

22.12

17.69

1592.64

1273.68

67906 00

Surgery

14.98

14.98

1078.56

1078.56

67908 00

Surgery

16.20

12.86

1166.40

925.92

67909 00

Surgery

16.40

13.01

1180.80

936.72

67911 00

Surgery

16.62

16.62

1196.64

1196.64

67912 00

Surgery

26.87

14.46

1934.64

1041.12

67914 00

Surgery

14.63

9.83

1053.36

707.76

67915 00

Surgery

9.47

5.98

681.84

430.56

67916 00

Surgery

18.22

12.78

1311.84

920.16

67917 00

Surgery

18.64

13.56

1342.08

976.32

67921 00

Surgery

14.30

9.33

1029.60

671.76

67922 00

Surgery

9.20

5.98

662.40

430.56

67923 00

Surgery

18.23

12.79

1312.56

920.88

67924 00

Surgery

19.40

13.56

1396.80

976.32

67930 00

Surgery

11.10

6.99

799.20

503.28

67935 00

Surgery

17.92

13.00

1290.24

936.00

67938 00

Surgery

8.08

3.51

581.76

252.72

67950 00

Surgery

17.49

13.74

1259.28

989.28

67961 00

Surgery

17.60

13.50

1267.20

972.00

67966 00

Surgery

23.21

19.40

1671.12

1396.80

67971 00

Surgery

21.31

21.31

1534.32

1534.32

67973 00

Surgery

27.41

27.41

1973.52

1973.52

67974 00

Surgery

27.34

27.34

1968.48

1968.48

67975 00

Surgery

20.19

20.19

1453.68

1453.68

67999 00

Surgery

0.00

0.00

BR

BR

68020 00

Surgery

3.63

3.28

261.36

236.16

68040 00

Surgery

1.86

1.41

133.92

101.52

68100 00

Surgery

5.37

2.83

386.64

203.76

68110 00

Surgery

7.07

4.42

509.04

318.24

68115 00

Surgery

9.93

5.44

714.96

391.68

68130 00

Surgery

16.52

12.30

1189.44

885.60

68135 00

Surgery

4.71

4.45

339.12

320.40

68200 00

Surgery

1.24

1.01

89.28

72.72

68320 00

Surgery

22.21

16.07

1599.12

1157.04

68325 00

Surgery

19.48

19.48

1402.56

1402.56

68326 00

Surgery

19.14

19.14

1378.08

1378.08

68328 00

Surgery

20.89

20.89

1504.08

1504.08

68330 00

Surgery

18.62

13.69

1340.64

985.68

68335 00

Surgery

19.19

19.19

1381.68

1381.68

68340 00

Surgery

18.02

11.84

1297.44

852.48

68360 00

Surgery

16.22

12.21

1167.84

879.12

68362 00

Surgery

19.45

19.45

1400.40

1400.40

68371 00

Surgery

12.27

12.27

883.44

883.44

68399 00

Surgery

0.00

0.00

BR

BR

68400 00

Surgery

8.88

3.91

639.36

281.52

68420 00

Surgery

9.91

4.95

713.52

356.40

68440 00

Surgery

3.14

3.00

226.08

216.00

68500 00

Surgery

31.65

31.65

2278.80

2278.80

68505 00

Surgery

31.51

31.51

2268.72

2268.72

68510 00

Surgery

13.45

8.48

968.40

610.56

68520 00

Surgery

22.01

22.01

1584.72

1584.72

68525 00

Surgery

7.60

7.60

547.20

547.20

68530 00

Surgery

12.96

7.53

933.12

542.16

68540 00

Surgery

29.29

29.29

2108.88

2108.88

68550 00

Surgery

36.47

36.47

2625.84

2625.84

68700 00

Surgery

17.90

17.90

1288.80

1288.80

68705 00

Surgery

7.81

4.93

562.32

354.96

68720 00

Surgery

24.14

24.14

1738.08

1738.08

68745 00

Surgery

24.27

24.27

1747.44

1747.44

68750 00

Surgery

25.65

25.65

1846.80

1846.80

68760 00

Surgery

6.56

4.35

472.32

313.20

68761 00

Surgery

4.36

3.49

313.92

251.28

68770 00

Surgery

18.61

18.61

1339.92

1339.92

68801 00

Surgery

2.89

2.38

208.08

171.36

68810 00

Surgery

4.82

3.81

347.04

274.32

68811 00

Surgery

4.02

4.02

289.44

289.44

68815 00

Surgery

11.21

6.62

807.12

476.64

68816 00

Surgery

25.30

4.67

1821.60

336.24

68840 00

Surgery

3.99

3.50

287.28

252.00

68841 00

Surgery

1.14

0.96

82.08

69.12

68850 00

Surgery

1.74

1.53

125.28

110.16

68899 00

Surgery

0.00

0.00

BR

BR

69000 00

Surgery

5.62

3.80

404.64

273.60

69005 00

Surgery

6.63

4.89

477.36

352.08

69020 00

Surgery

7.01

4.36

504.72

313.92

69090 00

Surgery

-

-

54.00

48.96

69100 00

Surgery

2.87

1.38

206.64

99.36

69105 00

Surgery

4.35

1.92

313.20

138.24

69110 00

Surgery

14.17

9.91

1020.24

713.52

69120 00

Surgery

11.71

11.71

843.12

843.12

69140 00

Surgery

27.21

27.21

1959.12

1959.12

69145 00

Surgery

12.41

7.81

893.52

562.32

69150 00

Surgery

30.32

30.32

2183.04

2183.04

69155 00

Surgery

48.99

48.99

3527.28

3527.28

69200 00

Surgery

2.42

1.42

174.24

102.24

69205 00

Surgery

2.88

2.88

207.36

207.36

69209 00

Surgery

0.48

0.48

34.56

34.56

69210 00

Surgery

1.44

0.97

103.68

69.84

69220 00

Surgery

2.36

1.54

169.92

110.88

69222 00

Surgery

6.53

4.14

470.16

298.08

69300 00

Surgery

19.66

14.22

1415.52

1023.84

69310 00

Surgery

33.64

33.64

2422.08

2422.08

69320 00

Surgery

46.93

46.93

3378.96

3378.96

69399 00

Surgery

0.00

0.00

BR

BR

69420 00

Surgery

5.77

3.66

415.44

263.52

69421 00

Surgery

4.60

4.60

331.20

331.20

69424 00

Surgery

3.84

1.82

276.48

131.04

69433 00

Surgery

6.11

4.02

439.92

289.44

69436 00

Surgery

4.84

4.84

348.48

348.48

69440 00

Surgery

20.94

20.94

1507.68

1507.68

69450 00

Surgery

16.59

16.59

1194.48

1194.48

69501 00

Surgery

21.46

21.46

1545.12

1545.12

69502 00

Surgery

28.49

28.49

2051.28

2051.28

69505 00

Surgery

36.99

36.99

2663.28

2663.28

69511 00

Surgery

37.86

37.86

2725.92

2725.92

69530 00

Surgery

50.37

50.37

3626.64

3626.64

69535 00

Surgery

79.94

79.94

5755.68

5755.68

69540 00

Surgery

6.38

3.95

459.36

284.40

69550 00

Surgery

32.02

32.02

2305.44

2305.44

69552 00

Surgery

47.70

47.70

3434.40

3434.40

69554 00

Surgery

76.01

76.01

5472.72

5472.72

69601 00

Surgery

30.70

30.70

2210.40

2210.40

69602 00

Surgery

32.85

32.85

2365.20

2365.20

69603 00

Surgery

38.66

38.66

2783.52

2783.52

69604 00

Surgery

33.55

33.55

2415.60

2415.60

69610 00

Surgery

11.58

8.67

833.76

624.24

69620 00

Surgery

22.39

14.97

1612.08

1077.84

69631 00

Surgery

26.89

26.89

1936.08

1936.08

69632 00

Surgery

32.62

32.62

2348.64

2348.64

69633 00

Surgery

31.77

31.77

2287.44

2287.44

69635 00

Surgery

38.57

38.57

2777.04

2777.04

69636 00

Surgery

42.39

42.39

3052.08

3052.08

69637 00

Surgery

42.21

42.21

3039.12

3039.12

69641 00

Surgery

31.43

31.43

2262.96

2262.96

69642 00

Surgery

40.34

40.34

2904.48

2904.48

69643 00

Surgery

36.86

36.86

2653.92

2653.92

69644 00

Surgery

45.30

45.30

3261.60

3261.60

69645 00

Surgery

44.45

44.45

3200.40

3200.40

69646 00

Surgery

47.29

47.29

3404.88

3404.88

69650 00

Surgery

24.27

24.27

1747.44

1747.44

69660 00

Surgery

27.88

27.88

2007.36

2007.36

69661 00

Surgery

36.31

36.31

2614.32

2614.32

69662 00

Surgery

34.88

34.88

2511.36

2511.36

69666 00

Surgery

24.42

24.42

1758.24

1758.24

69667 00

Surgery

24.50

24.50

1764.00

1764.00

69670 00

Surgery

28.48

28.48

2050.56

2050.56

69676 00

Surgery

25.20

25.20

1814.40

1814.40

69700 00

Surgery

20.12

20.12

1448.64

1448.64

69705 00

Surgery

80.55

5.19

5799.60

373.68

69706 00

Surgery

83.22

7.25

5991.84

522.00

69710 00

Surgery

0.00

0.00

BR

BR

69711 00

Surgery

25.31

25.31

1822.32

1822.32

69714 00

Surgery

14.93

14.93

1074.96

1074.96

69716 00

Surgery

18.68

18.68

1344.96

1344.96

69717 00

Surgery

16.91

16.91

1217.52

1217.52

69719 00

Surgery

19.40

19.40

1396.80

1396.80

69720 00

Surgery

35.48

35.48

2554.56

2554.56

69725 00

Surgery

56.16

56.16

4043.52

4043.52

69726 00

Surgery

14.39

14.39

1036.08

1036.08

69727 00

Surgery

16.05

16.05

1155.60

1155.60

69728 00

Surgery

18.15

18.15

1306.80

1306.80

69729 00

Surgery

20.26

20.26

1458.72

1458.72

69730 00

Surgery

21.01

21.01

1512.72

1512.72

69740 00

Surgery

34.94

34.94

2515.68

2515.68

69745 00

Surgery

37.25

37.25

2682.00

2682.00

69799 00

Surgery

0.00

0.00

BR

BR

69801 00

Surgery

6.87

3.73

494.64

268.56

69805 00

Surgery

31.00

31.00

2232.00

2232.00

69806 00

Surgery

27.77

27.77

1999.44

1999.44

69905 00

Surgery

27.73

27.73

1996.56

1996.56

69910 00

Surgery

29.85

29.85

2149.20

2149.20

69915 00

Surgery

45.17

45.17

3252.24

3252.24

69930 00

Surgery

36.57

36.57

2633.04

2633.04

69949 00

Surgery

0.00

0.00

BR

BR

69950 00

Surgery

52.40

52.40

3772.80

3772.80

69955 00

Surgery

59.06

59.06

4252.32

4252.32

69960 00

Surgery

56.57

56.57

4073.04

4073.04

69970 00

Surgery

63.84

63.84

4596.48

4596.48

69979 00

Surgery

0.00

0.00

BR

BR

69990 00

Surgery

6.52

6.52

469.44

469.44

RADIOLOGY GUIDELINES

Information regarding publications incorporated by reference is found in the Introduction Section of the Fee Schedule.

The following Commission guidelines are in addition to CMS and CPT® guidelines and represent additional guidance from the Commission relative to unit values for these services. To the extent that a conflict may exist between an incorporated portion of the CPT® and a code, guideline, identifier, or modifier unique to Arizona, then the Arizona code, guideline, identifier or modifier shall control. Codes that are unique to Arizona are preceded by an AZ identifier and numbered in the following format: AZxxx.

A. GENERAL GUIDELINES

1. Values include usual contrast media, equipment, and materials. An additional charge may be warranted when special surgical trays and materials are provided by the healthcare provider.

2. Values include consultation and written reports to the referring healthcare provider.

3. X-ray findings and attending healthcare provider's written orders for x-rays must be included with the statement for x-ray services. Bills unsupported by findings will not be paid.

4. X-rays should be taken, reported, and be properly marked for identification and orientation in accordance with the accepted standard of radiologic practice in the State of Arizona.

B. MODIFIERS

Modifiers identify circumstances that alter or enhance the description of the service. For radiology codes, two modifiers affect the assigned unit value and are listed in The Essential RBRVS. However, other modifiers may be required for correct reporting of service. See CMS and the 2024 CPT® publication for additional information on modifiers. Listed radiology modifiers affect the unit values as follows:

1. Total: When no modifier is listed, the unit value represents the global value of the procedure. The five-digit code is used to represent a global service inclusive of the professional and technical value of providing that service. The following sections provide additional definitions for each component.

2. Professional: Modifier 26 is used to designate professional services. The professional component includes examination of the patient, when indicated, performance and/or supervision of the procedure, interpretation and written report of the examination, and consultation with referring healthcare providers.

3. Technical: Modifier TC is used to designate the technical value of providing the service. The technical component includes personnel, materials, space, equipment, and other allocated facility overhead normally included in providing the service.

C. REFERENCE TO RELATIVE VALUES

Two patterns of billing currently prevail in radiology. The first pattern occurs when a total charge for the radiology service, including both the professional component ("PC") and technical component ("TC"), is billed by appropriately licensed health care providers working in offices, clinics, and, independent diagnostic testing facilities. The second pattern occurs when services are performed in settings such as a hospital or ambulatory surgery center radiology department. The radiologist submits a separate statement to the payer for services that compose the professional component. The hospital or ambulatory surgery center charges for use of the department facilities and the services of its employees as the technical component.

The Radiology Relative Values scales have been devised for use in radiology and are not coordinated with scales for services in other branches of medicine such as surgery, medicine or pathology. The two scales are compatible only within themselves. Some procedures are noted as a "BR" value or "By Report". This usage is intended to indicate that circumstances involving a given patient procedure may require much more than the average amount of time and effort to perform and thus a value would be unique and could not be anticipated or established. When such added involvement is claimed, a written explanation will usually be required as an addendum to the bill.

The PC values do not include TC charges made by the hospital in which the procedure was accomplished. Such charges by the hospital or ambulatory surgery center cover the services of technologists and other helpers, the films, contrast media, radioactive agents, chemical and other materials, the use of the space and facilities of the x-ray department plus any other hospital or ambulatory surgery center costs. Most hospitals or ambulatory surgery centers have derived their own schedule of charges for these items. Establishment of hospital or ambulatory surgery center charges is not the subject of the Fee Schedule.

The separation of billing in no way implies a division of responsibility, but only a division of the charge. The radiologist is a physician performing a needed medical service for a patient, and must retain full responsibility for his or her own activity and full responsibility for the potential supervision of technologists, the selection and maintenance of equipment, the control of radiation hazards, and the general administration of the radiology department.

D. REVIEW OF DIAGNOSTIC STUDIES

No separate charge is warranted for prior studies reviewed in conjunction with a visit, consultation, record review, or other evaluation by a healthcare provider; neither the professional component value modifier 26 nor the radiological consultation CPT® code 76140 is reimbursable. The review of diagnostic tests is included in the evaluation and management codes.

ARIZONA PHYSICIANS' FEE SCHEDULE

Radiology Codes 2024

Radiology Conversion Factor $70.00

Code

Category

FY24 NF RVU

FY24 FAC RVU

FY24 NF RBRVS Rate

FY24 FAC RBRVS Rate

70010 00

Radiology

1.72

1.72

120.40

120.40

70015 00

Radiology

4.98

4.98

348.60

348.60

70015 26

Radiology

1.67

1.67

116.90

116.90

70015 TC

Radiology

3.31

3.31

231.70

231.70

70030 00

Radiology

0.98

0.98

68.60

68.60

70030 26

Radiology

0.25

0.25

17.50

17.50

70030 TC

Radiology

0.73

0.73

51.10

51.10

70100 00

Radiology

1.17

1.17

81.90

81.90

70100 26

Radiology

0.26

0.26

18.20

18.20

70100 TC

Radiology

0.91

0.91

63.70

63.70

70110 00

Radiology

1.31

1.31

91.70

91.70

70110 26

Radiology

0.35

0.35

24.50

24.50

70110 TC

Radiology

0.96

0.96

67.20

67.20

70120 00

Radiology

1.15

1.15

80.50

80.50

70120 26

Radiology

0.26

0.26

18.20

18.20

70120 TC

Radiology

0.89

0.89

62.30

62.30

70130 00

Radiology

1.86

1.86

130.20

130.20

70130 26

Radiology

0.48

0.48

33.60

33.60

70130 TC

Radiology

1.38

1.38

96.60

96.60

70134 00

Radiology

1.86

1.86

130.20

130.20

70134 26

Radiology

0.51

0.51

35.70

35.70

70134 TC

Radiology

1.35

1.35

94.50

94.50

70140 00

Radiology

0.96

0.96

67.20

67.20

70140 26

Radiology

0.28

0.28

19.60

19.60

70140 TC

Radiology

0.68

0.68

47.60

47.60

70150 00

Radiology

1.42

1.42

99.40

99.40

70150 26

Radiology

0.37

0.37

25.90

25.90

70150 TC

Radiology

1.05

1.05

73.50

73.50

70160 00

Radiology

1.13

1.13

79.10

79.10

70160 26

Radiology

0.24

0.24

16.80

16.80

70160 TC

Radiology

0.89

0.89

62.30

62.30

70170 00

Radiology

-

-

103.60

103.60

70170 26

Radiology

0.43

0.43

30.10

30.10

70170 TC

Radiology

-

-

73.50

73.50

70190 00

Radiology

1.13

1.13

79.10

79.10

70190 26

Radiology

0.32

0.32

22.40

22.40

70190 TC

Radiology

0.81

0.81

56.70

56.70

70200 00

Radiology

1.44

1.44

100.80

100.80

70200 26

Radiology

0.40

0.40

28.00

28.00

70200 TC

Radiology

1.04

1.04

72.80

72.80

70210 00

Radiology

0.97

0.97

67.90

67.90

70210 26

Radiology

0.25

0.25

17.50

17.50

70210 TC

Radiology

0.72

0.72

50.40

50.40

70220 00

Radiology

1.13

1.13

79.10

79.10

70220 26

Radiology

0.31

0.31

21.70

21.70

70220 TC

Radiology

0.82

0.82

57.40

57.40

70240 00

Radiology

0.99

0.99

69.30

69.30

70240 26

Radiology

0.27

0.27

18.90

18.90

70240 TC

Radiology

0.72

0.72

50.40

50.40

70250 00

Radiology

1.09

1.09

76.30

76.30

70250 26

Radiology

0.26

0.26

18.20

18.20

70250 TC

Radiology

0.83

0.83

58.10

58.10

70260 00

Radiology

1.34

1.34

93.80

93.80

70260 26

Radiology

0.40

0.40

28.00

28.00

70260 TC

Radiology

0.94

0.94

65.80

65.80

70300 00

Radiology

0.39

0.39

27.30

27.30

70300 26

Radiology

0.15

0.15

10.50

10.50

70300 TC

Radiology

0.24

0.24

16.80

16.80

70310 00

Radiology

1.22

1.22

85.40

85.40

70310 26

Radiology

0.24

0.24

16.80

16.80

70310 TC

Radiology

0.98

0.98

68.60

68.60

70320 00

Radiology

1.60

1.60

112.00

112.00

70320 26

Radiology

0.32

0.32

22.40

22.40

70320 TC

Radiology

1.28

1.28

89.60

89.60

70328 00

Radiology

1.04

1.04

72.80

72.80

70328 26

Radiology

0.26

0.26

18.20

18.20

70328 TC

Radiology

0.78

0.78

54.60

54.60

70330 00

Radiology

1.59

1.59

111.30

111.30

70330 26

Radiology

0.34

0.34

23.80

23.80

70330 TC

Radiology

1.25

1.25

87.50

87.50

70332 00

Radiology

2.48

2.48

173.60

173.60

70332 26

Radiology

0.76

0.76

53.20

53.20

70332 TC

Radiology

1.72

1.72

120.40

120.40

70336 00

Radiology

8.15

8.15

570.50

570.50

70336 26

Radiology

2.07

2.07

144.90

144.90

70336 TC

Radiology

6.08

6.08

425.60

425.60

70350 00

Radiology

0.50

0.50

35.00

35.00

70350 26

Radiology

0.25

0.25

17.50

17.50

70350 TC

Radiology

0.25

0.25

17.50

17.50

70355 00

Radiology

0.55

0.55

38.50

38.50

70355 26

Radiology

0.29

0.29

20.30

20.30

70355 TC

Radiology

0.26

0.26

18.20

18.20

70360 00

Radiology

0.94

0.94

65.80

65.80

70360 26

Radiology

0.26

0.26

18.20

18.20

70360 TC

Radiology

0.68

0.68

47.60

47.60

70370 00

Radiology

3.15

3.15

220.50

220.50

70370 26

Radiology

0.45

0.45

31.50

31.50

70370 TC

Radiology

2.70

2.70

189.00

189.00

70371 00

Radiology

3.28

3.28

229.60

229.60

70371 26

Radiology

1.23

1.23

86.10

86.10

70371 TC

Radiology

2.05

2.05

143.50

143.50

70380 00

Radiology

1.13

1.13

79.10

79.10

70380 26

Radiology

0.24

0.24

16.80

16.80

70380 TC

Radiology

0.89

0.89

62.30

62.30

70390 00

Radiology

3.47

3.47

242.90

242.90

70390 26

Radiology

0.53

0.53

37.10

37.10

70390 TC

Radiology

2.94

2.94

205.80

205.80

70450 00

Radiology

3.26

3.26

228.20

228.20

70450 26

Radiology

1.19

1.19

83.30

83.30

70450 TC

Radiology

2.07

2.07

144.90

144.90

70460 00

Radiology

4.56

4.56

319.20

319.20

70460 26

Radiology

1.59

1.59

111.30

111.30

70460 TC

Radiology

2.97

2.97

207.90

207.90

70470 00

Radiology

5.34

5.34

373.80

373.80

70470 26

Radiology

1.79

1.79

125.30

125.30

70470 TC

Radiology

3.55

3.55

248.50

248.50

70480 00

Radiology

4.89

4.89

342.30

342.30

70480 26

Radiology

1.81

1.81

126.70

126.70

70480 TC

Radiology

3.08

3.08

215.60

215.60

70481 00

Radiology

5.56

5.56

389.20

389.20

70481 26

Radiology

1.59

1.59

111.30

111.30

70481 TC

Radiology

3.97

3.97

277.90

277.90

70482 00

Radiology

6.49

6.49

454.30

454.30

70482 26

Radiology

1.78

1.78

124.60

124.60

70482 TC

Radiology

4.71

4.71

329.70

329.70

70486 00

Radiology

3.94

3.94

275.80

275.80

70486 26

Radiology

1.20

1.20

84.00

84.00

70486 TC

Radiology

2.74

2.74

191.80

191.80

70487 00

Radiology

4.68

4.68

327.60

327.60

70487 26

Radiology

1.58

1.58

110.60

110.60

70487 TC

Radiology

3.10

3.10

217.00

217.00

70488 00

Radiology

5.67

5.67

396.90

396.90

70488 26

Radiology

1.78

1.78

124.60

124.60

70488 TC

Radiology

3.89

3.89

272.30

272.30

70490 00

Radiology

4.61

4.61

322.70

322.70

70490 26

Radiology

1.80

1.80

126.00

126.00

70490 TC

Radiology

2.81

2.81

196.70

196.70

70491 00

Radiology

5.67

5.67

396.90

396.90

70491 26

Radiology

1.94

1.94

135.80

135.80

70491 TC

Radiology

3.73

3.73

261.10

261.10

70492 00

Radiology

6.80

6.80

476.00

476.00

70492 26

Radiology

2.26

2.26

158.20

158.20

70492 TC

Radiology

4.54

4.54

317.80

317.80

70496 00

Radiology

8.49

8.49

594.30

594.30

70496 26

Radiology

2.45

2.45

171.50

171.50

70496 TC

Radiology

6.04

6.04

422.80

422.80

70498 00

Radiology

8.48

8.48

593.60

593.60

70498 26

Radiology

2.45

2.45

171.50

171.50

70498 TC

Radiology

6.03

6.03

422.10

422.10

70540 00

Radiology

6.98

6.98

488.60

488.60

70540 26

Radiology

1.89

1.89

132.30

132.30

70540 TC

Radiology

5.09

5.09

356.30

356.30

70542 00

Radiology

8.28

8.28

579.60

579.60

70542 26

Radiology

2.27

2.27

158.90

158.90

70542 TC

Radiology

6.01

6.01

420.70

420.70

70543 00

Radiology

10.45

10.45

731.50

731.50

70543 26

Radiology

3.01

3.01

210.70

210.70

70543 TC

Radiology

7.44

7.44

520.80

520.80

70544 00

Radiology

6.65

6.65

465.50

465.50

70544 26

Radiology

1.68

1.68

117.60

117.60

70544 TC

Radiology

4.97

4.97

347.90

347.90

70545 00

Radiology

7.01

7.01

490.70

490.70

70545 26

Radiology

1.68

1.68

117.60

117.60

70545 TC

Radiology

5.33

5.33

373.10

373.10

70546 00

Radiology

10.19

10.19

713.30

713.30

70546 26

Radiology

2.08

2.08

145.60

145.60

70546 TC

Radiology

8.11

8.11

567.70

567.70

70547 00

Radiology

6.66

6.66

466.20

466.20

70547 26

Radiology

1.68

1.68

117.60

117.60

70547 TC

Radiology

4.98

4.98

348.60

348.60

70548 00

Radiology

7.60

7.60

532.00

532.00

70548 26

Radiology

2.11

2.11

147.70

147.70

70548 TC

Radiology

5.49

5.49

384.30

384.30

70549 00

Radiology

10.66

10.66

746.20

746.20

70549 26

Radiology

2.52

2.52

176.40

176.40

70549 TC

Radiology

8.14

8.14

569.80

569.80

70551 00

Radiology

6.05

6.05

423.50

423.50

70551 26

Radiology

2.08

2.08

145.60

145.60

70551 TC

Radiology

3.97

3.97

277.90

277.90

70552 00

Radiology

8.34

8.34

583.80

583.80

70552 26

Radiology

2.50

2.50

175.00

175.00

70552 TC

Radiology

5.84

5.84

408.80

408.80

70553 00

Radiology

9.82

9.82

687.40

687.40

70553 26

Radiology

3.21

3.21

224.70

224.70

70553 TC

Radiology

6.61

6.61

462.70

462.70

70554 00

Radiology

11.73

11.73

821.10

821.10

70554 26

Radiology

2.98

2.98

208.60

208.60

70554 TC

Radiology

8.75

8.75

612.50

612.50

70555 00

Radiology

-

-

1441.30

1441.30

70555 26

Radiology

3.50

3.50

245.00

245.00

70555 TC

Radiology

-

-

1196.30

1196.30

70557 00

Radiology

-

-

315.00

315.00

70557 26

Radiology

4.50

4.50

315.00

315.00

70557 TC

Radiology

0.00

0.00

BR

BR

70558 00

Radiology

-

-

1388.80

1388.80

70558 26

Radiology

4.96

4.96

347.20

347.20

70558 TC

Radiology

-

-

1041.60

1041.60

70559 00

Radiology

-

-

905.80

905.80

70559 26

Radiology

4.66

4.66

326.20

326.20

70559 TC

Radiology

-

-

579.60

579.60

71045 00

Radiology

0.77

0.77

53.90

53.90

71045 26

Radiology

0.25

0.25

17.50

17.50

71045 TC

Radiology

0.52

0.52

36.40

36.40

71046 00

Radiology

1.01

1.01

70.70

70.70

71046 26

Radiology

0.31

0.31

21.70

21.70

71046 TC

Radiology

0.70

0.70

49.00

49.00

71047 00

Radiology

1.27

1.27

88.90

88.90

71047 26

Radiology

0.39

0.39

27.30

27.30

71047 TC

Radiology

0.88

0.88

61.60

61.60

71048 00

Radiology

1.37

1.37

95.90

95.90

71048 26

Radiology

0.43

0.43

30.10

30.10

71048 TC

Radiology

0.94

0.94

65.80

65.80

71100 00

Radiology

1.10

1.10

77.00

77.00

71100 26

Radiology

0.31

0.31

21.70

21.70

71100 TC

Radiology

0.79

0.79

55.30

55.30

71101 00

Radiology

1.27

1.27

88.90

88.90

71101 26

Radiology

0.38

0.38

26.60

26.60

71101 TC

Radiology

0.89

0.89

62.30

62.30

71110 00

Radiology

1.32

1.32

92.40

92.40

71110 26

Radiology

0.41

0.41

28.70

28.70

71110 TC

Radiology

0.91

0.91

63.70

63.70

71111 00

Radiology

1.58

1.58

110.60

110.60

71111 26

Radiology

0.46

0.46

32.20

32.20

71111 TC

Radiology

1.12

1.12

78.40

78.40

71120 00

Radiology

1.01

1.01

70.70

70.70

71120 26

Radiology

0.28

0.28

19.60

19.60

71120 TC

Radiology

0.73

0.73

51.10

51.10

71130 00

Radiology

1.24

1.24

86.80

86.80

71130 26

Radiology

0.31

0.31

21.70

21.70

71130 TC

Radiology

0.93

0.93

65.10

65.10

71250 00

Radiology

4.09

4.09

286.30

286.30

71250 26

Radiology

1.52

1.52

106.40

106.40

71250 TC

Radiology

2.57

2.57

179.90

179.90

71260 00

Radiology

5.14

5.14

359.80

359.80

71260 26

Radiology

1.64

1.64

114.80

114.80

71260 TC

Radiology

3.50

3.50

245.00

245.00

71270 00

Radiology

6.04

6.04

422.80

422.80

71270 26

Radiology

1.75

1.75

122.50

122.50

71270 TC

Radiology

4.29

4.29

300.30

300.30

71271 00

Radiology

4.23

4.23

296.10

296.10

71271 26

Radiology

1.52

1.52

106.40

106.40

71271 TC

Radiology

2.71

2.71

189.70

189.70

71275 00

Radiology

8.66

8.66

606.20

606.20

71275 26

Radiology

2.55

2.55

178.50

178.50

71275 TC

Radiology

6.11

6.11

427.70

427.70

71550 00

Radiology

10.43

10.43

730.10

730.10

71550 26

Radiology

2.05

2.05

143.50

143.50

71550 TC

Radiology

8.38

8.38

586.60

586.60

71551 00

Radiology

11.53

11.53

807.10

807.10

71551 26

Radiology

2.43

2.43

170.10

170.10

71551 TC

Radiology

9.10

9.10

637.00

637.00

71552 00

Radiology

14.55

14.55

1018.50

1018.50

71552 26

Radiology

3.17

3.17

221.90

221.90

71552 TC

Radiology

11.38

11.38

796.60

796.60

71555 00

Radiology

10.30

10.30

721.00

721.00

71555 26

Radiology

2.51

2.51

175.70

175.70

71555 TC

Radiology

7.79

7.79

545.30

545.30

72020 00

Radiology

0.73

0.73

51.10

51.10

72020 26

Radiology

0.23

0.23

16.10

16.10

72020 TC

Radiology

0.50

0.50

35.00

35.00

72040 00

Radiology

1.19

1.19

83.30

83.30

72040 26

Radiology

0.32

0.32

22.40

22.40

72040 TC

Radiology

0.87

0.87

60.90

60.90

72050 00

Radiology

1.61

1.61

112.70

112.70

72050 26

Radiology

0.38

0.38

26.60

26.60

72050 TC

Radiology

1.23

1.23

86.10

86.10

72052 00

Radiology

1.88

1.88

131.60

131.60

72052 26

Radiology

0.43

0.43

30.10

30.10

72052 TC

Radiology

1.45

1.45

101.50

101.50

72070 00

Radiology

0.99

0.99

69.30

69.30

72070 26

Radiology

0.29

0.29

20.30

20.30

72070 TC

Radiology

0.70

0.70

49.00

49.00

72072 00

Radiology

1.19

1.19

83.30

83.30

72072 26

Radiology

0.32

0.32

22.40

22.40

72072 TC

Radiology

0.87

0.87

60.90

60.90

72074 00

Radiology

1.34

1.34

93.80

93.80

72074 26

Radiology

0.35

0.35

24.50

24.50

72074 TC

Radiology

0.99

0.99

69.30

69.30

72080 00

Radiology

1.04

1.04

72.80

72.80

72080 26

Radiology

0.30

0.30

21.00

21.00

72080 TC

Radiology

0.74

0.74

51.80

51.80

72081 00

Radiology

1.28

1.28

89.60

89.60

72081 26

Radiology

0.37

0.37

25.90

25.90

72081 TC

Radiology

0.91

0.91

63.70

63.70

72082 00

Radiology

2.11

2.11

147.70

147.70

72082 26

Radiology

0.45

0.45

31.50

31.50

72082 TC

Radiology

1.66

1.66

116.20

116.20

72083 00

Radiology

2.39

2.39

167.30

167.30

72083 26

Radiology

0.51

0.51

35.70

35.70

72083 TC

Radiology

1.88

1.88

131.60

131.60

72084 00

Radiology

2.96

2.96

207.20

207.20

72084 26

Radiology

0.59

0.59

41.30

41.30

72084 TC

Radiology

2.37

2.37

165.90

165.90

72100 00

Radiology

1.20

1.20

84.00

84.00

72100 26

Radiology

0.32

0.32

22.40

22.40

72100 TC

Radiology

0.88

0.88

61.60

61.60

72110 00

Radiology

1.56

1.56

109.20

109.20

72110 26

Radiology

0.37

0.37

25.90

25.90

72110 TC

Radiology

1.19

1.19

83.30

83.30

72114 00

Radiology

1.84

1.84

128.80

128.80

72114 26

Radiology

0.43

0.43

30.10

30.10

72114 TC

Radiology

1.41

1.41

98.70

98.70

72120 00

Radiology

1.22

1.22

85.40

85.40

72120 26

Radiology

0.32

0.32

22.40

22.40

72120 TC

Radiology

0.90

0.90

63.00

63.00

72125 00

Radiology

4.00

4.00

280.00

280.00

72125 26

Radiology

1.40

1.40

98.00

98.00

72125 TC

Radiology

2.60

2.60

182.00

182.00

72126 00

Radiology

5.19

5.19

363.30

363.30

72126 26

Radiology

1.71

1.71

119.70

119.70

72126 TC

Radiology

3.48

3.48

243.60

243.60

72127 00

Radiology

6.08

6.08

425.60

425.60

72127 26

Radiology

1.78

1.78

124.60

124.60

72127 TC

Radiology

4.30

4.30

301.00

301.00

72128 00

Radiology

3.99

3.99

279.30

279.30

72128 26

Radiology

1.40

1.40

98.00

98.00

72128 TC

Radiology

2.59

2.59

181.30

181.30

72129 00

Radiology

5.23

5.23

366.10

366.10

72129 26

Radiology

1.72

1.72

120.40

120.40

72129 TC

Radiology

3.51

3.51

245.70

245.70

72130 00

Radiology

6.12

6.12

428.40

428.40

72130 26

Radiology

1.79

1.79

125.30

125.30

72130 TC

Radiology

4.33

4.33

303.10

303.10

72131 00

Radiology

3.97

3.97

277.90

277.90

72131 26

Radiology

1.40

1.40

98.00

98.00

72131 TC

Radiology

2.57

2.57

179.90

179.90

72132 00

Radiology

5.20

5.20

364.00

364.00

72132 26

Radiology

1.71

1.71

119.70

119.70

72132 TC

Radiology

3.49

3.49

244.30

244.30

72133 00

Radiology

6.09

6.09

426.30

426.30

72133 26

Radiology

1.78

1.78

124.60

124.60

72133 TC

Radiology

4.31

4.31

301.70

301.70

72141 00

Radiology

5.88

5.88

411.60

411.60

72141 26

Radiology

2.08

2.08

145.60

145.60

72141 TC

Radiology

3.80

3.80

266.00

266.00

72142 00

Radiology

8.50

8.50

595.00

595.00

72142 26

Radiology

2.52

2.52

176.40

176.40

72142 TC

Radiology

5.98

5.98

418.60

418.60

72146 00

Radiology

5.87

5.87

410.90

410.90

72146 26

Radiology

2.08

2.08

145.60

145.60

72146 TC

Radiology

3.79

3.79

265.30

265.30

72147 00

Radiology

8.42

8.42

589.40

589.40

72147 26

Radiology

2.50

2.50

175.00

175.00

72147 TC

Radiology

5.92

5.92

414.40

414.40

72148 00

Radiology

5.90

5.90

413.00

413.00

72148 26

Radiology

2.09

2.09

146.30

146.30

72148 TC

Radiology

3.81

3.81

266.70

266.70

72149 00

Radiology

8.35

8.35

584.50

584.50

72149 26

Radiology

2.51

2.51

175.70

175.70

72149 TC

Radiology

5.84

5.84

408.80

408.80

72156 00

Radiology

9.87

9.87

690.90

690.90

72156 26

Radiology

3.22

3.22

225.40

225.40

72156 TC

Radiology

6.65

6.65

465.50

465.50

72157 00

Radiology

9.89

9.89

692.30

692.30

72157 26

Radiology

3.22

3.22

225.40

225.40

72157 TC

Radiology

6.67

6.67

466.90

466.90

72158 00

Radiology

9.85

9.85

689.50

689.50

72158 26

Radiology

3.22

3.22

225.40

225.40

72158 TC

Radiology

6.63

6.63

464.10

464.10

72159 00

Radiology

10.66

10.66

746.20

746.20

72159 26

Radiology

2.53

2.53

177.10

177.10

72159 TC

Radiology

8.13

8.13

569.10

569.10

72170 00

Radiology

0.84

0.84

58.80

58.80

72170 26

Radiology

0.25

0.25

17.50

17.50

72170 TC

Radiology

0.59

0.59

41.30

41.30

72190 00

Radiology

1.27

1.27

88.90

88.90

72190 26

Radiology

0.36

0.36

25.20

25.20

72190 TC

Radiology

0.91

0.91

63.70

63.70

72191 00

Radiology

9.37

9.37

655.90

655.90

72191 26

Radiology

2.51

2.51

175.70

175.70

72191 TC

Radiology

6.86

6.86

480.20

480.20

72192 00

Radiology

4.09

4.09

286.30

286.30

72192 26

Radiology

1.53

1.53

107.10

107.10

72192 TC

Radiology

2.56

2.56

179.20

179.20

72193 00

Radiology

7.05

7.05

493.50

493.50

72193 26

Radiology

1.63

1.63

114.10

114.10

72193 TC

Radiology

5.42

5.42

379.40

379.40

72194 00

Radiology

7.78

7.78

544.60

544.60

72194 26

Radiology

1.70

1.70

119.00

119.00

72194 TC

Radiology

6.08

6.08

425.60

425.60

72195 00

Radiology

7.07

7.07

494.90

494.90

72195 26

Radiology

2.06

2.06

144.20

144.20

72195 TC

Radiology

5.01

5.01

350.70

350.70

72196 00

Radiology

8.28

8.28

579.60

579.60

72196 26

Radiology

2.42

2.42

169.40

169.40

72196 TC

Radiology

5.86

5.86

410.20

410.20

72197 00

Radiology

10.39

10.39

727.30

727.30

72197 26

Radiology

3.08

3.08

215.60

215.60

72197 TC

Radiology

7.31

7.31

511.70

511.70

72198 00

Radiology

10.43

10.43

730.10

730.10

72198 26

Radiology

2.50

2.50

175.00

175.00

72198 TC

Radiology

7.93

7.93

555.10

555.10

72200 00

Radiology

1.00

1.00

70.00

70.00

72200 26

Radiology

0.24

0.24

16.80

16.80

72200 TC

Radiology

0.76

0.76

53.20

53.20

72202 00

Radiology

1.18

1.18

82.60

82.60

72202 26

Radiology

0.32

0.32

22.40

22.40

72202 TC

Radiology

0.86

0.86

60.20

60.20

72220 00

Radiology

0.98

0.98

68.60

68.60

72220 26

Radiology

0.25

0.25

17.50

17.50

72220 TC

Radiology

0.73

0.73

51.10

51.10

72240 00

Radiology

3.36

3.36

235.20

235.20

72240 26

Radiology

1.29

1.29

90.30

90.30

72240 TC

Radiology

2.07

2.07

144.90

144.90

72255 00

Radiology

3.23

3.23

226.10

226.10

72255 26

Radiology

1.28

1.28

89.60

89.60

72255 TC

Radiology

1.95

1.95

136.50

136.50

72265 00

Radiology

3.27

3.27

228.90

228.90

72265 26

Radiology

1.18

1.18

82.60

82.60

72265 TC

Radiology

2.09

2.09

146.30

146.30

72270 00

Radiology

4.58

4.58

320.60

320.60

72270 26

Radiology

1.93

1.93

135.10

135.10

72270 TC

Radiology

2.65

2.65

185.50

185.50

72285 00

Radiology

3.96

3.96

277.20

277.20

72285 26

Radiology

1.65

1.65

115.50

115.50

72285 TC

Radiology

2.31

2.31

161.70

161.70

72295 00

Radiology

3.34

3.34

233.80

233.80

72295 26

Radiology

1.17

1.17

81.90

81.90

72295 TC

Radiology

2.17

2.17

151.90

151.90

73000 00

Radiology

0.98

0.98

68.60

68.60

73000 26

Radiology

0.24

0.24

16.80

16.80

73000 TC

Radiology

0.74

0.74

51.80

51.80

73010 00

Radiology

0.72

0.72

50.40

50.40

73010 26

Radiology

0.26

0.26

18.20

18.20

73010 TC

Radiology

0.46

0.46

32.20

32.20

73020 00

Radiology

0.65

0.65

45.50

45.50

73020 26

Radiology

0.22

0.22

15.40

15.40

73020 TC

Radiology

0.43

0.43

30.10

30.10

73030 00

Radiology

1.05

1.05

73.50

73.50

73030 26

Radiology

0.27

0.27

18.90

18.90

73030 TC

Radiology

0.78

0.78

54.60

54.60

73040 00

Radiology

3.95

3.95

276.50

276.50

73040 26

Radiology

0.79

0.79

55.30

55.30

73040 TC

Radiology

3.16

3.16

221.20

221.20

73050 00

Radiology

0.87

0.87

60.90

60.90

73050 26

Radiology

0.27

0.27

18.90

18.90

73050 TC

Radiology

0.60

0.60

42.00

42.00

73060 00

Radiology

0.96

0.96

67.20

67.20

73060 26

Radiology

0.23

0.23

16.10

16.10

73060 TC

Radiology

0.73

0.73

51.10

51.10

73070 00

Radiology

0.88

0.88

61.60

61.60

73070 26

Radiology

0.24

0.24

16.80

16.80

73070 TC

Radiology

0.64

0.64

44.80

44.80

73080 00

Radiology

0.99

0.99

69.30

69.30

73080 26

Radiology

0.25

0.25

17.50

17.50

73080 TC

Radiology

0.74

0.74

51.80

51.80

73085 00

Radiology

3.00

3.00

210.00

210.00

73085 26

Radiology

0.76

0.76

53.20

53.20

73085 TC

Radiology

2.24

2.24

156.80

156.80

73090 00

Radiology

0.88

0.88

61.60

61.60

73090 26

Radiology

0.23

0.23

16.10

16.10

73090 TC

Radiology

0.65

0.65

45.50

45.50

73092 00

Radiology

0.95

0.95

66.50

66.50

73092 26

Radiology

0.23

0.23

16.10

16.10

73092 TC

Radiology

0.72

0.72

50.40

50.40

73100 00

Radiology

1.02

1.02

71.40

71.40

73100 26

Radiology

0.24

0.24

16.80

16.80

73100 TC

Radiology

0.78

0.78

54.60

54.60

73110 00

Radiology

1.24

1.24

86.80

86.80

73110 26

Radiology

0.25

0.25

17.50

17.50

73110 TC

Radiology

0.99

0.99

69.30

69.30

73115 00

Radiology

4.05

4.05

283.50

283.50

73115 26

Radiology

0.80

0.80

56.00

56.00

73115 TC

Radiology

3.25

3.25

227.50

227.50

73120 00

Radiology

0.95

0.95

66.50

66.50

73120 26

Radiology

0.24

0.24

16.80

16.80

73120 TC

Radiology

0.71

0.71

49.70

49.70

73130 00

Radiology

1.12

1.12

78.40

78.40

73130 26

Radiology

0.25

0.25

17.50

17.50

73130 TC

Radiology

0.87

0.87

60.90

60.90

73140 00

Radiology

1.15

1.15

80.50

80.50

73140 26

Radiology

0.20

0.20

14.00

14.00

73140 TC

Radiology

0.95

0.95

66.50

66.50

73200 00

Radiology

4.96

4.96

347.20

347.20

73200 26

Radiology

1.40

1.40

98.00

98.00

73200 TC

Radiology

3.56

3.56

249.20

249.20

73201 00

Radiology

6.18

6.18

432.60

432.60

73201 26

Radiology

1.63

1.63

114.10

114.10

73201 TC

Radiology

4.55

4.55

318.50

318.50

73202 00

Radiology

7.66

7.66

536.20

536.20

73202 26

Radiology

1.70

1.70

119.00

119.00

73202 TC

Radiology

5.96

5.96

417.20

417.20

73206 00

Radiology

9.14

9.14

639.80

639.80

73206 26

Radiology

2.51

2.51

175.70

175.70

73206 TC

Radiology

6.63

6.63

464.10

464.10

73218 00

Radiology

9.37

9.37

655.90

655.90

73218 26

Radiology

1.91

1.91

133.70

133.70

73218 TC

Radiology

7.46

7.46

522.20

522.20

73219 00

Radiology

10.23

10.23

716.10

716.10

73219 26

Radiology

2.28

2.28

159.60

159.60

73219 TC

Radiology

7.95

7.95

556.50

556.50

73220 00

Radiology

12.65

12.65

885.50

885.50

73220 26

Radiology

3.02

3.02

211.40

211.40

73220 TC

Radiology

9.63

9.63

674.10

674.10

73221 00

Radiology

6.26

6.26

438.20

438.20

73221 26

Radiology

1.91

1.91

133.70

133.70

73221 TC

Radiology

4.35

4.35

304.50

304.50

73222 00

Radiology

9.67

9.67

676.90

676.90

73222 26

Radiology

2.29

2.29

160.30

160.30

73222 TC

Radiology

7.38

7.38

516.60

516.60

73223 00

Radiology

11.95

11.95

836.50

836.50

73223 26

Radiology

3.03

3.03

212.10

212.10

73223 TC

Radiology

8.92

8.92

624.40

624.40

73225 00

Radiology

10.56

10.56

739.20

739.20

73225 26

Radiology

2.43

2.43

170.10

170.10

73225 TC

Radiology

8.13

8.13

569.10

569.10

73501 00

Radiology

0.99

0.99

69.30

69.30

73501 26

Radiology

0.27

0.27

18.90

18.90

73501 TC

Radiology

0.72

0.72

50.40

50.40

73502 00

Radiology

1.43

1.43

100.10

100.10

73502 26

Radiology

0.32

0.32

22.40

22.40

73502 TC

Radiology

1.11

1.11

77.70

77.70

73503 00

Radiology

1.80

1.80

126.00

126.00

73503 26

Radiology

0.39

0.39

27.30

27.30

73503 TC

Radiology

1.41

1.41

98.70

98.70

73521 00

Radiology

1.24

1.24

86.80

86.80

73521 26

Radiology

0.32

0.32

22.40

22.40

73521 TC

Radiology

0.92

0.92

64.40

64.40

73522 00

Radiology

1.62

1.62

113.40

113.40

73522 26

Radiology

0.42

0.42

29.40

29.40

73522 TC

Radiology

1.20

1.20

84.00

84.00

73523 00

Radiology

1.86

1.86

130.20

130.20

73523 26

Radiology

0.45

0.45

31.50

31.50

73523 TC

Radiology

1.41

1.41

98.70

98.70

73525 00

Radiology

3.87

3.87

270.90

270.90

73525 26

Radiology

0.84

0.84

58.80

58.80

73525 TC

Radiology

3.03

3.03

212.10

212.10

73551 00

Radiology

0.88

0.88

61.60

61.60

73551 26

Radiology

0.24

0.24

16.80

16.80

73551 TC

Radiology

0.64

0.64

44.80

44.80

73552 00

Radiology

1.07

1.07

74.90

74.90

73552 26

Radiology

0.26

0.26

18.20

18.20

73552 TC

Radiology

0.81

0.81

56.70

56.70

73560 00

Radiology

1.03

1.03

72.10

72.10

73560 26

Radiology

0.24

0.24

16.80

16.80

73560 TC

Radiology

0.79

0.79

55.30

55.30

73562 00

Radiology

1.23

1.23

86.10

86.10

73562 26

Radiology

0.27

0.27

18.90

18.90

73562 TC

Radiology

0.96

0.96

67.20

67.20

73564 00

Radiology

1.42

1.42

99.40

99.40

73564 26

Radiology

0.33

0.33

23.10

23.10

73564 TC

Radiology

1.09

1.09

76.30

76.30

73565 00

Radiology

1.20

1.20

84.00

84.00

73565 26

Radiology

0.24

0.24

16.80

16.80

73565 TC

Radiology

0.96

0.96

67.20

67.20

73580 00

Radiology

3.32

3.32

232.40

232.40

73580 26

Radiology

0.91

0.91

63.70

63.70

73580 TC

Radiology

2.41

2.41

168.70

168.70

73590 00

Radiology

0.95

0.95

66.50

66.50

73590 26

Radiology

0.23

0.23

16.10

16.10

73590 TC

Radiology

0.72

0.72

50.40

50.40

73592 00

Radiology

0.95

0.95

66.50

66.50

73592 26

Radiology

0.23

0.23

16.10

16.10

73592 TC

Radiology

0.72

0.72

50.40

50.40

73600 00

Radiology

0.97

0.97

67.90

67.90

73600 26

Radiology

0.23

0.23

16.10

16.10

73600 TC

Radiology

0.74

0.74

51.80

51.80

73610 00

Radiology

1.10

1.10

77.00

77.00

73610 26

Radiology

0.25

0.25

17.50

17.50

73610 TC

Radiology

0.85

0.85

59.50

59.50

73615 00

Radiology

3.84

3.84

268.80

268.80

73615 26

Radiology

0.81

0.81

56.70

56.70

73615 TC

Radiology

3.03

3.03

212.10

212.10

73620 00

Radiology

0.86

0.86

60.20

60.20

73620 26

Radiology

0.22

0.22

15.40

15.40

73620 TC

Radiology

0.64

0.64

44.80

44.80

73630 00

Radiology

1.03

1.03

72.10

72.10

73630 26

Radiology

0.24

0.24

16.80

16.80

73630 TC

Radiology

0.79

0.79

55.30

55.30

73650 00

Radiology

0.86

0.86

60.20

60.20

73650 26

Radiology

0.23

0.23

16.10

16.10

73650 TC

Radiology

0.63

0.63

44.10

44.10

73660 00

Radiology

0.88

0.88

61.60

61.60

73660 26

Radiology

0.19

0.19

13.30

13.30

73660 TC

Radiology

0.69

0.69

48.30

48.30

73700 00

Radiology

3.98

3.98

278.60

278.60

73700 26

Radiology

1.40

1.40

98.00

98.00

73700 TC

Radiology

2.58

2.58

180.60

180.60

73701 00

Radiology

5.13

5.13

359.10

359.10

73701 26

Radiology

1.63

1.63

114.10

114.10

73701 TC

Radiology

3.50

3.50

245.00

245.00

73702 00

Radiology

6.01

6.01

420.70

420.70

73702 26

Radiology

1.70

1.70

119.00

119.00

73702 TC

Radiology

4.31

4.31

301.70

301.70

73706 00

Radiology

9.94

9.94

695.80

695.80

73706 26

Radiology

2.64

2.64

184.80

184.80

73706 TC

Radiology

7.30

7.30

511.00

511.00

73718 00

Radiology

6.89

6.89

482.30

482.30

73718 26

Radiology

1.89

1.89

132.30

132.30

73718 TC

Radiology

5.00

5.00

350.00

350.00

73719 00

Radiology

8.12

8.12

568.40

568.40

73719 26

Radiology

2.27

2.27

158.90

158.90

73719 TC

Radiology

5.85

5.85

409.50

409.50

73720 00

Radiology

10.40

10.40

728.00

728.00

73720 26

Radiology

3.01

3.01

210.70

210.70

73720 TC

Radiology

7.39

7.39

517.30

517.30

73721 00

Radiology

6.25

6.25

437.50

437.50

73721 26

Radiology

1.91

1.91

133.70

133.70

73721 TC

Radiology

4.34

4.34

303.80

303.80

73722 00

Radiology

9.68

9.68

677.60

677.60

73722 26

Radiology

2.28

2.28

159.60

159.60

73722 TC

Radiology

7.40

7.40

518.00

518.00

73723 00

Radiology

11.90

11.90

833.00

833.00

73723 26

Radiology

3.02

3.02

211.40

211.40

73723 TC

Radiology

8.88

8.88

621.60

621.60

73725 00

Radiology

10.36

10.36

725.20

725.20

73725 26

Radiology

2.52

2.52

176.40

176.40

73725 TC

Radiology

7.84

7.84

548.80

548.80

74018 00

Radiology

0.91

0.91

63.70

63.70

74018 26

Radiology

0.26

0.26

18.20

18.20

74018 TC

Radiology

0.65

0.65

45.50

45.50

74019 00

Radiology

1.10

1.10

77.00

77.00

74019 26

Radiology

0.32

0.32

22.40

22.40

74019 TC

Radiology

0.78

0.78

54.60

54.60

74021 00

Radiology

1.29

1.29

90.30

90.30

74021 26

Radiology

0.38

0.38

26.60

26.60

74021 TC

Radiology

0.91

0.91

63.70

63.70

74022 00

Radiology

1.50

1.50

105.00

105.00

74022 26

Radiology

0.45

0.45

31.50

31.50

74022 TC

Radiology

1.05

1.05

73.50

73.50

74150 00

Radiology

4.20

4.20

294.00

294.00

74150 26

Radiology

1.67

1.67

116.90

116.90

74150 TC

Radiology

2.53

2.53

177.10

177.10

74160 00

Radiology

7.18

7.18

502.60

502.60

74160 26

Radiology

1.79

1.79

125.30

125.30

74160 TC

Radiology

5.39

5.39

377.30

377.30

74170 00

Radiology

8.07

8.07

564.90

564.90

74170 26

Radiology

1.96

1.96

137.20

137.20

74170 TC

Radiology

6.11

6.11

427.70

427.70

74174 00

Radiology

11.71

11.71

819.70

819.70

74174 26

Radiology

3.07

3.07

214.90

214.90

74174 TC

Radiology

8.64

8.64

604.80

604.80

74175 00

Radiology

9.41

9.41

658.70

658.70

74175 26

Radiology

2.54

2.54

177.80

177.80

74175 TC

Radiology

6.87

6.87

480.90

480.90

74176 00

Radiology

5.63

5.63

394.10

394.10

74176 26

Radiology

2.44

2.44

170.80

170.80

74176 TC

Radiology

3.19

3.19

223.30

223.30

74177 00

Radiology

9.34

9.34

653.80

653.80

74177 26

Radiology

2.55

2.55

178.50

178.50

74177 TC

Radiology

6.79

6.79

475.30

475.30

74178 00

Radiology

10.48

10.48

733.60

733.60

74178 26

Radiology

2.81

2.81

196.70

196.70

74178 TC

Radiology

7.67

7.67

536.90

536.90

74181 00

Radiology

6.04

6.04

422.80

422.80

74181 26

Radiology

2.05

2.05

143.50

143.50

74181 TC

Radiology

3.99

3.99

279.30

279.30

74182 00

Radiology

9.33

9.33

653.10

653.10

74182 26

Radiology

2.42

2.42

169.40

169.40

74182 TC

Radiology

6.91

6.91

483.70

483.70

74183 00

Radiology

10.43

10.43

730.10

730.10

74183 26

Radiology

3.08

3.08

215.60

215.60

74183 TC

Radiology

7.35

7.35

514.50

514.50

74185 00

Radiology

10.39

10.39

727.30

727.30

74185 26

Radiology

2.50

2.50

175.00

175.00

74185 TC

Radiology

7.89

7.89

552.30

552.30

74190 00

Radiology

-

-

151.90

151.90

74190 26

Radiology

0.65

0.65

45.50

45.50

74190 TC

Radiology

-

-

106.40

106.40

74210 00

Radiology

2.84

2.84

198.80

198.80

74210 26

Radiology

0.82

0.82

57.40

57.40

74210 TC

Radiology

2.02

2.02

141.40

141.40

74220 00

Radiology

2.92

2.92

204.40

204.40

74220 26

Radiology

0.84

0.84

58.80

58.80

74220 TC

Radiology

2.08

2.08

145.60

145.60

74221 00

Radiology

3.29

3.29

230.30

230.30

74221 26

Radiology

0.98

0.98

68.60

68.60

74221 TC

Radiology

2.31

2.31

161.70

161.70

74230 00

Radiology

3.74

3.74

261.80

261.80

74230 26

Radiology

0.75

0.75

52.50

52.50

74230 TC

Radiology

2.99

2.99

209.30

209.30

74235 00

Radiology

-

-

333.90

333.90

74235 26

Radiology

1.67

1.67

116.90

116.90

74235 TC

Radiology

-

-

217.00

217.00

74240 00

Radiology

3.68

3.68

257.60

257.60

74240 26

Radiology

1.13

1.13

79.10

79.10

74240 TC

Radiology

2.55

2.55

178.50

178.50

74246 00

Radiology

4.17

4.17

291.90

291.90

74246 26

Radiology

1.26

1.26

88.20

88.20

74246 TC

Radiology

2.91

2.91

203.70

203.70

74248 00

Radiology

2.47

2.47

172.90

172.90

74248 26

Radiology

0.98

0.98

68.60

68.60

74248 TC

Radiology

1.49

1.49

104.30

104.30

74250 00

Radiology

3.65

3.65

255.50

255.50

74250 26

Radiology

1.13

1.13

79.10

79.10

74250 TC

Radiology

2.52

2.52

176.40

176.40

74251 00

Radiology

10.87

10.87

760.90

760.90

74251 26

Radiology

1.64

1.64

114.80

114.80

74251 TC

Radiology

9.23

9.23

646.10

646.10

74261 00

Radiology

12.76

12.76

893.20

893.20

74261 26

Radiology

3.36

3.36

235.20

235.20

74261 TC

Radiology

9.40

9.40

658.00

658.00

74262 00

Radiology

14.36

14.36

1005.20

1005.20

74262 26

Radiology

3.51

3.51

245.70

245.70

74262 TC

Radiology

10.85

10.85

759.50

759.50

74263 00

Radiology

20.22

20.22

1415.40

1415.40

74263 26

Radiology

3.21

3.21

224.70

224.70

74263 TC

Radiology

17.01

17.01

1190.70

1190.70

74270 00

Radiology

4.60

4.60

322.00

322.00

74270 26

Radiology

1.45

1.45

101.50

101.50

74270 TC

Radiology

3.15

3.15

220.50

220.50

74280 00

Radiology

6.59

6.59

461.30

461.30

74280 26

Radiology

1.77

1.77

123.90

123.90

74280 TC

Radiology

4.82

4.82

337.40

337.40

74283 00

Radiology

7.64

7.64

534.80

534.80

74283 26

Radiology

2.95

2.95

206.50

206.50

74283 TC

Radiology

4.69

4.69

328.30

328.30

74290 00

Radiology

2.55

2.55

178.50

178.50

74290 26

Radiology

0.45

0.45

31.50

31.50

74290 TC

Radiology

2.10

2.10

147.00

147.00

74300 00

Radiology

-

-

91.00

91.00

74300 26

Radiology

0.39

0.39

27.30

27.30

74300 TC

Radiology

-

-

63.70

63.70

74301 00

Radiology

-

-

81.20

81.20

74301 26

Radiology

0.29

0.29

20.30

20.30

74301 TC

Radiology

-

-

60.90

60.90

74328 00

Radiology

-

-

226.80

226.80

74328 26

Radiology

0.68

0.68

47.60

47.60

74328 TC

Radiology

-

-

179.20

179.20

74329 00

Radiology

-

-

219.80

219.80

74329 26

Radiology

0.69

0.69

48.30

48.30

74329 TC

Radiology

-

-

171.50

171.50

74330 00

Radiology

-

-

207.20

207.20

74330 26

Radiology

0.80

0.80

56.00

56.00

74330 TC

Radiology

-

-

151.20

151.20

74340 00

Radiology

-

-

276.50

276.50

74340 26

Radiology

0.75

0.75

52.50

52.50

74340 TC

Radiology

-

-

224.00

224.00

74355 00

Radiology

-

-

277.20

277.20

74355 26

Radiology

1.07

1.07

74.90

74.90

74355 TC

Radiology

-

-

202.30

202.30

74360 00

Radiology

-

-

329.70

329.70

74360 26

Radiology

0.80

0.80

56.00

56.00

74360 TC

Radiology

-

-

273.70

273.70

74363 00

Radiology

-

-

449.40

449.40

74363 26

Radiology

1.22

1.22

85.40

85.40

74363 TC

Radiology

-

-

364.00

364.00

74400 00

Radiology

4.05

4.05

283.50

283.50

74400 26

Radiology

0.69

0.69

48.30

48.30

74400 TC

Radiology

3.36

3.36

235.20

235.20

74410 00

Radiology

4.25

4.25

297.50

297.50

74410 26

Radiology

0.68

0.68

47.60

47.60

74410 TC

Radiology

3.57

3.57

249.90

249.90

74415 00

Radiology

4.53

4.53

317.10

317.10

74415 26

Radiology

0.68

0.68

47.60

47.60

74415 TC

Radiology

3.85

3.85

269.50

269.50

74420 00

Radiology

2.34

2.34

163.80

163.80

74420 26

Radiology

0.72

0.72

50.40

50.40

74420 TC

Radiology

1.62

1.62

113.40

113.40

74425 00

Radiology

4.07

4.07

284.90

284.90

74425 26

Radiology

0.70

0.70

49.00

49.00

74425 TC

Radiology

3.37

3.37

235.90

235.90

74430 00

Radiology

1.24

1.24

86.80

86.80

74430 26

Radiology

0.45

0.45

31.50

31.50

74430 TC

Radiology

0.79

0.79

55.30

55.30

74440 00

Radiology

2.92

2.92

204.40

204.40

74440 26

Radiology

0.52

0.52

36.40

36.40

74440 TC

Radiology

2.40

2.40

168.00

168.00

74445 00

Radiology

-

-

193.90

193.90

74445 26

Radiology

1.58

1.58

110.60

110.60

74445 TC

Radiology

-

-

83.30

83.30

74450 00

Radiology

-

-

140.00

140.00

74450 26

Radiology

0.46

0.46

32.20

32.20

74450 TC

Radiology

-

-

107.80

107.80

74455 00

Radiology

3.12

3.12

218.40

218.40

74455 26

Radiology

0.46

0.46

32.20

32.20

74455 TC

Radiology

2.66

2.66

186.20

186.20

74470 00

Radiology

-

-

142.10

142.10

74470 26

Radiology

0.73

0.73

51.10

51.10

74470 TC

Radiology

-

-

91.00

91.00

74485 00

Radiology

3.58

3.58

250.60

250.60

74485 26

Radiology

1.15

1.15

80.50

80.50

74485 TC

Radiology

2.43

2.43

170.10

170.10

74712 00

Radiology

12.60

12.60

882.00

882.00

74712 26

Radiology

4.22

4.22

295.40

295.40

74712 TC

Radiology

8.38

8.38

586.60

586.60

74713 00

Radiology

6.12

6.12

428.40

428.40

74713 26

Radiology

2.60

2.60

182.00

182.00

74713 TC

Radiology

3.52

3.52

246.40

246.40

74740 00

Radiology

2.81

2.81

196.70

196.70

74740 26

Radiology

0.54

0.54

37.80

37.80

74740 TC

Radiology

2.27

2.27

158.90

158.90

74742 00

Radiology

-

-

240.80

240.80

74742 26

Radiology

0.86

0.86

60.20

60.20

74742 TC

Radiology

-

-

180.60

180.60

74775 00

Radiology

-

-

196.70

196.70

74775 26

Radiology

0.87

0.87

60.90

60.90

74775 TC

Radiology

-

-

135.80

135.80

75557 00

Radiology

8.58

8.58

600.60

600.60

75557 26

Radiology

3.26

3.26

228.20

228.20

75557 TC

Radiology

5.32

5.32

372.40

372.40

75559 00

Radiology

11.54

11.54

807.80

807.80

75559 26

Radiology

4.05

4.05

283.50

283.50

75559 TC

Radiology

7.49

7.49

524.30

524.30

75561 00

Radiology

11.21

11.21

784.70

784.70

75561 26

Radiology

3.61

3.61

252.70

252.70

75561 TC

Radiology

7.60

7.60

532.00

532.00

75563 00

Radiology

13.07

13.07

914.90

914.90

75563 26

Radiology

4.13

4.13

289.10

289.10

75563 TC

Radiology

8.94

8.94

625.80

625.80

75565 00

Radiology

1.40

1.40

98.00

98.00

75565 26

Radiology

0.35

0.35

24.50

24.50

75565 TC

Radiology

1.05

1.05

73.50

73.50

75571 00

Radiology

3.07

3.07

214.90

214.90

75571 26

Radiology

0.81

0.81

56.70

56.70

75571 TC

Radiology

2.26

2.26

158.20

158.20

75572 00

Radiology

7.00

7.00

490.00

490.00

75572 26

Radiology

2.43

2.43

170.10

170.10

75572 TC

Radiology

4.57

4.57

319.90

319.90

75573 00

Radiology

9.34

9.34

653.80

653.80

75573 26

Radiology

3.55

3.55

248.50

248.50

75573 TC

Radiology

5.79

5.79

405.30

405.30

75574 00

Radiology

9.90

9.90

693.00

693.00

75574 26

Radiology

3.34

3.34

233.80

233.80

75574 TC

Radiology

6.56

6.56

459.20

459.20

75580 00

Radiology

27.12

27.12

1898.40

1898.40

75580 26

Radiology

1.04

1.04

72.80

72.80

75580 TC

Radiology

26.08

26.08

1825.60

1825.60

75600 00

Radiology

5.47

5.47

382.90

382.90

75600 26

Radiology

0.69

0.69

48.30

48.30

75600 TC

Radiology

4.78

4.78

334.60

334.60

75605 00

Radiology

3.62

3.62

253.40

253.40

75605 26

Radiology

1.57

1.57

109.90

109.90

75605 TC

Radiology

2.05

2.05

143.50

143.50

75625 00

Radiology

3.79

3.79

265.30

265.30

75625 26

Radiology

1.99

1.99

139.30

139.30

75625 TC

Radiology

1.80

1.80

126.00

126.00

75630 00

Radiology

4.70

4.70

329.00

329.00

75630 26

Radiology

2.76

2.76

193.20

193.20

75630 TC

Radiology

1.94

1.94

135.80

135.80

75635 00

Radiology

12.64

12.64

884.80

884.80

75635 26

Radiology

3.32

3.32

232.40

232.40

75635 TC

Radiology

9.32

9.32

652.40

652.40

75705 00

Radiology

7.51

7.51

525.70

525.70

75705 26

Radiology

3.44

3.44

240.80

240.80

75705 TC

Radiology

4.07

4.07

284.90

284.90

75710 00

Radiology

4.50

4.50

315.00

315.00

75710 26

Radiology

2.43

2.43

170.10

170.10

75710 TC

Radiology

2.07

2.07

144.90

144.90

75716 00

Radiology

4.88

4.88

341.60

341.60

75716 26

Radiology

2.72

2.72

190.40

190.40

75716 TC

Radiology

2.16

2.16

151.20

151.20

75726 00

Radiology

5.09

5.09

356.30

356.30

75726 26

Radiology

2.76

2.76

193.20

193.20

75726 TC

Radiology

2.33

2.33

163.10

163.10

75731 00

Radiology

4.60

4.60

322.00

322.00

75731 26

Radiology

1.60

1.60

112.00

112.00

75731 TC

Radiology

3.00

3.00

210.00

210.00

75733 00

Radiology

5.17

5.17

361.90

361.90

75733 26

Radiology

1.80

1.80

126.00

126.00

75733 TC

Radiology

3.37

3.37

235.90

235.90

75736 00

Radiology

4.30

4.30

301.00

301.00

75736 26

Radiology

1.53

1.53

107.10

107.10

75736 TC

Radiology

2.77

2.77

193.90

193.90

75741 00

Radiology

3.89

3.89

272.30

272.30

75741 26

Radiology

1.77

1.77

123.90

123.90

75741 TC

Radiology

2.12

2.12

148.40

148.40

75743 00

Radiology

4.42

4.42

309.40

309.40

75743 26

Radiology

2.26

2.26

158.20

158.20

75743 TC

Radiology

2.16

2.16

151.20

151.20

75746 00

Radiology

4.04

4.04

282.80

282.80

75746 26

Radiology

1.55

1.55

108.50

108.50

75746 TC

Radiology

2.49

2.49

174.30

174.30

75756 00

Radiology

4.95

4.95

346.50

346.50

75756 26

Radiology

1.61

1.61

112.70

112.70

75756 TC

Radiology

3.34

3.34

233.80

233.80

75774 00

Radiology

2.89

2.89

202.30

202.30

75774 26

Radiology

1.36

1.36

95.20

95.20

75774 TC

Radiology

1.53

1.53

107.10

107.10

75801 00

Radiology

-

-

518.70

518.70

75801 26

Radiology

1.26

1.26

88.20

88.20

75801 TC

Radiology

-

-

430.50

430.50

75803 00

Radiology

-

-

525.00

525.00

75803 26

Radiology

1.65

1.65

115.50

115.50

75803 TC

Radiology

-

-

409.50

409.50

75805 00

Radiology

-

-

532.00

532.00

75805 26

Radiology

1.14

1.14

79.80

79.80

75805 TC

Radiology

-

-

452.20

452.20

75807 00

Radiology

-

-

542.50

542.50

75807 26

Radiology

1.55

1.55

108.50

108.50

75807 TC

Radiology

-

-

434.00

434.00

75809 00

Radiology

2.45

2.45

171.50

171.50

75809 26

Radiology

0.67

0.67

46.90

46.90

75809 TC

Radiology

1.78

1.78

124.60

124.60

75810 00

Radiology

-

-

903.70

903.70

75810 26

Radiology

1.42

1.42

99.40

99.40

75810 TC

Radiology

-

-

804.30

804.30

75820 00

Radiology

3.23

3.23

226.10

226.10

75820 26

Radiology

1.45

1.45

101.50

101.50

75820 TC

Radiology

1.78

1.78

124.60

124.60

75822 00

Radiology

4.00

4.00

280.00

280.00

75822 26

Radiology

2.03

2.03

142.10

142.10

75822 TC

Radiology

1.97

1.97

137.90

137.90

75825 00

Radiology

3.42

3.42

239.40

239.40

75825 26

Radiology

1.57

1.57

109.90

109.90

75825 TC

Radiology

1.85

1.85

129.50

129.50

75827 00

Radiology

3.56

3.56

249.20

249.20

75827 26

Radiology

1.58

1.58

110.60

110.60

75827 TC

Radiology

1.98

1.98

138.60

138.60

75831 00

Radiology

3.58

3.58

250.60

250.60

75831 26

Radiology

1.52

1.52

106.40

106.40

75831 TC

Radiology

2.06

2.06

144.20

144.20

75833 00

Radiology

4.43

4.43

310.10

310.10

75833 26

Radiology

2.05

2.05

143.50

143.50

75833 TC

Radiology

2.38

2.38

166.60

166.60

75840 00

Radiology

3.85

3.85

269.50

269.50

75840 26

Radiology

1.60

1.60

112.00

112.00

75840 TC

Radiology

2.25

2.25

157.50

157.50

75842 00

Radiology

4.76

4.76

333.20

333.20

75842 26

Radiology

2.10

2.10

147.00

147.00

75842 TC

Radiology

2.66

2.66

186.20

186.20

75860 00

Radiology

3.76

3.76

263.20

263.20

75860 26

Radiology

1.57

1.57

109.90

109.90

75860 TC

Radiology

2.19

2.19

153.30

153.30

75870 00

Radiology

4.66

4.66

326.20

326.20

75870 26

Radiology

1.72

1.72

120.40

120.40

75870 TC

Radiology

2.94

2.94

205.80

205.80

75872 00

Radiology

3.85

3.85

269.50

269.50

75872 26

Radiology

1.60

1.60

112.00

112.00

75872 TC

Radiology

2.25

2.25

157.50

157.50

75880 00

Radiology

3.23

3.23

226.10

226.10

75880 26

Radiology

0.99

0.99

69.30

69.30

75880 TC

Radiology

2.24

2.24

156.80

156.80

75885 00

Radiology

4.09

4.09

286.30

286.30

75885 26

Radiology

1.92

1.92

134.40

134.40

75885 TC

Radiology

2.17

2.17

151.90

151.90

75887 00

Radiology

4.12

4.12

288.40

288.40

75887 26

Radiology

1.93

1.93

135.10

135.10

75887 TC

Radiology

2.19

2.19

153.30

153.30

75889 00

Radiology

3.70

3.70

259.00

259.00

75889 26

Radiology

1.53

1.53

107.10

107.10

75889 TC

Radiology

2.17

2.17

151.90

151.90

75891 00

Radiology

3.72

3.72

260.40

260.40

75891 26

Radiology

1.53

1.53

107.10

107.10

75891 TC

Radiology

2.19

2.19

153.30

153.30

75893 00

Radiology

3.15

3.15

220.50

220.50

75893 26

Radiology

0.75

0.75

52.50

52.50

75893 TC

Radiology

2.40

2.40

168.00

168.00

75894 00

Radiology

-

-

2109.80

2109.80

75894 26

Radiology

2.11

2.11

147.70

147.70

75894 TC

Radiology

-

-

1962.10

1962.10

75898 00

Radiology

-

-

280.70

280.70

75898 26

Radiology

2.69

2.69

188.30

188.30

75898 TC

Radiology

-

-

92.40

92.40

75901 00

Radiology

6.82

6.82

477.40

477.40

75901 26

Radiology

0.66

0.66

46.20

46.20

75901 TC

Radiology

6.16

6.16

431.20

431.20

75902 00

Radiology

2.63

2.63

184.10

184.10

75902 26

Radiology

0.53

0.53

37.10

37.10

75902 TC

Radiology

2.10

2.10

147.00

147.00

75956 00

Radiology

-

-

1711.50

1711.50

75956 26

Radiology

9.78

9.78

684.60

684.60

75956 TC

Radiology

-

-

1026.90

1026.90

75957 00

Radiology

-

-

1633.10

1633.10

75957 26

Radiology

8.40

8.40

588.00

588.00

75957 TC

Radiology

-

-

1045.10

1045.10

75958 00

Radiology

-

-

1071.70

1071.70

75958 26

Radiology

5.51

5.51

385.70

385.70

75958 TC

Radiology

-

-

686.00

686.00

75959 00

Radiology

-

-

977.90

977.90

75959 26

Radiology

4.89

4.89

342.30

342.30

75959 TC

Radiology

-

-

635.60

635.60

75970 00

Radiology

-

-

863.10

863.10

75970 26

Radiology

1.11

1.11

77.70

77.70

75970 TC

Radiology

-

-

785.40

785.40

75984 00

Radiology

2.86

2.86

200.20

200.20

75984 26

Radiology

1.12

1.12

78.40

78.40

75984 TC

Radiology

1.74

1.74

121.80

121.80

75989 00

Radiology

3.34

3.34

233.80

233.80

75989 26

Radiology

1.63

1.63

114.10

114.10

75989 TC

Radiology

1.71

1.71

119.70

119.70

76000 00

Radiology

1.28

1.28

89.60

89.60

76000 26

Radiology

0.44

0.44

30.80

30.80

76000 TC

Radiology

0.84

0.84

58.80

58.80

76010 00

Radiology

0.88

0.88

61.60

61.60

76010 26

Radiology

0.25

0.25

17.50

17.50

76010 TC

Radiology

0.63

0.63

44.10

44.10

76080 00

Radiology

1.79

1.79

125.30

125.30

76080 26

Radiology

0.73

0.73

51.10

51.10

76080 TC

Radiology

1.06

1.06

74.20

74.20

76098 00

Radiology

1.28

1.28

89.60

89.60

76098 26

Radiology

0.45

0.45

31.50

31.50

76098 TC

Radiology

0.83

0.83

58.10

58.10

76100 00

Radiology

2.68

2.68

187.60

187.60

76100 26

Radiology

0.82

0.82

57.40

57.40

76100 TC

Radiology

1.86

1.86

130.20

130.20

76120 00

Radiology

3.54

3.54

247.80

247.80

76120 26

Radiology

0.57

0.57

39.90

39.90

76120 TC

Radiology

2.97

2.97

207.90

207.90

76125 00

Radiology

-

-

88.20

88.20

76125 26

Radiology

0.39

0.39

27.30

27.30

76125 TC

Radiology

-

-

60.90

60.90

76140 00

Radiology

0.00

0.00

BR

BR

76145 00

Radiology

27.21

27.21

1904.70

1904.70

76376 00

Radiology

0.75

0.75

52.50

52.50

76376 26

Radiology

0.28

0.28

19.60

19.60

76376 TC

Radiology

0.47

0.47

32.90

32.90

76377 00

Radiology

2.34

2.34

163.80

163.80

76377 26

Radiology

1.12

1.12

78.40

78.40

76377 TC

Radiology

1.22

1.22

85.40

85.40

76380 00

Radiology

4.02

4.02

281.40

281.40

76380 26

Radiology

1.34

1.34

93.80

93.80

76380 TC

Radiology

2.68

2.68

187.60

187.60

76390 00

Radiology

-

-

1099.00

1099.00

76390 26

Radiology

-

-

186.90

186.90

76390 TC

Radiology

-

-

912.10

912.10

76391 00

Radiology

6.20

6.20

434.00

434.00

76391 26

Radiology

1.55

1.55

108.50

108.50

76391 TC

Radiology

4.65

4.65

325.50

325.50

76496 00

Radiology

0.00

0.00

BR

BR

76496 26

Radiology

0.00

0.00

BR

BR

76496 TC

Radiology

0.00

0.00

BR

BR

76497 00

Radiology

0.00

0.00

BR

BR

76497 26

Radiology

0.00

0.00

BR

BR

76497 TC

Radiology

0.00

0.00

BR

BR

76498 00

Radiology

0.00

0.00

BR

BR

76498 26

Radiology

0.00

0.00

BR

BR

76498 TC

Radiology

0.00

0.00

BR

BR

76499 00

Radiology

0.00

0.00

BR

BR

76499 26

Radiology

0.00

0.00

BR

BR

76499 TC

Radiology

0.00

0.00

BR

BR

76506 00

Radiology

3.39

3.39

237.30

237.30

76506 26

Radiology

0.92

0.92

64.40

64.40

76506 TC

Radiology

2.47

2.47

172.90

172.90

76510 00

Radiology

2.06

2.06

144.20

144.20

76510 26

Radiology

1.15

1.15

80.50

80.50

76510 TC

Radiology

0.91

0.91

63.70

63.70

76511 00

Radiology

1.71

1.71

119.70

119.70

76511 26

Radiology

1.05

1.05

73.50

73.50

76511 TC

Radiology

0.66

0.66

46.20

46.20

76512 00

Radiology

1.44

1.44

100.80

100.80

76512 26

Radiology

0.90

0.90

63.00

63.00

76512 TC

Radiology

0.54

0.54

37.80

37.80

76513 00

Radiology

2.25

2.25

157.50

157.50

76513 26

Radiology

0.95

0.95

66.50

66.50

76513 TC

Radiology

1.30

1.30

91.00

91.00

76514 00

Radiology

0.34

0.34

23.80

23.80

76514 26

Radiology

0.23

0.23

16.10

16.10

76514 TC

Radiology

0.11

0.11

7.70

7.70

76516 00

Radiology

1.40

1.40

98.00

98.00

76516 26

Radiology

0.66

0.66

46.20

46.20

76516 TC

Radiology

0.74

0.74

51.80

51.80

76519 00

Radiology

2.04

2.04

142.80

142.80

76519 26

Radiology

0.89

0.89

62.30

62.30

76519 TC

Radiology

1.15

1.15

80.50

80.50

76529 00

Radiology

2.57

2.57

179.90

179.90

76529 26

Radiology

0.95

0.95

66.50

66.50

76529 TC

Radiology

1.62

1.62

113.40

113.40

76536 00

Radiology

3.31

3.31

231.70

231.70

76536 26

Radiology

0.79

0.79

55.30

55.30

76536 TC

Radiology

2.52

2.52

176.40

176.40

76604 00

Radiology

1.71

1.71

119.70

119.70

76604 26

Radiology

0.80

0.80

56.00

56.00

76604 TC

Radiology

0.91

0.91

63.70

63.70

76641 00

Radiology

3.08

3.08

215.60

215.60

76641 26

Radiology

1.03

1.03

72.10

72.10

76641 TC

Radiology

2.05

2.05

143.50

143.50

76642 00

Radiology

2.55

2.55

178.50

178.50

76642 26

Radiology

0.96

0.96

67.20

67.20

76642 TC

Radiology

1.59

1.59

111.30

111.30

76700 00

Radiology

3.49

3.49

244.30

244.30

76700 26

Radiology

1.13

1.13

79.10

79.10

76700 TC

Radiology

2.36

2.36

165.20

165.20

76705 00

Radiology

2.61

2.61

182.70

182.70

76705 26

Radiology

0.82

0.82

57.40

57.40

76705 TC

Radiology

1.79

1.79

125.30

125.30

76706 00

Radiology

3.20

3.20

224.00

224.00

76706 26

Radiology

0.77

0.77

53.90

53.90

76706 TC

Radiology

2.43

2.43

170.10

170.10

76770 00

Radiology

3.25

3.25

227.50

227.50

76770 26

Radiology

1.04

1.04

72.80

72.80

76770 TC

Radiology

2.21

2.21

154.70

154.70

76775 00

Radiology

1.79

1.79

125.30

125.30

76775 26

Radiology

0.81

0.81

56.70

56.70

76775 TC

Radiology

0.98

0.98

68.60

68.60

76776 00

Radiology

4.42

4.42

309.40

309.40

76776 26

Radiology

1.06

1.06

74.20

74.20

76776 TC

Radiology

3.36

3.36

235.20

235.20

76800 00

Radiology

5.19

5.19

363.30

363.30

76800 26

Radiology

1.84

1.84

128.80

128.80

76800 TC

Radiology

3.35

3.35

234.50

234.50

76801 00

Radiology

3.52

3.52

246.40

246.40

76801 26

Radiology

1.39

1.39

97.30

97.30

76801 TC

Radiology

2.13

2.13

149.10

149.10

76802 00

Radiology

1.80

1.80

126.00

126.00

76802 26

Radiology

1.17

1.17

81.90

81.90

76802 TC

Radiology

0.63

0.63

44.10

44.10

76805 00

Radiology

4.07

4.07

284.90

284.90

76805 26

Radiology

1.40

1.40

98.00

98.00

76805 TC

Radiology

2.67

2.67

186.90

186.90

76810 00

Radiology

2.62

2.62

183.40

183.40

76810 26

Radiology

1.38

1.38

96.60

96.60

76810 TC

Radiology

1.24

1.24

86.80

86.80

76811 00

Radiology

5.32

5.32

372.40

372.40

76811 26

Radiology

2.67

2.67

186.90

186.90

76811 TC

Radiology

2.65

2.65

185.50

185.50

76812 00

Radiology

5.75

5.75

402.50

402.50

76812 26

Radiology

2.51

2.51

175.70

175.70

76812 TC

Radiology

3.24

3.24

226.80

226.80

76813 00

Radiology

3.47

3.47

242.90

242.90

76813 26

Radiology

1.66

1.66

116.20

116.20

76813 TC

Radiology

1.81

1.81

126.70

126.70

76814 00

Radiology

2.23

2.23

156.10

156.10

76814 26

Radiology

1.39

1.39

97.30

97.30

76814 TC

Radiology

0.84

0.84

58.80

58.80

76815 00

Radiology

2.43

2.43

170.10

170.10

76815 26

Radiology

0.91

0.91

63.70

63.70

76815 TC

Radiology

1.52

1.52

106.40

106.40

76816 00

Radiology

3.30

3.30

231.00

231.00

76816 26

Radiology

1.20

1.20

84.00

84.00

76816 TC

Radiology

2.10

2.10

147.00

147.00

76817 00

Radiology

2.78

2.78

194.60

194.60

76817 26

Radiology

1.06

1.06

74.20

74.20

76817 TC

Radiology

1.72

1.72

120.40

120.40

76818 00

Radiology

3.56

3.56

249.20

249.20

76818 26

Radiology

1.48

1.48

103.60

103.60

76818 TC

Radiology

2.08

2.08

145.60

145.60

76819 00

Radiology

2.57

2.57

179.90

179.90

76819 26

Radiology

1.08

1.08

75.60

75.60

76819 TC

Radiology

1.49

1.49

104.30

104.30

76820 00

Radiology

1.34

1.34

93.80

93.80

76820 26

Radiology

0.70

0.70

49.00

49.00

76820 TC

Radiology

0.64

0.64

44.80

44.80

76821 00

Radiology

2.67

2.67

186.90

186.90

76821 26

Radiology

0.99

0.99

69.30

69.30

76821 TC

Radiology

1.68

1.68

117.60

117.60

76825 00

Radiology

7.85

7.85

549.50

549.50

76825 26

Radiology

2.34

2.34

163.80

163.80

76825 TC

Radiology

5.51

5.51

385.70

385.70

76826 00

Radiology

4.70

4.70

329.00

329.00

76826 26

Radiology

1.16

1.16

81.20

81.20

76826 TC

Radiology

3.54

3.54

247.80

247.80

76827 00

Radiology

2.10

2.10

147.00

147.00

76827 26

Radiology

0.82

0.82

57.40

57.40

76827 TC

Radiology

1.28

1.28

89.60

89.60

76828 00

Radiology

1.46

1.46

102.20

102.20

76828 26

Radiology

0.78

0.78

54.60

54.60

76828 TC

Radiology

0.68

0.68

47.60

47.60

76830 00

Radiology

3.58

3.58

250.60

250.60

76830 26

Radiology

0.97

0.97

67.90

67.90

76830 TC

Radiology

2.61

2.61

182.70

182.70

76831 00

Radiology

3.49

3.49

244.30

244.30

76831 26

Radiology

1.02

1.02

71.40

71.40

76831 TC

Radiology

2.47

2.47

172.90

172.90

76856 00

Radiology

3.16

3.16

221.20

221.20

76856 26

Radiology

0.96

0.96

67.20

67.20

76856 TC

Radiology

2.20

2.20

154.00

154.00

76857 00

Radiology

1.48

1.48

103.60

103.60

76857 26

Radiology

0.69

0.69

48.30

48.30

76857 TC

Radiology

0.79

0.79

55.30

55.30

76870 00

Radiology

3.00

3.00

210.00

210.00

76870 26

Radiology

0.89

0.89

62.30

62.30

76870 TC

Radiology

2.11

2.11

147.70

147.70

76872 00

Radiology

6.04

6.04

422.80

422.80

76872 26

Radiology

0.96

0.96

67.20

67.20

76872 TC

Radiology

5.08

5.08

355.60

355.60

76873 00

Radiology

5.27

5.27

368.90

368.90

76873 26

Radiology

2.26

2.26

158.20

158.20

76873 TC

Radiology

3.01

3.01

210.70

210.70

76881 00

Radiology

1.61

1.61

112.70

112.70

76881 26

Radiology

1.28

1.28

89.60

89.60

76881 TC

Radiology

0.33

0.33

23.10

23.10

76882 00

Radiology

1.90

1.90

133.00

133.00

76882 26

Radiology

0.97

0.97

67.90

67.90

76882 TC

Radiology

0.93

0.93

65.10

65.10

76883 00

Radiology

2.14

2.14

149.80

149.80

76883 26

Radiology

1.71

1.71

119.70

119.70

76883 TC

Radiology

0.43

0.43

30.10

30.10

76885 00

Radiology

4.07

4.07

284.90

284.90

76885 26

Radiology

1.04

1.04

72.80

72.80

76885 TC

Radiology

3.03

3.03

212.10

212.10

76886 00

Radiology

2.99

2.99

209.30

209.30

76886 26

Radiology

0.87

0.87

60.90

60.90

76886 TC

Radiology

2.12

2.12

148.40

148.40

76932 00

Radiology

-

-

200.20

200.20

76932 26

Radiology

1.06

1.06

74.20

74.20

76932 TC

Radiology

-

-

126.00

126.00

76936 00

Radiology

7.81

7.81

546.70

546.70

76936 26

Radiology

2.76

2.76

193.20

193.20

76936 TC

Radiology

5.05

5.05

353.50

353.50

76937 00

Radiology

1.15

1.15

80.50

80.50

76937 26

Radiology

0.41

0.41

28.70

28.70

76937 TC

Radiology

0.74

0.74

51.80

51.80

76940 00

Radiology

-

-

333.90

333.90

76940 26

Radiology

2.96

2.96

207.20

207.20

76940 TC

Radiology

-

-

126.70

126.70

76941 00

Radiology

-

-

245.00

245.00

76941 26

Radiology

1.89

1.89

132.30

132.30

76941 TC

Radiology

-

-

112.70

112.70

76942 00

Radiology

1.74

1.74

121.80

121.80

76942 26

Radiology

0.89

0.89

62.30

62.30

76942 TC

Radiology

0.85

0.85

59.50

59.50

76945 00

Radiology

-

-

182.70

182.70

76945 26

Radiology

0.94

0.94

65.80

65.80

76945 TC

Radiology

-

-

116.90

116.90

76946 00

Radiology

1.00

1.00

70.00

70.00

76946 26

Radiology

0.54

0.54

37.80

37.80

76946 TC

Radiology

0.46

0.46

32.20

32.20

76948 00

Radiology

2.42

2.42

169.40

169.40

76948 26

Radiology

0.94

0.94

65.80

65.80

76948 TC

Radiology

1.48

1.48

103.60

103.60

76965 00

Radiology

2.83

2.83

198.10

198.10

76965 26

Radiology

2.00

2.00

140.00

140.00

76965 TC

Radiology

0.83

0.83

58.10

58.10

76975 00

Radiology

-

-

205.10

205.10

76975 26

Radiology

1.20

1.20

84.00

84.00

76975 TC

Radiology

-

-

121.10

121.10

76977 00

Radiology

0.22

0.22

15.40

15.40

76977 26

Radiology

0.08

0.08

5.60

5.60

76977 TC

Radiology

0.14

0.14

9.80

9.80

76978 00

Radiology

6.65

6.65

465.50

465.50

76978 26

Radiology

2.28

2.28

159.60

159.60

76978 TC

Radiology

4.37

4.37

305.90

305.90

76979 00

Radiology

4.28

4.28

299.60

299.60

76979 26

Radiology

1.19

1.19

83.30

83.30

76979 TC

Radiology

3.09

3.09

216.30

216.30

76981 00

Radiology

3.13

3.13

219.10

219.10

76981 26

Radiology

0.84

0.84

58.80

58.80

76981 TC

Radiology

2.29

2.29

160.30

160.30

76982 00

Radiology

2.80

2.80

196.00

196.00

76982 26

Radiology

0.84

0.84

58.80

58.80

76982 TC

Radiology

1.96

1.96

137.20

137.20

76983 00

Radiology

1.85

1.85

129.50

129.50

76983 26

Radiology

0.74

0.74

51.80

51.80

76983 TC

Radiology

1.11

1.11

77.70

77.70

76984 00

Radiology

-

-

149.80

149.80

76984 26

Radiology

0.92

0.92

64.40

64.40

76984 TC

Radiology

-

-

85.40

85.40

76987 00

Radiology

-

-

457.10

457.10

76987 26

Radiology

2.81

2.81

196.70

196.70

76987 TC

Radiology

-

-

260.40

260.40

76988 00

Radiology

-

-

291.20

291.20

76988 26

Radiology

1.79

1.79

125.30

125.30

76988 TC

Radiology

-

-

165.90

165.90

76989 00

Radiology

-

-

170.80

170.80

76989 26

Radiology

1.05

1.05

73.50

73.50

76989 TC

Radiology

-

-

97.30

97.30

76998 00

Radiology

-

-

224.70

224.70

76998 26

Radiology

1.38

1.38

96.60

96.60

76998 TC

Radiology

-

-

128.10

128.10

76999 00

Radiology

0.00

0.00

BR

BR

76999 26

Radiology

0.00

0.00

BR

BR

76999 TC

Radiology

0.00

0.00

BR

BR

77001 00

Radiology

2.96

2.96

207.20

207.20

77001 26

Radiology

0.53

0.53

37.10

37.10

77001 TC

Radiology

2.43

2.43

170.10

170.10

77002 00

Radiology

3.48

3.48

243.60

243.60

77002 26

Radiology

0.79

0.79

55.30

55.30

77002 TC

Radiology

2.69

2.69

188.30

188.30

77003 00

Radiology

3.16

3.16

221.20

221.20

77003 26

Radiology

0.85

0.85

59.50

59.50

77003 TC

Radiology

2.31

2.31

161.70

161.70

77011 00

Radiology

6.64

6.64

464.80

464.80

77011 26

Radiology

1.82

1.82

127.40

127.40

77011 TC

Radiology

4.82

4.82

337.40

337.40

77012 00

Radiology

4.17

4.17

291.90

291.90

77012 26

Radiology

2.05

2.05

143.50

143.50

77012 TC

Radiology

2.12

2.12

148.40

148.40

77013 00

Radiology

-

-

1044.40

1044.40

77013 26

Radiology

5.37

5.37

375.90

375.90

77013 TC

Radiology

-

-

668.50

668.50

77014 00

Radiology

3.59

3.59

251.30

251.30

77014 26

Radiology

1.33

1.33

93.10

93.10

77014 TC

Radiology

2.26

2.26

158.20

158.20

77021 00

Radiology

12.77

12.77

893.90

893.90

77021 26

Radiology

2.09

2.09

146.30

146.30

77021 TC

Radiology

10.68

10.68

747.60

747.60

77022 00

Radiology

-

-

1323.00

1323.00

77022 26

Radiology

5.86

5.86

410.20

410.20

77022 TC

Radiology

-

-

912.80

912.80

77046 00

Radiology

6.57

6.57

459.90

459.90

77046 26

Radiology

2.03

2.03

142.10

142.10

77046 TC

Radiology

4.54

4.54

317.80

317.80

77047 00

Radiology

6.75

6.75

472.50

472.50

77047 26

Radiology

2.24

2.24

156.80

156.80

77047 TC

Radiology

4.51

4.51

315.70

315.70

77048 00

Radiology

10.36

10.36

725.20

725.20

77048 26

Radiology

2.95

2.95

206.50

206.50

77048 TC

Radiology

7.41

7.41

518.70

518.70

77049 00

Radiology

10.57

10.57

739.90

739.90

77049 26

Radiology

3.23

3.23

226.10

226.10

77049 TC

Radiology

7.34

7.34

513.80

513.80

77053 00

Radiology

1.62

1.62

113.40

113.40

77053 26

Radiology

0.51

0.51

35.70

35.70

77053 TC

Radiology

1.11

1.11

77.70

77.70

77054 00

Radiology

2.08

2.08

145.60

145.60

77054 26

Radiology

0.63

0.63

44.10

44.10

77054 TC

Radiology

1.45

1.45

101.50

101.50

77061 00

Radiology

-

-

132.30

132.30

77061 26

Radiology

0.00

0.00

BR

BR

77061 TC

Radiology

-

-

132.30

132.30

77062 00

Radiology

-

-

132.30

132.30

77062 26

Radiology

0.00

0.00

BR

BR

77062 TC

Radiology

-

-

132.30

132.30

77063 00

Radiology

1.56

1.56

109.20

109.20

77063 26

Radiology

0.84

0.84

58.80

58.80

77063 TC

Radiology

0.72

0.72

50.40

50.40

77065 00

Radiology

3.76

3.76

263.20

263.20

77065 26

Radiology

1.14

1.14

79.80

79.80

77065 TC

Radiology

2.62

2.62

183.40

183.40

77066 00

Radiology

4.76

4.76

333.20

333.20

77066 26

Radiology

1.40

1.40

98.00

98.00

77066 TC

Radiology

3.36

3.36

235.20

235.20

77067 00

Radiology

3.84

3.84

268.80

268.80

77067 26

Radiology

1.07

1.07

74.90

74.90

77067 TC

Radiology

2.77

2.77

193.90

193.90

77071 00

Radiology

1.65

1.65

115.50

115.50

77072 00

Radiology

0.78

0.78

54.60

54.60

77072 26

Radiology

0.27

0.27

18.90

18.90

77072 TC

Radiology

0.51

0.51

35.70

35.70

77073 00

Radiology

1.36

1.36

95.20

95.20

77073 26

Radiology

0.39

0.39

27.30

27.30

77073 TC

Radiology

0.97

0.97

67.90

67.90

77074 00

Radiology

1.96

1.96

137.20

137.20

77074 26

Radiology

0.62

0.62

43.40

43.40

77074 TC

Radiology

1.34

1.34

93.80

93.80

77075 00

Radiology

2.99

2.99

209.30

209.30

77075 26

Radiology

0.78

0.78

54.60

54.60

77075 TC

Radiology

2.21

2.21

154.70

154.70

77076 00

Radiology

3.22

3.22

225.40

225.40

77076 26

Radiology

0.99

0.99

69.30

69.30

77076 TC

Radiology

2.23

2.23

156.10

156.10

77077 00

Radiology

1.41

1.41

98.70

98.70

77077 26

Radiology

0.49

0.49

34.30

34.30

77077 TC

Radiology

0.92

0.92

64.40

64.40

77078 00

Radiology

3.10

3.10

217.00

217.00

77078 26

Radiology

0.35

0.35

24.50

24.50

77078 TC

Radiology

2.75

2.75

192.50

192.50

77080 00

Radiology

1.17

1.17

81.90

81.90

77080 26

Radiology

0.28

0.28

19.60

19.60

77080 TC

Radiology

0.89

0.89

62.30

62.30

77081 00

Radiology

0.95

0.95

66.50

66.50

77081 26

Radiology

0.28

0.28

19.60

19.60

77081 TC

Radiology

0.67

0.67

46.90

46.90

77084 00

Radiology

9.78

9.78

684.60

684.60

77084 26

Radiology

2.25

2.25

157.50

157.50

77084 TC

Radiology

7.53

7.53

527.10

527.10

77085 00

Radiology

1.60

1.60

112.00

112.00

77085 26

Radiology

0.42

0.42

29.40

29.40

77085 TC

Radiology

1.18

1.18

82.60

82.60

77086 00

Radiology

1.01

1.01

70.70

70.70

77086 26

Radiology

0.24

0.24

16.80

16.80

77086 TC

Radiology

0.77

0.77

53.90

53.90

77089 00

Radiology

1.21

1.21

84.70

84.70

77090 00

Radiology

0.08

0.08

5.60

5.60

77091 00

Radiology

0.84

0.84

58.80

58.80

77092 00

Radiology

0.29

0.29

20.30

20.30

77261 00

Radiology

2.11

2.11

147.70

147.70

77262 00

Radiology

3.23

3.23

226.10

226.10

77263 00

Radiology

5.01

5.01

350.70

350.70

77280 00

Radiology

8.08

8.08

565.60

565.60

77280 26

Radiology

1.12

1.12

78.40

78.40

77280 TC

Radiology

6.96

6.96

487.20

487.20

77285 00

Radiology

13.23

13.23

926.10

926.10

77285 26

Radiology

1.69

1.69

118.30

118.30

77285 TC

Radiology

11.54

11.54

807.80

807.80

77290 00

Radiology

13.43

13.43

940.10

940.10

77290 26

Radiology

2.45

2.45

171.50

171.50

77290 TC

Radiology

10.98

10.98

768.60

768.60

77293 00

Radiology

12.25

12.25

857.50

857.50

77293 26

Radiology

3.13

3.13

219.10

219.10

77293 TC

Radiology

9.12

9.12

638.40

638.40

77295 00

Radiology

14.42

14.42

1009.40

1009.40

77295 26

Radiology

6.70

6.70

469.00

469.00

77295 TC

Radiology

7.72

7.72

540.40

540.40

77299 00

Radiology

0.00

0.00

BR

BR

77299 26

Radiology

0.00

0.00

BR

BR

77299 TC

Radiology

0.00

0.00

BR

BR

77300 00

Radiology

1.98

1.98

138.60

138.60

77300 26

Radiology

0.97

0.97

67.90

67.90

77300 TC

Radiology

1.01

1.01

70.70

70.70

77301 00

Radiology

55.36

55.36

3875.20

3875.20

77301 26

Radiology

12.49

12.49

874.30

874.30

77301 TC

Radiology

42.87

42.87

3000.90

3000.90

77306 00

Radiology

4.45

4.45

311.50

311.50

77306 26

Radiology

2.19

2.19

153.30

153.30

77306 TC

Radiology

2.26

2.26

158.20

158.20

77307 00

Radiology

8.62

8.62

603.40

603.40

77307 26

Radiology

4.53

4.53

317.10

317.10

77307 TC

Radiology

4.09

4.09

286.30

286.30

77316 00

Radiology

7.39

7.39

517.30

517.30

77316 26

Radiology

2.19

2.19

153.30

153.30

77316 TC

Radiology

5.20

5.20

364.00

364.00

77317 00

Radiology

9.72

9.72

680.40

680.40

77317 26

Radiology

2.87

2.87

200.90

200.90

77317 TC

Radiology

6.85

6.85

479.50

479.50

77318 00

Radiology

13.78

13.78

964.60

964.60

77318 26

Radiology

4.52

4.52

316.40

316.40

77318 TC

Radiology

9.26

9.26

648.20

648.20

77321 00

Radiology

2.83

2.83

198.10

198.10

77321 26

Radiology

1.49

1.49

104.30

104.30

77321 TC

Radiology

1.34

1.34

93.80

93.80

77331 00

Radiology

1.95

1.95

136.50

136.50

77331 26

Radiology

1.37

1.37

95.90

95.90

77331 TC

Radiology

0.58

0.58

40.60

40.60

77332 00

Radiology

1.18

1.18

82.60

82.60

77332 26

Radiology

0.71

0.71

49.70

49.70

77332 TC

Radiology

0.47

0.47

32.90

32.90

77333 00

Radiology

4.11

4.11

287.70

287.70

77333 26

Radiology

1.17

1.17

81.90

81.90

77333 TC

Radiology

2.94

2.94

205.80

205.80

77334 00

Radiology

3.77

3.77

263.90

263.90

77334 26

Radiology

1.80

1.80

126.00

126.00

77334 TC

Radiology

1.97

1.97

137.90

137.90

77336 00

Radiology

2.67

2.67

186.90

186.90

77338 00

Radiology

14.06

14.06

984.20

984.20

77338 26

Radiology

6.71

6.71

469.70

469.70

77338 TC

Radiology

7.35

7.35

514.50

514.50

77370 00

Radiology

4.34

4.34

303.80

303.80

77371 00

Radiology

-

-

4751.60

4751.60

77372 00

Radiology

28.59

28.59

2001.30

2001.30

77373 00

Radiology

29.85

29.85

2089.50

2089.50

77385 00

Radiology

-

-

1461.60

1461.60

77386 00

Radiology

-

-

1461.60

1461.60

77387 00

Radiology

-

-

191.80

191.80

77399 00

Radiology

0.00

0.00

BR

BR

77399 26

Radiology

0.00

0.00

BR

BR

77399 TC

Radiology

0.00

0.00

BR

BR

77401 00

Radiology

1.25

1.25

87.50

87.50

77402 00

Radiology

-

-

211.40

211.40

77407 00

Radiology

0.00

0.00

BR

BR

77412 00

Radiology

-

-

370.30

370.30

77417 00

Radiology

0.45

0.45

31.50

31.50

77423 00

Radiology

0.00

0.00

BR

BR

77424 00

Radiology

0.00

0.00

BR

BR

77425 00

Radiology

0.00

0.00

BR

BR

77427 00

Radiology

5.70

5.70

399.00

399.00

77431 00

Radiology

3.22

3.22

225.40

225.40

77432 00

Radiology

12.67

12.67

886.90

886.90

77435 00

Radiology

19.16

19.16

1341.20

1341.20

77469 00

Radiology

9.53

9.53

667.10

667.10

77470 00

Radiology

4.26

4.26

298.20

298.20

77470 26

Radiology

3.18

3.18

222.60

222.60

77470 TC

Radiology

1.08

1.08

75.60

75.60

77499 00

Radiology

0.00

0.00

BR

BR

77499 26

Radiology

0.00

0.00

BR

BR

77499 TC

Radiology

0.00

0.00

BR

BR

77520 00

Radiology

-

-

2664.20

2664.20

77522 00

Radiology

-

-

2487.10

2487.10

77523 00

Radiology

-

-

2804.90

2804.90

77525 00

Radiology

-

-

3495.10

3495.10

77600 00

Radiology

16.35

16.35

1144.50

1144.50

77600 26

Radiology

2.12

2.12

148.40

148.40

77600 TC

Radiology

14.23

14.23

996.10

996.10

77605 00

Radiology

28.35

28.35

1984.50

1984.50

77605 26

Radiology

2.99

2.99

209.30

209.30

77605 TC

Radiology

25.36

25.36

1775.20

1775.20

77610 00

Radiology

20.54

20.54

1437.80

1437.80

77610 26

Radiology

2.06

2.06

144.20

144.20

77610 TC

Radiology

18.48

18.48

1293.60

1293.60

77615 00

Radiology

32.25

32.25

2257.50

2257.50

77615 26

Radiology

2.89

2.89

202.30

202.30

77615 TC

Radiology

29.36

29.36

2055.20

2055.20

77620 00

Radiology

19.12

19.12

1338.40

1338.40

77620 26

Radiology

2.47

2.47

172.90

172.90

77620 TC

Radiology

16.65

16.65

1165.50

1165.50

77750 00

Radiology

11.80

11.80

826.00

826.00

77750 26

Radiology

7.82

7.82

547.40

547.40

77750 TC

Radiology

3.98

3.98

278.60

278.60

77761 00

Radiology

12.65

12.65

885.50

885.50

77761 26

Radiology

6.02

6.02

421.40

421.40

77761 TC

Radiology

6.63

6.63

464.10

464.10

77762 00

Radiology

16.62

16.62

1163.40

1163.40

77762 26

Radiology

9.01

9.01

630.70

630.70

77762 TC

Radiology

7.61

7.61

532.70

532.70

77763 00

Radiology

23.48

23.48

1643.60

1643.60

77763 26

Radiology

13.54

13.54

947.80

947.80

77763 TC

Radiology

9.94

9.94

695.80

695.80

77767 00

Radiology

7.50

7.50

525.00

525.00

77767 26

Radiology

1.64

1.64

114.80

114.80

77767 TC

Radiology

5.86

5.86

410.20

410.20

77768 00

Radiology

10.99

10.99

769.30

769.30

77768 26

Radiology

2.19

2.19

153.30

153.30

77768 TC

Radiology

8.80

8.80

616.00

616.00

77770 00

Radiology

10.45

10.45

731.50

731.50

77770 26

Radiology

3.05

3.05

213.50

213.50

77770 TC

Radiology

7.40

7.40

518.00

518.00

77771 00

Radiology

18.17

18.17

1271.90

1271.90

77771 26

Radiology

5.94

5.94

415.80

415.80

77771 TC

Radiology

12.23

12.23

856.10

856.10

77772 00

Radiology

27.14

27.14

1899.80

1899.80

77772 26

Radiology

8.39

8.39

587.30

587.30

77772 TC

Radiology

18.75

18.75

1312.50

1312.50

77778 00

Radiology

27.63

27.63

1934.10

1934.10

77778 26

Radiology

13.70

13.70

959.00

959.00

77778 TC

Radiology

13.93

13.93

975.10

975.10

77789 00

Radiology

4.00

4.00

280.00

280.00

77789 26

Radiology

1.79

1.79

125.30

125.30

77789 TC

Radiology

2.21

2.21

154.70

154.70

77790 00

Radiology

0.54

0.54

37.80

37.80

77799 00

Radiology

0.00

0.00

BR

BR

77799 26

Radiology

0.00

0.00

BR

BR

77799 TC

Radiology

0.00

0.00

BR

BR

78012 00

Radiology

2.43

2.43

170.10

170.10

78012 26

Radiology

0.26

0.26

18.20

18.20

78012 TC

Radiology

2.17

2.17

151.90

151.90

78013 00

Radiology

5.14

5.14

359.80

359.80

78013 26

Radiology

0.51

0.51

35.70

35.70

78013 TC

Radiology

4.63

4.63

324.10

324.10

78014 00

Radiology

6.53

6.53

457.10

457.10

78014 26

Radiology

0.68

0.68

47.60

47.60

78014 TC

Radiology

5.85

5.85

409.50

409.50

78015 00

Radiology

6.36

6.36

445.20

445.20

78015 26

Radiology

0.94

0.94

65.80

65.80

78015 TC

Radiology

5.42

5.42

379.40

379.40

78016 00

Radiology

7.58

7.58

530.60

530.60

78016 26

Radiology

0.96

0.96

67.20

67.20

78016 TC

Radiology

6.62

6.62

463.40

463.40

78018 00

Radiology

8.52

8.52

596.40

596.40

78018 26

Radiology

1.14

1.14

79.80

79.80

78018 TC

Radiology

7.38

7.38

516.60

516.60

78020 00

Radiology

2.34

2.34

163.80

163.80

78020 26

Radiology

0.77

0.77

53.90

53.90

78020 TC

Radiology

1.57

1.57

109.90

109.90

78070 00

Radiology

8.08

8.08

565.60

565.60

78070 26

Radiology

1.11

1.11

77.70

77.70

78070 TC

Radiology

6.97

6.97

487.90

487.90

78071 00

Radiology

9.61

9.61

672.70

672.70

78071 26

Radiology

1.65

1.65

115.50

115.50

78071 TC

Radiology

7.96

7.96

557.20

557.20

78072 00

Radiology

11.92

11.92

834.40

834.40

78072 26

Radiology

2.16

2.16

151.20

151.20

78072 TC

Radiology

9.76

9.76

683.20

683.20

78075 00

Radiology

12.17

12.17

851.90

851.90

78075 26

Radiology

1.04

1.04

72.80

72.80

78075 TC

Radiology

11.13

11.13

779.10

779.10

78099 00

Radiology

0.00

0.00

BR

BR

78099 26

Radiology

0.00

0.00

BR

BR

78099 TC

Radiology

0.00

0.00

BR

BR

78102 00

Radiology

4.81

4.81

336.70

336.70

78102 26

Radiology

0.73

0.73

51.10

51.10

78102 TC

Radiology

4.08

4.08

285.60

285.60

78103 00

Radiology

5.13

5.13

359.10

359.10

78103 26

Radiology

0.88

0.88

61.60

61.60

78103 TC

Radiology

4.25

4.25

297.50

297.50

78104 00

Radiology

6.89

6.89

482.30

482.30

78104 26

Radiology

1.08

1.08

75.60

75.60

78104 TC

Radiology

5.81

5.81

406.70

406.70

78110 00

Radiology

2.07

2.07

144.90

144.90

78110 26

Radiology

0.23

0.23

16.10

16.10

78110 TC

Radiology

1.84

1.84

128.80

128.80

78111 00

Radiology

2.19

2.19

153.30

153.30

78111 26

Radiology

0.26

0.26

18.20

18.20

78111 TC

Radiology

1.93

1.93

135.10

135.10

78120 00

Radiology

2.12

2.12

148.40

148.40

78120 26

Radiology

0.28

0.28

19.60

19.60

78120 TC

Radiology

1.84

1.84

128.80

128.80

78121 00

Radiology

2.31

2.31

161.70

161.70

78121 26

Radiology

0.38

0.38

26.60

26.60

78121 TC

Radiology

1.93

1.93

135.10

135.10

78122 00

Radiology

2.94

2.94

205.80

205.80

78122 26

Radiology

0.60

0.60

42.00

42.00

78122 TC

Radiology

2.34

2.34

163.80

163.80

78130 00

Radiology

3.72

3.72

260.40

260.40

78130 26

Radiology

0.72

0.72

50.40

50.40

78130 TC

Radiology

3.00

3.00

210.00

210.00

78140 00

Radiology

3.28

3.28

229.60

229.60

78140 26

Radiology

0.72

0.72

50.40

50.40

78140 TC

Radiology

2.56

2.56

179.20

179.20

78185 00

Radiology

4.64

4.64

324.80

324.80

78185 26

Radiology

0.47

0.47

32.90

32.90

78185 TC

Radiology

4.17

4.17

291.90

291.90

78191 00

Radiology

3.72

3.72

260.40

260.40

78191 26

Radiology

0.72

0.72

50.40

50.40

78191 TC

Radiology

3.00

3.00

210.00

210.00

78195 00

Radiology

9.71

9.71

679.70

679.70

78195 26

Radiology

1.64

1.64

114.80

114.80

78195 TC

Radiology

8.07

8.07

564.90

564.90

78199 00

Radiology

0.00

0.00

BR

BR

78199 26

Radiology

0.00

0.00

BR

BR

78199 TC

Radiology

0.00

0.00

BR

BR

78201 00

Radiology

5.30

5.30

371.00

371.00

78201 26

Radiology

0.59

0.59

41.30

41.30

78201 TC

Radiology

4.71

4.71

329.70

329.70

78202 00

Radiology

5.83

5.83

408.10

408.10

78202 26

Radiology

0.69

0.69

48.30

48.30

78202 TC

Radiology

5.14

5.14

359.80

359.80

78215 00

Radiology

5.46

5.46

382.20

382.20

78215 26

Radiology

0.67

0.67

46.90

46.90

78215 TC

Radiology

4.79

4.79

335.30

335.30

78216 00

Radiology

3.83

3.83

268.10

268.10

78216 26

Radiology

0.76

0.76

53.20

53.20

78216 TC

Radiology

3.07

3.07

214.90

214.90

78226 00

Radiology

8.90

8.90

623.00

623.00

78226 26

Radiology

1.03

1.03

72.10

72.10

78226 TC

Radiology

7.87

7.87

550.90

550.90

78227 00

Radiology

11.94

11.94

835.80

835.80

78227 26

Radiology

1.24

1.24

86.80

86.80

78227 TC

Radiology

10.70

10.70

749.00

749.00

78230 00

Radiology

4.91

4.91

343.70

343.70

78230 26

Radiology

0.63

0.63

44.10

44.10

78230 TC

Radiology

4.28

4.28

299.60

299.60

78231 00

Radiology

3.11

3.11

217.70

217.70

78231 26

Radiology

0.61

0.61

42.70

42.70

78231 TC

Radiology

2.50

2.50

175.00

175.00

78232 00

Radiology

3.05

3.05

213.50

213.50

78232 26

Radiology

0.55

0.55

38.50

38.50

78232 TC

Radiology

2.50

2.50

175.00

175.00

78258 00

Radiology

5.93

5.93

415.10

415.10

78258 26

Radiology

0.98

0.98

68.60

68.60

78258 TC

Radiology

4.95

4.95

346.50

346.50

78261 00

Radiology

5.55

5.55

388.50

388.50

78261 26

Radiology

0.81

0.81

56.70

56.70

78261 TC

Radiology

4.74

4.74

331.80

331.80

78262 00

Radiology

6.79

6.79

475.30

475.30

78262 26

Radiology

0.95

0.95

66.50

66.50

78262 TC

Radiology

5.84

5.84

408.80

408.80

78264 00

Radiology

9.06

9.06

634.20

634.20

78264 26

Radiology

1.09

1.09

76.30

76.30

78264 TC

Radiology

7.97

7.97

557.90

557.90

78265 00

Radiology

10.77

10.77

753.90

753.90

78265 26

Radiology

1.34

1.34

93.80

93.80

78265 TC

Radiology

9.43

9.43

660.10

660.10

78266 00

Radiology

12.25

12.25

857.50

857.50

78266 26

Radiology

1.44

1.44

100.80

100.80

78266 TC

Radiology

10.81

10.81

756.70

756.70

78267 00

Radiology

0.34

0.34

23.64

23.64

78268 00

Radiology

2.88

2.88

201.83

201.83

78278 00

Radiology

9.56

9.56

669.20

669.20

78278 26

Radiology

1.37

1.37

95.90

95.90

78278 TC

Radiology

8.19

8.19

573.30

573.30

78282 00

Radiology

-

-

185.50

185.50

78282 26

Radiology

0.45

0.45

31.50

31.50

78282 TC

Radiology

-

-

154.00

154.00

78290 00

Radiology

9.01

9.01

630.70

630.70

78290 26

Radiology

0.93

0.93

65.10

65.10

78290 TC

Radiology

8.08

8.08

565.60

565.60

78291 00

Radiology

7.27

7.27

508.90

508.90

78291 26

Radiology

1.24

1.24

86.80

86.80

78291 TC

Radiology

6.03

6.03

422.10

422.10

78299 00

Radiology

0.00

0.00

BR

BR

78299 26

Radiology

0.00

0.00

BR

BR

78299 TC

Radiology

0.00

0.00

BR

BR

78300 00

Radiology

6.20

6.20

434.00

434.00

78300 26

Radiology

0.86

0.86

60.20

60.20

78300 TC

Radiology

5.34

5.34

373.80

373.80

78305 00

Radiology

7.48

7.48

523.60

523.60

78305 26

Radiology

1.14

1.14

79.80

79.80

78305 TC

Radiology

6.34

6.34

443.80

443.80

78306 00

Radiology

8.08

8.08

565.60

565.60

78306 26

Radiology

1.18

1.18

82.60

82.60

78306 TC

Radiology

6.90

6.90

483.00

483.00

78315 00

Radiology

9.50

9.50

665.00

665.00

78315 26

Radiology

1.41

1.41

98.70

98.70

78315 TC

Radiology

8.09

8.09

566.30

566.30

78350 00

Radiology

0.96

0.96

67.20

67.20

78350 26

Radiology

0.32

0.32

22.40

22.40

78350 TC

Radiology

0.64

0.64

44.80

44.80

78351 00

Radiology

0.44

0.44

30.80

30.80

78399 00

Radiology

0.00

0.00

BR

BR

78399 26

Radiology

0.00

0.00

BR

BR

78399 TC

Radiology

0.00

0.00

BR

BR

78414 00

Radiology

-

-

289.10

289.10

78414 26

Radiology

0.62

0.62

43.40

43.40

78414 TC

Radiology

-

-

245.70

245.70

78428 00

Radiology

5.21

5.21

364.70

364.70

78428 26

Radiology

1.06

1.06

74.20

74.20

78428 TC

Radiology

4.15

4.15

290.50

290.50

78429 00

Radiology

-

-

2011.10

2011.10

78429 26

Radiology

2.32

2.32

162.40

162.40

78429 TC

Radiology

-

-

1848.70

1848.70

78430 00

Radiology

0.00

0.00

BR

BR

78430 26

Radiology

2.21

2.21

154.70

154.70

78430 TC

Radiology

0.00

0.00

BR

BR

78431 00

Radiology

-

-

2646.00

2646.00

78431 26

Radiology

2.58

2.58

180.60

180.60

78431 TC

Radiology

-

-

2465.40

2465.40

78432 00

Radiology

0.00

0.00

BR

BR

78432 26

Radiology

2.76

2.76

193.20

193.20

78432 TC

Radiology

0.00

0.00

BR

BR

78433 00

Radiology

-

-

3175.20

3175.20

78433 26

Radiology

3.02

3.02

211.40

211.40

78433 TC

Radiology

-

-

2963.80

2963.80

78434 00

Radiology

-

-

224.70

224.70

78434 26

Radiology

0.85

0.85

59.50

59.50

78434 TC

Radiology

-

-

165.20

165.20

78445 00

Radiology

5.66

5.66

396.20

396.20

78445 26

Radiology

0.72

0.72

50.40

50.40

78445 TC

Radiology

4.94

4.94

345.80

345.80

78451 00

Radiology

9.39

9.39

657.30

657.30

78451 26

Radiology

1.89

1.89

132.30

132.30

78451 TC

Radiology

7.50

7.50

525.00

525.00

78452 00

Radiology

13.00

13.00

910.00

910.00

78452 26

Radiology

2.23

2.23

156.10

156.10

78452 TC

Radiology

10.77

10.77

753.90

753.90

78453 00

Radiology

8.00

8.00

560.00

560.00

78453 26

Radiology

1.34

1.34

93.80

93.80

78453 TC

Radiology

6.66

6.66

466.20

466.20

78454 00

Radiology

11.95

11.95

836.50

836.50

78454 26

Radiology

1.87

1.87

130.90

130.90

78454 TC

Radiology

10.08

10.08

705.60

705.60

78456 00

Radiology

8.65

8.65

605.50

605.50

78456 26

Radiology

1.37

1.37

95.90

95.90

78456 TC

Radiology

7.28

7.28

509.60

509.60

78457 00

Radiology

4.64

4.64

324.80

324.80

78457 26

Radiology

1.06

1.06

74.20

74.20

78457 TC

Radiology

3.58

3.58

250.60

250.60

78458 00

Radiology

5.78

5.78

404.60

404.60

78458 26

Radiology

1.27

1.27

88.90

88.90

78458 TC

Radiology

4.51

4.51

315.70

315.70

78459 00

Radiology

-

-

3762.50

3762.50

78459 26

Radiology

2.15

2.15

150.50

150.50

78459 TC

Radiology

-

-

3612.00

3612.00

78466 00

Radiology

5.00

5.00

350.00

350.00

78466 26

Radiology

0.94

0.94

65.80

65.80

78466 TC

Radiology

4.06

4.06

284.20

284.20

78468 00

Radiology

5.50

5.50

385.00

385.00

78468 26

Radiology

1.10

1.10

77.00

77.00

78468 TC

Radiology

4.40

4.40

308.00

308.00

78469 00

Radiology

6.16

6.16

431.20

431.20

78469 26

Radiology

1.26

1.26

88.20

88.20

78469 TC

Radiology

4.90

4.90

343.00

343.00

78472 00

Radiology

6.31

6.31

441.70

441.70

78472 26

Radiology

1.35

1.35

94.50

94.50

78472 TC

Radiology

4.96

4.96

347.20

347.20

78473 00

Radiology

8.04

8.04

562.80

562.80

78473 26

Radiology

2.01

2.01

140.70

140.70

78473 TC

Radiology

6.03

6.03

422.10

422.10

78481 00

Radiology

4.96

4.96

347.20

347.20

78481 26

Radiology

1.35

1.35

94.50

94.50

78481 TC

Radiology

3.61

3.61

252.70

252.70

78483 00

Radiology

6.66

6.66

466.20

466.20

78483 26

Radiology

2.02

2.02

141.40

141.40

78483 TC

Radiology

4.64

4.64

324.80

324.80

78491 00

Radiology

-

-

1640.80

1640.80

78491 26

Radiology

2.11

2.11

147.70

147.70

78491 TC

Radiology

-

-

1493.10

1493.10

78492 00

Radiology

-

-

2893.80

2893.80

78492 26

Radiology

2.48

2.48

173.60

173.60

78492 TC

Radiology

-

-

2720.20

2720.20

78494 00

Radiology

6.36

6.36

445.20

445.20

78494 26

Radiology

1.63

1.63

114.10

114.10

78494 TC

Radiology

4.73

4.73

331.10

331.10

78496 00

Radiology

1.26

1.26

88.20

88.20

78496 26

Radiology

0.69

0.69

48.30

48.30

78496 TC

Radiology

0.57

0.57

39.90

39.90

78499 00

Radiology

0.00

0.00

BR

BR

78499 26

Radiology

0.00

0.00

BR

BR

78499 TC

Radiology

0.00

0.00

BR

BR

78579 00

Radiology

5.17

5.17

361.90

361.90

78579 26

Radiology

0.67

0.67

46.90

46.90

78579 TC

Radiology

4.50

4.50

315.00

315.00

78580 00

Radiology

6.50

6.50

455.00

455.00

78580 26

Radiology

1.02

1.02

71.40

71.40

78580 TC

Radiology

5.48

5.48

383.60

383.60

78582 00

Radiology

9.10

9.10

637.00

637.00

78582 26

Radiology

1.47

1.47

102.90

102.90

78582 TC

Radiology

7.63

7.63

534.10

534.10

78597 00

Radiology

5.51

5.51

385.70

385.70

78597 26

Radiology

0.99

0.99

69.30

69.30

78597 TC

Radiology

4.52

4.52

316.40

316.40

78598 00

Radiology

8.26

8.26

578.20

578.20

78598 26

Radiology

1.14

1.14

79.80

79.80

78598 TC

Radiology

7.12

7.12

498.40

498.40

78599 00

Radiology

0.00

0.00

BR

BR

78599 26

Radiology

0.00

0.00

BR

BR

78599 TC

Radiology

0.00

0.00

BR

BR

78600 00

Radiology

5.05

5.05

353.50

353.50

78600 26

Radiology

0.61

0.61

42.70

42.70

78600 TC

Radiology

4.44

4.44

310.80

310.80

78601 00

Radiology

6.01

6.01

420.70

420.70

78601 26

Radiology

0.70

0.70

49.00

49.00

78601 TC

Radiology

5.31

5.31

371.70

371.70

78605 00

Radiology

5.58

5.58

390.60

390.60

78605 26

Radiology

0.75

0.75

52.50

52.50

78605 TC

Radiology

4.83

4.83

338.10

338.10

78606 00

Radiology

9.04

9.04

632.80

632.80

78606 26

Radiology

0.88

0.88

61.60

61.60

78606 TC

Radiology

8.16

8.16

571.20

571.20

78608 00

Radiology

-

-

3552.50

3552.50

78608 26

Radiology

2.03

2.03

142.10

142.10

78608 TC

Radiology

-

-

3410.40

3410.40

78609 00

Radiology

2.11

2.11

147.70

147.70

78609 26

Radiology

2.11

2.11

147.70

147.70

78609 TC

Radiology

0.00

0.00

BR

BR

78610 00

Radiology

4.86

4.86

340.20

340.20

78610 26

Radiology

0.41

0.41

28.70

28.70

78610 TC

Radiology

4.45

4.45

311.50

311.50

78630 00

Radiology

9.23

9.23

646.10

646.10

78630 26

Radiology

0.93

0.93

65.10

65.10

78630 TC

Radiology

8.30

8.30

581.00

581.00

78635 00

Radiology

9.26

9.26

648.20

648.20

78635 26

Radiology

0.86

0.86

60.20

60.20

78635 TC

Radiology

8.40

8.40

588.00

588.00

78645 00

Radiology

8.86

8.86

620.20

620.20

78645 26

Radiology

0.78

0.78

54.60

54.60

78645 TC

Radiology

8.08

8.08

565.60

565.60

78650 00

Radiology

7.43

7.43

520.10

520.10

78650 26

Radiology

0.72

0.72

50.40

50.40

78650 TC

Radiology

6.71

6.71

469.70

469.70

78660 00

Radiology

3.98

3.98

278.60

278.60

78660 26

Radiology

0.62

0.62

43.40

43.40

78660 TC

Radiology

3.36

3.36

235.20

235.20

78699 00

Radiology

0.00

0.00

BR

BR

78699 26

Radiology

0.00

0.00

BR

BR

78699 TC

Radiology

0.00

0.00

BR

BR

78700 00

Radiology

4.75

4.75

332.50

332.50

78700 26

Radiology

0.61

0.61

42.70

42.70

78700 TC

Radiology

4.14

4.14

289.80

289.80

78701 00

Radiology

6.24

6.24

436.80

436.80

78701 26

Radiology

0.68

0.68

47.60

47.60

78701 TC

Radiology

5.56

5.56

389.20

389.20

78707 00

Radiology

6.45

6.45

451.50

451.50

78707 26

Radiology

1.30

1.30

91.00

91.00

78707 TC

Radiology

5.15

5.15

360.50

360.50

78708 00

Radiology

5.25

5.25

367.50

367.50

78708 26

Radiology

1.65

1.65

115.50

115.50

78708 TC

Radiology

3.60

3.60

252.00

252.00

78709 00

Radiology

10.13

10.13

709.10

709.10

78709 26

Radiology

1.92

1.92

134.40

134.40

78709 TC

Radiology

8.21

8.21

574.70

574.70

78725 00

Radiology

2.90

2.90

203.00

203.00

78725 26

Radiology

0.50

0.50

35.00

35.00

78725 TC

Radiology

2.40

2.40

168.00

168.00

78730 00

Radiology

2.05

2.05

143.50

143.50

78730 26

Radiology

0.22

0.22

15.40

15.40

78730 TC

Radiology

1.83

1.83

128.10

128.10

78740 00

Radiology

6.31

6.31

441.70

441.70

78740 26

Radiology

0.78

0.78

54.60

54.60

78740 TC

Radiology

5.53

5.53

387.10

387.10

78761 00

Radiology

5.91

5.91

413.70

413.70

78761 26

Radiology

1.00

1.00

70.00

70.00

78761 TC

Radiology

4.91

4.91

343.70

343.70

78799 00

Radiology

0.00

0.00

BR

BR

78799 26

Radiology

0.00

0.00

BR

BR

78799 TC

Radiology

0.00

0.00

BR

BR

78800 00

Radiology

6.97

6.97

487.90

487.90

78800 26

Radiology

0.91

0.91

63.70

63.70

78800 TC

Radiology

6.06

6.06

424.20

424.20

78801 00

Radiology

7.47

7.47

522.90

522.90

78801 26

Radiology

1.00

1.00

70.00

70.00

78801 TC

Radiology

6.47

6.47

452.90

452.90

78802 00

Radiology

8.44

8.44

590.80

590.80

78802 26

Radiology

1.09

1.09

76.30

76.30

78802 TC

Radiology

7.35

7.35

514.50

514.50

78803 00

Radiology

10.42

10.42

729.40

729.40

78803 26

Radiology

1.48

1.48

103.60

103.60

78803 TC

Radiology

8.94

8.94

625.80

625.80

78804 00

Radiology

17.58

17.58

1230.60

1230.60

78804 26

Radiology

1.38

1.38

96.60

96.60

78804 TC

Radiology

16.20

16.20

1134.00

1134.00

78808 00

Radiology

1.19

1.19

83.30

83.30

78811 00

Radiology

-

-

3657.50

3657.50

78811 26

Radiology

2.09

2.09

146.30

146.30

78811 TC

Radiology

-

-

3511.20

3511.20

78812 00

Radiology

-

-

4620.00

4620.00

78812 26

Radiology

2.64

2.64

184.80

184.80

78812 TC

Radiology

-

-

4435.20

4435.20

78813 00

Radiology

-

-

4725.00

4725.00

78813 26

Radiology

2.70

2.70

189.00

189.00

78813 TC

Radiology

-

-

4536.00

4536.00

78814 00

Radiology

-

-

5232.50

5232.50

78814 26

Radiology

2.99

2.99

209.30

209.30

78814 TC

Radiology

-

-

5023.20

5023.20

78815 00

Radiology

-

-

5827.50

5827.50

78815 26

Radiology

3.33

3.33

233.10

233.10

78815 TC

Radiology

-

-

5594.40

5594.40

78816 00

Radiology

-

-

5880.00

5880.00

78816 26

Radiology

3.36

3.36

235.20

235.20

78816 TC

Radiology

-

-

5644.80

5644.80

78830 00

Radiology

13.05

13.05

913.50

913.50

78830 26

Radiology

1.98

1.98

138.60

138.60

78830 TC

Radiology

11.07

11.07

774.90

774.90

78831 00

Radiology

19.52

19.52

1366.40

1366.40

78831 26

Radiology

2.50

2.50

175.00

175.00

78831 TC

Radiology

17.02

17.02

1191.40

1191.40

78832 00

Radiology

24.66

24.66

1726.20

1726.20

78832 26

Radiology

2.84

2.84

198.80

198.80

78832 TC

Radiology

21.82

21.82

1527.40

1527.40

78835 00

Radiology

2.67

2.67

186.90

186.90

78835 26

Radiology

0.62

0.62

43.40

43.40

78835 TC

Radiology

2.05

2.05

143.50

143.50

78999 00

Radiology

0.00

0.00

BR

BR

78999 26

Radiology

0.00

0.00

BR

BR

78999 TC

Radiology

0.00

0.00

BR

BR

79005 00

Radiology

4.01

4.01

280.70

280.70

79005 26

Radiology

2.47

2.47

172.90

172.90

79005 TC

Radiology

1.54

1.54

107.80

107.80

79101 00

Radiology

4.36

4.36

305.20

305.20

79101 26

Radiology

2.75

2.75

192.50

192.50

79101 TC

Radiology

1.61

1.61

112.70

112.70

79200 00

Radiology

3.90

3.90

273.00

273.00

79200 26

Radiology

2.32

2.32

162.40

162.40

79200 TC

Radiology

1.58

1.58

110.60

110.60

79300 00

Radiology

-

-

467.60

467.60

79300 26

Radiology

1.87

1.87

130.90

130.90

79300 TC

Radiology

-

-

336.70

336.70

79403 00

Radiology

6.27

6.27

438.90

438.90

79403 26

Radiology

3.24

3.24

226.80

226.80

79403 TC

Radiology

3.03

3.03

212.10

212.10

79440 00

Radiology

3.51

3.51

245.70

245.70

79440 26

Radiology

2.32

2.32

162.40

162.40

79440 TC

Radiology

1.19

1.19

83.30

83.30

79445 00

Radiology

-

-

408.80

408.80

79445 26

Radiology

3.21

3.21

224.70

224.70

79445 TC

Radiology

-

-

184.10

184.10

79999 00

Radiology

0.00

0.00

BR

BR

79999 26

Radiology

0.00

0.00

BR

BR

79999 TC

Radiology

0.00

0.00

BR

BR

PATHOLOGY AND LABORATORY GUIDELINES

Information regarding publications incorporated by reference is found in the Introduction Section of the Fee Schedule.

The following Commission guidelines are in addition to the CPT® guidelines and represent additional guidance from the Commission relative to unit values for these services. To the extent that a conflict may exist between an incorporated portion of the CPT® publication or HCPCS code and a code, guideline, identifier, or modifier unique to Arizona, then the Arizona code, guideline, identifier, or modifier shall control. Codes that are unique to Arizona are preceded by an AZ identifier and numbered in the following format: AZxxx.

A healthcare provider seeking reimbursement for presumptive, or "point of care" drug testing shall submit to the payer written documentation establishing:

1. That the testing is medically necessary and reasonably required;

2. The type of drug testing utilized; and

3. The healthcare provider's interpretation of the "point of care" testing.

For purposes of this section, presumptive or "point of care" testing is testing that is performed at or near the site of patient care (i.e., the healthcare provider's office).

CPT® codes 80305-80307 are used for reporting presumptive drug class screening. Each code represents all drugs and drug classes performed by the respective methodology per date of service.

Healthcare providers performing validity testing on urine specimens utilized for drug testing shall not separately bill the validity testing. For example, if a laboratory performs a urinary pH, specific gravity, creatinine, nitrates, oxidants, or other tests to confirm that a urine specimen is not adulterated, this testing is not separately billed.

Definitive drug testing may be reported with HCPCS codes G0480 - G0483. These codes differ based on the number of drug classes including metabolites tested. Only one code from this group of codes may be reported per date of service. Requests for quantitative or definitive testing require documentation that qualifies necessity.

G0480 - Definitive drug testing 1 - 7 drug class(es) including metabolites(s) if performed

G0481 - Definitive drug testing 8 - 14 drug class(es) including metabolite(s) if performed

G0482 - Definitive drug testing 15 - 21 drug class(es) including metabolites(s) if performed

G0483 - Definitive drug testing of 22 or more drug class(es), including metabolite(s) if performed.

ARIZONA PHYSICIANS' FEE SCHEDULE

Pathology Codes 2024

Pathology Conversion Factor $68.00

Code

Category

FY24 NF RVU

FY24 FAC RVU

FY24 NF RBRVS Rate

FY24 FAC RBRVS Rate

80047 00

Pathology

0.42

0.42

28.51

28.51

80048 00

Pathology

0.26

0.26

17.57

17.57

80050 00

Pathology

-

-

320.96

320.96

80051 00

Pathology

0.21

0.21

14.56

14.56

80053 00

Pathology

0.32

0.32

21.93

21.93

80055 00

Pathology

1.46

1.46

99.29

99.29

80061 00

Pathology

0.41

0.41

27.81

27.81

80069 00

Pathology

0.27

0.27

18.03

18.03

80074 00

Pathology

1.45

1.45

98.91

98.91

80076 00

Pathology

0.25

0.25

16.97

16.97

80081 00

Pathology

2.29

2.29

155.46

155.46

80143 00

Pathology

0.57

0.57

38.71

38.71

80145 00

Pathology

1.18

1.18

80.10

80.10

80150 00

Pathology

0.46

0.46

31.32

31.32

80151 00

Pathology

0.57

0.57

38.71

38.71

80155 00

Pathology

1.18

1.18

80.10

80.10

80156 00

Pathology

0.44

0.44

30.26

30.26

80157 00

Pathology

0.40

0.40

27.52

27.52

80158 00

Pathology

0.55

0.55

37.48

37.48

80159 00

Pathology

0.62

0.62

41.85

41.85

80161 00

Pathology

0.57

0.57

38.71

38.71

80162 00

Pathology

0.41

0.41

27.58

27.58

80163 00

Pathology

0.41

0.41

27.58

27.58

80164 00

Pathology

0.41

0.41

28.12

28.12

80165 00

Pathology

0.41

0.41

28.12

28.12

80167 00

Pathology

0.57

0.57

38.71

38.71

80168 00

Pathology

0.50

0.50

33.93

33.93

80169 00

Pathology

0.42

0.42

28.51

28.51

80170 00

Pathology

0.50

0.50

34.02

34.02

80171 00

Pathology

0.66

0.66

45.00

45.00

80173 00

Pathology

0.48

0.48

32.77

32.77

80175 00

Pathology

0.40

0.40

27.52

27.52

80176 00

Pathology

0.45

0.45

30.51

30.51

80177 00

Pathology

0.40

0.40

27.52

27.52

80178 00

Pathology

0.20

0.20

13.73

13.73

80179 00

Pathology

0.57

0.57

38.71

38.71

80180 00

Pathology

0.55

0.55

37.48

37.48

80181 00

Pathology

0.57

0.57

38.71

38.71

80183 00

Pathology

0.40

0.40

27.52

27.52

80184 00

Pathology

0.47

0.47

31.77

31.77

80185 00

Pathology

0.40

0.40

27.52

27.52

80186 00

Pathology

0.42

0.42

28.58

28.58

80187 00

Pathology

0.83

0.83

56.30

56.30

80188 00

Pathology

0.51

0.51

34.45

34.45

80189 00

Pathology

0.83

0.83

56.30

56.30

80190 00

Pathology

1.83

1.83

124.60

124.60

80192 00

Pathology

0.51

0.51

34.78

34.78

80193 00

Pathology

1.18

1.18

80.10

80.10

80194 00

Pathology

0.45

0.45

30.32

30.32

80195 00

Pathology

0.42

0.42

28.51

28.51

80197 00

Pathology

0.42

0.42

28.51

28.51

80198 00

Pathology

0.43

0.43

29.36

29.36

80199 00

Pathology

0.83

0.83

56.30

56.30

80200 00

Pathology

0.49

0.49

33.50

33.50

80201 00

Pathology

0.36

0.36

24.75

24.75

80202 00

Pathology

0.41

0.41

28.12

28.12

80203 00

Pathology

0.40

0.40

27.52

27.52

80204 00

Pathology

1.18

1.18

80.10

80.10

80210 00

Pathology

0.83

0.83

56.30

56.30

80220 00

Pathology

0.57

0.57

38.71

38.71

80230 00

Pathology

1.18

1.18

80.10

80.10

80235 00

Pathology

0.83

0.83

56.30

56.30

80280 00

Pathology

1.18

1.18

80.10

80.10

80285 00

Pathology

0.83

0.83

56.30

56.30

80299 00

Pathology

0.57

0.57

38.71

38.71

80305 00

Pathology

0.38

0.38

26.17

26.17

80306 00

Pathology

0.52

0.52

35.59

35.59

80307 00

Pathology

1.90

1.90

129.05

129.05

80320 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80321 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80322 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80323 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80324 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80325 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80326 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80327 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80328 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80329 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80330 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80331 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80332 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80333 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80334 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80335 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80336 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80337 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80338 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80339 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80340 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80341 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80342 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80343 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80344 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80345 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80346 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80347 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80348 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80349 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80350 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80351 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80352 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80353 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80354 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80355 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80356 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80357 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80358 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80359 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80360 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80361 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80362 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80363 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80364 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80365 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80366 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80367 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80368 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80369 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80370 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80371 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80372 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80373 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80374 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80375 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80376 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80377 00

Pathology

0.00

0.00

See G0480-G0483

See G0480-G0483

80400 00

Pathology

1.00

1.00

67.74

67.74

80402 00

Pathology

2.66

2.66

180.59

180.59

80406 00

Pathology

2.39

2.39

162.52

162.52

80408 00

Pathology

3.83

3.83

260.63

260.63

80410 00

Pathology

2.45

2.45

166.90

166.90

80412 00

Pathology

24.48

24.48

1664.73

1664.73

80414 00

Pathology

1.58

1.58

107.24

107.24

80415 00

Pathology

1.71

1.71

116.07

116.07

80416 00

Pathology

6.39

6.39

434.70

434.70

80417 00

Pathology

1.34

1.34

91.35

91.35

80418 00

Pathology

17.70

17.70

1203.41

1203.41

80420 00

Pathology

4.94

4.94

336.18

336.18

80422 00

Pathology

1.41

1.41

95.67

95.67

80424 00

Pathology

1.54

1.54

104.87

104.87

80426 00

Pathology

4.53

4.53

308.20

308.20

80428 00

Pathology

2.04

2.04

138.52

138.52

80430 00

Pathology

3.95

3.95

268.58

268.58

80432 00

Pathology

5.06

5.06

343.92

343.92

80434 00

Pathology

8.70

8.70

591.92

591.92

80435 00

Pathology

3.15

3.15

213.90

213.90

80436 00

Pathology

2.78

2.78

189.31

189.31

80438 00

Pathology

1.54

1.54

104.69

104.69

80439 00

Pathology

2.05

2.05

139.58

139.58

80503 00

Pathology

0.80

0.65

54.40

44.20

80504 00

Pathology

1.58

1.40

107.44

95.20

80505 00

Pathology

2.85

2.63

193.80

178.84

80506 00

Pathology

1.26

1.26

85.68

85.68

81000 00

Pathology

0.12

0.12

8.35

8.35

81001 00

Pathology

0.10

0.10

6.58

6.58

81002 00

Pathology

0.11

0.11

7.23

7.23

81003 00

Pathology

0.07

0.07

4.67

4.67

81005 00

Pathology

0.07

0.07

4.51

4.51

81007 00

Pathology

0.92

0.92

62.26

62.26

81015 00

Pathology

0.09

0.09

6.33

6.33

81020 00

Pathology

0.14

0.14

9.76

9.76

81025 00

Pathology

0.26

0.26

17.88

17.88

81050 00

Pathology

0.11

0.11

7.56

7.56

81099 00

Pathology

0.00

0.00

BR

BR

81105 00

Pathology

3.73

3.73

253.81

253.81

81106 00

Pathology

3.73

3.73

253.81

253.81

81107 00

Pathology

3.73

3.73

253.81

253.81

81108 00

Pathology

3.73

3.73

253.81

253.81

81109 00

Pathology

3.73

3.73

253.81

253.81

81110 00

Pathology

3.73

3.73

253.81

253.81

81111 00

Pathology

3.73

3.73

253.81

253.81

81112 00

Pathology

3.73

3.73

253.81

253.81

81120 00

Pathology

5.90

5.90

401.32

401.32

81121 00

Pathology

9.03

9.03

614.27

614.27

81161 00

Pathology

8.52

8.52

579.40

579.40

81162 00

Pathology

55.73

55.73

3789.73

3789.73

81163 00

Pathology

14.29

14.29

971.90

971.90

81164 00

Pathology

17.84

17.84

1213.27

1213.27

81165 00

Pathology

8.64

8.64

587.46

587.46

81166 00

Pathology

9.20

9.20

625.81

625.81

81167 00

Pathology

8.64

8.64

587.46

587.46

81168 00

Pathology

6.33

6.33

430.52

430.52

81170 00

Pathology

9.16

9.16

623.01

623.01

81171 00

Pathology

4.18

4.18

284.51

284.51

81172 00

Pathology

8.39

8.39

570.74

570.74

81173 00

Pathology

9.20

9.20

625.81

625.81

81174 00

Pathology

5.66

5.66

384.61

384.61

81175 00

Pathology

20.66

20.66

1404.89

1404.89

81176 00

Pathology

7.39

7.39

502.35

502.35

81177 00

Pathology

4.18

4.18

284.51

284.51

81178 00

Pathology

4.18

4.18

284.51

284.51

81179 00

Pathology

4.18

4.18

284.51

284.51

81180 00

Pathology

4.18

4.18

284.51

284.51

81181 00

Pathology

4.18

4.18

284.51

284.51

81182 00

Pathology

4.18

4.18

284.51

284.51

81183 00

Pathology

4.18

4.18

284.51

284.51

81184 00

Pathology

4.18

4.18

284.51

284.51

81185 00

Pathology

25.84

25.84

1757.45

1757.45

81186 00

Pathology

5.66

5.66

384.61

384.61

81187 00

Pathology

4.18

4.18

284.51

284.51

81188 00

Pathology

4.18

4.18

284.51

284.51

81189 00

Pathology

8.39

8.39

570.74

570.74

81190 00

Pathology

5.66

5.66

384.61

384.61

81191 00

Pathology

6.33

6.33

430.52

430.52

81192 00

Pathology

6.33

6.33

430.52

430.52

81193 00

Pathology

6.33

6.33

430.52

430.52

81194 00

Pathology

15.83

15.83

1076.31

1076.31

81200 00

Pathology

1.44

1.44

98.12

98.12

81201 00

Pathology

23.82

23.82

1619.83

1619.83

81202 00

Pathology

8.55

8.55

581.48

581.48

81203 00

Pathology

6.11

6.11

415.34

415.34

81204 00

Pathology

4.18

4.18

284.51

284.51

81205 00

Pathology

2.90

2.90

197.27

197.27

81206 00

Pathology

5.01

5.01

340.50

340.50

81207 00

Pathology

4.42

4.42

300.79

300.79

81208 00

Pathology

6.55

6.55

445.70

445.70

81209 00

Pathology

1.20

1.20

81.64

81.64

81210 00

Pathology

5.36

5.36

364.25

364.25

81212 00

Pathology

13.44

13.44

913.75

913.75

81215 00

Pathology

11.46

11.46

779.28

779.28

81216 00

Pathology

5.65

5.65

384.44

384.44

81217 00

Pathology

11.46

11.46

779.28

779.28

81218 00

Pathology

7.39

7.39

502.35

502.35

81219 00

Pathology

3.71

3.71

252.59

252.59

81220 00

Pathology

17.00

17.00

1155.89

1155.89

81221 00

Pathology

2.97

2.97

201.90

201.90

81222 00

Pathology

13.29

13.29

903.51

903.51

81223 00

Pathology

15.24

15.24

1036.28

1036.28

81224 00

Pathology

5.15

5.15

350.44

350.44

81225 00

Pathology

8.90

8.90

605.07

605.07

81226 00

Pathology

13.77

13.77

936.41

936.41

81227 00

Pathology

5.34

5.34

363.03

363.03

81228 00

Pathology

27.49

27.49

1869.03

1869.03

81229 00

Pathology

35.43

35.43

2408.98

2408.98

81230 00

Pathology

5.34

5.34

363.03

363.03

81231 00

Pathology

5.34

5.34

363.03

363.03

81232 00

Pathology

5.34

5.34

363.03

363.03

81233 00

Pathology

5.36

5.36

364.25

364.25

81234 00

Pathology

4.18

4.18

284.51

284.51

81235 00

Pathology

9.91

9.91

674.06

674.06

81236 00

Pathology

8.64

8.64

587.46

587.46

81237 00

Pathology

5.36

5.36

364.25

364.25

81238 00

Pathology

18.32

18.32

1246.02

1246.02

81239 00

Pathology

8.39

8.39

570.74

570.74

81240 00

Pathology

2.01

2.01

136.42

136.42

81241 00

Pathology

2.24

2.24

152.37

152.37

81242 00

Pathology

1.12

1.12

76.05

76.05

81243 00

Pathology

1.74

1.74

118.46

118.46

81244 00

Pathology

1.37

1.37

93.22

93.22

81245 00

Pathology

5.05

5.05

343.72

343.72

81246 00

Pathology

2.53

2.53

172.37

172.37

81247 00

Pathology

5.34

5.34

363.03

363.03

81248 00

Pathology

11.46

11.46

779.28

779.28

81249 00

Pathology

18.32

18.32

1246.02

1246.02

81250 00

Pathology

1.79

1.79

121.47

121.47

81251 00

Pathology

1.44

1.44

98.12

98.12

81252 00

Pathology

3.09

3.09

210.00

210.00

81253 00

Pathology

1.88

1.88

127.76

127.76

81254 00

Pathology

1.07

1.07

72.68

72.68

81255 00

Pathology

1.57

1.57

106.85

106.85

81256 00

Pathology

2.00

2.00

135.73

135.73

81257 00

Pathology

3.12

3.12

212.36

212.36

81258 00

Pathology

11.46

11.46

779.28

779.28

81259 00

Pathology

18.32

18.32

1246.02

1246.02

81260 00

Pathology

1.20

1.20

81.64

81.64

81261 00

Pathology

6.05

6.05

411.17

411.17

81262 00

Pathology

2.09

2.09

142.36

142.36

81263 00

Pathology

8.99

8.99

611.63

611.63

81264 00

Pathology

5.28

5.28

358.71

358.71

81265 00

Pathology

7.12

7.12

484.02

484.02

81266 00

Pathology

9.31

9.31

633.00

633.00

81267 00

Pathology

6.34

6.34

430.83

430.83

81268 00

Pathology

7.96

7.96

541.58

541.58

81269 00

Pathology

6.18

6.18

420.32

420.32

81270 00

Pathology

2.80

2.80

190.35

190.35

81271 00

Pathology

4.18

4.18

284.51

284.51

81272 00

Pathology

10.06

10.06

684.29

684.29

81273 00

Pathology

3.81

3.81

259.32

259.32

81274 00

Pathology

8.39

8.39

570.74

570.74

81275 00

Pathology

5.90

5.90

401.32

401.32

81276 00

Pathology

5.90

5.90

401.32

401.32

81277 00

Pathology

35.43

35.43

2408.98

2408.98

81278 00

Pathology

6.33

6.33

430.52

430.52

81279 00

Pathology

5.66

5.66

384.61

384.61

81283 00

Pathology

2.24

2.24

152.37

152.37

81284 00

Pathology

4.18

4.18

284.51

284.51

81285 00

Pathology

8.39

8.39

570.74

570.74

81286 00

Pathology

8.39

8.39

570.74

570.74

81287 00

Pathology

3.81

3.81

258.84

258.84

81288 00

Pathology

5.87

5.87

399.39

399.39

81289 00

Pathology

5.66

5.66

384.61

384.61

81290 00

Pathology

1.20

1.20

81.64

81.64

81291 00

Pathology

2.00

2.00

135.69

135.69

81292 00

Pathology

20.63

20.63

1402.61

1402.61

81293 00

Pathology

10.11

10.11

687.39

687.39

81294 00

Pathology

6.18

6.18

420.32

420.32

81295 00

Pathology

11.66

11.66

792.68

792.68

81296 00

Pathology

10.31

10.31

701.37

701.37

81297 00

Pathology

6.51

6.51

442.96

442.96

81298 00

Pathology

19.60

19.60

1332.93

1332.93

81299 00

Pathology

9.41

9.41

639.62

639.62

81300 00

Pathology

7.27

7.27

494.26

494.26

81301 00

Pathology

10.64

10.64

723.86

723.86

81302 00

Pathology

16.12

16.12

1096.23

1096.23

81303 00

Pathology

3.66

3.66

249.20

249.20

81304 00

Pathology

4.58

4.58

311.51

311.51

81305 00

Pathology

5.36

5.36

364.25

364.25

81306 00

Pathology

8.90

8.90

605.07

605.07

81307 00

Pathology

20.66

20.66

1404.89

1404.89

81308 00

Pathology

9.20

9.20

625.81

625.81

81309 00

Pathology

8.39

8.39

570.74

570.74

81310 00

Pathology

7.53

7.53

511.95

511.95

81311 00

Pathology

9.03

9.03

614.27

614.27

81312 00

Pathology

4.18

4.18

284.51

284.51

81313 00

Pathology

7.79

7.79

529.66

529.66

81314 00

Pathology

10.06

10.06

684.29

684.29

81315 00

Pathology

6.33

6.33

430.52

430.52

81316 00

Pathology

6.33

6.33

430.52

430.52

81317 00

Pathology

20.66

20.66

1404.89

1404.89

81318 00

Pathology

10.11

10.11

687.39

687.39

81319 00

Pathology

6.21

6.21

422.61

422.61

81320 00

Pathology

8.90

8.90

605.07

605.07

81321 00

Pathology

18.32

18.32

1246.02

1246.02

81322 00

Pathology

1.42

1.42

96.77

96.77

81323 00

Pathology

9.16

9.16

623.01

623.01

81324 00

Pathology

23.16

23.16

1574.89

1574.89

81325 00

Pathology

23.50

23.50

1598.19

1598.19

81326 00

Pathology

1.42

1.42

96.77

96.77

81327 00

Pathology

5.86

5.86

398.73

398.73

81328 00

Pathology

5.34

5.34

363.03

363.03

81329 00

Pathology

4.18

4.18

284.51

284.51

81330 00

Pathology

1.44

1.44

97.61

97.61

81331 00

Pathology

1.56

1.56

106.06

106.06

81332 00

Pathology

1.33

1.33

90.65

90.65

81333 00

Pathology

4.18

4.18

284.51

284.51

81334 00

Pathology

10.06

10.06

684.29

684.29

81335 00

Pathology

5.34

5.34

363.03

363.03

81336 00

Pathology

9.20

9.20

625.81

625.81

81337 00

Pathology

5.66

5.66

384.61

384.61

81338 00

Pathology

4.59

4.59

312.19

312.19

81339 00

Pathology

5.66

5.66

384.61

384.61

81340 00

Pathology

6.38

6.38

433.86

433.86

81341 00

Pathology

1.51

1.51

102.98

102.98

81342 00

Pathology

6.15

6.15

418.46

418.46

81343 00

Pathology

4.18

4.18

284.51

284.51

81344 00

Pathology

4.18

4.18

284.51

284.51

81345 00

Pathology

5.66

5.66

384.61

384.61

81346 00

Pathology

5.34

5.34

363.03

363.03

81347 00

Pathology

5.90

5.90

401.32

401.32

81348 00

Pathology

5.36

5.36

364.25

364.25

81349 00

Pathology

35.43

35.43

2408.98

2408.98

81350 00

Pathology

7.15

7.15

485.95

485.95

81351 00

Pathology

19.60

19.60

1332.93

1332.93

81352 00

Pathology

10.06

10.06

684.29

684.29

81353 00

Pathology

9.41

9.41

639.62

639.62

81355 00

Pathology

2.69

2.69

183.17

183.17

81357 00

Pathology

5.90

5.90

401.32

401.32

81360 00

Pathology

5.90

5.90

401.32

401.32

81361 00

Pathology

5.34

5.34

363.03

363.03

81362 00

Pathology

11.46

11.46

779.28

779.28

81363 00

Pathology

6.18

6.18

420.32

420.32

81364 00

Pathology

9.91

9.91

674.06

674.06

81370 00

Pathology

12.28

12.28

835.08

835.08

81371 00

Pathology

12.35

12.35

840.07

840.07

81372 00

Pathology

12.33

12.33

838.14

838.14

81373 00

Pathology

3.89

3.89

264.63

264.63

81374 00

Pathology

2.27

2.27

154.36

154.36

81375 00

Pathology

6.74

6.74

458.41

458.41

81376 00

Pathology

3.73

3.73

253.81

253.81

81377 00

Pathology

2.89

2.89

196.75

196.75

81378 00

Pathology

10.55

10.55

717.65

717.65

81379 00

Pathology

10.24

10.24

696.48

696.48

81380 00

Pathology

5.41

5.41

368.10

368.10

81381 00

Pathology

5.19

5.19

352.83

352.83

81382 00

Pathology

3.78

3.78

256.85

256.85

81383 00

Pathology

3.33

3.33

226.63

226.63

81400 00

Pathology

1.95

1.95

132.83

132.83

81401 00

Pathology

4.18

4.18

284.51

284.51

81402 00

Pathology

4.59

4.59

312.19

312.19

81403 00

Pathology

5.66

5.66

384.61

384.61

81404 00

Pathology

8.39

8.39

570.74

570.74

81405 00

Pathology

9.20

9.20

625.81

625.81

81406 00

Pathology

8.64

8.64

587.46

587.46

81407 00

Pathology

25.84

25.84

1757.45

1757.45

81408 00

Pathology

61.08

61.08

4153.41

4153.41

81410 00

Pathology

15.39

15.39

1046.66

1046.66

81411 00

Pathology

41.23

41.23

2803.94

2803.94

81412 00

Pathology

74.78

74.78

5084.93

5084.93

81413 00

Pathology

17.86

17.86

1214.66

1214.66

81414 00

Pathology

17.86

17.86

1214.66

1214.66

81415 00

Pathology

145.98

145.98

9926.64

9926.64

81416 00

Pathology

366.48

366.48

24920.44

24920.44

81417 00

Pathology

9.77

9.77

664.55

664.55

81418 00

Pathology

28.01

28.01

1904.50

1904.50

81419 00

Pathology

74.78

74.78

5084.93

5084.93

81420 00

Pathology

23.18

23.18

1576.32

1576.32

81422 00

Pathology

23.18

23.18

1576.32

1576.32

81425 00

Pathology

153.65

153.65

10448.31

10448.31

81426 00

Pathology

82.76

82.76

5627.76

5627.76

81427 00

Pathology

71.39

71.39

4854.61

4854.61

81430 00

Pathology

49.63

49.63

3374.64

3374.64

81431 00

Pathology

20.75

20.75

1411.27

1411.27

81432 00

Pathology

20.74

20.74

1410.19

1410.19

81433 00

Pathology

13.40

13.40

911.53

911.53

81434 00

Pathology

18.26

18.26

1241.68

1241.68

81435 00

Pathology

17.86

17.86

1214.66

1214.66

81436 00

Pathology

17.86

17.86

1214.66

1214.66

81437 00

Pathology

13.40

13.40

911.53

911.53

81438 00

Pathology

13.40

13.40

911.53

911.53

81439 00

Pathology

17.86

17.86

1214.66

1214.66

81440 00

Pathology

101.51

101.51

6902.96

6902.96

81441 00

Pathology

74.78

74.78

5084.93

5084.93

81442 00

Pathology

65.47

65.47

4451.62

4451.62

81443 00

Pathology

74.78

74.78

5084.93

5084.93

81445 00

Pathology

18.26

18.26

1241.68

1241.68

81448 00

Pathology

17.86

17.86

1214.66

1214.66

81449 00

Pathology

18.26

18.26

1241.68

1241.68

81450 00

Pathology

23.20

23.20

1577.32

1577.32

81451 00

Pathology

23.20

23.20

1577.32

1577.32

81455 00

Pathology

89.16

89.16

6063.14

6063.14

81456 00

Pathology

89.16

89.16

6063.14

6063.14

81457 00

Pathology

0.00

0.00

BR

BR

81458 00

Pathology

0.00

0.00

BR

BR

81459 00

Pathology

0.00

0.00

BR

BR

81460 00

Pathology

39.30

39.30

2672.72

2672.72

81462 00

Pathology

0.00

0.00

BR

BR

81463 00

Pathology

0.00

0.00

BR

BR

81464 00

Pathology

0.00

0.00

BR

BR

81465 00

Pathology

28.59

28.59

1943.79

1943.79

81470 00

Pathology

27.91

27.91

1898.11

1898.11

81471 00

Pathology

27.91

27.91

1898.11

1898.11

81479 00

Pathology

0.00

0.00

BR

BR

81490 00

Pathology

25.67

25.67

1745.78

1745.78

81493 00

Pathology

32.07

32.07

2180.54

2180.54

81500 00

Pathology

7.96

7.96

540.98

540.98

81503 00

Pathology

27.39

27.39

1862.80

1862.80

81504 00

Pathology

15.88

15.88

1079.89

1079.89

81506 00

Pathology

2.10

2.10

143.13

143.13

81507 00

Pathology

24.28

24.28

1650.98

1650.98

81508 00

Pathology

1.66

1.66

112.77

112.77

81509 00

Pathology

45.42

45.42

3088.83

3088.83

81510 00

Pathology

1.70

1.70

115.34

115.34

81511 00

Pathology

4.69

4.69

318.77

318.77

81512 00

Pathology

2.12

2.12

144.37

144.37

81513 00

Pathology

4.36

4.36

296.20

296.20

81514 00

Pathology

8.03

8.03

546.15

546.15

81517 00

Pathology

5.38

5.38

365.89

365.89

81518 00

Pathology

118.28

118.28

8043.07

8043.07

81519 00

Pathology

118.28

118.28

8043.07

8043.07

81520 00

Pathology

76.66

76.66

5212.96

5212.96

81521 00

Pathology

118.28

118.28

8043.07

8043.07

81522 00

Pathology

118.28

118.28

8043.07

8043.07

81523 00

Pathology

118.28

118.28

8043.07

8043.07

81525 00

Pathology

95.16

95.16

6471.01

6471.01

81528 00

Pathology

15.54

15.54

1056.77

1056.77

81529 00

Pathology

219.67

219.67

14937.73

14937.73

81535 00

Pathology

17.70

17.70

1203.37

1203.37

81536 00

Pathology

5.42

5.42

368.74

368.74

81538 00

Pathology

87.68

87.68

5962.22

5962.22

81539 00

Pathology

23.21

23.21

1578.29

1578.29

81540 00

Pathology

114.52

114.52

7787.64

7787.64

81541 00

Pathology

118.28

118.28

8043.07

8043.07

81542 00

Pathology

118.28

118.28

8043.07

8043.07

81546 00

Pathology

109.94

109.94

7476.13

7476.13

81551 00

Pathology

62.00

62.00

4215.71

4215.71

81552 00

Pathology

237.48

237.48

16148.45

16148.45

81554 00

Pathology

167.97

167.97

11421.87

11421.87

81560 00

Pathology

19.57

19.57

1330.61

1330.61

81595 00

Pathology

98.95

98.95

6728.52

6728.52

81596 00

Pathology

2.20

2.20

149.92

149.92

81599 00

Pathology

0.00

0.00

BR

BR

82009 00

Pathology

0.14

0.14

9.39

9.39

82010 00

Pathology

0.25

0.25

16.97

16.97

82013 00

Pathology

0.38

0.38

25.52

25.52

82016 00

Pathology

0.50

0.50

34.24

34.24

82017 00

Pathology

0.52

0.52

35.03

35.03

82024 00

Pathology

1.18

1.18

80.20

80.20

82030 00

Pathology

0.79

0.79

53.58

53.58

82040 00

Pathology

0.15

0.15

10.28

10.28

82042 00

Pathology

0.24

0.24

16.16

16.16

82043 00

Pathology

0.18

0.18

12.00

12.00

82044 00

Pathology

0.19

0.19

12.94

12.94

82045 00

Pathology

1.04

1.04

70.48

70.48

82075 00

Pathology

0.92

0.92

62.30

62.30

82077 00

Pathology

0.53

0.53

35.86

35.86

82085 00

Pathology

0.30

0.30

20.16

20.16

82088 00

Pathology

1.24

1.24

84.63

84.63

82103 00

Pathology

0.41

0.41

27.91

27.91

82104 00

Pathology

0.44

0.44

30.03

30.03

82105 00

Pathology

0.51

0.51

34.83

34.83

82106 00

Pathology

0.52

0.52

35.30

35.30

82107 00

Pathology

1.97

1.97

133.76

133.76

82108 00

Pathology

0.78

0.78

52.91

52.91

82120 00

Pathology

0.18

0.18

12.44

12.44

82127 00

Pathology

0.43

0.43

29.45

29.45

82128 00

Pathology

0.42

0.42

28.80

28.80

82131 00

Pathology

0.70

0.70

47.72

47.72

82135 00

Pathology

0.50

0.50

34.16

34.16

82136 00

Pathology

0.60

0.60

40.72

40.72

82139 00

Pathology

0.52

0.52

35.03

35.03

82140 00

Pathology

0.44

0.44

30.26

30.26

82143 00

Pathology

0.29

0.29

19.42

19.42

82150 00

Pathology

0.20

0.20

13.46

13.46

82154 00

Pathology

0.88

0.88

59.87

59.87

82157 00

Pathology

0.89

0.89

60.81

60.81

82160 00

Pathology

0.78

0.78

53.06

53.06

82163 00

Pathology

0.63

0.63

42.61

42.61

82164 00

Pathology

0.45

0.45

30.32

30.32

82166 00

Pathology

1.18

1.18

80.20

80.20

82172 00

Pathology

0.64

0.64

43.80

43.80

82175 00

Pathology

0.58

0.58

39.40

39.40

82180 00

Pathology

0.30

0.30

20.54

20.54

82190 00

Pathology

0.49

0.49

33.02

33.02

82232 00

Pathology

0.49

0.49

33.60

33.60

82239 00

Pathology

0.52

0.52

35.55

35.55

82240 00

Pathology

0.81

0.81

55.20

55.20

82247 00

Pathology

0.15

0.15

10.43

10.43

82248 00

Pathology

0.15

0.15

10.43

10.43

82252 00

Pathology

0.14

0.14

9.47

9.47

82261 00

Pathology

0.52

0.52

35.03

35.03

82270 00

Pathology

0.13

0.13

9.10

9.10

82271 00

Pathology

0.16

0.16

11.05

11.05

82272 00

Pathology

0.13

0.13

8.78

8.78

82274 00

Pathology

0.49

0.49

33.06

33.06

82286 00

Pathology

0.16

0.16

10.72

10.72

82300 00

Pathology

0.72

0.72

49.09

49.09

82306 00

Pathology

0.90

0.90

61.47

61.47

82308 00

Pathology

0.82

0.82

55.63

55.63

82310 00

Pathology

0.16

0.16

10.72

10.72

82330 00

Pathology

0.42

0.42

28.41

28.41

82331 00

Pathology

0.41

0.41

27.70

27.70

82340 00

Pathology

0.18

0.18

12.52

12.52

82355 00

Pathology

0.35

0.35

24.05

24.05

82360 00

Pathology

0.39

0.39

26.73

26.73

82365 00

Pathology

0.39

0.39

26.79

26.79

82370 00

Pathology

0.38

0.38

26.00

26.00

82373 00

Pathology

0.55

0.55

37.51

37.51

82374 00

Pathology

0.15

0.15

10.13

10.13

82375 00

Pathology

0.38

0.38

25.58

25.58

82376 00

Pathology

0.43

0.43

29.22

29.22

82378 00

Pathology

0.58

0.58

39.37

39.37

82379 00

Pathology

0.52

0.52

35.03

35.03

82380 00

Pathology

0.28

0.28

19.15

19.15

82382 00

Pathology

0.83

0.83

56.69

56.69

82383 00

Pathology

0.89

0.89

60.39

60.39

82384 00

Pathology

0.77

0.77

52.44

52.44

82387 00

Pathology

0.55

0.55

37.51

37.51

82390 00

Pathology

0.33

0.33

22.30

22.30

82397 00

Pathology

0.43

0.43

29.32

29.32

82415 00

Pathology

0.39

0.39

26.31

26.31

82435 00

Pathology

0.14

0.14

9.55

9.55

82436 00

Pathology

0.18

0.18

11.94

11.94

82438 00

Pathology

0.15

0.15

10.38

10.38

82441 00

Pathology

0.18

0.18

12.48

12.48

82465 00

Pathology

0.13

0.13

9.03

9.03

82480 00

Pathology

0.24

0.24

16.34

16.34

82482 00

Pathology

0.30

0.30

20.37

20.37

82485 00

Pathology

0.63

0.63

42.88

42.88

82495 00

Pathology

0.62

0.62

42.12

42.12

82507 00

Pathology

0.85

0.85

57.73

57.73

82523 00

Pathology

0.57

0.57

38.79

38.79

82525 00

Pathology

0.38

0.38

25.77

25.77

82528 00

Pathology

0.69

0.69

46.77

46.77

82530 00

Pathology

0.51

0.51

34.70

34.70

82533 00

Pathology

0.50

0.50

33.85

33.85

82540 00

Pathology

0.14

0.14

9.64

9.64

82542 00

Pathology

0.74

0.74

50.03

50.03

82550 00

Pathology

0.20

0.20

13.52

13.52

82552 00

Pathology

0.41

0.41

27.81

27.81

82553 00

Pathology

0.35

0.35

23.99

23.99

82554 00

Pathology

0.36

0.36

24.65

24.65

82565 00

Pathology

0.16

0.16

10.63

10.63

82570 00

Pathology

0.16

0.16

10.76

10.76

82575 00

Pathology

0.29

0.29

19.65

19.65

82585 00

Pathology

0.43

0.43

29.36

29.36

82595 00

Pathology

0.20

0.20

13.44

13.44

82600 00

Pathology

0.59

0.59

40.29

40.29

82607 00

Pathology

0.46

0.46

31.32

31.32

82608 00

Pathology

0.44

0.44

29.74

29.74

82610 00

Pathology

0.57

0.57

38.46

38.46

82615 00

Pathology

0.29

0.29

19.83

19.83

82626 00

Pathology

0.77

0.77

52.48

52.48

82627 00

Pathology

0.68

0.68

46.17

46.17

82633 00

Pathology

0.95

0.95

64.34

64.34

82634 00

Pathology

0.89

0.89

60.81

60.81

82638 00

Pathology

0.37

0.37

25.44

25.44

82642 00

Pathology

0.89

0.89

60.81

60.81

82652 00

Pathology

1.18

1.18

79.95

79.95

82653 00

Pathology

0.70

0.70

47.70

47.70

82656 00

Pathology

0.35

0.35

23.94

23.94

82657 00

Pathology

0.68

0.68

46.04

46.04

82658 00

Pathology

1.34

1.34

91.44

91.44

82664 00

Pathology

1.88

1.88

127.72

127.72

82668 00

Pathology

0.57

0.57

39.02

39.02

82670 00

Pathology

0.85

0.85

58.02

58.02

82671 00

Pathology

0.99

0.99

67.08

67.08

82672 00

Pathology

0.66

0.66

45.06

45.06

82677 00

Pathology

0.74

0.74

50.21

50.21

82679 00

Pathology

0.76

0.76

51.81

51.81

82681 00

Pathology

0.85

0.85

58.02

58.02

82693 00

Pathology

0.46

0.46

30.94

30.94

82696 00

Pathology

0.80

0.80

54.49

54.49

82705 00

Pathology

0.16

0.16

10.59

10.59

82710 00

Pathology

0.51

0.51

34.89

34.89

82715 00

Pathology

0.70

0.70

47.70

47.70

82725 00

Pathology

0.57

0.57

38.98

38.98

82726 00

Pathology

0.60

0.60

41.01

41.01

82728 00

Pathology

0.42

0.42

28.31

28.31

82731 00

Pathology

1.97

1.97

133.76

133.76

82735 00

Pathology

0.57

0.57

38.50

38.50

82746 00

Pathology

0.45

0.45

30.53

30.53

82747 00

Pathology

0.54

0.54

36.65

36.65

82757 00

Pathology

0.53

0.53

36.01

36.01

82759 00

Pathology

0.66

0.66

44.61

44.61

82760 00

Pathology

0.34

0.34

23.26

23.26

82775 00

Pathology

0.64

0.64

43.76

43.76

82776 00

Pathology

0.36

0.36

24.38

24.38

82777 00

Pathology

1.35

1.35

91.89

91.89

82784 00

Pathology

0.28

0.28

19.31

19.31

82785 00

Pathology

0.50

0.50

34.18

34.18

82787 00

Pathology

0.24

0.24

16.66

16.66

82800 00

Pathology

0.34

0.34

22.84

22.84

82803 00

Pathology

0.80

0.80

54.14

54.14

82805 00

Pathology

2.41

2.41

163.58

163.58

82810 00

Pathology

0.30

0.30

20.29

20.29

82820 00

Pathology

0.41

0.41

27.70

27.70

82930 00

Pathology

0.20

0.20

13.93

13.93

82938 00

Pathology

0.54

0.54

36.74

36.74

82941 00

Pathology

0.54

0.54

36.61

36.61

82943 00

Pathology

0.44

0.44

29.68

29.68

82945 00

Pathology

0.12

0.12

8.16

8.16

82946 00

Pathology

0.54

0.54

36.90

36.90

82947 00

Pathology

0.12

0.12

8.16

8.16

82948 00

Pathology

0.15

0.15

10.47

10.47

82950 00

Pathology

0.15

0.15

9.86

9.86

82951 00

Pathology

0.39

0.39

26.73

26.73

82952 00

Pathology

0.12

0.12

8.14

8.14

82955 00

Pathology

0.30

0.30

20.14

20.14

82960 00

Pathology

0.18

0.18

12.56

12.56

82962 00

Pathology

0.10

0.10

6.81

6.81

82963 00

Pathology

0.66

0.66

44.61

44.61

82965 00

Pathology

0.40

0.40

27.31

27.31

82977 00

Pathology

0.22

0.22

14.95

14.95

82978 00

Pathology

0.47

0.47

32.09

32.09

82979 00

Pathology

0.29

0.29

19.60

19.60

82985 00

Pathology

0.51

0.51

34.81

34.81

83001 00

Pathology

0.57

0.57

38.59

38.59

83002 00

Pathology

0.57

0.57

38.46

38.46

83003 00

Pathology

0.51

0.51

34.62

34.62

83006 00

Pathology

2.31

2.31

157.00

157.00

83009 00

Pathology

2.06

2.06

139.89

139.89

83010 00

Pathology

0.38

0.38

26.12

26.12

83012 00

Pathology

0.82

0.82

55.84

55.84

83013 00

Pathology

2.06

2.06

139.89

139.89

83014 00

Pathology

0.24

0.24

16.32

16.32

83015 00

Pathology

0.64

0.64

43.49

43.49

83018 00

Pathology

0.67

0.67

45.60

45.60

83020 00

Pathology

0.39

0.39

26.73

26.73

83020 26

Pathology

0.52

0.52

35.36

35.36

83021 00

Pathology

0.55

0.55

37.51

37.51

83026 00

Pathology

0.12

0.12

8.33

8.33

83030 00

Pathology

0.33

0.33

22.30

22.30

83033 00

Pathology

0.24

0.24

16.61

16.61

83036 00

Pathology

0.30

0.30

20.16

20.16

83037 00

Pathology

0.30

0.30

20.16

20.16

83045 00

Pathology

0.20

0.20

13.48

13.48

83050 00

Pathology

0.25

0.25

17.03

17.03

83051 00

Pathology

0.22

0.22

15.18

15.18

83060 00

Pathology

0.27

0.27

18.27

18.27

83065 00

Pathology

0.27

0.27

18.69

18.69

83068 00

Pathology

0.29

0.29

19.67

19.67

83069 00

Pathology

0.12

0.12

8.20

8.20

83070 00

Pathology

0.15

0.15

9.86

9.86

83080 00

Pathology

0.52

0.52

35.03

35.03

83088 00

Pathology

0.90

0.90

61.33

61.33

83090 00

Pathology

0.55

0.55

37.21

37.21

83150 00

Pathology

0.68

0.68

46.54

46.54

83491 00

Pathology

0.55

0.55

37.17

37.17

83497 00

Pathology

0.39

0.39

26.79

26.79

83498 00

Pathology

0.83

0.83

56.42

56.42

83500 00

Pathology

0.69

0.69

47.04

47.04

83505 00

Pathology

0.74

0.74

50.46

50.46

83516 00

Pathology

0.35

0.35

23.94

23.94

83518 00

Pathology

0.29

0.29

20.02

20.02

83519 00

Pathology

0.56

0.56

38.21

38.21

83520 00

Pathology

0.53

0.53

35.86

35.86

83521 00

Pathology

0.53

0.53

35.86

35.86

83525 00

Pathology

0.35

0.35

23.74

23.74

83527 00

Pathology

0.40

0.40

26.89

26.89

83528 00

Pathology

0.61

0.61

41.16

41.16

83529 00

Pathology

0.53

0.53

35.86

35.86

83540 00

Pathology

0.20

0.20

13.44

13.44

83550 00

Pathology

0.27

0.27

18.15

18.15

83570 00

Pathology

0.27

0.27

18.38

18.38

83582 00

Pathology

0.47

0.47

32.13

32.13

83586 00

Pathology

0.39

0.39

26.58

26.58

83593 00

Pathology

0.87

0.87

59.19

59.19

83605 00

Pathology

0.35

0.35

24.03

24.03

83615 00

Pathology

0.18

0.18

12.54

12.54

83625 00

Pathology

0.39

0.39

26.56

26.56

83630 00

Pathology

0.60

0.60

40.91

40.91

83631 00

Pathology

0.60

0.60

40.77

40.77

83632 00

Pathology

0.62

0.62

41.99

41.99

83633 00

Pathology

0.34

0.34

23.36

23.36

83655 00

Pathology

0.37

0.37

25.15

25.15

83661 00

Pathology

0.67

0.67

45.67

45.67

83662 00

Pathology

0.58

0.58

39.27

39.27

83663 00

Pathology

0.58

0.58

39.27

39.27

83664 00

Pathology

0.59

0.59

40.12

40.12

83670 00

Pathology

0.30

0.30

20.37

20.37

83690 00

Pathology

0.21

0.21

14.31

14.31

83695 00

Pathology

0.44

0.44

29.74

29.74

83698 00

Pathology

1.41

1.41

96.17

96.17

83700 00

Pathology

0.34

0.34

23.38

23.38

83701 00

Pathology

1.03

1.03

70.32

70.32

83704 00

Pathology

1.04

1.04

71.00

71.00

83718 00

Pathology

0.25

0.25

17.01

17.01

83719 00

Pathology

0.39

0.39

26.48

26.48

83721 00

Pathology

0.32

0.32

21.81

21.81

83722 00

Pathology

1.04

1.04

71.00

71.00

83727 00

Pathology

0.52

0.52

35.70

35.70

83735 00

Pathology

0.20

0.20

13.91

13.91

83775 00

Pathology

0.23

0.23

15.31

15.31

83785 00

Pathology

0.81

0.81

55.34

55.34

83789 00

Pathology

0.74

0.74

50.07

50.07

83825 00

Pathology

0.50

0.50

33.77

33.77

83835 00

Pathology

0.52

0.52

35.18

35.18

83857 00

Pathology

0.33

0.33

22.30

22.30

83861 00

Pathology

0.69

0.69

46.68

46.68

83864 00

Pathology

0.87

0.87

59.19

59.19

83872 00

Pathology

0.18

0.18

12.17

12.17

83873 00

Pathology

0.53

0.53

35.72

35.72

83874 00

Pathology

0.39

0.39

26.83

26.83

83876 00

Pathology

1.55

1.55

105.62

105.62

83880 00

Pathology

1.20

1.20

81.53

81.53

83883 00

Pathology

0.42

0.42

28.24

28.24

83885 00

Pathology

0.75

0.75

50.90

50.90

83915 00

Pathology

0.34

0.34

23.16

23.16

83916 00

Pathology

0.84

0.84

56.88

56.88

83918 00

Pathology

0.72

0.72

49.01

49.01

83919 00

Pathology

0.50

0.50

34.16

34.16

83921 00

Pathology

0.65

0.65

44.05

44.05

83930 00

Pathology

0.20

0.20

13.73

13.73

83935 00

Pathology

0.21

0.21

14.16

14.16

83937 00

Pathology

0.91

0.91

61.99

61.99

83945 00

Pathology

0.44

0.44

30.01

30.01

83950 00

Pathology

1.97

1.97

133.76

133.76

83951 00

Pathology

1.97

1.97

133.76

133.76

83970 00

Pathology

1.26

1.26

85.73

85.73

83986 00

Pathology

0.11

0.11

7.43

7.43

83987 00

Pathology

0.11

0.11

7.43

7.43

83992 00

Pathology

-

-

79.56

79.56

83993 00

Pathology

0.60

0.60

40.77

40.77

84030 00

Pathology

0.17

0.17

11.42

11.42

84035 00

Pathology

0.12

0.12

8.27

8.27

84060 00

Pathology

0.23

0.23

15.87

15.87

84066 00

Pathology

0.30

0.30

20.06

20.06

84075 00

Pathology

0.16

0.16

10.76

10.76

84078 00

Pathology

0.25

0.25

17.15

17.15

84080 00

Pathology

0.45

0.45

30.69

30.69

84081 00

Pathology

0.50

0.50

34.31

34.31

84085 00

Pathology

0.29

0.29

19.60

19.60

84087 00

Pathology

0.33

0.33

22.28

22.28

84100 00

Pathology

0.14

0.14

9.84

9.84

84105 00

Pathology

0.18

0.18

12.00

12.00

84106 00

Pathology

0.18

0.18

12.09

12.09

84110 00

Pathology

0.26

0.26

17.53

17.53

84112 00

Pathology

3.00

3.00

203.75

203.75

84119 00

Pathology

0.41

0.41

27.74

27.74

84120 00

Pathology

0.45

0.45

30.55

30.55

84126 00

Pathology

1.19

1.19

81.22

81.22

84132 00

Pathology

0.15

0.15

9.89

9.89

84133 00

Pathology

0.14

0.14

9.82

9.82

84134 00

Pathology

0.45

0.45

30.30

30.30

84135 00

Pathology

0.65

0.65

44.17

44.17

84138 00

Pathology

0.64

0.64

43.71

43.71

84140 00

Pathology

0.63

0.63

42.93

42.93

84143 00

Pathology

0.70

0.70

47.37

47.37

84144 00

Pathology

0.64

0.64

43.32

43.32

84145 00

Pathology

0.83

0.83

56.53

56.53

84146 00

Pathology

0.59

0.59

40.25

40.25

84150 00

Pathology

1.28

1.28

86.74

86.74

84152 00

Pathology

0.56

0.56

38.19

38.19

84153 00

Pathology

0.56

0.56

38.19

38.19

84154 00

Pathology

0.56

0.56

38.19

38.19

84155 00

Pathology

0.11

0.11

7.62

7.62

84156 00

Pathology

0.11

0.11

7.62

7.62

84157 00

Pathology

0.12

0.12

8.31

8.31

84160 00

Pathology

0.17

0.17

11.65

11.65

84163 00

Pathology

0.46

0.46

31.25

31.25

84165 00

Pathology

0.33

0.33

22.30

22.30

84165 26

Pathology

0.52

0.52

35.36

35.36

84166 00

Pathology

0.54

0.54

37.03

37.03

84166 26

Pathology

0.52

0.52

35.36

35.36

84181 00

Pathology

0.52

0.52

35.37

35.37

84181 26

Pathology

0.52

0.52

35.36

35.36

84182 00

Pathology

0.89

0.89

60.66

60.66

84182 26

Pathology

0.52

0.52

35.36

35.36

84202 00

Pathology

0.44

0.44

29.80

29.80

84203 00

Pathology

0.30

0.30

20.23

20.23

84206 00

Pathology

0.82

0.82

55.43

55.43

84207 00

Pathology

0.86

0.86

58.36

58.36

84210 00

Pathology

0.44

0.44

30.07

30.07

84220 00

Pathology

0.29

0.29

19.60

19.60

84228 00

Pathology

0.36

0.36

24.15

24.15

84233 00

Pathology

2.68

2.68

182.50

182.50

84234 00

Pathology

1.98

1.98

134.74

134.74

84235 00

Pathology

2.18

2.18

147.92

147.92

84238 00

Pathology

1.12

1.12

75.95

75.95

84244 00

Pathology

0.67

0.67

45.67

45.67

84252 00

Pathology

0.62

0.62

42.03

42.03

84255 00

Pathology

0.78

0.78

53.02

53.02

84260 00

Pathology

0.95

0.95

64.34

64.34

84270 00

Pathology

0.66

0.66

45.13

45.13

84275 00

Pathology

0.41

0.41

27.91

27.91

84285 00

Pathology

0.77

0.77

52.35

52.35

84295 00

Pathology

0.15

0.15

9.99

9.99

84300 00

Pathology

0.15

0.15

10.51

10.51

84302 00

Pathology

0.15

0.15

10.09

10.09

84305 00

Pathology

0.65

0.65

44.15

44.15

84307 00

Pathology

0.56

0.56

37.96

37.96

84311 00

Pathology

0.25

0.25

16.82

16.82

84315 00

Pathology

0.10

0.10

6.81

6.81

84375 00

Pathology

1.19

1.19

80.99

80.99

84376 00

Pathology

0.17

0.17

11.42

11.42

84377 00

Pathology

0.17

0.17

11.42

11.42

84378 00

Pathology

0.35

0.35

23.94

23.94

84379 00

Pathology

0.35

0.35

23.94

23.94

84392 00

Pathology

0.17

0.17

11.40

11.40

84402 00

Pathology

0.78

0.78

52.89

52.89

84403 00

Pathology

0.79

0.79

53.60

53.60

84410 00

Pathology

1.57

1.57

106.49

106.49

84425 00

Pathology

0.65

0.65

44.09

44.09

84430 00

Pathology

0.36

0.36

24.15

24.15

84431 00

Pathology

1.07

1.07

72.91

72.91

84432 00

Pathology

0.49

0.49

33.35

33.35

84433 00

Pathology

0.68

0.68

46.04

46.04

84436 00

Pathology

0.21

0.21

14.27

14.27

84437 00

Pathology

0.20

0.20

13.44

13.44

84439 00

Pathology

0.28

0.28

18.73

18.73

84442 00

Pathology

0.45

0.45

30.69

30.69

84443 00

Pathology

0.51

0.51

34.89

34.89

84445 00

Pathology

1.55

1.55

105.62

105.62

84446 00

Pathology

0.43

0.43

29.45

29.45

84449 00

Pathology

0.55

0.55

37.38

37.38

84450 00

Pathology

0.16

0.16

10.76

10.76

84460 00

Pathology

0.16

0.16

11.01

11.01

84466 00

Pathology

0.39

0.39

26.50

26.50

84478 00

Pathology

0.18

0.18

11.92

11.92

84479 00

Pathology

0.20

0.20

13.44

13.44

84480 00

Pathology

0.43

0.43

29.45

29.45

84481 00

Pathology

0.52

0.52

35.18

35.18

84482 00

Pathology

0.48

0.48

32.73

32.73

84484 00

Pathology

0.38

0.38

25.90

25.90

84485 00

Pathology

0.22

0.22

14.95

14.95

84488 00

Pathology

0.22

0.22

15.16

15.16

84490 00

Pathology

0.30

0.30

20.62

20.62

84510 00

Pathology

0.32

0.32

22.08

22.08

84512 00

Pathology

0.31

0.31

20.95

20.95

84520 00

Pathology

0.12

0.12

8.20

8.20

84525 00

Pathology

0.16

0.16

10.65

10.65

84540 00

Pathology

0.17

0.17

11.55

11.55

84545 00

Pathology

0.22

0.22

14.95

14.95

84550 00

Pathology

0.14

0.14

9.39

9.39

84560 00

Pathology

0.16

0.16

10.55

10.55

84577 00

Pathology

0.51

0.51

34.89

34.89

84578 00

Pathology

0.14

0.14

9.28

9.28

84580 00

Pathology

0.29

0.29

19.83

19.83

84583 00

Pathology

0.18

0.18

12.56

12.56

84585 00

Pathology

0.47

0.47

32.19

32.19

84586 00

Pathology

1.08

1.08

73.37

73.37

84588 00

Pathology

1.04

1.04

70.48

70.48

84590 00

Pathology

0.35

0.35

24.11

24.11

84591 00

Pathology

0.52

0.52

35.43

35.43

84597 00

Pathology

0.42

0.42

28.49

28.49

84600 00

Pathology

0.52

0.52

35.53

35.53

84620 00

Pathology

0.39

0.39

26.81

26.81

84630 00

Pathology

0.35

0.35

23.65

23.65

84681 00

Pathology

0.64

0.64

43.22

43.22

84702 00

Pathology

0.46

0.46

31.25

31.25

84703 00

Pathology

0.23

0.23

15.62

15.62

84704 00

Pathology

0.47

0.47

31.75

31.75

84830 00

Pathology

0.39

0.39

26.37

26.37

84999 00

Pathology

0.00

0.00

BR

BR

85002 00

Pathology

0.15

0.15

10.01

10.01

85004 00

Pathology

0.20

0.20

13.44

13.44

85007 00

Pathology

0.12

0.12

7.89

7.89

85008 00

Pathology

0.10

0.10

7.12

7.12

85009 00

Pathology

0.15

0.15

10.53

10.53

85013 00

Pathology

0.21

0.21

14.54

14.54

85014 00

Pathology

0.07

0.07

4.92

4.92

85018 00

Pathology

0.07

0.07

4.92

4.92

85025 00

Pathology

0.24

0.24

16.14

16.14

85027 00

Pathology

0.20

0.20

13.44

13.44

85032 00

Pathology

0.13

0.13

8.95

8.95

85041 00

Pathology

0.09

0.09

6.27

6.27

85044 00

Pathology

0.13

0.13

8.95

8.95

85045 00

Pathology

0.12

0.12

8.29

8.29

85046 00

Pathology

0.17

0.17

11.57

11.57

85048 00

Pathology

0.08

0.08

5.27

5.27

85049 00

Pathology

0.14

0.14

9.30

9.30

85055 00

Pathology

1.09

1.09

74.22

74.22

85060 00

Pathology

0.70

0.70

47.60

47.60

85097 00

Pathology

2.08

1.41

141.44

95.88

85130 00

Pathology

0.36

0.36

24.69

24.69

85170 00

Pathology

0.50

0.50

33.85

33.85

85175 00

Pathology

0.62

0.62

42.30

42.30

85210 00

Pathology

0.40

0.40

26.96

26.96

85220 00

Pathology

0.54

0.54

36.65

36.65

85230 00

Pathology

0.55

0.55

37.17

37.17

85240 00

Pathology

0.55

0.55

37.17

37.17

85244 00

Pathology

0.62

0.62

42.41

42.41

85245 00

Pathology

0.70

0.70

47.64

47.64

85246 00

Pathology

0.70

0.70

47.64

47.64

85247 00

Pathology

0.70

0.70

47.64

47.64

85250 00

Pathology

0.58

0.58

39.54

39.54

85260 00

Pathology

0.55

0.55

37.17

37.17

85270 00

Pathology

0.55

0.55

37.17

37.17

85280 00

Pathology

0.59

0.59

40.18

40.18

85290 00

Pathology

0.50

0.50

33.93

33.93

85291 00

Pathology

0.28

0.28

18.92

18.92

85292 00

Pathology

0.58

0.58

39.31

39.31

85293 00

Pathology

0.58

0.58

39.31

39.31

85300 00

Pathology

0.36

0.36

24.61

24.61

85301 00

Pathology

0.33

0.33

22.45

22.45

85302 00

Pathology

0.37

0.37

24.94

24.94

85303 00

Pathology

0.42

0.42

28.74

28.74

85305 00

Pathology

0.35

0.35

24.11

24.11

85306 00

Pathology

0.47

0.47

31.82

31.82

85307 00

Pathology

0.47

0.47

31.82

31.82

85335 00

Pathology

0.39

0.39

26.73

26.73

85337 00

Pathology

0.53

0.53

35.86

35.86

85345 00

Pathology

0.14

0.14

9.74

9.74

85347 00

Pathology

0.13

0.13

8.89

8.89

85348 00

Pathology

0.14

0.14

9.32

9.32

85360 00

Pathology

0.26

0.26

17.47

17.47

85362 00

Pathology

0.21

0.21

14.31

14.31

85366 00

Pathology

2.46

2.46

167.09

167.09

85370 00

Pathology

0.38

0.38

25.81

25.81

85378 00

Pathology

0.30

0.30

20.19

20.19

85379 00

Pathology

0.31

0.31

21.14

21.14

85380 00

Pathology

0.31

0.31

21.14

21.14

85384 00

Pathology

0.30

0.30

20.19

20.19

85385 00

Pathology

0.44

0.44

30.03

30.03

85390 00

Pathology

0.47

0.47

32.15

32.15

85390 26

Pathology

1.06

1.06

72.08

72.08

85396 00

Pathology

0.57

0.57

38.76

38.76

85397 00

Pathology

0.94

0.94

64.09

64.09

85400 00

Pathology

0.24

0.24

16.01

16.01

85410 00

Pathology

0.24

0.24

16.01

16.01

85415 00

Pathology

0.52

0.52

35.70

35.70

85420 00

Pathology

0.20

0.20

13.56

13.56

85421 00

Pathology

0.31

0.31

21.14

21.14

85441 00

Pathology

0.13

0.13

8.72

8.72

85445 00

Pathology

0.21

0.21

14.16

14.16

85460 00

Pathology

0.24

0.24

16.05

16.05

85461 00

Pathology

0.29

0.29

19.44

19.44

85475 00

Pathology

0.27

0.27

18.42

18.42

85520 00

Pathology

0.40

0.40

27.18

27.18

85525 00

Pathology

0.36

0.36

24.59

24.59

85530 00

Pathology

0.40

0.40

27.18

27.18

85536 00

Pathology

0.21

0.21

14.29

14.29

85540 00

Pathology

0.26

0.26

17.86

17.86

85547 00

Pathology

0.26

0.26

17.86

17.86

85549 00

Pathology

0.57

0.57

38.94

38.94

85555 00

Pathology

0.23

0.23

15.51

15.51

85557 00

Pathology

0.41

0.41

27.74

27.74

85576 00

Pathology

0.76

0.76

51.73

51.73

85576 26

Pathology

0.52

0.52

35.36

35.36

85597 00

Pathology

0.55

0.55

37.34

37.34

85598 00

Pathology

0.55

0.55

37.34

37.34

85610 00

Pathology

0.13

0.13

8.91

8.91

85611 00

Pathology

0.12

0.12

8.18

8.18

85612 00

Pathology

0.53

0.53

36.32

36.32

85613 00

Pathology

0.29

0.29

19.89

19.89

85635 00

Pathology

0.30

0.30

20.46

20.46

85651 00

Pathology

0.13

0.13

8.87

8.87

85652 00

Pathology

0.08

0.08

5.61

5.61

85660 00

Pathology

0.17

0.17

11.44

11.44

85670 00

Pathology

0.18

0.18

11.98

11.98

85675 00

Pathology

0.21

0.21

14.23

14.23

85705 00

Pathology

0.29

0.29

20.00

20.00

85730 00

Pathology

0.18

0.18

12.48

12.48

85732 00

Pathology

0.20

0.20

13.44

13.44

85810 00

Pathology

0.36

0.36

24.24

24.24

85999 00

Pathology

0.00

0.00

BR

BR

86000 00

Pathology

0.21

0.21

14.50

14.50

86001 00

Pathology

0.24

0.24

16.24

16.24

86003 00

Pathology

0.16

0.16

10.84

10.84

86005 00

Pathology

0.24

0.24

16.55

16.55

86008 00

Pathology

0.55

0.55

37.24

37.24

86015 00

Pathology

0.37

0.37

25.02

25.02

86021 00

Pathology

0.46

0.46

31.25

31.25

86022 00

Pathology

0.56

0.56

38.15

38.15

86023 00

Pathology

0.38

0.38

25.88

25.88

86036 00

Pathology

0.37

0.37

25.02

25.02

86037 00

Pathology

0.37

0.37

25.02

25.02

86038 00

Pathology

0.37

0.37

25.11

25.11

86039 00

Pathology

0.34

0.34

23.18

23.18

86041 00

Pathology

0.56

0.56

38.21

38.21

86042 00

Pathology

0.56

0.56

38.21

38.21

86043 00

Pathology

0.37

0.37

25.02

25.02

86051 00

Pathology

0.35

0.35

23.94

23.94

86052 00

Pathology

0.37

0.37

25.02

25.02

86053 00

Pathology

1.15

1.15

78.35

78.35

86060 00

Pathology

0.22

0.22

15.16

15.16

86063 00

Pathology

0.18

0.18

11.98

11.98

86077 00

Pathology

1.58

1.44

107.44

97.92

86078 00

Pathology

1.58

1.44

107.44

97.92

86079 00

Pathology

1.58

1.44

107.44

97.92

86140 00

Pathology

0.16

0.16

10.76

10.76

86141 00

Pathology

0.40

0.40

26.89

26.89

86146 00

Pathology

0.78

0.78

52.85

52.85

86147 00

Pathology

0.78

0.78

52.85

52.85

86148 00

Pathology

0.49

0.49

33.37

33.37

86152 00

Pathology

7.66

7.66

520.80

520.80

86153 26

Pathology

0.98

0.98

66.64

66.64

86155 00

Pathology

0.49

0.49

33.21

33.21

86156 00

Pathology

0.25

0.25

16.76

16.76

86157 00

Pathology

0.25

0.25

16.74

16.74

86160 00

Pathology

0.37

0.37

24.92

24.92

86161 00

Pathology

0.37

0.37

24.92

24.92

86162 00

Pathology

0.62

0.62

42.20

42.20

86171 00

Pathology

0.31

0.31

20.79

20.79

86200 00

Pathology

0.40

0.40

26.89

26.89

86215 00

Pathology

0.40

0.40

27.52

27.52

86225 00

Pathology

0.42

0.42

28.53

28.53

86226 00

Pathology

0.37

0.37

25.15

25.15

86231 00

Pathology

0.37

0.37

25.11

25.11

86235 00

Pathology

0.55

0.55

37.24

37.24

86255 00

Pathology

0.37

0.37

25.02

25.02

86255 26

Pathology

0.52

0.52

35.36

35.36

86256 00

Pathology

0.37

0.37

25.02

25.02

86256 26

Pathology

0.52

0.52

35.36

35.36

86258 00

Pathology

0.37

0.37

25.02

25.02

86277 00

Pathology

0.48

0.48

32.69

32.69

86280 00

Pathology

0.25

0.25

17.01

17.01

86294 00

Pathology

0.78

0.78

53.10

53.10

86300 00

Pathology

0.64

0.64

43.22

43.22

86301 00

Pathology

0.64

0.64

43.22

43.22

86304 00

Pathology

0.64

0.64

43.22

43.22

86305 00

Pathology

0.64

0.64

43.22

43.22

86308 00

Pathology

0.16

0.16

10.76

10.76

86309 00

Pathology

0.20

0.20

13.44

13.44

86310 00

Pathology

0.23

0.23

15.31

15.31

86316 00

Pathology

0.64

0.64

43.22

43.22

86317 00

Pathology

0.46

0.46

31.13

31.13

86318 00

Pathology

0.55

0.55

37.57

37.57

86320 00

Pathology

0.91

0.91

62.13

62.13

86320 26

Pathology

0.52

0.52

35.36

35.36

86325 00

Pathology

0.71

0.71

48.03

48.03

86325 26

Pathology

0.52

0.52

35.36

35.36

86327 00

Pathology

0.91

0.91

62.13

62.13

86327 26

Pathology

0.63

0.63

42.84

42.84

86328 00

Pathology

1.38

1.38

94.03

94.03

86329 00

Pathology

0.43

0.43

29.18

29.18

86331 00

Pathology

0.37

0.37

24.88

24.88

86332 00

Pathology

0.74

0.74

50.61

50.61

86334 00

Pathology

0.68

0.68

46.39

46.39

86334 26

Pathology

0.52

0.52

35.36

35.36

86335 00

Pathology

0.90

0.90

60.95

60.95

86335 26

Pathology

0.52

0.52

35.36

35.36

86336 00

Pathology

0.48

0.48

32.38

32.38

86337 00

Pathology

0.65

0.65

44.46

44.46

86340 00

Pathology

0.46

0.46

31.32

31.32

86341 00

Pathology

0.72

0.72

48.95

48.95

86343 00

Pathology

0.38

0.38

25.88

25.88

86344 00

Pathology

0.32

0.32

21.58

21.58

86352 00

Pathology

4.15

4.15

282.14

282.14

86353 00

Pathology

1.50

1.50

101.82

101.82

86355 00

Pathology

1.15

1.15

78.35

78.35

86356 00

Pathology

0.82

0.82

55.61

55.61

86357 00

Pathology

1.15

1.15

78.35

78.35

86359 00

Pathology

1.15

1.15

78.35

78.35

86360 00

Pathology

1.43

1.43

97.56

97.56

86361 00

Pathology

0.82

0.82

55.61

55.61

86362 00

Pathology

0.37

0.37

25.02

25.02

86363 00

Pathology

1.15

1.15

78.35

78.35

86364 00

Pathology

0.35

0.35

23.94

23.94

86366 00

Pathology

0.56

0.56

38.21

38.21

86367 00

Pathology

2.38

2.38

161.53

161.53

86376 00

Pathology

0.44

0.44

30.22

30.22

86381 00

Pathology

0.78

0.78

52.85

52.85

86382 00

Pathology

0.52

0.52

35.12

35.12

86384 00

Pathology

0.42

0.42

28.26

28.26

86386 00

Pathology

0.67

0.67

45.23

45.23

86403 00

Pathology

0.35

0.35

23.97

23.97

86406 00

Pathology

0.32

0.32

22.10

22.10

86408 00

Pathology

1.29

1.29

87.49

87.49

86409 00

Pathology

-

-

349.52

349.52

86413 00

Pathology

-

-

170.68

170.68

86430 00

Pathology

0.19

0.19

12.75

12.75

86431 00

Pathology

0.17

0.17

11.77

11.77

86480 00

Pathology

1.89

1.89

128.71

128.71

86481 00

Pathology

3.05

3.05

207.67

207.67

86485 00

Pathology

-

-

66.64

66.64

86486 00

Pathology

0.19

0.19

12.92

12.92

86490 00

Pathology

2.29

2.29

155.72

155.72

86510 00

Pathology

0.23

0.23

15.64

15.64

86580 00

Pathology

0.31

0.31

21.08

21.08

86590 00

Pathology

0.39

0.39

26.29

26.29

86592 00

Pathology

0.13

0.13

8.87

8.87

86593 00

Pathology

0.13

0.13

9.14

9.14

86596 00

Pathology

0.37

0.37

25.02

25.02

86602 00

Pathology

0.31

0.31

21.14

21.14

86603 00

Pathology

0.39

0.39

26.73

26.73

86606 00

Pathology

0.46

0.46

31.25

31.25

86609 00

Pathology

0.39

0.39

26.75

26.75

86611 00

Pathology

0.31

0.31

21.14

21.14

86612 00

Pathology

0.39

0.39

26.79

26.79

86615 00

Pathology

0.40

0.40

27.39

27.39

86617 00

Pathology

0.47

0.47

32.17

32.17

86618 00

Pathology

0.52

0.52

35.37

35.37

86619 00

Pathology

0.41

0.41

27.79

27.79

86622 00

Pathology

0.27

0.27

18.54

18.54

86625 00

Pathology

0.40

0.40

27.25

27.25

86628 00

Pathology

0.37

0.37

24.94

24.94

86631 00

Pathology

0.36

0.36

24.55

24.55

86632 00

Pathology

0.39

0.39

26.33

26.33

86635 00

Pathology

0.35

0.35

23.82

23.82

86638 00

Pathology

0.37

0.37

25.17

25.17

86641 00

Pathology

0.44

0.44

29.93

29.93

86644 00

Pathology

0.44

0.44

29.88

29.88

86645 00

Pathology

0.51

0.51

34.99

34.99

86648 00

Pathology

0.46

0.46

31.59

31.59

86651 00

Pathology

0.40

0.40

27.39

27.39

86652 00

Pathology

0.40

0.40

27.39

27.39

86653 00

Pathology

0.40

0.40

27.39

27.39

86654 00

Pathology

0.40

0.40

27.39

27.39

86658 00

Pathology

0.40

0.40

27.06

27.06

86663 00

Pathology

0.40

0.40

27.25

27.25

86664 00

Pathology

0.47

0.47

31.75

31.75

86665 00

Pathology

0.55

0.55

37.67

37.67

86666 00

Pathology

0.31

0.31

21.14

21.14

86668 00

Pathology

0.43

0.43

29.41

29.41

86671 00

Pathology

0.37

0.37

25.44

25.44

86674 00

Pathology

0.45

0.45

30.57

30.57

86677 00

Pathology

0.51

0.51

34.99

34.99

86682 00

Pathology

0.40

0.40

27.02

27.02

86684 00

Pathology

0.48

0.48

32.89

32.89

86687 00

Pathology

0.28

0.28

18.88

18.88

86688 00

Pathology

0.43

0.43

29.07

29.07

86689 00

Pathology

0.59

0.59

40.18

40.18

86692 00

Pathology

0.52

0.52

35.64

35.64

86694 00

Pathology

0.44

0.44

29.88

29.88

86695 00

Pathology

0.40

0.40

27.39

27.39

86696 00

Pathology

0.59

0.59

40.18

40.18

86698 00

Pathology

0.42

0.42

28.64

28.64

86701 00

Pathology

0.27

0.27

18.46

18.46

86702 00

Pathology

0.41

0.41

28.08

28.08

86703 00

Pathology

0.42

0.42

28.47

28.47

86704 00

Pathology

0.37

0.37

25.02

25.02

86705 00

Pathology

0.36

0.36

24.44

24.44

86706 00

Pathology

0.33

0.33

22.30

22.30

86707 00

Pathology

0.35

0.35

24.03

24.03

86708 00

Pathology

0.38

0.38

25.73

25.73

86709 00

Pathology

0.34

0.34

23.38

23.38

86710 00

Pathology

0.41

0.41

28.14

28.14

86711 00

Pathology

0.52

0.52

35.08

35.08

86713 00

Pathology

0.47

0.47

31.77

31.77

86717 00

Pathology

0.37

0.37

25.44

25.44

86720 00

Pathology

0.49

0.49

33.64

33.64

86723 00

Pathology

0.40

0.40

27.39

27.39

86727 00

Pathology

0.39

0.39

26.73

26.73

86732 00

Pathology

0.46

0.46

31.15

31.15

86735 00

Pathology

0.40

0.40

27.10

27.10

86738 00

Pathology

0.40

0.40

27.50

27.50

86741 00

Pathology

0.40

0.40

27.39

27.39

86744 00

Pathology

0.49

0.49

33.21

33.21

86747 00

Pathology

0.46

0.46

31.21

31.21

86750 00

Pathology

0.40

0.40

27.39

27.39

86753 00

Pathology

0.38

0.38

25.73

25.73

86756 00

Pathology

0.49

0.49

33.00

33.00

86757 00

Pathology

0.59

0.59

40.18

40.18

86759 00

Pathology

0.56

0.56

37.86

37.86

86762 00

Pathology

0.44

0.44

29.88

29.88

86765 00

Pathology

0.39

0.39

26.75

26.75

86768 00

Pathology

0.40

0.40

27.39

27.39

86769 00

Pathology

1.29

1.29

87.49

87.49

86771 00

Pathology

0.75

0.75

50.84

50.84

86774 00

Pathology

0.45

0.45

30.74

30.74

86777 00

Pathology

0.44

0.44

29.88

29.88

86778 00

Pathology

0.44

0.44

29.93

29.93

86780 00

Pathology

0.40

0.40

27.50

27.50

86784 00

Pathology

0.38

0.38

26.08

26.08

86787 00

Pathology

0.39

0.39

26.75

26.75

86788 00

Pathology

0.51

0.51

34.99

34.99

86789 00

Pathology

0.44

0.44

29.88

29.88

86790 00

Pathology

0.39

0.39

26.75

26.75

86793 00

Pathology

0.40

0.40

27.39

27.39

86794 00

Pathology

0.51

0.51

34.99

34.99

86800 00

Pathology

0.49

0.49

33.04

33.04

86803 00

Pathology

0.44

0.44

29.63

29.63

86804 00

Pathology

0.47

0.47

32.17

32.17

86805 00

Pathology

5.79

5.79

393.56

393.56

86806 00

Pathology

1.45

1.45

98.83

98.83

86807 00

Pathology

2.40

2.40

163.33

163.33

86808 00

Pathology

0.91

0.91

61.64

61.64

86812 00

Pathology

0.79

0.79

53.60

53.60

86813 00

Pathology

1.77

1.77

120.45

120.45

86816 00

Pathology

0.92

0.92

62.65

62.65

86817 00

Pathology

3.24

3.24

220.42

220.42

86821 00

Pathology

1.12

1.12

75.92

75.92

86825 00

Pathology

3.34

3.34

227.38

227.38

86826 00

Pathology

1.12

1.12

75.86

75.86

86828 00

Pathology

1.96

1.96

133.30

133.30

86829 00

Pathology

1.96

1.96

133.30

133.30

86830 00

Pathology

2.92

2.92

198.37

198.37

86831 00

Pathology

2.50

2.50

170.04

170.04

86832 00

Pathology

9.89

9.89

672.33

672.33

86833 00

Pathology

9.95

9.95

676.59

676.59

86834 00

Pathology

10.92

10.92

742.55

742.55

86835 00

Pathology

9.86

9.86

670.69

670.69

86849 00

Pathology

0.00

0.00

BR

BR

86850 00

Pathology

0.30

0.30

20.29

20.29

86860 00

Pathology

-

-

234.60

234.60

86870 00

Pathology

-

-

174.08

174.08

86880 00

Pathology

0.16

0.16

11.19

11.19

86885 00

Pathology

0.17

0.17

11.88

11.88

86886 00

Pathology

0.16

0.16

10.76

10.76

86890 00

Pathology

-

-

246.84

246.84

86891 00

Pathology

-

-

1243.04

1243.04

86900 00

Pathology

0.09

0.09

6.21

6.21

86901 00

Pathology

0.09

0.09

6.21

6.21

86902 00

Pathology

0.19

0.19

13.19

13.19

86904 00

Pathology

0.50

0.50

33.93

33.93

86905 00

Pathology

0.12

0.12

7.95

7.95

86906 00

Pathology

0.24

0.24

16.09

16.09

86910 00

Pathology

0.00

0.00

BR

BR

86911 00

Pathology

0.00

0.00

BR

BR

86920 00

Pathology

-

-

129.20

129.20

86921 00

Pathology

-

-

124.44

124.44

86922 00

Pathology

-

-

157.76

157.76

86923 00

Pathology

-

-

36.72

36.72

86927 00

Pathology

-

-

23.12

23.12

86930 00

Pathology

0.00

0.00

BR

BR

86931 00

Pathology

0.00

0.00

BR

BR

86932 00

Pathology

0.00

0.00

BR

BR

86940 00

Pathology

0.27

0.27

18.21

18.21

86941 00

Pathology

0.37

0.37

25.15

25.15

86945 00

Pathology

-

-

76.84

76.84

86950 00

Pathology

0.00

0.00

BR

BR

86960 00

Pathology

-

-

99.28

99.28

86965 00

Pathology

-

-

742.56

742.56

86970 00

Pathology

-

-

305.32

305.32

86971 00

Pathology

-

-

74.80

74.80

86972 00

Pathology

-

-

174.08

174.08

86975 00

Pathology

0.00

0.00

BR

BR

86976 00

Pathology

-

-

127.84

127.84

86977 00

Pathology

0.00

0.00

BR

BR

86978 00

Pathology

-

-

218.96

218.96

86985 00

Pathology

-

-

132.60

132.60

86999 00

Pathology

0.00

0.00

BR

BR

87003 00

Pathology

0.51

0.51

34.97

34.97

87015 00

Pathology

0.20

0.20

13.87

13.87

87040 00

Pathology

0.32

0.32

21.43

21.43

87045 00

Pathology

0.29

0.29

19.60

19.60

87046 00

Pathology

0.29

0.29

19.60

19.60

87070 00

Pathology

0.26

0.26

17.90

17.90

87071 00

Pathology

0.30

0.30

20.54

20.54

87073 00

Pathology

0.30

0.30

20.06

20.06

87075 00

Pathology

0.29

0.29

19.67

19.67

87076 00

Pathology

0.25

0.25

16.78

16.78

87077 00

Pathology

0.25

0.25

16.78

16.78

87081 00

Pathology

0.20

0.20

13.77

13.77

87084 00

Pathology

0.83

0.83

56.22

56.22

87086 00

Pathology

0.25

0.25

16.76

16.76

87088 00

Pathology

0.25

0.25

16.80

16.80

87101 00

Pathology

0.24

0.24

16.01

16.01

87102 00

Pathology

0.26

0.26

17.47

17.47

87103 00

Pathology

0.62

0.62

42.49

42.49

87106 00

Pathology

0.32

0.32

21.43

21.43

87107 00

Pathology

0.32

0.32

21.43

21.43

87109 00

Pathology

0.47

0.47

31.96

31.96

87110 00

Pathology

0.60

0.60

40.70

40.70

87116 00

Pathology

0.33

0.33

22.43

22.43

87118 00

Pathology

0.45

0.45

30.34

30.34

87140 00

Pathology

0.17

0.17

11.57

11.57

87143 00

Pathology

0.38

0.38

26.00

26.00

87147 00

Pathology

0.16

0.16

10.76

10.76

87149 00

Pathology

0.61

0.61

41.64

41.64

87150 00

Pathology

1.07

1.07

72.87

72.87

87152 00

Pathology

0.24

0.24

16.07

16.07

87153 00

Pathology

3.52

3.52

239.57

239.57

87154 00

Pathology

6.66

6.66

452.85

452.85

87158 00

Pathology

0.24

0.24

16.07

16.07

87164 00

Pathology

0.33

0.33

22.30

22.30

87164 26

Pathology

0.56

0.56

38.08

38.08

87166 00

Pathology

0.35

0.35

23.47

23.47

87168 00

Pathology

0.13

0.13

8.87

8.87

87169 00

Pathology

0.13

0.13

8.95

8.95

87172 00

Pathology

0.13

0.13

8.87

8.87

87176 00

Pathology

0.18

0.18

12.21

12.21

87177 00

Pathology

0.27

0.27

18.48

18.48

87181 00

Pathology

0.15

0.15

9.86

9.86

87184 00

Pathology

0.23

0.23

15.53

15.53

87185 00

Pathology

0.15

0.15

9.86

9.86

87186 00

Pathology

0.26

0.26

17.96

17.96

87187 00

Pathology

1.23

1.23

83.42

83.42

87188 00

Pathology

0.20

0.20

13.79

13.79

87190 00

Pathology

0.22

0.22

15.18

15.18

87197 00

Pathology

0.46

0.46

31.19

31.19

87205 00

Pathology

0.13

0.13

8.87

8.87

87206 00

Pathology

0.16

0.16

11.19

11.19

87207 00

Pathology

0.18

0.18

12.44

12.44

87207 26

Pathology

0.52

0.52

35.36

35.36

87209 00

Pathology

0.55

0.55

37.34

37.34

87210 00

Pathology

0.18

0.18

12.09

12.09

87220 00

Pathology

0.13

0.13

8.87

8.87

87230 00

Pathology

0.60

0.60

40.99

40.99

87250 00

Pathology

0.60

0.60

40.62

40.62

87252 00

Pathology

0.80

0.80

54.14

54.14

87253 00

Pathology

0.62

0.62

41.95

41.95

87254 00

Pathology

0.60

0.60

40.62

40.62

87255 00

Pathology

1.03

1.03

70.32

70.32

87260 00

Pathology

0.44

0.44

29.97

29.97

87265 00

Pathology

0.37

0.37

24.88

24.88

87267 00

Pathology

0.41

0.41

27.87

27.87

87269 00

Pathology

0.42

0.42

28.26

28.26

87270 00

Pathology

0.37

0.37

24.88

24.88

87271 00

Pathology

0.41

0.41

27.87

27.87

87272 00

Pathology

0.37

0.37

24.88

24.88

87273 00

Pathology

0.37

0.37

24.88

24.88

87274 00

Pathology

0.37

0.37

24.88

24.88

87275 00

Pathology

0.37

0.37

25.44

25.44

87276 00

Pathology

0.49

0.49

33.37

33.37

87278 00

Pathology

0.48

0.48

32.40

32.40

87279 00

Pathology

0.50

0.50

34.12

34.12

87280 00

Pathology

0.41

0.41

27.87

27.87

87281 00

Pathology

0.37

0.37

24.88

24.88

87283 00

Pathology

1.86

1.86

126.26

126.26

87285 00

Pathology

0.37

0.37

25.29

25.29

87290 00

Pathology

0.41

0.41

27.87

27.87

87299 00

Pathology

0.49

0.49

33.43

33.43

87300 00

Pathology

0.37

0.37

24.88

24.88

87301 00

Pathology

0.37

0.37

24.88

24.88

87305 00

Pathology

0.37

0.37

24.88

24.88

87320 00

Pathology

0.46

0.46

31.15

31.15

87324 00

Pathology

0.37

0.37

24.88

24.88

87327 00

Pathology

0.41

0.41

27.87

27.87

87328 00

Pathology

0.42

0.42

28.70

28.70

87329 00

Pathology

0.37

0.37

24.88

24.88

87332 00

Pathology

0.37

0.37

24.88

24.88

87335 00

Pathology

0.39

0.39

26.29

26.29

87336 00

Pathology

0.49

0.49

33.23

33.23

87337 00

Pathology

0.37

0.37

24.88

24.88

87338 00

Pathology

0.44

0.44

29.86

29.86

87339 00

Pathology

0.49

0.49

33.23

33.23

87340 00

Pathology

0.32

0.32

21.45

21.45

87341 00

Pathology

0.32

0.32

21.45

21.45

87350 00

Pathology

0.35

0.35

23.94

23.94

87380 00

Pathology

0.56

0.56

38.13

38.13

87385 00

Pathology

0.40

0.40

27.52

27.52

87389 00

Pathology

0.74

0.74

50.01

50.01

87390 00

Pathology

0.73

0.73

49.97

49.97

87391 00

Pathology

0.67

0.67

45.48

45.48

87400 00

Pathology

0.43

0.43

29.34

29.34

87420 00

Pathology

0.42

0.42

28.89

28.89

87425 00

Pathology

0.37

0.37

24.88

24.88

87426 00

Pathology

1.08

1.08

73.37

73.37

87427 00

Pathology

0.37

0.37

24.88

24.88

87428 00

Pathology

2.15

2.15

145.97

145.97

87430 00

Pathology

0.51

0.51

34.91

34.91

87449 00

Pathology

0.37

0.37

24.88

24.88

87451 00

Pathology

0.32

0.32

21.83

21.83

87467 00

Pathology

-

-

30.20

30.20

87468 00

Pathology

1.07

1.07

72.87

72.87

87469 00

Pathology

1.07

1.07

72.87

72.87

87471 00

Pathology

1.07

1.07

72.87

72.87

87472 00

Pathology

1.31

1.31

88.97

88.97

87475 00

Pathology

0.61

0.61

41.64

41.64

87476 00

Pathology

1.07

1.07

72.87

72.87

87478 00

Pathology

1.07

1.07

72.87

72.87

87480 00

Pathology

0.61

0.61

41.64

41.64

87481 00

Pathology

1.07

1.07

72.87

72.87

87482 00

Pathology

1.70

1.70

115.76

115.76

87483 00

Pathology

12.73

12.73

865.53

865.53

87484 00

Pathology

1.07

1.07

72.87

72.87

87485 00

Pathology

0.61

0.61

41.64

41.64

87486 00

Pathology

1.07

1.07

72.87

72.87

87487 00

Pathology

1.31

1.31

88.97

88.97

87490 00

Pathology

0.69

0.69

47.25

47.25

87491 00

Pathology

1.07

1.07

72.87

72.87

87492 00

Pathology

1.63

1.63

111.04

111.04

87493 00

Pathology

1.14

1.14

77.40

77.40

87495 00

Pathology

0.92

0.92

62.36

62.36

87496 00

Pathology

1.07

1.07

72.87

72.87

87497 00

Pathology

1.31

1.31

88.97

88.97

87498 00

Pathology

1.07

1.07

72.87

72.87

87500 00

Pathology

1.07

1.07

72.87

72.87

87501 00

Pathology

1.57

1.57

106.56

106.56

87502 00

Pathology

2.93

2.93

198.95

198.95

87503 00

Pathology

0.89

0.89

60.68

60.68

87505 00

Pathology

3.92

3.92

266.42

266.42

87506 00

Pathology

8.03

8.03

546.15

546.15

87507 00

Pathology

12.73

12.73

865.53

865.53

87510 00

Pathology

0.61

0.61

41.64

41.64

87511 00

Pathology

1.07

1.07

72.87

72.87

87512 00

Pathology

1.28

1.28

86.72

86.72

87516 00

Pathology

1.07

1.07

72.87

72.87

87517 00

Pathology

1.31

1.31

88.97

88.97

87520 00

Pathology

0.95

0.95

64.83

64.83

87521 00

Pathology

1.07

1.07

72.87

72.87

87522 00

Pathology

1.31

1.31

88.97

88.97

87523 00

Pathology

1.31

1.31

88.97

88.97

87525 00

Pathology

0.91

0.91

61.89

61.89

87526 00

Pathology

1.20

1.20

81.53

81.53

87527 00

Pathology

1.28

1.28

86.72

86.72

87528 00

Pathology

0.61

0.61

41.64

41.64

87529 00

Pathology

1.07

1.07

72.87

72.87

87530 00

Pathology

1.31

1.31

88.97

88.97

87531 00

Pathology

1.77

1.77

120.45

120.45

87532 00

Pathology

1.07

1.07

72.87

72.87

87533 00

Pathology

1.28

1.28

86.72

86.72

87534 00

Pathology

0.67

0.67

45.52

45.52

87535 00

Pathology

1.07

1.07

72.87

72.87

87536 00

Pathology

2.60

2.60

176.73

176.73

87537 00

Pathology

0.67

0.67

45.52

45.52

87538 00

Pathology

1.07

1.07

72.87

72.87

87539 00

Pathology

1.79

1.79

121.74

121.74

87540 00

Pathology

0.61

0.61

41.64

41.64

87541 00

Pathology

1.07

1.07

72.87

72.87

87542 00

Pathology

1.28

1.28

86.72

86.72

87550 00

Pathology

0.61

0.61

41.64

41.64

87551 00

Pathology

1.47

1.47

100.18

100.18

87552 00

Pathology

1.31

1.31

88.97

88.97

87555 00

Pathology

0.82

0.82

55.82

55.82

87556 00

Pathology

1.27

1.27

86.56

86.56

87557 00

Pathology

1.31

1.31

88.97

88.97

87560 00

Pathology

0.83

0.83

56.67

56.67

87561 00

Pathology

1.07

1.07

72.87

72.87

87562 00

Pathology

1.31

1.31

88.97

88.97

87563 00

Pathology

1.07

1.07

72.87

72.87

87580 00

Pathology

0.61

0.61

41.64

41.64

87581 00

Pathology

1.07

1.07

72.87

72.87

87582 00

Pathology

9.24

9.24

628.45

628.45

87590 00

Pathology

0.82

0.82

55.82

55.82

87591 00

Pathology

1.07

1.07

72.87

72.87

87592 00

Pathology

1.31

1.31

88.97

88.97

87593 00

Pathology

-

-

82.96

82.96

87623 00

Pathology

1.07

1.07

72.87

72.87

87624 00

Pathology

1.07

1.07

72.87

72.87

87625 00

Pathology

1.24

1.24

84.21

84.21

87631 00

Pathology

4.36

4.36

296.20

296.20

87632 00

Pathology

6.66

6.66

452.85

452.85

87633 00

Pathology

12.73

12.73

865.53

865.53

87634 00

Pathology

2.14

2.14

145.78

145.78

87635 00

Pathology

1.57

1.57

106.56

106.56

87636 00

Pathology

4.36

4.36

296.20

296.20

87637 00

Pathology

4.36

4.36

296.20

296.20

87640 00

Pathology

1.07

1.07

72.87

72.87

87641 00

Pathology

1.07

1.07

72.87

72.87

87650 00

Pathology

0.61

0.61

41.64

41.64

87651 00

Pathology

1.07

1.07

72.87

72.87

87652 00

Pathology

1.28

1.28

86.72

86.72

87653 00

Pathology

1.07

1.07

72.87

72.87

87660 00

Pathology

0.61

0.61

41.64

41.64

87661 00

Pathology

1.07

1.07

72.87

72.87

87662 00

Pathology

1.57

1.57

106.56

106.56

87797 00

Pathology

0.92

0.92

62.36

62.36

87798 00

Pathology

1.07

1.07

72.87

72.87

87799 00

Pathology

1.31

1.31

88.97

88.97

87800 00

Pathology

1.33

1.33

90.69

90.69

87801 00

Pathology

2.14

2.14

145.78

145.78

87802 00

Pathology

0.39

0.39

26.44

26.44

87803 00

Pathology

0.49

0.49

33.23

33.23

87804 00

Pathology

0.51

0.51

34.37

34.37

87806 00

Pathology

1.00

1.00

68.05

68.05

87807 00

Pathology

0.40

0.40

27.20

27.20

87808 00

Pathology

0.47

0.47

31.75

31.75

87809 00

Pathology

0.66

0.66

45.19

45.19

87810 00

Pathology

1.08

1.08

73.29

73.29

87811 00

Pathology

1.26

1.26

85.93

85.93

87850 00

Pathology

0.75

0.75

51.00

51.00

87880 00

Pathology

0.50

0.50

34.33

34.33

87899 00

Pathology

0.49

0.49

33.37

33.37

87900 00

Pathology

3.98

3.98

270.70

270.70

87901 00

Pathology

7.86

7.86

534.65

534.65

87902 00

Pathology

7.86

7.86

534.65

534.65

87903 00

Pathology

14.92

14.92

1014.80

1014.80

87904 00

Pathology

0.80

0.80

54.14

54.14

87905 00

Pathology

0.37

0.37

25.38

25.38

87906 00

Pathology

3.93

3.93

267.33

267.33

87910 00

Pathology

7.86

7.86

534.65

534.65

87912 00

Pathology

7.86

7.86

534.65

534.65

87913 00

Pathology

7.86

7.86

534.65

534.65

87999 00

Pathology

0.00

0.00

BR

BR

88000 00

Pathology

0.00

0.00

BR

BR

88005 00

Pathology

0.00

0.00

BR

BR

88007 00

Pathology

0.00

0.00

BR

BR

88012 00

Pathology

0.00

0.00

BR

BR

88014 00

Pathology

0.00

0.00

BR

BR

88016 00

Pathology

0.00

0.00

BR

BR

88020 00

Pathology

0.00

0.00

BR

BR

88025 00

Pathology

0.00

0.00

BR

BR

88027 00

Pathology

0.00

0.00

BR

BR

88028 00

Pathology

0.00

0.00

BR

BR

88029 00

Pathology

0.00

0.00

BR

BR

88036 00

Pathology

0.00

0.00

BR

BR

88037 00

Pathology

0.00

0.00

BR

BR

88040 00

Pathology

0.00

0.00

BR

BR

88045 00

Pathology

0.00

0.00

BR

BR

88099 00

Pathology

0.00

0.00

BR

BR

88104 00

Pathology

2.27

2.27

154.36

154.36

88104 26

Pathology

0.80

0.80

54.40

54.40

88104 TC

Pathology

1.47

1.47

99.96

99.96

88106 00

Pathology

2.14

2.14

145.52

145.52

88106 26

Pathology

0.55

0.55

37.40

37.40

88106 TC

Pathology

1.59

1.59

108.12

108.12

88108 00

Pathology

2.06

2.06

140.08

140.08

88108 26

Pathology

0.65

0.65

44.20

44.20

88108 TC

Pathology

1.41

1.41

95.88

95.88

88112 00

Pathology

2.04

2.04

138.72

138.72

88112 26

Pathology

0.80

0.80

54.40

54.40

88112 TC

Pathology

1.24

1.24

84.32

84.32

88120 00

Pathology

17.39

17.39

1182.52

1182.52

88120 26

Pathology

1.68

1.68

114.24

114.24

88120 TC

Pathology

15.71

15.71

1068.28

1068.28

88121 00

Pathology

12.58

12.58

855.44

855.44

88121 26

Pathology

1.40

1.40

95.20

95.20

88121 TC

Pathology

11.18

11.18

760.24

760.24

88125 00

Pathology

0.86

0.86

58.48

58.48

88125 26

Pathology

0.40

0.40

27.20

27.20

88125 TC

Pathology

0.46

0.46

31.28

31.28

88130 00

Pathology

0.55

0.55

37.34

37.34

88140 00

Pathology

0.24

0.24

16.59

16.59

88141 00

Pathology

0.72

0.72

48.96

48.96

88142 00

Pathology

0.62

0.62

42.07

42.07

88143 00

Pathology

0.70

0.70

47.85

47.85

88147 00

Pathology

1.54

1.54

105.00

105.00

88148 00

Pathology

0.54

0.54

36.88

36.88

88150 00

Pathology

0.54

0.54

36.88

36.88

88152 00

Pathology

0.84

0.84

57.40

57.40

88153 00

Pathology

0.73

0.73

49.90

49.90

88155 00

Pathology

0.45

0.45

30.42

30.42

88160 00

Pathology

2.39

2.39

162.52

162.52

88160 26

Pathology

0.74

0.74

50.32

50.32

88160 TC

Pathology

1.65

1.65

112.20

112.20

88161 00

Pathology

2.44

2.44

165.92

165.92

88161 26

Pathology

0.73

0.73

49.64

49.64

88161 TC

Pathology

1.71

1.71

116.28

116.28

88162 00

Pathology

3.86

3.86

262.48

262.48

88162 26

Pathology

1.14

1.14

77.52

77.52

88162 TC

Pathology

2.72

2.72

184.96

184.96

88164 00

Pathology

0.54

0.54

36.88

36.88

88165 00

Pathology

1.29

1.29

87.68

87.68

88166 00

Pathology

0.54

0.54

36.88

36.88

88167 00

Pathology

0.54

0.54

36.88

36.88

88172 00

Pathology

1.67

1.67

113.56

113.56

88172 26

Pathology

1.02

1.02

69.36

69.36

88172 TC

Pathology

0.65

0.65

44.20

44.20

88173 00

Pathology

5.02

5.02

341.36

341.36

88173 26

Pathology

2.02

2.02

137.36

137.36

88173 TC

Pathology

3.00

3.00

204.00

204.00

88174 00

Pathology

0.77

0.77

52.69

52.69

88175 00

Pathology

0.81

0.81

55.26

55.26

88177 00

Pathology

0.88

0.88

59.84

59.84

88177 26

Pathology

0.63

0.63

42.84

42.84

88177 TC

Pathology

0.25

0.25

17.00

17.00

88182 00

Pathology

5.01

5.01

340.68

340.68

88182 26

Pathology

1.11

1.11

75.48

75.48

88182 TC

Pathology

3.90

3.90

265.20

265.20

88184 00

Pathology

2.34

2.34

159.12

159.12

88185 00

Pathology

0.71

0.71

48.28

48.28

88187 00

Pathology

1.05

1.05

71.40

71.40

88188 00

Pathology

1.81

1.81

123.08

123.08

88189 00

Pathology

2.45

2.45

166.60

166.60

88199 00

Pathology

0.00

0.00

BR

BR

88199 26

Pathology

0.00

0.00

BR

BR

88199 TC

Pathology

0.00

0.00

BR

BR

88230 00

Pathology

3.56

3.56

241.92

241.92

88233 00

Pathology

4.30

4.30

292.25

292.25

88235 00

Pathology

4.59

4.59

312.13

312.13

88237 00

Pathology

4.39

4.39

298.53

298.53

88239 00

Pathology

4.51

4.51

306.36

306.36

88240 00

Pathology

0.40

0.40

27.14

27.14

88241 00

Pathology

0.37

0.37

25.11

25.11

88245 00

Pathology

5.29

5.29

359.62

359.62

88248 00

Pathology

5.29

5.29

359.62

359.62

88249 00

Pathology

5.29

5.29

359.62

359.62

88261 00

Pathology

8.07

8.07

548.96

548.96

88262 00

Pathology

3.83

3.83

260.61

260.61

88263 00

Pathology

4.59

4.59

312.11

312.11

88264 00

Pathology

4.42

4.42

300.31

300.31

88267 00

Pathology

5.76

5.76

391.60

391.60

88269 00

Pathology

5.30

5.30

360.64

360.64

88271 00

Pathology

0.65

0.65

44.48

44.48

88272 00

Pathology

1.24

1.24

84.52

84.52

88273 00

Pathology

1.06

1.06

72.29

72.29

88274 00

Pathology

1.29

1.29

88.01

88.01

88275 00

Pathology

1.56

1.56

106.31

106.31

88280 00

Pathology

1.02

1.02

69.51

69.51

88283 00

Pathology

2.10

2.10

142.46

142.46

88285 00

Pathology

0.82

0.82

55.88

55.88

88289 00

Pathology

1.05

1.05

71.50

71.50

88291 00

Pathology

1.00

1.00

68.00

68.00

88299 00

Pathology

0.00

0.00

BR

BR

88300 00

Pathology

0.49

0.49

33.32

33.32

88300 26

Pathology

0.13

0.13

8.84

8.84

88300 TC

Pathology

0.36

0.36

24.48

24.48

88302 00

Pathology

1.00

1.00

68.00

68.00

88302 26

Pathology

0.20

0.20

13.60

13.60

88302 TC

Pathology

0.80

0.80

54.40

54.40

88304 00

Pathology

1.29

1.29

87.72

87.72

88304 26

Pathology

0.33

0.33

22.44

22.44

88304 TC

Pathology

0.96

0.96

65.28

65.28

88305 00

Pathology

2.15

2.15

146.20

146.20

88305 26

Pathology

1.08

1.08

73.44

73.44

88305 TC

Pathology

1.07

1.07

72.76

72.76

88307 00

Pathology

8.64

8.64

587.52

587.52

88307 26

Pathology

2.37

2.37

161.16

161.16

88307 TC

Pathology

6.27

6.27

426.36

426.36

88309 00

Pathology

12.98

12.98

882.64

882.64

88309 26

Pathology

4.18

4.18

284.24

284.24

88309 TC

Pathology

8.80

8.80

598.40

598.40

88311 00

Pathology

0.61

0.61

41.48

41.48

88311 26

Pathology

0.35

0.35

23.80

23.80

88311 TC

Pathology

0.26

0.26

17.68

17.68

88312 00

Pathology

3.38

3.38

229.84

229.84

88312 26

Pathology

0.77

0.77

52.36

52.36

88312 TC

Pathology

2.61

2.61

177.48

177.48

88313 00

Pathology

2.49

2.49

169.32

169.32

88313 26

Pathology

0.35

0.35

23.80

23.80

88313 TC

Pathology

2.14

2.14

145.52

145.52

88314 00

Pathology

2.66

2.66

180.88

180.88

88314 26

Pathology

0.59

0.59

40.12

40.12

88314 TC

Pathology

2.07

2.07

140.76

140.76

88319 00

Pathology

4.10

4.10

278.80

278.80

88319 26

Pathology

0.78

0.78

53.04

53.04

88319 TC

Pathology

3.32

3.32

225.76

225.76

88321 00

Pathology

2.89

2.44

196.52

165.92

88323 00

Pathology

3.45

3.45

234.60

234.60

88323 26

Pathology

2.56

2.56

174.08

174.08

88323 TC

Pathology

0.89

0.89

60.52

60.52

88325 00

Pathology

4.63

3.92

314.84

266.56

88329 00

Pathology

1.65

1.03

112.20

70.04

88331 00

Pathology

3.03

3.03

206.04

206.04

88331 26

Pathology

1.79

1.79

121.72

121.72

88331 TC

Pathology

1.24

1.24

84.32

84.32

88332 00

Pathology

1.63

1.63

110.84

110.84

88332 26

Pathology

0.88

0.88

59.84

59.84

88332 TC

Pathology

0.75

0.75

51.00

51.00

88333 00

Pathology

2.74

2.74

186.32

186.32

88333 26

Pathology

1.78

1.78

121.04

121.04

88333 TC

Pathology

0.96

0.96

65.28

65.28

88334 00

Pathology

1.66

1.66

112.88

112.88

88334 26

Pathology

1.08

1.08

73.44

73.44

88334 TC

Pathology

0.58

0.58

39.44

39.44

88341 00

Pathology

2.72

2.72

184.96

184.96

88341 26

Pathology

0.81

0.81

55.08

55.08

88341 TC

Pathology

1.91

1.91

129.88

129.88

88342 00

Pathology

3.18

3.18

216.24

216.24

88342 26

Pathology

1.01

1.01

68.68

68.68

88342 TC

Pathology

2.17

2.17

147.56

147.56

88344 00

Pathology

5.19

5.19

352.92

352.92

88344 26

Pathology

1.11

1.11

75.48

75.48

88344 TC

Pathology

4.08

4.08

277.44

277.44

88346 00

Pathology

4.50

4.50

306.00

306.00

88346 26

Pathology

1.04

1.04

70.72

70.72

88346 TC

Pathology

3.46

3.46

235.28

235.28

88348 00

Pathology

14.53

14.53

988.04

988.04

88348 26

Pathology

2.23

2.23

151.64

151.64

88348 TC

Pathology

12.30

12.30

836.40

836.40

88350 00

Pathology

3.42

3.42

232.56

232.56

88350 26

Pathology

0.84

0.84

57.12

57.12

88350 TC

Pathology

2.58

2.58

175.44

175.44

88355 00

Pathology

3.79

3.79

257.72

257.72

88355 26

Pathology

2.21

2.21

150.28

150.28

88355 TC

Pathology

1.58

1.58

107.44

107.44

88356 00

Pathology

7.06

7.06

480.08

480.08

88356 26

Pathology

3.55

3.55

241.40

241.40

88356 TC

Pathology

3.51

3.51

238.68

238.68

88358 00

Pathology

4.10

4.10

278.80

278.80

88358 26

Pathology

1.43

1.43

97.24

97.24

88358 TC

Pathology

2.67

2.67

181.56

181.56

88360 00

Pathology

3.61

3.61

245.48

245.48

88360 26

Pathology

1.20

1.20

81.60

81.60

88360 TC

Pathology

2.41

2.41

163.88

163.88

88361 00

Pathology

3.58

3.58

243.44

243.44

88361 26

Pathology

1.26

1.26

85.68

85.68

88361 TC

Pathology

2.32

2.32

157.76

157.76

88362 00

Pathology

6.87

6.87

467.16

467.16

88362 26

Pathology

3.22

3.22

218.96

218.96

88362 TC

Pathology

3.65

3.65

248.20

248.20

88363 00

Pathology

0.69

0.56

46.92

38.08

88364 00

Pathology

4.00

4.00

272.00

272.00

88364 26

Pathology

0.98

0.98

66.64

66.64

88364 TC

Pathology

3.02

3.02

205.36

205.36

88365 00

Pathology

5.32

5.32

361.76

361.76

88365 26

Pathology

1.24

1.24

84.32

84.32

88365 TC

Pathology

4.08

4.08

277.44

277.44

88366 00

Pathology

8.15

8.15

554.20

554.20

88366 26

Pathology

1.78

1.78

121.04

121.04

88366 TC

Pathology

6.37

6.37

433.16

433.16

88367 00

Pathology

3.35

3.35

227.80

227.80

88367 26

Pathology

0.96

0.96

65.28

65.28

88367 TC

Pathology

2.39

2.39

162.52

162.52

88368 00

Pathology

4.44

4.44

301.92

301.92

88368 26

Pathology

1.22

1.22

82.96

82.96

88368 TC

Pathology

3.22

3.22

218.96

218.96

88369 00

Pathology

3.85

3.85

261.80

261.80

88369 26

Pathology

0.97

0.97

65.96

65.96

88369 TC

Pathology

2.88

2.88

195.84

195.84

88371 00

Pathology

0.68

0.68

46.17

46.17

88371 26

Pathology

0.56

0.56

38.08

38.08

88372 00

Pathology

0.80

0.80

54.45

54.45

88372 26

Pathology

0.52

0.52

35.36

35.36

88373 00

Pathology

2.03

2.03

138.04

138.04

88373 26

Pathology

0.73

0.73

49.64

49.64

88373 TC

Pathology

1.30

1.30

88.40

88.40

88374 00

Pathology

8.63

8.63

586.84

586.84

88374 26

Pathology

1.22

1.22

82.96

82.96

88374 TC

Pathology

7.41

7.41

503.88

503.88

88375 00

Pathology

1.40

1.40

95.20

95.20

88377 00

Pathology

11.86

11.86

806.48

806.48

88377 26

Pathology

1.85

1.85

125.80

125.80

88377 TC

Pathology

10.01

10.01

680.68

680.68

88380 00

Pathology

3.73

3.73

253.64

253.64

88380 26

Pathology

1.52

1.52

103.36

103.36

88380 TC

Pathology

2.21

2.21

150.28

150.28

88381 00

Pathology

6.04

6.04

410.72

410.72

88381 26

Pathology

0.68

0.68

46.24

46.24

88381 TC

Pathology

5.36

5.36

364.48

364.48

88387 00

Pathology

0.99

0.99

67.32

67.32

88387 26

Pathology

0.77

0.77

52.36

52.36

88387 TC

Pathology

0.22

0.22

14.96

14.96

88388 00

Pathology

1.08

1.08

73.44

73.44

88388 26

Pathology

0.68

0.68

46.24

46.24

88388 TC

Pathology

0.40

0.40

27.20

27.20

88399 00

Pathology

0.00

0.00

BR

BR

88399 26

Pathology

0.00

0.00

BR

BR

88399 TC

Pathology

0.00

0.00

BR

BR

88720 00

Pathology

0.15

0.15

10.43

10.43

88738 00

Pathology

0.15

0.15

10.43

10.43

88740 00

Pathology

0.29

0.29

19.46

19.46

88741 00

Pathology

0.29

0.29

19.46

19.46

88749 00

Pathology

0.00

0.00

BR

BR

89049 00

Pathology

8.57

1.82

582.76

123.76

89050 00

Pathology

0.14

0.14

9.80

9.80

89051 00

Pathology

0.17

0.17

11.63

11.63

89055 00

Pathology

0.13

0.13

8.87

8.87

89060 00

Pathology

0.22

0.22

15.22

15.22

89060 26

Pathology

0.52

0.52

35.36

35.36

89125 00

Pathology

0.18

0.18

12.21

12.21

89160 00

Pathology

0.15

0.15

10.07

10.07

89190 00

Pathology

0.18

0.18

12.02

12.02

89220 00

Pathology

0.58

0.58

39.44

39.44

89230 00

Pathology

0.09

0.09

6.12

6.12

89240 00

Pathology

0.00

0.00

BR

BR

89250 00

Pathology

-

-

3315.68

3315.68

89251 00

Pathology

-

-

2486.76

2486.76

89253 00

Pathology

-

-

1657.84

1657.84

89254 00

Pathology

-

-

1339.60

1339.60

89255 00

Pathology

-

-

994.84

994.84

89257 00

Pathology

-

-

994.84

994.84

89258 00

Pathology

-

-

1989.00

1989.00

89259 00

Pathology

-

-

515.44

515.44

89260 00

Pathology

-

-

429.08

429.08

89261 00

Pathology

-

-

488.92

488.92

89264 00

Pathology

-

-

1077.80

1077.80

89268 00

Pathology

-

-

1357.96

1357.96

89272 00

Pathology

-

-

2536.40

2536.40

89280 00

Pathology

-

-

3542.80

3542.80

89281 00

Pathology

-

-

3201.44

3201.44

89290 00

Pathology

-

-

3389.80

3389.80

89291 00

Pathology

-

-

4144.60

4144.60

89300 00

Pathology

0.30

0.30

20.43

20.43

89310 00

Pathology

0.26

0.26

17.88

17.88

89320 00

Pathology

0.38

0.38

25.56

25.56

89321 00

Pathology

0.37

0.37

25.02

25.02

89322 00

Pathology

0.47

0.47

32.19

32.19

89325 00

Pathology

0.33

0.33

22.16

22.16

89329 00

Pathology

0.60

0.60

40.68

40.68

89330 00

Pathology

0.32

0.32

21.56

21.56

89331 00

Pathology

0.60

0.60

40.68

40.68

89335 00

Pathology

-

-

663.00

663.00

89337 00

Pathology

-

-

7874.40

7874.40

89342 00

Pathology

-

-

1243.04

1243.04

89343 00

Pathology

-

-

1094.12

1094.12

89344 00

Pathology

-

-

994.84

994.84

89346 00

Pathology

-

-

1300.84

1300.84

89352 00

Pathology

-

-

1044.48

1044.48

89353 00

Pathology

-

-

331.84

331.84

89354 00

Pathology

-

-

497.08

497.08

89356 00

Pathology

-

-

994.84

994.84

89398 00

Pathology

0.00

0.00

BR

BR

G0480 00

Pathology

3.49

3.49

237.64

237.64

G0481 00

Pathology

4.78

4.78

325.19

325.19

G0482 00

Pathology

6.07

6.07

412.72

412.72

G0483 00

Pathology

7.54

7.54

512.78

512.78

G0659 00

Pathology

1.90

1.90

129.05

129.05

MEDICINE GUIDELINES

Information regarding publications incorporated by reference is found in the Introduction Section of the Fee Schedule.

The following Commission guidelines are in addition to the CPT® guidelines and represent additional guidance from the Commission relative to unit values for these services. To the extent that a conflict may exist between an incorporated portion of the CPT® publication or HCPCS codes and a code, guideline, identifier, or modifier unique to Arizona, then the Arizona code, guideline, identifier, or modifier shall control. Codes that are unique to Arizona are preceded by an AZ identifier and numbered in the following format: AZxxx.

A. MATERIALS SUPPLIED BY A HEALTHCARE PROVIDER: A healthcare provider may charge for materials and supplies as described in the HCPCS Section of the Physician's Fee Schedule.

B. COMPLIANCE WITH THE AMERICANS WITH DISABILITIES ACT: CPT® Code 99199 can be used to bill for the services of an interpreter when they are used to comply with the provisions of "The Americans With Disabilities Act", i.e., interpreters for the hearing impaired.

C. ADD-ON CODES: Some of the listed procedures are commonly carried out in addition to the primary procedure performed. All add-on codes found in the CPT® codebook are exempt from the multiple procedure concept. They are exempt from the use of modifier 51.

D. SEPARATE PROCEDURES: Some of the procedures or services listed in the CPT® codebook that are commonly carried out as an integral component of a total service or procedure have been identified by the inclusion of the term "separate procedure". The codes designated as a "separate procedure" should not be reported in addition to the code for the total procedure or service of which it is considered an integral component.

When a procedure or service is carried out independently or considered to be unrelated or distinct from other procedures/services provided at that time, it may be reported by itself, or in addition to other procedures/services by appending modifier 59 to the specific "separate procedure" code to indicate that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure.

E. BUNDLED CODES: Indicates that the service is always bundled in a payment for another service. If these services are covered, payment for them is subsumed by the payment for the services to which they are incident (e.g., a telephone call from a hospital nurse regarding the care of a patient).

F. MODERATE SEDATION: Codes specific to the provider performing the services (e.g., CPT® codes 99151, 99152, and 99153) are used when the physician performing the procedure provides the sedation whereas CPT® codes 99155, 99156, and 99157 are used when sedation is provided by a healthcare professional other than the physician performing the procedure.

ARIZONA PHYSICIANS' FEE SCHEDULE

Medicine Codes 2024

Medicine Conversion Factor $68.00

Code

Category

FY24 NF RVU

FY24 FAC RVU

FY24 NF RBRVS Rate

FY24 FAC RBRVS Rate

90281 00

Medicine

-

-

101.32

101.32

90283 00

Medicine

-

-

30.60

30.60

90284 00

Medicine

0.00

0.00

BR

BR

90287 00

Medicine

0.00

0.00

BR

BR

90288 00

Medicine

0.00

0.00

BR

BR

90291 00

Medicine

-

-

114.92

114.92

90296 00

Medicine

0.00

0.00

BR

BR

90371 00

Medicine

-

-

286.28

286.28

90375 00

Medicine

-

-

602.48

602.48

90376 00

Medicine

-

-

996.20

996.20

90377 00

Medicine

-

-

532.44

532.44

90378 00

Medicine

-

-

1885.64

1885.64

90380 00

Medicine

0.00

0.00

BR

BR

90381 00

Medicine

0.00

0.00

BR

BR

90384 00

Medicine

-

-

133.96

133.96

90385 00

Medicine

-

-

63.92

63.92

90386 00

Medicine

-

-

84.32

84.32

90389 00

Medicine

-

-

101.32

101.32

90393 00

Medicine

-

-

34.00

34.00

90396 00

Medicine

-

-

149.60

149.60

90399 00

Medicine

0.00

0.00

BR

BR

90460 00

Medicine

0.69

0.69

46.92

46.92

90461 00

Medicine

0.26

0.26

17.68

17.68

90471 00

Medicine

0.62

0.62

42.16

42.16

90472 00

Medicine

0.44

0.44

29.92

29.92

90473 00

Medicine

0.50

0.50

34.00

34.00

90474 00

Medicine

0.36

0.36

24.48

24.48

90476 00

Medicine

-

-

47.60

47.60

90477 00

Medicine

0.00

0.00

BR

BR

90480 00

Medicine

-

-

51.00

51.00

90581 00

Medicine

0.00

0.00

BR

BR

90584 00

Medicine

0.00

0.00

BR

BR

90585 00

Medicine

-

-

31.28

31.28

90586 00

Medicine

-

-

299.88

299.88

90587 00

Medicine

0.00

0.00

BR

BR

90589 00

Medicine

0.00

0.00

BR

BR

90611 00

Medicine

-

-

27.20

27.20

90619 00

Medicine

-

-

152.32

152.32

90620 00

Medicine

-

-

201.96

201.96

90621 00

Medicine

-

-

166.60

166.60

90622 00

Medicine

-

-

23.80

23.80

90623 00

Medicine

0.00

0.00

BR

BR

90625 00

Medicine

-

-

267.24

267.24

90626 00

Medicine

-

-

334.56

334.56

90627 00

Medicine

-

-

283.56

283.56

90630 00

Medicine

-

-

34.00

34.00

90632 00

Medicine

-

-

146.20

146.20

90633 00

Medicine

-

-

48.96

48.96

90634 00

Medicine

-

-

70.04

70.04

90636 00

Medicine

-

-

124.44

124.44

90644 00

Medicine

-

-

52.36

52.36

90647 00

Medicine

-

-

42.16

42.16

90648 00

Medicine

-

-

37.40

37.40

90649 00

Medicine

-

-

174.76

174.76

90650 00

Medicine

-

-

178.16

178.16

90651 00

Medicine

-

-

242.08

242.08

90653 00

Medicine

-

-

55.76

55.76

90654 00

Medicine

-

-

25.84

25.84

90655 00

Medicine

-

-

23.80

23.80

90656 00

Medicine

-

-

27.20

27.20

90657 00

Medicine

-

-

23.80

23.80

90658 00

Medicine

-

-

23.80

23.80

90660 00

Medicine

-

-

40.80

40.80

90661 00

Medicine

-

-

23.80

23.80

90662 00

Medicine

-

-

152.32

152.32

90664 00

Medicine

0.00

0.00

BR

BR

90666 00

Medicine

-

-

47.60

47.60

90667 00

Medicine

-

-

10.20

10.20

90668 00

Medicine

-

-

34.00

34.00

90670 00

Medicine

-

-

535.84

535.84

90671 00

Medicine

-

-

526.32

526.32

90672 00

Medicine

-

-

57.80

57.80

90673 00

Medicine

-

-

47.60

47.60

90674 00

Medicine

-

-

70.72

70.72

90675 00

Medicine

-

-

674.56

674.56

90676 00

Medicine

-

-

182.24

182.24

90677 00

Medicine

-

-

599.76

599.76

90678 00

Medicine

0.00

0.00

BR

BR

90679 00

Medicine

0.00

0.00

BR

BR

90680 00

Medicine

-

-

101.32

101.32

90681 00

Medicine

-

-

135.32

135.32

90682 00

Medicine

-

-

152.32

152.32

90683 00

Medicine

0.00

0.00

BR

BR

90685 00

Medicine

-

-

34.00

34.00

90686 00

Medicine

-

-

46.24

46.24

90687 00

Medicine

-

-

21.76

21.76

90688 00

Medicine

-

-

43.52

43.52

90689 00

Medicine

-

-

64.60

64.60

90690 00

Medicine

-

-

93.84

93.84

90691 00

Medicine

-

-

104.04

104.04

90694 00

Medicine

-

-

160.48

160.48

90696 00

Medicine

-

-

78.20

78.20

90697 00

Medicine

-

-

142.80

142.80

90698 00

Medicine

-

-

108.12

108.12

90700 00

Medicine

-

-

40.80

40.80

90702 00

Medicine

-

-

40.80

40.80

90707 00

Medicine

-

-

86.36

86.36

90710 00

Medicine

-

-

234.60

234.60

90713 00

Medicine

-

-

44.20

44.20

90714 00

Medicine

-

-

63.24

63.24

90715 00

Medicine

-

-

79.56

79.56

90716 00

Medicine

-

-

143.48

143.48

90717 00

Medicine

-

-

173.40

173.40

90723 00

Medicine

-

-

103.36

103.36

90732 00

Medicine

-

-

277.44

277.44

90733 00

Medicine

-

-

135.32

135.32

90734 00

Medicine

-

-

144.84

144.84

90736 00

Medicine

-

-

202.64

202.64

90738 00

Medicine

-

-

287.64

287.64

90739 00

Medicine

-

-

332.52

332.52

90740 00

Medicine

-

-

316.20

316.20

90743 00

Medicine

-

-

156.40

156.40

90744 00

Medicine

-

-

63.92

63.92

90746 00

Medicine

-

-

146.20

146.20

90747 00

Medicine

-

-

292.40

292.40

90748 00

Medicine

-

-

61.88

61.88

90749 00

Medicine

0.00

0.00

BR

BR

90750 00

Medicine

-

-

181.56

181.56

90756 00

Medicine

-

-

67.32

67.32

90758 00

Medicine

0.00

0.00

BR

BR

90759 00

Medicine

-

-

153.00

153.00

90785 00

Medicine

0.44

0.39

29.92

26.52

90791 00

Medicine

5.17

4.43

351.56

301.24

90792 00

Medicine

5.82

5.08

395.76

345.44

90832 00

Medicine

2.35

2.05

159.80

139.40

90833 00

Medicine

2.16

1.92

146.88

130.56

90834 00

Medicine

3.10

2.71

210.80

184.28

90836 00

Medicine

2.73

2.43

185.64

165.24

90837 00

Medicine

4.57

4.00

310.76

272.00

90838 00

Medicine

3.62

3.22

246.16

218.96

90839 00

Medicine

4.40

3.87

299.20

263.16

90840 00

Medicine

2.18

1.94

148.24

131.92

90845 00

Medicine

2.94

2.60

199.92

176.80

90846 00

Medicine

2.93

2.92

199.24

198.56

90847 00

Medicine

3.07

3.05

208.76

207.40

90849 00

Medicine

1.13

0.88

76.84

59.84

90853 00

Medicine

0.83

0.72

56.44

48.96

90863 00

Medicine

0.75

0.70

51.00

47.60

90865 00

Medicine

4.85

3.64

329.80

247.52

90867 00

Medicine

-

-

542.64

477.36

90868 00

Medicine

-

-

405.96

357.00

90869 00

Medicine

-

-

811.24

714.00

90870 00

Medicine

5.18

3.12

352.24

212.16

90875 00

Medicine

1.75

1.74

119.00

118.32

90876 00

Medicine

3.08

2.76

209.44

187.68

90880 00

Medicine

3.08

2.57

209.44

174.76

90882 00

Medicine

-

-

40.80

36.04

90885 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

90887 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

90889 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

90899 00

Medicine

0.00

0.00

BR

BR

90901 00

Medicine

1.23

0.57

83.64

38.76

90912 00

Medicine

2.42

1.26

164.56

85.68

90913 00

Medicine

0.96

0.71

65.28

48.28

90935 00

Medicine

2.10

2.10

142.80

142.80

90937 00

Medicine

3.02

3.02

205.36

205.36

90940 00

Medicine

-

-

38.08

38.08

90945 00

Medicine

2.54

2.54

172.72

172.72

90947 00

Medicine

3.62

3.62

246.16

246.16

90951 00

Medicine

34.74

34.74

2362.32

2362.32

90952 00

Medicine

0.00

0.00

BR

BR

90953 00

Medicine

-

-

304.64

304.64

90954 00

Medicine

29.78

29.78

2025.04

2025.04

90955 00

Medicine

15.49

15.49

1053.32

1053.32

90956 00

Medicine

10.33

10.33

702.44

702.44

90957 00

Medicine

22.80

22.80

1550.40

1550.40

90958 00

Medicine

14.84

14.84

1009.12

1009.12

90959 00

Medicine

9.68

9.68

658.24

658.24

90960 00

Medicine

10.50

10.50

714.00

714.00

90961 00

Medicine

8.72

8.72

592.96

592.96

90962 00

Medicine

6.02

6.02

409.36

409.36

90963 00

Medicine

18.00

18.00

1224.00

1224.00

90964 00

Medicine

15.43

15.43

1049.24

1049.24

90965 00

Medicine

14.81

14.81

1007.08

1007.08

90966 00

Medicine

8.72

8.72

592.96

592.96

90967 00

Medicine

0.52

0.52

35.36

35.36

90968 00

Medicine

0.51

0.51

34.68

34.68

90969 00

Medicine

0.50

0.50

34.00

34.00

90970 00

Medicine

0.28

0.28

19.04

19.04

90989 00

Medicine

-

-

608.60

608.60

90993 00

Medicine

-

-

91.12

91.12

90997 00

Medicine

2.60

2.60

176.80

176.80

90999 00

Medicine

0.00

0.00

BR

BR

91010 00

Medicine

6.63

6.63

450.84

450.84

91010 26

Medicine

1.90

1.90

129.20

129.20

91010 TC

Medicine

4.73

4.73

321.64

321.64

91013 00

Medicine

0.76

0.76

51.68

51.68

91013 26

Medicine

0.27

0.27

18.36

18.36

91013 TC

Medicine

0.49

0.49

33.32

33.32

91020 00

Medicine

8.29

8.29

563.72

563.72

91020 26

Medicine

2.13

2.13

144.84

144.84

91020 TC

Medicine

6.16

6.16

418.88

418.88

91022 00

Medicine

5.21

5.21

354.28

354.28

91022 26

Medicine

2.13

2.13

144.84

144.84

91022 TC

Medicine

3.08

3.08

209.44

209.44

91030 00

Medicine

4.36

4.36

296.48

296.48

91030 26

Medicine

1.35

1.35

91.80

91.80

91030 TC

Medicine

3.01

3.01

204.68

204.68

91034 00

Medicine

5.74

5.74

390.32

390.32

91034 26

Medicine

1.46

1.46

99.28

99.28

91034 TC

Medicine

4.28

4.28

291.04

291.04

91035 00

Medicine

13.64

13.64

927.52

927.52

91035 26

Medicine

2.39

2.39

162.52

162.52

91035 TC

Medicine

11.25

11.25

765.00

765.00

91037 00

Medicine

5.06

5.06

344.08

344.08

91037 26

Medicine

1.43

1.43

97.24

97.24

91037 TC

Medicine

3.63

3.63

246.84

246.84

91038 00

Medicine

12.08

12.08

821.44

821.44

91038 26

Medicine

1.63

1.63

110.84

110.84

91038 TC

Medicine

10.45

10.45

710.60

710.60

91040 00

Medicine

15.49

15.49

1053.32

1053.32

91040 26

Medicine

1.45

1.45

98.60

98.60

91040 TC

Medicine

14.04

14.04

954.72

954.72

91065 00

Medicine

2.22

2.22

150.96

150.96

91065 26

Medicine

0.29

0.29

19.72

19.72

91065 TC

Medicine

1.93

1.93

131.24

131.24

91110 00

Medicine

21.90

21.90

1489.20

1489.20

91110 26

Medicine

3.30

3.30

224.40

224.40

91110 TC

Medicine

18.60

18.60

1264.80

1264.80

91111 00

Medicine

26.24

26.24

1784.32

1784.32

91111 26

Medicine

1.33

1.33

90.44

90.44

91111 TC

Medicine

24.91

24.91

1693.88

1693.88

91112 00

Medicine

48.27

48.27

3282.36

3282.36

91112 26

Medicine

3.10

3.10

210.80

210.80

91112 TC

Medicine

45.17

45.17

3071.56

3071.56

91113 00

Medicine

26.81

26.81

1823.08

1823.08

91113 26

Medicine

3.56

3.56

242.08

242.08

91113 TC

Medicine

23.25

23.25

1581.00

1581.00

91117 00

Medicine

4.02

4.02

273.36

273.36

91120 00

Medicine

15.00

15.00

1020.00

1020.00

91120 26

Medicine

1.42

1.42

96.56

96.56

91120 TC

Medicine

13.58

13.58

923.44

923.44

91122 00

Medicine

8.28

8.28

563.04

563.04

91122 26

Medicine

2.58

2.58

175.44

175.44

91122 TC

Medicine

5.70

5.70

387.60

387.60

91132 00

Medicine

13.12

13.12

892.16

892.16

91132 26

Medicine

0.77

0.77

52.36

52.36

91132 TC

Medicine

12.35

12.35

839.80

839.80

91133 00

Medicine

13.79

13.79

937.72

937.72

91133 26

Medicine

0.97

0.97

65.96

65.96

91133 TC

Medicine

12.82

12.82

871.76

871.76

91200 00

Medicine

0.92

0.92

62.56

62.56

91200 26

Medicine

0.31

0.31

21.08

21.08

91200 TC

Medicine

0.61

0.61

41.48

41.48

91299 00

Medicine

0.00

0.00

BR

BR

91299 26

Medicine

0.00

0.00

BR

BR

91299 TC

Medicine

0.00

0.00

BR

BR

91304 00

Medicine

-

-

308.04

308.04

91318 00

Medicine

-

-

136.00

136.00

91319 00

Medicine

-

-

182.24

182.24

91320 00

Medicine

-

-

272.00

272.00

91321 00

Medicine

-

-

303.28

303.28

91322 00

Medicine

-

-

303.28

303.28

92002 00

Medicine

2.54

1.34

172.72

91.12

92004 00

Medicine

4.46

2.77

303.28

188.36

92012 00

Medicine

2.67

1.48

181.56

100.64

92014 00

Medicine

3.77

2.23

256.36

151.64

92015 00

Medicine

0.57

0.55

38.76

37.40

92018 00

Medicine

4.11

4.11

279.48

279.48

92019 00

Medicine

2.15

2.15

146.20

146.20

92020 00

Medicine

0.82

0.60

55.76

40.80

92025 00

Medicine

1.09

1.09

74.12

74.12

92025 26

Medicine

0.57

0.57

38.76

38.76

92025 TC

Medicine

0.52

0.52

35.36

35.36

92060 00

Medicine

1.91

1.91

129.88

129.88

92060 26

Medicine

1.09

1.09

74.12

74.12

92060 TC

Medicine

0.82

0.82

55.76

55.76

92065 00

Medicine

1.19

0.99

80.92

67.32

92066 00

Medicine

0.79

0.79

53.72

53.72

92071 00

Medicine

1.08

0.95

73.44

64.60

92072 00

Medicine

3.73

2.75

253.64

187.00

92081 00

Medicine

1.00

1.00

68.00

68.00

92081 26

Medicine

0.47

0.47

31.96

31.96

92081 TC

Medicine

0.53

0.53

36.04

36.04

92082 00

Medicine

1.41

1.41

95.88

95.88

92082 26

Medicine

0.61

0.61

41.48

41.48

92082 TC

Medicine

0.80

0.80

54.40

54.40

92083 00

Medicine

1.90

1.90

129.20

129.20

92083 26

Medicine

0.79

0.79

53.72

53.72

92083 TC

Medicine

1.11

1.11

75.48

75.48

92100 00

Medicine

2.55

0.95

173.40

64.60

92132 00

Medicine

0.94

0.94

63.92

63.92

92132 26

Medicine

0.48

0.48

32.64

32.64

92132 TC

Medicine

0.46

0.46

31.28

31.28

92133 00

Medicine

1.09

1.09

74.12

74.12

92133 26

Medicine

0.63

0.63

42.84

42.84

92133 TC

Medicine

0.46

0.46

31.28

31.28

92134 00

Medicine

1.21

1.21

82.28

82.28

92134 26

Medicine

0.73

0.73

49.64

49.64

92134 TC

Medicine

0.48

0.48

32.64

32.64

92136 00

Medicine

1.41

1.41

95.88

95.88

92136 26

Medicine

0.89

0.89

60.52

60.52

92136 TC

Medicine

0.52

0.52

35.36

35.36

92145 00

Medicine

0.39

0.39

26.52

26.52

92145 26

Medicine

0.16

0.16

10.88

10.88

92145 TC

Medicine

0.23

0.23

15.64

15.64

92201 00

Medicine

0.74

0.67

50.32

45.56

92202 00

Medicine

0.46

0.43

31.28

29.24

92227 00

Medicine

0.53

0.53

36.04

36.04

92228 00

Medicine

0.89

0.89

60.52

60.52

92228 26

Medicine

0.49

0.49

33.32

33.32

92228 TC

Medicine

0.40

0.40

27.20

27.20

92229 00

Medicine

1.23

1.23

83.64

83.64

92230 00

Medicine

4.11

1.02

279.48

69.36

92235 00

Medicine

4.87

4.87

331.16

331.16

92235 26

Medicine

1.24

1.24

84.32

84.32

92235 TC

Medicine

3.63

3.63

246.84

246.84

92240 00

Medicine

5.64

5.64

383.52

383.52

92240 26

Medicine

1.38

1.38

93.84

93.84

92240 TC

Medicine

4.26

4.26

289.68

289.68

92242 00

Medicine

8.43

8.43

573.24

573.24

92242 26

Medicine

1.59

1.59

108.12

108.12

92242 TC

Medicine

6.84

6.84

465.12

465.12

92250 00

Medicine

1.11

1.11

75.48

75.48

92250 26

Medicine

0.61

0.61

41.48

41.48

92250 TC

Medicine

0.50

0.50

34.00

34.00

92260 00

Medicine

0.58

0.32

39.44

21.76

92265 00

Medicine

2.61

2.61

177.48

177.48

92265 26

Medicine

1.34

1.34

91.12

91.12

92265 TC

Medicine

1.27

1.27

86.36

86.36

92270 00

Medicine

3.52

3.52

239.36

239.36

92270 26

Medicine

1.24

1.24

84.32

84.32

92270 TC

Medicine

2.28

2.28

155.04

155.04

92273 00

Medicine

3.78

3.78

257.04

257.04

92273 26

Medicine

1.06

1.06

72.08

72.08

92273 TC

Medicine

2.72

2.72

184.96

184.96

92274 00

Medicine

2.68

2.68

182.24

182.24

92274 26

Medicine

0.97

0.97

65.96

65.96

92274 TC

Medicine

1.71

1.71

116.28

116.28

92283 00

Medicine

1.63

1.63

110.84

110.84

92283 26

Medicine

0.25

0.25

17.00

17.00

92283 TC

Medicine

1.38

1.38

93.84

93.84

92284 00

Medicine

1.12

1.12

76.16

76.16

92285 00

Medicine

0.70

0.70

47.60

47.60

92285 26

Medicine

0.09

0.09

6.12

6.12

92285 TC

Medicine

0.61

0.61

41.48

41.48

92286 00

Medicine

1.17

1.17

79.56

79.56

92286 26

Medicine

0.63

0.63

42.84

42.84

92286 TC

Medicine

0.54

0.54

36.72

36.72

92287 00

Medicine

4.28

4.28

291.04

291.04

92287 26

Medicine

0.87

0.87

59.16

59.16

92287 TC

Medicine

3.41

3.41

231.88

231.88

92310 00

Medicine

2.99

1.69

203.32

114.92

92311 00

Medicine

3.09

1.51

210.12

102.68

92312 00

Medicine

3.69

1.80

250.92

122.40

92313 00

Medicine

2.94

1.26

199.92

85.68

92314 00

Medicine

2.60

1.00

176.80

68.00

92315 00

Medicine

2.45

0.61

166.60

41.48

92316 00

Medicine

3.03

0.92

206.04

62.56

92317 00

Medicine

2.59

0.61

176.12

41.48

92325 00

Medicine

1.23

1.23

83.64

83.64

92326 00

Medicine

1.18

1.18

80.24

80.24

92340 00

Medicine

1.04

0.53

70.72

36.04

92341 00

Medicine

1.19

0.68

80.92

46.24

92342 00

Medicine

1.27

0.77

86.36

52.36

92352 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92353 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92354 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92355 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92358 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92370 00

Medicine

0.91

0.46

61.88

31.28

92371 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92499 00

Medicine

0.00

0.00

BR

BR

92499 26

Medicine

0.00

0.00

BR

BR

92499 TC

Medicine

0.00

0.00

BR

BR

92502 00

Medicine

2.85

2.85

193.80

193.80

92504 00

Medicine

0.87

0.27

59.16

18.36

92507 00

Medicine

2.29

2.29

155.72

155.72

92508 00

Medicine

0.73

0.73

49.64

49.64

92511 00

Medicine

3.52

1.13

239.36

76.84

92512 00

Medicine

1.93

0.81

131.24

55.08

92516 00

Medicine

2.17

0.67

147.56

45.56

92517 00

Medicine

2.31

1.25

157.08

85.00

92518 00

Medicine

2.34

1.27

159.12

86.36

92519 00

Medicine

3.82

1.88

259.76

127.84

92520 00

Medicine

2.63

1.18

178.84

80.24

92521 00

Medicine

3.99

3.99

271.32

271.32

92522 00

Medicine

3.34

3.34

227.12

227.12

92523 00

Medicine

6.84

6.84

465.12

465.12

92524 00

Medicine

3.29

3.29

223.72

223.72

92526 00

Medicine

2.54

2.54

172.72

172.72

92531 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92532 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92533 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92534 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92537 00

Medicine

1.19

1.19

80.92

80.92

92537 26

Medicine

0.91

0.91

61.88

61.88

92537 TC

Medicine

0.28

0.28

19.04

19.04

92538 00

Medicine

0.67

0.67

45.56

45.56

92538 26

Medicine

0.47

0.47

31.96

31.96

92538 TC

Medicine

0.20

0.20

13.60

13.60

92540 00

Medicine

3.20

3.20

217.60

217.60

92540 26

Medicine

2.27

2.27

154.36

154.36

92540 TC

Medicine

0.93

0.93

63.24

63.24

92541 00

Medicine

0.75

0.75

51.00

51.00

92541 26

Medicine

0.62

0.62

42.16

42.16

92541 TC

Medicine

0.13

0.13

8.84

8.84

92542 00

Medicine

0.86

0.86

58.48

58.48

92542 26

Medicine

0.73

0.73

49.64

49.64

92542 TC

Medicine

0.13

0.13

8.84

8.84

92544 00

Medicine

0.53

0.53

36.04

36.04

92544 26

Medicine

0.42

0.42

28.56

28.56

92544 TC

Medicine

0.11

0.11

7.48

7.48

92545 00

Medicine

0.50

0.50

34.00

34.00

92545 26

Medicine

0.39

0.39

26.52

26.52

92545 TC

Medicine

0.11

0.11

7.48

7.48

92546 00

Medicine

3.98

3.98

270.64

270.64

92546 26

Medicine

0.44

0.44

29.92

29.92

92546 TC

Medicine

3.54

3.54

240.72

240.72

92547 00

Medicine

0.32

0.32

21.76

21.76

92548 00

Medicine

1.41

1.41

95.88

95.88

92548 26

Medicine

0.99

0.99

67.32

67.32

92548 TC

Medicine

0.42

0.42

28.56

28.56

92549 00

Medicine

1.93

1.93

131.24

131.24

92549 26

Medicine

1.32

1.32

89.76

89.76

92549 TC

Medicine

0.61

0.61

41.48

41.48

92550 00

Medicine

0.65

0.65

44.20

44.20

92551 00

Medicine

0.38

0.38

25.84

25.84

92552 00

Medicine

1.14

1.14

77.52

77.52

92553 00

Medicine

1.38

1.38

93.84

93.84

92555 00

Medicine

0.87

0.87

59.16

59.16

92556 00

Medicine

1.35

1.35

91.80

91.80

92557 00

Medicine

1.09

0.94

74.12

63.92

92558 00

Medicine

0.28

0.25

19.04

17.00

92562 00

Medicine

1.45

1.45

98.60

98.60

92563 00

Medicine

1.04

1.04

70.72

70.72

92565 00

Medicine

0.63

0.63

42.84

42.84

92567 00

Medicine

0.49

0.32

33.32

21.76

92568 00

Medicine

0.45

0.44

30.60

29.92

92570 00

Medicine

0.96

0.86

65.28

58.48

92571 00

Medicine

0.93

0.93

63.24

63.24

92572 00

Medicine

1.60

1.60

108.80

108.80

92575 00

Medicine

2.22

2.22

150.96

150.96

92576 00

Medicine

1.28

1.28

87.04

87.04

92577 00

Medicine

0.66

0.66

44.88

44.88

92579 00

Medicine

1.32

1.09

89.76

74.12

92582 00

Medicine

2.60

2.60

176.80

176.80

92583 00

Medicine

1.71

1.71

116.28

116.28

92584 00

Medicine

3.32

3.32

225.76

225.76

92587 00

Medicine

0.64

0.64

43.52

43.52

92587 26

Medicine

0.53

0.53

36.04

36.04

92587 TC

Medicine

0.11

0.11

7.48

7.48

92588 00

Medicine

0.99

0.99

67.32

67.32

92588 26

Medicine

0.84

0.84

57.12

57.12

92588 TC

Medicine

0.15

0.15

10.20

10.20

92590 00

Medicine

-

-

100.64

91.80

92591 00

Medicine

-

-

101.32

92.48

92592 00

Medicine

-

-

40.80

36.72

92593 00

Medicine

-

-

54.40

48.96

92594 00

Medicine

-

-

47.60

42.84

92595 00

Medicine

-

-

80.92

74.12

92596 00

Medicine

2.31

2.31

157.08

157.08

92597 00

Medicine

2.17

2.17

147.56

147.56

92601 00

Medicine

4.74

3.62

322.32

246.16

92602 00

Medicine

2.98

2.04

202.64

138.72

92603 00

Medicine

4.45

3.52

302.60

239.36

92604 00

Medicine

2.68

1.95

182.24

132.60

92605 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92606 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92607 00

Medicine

3.72

3.72

252.96

252.96

92608 00

Medicine

1.46

1.46

99.28

99.28

92609 00

Medicine

3.10

3.10

210.80

210.80

92610 00

Medicine

2.56

2.10

174.08

142.80

92611 00

Medicine

2.76

2.76

187.68

187.68

92612 00

Medicine

5.96

1.97

405.28

133.96

92613 00

Medicine

1.08

1.08

73.44

73.44

92614 00

Medicine

4.48

1.94

304.64

131.92

92615 00

Medicine

0.97

0.97

65.96

65.96

92616 00

Medicine

6.86

2.95

466.48

200.60

92617 00

Medicine

1.21

1.21

82.28

82.28

92618 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92620 00

Medicine

2.64

2.34

179.52

159.12

92621 00

Medicine

0.65

0.55

44.20

37.40

92622 00

Medicine

2.37

1.96

161.16

133.28

92623 00

Medicine

0.61

0.52

41.48

35.36

92625 00

Medicine

2.01

1.80

136.68

122.40

92626 00

Medicine

2.58

2.20

175.44

149.60

92627 00

Medicine

0.61

0.52

41.48

35.36

92630 00

Medicine

-

-

118.32

107.44

92633 00

Medicine

-

-

91.12

82.96

92640 00

Medicine

3.24

2.76

220.32

187.68

92650 00

Medicine

0.81

0.81

55.08

55.08

92651 00

Medicine

2.48

2.48

168.64

168.64

92652 00

Medicine

3.36

3.36

228.48

228.48

92653 00

Medicine

2.49

2.49

169.32

169.32

92700 00

Medicine

0.00

0.00

BR

BR

92920 00

Medicine

15.45

15.45

1050.60

1050.60

92921 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92924 00

Medicine

18.43

18.43

1253.24

1253.24

92925 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92928 00

Medicine

17.19

17.19

1168.92

1168.92

92929 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92933 00

Medicine

19.28

19.28

1311.04

1311.04

92934 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92937 00

Medicine

17.19

17.19

1168.92

1168.92

92938 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92941 00

Medicine

19.30

19.30

1312.40

1312.40

92943 00

Medicine

19.30

19.30

1312.40

1312.40

92944 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

92950 00

Medicine

9.71

5.41

660.28

367.88

92953 00

Medicine

0.03

0.03

2.04

2.04

92960 00

Medicine

4.59

3.18

312.12

216.24

92961 00

Medicine

7.16

7.16

486.88

486.88

92970 00

Medicine

5.51

5.51

374.68

374.68

92971 00

Medicine

2.93

2.93

199.24

199.24

92972 00

Medicine

4.28

4.28

291.04

291.04

92973 00

Medicine

5.15

5.15

350.20

350.20

92974 00

Medicine

4.72

4.72

320.96

320.96

92975 00

Medicine

10.98

10.98

746.64

746.64

92977 00

Medicine

1.66

1.66

112.88

112.88

92978 00

Medicine

-

-

536.52

536.52

92978 26

Medicine

2.76

2.76

187.68

187.68

92978 TC

Medicine

-

-

348.84

348.84

92979 00

Medicine

-

-

323.68

323.68

92979 26

Medicine

2.19

2.19

148.92

148.92

92979 TC

Medicine

-

-

174.76

174.76

92986 00

Medicine

38.98

38.98

2650.64

2650.64

92987 00

Medicine

40.17

40.17

2731.56

2731.56

92990 00

Medicine

32.17

32.17

2187.56

2187.56

92997 00

Medicine

18.53

18.53

1260.04

1260.04

92998 00

Medicine

9.30

9.30

632.40

632.40

93000 00

Medicine

0.43

0.43

29.24

29.24

93005 00

Medicine

0.19

0.19

12.92

12.92

93010 00

Medicine

0.24

0.24

16.32

16.32

93015 00

Medicine

2.16

2.16

146.88

146.88

93016 00

Medicine

0.62

0.62

42.16

42.16

93017 00

Medicine

1.13

1.13

76.84

76.84

93018 00

Medicine

0.41

0.41

27.88

27.88

93024 00

Medicine

3.35

3.35

227.80

227.80

93024 26

Medicine

1.61

1.61

109.48

109.48

93024 TC

Medicine

1.74

1.74

118.32

118.32

93025 00

Medicine

3.75

3.75

255.00

255.00

93025 26

Medicine

1.09

1.09

74.12

74.12

93025 TC

Medicine

2.66

2.66

180.88

180.88

93040 00

Medicine

0.39

0.39

26.52

26.52

93041 00

Medicine

0.19

0.19

12.92

12.92

93042 00

Medicine

0.20

0.20

13.60

13.60

93050 00

Medicine

0.48

0.48

32.64

32.64

93050 26

Medicine

0.24

0.24

16.32

16.32

93050 TC

Medicine

0.24

0.24

16.32

16.32

93150 00

Medicine

2.99

1.26

203.32

85.68

93151 00

Medicine

2.61

1.19

177.48

80.92

93152 00

Medicine

4.72

2.78

320.96

189.04

93153 00

Medicine

1.55

0.64

105.40

43.52

93224 00

Medicine

2.16

2.16

146.88

146.88

93225 00

Medicine

0.55

0.55

37.40

37.40

93226 00

Medicine

1.07

1.07

72.76

72.76

93227 00

Medicine

0.54

0.54

36.72

36.72

93228 00

Medicine

0.74

0.74

50.32

50.32

93229 00

Medicine

24.42

24.42

1660.56

1660.56

93241 00

Medicine

7.75

7.75

527.00

527.00

93242 00

Medicine

0.36

0.36

24.48

24.48

93243 00

Medicine

6.71

6.71

456.28

456.28

93244 00

Medicine

0.68

0.68

46.24

46.24

93245 00

Medicine

8.15

8.15

554.20

554.20

93246 00

Medicine

0.36

0.36

24.48

24.48

93247 00

Medicine

7.04

7.04

478.72

478.72

93248 00

Medicine

0.75

0.75

51.00

51.00

93260 00

Medicine

2.26

2.26

153.68

153.68

93260 26

Medicine

1.21

1.21

82.28

82.28

93260 TC

Medicine

1.05

1.05

71.40

71.40

93261 00

Medicine

2.08

2.08

141.44

141.44

93261 26

Medicine

1.04

1.04

70.72

70.72

93261 TC

Medicine

1.04

1.04

70.72

70.72

93264 00

Medicine

1.54

1.05

104.72

71.40

93268 00

Medicine

5.25

5.25

357.00

357.00

93270 00

Medicine

0.25

0.25

17.00

17.00

93271 00

Medicine

4.29

4.29

291.72

291.72

93272 00

Medicine

0.71

0.71

48.28

48.28

93278 00

Medicine

0.95

0.95

64.60

64.60

93278 26

Medicine

0.37

0.37

25.16

25.16

93278 TC

Medicine

0.58

0.58

39.44

39.44

93279 00

Medicine

2.01

2.01

136.68

136.68

93279 26

Medicine

0.91

0.91

61.88

61.88

93279 TC

Medicine

1.10

1.10

74.80

74.80

93280 00

Medicine

2.35

2.35

159.80

159.80

93280 26

Medicine

1.08

1.08

73.44

73.44

93280 TC

Medicine

1.27

1.27

86.36

86.36

93281 00

Medicine

2.50

2.50

170.00

170.00

93281 26

Medicine

1.21

1.21

82.28

82.28

93281 TC

Medicine

1.29

1.29

87.72

87.72

93282 00

Medicine

2.37

2.37

161.16

161.16

93282 26

Medicine

1.20

1.20

81.60

81.60

93282 TC

Medicine

1.17

1.17

79.56

79.56

93283 00

Medicine

2.91

2.91

197.88

197.88

93283 26

Medicine

1.63

1.63

110.84

110.84

93283 TC

Medicine

1.28

1.28

87.04

87.04

93284 00

Medicine

3.14

3.14

213.52

213.52

93284 26

Medicine

1.77

1.77

120.36

120.36

93284 TC

Medicine

1.37

1.37

93.16

93.16

93285 00

Medicine

1.79

1.79

121.72

121.72

93285 26

Medicine

0.74

0.74

50.32

50.32

93285 TC

Medicine

1.05

1.05

71.40

71.40

93286 00

Medicine

1.35

1.35

91.80

91.80

93286 26

Medicine

0.43

0.43

29.24

29.24

93286 TC

Medicine

0.92

0.92

62.56

62.56

93287 00

Medicine

1.56

1.56

106.08

106.08

93287 26

Medicine

0.63

0.63

42.84

42.84

93287 TC

Medicine

0.93

0.93

63.24

63.24

93288 00

Medicine

1.68

1.68

114.24

114.24

93288 26

Medicine

0.60

0.60

40.80

40.80

93288 TC

Medicine

1.08

1.08

73.44

73.44

93289 00

Medicine

2.15

2.15

146.20

146.20

93289 26

Medicine

1.06

1.06

72.08

72.08

93289 TC

Medicine

1.09

1.09

74.12

74.12

93290 00

Medicine

1.59

1.59

108.12

108.12

93290 26

Medicine

0.61

0.61

41.48

41.48

93290 TC

Medicine

0.98

0.98

66.64

66.64

93291 00

Medicine

1.46

1.46

99.28

99.28

93291 26

Medicine

0.52

0.52

35.36

35.36

93291 TC

Medicine

0.94

0.94

63.92

63.92

93292 00

Medicine

1.53

1.53

104.04

104.04

93292 26

Medicine

0.61

0.61

41.48

41.48

93292 TC

Medicine

0.92

0.92

62.56

62.56

93293 00

Medicine

1.32

1.32

89.76

89.76

93293 26

Medicine

0.42

0.42

28.56

28.56

93293 TC

Medicine

0.90

0.90

61.20

61.20

93294 00

Medicine

0.87

0.87

59.16

59.16

93295 00

Medicine

1.08

1.08

73.44

73.44

93296 00

Medicine

0.64

0.64

43.52

43.52

93297 00

Medicine

1.81

1.81

123.08

123.08

93297 26

Medicine

0.73

0.73

49.64

49.64

93297 TC

Medicine

1.08

1.08

73.44

73.44

93298 00

Medicine

3.05

3.05

207.40

207.40

93298 26

Medicine

0.73

0.73

49.64

49.64

93298 TC

Medicine

2.32

2.32

157.76

157.76

93303 00

Medicine

6.58

6.58

447.44

447.44

93303 26

Medicine

1.80

1.80

122.40

122.40

93303 TC

Medicine

4.78

4.78

325.04

325.04

93304 00

Medicine

4.66

4.66

316.88

316.88

93304 26

Medicine

1.05

1.05

71.40

71.40

93304 TC

Medicine

3.61

3.61

245.48

245.48

93306 00

Medicine

5.89

5.89

400.52

400.52

93306 26

Medicine

2.02

2.02

137.36

137.36

93306 TC

Medicine

3.87

3.87

263.16

263.16

93307 00

Medicine

4.09

4.09

278.12

278.12

93307 26

Medicine

1.27

1.27

86.36

86.36

93307 TC

Medicine

2.82

2.82

191.76

191.76

93308 00

Medicine

2.96

2.96

201.28

201.28

93308 26

Medicine

0.73

0.73

49.64

49.64

93308 TC

Medicine

2.23

2.23

151.64

151.64

93312 00

Medicine

7.06

7.06

480.08

480.08

93312 26

Medicine

3.11

3.11

211.48

211.48

93312 TC

Medicine

3.95

3.95

268.60

268.60

93313 00

Medicine

0.33

0.33

22.44

22.44

93314 00

Medicine

6.77

6.77

460.36

460.36

93314 26

Medicine

2.60

2.60

176.80

176.80

93314 TC

Medicine

4.17

4.17

283.56

283.56

93315 00

Medicine

-

-

557.60

557.60

93315 26

Medicine

3.69

3.69

250.92

250.92

93315 TC

Medicine

-

-

306.68

306.68

93316 00

Medicine

0.76

0.76

51.68

51.68

93317 00

Medicine

-

-

499.12

499.12

93317 26

Medicine

2.57

2.57

174.76

174.76

93317 TC

Medicine

-

-

324.36

324.36

93318 00

Medicine

-

-

577.32

577.32

93318 26

Medicine

2.97

2.97

201.96

201.96

93318 TC

Medicine

-

-

375.36

375.36

93319 00

Medicine

1.66

0.69

112.88

46.92

93320 00

Medicine

1.52

1.52

103.36

103.36

93320 26

Medicine

0.52

0.52

35.36

35.36

93320 TC

Medicine

1.00

1.00

68.00

68.00

93321 00

Medicine

0.75

0.75

51.00

51.00

93321 26

Medicine

0.21

0.21

14.28

14.28

93321 TC

Medicine

0.54

0.54

36.72

36.72

93325 00

Medicine

0.70

0.70

47.60

47.60

93325 26

Medicine

0.09

0.09

6.12

6.12

93325 TC

Medicine

0.61

0.61

41.48

41.48

93350 00

Medicine

5.56

5.56

378.08

378.08

93350 26

Medicine

2.02

2.02

137.36

137.36

93350 TC

Medicine

3.54

3.54

240.72

240.72

93351 00

Medicine

6.96

6.96

473.28

473.28

93351 26

Medicine

2.42

2.42

164.56

164.56

93351 TC

Medicine

4.54

4.54

308.72

308.72

93352 00

Medicine

1.04

1.04

70.72

70.72

93355 00

Medicine

6.58

6.58

447.44

447.44

93356 00

Medicine

1.11

0.34

75.48

23.12

93451 00

Medicine

25.50

25.50

1734.00

1734.00

93451 26

Medicine

3.81

3.81

259.08

259.08

93451 TC

Medicine

21.69

21.69

1474.92

1474.92

93452 00

Medicine

26.52

26.52

1803.36

1803.36

93452 26

Medicine

6.89

6.89

468.52

468.52

93452 TC

Medicine

19.63

19.63

1334.84

1334.84

93453 00

Medicine

33.84

33.84

2301.12

2301.12

93453 26

Medicine

9.20

9.20

625.60

625.60

93453 TC

Medicine

24.64

24.64

1675.52

1675.52

93454 00

Medicine

26.74

26.74

1818.32

1818.32

93454 26

Medicine

6.96

6.96

473.28

473.28

93454 TC

Medicine

19.78

19.78

1345.04

1345.04

93455 00

Medicine

29.80

29.80

2026.40

2026.40

93455 26

Medicine

8.11

8.11

551.48

551.48

93455 TC

Medicine

21.69

21.69

1474.92

1474.92

93456 00

Medicine

33.27

33.27

2262.36

2262.36

93456 26

Medicine

9.07

9.07

616.76

616.76

93456 TC

Medicine

24.20

24.20

1645.60

1645.60

93457 00

Medicine

36.26

36.26

2465.68

2465.68

93457 26

Medicine

10.18

10.18

692.24

692.24

93457 TC

Medicine

26.08

26.08

1773.44

1773.44

93458 00

Medicine

30.76

30.76

2091.68

2091.68

93458 26

Medicine

8.59

8.59

584.12

584.12

93458 TC

Medicine

22.17

22.17

1507.56

1507.56

93459 00

Medicine

33.09

33.09

2250.12

2250.12

93459 26

Medicine

9.73

9.73

661.64

661.64

93459 TC

Medicine

23.36

23.36

1588.48

1588.48

93460 00

Medicine

36.71

36.71

2496.28

2496.28

93460 26

Medicine

10.88

10.88

739.84

739.84

93460 TC

Medicine

25.83

25.83

1756.44

1756.44

93461 00

Medicine

40.50

40.50

2754.00

2754.00

93461 26

Medicine

12.03

12.03

818.04

818.04

93461 TC

Medicine

28.47

28.47

1935.96

1935.96

93462 00

Medicine

6.06

6.06

412.08

412.08

93463 00

Medicine

2.86

2.86

194.48

194.48

93464 00

Medicine

6.53

6.53

444.04

444.04

93464 26

Medicine

2.59

2.59

176.12

176.12

93464 TC

Medicine

3.94

3.94

267.92

267.92

93503 00

Medicine

2.57

2.57

174.76

174.76

93505 00

Medicine

19.13

19.13

1300.84

1300.84

93505 26

Medicine

6.63

6.63

450.84

450.84

93505 TC

Medicine

12.50

12.50

850.00

850.00

93563 00

Medicine

1.51

1.51

102.68

102.68

93564 00

Medicine

1.62

1.62

110.16

110.16

93565 00

Medicine

0.79

0.79

53.72

53.72

93566 00

Medicine

0.76

0.76

51.68

51.68

93567 00

Medicine

1.10

1.10

74.80

74.80

93568 00

Medicine

1.36

1.36

92.48

92.48

93569 00

Medicine

1.11

1.11

75.48

75.48

93571 00

Medicine

-

-

408.00

408.00

93571 26

Medicine

2.10

2.10

142.80

142.80

93571 TC

Medicine

-

-

265.20

265.20

93572 00

Medicine

-

-

221.68

221.68

93572 26

Medicine

1.53

1.53

104.04

104.04

93572 TC

Medicine

-

-

117.64

117.64

93573 00

Medicine

1.84

1.84

125.12

125.12

93574 00

Medicine

2.05

2.05

139.40

139.40

93575 00

Medicine

2.72

2.72

184.96

184.96

93580 00

Medicine

28.52

28.52

1939.36

1939.36

93581 00

Medicine

38.70

38.70

2631.60

2631.60

93582 00

Medicine

19.32

19.32

1313.76

1313.76

93583 00

Medicine

21.68

21.68

1474.24

1474.24

93584 00

Medicine

1.73

1.73

117.64

117.64

93585 00

Medicine

1.63

1.63

110.84

110.84

93586 00

Medicine

2.06

2.06

140.08

140.08

93587 00

Medicine

3.04

3.04

206.72

206.72

93588 00

Medicine

3.07

3.07

208.76

208.76

93590 00

Medicine

31.26

31.26

2125.68

2125.68

93591 00

Medicine

25.70

25.70

1747.60

1747.60

93592 00

Medicine

11.26

11.26

765.68

765.68

93593 00

Medicine

0.00

0.00

BR

BR

93593 26

Medicine

5.51

5.51

374.68

374.68

93593 TC

Medicine

0.00

0.00

BR

BR

93594 00

Medicine

-

-

943.16

924.12

93594 26

Medicine

8.37

8.37

569.16

569.16

93594 TC

Medicine

-

-

374.00

354.96

93595 00

Medicine

0.00

0.00

BR

BR

93595 26

Medicine

7.59

7.59

516.12

516.12

93595 TC

Medicine

0.00

0.00

BR

BR

93596 00

Medicine

-

-

1029.52

1009.12

93596 26

Medicine

9.44

9.44

641.92

641.92

93596 TC

Medicine

-

-

387.60

367.20

93597 00

Medicine

-

-

1372.92

1345.72

93597 26

Medicine

12.33

12.33

838.44

838.44

93597 TC

Medicine

-

-

534.48

507.28

93598 00

Medicine

0.00

0.00

BR

BR

93598 26

Medicine

1.95

1.95

132.60

132.60

93598 TC

Medicine

0.00

0.00

BR

BR

93600 00

Medicine

-

-

382.84

382.84

93600 26

Medicine

3.38

3.38

229.84

229.84

93600 TC

Medicine

-

-

153.00

153.00

93602 00

Medicine

-

-

313.48

313.48

93602 26

Medicine

3.32

3.32

225.76

225.76

93602 TC

Medicine

-

-

87.72

87.72

93603 00

Medicine

-

-

358.36

358.36

93603 26

Medicine

3.32

3.32

225.76

225.76

93603 TC

Medicine

-

-

132.60

132.60

93609 00

Medicine

-

-

748.68

748.68

93609 26

Medicine

7.93

7.93

539.24

539.24

93609 TC

Medicine

-

-

209.44

209.44

93610 00

Medicine

-

-

425.00

425.00

93610 26

Medicine

4.69

4.69

318.92

318.92

93610 TC

Medicine

-

-

106.08

106.08

93612 00

Medicine

-

-

436.56

436.56

93612 26

Medicine

4.62

4.62

314.16

314.16

93612 TC

Medicine

-

-

122.40

122.40

93613 00

Medicine

8.52

8.52

579.36

579.36

93615 00

Medicine

-

-

96.56

96.56

93615 26

Medicine

1.05

1.05

71.40

71.40

93615 TC

Medicine

-

-

25.16

25.16

93616 00

Medicine

-

-

195.84

195.84

93616 26

Medicine

1.70

1.70

115.60

115.60

93616 TC

Medicine

-

-

80.24

80.24

93618 00

Medicine

-

-

710.60

710.60

93618 26

Medicine

6.27

6.27

426.36

426.36

93618 TC

Medicine

-

-

284.24

284.24

93619 00

Medicine

-

-

1336.20

1336.20

93619 26

Medicine

11.20

11.20

761.60

761.60

93619 TC

Medicine

-

-

574.60

574.60

93620 00

Medicine

-

-

1939.36

1939.36

93620 26

Medicine

17.97

17.97

1221.96

1221.96

93620 TC

Medicine

-

-

717.40

717.40

93621 00

Medicine

-

-

706.52

706.52

93621 26

Medicine

2.39

2.39

162.52

162.52

93621 TC

Medicine

-

-

544.00

544.00

93622 00

Medicine

-

-

1396.72

1396.72

93622 26

Medicine

4.93

4.93

335.24

335.24

93622 TC

Medicine

-

-

1061.48

1061.48

93623 00

Medicine

-

-

384.88

384.88

93623 26

Medicine

1.98

1.98

134.64

134.64

93623 TC

Medicine

-

-

250.24

250.24

93624 00

Medicine

-

-

607.92

607.92

93624 26

Medicine

6.97

6.97

473.96

473.96

93624 TC

Medicine

-

-

138.72

138.72

93631 00

Medicine

-

-

1662.60

1662.60

93631 26

Medicine

11.49

11.49

781.32

781.32

93631 TC

Medicine

-

-

881.28

881.28

93640 00

Medicine

-

-

872.44

872.44

93640 26

Medicine

5.13

5.13

348.84

348.84

93640 TC

Medicine

-

-

523.60

523.60

93641 00

Medicine

-

-

1150.56

1150.56

93641 26

Medicine

8.97

8.97

609.96

609.96

93641 TC

Medicine

-

-

540.60

540.60

93642 00

Medicine

9.77

9.77

664.36

664.36

93642 26

Medicine

7.32

7.32

497.76

497.76

93642 TC

Medicine

2.45

2.45

166.60

166.60

93644 00

Medicine

5.69

5.69

386.92

386.92

93644 26

Medicine

4.17

4.17

283.56

283.56

93644 TC

Medicine

1.52

1.52

103.36

103.36

93650 00

Medicine

17.00

17.00

1156.00

1156.00

93653 00

Medicine

24.42

24.42

1660.56

1660.56

93654 00

Medicine

29.42

29.42

2000.56

2000.56

93655 00

Medicine

8.95

8.95

608.60

608.60

93656 00

Medicine

27.69

27.69

1882.92

1882.92

93657 00

Medicine

8.96

8.96

609.28

609.28

93660 00

Medicine

4.86

4.86

330.48

330.48

93660 26

Medicine

2.67

2.67

181.56

181.56

93660 TC

Medicine

2.19

2.19

148.92

148.92

93662 00

Medicine

-

-

324.36

324.36

93662 26

Medicine

2.05

2.05

139.40

139.40

93662 TC

Medicine

-

-

184.96

184.96

93668 00

Medicine

0.44

0.44

29.92

29.92

93701 00

Medicine

0.81

0.81

55.08

55.08

93702 00

Medicine

3.67

3.67

249.56

249.56

93724 00

Medicine

8.28

8.28

563.04

563.04

93724 26

Medicine

6.89

6.89

468.52

468.52

93724 TC

Medicine

1.39

1.39

94.52

94.52

93740 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

93745 00

Medicine

0.00

0.00

BR

BR

93745 26

Medicine

0.00

0.00

BR

BR

93745 TC

Medicine

0.00

0.00

BR

BR

93750 00

Medicine

1.52

1.18

103.36

80.24

93770 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

93784 00

Medicine

1.38

1.38

93.84

93.84

93786 00

Medicine

0.68

0.68

46.24

46.24

93788 00

Medicine

0.17

0.17

11.56

11.56

93790 00

Medicine

0.53

0.53

36.04

36.04

93792 00

Medicine

2.11

2.11

143.48

143.48

93793 00

Medicine

0.34

0.34

23.12

23.12

93797 00

Medicine

0.51

0.26

34.68

17.68

93798 00

Medicine

0.77

0.40

52.36

27.20

93799 00

Medicine

0.00

0.00

BR

BR

93799 26

Medicine

0.00

0.00

BR

BR

93799 TC

Medicine

0.00

0.00

BR

BR

93880 00

Medicine

5.70

5.70

387.60

387.60

93880 26

Medicine

1.12

1.12

76.16

76.16

93880 TC

Medicine

4.58

4.58

311.44

311.44

93882 00

Medicine

3.74

3.74

254.32

254.32

93882 26

Medicine

0.70

0.70

47.60

47.60

93882 TC

Medicine

3.04

3.04

206.72

206.72

93886 00

Medicine

8.23

8.23

559.64

559.64

93886 26

Medicine

1.36

1.36

92.48

92.48

93886 TC

Medicine

6.87

6.87

467.16

467.16

93888 00

Medicine

4.79

4.79

325.72

325.72

93888 26

Medicine

0.73

0.73

49.64

49.64

93888 TC

Medicine

4.06

4.06

276.08

276.08

93890 00

Medicine

8.52

8.52

579.36

579.36

93890 26

Medicine

1.50

1.50

102.00

102.00

93890 TC

Medicine

7.02

7.02

477.36

477.36

93892 00

Medicine

9.82

9.82

667.76

667.76

93892 26

Medicine

1.74

1.74

118.32

118.32

93892 TC

Medicine

8.08

8.08

549.44

549.44

93893 00

Medicine

12.09

12.09

822.12

822.12

93893 26

Medicine

1.76

1.76

119.68

119.68

93893 TC

Medicine

10.33

10.33

702.44

702.44

93895 00

Medicine

-

-

287.64

287.64

93895 26

Medicine

0.00

0.00

BR

BR

93895 TC

Medicine

-

-

287.64

287.64

93922 00

Medicine

2.47

2.47

167.96

167.96

93922 26

Medicine

0.35

0.35

23.80

23.80

93922 TC

Medicine

2.12

2.12

144.16

144.16

93923 00

Medicine

3.91

3.91

265.88

265.88

93923 26

Medicine

0.64

0.64

43.52

43.52

93923 TC

Medicine

3.27

3.27

222.36

222.36

93924 00

Medicine

4.80

4.80

326.40

326.40

93924 26

Medicine

0.70

0.70

47.60

47.60

93924 TC

Medicine

4.10

4.10

278.80

278.80

93925 00

Medicine

7.21

7.21

490.28

490.28

93925 26

Medicine

1.11

1.11

75.48

75.48

93925 TC

Medicine

6.10

6.10

414.80

414.80

93926 00

Medicine

4.32

4.32

293.76

293.76

93926 26

Medicine

0.68

0.68

46.24

46.24

93926 TC

Medicine

3.64

3.64

247.52

247.52

93930 00

Medicine

5.94

5.94

403.92

403.92

93930 26

Medicine

1.12

1.12

76.16

76.16

93930 TC

Medicine

4.82

4.82

327.76

327.76

93931 00

Medicine

3.71

3.71

252.28

252.28

93931 26

Medicine

0.69

0.69

46.92

46.92

93931 TC

Medicine

3.02

3.02

205.36

205.36

93970 00

Medicine

5.61

5.61

381.48

381.48

93970 26

Medicine

0.97

0.97

65.96

65.96

93970 TC

Medicine

4.64

4.64

315.52

315.52

93971 00

Medicine

3.57

3.57

242.76

242.76

93971 26

Medicine

0.62

0.62

42.16

42.16

93971 TC

Medicine

2.95

2.95

200.60

200.60

93975 00

Medicine

7.93

7.93

539.24

539.24

93975 26

Medicine

1.62

1.62

110.16

110.16

93975 TC

Medicine

6.31

6.31

429.08

429.08

93976 00

Medicine

4.76

4.76

323.68

323.68

93976 26

Medicine

1.12

1.12

76.16

76.16

93976 TC

Medicine

3.64

3.64

247.52

247.52

93978 00

Medicine

5.41

5.41

367.88

367.88

93978 26

Medicine

1.12

1.12

76.16

76.16

93978 TC

Medicine

4.29

4.29

291.72

291.72

93979 00

Medicine

3.54

3.54

240.72

240.72

93979 26

Medicine

0.70

0.70

47.60

47.60

93979 TC

Medicine

2.84

2.84

193.12

193.12

93980 00

Medicine

3.51

3.51

238.68

238.68

93980 26

Medicine

1.76

1.76

119.68

119.68

93980 TC

Medicine

1.75

1.75

119.00

119.00

93981 00

Medicine

2.12

2.12

144.16

144.16

93981 26

Medicine

0.62

0.62

42.16

42.16

93981 TC

Medicine

1.50

1.50

102.00

102.00

93985 00

Medicine

7.43

7.43

505.24

505.24

93985 26

Medicine

1.11

1.11

75.48

75.48

93985 TC

Medicine

6.32

6.32

429.76

429.76

93986 00

Medicine

4.37

4.37

297.16

297.16

93986 26

Medicine

0.69

0.69

46.92

46.92

93986 TC

Medicine

3.68

3.68

250.24

250.24

93990 00

Medicine

4.41

4.41

299.88

299.88

93990 26

Medicine

0.69

0.69

46.92

46.92

93990 TC

Medicine

3.72

3.72

252.96

252.96

93998 00

Medicine

0.00

0.00

BR

BR

94002 00

Medicine

2.70

2.70

183.60

183.60

94003 00

Medicine

1.90

1.90

129.20

129.20

94004 00

Medicine

1.41

1.41

95.88

95.88

94005 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

94010 00

Medicine

0.82

0.82

55.76

55.76

94010 26

Medicine

0.24

0.24

16.32

16.32

94010 TC

Medicine

0.58

0.58

39.44

39.44

94011 00

Medicine

2.51

2.51

170.68

170.68

94012 00

Medicine

4.10

4.10

278.80

278.80

94013 00

Medicine

0.55

0.55

37.40

37.40

94014 00

Medicine

1.68

1.68

114.24

114.24

94015 00

Medicine

0.96

0.96

65.28

65.28

94016 00

Medicine

0.72

0.72

48.96

48.96

94060 00

Medicine

1.17

1.17

79.56

79.56

94060 26

Medicine

0.30

0.30

20.40

20.40

94060 TC

Medicine

0.87

0.87

59.16

59.16

94070 00

Medicine

1.89

1.89

128.52

128.52

94070 26

Medicine

0.81

0.81

55.08

55.08

94070 TC

Medicine

1.08

1.08

73.44

73.44

94150 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

94150 26

Medicine

0.00

0.00

Bundled Code

Bundled Code

94150 TC

Medicine

0.00

0.00

Bundled Code

Bundled Code

94200 00

Medicine

0.45

0.45

30.60

30.60

94200 26

Medicine

0.08

0.08

5.44

5.44

94200 TC

Medicine

0.37

0.37

25.16

25.16

94375 00

Medicine

1.17

1.17

79.56

79.56

94375 26

Medicine

0.42

0.42

28.56

28.56

94375 TC

Medicine

0.75

0.75

51.00

51.00

94450 00

Medicine

2.39

2.39

162.52

162.52

94450 26

Medicine

0.57

0.57

38.76

38.76

94450 TC

Medicine

1.82

1.82

123.76

123.76

94452 00

Medicine

1.51

1.51

102.68

102.68

94452 26

Medicine

0.41

0.41

27.88

27.88

94452 TC

Medicine

1.10

1.10

74.80

74.80

94453 00

Medicine

2.01

2.01

136.68

136.68

94453 26

Medicine

0.54

0.54

36.72

36.72

94453 TC

Medicine

1.47

1.47

99.96

99.96

94610 00

Medicine

1.67

1.67

113.56

113.56

94617 00

Medicine

2.67

2.67

181.56

181.56

94617 26

Medicine

0.93

0.93

63.24

63.24

94617 TC

Medicine

1.74

1.74

118.32

118.32

94618 00

Medicine

1.02

1.02

69.36

69.36

94618 26

Medicine

0.65

0.65

44.20

44.20

94618 TC

Medicine

0.37

0.37

25.16

25.16

94619 00

Medicine

1.95

1.95

132.60

132.60

94619 26

Medicine

0.63

0.63

42.84

42.84

94619 TC

Medicine

1.32

1.32

89.76

89.76

94621 00

Medicine

4.64

4.64

315.52

315.52

94621 26

Medicine

1.99

1.99

135.32

135.32

94621 TC

Medicine

2.65

2.65

180.20

180.20

94625 00

Medicine

2.22

0.55

150.96

37.40

94626 00

Medicine

2.41

0.81

163.88

55.08

94640 00

Medicine

0.24

0.24

16.32

16.32

94642 00

Medicine

-

-

78.20

76.16

94644 00

Medicine

1.79

1.79

121.72

121.72

94645 00

Medicine

0.49

0.49

33.32

33.32

94660 00

Medicine

1.94

1.10

131.92

74.80

94662 00

Medicine

1.03

1.03

70.04

70.04

94664 00

Medicine

0.54

0.54

36.72

36.72

94667 00

Medicine

0.75

0.75

51.00

51.00

94668 00

Medicine

1.18

1.18

80.24

80.24

94669 00

Medicine

0.62

0.62

42.16

42.16

94680 00

Medicine

1.62

1.62

110.16

110.16

94680 26

Medicine

0.37

0.37

25.16

25.16

94680 TC

Medicine

1.25

1.25

85.00

85.00

94681 00

Medicine

1.44

1.44

97.92

97.92

94681 26

Medicine

0.28

0.28

19.04

19.04

94681 TC

Medicine

1.16

1.16

78.88

78.88

94690 00

Medicine

1.46

1.46

99.28

99.28

94690 26

Medicine

0.11

0.11

7.48

7.48

94690 TC

Medicine

1.35

1.35

91.80

91.80

94726 00

Medicine

1.68

1.68

114.24

114.24

94726 26

Medicine

0.35

0.35

23.80

23.80

94726 TC

Medicine

1.33

1.33

90.44

90.44

94727 00

Medicine

1.34

1.34

91.12

91.12

94727 26

Medicine

0.35

0.35

23.80

23.80

94727 TC

Medicine

0.99

0.99

67.32

67.32

94728 00

Medicine

1.33

1.33

90.44

90.44

94728 26

Medicine

0.36

0.36

24.48

24.48

94728 TC

Medicine

0.97

0.97

65.96

65.96

94729 00

Medicine

1.70

1.70

115.60

115.60

94729 26

Medicine

0.26

0.26

17.68

17.68

94729 TC

Medicine

1.44

1.44

97.92

97.92

94760 00

Medicine

0.08

0.08

5.44

5.44

94761 00

Medicine

0.12

0.12

8.16

8.16

94762 00

Medicine

0.76

0.76

51.68

51.68

94772 00

Medicine

-

-

422.28

410.04

94772 26

Medicine

-

-

169.32

163.88

94772 TC

Medicine

-

-

252.96

246.16

94774 00

Medicine

0.00

0.00

BR

BR

94775 00

Medicine

0.00

0.00

BR

BR

94776 00

Medicine

0.00

0.00

BR

BR

94777 00

Medicine

-

-

125.80

122.40

94780 00

Medicine

1.60

0.69

108.80

46.92

94781 00

Medicine

0.64

0.24

43.52

16.32

94799 00

Medicine

0.00

0.00

BR

BR

94799 26

Medicine

0.00

0.00

BR

BR

94799 TC

Medicine

0.00

0.00

BR

BR

95004 00

Medicine

0.11

0.11

7.48

7.48

95012 00

Medicine

0.57

0.57

38.76

38.76

95017 00

Medicine

0.26

0.11

17.68

7.48

95018 00

Medicine

0.60

0.21

40.80

14.28

95024 00

Medicine

0.24

0.03

16.32

2.04

95027 00

Medicine

0.15

0.15

10.20

10.20

95028 00

Medicine

0.38

0.38

25.84

25.84

95044 00

Medicine

0.15

0.15

10.20

10.20

95052 00

Medicine

0.19

0.19

12.92

12.92

95056 00

Medicine

1.57

1.57

106.76

106.76

95060 00

Medicine

1.18

1.18

80.24

80.24

95065 00

Medicine

0.87

0.87

59.16

59.16

95070 00

Medicine

1.05

1.05

71.40

71.40

95076 00

Medicine

3.70

2.18

251.60

148.24

95079 00

Medicine

2.56

2.01

174.08

136.68

95115 00

Medicine

0.31

0.31

21.08

21.08

95117 00

Medicine

0.37

0.37

25.16

25.16

95120 00

Medicine

-

-

37.40

22.44

95125 00

Medicine

-

-

40.80

24.48

95130 00

Medicine

-

-

34.68

21.08

95131 00

Medicine

-

-

54.40

33.32

95132 00

Medicine

-

-

70.72

43.52

95133 00

Medicine

-

-

116.28

70.72

95134 00

Medicine

-

-

148.24

90.44

95144 00

Medicine

0.50

0.10

34.00

6.80

95145 00

Medicine

1.09

0.09

74.12

6.12

95146 00

Medicine

2.03

0.09

138.04

6.12

95147 00

Medicine

1.95

0.09

132.60

6.12

95148 00

Medicine

2.90

0.09

197.20

6.12

95149 00

Medicine

3.86

0.09

262.48

6.12

95165 00

Medicine

0.44

0.10

29.92

6.80

95170 00

Medicine

0.33

0.09

22.44

6.12

95180 00

Medicine

4.15

3.03

282.20

206.04

95199 00

Medicine

0.00

0.00

BR

BR

95249 00

Medicine

1.96

1.96

133.28

133.28

95250 00

Medicine

4.43

4.43

301.24

301.24

95251 00

Medicine

1.03

1.03

70.04

70.04

95700 00

Medicine

-

-

538.56

528.36

95705 00

Medicine

-

-

799.00

783.36

95706 00

Medicine

-

-

337.96

331.16

95707 00

Medicine

-

-

2186.88

2142.68

95708 00

Medicine

-

-

675.92

662.32

95709 00

Medicine

-

-

1622.48

1590.52

95710 00

Medicine

-

-

743.92

728.96

95711 00

Medicine

-

-

675.92

662.32

95712 00

Medicine

-

-

1217.20

1192.72

95713 00

Medicine

-

-

1014.56

994.16

95714 00

Medicine

-

-

678.64

665.04

95715 00

Medicine

-

-

2028.44

1987.64

95716 00

Medicine

-

-

3981.40

3901.84

95717 00

Medicine

3.18

3.13

216.24

212.84

95718 00

Medicine

4.04

3.97

274.72

269.96

95719 00

Medicine

4.82

4.74

327.76

322.32

95720 00

Medicine

6.22

6.11

422.96

415.48

95721 00

Medicine

6.22

6.10

422.96

414.80

95722 00

Medicine

7.54

7.40

512.72

503.20

95723 00

Medicine

7.54

7.40

512.72

503.20

95724 00

Medicine

9.48

9.31

644.64

633.08

95725 00

Medicine

8.75

8.54

595.00

580.72

95726 00

Medicine

12.17

11.93

827.56

811.24

95782 00

Medicine

29.38

29.38

1997.84

1997.84

95782 26

Medicine

3.63

3.63

246.84

246.84

95782 TC

Medicine

25.75

25.75

1751.00

1751.00

95783 00

Medicine

31.15

31.15

2118.20

2118.20

95783 26

Medicine

3.96

3.96

269.28

269.28

95783 TC

Medicine

27.19

27.19

1848.92

1848.92

95800 00

Medicine

4.08

4.08

277.44

277.44

95800 26

Medicine

1.16

1.16

78.88

78.88

95800 TC

Medicine

2.92

2.92

198.56

198.56

95801 00

Medicine

2.92

2.92

198.56

198.56

95801 26

Medicine

1.20

1.20

81.60

81.60

95801 TC

Medicine

1.72

1.72

116.96

116.96

95803 00

Medicine

4.06

4.06

276.08

276.08

95803 26

Medicine

1.23

1.23

83.64

83.64

95803 TC

Medicine

2.83

2.83

192.44

192.44

95805 00

Medicine

12.96

12.96

881.28

881.28

95805 26

Medicine

1.68

1.68

114.24

114.24

95805 TC

Medicine

11.28

11.28

767.04

767.04

95806 00

Medicine

2.83

2.83

192.44

192.44

95806 26

Medicine

1.29

1.29

87.72

87.72

95806 TC

Medicine

1.54

1.54

104.72

104.72

95807 00

Medicine

12.30

12.30

836.40

836.40

95807 26

Medicine

1.74

1.74

118.32

118.32

95807 TC

Medicine

10.56

10.56

718.08

718.08

95808 00

Medicine

15.37

15.37

1045.16

1045.16

95808 26

Medicine

2.44

2.44

165.92

165.92

95808 TC

Medicine

12.93

12.93

879.24

879.24

95810 00

Medicine

18.72

18.72

1272.96

1272.96

95810 26

Medicine

3.47

3.47

235.96

235.96

95810 TC

Medicine

15.25

15.25

1037.00

1037.00

95811 00

Medicine

19.57

19.57

1330.76

1330.76

95811 26

Medicine

3.61

3.61

245.48

245.48

95811 TC

Medicine

15.96

15.96

1085.28

1085.28

95812 00

Medicine

10.52

10.52

715.36

715.36

95812 26

Medicine

1.67

1.67

113.56

113.56

95812 TC

Medicine

8.85

8.85

601.80

601.80

95813 00

Medicine

13.30

13.30

904.40

904.40

95813 26

Medicine

2.52

2.52

171.36

171.36

95813 TC

Medicine

10.78

10.78

733.04

733.04

95816 00

Medicine

11.85

11.85

805.80

805.80

95816 26

Medicine

1.67

1.67

113.56

113.56

95816 TC

Medicine

10.18

10.18

692.24

692.24

95819 00

Medicine

13.65

13.65

928.20

928.20

95819 26

Medicine

1.67

1.67

113.56

113.56

95819 TC

Medicine

11.98

11.98

814.64

814.64

95822 00

Medicine

12.40

12.40

843.20

843.20

95822 26

Medicine

1.67

1.67

113.56

113.56

95822 TC

Medicine

10.73

10.73

729.64

729.64

95824 00

Medicine

-

-

198.56

198.56

95824 26

Medicine

1.14

1.14

77.52

77.52

95824 TC

Medicine

-

-

121.04

121.04

95829 00

Medicine

53.09

53.09

3610.12

3610.12

95829 26

Medicine

9.67

9.67

657.56

657.56

95829 TC

Medicine

43.42

43.42

2952.56

2952.56

95830 00

Medicine

20.62

2.71

1402.16

184.28

95836 00

Medicine

3.13

3.13

212.84

212.84

95851 00

Medicine

0.65

0.23

44.20

15.64

95852 00

Medicine

0.54

0.16

36.72

10.88

95857 00

Medicine

1.91

0.84

129.88

57.12

95860 00

Medicine

3.37

3.37

229.16

229.16

95860 26

Medicine

1.49

1.49

101.32

101.32

95860 TC

Medicine

1.88

1.88

127.84

127.84

95861 00

Medicine

4.78

4.78

325.04

325.04

95861 26

Medicine

2.38

2.38

161.84

161.84

95861 TC

Medicine

2.40

2.40

163.20

163.20

95863 00

Medicine

6.21

6.21

422.28

422.28

95863 26

Medicine

2.90

2.90

197.20

197.20

95863 TC

Medicine

3.31

3.31

225.08

225.08

95864 00

Medicine

6.94

6.94

471.92

471.92

95864 26

Medicine

3.09

3.09

210.12

210.12

95864 TC

Medicine

3.85

3.85

261.80

261.80

95865 00

Medicine

4.46

4.46

303.28

303.28

95865 26

Medicine

2.42

2.42

164.56

164.56

95865 TC

Medicine

2.04

2.04

138.72

138.72

95866 00

Medicine

3.67

3.67

249.56

249.56

95866 26

Medicine

1.86

1.86

126.48

126.48

95866 TC

Medicine

1.81

1.81

123.08

123.08

95867 00

Medicine

3.19

3.19

216.92

216.92

95867 26

Medicine

1.22

1.22

82.96

82.96

95867 TC

Medicine

1.97

1.97

133.96

133.96

95868 00

Medicine

4.15

4.15

282.20

282.20

95868 26

Medicine

1.83

1.83

124.44

124.44

95868 TC

Medicine

2.32

2.32

157.76

157.76

95869 00

Medicine

2.85

2.85

193.80

193.80

95869 26

Medicine

0.58

0.58

39.44

39.44

95869 TC

Medicine

2.27

2.27

154.36

154.36

95870 00

Medicine

2.49

2.49

169.32

169.32

95870 26

Medicine

0.58

0.58

39.44

39.44

95870 TC

Medicine

1.91

1.91

129.88

129.88

95872 00

Medicine

5.63

5.63

382.84

382.84

95872 26

Medicine

4.36

4.36

296.48

296.48

95872 TC

Medicine

1.27

1.27

86.36

86.36

95873 00

Medicine

2.11

2.11

143.48

143.48

95873 26

Medicine

0.57

0.57

38.76

38.76

95873 TC

Medicine

1.54

1.54

104.72

104.72

95874 00

Medicine

2.28

2.28

155.04

155.04

95874 26

Medicine

0.57

0.57

38.76

38.76

95874 TC

Medicine

1.71

1.71

116.28

116.28

95875 00

Medicine

3.66

3.66

248.88

248.88

95875 26

Medicine

1.72

1.72

116.96

116.96

95875 TC

Medicine

1.94

1.94

131.92

131.92

95885 00

Medicine

1.85

1.85

125.80

125.80

95885 26

Medicine

0.54

0.54

36.72

36.72

95885 TC

Medicine

1.31

1.31

89.08

89.08

95886 00

Medicine

2.88

2.88

195.84

195.84

95886 26

Medicine

1.32

1.32

89.76

89.76

95886 TC

Medicine

1.56

1.56

106.08

106.08

95887 00

Medicine

2.48

2.48

168.64

168.64

95887 26

Medicine

1.08

1.08

73.44

73.44

95887 TC

Medicine

1.40

1.40

95.20

95.20

95905 00

Medicine

1.01

1.01

68.68

68.68

95905 26

Medicine

0.08

0.08

5.44

5.44

95905 TC

Medicine

0.93

0.93

63.24

63.24

95907 00

Medicine

2.70

2.70

183.60

183.60

95907 26

Medicine

1.55

1.55

105.40

105.40

95907 TC

Medicine

1.15

1.15

78.20

78.20

95908 00

Medicine

3.35

3.35

227.80

227.80

95908 26

Medicine

1.94

1.94

131.92

131.92

95908 TC

Medicine

1.41

1.41

95.88

95.88

95909 00

Medicine

4.02

4.02

273.36

273.36

95909 26

Medicine

2.32

2.32

157.76

157.76

95909 TC

Medicine

1.70

1.70

115.60

115.60

95910 00

Medicine

5.25

5.25

357.00

357.00

95910 26

Medicine

3.09

3.09

210.12

210.12

95910 TC

Medicine

2.16

2.16

146.88

146.88

95911 00

Medicine

6.33

6.33

430.44

430.44

95911 26

Medicine

3.86

3.86

262.48

262.48

95911 TC

Medicine

2.47

2.47

167.96

167.96

95912 00

Medicine

7.40

7.40

503.20

503.20

95912 26

Medicine

4.61

4.61

313.48

313.48

95912 TC

Medicine

2.79

2.79

189.72

189.72

95913 00

Medicine

8.54

8.54

580.72

580.72

95913 26

Medicine

5.45

5.45

370.60

370.60

95913 TC

Medicine

3.09

3.09

210.12

210.12

95919 00

Medicine

0.47

0.47

31.96

31.96

95919 26

Medicine

0.29

0.29

19.72

19.72

95919 TC

Medicine

0.18

0.18

12.24

12.24

95921 00

Medicine

2.63

2.63

178.84

178.84

95921 26

Medicine

1.30

1.30

88.40

88.40

95921 TC

Medicine

1.33

1.33

90.44

90.44

95922 00

Medicine

2.84

2.84

193.12

193.12

95922 26

Medicine

1.35

1.35

91.80

91.80

95922 TC

Medicine

1.49

1.49

101.32

101.32

95923 00

Medicine

3.66

3.66

248.88

248.88

95923 26

Medicine

1.31

1.31

89.08

89.08

95923 TC

Medicine

2.35

2.35

159.80

159.80

95924 00

Medicine

4.53

4.53

308.04

308.04

95924 26

Medicine

2.55

2.55

173.40

173.40

95924 TC

Medicine

1.98

1.98

134.64

134.64

95925 00

Medicine

5.28

5.28

359.04

359.04

95925 26

Medicine

0.82

0.82

55.76

55.76

95925 TC

Medicine

4.46

4.46

303.28

303.28

95926 00

Medicine

4.73

4.73

321.64

321.64

95926 26

Medicine

0.80

0.80

54.40

54.40

95926 TC

Medicine

3.93

3.93

267.24

267.24

95927 00

Medicine

5.47

5.47

371.96

371.96

95927 26

Medicine

0.80

0.80

54.40

54.40

95927 TC

Medicine

4.67

4.67

317.56

317.56

95928 00

Medicine

7.22

7.22

490.96

490.96

95928 26

Medicine

2.32

2.32

157.76

157.76

95928 TC

Medicine

4.90

4.90

333.20

333.20

95929 00

Medicine

7.30

7.30

496.40

496.40

95929 26

Medicine

2.31

2.31

157.08

157.08

95929 TC

Medicine

4.99

4.99

339.32

339.32

95930 00

Medicine

2.02

2.02

137.36

137.36

95930 26

Medicine

0.54

0.54

36.72

36.72

95930 TC

Medicine

1.48

1.48

100.64

100.64

95933 00

Medicine

2.47

2.47

167.96

167.96

95933 26

Medicine

0.92

0.92

62.56

62.56

95933 TC

Medicine

1.55

1.55

105.40

105.40

95937 00

Medicine

3.12

3.12

212.16

212.16

95937 26

Medicine

1.01

1.01

68.68

68.68

95937 TC

Medicine

2.11

2.11

143.48

143.48

95938 00

Medicine

11.25

11.25

765.00

765.00

95938 26

Medicine

1.33

1.33

90.44

90.44

95938 TC

Medicine

9.92

9.92

674.56

674.56

95939 00

Medicine

16.74

16.74

1138.32

1138.32

95939 26

Medicine

3.47

3.47

235.96

235.96

95939 TC

Medicine

13.27

13.27

902.36

902.36

95940 00

Medicine

0.95

0.95

64.60

64.60

95941 00

Medicine

-

-

1828.52

1791.80

95954 00

Medicine

11.81

11.81

803.08

803.08

95954 26

Medicine

3.30

3.30

224.40

224.40

95954 TC

Medicine

8.51

8.51

578.68

578.68

95955 00

Medicine

5.71

5.71

388.28

388.28

95955 26

Medicine

1.56

1.56

106.08

106.08

95955 TC

Medicine

4.15

4.15

282.20

282.20

95957 00

Medicine

8.80

8.80

598.40

598.40

95957 26

Medicine

2.99

2.99

203.32

203.32

95957 TC

Medicine

5.81

5.81

395.08

395.08

95958 00

Medicine

21.01

21.01

1428.68

1428.68

95958 26

Medicine

6.58

6.58

447.44

447.44

95958 TC

Medicine

14.43

14.43

981.24

981.24

95961 00

Medicine

9.85

9.85

669.80

669.80

95961 26

Medicine

4.76

4.76

323.68

323.68

95961 TC

Medicine

5.09

5.09

346.12

346.12

95962 00

Medicine

8.35

8.35

567.80

567.80

95962 26

Medicine

5.07

5.07

344.76

344.76

95962 TC

Medicine

3.28

3.28

223.04

223.04

95965 00

Medicine

-

-

3283.04

3283.04

95965 26

Medicine

12.07

12.07

820.76

820.76

95965 TC

Medicine

-

-

2462.28

2462.28

95966 00

Medicine

-

-

1978.80

1978.80

95966 26

Medicine

5.82

5.82

395.76

395.76

95966 TC

Medicine

-

-

1583.04

1583.04

95967 00

Medicine

-

-

1183.88

1183.88

95967 26

Medicine

5.05

5.05

343.40

343.40

95967 TC

Medicine

-

-

840.48

840.48

95970 00

Medicine

0.56

0.54

38.08

36.72

95971 00

Medicine

1.44

1.15

97.92

78.20

95972 00

Medicine

1.70

1.19

115.60

80.92

95976 00

Medicine

1.17

1.15

79.56

78.20

95977 00

Medicine

1.56

1.53

106.08

104.04

95980 00

Medicine

1.34

1.34

91.12

91.12

95981 00

Medicine

1.17

0.53

79.56

36.04

95982 00

Medicine

1.78

1.08

121.04

73.44

95983 00

Medicine

1.49

1.46

101.32

99.28

95984 00

Medicine

1.30

1.28

88.40

87.04

95990 00

Medicine

2.71

2.71

184.28

184.28

95991 00

Medicine

3.32

1.18

225.76

80.24

95992 00

Medicine

1.27

1.06

86.36

72.08

95999 00

Medicine

0.00

0.00

BR

BR

96000 00

Medicine

2.46

2.46

167.28

167.28

96001 00

Medicine

3.26

3.26

221.68

221.68

96002 00

Medicine

0.63

0.63

42.84

42.84

96003 00

Medicine

0.49

0.49

33.32

33.32

96004 00

Medicine

3.19

3.19

216.92

216.92

96020 00

Medicine

-

-

314.16

314.16

96020 26

Medicine

4.62

4.62

314.16

314.16

96020 TC

Medicine

0.00

0.00

BR

BR

96040 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

96105 00

Medicine

2.88

2.88

195.84

195.84

96110 00

Medicine

0.35

0.35

23.80

23.80

96112 00

Medicine

3.72

3.69

252.96

250.92

96113 00

Medicine

1.80

1.69

122.40

114.92

96116 00

Medicine

2.76

2.37

187.68

161.16

96121 00

Medicine

2.25

1.97

153.00

133.96

96125 00

Medicine

3.07

3.07

208.76

208.76

96127 00

Medicine

0.14

0.14

9.52

9.52

96130 00

Medicine

3.60

3.25

244.80

221.00

96131 00

Medicine

2.57

2.25

174.76

153.00

96132 00

Medicine

3.85

3.14

261.80

213.52

96133 00

Medicine

2.92

2.26

198.56

153.68

96136 00

Medicine

1.25

0.69

85.00

46.92

96137 00

Medicine

1.13

0.53

76.84

36.04

96138 00

Medicine

1.03

1.03

70.04

70.04

96139 00

Medicine

1.06

1.06

72.08

72.08

96146 00

Medicine

0.07

0.07

4.76

4.76

96156 00

Medicine

2.97

2.63

201.96

178.84

96158 00

Medicine

2.01

1.76

136.68

119.68

96159 00

Medicine

0.68

0.59

46.24

40.12

96160 00

Medicine

0.09

0.09

6.12

6.12

96161 00

Medicine

0.09

0.09

6.12

6.12

96164 00

Medicine

0.31

0.28

21.08

19.04

96165 00

Medicine

0.14

0.12

9.52

8.16

96167 00

Medicine

2.12

1.86

144.16

126.48

96168 00

Medicine

0.76

0.66

51.68

44.88

96170 00

Medicine

2.32

2.17

157.76

147.56

96171 00

Medicine

0.83

0.78

56.44

53.04

96202 00

Medicine

0.71

0.63

48.28

42.84

96203 00

Medicine

0.17

0.17

11.56

11.56

96360 00

Medicine

0.97

0.97

65.96

65.96

96361 00

Medicine

0.37

0.37

25.16

25.16

96365 00

Medicine

1.88

1.88

127.84

127.84

96366 00

Medicine

0.61

0.61

41.48

41.48

96367 00

Medicine

0.85

0.85

57.80

57.80

96368 00

Medicine

0.59

0.59

40.12

40.12

96369 00

Medicine

4.24

4.24

288.32

288.32

96370 00

Medicine

0.48

0.48

32.64

32.64

96371 00

Medicine

1.81

1.81

123.08

123.08

96372 00

Medicine

0.43

0.43

29.24

29.24

96373 00

Medicine

0.56

0.56

38.08

38.08

96374 00

Medicine

1.10

1.10

74.80

74.80

96375 00

Medicine

0.46

0.46

31.28

31.28

96376 00

Medicine

-

-

68.00

59.84

96377 00

Medicine

0.55

0.55

37.40

37.40

96379 00

Medicine

0.00

0.00

BR

BR

96380 00

Medicine

0.68

0.68

46.24

46.24

96381 00

Medicine

0.59

0.59

40.12

40.12

96401 00

Medicine

2.15

2.15

146.20

146.20

96402 00

Medicine

1.06

1.06

72.08

72.08

96405 00

Medicine

2.49

0.85

169.32

57.80

96406 00

Medicine

3.89

1.32

264.52

89.76

96409 00

Medicine

3.00

3.00

204.00

204.00

96411 00

Medicine

1.63

1.63

110.84

110.84

96413 00

Medicine

3.88

3.88

263.84

263.84

96415 00

Medicine

0.83

0.83

56.44

56.44

96416 00

Medicine

3.82

3.82

259.76

259.76

96417 00

Medicine

1.91

1.91

129.88

129.88

96420 00

Medicine

3.06

3.06

208.08

208.08

96422 00

Medicine

4.68

4.68

318.24

318.24

96423 00

Medicine

2.18

2.18

148.24

148.24

96425 00

Medicine

5.05

5.05

343.40

343.40

96440 00

Medicine

22.38

4.01

1521.84

272.68

96446 00

Medicine

4.79

0.61

325.72

41.48

96450 00

Medicine

4.85

2.26

329.80

153.68

96521 00

Medicine

3.72

3.72

252.96

252.96

96522 00

Medicine

3.53

3.53

240.04

240.04

96523 00

Medicine

0.75

0.75

51.00

51.00

96542 00

Medicine

3.92

1.25

266.56

85.00

96547 00

Medicine

0.00

0.00

BR

BR

96548 00

Medicine

0.00

0.00

BR

BR

96549 00

Medicine

0.00

0.00

BR

BR

96567 00

Medicine

4.11

4.11

279.48

279.48

96570 00

Medicine

1.49

1.49

101.32

101.32

96571 00

Medicine

0.74

0.74

50.32

50.32

96573 00

Medicine

6.80

6.80

462.40

462.40

96574 00

Medicine

8.33

8.33

566.44

566.44

96900 00

Medicine

0.75

0.75

51.00

51.00

96902 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

96904 00

Medicine

2.06

2.06

140.08

140.08

96910 00

Medicine

3.56

3.56

242.08

242.08

96912 00

Medicine

3.03

3.03

206.04

206.04

96913 00

Medicine

4.59

4.59

312.12

312.12

96920 00

Medicine

4.67

1.88

317.56

127.84

96921 00

Medicine

5.12

2.13

348.16

144.84

96922 00

Medicine

6.97

3.43

473.96

233.24

96931 00

Medicine

5.09

5.09

346.12

346.12

96932 00

Medicine

3.81

3.81

259.08

259.08

96933 00

Medicine

1.28

1.28

87.04

87.04

96934 00

Medicine

3.53

3.53

240.04

240.04

96935 00

Medicine

2.32

2.32

157.76

157.76

96936 00

Medicine

1.21

1.21

82.28

82.28

96999 00

Medicine

0.00

0.00

BR

BR

99000 00

Medicine

-

-

13.60

13.60

99001 00

Medicine

-

-

22.44

22.44

99002 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

99024 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

99026 00

Medicine

-

-

80.92

80.92

99027 00

Medicine

0.00

0.00

BR

BR

99050 00

Medicine

-

-

34.00

34.00

99051 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

99053 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

99056 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

99058 00

Medicine

-

-

42.84

42.84

99060 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

99070 00

Medicine

0.00

0.00

BR

BR

99071 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

99072 00

Medicine

0.00

0.00

BR

BR

99075 00

Medicine

0.00

0.00

BR

BR

99078 00

Medicine

0.00

0.00

Bundled Code

Bundled Code

99080 00

Medicine

0.00

0.00

BR

BR

99082 00

Medicine

0.00

0.00

BR

BR

99091 00

Medicine

1.61

1.61

109.48

109.48

99151 00

Medicine

1.82

0.71

123.76

48.28

99152 00

Medicine

1.51

0.36

102.68

24.48

99153 00

Medicine

0.35

0.35

23.80

23.80

99155 00

Medicine

2.45

2.45

166.60

166.60

99156 00

Medicine

2.22

2.22

150.96

150.96

99157 00

Medicine

1.76

1.76

119.68

119.68

99170 00

Medicine

4.95

2.51

336.60

170.68

99172 00

Medicine

-

-

34.00

31.28

99173 00

Medicine

0.10

0.10

6.80

6.80

99174 00

Medicine

0.19

0.19

12.92

12.92

99175 00

Medicine

0.90

0.90

61.20

61.20

99177 00

Medicine

0.15

0.15

10.20

10.20

99183 00

Medicine

3.14

3.14

213.52

213.52

99184 00

Medicine

6.34

6.34

431.12

431.12

99188 00

Medicine

0.35

0.29

23.80

19.72

99190 00

Medicine

-

-

567.80

528.36

99191 00

Medicine

-

-

439.28

408.68

99192 00

Medicine

-

-

291.04

270.64

99195 00

Medicine

2.87

2.87

195.16

195.16

99199 00

Medicine

0.00

0.00

BR

BR

99500 00

Medicine

-

-

BR

BR

99501 00

Medicine

-

-

BR

BR

99502 00

Medicine

-

-

BR

BR

99503 00

Medicine

-

-

BR

BR

99504 00

Medicine

-

-

BR

BR

99505 00

Medicine

-

-

BR

BR

99506 00

Medicine

-

-

BR

BR

99507 00

Medicine

-

-

BR

BR

99509 00

Medicine

-

-

BR

BR

99510 00

Medicine

-

-

BR

BR

99511 00

Medicine

-

-

BR

BR

99512 00

Medicine

-

-

BR

BR

99600 00

Medicine

0.00

0.00

BR

BR

99601 00

Medicine

-

-

BR

BR

99602 00

Medicine

-

-

BR

BR

99605 00

Medicine

-

-

40.80

40.80

99606 00

Medicine

-

-

38.08

38.08

99607 00

Medicine

-

-

38.08

38.08

PHYSICAL MEDICINE AND REHABILITATION GUIDELINES

Information regarding publications incorporated by reference is found in the Introduction Section of the Fee Schedule.

The following Commission guidelines are in addition to the CPT® guidelines and represent additional guidance from the Commission relative to physical medicine and rehabilitation services. To the extent that a conflict may exist between an incorporated portion of the CPT® and a code, guideline, identifier, or modifier unique to Arizona, then the Arizona code, guideline, identifier or modifier shall control. Codes that are unique to Arizona are preceded by an AZ identifier and numbered in the following format: AZxxx.

General requirements on reporting services are found in the Introduction of the Fee Schedule. In addition to the definitions and commonalities preceding the coded medical procedures, several other requirements unique to this Section (Physical Medicine and Rehabilitation) are defined or identified as follows:

A. Physical therapy (PT) evaluation codes (97161-97163) and occupational therapy (OT) evaluation codes (97165-97167) are billed at the initial visit and a re-evaluation code (97164 for PT, 97168 for OT) may be billed once every two calendar weeks following an initial evaluation. Additional billing for PT and OT evaluation services may be allowed when specific additional services are warranted. Approval of the payer must be obtained prior to performing additional services. Criteria to select the appropriate evaluation and re-evaluation codes are outlined in the current CPT® publication.

Note: These limitations do not apply to referring healthcare providers or to providers who treat patients once per month.

B. When multiple modalities (untimed 97012-97028 and/or time-based 97032-97036) are performed, the first modality (or the first unit of a time-based modality) is reported as listed. The second modality (or the second unit of a timebased modality) is identified by adding modifier -51 to the code number. The second and each subsequent modality (or unit(s) of a time-based modality) should be valued at 50% of its listed value.

First modality reported or first unit of a time-based modality

-100%

Second, third, and additional approved modality or unit(s)

- 50%

Any more than three modalities or more than three units of a time-based modality or any combination of time-based and untimed modalities equaling three billed units per body part being treated must have prior approval from the payer. The time a healthcare provider bills for a time-based modality (97032-97036) does not count towards the total timed therapeutic procedure maximum of four units or 67 minutes. However, the time spent performing time-based modalities counts towards the total treatment time and should be used to determine the number of units a provider bills (see Section E and Example 5). The amount of time spent performing each specific procedure or modality provided to the patient is not required to be documented in the treatment notes (see Section G).

Note: 97010 is a bundled service and not separately reportable.

Example:

During a visit, a patient receives the following services:

45 minutes therapeutic exercise 97110

15 minutes mechanical traction 97012

15 minutes unattended electrical stimulation 97014

10 minutes ultrasound 97035

15 minutes moist heat 97010 while receiving the electric stimulation

Under the multiple modality rule, the healthcare provider would bill:

97110 3 units at 100% of value (therapeutic procedure, timed code)

97012 1 unit at 100% of value (modality, untimed code)

97014 1 unit at 50% of value (modality, untimed code)

97035 1 unit at 50% of value (modality, timed code)

97010 is bundled into the above services and not paid as a separate service. The total time spent performing time-based codes (97110 and 97035) is 55 minutes and justifies billing four units of time-based services (see Section E).

C. CPT® codes describing therapeutic procedures (97110-97150 and 97530-97546) are not subject to the multiple modality rule and shall be paid at 100% of their listed value. When performing therapeutic procedure(s), (excluding work hardening/conditioning, 97545-97546, and physical test or measures for functional capacity evaluation, 97750), a maximum of four units or 67 minutes is allowed each day. Approval must be obtained from the payer prior to performing therapeutic procedures in excess of this maximum (e.g. when multiple body parts are treated in a single visit).

D. The values for the codes in this section include the time and work of the provider, the equipment required to provide the service, and the cost of the healthcare provider's liability insurance. Medications and disposable electrodes used in these procedures should be considered supplies and managed in accordance with the HCPCS Section of this Fee Schedule.

E. Time-Based Physical Medicine and Rehabilitation CPT® codes are billed according to guidance from the Centers for Medicare and Medicaid Services (CMS), as published in the Medicare Claims Processing Manual, Chapter 5, Section 20.2, C. Counting Minutes for Timed Codes in 15 Minute Units.

When only one service is provided in a day, healthcare providers should not bill for services provided for less than 8 minutes. For any single 15-minute timed CPT® code in the same day, healthcare providers bill a single 15-minute unit for treatment of greater than or equal to 8 minutes through and including 22 minutes. If the duration of a single procedure in a day is greater than or equal to 23 minutes through and including 37 minutes, two units should be billed. Please refer to the table below, which outlines how to bill for up to four units or 67 minutes, without payer approval.

Units

Number of Minutes

0

[LESS THAN] 8 minutes

1

[GREATER THAN EQUAL TO] 8 minutes and [LESS THAN EQUAL TO] 22 minutes

2

[GREATER THAN EQUAL TO] 23 minutes and [LESS THAN EQUAL TO] 37 minutes

3

[GREATER THAN EQUAL TO] 38 minutes and [LESS THAN EQUAL TO] 52 minutes

4

[GREATER THAN EQUAL TO] 53 minutes and [LESS THAN EQUAL TO] 67 minutes

If additional therapeutic procedures and/or time-based modalities are approved by the payer, the pattern for determining time/units is continued.

When more than one service represented by 15-minute timed codes is performed in a single day, the total number of minutes of service determines the number of timed units billed (as noted in the chart above). For any service represented by a 15-minute timed code that is performed for 7 minutes or less on the same day as another service also represented by a 15-minute timed code performed for 7 minutes or less, and the total time of these two services is 8 minutes or greater, the provider may bill one unit of service that was performed for the most minutes. The same logic is applied if three or more different services are performed on the same day for 7 minutes or less.

The expectation, based on the work values assigned to these codes, is that a provider's direct patient contact time for each unit will average 15 minutes in length. If more than one 15-minute timed CPT® code is billed during a single calendar day, the total number of units billed is constrained by the total treatment time for that day.

When documenting to support the billing of timed CPT® codes, the provider should document the total number of timed minutes and the total time of the treatment provided that day. Total treatment time includes the minutes for timed code treatment and untimed code treatment. Total treatment time does not include time for services that are not billable (e.g., rest periods). The amount of time for each specific intervention/modality provided to the patient is not required to be documented in the treatment note.

It is important that the total number of timed treatment minutes support the billing of units on the invoice and that the total treatment time also reflects the services billed as untimed codes. The billing and the total timed code treatment minutes documented must be consistent. Additional guidance for documentation of timed codes is found in the CMS Benefit Policy Manual, Chapter 15, 220.3, E. Treatment Note

Examples of how to count the appropriate number of minutes for the total therapy minutes provided:

Example 1

During a visit, the patient receives the following services:

45 minutes therapeutic exercise 97110

5 minutes manual therapy 97140

7 minutes therapeutic activities 97530

Total Timed Codes: 57 minutes

The healthcare provider would bill: 4 units

97110

3 units

97530

1 unit

Since the total time spent providing manual therapy and therapeutic exercises is greater than 8 minutes, one unit is billed for the service which was performed for more time.

Example 2

During a visit, the patient receives the following services:

24 minutes neuromuscular reeducation 97112

23 minutes therapeutic exercise 97110

Total Timed Codes: 47 minutes

The healthcare provider would bill: 3 units

97112

2 units

97110

1 unit

Each service is provided for more than 15 minutes, so at least one unit is appropriate for each. Two units are billed for Neuromuscular reeducation since that service was performed for more time.

Example 3

During a visit, the patient receives the following services:

20 minutes therapeutic activities 97530

20 minutes therapeutic exercise 97110

Total Timed Codes: 40 minutes

The healthcare provider would bill: 3 units

97530

2 units

97110

1 unit

OR

97110

2 units

97530

1 unit

Each service was provided for 20 minutes, which would allow for one unit for each service. However, the total time of 40 minutes allows for three units to be billed. Since the time for each service is the same, the provider can choose which code to bill for two units and which code to bill for one unit.

Example 4

During a visit, the patient receives the following services:

33 minutes therapeutic exercise 97110

7 minutes manual therapy 97140

Total Timed Codes: 40 minutes

The healthcare provider would bill: 3 units

97110

2 units

97140

1 unit

The first 30 minutes of therapeutic exercise is 2 units. The remaining 3 minutes is added to the 7 minutes of manual therapy and then is billed for one unit of manual therapy. The time for manual therapy is greater than the remaining time from the therapeutic exercise.

Example 5

During a visit, the patient receives the following services:

18 minutes therapeutic exercise 97110

13 minutes manual therapy 97140

10 minutes gait training 97116

8 minutes ultrasound 97035

Total Timed Codes: 49 minutes

The healthcare provider would bill: 3 units

97110

1 unit

97140

1 unit

97116

1 unit

Bill the procedures that the most time was spent performing. One unit each of 97110, 97140, and 97116. Although the ultrasound should be documented, it cannot be billed, as the healthcare provider is constrained by the total timed codes minutes. Since the total for the timed codes is 49 minutes, only three units would be billed.

F. A work hardening program is limited to 6 1/2 hours per day, not to exceed a 6 week period of time.

G. The payer has the right to require documentation to establish that a modality or therapeutic procedure was performed. Inasmuch as these Guidelines allow for re-evaluations to be performed every two weeks, it is at that time the healthcare provider should address and document the status of the treatment protocol.

It is not appropriate for the payer on a per billing basis to require a healthcare provider to provide unnecessarily detailed documentation to justify payment. A healthcare provider is required to comply with A.R.S. § 23-1062.01 when submitting a bill. For example, the purpose of modalities like hot and cold packs, paraffin baths, and whirlpools is straightforward. Modalities are utilized as a sub-element of the overall treatment protocol to prepare the injured worker for therapy or to minimize the impact of the therapy on the injured worker. Other than a statement that certain modalities were performed, any additional documentation such as the purpose of the application of modalities, resulting flexibility or comfort is unnecessary. Additionally, listing the amount of weight an individual is lifting, repetitions, and sets is, again, unnecessary. During a re-evaluation visit, the healthcare provider should provide documentation regarding changes in strength, stamina, and flexibility.

Documentation of each treatment shall include the following elements:

* Date of treatment.

* Identification of each specific intervention/modality provided and billed, both timed and untimed services in a manner that it can be compared with the billing record to verify correct coding.

* Total timed code treatment minutes and total treatment time in minutes (the amount of time for each specific intervention/modality provided is not required).

* Signatures (written or electronic) and professional designation of the qualified healthcare provider who furnished or supervised the services provided.

ARIZONA PHYSICIANS' FEE SCHEDULE

Physical Medicine Codes 2024

Physical Medicine Conversion Factor $68.00

Code

Category

FY24 NF RVU

FY24 FAC RVU

FY24 NF RBRVS Rate

FY24 FAC RBRVS Rate

97010 00

Physical Medicine

0.19

0.19

12.92

12.92

97012 00

Physical Medicine

0.42

0.42

28.56

28.56

97014 00

Physical Medicine

0.37

0.37

25.16

25.16

97016 00

Physical Medicine

0.35

0.35

23.80

23.80

97018 00

Physical Medicine

0.17

0.17

11.56

11.56

97022 00

Physical Medicine

0.51

0.51

34.68

34.68

97024 00

Physical Medicine

0.22

0.22

14.96

14.96

97026 00

Physical Medicine

0.20

0.20

13.60

13.60

97028 00

Physical Medicine

0.25

0.25

17.00

17.00

97032 00

Physical Medicine

0.43

0.43

29.24

29.24

97033 00

Physical Medicine

0.58

0.58

39.44

39.44

97034 00

Physical Medicine

0.42

0.42

28.56

28.56

97035 00

Physical Medicine

0.42

0.42

28.56

28.56

97036 00

Physical Medicine

1.05

1.05

71.40

71.40

97037 00

Physical Medicine

0.00

0.00

BR

BR

97039 00

Physical Medicine

0.00

0.00

BR

BR

97110 00

Physical Medicine

0.88

0.88

59.84

59.84

97112 00

Physical Medicine

1.01

1.01

68.68

68.68

97113 00

Physical Medicine

1.10

1.10

74.80

74.80

97116 00

Physical Medicine

0.88

0.88

59.84

59.84

97124 00

Physical Medicine

0.91

0.91

61.88

61.88

97129 00

Physical Medicine

0.67

0.66

45.56

44.88

97130 00

Physical Medicine

0.64

0.63

43.52

42.84

97139 00

Physical Medicine

0.00

0.00

BR

BR

97140 00

Physical Medicine

0.81

0.81

55.08

55.08

97150 00

Physical Medicine

0.54

0.54

36.72

36.72

97151 00

Physical Medicine

-

-

30.60

30.60

97152 00

Physical Medicine

-

-

22.44

22.44

97153 00

Physical Medicine

-

-

20.40

20.40

97154 00

Physical Medicine

-

-

17.00

17.00

97155 00

Physical Medicine

-

-

27.20

27.20

97156 00

Physical Medicine

-

-

23.80

23.80

97157 00

Physical Medicine

-

-

21.76

21.76

97158 00

Physical Medicine

-

-

16.32

16.32

97161 00

Physical Medicine

3.01

3.01

204.68

204.68

97162 00

Physical Medicine

3.01

3.01

204.68

204.68

97163 00

Physical Medicine

3.01

3.01

204.68

204.68

97164 00

Physical Medicine

2.09

2.09

142.12

142.12

97165 00

Physical Medicine

3.04

3.04

206.72

206.72

97166 00

Physical Medicine

3.04

3.04

206.72

206.72

97167 00

Physical Medicine

3.04

3.04

206.72

206.72

97168 00

Physical Medicine

2.10

2.10

142.80

142.80

97169 00

Physical Medicine

-

-

67.32

60.52

97170 00

Physical Medicine

-

-

118.32

106.76

97171 00

Physical Medicine

-

-

236.64

212.84

97172 00

Physical Medicine

-

-

84.32

76.16

97530 00

Physical Medicine

1.10

1.10

74.80

74.80

97533 00

Physical Medicine

1.87

1.87

127.16

127.16

97535 00

Physical Medicine

0.98

0.98

66.64

66.64

97537 00

Physical Medicine

0.95

0.95

64.60

64.60

97542 00

Physical Medicine

0.95

0.95

64.60

64.60

97545 00

Physical Medicine

-

-

169.32

152.32

97546 00

Physical Medicine

-

-

84.32

75.48

97550 00

Physical Medicine

1.59

1.59

108.12

108.12

97551 00

Physical Medicine

0.79

0.73

53.72

49.64

97552 00

Physical Medicine

0.67

0.67

45.56

45.56

97597 00

Physical Medicine

3.03

1.05

206.04

71.40

97598 00

Physical Medicine

1.35

0.73

91.80

49.64

97602 00

Physical Medicine

-

-

68.68

61.88

97605 00

Physical Medicine

1.29

0.72

87.72

48.96

97606 00

Physical Medicine

1.53

0.79

104.04

53.72

97607 00

Physical Medicine

10.45

0.63

710.60

42.84

97608 00

Physical Medicine

10.81

0.74

735.08

50.32

97610 00

Physical Medicine

12.83

0.53

872.44

36.04

97750 00

Physical Medicine

1.02

1.02

69.36

69.36

97755 00

Physical Medicine

1.15

1.15

78.20

78.20

97760 00

Physical Medicine

1.43

1.43

97.24

97.24

97761 00

Physical Medicine

1.25

1.25

85.00

85.00

97763 00

Physical Medicine

1.57

1.57

106.76

106.76

97799 00

Physical Medicine

0.00

0.00

BR

BR

97802 00

Physical Medicine

1.09

0.95

74.12

64.60

97803 00

Physical Medicine

0.95

0.81

64.60

55.08

97804 00

Physical Medicine

0.50

0.46

34.00

31.28

97810 00

Physical Medicine

1.15

0.91

78.20

61.88

97811 00

Physical Medicine

0.85

0.76

57.80

51.68

97813 00

Physical Medicine

1.36

0.99

92.48

67.32

97814 00

Physical Medicine

1.10

0.84

74.80

57.12

98925 00

Physical Medicine

0.94

0.68

63.92

46.24

98926 00

Physical Medicine

1.35

1.03

91.80

70.04

98927 00

Physical Medicine

1.76

1.37

119.68

93.16

98928 00

Physical Medicine

2.15

1.73

146.20

117.64

98929 00

Physical Medicine

2.53

2.07

172.04

140.76

98940 00

Physical Medicine

0.82

0.65

55.76

44.20

98941 00

Physical Medicine

1.18

1.00

80.24

68.00

98942 00

Physical Medicine

1.52

1.34

103.36

91.12

98943 00

Physical Medicine

0.77

0.67

52.36

45.56

98960 00

Physical Medicine

0.92

0.92

62.56

62.56

98961 00

Physical Medicine

0.44

0.44

29.92

29.92

98962 00

Physical Medicine

0.33

0.33

22.44

22.44

98966 00

Physical Medicine

0.39

0.34

26.52

23.12

98967 00

Physical Medicine

0.72

0.66

48.96

44.88

98968 00

Physical Medicine

0.99

0.92

67.32

62.56

98970 00

Physical Medicine

0.35

0.35

23.80

23.80

98971 00

Physical Medicine

0.62

0.62

42.16

42.16

98972 00

Physical Medicine

0.92

0.91

62.56

61.88

98975 00

Physical Medicine

0.60

0.60

40.80

40.80

98976 00

Physical Medicine

1.42

1.42

96.56

96.56

98977 00

Physical Medicine

1.42

1.42

96.56

96.56

98978 00

Physical Medicine

0.00

0.00

BR

BR

98980 00

Physical Medicine

1.52

0.91

103.36

61.88

98981 00

Physical Medicine

1.20

0.90

81.60

61.20

EVALUATION AND MANAGEMENT GUIDELINES

Information regarding publications incorporated by reference is found in the Introduction of the Fee Schedule.

The evaluation and management guidelines incorporated by reference may be found in the CPT® published by the AMA and is reprinted, in part, below with permission. To the extent that a conflict may exist between an incorporated portion of the CPT® publication or HCPCS code and a code, guideline, identifier or modifier unique to Arizona, then the Arizona code, guideline, identifier or modifier shall control. Codes that are unique to Arizona are preceded by an AZ identifier and numbered in the following format: AZxxx.

Documentation and review of records, when required, is inclusive to the performance of the appropriate E/M service. A health care provider shall only be reimbursed for time that is not accounted for in the E/M service code by billing prolonged services codes 99415, 99416, 99417, or 99418. Proper documentation must justify the use of these codes and accompany the invoice.

Impairment Examinations

Impairment examinations shall be billed using CPT® 99455, work related or medical disability examination by the treating physician, or CPT® 99456, work related or medical disability examination by other than the treating physician. Physicians may bill one unit of these codes for the initial hour and an additional unit for each 30-minute increment after the initial hour. Each 30 minute increment commences the minute following the end of the previous time interval. The physician shall include documentation that demonstrates the complexity of the case and the time spent on the service to justify billing each additional unit. Reimbursement for CPT® codes 99455 and 99456 shall be made at 100% of the listed reimbursement value for the initial unit and then 50% of the listed reimbursement value for each additional unit.

Example:

A physician spends 72 minutes performing a work related disability examination on a patient they previously treated.

The physician would bill two units of 99455 and be reimbursed at 1.5 times the listed reimbursement value for CPT® 99455.

Remote Monitoring

Two HCPCS codes are included in this section of the 2024/2025 Fee Schedule for remote monitoring:

G2010 - Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.

G2012 - Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment: 5-10 minutes of medical discussion.

A. CLASSIFICATION OF EVALUATION AND MANAGEMENT (E/M) SERVICES.

The E/M section is divided into broad categories such as office visits, hospital inpatient or observation care visits, and consultations. Most of the categories are further divided into two or more subcategories of E/M services. For example, there are two subcategories of office visits (new patient and established patient) and there are two subcategories of hospital inpatient and observation care visits (initial and subsequent). The subcategories of E/M services are further classified into levels of E/M services that are identified by specific codes.

The basic format of the levels of E/M services based on medical decision making (MDM) or time is the same. First, a unique code number is listed. Second, the place and/or type of service is specified, (e.g., office or other outpatient visit). Third, the content of the service is defined. Fourth, time is specified. (A detailed discussion of time is provided in the Guidelines for Selecting Level of Service Based on Time.)

The place of service and service type are defined by the location where the face-to-face encounter with the patient and/or family/caregiver occurs. For example, service provided to a nursing facility resident brought to the office is reported with an office or other outpatient code.

New and Established Patients

Solely for the purposes of distinguishing between new and established patients, professional services are those face-to-face services rendered by physicians and other qualified health care professionals who may report evaluation and management services. A new patient is one who has not received any professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.

An established patient is one who has received professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years. In the instance where a physician or other qualified health care professional is on call for or covering for another physician or other qualified health care professional, the patient's encounter will be classified as it would have been by the physician or other qualified health care professional who is not available. When advanced practice nurses and physician assistants are working with physicians, they are considered as working in the exact same specialty and subspecialty as the physician.

No distinction is made between new and established patients in the emergency department. E/M services in the emergency department category may be reported for any new or established patient who presents for treatment in the emergency department.

Initial and Subsequent Services

Some categories apply to both new and established patients (e.g., hospital inpatient or observation care). These categories differentiate services by whether the service is the initial service or a subsequent service. For the purpose of distinguishing between initial or subsequent visits, professional services are those face-to-face services rendered by physicians and other qualified health care professionals who may report evaluation and management services. An initial service is when the patient has not received any professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, during the inpatient, observation, or nursing facility admission and stay.

A subsequent service is when the patient has received professional service(s) from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, during the admission and stay.

In the instance when a physician or other qualified health care professional is on call for or covering for another physician or other qualified health care professional, the patient's encounter will be classified as it would have been by the physician or other qualified health care professional who is not available. When advanced practice nurses and physician assistants are working with physicians, they are considered as working in the exact same specialty and subspecialty as the physician.

For reporting hospital inpatient or observation care services, a stay that includes a transition from observation to inpatient is a single stay. For reporting nursing facility services, a stay that includes transition(s) between skilled nursing facility and nursing facility level of care is the same stay.

Split or Shared Visits

Physician(s) and other qualified health care professionals(s) (QHP[s]) may act as a team in providing care for the patient, working together during a single E/M service. The split or shared visits guidelines are applied to determine which professional may report the service. If the physician or other QHP performs a substantive portion of the encounter, the physician or other QHP may report the service. If code selection is based on total time on the date of the encounter, the service is reported by the professional who spent the majority of the face-to-face or non-face-to-face time performing the service. For the purpose of reporting E/M services within the context of team-based care, performance of a substantive part of the MDM requires that the physician'(s) or other QHP(s) made or approved the management plan for the number and complexity of problems addressed at the encounter and takes responsibility for that plan with its inherent risk of complications and/or morbidity or mortality of patient management. By doing so, a physician or other QHP has performed two of the three elements used in the selection of the code level based on MDM. If the amount and/or complexity of data to be reviewed and analyzed is used by the physician or other QHP to determine the reported code level, assessing an independent historian's narrative and the ordering or review of tests or documents do not have to be personally performed by the physician or other QHP, because the relevant items would be considered in formulating the management plan. Independent interpretation of tests and discussion of management plan or test interpretation must be personally performed by the physician or other QHP if these are used to determine the reported code level by the physician or other QHP.

Multiple Evaluation and Management Services on the Same Date

The following guidelines apply to services that a patient may receive for hospital inpatient care, observation care, or nursing facility care. For instructions regarding transitions to these settings from the office or outpatient, home or residence, or emergency department setting, see guidelines for Hospital Inpatient and Observation Care Services or Nursing Facility Services.

A patient may receive E/M services in more than one setting on a calendar date. A patient may also have more than one visit in the same setting on a calendar date. The guidelines for multiple E/M services on the same date address circumstances in which the patient has received multiple visits or services from the same physician or other QHP or another physician or QHP of the exact same specialty and subspecialty who belongs to the same group practice.

Per day: The hospital inpatient and observation care services and the nursing facility services are "per day" services. When multiple visits occur over the course of a single calendar date in the same setting, a single service is reported. When using MDM for code level selection, use the aggregated MDM over the course of the calendar date. When using time for code level selection, sum the time over the course of the day using the guidelines for reporting time.

Multiple encounters in different settings or facilities: A patient may be seen and treated in different facilities (e.g., a hospital-to-hospital transfer). When more than one primary E/M service is reported and time is used to select the code level for either service, only the time spent providing that individual service may be allocated to the code level selected for reporting that service. No time may be counted twice when reporting more than one E/M service. Prolonged services are also based on the same allocation and their relationship to the primary service. The designation of the facility may be defined by licensure or regulation. Transfer from a hospital bed to a nursing facility bed in a hospital with nursing facility beds is considered as two services in two facilities because there is a discharge from one type of designation to another. An intra-facility transfer for a different level of care (e.g., from a routine unit to a critical care unit) does not constitute a new stay, nor does it constitute a transfer to a different facility.

Emergency department (ED) and services in other settings (same or different facilities): Time spent in an ED by a physician or other QHP who provides subsequent E/M services may be included in calculating total time on the date of the encounter when ED services are not reported and another E/M service is reported (e.g., hospital inpatient and observation care services).

Discharge services and services in other facilities: Each service may be reported separately as long as any time spent on the discharge service is not counted towards the total time of a subsequent service in which code level selection for the subsequent service is based on time. This includes any hospital inpatient or observation care services (including admission and discharge services) time (99234, 99235, 99236) because these services may be selected based on MDM or time. When these services are reported with another E/M service on the same calendar date, time related to the hospital inpatient or observation care service (including admission and discharge services) may not be used for code selection of the subsequent service.

Discharge Services and services in the same facility: If the patient is discharged and readmitted to the same facility on the same calendar date, report a subsequent care service instead of a discharge or initial service. For the purpose of E/M reporting, this is a single stay.

Discharge services and services in a different facility: If the patient is admitted to another facility, for the purpose of E/M reporting, this is considered a different stay. Discharge and initial services may be reported as long as time spent on the discharge service is not counted towards the total time of the subsequent service reported when code level selection is based on time.

Critical care services (including neonatal intensive care services and pediatric and neonatal critical care): Reporting guidelines for intensive and critical care services that are performed on the same calendar date as another E/M service are described in the service specific section guidelines.

Transitions between office or other outpatient, home or residence, or emergency department and hospital inpatient or observation or nursing facility: See the guidelines for Hospital Inpatient and Observation Care Services or Nursing Facility Services. If the patient is seen in two settings and only one service is reported, the total time on the date of the encounter of the aggregated MDM is used for determining the level of the single reported service. If prolonged services are reported, use the prolonged services code that is appropriate for the primary service reported, regardless of where the patient was located when the prolonged services time threshold was met. The choice of the primary service is at the discretion of the reporting physician or other QHP.

Services Reported Separately

Any specifically identifiable procedure or service (i.e., identified with a specific CPT code) performed on the date of E/M services may be reported separately.

The ordering and actual performance and/or interpretation of diagnostic tests/studies during a patient encounter are not included in determining the levels of E/M services when the professional interpretation of those tests/studies is reported separately by the physician or other qualified health care professional reporting the E/M service. Tests that do not require separate interpretation (e.g., tests that are results only) and are analyzed as part of MDM do not count as an independent interpretation, but may be counted as ordered or reviewed for selecting an MDM level. The performance of diagnostic tests/studies for which specific CPT codes are available may be reported separately, in addition to the appropriate E/M code. The interpretation of the results of diagnostic tests/studies (i.e., professional component) with preparation of a separate distinctly identifiable signed written report may also be reported separately, using the appropriate CPT code and, if required, with modifier 26 appended. The physician or other qualified health care professional may need to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant separately identifiable E/M service. The E/M service may be caused or prompted by the symptoms or condition for which the procedure and/or service was provided. This circumstance may be reported by adding modifier 25 to the appropriate level of E/M service. As such, different diagnoses are not required for reporting of the procedure and the E/M services on the same date.

History and/or Examination

E/M codes that have levels of services include a medically appropriate history and/or physical examination, when performed. The nature and extent of the history and/or physical examination are determined by the treating physician or other qualified health care professional reporting the service. The care team may collect information, and the patient or caregiver may supply information directly (e.g., by electronic health record [EHR] portal or questionnaire) that is reviewed by the reporting physician or other qualified health care professional. The extent of history and physical examination is not an element in the selection of the level of these E/M service codes.

B. LEVELS OF E/M SERVICES.

Select the appropriate level of E/M services based on the following:

1. The level of the MDM as defined for each service, or

2. The total time for E/M services performed on the date of the encounter.

Within each category or subcategory of E/M service based on MDM or time, there are three to five levels of E/M services available for reporting purposes. Levels of E/M services are NOT interchangeable among the different categories or subcategories of service. For example, the first level of E/M services in the subcategory of office visit, new patient, does not have the same definition as the first level of E/M services in the subcategory of office visit, established patient. Each level of E/M services may be used by all physicians or other qualified health care professionals.

Guidelines for Selecting Level of Service Based on Medical Decision Making

Four types of MDM are recognized: straightforward, low, moderate, and high. The concept of the level of MDM does not apply to CPT codes 99211 and 99281.

MDM includes establishing diagnoses, assessing the status of a condition, and/or selecting a management option. MDM is defined by three elements. The elements are:

* The number and complexity of problem(s) that are addressed during the encounter.

* The amount and/or complexity of data to be reviewed and analyzed. These data include medical records, tests, and/or other information that must be obtained, ordered, reviewed, and analyzed for the encounter. This includes information obtained from multiple sources or interprofessional communications that are not reported separately and interpretation of tests that are not reported separately. Ordering a test is included in the category of test result(s) and the review of the test result is part of the encounter and not a subsequent encounter. Ordering a test may include those considered but not selected after shared decision making. For example, a patient may request diagnostic imaging that is not necessary for their condition and discussion of the lack of benefit may be required. Alternatively, a test may normally be performed, but due to the risk for a specific patient it is not ordered. These considerations must be documented. Data are divided into three categories:

1. Tests, documents, orders, or independent historian(s). (Each unique test, order, or document is counted to meet a threshold number.)

2. Independent interpretation of tests (not separately reported).

3. Discussion of management or test interpretation with an external physician or other qualified health care professional or appropriate source (not separately reported).

* The risk of complications and/or morbidity or mortality of patient management. This includes decisions made at the encounter, associated with diagnostic procedure(s), and treatment(s). This includes the possible management options selected and those considered but not selected after shared decision making with the patient and/or family. For example, a decision about hospitalization includes considerations of alternative levels of care. Examples may include a psychiatric patient with a sufficient degree of support in the outpatient setting or the decision to not hospitalize a patient with advanced dementia with an acute condition that would generally warrant inpatient care, but for whom the goal is palliative treatment.

Shared decision making involves eliciting patient and/or family preferences, patient and/or family education, and explaining risks and benefits of management options.

MDM may be impacted by role and management responsibility.

When the physician or other qualified health care professional is reporting a separate CPT® code that includes interpretation and/or report, the interpretation and/or report is not counted toward the MDM when selecting a level of E/M services. When the physician or other qualified health care professional is reporting a separate service for discussion of management with a physician or another qualified health care professional, the discussion is not counted toward the MDM when selecting a level of outpatient E/M services.

The Levels of Medical Decision Making (MDM) table (Table 1) is a guide to assist in selecting the level of MDM for reporting an E/M services code. The table includes the four levels of MDM (i.e., straightforward, low, moderate, high) and the three elements of MDM (i.e., number and complexity of problems addressed at the encounter, amount and/or complexity of data reviewed and analyzed, and risk of complications and/or morbidity or mortality of patient management). To qualify for a particular level of MDM, two of the three elements for that level of MDM must be met or exceeded.

Examples in the table may be more or less applicable to specific settings of care. For example, the decision to hospitalize applies to the outpatient or nursing facility encounters, whereas the decision to escalate hospital level of care (e.g., transfer to ICU) applies to the hospitalized or observation care patient. See also the introductory guidelines of each code family section.

The elements listed in Table 1, Levels of Medical Decision Making, are defined in the guidelines for number and complexity of problems addressed at the encounter, amount and/or complexity of data to be reviewed and analyzed, and risk of complications and/or morbidity or mortality of patient management.

Table 1: Levels of Medical Decision Making (MDM)

Elements of Medical Decision Making

Level of MDM

(Based on 2 out of 3 Elements of MDM)

Number and Complexity of Problems Addressed at the Encounter

Amount and/or Complexity of Data to Be Reviewed and Analyzed

*Each unique test, order, or document contributes to the combination of 2 or combination of 3 in Category 1 below.

Risk of Complications and/or Morbidity or Mortality of Patient Management

Straightforward

Minimal

1 self-limited or minor problem

Minimal or none

Minimal risk of morbidity from additional diagnostic testing or treatment

Low

Low

* 2 or more selflimited or minor problems;

or

* 1 stable, chronic illness;

or

* 1 acute, uncomplicated illness or injury;

or

* 1 stable, acute illness;

or

* 1 acute, uncomplicated illness or injury requiring hospital inpatient or observation level of care

Limited

(Must meet the requirements of at least 1 out of 2 categories)

Category 1: Tests and documents

* Any combination of 2 from the following:

* Review of prior external note(s) from each unique source*;

* Review of the result(s) of each unique test*;\

* Ordering of each unique test*

or

Category 2: Assessment requiring an independent historian(s)

(For the categories of independent interpretation of tests and discussion of management or test interpretation, see moderate or high)

Low risk or morbidity from additional diagnostic testing or treatment

Moderate

Moderate

* 1 or more chronic illnesses with exacerbation, progression, or side effects of treatment;

or

* 2 or more stable, chronic illnesses;

or

* 1 undiagnosed new problem with uncertain prognosis;

or

* 1 acute illness with systemic symptoms;

or

* 1 acute, complicated injury

Moderate

(Must meet the requirements of at least 1 out of 3 categories)

Category 1: Tests, documents, or independent historian(s)

* Any combination of 3 from the following:

* Review of prior external note(s) from each unique source*;

* Review of the result(s) of each unique test*;

* Ordering of each unique test*;

* Assessment requiring an independent historian(s)

or

Category 2: Independent interpretation of tests

* Independent interpretation of a test performed by another physician /other qualified health care professional (not separately reported);

or

Category 3: Discussion of management or test interpretation

* Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported)

Moderate risk of morbidity from additional diagnostic testing or treatment

Examples only:

* Prescription drug management

* Decision regarding minor surgery with identified patient or procedure risk factors

* Decision regarding elective major surgery without identified patient or procedure risk factors

* Diagnosis or treatment significantly limited by social determinants of health.

High

High

Extensive

High risk of morbidity from

* 1 or more chronic illnesses with severe exacerbation, progression, or side effects of treatment;

or

* 1 acute or chronic illness or injury that poses a threat to life or bodily function

(Must meet the requirements of at least 2 out of 3 categories)

Category 1: Tests, documents or independent historian(s)

Any combination of 3 from the following:

* Review of prior external note(s) from each unique source*;

* Review of the result(s) of each unique test*;

* Ordering of each unique test*;

* Assessment requiring an independent historian(s)

or

Category 2: Independent interpretation of tests

* Independent interpretation of a test performed by another physician/other qualified healthcare professional (not separately reported);

or

Category 3: Discussion of management or test interpretation

* Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported)

additional diagnostic testing or treatment

Examples only:

* Drug therapy requiring intensive monitoring for toxicity

* Decision regarding elective major surgery with identified patient or procedure risk factors

* Decision regarding emergency major surgery

* Decision regarding hospitalization or escalation of hospital-level care

* Decision not to resuscitate or to de-escalate care because of poor prognosis

* Decision regarding parenteral controlled substances

Number and Complexity of Problems Addressed at the Encounter

One element used in selecting the level of office or other outpatient services is the number and complexity of the problems that are addressed at an encounter. Multiple new or established conditions may be addressed at the same time and may affect MDM. Symptoms may cluster around a specific diagnosis and each symptom is not necessarily a unique condition. Comorbidities/underlying diseases, in and of themselves, are not considered in selecting a level of E/M services unless they are addressed, and their presence increases the amount and/or complexity of data to be reviewed and analyzed or the risk of complications and/or morbidity or mortality of patient management. The final diagnosis for a condition does not, in and of itself, determine the complexity or risk, as extensive evaluation may be required to reach the conclusion that the signs or symptoms do not represent a highly morbid condition. Therefore, presenting symptoms that are unlikely to represent a highly morbid condition may "drive" MDM even when the ultimate diagnosis is not highly morbid. The evaluation and/or treatment should be consistent with the likely nature of the condition. Multiple problems of a lower severity may, in the aggregate, create higher risk due to interaction.

The term "risk" as used in these definitions relates to risk from the condition. While condition risk and management risk may often correlate, the risk from the condition is distinct from the risk of management.

Definitions for the elements of MDM (see Table 1, Levels of Medical Decision Making) are:

Problem: A problem is a disease, condition, illness, injury, symptom, sign, finding, complaint, or other matter addressed at the encounter, with or without a diagnosis being established at the time of the encounter.

Problem addressed: A problem is addressed or managed when it is evaluated or treated at the encounter by the physician or other qualified healthcare provider reporting the service. This includes consideration of further testing or treatment that may not be elected by virtue of risk/benefit analysis or patient/parent/guardian/surrogate choice. Notation in the patient's medical record that another professional is managing the problem without additional assessment or care coordination documented does not qualify as being addressed or managed by the physician or other qualified healthcare professional reporting the service. Referral without evaluation (by history, examination, or diagnostic study[ies]) or consideration of treatment does not qualify as being addressed or managed by the physician or other qualified health care professional reporting the service. For hospital inpatient and observation care services the problem addressed is the problem status on the date of the encounter, which may be significantly different than on admission. It is the problem being managed or co-managed by the reporting physician or other qualified health care professional and may not be the cause of admission or continued stay.

Minimal problem: A problem that may not require the presence of the physician or other qualified healthcare professional, but the service is provided under the physician's or other qualified health care professional's supervision (see CPT codes 99211, 99281).

Self-limiting or minor problem: A problem that runs a definite and prescribed course, is transient in nature, and is not likely to permanently alter health status.

Stable, chronic illness: A problem with an expected duration of at least one year or until the death of the patient. For the purpose of defining chronicity, conditions are treated as chronic whether or not stage or severity changes (e.g., uncontrolled diabetes and controlled diabetes are a single chronic condition). "Stable" for the purposes of categorizing MDM is defined by the specific treatment goals for an individual patient. A patient who is not at his or her treatment goal is not stable, even if the condition has not changed and there is no short-term threat to life or function. For example, in a patient with persistently poorly controlled blood pressure for whom better control is a goal is not stable, even if the pressures are not changing and the patient is asymptomatic, the risk of morbidity without treatment is significant.

Acute, uncomplicated illness or injury: A recent or new short-term problem with low risk of morbidity for which treatment is considered. There is little to no risk of mortality with treatment, and full recovery without functional impairment is expected. A problem that is normally self-limited or minor but is not resolving consistent with a definite and prescribed course is an acute, uncomplicated illness.

Acute, uncomplicated illness or injury requiring hospital inpatient or observation level care: A recent or new short-term problem with low risk of morbidity for which treatment is required. There is little to no risk of mortality with treatment, and full recovery without functional impairment is expected. The treatment required is delivered in a hospital inpatient or observation l level setting.

Stable, acute illness: A problem that is new or recent for which treatment has been initiated. The patient is improved and, while resolution may not be complete, is stable with respect to this condition.

Chronic illness with exacerbation, progression, or side effects of treatment: A chronic illness that is acutely worsening, poorly controlled, or progressing with an intent to control progression and requiring additional supportive care or requiring attention to treatment for side effects.

Undiagnosed new problem with uncertain prognosis: A problem in the differential diagnosis that represents a condition likely to result in a high risk of morbidity without treatment.

Acute illness with systemic symptoms: An illness that causes systemic symptoms and has a high risk of morbidity without treatment. For systemic general symptoms, such as fever, body aches, or fatigue in a minor illness that may be treated to alleviate symptoms, see the definitions for self-limited or minor problem or acute, uncomplicated illness or injury. Systemic symptoms may not be general but may be a single system.

Acute, complicated injury: An injury which requires treatment that includes evaluation of body systems that are not directly part of the injured organ, the injury is extensive, or the treatment options are multiple and/or associated with a risk of morbidity.

Chronic illness with severe exacerbation, progression, or side effects of treatment: The severe exacerbation or progression of a chronic illness or severe side effects of treatment that have significant risk of morbidity and may require escalation in level of care.

Acute or chronic illness or injury that poses a threat to life or bodily function: An acute illness with systemic symptoms, and acute complicated injury, or a chronic illness or injury with exacerbation and/or progression or side effects of treatment, that poses a threat to life or bodily function in the near term without treatment. Some symptoms may represent a condition that is significantly probable and poses a potential threat to life or bodily function. These may be included in this category when the evaluation and treatment are consistent with this degree of potential severity.

Amount and/or Complexity of Data to Be Reviewed and Analyzed

One element used in selecting the level of services is the amount and/or complexity of data to be reviewed or analyzed at an encounter.

Analyzed: the process of using the data as part of the MDM. The data element itself may not be subject to analysis (e.g., glucose), but it is instead included in the thought processes for diagnosis, evaluation, or treatment. Tests ordered are presumed to be analyzed when the results are reported. Therefore, when they are ordered during an encounter, they are counted in that encounter. Tests that are ordered outside of an encounter may be counted in the encounter in which they are analyzed. In the case of a recurring order, each new result may be counted in the encounter in which it is analyzed. For example, an encounter that includes an order for monthly prothrombin times would count for one prothrombin time ordered and reviewed. Additional future results, if analyzed in a subsequent encounter, may be counted as a single test in that subsequent encounter. Any service for which the professional component is separately reported by the physician or other qualified health care professional reporting the E/M services is not counted as a data element ordered, reviewed, analyzed, or independently interpreted for the purposes of determining the level of MDM.

Test: Tests are imaging, laboratory, psychometric, or physiologic data. A clinical laboratory panel (e.g., basic metabolic panel [80047]) is a single test. The differentiation between single or multiple tests is defined in accordance with the CPT® code set. For the purposes of data reviewed and analyzed, pulse oximetry is not a test.

Unique: A unique test is defined by the CPT® code set. When multiple results of the same unique test (e.g., serial blood glucose values) are compared during an E/M service, count it as one unique test. Tests that have overlapping elements are not unique, even if they are identified with distinct CPT® codes. For example, a CBC with differential would incorporate the set of hemoglobin, CBC, without differential, and platelet count. A unique source is defined as a physician or other qualified healthcare professional in a distinct group or different specialty or subspecialty, or a unique entity. Review of all the materials from any unique source counts as one element toward MDM.

Combination of Data Elements: A combination of different data elements, for example, a combination of notes reviewed, tests ordered, tests reviewed, or independent historian, allows these elements to be summed. It does not require each item type or category to be represented. A unique test ordered, plus a note reviewed and an independent historian would be a combination of three elements.

External: External records, communications, and/or test results are from an external physician, other qualified health care professional, facility, or health care organization.

External physician or other qualified health care professional: An external physician or other qualified health care professional who is not in the same group practice or is of a different specialty or subspecialty. This includes licensed professionals who are practicing independently. The individual may also be a facility or organizational provider such as from a hospital, nursing facility, or home health care agency.

Discussion: Discussion requires an interactive exchange. The exchange must be direct and not through intermediaries (e.g., clinical staff or trainees). Sending chart notes or written exchanges that are within progress notes does not qualify as an interactive exchange. The discussion does not need to be on the date of the encounter, but it is counted only once and only when it is used in the decision making of the encounter. It may be synchronous (i.e., does not need to be in person), but it must be initiated and completed within a short time period (e.g., within a day or two).

Independent historian(s): An individual (e.g., parent, guardian, surrogate, spouse, witness) who provides a history in addition to a history provided by the patient who is unable to provide a complete or reliable history (e.g., due to developmental stage, dementia, or psychosis) or because a confirmatory history is judged to be necessary. In the case where there may be conflict or poor communication between multiple historians and more than one historian is needed, the independent historian requirement is met. It does not include translation services. The independent history does not need to be obtained in person but does need to be obtained directly from the historian providing the independent information.

Independent interpretations: The interpretation of a test for which there is a CPT® code and an interpretation or report is customary. This does not apply when the physician or other healthcare professional who reports the E/M service is reporting or has previously reported the test. A form of interpretation should be documented but need not conform to the usual standards of a complete report for the test. A test that is ordered and independently interpreted may count both as a test ordered and interpreted.

Appropriate source: For the purpose of the discussion of management data element (see Table 1, levels of Medical Decision Making), an appropriate source includes professionals who are not health care professionals but may be involved in the management of the patient (e.g., lawyer, parole officer, case manager, teacher). It does not include discussion with family or informal caregivers. For the purpose of documents reviewed, documents from an appropriate source may be counted.

Risk of Complications and/or Morbidity or Mortality of Patient Management

One element used in selecting the level of service is the risk of complications and/or morbidity or mortality of patient management at an encounter. This is distinct from the risk of the condition itself.

Risk: The probability and/or consequences of an event. The assessment of the level of risk is affected by the nature of the event under consideration. For example, a low probability of death may be high risk, whereas a high chance of a minor, self-limited adverse effect of treatment may be low risk. Definitions of risk are based upon the usual behavior and thought processes of a physician or other qualified healthcare professional in the same specialty. Trained clinicians apply common language usage meanings to terms such as high, medium, low, or minimal risk and do not require quantification for these definitions (though quantification may be provided when evidence-based medicine has established probabilities). For the purposes of MDM, level of risk is based upon consequences of the problem(s) addressed at the encounter when appropriately treated. Risk also includes MDM related to the need to initiate or forego further testing, treatment and/or hospitalization. The risk of patient management criteria applies to the patient management decisions made by the reporting physician or other health care professional as part of the reported encounter.

Morbidity: A state of illness or functional impairment that is expected to be of substantial duration during which function is limited, quality of life is impaired, or there is organ damage that may not be transient despite treatment.

Social determinants of health: Economic and social conditions that influence the health of people and communities. Examples may include food or housing insecurity.

Surgery (minor or major, elective, emergency, procedure or patient risk):

Surgery - Minor or Major: The classification of surgery into minor or major is based on the common meaning of such terms when used by trained clinicians, similar to the use of the term "risk." These terms are not defined by a surgical package classification.

Surgery - Elective or Emergency: Elective procedures and emergent or urgent procedures describe the timing of the procedure when the timing is related to the patient's condition. An elective procedure is typically planned in advance (e.g., scheduled for weeks later), while an emergent procedure is typically performed immediately or with minimal delay to allow for patient stabilization. Both elective and emergent procedures may be minor or major procedures.

Surgery - Risk Factors, Patient or Procedure: Risk factors are those that are relevant to the patient and procedure. Evidence-based risk calculators may be used, but are not required, in assessing patient and procedure risk.

Drug therapy requiring intensive monitoring for toxicity: A drug that requires intensive monitoring is a therapeutic agent that has the potential to cause serious morbidity or death. The monitoring is performed for assessment of these adverse effects and not primarily for assessment of therapeutic efficacy. The monitoring should be that which is generally accepted practice for the agent but may be patient-specific in some cases. Intensive monitoring may be long-term or short-term. Long-term intensive monitoring is not performed less than quarterly. The monitoring may be performed with a laboratory test, a physiologic test, or imaging. Monitoring by history or examination does not qualify. The monitoring affects the level of MDM in an encounter in which it is considered in the management of the patient. An example may be monitoring for cytopenia with the use of an antineoplastic agent between dose cycles. Examples of monitoring that do not qualify include monitoring glucose levels during insulin therapy, as the primary reason is the therapeutic effect (unless severe hypoglycemia is a current, significant concern); or annual electrolytes and renal function for a patient on a diuretic, as the frequency does not meet the threshold.

Parenteral controlled substances: The level of risk is based on the usual behavior and thought processes of a physician or other qualified health care professional in the same specialty and subspecialty and not simply based on the presence of an order for parenteral controlled substances.

Guidelines for Selecting Level of Service Based on Time

Certain categories of time-based E/M codes that do not have levels of services based on MDM (e.g., Critical Care Services) in the E/M section use time differently. It is important to review the instructions for each category.

Time is not a descriptive component for the emergency department levels of E/M services because emergency department services are typically provided on a variable intensity basis, often involving multiple encounters with several patients over an extended period of time.

When time is used for reporting E/M services codes, the time defined in the service descriptors is used for selecting the appropriate level of services. The E/M services for which these guidelines apply require a face-to-face encounter with the physician or other qualified health care professional and the patient and/or family/caregiver. For office or other outpatient services, if the physician's or other qualified health care professional's time is spent in the supervision of clinical staff who perform the face-to-face services of the encounter, use 99211.

For coding purposes, time for these services is the total time on the date of the encounter. It includes both the face-to-face time with the patient and/or family/caregiver and non-face-to-face time personally spent by the physician and/or other qualified health care professional(s) on the day of the encounter (includes time in activities that require the physician or other qualified health care professional and does not include time in activities normally performed by clinical staff). It includes time regardless of the location of the physician or other qualified health care professional (e.g., whether on or off the inpatient unit or in or out of the outpatient office). It does not include any time spent in the performance of other separately reported service(s).

Each service that may be reported using time for code level selection has a required time threshold. The concept of attaining a mid-point between levels does not apply. A full 15 minutes is required to report any unit of prolonged service codes 99417, and 99418.

Physician(s) and other qualified health care professional(s) may each provide a portion of the face-to-face and non-face-to-face work related to the service. When time is being used to select the appropriate level of services for which time-based reporting is allowed, the time personally spent by the physician(s) and other qualified health care professional(s) assessing and managing the patient and/or counseling, educating, communicating results to the patient/family/caregiver on the date of the encounter is summed to define total time. Only distinct time should be summed (i.e., when two or more individuals jointly meet with or discuss the patient, only the time of one individual should be counted).

When prolonged time occurs, the appropriate prolonged services code may be reported. The total time on the date of the encounter spent caring for the patient should be documented in the medical record when it is used as the basis for code selection.

Physician or other qualified health care professional time includes the following activities, when performed:

* Preparing to see the patient (e.g., review of tests)

* Obtaining and/or reviewing separately obtained history

* Performing a medically appropriate examination and/or evaluation

* Counseling and educating the patient/family/caregiver

* Ordering medications, tests, or procedures

* Referring and communicating with other health care professionals (when not separately reported)

* Documenting clinical information in the electronic or other health record

* Independently interpreting results (not separately reported) and communicating results to the patient/family/caregiver

* Care coordination (not separately reported)

Do not count time spent on the following:

* The performance of other services that are reported separately

* Travel

* Teaching that is general and not limited to discussion that is required for the management of a specific patient

For split or shared visits, see the split or shared visits guidelines.

C. UNLISTED SERVICE

An E/M service may be provided that is not listed in this section of CPT® codebook. When reporting such a service, the appropriate unlisted code may be used to indicate the service, identifying it by "Special Report," as discussed in item E. The "Unlisted Services" and accompanying codes for the E/M section are as follows:

99429 Unlisted preventive medicine service

99499 Unlisted evaluation and management service

D. SPECIAL REPORT.

An unlisted service or one that is unusual, variable, or new may require a special report demonstrating the medical appropriateness of the service. Pertinent information should include an adequate definition or description of the nature, extent, and need for the procedure and the time, effort, and equipment necessary to provide the service. Additional items that may be included are complexity of symptoms, final diagnosis, pertinent physical findings, diagnostic and therapeutic procedures, concurrent problems, and follow-up care.

ARIZONA PHYSICIANS' FEE SCHEDULE

Evaluation and Management Codes 2024

E&M Conversion Factor $68.00

Code

Category

FY24 NF RVU

FY24 FAC RVU

FY24 NF RBRVS Rate

FY24 FAC RBRVS Rate

99202 00

E&M

2.17

1.41

147.56

95.88

99203 00

E&M

3.35

2.44

227.80

165.92

99204 00

E&M

5.02

3.97

341.36

269.96

99205 00

E&M

6.62

5.40

450.16

367.20

99211 00

E&M

0.70

0.26

47.60

17.68

99212 00

E&M

1.70

1.05

115.60

71.40

99213 00

E&M

2.73

1.96

185.64

133.28

99214 00

E&M

3.85

2.89

261.80

196.52

99215 00

E&M

5.42

4.29

368.56

291.72

99221 00

E&M

2.46

2.46

167.28

167.28

99222 00

E&M

3.88

3.88

263.84

263.84

99223 00

E&M

5.14

5.14

349.52

349.52

99231 00

E&M

1.47

1.47

99.96

99.96

99232 00

E&M

2.34

2.34

159.12

159.12

99233 00

E&M

3.52

3.52

239.36

239.36

99234 00

E&M

2.90

2.90

197.20

197.20

99235 00

E&M

4.73

4.73

321.64

321.64

99236 00

E&M

6.18

6.18

420.24

420.24

99238 00

E&M

2.41

2.41

163.88

163.88

99239 00

E&M

3.40

3.40

231.20

231.20

99242 00

E&M

2.25

1.66

153.00

112.88

99243 00

E&M

3.37

2.62

229.16

178.16

99244 00

E&M

4.81

3.99

327.08

271.32

99245 00

E&M

6.28

5.36

427.04

364.48

99252 00

E&M

2.11

2.11

143.48

143.48

99253 00

E&M

2.96

2.96

201.28

201.28

99254 00

E&M

4.11

4.11

279.48

279.48

99255 00

E&M

5.53

5.53

376.04

376.04

99281 00

E&M

0.34

0.34

23.12

23.12

99282 00

E&M

1.24

1.24

84.32

84.32

99283 00

E&M

2.11

2.11

143.48

143.48

99284 00

E&M

3.59

3.59

244.12

244.12

99285 00

E&M

5.20

5.20

353.60

353.60

99288 00

E&M

0.00

0.00

Bundled Code

Bundled Code

99291 00

E&M

8.18

6.31

556.24

429.08

99292 00

E&M

3.58

3.18

243.44

216.24

99304 00

E&M

2.39

2.39

162.52

162.52

99305 00

E&M

3.97

3.97

269.96

269.96

99306 00

E&M

5.42

5.42

368.56

368.56

99307 00

E&M

1.20

1.20

81.60

81.60

99308 00

E&M

2.22

2.22

150.96

150.96

99309 00

E&M

3.21

3.21

218.28

218.28

99310 00

E&M

4.58

4.58

311.44

311.44

99315 00

E&M

2.43

2.43

165.24

165.24

99316 00

E&M

3.90

3.90

265.20

265.20

99341 00

E&M

1.47

1.47

99.96

99.96

99342 00

E&M

2.33

2.33

158.44

158.44

99344 00

E&M

4.23

4.23

287.64

287.64

99345 00

E&M

6.01

6.01

408.68

408.68

99347 00

E&M

1.35

1.35

91.80

91.80

99348 00

E&M

2.28

2.28

155.04

155.04

99349 00

E&M

3.79

3.79

257.72

257.72

99350 00

E&M

5.52

5.52

375.36

375.36

99358 00

E&M

2.65

2.61

180.20

177.48

99359 00

E&M

1.13

1.09

76.84

74.12

99360 00

E&M

1.74

1.74

118.32

118.32

99366 00

E&M

1.22

1.19

82.96

80.92

99367 00

E&M

1.60

1.60

108.80

108.80

99368 00

E&M

1.04

1.04

70.72

70.72

99374 00

E&M

0.00

0.00

Bundled Code

Bundled Code

99375 00

E&M

3.03

2.50

206.04

170.00

99377 00

E&M

0.00

0.00

Bundled Code

Bundled Code

99378 00

E&M

3.03

2.50

206.04

170.00

99379 00

E&M

0.00

0.00

Bundled Code

Bundled Code

99380 00

E&M

0.00

0.00

Bundled Code

Bundled Code

99381 00

E&M

0.00

0.00

BR

BR

99382 00

E&M

0.00

0.00

BR

BR

99383 00

E&M

0.00

0.00

BR

BR

99384 00

E&M

0.00

0.00

BR

BR

99385 00

E&M

0.00

0.00

BR

BR

99386 00

E&M

0.00

0.00

BR

BR

99387 00

E&M

0.00

0.00

BR

BR

99391 00

E&M

0.00

0.00

BR

BR

99392 00

E&M

0.00

0.00

BR

BR

99393 00

E&M

0.00

0.00

BR

BR

99394 00

E&M

0.00

0.00

BR

BR

99395 00

E&M

0.00

0.00

BR

BR

99396 00

E&M

0.00

0.00

BR

BR

99397 00

E&M

0.00

0.00

BR

BR

99401 00

E&M

0.00

0.00

BR

BR

99402 00

E&M

0.00

0.00

BR

BR

99403 00

E&M

0.00

0.00

BR

BR

99404 00

E&M

0.00

0.00

BR

BR

99406 00

E&M

0.00

0.00

BR

BR

99407 00

E&M

0.00

0.00

BR

BR

99408 00

E&M

0.00

0.00

BR

BR

99409 00

E&M

0.00

0.00

BR

BR

99411 00

E&M

0.00

0.00

BR

BR

99412 00

E&M

0.00

0.00

BR

BR

99415 00

E&M

0.62

0.62

42.16

42.16

99416 00

E&M

0.29

0.29

19.72

19.72

99417 00

E&M

0.92

0.89

62.56

60.52

99418 00

E&M

1.17

1.17

79.56

79.56

99421 00

E&M

0.45

0.38

30.60

25.84

99422 00

E&M

0.88

0.75

59.84

51.00

99423 00

E&M

1.40

1.20

95.20

81.60

99424 00

E&M

2.48

2.21

168.64

150.28

99425 00

E&M

1.80

1.52

122.40

103.36

99426 00

E&M

1.86

1.47

126.48

99.96

99427 00

E&M

1.42

1.03

96.56

70.04

99429 00

E&M

0.00

0.00

BR

BR

99437 00

E&M

1.79

1.50

121.72

102.00

99439 00

E&M

1.44

1.04

97.92

70.72

99441 00

E&M

1.69

1.04

114.92

70.72

99442 00

E&M

2.72

1.95

184.96

132.60

99443 00

E&M

3.85

2.89

261.80

196.52

99446 00

E&M

0.53

0.53

36.04

36.04

99447 00

E&M

1.08

1.08

73.44

73.44

99448 00

E&M

1.60

1.60

108.80

108.80

99449 00

E&M

2.13

2.13

144.84

144.84

99450 00

E&M

0.00

0.00

BR

BR

99451 00

E&M

1.04

1.04

70.72

70.72

99452 00

E&M

1.01

1.01

68.68

68.68

99453 00

E&M

0.60

0.60

40.80

40.80

99454 00

E&M

1.42

1.42

96.56

96.56

99455 00

E&M

5.23

5.23

355.64

355.64

99456 00

E&M

6.87

6.87

467.16

467.16

99457 00

E&M

1.47

0.89

99.96

60.52

99458 00

E&M

1.18

0.89

80.24

60.52

99459 00

E&M

0.68

0.68

46.24

46.24

99460 00

E&M

2.75

2.75

187.00

187.00

99461 00

E&M

2.75

1.81

187.00

123.08

99462 00

E&M

1.21

1.21

82.28

82.28

99463 00

E&M

3.21

3.21

218.28

218.28

99464 00

E&M

2.15

2.15

146.20

146.20

99465 00

E&M

4.21

4.21

286.28

286.28

99466 00

E&M

6.87

6.87

467.16

467.16

99467 00

E&M

3.45

3.45

234.60

234.60

99468 00

E&M

26.48

26.48

1800.64

1800.64

99469 00

E&M

11.45

11.45

778.60

778.60

99471 00

E&M

22.94

22.94

1559.92

1559.92

99472 00

E&M

11.75

11.75

799.00

799.00

99473 00

E&M

0.43

0.43

29.24

29.24

99474 00

E&M

0.50

0.26

34.00

17.68

99475 00

E&M

16.53

16.53

1124.04

1124.04

99476 00

E&M

9.95

9.95

676.60

676.60

99477 00

E&M

10.03

10.03

682.04

682.04

99478 00

E&M

3.95

3.95

268.60

268.60

99479 00

E&M

3.59

3.59

244.12

244.12

99480 00

E&M

3.45

3.45

234.60

234.60

99483 00

E&M

8.19

5.74

556.92

390.32

99484 00

E&M

1.65

1.31

112.20

89.08

99485 00

E&M

0.00

0.00

Bundled Code

Bundled Code

99486 00

E&M

0.00

0.00

Bundled Code

Bundled Code

99487 00

E&M

4.03

2.68

274.04

182.24

99489 00

E&M

2.17

1.49

147.56

101.32

99490 00

E&M

1.88

1.49

127.84

101.32

99491 00

E&M

2.54

2.24

172.72

152.32

99492 00

E&M

4.60

2.79

312.80

189.72

99493 00

E&M

4.20

3.05

285.60

207.40

99494 00

E&M

1.78

1.22

121.04

82.96

99495 00

E&M

6.21

4.16

422.28

282.88

99496 00

E&M

8.40

5.65

571.20

384.20

99497 00

E&M

2.46

2.24

167.28

152.32

99498 00

E&M

2.13

2.11

144.84

143.48

99499 00

E&M

0.00

0.00

BR

BR

G2010 00

E&M

0.37

0.27

25.16

18.36

G2012 00

E&M

0.42

0.38

28.56

25.84

CATEGORY III CODES GUIDELINES

Information regarding publications incorporated by reference is found in the Introduction Section of the Fee Schedule.

The following Commission guidelines are in addition to the CPT® guidelines and represent additional guidance from the Commission relative to unit values for these services. To the extent that a conflict may exist between an incorporated portion of the CPT® publication or HCPCS code and a code, guideline, identifier or modifier unique to Arizona, then the Arizona code, guideline, identifier, or modifier shall control. Codes that are unique to Arizona are preceded by an AZ identifier and numbered in the following format: AZxxx.

Category III Codes are temporary codes developed to allow collection of data for emerging technology, services, and procedures. The five character alphanumeric codes contain four numbers with one alpha character in the fifth place. If a Category III Code is available, this code must be reported instead of a Category I unlisted code.

ARIZONA PHYSICIANS' FEE SCHEDULE

Category III Codes 2024

Code

Category

FY24 NF RVU

FY24 FAC RVU

FY24 NF RBRVS Rate

FY24 FAC RBRVS Rate

0042T 00

Category III

0.00

0.00

RNE

RNE

0054T 00

Category III

0.00

0.00

RNE

RNE

0055T 00

Category III

0.00

0.00

RNE

RNE

0071T 00

Category III

0.00

0.00

RNE

RNE

0072T 00

Category III

0.00

0.00

RNE

RNE

0075T 00

Category III

0.00

0.00

RNE

RNE

0075T 26

Category III

0.00

0.00

RNE

RNE

0075T TC

Category III

0.00

0.00

RNE

RNE

0076T 00

Category III

0.00

0.00

RNE

RNE

0076T 26

Category III

0.00

0.00

RNE

RNE

0076T TC

Category III

0.00

0.00

RNE

RNE

0095T 00

Category III

0.00

0.00

RNE

RNE

0098T 00

Category III

0.00

0.00

RNE

RNE

0100T 00

Category III

0.00

0.00

RNE

RNE

0101T 00

Category III

0.00

0.00

RNE

RNE

0102T 00

Category III

0.00

0.00

RNE

RNE

0106T 00

Category III

0.00

0.00

RNE

RNE

0107T 00

Category III

0.00

0.00

RNE

RNE

0108T 00

Category III

0.00

0.00

RNE

RNE

0109T 00

Category III

0.00

0.00

RNE

RNE

0110T 00

Category III

0.00

0.00

RNE

RNE

0164T 00

Category III

0.00

0.00

RNE

RNE

0165T 00

Category III

0.00

0.00

RNE

RNE

0174T 00

Category III

0.00

0.00

RNE

RNE

0175T 00

Category III

0.00

0.00

RNE

RNE

0184T 00

Category III

0.00

0.00

RNE

RNE

0198T 00

Category III

0.00

0.00

RNE

RNE

0200T 00

Category III

0.00

0.00

RNE

RNE

0201T 00

Category III

0.00

0.00

RNE

RNE

0202T 00

Category III

0.00

0.00

RNE

RNE

0207T 00

Category III

0.00

0.00

RNE

RNE

0208T 00

Category III

0.00

0.00

RNE

RNE

0209T 00

Category III

0.00

0.00

RNE

RNE

0210T 00

Category III

0.00

0.00

RNE

RNE

0211T 00

Category III

0.00

0.00

RNE

RNE

0212T 00

Category III

0.00

0.00

RNE

RNE

0213T 00

Category III

0.00

0.00

RNE

RNE

0214T 00

Category III

0.00

0.00

RNE

RNE

0215T 00

Category III

0.00

0.00

RNE

RNE

0216T 00

Category III

0.00

0.00

RNE

RNE

0217T 00

Category III

0.00

0.00

RNE

RNE

0218T 00

Category III

0.00

0.00

RNE

RNE

0219T 00

Category III

0.00

0.00

RNE

RNE

0220T 00

Category III

0.00

0.00

RNE

RNE

0221T 00

Category III

0.00

0.00

RNE

RNE

0222T 00

Category III

0.00

0.00

RNE

RNE

0232T 00

Category III

0.00

0.00

RNE

RNE

0234T 00

Category III

0.00

0.00

RNE

RNE

0235T 00

Category III

0.00

0.00

RNE

RNE

0236T 00

Category III

0.00

0.00

RNE

RNE

0237T 00

Category III

0.00

0.00

RNE

RNE

0238T 00

Category III

0.00

0.00

RNE

RNE

0253T 00

Category III

0.00

0.00

RNE

RNE

0263T 00

Category III

0.00

0.00

RNE

RNE

0264T 00

Category III

0.00

0.00

RNE

RNE

0265T 00

Category III

0.00

0.00

RNE

RNE

0266T 00

Category III

0.00

0.00

RNE

RNE

0267T 00

Category III

0.00

0.00

RNE

RNE

0268T 00

Category III

0.00

0.00

RNE

RNE

0269T 00

Category III

0.00

0.00

RNE

RNE

0270T 00

Category III

0.00

0.00

RNE

RNE

0271T 00

Category III

0.00

0.00

RNE

RNE

0272T 00

Category III

0.00

0.00

RNE

RNE

0273T 00

Category III

0.00

0.00

RNE

RNE

0274T 00

Category III

0.00

0.00

RNE

RNE

0275T 00

Category III

0.00

0.00

RNE

RNE

0278T 00

Category III

0.00

0.00

RNE

RNE

0308T 00

Category III

0.00

0.00

RNE

RNE

0329T 00

Category III

0.00

0.00

RNE

RNE

0330T 00

Category III

0.00

0.00

RNE

RNE

0331T 00

Category III

0.00

0.00

RNE

RNE

0332T 00

Category III

0.00

0.00

RNE

RNE

0333T 00

Category III

0.00

0.00

RNE

RNE

0335T 00

Category III

0.00

0.00

RNE

RNE

0338T 00

Category III

0.00

0.00

RNE

RNE

0339T 00

Category III

0.00

0.00

RNE

RNE

0342T 00

Category III

0.00

0.00

RNE

RNE

0345T 00

Category III

0.00

0.00

RNE

RNE

0347T 00

Category III

0.00

0.00

RNE

RNE

0348T 00

Category III

0.00

0.00

RNE

RNE

0349T 00

Category III

0.00

0.00

RNE

RNE

0350T 00

Category III

0.00

0.00

RNE

RNE

0351T 00

Category III

0.00

0.00

RNE

RNE

0352T 00

Category III

0.00

0.00

RNE

RNE

0353T 00

Category III

0.00

0.00

RNE

RNE

0354T 00

Category III

0.00

0.00

RNE

RNE

0358T 00

Category III

0.00

0.00

RNE

RNE

0362T 00

Category III

0.00

0.00

RNE

RNE

0373T 00

Category III

0.00

0.00

RNE

RNE

0378T 00

Category III

0.00

0.00

RNE

RNE

0379T 00

Category III

0.00

0.00

RNE

RNE

0394T 00

Category III

0.00

0.00

RNE

RNE

0395T 00

Category III

0.00

0.00

RNE

RNE

0397T 00

Category III

0.00

0.00

RNE

RNE

0398T 00

Category III

0.00

0.00

RNE

RNE

0398T 26

Category III

0.00

0.00

RNE

RNE

0398T TC

Category III

0.00

0.00

RNE

RNE

0402T 00

Category III

0.00

0.00

RNE

RNE

0403T 00

Category III

0.00

0.00

RNE

RNE

0408T 00

Category III

0.00

0.00

RNE

RNE

0409T 00

Category III

0.00

0.00

RNE

RNE

0410T 00

Category III

0.00

0.00

RNE

RNE

0411T 00

Category III

0.00

0.00

RNE

RNE

0412T 00

Category III

0.00

0.00

RNE

RNE

0413T 00

Category III

0.00

0.00

RNE

RNE

0414T 00

Category III

0.00

0.00

RNE

RNE

0415T 00

Category III

0.00

0.00

RNE

RNE

0416T 00

Category III

0.00

0.00

RNE

RNE

0417T 00

Category III

0.00

0.00

RNE

RNE

0418T 00

Category III

0.00

0.00

RNE

RNE

0419T 00

Category III

0.00

0.00

RNE

RNE

0420T 00

Category III

0.00

0.00

RNE

RNE

0421T 00

Category III

0.00

0.00

RNE

RNE

0422T 00

Category III

0.00

0.00

RNE

RNE

0437T 00

Category III

0.00

0.00

RNE

RNE

0439T 00

Category III

0.00

0.00

RNE

RNE

0440T 00

Category III

0.00

0.00

RNE

RNE

0441T 00

Category III

0.00

0.00

RNE

RNE

0442T 00

Category III

0.00

0.00

RNE

RNE

0443T 00

Category III

0.00

0.00

RNE

RNE

0444T 00

Category III

0.00

0.00

RNE

RNE

0445T 00

Category III

0.00

0.00

RNE

RNE

0449T 00

Category III

0.00

0.00

RNE

RNE

0450T 00

Category III

0.00

0.00

RNE

RNE

0464T 00

Category III

0.00

0.00

RNE

RNE

0469T 00

Category III

0.00

0.00

RNE

RNE

0472T 00

Category III

0.00

0.00

RNE

RNE

0473T 00

Category III

0.00

0.00

RNE

RNE

0474T 00

Category III

0.00

0.00

RNE

RNE

0479T 00

Category III

0.00

0.00

RNE

RNE

0480T 00

Category III

0.00

0.00

RNE

RNE

0481T 00

Category III

0.00

0.00

RNE

RNE

0483T 00

Category III

0.00

0.00

RNE

RNE

0484T 00

Category III

0.00

0.00

RNE

RNE

0485T 00

Category III

0.00

0.00

RNE

RNE

0485T 26

Category III

0.00

0.00

RNE

RNE

0485T TC

Category III

0.00

0.00

RNE

RNE

0486T 00

Category III

0.00

0.00

RNE

RNE

0486T 26

Category III

0.00

0.00

RNE

RNE

0486T TC

Category III

0.00

0.00

RNE

RNE

0488T 00

Category III

0.00

0.00

RNE

RNE

0489T 00

Category III

0.00

0.00

RNE

RNE

0490T 00

Category III

0.00

0.00

RNE

RNE

0494T 00

Category III

0.00

0.00

RNE

RNE

0495T 00

Category III

0.00

0.00

RNE

RNE

0496T 00

Category III

0.00

0.00

RNE

RNE

0500T 00

Category III

0.00

0.00

RNE

RNE

0505T 00

Category III

0.00

0.00

RNE

RNE

0506T 00

Category III

0.00

0.00

RNE

RNE

0506T 26

Category III

0.00

0.00

RNE

RNE

0506T TC

Category III

0.00

0.00

RNE

RNE

0507T 00

Category III

0.00

0.00

RNE

RNE

0507T 26

Category III

0.00

0.00

RNE

RNE

0507T TC

Category III

0.00

0.00

RNE

RNE

0510T 00

Category III

0.00

0.00

RNE

RNE

0511T 00

Category III

0.00

0.00

RNE

RNE

0512T 00

Category III

0.00

0.00

RNE

RNE

0513T 00

Category III

0.00

0.00

RNE

RNE

0515T 00

Category III

0.00

0.00

RNE

RNE

0516T 00

Category III

0.00

0.00

RNE

RNE

0517T 00

Category III

0.00

0.00

RNE

RNE

0518T 00

Category III

0.00

0.00

RNE

RNE

0519T 00

Category III

0.00

0.00

RNE

RNE

0520T 00

Category III

0.00

0.00

RNE

RNE

0521T 00

Category III

0.00

0.00

RNE

RNE

0521T 26

Category III

0.00

0.00

RNE

RNE

0521T TC

Category III

0.00

0.00

RNE

RNE

0522T 00

Category III

0.00

0.00

RNE

RNE

0522T 26

Category III

0.00

0.00

RNE

RNE

0522T TC

Category III

0.00

0.00

RNE

RNE

0523T 00

Category III

0.00

0.00

RNE

RNE

0524T 00

Category III

0.00

0.00

RNE

RNE

0525T 00

Category III

0.00

0.00

RNE

RNE

0526T 00

Category III

0.00

0.00

RNE

RNE

0527T 00

Category III

0.00

0.00

RNE

RNE

0528T 00

Category III

0.00

0.00

RNE

RNE

0528T 26

Category III

0.00

0.00

RNE

RNE

0528T TC

Category III

0.00

0.00

RNE

RNE

0529T 00

Category III

0.00

0.00

RNE

RNE

0529T 26

Category III

0.00

0.00

RNE

RNE

0529T TC

Category III

0.00

0.00

RNE

RNE

0530T 00

Category III

0.00

0.00

RNE

RNE

0531T 00

Category III

0.00

0.00

RNE

RNE

0532T 00

Category III

0.00

0.00

RNE

RNE

0537T 00

Category III

0.00

0.00

Bundled Code

Bundled Code

0538T 00

Category III

0.00

0.00

Bundled Code

Bundled Code

0539T 00

Category III

0.00

0.00

Bundled Code

Bundled Code

0540T 00

Category III

0.00

0.00

RNE

RNE

0541T 00

Category III

0.00

0.00

RNE

RNE

0542T 00

Category III

0.00

0.00

RNE

RNE

0543T 00

Category III

0.00

0.00

RNE

RNE

0544T 00

Category III

0.00

0.00

RNE

RNE

0545T 00

Category III

0.00

0.00

RNE

RNE

0546T 00

Category III

0.00

0.00

RNE

RNE

0547T 00

Category III

0.00

0.00

RNE

RNE

0552T 00

Category III

0.00

0.00

RNE

RNE

0553T 00

Category III

0.00

0.00

RNE

RNE

0554T 00

Category III

0.00

0.00

RNE

RNE

0555T 00

Category III

0.00

0.00

RNE

RNE

0556T 00

Category III

0.00

0.00

RNE

RNE

0557T 00

Category III

0.00

0.00

RNE

RNE

0558T 00

Category III

0.00

0.00

RNE

RNE

0559T 00

Category III

0.00

0.00

RNE

RNE

0560T 00

Category III

0.00

0.00

RNE

RNE

0561T 00

Category III

0.00

0.00

RNE

RNE

0562T 00

Category III

0.00

0.00

RNE

RNE

0563T 00

Category III

0.00

0.00

RNE

RNE

0564T 00

Category III

0.00

0.00

RNE

RNE

0565T 00

Category III

0.00

0.00

RNE

RNE

0566T 00

Category III

0.00

0.00

RNE

RNE

0567T 00

Category III

0.00

0.00

RNE

RNE

0568T 00

Category III

0.00

0.00

RNE

RNE

0569T 00

Category III

0.00

0.00

RNE

RNE

0570T 00

Category III

0.00

0.00

RNE

RNE

0571T 00

Category III

0.00

0.00

RNE

RNE

0572T 00

Category III

0.00

0.00

RNE

RNE

0573T 00

Category III

0.00

0.00

RNE

RNE

0574T 00

Category III

0.00

0.00

RNE

RNE

0575T 00

Category III

0.00

0.00

RNE

RNE

0576T 00

Category III

0.00

0.00

RNE

RNE

0577T 00

Category III

0.00

0.00

RNE

RNE

0578T 00

Category III

0.00

0.00

RNE

RNE

0579T 00

Category III

0.00

0.00

RNE

RNE

0580T 00

Category III

0.00

0.00

RNE

RNE

0581T 00

Category III

0.00

0.00

RNE

RNE

0582T 00

Category III

0.00

0.00

RNE

RNE

0583T 00

Category III

0.00

0.00

RNE

RNE

0584T 00

Category III

0.00

0.00

RNE

RNE

0585T 00

Category III

0.00

0.00

RNE

RNE

0586T 00

Category III

0.00

0.00

RNE

RNE

0587T 00

Category III

0.00

0.00

RNE

RNE

0588T 00

Category III

0.00

0.00

RNE

RNE

0589T 00

Category III

0.00

0.00

RNE

RNE

0590T 00

Category III

0.00

0.00

RNE

RNE

0591T 00

Category III

0.00

0.00

RNE

RNE

0592T 00

Category III

0.00

0.00

RNE

RNE

0593T 00

Category III

0.00

0.00

RNE

RNE

0594T 00

Category III

0.00

0.00

RNE

RNE

0596T 00

Category III

0.00

0.00

RNE

RNE

0597T 00

Category III

0.00

0.00

RNE

RNE

0598T 00

Category III

0.00

0.00

RNE

RNE

0599T 00

Category III

0.00

0.00

RNE

RNE

0600T 00

Category III

0.00

0.00

RNE

RNE

0601T 00

Category III

0.00

0.00

RNE

RNE

0602T 00

Category III

0.00

0.00

RNE

RNE

0603T 00

Category III

0.00

0.00

RNE

RNE

0604T 00

Category III

0.00

0.00

RNE

RNE

0605T 00

Category III

0.00

0.00

RNE

RNE

0606T 00

Category III

0.00

0.00

RNE

RNE

0607T 00

Category III

0.00

0.00

RNE

RNE

0608T 00

Category III

0.00

0.00

RNE

RNE

0609T 00

Category III

0.00

0.00

RNE

RNE

0610T 00

Category III

0.00

0.00

RNE

RNE

0611T 00

Category III

0.00

0.00

RNE

RNE

0612T 00

Category III

0.00

0.00

RNE

RNE

0613T 00

Category III

0.00

0.00

RNE

RNE

0614T 00

Category III

0.00

0.00

RNE

RNE

0615T 00

Category III

0.00

0.00

RNE

RNE

0616T 00

Category III

0.00

0.00

RNE

RNE

0617T 00

Category III

0.00

0.00

RNE

RNE

0618T 00

Category III

0.00

0.00

RNE

RNE

0619T 00

Category III

0.00

0.00

RNE

RNE

0620T 00

Category III

0.00

0.00

RNE

RNE

0621T 00

Category III

0.00

0.00

RNE

RNE

0622T 00

Category III

0.00

0.00

RNE

RNE

0623T 00

Category III

0.00

0.00

RNE

RNE

0624T 00

Category III

0.00

0.00

RNE

RNE

0625T 00

Category III

0.00

0.00

RNE

RNE

0626T 00

Category III

0.00

0.00

RNE

RNE

0627T 00

Category III

0.00

0.00

RNE

RNE

0628T 00

Category III

0.00

0.00

RNE

RNE

0629T 00

Category III

0.00

0.00

RNE

RNE

0630T 00

Category III

0.00

0.00

RNE

RNE

0631T 00

Category III

0.00

0.00

RNE

RNE

0632T 00

Category III

0.00

0.00

RNE

RNE

0633T 00

Category III

0.00

0.00

RNE

RNE

0633T 26

Category III

0.00

0.00

RNE

RNE

0633T TC

Category III

0.00

0.00

RNE

RNE

0634T 00

Category III

0.00

0.00

RNE

RNE

0634T 26

Category III

0.00

0.00

RNE

RNE

0634T TC

Category III

0.00

0.00

RNE

RNE

0635T 00

Category III

0.00

0.00

RNE

RNE

0635T 26

Category III

0.00

0.00

RNE

RNE

0635T TC

Category III

0.00

0.00

RNE

RNE

0636T 00

Category III

0.00

0.00

RNE

RNE

0636T 26

Category III

0.00

0.00

RNE

RNE

0636T TC

Category III

0.00

0.00

RNE

RNE

0637T 00

Category III

0.00

0.00

RNE

RNE

0637T 26

Category III

0.00

0.00

RNE

RNE

0637T TC

Category III

0.00

0.00

RNE

RNE

0638T 00

Category III

0.00

0.00

RNE

RNE

0638T 26

Category III

0.00

0.00

RNE

RNE

0638T TC

Category III

0.00

0.00

RNE

RNE

0639T 00

Category III

0.00

0.00

RNE

RNE

0640T 00

Category III

0.00

0.00

RNE

RNE

0643T 00

Category III

0.00

0.00

RNE

RNE

0644T 00

Category III

0.00

0.00

RNE

RNE

0645T 00

Category III

0.00

0.00

RNE

RNE

0646T 00

Category III

0.00

0.00

RNE

RNE

0647T 00

Category III

0.00

0.00

RNE

RNE

0648T 00

Category III

0.00

0.00

RNE

RNE

0648T 26

Category III

0.00

0.00

RNE

RNE

0648T TC

Category III

0.00

0.00

RNE

RNE

0649T 00

Category III

0.00

0.00

RNE

RNE

0649T 26

Category III

0.00

0.00

RNE

RNE

0649T TC

Category III

0.00

0.00

RNE

RNE

0650T 00

Category III

0.00

0.00

RNE

RNE

0650T 26

Category III

0.00

0.00

RNE

RNE

0650T TC

Category III

0.00

0.00

RNE

RNE

0651T 00

Category III

0.00

0.00

RNE

RNE

0652T 00

Category III

0.00

0.00

RNE

RNE

0653T 00

Category III

0.00

0.00

RNE

RNE

0654T 00

Category III

0.00

0.00

RNE

RNE

0655T 00

Category III

0.00

0.00

RNE

RNE

0656T 00

Category III

0.00

0.00

RNE

RNE

0657T 00

Category III

0.00

0.00

RNE

RNE

0658T 00

Category III

0.00

0.00

RNE

RNE

0659T 00

Category III

0.00

0.00

RNE

RNE

0660T 00

Category III

0.00

0.00

RNE

RNE

0661T 00

Category III

0.00

0.00

RNE

RNE

0662T 00

Category III

0.00

0.00

RNE

RNE

0663T 00

Category III

0.00

0.00

RNE

RNE

0664T 00

Category III

0.00

0.00

RNE

RNE

0665T 00

Category III

0.00

0.00

RNE

RNE

0666T 00

Category III

0.00

0.00

RNE

RNE

0667T 00

Category III

0.00

0.00

RNE

RNE

0668T 00

Category III

0.00

0.00

RNE

RNE

0669T 00

Category III

0.00

0.00

RNE

RNE

0670T 00

Category III

0.00

0.00

RNE

RNE

0671T 00

Category III

0.00

0.00

RNE

RNE

0672T 00

Category III

0.00

0.00

RNE

RNE

0673T 00

Category III

0.00

0.00

RNE

RNE

0674T 00

Category III

0.00

0.00

RNE

RNE

0675T 00

Category III

0.00

0.00

RNE

RNE

0676T 00

Category III

0.00

0.00

RNE

RNE

0677T 00

Category III

0.00

0.00

RNE

RNE

0678T 00

Category III

0.00

0.00

RNE

RNE

0679T 00

Category III

0.00

0.00

RNE

RNE

0680T 00

Category III

0.00

0.00

RNE

RNE

0681T 00

Category III

0.00

0.00

RNE

RNE

0682T 00

Category III

0.00

0.00

RNE

RNE

0683T 00

Category III

0.00

0.00

RNE

RNE

0683T 26

Category III

0.00

0.00

RNE

RNE

0683T TC

Category III

0.00

0.00

RNE

RNE

0684T 00

Category III

0.00

0.00

RNE

RNE

0684T 26

Category III

0.00

0.00

RNE

RNE

0684T TC

Category III

0.00

0.00

RNE

RNE

0685T 00

Category III

0.00

0.00

RNE

RNE

0685T 26

Category III

0.00

0.00

RNE

RNE

0685T TC

Category III

0.00

0.00

RNE

RNE

0686T 00

Category III

0.00

0.00

RNE

RNE

0687T 00

Category III

0.00

0.00

RNE

RNE

0688T 00

Category III

0.00

0.00

RNE

RNE

0689T 00

Category III

0.00

0.00

RNE

RNE

0689T 26

Category III

0.00

0.00

RNE

RNE

0689T TC

Category III

0.00

0.00

RNE

RNE

0690T 00

Category III

0.00

0.00

RNE

RNE

0690T 26

Category III

0.00

0.00

RNE

RNE

0690T TC

Category III

0.00

0.00

RNE

RNE

0691T 00

Category III

0.00

0.00

RNE

RNE

0691T 26

Category III

0.00

0.00

RNE

RNE

0691T TC

Category III

0.00

0.00

RNE

RNE

0692T 00

Category III

0.00

0.00

RNE

RNE

0693T 00

Category III

0.00

0.00

RNE

RNE

0694T 00

Category III

0.00

0.00

RNE

RNE

0694T 26

Category III

0.00

0.00

RNE

RNE

0694T TC

Category III

0.00

0.00

RNE

RNE

0695T 00

Category III

0.00

0.00

RNE

RNE

0696T 00

Category III

0.00

0.00

RNE

RNE

0697T 00

Category III

0.00

0.00

RNE

RNE

0697T 26

Category III

0.00

0.00

RNE

RNE

0697T TC

Category III

0.00

0.00

RNE

RNE

0698T 00

Category III

0.00

0.00

RNE

RNE

0698T 26

Category III

0.00

0.00

RNE

RNE

0698T TC

Category III

0.00

0.00

RNE

RNE

0699T 00

Category III

0.00

0.00

RNE

RNE

0700T 00

Category III

0.00

0.00

RNE

RNE

0700T 26

Category III

0.00

0.00

RNE

RNE

0700T TC

Category III

0.00

0.00

RNE

RNE

0701T 00

Category III

0.00

0.00

RNE

RNE

0701T 26

Category III

0.00

0.00

RNE

RNE

0701T TC

Category III

0.00

0.00

RNE

RNE

0704T 00

Category III

0.00

0.00

RNE

RNE

0705T 00

Category III

0.00

0.00

RNE

RNE

0706T 00

Category III

0.00

0.00

RNE

RNE

0707T 00

Category III

0.00

0.00

RNE

RNE

0708T 00

Category III

0.00

0.00

RNE

RNE

0709T 00

Category III

0.00

0.00

RNE

RNE

0710T 00

Category III

0.00

0.00

RNE

RNE

0711T 00

Category III

0.00

0.00

RNE

RNE

0712T 00

Category III

0.00

0.00

RNE

RNE

0713T 00

Category III

0.00

0.00

RNE

RNE

0714T 00

Category III

0.00

0.00

RNE

RNE

0716T 00

Category III

0.00

0.00

RNE

RNE

0717T 00

Category III

0.00

0.00

RNE

RNE

0718T 00

Category III

0.00

0.00

RNE

RNE

0719T 00

Category III

0.00

0.00

RNE

RNE

0720T 00

Category III

0.00

0.00

RNE

RNE

0721T 00

Category III

0.00

0.00

RNE

RNE

0721T 26

Category III

0.00

0.00

RNE

RNE

0721T TC

Category III

0.00

0.00

RNE

RNE

0722T 00

Category III

0.00

0.00

RNE

RNE

0722T 26

Category III

0.00

0.00

RNE

RNE

0722T TC

Category III

0.00

0.00

RNE

RNE

0723T 00

Category III

0.00

0.00

RNE

RNE

0723T 26

Category III

0.00

0.00

RNE

RNE

0723T TC

Category III

0.00

0.00

RNE

RNE

0724T 00

Category III

0.00

0.00

RNE

RNE

0724T 26

Category III

0.00

0.00

RNE

RNE

0724T TC

Category III

0.00

0.00

RNE

RNE

0725T 00

Category III

0.00

0.00

RNE

RNE

0726T 00

Category III

0.00

0.00

RNE

RNE

0727T 00

Category III

0.00

0.00

RNE

RNE

0728T 00

Category III

0.00

0.00

RNE

RNE

0729T 00

Category III

0.00

0.00

RNE

RNE

0730T 00

Category III

0.00

0.00

RNE

RNE

0731T 00

Category III

0.00

0.00

RNE

RNE

0732T 00

Category III

0.00

0.00

RNE

RNE

0733T 00

Category III

0.00

0.00

RNE

RNE

0734T 00

Category III

0.00

0.00

RNE

RNE

0735T 00

Category III

0.00

0.00

RNE

RNE

0736T 00

Category III

0.00

0.00

RNE

RNE

0737T 00

Category III

0.00

0.00

RNE

RNE

0738T 00

Category III

0.00

0.00

RNE

RNE

0739T 00

Category III

0.00

0.00

RNE

RNE

0740T 00

Category III

0.00

0.00

RNE

RNE

0741T 00

Category III

0.00

0.00

RNE

RNE

0742T 00

Category III

0.00

0.00

RNE

RNE

0742T 26

Category III

0.00

0.00

RNE

RNE

0742T TC

Category III

0.00

0.00

RNE

RNE

0743T 00

Category III

0.00

0.00

RNE

RNE

0743T 26

Category III

0.00

0.00

RNE

RNE

0743T TC

Category III

0.00

0.00

RNE

RNE

0744T 00

Category III

0.00

0.00

RNE

RNE

0745T 00

Category III

0.00

0.00

RNE

RNE

0746T 00

Category III

0.00

0.00

RNE

RNE

0747T 00

Category III

0.00

0.00

RNE

RNE

0748T 00

Category III

0.00

0.00

RNE

RNE

0749T 00

Category III

0.00

0.00

RNE

RNE

0750T 00

Category III

0.00

0.00

RNE

RNE

0751T 00

Category III

0.00

0.00

RNE

RNE

0752T 00

Category III

0.00

0.00

RNE

RNE

0753T 00

Category III

0.00

0.00

RNE

RNE

0754T 00

Category III

0.00

0.00

RNE

RNE

0755T 00

Category III

0.00

0.00

RNE

RNE

0756T 00

Category III

0.00

0.00

RNE

RNE

0757T 00

Category III

0.00

0.00

RNE

RNE

0758T 00

Category III

0.00

0.00

RNE

RNE

0759T 00

Category III

0.00

0.00

RNE

RNE

0760T 00

Category III

0.00

0.00

RNE

RNE

0761T 00

Category III

0.00

0.00

RNE

RNE

0762T 00

Category III

0.00

0.00

RNE

RNE

0763T 00

Category III

0.00

0.00

RNE

RNE

0764T 00

Category III

0.00

0.00

RNE

RNE

0765T 00

Category III

0.00

0.00

RNE

RNE

0766T 00

Category III

0.00

0.00

RNE

RNE

0767T 00

Category III

0.00

0.00

RNE

RNE

0770T 00

Category III

0.00

0.00

RNE

RNE

0771T 00

Category III

0.00

0.00

RNE

RNE

0772T 00

Category III

0.00

0.00

RNE

RNE

0773T 00

Category III

0.00

0.00

RNE

RNE

0774T 00

Category III

0.00

0.00

RNE

RNE

0776T 00

Category III

0.00

0.00

RNE

RNE

0777T 00

Category III

0.00

0.00

RNE

RNE

0777T 26

Category III

0.00

0.00

RNE

RNE

0777T TC

Category III

0.00

0.00

RNE

RNE

0778T 00

Category III

0.00

0.00

RNE

RNE

0779T 00

Category III

0.00

0.00

RNE

RNE

0779T 26

Category III

0.00

0.00

RNE

RNE

0779T TC

Category III

0.00

0.00

RNE

RNE

0780T 00

Category III

0.00

0.00

RNE

RNE

0781T 00

Category III

0.00

0.00

RNE

RNE

0782T 00

Category III

0.00

0.00

RNE

RNE

0783T 00

Category III

0.00

0.00

RNE

RNE

0784T 00

Category III

0.00

0.00

RNE

RNE

0785T 00

Category III

0.00

0.00

RNE

RNE

0786T 00

Category III

0.00

0.00

RNE

RNE

0787T 00

Category III

0.00

0.00

RNE

RNE

0788T 00

Category III

0.00

0.00

RNE

RNE

0789T 00

Category III

0.00

0.00

RNE

RNE

0790T 00

Category III

0.00

0.00

RNE

RNE

0791T 00

Category III

0.00

0.00

RNE

RNE

0792T 00

Category III

0.00

0.00

RNE

RNE

0793T 00

Category III

0.00

0.00

RNE

RNE

0794T 00

Category III

0.00

0.00

RNE

RNE

0795T 00

Category III

0.00

0.00

RNE

RNE

0796T 00

Category III

0.00

0.00

RNE

RNE

0797T 00

Category III

0.00

0.00

RNE

RNE

0798T 00

Category III

0.00

0.00

RNE

RNE

0799T 00

Category III

0.00

0.00

RNE

RNE

0800T 00

Category III

0.00

0.00

RNE

RNE

0801T 00

Category III

0.00

0.00

RNE

RNE

0802T 00

Category III

0.00

0.00

RNE

RNE

0803T 00

Category III

0.00

0.00

RNE

RNE

0804T 00

Category III

0.00

0.00

RNE

RNE

0804T 26

Category III

0.00

0.00

RNE

RNE

0804T TC

Category III

0.00

0.00

RNE

RNE

0805T 00

Category III

0.00

0.00

RNE

RNE

0806T 00

Category III

0.00

0.00

RNE

RNE

0807T 00

Category III

0.00

0.00

RNE

RNE

0807T 26

Category III

0.00

0.00

RNE

RNE

0807T TC

Category III

0.00

0.00

RNE

RNE

0808T 00

Category III

0.00

0.00

RNE

RNE

0808T 26

Category III

0.00

0.00

RNE

RNE

0808T TC

Category III

0.00

0.00

RNE

RNE

0810T 00

Category III

0.00

0.00

RNE

RNE

0811T 00

Category III

0.00

0.00

RNE

RNE

0812T 00

Category III

0.00

0.00

RNE

RNE

0813T 00

Category III

0.00

0.00

RNE

RNE

0814T 00

Category III

0.00

0.00

RNE

RNE

0815T 00

Category III

0.00

0.00

RNE

RNE

0815T 26

Category III

0.00

0.00

RNE

RNE

0815T TC

Category III

0.00

0.00

RNE

RNE

0816T 00

Category III

0.00

0.00

RNE

RNE

0817T 00

Category III

0.00

0.00

RNE

RNE

0818T 00

Category III

0.00

0.00

RNE

RNE

0819T 00

Category III

0.00

0.00

RNE

RNE

0820T 00

Category III

0.00

0.00

RNE

RNE

0821T 00

Category III

0.00

0.00

RNE

RNE

0822T 00

Category III

0.00

0.00

RNE

RNE

0823T 00

Category III

0.00

0.00

RNE

RNE

0824T 00

Category III

0.00

0.00

RNE

RNE

0825T 00

Category III

0.00

0.00

RNE

RNE

0826T 00

Category III

0.00

0.00

RNE

RNE

0826T 26

Category III

0.00

0.00

RNE

RNE

0826T TC

Category III

0.00

0.00

RNE

RNE

0827T 00

Category III

0.00

0.00

RNE

RNE

0828T 00

Category III

0.00

0.00

RNE

RNE

0829T 00

Category III

0.00

0.00

RNE

RNE

0830T 00

Category III

0.00

0.00

RNE

RNE

0831T 00

Category III

0.00

0.00

RNE

RNE

0832T 00

Category III

0.00

0.00

RNE

RNE

0833T 00

Category III

0.00

0.00

RNE

RNE

0834T 00

Category III

0.00

0.00

RNE

RNE

0835T 00

Category III

0.00

0.00

RNE

RNE

0836T 00

Category III

0.00

0.00

RNE

RNE

0837T 00

Category III

0.00

0.00

RNE

RNE

0838T 00

Category III

0.00

0.00

RNE

RNE

0839T 00

Category III

0.00

0.00

RNE

RNE

0840T 00

Category III

0.00

0.00

RNE

RNE

0841T 00

Category III

0.00

0.00

RNE

RNE

0842T 00

Category III

0.00

0.00

RNE

RNE

0843T 00

Category III

0.00

0.00

RNE

RNE

0844T 00

Category III

0.00

0.00

RNE

RNE

0845T 00

Category III

0.00

0.00

RNE

RNE

0846T 00

Category III

0.00

0.00

RNE

RNE

0847T 00

Category III

0.00

0.00

RNE

RNE

0848T 00

Category III

0.00

0.00

RNE

RNE

0849T 00

Category III

0.00

0.00

RNE

RNE

0850T 00

Category III

0.00

0.00

RNE

RNE

0851T 00

Category III

0.00

0.00

RNE

RNE

0852T 00

Category III

0.00

0.00

RNE

RNE

0853T 00

Category III

0.00

0.00

RNE

RNE

0854T 00

Category III

0.00

0.00

RNE

RNE

0855T 00

Category III

0.00

0.00

RNE

RNE

0856T 00

Category III

0.00

0.00

RNE

RNE

0857T 00

Category III

0.00

0.00

RNE

RNE

0857T 26

Category III

0.00

0.00

RNE

RNE

0857T TC

Category III

0.00

0.00

RNE

RNE

0858T 00

Category III

0.00

0.00

RNE

RNE

0858T 26

Category III

0.00

0.00

RNE

RNE

0858T TC

Category III

0.00

0.00

RNE

RNE

0859T 00

Category III

0.00

0.00

RNE

RNE

0860T 00

Category III

0.00

0.00

RNE

RNE

0861T 00

Category III

0.00

0.00

RNE

RNE

0862T 00

Category III

0.00

0.00

RNE

RNE

0863T 00

Category III

0.00

0.00

RNE

RNE

0864T 00

Category III

0.00

0.00

RNE

RNE

0865T 00

Category III

0.00

0.00

RNE

RNE

0865T 26

Category III

0.00

0.00

RNE

RNE

0865T TC

Category III

0.00

0.00

RNE

RNE

0866T 00

Category III

0.00

0.00

RNE

RNE

0866T 26

Category III

0.00

0.00

RNE

RNE

0866T TC

Category III

0.00

0.00

RNE

RNE

HCPCS GUIDELINES

Information regarding the incorporation of HCPCS codes is found in the Introduction to the Fee Schedule.

HCPCS codes are five-character codes with a leading alpha-character followed by four numeric digits.

The following Commission guidelines are provided in addition to the Center for Medicare & Medicaid Services' (CMS) HCPCS codes and descriptions and represent additional guidance from the Commission relative to services unique or uniquely utilized in Workers' Compensation. To the extent that a conflict may exist between an incorporated HCPCS code and a code, guideline, identifier, or modifier unique to Arizona, then the Arizona code, guideline, identifier, or modifier shall control. Codes that contain explanatory language specific to Arizona are preceded by Î" in this Fee Schedule. Codes that are unique to Arizona are preceded by an AZ identifier and numbered in the following format: AZxxx.

HCPCS codes in this section are used to bill for services, equipment, and supplies including:

* Medical and surgical supplies

* Durable medical equipment

* Physician-administered drugs

* Prosthetics and orthotics

* Vision and hearing supplies

In this section, any reference to Durable Medical Equipment (DME) includes reimbursable supplies, prosthetics, and orthotics

A. REIMBURSEMENT

1. Materials and supplies normally necessary to perform a service, such as needles and syringes, ultrasound pads and gel, band-aids, and dressings are considered part of a healthcare provider's overhead and are not separately reimbursable. Please see Section J of the Introduction Guidelines to the Fee Schedule for more examples of non-reimbursable supplies and materials.

2. This section of the fee schedule includes maximum reimbursement amounts for DME, services, and procedures billed with HCPCS codes.

3. DME dispensed by a healthcare provider to the patient ancillary to an office visit shall be reimbursed at the lesser of the provider's billed charge or the value listed in the fee schedule.

4. DME may be reimbursed differently based on whether the zip code where the materials are provided are classified by CMS as rural or nonrural. The fee schedule includes different rates for rural and nonrural zip codes where applicable. The zip codes included on the list below shall be reimbursed based on the fees in the "Rural" column in the fee schedule. All other zip codes shall be reimbursed based on the "Nonrural" fee.

Rural Zip Codes

85135

85371

85542

85621

85920

85936

86034

86511

85192

85390

85543

85623

85922

85937

86039

86512

85320

85501

85544

85624

85923

85938

86042

86514

85321

85502

85545

85628

85924

85939

86043

86515

85325

85530

85546

85631

85925

85940

86047

86520

85328

85531

85547

85634

85926

85941

86054

86535

85334

85532

85548

85637

85927

85942

86502

86538

85341

85533

85550

85640

85928

86025

86503

86540

85344

85534

85551

85646

85929

86028

86504

86544

85346

85535

85552

85648

85930

86029

86505

86545

85348

85536

85553

85901

85932

86030

86506

86547

85357

85539

85554

85902

85933

86031

86507

86556

85358

85540

85611

85911

85934

86032

86508

85359

85541

85618

85912

85935

86033

86510

5. DME shipped to the patient shall be reimbursed based on the location of the patient when determining if the fees for rural or nonrural zip codes apply.

6. HCPCS codes describing physician-administered drugs and biologicals including, chemotherapy and immunosuppressive drugs, inhalation solutions and other miscellaneous drugs and solutions shall be used when billing for these products. Please refer to the Pharmaceutical Fee Schedule for billing and reimbursement information for prescription and over-the-counter drugs, including those that are described by HCPCS codes.

7. Services and materials that are listed as By Report or have no listed value in the fee schedule, shall be reimbursed based on a predetermined agreement between the provider and the payer. HCPCS codes representing professional services that are not listed in the fee schedule may be reimbursed based on a predetermined agreement between the provider and the payer.

8. Reimbursement for DME shall not be less than the actual cost of an item. Specialized (e.g., bariatric) equipment may have an actual cost that is greater than the reimbursement value listed in the Fee Schedule. The DME provider must demonstrate the actual cost of the DME is greater than the listed reimbursement value by presenting a copy of the original invoice for that item. The reimbursement value for the item shall be based on a predetermined agreement between the DME provider and the payer. When the DME was procured from an intermediary entity (e.g., wholesaler) and not the original manufacturer, the provider must disclose any rebates, reductions, discounts, or relationship with that intermediary entity and the impact on the original manufacturer's cost of that item.

9. Home Health Care - please see the Home Health Care Fee Schedule Guidelines.

B. MODIFIERS

1. As appropriate, durable medical equipment, should be billed with the following modifiers:

a. NU - indicates the purchase of new equipment.

b. UE - indicates the purchase of used equipment.

c. RR - indicates that the equipment is being rented. Rental periods shall be considered monthly unless defined differently in the code description.

i. The maximum rental period is 13 months. After 13 months, the equipment shall be considered purchased.

Note: Not all durable medical equipment will have modifiers. For example, certain supplies are low cost and therefore will not have used or rental options; other codes may have "rental" or "used" included in the code description.

C. BILLING

1. Providers of orthotics and prostheses may bill for fitting, training, and management using CPT® codes 97760-97763.

2. DME and Implantable devices shall be billed separately from facility and professional service fees only if they are not considered bundled with the primary service code.

3. Certain DME may be rented. Determination to purchase or rent DME shall be based on CMS Medicare guidelines in effect on the date the patient takes possession of the DME.

4. Materials, supplies, and equipment billed with a miscellaneous code (e.g., E1399 - durable medical equipment, miscellaneous) shall include the brand name and model number of the DME being supplied when available.

5. Actual shipping or delivery costs necessary to transit DME to the injured worker may be billed. Documentation demonstrating the cost of shipping shall be included with the invoice.

ARIZONA PHYSICIANS' FEE SCHEDULE

HCPCS Codes 2024

Code

Modifier

FY24 Non-rural Rate

FY24 Rural Rate

A2001

$ 737.28

$ 737.28

A2002

$ 99.12

$ 99.12

A2005

$ 234.63

$ 234.63

A2006

BR

BR

A2007

$ 314.38

$ 314.38

A2008

BR

BR

A2009

$ 67.13

$ 67.13

A2010

BR

BR

A2011

BR

BR

A2012

BR

BR

A2013

$ 1,005.31

$ 1,005.31

A2014

$ 43.64

$ 43.64

A4100

BR

BR

A4206

$ 0.77

$ 0.77

A4207

$ 1.36

$ 1.36

A4208

$ 6.79

$ 6.79

A4209

$ 1.36

$ 1.36

A4210

$ 1.36

$ 1.36

A4211

$ 23.88

$ 23.88

A4212

$ 9.90

$ 9.90

A4213

$ 4.07

$ 4.07

A4215

$ 0.84

$ 0.84

A4216

$ 0.84

$ 0.84

A4217

$ 5.99

$ 5.99

A4218

$ 1.30

$ 1.30

A4220

$ 50.44

$ 50.44

A4221

$ 34.24

$ 38.39

A4222

$ 64.95

$ 74.65

A4223

$ 80.60

$ 80.60

A4224

$ 34.24

$ 38.39

A4225

$ 4.59

$ 4.79

A4230

$ 9.90

$ 9.90

A4231

$ 6.79

$ 6.79

A4232

$ 3.18

$ 3.18

A4233

NU

$ 0.71

$ 0.71

A4234

NU

$ 3.30

$ 3.30

A4235

NU

$ 1.40

$ 1.40

A4236

NU

$ 1.62

$ 1.62

A4238

$ 407.62

$ 407.62

A4239

$ 366.30

$ 366.30

A4244

$ 1.81

$ 1.81

A4245

$ 4.98

$ 4.98

A4246

$ 6.79

$ 6.79

A4247

$ 9.90

$ 9.90

A4248

$ 0.10

$ 0.10

A4250

$ 16.70

$ 16.70

A4252

$ 13.08

$ 13.08

A4253

NU

$ 11.65

$ 11.65

A4255

$ 7.85

$ 7.85

A4256

$ 4.73

$ 4.73

A4257

$ 24.37

$ 24.37

A4258

$ 2.97

$ 2.97

A4259

$ 1.99

$ 1.99

A4262

$ 20.27

$ 20.27

A4263

$ 45.05

$ 45.05

A4264

$ 67.52

$ 67.52

A4265

$ 6.51

$ 6.51

A4266

$ 61.70

$ 61.70

A4267

$ 0.67

$ 0.67

A4268

$ 0.84

$ 0.84

A4269

$ 15.79

$ 15.79

A4270

$ 11.72

$ 11.72

A4280

$ 9.90

$ 9.90

A4281

$ 13.47

$ 13.47

A4282

$ 14.88

$ 14.88

A4283

$ 2.66

$ 2.66

A4284

$ 7.18

$ 7.18

A4285

$ 4.98

$ 4.98

A4286

$ 5.89

$ 5.89

A4290

$ 234.63

$ 234.63

A4300

$ 16.70

$ 16.70

A4301

$ 166.19

$ 166.19

A4305

$ 53.61

$ 53.61

A4306

$ 26.60

$ 26.60

A4310

$ 14.73

$ 14.73

A4311

$ 28.01

$ 28.01

A4312

$ 34.45

$ 34.45

A4313

$ 35.38

$ 35.38

A4314

$ 41.05

$ 41.05

A4315

$ 50.39

$ 50.39

A4316

$ 54.25

$ 54.25

A4320

$ 10.04

$ 10.04

A4321

$ 22.08

$ 22.08

A4322

$ 5.82

$ 5.82

A4326

$ 20.61

$ 20.61

A4327

$ 80.74

$ 80.74

A4328

$ 19.94

$ 19.94

A4330

$ 13.69

$ 13.69

A4331

$ 6.08

$ 6.08

A4332

$ 0.21

$ 0.21

A4333

$ 4.24

$ 4.24

A4334

$ 9.39

$ 9.39

A4335

BR

BR

A4336

$ 2.74

$ 2.74

A4338

$ 23.44

$ 23.44

A4340

$ 60.65

$ 60.65

A4341

$ 466.12

$ 466.12

A4342

$ 1,176.92

$ 1,176.92

A4344

$ 30.58

$ 30.58

A4346

$ 36.78

$ 36.78

A4349

$ 3.84

$ 3.84

A4351

$ 3.46

$ 3.46

A4352

$ 12.26

$ 12.26

A4353

$ 13.38

$ 13.38

A4354

$ 22.55

$ 22.55

A4355

$ 15.04

$ 15.04

A4356

$ 81.76

$ 81.76

A4357

$ 18.45

$ 18.45

A4358

$ 11.26

$ 11.26

A4360

$ 0.90

$ 0.90

A4361

$ 35.07

$ 35.07

A4362

$ 6.64

$ 6.64

A4363

$ 4.24

$ 4.24

A4364

$ 5.61

$ 5.61

A4366

$ 2.46

$ 2.46

A4367

$ 14.06

$ 14.06

A4368

$ 0.48

$ 0.48

A4369

$ 3.93

$ 3.93

A4371

$ 6.86

$ 6.86

A4372

$ 8.02

$ 8.02

A4373

$ 11.97

$ 11.97

A4375

$ 32.80

$ 32.80

A4376

$ 90.89

$ 90.89

A4377

$ 8.19

$ 8.19

A4378

$ 58.73

$ 58.73

A4379

$ 28.69

$ 28.69

A4380

$ 71.32

$ 71.32

A4381

$ 8.83

$ 8.83

A4382

$ 47.03

$ 47.03

A4383

$ 53.84

$ 53.84

A4384

$ 18.35

$ 18.35

A4385

$ 9.73

$ 9.73

A4387

$ 4.30

$ 4.30

A4388

$ 8.33

$ 8.33

A4389

$ 11.86

$ 11.86

A4390

$ 18.34

$ 18.34

A4391

$ 13.50

$ 13.50

A4392

$ 15.61

$ 15.61

A4393

$ 17.26

$ 17.26

A4394

$ 4.96

$ 4.96

A4395

$ 0.07

$ 0.07

A4396

$ 77.32

$ 77.32

A4398

$ 26.40

$ 26.40

A4399

$ 23.44

$ 23.44

A4400

$ 93.35

$ 93.35

A4402

$ 3.05

$ 3.05

A4404

$ 2.93

$ 2.93

A4405

$ 6.52

$ 6.52

A4406

$ 10.93

$ 10.93

A4407

$ 16.73

$ 16.73

A4408

$ 18.86

$ 18.86

A4409

$ 11.86

$ 11.86

A4410

$ 17.26

$ 17.26

A4411

$ 9.73

$ 9.73

A4412

$ 5.17

$ 5.17

A4413

$ 10.53

$ 10.53

A4414

$ 9.39

$ 9.39

A4415

$ 11.45

$ 11.45

A4416

$ 5.26

$ 5.26

A4417

$ 7.13

$ 7.13

A4418

$ 3.46

$ 3.46

A4419

$ 3.29

$ 3.29

A4420

$ 1.81

$ 1.81

A4421

BR

BR

A4422

$ 0.21

$ 0.21

A4423

$ 3.54

$ 3.54

A4424

$ 9.09

$ 9.09

A4425

$ 6.83

$ 6.83

A4426

$ 5.21

$ 5.21

A4427

$ 5.33

$ 5.33

A4428

$ 12.46

$ 12.46

A4429

$ 15.76

$ 15.76

A4430

$ 16.27

$ 16.27

A4431

$ 11.86

$ 11.86

A4432

$ 6.85

$ 6.85

A4433

$ 6.41

$ 6.41

A4434

$ 7.18

$ 7.18

A4435

$ 11.00

$ 11.00

A4436

$ 31.14

$ 31.14

A4437

$ 31.14

$ 31.14

A4450

$ 0.11

$ 0.11

A4452

$ 0.42

$ 0.42

A4453

$ 42.34

$ 42.34

A4455

$ 2.31

$ 2.31

A4456

$ 0.46

$ 0.46

A4458

$ 7.18

$ 7.18

A4459

$ 4,101.89

$ 4,101.89

A4461

$ 6.30

$ 6.30

A4463

$ 25.42

$ 25.42

A4465

$ 28.87

$ 28.87

A4467

$ 23.44

$ 23.44

A4480

$ 20.27

$ 20.27

A4481

$ 0.70

$ 0.70

A4483

$ 4.52

$ 4.52

A4495

$ 26.15

$ 26.15

A4500

$ 26.15

$ 26.15

A4510

$ 83.78

$ 83.78

A4520

$ 0.77

$ 0.77

A4541

$ 54.15

$ 54.15

A4542

$ 706.17

$ 706.17

A4550

$ 36.06

$ 36.06

A4553

$ 10.81

$ 10.81

A4554

$ 0.46

$ 0.46

A4555

$ 13.47

$ 13.47

A4556

$ 23.20

$ 23.20

A4557

$ 15.93

$ 26.43

A4558

$ 10.42

$ 10.42

A4559

$ 0.18

$ 0.18

A4561

$ 38.11

$ 38.11

A4562

$ 94.91

$ 94.91

A4563

$ 2,198.63

$ 2,198.63

A4565

$ 14.71

$ 14.71

A4566

$ 29.65

$ 29.65

A4570

$ 23.44

$ 23.44

A4575

$ 485.56

$ 485.56

A4580

$ 67.13

$ 67.13

A4590

$ 53.61

$ 53.61

A4595

$ 17.00

$ 36.36

A4596

$ 54.15

$ 54.15

A4600

$ 27.97

$ 27.97

A4601

$ 103.12

$ 103.12

A4602

NU

$ 7.13

$ 7.13

A4604

NU

$ 65.55

$ 91.69

A4605

NU

$ 31.33

$ 31.33

A4606

$ 63.06

$ 63.06

A4608

$ 95.76

$ 95.76

A4613

NU

$ 480.05

$ 480.05

A4613

RR

$ 48.30

$ 48.30

A4613

UE

$ 359.80

$ 359.80

A4614

$ 45.43

$ 45.43

A4615

$ 1.40

$ 1.40

A4616

$ 0.11

$ 0.11

A4617

$ 5.92

$ 5.92

A4618

NU

$ 14.45

$ 14.45

A4618

RR

$ 1.97

$ 1.97

A4618

UE

$ 10.84

$ 10.84

A4619

NU

$ 3.40

$ 3.47

A4620

$ 1.15

$ 1.15

A4623

$ 10.65

$ 10.65

A4624

NU

$ 5.04

$ 5.04

A4625

$ 12.59

$ 12.59

A4626

$ 5.18

$ 5.18

A4627

$ 26.99

$ 26.99

A4628

NU

$ 6.97

$ 6.97

A4629

$ 8.83

$ 8.83

A4630

NU

$ 11.82

$ 11.82

A4633

NU

$ 78.40

$ 78.40

A4635

NU

$ 8.29

$ 8.29

A4635

RR

$ 1.33

$ 1.33

A4635

UE

$ 5.53

$ 5.53

A4636

NU

$ 5.25

$ 5.57

A4636

RR

$ 0.53

$ 0.62

A4636

UE

$ 3.93

$ 4.12

A4637

NU

$ 2.91

$ 2.95

A4637

RR

$ 0.29

$ 0.39

A4637

UE

$ 2.18

$ 2.23

A4639

RR

$ 54.88

$ 54.88

A4640

NU

$ 82.33

$ 99.36

A4640

RR

$ 8.23

$ 10.96

A4640

UE

$ 61.75

$ 72.39

A4648

$ 214.35

$ 214.35

A4649

BR

BR

A4651

$ 9.90

$ 9.90

A4657

$ 0.91

$ 0.91

A4660

$ 41.44

$ 41.44

A4663

$ 33.35

$ 33.35

A4670

$ 112.59

$ 112.59

A4671

$ 90.51

$ 90.51

A4674

$ 81.12

$ 81.12

A4680

$ 95.89

$ 95.89

A4690

$ 138.74

$ 138.74

A4706

$ 41.44

$ 41.44

A4709

$ 40.53

$ 40.53

A4714

$ 25.26

$ 25.26

A4723

$ 13.08

$ 13.08

A4725

$ 8.09

$ 8.09

A4726

$ 37.35

$ 37.35

A4736

$ 31.53

$ 31.53

A4750

$ 11.27

$ 11.27

A4755

$ 92.32

$ 92.32

A4770

$ 6.79

$ 6.79

A4772

$ 1.30

$ 1.30

A4860

$ 5.89

$ 5.89

A4890

$ 442.32

$ 442.32

A4911

$ 10.81

$ 10.81

A4913

BR

BR

A4927

$ 10.81

$ 10.81

A4928

$ 4.91

$ 4.91

A4930

$ 0.78

$ 0.78

A4931

$ 11.72

$ 11.72

A5051

$ 3.93

$ 3.93

A5052

$ 2.84

$ 2.84

A5053

$ 2.80

$ 2.80

A5054

$ 3.43

$ 3.43

A5055

$ 2.66

$ 2.66

A5056

$ 8.93

$ 8.93

A5057

$ 18.34

$ 18.34

A5061

$ 6.75

$ 6.75

A5062

$ 3.96

$ 3.96

A5063

$ 5.17

$ 5.17

A5071

$ 11.48

$ 11.48

A5072

$ 6.58

$ 6.58

A5073

$ 5.81

$ 5.81

A5081

$ 5.38

$ 5.38

A5082

$ 19.32

$ 19.32

A5083

$ 1.23

$ 1.23

A5093

$ 3.74

$ 3.74

A5102

$ 37.32

$ 37.32

A5105

$ 77.88

$ 77.88

A5112

$ 66.15

$ 66.15

A5113

$ 9.00

$ 9.00

A5114

$ 17.09

$ 17.09

A5120

$ 0.42

$ 0.42

A5121

$ 12.10

$ 12.10

A5122

$ 24.53

$ 24.53

A5126

$ 2.51

$ 2.51

A5131

$ 25.75

$ 25.75

A5200

$ 21.57

$ 21.57

A5500

$ 121.48

$ 121.48

A5501

$ 364.31

$ 364.31

A5503

$ 61.95

$ 61.95

A5504

$ 61.95

$ 61.95

A5505

$ 61.95

$ 61.95

A5506

$ 61.95

$ 61.95

A5507

$ 61.95

$ 61.95

A5508

$ 73.81

$ 73.81

A5510

$ 108.05

$ 108.05

A5512

$ 49.55

$ 49.55

A5513

$ 73.93

$ 73.93

A5514

$ 73.93

$ 73.93

A6010

$ 59.16

$ 59.16

A6011

$ 4.37

$ 4.37

A6021

$ 40.17

$ 40.17

A6022

$ 40.17

$ 40.17

A6023

$ 363.54

$ 363.54

A6024

$ 11.82

$ 11.82

A6025

$ 22.47

$ 22.47

A6154

$ 27.44

$ 27.44

A6196

$ 14.06

$ 14.06

A6197

$ 31.42

$ 31.42

A6198

$ 26.15

$ 26.15

A6199

$ 10.08

$ 10.08

A6203

$ 6.44

$ 6.44

A6204

$ 11.89

$ 11.89

A6205

$ 0.28

$ 0.28

A6206

$ 9.00

$ 9.00

A6207

$ 14.03

$ 14.03

A6208

$ 69.85

$ 69.85

A6209

$ 14.28

$ 14.28

A6210

$ 38.07

$ 38.07

A6211

$ 56.11

$ 56.11

A6212

$ 18.55

$ 18.55

A6213

$ 12.68

$ 12.68

A6214

$ 19.67

$ 19.67

A6215

$ 4.07

$ 4.07

A6216

$ 0.07

$ 0.07

A6217

$ 0.29

$ 0.29

A6218

$ 0.17

$ 0.17

A6219

$ 1.82

$ 1.82

A6220

$ 4.96

$ 4.96

A6221

$ 2.72

$ 2.72

A6222

$ 4.07

$ 4.07

A6223

$ 4.63

$ 4.63

A6224

$ 6.87

$ 6.87

A6228

$ 4.47

$ 4.47

A6229

$ 6.87

$ 6.87

A6231

$ 8.96

$ 8.96

A6232

$ 13.12

$ 13.12

A6233

$ 36.62

$ 36.62

A6234

$ 12.52

$ 12.52

A6235

$ 32.13

$ 32.13

A6236

$ 52.05

$ 52.05

A6237

$ 15.11

$ 15.11

A6238

$ 43.55

$ 43.55

A6240

$ 23.39

$ 23.39

A6241

$ 4.91

$ 4.91

A6242

$ 11.56

$ 11.56

A6243

$ 23.55

$ 23.55

A6244

$ 75.04

$ 75.04

A6245

$ 13.89

$ 13.89

A6246

$ 18.97

$ 18.97

A6247

$ 45.43

$ 45.43

A6248

$ 31.04

$ 31.04

A6251

$ 3.79

$ 3.79

A6252

$ 6.22

$ 6.22

A6253

$ 12.10

$ 12.10

A6254

$ 2.28

$ 2.28

A6255

$ 5.81

$ 5.81

A6256

$ 3.11

$ 3.11

A6257

$ 2.93

$ 2.93

A6258

$ 8.23

$ 8.23

A6259

$ 20.89

$ 20.89

A6260

$ 0.32

$ 0.32

A6261

$ 44.55

$ 44.55

A6262

$ 0.63

$ 0.63

A6266

$ 3.65

$ 3.65

A6402

$ 0.21

$ 0.21

A6403

$ 0.78

$ 0.78

A6404

$ 0.91

$ 0.91

A6407

$ 3.57

$ 3.57

A6410

$ 0.71

$ 0.71

A6411

$ 6.79

$ 6.79

A6412

$ 0.64

$ 0.64

A6413

$ 0.20

$ 0.20

A6441

$ 1.30

$ 1.30

A6442

$ 0.31

$ 0.31

A6443

$ 0.53

$ 0.53

A6444

$ 1.06

$ 1.06

A6445

$ 0.60

$ 0.60

A6446

$ 0.74

$ 0.74

A6447

$ 1.30

$ 1.30

A6448

$ 2.20

$ 2.20

A6449

$ 3.35

$ 3.35

A6450

$ 3.35

$ 3.35

A6451

$ 3.35

$ 3.35

A6452

$ 11.27

$ 11.27

A6453

$ 1.20

$ 1.20

A6454

$ 1.50

$ 1.50

A6455

$ 2.66

$ 2.66

A6456

$ 2.39

$ 2.39

A6457

$ 2.17

$ 2.17

A6501

$ 45.05

$ 45.05

A6502

$ 363.01

$ 363.01

A6503

$ 0.36

$ 0.36

A6504

$ 301.76

$ 301.76

A6505

$ 441.80

$ 441.80

A6506

$ 308.56

$ 308.56

A6507

$ 204.90

$ 204.90

A6508

$ 559.37

$ 559.37

A6509

$ 402.23

$ 402.23

A6511

$ 537.29

$ 537.29

A6520

$ 167.36

$ 167.36

A6521

$ 664.06

$ 664.06

A6522

$ 406.66

$ 406.66

A6523

$ 964.84

$ 964.84

A6524

$ 507.35

$ 507.35

A6525

$ 1,024.24

$ 1,024.24

A6526

$ 917.25

$ 917.25

A6527

$ 1,686.72

$ 1,686.72

A6528

$ 882.00

$ 882.00

A6529

$ 1,393.70

$ 1,393.70

A6530

$ 51.70

$ 51.70

A6531

$ 41.44

$ 41.44

A6532

$ 77.04

$ 77.04

A6533

$ 72.60

$ 72.60

A6534

$ 82.91

$ 82.91

A6535

$ 95.45

$ 95.45

A6536

$ 97.87

$ 97.87

A6537

$ 116.03

$ 116.03

A6538

$ 135.86

$ 135.86

A6539

$ 129.51

$ 129.51

A6540

$ 154.42

$ 154.42

A6541

$ 182.92

$ 182.92

A6544

$ 67.13

$ 67.13

A6545

$ 86.49

$ 86.49

A6549

$ 266.60

$ 266.60

A6550

$ 41.50

$ 45.18

A6552

$ 76.73

$ 76.73

A6553

$ 299.61

$ 299.61

A6554

$ 105.50

$ 105.50

A6555

$ 299.61

$ 299.61

A6556

$ 410.61

$ 410.61

A6557

$ 410.61

$ 410.61

A6558

$ 423.74

$ 423.74

A6562

$ 1,343.83

$ 1,343.83

A6563

$ 1,343.83

$ 1,343.83

A6564

$ 1,447.60

$ 1,447.60

A6565

$ 232.20

$ 232.20

A6566

$ 337.16

$ 337.16

A6567

$ 1,059.35

$ 1,059.35

A6568

$ 220.04

$ 220.04

A6569

$ 1,253.00

$ 1,253.00

A6570

$ 149.93

$ 149.93

A6571

$ 901.08

$ 901.08

A6572

$ 139.12

$ 139.12

A6573

$ 330.12

$ 330.12

A6574

$ 420.85

$ 420.85

A6575

$ 136.39

$ 136.39

A6576

$ 258.30

$ 258.30

A6577

$ 213.78

$ 213.78

A6578

$ 105.28

$ 105.28

A6579

$ 414.60

$ 414.60

A6580

$ 411.54

$ 411.54

A6581

$ 96.60

$ 96.60

A6582

$ 64.43

$ 64.43

A6583

$ 211.93

$ 211.93

A6585

$ 250.94

$ 250.94

A6586

$ 739.28

$ 739.28

A6587

$ 96.84

$ 96.84

A6588

$ 322.76

$ 322.76

A6589

$ 127.41

$ 127.41

A6590

$ 598.08

$ 598.08

A6591

$ 121.49

$ 121.49

A6594

$ 46.40

$ 46.40

A6595

$ 45.63

$ 45.63

A6596

$ 0.24

$ 0.24

A6597

$ 2.06

$ 2.06

A6598

$ 0.99

$ 0.99

A6599

$ 2.25

$ 2.25

A6600

$ 4.06

$ 4.06

A6601

$ 4.56

$ 4.56

A6602

$ 6.66

$ 6.66

A6603

$ 3.12

$ 3.12

A6604

$ 1.82

$ 1.82

A6605

$ 2.09

$ 2.09

A6606

$ 6.19

$ 6.19

A6607

$ 1.65

$ 1.65

A6608

$ 6.89

$ 6.89

A6610

$ 299.61

$ 299.61

A7000

NU

$ 13.93

$ 15.43

A7001

NU

$ 63.18

$ 63.18

A7002

NU

$ 7.32

$ 7.32

A7003

NU

$ 2.56

$ 4.00

A7004

NU

$ 2.07

$ 2.87

A7005

NU

$ 18.52

$ 40.25

A7006

NU

$ 11.00

$ 15.68

A7007

NU

$ 4.91

$ 7.31

A7008

NU

$ 21.00

$ 21.00

A7009

NU

$ 80.33

$ 80.33

A7010

NU

$ 23.31

$ 36.53

A7012

NU

$ 4.30

$ 6.17

A7013

NU

$ 0.85

$ 1.30

A7014

NU

$ 5.05

$ 7.24

A7015

NU

$ 2.03

$ 2.95

A7016

NU

$ 13.86

$ 13.86

A7017

NU

$ 173.14

$ 233.86

A7017

RR

$ 17.32

$ 23.39

A7017

UE

$ 129.86

$ 175.39

A7018

$ 0.50

$ 0.66

A7020

NU

$ 26.63

$ 26.63

A7025

RR

$ 83.09

$ 83.09

A7026

NU

$ 54.91

$ 54.91

A7027

NU

$ 194.74

$ 281.34

A7028

NU

$ 54.08

$ 78.22

A7029

NU

$ 25.61

$ 33.49

A7030

NU

$ 145.12

$ 237.34

A7031

NU

$ 55.19

$ 88.63

A7032

NU

$ 31.01

$ 50.81

A7033

NU

$ 25.63

$ 37.69

A7034

NU

$ 92.64

$ 148.16

A7035

NU

$ 29.86

$ 49.69

A7036

NU

$ 17.21

$ 24.71

A7037

NU

$ 19.50

$ 44.77

A7038

NU

$ 3.47

$ 6.38

A7039

NU

$ 10.16

$ 18.21

A7040

$ 75.39

$ 75.39

A7041

$ 141.72

$ 141.72

A7044

NU

$ 131.87

$ 175.87

A7045

NU

$ 18.93

$ 27.13

A7045

RR

$ 1.89

$ 2.72

A7045

UE

$ 14.20

$ 20.36

A7046

NU

$ 21.52

$ 28.31

A7047

NU

$ 230.96

$ 230.96

A7048

$ 78.90

$ 78.90

A7501

$ 200.61

$ 200.61

A7502

$ 95.37

$ 95.37

A7503

$ 21.67

$ 21.67

A7504

$ 1.30

$ 1.30

A7505

$ 8.96

$ 8.96

A7506

$ 0.62

$ 0.62

A7507

$ 4.77

$ 4.77

A7508

$ 5.49

$ 5.49

A7509

$ 2.69

$ 2.69

A7520

$ 90.69

$ 90.69

A7521

$ 89.87

$ 89.87

A7522

$ 86.27

$ 86.27

A7523

$ 27.97

$ 27.97

A7524

$ 147.88

$ 147.88

A7525

$ 3.93

$ 3.93

A7526

$ 6.48

$ 6.48

A7527

$ 6.83

$ 6.83

A8000

NU

$ 292.96

$ 292.96

A8000

RR

$ 29.30

$ 29.30

A8000

UE

$ 219.77

$ 219.77

A8001

NU

$ 292.96

$ 292.96

A8001

RR

$ 29.30

$ 29.30

A8001

UE

$ 219.77

$ 219.77

A9152

$ 0.13

$ 0.13

A9153

$ 41.89

$ 41.89

A9180

$ 89.60

$ 89.60

A9272

$ 1.81

$ 1.81

A9273

$ 7.18

$ 7.18

A9274

$ 34.69

$ 34.69

A9276

$ 17.99

$ 17.99

A9277

$ 1,372.91

$ 1,372.91

A9278

$ 1,185.03

$ 1,185.03

A9281

$ 62.61

$ 62.61

A9282

$ 638.22

$ 638.22

A9283

$ 28.36

$ 28.36

A9284

$ 18.90

$ 18.90

A9500

$ 290.11

$ 290.11

A9502

$ 262.60

$ 262.60

A9503

$ 68.43

$ 68.43

A9505

$ 315.28

$ 315.28

A9509

$ 596.72

$ 596.72

A9510

$ 63.06

$ 63.06

A9512

$ 28.36

$ 28.36

A9513

$ 541.42

$ 541.42

A9516

$ 286.87

$ 286.87

A9517

$ 78.79

$ 78.79

A9520

$ 1,031.00

$ 1,031.00

A9521

$ 735.98

$ 735.98

A9526

$ 1,567.01

$ 1,567.01

A9528

$ 263.05

$ 263.05

A9531

$ 13.52

$ 13.52

A9537

$ 138.74

$ 138.74

A9538

$ 119.77

$ 119.77

A9539

$ 132.45

$ 132.45

A9540

$ 354.52

$ 354.52

A9541

$ 264.85

$ 264.85

A9548

$ 2,071.86

$ 2,071.86

A9552

$ 714.81

$ 714.81

A9555

$ 840.92

$ 840.92

A9556

$ 168.00

$ 168.00

A9558

$ 517.03

$ 517.03

A9560

$ 262.99

$ 262.99

A9561

$ 72.51

$ 72.51

A9562

$ 1,298.46

$ 1,298.46

A9567

$ 189.63

$ 189.63

A9568

$ 10.36

$ 10.36

A9569

$ 2,865.46

$ 2,865.46

A9570

$ 7,432.64

$ 7,432.64

A9572

$ 6,801.16

$ 6,801.16

A9573

$ 5.89

$ 5.89

A9575

$ 0.17

$ 0.17

A9576

$ 2.14

$ 2.14

A9577

$ 2.58

$ 2.58

A9578

$ 2.48

$ 2.48

A9579

$ 2.13

$ 2.13

A9580

$ 603.53

$ 603.53

A9581

$ 20.64

$ 20.64

A9584

$ 4,746.78

$ 4,746.78

A9585

$ 0.48

$ 0.48

A9587

$ 171.63

$ 171.63

A9588

$ 1,039.56

$ 1,039.56

A9589

$ 1,850.58

$ 1,850.58

A9590

$ 1,262.00

$ 1,262.00

A9591

$ 1,576.85

$ 1,576.85

A9592

$ 2,483.56

$ 2,483.56

A9595

$ 967.04

$ 967.04

A9596

$ 2,413.75

$ 2,413.75

A9606

$ 353.11

$ 353.11

A9607

$ 523.82

$ 523.82

A9700

$ 273.41

$ 273.41

A9800

$ 1,437.72

$ 1,437.72

A9900

BR

BR

A9901

BR

BR

A9999

BR

BR

E0100

NU

$ 39.65

$ 39.65

E0100

RR

$ 11.31

$ 11.31

E0100

UE

$ 29.72

$ 29.72

E0105

NU

$ 93.83

$ 93.83

E0105

RR

$ 16.94

$ 16.94

E0105

UE

$ 71.46

$ 71.46

E0110

NU

$ 125.99

$ 125.99

E0110

RR

$ 30.53

$ 30.53

E0110

UE

$ 94.44

$ 94.44

E0111

NU

$ 86.45

$ 86.45

E0111

RR

$ 16.10

$ 16.10

E0111

UE

$ 66.75

$ 66.75

E0112

NU

$ 60.10

$ 60.10

E0112

RR

$ 18.98

$ 18.98

E0112

UE

$ 45.84

$ 45.84

E0113

NU

$ 34.33

$ 34.33

E0113

RR

$ 9.81

$ 9.81

E0113

UE

$ 25.75

$ 25.75

E0114

NU

$ 76.62

$ 76.62

E0114

RR

$ 16.37

$ 16.37

E0114

UE

$ 57.93

$ 57.93

E0116

NU

$ 45.05

$ 45.05

E0116

RR

$ 10.23

$ 10.23

E0116

UE

$ 33.92

$ 33.92

E0117

RR

$ 36.79

$ 36.79

E0118

$ 681.70

$ 681.70

E0130

NU

$ 70.81

$ 98.91

E0130

RR

$ 7.08

$ 17.95

E0130

UE

$ 53.10

$ 75.15

E0135

NU

$ 70.81

$ 110.18

E0135

RR

$ 7.08

$ 18.31

E0135

UE

$ 53.10

$ 83.83

E0140

RR

$ 42.52

$ 55.03

E0141

NU

$ 79.03

$ 135.30

E0141

RR

$ 7.90

$ 22.71

E0141

UE

$ 59.28

$ 101.46

E0143

NU

$ 79.03

$ 141.86

E0143

RR

$ 7.90

$ 22.06

E0143

UE

$ 59.28

$ 106.25

E0144

RR

$ 45.47

$ 48.97

E0147

NU

$ 661.54

$ 841.85

E0147

RR

$ 66.15

$ 84.20

E0147

UE

$ 496.16

$ 631.40

E0148

NU

$ 128.74

$ 179.33

E0148

RR

$ 12.88

$ 17.95

E0148

UE

$ 96.56

$ 134.48

E0149

RR

$ 18.34

$ 28.97

E0153

NU

$ 126.34

$ 126.34

E0153

RR

$ 14.99

$ 14.99

E0153

UE

$ 94.74

$ 94.74

E0154

NU

$ 75.08

$ 102.30

E0154

RR

$ 7.50

$ 11.47

E0154

UE

$ 56.31

$ 77.28

E0155

NU

$ 32.37

$ 40.94

E0155

RR

$ 3.23

$ 5.05

E0155

UE

$ 24.29

$ 30.98

E0156

NU

$ 24.60

$ 35.95

E0156

RR

$ 2.46

$ 4.21

E0156

UE

$ 18.45

$ 26.96

E0157

NU

$ 83.41

$ 118.10

E0157

RR

$ 8.34

$ 12.47

E0157

UE

$ 62.57

$ 88.58

E0158

NU

$ 33.21

$ 42.04

E0158

RR

$ 3.32

$ 4.89

E0158

UE

$ 24.91

$ 31.64

E0159

NU

$ 23.10

$ 27.96

E0159

RR

$ 2.31

$ 2.81

E0159

UE

$ 17.33

$ 20.99

E0160

NU

$ 44.84

$ 52.93

E0160

RR

$ 4.48

$ 6.20

E0160

UE

$ 33.64

$ 39.69

E0161

NU

$ 37.79

$ 42.57

E0161

RR

$ 3.78

$ 5.66

E0161

UE

$ 28.35

$ 31.88

E0162

NU

$ 236.59

$ 236.59

E0162

RR

$ 24.84

$ 24.84

E0162

UE

$ 183.46

$ 183.46

E0163

NU

$ 86.66

$ 153.05

E0163

RR

$ 8.67

$ 28.08

E0163

UE

$ 65.00

$ 117.01

E0165

RR

$ 19.50

$ 28.81

E0167

NU

$ 17.47

$ 21.25

E0167

RR

$ 1.75

$ 2.17

E0167

UE

$ 13.12

$ 15.99

E0168

NU

$ 184.34

$ 249.94

E0168

RR

$ 18.44

$ 24.99

E0168

UE

$ 138.25

$ 187.45

E0170

RR

$ 264.43

$ 301.07

E0171

RR

$ 49.78

$ 55.24

E0175

NU

$ 107.53

$ 107.53

E0175

RR

$ 10.75

$ 10.75

E0175

UE

$ 79.16

$ 79.16

E0181

RR

$ 26.26

$ 38.95

E0182

RR

$ 34.09

$ 43.82

E0183

RR

$ 26.26

$ 38.95

E0184

NU

$ 251.55

$ 303.51

E0184

RR

$ 25.16

$ 34.50

E0184

UE

$ 188.66

$ 230.31

E0185

NU

$ 285.53

$ 412.87

E0185

RR

$ 28.55

$ 51.81

E0185

UE

$ 214.16

$ 314.19

E0186

RR

$ 30.38

$ 36.29

E0187

RR

$ 35.57

$ 40.64

E0188

NU

$ 37.70

$ 47.53

E0188

RR

$ 3.78

$ 5.19

E0188

UE

$ 28.28

$ 35.67

E0189

NU

$ 84.53

$ 94.61

E0189

RR

$ 8.46

$ 9.87

E0189

UE

$ 63.41

$ 70.95

E0190

NU

$ 90.57

$ 90.57

E0190

RR

$ 9.10

$ 9.10

E0190

UE

$ 67.58

$ 67.58

E0191

NU

$ 16.23

$ 16.23

E0191

RR

$ 1.97

$ 1.97

E0191

UE

$ 12.10

$ 12.10

E0193

RR

$ 1,141.27

$ 1,322.87

E0194

RR

$ 6,216.50

$ 6,216.50

E0196

RR

$ 51.74

$ 52.75

E0197

RR

$ 28.56

$ 41.22

E0198

RR

$ 41.87

$ 41.87

E0199

NU

$ 50.72

$ 58.16

E0199

RR

$ 5.07

$ 5.80

E0199

UE

$ 38.04

$ 43.61

E0200

NU

$ 128.72

$ 128.72

E0200

RR

$ 17.49

$ 17.49

E0200

UE

$ 96.60

$ 96.60

E0202

RR

$ 101.68

$ 101.68

E0203

$ 437.67

$ 437.67

E0205

NU

$ 315.10

$ 315.10

E0205

RR

$ 38.64

$ 38.64

E0205

UE

$ 236.32

$ 236.32

E0210

NU

$ 53.03

$ 53.03

E0210

RR

$ 5.88

$ 5.88

E0210

UE

$ 39.73

$ 39.73

E0215

NU

$ 122.51

$ 122.51

E0215

RR

$ 14.17

$ 14.17

E0215

UE

$ 91.84

$ 91.84

E0217

NU

$ 948.36

$ 948.36

E0217

RR

$ 105.57

$ 105.57

E0217

UE

$ 711.23

$ 711.23

E0218

NU

$ 2,148.40

$ 2,148.40

E0218

RR

$ 216.13

$ 216.13

E0218

UE

$ 1,610.22

$ 1,610.22

E0221

$ 3,311.67

$ 3,311.67

E0225

NU

$ 742.41

$ 742.41

E0225

RR

$ 73.18

$ 73.18

E0225

UE

$ 556.81

$ 556.81

E0235

RR

$ 32.96

$ 32.96

E0236

RR

$ 77.57

$ 77.57

E0239

NU

$ 859.28

$ 859.28

E0239

RR

$ 85.95

$ 85.95

E0239

UE

$ 644.48

$ 644.48

E0240

NU

$ 163.02

$ 163.02

E0240

RR

$ 16.39

$ 16.39

E0240

UE

$ 121.65

$ 121.65

E0241

$ 46.23

$ 46.23

E0243

$ 71.08

$ 71.08

E0244

$ 93.14

$ 93.14

E0245

$ 100.74

$ 100.74

E0246

$ 99.82

$ 99.82

E0247

NU

$ 144.90

$ 144.90

E0247

RR

$ 14.57

$ 14.57

E0247

UE

$ 108.14

$ 108.14

E0248

NU

$ 210.10

$ 210.10

E0248

RR

$ 21.14

$ 21.14

E0248

UE

$ 156.80

$ 156.80

E0249

NU

$ 161.73

$ 161.73

E0249

RR

$ 17.77

$ 17.77

E0249

UE

$ 121.27

$ 121.27

E0250

RR

$ 102.19

$ 135.44

E0251

RR

$ 95.73

$ 112.64

E0255

RR

$ 102.56

$ 152.08

E0256

RR

$ 100.32

$ 122.05

E0260

RR

$ 102.56

$ 171.05

E0261

RR

$ 102.56

$ 168.10

E0265

RR

$ 243.53

$ 286.31

E0266

RR

$ 211.90

$ 250.88

E0271

NU

$ 197.48

$ 294.57

E0271

RR

$ 19.75

$ 30.17

E0271

UE

$ 148.12

$ 226.62

E0272

NU

$ 222.11

$ 293.41

E0272

RR

$ 22.22

$ 30.09

E0272

UE

$ 166.59

$ 219.46

E0274

NU

$ 673.26

$ 673.26

E0274

RR

$ 67.73

$ 67.73

E0274

UE

$ 504.60

$ 504.60

E0275

NU

$ 23.11

$ 24.86

E0275

RR

$ 2.31

$ 2.80

E0275

UE

$ 17.35

$ 18.63

E0276

NU

$ 20.13

$ 21.60

E0276

RR

$ 2.02

$ 2.59

E0276

UE

$ 15.11

$ 16.67

E0277

RR

$ 339.65

$ 705.42

E0280

NU

$ 51.49

$ 53.47

E0280

RR

$ 5.15

$ 6.23

E0280

UE

$ 38.63

$ 40.10

E0290

RR

$ 96.31

$ 113.08

E0291

RR

$ 74.54

$ 81.72

E0292

RR

$ 102.31

$ 122.84

E0293

RR

$ 96.45

$ 109.69

E0294

RR

$ 102.56

$ 162.95

E0295

RR

$ 102.56

$ 160.19

E0296

RR

$ 190.01

$ 209.90

E0297

RR

$ 167.68

$ 197.82

E0300

RR

$ 423.40

$ 445.37

E0301

RR

$ 268.76

$ 350.81

E0302

RR

$ 779.52

$ 1,014.34

E0303

RR

$ 273.50

$ 380.20

E0304

RR

$ 788.76

$ 1,071.50

E0305

RR

$ 17.84

$ 24.23

E0310

NU

$ 181.48

$ 260.93

E0310

RR

$ 18.14

$ 27.48

E0310

UE

$ 136.12

$ 196.78

E0315

$ 256.66

$ 256.66

E0316

RR

$ 295.67

$ 295.67

E0325

NU

$ 15.55

$ 16.44

E0325

RR

$ 1.55

$ 2.27

E0325

UE

$ 10.86

$ 10.86

E0326

NU

$ 16.06

$ 17.63

E0326

RR

$ 1.61

$ 2.02

E0326

UE

$ 12.04

$ 13.23

E0328

$ 15,984.64

$ 15,984.64

E0329

$ 23,217.54

$ 23,217.54

E0371

RR

$ 339.65

$ 513.46

E0372

RR

$ 339.65

$ 586.12

E0373

RR

$ 339.65

$ 646.10

E0424

RR

$ 129.92

$ 236.54

E0425

$ 17.77

$ 17.77

E0430

$ 17.77

$ 17.77

E0431

RR

$ 29.26

$ 42.21

E0433

RR

$ 62.43

$ 71.65

E0434

RR

$ 62.43

$ 71.65

E0439

RR

$ 129.92

$ 236.54

E0441

$ 89.77

$ 103.33

E0442

$ 89.77

$ 103.33

E0443

$ 81.35

$ 98.80

E0444

$ 81.35

$ 98.80

E0445

$ 17.77

$ 17.77

E0446

$ 303.91

$ 303.91

E0447

$ 122.04

$ 149.98

E0462

RR

$ 473.17

$ 473.17

E0465

RR

$ 1,823.36

$ 1,823.36

E0466

RR

$ 1,823.36

$ 1,823.36

E0467

RR

$ 2,102.53

$ 2,138.78

E0470

RR

$ 176.54

$ 278.04

E0471

RR

$ 429.28

$ 773.93

E0472

RR

$ 653.59

$ 895.65

E0480

RR

$ 83.96

$ 83.96

E0481

$ 1,184.71

$ 1,184.71

E0482

RR

$ 762.43

$ 762.43

E0483

RR

$ 2,030.84

$ 2,030.84

E0484

NU

$ 70.56

$ 70.56

E0484

RR

$ 7.06

$ 7.06

E0484

UE

$ 52.92

$ 52.92

E0485

NU

$ 241.49

$ 241.49

E0485

RR

$ 24.29

$ 24.29

E0485

UE

$ 180.21

$ 180.21

E0486

NU

$ 7,848.36

$ 7,848.36

E0486

RR

$ 789.57

$ 789.57

E0486

UE

$ 5,856.98

$ 5,856.98

E0490

RR

$ 171.01

$ 171.01

E0491

$ 141.23

$ 141.23

E0500

RR

$ 202.36

$ 202.36

E0530

RR

$ 49.76

$ 49.76

E0550

RR

$ 95.77

$ 95.77

E0555

NU

$ 6.03

$ 6.03

E0555

RR

$ 0.60

$ 0.60

E0555

UE

$ 4.51

$ 4.51

E0560

NU

$ 282.37

$ 282.37

E0560

RR

$ 33.08

$ 33.08

E0560

UE

$ 211.79

$ 211.79

E0561

NU

$ 113.53

$ 154.10

E0561

RR

$ 11.35

$ 15.40

E0561

UE

$ 85.15

$ 115.57

E0562

NU

$ 224.74

$ 374.09

E0562

RR

$ 22.47

$ 37.39

E0562

UE

$ 168.56

$ 280.57

E0565

RR

$ 69.59

$ 87.75

E0570

RR

$ 9.46

$ 20.62

E0572

RR

$ 38.58

$ 60.05

E0574

RR

$ 71.79

$ 71.79

E0575

RR

$ 169.64

$ 169.64

E0580

NU

$ 220.70

$ 220.70

E0580

RR

$ 22.08

$ 22.08

E0580

UE

$ 165.49

$ 165.49

E0585

RR

$ 42.57

$ 54.21

E0600

RR

$ 80.86

$ 80.86

E0601

RR

$ 67.38

$ 129.57

E0602

NU

$ 56.38

$ 56.38

E0602

RR

$ 5.68

$ 5.68

E0602

UE

$ 42.29

$ 42.29

E0603

NU

$ 362.24

$ 362.24

E0603

RR

$ 36.44

$ 36.44

E0603

UE

$ 270.33

$ 270.33

E0604

NU

$ 1,080.16

$ 1,080.16

E0604

RR

$ 108.67

$ 108.67

E0604

UE

$ 809.56

$ 809.56

E0605

NU

$ 47.88

$ 47.88

E0605

RR

$ 5.88

$ 5.88

E0605

UE

$ 35.92

$ 35.92

E0606

RR

$ 43.83

$ 43.83

E0607

NU

$ 127.64

$ 127.64

E0607

RR

$ 12.75

$ 12.75

E0607

UE

$ 95.70

$ 95.70

E0610

NU

$ 454.34

$ 454.34

E0610

RR

$ 47.92

$ 47.92

E0610

UE

$ 340.80

$ 340.80

E0615

NU

$ 905.53

$ 905.53

E0615

RR

$ 94.99

$ 94.99

E0615

UE

$ 679.15

$ 679.15

E0617

RR

$ 580.78

$ 580.78

E0618

RR

$ 520.80

$ 520.80

E0619

RR

$ 487.45

$ 487.45

E0620

RR

$ 167.01

$ 167.01

E0621

NU

$ 140.24

$ 164.12

E0621

RR

$ 14.03

$ 16.39

E0621

UE

$ 105.18

$ 123.12

E0627

NU

$ 421.27

$ 553.28

E0627

RR

$ 42.13

$ 55.33

E0627

UE

$ 315.95

$ 414.95

E0629

NU

$ 413.50

$ 550.59

E0629

RR

$ 41.36

$ 55.06

E0629

UE

$ 310.13

$ 412.93

E0630

RR

$ 96.38

$ 149.37

E0635

RR

$ 208.12

$ 222.96

E0636

RR

$ 1,641.26

$ 1,900.39

E0637

NU

$ 5,020.53

$ 5,020.53

E0637

RR

$ 505.08

$ 505.08

E0637

UE

$ 3,746.65

$ 3,746.65

E0638

NU

$ 5,417.78

$ 5,417.78

E0638

RR

$ 545.05

$ 545.05

E0638

UE

$ 4,043.12

$ 4,043.12

E0639

RR

$ 213.09

$ 213.09

E0640

RR

$ 213.09

$ 213.09

E0641

$ 13,216.64

$ 13,216.64

E0642

$ 8,710.49

$ 8,710.49

E0650

NU

$ 1,375.75

$ 1,375.75

E0650

RR

$ 165.51

$ 165.51

E0650

UE

$ 1,031.83

$ 1,031.83

E0651

NU

$ 1,732.86

$ 1,732.86

E0651

RR

$ 179.23

$ 179.23

E0651

UE

$ 1,299.68

$ 1,299.68

E0652

NU

$ 10,126.98

$ 10,126.98

E0652

RR

$ 1,000.85

$ 1,000.85

E0652

UE

$ 7,588.45

$ 7,588.45

E0655

NU

$ 206.18

$ 206.18

E0655

RR

$ 24.23

$ 24.23

E0655

UE

$ 154.83

$ 154.83

E0656

RR

$ 110.39

$ 110.39

E0657

RR

$ 103.70

$ 103.70

E0660

NU

$ 304.98

$ 304.98

E0660

RR

$ 31.75

$ 31.75

E0660

UE

$ 228.76

$ 228.76

E0665

NU

$ 261.70

$ 261.70

E0665

RR

$ 26.87

$ 26.87

E0665

UE

$ 196.29

$ 196.29

E0666

NU

$ 263.79

$ 263.79

E0666

RR

$ 27.16

$ 27.16

E0666

UE

$ 197.88

$ 197.88

E0667

NU

$ 618.46

$ 618.46

E0667

RR

$ 69.83

$ 69.83

E0667

UE

$ 463.88

$ 463.88

E0668

NU

$ 844.09

$ 844.09

E0668

RR

$ 83.30

$ 83.30

E0668

UE

$ 633.09

$ 633.09

E0669

NU

$ 350.18

$ 350.18

E0669

RR

$ 35.01

$ 35.01

E0669

UE

$ 262.67

$ 262.67

E0670

NU

$ 2,401.25

$ 2,401.25

E0670

RR

$ 257.04

$ 257.04

E0670

UE

$ 1,800.85

$ 1,800.85

E0671

NU

$ 793.42

$ 793.42

E0671

RR

$ 79.39

$ 79.39

E0671

UE

$ 595.01

$ 595.01

E0672

NU

$ 616.46

$ 616.46

E0672

RR

$ 61.70

$ 61.70

E0672

UE

$ 462.38

$ 462.38

E0673

NU

$ 512.25

$ 512.25

E0673

RR

$ 51.23

$ 51.23

E0673

UE

$ 384.26

$ 384.26

E0675

RR

$ 734.57

$ 734.57

E0676

NU

$ 3,467.55

$ 3,467.55

E0676

RR

$ 348.85

$ 348.85

E0676

UE

$ 2,598.92

$ 2,598.92

E0677

RR

$ 110.39

$ 110.39

E0678

RR

$ 61.85

$ 61.85

E0679

RR

$ 35.01

$ 35.01

E0680

RR

$ 1,012.70

$ 1,012.70

E0681

RR

$ 173.29

$ 173.29

E0682

RR

$ 84.41

$ 84.41

E0691

NU

$ 1,716.50

$ 1,716.50

E0691

RR

$ 171.64

$ 171.64

E0691

UE

$ 1,287.38

$ 1,287.38

E0692

NU

$ 2,155.47

$ 2,155.47

E0692

RR

$ 215.52

$ 215.52

E0692

UE

$ 1,616.59

$ 1,616.59

E0693

NU

$ 2,657.07

$ 2,657.07

E0693

RR

$ 265.72

$ 265.72

E0693

UE

$ 1,992.80

$ 1,992.80

E0694

NU

$ 8,457.23

$ 8,457.23

E0694

RR

$ 845.71

$ 845.71

E0694

UE

$ 6,342.97

$ 6,342.97

E0705

NU

$ 74.52

$ 94.44

E0705

RR

$ 7.45

$ 9.53

E0705

UE

$ 55.89

$ 64.13

E0720

NU

$ 93.76

$ 373.04

E0730

NU

$ 93.13

$ 377.02

E0731

NU

$ 119.45

$ 416.43

E0732

RR

$ 62.51

$ 62.51

E0733

RR

$ 62.51

$ 62.51

E0734

RR

$ 600.94

$ 600.94

E0735

RR

$ 62.51

$ 62.51

E0740

RR

$ 99.89

$ 99.89

E0744

RR

$ 174.93

$ 174.93

E0745

RR

$ 171.01

$ 171.01

E0761

$ 2,982.38

$ 2,982.38

E0762

RR

$ 210.04

$ 210.04

E0764

NU

$ 22,434.15

$ 22,434.15

E0764

UE

$ 16,814.34

$ 16,814.34

E0765

NU

$ 160.71

$ 160.71

E0765

RR

$ 16.10

$ 16.10

E0765

UE

$ 120.57

$ 120.57

E0770

NU

$ 478.13

$ 478.13

E0770

RR

$ 48.10

$ 48.10

E0770

UE

$ 356.82

$ 356.82

E0776

NU

$ 232.46

$ 232.46

E0776

RR

$ 24.32

$ 29.97

E0776

UE

$ 172.27

$ 172.27

E0779

RR

$ 29.81

$ 29.81

E0780

NU

$ 19.81

$ 19.81

E0781

RR

$ 409.39

$ 439.49

E0784

RR

$ 738.18

$ 767.83

E0791

RR

$ 486.35

$ 545.19

E0830

$ 676.24

$ 676.24

E0840

NU

$ 139.96

$ 139.96

E0840

RR

$ 26.52

$ 26.52

E0840

UE

$ 104.93

$ 104.93

E0849

RR

$ 98.45

$ 98.45

E0850

NU

$ 170.56

$ 170.56

E0850

RR

$ 27.57

$ 27.57

E0850

UE

$ 127.93

$ 127.93

E0855

RR

$ 94.42

$ 94.42

E0856

RR

$ 29.40

$ 29.40

E0860

NU

$ 72.16

$ 72.16

E0860

RR

$ 12.46

$ 12.46

E0860

UE

$ 54.15

$ 54.15

E0870

NU

$ 222.19

$ 222.19

E0870

RR

$ 25.62

$ 25.62

E0870

UE

$ 166.67

$ 166.67

E0880

NU

$ 224.27

$ 224.27

E0880

RR

$ 37.65

$ 37.65

E0880

UE

$ 168.18

$ 168.18

E0890

NU

$ 195.50

$ 195.50

E0890

RR

$ 62.72

$ 62.72

E0890

UE

$ 157.49

$ 157.49

E0900

NU

$ 208.05

$ 208.05

E0900

RR

$ 52.78

$ 52.78

E0900

UE

$ 156.09

$ 156.09

E0910

RR

$ 17.95

$ 26.49

E0911

RR

$ 68.42

$ 79.07

E0912

RR

$ 135.23

$ 168.07

E0920

RR

$ 88.17

$ 88.17

E0930

RR

$ 87.25

$ 87.25

E0935

RR

$ 36.93

$ 36.93

E0936

$ 157.65

$ 157.65

E0940

RR

$ 33.95

$ 47.64

E0941

RR

$ 82.91

$ 82.91

E0942

NU

$ 32.23

$ 32.23

E0942

RR

$ 4.49

$ 4.49

E0942

UE

$ 24.11

$ 24.11

E0944

NU

$ 76.58

$ 76.58

E0944

RR

$ 8.82

$ 8.82

E0944

UE

$ 57.47

$ 57.47

E0945

NU

$ 76.58

$ 76.58

E0945

RR

$ 8.46

$ 8.46

E0945

UE

$ 57.47

$ 57.47

E0946

RR

$ 113.02

$ 113.02

E0947

NU

$ 1,158.47

$ 1,158.47

E0947

RR

$ 120.11

$ 120.11

E0947

UE

$ 868.83

$ 868.83

E0948

NU

$ 1,120.49

$ 1,120.49

E0948

RR

$ 112.01

$ 112.01

E0948

UE

$ 790.31

$ 790.31

E0950

NU

$ 123.06

$ 141.50

E0950

RR

$ 12.31

$ 15.36

E0950

UE

$ 92.30

$ 105.41

E0951

NU

$ 19.99

$ 27.31

E0951

RR

$ 2.00

$ 2.77

E0951

UE

$ 14.99

$ 20.48

E0952

NU

$ 27.45

$ 27.87

E0952

RR

$ 2.74

$ 2.98

E0952

UE

$ 20.59

$ 20.90

E0953

NU

$ 123.93

$ 149.21

E0953

RR

$ 12.39

$ 14.92

E0953

UE

$ 92.95

$ 111.92

E0954

NU

$ 86.48

$ 94.33

E0954

RR

$ 8.65

$ 9.66

E0954

UE

$ 64.86

$ 70.73

E0955

RR

$ 23.17

$ 29.57

E0956

NU

$ 123.93

$ 149.21

E0956

RR

$ 12.39

$ 14.92

E0956

UE

$ 92.95

$ 111.92

E0957

NU

$ 198.98

$ 220.63

E0957

RR

$ 19.89

$ 22.06

E0957

UE

$ 149.24

$ 165.47

E0958

RR

$ 67.21

$ 78.64

E0959

NU

$ 71.75

$ 71.78

E0959

RR

$ 7.18

$ 8.19

E0959

UE

$ 53.80

$ 54.32

E0960

NU

$ 118.06

$ 139.44

E0960

RR

$ 11.80

$ 13.96

E0960

UE

$ 88.55

$ 104.58

E0961

NU

$ 31.98

$ 46.63

E0961

RR

$ 3.19

$ 4.79

E0961

UE

$ 23.98

$ 27.85

E0966

NU

$ 117.08

$ 131.29

E0966

RR

$ 11.70

$ 13.05

E0966

UE

$ 87.81

$ 98.48

E0967

NU

$ 115.99

$ 123.40

E0967

RR

$ 11.59

$ 12.33

E0967

UE

$ 87.00

$ 92.50

E0968

RR

$ 34.20

$ 34.20

E0969

NU

$ 299.19

$ 299.19

E0969

RR

$ 29.62

$ 29.62

E0969

UE

$ 224.41

$ 224.41

E0971

NU

$ 46.33

$ 68.35

E0971

RR

$ 4.63

$ 6.85

E0971

UE

$ 34.75

$ 51.28

E0973

NU

$ 82.35

$ 142.20

E0973

RR

$ 8.23

$ 13.76

E0973

UE

$ 61.77

$ 106.64

E0974

NU

$ 121.87

$ 127.32

E0974

RR

$ 12.19

$ 14.48

E0974

UE

$ 91.41

$ 96.21

E0978

NU

$ 36.68

$ 53.89

E0978

RR

$ 3.67

$ 5.70

E0978

UE

$ 27.51

$ 40.40

E0980

NU

$ 53.68

$ 53.68

E0980

RR

$ 6.33

$ 6.33

E0980

UE

$ 40.03

$ 40.03

E0981

NU

$ 68.78

$ 70.80

E0981

RR

$ 6.87

$ 7.39

E0981

UE

$ 51.59

$ 53.10

E0982

NU

$ 72.11

$ 72.11

E0982

RR

$ 7.62

$ 8.05

E0982

UE

$ 54.10

$ 54.10

E0983

RR

$ 444.02

$ 444.02

E0984

RR

$ 364.94

$ 364.94

E0985

RR

$ 34.64

$ 38.57

E0986

RR

$ 929.21

$ 929.21

E0988

RR

$ 549.82

$ 549.82

E0990

NU

$ 107.49

$ 159.17

E0990

RR

$ 10.75

$ 17.14

E0990

UE

$ 80.63

$ 122.42

E0992

NU

$ 127.37

$ 162.11

E0992

RR

$ 12.74

$ 15.95

E0992

UE

$ 95.54

$ 121.59

E0994

NU

$ 33.68

$ 33.68

E0994

RR

$ 3.40

$ 3.40

E0994

UE

$ 25.26

$ 25.26

E0995

NU

$ 44.20

$ 46.62

E0995

RR

$ 4.42

$ 4.72

E0995

UE

$ 33.15

$ 34.99

E1002

RR

$ 613.35

$ 640.33

E1003

RR

$ 717.92

$ 720.47

E1004

RR

$ 789.10

$ 795.35

E1005

RR

$ 863.21

$ 865.45

E1006

RR

$ 1,062.85

$ 1,062.85

E1007

RR

$ 1,321.11

$ 1,380.16

E1008

RR

$ 1,355.10

$ 1,397.20

E1010

RR

$ 184.16

$ 186.24

E1012

RR

$ 184.16

$ 186.24

E1014

RR

$ 69.78

$ 69.78

E1015

NU

$ 190.99

$ 215.57

E1015

RR

$ 19.10

$ 21.55

E1015

UE

$ 143.23

$ 161.67

E1016

NU

$ 180.94

$ 207.61

E1016

RR

$ 18.10

$ 20.78

E1016

UE

$ 135.70

$ 155.69

E1020

RR

$ 29.30

$ 36.01

E1028

RR

$ 20.76

$ 28.98

E1029

RR

$ 60.82

$ 60.82

E1030

RR

$ 191.86

$ 191.86

E1031

RR

$ 69.41

$ 86.10

E1035

RR

$ 950.70

$ 1,111.04

E1036

RR

$ 1,339.52

$ 1,585.42

E1037

RR

$ 166.35

$ 199.12

E1038

RR

$ 23.81

$ 30.28

E1039

RR

$ 51.74

$ 62.02

E1050

RR

$ 194.56

$ 194.56

E1060

RR

$ 240.80

$ 240.80

E1070

RR

$ 209.24

$ 209.24

E1083

RR

$ 127.85

$ 127.85

E1084

RR

$ 187.39

$ 187.39

E1086

NU

$ 2,400.40

$ 2,400.40

E1086

RR

$ 241.49

$ 241.49

E1086

UE

$ 1,799.08

$ 1,799.08

E1087

RR

$ 205.45

$ 205.45

E1088

RR

$ 272.92

$ 272.92

E1090

NU

$ 4,080.64

$ 4,080.64

E1090

RR

$ 410.52

$ 410.52

E1090

UE

$ 3,058.43

$ 3,058.43

E1092

RR

$ 245.49

$ 245.49

E1093

RR

$ 211.12

$ 211.12

E1100

RR

$ 182.46

$ 182.46

E1110

RR

$ 182.46

$ 182.46

E1130

NU

$ 840.18

$ 840.18

E1130

RR

$ 84.53

$ 84.53

E1130

UE

$ 629.72

$ 629.72

E1140

NU

$ 2,306.60

$ 2,306.60

E1140

RR

$ 232.05

$ 232.05

E1140

UE

$ 1,728.79

$ 1,728.79

E1150

RR

$ 155.82

$ 155.82

E1160

RR

$ 119.41

$ 119.41

E1161

RR

$ 451.96

$ 451.96

E1170

RR

$ 170.63

$ 170.63

E1171

RR

$ 153.10

$ 153.10

E1172

RR

$ 187.17

$ 187.17

E1180

RR

$ 193.58

$ 193.58

E1190

RR

$ 223.64

$ 223.64

E1195

RR

$ 239.96

$ 239.96

E1200

RR

$ 166.21

$ 166.21

E1221

RR

$ 90.76

$ 90.76

E1222

RR

$ 126.17

$ 126.17

E1223

RR

$ 141.39

$ 141.39

E1224

RR

$ 155.02

$ 155.02

E1225

RR

$ 59.37

$ 76.52

E1226

NU

$ 593.15

$ 780.16

E1226

RR

$ 59.32

$ 87.36

E1226

UE

$ 444.86

$ 585.09

E1227

NU

$ 450.58

$ 450.58

E1227

RR

$ 53.02

$ 53.02

E1227

UE

$ 337.99

$ 337.99

E1228

RR

$ 53.54

$ 53.54

E1230

NU

$ 4,320.57

$ 4,320.57

E1230

RR

$ 424.94

$ 424.94

E1230

UE

$ 3,417.05

$ 3,417.05

E1232

RR

$ 408.52

$ 408.52

E1233

RR

$ 423.23

$ 423.23

E1234

RR

$ 368.48

$ 368.48

E1235

RR

$ 354.83

$ 354.83

E1236

RR

$ 313.04

$ 313.04

E1237

RR

$ 315.76

$ 315.76

E1238

RR

$ 313.04

$ 313.04

E1240

RR

$ 188.47

$ 188.47

E1260

NU

$ 3,075.69

$ 3,075.69

E1260

RR

$ 309.43

$ 309.43

E1260

UE

$ 2,305.23

$ 2,305.23

E1270

RR

$ 141.85

$ 141.85

E1280

RR

$ 250.73

$ 250.73

E1290

NU

$ 2,640.48

$ 2,640.48

E1290

RR

$ 265.64

$ 265.64

E1290

UE

$ 1,979.03

$ 1,979.03

E1295

RR

$ 232.02

$ 232.02

E1296

NU

$ 798.29

$ 798.29

E1296

RR

$ 95.44

$ 95.44

E1296

UE

$ 598.74

$ 598.74

E1297

NU

$ 199.82

$ 199.82

E1297

RR

$ 22.20

$ 22.20

E1297

UE

$ 149.84

$ 149.84

E1298

NU

$ 809.28

$ 809.28

E1298

RR

$ 82.80

$ 82.80

E1298

UE

$ 606.96

$ 606.96

E1310

NU

$ 3,486.74

$ 3,486.74

E1310

RR

$ 348.68

$ 348.68

E1310

UE

$ 2,615.03

$ 2,615.03

E1353

$ 54.10

$ 54.10

E1354

$ 29.61

$ 29.61

E1355

$ 40.77

$ 40.77

E1356

$ 466.68

$ 466.68

E1372

NU

$ 180.81

$ 244.17

E1372

RR

$ 18.09

$ 30.42

E1372

UE

$ 135.60

$ 181.85

E1390

RR

$ 129.92

$ 236.54

E1391

RR

$ 129.92

$ 236.54

E1392

RR

$ 62.43

$ 71.65

E1405

RR

$ 172.49

$ 290.75

E1406

RR

$ 139.38

$ 257.17

E1510

NU

$ 1,080.16

$ 1,080.16

E1510

RR

$ 108.67

$ 108.67

E1510

UE

$ 809.56

$ 809.56

E1610

NU

$ 6,481.03

$ 6,481.03

E1610

RR

$ 652.02

$ 652.02

E1610

UE

$ 4,857.51

$ 4,857.51

E1637

$ 67.02

$ 67.02

E1639

$ 153.20

$ 153.20

E1700

RR

$ 65.88

$ 65.88

E1701

$ 20.24

$ 20.24

E1702

$ 43.09

$ 43.09

E1800

RR

$ 234.01

$ 234.01

E1801

RR

$ 228.76

$ 228.76

E1802

RR

$ 624.29

$ 624.29

E1805

RR

$ 241.21

$ 241.21

E1806

RR

$ 187.71

$ 187.71

E1810

RR

$ 238.00

$ 238.00

E1811

RR

$ 237.76

$ 237.76

E1812

RR

$ 164.26

$ 164.26

E1815

RR

$ 241.21

$ 241.21

E1816

RR

$ 241.53

$ 241.53

E1818

RR

$ 246.57

$ 246.57

E1820

NU

$ 147.31

$ 147.31

E1820

RR

$ 14.76

$ 14.76

E1820

UE

$ 110.49

$ 110.49

E1821

NU

$ 201.03

$ 201.03

E1821

RR

$ 20.05

$ 20.05

E1821

UE

$ 150.82

$ 150.82

E1825

RR

$ 241.21

$ 241.21

E1830

RR

$ 241.21

$ 241.21

E1831

RR

$ 121.38

$ 121.38

E1840

RR

$ 699.82

$ 699.82

E1841

RR

$ 865.31

$ 865.31

E1905

RR

$ 904.46

$ 904.46

E2000

RR

$ 91.84

$ 91.84

E2001

RR

$ 80.86

$ 80.86

E2100

NU

$ 1,228.61

$ 1,228.61

E2100

RR

$ 122.89

$ 122.89

E2100

UE

$ 921.49

$ 921.49

E2101

NU

$ 360.18

$ 360.18

E2101

RR

$ 36.02

$ 36.02

E2101

UE

$ 270.14

$ 270.14

E2103

NU

$ 403.82

$ 403.82

E2103

RR

$ 40.39

$ 40.39

E2103

UE

$ 302.86

$ 302.86

E2120

RR

$ 541.59

$ 541.59

E2201

NU

$ 492.42

$ 629.02

E2201

RR

$ 49.24

$ 62.90

E2201

UE

$ 369.32

$ 471.76

E2202

NU

$ 702.74

$ 849.94

E2202

RR

$ 70.27

$ 84.99

E2202

UE

$ 527.07

$ 637.49

E2203

NU

$ 671.69

$ 829.14

E2203

RR

$ 67.17

$ 82.91

E2203

UE

$ 503.76

$ 621.84

E2204

NU

$ 1,154.37

$ 1,427.19

E2204

RR

$ 115.44

$ 142.73

E2204

UE

$ 865.77

$ 1,070.40

E2205

NU

$ 55.19

$ 61.35

E2205

RR

$ 5.52

$ 6.09

E2205

UE

$ 41.40

$ 46.06

E2206

NU

$ 60.19

$ 71.92

E2206

RR

$ 6.02

$ 7.18

E2206

UE

$ 45.14

$ 53.96

E2207

NU

$ 72.59

$ 81.05

E2207

RR

$ 7.27

$ 8.12

E2207

UE

$ 54.45

$ 60.79

E2208

NU

$ 120.88

$ 163.86

E2208

RR

$ 12.10

$ 16.39

E2208

UE

$ 90.66

$ 122.89

E2209

NU

$ 131.14

$ 160.64

E2209

RR

$ 13.12

$ 16.06

E2209

UE

$ 98.35

$ 120.50

E2210

NU

$ 8.44

$ 10.11

E2210

RR

$ 0.84

$ 1.02

E2210

UE

$ 6.33

$ 7.60

E2211

NU

$ 53.56

$ 63.28

E2211

RR

$ 5.35

$ 6.83

E2211

UE

$ 40.17

$ 46.34

E2212

NU

$ 9.87

$ 11.02

E2212

RR

$ 0.99

$ 1.15

E2212

UE

$ 7.41

$ 8.29

E2213

NU

$ 47.00

$ 54.84

E2213

RR

$ 4.70

$ 5.52

E2213

UE

$ 35.25

$ 41.10

E2214

NU

$ 50.65

$ 58.14

E2214

RR

$ 5.07

$ 6.66

E2214

UE

$ 38.00

$ 43.60

E2215

NU

$ 16.04

$ 18.03

E2215

RR

$ 1.61

$ 1.81

E2215

UE

$ 12.04

$ 13.52

E2216

NU

$ 69.50

$ 76.78

E2216

RR

$ 6.94

$ 9.14

E2216

UE

$ 52.12

$ 57.58

E2217

NU

$ 61.50

$ 67.94

E2217

RR

$ 6.15

$ 8.09

E2217

UE

$ 46.13

$ 50.96

E2218

NU

$ 69.50

$ 76.78

E2218

RR

$ 6.94

$ 9.14

E2218

UE

$ 52.12

$ 57.58

E2219

NU

$ 61.50

$ 67.94

E2219

RR

$ 6.15

$ 8.09

E2219

UE

$ 46.13

$ 50.96

E2220

NU

$ 44.65

$ 53.02

E2220

RR

$ 4.47

$ 5.21

E2220

UE

$ 33.49

$ 40.17

E2221

NU

$ 41.80

$ 47.49

E2221

RR

$ 4.19

$ 4.72

E2221

UE

$ 31.36

$ 35.62

E2222

NU

$ 35.77

$ 39.75

E2222

RR

$ 3.57

$ 3.95

E2222

UE

$ 26.82

$ 29.82

E2224

NU

$ 144.97

$ 159.21

E2224

RR

$ 14.50

$ 18.17

E2224

UE

$ 108.72

$ 119.42

E2225

NU

$ 29.88

$ 33.18

E2225

RR

$ 2.98

$ 3.32

E2225

UE

$ 22.41

$ 24.86

E2226

NU

$ 62.20

$ 70.95

E2226

RR

$ 6.23

$ 7.10

E2226

UE

$ 46.65

$ 53.21

E2227

RR

$ 343.57

$ 343.57

E2228

RR

$ 148.96

$ 173.45

E2231

NU

$ 221.41

$ 269.56

E2231

RR

$ 22.15

$ 26.96

E2231

UE

$ 166.05

$ 202.16

E2291

$ 643.41

$ 643.41

E2292

$ 716.49

$ 716.49

E2293

$ 1,225.08

$ 1,225.08

E2294

$ 774.76

$ 774.76

E2300

$ 6,121.05

$ 6,121.05

E2301

$ 22,712.63

$ 22,712.63

E2310

RR

$ 179.61

$ 186.13

E2311

RR

$ 362.43

$ 376.25

E2312

RR

$ 370.44

$ 370.44

E2313

RR

$ 58.87

$ 58.87

E2321

RR

$ 244.03

$ 252.84

E2322

RR

$ 230.55

$ 231.36

E2323

NU

$ 112.38

$ 113.13

E2323

RR

$ 11.24

$ 11.31

E2323

UE

$ 84.29

$ 84.84

E2324

NU

$ 72.14

$ 72.14

E2324

RR

$ 7.18

$ 7.18

E2324

UE

$ 54.11

$ 54.11

E2325

RR

$ 220.35

$ 221.06

E2326

RR

$ 57.18

$ 57.18

E2327

RR

$ 430.09

$ 430.09

E2328

RR

$ 813.55

$ 814.69

E2329

RR

$ 290.78

$ 290.78

E2330

RR

$ 563.40

$ 563.40

E2331

$ 1,697.77

$ 1,697.77

E2340

NU

$ 684.53

$ 684.53

E2340

RR

$ 68.49

$ 68.49

E2340

UE

$ 513.46

$ 513.46

E2341

NU

$ 1,026.90

$ 1,026.90

E2341

RR

$ 102.68

$ 102.68

E2341

UE

$ 770.21

$ 770.21

E2342

NU

$ 855.76

$ 855.76

E2342

RR

$ 85.57

$ 85.57

E2342

UE

$ 641.83

$ 641.83

E2343

NU

$ 1,369.23

$ 1,369.23

E2343

RR

$ 136.91

$ 136.91

E2343

UE

$ 1,026.90

$ 1,026.90

E2351

NU

$ 1,150.66

$ 1,150.66

E2351

RR

$ 115.07

$ 115.07

E2351

UE

$ 862.99

$ 862.99

E2359

NU

$ 266.69

$ 307.82

E2359

RR

$ 26.67

$ 30.79

E2359

UE

$ 200.02

$ 230.86

E2360

NU

$ 182.42

$ 182.42

E2360

RR

$ 20.20

$ 21.56

E2360

UE

$ 136.78

$ 136.78

E2361

NU

$ 179.65

$ 214.91

E2361

RR

$ 17.96

$ 21.50

E2361

UE

$ 134.74

$ 161.18

E2362

NU

$ 172.77

$ 172.77

E2362

RR

$ 17.28

$ 17.28

E2362

UE

$ 129.54

$ 129.54

E2363

NU

$ 220.92

$ 279.51

E2363

RR

$ 22.09

$ 27.96

E2363

UE

$ 165.69

$ 209.64

E2364

NU

$ 182.42

$ 182.42

E2364

RR

$ 20.43

$ 20.86

E2364

UE

$ 136.78

$ 136.78

E2365

NU

$ 115.64

$ 158.80

E2365

RR

$ 11.56

$ 15.88

E2365

UE

$ 86.73

$ 119.13

E2366

NU

$ 238.22

$ 323.16

E2366

RR

$ 23.83

$ 35.63

E2366

UE

$ 178.67

$ 242.38

E2367

NU

$ 619.28

$ 678.54

E2367

RR

$ 61.92

$ 67.86

E2367

UE

$ 464.45

$ 508.90

E2368

RR

$ 64.50

$ 78.74

E2369

RR

$ 59.81

$ 71.34

E2370

RR

$ 84.00

$ 113.06

E2371

NU

$ 221.41

$ 247.87

E2371

RR

$ 22.13

$ 24.79

E2371

UE

$ 166.05

$ 185.91

E2373

RR

$ 129.15

$ 129.15

E2374

RR

$ 82.75

$ 85.34

E2375

RR

$ 106.32

$ 130.33

E2376

RR

$ 205.60

$ 213.30

E2377

RR

$ 76.16

$ 78.06

E2378

RR

$ 88.54

$ 97.36

E2381

NU

$ 95.14

$ 115.58

E2381

RR

$ 9.52

$ 11.55

E2381

UE

$ 71.36

$ 86.69

E2382

NU

$ 30.17

$ 31.88

E2382

RR

$ 3.01

$ 3.16

E2382

UE

$ 22.64

$ 23.93

E2383

NU

$ 203.94

$ 236.10

E2383

RR

$ 20.40

$ 23.60

E2383

UE

$ 152.95

$ 177.09

E2384

NU

$ 96.04

$ 119.90

E2384

RR

$ 9.60

$ 11.97

E2384

UE

$ 72.03

$ 89.91

E2385

NU

$ 72.39

$ 76.27

E2385

RR

$ 7.24

$ 7.63

E2385

UE

$ 54.29

$ 57.19

E2386

NU

$ 163.79

$ 212.56

E2386

RR

$ 16.38

$ 21.25

E2386

UE

$ 122.85

$ 159.45

E2387

NU

$ 77.31

$ 96.11

E2387

RR

$ 7.73

$ 9.59

E2387

UE

$ 57.97

$ 72.07

E2388

NU

$ 78.78

$ 80.85

E2388

RR

$ 7.88

$ 8.09

E2388

UE

$ 59.08

$ 60.66

E2389

NU

$ 44.03

$ 44.55

E2389

RR

$ 4.40

$ 4.47

E2389

UE

$ 33.03

$ 33.39

E2390

NU

$ 68.17

$ 69.30

E2390

RR

$ 6.82

$ 6.93

E2390

UE

$ 51.13

$ 51.97

E2391

NU

$ 27.78

$ 32.49

E2391

RR

$ 2.77

$ 3.26

E2391

UE

$ 20.83

$ 24.37

E2392

NU

$ 65.20

$ 81.72

E2392

RR

$ 6.52

$ 8.19

E2392

UE

$ 48.90

$ 61.29

E2394

NU

$ 92.90

$ 114.73

E2394

RR

$ 9.30

$ 11.48

E2394

UE

$ 69.68

$ 86.04

E2395

NU

$ 69.79

$ 83.50

E2395

RR

$ 6.99

$ 8.36

E2395

UE

$ 52.35

$ 62.64

E2396

NU

$ 80.91

$ 101.15

E2396

RR

$ 8.09

$ 10.50

E2396

UE

$ 60.68

$ 75.88

E2397

NU

$ 704.69

$ 789.57

E2397

RR

$ 70.48

$ 78.96

E2397

UE

$ 528.53

$ 592.16

E2398

NU

$ 219.13

$ 219.13

E2398

RR

$ 21.91

$ 21.91

E2398

UE

$ 164.33

$ 164.33

E2402

RR

$ 1,056.17

$ 2,008.87

E2500

NU

$ 746.98

$ 746.98

E2500

RR

$ 74.70

$ 74.70

E2500

UE

$ 560.24

$ 560.24

E2502

NU

$ 2,284.23

$ 2,284.23

E2502

RR

$ 228.45

$ 228.45

E2502

UE

$ 1,713.19

$ 1,713.19

E2504

NU

$ 3,013.23

$ 3,013.23

E2504

RR

$ 301.35

$ 301.35

E2504

UE

$ 2,259.94

$ 2,259.94

E2506

NU

$ 4,418.26

$ 4,418.26

E2506

RR

$ 441.81

$ 441.81

E2506

UE

$ 3,313.63

$ 3,313.63

E2508

NU

$ 6,832.13

$ 6,832.13

E2508

RR

$ 683.21

$ 683.21

E2508

UE

$ 5,124.11

$ 5,124.11

E2510

NU

$ 12,928.89

$ 12,928.89

E2510

RR

$ 1,292.89

$ 1,292.89

E2510

UE

$ 9,696.64

$ 9,696.64

E2511

NU

$ 50.72

$ 50.72

E2511

RR

$ 5.11

$ 5.11

E2511

UE

$ 37.84

$ 37.84

E2512

NU

$ 1,436.85

$ 1,436.85

E2512

RR

$ 144.55

$ 144.55

E2512

UE

$ 1,072.29

$ 1,072.29

E2601

NU

$ 60.12

$ 84.84

E2601

RR

$ 6.01

$ 8.50

E2601

UE

$ 45.09

$ 63.64

E2602

NU

$ 129.98

$ 172.69

E2602

RR

$ 13.01

$ 17.28

E2602

UE

$ 97.48

$ 129.51

E2603

NU

$ 163.79

$ 215.96

E2603

RR

$ 16.38

$ 21.60

E2603

UE

$ 122.84

$ 161.99

E2604

NU

$ 238.74

$ 284.23

E2604

RR

$ 23.87

$ 28.42

E2604

UE

$ 179.06

$ 213.19

E2605

NU

$ 335.85

$ 407.67

E2605

RR

$ 33.59

$ 40.77

E2605

UE

$ 251.89

$ 305.77

E2606

NU

$ 541.94

$ 644.07

E2606

RR

$ 54.19

$ 64.41

E2606

UE

$ 406.46

$ 483.03

E2607

NU

$ 325.99

$ 418.77

E2607

RR

$ 32.59

$ 41.87

E2607

UE

$ 244.50

$ 314.08

E2608

NU

$ 416.60

$ 513.52

E2608

RR

$ 41.66

$ 51.34

E2608

UE

$ 312.45

$ 385.14

E2609

$ 3,306.21

$ 3,306.21

E2611

NU

$ 244.75

$ 395.79

E2611

RR

$ 24.47

$ 39.56

E2611

UE

$ 183.55

$ 296.87

E2612

NU

$ 483.28

$ 618.46

E2612

RR

$ 48.33

$ 61.85

E2612

UE

$ 362.46

$ 463.85

E2613

NU

$ 491.09

$ 597.42

E2613

RR

$ 49.11

$ 59.75

E2613

UE

$ 368.33

$ 448.07

E2614

NU

$ 723.84

$ 851.86

E2614

RR

$ 72.38

$ 85.19

E2614

UE

$ 542.89

$ 638.90

E2615

NU

$ 561.37

$ 684.74

E2615

RR

$ 56.14

$ 68.49

E2615

UE

$ 421.04

$ 513.56

E2616

NU

$ 755.92

$ 921.75

E2616

RR

$ 75.60

$ 92.18

E2616

UE

$ 566.94

$ 691.32

E2617

$ 3,871.92

$ 3,871.92

E2619

NU

$ 81.10

$ 82.80

E2619

RR

$ 8.11

$ 8.29

E2619

UE

$ 60.83

$ 62.13

E2620

NU

$ 613.27

$ 785.71

E2620

RR

$ 61.33

$ 78.57

E2620

UE

$ 459.96

$ 589.29

E2621

NU

$ 721.71

$ 869.76

E2621

RR

$ 72.17

$ 86.98

E2621

UE

$ 541.28

$ 652.33

E2622

NU

$ 514.50

$ 530.11

E2622

RR

$ 51.45

$ 53.02

E2622

UE

$ 385.88

$ 397.59

E2623

NU

$ 650.64

$ 672.52

E2623

RR

$ 65.06

$ 67.26

E2623

UE

$ 487.97

$ 504.38

E2624

NU

$ 522.83

$ 536.52

E2624

RR

$ 52.29

$ 53.66

E2624

UE

$ 392.13

$ 402.40

E2625

NU

$ 647.04

$ 671.79

E2625

RR

$ 64.71

$ 67.17

E2625

UE

$ 485.28

$ 503.83

E2626

NU

$ 1,000.68

$ 1,164.81

E2626

RR

$ 100.07

$ 116.47

E2626

UE

$ 750.51

$ 873.57

E2627

NU

$ 1,609.47

$ 1,828.20

E2627

RR

$ 160.94

$ 182.85

E2627

UE

$ 1,207.11

$ 1,371.15

E2628

NU

$ 1,195.75

$ 1,397.91

E2628

RR

$ 119.57

$ 139.79

E2628

UE

$ 896.83

$ 1,048.43

E2629

NU

$ 1,555.74

$ 1,763.23

E2629

RR

$ 155.57

$ 176.32

E2629

UE

$ 1,166.80

$ 1,322.43

E2630

NU

$ 1,078.41

$ 1,215.69

E2630

RR

$ 107.84

$ 121.58

E2630

UE

$ 808.81

$ 911.76

E2631

NU

$ 435.04

$ 494.38

E2631

RR

$ 43.50

$ 49.45

E2631

UE

$ 326.27

$ 370.78

E2632

NU

$ 274.97

$ 310.38

E2632

RR

$ 27.50

$ 31.04

E2632

UE

$ 206.23

$ 232.78

E2633

NU

$ 228.91

$ 261.73

E2633

RR

$ 22.89

$ 26.18

E2633

UE

$ 171.68

$ 196.31

E3000

RR

$ 328.17

$ 328.17

E8000

$ 4,461.93

$ 4,461.93

E8001

$ 6,908.36

$ 6,908.36

E8002

$ 6,884.42

$ 6,884.42

G0480-G0483, G0659

BR

BR

G2010, G2012

BR

BR

JXXXX

BR

BR

K0001

RR

$ 37.74

$ 71.06

K0002

RR

$ 61.31

$ 113.97

K0003

RR

$ 58.79

$ 106.06

K0004

RR

$ 69.72

$ 165.98

K0005

NU

$ 3,472.48

$ 3,472.48

K0005

RR

$ 347.26

$ 347.26

K0005

UE

$ 2,604.39

$ 2,604.39

K0006

RR

$ 101.60

$ 176.69

K0007

RR

$ 137.86

$ 237.66

K0009

RR

$ 136.53

$ 136.53

K0010

RR

$ 813.74

$ 813.74

K0011

RR

$ 938.99

$ 938.99

K0012

RR

$ 576.02

$ 576.02

K0015

RR

$ 22.89

$ 27.29

K0017

NU

$ 78.08

$ 80.40

K0017

RR

$ 7.81

$ 8.05

K0017

UE

$ 58.56

$ 60.30

K0018

NU

$ 44.14

$ 45.19

K0018

RR

$ 4.41

$ 4.51

K0018

UE

$ 33.11

$ 33.91

K0019

NU

$ 19.54

$ 25.98

K0019

RR

$ 1.96

$ 2.60

K0019

UE

$ 14.67

$ 19.50

K0020

NU

$ 75.21

$ 75.21

K0020

RR

$ 7.52

$ 7.52

K0020

UE

$ 56.39

$ 56.39

K0037

NU

$ 73.46

$ 76.37

K0037

RR

$ 7.07

$ 7.07

K0037

UE

$ 55.10

$ 57.30

K0038

NU

$ 39.03

$ 39.14

K0038

RR

$ 3.91

$ 3.91

K0038

UE

$ 29.27

$ 29.34

K0039

NU

$ 83.80

$ 85.51

K0039

RR

$ 8.39

$ 8.58

K0039

UE

$ 62.85

$ 64.12

K0040

NU

$ 84.90

$ 106.96

K0040

RR

$ 8.48

$ 10.70

K0040

UE

$ 63.67

$ 80.22

K0041

NU

$ 80.08

$ 82.91

K0041

RR

$ 8.01

$ 8.29

K0041

UE

$ 60.06

$ 62.15

K0042

NU

$ 50.99

$ 50.99

K0042

RR

$ 5.10

$ 5.10

K0042

UE

$ 38.22

$ 38.22

K0043

NU

$ 31.61

$ 31.61

K0043

RR

$ 3.16

$ 3.16

K0043

UE

$ 23.72

$ 23.72

K0044

NU

$ 26.95

$ 26.95

K0044

RR

$ 2.70

$ 2.70

K0044

UE

$ 20.17

$ 20.17

K0045

NU

$ 90.87

$ 92.05

K0045

RR

$ 9.09

$ 9.35

K0045

UE

$ 68.15

$ 69.03

K0046

NU

$ 31.61

$ 31.61

K0046

RR

$ 3.16

$ 3.16

K0046

UE

$ 23.72

$ 23.72

K0047

NU

$ 112.94

$ 118.36

K0047

RR

$ 11.30

$ 11.84

K0047

UE

$ 84.70

$ 88.79

K0050

NU

$ 52.40

$ 52.50

K0050

RR

$ 5.24

$ 5.25

K0050

UE

$ 39.30

$ 39.40

K0051

NU

$ 82.89

$ 84.01

K0051

RR

$ 8.29

$ 8.40

K0051

UE

$ 62.17

$ 63.01

K0052

NU

$ 112.92

$ 137.82

K0052

RR

$ 11.30

$ 13.80

K0052

UE

$ 84.69

$ 103.35

K0053

NU

$ 134.39

$ 157.57

K0053

RR

$ 13.44

$ 15.76

K0053

UE

$ 100.79

$ 118.16

K0056

NU

$ 147.08

$ 172.90

K0056

RR

$ 14.71

$ 17.30

K0056

UE

$ 110.32

$ 129.70

K0065

NU

$ 74.86

$ 83.33

K0065

RR

$ 7.49

$ 8.33

K0065

UE

$ 56.14

$ 62.52

K0069

NU

$ 149.81

$ 177.83

K0069

RR

$ 14.98

$ 17.79

K0069

UE

$ 112.36

$ 133.38

K0070

RR

$ 25.44

$ 31.28

K0071

NU

$ 174.86

$ 199.47

K0071

RR

$ 17.49

$ 19.98

K0071

UE

$ 131.14

$ 149.62

K0072

NU

$ 109.31

$ 121.97

K0072

RR

$ 10.93

$ 12.19

K0072

UE

$ 81.98

$ 91.48

K0073

NU

$ 56.25

$ 62.87

K0073

RR

$ 5.63

$ 6.29

K0073

UE

$ 42.20

$ 47.12

K0077

NU

$ 86.11

$ 102.90

K0077

RR

$ 8.61

$ 10.28

K0077

UE

$ 64.60

$ 77.15

K0098

NU

$ 38.47

$ 42.70

K0098

RR

$ 3.85

$ 4.28

K0098

UE

$ 28.87

$ 32.03

K0105

NU

$ 159.10

$ 181.76

K0105

RR

$ 15.90

$ 18.17

K0105

UE

$ 119.32

$ 136.33

K0195

RR

$ 16.80

$ 26.17

K0455

RR

$ 469.56

$ 469.56

K0552

$ 4.59

$ 4.79

K0601

NU

$ 2.09

$ 2.10

K0602

NU

$ 11.75

$ 11.94

K0603

NU

$ 1.05

$ 1.06

K0604

NU

$ 11.33

$ 11.47

K0605

NU

$ 27.06

$ 27.48

K0607

RR

$ 37.11

$ 37.11

K0608

NU

$ 231.53

$ 231.53

K0608

RR

$ 23.20

$ 23.20

K0608

UE

$ 173.64

$ 173.64

K0609

$ 1,539.79

$ 1,539.79

K0669

$ 594.82

$ 594.82

K0672

$ 136.32

$ 136.32

K0730

RR

$ 329.31

$ 329.31

K0733

NU

$ 45.68

$ 49.74

K0733

RR

$ 4.56

$ 5.01

K0733

UE

$ 34.26

$ 37.32

K0738

RR

$ 62.43

$ 71.65

K0739

$ 51.86

$ 51.86

K0740

$ 29.62

$ 29.62

K0800

NU

$ 1,347.72

$ 1,812.36

K0800

RR

$ 134.78

$ 181.24

K0800

UE

$ 1,010.79

$ 1,359.27

K0801

NU

$ 2,419.96

$ 3,083.91

K0801

RR

$ 241.99

$ 308.36

K0801

UE

$ 1,814.97

$ 2,312.93

K0802

NU

$ 3,269.80

$ 3,764.89

K0802

RR

$ 326.98

$ 376.49

K0802

UE

$ 2,452.35

$ 2,823.67

K0806

NU

$ 2,314.56

$ 2,444.69

K0806

RR

$ 231.46

$ 244.47

K0806

UE

$ 1,735.93

$ 1,833.54

K0807

NU

$ 3,587.00

$ 3,747.03

K0807

RR

$ 358.69

$ 374.71

K0807

UE

$ 2,690.25

$ 2,810.28

K0808

NU

$ 5,544.91

$ 5,794.95

K0808

RR

$ 554.50

$ 579.49

K0808

UE

$ 4,158.69

$ 4,346.20

K0813

RR

$ 429.91

$ 533.29

K0814

RR

$ 447.19

$ 624.79

K0815

RR

$ 498.18

$ 702.83

K0816

RR

$ 458.00

$ 664.93

K0820

RR

$ 445.47

$ 560.00

K0821

RR

$ 458.00

$ 657.99

K0822

RR

$ 498.18

$ 761.99

K0823

RR

$ 458.00

$ 746.61

K0824

RR

$ 708.04

$ 982.88

K0825

RR

$ 662.56

$ 904.08

K0826

RR

$ 1,133.82

$ 1,425.86

K0827

RR

$ 1,006.11

$ 1,227.67

K0828

RR

$ 1,472.16

$ 1,660.71

K0829

RR

$ 1,420.52

$ 1,566.68

K0835

RR

$ 594.71

$ 798.36

K0836

RR

$ 616.84

$ 827.99

K0837

RR

$ 762.79

$ 979.37

K0838

RR

$ 676.09

$ 872.98

K0839

RR

$ 1,013.24

$ 1,280.79

K0840

RR

$ 1,555.64

$ 1,950.66

K0841

RR

$ 670.18

$ 868.38

K0842

RR

$ 669.21

$ 867.89

K0843

RR

$ 794.44

$ 1,039.28

K0848

RR

$ 1,305.08

$ 1,305.08

K0849

RR

$ 1,254.74

$ 1,254.74

K0850

RR

$ 1,513.81

$ 1,513.81

K0851

RR

$ 1,455.55

$ 1,455.55

K0852

RR

$ 1,749.12

$ 1,749.12

K0853

RR

$ 1,796.80

$ 1,796.80

K0854

RR

$ 2,380.36

$ 2,380.36

K0855

RR

$ 2,248.60

$ 2,248.60

K0856

RR

$ 1,400.83

$ 1,400.83

K0857

RR

$ 1,428.91

$ 1,428.91

K0858

RR

$ 1,738.03

$ 1,738.03

K0859

RR

$ 1,657.54

$ 1,657.54

K0860

RR

$ 2,483.00

$ 2,483.00

K0861

RR

$ 1,403.08

$ 1,403.08

K0862

RR

$ 1,738.03

$ 1,738.03

K0863

RR

$ 2,483.00

$ 2,483.00

K0864

RR

$ 2,954.77

$ 2,954.77

K0884

$ 35,538.37

$ 35,538.37

K0899

$ 4,336.99

$ 4,336.99

K1027

$ 8,414.41

$ 8,414.41

L0112

$ 2,250.30

$ 2,250.30

L0113

$ 458.50

$ 458.50

L0120

$ 54.50

$ 54.50

L0130

$ 272.19

$ 272.19

L0140

$ 98.60

$ 98.60

L0150

$ 221.93

$ 221.93

L0160

$ 272.27

$ 272.27

L0170

$ 1,313.23

$ 1,313.23

L0172

$ 245.17

$ 245.17

L0174

$ 564.16

$ 564.16

L0180

$ 731.39

$ 731.39

L0190

$ 1,017.31

$ 1,017.31

L0200

$ 1,060.54

$ 1,060.54

L0220

$ 188.64

$ 188.64

L0450

$ 181.09

$ 274.48

L0452

$ 640.93

$ 640.93

L0454

$ 557.61

$ 557.61

L0455

$ 336.18

$ 457.06

L0456

$ 1,599.07

$ 1,599.07

L0457

$ 964.07

$ 1,310.69

L0458

$ 1,433.87

$ 1,433.87

L0460

$ 1,613.92

$ 1,613.92

L0462

$ 2,007.47

$ 2,007.47

L0464

$ 2,389.86

$ 2,389.86

L0466

$ 767.28

$ 767.28

L0467

$ 377.03

$ 583.55

L0468

$ 929.96

$ 929.96

L0469

$ 480.41

$ 719.71

L0470

$ 1,309.32

$ 1,309.32

L0472

$ 830.40

$ 830.40

L0480

$ 2,491.76

$ 2,491.76

L0482

$ 2,841.68

$ 2,841.68

L0484

$ 3,197.87

$ 3,197.87

L0486

$ 3,463.35

$ 3,463.35

L0488

$ 1,613.92

$ 1,613.92

L0490

$ 454.83

$ 454.83

L0491

$ 1,234.76

$ 1,234.76

L0492

$ 852.08

$ 852.08

L0621

$ 95.48

$ 145.31

L0622

$ 530.54

$ 530.54

L0623

$ 171.14

$ 233.00

L0625

$ 53.42

$ 72.59

L0626

$ 125.30

$ 125.30

L0627

$ 660.91

$ 660.91

L0628

$ 81.33

$ 110.57

L0629

$ 273.50

$ 273.50

L0630

$ 260.39

$ 260.39

L0631

$ 1,650.53

$ 1,650.53

L0633

$ 461.06

$ 461.06

L0635

$ 1,965.77

$ 1,965.77

L0636

$ 2,910.07

$ 2,910.07

L0637

$ 1,945.17

$ 1,945.17

L0638

$ 2,120.51

$ 2,120.51

L0639

$ 1,945.17

$ 1,945.17

L0640

$ 1,682.44

$ 1,682.44

L0641

$ 75.57

$ 102.72

L0642

$ 398.54

$ 541.77

L0643

$ 157.01

$ 213.44

L0648

$ 995.32

$ 1,352.99

L0649

$ 278.03

$ 377.94

L0650

$ 1,151.64

$ 1,583.20

L0651

$ 1,151.64

$ 1,583.20

L0700

$ 4,151.92

$ 4,151.92

L0710

$ 4,289.11

$ 4,289.11

L0810

$ 5,297.31

$ 5,297.31

L0820

$ 4,175.89

$ 4,175.89

L0830

$ 6,439.89

$ 6,439.89

L0859

$ 1,876.39

$ 1,876.39

L0861

$ 346.53

$ 346.53

L0970

$ 234.72

$ 234.72

L0972

$ 211.36

$ 211.36

L0974

$ 355.39

$ 355.39

L0976

$ 250.89

$ 250.89

L0978

$ 395.32

$ 395.32

L0980

$ 26.89

$ 26.89

L0982

$ 26.67

$ 26.67

L0984

$ 105.32

$ 105.32

L1000

$ 4,169.42

$ 4,169.42

L1005

$ 5,145.98

$ 5,145.98

L1010

$ 117.00

$ 117.00

L1020

$ 177.51

$ 177.51

L1025

$ 239.13

$ 239.13

L1030

$ 102.63

$ 102.63

L1040

$ 160.22

$ 160.22

L1050

$ 171.00

$ 171.00

L1060

$ 196.41

$ 196.41

L1070

$ 184.80

$ 184.80

L1080

$ 98.29

$ 98.29

L1085

$ 316.12

$ 316.12

L1090

$ 188.24

$ 188.24

L1100

$ 326.59

$ 326.59

L1110

$ 524.51

$ 524.51

L1120

$ 81.56

$ 81.56

L1200

$ 3,217.75

$ 3,217.75

L1210

$ 537.36

$ 537.36

L1220

$ 454.99

$ 454.99

L1230

$ 914.23

$ 914.23

L1240

$ 159.46

$ 159.46

L1250

$ 126.49

$ 126.49

L1260

$ 138.31

$ 138.31

L1270

$ 159.12

$ 159.12

L1280

$ 177.17

$ 177.17

L1290

$ 161.42

$ 161.42

L1300

$ 3,430.53

$ 3,430.53

L1310

$ 3,223.79

$ 3,223.79

L1600

$ 252.21

$ 252.21

L1610

$ 90.16

$ 90.16

L1620

$ 255.88

$ 255.88

L1630

$ 283.93

$ 283.93

L1640

$ 710.72

$ 710.72

L1650

$ 416.11

$ 416.11

L1652

$ 573.10

$ 573.10

L1660

$ 263.59

$ 263.59

L1680

$ 2,502.25

$ 2,502.25

L1681

$ 3,746.71

$ 3,746.71

L1685

$ 2,442.82

$ 2,442.82

L1686

$ 1,873.35

$ 1,873.35

L1690

$ 3,109.06

$ 3,109.06

L1700

$ 3,136.20

$ 3,136.20

L1710

$ 3,671.26

$ 3,671.26

L1720

$ 2,706.16

$ 2,706.16

L1730

$ 2,324.32

$ 2,324.32

L1755

$ 3,234.90

$ 3,234.90

L1810

$ 200.10

$ 200.10

L1812

$ 92.81

$ 156.77

L1820

$ 243.66

$ 243.66

L1830

$ 83.62

$ 140.94

L1831

$ 473.21

$ 473.21

L1832

$ 1,118.19

$ 1,118.19

L1833

$ 602.41

$ 927.22

L1834

$ 1,506.76

$ 1,506.76

L1836

$ 118.24

$ 179.54

L1840

$ 1,888.32

$ 1,888.32

L1843

$ 1,442.60

$ 1,442.60

L1844

$ 3,265.49

$ 3,265.49

L1845

$ 1,258.94

$ 1,258.94

L1846

$ 2,294.22

$ 2,294.22

L1847

$ 924.76

$ 924.76

L1848

$ 924.76

$ 924.76

L1850

$ 272.34

$ 462.00

L1851

$ 795.12

$ 1,207.22

L1852

$ 758.53

$ 1,093.01

L1860

$ 2,203.71

$ 2,203.71

L1900

$ 470.01

$ 470.01

L1902

$ 140.88

$ 140.88

L1904

$ 965.72

$ 965.72

L1906

$ 246.97

$ 246.97

L1907

$ 904.69

$ 904.69

L1910

$ 549.19

$ 549.19

L1920

$ 561.51

$ 561.51

L1930

$ 485.81

$ 485.81

L1932

$ 1,434.72

$ 1,434.72

L1940

$ 1,015.64

$ 1,015.64

L1945

$ 1,901.07

$ 1,901.07

L1950

$ 1,529.68

$ 1,529.68

L1951

$ 1,350.26

$ 1,350.26

L1960

$ 1,138.34

$ 1,138.34

L1970

$ 1,190.29

$ 1,190.29

L1971

$ 753.61

$ 753.61

L1980

$ 753.70

$ 753.70

L1990

$ 915.43

$ 915.43

L2000

$ 2,083.03

$ 2,083.03

L2005

$ 6,588.25

$ 6,588.25

L2006

$ 53,532.25

$ 53,532.25

L2010

$ 1,898.88

$ 1,898.88

L2020

$ 2,397.98

$ 2,397.98

L2030

$ 2,080.46

$ 2,080.46

L2034

$ 3,221.15

$ 3,221.15

L2035

$ 278.50

$ 278.50

L2036

$ 3,416.74

$ 3,416.74

L2037

$ 3,420.61

$ 3,420.61

L2038

$ 2,513.63

$ 2,513.63

L2040

$ 273.48

$ 273.48

L2050

$ 978.29

$ 978.29

L2060

$ 1,192.35

$ 1,192.35

L2070

$ 228.34

$ 228.34

L2080

$ 738.67

$ 738.67

L2090

$ 900.52

$ 900.52

L2106

$ 1,396.33

$ 1,396.33

L2108

$ 2,029.30

$ 2,029.30

L2112

$ 884.06

$ 884.06

L2114

$ 1,192.03

$ 1,192.03

L2116

$ 1,462.01

$ 1,462.01

L2126

$ 2,110.11

$ 2,110.11

L2128

$ 3,314.47

$ 3,314.47

L2132

$ 1,280.51

$ 1,280.51

L2134

$ 1,986.28

$ 1,986.28

L2136

$ 2,428.68

$ 2,428.68

L2180

$ 240.51

$ 240.51

L2182

$ 164.64

$ 164.64

L2184

$ 190.81

$ 190.81

L2186

$ 231.88

$ 231.88

L2188

$ 461.29

$ 461.29

L2190

$ 134.51

$ 134.51

L2192

$ 732.26

$ 732.26

L2200

$ 97.64

$ 97.64

L2210

$ 138.04

$ 138.04

L2220

$ 168.18

$ 168.18

L2230

$ 157.57

$ 157.57

L2232

$ 160.02

$ 160.02

L2240

$ 171.77

$ 171.77

L2250

$ 729.72

$ 729.72

L2260

$ 411.68

$ 411.68

L2265

$ 241.86

$ 241.86

L2270

$ 110.29

$ 110.29

L2275

$ 240.90

$ 240.90

L2280

$ 929.92

$ 929.92

L2300

$ 552.94

$ 552.94

L2310

$ 252.64

$ 252.64

L2320

$ 422.55

$ 422.55

L2330

$ 806.40

$ 806.40

L2335

$ 466.54

$ 466.54

L2340

$ 917.85

$ 917.85

L2350

$ 1,829.94

$ 1,829.94

L2360

$ 105.11

$ 105.11

L2370

$ 527.18

$ 527.18

L2375

$ 232.05

$ 232.05

L2380

$ 252.84

$ 252.84

L2385

$ 275.07

$ 275.07

L2387

$ 339.86

$ 339.86

L2390

$ 224.81

$ 224.81

L2395

$ 294.50

$ 294.50

L2397

$ 203.55

$ 203.55

L2405

$ 140.17

$ 140.17

L2415

$ 195.27

$ 195.27

L2425

$ 230.45

$ 230.45

L2430

$ 230.45

$ 230.45

L2492

$ 182.11

$ 182.11

L2500

$ 647.89

$ 647.89

L2510

$ 1,491.74

$ 1,491.74

L2520

$ 946.09

$ 946.09

L2525

$ 2,336.92

$ 2,336.92

L2526

$ 1,304.42

$ 1,304.42

L2530

$ 482.52

$ 482.52

L2540

$ 868.27

$ 868.27

L2550

$ 589.83

$ 589.83

L2570

$ 978.18

$ 978.18

L2580

$ 953.13

$ 953.13

L2600

$ 421.79

$ 421.79

L2610

$ 498.75

$ 498.75

L2620

$ 549.11

$ 549.11

L2622

$ 629.78

$ 629.78

L2624

$ 680.06

$ 680.06

L2627

$ 2,640.47

$ 2,640.47

L2628

$ 2,580.54

$ 2,580.54

L2630

$ 508.54

$ 508.54

L2640

$ 690.14

$ 690.14

L2650

$ 205.95

$ 205.95

L2660

$ 382.76

$ 382.76

L2670

$ 314.09

$ 314.09

L2680

$ 291.58

$ 291.58

L2750

$ 128.73

$ 128.73

L2755

$ 210.11

$ 210.11

L2760

$ 124.78

$ 124.78

L2768

$ 209.45

$ 209.45

L2780

$ 138.99

$ 138.99

L2785

$ 65.09

$ 65.09

L2795

$ 174.51

$ 174.51

L2800

$ 219.06

$ 219.06

L2810

$ 160.40

$ 160.40

L2820

$ 178.35

$ 178.35

L2830

$ 192.93

$ 192.93

L2840

$ 67.30

$ 67.30

L2850

$ 115.29

$ 115.29

L2861

$ 631.57

$ 631.57

L3000

$ 505.05

$ 505.05

L3001

$ 212.66

$ 212.66

L3002

$ 259.67

$ 259.67

L3003

$ 280.20

$ 280.20

L3010

$ 280.20

$ 280.20

L3020

$ 318.96

$ 318.96

L3030

$ 122.71

$ 122.71

L3031

$ 196.92

$ 196.92

L3040

$ 75.66

$ 75.66

L3050

$ 75.66

$ 75.66

L3060

$ 118.57

$ 118.57

L3070

$ 51.07

$ 51.07

L3080

$ 51.07

$ 51.07

L3090

$ 65.45

$ 65.45

L3100

$ 69.51

$ 69.51

L3140

$ 143.16

$ 143.16

L3150

$ 130.87

$ 130.87

L3160

$ 177.73

$ 177.73

L3170

$ 81.82

$ 81.82

L3201

$ 66.37

$ 66.37

L3202

$ 75.81

$ 75.81

L3203

$ 72.25

$ 72.25

L3204

$ 73.46

$ 73.46

L3206

$ 75.81

$ 75.81

L3207

$ 65.18

$ 65.18

L3209

$ 45.02

$ 45.02

L3211

$ 45.02

$ 45.02

L3213

$ 122.04

$ 122.04

L3215

$ 97.19

$ 97.19

L3216

$ 119.29

$ 119.29

L3217

$ 165.83

$ 165.83

L3219

$ 184.83

$ 184.83

L3221

$ 142.14

$ 142.14

L3222

$ 195.58

$ 195.58

L3224

$ 120.76

$ 120.76

L3225

$ 138.92

$ 138.92

L3230

$ 522.31

$ 522.31

L3250

$ 484.86

$ 484.86

L3252

$ 355.53

$ 355.53

L3253

$ 118.45

$ 118.45

L3254

$ 35.55

$ 35.55

L3255

$ 35.55

$ 35.55

L3257

$ 71.08

$ 71.08

L3260

$ 47.42

$ 47.42

L3265

$ 35.55

$ 35.55

L3300

$ 83.83

$ 83.83

L3310

$ 130.87

$ 130.87

L3320

$ 171.82

$ 171.82

L3330

$ 909.93

$ 909.93

L3332

$ 118.57

$ 118.57

L3334

$ 61.36

$ 61.36

L3340

$ 137.06

$ 137.06

L3350

$ 36.83

$ 36.83

L3360

$ 57.26

$ 57.26

L3370

$ 79.69

$ 79.69

L3380

$ 79.69

$ 79.69

L3390

$ 79.69

$ 79.69

L3400

$ 65.45

$ 65.45

L3410

$ 149.25

$ 149.25

L3420

$ 87.95

$ 87.95

L3430

$ 257.64

$ 257.64

L3440

$ 122.71

$ 122.71

L3450

$ 169.75

$ 169.75

L3455

$ 65.45

$ 65.45

L3460

$ 55.16

$ 55.16

L3465

$ 94.04

$ 94.04

L3470

$ 100.17

$ 100.17

L3480

$ 100.17

$ 100.17

L3485

$ 42.66

$ 42.66

L3500

$ 47.03

$ 47.03

L3510

$ 47.03

$ 47.03

L3520

$ 51.07

$ 51.07

L3530

$ 51.07

$ 51.07

L3540

$ 81.82

$ 81.82

L3550

$ 14.28

$ 14.28

L3560

$ 36.83

$ 36.83

L3570

$ 137.06

$ 137.06

L3580

$ 104.29

$ 104.29

L3590

$ 85.88

$ 85.88

L3595

$ 67.45

$ 67.45

L3600

$ 122.71

$ 122.71

L3610

$ 161.53

$ 161.53

L3620

$ 122.71

$ 122.71

L3630

$ 161.53

$ 161.53

L3640

$ 69.51

$ 69.51

L3650

$ 119.18

$ 119.18

L3660

$ 183.34

$ 183.34

L3670

$ 227.25

$ 227.25

L3671

$ 1,318.51

$ 1,318.51

L3674

$ 1,729.59

$ 1,729.59

L3675

$ 256.79

$ 256.79

L3677

$ 108.07

$ 108.07

L3678

$ 118.47

$ 118.47

L3702

$ 422.51

$ 422.51

L3710

$ 208.61

$ 208.61

L3720

$ 1,314.45

$ 1,314.45

L3730

$ 1,811.59

$ 1,811.59

L3740

$ 2,147.78

$ 2,147.78

L3760

$ 731.72

$ 731.72

L3761

$ 731.72

$ 731.72

L3762

$ 157.33

$ 157.33

L3763

$ 1,233.99

$ 1,233.99

L3764

$ 1,419.04

$ 1,419.04

L3765

$ 1,876.21

$ 1,876.21

L3766

$ 1,986.77

$ 1,986.77

L3806

$ 664.69

$ 664.69

L3807

$ 365.89

$ 365.89

L3808

$ 665.48

$ 665.48

L3809

$ 365.89

$ 365.89

L3891

$ 266.60

$ 266.60

L3900

$ 2,387.76

$ 2,387.76

L3901

$ 2,939.09

$ 2,939.09

L3904

$ 5,885.08

$ 5,885.08

L3905

$ 1,451.11

$ 1,451.11

L3906

$ 794.08

$ 794.08

L3908

$ 120.40

$ 120.40

L3912

$ 190.58

$ 190.58

L3913

$ 396.30

$ 396.30

L3915

$ 777.80

$ 777.80

L3916

$ 777.80

$ 777.80

L3917

$ 154.64

$ 154.64

L3918

$ 154.64

$ 154.64

L3919

$ 396.30

$ 396.30

L3921

$ 470.01

$ 470.01

L3923

$ 131.11

$ 131.11

L3924

$ 131.11

$ 131.11

L3925

$ 96.14

$ 96.14

L3927

$ 51.16

$ 51.16

L3929

$ 157.09

$ 157.09

L3930

$ 157.09

$ 157.09

L3931

$ 350.83

$ 350.83

L3933

$ 312.16

$ 312.16

L3935

$ 323.23

$ 323.23

L3956

$ 126.67

$ 126.67

L3960

$ 1,476.93

$ 1,476.93

L3961

$ 2,458.39

$ 2,458.39

L3962

$ 1,441.90

$ 1,441.90

L3967

$ 2,902.54

$ 2,902.54

L3971

$ 2,755.20

$ 2,755.20

L3973

$ 2,902.54

$ 2,902.54

L3975

$ 2,458.39

$ 2,458.39

L3976

$ 2,458.39

$ 2,458.39

L3977

$ 2,755.20

$ 2,755.20

L3978

$ 2,902.54

$ 2,902.54

L3980

$ 621.28

$ 621.28

L3981

$ 1,472.84

$ 1,472.84

L3982

$ 750.22

$ 750.22

L3984

$ 691.70

$ 691.70

L3995

$ 57.44

$ 57.44

L4000

$ 2,618.53

$ 2,618.53

L4002

$ 35.55

$ 35.55

L4010

$ 1,378.26

$ 1,378.26

L4020

$ 1,768.90

$ 1,768.90

L4030

$ 1,036.87

$ 1,036.87

L4040

$ 838.31

$ 838.31

L4045

$ 673.67

$ 673.67

L4050

$ 847.84

$ 847.84

L4055

$ 549.01

$ 549.01

L4060

$ 652.67

$ 652.67

L4070

$ 577.95

$ 577.95

L4080

$ 178.01

$ 178.01

L4090

$ 169.54

$ 169.54

L4100

$ 214.21

$ 214.21

L4110

$ 174.16

$ 174.16

L4130

$ 1,018.89

$ 1,018.89

L4205

$ 48.86

$ 48.86

L4210

$ 177.76

$ 177.76

L4350

$ 183.57

$ 183.57

L4360

$ 497.59

$ 497.59

L4361

$ 497.59

$ 497.59

L4370

$ 290.78

$ 290.78

L4386

$ 254.88

$ 254.88

L4387

$ 254.88

$ 254.88

L4392

$ 37.20

$ 37.20

L4394

$ 27.10

$ 27.10

L4396

$ 265.26

$ 265.26

L4397

$ 265.26

$ 265.26

L4398

$ 122.15

$ 122.15

L4631

$ 3,026.00

$ 3,026.00

L5000

$ 986.16

$ 986.16

L5010

$ 2,213.93

$ 2,213.93

L5020

$ 4,335.95

$ 4,335.95

L5050

$ 4,369.27

$ 4,369.27

L5060

$ 6,043.11

$ 6,043.11

L5100

$ 4,411.65

$ 4,411.65

L5105

$ 7,600.80

$ 7,600.80

L5150

$ 7,683.37

$ 7,683.37

L5160

$ 8,357.05

$ 8,357.05

L5200

$ 6,585.40

$ 6,585.40

L5210

$ 4,858.84

$ 4,858.84

L5220

$ 6,034.88

$ 6,034.88

L5230

$ 8,323.29

$ 8,323.29

L5250

$ 11,352.24

$ 11,352.24

L5270

$ 11,252.79

$ 11,252.79

L5280

$ 11,140.28

$ 11,140.28

L5301

$ 5,002.09

$ 5,002.09

L5312

$ 6,465.93

$ 6,465.93

L5321

$ 7,191.11

$ 7,191.11

L5331

$ 9,556.40

$ 9,556.40

L5341

$ 11,057.77

$ 11,057.77

L5400

$ 2,603.89

$ 2,603.89

L5410

$ 685.61

$ 685.61

L5420

$ 3,325.71

$ 3,325.71

L5430

$ 926.93

$ 926.93

L5450

$ 668.53

$ 668.53

L5460

$ 894.80

$ 894.80

L5500

$ 2,798.47

$ 2,798.47

L5505

$ 3,805.52

$ 3,805.52

L5510

$ 2,886.77

$ 2,886.77

L5520

$ 3,144.46

$ 3,144.46

L5530

$ 3,779.09

$ 3,779.09

L5535

$ 3,710.32

$ 3,710.32

L5540

$ 3,957.46

$ 3,957.46

L5560

$ 3,857.67

$ 3,857.67

L5570

$ 4,229.30

$ 4,229.30

L5580

$ 5,133.31

$ 5,133.31

L5585

$ 4,546.15

$ 4,546.15

L5590

$ 5,259.66

$ 5,259.66

L5595

$ 8,809.74

$ 8,809.74

L5600

$ 9,728.60

$ 9,728.60

L5610

$ 4,021.14

$ 4,021.14

L5611

$ 3,252.00

$ 3,252.00

L5613

$ 5,361.99

$ 5,361.99

L5614

$ 2,718.37

$ 2,718.37

L5615

$ 11,756.18

$ 11,756.18

L5616

$ 2,315.78

$ 2,315.78

L5617

$ 901.31

$ 901.31

L5618

$ 473.86

$ 473.86

L5620

$ 479.95

$ 479.95

L5622

$ 622.06

$ 622.06

L5624

$ 682.29

$ 682.29

L5626

$ 896.38

$ 896.38

L5628

$ 793.23

$ 793.23

L5629

$ 521.49

$ 521.49

L5630

$ 904.12

$ 904.12

L5631

$ 721.00

$ 721.00

L5632

$ 387.79

$ 387.79

L5634

$ 665.55

$ 665.55

L5636

$ 418.11

$ 418.11

L5637

$ 629.61

$ 629.61

L5638

$ 1,064.78

$ 1,064.78

L5639

$ 2,453.07

$ 2,453.07

L5640

$ 1,273.19

$ 1,273.19

L5642

$ 1,016.68

$ 1,016.68

L5643

$ 2,554.05

$ 2,554.05

L5644

$ 969.22

$ 969.22

L5645

$ 1,482.08

$ 1,482.08

L5646

$ 899.09

$ 899.09

L5647

$ 1,740.42

$ 1,740.42

L5648

$ 1,080.37

$ 1,080.37

L5649

$ 3,144.60

$ 3,144.60

L5650

$ 1,068.12

$ 1,068.12

L5651

$ 1,970.65

$ 1,970.65

L5652

$ 715.43

$ 715.43

L5653

$ 1,069.05

$ 1,069.05

L5654

$ 668.63

$ 668.63

L5655

$ 580.33

$ 580.33

L5656

$ 811.61

$ 811.61

L5658

$ 617.68

$ 617.68

L5661

$ 1,234.31

$ 1,234.31

L5665

$ 1,120.28

$ 1,120.28

L5666

$ 153.15

$ 153.15

L5668

$ 220.95

$ 220.95

L5670

$ 593.70

$ 593.70

L5671

$ 1,088.32

$ 1,088.32

L5672

$ 517.26

$ 517.26

L5673

$ 1,285.82

$ 1,285.82

L5676

$ 792.85

$ 792.85

L5677

$ 1,078.77

$ 1,078.77

L5678

$ 86.87

$ 86.87

L5679

$ 1,071.49

$ 1,071.49

L5680

$ 523.29

$ 523.29

L5681

$ 2,119.00

$ 2,119.00

L5682

$ 1,368.30

$ 1,368.30

L5683

$ 2,119.00

$ 2,119.00

L5684

$ 105.31

$ 105.31

L5685

$ 206.33

$ 206.33

L5686

$ 101.85

$ 101.85

L5688

$ 133.66

$ 133.66

L5690

$ 214.10

$ 214.10

L5692

$ 290.72

$ 290.72

L5694

$ 396.93

$ 396.93

L5695

$ 356.80

$ 356.80

L5696

$ 404.81

$ 404.81

L5697

$ 175.64

$ 175.64

L5698

$ 225.11

$ 225.11

L5699

$ 407.95

$ 407.95

L5700

$ 5,991.78

$ 5,991.78

L5701

$ 7,439.28

$ 7,439.28

L5702

$ 9,505.83

$ 9,505.83

L5703

$ 3,950.09

$ 3,950.09

L5704

$ 1,000.65

$ 1,000.65

L5705

$ 1,642.80

$ 1,642.80

L5706

$ 1,628.20

$ 1,628.20

L5707

$ 2,314.61

$ 2,314.61

L5710

$ 786.91

$ 786.91

L5711

$ 1,142.46

$ 1,142.46

L5712

$ 942.77

$ 942.77

L5714

$ 819.35

$ 819.35

L5716

$ 1,594.64

$ 1,594.64

L5718

$ 1,993.15

$ 1,993.15

L5722

$ 1,780.51

$ 1,780.51

L5724

$ 3,164.74

$ 3,164.74

L5726

$ 3,236.38

$ 3,236.38

L5728

$ 5,206.21

$ 5,206.21

L5780

$ 2,504.99

$ 2,504.99

L5781

$ 6,445.57

$ 6,445.57

L5782

$ 6,795.08

$ 6,795.08

L5785

$ 901.36

$ 901.36

L5790

$ 1,451.25

$ 1,451.25

L5795

$ 1,831.24

$ 1,831.24

L5810

$ 1,065.22

$ 1,065.22

L5811

$ 1,595.71

$ 1,595.71

L5812

$ 1,236.84

$ 1,236.84

L5814

$ 5,982.77

$ 5,982.77

L5816

$ 1,860.73

$ 1,860.73

L5818

$ 2,101.13

$ 2,101.13

L5822

$ 2,794.39

$ 2,794.39

L5824

$ 3,355.34

$ 3,355.34

L5826

$ 5,030.76

$ 5,030.76

L5828

$ 6,002.70

$ 6,002.70

L5830

$ 4,151.69

$ 4,151.69

L5840

$ 6,623.20

$ 6,623.20

L5845

$ 2,887.37

$ 2,887.37

L5848

$ 1,732.28

$ 1,732.28

L5850

$ 209.92

$ 209.92

L5855

$ 675.71

$ 675.71

L5856

$ 38,671.61

$ 38,671.61

L5857

$ 13,722.20

$ 13,722.20

L5858

$ 29,939.35

$ 29,939.35

L5859

$ 23,373.41

$ 23,373.41

L5910

$ 594.31

$ 594.31

L5920

$ 870.69

$ 870.69

L5925

$ 715.68

$ 715.68

L5926

$ 1,246.41

$ 1,246.41

L5930

$ 5,422.26

$ 5,422.26

L5940

$ 874.85

$ 874.85

L5950

$ 1,276.67

$ 1,276.67

L5960

$ 1,581.94

$ 1,581.94

L5961

$ 8,418.26

$ 8,418.26

L5962

$ 1,286.04

$ 1,286.04

L5964

$ 1,851.37

$ 1,851.37

L5966

$ 2,400.23

$ 2,400.23

L5968

$ 5,853.99

$ 5,853.99

L5970

$ 419.27

$ 419.27

L5971

$ 419.27

$ 419.27

L5972

$ 771.09

$ 771.09

L5973

$ 28,319.09

$ 28,319.09

L5974

$ 509.85

$ 509.85

L5975

$ 746.80

$ 746.80

L5976

$ 1,225.31

$ 1,225.31

L5978

$ 638.50

$ 638.50

L5979

$ 4,946.26

$ 4,946.26

L5980

$ 6,925.35

$ 6,925.35

L5981

$ 5,375.19

$ 5,375.19

L5982

$ 1,264.87

$ 1,264.87

L5984

$ 1,246.41

$ 1,246.41

L5985

$ 454.92

$ 454.92

L5986

$ 1,386.46

$ 1,386.46

L5987

$ 11,588.57

$ 11,588.57

L5988

$ 3,218.17

$ 3,218.17

L5990

$ 2,922.58

$ 2,922.58

L5991

$ 15,756.22

$ 15,756.22

L6000

$ 2,907.10

$ 2,907.10

L6010

$ 3,235.13

$ 3,235.13

L6020

$ 3,016.23

$ 3,016.23

L6026

$ 7,604.97

$ 7,604.97

L6050

$ 4,143.06

$ 4,143.06

L6055

$ 5,313.34

$ 5,313.34

L6100

$ 3,447.78

$ 3,447.78

L6110

$ 4,465.09

$ 4,465.09

L6120

$ 5,070.03

$ 5,070.03

L6130

$ 5,663.95

$ 5,663.95

L6200

$ 5,968.89

$ 5,968.89

L6205

$ 7,286.26

$ 7,286.26

L6250

$ 5,875.38

$ 5,875.38

L6300

$ 8,151.46

$ 8,151.46

L6310

$ 6,639.54

$ 6,639.54

L6320

$ 3,739.05

$ 3,739.05

L6350

$ 8,505.39

$ 8,505.39

L6360

$ 6,968.99

$ 6,968.99

L6370

$ 4,443.88

$ 4,443.88

L6380

$ 2,122.62

$ 2,122.62

L6382

$ 2,670.33

$ 2,670.33

L6384

$ 3,462.62

$ 3,462.62

L6386

$ 878.64

$ 878.64

L6388

$ 897.06

$ 897.06

L6400

$ 5,076.89

$ 5,076.89

L6450

$ 6,188.50

$ 6,188.50

L6500

$ 5,625.90

$ 5,625.90

L6550

$ 8,343.16

$ 8,343.16

L6570

$ 9,576.35

$ 9,576.35

L6580

$ 2,932.61

$ 2,932.61

L6582

$ 2,258.47

$ 2,258.47

L6584

$ 3,666.59

$ 3,666.59

L6586

$ 3,118.96

$ 3,118.96

L6588

$ 5,306.25

$ 5,306.25

L6590

$ 4,661.96

$ 4,661.96

L6600

$ 410.41

$ 410.41

L6605

$ 405.23

$ 405.23

L6610

$ 364.27

$ 364.27

L6611

$ 663.29

$ 663.29

L6615

$ 300.62

$ 300.62

L6616

$ 106.44

$ 106.44

L6620

$ 627.06

$ 627.06

L6621

$ 3,684.67

$ 3,684.67

L6623

$ 1,052.62

$ 1,052.62

L6624

$ 6,066.93

$ 6,066.93

L6625

$ 1,163.65

$ 1,163.65

L6628

$ 786.10

$ 786.10

L6629

$ 287.32

$ 287.32

L6630

$ 353.65

$ 353.65

L6632

$ 106.61

$ 106.61

L6635

$ 385.38

$ 385.38

L6637

$ 703.67

$ 703.67

L6638

$ 4,028.50

$ 4,028.50

L6640

$ 459.65

$ 459.65

L6641

$ 329.67

$ 329.67

L6642

$ 427.52

$ 427.52

L6645

$ 698.46

$ 698.46

L6646

$ 5,080.85

$ 5,080.85

L6647

$ 836.44

$ 836.44

L6648

$ 5,240.16

$ 5,240.16

L6650

$ 740.59

$ 740.59

L6655

$ 164.36

$ 164.36

L6660

$ 200.83

$ 200.83

L6665

$ 81.37

$ 81.37

L6670

$ 104.93

$ 104.93

L6672

$ 368.91

$ 368.91

L6675

$ 250.47

$ 250.47

L6676

$ 265.34

$ 265.34

L6677

$ 477.88

$ 477.88

L6680

$ 507.61

$ 507.61

L6682

$ 505.44

$ 505.44

L6684

$ 762.65

$ 762.65

L6686

$ 1,291.68

$ 1,291.68

L6687

$ 957.33

$ 957.33

L6688

$ 1,037.09

$ 1,037.09

L6689

$ 1,182.66

$ 1,182.66

L6690

$ 1,370.00

$ 1,370.00

L6691

$ 753.79

$ 753.79

L6692

$ 1,223.56

$ 1,223.56

L6693

$ 4,573.42

$ 4,573.42

L6694

$ 1,285.82

$ 1,285.82

L6695

$ 1,071.49

$ 1,071.49

L6696

$ 2,119.00

$ 2,119.00

L6697

$ 2,119.00

$ 2,119.00

L6698

$ 1,088.32

$ 1,088.32

L6703

$ 589.76

$ 589.76

L6704

$ 1,281.34

$ 1,281.34

L6706

$ 708.19

$ 708.19

L6707

$ 2,704.14

$ 2,704.14

L6708

$ 1,830.14

$ 1,830.14

L6709

$ 2,650.77

$ 2,650.77

L6711

$ 1,083.05

$ 1,083.05

L6712

$ 1,994.08

$ 1,994.08

L6713

$ 2,516.79

$ 2,516.79

L6714

$ 2,131.71

$ 2,131.71

L6715

$ 5,085.89

$ 5,085.89

L6721

$ 3,788.81

$ 3,788.81

L6722

$ 3,266.26

$ 3,266.26

L6805

$ 694.85

$ 694.85

L6810

$ 357.18

$ 357.18

L6880

$ 38,489.01

$ 38,489.01

L6881

$ 6,585.87

$ 6,585.87

L6882

$ 4,995.69

$ 4,995.69

L6883

$ 2,820.82

$ 2,820.82

L6884

$ 4,884.61

$ 4,884.61

L6885

$ 6,968.99

$ 6,968.99

L6890

$ 372.15

$ 372.15

L6895

$ 916.30

$ 916.30

L6900

$ 3,291.95

$ 3,291.95

L6905

$ 3,212.36

$ 3,212.36

L6910

$ 3,129.49

$ 3,129.49

L6915

$ 1,324.90

$ 1,324.90

L6920

$ 12,234.39

$ 12,234.39

L6925

$ 13,962.90

$ 13,962.90

L6930

$ 11,387.11

$ 11,387.11

L6935

$ 13,225.42

$ 13,225.42

L6940

$ 14,412.69

$ 14,412.69

L6945

$ 16,749.59

$ 16,749.59

L6950

$ 16,364.57

$ 16,364.57

L6955

$ 19,598.80

$ 19,598.80

L6960

$ 20,969.21

$ 20,969.21

L6965

$ 24,346.88

$ 24,346.88

L6970

$ 25,785.21

$ 25,785.21

L6975

$ 30,489.97

$ 30,489.97

L7007

$ 5,646.63

$ 5,646.63

L7008

$ 9,492.59

$ 9,492.59

L7009

$ 5,761.35

$ 5,761.35

L7040

$ 4,626.15

$ 4,626.15

L7045

$ 2,652.33

$ 2,652.33

L7170

$ 9,621.77

$ 9,621.77

L7180

$ 59,455.03

$ 59,455.03

L7181

$ 64,546.66

$ 64,546.66

L7185

$ 9,823.98

$ 9,823.98

L7186

$ 14,515.17

$ 14,515.17

L7190

$ 12,868.02

$ 12,868.02

L7191

$ 15,167.49

$ 15,167.49

L7259

$ 6,620.43

$ 6,620.43

L7360

$ 398.61

$ 398.61

L7362

$ 423.67

$ 423.67

L7364

$ 779.44

$ 779.44

L7366

$ 1,007.05

$ 1,007.05

L7367

$ 627.17

$ 627.17

L7368

$ 813.02

$ 813.02

L7400

$ 493.74

$ 493.74

L7401

$ 552.75

$ 552.75

L7402

$ 596.92

$ 596.92

L7403

$ 593.22

$ 593.22

L7404

$ 895.40

$ 895.40

L7405

$ 1,171.03

$ 1,171.03

L7510

$ 135.06

$ 135.06

L7520

$ 71.11

$ 71.11

L7600

$ 137.45

$ 137.45

L7700

$ 201.78

$ 201.78

L7900

$ 733.52

$ 733.52

L7902

$ 50.83

$ 50.83

L8000

$ 79.88

$ 79.88

L8001

$ 202.09

$ 202.09

L8002

$ 265.75

$ 265.75

L8010

$ 105.50

$ 105.50

L8015

$ 96.57

$ 96.57

L8020

$ 343.01

$ 343.01

L8030

$ 626.70

$ 626.70

L8031

$ 626.70

$ 626.70

L8032

$ 63.11

$ 63.11

L8035

$ 5,901.85

$ 5,901.85

L8040

$ 4,219.75

$ 4,219.75

L8041

$ 5,086.48

$ 5,086.48

L8042

$ 5,715.15

$ 5,715.15

L8043

$ 6,400.98

$ 6,400.98

L8044

$ 7,086.79

$ 7,086.79

L8045

$ 4,454.17

$ 4,454.17

L8046

$ 4,572.15

$ 4,572.15

L8047

$ 2,343.14

$ 2,343.14

L8300

$ 184.56

$ 184.56

L8310

$ 291.40

$ 291.40

L8320

$ 116.94

$ 116.94

L8330

$ 108.01

$ 108.01

L8400

$ 34.44

$ 34.44

L8410

$ 44.42

$ 44.42

L8415

$ 39.30

$ 39.30

L8417

$ 121.16

$ 121.16

L8420

$ 42.55

$ 42.55

L8430

$ 45.70

$ 45.70

L8435

$ 42.38

$ 42.38

L8440

$ 91.49

$ 91.49

L8460

$ 145.82

$ 145.82

L8465

$ 80.04

$ 80.04

L8470

$ 14.60

$ 14.60

L8480

$ 17.43

$ 17.43

L8485

$ 23.62

$ 23.62

L8500

$ 1,082.96

$ 1,082.96

L8501

$ 198.23

$ 198.23

L8505

$ 117.43

$ 117.43

L8507

$ 67.47

$ 67.47

L8509

$ 175.91

$ 175.91

L8510

$ 407.06

$ 407.06

L8511

$ 117.17

$ 117.17

L8512

$ 3.47

$ 3.47

L8513

$ 8.37

$ 8.37

L8514

$ 151.89

$ 151.89

L8515

$ 101.65

$ 101.65

L8600

$ 1,116.82

$ 1,116.82

L8603

$ 719.52

$ 719.52

L8605

$ 1,153.80

$ 1,153.80

L8606

$ 373.62

$ 373.62

L8607

$ 69.08

$ 69.08

L8609

$ 10,495.90

$ 10,495.90

L8610

$ 960.48

$ 960.48

L8612

$ 1,305.47

$ 1,305.47

L8613

$ 484.60

$ 484.60

L8614

$ 32,368.91

$ 32,368.91

L8615

$ 726.54

$ 726.54

L8616

$ 169.23

$ 169.23

L8617

$ 147.81

$ 147.81

L8618

$ 42.22

$ 42.22

L8619

$ 13,895.76

$ 13,895.76

L8621

$ 1.01

$ 1.01

L8622

$ 0.52

$ 0.52

L8623

$ 104.22

$ 104.22

L8624

$ 259.80

$ 259.80

L8625

$ 304.22

$ 304.22

L8627

$ 11,803.22

$ 11,803.22

L8628

$ 2,092.55

$ 2,092.55

L8629

$ 288.43

$ 288.43

L8630

$ 552.85

$ 552.85

L8631

$ 3,672.10

$ 3,672.10

L8641

$ 580.97

$ 580.97

L8642

$ 568.41

$ 568.41

L8658

$ 500.82

$ 500.82

L8659

$ 3,108.57

$ 3,108.57

L8670

$ 913.46

$ 913.46

L8678

$ 17.00

$ 36.36

L8679

$ 14,114.11

$ 14,114.11

L8680

$ 858.84

$ 858.84

L8681

$ 1,770.26

$ 1,770.26

L8682

$ 10,084.21

$ 10,084.21

L8683

$ 8,876.43

$ 8,876.43

L8684

$ 1,292.45

$ 1,292.45

L8689

$ 2,778.75

$ 2,778.75

L8690

$ 7,663.46

$ 7,663.46

L8691

$ 2,774.23

$ 2,774.23

L8692

$ 7,656.99

$ 7,656.99

L8693

$ 2,442.69

$ 2,442.69

L8694

$ 1,521.31

$ 1,521.31

L8695

$ 26.81

$ 26.81

L8696

$ 349.15

$ 349.15

Q0035

$ 24.30

$ 24.30

Q0081

$ 287.78

$ 287.78

Q0083

BR

BR

Q0091

$ 60.97

$ 60.97

Q0092

$ 35.76

$ 35.76

Q0111

$ 24.86

$ 24.86

Q0112

$ 8.16

$ 8.16

Q0113

$ 5.98

$ 5.98

Q0114

$ 13.64

$ 13.64

Q0115

$ 35.00

$ 35.00

Q0477

$ 1,249.77

$ 1,249.77

Q0478

$ 296.04

$ 296.04

Q0479

$ 19,283.78

$ 19,283.78

Q0480

$ 139,999.87

$ 139,999.87

Q0481

$ 23,408.10

$ 23,408.10

Q0482

$ 7,331.86

$ 7,331.86

Q0483

$ 30,204.02

$ 30,204.02

Q0484

$ 5,865.54

$ 5,865.54

Q0485

$ 566.27

$ 566.27

Q0486

$ 471.34

$ 471.34

Q0487

$ 549.89

$ 549.89

Q0489

$ 26,185.22

$ 26,185.22

Q0490

$ 1,132.66

$ 1,132.66

Q0491

$ 1,780.66

$ 1,780.66

Q0492

$ 143.43

$ 143.43

Q0493

$ 408.51

$ 408.51

Q0494

$ 345.67

$ 345.67

Q0495

$ 6,728.93

$ 6,728.93

Q0496

$ 2,415.13

$ 2,415.13

Q0497

$ 754.15

$ 754.15

Q0498

$ 827.48

$ 827.48

Q0499

$ 268.86

$ 268.86

Q0500

$ 49.21

$ 49.21

Q0501

$ 822.67

$ 822.67

Q0502

$ 1,047.37

$ 1,047.37

Q0503

$ 2,094.81

$ 2,094.81

Q0504

$ 1,105.38

$ 1,105.38

Q0506

$ 1,375.95

$ 1,375.95

Q0507

BR

BR

Q0508

BR

BR

Q0509

BR

BR

Q0510

$ 52.64

$ 52.64

Q0511

$ 25.26

$ 25.26

Q0512

$ 16.70

$ 16.70

Q0513

$ 138.74

$ 138.74

Q0514

$ 69.34

$ 69.34

Q0515

BR

BR

Q0516

BR

BR

Q0517

BR

BR

Q0518

BR

BR

Q1004

BR

BR

Q1005

BR

BR

Q3031

BR

BR

Q4001

$ 83.59

$ 83.59

Q4002

$ 315.85

$ 315.85

Q4003

$ 60.02

$ 60.02

Q4004

$ 207.80

$ 207.80

Q4005

$ 22.13

$ 22.13

Q4006

$ 49.87

$ 49.87

Q4007

$ 11.06

$ 11.06

Q4008

$ 24.92

$ 24.92

Q4009

$ 14.78

$ 14.78

Q4010

$ 33.24

$ 33.24

Q4011

$ 7.36

$ 7.36

Q4012

$ 16.66

$ 16.66

Q4013

$ 26.91

$ 26.91

Q4014

$ 45.36

$ 45.36

Q4015

$ 13.47

$ 13.47

Q4016

$ 22.67

$ 22.67

Q4017

$ 15.54

$ 15.54

Q4018

$ 24.78

$ 24.78

Q4019

$ 7.78

$ 7.78

Q4020

$ 12.45

$ 12.45

Q4021

$ 11.51

$ 11.51

Q4022

$ 20.78

$ 20.78

Q4023

$ 5.78

$ 5.78

Q4024

$ 10.40

$ 10.40

Q4025

$ 64.50

$ 64.50

Q4026

$ 201.49

$ 201.49

Q4027

$ 32.28

$ 32.28

Q4028

$ 100.80

$ 100.80

Q4029

$ 49.35

$ 49.35

Q4030

$ 129.91

$ 129.91

Q4031

$ 24.65

$ 24.65

Q4032

$ 64.96

$ 64.96

Q4033

$ 46.05

$ 46.05

Q4034

$ 114.46

$ 114.46

Q4035

$ 23.02

$ 23.02

Q4036

$ 57.27

$ 57.27

Q4037

$ 28.04

$ 28.04

Q4038

$ 70.34

$ 70.34

Q4039

$ 14.07

$ 14.07

Q4040

$ 35.17

$ 35.17

Q4041

$ 34.15

$ 34.15

Q4042

$ 58.30

$ 58.30

Q4043

$ 17.08

$ 17.08

Q4044

$ 29.19

$ 29.19

Q4045

$ 19.82

$ 19.82

Q4046

$ 31.88

$ 31.88

Q4047

$ 9.87

$ 9.87

Q4048

$ 15.96

$ 15.96

Q4049

$ 3.60

$ 3.60

Q5001

$ 105.39

$ 105.39

Q5002

$ 311.67

$ 311.67

Q5003

$ 1.36

$ 1.36

Q5005

$ 1,126.05

$ 1,126.05

Q5006

$ 1,354.39

$ 1,354.39

Q5007

BR

BR

Q5008

BR

BR

Q5009

BR

BR

Q5010

BR

BR

Q9950

$ 26.47

$ 26.47

Q9951

$ 2.20

$ 2.20

Q9953

$ 157.64

$ 157.64

Q9954

$ 22.08

$ 22.08

Q9955

$ 409.88

$ 409.88

Q9956

$ 59.02

$ 59.02

Q9957

$ 59.02

$ 59.02

Q9958

$ 0.12

$ 0.12

Q9959

$ 2.27

$ 2.27

Q9960

$ 0.91

$ 0.91

Q9961

$ 0.39

$ 0.39

Q9962

$ 0.91

$ 0.91

Q9963

$ 0.29

$ 0.29

Q9964

$ 0.91

$ 0.91

Q9965

$ 1.91

$ 1.91

Q9966

$ 0.52

$ 0.52

Q9967

$ 0.16

$ 0.16

Q9968

$ 50.44

$ 50.44

Q9969

$ 13.52

$ 13.52

S9122

S9123

S9124

S9125

S9126

S9127

S9128

S9129

S9131

V2020

$ 137.19

$ 137.19

V2025

$ 153.17

$ 153.17

V2100

$ 64.29

$ 64.29

V2101

$ 86.17

$ 86.17

V2102

$ 104.51

$ 104.51

V2103

$ 61.38

$ 61.38

V2104

$ 64.93

$ 64.93

V2105

$ 71.20

$ 71.20

V2106

$ 85.19

$ 85.19

V2107

$ 91.70

$ 91.70

V2108

$ 87.18

$ 87.18

V2109

$ 97.99

$ 97.99

V2110

$ 83.93

$ 83.93

V2111

$ 98.92

$ 98.92

V2112

$ 103.84

$ 103.84

V2113

$ 102.96

$ 102.96

V2114

$ 111.54

$ 111.54

V2115

$ 155.41

$ 155.41

V2118

$ 155.13

$ 155.13

V2121

$ 165.65

$ 165.65

V2200

$ 96.07

$ 96.07

V2201

$ 116.90

$ 116.90

V2202

$ 107.90

$ 107.90

V2203

$ 104.51

$ 104.51

V2204

$ 106.06

$ 106.06

V2205

$ 104.71

$ 104.71

V2206

$ 117.66

$ 117.66

V2207

$ 114.23

$ 114.23

V2208

$ 125.83

$ 125.83

V2209

$ 118.08

$ 118.08

V2210

$ 125.93

$ 125.93

V2211

$ 152.94

$ 152.94

V2212

$ 143.57

$ 143.57

V2213

$ 133.73

$ 133.73

V2214

$ 151.24

$ 151.24

V2215

$ 185.99

$ 185.99

V2218

$ 178.53

$ 178.53

V2219

$ 73.07

$ 73.07

V2220

$ 69.05

$ 69.05

V2221

$ 193.26

$ 193.26

V2299

$ 106.76

$ 106.76

V2300

$ 118.83

$ 118.83

V2301

$ 146.31

$ 146.31

V2302

$ 134.57

$ 134.57

V2303

$ 128.20

$ 128.20

V2304

$ 133.00

$ 133.00

V2305

$ 133.41

$ 133.41

V2306

$ 134.48

$ 134.48

V2307

$ 144.07

$ 144.07

V2308

$ 140.50

$ 140.50

V2309

$ 170.13

$ 170.13

V2310

$ 143.70

$ 143.70

V2311

$ 175.91

$ 175.91

V2312

$ 196.06

$ 196.06

V2313

$ 218.96

$ 218.96

V2314

$ 203.24

$ 203.24

V2315

$ 252.15

$ 252.15

V2318

$ 320.94

$ 320.94

V2319

$ 81.49

$ 81.49

V2320

$ 85.97

$ 85.97

V2321

$ 239.22

$ 239.22

V2399

$ 236.95

$ 236.95

V2410

$ 196.18

$ 196.18

V2430

$ 236.43

$ 236.43

V2499

$ 42.73

$ 42.73

V2500

$ 144.28

$ 144.28

V2501

$ 226.95

$ 226.95

V2502

$ 332.05

$ 332.05

V2503

$ 230.51

$ 230.51

V2510

$ 194.00

$ 194.00

V2511

$ 313.50

$ 313.50

V2512

$ 363.96

$ 363.96

V2513

$ 333.94

$ 333.94

V2520

$ 171.12

$ 171.12

V2521

$ 297.95

$ 297.95

V2522

$ 386.61

$ 386.61

V2523

$ 247.10

$ 247.10

V2524

$ 198.04

$ 198.04

V2525

$ 165.73

$ 165.73

V2530

$ 365.99

$ 365.99

V2531

$ 872.26

$ 872.26

V2600

$ 169.82

$ 169.82

V2623

$ 1,963.98

$ 1,963.98

V2624

$ 99.90

$ 99.90

V2625

$ 708.26

$ 708.26

V2626

$ 436.52

$ 436.52

V2627

$ 2,114.42

$ 2,114.42

V2628

$ 499.25

$ 499.25

V2629

$ 2,962.32

$ 2,962.32

V2630

$ 195.33

$ 195.33

V2631

$ 195.33

$ 195.33

V2632

$ 195.33

$ 195.33

V2700

$ 95.84

$ 95.84

V2702

$ 24.28

$ 24.28

V2710

$ 132.85

$ 132.85

V2715

$ 25.44

$ 25.44

V2718

$ 62.47

$ 62.47

V2730

$ 44.81

$ 44.81

V2744

$ 26.92

$ 26.92

V2745

$ 17.44

$ 17.44

V2750

$ 39.23

$ 39.23

V2755

$ 27.26

$ 27.26

V2756

$ 5.43

$ 5.43

V2760

$ 35.04

$ 35.04

V2761

$ 53.16

$ 53.16

V2762

$ 96.01

$ 96.01

V2770

$ 42.70

$ 42.70

V2780

$ 27.41

$ 27.41

V2781

$ 163.02

$ 163.02

V2782

$ 103.71

$ 103.71

V2783

$ 116.90

$ 116.90

V2784

$ 76.03

$ 76.03

V2786

$ 100.48

$ 100.48

V2787

$ 669.75

$ 669.75

V2788

$ 1,119.26

$ 1,119.26

V2790

$ 645.40

$ 645.40

V2797

$ 29.65

$ 29.65

V2799

BR

BR

V5008

$ 95.89

$ 95.89

V5010

$ 143.72

$ 143.72

V5011

$ 287.78

$ 287.78

V5014

$ 181.99

$ 181.99

V5020

$ 143.72

$ 143.72

V5030

$ 2,250.74

$ 2,250.74

V5040

$ 3,033.46

$ 3,033.46

V5050

$ 1,777.29

$ 1,777.29

V5060

$ 2,014.24

$ 2,014.24

V5090

$ 414.86

$ 414.86

V5100

$ 2,547.51

$ 2,547.51

V5110

$ 481.10

$ 481.10

V5120

$ 1,895.82

$ 1,895.82

V5130

$ 2,843.89

$ 2,843.89

V5140

$ 4,382.92

$ 4,382.92

V5150

$ 82.88

$ 82.88

V5160

$ 829.67

$ 829.67

V5181

$ 1,777.73

$ 1,777.73

V5200

$ 414.86

$ 414.86

V5211

$ 4,147.35

$ 4,147.35

V5215

$ 3,903.20

$ 3,903.20

V5221

$ 4,203.21

$ 4,203.21

V5240

$ 592.26

$ 592.26

V5241

$ 474.29

$ 474.29

V5247

$ 2,125.86

$ 2,125.86

V5248

$ 4,265.81

$ 4,265.81

V5250

$ 4,087.45

$ 4,087.45

V5251

$ 3,555.54

$ 3,555.54

V5252

$ 3,614.52

$ 3,614.52

V5253

$ 4,264.01

$ 4,264.01

V5254

$ 2,961.85

$ 2,961.85

V5255

$ 2,962.32

$ 2,962.32

V5256

$ 2,962.32

$ 2,962.32

V5257

$ 2,962.32

$ 2,962.32

V5258

$ 5,791.77

$ 5,791.77

V5259

$ 4,493.26

$ 4,493.26

V5260

$ 4,029.31

$ 4,029.31

V5261

$ 5,924.62

$ 5,924.62

V5262

$ 2,013.33

$ 2,013.33

V5263

$ 4,441.92

$ 4,441.92

V5264

$ 112.59

$ 112.59

V5265

$ 44.55

$ 44.55

V5266

$ 1.30

$ 1.30

V5268

$ 295.99

$ 295.99

V5270

$ 355.43

$ 355.43

V5275

$ 88.70

$ 88.70

V5281

$ 59.43

$ 59.43

V5282

$ 2,960.96

$ 2,960.96

V5284

$ 88.70

$ 88.70

V5288

$ 1,143.14

$ 1,143.14

V5290

$ 592.33

$ 592.33

V5299

BR

BR

V5336

$ 199.99

$ 199.99

V5362

$ 134.27

$ 134.27

V5363

$ 140.94

$ 140.94

V5364

$ 202.26

$ 202.26

HOME HEALTHCARE GUIDELINES

Information regarding publications incorporated by reference is found in the Introduction of the Fee Schedule.

The following Commission guidelines are in addition to the CPT® guidelines and the Center for Medicare & Medicaid Services' (CMS) HCPCS codes and descriptions and represent additional guidance from the Commission relative to services unique or uniquely utilized in Workers' Compensation. To the extent that a conflict may exist between an incorporated portion of the CPT® publication or a HCPCS code and a code, guideline, identifier, or modifier unique to Arizona, then the Arizona code, guideline, identifier, or modifier shall control. Codes that are unique to Arizona are preceded by an AZ identifier and numbered in the following format: AZxxx.

GENERAL GUIDANCE:

1. The determination that the injury/illness or condition is work related must be made by the payer and home health services shall be authorized as medically necessary.

2. All nursing services and personal care services shall have prior authorization by the payer.

3. A description of needed nursing or other attendant care must accompany the request for authorization.

4. Rates and reimbursement guidelines shall be predetermined in writing.

5. Except when governed by a separate contract or network that governs fees pursuant to A.R.S. § 23-908(J)(1), reasonably required supplies shall be reimbursed based on the HCPCS Guidelines. This includes supplies dispensed prior to the execution of an agreement and during times when preauthorization of services is in process.

6. Submission of invoices and reimbursement for invoices shall be made in accordance with A.R.S. § 23-1062.01 (See Section B of the Introduction).

ARIZONA SPECIFIC CODES GUIDELINES

Information regarding publications incorporated by reference is found in the Introduction Section of the Fee Schedule.

The following Commission guidelines are in addition to the CPT® guidelines and represent additional guidance from the Commission relative to services uniquely utilized in Workers' Compensation in Arizona. To the extent that a conflict may exist between an incorporated portion of the CPT® and a code, guideline, identifier, or modifier unique to Arizona, then the Arizona code, guideline, identifier or modifier shall control. Codes that are unique to Arizona are preceded by an AZ identifier and numbered in the following format: AZxxx.

A. PEER TO PEER CONSULTATION: Medical providers may bill for Peer-to-Peer consultations by using Arizona state specific codes AZ001 and AZ002. Determination of the proper code is based on time spent in discussion and review.

AZ001 Peer-to-Peer interprofessional telephone consultations between treating physician or medical provider and Peer Reviewer; 5-10 minutes of medical consultative discussion and review

AZ002 Peer-to-Peer interprofessional telephone consultations between treating physician or medical provider and Peer Reviewer; 11-30 minutes of medical consultative discussion and review

B. NURSE CASE MANAGER MEETING: Medical providers may bill for meeting with a nurse case manager (NCM) by using Arizona state specific codes AZ003 and AZ004. Determination of the proper code is based on patient presence during the meeting.

AZ003 Meeting with NCM with patient.

AZ003 may be billed if time is spent discussing a patient's treatment plan or other related information with the NCM when the patient is present. This should not be billed if there is no interaction with the NCM who is present during the time that a service, which is billed using a separate CPT® code, is performed. The documentation must include:

* The name of the NCM.

* The name of the organization the NCM is representing

* The purpose of the interaction

AZ004 Meeting with NCM without patient

AZ004 may be billed if time is spent discussing a patient's treatment plan or other related information with the NCM when the patient is not present. The documentation must include:

* The name of the NCM.

* The name of the organization the NCM is representing.

* The purpose of the interaction.

It is not appropriate for the payer on a per billing basis to require a healthcare provider to provide unnecessarily detailed documentation to justify payment. A healthcare provider is required to comply with A.R.S. § 23-1062.01 when submitting a bill.

C. SPECIAL REPORTS: Medical providers may bill for completion of workers' compensation insurance forms by using Arizona state specific code AZ005 when the request is submitted by the Commission, the payer or third-party administrator of the payer, or the Special Fund of the Commission and limited to one billing of code AZ005 per thirtyday period. The applicable form must be attached to the billing.

AZ005 Completion of workers' compensation insurance forms (i.e. return-to-work status, work restrictions, supportive care restrictions) which are requested or required either by the Commission, the applicable payer (insurance, self-insured employer, or the Special Fund of the Commission), or a third-party administrator of the applicable payer, not to exceed more than one billing in a thirty (30) day period. The applicable form must be attached to the billing.

D. TRAVEL REIMBURSEMENT: Medical providers may bill for collection and handling performed outside of a physician's office or laboratory.

AZ026 Mileage charge for collection and handling service performed outside of the physician's office or laboratory, within a radius of 7 miles.

AZ027 Mileage charge for collection and handling service performed outside of the physician's office or laboratory, per mile over 7 miles.

AZ028 When more than one patient is seen, apportion mileage charge among total number of patients.

AZ030 Mileage round trip: each mile in excess of 8 miles of travel by physician.

AZ031 Within large metropolitan areas a travel time basis may be appropriate. Code AZ031 would apply to Arizona's major metropolitan areas, to include Phoenix, Tucson, Flagstaff, Kingman, and Yuma. This code would only be used when travel times are 45 minutes or more.

E. EXPERT TESTIMONY: Medical testimony by personal appearance or deposition of a physician is reported using Arizona specific code AZ099. Reimbursement for time spent providing testimony at hearing is described in Section I of the Introduction Section of the Fee Schedule.

ARIZONA PHYSICIANS' FEE SCHEDULE

Arizona Specific Codes 2024

Code

Category

Description

FY24 NF RBRVS Rate

FY24 FAC RBRVS Rate

AZ001 00

AZ Specific Codes

Peer-to-Peer interprofessional telephone consultations between treating physician or medical provider and Peer Reviewer; 5-10 minutes of medical consultative discussion and review.

75.00

75.00

AZ002 00

AZ Specific Codes

Peer-to-Peer interprofessional telephone consultations between treating physician or medical provider and Peer Reviewer; 11-30 minutes of medical consultative discussion and review.

100.00

100.00

AZ003 00

AZ Specific Codes

Meeting with NCM with patient.

75.00

75.00

AZ004 00

AZ Specific Codes

Meeting with NCM without patient.

100.00

100.00

AZ005 00

AZ Specific Codes

Completion of workers' compensation insurance forms (i.e. return-to-work status, work restrictions, supportive care restrictions) which are requested or required by the Commission, the applicable payer (insurance, selfinsured employer, or the Special Fund of the Commission), or a third party administrator of the applicable payer, not to exceed more than one billing in a thirty (30) day period. The applicable form must be attached to the billing.

40.00

40.00

AZ026 00

AZ Specific Codes

Mileage charge, within a radius of 7 miles, for a collection and handling service performed outside the physician's office or laboratory.

BR

BR

AZ027 00

AZ Specific Codes

Over 7 miles, per mile.

BR

BR

AZ028 00

AZ Specific Codes

When more than one patient seen, apportion mileage charge among total number of patients.

BR

BR

AZ030 00

AZ Specific Codes

Mileage round-trip: each mile in excess of 8 miles of travel by physician.

BR

BR

AZ031 00

AZ Specific Codes

Within large metropolitan areas a travel time basis may be appropriate. Code AZ031 00 would apply to Arizona's major metropolitan areas, to include Phoenix, Tucson, Flagstaff, Kingman and Yuma. This code would only be used when travel times are 45 minutes or more.

BR

BR

AZ099 00

AZ Specific Codes

Expert testimony at hearing, for the initial hour (or any portion thereof), prorated for each additional 20 minute increment (or any portion thereof).

150.00

150.00

1 It should be noted that the law governing directed care is not limited to "medical doctors," but instead applies to medical, surgical, and hospital benefits. See A.R.S. § 23-1070. The phrase, "medical, surgical, and hospital benefits" is defined in A.R.S. § 23- 1062(A), which states: "Promptly, upon notice to the employer, every injured employee shall receive medical, surgical and hospital benefits or other treatment, nursing, medicine, surgical supplies, crutches and other apparatus, including artificial members, reasonably required at the time of the injury, and during the period of disability. Such benefits shall be termed 'medical, surgical and hospital benefits.'"

1 A.R.S. § 32-1963.01(A) states: "If a medical practitioner prescribes a brand name drug and does not indicate an intent to prevent substitution as prescribed in subsection E of this section, a pharmacist may fill the prescription with a generic equivalent drug."

2 A.R.S. § 32-1963.01(E) states: "A prescription generated in this state must be dispensed as written only if the prescriber writes or clearly displays 'DAW', 'dispense as written', 'do not substitute' or 'medically necessary' or any statement by the prescriber that clearly indicates an intent to prevent substitution on the face of the prescription form. A prescription from out of state or from agencies of the United States government must be dispensed as written only if the prescriber writes or clearly displays 'do not substitute', 'dispense as written' or 'medically necessary' or any statement by the prescriber that clearly indicates an intent to prevent substitution on the face of the prescription form."

3 A.R.S. § 32-1963.01(L) states, in part:

2. "Brand name drug" means a drug with a proprietary name assigned to it by the manufacturer or distributor.

4. "Generic equivalent" or "generically equivalent" means a drug that has an identical amount of the same active chemical ingredients in the same dosage form, that meets applicable standards of strength, quality and purity according to the United States pharmacopeia or other nationally recognized compendium and that, if administered in the same amounts, will provide comparable therapeutic effects. Generic equivalent or generically equivalent does not include a drug that is listed by the United States food and drug administration as having unresolved bioequivalence concerns according to the administration's most recent publication of approved drug products with therapeutic equivalence evaluations.

4 Dispensing pursuant to Section VII is subject to the Arizona Opioid Epidemic Act, which imposes statutory limits on the prescribing and dispensing of schedule II opioids. For more information about the Arizona Opioid Epidemic Act, please see the FAQs published by the Arizona State Board of Pharmacy, available at https://drive.google.com/file/d/1JCIs8VwtdJ1T-DyGfJN3WWUm4KhDMXe-/view.

5 Section VII sets forth reimbursement guidelines for medications dispensed in settings that are not accessible to the general public in Arizona's worker's compensation system and does not interfere with a medical practitioner's ability to dispense medications pursuant to A.R.S. § 32-1491 or seek payment from sources unrelated to workers' compensation.

Ariz. Admin. Code tit. 20, ch. 05, art. 6, app A

Appendix A adopted effective June 26, 1998 (Supp. 98-2). Amended by final exempt rulemaking at 26 A.A.R. 2119, effective 10/1/2020. Amended by exempt rulemaking at 27 A.A.R. 1690, effective 10/1/2021 through 9/30/2022. New Section made by exempt Rulemaking at 28 A.A.R. 1481, effective 10/1/2022. Adopted by exempt rulemaking at 29 A.A.R. 2537, effective 10/1/2023. New Section made by Exempt rulemaking at 30 A.A.R. 1093, effective 5/1/2024.