CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

A0021 0.00 0.00 0.00 0.00 $0.00 $0.00A0080 0.00 0.00 0.00 0.00 $0.00 $0.00A0090 0.00 0.00 0.00 0.00 $0.00 $0.00A0100 0.00 0.00 0.00 0.00 $0.00 $0.00A0110 0.00 0.00 0.00 0.00 $0.00 $0.00A0120 0.00 0.00 0.00 0.00 $0.00 $0.00A0130 0.00 0.00 0.00 0.00 $0.00 $0.00A0140 0.00 0.00 0.00 0.00 $0.00 $0.00A0160 0.00 0.00 0.00 0.00 $0.00 $0.00A0170 0.00 0.00 0.00 0.00 $0.00 $0.00A0180 0.00 0.00 0.00 0.00 $0.00 $0.00A0190 0.00 0.00 0.00 0.00 $0.00 $0.00A0200 0.00 0.00 0.00 0.00 $0.00 $0.00A0210 0.00 0.00 0.00 0.00 $0.00 $0.00A0225 0.00 0.00 0.00 0.00 $0.00 $0.00A0380 0.00 0.00 0.00 0.00 $0.00 $0.00A0382 0.00 0.00 0.00 0.00 $0.00 $0.00A0384 0.00 0.00 0.00 0.00 $0.00 $0.00A0390 0.00 0.00 0.00 0.00 $0.00 $0.00A0392 0.00 0.00 0.00 0.00 $0.00 $0.00A0394 0.00 0.00 0.00 0.00 $0.00 $0.00A0396 0.00 0.00 0.00 0.00 $0.00 $0.00A0398 0.00 0.00 0.00 0.00 $0.00 $0.00A0420 0.00 0.00 0.00 0.00 $0.00 $0.00A0422 0.00 0.00 0.00 0.00 $0.00 $0.00A0424 0.00 0.00 0.00 0.00 $0.00 $0.00A0425 0.00 0.00 0.00 0.00 $0.00 $0.00A0426 0.00 0.00 0.00 0.00 $0.00 $0.00A0427 0.00 0.00 0.00 0.00 $0.00 $0.00A0428 0.00 0.00 0.00 0.00 $0.00 $0.00A0429 0.00 0.00 0.00 0.00 $0.00 $0.00A0430 0.00 0.00 0.00 0.00 $0.00 $0.00A0431 0.00 0.00 0.00 0.00 $0.00 $0.00A0432 0.00 0.00 0.00 0.00 $0.00 $0.00A0433 0.00 0.00 0.00 0.00 $0.00 $0.00A0434 0.00 0.00 0.00 0.00 $0.00 $0.00

Maryland Workers' Compensation Commission Calendar Year 2012 Medical Fee GuideRELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MARYLAND

WORKERS' COMPENSATION COMMISSION REIMBURSEMENTMedical Services & Treatment Codes/Procedures

*Ortho/Neuro CPT Codes begin on page 338 MRA 2012

Updated December 2011 1 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

A0435 0.00 0.00 0.00 0.00 $0.00 $0.00A0436 0.00 0.00 0.00 0.00 $0.00 $0.00A0888 0.00 0.00 0.00 0.00 $0.00 $0.00A0998 0.00 0.00 0.00 0.00 $0.00 $0.00A0999 0.00 0.00 0.00 0.00 $0.00 $0.00A4206 0.00 0.00 0.00 0.00 $0.00 $0.00A4207 0.00 0.00 0.00 0.00 $0.00 $0.00A4208 0.00 0.00 0.00 0.00 $0.00 $0.00A4209 0.00 0.00 0.00 0.00 $0.00 $0.00A4210 0.00 0.00 0.00 0.00 $0.00 $0.00A4211 0.00 0.00 0.00 0.00 $0.00 $0.00A4212 0.00 0.00 0.00 0.00 $0.00 $0.00A4213 0.00 0.00 0.00 0.00 $0.00 $0.00A4215 0.00 0.00 0.00 0.00 $0.00 $0.00A4216 0.00 0.00 0.00 0.00 $0.00 $0.00A4217 0.00 0.00 0.00 0.00 $0.00 $0.00A4218 0.00 0.00 0.00 0.00 $0.00 $0.00A4220 0.00 0.00 0.00 0.00 $0.00 $0.00A4221 0.00 0.00 0.00 0.00 $0.00 $0.00A4222 0.00 0.00 0.00 0.00 $0.00 $0.00A4223 0.00 0.00 0.00 0.00 $0.00 $0.00A4230 0.00 0.00 0.00 0.00 $0.00 $0.00A4231 0.00 0.00 0.00 0.00 $0.00 $0.00A4232 0.00 0.00 0.00 0.00 $0.00 $0.00A4233 0.00 0.00 0.00 0.00 $0.00 $0.00A4234 0.00 0.00 0.00 0.00 $0.00 $0.00A4235 0.00 0.00 0.00 0.00 $0.00 $0.00A4236 0.00 0.00 0.00 0.00 $0.00 $0.00A4244 0.00 0.00 0.00 0.00 $0.00 $0.00A4245 0.00 0.00 0.00 0.00 $0.00 $0.00A4246 0.00 0.00 0.00 0.00 $0.00 $0.00A4247 0.00 0.00 0.00 0.00 $0.00 $0.00A4248 0.00 0.00 0.00 0.00 $0.00 $0.00A4250 0.00 0.00 0.00 0.00 $0.00 $0.00A4252 0.00 0.00 0.00 0.00 $0.00 $0.00A4253 0.00 0.00 0.00 0.00 $0.00 $0.00A4255 0.00 0.00 0.00 0.00 $0.00 $0.00A4256 0.00 0.00 0.00 0.00 $0.00 $0.00A4257 0.00 0.00 0.00 0.00 $0.00 $0.00A4258 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 2 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

A4259 0.00 0.00 0.00 0.00 $0.00 $0.00A4261 0.00 0.00 0.00 0.00 $0.00 $0.00A4262 0.00 0.00 0.00 0.00 $0.00 $0.00A4263 0.00 0.00 0.00 0.00 $0.00 $0.00A4264 0.00 0.00 0.00 0.00 $0.00 $0.00A4265 0.00 0.00 0.00 0.00 $0.00 $0.00A4266 0.00 0.00 0.00 0.00 $0.00 $0.00A4267 0.00 0.00 0.00 0.00 $0.00 $0.00A4268 0.00 0.00 0.00 0.00 $0.00 $0.00A4269 0.00 0.00 0.00 0.00 $0.00 $0.00A4270 0.00 0.00 0.00 0.00 $0.00 $0.00A4280 0.00 0.00 0.00 0.00 $0.00 $0.00A4281 0.00 0.00 0.00 0.00 $0.00 $0.00A4282 0.00 0.00 0.00 0.00 $0.00 $0.00A4283 0.00 0.00 0.00 0.00 $0.00 $0.00A4284 0.00 0.00 0.00 0.00 $0.00 $0.00A4285 0.00 0.00 0.00 0.00 $0.00 $0.00A4286 0.00 0.00 0.00 0.00 $0.00 $0.00A4290 0.00 0.00 0.00 0.00 $0.00 $0.00A4300 0.00 0.00 0.00 0.00 $0.00 $0.00A4301 0.00 0.00 0.00 0.00 $0.00 $0.00A4305 0.00 0.00 0.00 0.00 $0.00 $0.00A4306 0.00 0.00 0.00 0.00 $0.00 $0.00A4310 0.00 0.00 0.00 0.00 $0.00 $0.00A4311 0.00 0.00 0.00 0.00 $0.00 $0.00A4312 0.00 0.00 0.00 0.00 $0.00 $0.00A4313 0.00 0.00 0.00 0.00 $0.00 $0.00A4314 0.00 0.00 0.00 0.00 $0.00 $0.00A4315 0.00 0.00 0.00 0.00 $0.00 $0.00A4316 0.00 0.00 0.00 0.00 $0.00 $0.00A4320 0.00 0.00 0.00 0.00 $0.00 $0.00A4321 0.00 0.00 0.00 0.00 $0.00 $0.00A4322 0.00 0.00 0.00 0.00 $0.00 $0.00A4326 0.00 0.00 0.00 0.00 $0.00 $0.00A4327 0.00 0.00 0.00 0.00 $0.00 $0.00A4328 0.00 0.00 0.00 0.00 $0.00 $0.00A4330 0.00 0.00 0.00 0.00 $0.00 $0.00A4331 0.00 0.00 0.00 0.00 $0.00 $0.00A4332 0.00 0.00 0.00 0.00 $0.00 $0.00A4333 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 3 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

A4334 0.00 0.00 0.00 0.00 $0.00 $0.00A4335 0.00 0.00 0.00 0.00 $0.00 $0.00A4336 0.00 0.00 0.00 0.00 $0.00 $0.00A4338 0.00 0.00 0.00 0.00 $0.00 $0.00A4340 0.00 0.00 0.00 0.00 $0.00 $0.00A4344 0.00 0.00 0.00 0.00 $0.00 $0.00A4346 0.00 0.00 0.00 0.00 $0.00 $0.00A4349 0.00 0.00 0.00 0.00 $0.00 $0.00A4351 0.00 0.00 0.00 0.00 $0.00 $0.00A4352 0.00 0.00 0.00 0.00 $0.00 $0.00A4353 0.00 0.00 0.00 0.00 $0.00 $0.00A4354 0.00 0.00 0.00 0.00 $0.00 $0.00A4355 0.00 0.00 0.00 0.00 $0.00 $0.00A4356 0.00 0.00 0.00 0.00 $0.00 $0.00A4357 0.00 0.00 0.00 0.00 $0.00 $0.00A4358 0.00 0.00 0.00 0.00 $0.00 $0.00A4360 0.00 0.00 0.00 0.00 $0.00 $0.00A4361 0.00 0.00 0.00 0.00 $0.00 $0.00A4362 0.00 0.00 0.00 0.00 $0.00 $0.00A4363 0.00 0.00 0.00 0.00 $0.00 $0.00A4364 0.00 0.00 0.00 0.00 $0.00 $0.00A4366 0.00 0.00 0.00 0.00 $0.00 $0.00A4367 0.00 0.00 0.00 0.00 $0.00 $0.00A4368 0.00 0.00 0.00 0.00 $0.00 $0.00A4369 0.00 0.00 0.00 0.00 $0.00 $0.00A4371 0.00 0.00 0.00 0.00 $0.00 $0.00A4372 0.00 0.00 0.00 0.00 $0.00 $0.00A4373 0.00 0.00 0.00 0.00 $0.00 $0.00A4375 0.00 0.00 0.00 0.00 $0.00 $0.00A4376 0.00 0.00 0.00 0.00 $0.00 $0.00A4377 0.00 0.00 0.00 0.00 $0.00 $0.00A4378 0.00 0.00 0.00 0.00 $0.00 $0.00A4379 0.00 0.00 0.00 0.00 $0.00 $0.00A4380 0.00 0.00 0.00 0.00 $0.00 $0.00A4381 0.00 0.00 0.00 0.00 $0.00 $0.00A4382 0.00 0.00 0.00 0.00 $0.00 $0.00A4383 0.00 0.00 0.00 0.00 $0.00 $0.00A4384 0.00 0.00 0.00 0.00 $0.00 $0.00A4385 0.00 0.00 0.00 0.00 $0.00 $0.00A4387 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 4 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

A4388 0.00 0.00 0.00 0.00 $0.00 $0.00A4389 0.00 0.00 0.00 0.00 $0.00 $0.00A4390 0.00 0.00 0.00 0.00 $0.00 $0.00A4391 0.00 0.00 0.00 0.00 $0.00 $0.00A4392 0.00 0.00 0.00 0.00 $0.00 $0.00A4393 0.00 0.00 0.00 0.00 $0.00 $0.00A4394 0.00 0.00 0.00 0.00 $0.00 $0.00A4395 0.00 0.00 0.00 0.00 $0.00 $0.00A4396 0.00 0.00 0.00 0.00 $0.00 $0.00A4397 0.00 0.00 0.00 0.00 $0.00 $0.00A4398 0.00 0.00 0.00 0.00 $0.00 $0.00A4399 0.00 0.00 0.00 0.00 $0.00 $0.00A4400 0.00 0.00 0.00 0.00 $0.00 $0.00A4402 0.00 0.00 0.00 0.00 $0.00 $0.00A4404 0.00 0.00 0.00 0.00 $0.00 $0.00A4405 0.00 0.00 0.00 0.00 $0.00 $0.00A4406 0.00 0.00 0.00 0.00 $0.00 $0.00A4407 0.00 0.00 0.00 0.00 $0.00 $0.00A4408 0.00 0.00 0.00 0.00 $0.00 $0.00A4409 0.00 0.00 0.00 0.00 $0.00 $0.00A4410 0.00 0.00 0.00 0.00 $0.00 $0.00A4411 0.00 0.00 0.00 0.00 $0.00 $0.00A4412 0.00 0.00 0.00 0.00 $0.00 $0.00A4413 0.00 0.00 0.00 0.00 $0.00 $0.00A4414 0.00 0.00 0.00 0.00 $0.00 $0.00A4415 0.00 0.00 0.00 0.00 $0.00 $0.00A4416 0.00 0.00 0.00 0.00 $0.00 $0.00A4417 0.00 0.00 0.00 0.00 $0.00 $0.00A4418 0.00 0.00 0.00 0.00 $0.00 $0.00A4419 0.00 0.00 0.00 0.00 $0.00 $0.00A4420 0.00 0.00 0.00 0.00 $0.00 $0.00A4421 0.00 0.00 0.00 0.00 $0.00 $0.00A4422 0.00 0.00 0.00 0.00 $0.00 $0.00A4423 0.00 0.00 0.00 0.00 $0.00 $0.00A4424 0.00 0.00 0.00 0.00 $0.00 $0.00A4425 0.00 0.00 0.00 0.00 $0.00 $0.00A4426 0.00 0.00 0.00 0.00 $0.00 $0.00A4427 0.00 0.00 0.00 0.00 $0.00 $0.00A4428 0.00 0.00 0.00 0.00 $0.00 $0.00A4429 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 5 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

A4430 0.00 0.00 0.00 0.00 $0.00 $0.00A4431 0.00 0.00 0.00 0.00 $0.00 $0.00A4432 0.00 0.00 0.00 0.00 $0.00 $0.00A4433 0.00 0.00 0.00 0.00 $0.00 $0.00A4434 0.00 0.00 0.00 0.00 $0.00 $0.00A4450 0.00 0.00 0.00 0.00 $0.00 $0.00A4452 0.00 0.00 0.00 0.00 $0.00 $0.00A4455 0.00 0.00 0.00 0.00 $0.00 $0.00A4456 0.00 0.00 0.00 0.00 $0.00 $0.00A4458 0.00 0.00 0.00 0.00 $0.00 $0.00A4461 0.00 0.00 0.00 0.00 $0.00 $0.00A4463 0.00 0.00 0.00 0.00 $0.00 $0.00A4465 0.00 0.00 0.00 0.00 $0.00 $0.00A4466 0.00 0.00 0.00 0.00 $0.00 $0.00A4470 0.00 0.00 0.00 0.00 $0.00 $0.00A4480 0.00 0.00 0.00 0.00 $0.00 $0.00A4481 0.00 0.00 0.00 0.00 $0.00 $0.00A4483 0.00 0.00 0.00 0.00 $0.00 $0.00A4490 0.00 0.00 0.00 0.00 $0.00 $0.00A4495 0.00 0.00 0.00 0.00 $0.00 $0.00A4500 0.00 0.00 0.00 0.00 $0.00 $0.00A4510 0.00 0.00 0.00 0.00 $0.00 $0.00A4520 0.00 0.00 0.00 0.00 $0.00 $0.00A4550 0.00 0.00 0.00 0.00 $0.00 $0.00A4554 0.00 0.00 0.00 0.00 $0.00 $0.00A4556 0.00 0.00 0.00 0.00 $0.00 $0.00A4557 0.00 0.00 0.00 0.00 $0.00 $0.00A4558 0.00 0.00 0.00 0.00 $0.00 $0.00A4559 0.00 0.00 0.00 0.00 $0.00 $0.00A4561 0.00 0.00 0.00 0.00 $0.00 $0.00A4562 0.00 0.00 0.00 0.00 $0.00 $0.00A4565 0.00 0.00 0.00 0.00 $0.00 $0.00A4566 0.00 0.00 0.00 0.00 $0.00 $0.00A4570 0.00 0.00 0.00 0.00 $0.00 $0.00A4575 0.00 0.00 0.00 0.00 $0.00 $0.00A4580 0.00 0.00 0.00 0.00 $0.00 $0.00A4590 0.00 0.00 0.00 0.00 $0.00 $0.00A4595 0.00 0.00 0.00 0.00 $0.00 $0.00A4600 0.00 0.00 0.00 0.00 $0.00 $0.00A4601 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 6 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

A4604 0.00 0.00 0.00 0.00 $0.00 $0.00A4605 0.00 0.00 0.00 0.00 $0.00 $0.00A4606 0.00 0.00 0.00 0.00 $0.00 $0.00A4608 0.00 0.00 0.00 0.00 $0.00 $0.00A4611 0.00 0.00 0.00 0.00 $0.00 $0.00A4612 0.00 0.00 0.00 0.00 $0.00 $0.00A4613 0.00 0.00 0.00 0.00 $0.00 $0.00A4614 0.00 0.00 0.00 0.00 $0.00 $0.00A4615 0.00 0.00 0.00 0.00 $0.00 $0.00A4616 0.00 0.00 0.00 0.00 $0.00 $0.00A4617 0.00 0.00 0.00 0.00 $0.00 $0.00A4618 0.00 0.00 0.00 0.00 $0.00 $0.00A4619 0.00 0.00 0.00 0.00 $0.00 $0.00A4620 0.00 0.00 0.00 0.00 $0.00 $0.00A4623 0.00 0.00 0.00 0.00 $0.00 $0.00A4624 0.00 0.00 0.00 0.00 $0.00 $0.00A4625 0.00 0.00 0.00 0.00 $0.00 $0.00A4626 0.00 0.00 0.00 0.00 $0.00 $0.00A4627 0.00 0.00 0.00 0.00 $0.00 $0.00A4628 0.00 0.00 0.00 0.00 $0.00 $0.00A4629 0.00 0.00 0.00 0.00 $0.00 $0.00A4630 0.00 0.00 0.00 0.00 $0.00 $0.00A4633 0.00 0.00 0.00 0.00 $0.00 $0.00A4634 0.00 0.00 0.00 0.00 $0.00 $0.00A4635 0.00 0.00 0.00 0.00 $0.00 $0.00A4636 0.00 0.00 0.00 0.00 $0.00 $0.00A4637 0.00 0.00 0.00 0.00 $0.00 $0.00A4638 0.00 0.00 0.00 0.00 $0.00 $0.00A4639 0.00 0.00 0.00 0.00 $0.00 $0.00A4640 0.00 0.00 0.00 0.00 $0.00 $0.00A4641 0.00 0.00 0.00 0.00 $0.00 $0.00A4642 0.00 0.00 0.00 0.00 $0.00 $0.00A4648 0.00 0.00 0.00 0.00 $0.00 $0.00A4649 0.00 0.00 0.00 0.00 $0.00 $0.00A4650 0.00 0.00 0.00 0.00 $0.00 $0.00A4651 0.00 0.00 0.00 0.00 $0.00 $0.00A4652 0.00 0.00 0.00 0.00 $0.00 $0.00A4653 0.00 0.00 0.00 0.00 $0.00 $0.00A4657 0.00 0.00 0.00 0.00 $0.00 $0.00A4660 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 7 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

A4663 0.00 0.00 0.00 0.00 $0.00 $0.00A4670 0.00 0.00 0.00 0.00 $0.00 $0.00A4671 0.00 0.00 0.00 0.00 $0.00 $0.00A4672 0.00 0.00 0.00 0.00 $0.00 $0.00A4673 0.00 0.00 0.00 0.00 $0.00 $0.00A4674 0.00 0.00 0.00 0.00 $0.00 $0.00A4680 0.00 0.00 0.00 0.00 $0.00 $0.00A4690 0.00 0.00 0.00 0.00 $0.00 $0.00A4706 0.00 0.00 0.00 0.00 $0.00 $0.00A4707 0.00 0.00 0.00 0.00 $0.00 $0.00A4708 0.00 0.00 0.00 0.00 $0.00 $0.00A4709 0.00 0.00 0.00 0.00 $0.00 $0.00A4714 0.00 0.00 0.00 0.00 $0.00 $0.00A4719 0.00 0.00 0.00 0.00 $0.00 $0.00A4720 0.00 0.00 0.00 0.00 $0.00 $0.00A4721 0.00 0.00 0.00 0.00 $0.00 $0.00A4722 0.00 0.00 0.00 0.00 $0.00 $0.00A4723 0.00 0.00 0.00 0.00 $0.00 $0.00A4724 0.00 0.00 0.00 0.00 $0.00 $0.00A4725 0.00 0.00 0.00 0.00 $0.00 $0.00A4726 0.00 0.00 0.00 0.00 $0.00 $0.00A4728 0.00 0.00 0.00 0.00 $0.00 $0.00A4730 0.00 0.00 0.00 0.00 $0.00 $0.00A4736 0.00 0.00 0.00 0.00 $0.00 $0.00A4737 0.00 0.00 0.00 0.00 $0.00 $0.00A4740 0.00 0.00 0.00 0.00 $0.00 $0.00A4750 0.00 0.00 0.00 0.00 $0.00 $0.00A4755 0.00 0.00 0.00 0.00 $0.00 $0.00A4760 0.00 0.00 0.00 0.00 $0.00 $0.00A4765 0.00 0.00 0.00 0.00 $0.00 $0.00A4766 0.00 0.00 0.00 0.00 $0.00 $0.00A4770 0.00 0.00 0.00 0.00 $0.00 $0.00A4771 0.00 0.00 0.00 0.00 $0.00 $0.00A4772 0.00 0.00 0.00 0.00 $0.00 $0.00A4773 0.00 0.00 0.00 0.00 $0.00 $0.00A4774 0.00 0.00 0.00 0.00 $0.00 $0.00A4802 0.00 0.00 0.00 0.00 $0.00 $0.00A4860 0.00 0.00 0.00 0.00 $0.00 $0.00A4870 0.00 0.00 0.00 0.00 $0.00 $0.00A4890 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 8 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

A4911 0.00 0.00 0.00 0.00 $0.00 $0.00A4913 0.00 0.00 0.00 0.00 $0.00 $0.00A4918 0.00 0.00 0.00 0.00 $0.00 $0.00A4927 0.00 0.00 0.00 0.00 $0.00 $0.00A4928 0.00 0.00 0.00 0.00 $0.00 $0.00A4929 0.00 0.00 0.00 0.00 $0.00 $0.00A4930 0.00 0.00 0.00 0.00 $0.00 $0.00A4931 0.00 0.00 0.00 0.00 $0.00 $0.00A4932 0.00 0.00 0.00 0.00 $0.00 $0.00A5051 0.00 0.00 0.00 0.00 $0.00 $0.00A5052 0.00 0.00 0.00 0.00 $0.00 $0.00A5053 0.00 0.00 0.00 0.00 $0.00 $0.00A5054 0.00 0.00 0.00 0.00 $0.00 $0.00A5055 0.00 0.00 0.00 0.00 $0.00 $0.00A5056 0.00 0.00 0.00 0.00 $0.00 $0.00A5057 0.00 0.00 0.00 0.00 $0.00 $0.00A5061 0.00 0.00 0.00 0.00 $0.00 $0.00A5062 0.00 0.00 0.00 0.00 $0.00 $0.00A5063 0.00 0.00 0.00 0.00 $0.00 $0.00A5071 0.00 0.00 0.00 0.00 $0.00 $0.00A5072 0.00 0.00 0.00 0.00 $0.00 $0.00A5073 0.00 0.00 0.00 0.00 $0.00 $0.00A5081 0.00 0.00 0.00 0.00 $0.00 $0.00A5082 0.00 0.00 0.00 0.00 $0.00 $0.00A5083 0.00 0.00 0.00 0.00 $0.00 $0.00A5093 0.00 0.00 0.00 0.00 $0.00 $0.00A5102 0.00 0.00 0.00 0.00 $0.00 $0.00A5105 0.00 0.00 0.00 0.00 $0.00 $0.00A5112 0.00 0.00 0.00 0.00 $0.00 $0.00A5113 0.00 0.00 0.00 0.00 $0.00 $0.00A5114 0.00 0.00 0.00 0.00 $0.00 $0.00A5120 0.00 0.00 0.00 0.00 $0.00 $0.00A5121 0.00 0.00 0.00 0.00 $0.00 $0.00A5122 0.00 0.00 0.00 0.00 $0.00 $0.00A5126 0.00 0.00 0.00 0.00 $0.00 $0.00A5131 0.00 0.00 0.00 0.00 $0.00 $0.00A5200 0.00 0.00 0.00 0.00 $0.00 $0.00A5500 0.00 0.00 0.00 0.00 $0.00 $0.00A5501 0.00 0.00 0.00 0.00 $0.00 $0.00A5503 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 9 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

A5504 0.00 0.00 0.00 0.00 $0.00 $0.00A5505 0.00 0.00 0.00 0.00 $0.00 $0.00A5506 0.00 0.00 0.00 0.00 $0.00 $0.00A5507 0.00 0.00 0.00 0.00 $0.00 $0.00A5508 0.00 0.00 0.00 0.00 $0.00 $0.00A5510 0.00 0.00 0.00 0.00 $0.00 $0.00A5512 0.00 0.00 0.00 0.00 $0.00 $0.00A5513 0.00 0.00 0.00 0.00 $0.00 $0.00A6000 0.00 0.00 0.00 0.00 $0.00 $0.00A6010 0.00 0.00 0.00 0.00 $0.00 $0.00A6011 0.00 0.00 0.00 0.00 $0.00 $0.00A6021 0.00 0.00 0.00 0.00 $0.00 $0.00A6022 0.00 0.00 0.00 0.00 $0.00 $0.00A6023 0.00 0.00 0.00 0.00 $0.00 $0.00A6024 0.00 0.00 0.00 0.00 $0.00 $0.00A6025 0.00 0.00 0.00 0.00 $0.00 $0.00A6154 0.00 0.00 0.00 0.00 $0.00 $0.00A6196 0.00 0.00 0.00 0.00 $0.00 $0.00A6197 0.00 0.00 0.00 0.00 $0.00 $0.00A6198 0.00 0.00 0.00 0.00 $0.00 $0.00A6199 0.00 0.00 0.00 0.00 $0.00 $0.00A6203 0.00 0.00 0.00 0.00 $0.00 $0.00A6204 0.00 0.00 0.00 0.00 $0.00 $0.00A6205 0.00 0.00 0.00 0.00 $0.00 $0.00A6206 0.00 0.00 0.00 0.00 $0.00 $0.00A6207 0.00 0.00 0.00 0.00 $0.00 $0.00A6208 0.00 0.00 0.00 0.00 $0.00 $0.00A6209 0.00 0.00 0.00 0.00 $0.00 $0.00A6210 0.00 0.00 0.00 0.00 $0.00 $0.00A6211 0.00 0.00 0.00 0.00 $0.00 $0.00A6212 0.00 0.00 0.00 0.00 $0.00 $0.00A6213 0.00 0.00 0.00 0.00 $0.00 $0.00A6214 0.00 0.00 0.00 0.00 $0.00 $0.00A6215 0.00 0.00 0.00 0.00 $0.00 $0.00A6216 0.00 0.00 0.00 0.00 $0.00 $0.00A6217 0.00 0.00 0.00 0.00 $0.00 $0.00A6218 0.00 0.00 0.00 0.00 $0.00 $0.00A6219 0.00 0.00 0.00 0.00 $0.00 $0.00A6220 0.00 0.00 0.00 0.00 $0.00 $0.00A6221 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 10 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

A6222 0.00 0.00 0.00 0.00 $0.00 $0.00A6223 0.00 0.00 0.00 0.00 $0.00 $0.00A6224 0.00 0.00 0.00 0.00 $0.00 $0.00A6228 0.00 0.00 0.00 0.00 $0.00 $0.00A6229 0.00 0.00 0.00 0.00 $0.00 $0.00A6230 0.00 0.00 0.00 0.00 $0.00 $0.00A6231 0.00 0.00 0.00 0.00 $0.00 $0.00A6232 0.00 0.00 0.00 0.00 $0.00 $0.00A6233 0.00 0.00 0.00 0.00 $0.00 $0.00A6234 0.00 0.00 0.00 0.00 $0.00 $0.00A6235 0.00 0.00 0.00 0.00 $0.00 $0.00A6236 0.00 0.00 0.00 0.00 $0.00 $0.00A6237 0.00 0.00 0.00 0.00 $0.00 $0.00A6238 0.00 0.00 0.00 0.00 $0.00 $0.00A6239 0.00 0.00 0.00 0.00 $0.00 $0.00A6240 0.00 0.00 0.00 0.00 $0.00 $0.00A6241 0.00 0.00 0.00 0.00 $0.00 $0.00A6242 0.00 0.00 0.00 0.00 $0.00 $0.00A6243 0.00 0.00 0.00 0.00 $0.00 $0.00A6244 0.00 0.00 0.00 0.00 $0.00 $0.00A6245 0.00 0.00 0.00 0.00 $0.00 $0.00A6246 0.00 0.00 0.00 0.00 $0.00 $0.00A6247 0.00 0.00 0.00 0.00 $0.00 $0.00A6248 0.00 0.00 0.00 0.00 $0.00 $0.00A6250 0.00 0.00 0.00 0.00 $0.00 $0.00A6251 0.00 0.00 0.00 0.00 $0.00 $0.00A6252 0.00 0.00 0.00 0.00 $0.00 $0.00A6253 0.00 0.00 0.00 0.00 $0.00 $0.00A6254 0.00 0.00 0.00 0.00 $0.00 $0.00A6255 0.00 0.00 0.00 0.00 $0.00 $0.00A6256 0.00 0.00 0.00 0.00 $0.00 $0.00A6257 0.00 0.00 0.00 0.00 $0.00 $0.00A6258 0.00 0.00 0.00 0.00 $0.00 $0.00A6259 0.00 0.00 0.00 0.00 $0.00 $0.00A6260 0.00 0.00 0.00 0.00 $0.00 $0.00A6261 0.00 0.00 0.00 0.00 $0.00 $0.00A6262 0.00 0.00 0.00 0.00 $0.00 $0.00A6266 0.00 0.00 0.00 0.00 $0.00 $0.00A6402 0.00 0.00 0.00 0.00 $0.00 $0.00A6403 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 11 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

A6404 0.00 0.00 0.00 0.00 $0.00 $0.00A6407 0.00 0.00 0.00 0.00 $0.00 $0.00A6410 0.00 0.00 0.00 0.00 $0.00 $0.00A6411 0.00 0.00 0.00 0.00 $0.00 $0.00A6412 0.00 0.00 0.00 0.00 $0.00 $0.00A6413 0.00 0.00 0.00 0.00 $0.00 $0.00A6441 0.00 0.00 0.00 0.00 $0.00 $0.00A6442 0.00 0.00 0.00 0.00 $0.00 $0.00A6443 0.00 0.00 0.00 0.00 $0.00 $0.00A6444 0.00 0.00 0.00 0.00 $0.00 $0.00A6445 0.00 0.00 0.00 0.00 $0.00 $0.00A6446 0.00 0.00 0.00 0.00 $0.00 $0.00A6447 0.00 0.00 0.00 0.00 $0.00 $0.00A6448 0.00 0.00 0.00 0.00 $0.00 $0.00A6449 0.00 0.00 0.00 0.00 $0.00 $0.00A6450 0.00 0.00 0.00 0.00 $0.00 $0.00A6451 0.00 0.00 0.00 0.00 $0.00 $0.00A6452 0.00 0.00 0.00 0.00 $0.00 $0.00A6453 0.00 0.00 0.00 0.00 $0.00 $0.00A6454 0.00 0.00 0.00 0.00 $0.00 $0.00A6455 0.00 0.00 0.00 0.00 $0.00 $0.00A6456 0.00 0.00 0.00 0.00 $0.00 $0.00A6457 0.00 0.00 0.00 0.00 $0.00 $0.00A6501 0.00 0.00 0.00 0.00 $0.00 $0.00A6502 0.00 0.00 0.00 0.00 $0.00 $0.00A6503 0.00 0.00 0.00 0.00 $0.00 $0.00A6504 0.00 0.00 0.00 0.00 $0.00 $0.00A6505 0.00 0.00 0.00 0.00 $0.00 $0.00A6506 0.00 0.00 0.00 0.00 $0.00 $0.00A6507 0.00 0.00 0.00 0.00 $0.00 $0.00A6508 0.00 0.00 0.00 0.00 $0.00 $0.00A6509 0.00 0.00 0.00 0.00 $0.00 $0.00A6510 0.00 0.00 0.00 0.00 $0.00 $0.00A6511 0.00 0.00 0.00 0.00 $0.00 $0.00A6512 0.00 0.00 0.00 0.00 $0.00 $0.00A6513 0.00 0.00 0.00 0.00 $0.00 $0.00A6530 0.00 0.00 0.00 0.00 $0.00 $0.00A6531 0.00 0.00 0.00 0.00 $0.00 $0.00A6532 0.00 0.00 0.00 0.00 $0.00 $0.00A6533 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 12 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

A6534 0.00 0.00 0.00 0.00 $0.00 $0.00A6535 0.00 0.00 0.00 0.00 $0.00 $0.00A6536 0.00 0.00 0.00 0.00 $0.00 $0.00A6537 0.00 0.00 0.00 0.00 $0.00 $0.00A6538 0.00 0.00 0.00 0.00 $0.00 $0.00A6539 0.00 0.00 0.00 0.00 $0.00 $0.00A6540 0.00 0.00 0.00 0.00 $0.00 $0.00A6541 0.00 0.00 0.00 0.00 $0.00 $0.00A6544 0.00 0.00 0.00 0.00 $0.00 $0.00A6545 0.00 0.00 0.00 0.00 $0.00 $0.00A6549 0.00 0.00 0.00 0.00 $0.00 $0.00A6550 0.00 0.00 0.00 0.00 $0.00 $0.00A7000 0.00 0.00 0.00 0.00 $0.00 $0.00A7001 0.00 0.00 0.00 0.00 $0.00 $0.00A7002 0.00 0.00 0.00 0.00 $0.00 $0.00A7003 0.00 0.00 0.00 0.00 $0.00 $0.00A7004 0.00 0.00 0.00 0.00 $0.00 $0.00A7005 0.00 0.00 0.00 0.00 $0.00 $0.00A7006 0.00 0.00 0.00 0.00 $0.00 $0.00A7007 0.00 0.00 0.00 0.00 $0.00 $0.00A7008 0.00 0.00 0.00 0.00 $0.00 $0.00A7009 0.00 0.00 0.00 0.00 $0.00 $0.00A7010 0.00 0.00 0.00 0.00 $0.00 $0.00A7011 0.00 0.00 0.00 0.00 $0.00 $0.00A7012 0.00 0.00 0.00 0.00 $0.00 $0.00A7013 0.00 0.00 0.00 0.00 $0.00 $0.00A7014 0.00 0.00 0.00 0.00 $0.00 $0.00A7015 0.00 0.00 0.00 0.00 $0.00 $0.00A7016 0.00 0.00 0.00 0.00 $0.00 $0.00A7017 0.00 0.00 0.00 0.00 $0.00 $0.00A7018 0.00 0.00 0.00 0.00 $0.00 $0.00A7020 0.00 0.00 0.00 0.00 $0.00 $0.00A7025 0.00 0.00 0.00 0.00 $0.00 $0.00A7026 0.00 0.00 0.00 0.00 $0.00 $0.00A7027 0.00 0.00 0.00 0.00 $0.00 $0.00A7028 0.00 0.00 0.00 0.00 $0.00 $0.00A7029 0.00 0.00 0.00 0.00 $0.00 $0.00A7030 0.00 0.00 0.00 0.00 $0.00 $0.00A7031 0.00 0.00 0.00 0.00 $0.00 $0.00A7032 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 13 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

A7033 0.00 0.00 0.00 0.00 $0.00 $0.00A7034 0.00 0.00 0.00 0.00 $0.00 $0.00A7035 0.00 0.00 0.00 0.00 $0.00 $0.00A7036 0.00 0.00 0.00 0.00 $0.00 $0.00A7037 0.00 0.00 0.00 0.00 $0.00 $0.00A7038 0.00 0.00 0.00 0.00 $0.00 $0.00A7039 0.00 0.00 0.00 0.00 $0.00 $0.00A7040 0.00 0.00 0.00 0.00 $0.00 $0.00A7041 0.00 0.00 0.00 0.00 $0.00 $0.00A7042 0.00 0.00 0.00 0.00 $0.00 $0.00A7043 0.00 0.00 0.00 0.00 $0.00 $0.00A7044 0.00 0.00 0.00 0.00 $0.00 $0.00A7045 0.00 0.00 0.00 0.00 $0.00 $0.00A7046 0.00 0.00 0.00 0.00 $0.00 $0.00A7501 0.00 0.00 0.00 0.00 $0.00 $0.00A7502 0.00 0.00 0.00 0.00 $0.00 $0.00A7503 0.00 0.00 0.00 0.00 $0.00 $0.00A7504 0.00 0.00 0.00 0.00 $0.00 $0.00A7505 0.00 0.00 0.00 0.00 $0.00 $0.00A7506 0.00 0.00 0.00 0.00 $0.00 $0.00A7507 0.00 0.00 0.00 0.00 $0.00 $0.00A7508 0.00 0.00 0.00 0.00 $0.00 $0.00A7509 0.00 0.00 0.00 0.00 $0.00 $0.00A7520 0.00 0.00 0.00 0.00 $0.00 $0.00A7521 0.00 0.00 0.00 0.00 $0.00 $0.00A7522 0.00 0.00 0.00 0.00 $0.00 $0.00A7523 0.00 0.00 0.00 0.00 $0.00 $0.00A7524 0.00 0.00 0.00 0.00 $0.00 $0.00A7525 0.00 0.00 0.00 0.00 $0.00 $0.00A7526 0.00 0.00 0.00 0.00 $0.00 $0.00A7527 0.00 0.00 0.00 0.00 $0.00 $0.00A8000 0.00 0.00 0.00 0.00 $0.00 $0.00A8001 0.00 0.00 0.00 0.00 $0.00 $0.00A8002 0.00 0.00 0.00 0.00 $0.00 $0.00A8003 0.00 0.00 0.00 0.00 $0.00 $0.00A8004 0.00 0.00 0.00 0.00 $0.00 $0.00A9150 0.00 0.00 0.00 0.00 $0.00 $0.00A9152 0.00 0.00 0.00 0.00 $0.00 $0.00A9153 0.00 0.00 0.00 0.00 $0.00 $0.00A9155 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 14 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

A9180 0.00 0.00 0.00 0.00 $0.00 $0.00A9270 0.00 0.00 0.00 0.00 $0.00 $0.00A9272 0.00 0.00 0.00 0.00 $0.00 $0.00A9273 0.00 0.00 0.00 0.00 $0.00 $0.00A9274 0.00 0.00 0.00 0.00 $0.00 $0.00A9275 0.00 0.00 0.00 0.00 $0.00 $0.00A9276 0.00 0.00 0.00 0.00 $0.00 $0.00A9277 0.00 0.00 0.00 0.00 $0.00 $0.00A9278 0.00 0.00 0.00 0.00 $0.00 $0.00A9279 0.00 0.00 0.00 0.00 $0.00 $0.00A9280 0.00 0.00 0.00 0.00 $0.00 $0.00A9281 0.00 0.00 0.00 0.00 $0.00 $0.00A9282 0.00 0.00 0.00 0.00 $0.00 $0.00A9283 0.00 0.00 0.00 0.00 $0.00 $0.00A9284 0.00 0.00 0.00 0.00 $0.00 $0.00A9300 0.00 0.00 0.00 0.00 $0.00 $0.00A9500 0.00 0.00 0.00 0.00 $0.00 $0.00A9501 0.00 0.00 0.00 0.00 $0.00 $0.00A9502 0.00 0.00 0.00 0.00 $0.00 $0.00A9503 0.00 0.00 0.00 0.00 $0.00 $0.00A9504 0.00 0.00 0.00 0.00 $0.00 $0.00A9505 0.00 0.00 0.00 0.00 $0.00 $0.00A9507 0.00 0.00 0.00 0.00 $0.00 $0.00A9508 0.00 0.00 0.00 0.00 $0.00 $0.00A9509 0.00 0.00 0.00 0.00 $0.00 $0.00A9510 0.00 0.00 0.00 0.00 $0.00 $0.00A9512 0.00 0.00 0.00 0.00 $0.00 $0.00A9516 0.00 0.00 0.00 0.00 $0.00 $0.00A9517 0.00 0.00 0.00 0.00 $0.00 $0.00A9521 0.00 0.00 0.00 0.00 $0.00 $0.00A9524 0.00 0.00 0.00 0.00 $0.00 $0.00A9526 0.00 0.00 0.00 0.00 $0.00 $0.00A9527 0.00 0.00 0.00 0.00 $0.00 $0.00A9528 0.00 0.00 0.00 0.00 $0.00 $0.00A9529 0.00 0.00 0.00 0.00 $0.00 $0.00A9530 0.00 0.00 0.00 0.00 $0.00 $0.00A9531 0.00 0.00 0.00 0.00 $0.00 $0.00A9532 0.00 0.00 0.00 0.00 $0.00 $0.00A9536 0.00 0.00 0.00 0.00 $0.00 $0.00A9537 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 15 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

A9538 0.00 0.00 0.00 0.00 $0.00 $0.00A9539 0.00 0.00 0.00 0.00 $0.00 $0.00A9540 0.00 0.00 0.00 0.00 $0.00 $0.00A9541 0.00 0.00 0.00 0.00 $0.00 $0.00A9542 0.00 0.00 0.00 0.00 $0.00 $0.00A9543 0.00 0.00 0.00 0.00 $0.00 $0.00A9544 0.00 0.00 0.00 0.00 $0.00 $0.00A9545 0.00 0.00 0.00 0.00 $0.00 $0.00A9546 0.00 0.00 0.00 0.00 $0.00 $0.00A9547 0.00 0.00 0.00 0.00 $0.00 $0.00A9548 0.00 0.00 0.00 0.00 $0.00 $0.00A9550 0.00 0.00 0.00 0.00 $0.00 $0.00A9551 0.00 0.00 0.00 0.00 $0.00 $0.00A9552 0.00 0.00 0.00 0.00 $0.00 $0.00A9553 0.00 0.00 0.00 0.00 $0.00 $0.00A9554 0.00 0.00 0.00 0.00 $0.00 $0.00A9555 0.00 0.00 0.00 0.00 $0.00 $0.00A9556 0.00 0.00 0.00 0.00 $0.00 $0.00A9557 0.00 0.00 0.00 0.00 $0.00 $0.00A9558 0.00 0.00 0.00 0.00 $0.00 $0.00A9559 0.00 0.00 0.00 0.00 $0.00 $0.00A9560 0.00 0.00 0.00 0.00 $0.00 $0.00A9561 0.00 0.00 0.00 0.00 $0.00 $0.00A9562 0.00 0.00 0.00 0.00 $0.00 $0.00A9563 0.00 0.00 0.00 0.00 $0.00 $0.00A9564 0.00 0.00 0.00 0.00 $0.00 $0.00A9566 0.00 0.00 0.00 0.00 $0.00 $0.00A9567 0.00 0.00 0.00 0.00 $0.00 $0.00A9568 0.00 0.00 0.00 0.00 $0.00 $0.00A9569 0.00 0.00 0.00 0.00 $0.00 $0.00A9570 0.00 0.00 0.00 0.00 $0.00 $0.00A9571 0.00 0.00 0.00 0.00 $0.00 $0.00A9572 0.00 0.00 0.00 0.00 $0.00 $0.00A9576 0.00 0.00 0.00 0.00 $0.00 $0.00A9577 0.00 0.00 0.00 0.00 $0.00 $0.00A9578 0.00 0.00 0.00 0.00 $0.00 $0.00A9579 0.00 0.00 0.00 0.00 $0.00 $0.00A9580 0.00 0.00 0.00 0.00 $0.00 $0.00A9581 0.00 0.00 0.00 0.00 $0.00 $0.00A9582 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 16 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

A9583 0.00 0.00 0.00 0.00 $0.00 $0.00A9584 0.00 0.00 0.00 0.00 $0.00 $0.00A9585 0.00 0.00 0.00 0.00 $0.00 $0.00A9600 0.00 0.00 0.00 0.00 $0.00 $0.00A9604 0.00 0.00 0.00 0.00 $0.00 $0.00A9698 0.00 0.00 0.00 0.00 $0.00 $0.00A9699 0.00 0.00 0.00 0.00 $0.00 $0.00A9700 0.00 0.00 0.00 0.00 $0.00 $0.00A9900 0.00 0.00 0.00 0.00 $0.00 $0.00A9901 0.00 0.00 0.00 0.00 $0.00 $0.00A9999 0.00 0.00 0.00 0.00 $0.00 $0.00D0120 0.00 0.00 0.00 0.00 $0.00 $0.00D0140 0.00 0.00 0.00 0.00 $0.00 $0.00D0145 0.00 0.00 0.00 0.00 $0.00 $0.00D0150 0.00 0.00 0.00 0.00 $0.00 $0.00D0160 0.00 0.00 0.00 0.00 $0.00 $0.00D0170 0.00 0.00 0.00 0.00 $0.00 $0.00D0180 0.00 0.00 0.00 0.00 $0.00 $0.00D0210 0.00 0.00 0.00 0.00 $0.00 $0.00D0220 0.00 0.00 0.00 0.00 $0.00 $0.00D0230 0.00 0.00 0.00 0.00 $0.00 $0.00D0240 0.00 0.00 0.00 0.00 $0.00 $0.00D0250 0.00 0.00 0.00 0.00 $0.00 $0.00D0260 0.00 0.00 0.00 0.00 $0.00 $0.00D0270 0.00 0.00 0.00 0.00 $0.00 $0.00D0272 0.00 0.00 0.00 0.00 $0.00 $0.00D0273 0.00 0.00 0.00 0.00 $0.00 $0.00D0274 0.00 0.00 0.00 0.00 $0.00 $0.00D0277 0.00 0.00 0.00 0.00 $0.00 $0.00D0290 0.00 0.00 0.00 0.00 $0.00 $0.00D0310 0.00 0.00 0.00 0.00 $0.00 $0.00D0320 0.00 0.00 0.00 0.00 $0.00 $0.00D0321 0.00 0.00 0.00 0.00 $0.00 $0.00D0322 0.00 0.00 0.00 0.00 $0.00 $0.00D0330 0.00 0.00 0.00 0.00 $0.00 $0.00D0340 0.00 0.00 0.00 0.00 $0.00 $0.00D0350 0.00 0.00 0.00 0.00 $0.00 $0.00D0360 0.00 0.00 0.00 0.00 $0.00 $0.00D0362 0.00 0.00 0.00 0.00 $0.00 $0.00D0363 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 17 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

D0415 0.00 0.00 0.00 0.00 $0.00 $0.00D0416 0.00 0.00 0.00 0.00 $0.00 $0.00D0417 0.00 0.00 0.00 0.00 $0.00 $0.00D0418 0.00 0.00 0.00 0.00 $0.00 $0.00D0421 0.00 0.00 0.00 0.00 $0.00 $0.00D0425 0.00 0.00 0.00 0.00 $0.00 $0.00D0431 0.00 0.00 0.00 0.00 $0.00 $0.00D0460 0.00 0.00 0.00 0.00 $0.00 $0.00D0470 0.00 0.00 0.00 0.00 $0.00 $0.00D0472 0.00 0.00 0.00 0.00 $0.00 $0.00D0473 0.00 0.00 0.00 0.00 $0.00 $0.00D0474 0.00 0.00 0.00 0.00 $0.00 $0.00D0475 0.00 0.00 0.00 0.00 $0.00 $0.00D0476 0.00 0.00 0.00 0.00 $0.00 $0.00D0477 0.00 0.00 0.00 0.00 $0.00 $0.00D0478 0.00 0.00 0.00 0.00 $0.00 $0.00D0479 0.00 0.00 0.00 0.00 $0.00 $0.00D0480 0.00 0.00 0.00 0.00 $0.00 $0.00D0481 0.00 0.00 0.00 0.00 $0.00 $0.00D0482 0.00 0.00 0.00 0.00 $0.00 $0.00D0483 0.00 0.00 0.00 0.00 $0.00 $0.00D0484 0.00 0.00 0.00 0.00 $0.00 $0.00D0485 0.00 0.00 0.00 0.00 $0.00 $0.00D0486 0.00 0.00 0.00 0.00 $0.00 $0.00D0502 0.00 0.00 0.00 0.00 $0.00 $0.00D0999 0.00 0.00 0.00 0.00 $0.00 $0.00D1110 0.00 0.00 0.00 0.00 $0.00 $0.00D1120 0.00 0.00 0.00 0.00 $0.00 $0.00D1203 0.00 0.00 0.00 0.00 $0.00 $0.00D1204 0.00 0.00 0.00 0.00 $0.00 $0.00D1206 0.00 0.00 0.00 0.00 $0.00 $0.00D1310 0.00 0.00 0.00 0.00 $0.00 $0.00D1320 0.00 0.00 0.00 0.00 $0.00 $0.00D1330 0.00 0.00 0.00 0.00 $0.00 $0.00D1351 0.00 0.00 0.00 0.00 $0.00 $0.00D1352 0.00 0.00 0.00 0.00 $0.00 $0.00D1510 0.00 0.00 0.00 0.00 $0.00 $0.00D1515 0.00 0.00 0.00 0.00 $0.00 $0.00D1520 0.00 0.00 0.00 0.00 $0.00 $0.00D1525 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 18 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

D1550 0.00 0.00 0.00 0.00 $0.00 $0.00D1555 0.00 0.00 0.00 0.00 $0.00 $0.00D2140 0.00 0.00 0.00 0.00 $0.00 $0.00D2150 0.00 0.00 0.00 0.00 $0.00 $0.00D2160 0.00 0.00 0.00 0.00 $0.00 $0.00D2161 0.00 0.00 0.00 0.00 $0.00 $0.00D2330 0.00 0.00 0.00 0.00 $0.00 $0.00D2331 0.00 0.00 0.00 0.00 $0.00 $0.00D2332 0.00 0.00 0.00 0.00 $0.00 $0.00D2335 0.00 0.00 0.00 0.00 $0.00 $0.00D2390 0.00 0.00 0.00 0.00 $0.00 $0.00D2391 0.00 0.00 0.00 0.00 $0.00 $0.00D2392 0.00 0.00 0.00 0.00 $0.00 $0.00D2393 0.00 0.00 0.00 0.00 $0.00 $0.00D2394 0.00 0.00 0.00 0.00 $0.00 $0.00D2410 0.00 0.00 0.00 0.00 $0.00 $0.00D2420 0.00 0.00 0.00 0.00 $0.00 $0.00D2430 0.00 0.00 0.00 0.00 $0.00 $0.00D2510 0.00 0.00 0.00 0.00 $0.00 $0.00D2520 0.00 0.00 0.00 0.00 $0.00 $0.00D2530 0.00 0.00 0.00 0.00 $0.00 $0.00D2542 0.00 0.00 0.00 0.00 $0.00 $0.00D2543 0.00 0.00 0.00 0.00 $0.00 $0.00D2544 0.00 0.00 0.00 0.00 $0.00 $0.00D2610 0.00 0.00 0.00 0.00 $0.00 $0.00D2620 0.00 0.00 0.00 0.00 $0.00 $0.00D2630 0.00 0.00 0.00 0.00 $0.00 $0.00D2642 0.00 0.00 0.00 0.00 $0.00 $0.00D2643 0.00 0.00 0.00 0.00 $0.00 $0.00D2644 0.00 0.00 0.00 0.00 $0.00 $0.00D2650 0.00 0.00 0.00 0.00 $0.00 $0.00D2651 0.00 0.00 0.00 0.00 $0.00 $0.00D2652 0.00 0.00 0.00 0.00 $0.00 $0.00D2662 0.00 0.00 0.00 0.00 $0.00 $0.00D2663 0.00 0.00 0.00 0.00 $0.00 $0.00D2664 0.00 0.00 0.00 0.00 $0.00 $0.00D2710 0.00 0.00 0.00 0.00 $0.00 $0.00D2712 0.00 0.00 0.00 0.00 $0.00 $0.00D2720 0.00 0.00 0.00 0.00 $0.00 $0.00D2721 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 19 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

D2722 0.00 0.00 0.00 0.00 $0.00 $0.00D2740 0.00 0.00 0.00 0.00 $0.00 $0.00D2750 0.00 0.00 0.00 0.00 $0.00 $0.00D2751 0.00 0.00 0.00 0.00 $0.00 $0.00D2752 0.00 0.00 0.00 0.00 $0.00 $0.00D2780 0.00 0.00 0.00 0.00 $0.00 $0.00D2781 0.00 0.00 0.00 0.00 $0.00 $0.00D2782 0.00 0.00 0.00 0.00 $0.00 $0.00D2783 0.00 0.00 0.00 0.00 $0.00 $0.00D2790 0.00 0.00 0.00 0.00 $0.00 $0.00D2791 0.00 0.00 0.00 0.00 $0.00 $0.00D2792 0.00 0.00 0.00 0.00 $0.00 $0.00D2794 0.00 0.00 0.00 0.00 $0.00 $0.00D2799 0.00 0.00 0.00 0.00 $0.00 $0.00D2910 0.00 0.00 0.00 0.00 $0.00 $0.00D2915 0.00 0.00 0.00 0.00 $0.00 $0.00D2920 0.00 0.00 0.00 0.00 $0.00 $0.00D2930 0.00 0.00 0.00 0.00 $0.00 $0.00D2931 0.00 0.00 0.00 0.00 $0.00 $0.00D2932 0.00 0.00 0.00 0.00 $0.00 $0.00D2933 0.00 0.00 0.00 0.00 $0.00 $0.00D2934 0.00 0.00 0.00 0.00 $0.00 $0.00D2940 0.00 0.00 0.00 0.00 $0.00 $0.00D2950 0.00 0.00 0.00 0.00 $0.00 $0.00D2951 0.00 0.00 0.00 0.00 $0.00 $0.00D2952 0.00 0.00 0.00 0.00 $0.00 $0.00D2953 0.00 0.00 0.00 0.00 $0.00 $0.00D2954 0.00 0.00 0.00 0.00 $0.00 $0.00D2955 0.00 0.00 0.00 0.00 $0.00 $0.00D2957 0.00 0.00 0.00 0.00 $0.00 $0.00D2960 0.00 0.00 0.00 0.00 $0.00 $0.00D2961 0.00 0.00 0.00 0.00 $0.00 $0.00D2962 0.00 0.00 0.00 0.00 $0.00 $0.00D2970 0.00 0.00 0.00 0.00 $0.00 $0.00D2971 0.00 0.00 0.00 0.00 $0.00 $0.00D2975 0.00 0.00 0.00 0.00 $0.00 $0.00D2980 0.00 0.00 0.00 0.00 $0.00 $0.00D2999 0.00 0.00 0.00 0.00 $0.00 $0.00D3110 0.00 0.00 0.00 0.00 $0.00 $0.00D3120 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 20 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

D3220 0.00 0.00 0.00 0.00 $0.00 $0.00D3221 0.00 0.00 0.00 0.00 $0.00 $0.00D3222 0.00 0.00 0.00 0.00 $0.00 $0.00D3230 0.00 0.00 0.00 0.00 $0.00 $0.00D3240 0.00 0.00 0.00 0.00 $0.00 $0.00D3310 0.00 0.00 0.00 0.00 $0.00 $0.00D3320 0.00 0.00 0.00 0.00 $0.00 $0.00D3330 0.00 0.00 0.00 0.00 $0.00 $0.00D3331 0.00 0.00 0.00 0.00 $0.00 $0.00D3332 0.00 0.00 0.00 0.00 $0.00 $0.00D3333 0.00 0.00 0.00 0.00 $0.00 $0.00D3346 0.00 0.00 0.00 0.00 $0.00 $0.00D3347 0.00 0.00 0.00 0.00 $0.00 $0.00D3348 0.00 0.00 0.00 0.00 $0.00 $0.00D3351 0.00 0.00 0.00 0.00 $0.00 $0.00D3352 0.00 0.00 0.00 0.00 $0.00 $0.00D3353 0.00 0.00 0.00 0.00 $0.00 $0.00D3354 0.00 0.00 0.00 0.00 $0.00 $0.00D3410 0.00 0.00 0.00 0.00 $0.00 $0.00D3421 0.00 0.00 0.00 0.00 $0.00 $0.00D3425 0.00 0.00 0.00 0.00 $0.00 $0.00D3426 0.00 0.00 0.00 0.00 $0.00 $0.00D3430 0.00 0.00 0.00 0.00 $0.00 $0.00D3450 0.00 0.00 0.00 0.00 $0.00 $0.00D3460 0.00 0.00 0.00 0.00 $0.00 $0.00D3470 0.00 0.00 0.00 0.00 $0.00 $0.00D3910 0.00 0.00 0.00 0.00 $0.00 $0.00D3920 0.00 0.00 0.00 0.00 $0.00 $0.00D3950 0.00 0.00 0.00 0.00 $0.00 $0.00D3999 0.00 0.00 0.00 0.00 $0.00 $0.00D4210 0.00 0.00 0.00 0.00 $0.00 $0.00D4211 0.00 0.00 0.00 0.00 $0.00 $0.00D4230 0.00 0.00 0.00 0.00 $0.00 $0.00D4231 0.00 0.00 0.00 0.00 $0.00 $0.00D4240 0.00 0.00 0.00 0.00 $0.00 $0.00D4241 0.00 0.00 0.00 0.00 $0.00 $0.00D4245 0.00 0.00 0.00 0.00 $0.00 $0.00D4249 0.00 0.00 0.00 0.00 $0.00 $0.00D4260 0.00 0.00 0.00 0.00 $0.00 $0.00D4261 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 21 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

D4263 0.00 0.00 0.00 0.00 $0.00 $0.00D4264 0.00 0.00 0.00 0.00 $0.00 $0.00D4265 0.00 0.00 0.00 0.00 $0.00 $0.00D4266 0.00 0.00 0.00 0.00 $0.00 $0.00D4267 0.00 0.00 0.00 0.00 $0.00 $0.00D4268 0.00 0.00 0.00 0.00 $0.00 $0.00D4270 0.00 0.00 0.00 0.00 $0.00 $0.00D4271 0.00 0.00 0.00 0.00 $0.00 $0.00D4273 0.00 0.00 0.00 0.00 $0.00 $0.00D4274 0.00 0.00 0.00 0.00 $0.00 $0.00D4275 0.00 0.00 0.00 0.00 $0.00 $0.00D4276 0.00 0.00 0.00 0.00 $0.00 $0.00D4320 0.00 0.00 0.00 0.00 $0.00 $0.00D4321 0.00 0.00 0.00 0.00 $0.00 $0.00D4341 0.00 0.00 0.00 0.00 $0.00 $0.00D4342 0.00 0.00 0.00 0.00 $0.00 $0.00D4355 0.00 0.00 0.00 0.00 $0.00 $0.00D4381 0.00 0.00 0.00 0.00 $0.00 $0.00D4910 0.00 0.00 0.00 0.00 $0.00 $0.00D4920 0.00 0.00 0.00 0.00 $0.00 $0.00D4999 0.00 0.00 0.00 0.00 $0.00 $0.00D5110 0.00 0.00 0.00 0.00 $0.00 $0.00D5120 0.00 0.00 0.00 0.00 $0.00 $0.00D5130 0.00 0.00 0.00 0.00 $0.00 $0.00D5140 0.00 0.00 0.00 0.00 $0.00 $0.00D5211 0.00 0.00 0.00 0.00 $0.00 $0.00D5212 0.00 0.00 0.00 0.00 $0.00 $0.00D5213 0.00 0.00 0.00 0.00 $0.00 $0.00D5214 0.00 0.00 0.00 0.00 $0.00 $0.00D5225 0.00 0.00 0.00 0.00 $0.00 $0.00D5226 0.00 0.00 0.00 0.00 $0.00 $0.00D5281 0.00 0.00 0.00 0.00 $0.00 $0.00D5410 0.00 0.00 0.00 0.00 $0.00 $0.00D5411 0.00 0.00 0.00 0.00 $0.00 $0.00D5421 0.00 0.00 0.00 0.00 $0.00 $0.00D5422 0.00 0.00 0.00 0.00 $0.00 $0.00D5510 0.00 0.00 0.00 0.00 $0.00 $0.00D5520 0.00 0.00 0.00 0.00 $0.00 $0.00D5610 0.00 0.00 0.00 0.00 $0.00 $0.00D5620 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 22 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

D5630 0.00 0.00 0.00 0.00 $0.00 $0.00D5640 0.00 0.00 0.00 0.00 $0.00 $0.00D5650 0.00 0.00 0.00 0.00 $0.00 $0.00D5660 0.00 0.00 0.00 0.00 $0.00 $0.00D5670 0.00 0.00 0.00 0.00 $0.00 $0.00D5671 0.00 0.00 0.00 0.00 $0.00 $0.00D5710 0.00 0.00 0.00 0.00 $0.00 $0.00D5711 0.00 0.00 0.00 0.00 $0.00 $0.00D5720 0.00 0.00 0.00 0.00 $0.00 $0.00D5721 0.00 0.00 0.00 0.00 $0.00 $0.00D5730 0.00 0.00 0.00 0.00 $0.00 $0.00D5731 0.00 0.00 0.00 0.00 $0.00 $0.00D5740 0.00 0.00 0.00 0.00 $0.00 $0.00D5741 0.00 0.00 0.00 0.00 $0.00 $0.00D5750 0.00 0.00 0.00 0.00 $0.00 $0.00D5751 0.00 0.00 0.00 0.00 $0.00 $0.00D5760 0.00 0.00 0.00 0.00 $0.00 $0.00D5761 0.00 0.00 0.00 0.00 $0.00 $0.00D5810 0.00 0.00 0.00 0.00 $0.00 $0.00D5811 0.00 0.00 0.00 0.00 $0.00 $0.00D5820 0.00 0.00 0.00 0.00 $0.00 $0.00D5821 0.00 0.00 0.00 0.00 $0.00 $0.00D5850 0.00 0.00 0.00 0.00 $0.00 $0.00D5851 0.00 0.00 0.00 0.00 $0.00 $0.00D5860 0.00 0.00 0.00 0.00 $0.00 $0.00D5861 0.00 0.00 0.00 0.00 $0.00 $0.00D5862 0.00 0.00 0.00 0.00 $0.00 $0.00D5867 0.00 0.00 0.00 0.00 $0.00 $0.00D5875 0.00 0.00 0.00 0.00 $0.00 $0.00D5899 0.00 0.00 0.00 0.00 $0.00 $0.00D5911 0.00 0.00 0.00 0.00 $0.00 $0.00D5912 0.00 0.00 0.00 0.00 $0.00 $0.00D5913 0.00 0.00 0.00 0.00 $0.00 $0.00D5914 0.00 0.00 0.00 0.00 $0.00 $0.00D5915 0.00 0.00 0.00 0.00 $0.00 $0.00D5916 0.00 0.00 0.00 0.00 $0.00 $0.00D5919 0.00 0.00 0.00 0.00 $0.00 $0.00D5922 0.00 0.00 0.00 0.00 $0.00 $0.00D5923 0.00 0.00 0.00 0.00 $0.00 $0.00D5924 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 23 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

D5925 0.00 0.00 0.00 0.00 $0.00 $0.00D5926 0.00 0.00 0.00 0.00 $0.00 $0.00D5927 0.00 0.00 0.00 0.00 $0.00 $0.00D5928 0.00 0.00 0.00 0.00 $0.00 $0.00D5929 0.00 0.00 0.00 0.00 $0.00 $0.00D5931 0.00 0.00 0.00 0.00 $0.00 $0.00D5932 0.00 0.00 0.00 0.00 $0.00 $0.00D5933 0.00 0.00 0.00 0.00 $0.00 $0.00D5934 0.00 0.00 0.00 0.00 $0.00 $0.00D5935 0.00 0.00 0.00 0.00 $0.00 $0.00D5936 0.00 0.00 0.00 0.00 $0.00 $0.00D5937 0.00 0.00 0.00 0.00 $0.00 $0.00D5951 0.00 0.00 0.00 0.00 $0.00 $0.00D5952 0.00 0.00 0.00 0.00 $0.00 $0.00D5953 0.00 0.00 0.00 0.00 $0.00 $0.00D5954 0.00 0.00 0.00 0.00 $0.00 $0.00D5955 0.00 0.00 0.00 0.00 $0.00 $0.00D5958 0.00 0.00 0.00 0.00 $0.00 $0.00D5959 0.00 0.00 0.00 0.00 $0.00 $0.00D5960 0.00 0.00 0.00 0.00 $0.00 $0.00D5982 0.00 0.00 0.00 0.00 $0.00 $0.00D5983 0.00 0.00 0.00 0.00 $0.00 $0.00D5984 0.00 0.00 0.00 0.00 $0.00 $0.00D5985 0.00 0.00 0.00 0.00 $0.00 $0.00D5986 0.00 0.00 0.00 0.00 $0.00 $0.00D5987 0.00 0.00 0.00 0.00 $0.00 $0.00D5988 0.00 0.00 0.00 0.00 $0.00 $0.00D5991 0.00 0.00 0.00 0.00 $0.00 $0.00D5992 0.00 0.00 0.00 0.00 $0.00 $0.00D5993 0.00 0.00 0.00 0.00 $0.00 $0.00D5999 0.00 0.00 0.00 0.00 $0.00 $0.00D6010 0.00 0.00 0.00 0.00 $0.00 $0.00D6012 0.00 0.00 0.00 0.00 $0.00 $0.00D6040 0.00 0.00 0.00 0.00 $0.00 $0.00D6050 0.00 0.00 0.00 0.00 $0.00 $0.00D6053 0.00 0.00 0.00 0.00 $0.00 $0.00D6054 0.00 0.00 0.00 0.00 $0.00 $0.00D6055 0.00 0.00 0.00 0.00 $0.00 $0.00D6056 0.00 0.00 0.00 0.00 $0.00 $0.00D6057 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 24 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

D6058 0.00 0.00 0.00 0.00 $0.00 $0.00D6059 0.00 0.00 0.00 0.00 $0.00 $0.00D6060 0.00 0.00 0.00 0.00 $0.00 $0.00D6061 0.00 0.00 0.00 0.00 $0.00 $0.00D6062 0.00 0.00 0.00 0.00 $0.00 $0.00D6063 0.00 0.00 0.00 0.00 $0.00 $0.00D6064 0.00 0.00 0.00 0.00 $0.00 $0.00D6065 0.00 0.00 0.00 0.00 $0.00 $0.00D6066 0.00 0.00 0.00 0.00 $0.00 $0.00D6067 0.00 0.00 0.00 0.00 $0.00 $0.00D6068 0.00 0.00 0.00 0.00 $0.00 $0.00D6069 0.00 0.00 0.00 0.00 $0.00 $0.00D6070 0.00 0.00 0.00 0.00 $0.00 $0.00D6071 0.00 0.00 0.00 0.00 $0.00 $0.00D6072 0.00 0.00 0.00 0.00 $0.00 $0.00D6073 0.00 0.00 0.00 0.00 $0.00 $0.00D6074 0.00 0.00 0.00 0.00 $0.00 $0.00D6075 0.00 0.00 0.00 0.00 $0.00 $0.00D6076 0.00 0.00 0.00 0.00 $0.00 $0.00D6077 0.00 0.00 0.00 0.00 $0.00 $0.00D6078 0.00 0.00 0.00 0.00 $0.00 $0.00D6079 0.00 0.00 0.00 0.00 $0.00 $0.00D6080 0.00 0.00 0.00 0.00 $0.00 $0.00D6090 0.00 0.00 0.00 0.00 $0.00 $0.00D6091 0.00 0.00 0.00 0.00 $0.00 $0.00D6092 0.00 0.00 0.00 0.00 $0.00 $0.00D6093 0.00 0.00 0.00 0.00 $0.00 $0.00D6094 0.00 0.00 0.00 0.00 $0.00 $0.00D6095 0.00 0.00 0.00 0.00 $0.00 $0.00D6100 0.00 0.00 0.00 0.00 $0.00 $0.00D6190 0.00 0.00 0.00 0.00 $0.00 $0.00D6194 0.00 0.00 0.00 0.00 $0.00 $0.00D6199 0.00 0.00 0.00 0.00 $0.00 $0.00D6205 0.00 0.00 0.00 0.00 $0.00 $0.00D6210 0.00 0.00 0.00 0.00 $0.00 $0.00D6211 0.00 0.00 0.00 0.00 $0.00 $0.00D6212 0.00 0.00 0.00 0.00 $0.00 $0.00D6214 0.00 0.00 0.00 0.00 $0.00 $0.00D6240 0.00 0.00 0.00 0.00 $0.00 $0.00D6241 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 25 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

D6242 0.00 0.00 0.00 0.00 $0.00 $0.00D6245 0.00 0.00 0.00 0.00 $0.00 $0.00D6250 0.00 0.00 0.00 0.00 $0.00 $0.00D6251 0.00 0.00 0.00 0.00 $0.00 $0.00D6252 0.00 0.00 0.00 0.00 $0.00 $0.00D6253 0.00 0.00 0.00 0.00 $0.00 $0.00D6254 0.00 0.00 0.00 0.00 $0.00 $0.00D6545 0.00 0.00 0.00 0.00 $0.00 $0.00D6548 0.00 0.00 0.00 0.00 $0.00 $0.00D6600 0.00 0.00 0.00 0.00 $0.00 $0.00D6601 0.00 0.00 0.00 0.00 $0.00 $0.00D6602 0.00 0.00 0.00 0.00 $0.00 $0.00D6603 0.00 0.00 0.00 0.00 $0.00 $0.00D6604 0.00 0.00 0.00 0.00 $0.00 $0.00D6605 0.00 0.00 0.00 0.00 $0.00 $0.00D6606 0.00 0.00 0.00 0.00 $0.00 $0.00D6607 0.00 0.00 0.00 0.00 $0.00 $0.00D6608 0.00 0.00 0.00 0.00 $0.00 $0.00D6609 0.00 0.00 0.00 0.00 $0.00 $0.00D6610 0.00 0.00 0.00 0.00 $0.00 $0.00D6611 0.00 0.00 0.00 0.00 $0.00 $0.00D6612 0.00 0.00 0.00 0.00 $0.00 $0.00D6613 0.00 0.00 0.00 0.00 $0.00 $0.00D6614 0.00 0.00 0.00 0.00 $0.00 $0.00D6615 0.00 0.00 0.00 0.00 $0.00 $0.00D6624 0.00 0.00 0.00 0.00 $0.00 $0.00D6634 0.00 0.00 0.00 0.00 $0.00 $0.00D6710 0.00 0.00 0.00 0.00 $0.00 $0.00D6720 0.00 0.00 0.00 0.00 $0.00 $0.00D6721 0.00 0.00 0.00 0.00 $0.00 $0.00D6722 0.00 0.00 0.00 0.00 $0.00 $0.00D6740 0.00 0.00 0.00 0.00 $0.00 $0.00D6750 0.00 0.00 0.00 0.00 $0.00 $0.00D6751 0.00 0.00 0.00 0.00 $0.00 $0.00D6752 0.00 0.00 0.00 0.00 $0.00 $0.00D6780 0.00 0.00 0.00 0.00 $0.00 $0.00D6781 0.00 0.00 0.00 0.00 $0.00 $0.00D6782 0.00 0.00 0.00 0.00 $0.00 $0.00D6783 0.00 0.00 0.00 0.00 $0.00 $0.00D6790 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 26 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

D6791 0.00 0.00 0.00 0.00 $0.00 $0.00D6792 0.00 0.00 0.00 0.00 $0.00 $0.00D6793 0.00 0.00 0.00 0.00 $0.00 $0.00D6794 0.00 0.00 0.00 0.00 $0.00 $0.00D6795 0.00 0.00 0.00 0.00 $0.00 $0.00D6920 0.00 0.00 0.00 0.00 $0.00 $0.00D6930 0.00 0.00 0.00 0.00 $0.00 $0.00D6940 0.00 0.00 0.00 0.00 $0.00 $0.00D6950 0.00 0.00 0.00 0.00 $0.00 $0.00D6970 0.00 0.00 0.00 0.00 $0.00 $0.00D6972 0.00 0.00 0.00 0.00 $0.00 $0.00D6973 0.00 0.00 0.00 0.00 $0.00 $0.00D6975 0.00 0.00 0.00 0.00 $0.00 $0.00D6976 0.00 0.00 0.00 0.00 $0.00 $0.00D6977 0.00 0.00 0.00 0.00 $0.00 $0.00D6980 0.00 0.00 0.00 0.00 $0.00 $0.00D6985 0.00 0.00 0.00 0.00 $0.00 $0.00D6999 0.00 0.00 0.00 0.00 $0.00 $0.00D7111 0.00 0.00 0.00 0.00 $0.00 $0.00D7140 0.00 0.00 0.00 0.00 $0.00 $0.00D7210 0.00 0.00 0.00 0.00 $0.00 $0.00D7220 0.00 0.00 0.00 0.00 $0.00 $0.00D7230 0.00 0.00 0.00 0.00 $0.00 $0.00D7240 0.00 0.00 0.00 0.00 $0.00 $0.00D7241 0.00 0.00 0.00 0.00 $0.00 $0.00D7250 0.00 0.00 0.00 0.00 $0.00 $0.00D7251 0.00 0.00 0.00 0.00 $0.00 $0.00D7260 0.00 0.00 0.00 0.00 $0.00 $0.00D7261 0.00 0.00 0.00 0.00 $0.00 $0.00D7270 0.00 0.00 0.00 0.00 $0.00 $0.00D7272 0.00 0.00 0.00 0.00 $0.00 $0.00D7280 0.00 0.00 0.00 0.00 $0.00 $0.00D7282 0.00 0.00 0.00 0.00 $0.00 $0.00D7283 0.00 0.00 0.00 0.00 $0.00 $0.00D7285 0.00 0.00 0.00 0.00 $0.00 $0.00D7286 0.00 0.00 0.00 0.00 $0.00 $0.00D7287 0.00 0.00 0.00 0.00 $0.00 $0.00D7288 0.00 0.00 0.00 0.00 $0.00 $0.00D7290 0.00 0.00 0.00 0.00 $0.00 $0.00D7291 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 27 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

D7292 0.00 0.00 0.00 0.00 $0.00 $0.00D7293 0.00 0.00 0.00 0.00 $0.00 $0.00D7294 0.00 0.00 0.00 0.00 $0.00 $0.00D7295 0.00 0.00 0.00 0.00 $0.00 $0.00D7310 0.00 0.00 0.00 0.00 $0.00 $0.00D7311 0.00 0.00 0.00 0.00 $0.00 $0.00D7320 0.00 0.00 0.00 0.00 $0.00 $0.00D7321 0.00 0.00 0.00 0.00 $0.00 $0.00D7340 0.00 0.00 0.00 0.00 $0.00 $0.00D7350 0.00 0.00 0.00 0.00 $0.00 $0.00D7410 0.00 0.00 0.00 0.00 $0.00 $0.00D7411 0.00 0.00 0.00 0.00 $0.00 $0.00D7412 0.00 0.00 0.00 0.00 $0.00 $0.00D7413 0.00 0.00 0.00 0.00 $0.00 $0.00D7414 0.00 0.00 0.00 0.00 $0.00 $0.00D7415 0.00 0.00 0.00 0.00 $0.00 $0.00D7440 0.00 0.00 0.00 0.00 $0.00 $0.00D7441 0.00 0.00 0.00 0.00 $0.00 $0.00D7450 0.00 0.00 0.00 0.00 $0.00 $0.00D7451 0.00 0.00 0.00 0.00 $0.00 $0.00D7460 0.00 0.00 0.00 0.00 $0.00 $0.00D7461 0.00 0.00 0.00 0.00 $0.00 $0.00D7465 0.00 0.00 0.00 0.00 $0.00 $0.00D7471 0.00 0.00 0.00 0.00 $0.00 $0.00D7472 0.00 0.00 0.00 0.00 $0.00 $0.00D7473 0.00 0.00 0.00 0.00 $0.00 $0.00D7485 0.00 0.00 0.00 0.00 $0.00 $0.00D7490 0.00 0.00 0.00 0.00 $0.00 $0.00D7510 0.00 0.00 0.00 0.00 $0.00 $0.00D7511 0.00 0.00 0.00 0.00 $0.00 $0.00D7520 0.00 0.00 0.00 0.00 $0.00 $0.00D7521 0.00 0.00 0.00 0.00 $0.00 $0.00D7530 0.00 0.00 0.00 0.00 $0.00 $0.00D7540 0.00 0.00 0.00 0.00 $0.00 $0.00D7550 0.00 0.00 0.00 0.00 $0.00 $0.00D7560 0.00 0.00 0.00 0.00 $0.00 $0.00D7610 0.00 0.00 0.00 0.00 $0.00 $0.00D7620 0.00 0.00 0.00 0.00 $0.00 $0.00D7630 0.00 0.00 0.00 0.00 $0.00 $0.00D7640 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 28 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

D7650 0.00 0.00 0.00 0.00 $0.00 $0.00D7660 0.00 0.00 0.00 0.00 $0.00 $0.00D7670 0.00 0.00 0.00 0.00 $0.00 $0.00D7671 0.00 0.00 0.00 0.00 $0.00 $0.00D7680 0.00 0.00 0.00 0.00 $0.00 $0.00D7710 0.00 0.00 0.00 0.00 $0.00 $0.00D7720 0.00 0.00 0.00 0.00 $0.00 $0.00D7730 0.00 0.00 0.00 0.00 $0.00 $0.00D7740 0.00 0.00 0.00 0.00 $0.00 $0.00D7750 0.00 0.00 0.00 0.00 $0.00 $0.00D7760 0.00 0.00 0.00 0.00 $0.00 $0.00D7770 0.00 0.00 0.00 0.00 $0.00 $0.00D7771 0.00 0.00 0.00 0.00 $0.00 $0.00D7780 0.00 0.00 0.00 0.00 $0.00 $0.00D7810 0.00 0.00 0.00 0.00 $0.00 $0.00D7820 0.00 0.00 0.00 0.00 $0.00 $0.00D7830 0.00 0.00 0.00 0.00 $0.00 $0.00D7840 0.00 0.00 0.00 0.00 $0.00 $0.00D7850 0.00 0.00 0.00 0.00 $0.00 $0.00D7852 0.00 0.00 0.00 0.00 $0.00 $0.00D7854 0.00 0.00 0.00 0.00 $0.00 $0.00D7856 0.00 0.00 0.00 0.00 $0.00 $0.00D7858 0.00 0.00 0.00 0.00 $0.00 $0.00D7860 0.00 0.00 0.00 0.00 $0.00 $0.00D7865 0.00 0.00 0.00 0.00 $0.00 $0.00D7870 0.00 0.00 0.00 0.00 $0.00 $0.00D7871 0.00 0.00 0.00 0.00 $0.00 $0.00D7872 0.00 0.00 0.00 0.00 $0.00 $0.00D7873 0.00 0.00 0.00 0.00 $0.00 $0.00D7874 0.00 0.00 0.00 0.00 $0.00 $0.00D7875 0.00 0.00 0.00 0.00 $0.00 $0.00D7876 0.00 0.00 0.00 0.00 $0.00 $0.00D7877 0.00 0.00 0.00 0.00 $0.00 $0.00D7880 0.00 0.00 0.00 0.00 $0.00 $0.00D7899 0.00 0.00 0.00 0.00 $0.00 $0.00D7910 0.00 0.00 0.00 0.00 $0.00 $0.00D7911 0.00 0.00 0.00 0.00 $0.00 $0.00D7912 0.00 0.00 0.00 0.00 $0.00 $0.00D7920 0.00 0.00 0.00 0.00 $0.00 $0.00D7940 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 29 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

D7941 0.00 0.00 0.00 0.00 $0.00 $0.00D7943 0.00 0.00 0.00 0.00 $0.00 $0.00D7944 0.00 0.00 0.00 0.00 $0.00 $0.00D7945 0.00 0.00 0.00 0.00 $0.00 $0.00D7946 0.00 0.00 0.00 0.00 $0.00 $0.00D7947 0.00 0.00 0.00 0.00 $0.00 $0.00D7948 0.00 0.00 0.00 0.00 $0.00 $0.00D7949 0.00 0.00 0.00 0.00 $0.00 $0.00D7950 0.00 0.00 0.00 0.00 $0.00 $0.00D7951 0.00 0.00 0.00 0.00 $0.00 $0.00D7953 0.00 0.00 0.00 0.00 $0.00 $0.00D7955 0.00 0.00 0.00 0.00 $0.00 $0.00D7960 0.00 0.00 0.00 0.00 $0.00 $0.00D7963 0.00 0.00 0.00 0.00 $0.00 $0.00D7970 0.00 0.00 0.00 0.00 $0.00 $0.00D7971 0.00 0.00 0.00 0.00 $0.00 $0.00D7972 0.00 0.00 0.00 0.00 $0.00 $0.00D7980 0.00 0.00 0.00 0.00 $0.00 $0.00D7981 0.00 0.00 0.00 0.00 $0.00 $0.00D7982 0.00 0.00 0.00 0.00 $0.00 $0.00D7983 0.00 0.00 0.00 0.00 $0.00 $0.00D7990 0.00 0.00 0.00 0.00 $0.00 $0.00D7991 0.00 0.00 0.00 0.00 $0.00 $0.00D7995 0.00 0.00 0.00 0.00 $0.00 $0.00D7996 0.00 0.00 0.00 0.00 $0.00 $0.00D7997 0.00 0.00 0.00 0.00 $0.00 $0.00D7998 0.00 0.00 0.00 0.00 $0.00 $0.00D7999 0.00 0.00 0.00 0.00 $0.00 $0.00D8010 0.00 0.00 0.00 0.00 $0.00 $0.00D8020 0.00 0.00 0.00 0.00 $0.00 $0.00D8030 0.00 0.00 0.00 0.00 $0.00 $0.00D8040 0.00 0.00 0.00 0.00 $0.00 $0.00D8050 0.00 0.00 0.00 0.00 $0.00 $0.00D8060 0.00 0.00 0.00 0.00 $0.00 $0.00D8070 0.00 0.00 0.00 0.00 $0.00 $0.00D8080 0.00 0.00 0.00 0.00 $0.00 $0.00D8090 0.00 0.00 0.00 0.00 $0.00 $0.00D8210 0.00 0.00 0.00 0.00 $0.00 $0.00D8220 0.00 0.00 0.00 0.00 $0.00 $0.00D8660 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 30 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

D8670 0.00 0.00 0.00 0.00 $0.00 $0.00D8680 0.00 0.00 0.00 0.00 $0.00 $0.00D8690 0.00 0.00 0.00 0.00 $0.00 $0.00D8691 0.00 0.00 0.00 0.00 $0.00 $0.00D8692 0.00 0.00 0.00 0.00 $0.00 $0.00D8693 0.00 0.00 0.00 0.00 $0.00 $0.00D8999 0.00 0.00 0.00 0.00 $0.00 $0.00D9110 0.00 0.00 0.00 0.00 $0.00 $0.00D9120 0.00 0.00 0.00 0.00 $0.00 $0.00D9210 0.00 0.00 0.00 0.00 $0.00 $0.00D9211 0.00 0.00 0.00 0.00 $0.00 $0.00D9212 0.00 0.00 0.00 0.00 $0.00 $0.00D9215 0.00 0.00 0.00 0.00 $0.00 $0.00D9220 0.00 0.00 0.00 0.00 $0.00 $0.00D9221 0.00 0.00 0.00 0.00 $0.00 $0.00D9230 0.00 0.00 0.00 0.00 $0.00 $0.00D9241 0.00 0.00 0.00 0.00 $0.00 $0.00D9242 0.00 0.00 0.00 0.00 $0.00 $0.00D9248 0.00 0.00 0.00 0.00 $0.00 $0.00D9310 0.00 0.00 0.00 0.00 $0.00 $0.00D9410 0.00 0.00 0.00 0.00 $0.00 $0.00D9420 0.00 0.00 0.00 0.00 $0.00 $0.00D9430 0.00 0.00 0.00 0.00 $0.00 $0.00D9440 0.00 0.00 0.00 0.00 $0.00 $0.00D9450 0.00 0.00 0.00 0.00 $0.00 $0.00D9610 0.00 0.00 0.00 0.00 $0.00 $0.00D9612 0.00 0.00 0.00 0.00 $0.00 $0.00D9630 0.00 0.00 0.00 0.00 $0.00 $0.00D9910 0.00 0.00 0.00 0.00 $0.00 $0.00D9911 0.00 0.00 0.00 0.00 $0.00 $0.00D9920 0.00 0.00 0.00 0.00 $0.00 $0.00D9930 0.00 0.00 0.00 0.00 $0.00 $0.00D9940 0.00 0.00 0.00 0.00 $0.00 $0.00D9941 0.00 0.00 0.00 0.00 $0.00 $0.00D9942 0.00 0.00 0.00 0.00 $0.00 $0.00D9950 0.00 0.00 0.00 0.00 $0.00 $0.00D9951 0.00 0.00 0.00 0.00 $0.00 $0.00D9952 0.00 0.00 0.00 0.00 $0.00 $0.00D9970 0.00 0.00 0.00 0.00 $0.00 $0.00D9971 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 31 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

D9972 0.00 0.00 0.00 0.00 $0.00 $0.00D9973 0.00 0.00 0.00 0.00 $0.00 $0.00D9974 0.00 0.00 0.00 0.00 $0.00 $0.00D9999 0.00 0.00 0.00 0.00 $0.00 $0.00G0008 0.00 0.00 0.00 0.00 $0.00 $0.00G0009 0.00 0.00 0.00 0.00 $0.00 $0.00G0010 0.00 0.00 0.00 0.00 $0.00 $0.00G0027 0.00 0.00 0.00 0.00 $0.00 $0.00G0101 0.45 0.62 0.32 0.03 $49.71 $35.83G0102 0.17 0.39 0.08 0.01 $25.92 $11.57G0103 0.00 0.00 0.00 0.00 $0.00 $0.00G0104 0.96 3.10 0.79 0.14 $192.15 $85.26G0105 3.69 7.56 2.20 0.59 $539.67 $291.66G0105 53 0.96 3.10 0.79 0.14 $192.15 $85.26G0106 0.99 5.43 5.43 0.04 $296.17 $296.17G0106 TC 0.00 5.06 5.06 0.01 $234.64 $234.64G0106 26 0.99 0.37 0.37 0.03 $61.53 $61.53G0108 0.90 0.62 0.62 0.05 $70.22 $70.22G0109 0.25 0.22 0.22 0.01 $21.52 $21.52G0117 0.45 1.04 1.04 0.03 $69.14 $69.14G0118 0.17 0.89 0.89 0.01 $49.05 $49.05G0120 0.99 5.43 5.43 0.04 $296.17 $296.17G0120 TC 0.00 5.06 5.06 0.01 $234.64 $234.64G0120 26 0.99 0.37 0.37 0.03 $61.53 $61.53G0121 3.69 7.56 2.20 0.59 $539.67 $291.66G0121 53 0.96 3.10 0.79 0.14 $192.15 $85.26G0122 0.99 7.36 7.36 0.05 $385.99 $385.99G0122 TC 0.00 6.95 6.95 0.01 $322.10 $322.10G0122 26 0.99 0.41 0.41 0.04 $63.89 $63.89G0123 0.00 0.00 0.00 0.00 $0.00 $0.00G0124 0.42 0.41 0.41 0.03 $38.69 $38.69G0127 0.17 0.47 0.05 0.01 $29.62 $10.19G0128 0.08 0.20 0.20 0.01 $13.23 $13.23G0130 0.22 0.76 0.76 0.02 $45.71 $45.71G0130 TC 0.00 0.67 0.67 0.01 $31.51 $31.51G0130 26 0.22 0.09 0.09 0.01 $14.20 $14.20G0141 0.42 0.41 0.41 0.03 $38.69 $38.69G0143 0.00 0.00 0.00 0.00 $0.00 $0.00G0144 0.00 0.00 0.00 0.00 $0.00 $0.00G0145 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 32 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

G0147 0.00 0.00 0.00 0.00 $0.00 $0.00G0148 0.00 0.00 0.00 0.00 $0.00 $0.00G0157 0.00 0.00 0.00 0.00 $0.00 $0.00G0158 0.00 0.00 0.00 0.00 $0.00 $0.00G0159 0.00 0.00 0.00 0.00 $0.00 $0.00G0160 0.00 0.00 0.00 0.00 $0.00 $0.00G0161 0.00 0.00 0.00 0.00 $0.00 $0.00G0162 0.00 0.00 0.00 0.00 $0.00 $0.00G0163 0.00 0.00 0.00 0.00 $0.00 $0.00G0164 0.00 0.00 0.00 0.00 $0.00 $0.00G0166 0.07 4.33 4.33 0.03 $204.91 $204.91G0168 0.45 2.35 0.30 0.03 $129.76 $34.90G0173 0.00 0.00 0.00 0.00 $0.00 $0.00G0175 0.00 0.00 0.00 0.00 $0.00 $0.00G0176 0.00 0.00 0.00 0.00 $0.00 $0.00G0177 0.00 0.00 0.00 0.00 $0.00 $0.00G0179 0.45 0.72 0.72 0.03 $54.34 $54.34G0180 0.67 0.84 0.84 0.04 $69.93 $69.93G0181 1.73 1.25 1.25 0.10 $137.87 $137.87G0182 1.73 1.29 1.29 0.10 $139.72 $139.72G0186 0.00 0.00 0.00 0.00 $0.00 $0.00G0202 0.70 3.36 3.36 0.05 $188.34 $188.34G0202 TC 0.00 3.08 3.08 0.01 $143.02 $143.02G0202 26 0.70 0.28 0.28 0.04 $45.31 $45.31G0204 0.87 4.03 4.03 0.06 $227.21 $227.21G0204 TC 0.00 3.68 3.68 0.01 $170.79 $170.79G0204 26 0.87 0.35 0.35 0.05 $56.43 $56.43G0206 0.70 3.17 3.17 0.05 $179.55 $179.55G0206 TC 0.00 2.89 2.89 0.01 $134.23 $134.23G0206 26 0.70 0.28 0.28 0.04 $45.31 $45.31G0219 0.00 0.00 0.00 0.00 $0.00 $0.00G0219 TC 0.00 0.00 0.00 0.00 $0.00 $0.00G0219 26 0.00 0.00 0.00 0.00 $0.00 $0.00G0235 0.00 0.00 0.00 0.00 $0.00 $0.00G0235 TC 0.00 0.00 0.00 0.00 $0.00 $0.00G0235 26 0.00 0.00 0.00 0.00 $0.00 $0.00G0237 0.00 0.29 0.29 0.01 $13.93 $13.93G0238 0.00 0.31 0.31 0.01 $14.85 $14.85G0239 0.00 0.36 0.36 0.01 $17.17 $17.17G0245 0.88 0.95 0.31 0.05 $84.62 $55.01

Updated December 2011 33 of 387 Effective January 2012

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MRA 2012

G0246 0.45 0.62 0.14 0.03 $49.71 $27.50G0247 0.50 1.37 0.15 0.04 $87.09 $30.63G0248 0.00 3.65 3.65 0.01 $169.40 $169.40G0249 0.00 3.36 3.36 0.01 $155.98 $155.98G0250 0.18 0.08 0.08 0.01 $12.01 $12.01G0251 0.00 0.00 0.00 0.00 $0.00 $0.00G0252 0.00 0.00 0.00 0.00 $0.00 $0.00G0252 TC 0.00 0.00 0.00 0.00 $0.00 $0.00G0252 26 1.50 0.64 0.64 0.10 $99.68 $99.68G0255 0.00 0.00 0.00 0.00 $0.00 $0.00G0255 TC 0.00 0.00 0.00 0.00 $0.00 $0.00G0255 26 0.00 0.00 0.00 0.00 $0.00 $0.00G0257 0.00 0.00 0.00 0.00 $0.00 $0.00G0259 0.00 0.00 0.00 0.00 $0.00 $0.00G0260 0.00 0.00 0.00 0.00 $0.00 $0.00G0268 0.61 0.89 0.31 0.03 $69.13 $42.29G0269 0.00 0.00 0.00 0.00 $0.00 $0.00G0270 0.45 0.39 0.32 0.03 $39.07 $35.83G0271 0.25 0.18 0.17 0.01 $19.67 $19.20G0275 0.25 0.11 0.11 0.01 $16.43 $16.43G0278 0.25 0.11 0.11 0.01 $16.43 $16.43G0281 0.18 0.20 0.20 0.01 $17.56 $17.56G0282 0.00 0.00 0.00 0.00 $0.00 $0.00G0283 0.18 0.20 0.20 0.01 $17.56 $17.56G0288 0.00 1.83 1.83 0.01 $85.19 $85.19G0289 1.48 0.81 0.81 0.29 $116.34 $116.34G0290 0.00 0.00 0.00 0.00 $0.00 $0.00G0291 0.00 0.00 0.00 0.00 $0.00 $0.00G0293 0.00 0.00 0.00 0.00 $0.00 $0.00G0294 0.00 0.00 0.00 0.00 $0.00 $0.00G0295 0.00 0.00 0.00 0.00 $0.00 $0.00G0302 0.00 0.00 0.00 0.00 $0.00 $0.00G0303 0.00 0.00 0.00 0.00 $0.00 $0.00G0304 0.00 0.00 0.00 0.00 $0.00 $0.00G0305 0.00 0.00 0.00 0.00 $0.00 $0.00G0306 0.00 0.00 0.00 0.00 $0.00 $0.00G0307 0.00 0.00 0.00 0.00 $0.00 $0.00G0328 0.00 0.00 0.00 0.00 $0.00 $0.00G0329 0.06 0.22 0.22 0.01 $13.29 $13.29G0333 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 34 of 387 Effective January 2012

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MRA 2012

G0337 1.42 0.58 0.58 0.10 $93.44 $93.44G0339 0.00 0.00 0.00 0.00 $0.00 $0.00G0340 0.00 0.00 0.00 0.00 $0.00 $0.00G0341 6.98 22.49 2.03 0.49 $1,367.94 $421.22G0342 11.92 6.43 6.43 0.84 $856.62 $856.62G0343 19.85 12.01 12.01 1.40 $1,486.82 $1,486.82G0364 0.16 0.19 0.09 0.01 $16.23 $11.60G0365 0.25 6.22 6.22 0.04 $300.67 $300.67G0365 TC 0.00 6.14 6.14 0.01 $284.62 $284.62G0365 26 0.25 0.08 0.08 0.03 $16.06 $16.06G0372 0.17 0.10 0.07 0.01 $12.50 $11.11G0378 0.00 0.00 0.00 0.00 $0.00 $0.00G0379 0.00 0.00 0.00 0.00 $0.00 $0.00G0389 0.58 2.68 2.68 0.04 $151.17 $151.17G0389 TC 0.00 2.46 2.46 0.01 $114.34 $114.34G0389 26 0.58 0.22 0.22 0.03 $36.83 $36.83G0396 0.65 0.32 0.27 0.04 $45.00 $42.69G0397 1.30 0.61 0.56 0.08 $88.61 $86.30G0398 0.00 0.00 0.00 0.00 $0.00 $0.00G0398 TC 0.00 0.00 0.00 0.00 $0.00 $0.00G0398 26 0.00 0.00 0.00 0.00 $0.00 $0.00G0399 0.00 0.00 0.00 0.00 $0.00 $0.00G0399 TC 0.00 0.00 0.00 0.00 $0.00 $0.00G0399 26 0.00 0.00 0.00 0.00 $0.00 $0.00G0400 0.00 0.00 0.00 0.00 $0.00 $0.00G0400 TC 0.00 0.00 0.00 0.00 $0.00 $0.00G0400 26 0.00 0.00 0.00 0.00 $0.00 $0.00G0402 2.43 2.03 1.09 0.12 $205.30 $161.81G0403 0.17 0.37 0.36 0.02 $25.50 $25.04G0404 0.00 0.30 0.30 0.01 $14.39 $14.39G0405 0.17 0.07 0.06 0.01 $11.11 $10.65G0406 0.76 0.31 0.31 0.05 $49.81 $49.81G0407 1.39 0.58 0.58 0.08 $91.12 $91.12G0408 2.00 0.82 0.82 0.12 $130.68 $130.68G0409 0.00 0.28 0.28 0.01 $13.46 $13.46G0410 0.00 0.00 0.00 0.00 $0.00 $0.00G0411 0.00 0.00 0.00 0.00 $0.00 $0.00G0412 10.45 8.80 8.80 2.04 $963.64 $963.64G0413 15.73 12.36 12.36 3.06 $1,408.98 $1,408.98G0414 14.65 12.06 12.06 2.86 $1,338.14 $1,338.14

Updated December 2011 35 of 387 Effective January 2012

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MRA 2012

G0415 20.93 15.30 15.30 4.21 $1,828.78 $1,828.78G0416 3.09 16.50 16.50 0.12 $903.44 $903.44G0416 TC 0.00 14.35 14.35 0.01 $664.50 $664.50G0416 26 3.09 2.15 2.15 0.11 $238.93 $238.93G0417 5.86 32.23 32.23 0.25 $1,757.89 $1,757.89G0417 TC 0.00 28.03 28.03 0.01 $1,297.50 $1,297.50G0417 26 5.86 4.20 4.20 0.24 $460.40 $460.40G0418 10.30 55.03 55.03 0.42 $3,013.87 $3,013.87G0418 TC 0.00 47.87 47.87 0.01 $2,215.52 $2,215.52G0418 26 10.30 7.16 7.16 0.41 $798.34 $798.34G0419 11.61 66.03 66.03 0.46 $3,581.64 $3,581.64G0419 TC 0.00 57.45 57.45 0.01 $2,658.80 $2,658.80G0419 26 11.61 8.58 8.58 0.45 $922.83 $922.83G0420 2.12 0.88 0.88 0.11 $138.15 $138.15G0421 0.50 0.19 0.19 0.03 $31.98 $31.98G0422 1.47 1.26 1.26 0.08 $126.05 $126.05G0423 1.47 1.26 1.26 0.08 $126.05 $126.05G0424 0.28 0.60 0.11 0.03 $41.42 $18.75G0425 1.92 0.82 0.82 0.18 $130.27 $130.27G0426 2.61 1.13 1.13 0.22 $176.54 $176.54G0427 3.86 1.67 1.67 0.29 $259.24 $259.24G0428 0.00 0.00 0.00 0.00 $0.00 $0.00G0429 1.19 1.57 0.77 0.24 $136.40 $99.39G0431 0.00 0.00 0.00 0.00 $0.00 $0.00G0432 0.00 0.00 0.00 0.00 $0.00 $0.00G0433 0.00 0.00 0.00 0.00 $0.00 $0.00G0434 0.00 0.00 0.00 0.00 $0.00 $0.00G0435 0.00 0.00 0.00 0.00 $0.00 $0.00G0436 0.24 0.15 0.10 0.01 $17.85 $15.53G0437 0.50 0.30 0.23 0.03 $37.07 $33.83G0438 2.43 2.34 2.34 0.12 $219.64 $219.64G0439 1.50 1.73 1.73 0.03 $146.55 $146.55G0442 0.18 0.32 0.08 0.01 $23.11 $12.01G0443 0.45 0.26 0.20 0.03 $33.05 $30.27G0444 0.18 0.32 0.08 0.01 $23.11 $12.01G0445 0.45 0.26 0.20 0.03 $33.05 $30.27G0446 0.45 0.26 0.20 0.03 $33.05 $30.27G0447 0.45 0.26 0.20 0.03 $33.05 $30.27G0448 0.00 0.00 0.00 0.00 $0.00 $0.00G0449 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 36 of 387 Effective January 2012

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MRA 2012

G0450 0.00 0.00 0.00 0.00 $0.00 $0.00G0451 0.00 0.28 0.28 0.01 $13.46 $13.46G0908 0.00 0.00 0.00 0.00 $0.00 $0.00G0909 0.00 0.00 0.00 0.00 $0.00 $0.00G0910 0.00 0.00 0.00 0.00 $0.00 $0.00G0911 0.00 0.00 0.00 0.00 $0.00 $0.00G0912 0.00 0.00 0.00 0.00 $0.00 $0.00G0913 0.00 0.00 0.00 0.00 $0.00 $0.00G0914 0.00 0.00 0.00 0.00 $0.00 $0.00G0915 0.00 0.00 0.00 0.00 $0.00 $0.00G0916 0.00 0.00 0.00 0.00 $0.00 $0.00G0917 0.00 0.00 0.00 0.00 $0.00 $0.00G0918 0.00 0.00 0.00 0.00 $0.00 $0.00G0919 0.00 0.00 0.00 0.00 $0.00 $0.00G0920 0.00 0.00 0.00 0.00 $0.00 $0.00G0921 0.00 0.00 0.00 0.00 $0.00 $0.00G0922 0.00 0.00 0.00 0.00 $0.00 $0.00G3001 0.00 0.00 0.00 0.00 $0.00 $0.00G8126 0.00 0.00 0.00 0.00 $0.00 $0.00G8127 0.00 0.00 0.00 0.00 $0.00 $0.00G8128 0.00 0.00 0.00 0.00 $0.00 $0.00G8395 0.00 0.00 0.00 0.00 $0.00 $0.00G8396 0.00 0.00 0.00 0.00 $0.00 $0.00G8397 0.00 0.00 0.00 0.00 $0.00 $0.00G8398 0.00 0.00 0.00 0.00 $0.00 $0.00G8399 0.00 0.00 0.00 0.00 $0.00 $0.00G8400 0.00 0.00 0.00 0.00 $0.00 $0.00G8401 0.00 0.00 0.00 0.00 $0.00 $0.00G8404 0.00 0.00 0.00 0.00 $0.00 $0.00G8405 0.00 0.00 0.00 0.00 $0.00 $0.00G8406 0.00 0.00 0.00 0.00 $0.00 $0.00G8410 0.00 0.00 0.00 0.00 $0.00 $0.00G8415 0.00 0.00 0.00 0.00 $0.00 $0.00G8416 0.00 0.00 0.00 0.00 $0.00 $0.00G8417 0.00 0.00 0.00 0.00 $0.00 $0.00G8418 0.00 0.00 0.00 0.00 $0.00 $0.00G8419 0.00 0.00 0.00 0.00 $0.00 $0.00G8420 0.00 0.00 0.00 0.00 $0.00 $0.00G8421 0.00 0.00 0.00 0.00 $0.00 $0.00G8422 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 37 of 387 Effective January 2012

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MRA 2012

G8427 0.00 0.00 0.00 0.00 $0.00 $0.00G8428 0.00 0.00 0.00 0.00 $0.00 $0.00G8430 0.00 0.00 0.00 0.00 $0.00 $0.00G8431 0.00 0.00 0.00 0.00 $0.00 $0.00G8432 0.00 0.00 0.00 0.00 $0.00 $0.00G8433 0.00 0.00 0.00 0.00 $0.00 $0.00G8442 0.00 0.00 0.00 0.00 $0.00 $0.00G8447 0.00 0.00 0.00 0.00 $0.00 $0.00G8448 0.00 0.00 0.00 0.00 $0.00 $0.00G8450 0.00 0.00 0.00 0.00 $0.00 $0.00G8451 0.00 0.00 0.00 0.00 $0.00 $0.00G8452 0.00 0.00 0.00 0.00 $0.00 $0.00G8458 0.00 0.00 0.00 0.00 $0.00 $0.00G8459 0.00 0.00 0.00 0.00 $0.00 $0.00G8460 0.00 0.00 0.00 0.00 $0.00 $0.00G8461 0.00 0.00 0.00 0.00 $0.00 $0.00G8462 0.00 0.00 0.00 0.00 $0.00 $0.00G8463 0.00 0.00 0.00 0.00 $0.00 $0.00G8464 0.00 0.00 0.00 0.00 $0.00 $0.00G8465 0.00 0.00 0.00 0.00 $0.00 $0.00G8468 0.00 0.00 0.00 0.00 $0.00 $0.00G8469 0.00 0.00 0.00 0.00 $0.00 $0.00G8470 0.00 0.00 0.00 0.00 $0.00 $0.00G8471 0.00 0.00 0.00 0.00 $0.00 $0.00G8472 0.00 0.00 0.00 0.00 $0.00 $0.00G8473 0.00 0.00 0.00 0.00 $0.00 $0.00G8474 0.00 0.00 0.00 0.00 $0.00 $0.00G8475 0.00 0.00 0.00 0.00 $0.00 $0.00G8476 0.00 0.00 0.00 0.00 $0.00 $0.00G8477 0.00 0.00 0.00 0.00 $0.00 $0.00G8478 0.00 0.00 0.00 0.00 $0.00 $0.00G8482 0.00 0.00 0.00 0.00 $0.00 $0.00G8483 0.00 0.00 0.00 0.00 $0.00 $0.00G8484 0.00 0.00 0.00 0.00 $0.00 $0.00G8485 0.00 0.00 0.00 0.00 $0.00 $0.00G8486 0.00 0.00 0.00 0.00 $0.00 $0.00G8487 0.00 0.00 0.00 0.00 $0.00 $0.00G8489 0.00 0.00 0.00 0.00 $0.00 $0.00G8490 0.00 0.00 0.00 0.00 $0.00 $0.00G8491 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 38 of 387 Effective January 2012

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Treatment

MRA 2012

G8492 0.00 0.00 0.00 0.00 $0.00 $0.00G8493 0.00 0.00 0.00 0.00 $0.00 $0.00G8494 0.00 0.00 0.00 0.00 $0.00 $0.00G8495 0.00 0.00 0.00 0.00 $0.00 $0.00G8496 0.00 0.00 0.00 0.00 $0.00 $0.00G8497 0.00 0.00 0.00 0.00 $0.00 $0.00G8498 0.00 0.00 0.00 0.00 $0.00 $0.00G8499 0.00 0.00 0.00 0.00 $0.00 $0.00G8500 0.00 0.00 0.00 0.00 $0.00 $0.00G8501 0.00 0.00 0.00 0.00 $0.00 $0.00G8502 0.00 0.00 0.00 0.00 $0.00 $0.00G8506 0.00 0.00 0.00 0.00 $0.00 $0.00G8509 0.00 0.00 0.00 0.00 $0.00 $0.00G8510 0.00 0.00 0.00 0.00 $0.00 $0.00G8511 0.00 0.00 0.00 0.00 $0.00 $0.00G8524 0.00 0.00 0.00 0.00 $0.00 $0.00G8525 0.00 0.00 0.00 0.00 $0.00 $0.00G8526 0.00 0.00 0.00 0.00 $0.00 $0.00G8530 0.00 0.00 0.00 0.00 $0.00 $0.00G8531 0.00 0.00 0.00 0.00 $0.00 $0.00G8532 0.00 0.00 0.00 0.00 $0.00 $0.00G8535 0.00 0.00 0.00 0.00 $0.00 $0.00G8536 0.00 0.00 0.00 0.00 $0.00 $0.00G8539 0.00 0.00 0.00 0.00 $0.00 $0.00G8540 0.00 0.00 0.00 0.00 $0.00 $0.00G8541 0.00 0.00 0.00 0.00 $0.00 $0.00G8542 0.00 0.00 0.00 0.00 $0.00 $0.00G8543 0.00 0.00 0.00 0.00 $0.00 $0.00G8544 0.00 0.00 0.00 0.00 $0.00 $0.00G8545 0.00 0.00 0.00 0.00 $0.00 $0.00G8546 0.00 0.00 0.00 0.00 $0.00 $0.00G8547 0.00 0.00 0.00 0.00 $0.00 $0.00G8548 0.00 0.00 0.00 0.00 $0.00 $0.00G8549 0.00 0.00 0.00 0.00 $0.00 $0.00G8550 0.00 0.00 0.00 0.00 $0.00 $0.00G8551 0.00 0.00 0.00 0.00 $0.00 $0.00G8552 0.00 0.00 0.00 0.00 $0.00 $0.00G8553 0.00 0.00 0.00 0.00 $0.00 $0.00G8556 0.00 0.00 0.00 0.00 $0.00 $0.00G8557 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 39 of 387 Effective January 2012

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And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

G8558 0.00 0.00 0.00 0.00 $0.00 $0.00G8559 0.00 0.00 0.00 0.00 $0.00 $0.00G8560 0.00 0.00 0.00 0.00 $0.00 $0.00G8561 0.00 0.00 0.00 0.00 $0.00 $0.00G8562 0.00 0.00 0.00 0.00 $0.00 $0.00G8563 0.00 0.00 0.00 0.00 $0.00 $0.00G8564 0.00 0.00 0.00 0.00 $0.00 $0.00G8565 0.00 0.00 0.00 0.00 $0.00 $0.00G8566 0.00 0.00 0.00 0.00 $0.00 $0.00G8567 0.00 0.00 0.00 0.00 $0.00 $0.00G8568 0.00 0.00 0.00 0.00 $0.00 $0.00G8569 0.00 0.00 0.00 0.00 $0.00 $0.00G8570 0.00 0.00 0.00 0.00 $0.00 $0.00G8571 0.00 0.00 0.00 0.00 $0.00 $0.00G8572 0.00 0.00 0.00 0.00 $0.00 $0.00G8573 0.00 0.00 0.00 0.00 $0.00 $0.00G8574 0.00 0.00 0.00 0.00 $0.00 $0.00G8575 0.00 0.00 0.00 0.00 $0.00 $0.00G8576 0.00 0.00 0.00 0.00 $0.00 $0.00G8577 0.00 0.00 0.00 0.00 $0.00 $0.00G8578 0.00 0.00 0.00 0.00 $0.00 $0.00G8579 0.00 0.00 0.00 0.00 $0.00 $0.00G8580 0.00 0.00 0.00 0.00 $0.00 $0.00G8581 0.00 0.00 0.00 0.00 $0.00 $0.00G8582 0.00 0.00 0.00 0.00 $0.00 $0.00G8583 0.00 0.00 0.00 0.00 $0.00 $0.00G8584 0.00 0.00 0.00 0.00 $0.00 $0.00G8585 0.00 0.00 0.00 0.00 $0.00 $0.00G8586 0.00 0.00 0.00 0.00 $0.00 $0.00G8587 0.00 0.00 0.00 0.00 $0.00 $0.00G8588 0.00 0.00 0.00 0.00 $0.00 $0.00G8589 0.00 0.00 0.00 0.00 $0.00 $0.00G8590 0.00 0.00 0.00 0.00 $0.00 $0.00G8591 0.00 0.00 0.00 0.00 $0.00 $0.00G8592 0.00 0.00 0.00 0.00 $0.00 $0.00G8593 0.00 0.00 0.00 0.00 $0.00 $0.00G8594 0.00 0.00 0.00 0.00 $0.00 $0.00G8595 0.00 0.00 0.00 0.00 $0.00 $0.00G8596 0.00 0.00 0.00 0.00 $0.00 $0.00G8597 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 40 of 387 Effective January 2012

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WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

G8598 0.00 0.00 0.00 0.00 $0.00 $0.00G8599 0.00 0.00 0.00 0.00 $0.00 $0.00G8600 0.00 0.00 0.00 0.00 $0.00 $0.00G8601 0.00 0.00 0.00 0.00 $0.00 $0.00G8602 0.00 0.00 0.00 0.00 $0.00 $0.00G8603 0.00 0.00 0.00 0.00 $0.00 $0.00G8604 0.00 0.00 0.00 0.00 $0.00 $0.00G8605 0.00 0.00 0.00 0.00 $0.00 $0.00G8606 0.00 0.00 0.00 0.00 $0.00 $0.00G8607 0.00 0.00 0.00 0.00 $0.00 $0.00G8608 0.00 0.00 0.00 0.00 $0.00 $0.00G8609 0.00 0.00 0.00 0.00 $0.00 $0.00G8610 0.00 0.00 0.00 0.00 $0.00 $0.00G8611 0.00 0.00 0.00 0.00 $0.00 $0.00G8612 0.00 0.00 0.00 0.00 $0.00 $0.00G8613 0.00 0.00 0.00 0.00 $0.00 $0.00G8614 0.00 0.00 0.00 0.00 $0.00 $0.00G8615 0.00 0.00 0.00 0.00 $0.00 $0.00G8616 0.00 0.00 0.00 0.00 $0.00 $0.00G8617 0.00 0.00 0.00 0.00 $0.00 $0.00G8618 0.00 0.00 0.00 0.00 $0.00 $0.00G8619 0.00 0.00 0.00 0.00 $0.00 $0.00G8620 0.00 0.00 0.00 0.00 $0.00 $0.00G8621 0.00 0.00 0.00 0.00 $0.00 $0.00G8622 0.00 0.00 0.00 0.00 $0.00 $0.00G8623 0.00 0.00 0.00 0.00 $0.00 $0.00G8624 0.00 0.00 0.00 0.00 $0.00 $0.00G8625 0.00 0.00 0.00 0.00 $0.00 $0.00G8626 0.00 0.00 0.00 0.00 $0.00 $0.00G8627 0.00 0.00 0.00 0.00 $0.00 $0.00G8628 0.00 0.00 0.00 0.00 $0.00 $0.00G8629 0.00 0.00 0.00 0.00 $0.00 $0.00G8630 0.00 0.00 0.00 0.00 $0.00 $0.00G8631 0.00 0.00 0.00 0.00 $0.00 $0.00G8632 0.00 0.00 0.00 0.00 $0.00 $0.00G8633 0.00 0.00 0.00 0.00 $0.00 $0.00G8634 0.00 0.00 0.00 0.00 $0.00 $0.00G8635 0.00 0.00 0.00 0.00 $0.00 $0.00G8642 0.00 0.00 0.00 0.00 $0.00 $0.00G8643 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 41 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

G8644 0.00 0.00 0.00 0.00 $0.00 $0.00G8645 0.00 0.00 0.00 0.00 $0.00 $0.00G8646 0.00 0.00 0.00 0.00 $0.00 $0.00G8647 0.00 0.00 0.00 0.00 $0.00 $0.00G8648 0.00 0.00 0.00 0.00 $0.00 $0.00G8649 0.00 0.00 0.00 0.00 $0.00 $0.00G8650 0.00 0.00 0.00 0.00 $0.00 $0.00G8651 0.00 0.00 0.00 0.00 $0.00 $0.00G8652 0.00 0.00 0.00 0.00 $0.00 $0.00G8653 0.00 0.00 0.00 0.00 $0.00 $0.00G8654 0.00 0.00 0.00 0.00 $0.00 $0.00G8655 0.00 0.00 0.00 0.00 $0.00 $0.00G8656 0.00 0.00 0.00 0.00 $0.00 $0.00G8657 0.00 0.00 0.00 0.00 $0.00 $0.00G8658 0.00 0.00 0.00 0.00 $0.00 $0.00G8659 0.00 0.00 0.00 0.00 $0.00 $0.00G8660 0.00 0.00 0.00 0.00 $0.00 $0.00G8661 0.00 0.00 0.00 0.00 $0.00 $0.00G8662 0.00 0.00 0.00 0.00 $0.00 $0.00G8663 0.00 0.00 0.00 0.00 $0.00 $0.00G8664 0.00 0.00 0.00 0.00 $0.00 $0.00G8665 0.00 0.00 0.00 0.00 $0.00 $0.00G8666 0.00 0.00 0.00 0.00 $0.00 $0.00G8667 0.00 0.00 0.00 0.00 $0.00 $0.00G8668 0.00 0.00 0.00 0.00 $0.00 $0.00G8669 0.00 0.00 0.00 0.00 $0.00 $0.00G8670 0.00 0.00 0.00 0.00 $0.00 $0.00G8671 0.00 0.00 0.00 0.00 $0.00 $0.00G8672 0.00 0.00 0.00 0.00 $0.00 $0.00G8673 0.00 0.00 0.00 0.00 $0.00 $0.00G8674 0.00 0.00 0.00 0.00 $0.00 $0.00G8682 0.00 0.00 0.00 0.00 $0.00 $0.00G8683 0.00 0.00 0.00 0.00 $0.00 $0.00G8685 0.00 0.00 0.00 0.00 $0.00 $0.00G8694 0.00 0.00 0.00 0.00 $0.00 $0.00G8695 0.00 0.00 0.00 0.00 $0.00 $0.00G8696 0.00 0.00 0.00 0.00 $0.00 $0.00G8697 0.00 0.00 0.00 0.00 $0.00 $0.00G8698 0.00 0.00 0.00 0.00 $0.00 $0.00G8699 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 42 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

G8700 0.00 0.00 0.00 0.00 $0.00 $0.00G8701 0.00 0.00 0.00 0.00 $0.00 $0.00G8702 0.00 0.00 0.00 0.00 $0.00 $0.00G8703 0.00 0.00 0.00 0.00 $0.00 $0.00G8704 0.00 0.00 0.00 0.00 $0.00 $0.00G8705 0.00 0.00 0.00 0.00 $0.00 $0.00G8706 0.00 0.00 0.00 0.00 $0.00 $0.00G8707 0.00 0.00 0.00 0.00 $0.00 $0.00G8708 0.00 0.00 0.00 0.00 $0.00 $0.00G8709 0.00 0.00 0.00 0.00 $0.00 $0.00G8710 0.00 0.00 0.00 0.00 $0.00 $0.00G8711 0.00 0.00 0.00 0.00 $0.00 $0.00G8712 0.00 0.00 0.00 0.00 $0.00 $0.00G8713 0.00 0.00 0.00 0.00 $0.00 $0.00G8714 0.00 0.00 0.00 0.00 $0.00 $0.00G8715 0.00 0.00 0.00 0.00 $0.00 $0.00G8716 0.00 0.00 0.00 0.00 $0.00 $0.00G8717 0.00 0.00 0.00 0.00 $0.00 $0.00G8718 0.00 0.00 0.00 0.00 $0.00 $0.00G8720 0.00 0.00 0.00 0.00 $0.00 $0.00G8721 0.00 0.00 0.00 0.00 $0.00 $0.00G8722 0.00 0.00 0.00 0.00 $0.00 $0.00G8723 0.00 0.00 0.00 0.00 $0.00 $0.00G8724 0.00 0.00 0.00 0.00 $0.00 $0.00G8725 0.00 0.00 0.00 0.00 $0.00 $0.00G8726 0.00 0.00 0.00 0.00 $0.00 $0.00G8727 0.00 0.00 0.00 0.00 $0.00 $0.00G8728 0.00 0.00 0.00 0.00 $0.00 $0.00G8730 0.00 0.00 0.00 0.00 $0.00 $0.00G8731 0.00 0.00 0.00 0.00 $0.00 $0.00G8732 0.00 0.00 0.00 0.00 $0.00 $0.00G8733 0.00 0.00 0.00 0.00 $0.00 $0.00G8734 0.00 0.00 0.00 0.00 $0.00 $0.00G8735 0.00 0.00 0.00 0.00 $0.00 $0.00G8736 0.00 0.00 0.00 0.00 $0.00 $0.00G8737 0.00 0.00 0.00 0.00 $0.00 $0.00G8738 0.00 0.00 0.00 0.00 $0.00 $0.00G8739 0.00 0.00 0.00 0.00 $0.00 $0.00G8740 0.00 0.00 0.00 0.00 $0.00 $0.00G8741 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 43 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

G8742 0.00 0.00 0.00 0.00 $0.00 $0.00G8743 0.00 0.00 0.00 0.00 $0.00 $0.00G8744 0.00 0.00 0.00 0.00 $0.00 $0.00G8745 0.00 0.00 0.00 0.00 $0.00 $0.00G8746 0.00 0.00 0.00 0.00 $0.00 $0.00G8747 0.00 0.00 0.00 0.00 $0.00 $0.00G8748 0.00 0.00 0.00 0.00 $0.00 $0.00G8749 0.00 0.00 0.00 0.00 $0.00 $0.00G8750 0.00 0.00 0.00 0.00 $0.00 $0.00G8751 0.00 0.00 0.00 0.00 $0.00 $0.00G8752 0.00 0.00 0.00 0.00 $0.00 $0.00G8753 0.00 0.00 0.00 0.00 $0.00 $0.00G8754 0.00 0.00 0.00 0.00 $0.00 $0.00G8755 0.00 0.00 0.00 0.00 $0.00 $0.00G8756 0.00 0.00 0.00 0.00 $0.00 $0.00G8757 0.00 0.00 0.00 0.00 $0.00 $0.00G8758 0.00 0.00 0.00 0.00 $0.00 $0.00G8759 0.00 0.00 0.00 0.00 $0.00 $0.00G8760 0.00 0.00 0.00 0.00 $0.00 $0.00G8761 0.00 0.00 0.00 0.00 $0.00 $0.00G8762 0.00 0.00 0.00 0.00 $0.00 $0.00G8763 0.00 0.00 0.00 0.00 $0.00 $0.00G8764 0.00 0.00 0.00 0.00 $0.00 $0.00G8765 0.00 0.00 0.00 0.00 $0.00 $0.00G8767 0.00 0.00 0.00 0.00 $0.00 $0.00G8768 0.00 0.00 0.00 0.00 $0.00 $0.00G8769 0.00 0.00 0.00 0.00 $0.00 $0.00G8770 0.00 0.00 0.00 0.00 $0.00 $0.00G8771 0.00 0.00 0.00 0.00 $0.00 $0.00G8772 0.00 0.00 0.00 0.00 $0.00 $0.00G8773 0.00 0.00 0.00 0.00 $0.00 $0.00G8774 0.00 0.00 0.00 0.00 $0.00 $0.00G8775 0.00 0.00 0.00 0.00 $0.00 $0.00G8776 0.00 0.00 0.00 0.00 $0.00 $0.00G8777 0.00 0.00 0.00 0.00 $0.00 $0.00G8778 0.00 0.00 0.00 0.00 $0.00 $0.00G8779 0.00 0.00 0.00 0.00 $0.00 $0.00G8780 0.00 0.00 0.00 0.00 $0.00 $0.00G8781 0.00 0.00 0.00 0.00 $0.00 $0.00G8782 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 44 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

G8783 0.00 0.00 0.00 0.00 $0.00 $0.00G8784 0.00 0.00 0.00 0.00 $0.00 $0.00G8785 0.00 0.00 0.00 0.00 $0.00 $0.00G8786 0.00 0.00 0.00 0.00 $0.00 $0.00G8787 0.00 0.00 0.00 0.00 $0.00 $0.00G8788 0.00 0.00 0.00 0.00 $0.00 $0.00G8789 0.00 0.00 0.00 0.00 $0.00 $0.00G8790 0.00 0.00 0.00 0.00 $0.00 $0.00G8791 0.00 0.00 0.00 0.00 $0.00 $0.00G8792 0.00 0.00 0.00 0.00 $0.00 $0.00G8793 0.00 0.00 0.00 0.00 $0.00 $0.00G8794 0.00 0.00 0.00 0.00 $0.00 $0.00G8795 0.00 0.00 0.00 0.00 $0.00 $0.00G8796 0.00 0.00 0.00 0.00 $0.00 $0.00G8797 0.00 0.00 0.00 0.00 $0.00 $0.00G8798 0.00 0.00 0.00 0.00 $0.00 $0.00G8799 0.00 0.00 0.00 0.00 $0.00 $0.00G8800 0.00 0.00 0.00 0.00 $0.00 $0.00G8801 0.00 0.00 0.00 0.00 $0.00 $0.00G8802 0.00 0.00 0.00 0.00 $0.00 $0.00G8803 0.00 0.00 0.00 0.00 $0.00 $0.00G8805 0.00 0.00 0.00 0.00 $0.00 $0.00G8806 0.00 0.00 0.00 0.00 $0.00 $0.00G8807 0.00 0.00 0.00 0.00 $0.00 $0.00G8808 0.00 0.00 0.00 0.00 $0.00 $0.00G8809 0.00 0.00 0.00 0.00 $0.00 $0.00G8810 0.00 0.00 0.00 0.00 $0.00 $0.00G8811 0.00 0.00 0.00 0.00 $0.00 $0.00G8812 0.00 0.00 0.00 0.00 $0.00 $0.00G8813 0.00 0.00 0.00 0.00 $0.00 $0.00G8814 0.00 0.00 0.00 0.00 $0.00 $0.00G8815 0.00 0.00 0.00 0.00 $0.00 $0.00G8816 0.00 0.00 0.00 0.00 $0.00 $0.00G8817 0.00 0.00 0.00 0.00 $0.00 $0.00G8818 0.00 0.00 0.00 0.00 $0.00 $0.00G8819 0.00 0.00 0.00 0.00 $0.00 $0.00G8820 0.00 0.00 0.00 0.00 $0.00 $0.00G8821 0.00 0.00 0.00 0.00 $0.00 $0.00G8822 0.00 0.00 0.00 0.00 $0.00 $0.00G8823 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 45 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

G8824 0.00 0.00 0.00 0.00 $0.00 $0.00G8825 0.00 0.00 0.00 0.00 $0.00 $0.00G8826 0.00 0.00 0.00 0.00 $0.00 $0.00G8827 0.00 0.00 0.00 0.00 $0.00 $0.00G8828 0.00 0.00 0.00 0.00 $0.00 $0.00G8829 0.00 0.00 0.00 0.00 $0.00 $0.00G8830 0.00 0.00 0.00 0.00 $0.00 $0.00G8831 0.00 0.00 0.00 0.00 $0.00 $0.00G8832 0.00 0.00 0.00 0.00 $0.00 $0.00G8833 0.00 0.00 0.00 0.00 $0.00 $0.00G8834 0.00 0.00 0.00 0.00 $0.00 $0.00G8835 0.00 0.00 0.00 0.00 $0.00 $0.00G8836 0.00 0.00 0.00 0.00 $0.00 $0.00G8837 0.00 0.00 0.00 0.00 $0.00 $0.00G8838 0.00 0.00 0.00 0.00 $0.00 $0.00G8839 0.00 0.00 0.00 0.00 $0.00 $0.00G8840 0.00 0.00 0.00 0.00 $0.00 $0.00G8841 0.00 0.00 0.00 0.00 $0.00 $0.00G8842 0.00 0.00 0.00 0.00 $0.00 $0.00G8843 0.00 0.00 0.00 0.00 $0.00 $0.00G8844 0.00 0.00 0.00 0.00 $0.00 $0.00G8845 0.00 0.00 0.00 0.00 $0.00 $0.00G8846 0.00 0.00 0.00 0.00 $0.00 $0.00G8847 0.00 0.00 0.00 0.00 $0.00 $0.00G8848 0.00 0.00 0.00 0.00 $0.00 $0.00G8849 0.00 0.00 0.00 0.00 $0.00 $0.00G8850 0.00 0.00 0.00 0.00 $0.00 $0.00G8851 0.00 0.00 0.00 0.00 $0.00 $0.00G8852 0.00 0.00 0.00 0.00 $0.00 $0.00G8853 0.00 0.00 0.00 0.00 $0.00 $0.00G8854 0.00 0.00 0.00 0.00 $0.00 $0.00G8855 0.00 0.00 0.00 0.00 $0.00 $0.00G8856 0.00 0.00 0.00 0.00 $0.00 $0.00G8857 0.00 0.00 0.00 0.00 $0.00 $0.00G8858 0.00 0.00 0.00 0.00 $0.00 $0.00G8859 0.00 0.00 0.00 0.00 $0.00 $0.00G8860 0.00 0.00 0.00 0.00 $0.00 $0.00G8861 0.00 0.00 0.00 0.00 $0.00 $0.00G8862 0.00 0.00 0.00 0.00 $0.00 $0.00G8863 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 46 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

G8864 0.00 0.00 0.00 0.00 $0.00 $0.00G8865 0.00 0.00 0.00 0.00 $0.00 $0.00G8866 0.00 0.00 0.00 0.00 $0.00 $0.00G8867 0.00 0.00 0.00 0.00 $0.00 $0.00G8868 0.00 0.00 0.00 0.00 $0.00 $0.00G8869 0.00 0.00 0.00 0.00 $0.00 $0.00G8870 0.00 0.00 0.00 0.00 $0.00 $0.00G8871 0.00 0.00 0.00 0.00 $0.00 $0.00G8872 0.00 0.00 0.00 0.00 $0.00 $0.00G8873 0.00 0.00 0.00 0.00 $0.00 $0.00G8874 0.00 0.00 0.00 0.00 $0.00 $0.00G8875 0.00 0.00 0.00 0.00 $0.00 $0.00G8876 0.00 0.00 0.00 0.00 $0.00 $0.00G8877 0.00 0.00 0.00 0.00 $0.00 $0.00G8878 0.00 0.00 0.00 0.00 $0.00 $0.00G8879 0.00 0.00 0.00 0.00 $0.00 $0.00G8880 0.00 0.00 0.00 0.00 $0.00 $0.00G8881 0.00 0.00 0.00 0.00 $0.00 $0.00G8882 0.00 0.00 0.00 0.00 $0.00 $0.00G8883 0.00 0.00 0.00 0.00 $0.00 $0.00G8884 0.00 0.00 0.00 0.00 $0.00 $0.00G8885 0.00 0.00 0.00 0.00 $0.00 $0.00G8886 0.00 0.00 0.00 0.00 $0.00 $0.00G8887 0.00 0.00 0.00 0.00 $0.00 $0.00G8888 0.00 0.00 0.00 0.00 $0.00 $0.00G8889 0.00 0.00 0.00 0.00 $0.00 $0.00G8890 0.00 0.00 0.00 0.00 $0.00 $0.00G8891 0.00 0.00 0.00 0.00 $0.00 $0.00G8892 0.00 0.00 0.00 0.00 $0.00 $0.00G8893 0.00 0.00 0.00 0.00 $0.00 $0.00G8894 0.00 0.00 0.00 0.00 $0.00 $0.00G8895 0.00 0.00 0.00 0.00 $0.00 $0.00G8896 0.00 0.00 0.00 0.00 $0.00 $0.00G8897 0.00 0.00 0.00 0.00 $0.00 $0.00G8898 0.00 0.00 0.00 0.00 $0.00 $0.00G8899 0.00 0.00 0.00 0.00 $0.00 $0.00G8900 0.00 0.00 0.00 0.00 $0.00 $0.00G8901 0.00 0.00 0.00 0.00 $0.00 $0.00G8902 0.00 0.00 0.00 0.00 $0.00 $0.00G8903 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 47 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

G8904 0.00 0.00 0.00 0.00 $0.00 $0.00G8905 0.00 0.00 0.00 0.00 $0.00 $0.00G8906 0.00 0.00 0.00 0.00 $0.00 $0.00G9001 0.00 0.00 0.00 0.00 $0.00 $0.00G9002 0.00 0.00 0.00 0.00 $0.00 $0.00G9003 0.00 0.00 0.00 0.00 $0.00 $0.00G9004 0.00 0.00 0.00 0.00 $0.00 $0.00G9005 0.00 0.00 0.00 0.00 $0.00 $0.00G9006 0.00 0.00 0.00 0.00 $0.00 $0.00G9007 0.00 0.00 0.00 0.00 $0.00 $0.00G9008 0.00 0.00 0.00 0.00 $0.00 $0.00G9009 0.00 0.00 0.00 0.00 $0.00 $0.00G9010 0.00 0.00 0.00 0.00 $0.00 $0.00G9011 0.00 0.00 0.00 0.00 $0.00 $0.00G9012 0.00 0.00 0.00 0.00 $0.00 $0.00G9013 0.00 0.00 0.00 0.00 $0.00 $0.00G9014 0.00 0.00 0.00 0.00 $0.00 $0.00G9016 0.00 0.00 0.00 0.00 $0.00 $0.00G9017 0.00 0.00 0.00 0.00 $0.00 $0.00G9018 0.00 0.00 0.00 0.00 $0.00 $0.00G9019 0.00 0.00 0.00 0.00 $0.00 $0.00G9020 0.00 0.00 0.00 0.00 $0.00 $0.00G9033 0.00 0.00 0.00 0.00 $0.00 $0.00G9034 0.00 0.00 0.00 0.00 $0.00 $0.00G9035 0.00 0.00 0.00 0.00 $0.00 $0.00G9036 0.00 0.00 0.00 0.00 $0.00 $0.00G9050 0.00 0.00 0.00 0.00 $0.00 $0.00G9051 0.00 0.00 0.00 0.00 $0.00 $0.00G9052 0.00 0.00 0.00 0.00 $0.00 $0.00G9053 0.00 0.00 0.00 0.00 $0.00 $0.00G9054 0.00 0.00 0.00 0.00 $0.00 $0.00G9055 0.00 0.00 0.00 0.00 $0.00 $0.00G9056 0.00 0.00 0.00 0.00 $0.00 $0.00G9057 0.00 0.00 0.00 0.00 $0.00 $0.00G9058 0.00 0.00 0.00 0.00 $0.00 $0.00G9059 0.00 0.00 0.00 0.00 $0.00 $0.00G9060 0.00 0.00 0.00 0.00 $0.00 $0.00G9061 0.00 0.00 0.00 0.00 $0.00 $0.00G9062 0.00 0.00 0.00 0.00 $0.00 $0.00G9063 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 48 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

G9064 0.00 0.00 0.00 0.00 $0.00 $0.00G9065 0.00 0.00 0.00 0.00 $0.00 $0.00G9066 0.00 0.00 0.00 0.00 $0.00 $0.00G9067 0.00 0.00 0.00 0.00 $0.00 $0.00G9068 0.00 0.00 0.00 0.00 $0.00 $0.00G9069 0.00 0.00 0.00 0.00 $0.00 $0.00G9070 0.00 0.00 0.00 0.00 $0.00 $0.00G9071 0.00 0.00 0.00 0.00 $0.00 $0.00G9072 0.00 0.00 0.00 0.00 $0.00 $0.00G9073 0.00 0.00 0.00 0.00 $0.00 $0.00G9074 0.00 0.00 0.00 0.00 $0.00 $0.00G9075 0.00 0.00 0.00 0.00 $0.00 $0.00G9077 0.00 0.00 0.00 0.00 $0.00 $0.00G9078 0.00 0.00 0.00 0.00 $0.00 $0.00G9079 0.00 0.00 0.00 0.00 $0.00 $0.00G9080 0.00 0.00 0.00 0.00 $0.00 $0.00G9083 0.00 0.00 0.00 0.00 $0.00 $0.00G9084 0.00 0.00 0.00 0.00 $0.00 $0.00G9085 0.00 0.00 0.00 0.00 $0.00 $0.00G9086 0.00 0.00 0.00 0.00 $0.00 $0.00G9087 0.00 0.00 0.00 0.00 $0.00 $0.00G9088 0.00 0.00 0.00 0.00 $0.00 $0.00G9089 0.00 0.00 0.00 0.00 $0.00 $0.00G9090 0.00 0.00 0.00 0.00 $0.00 $0.00G9091 0.00 0.00 0.00 0.00 $0.00 $0.00G9092 0.00 0.00 0.00 0.00 $0.00 $0.00G9093 0.00 0.00 0.00 0.00 $0.00 $0.00G9094 0.00 0.00 0.00 0.00 $0.00 $0.00G9095 0.00 0.00 0.00 0.00 $0.00 $0.00G9096 0.00 0.00 0.00 0.00 $0.00 $0.00G9097 0.00 0.00 0.00 0.00 $0.00 $0.00G9098 0.00 0.00 0.00 0.00 $0.00 $0.00G9099 0.00 0.00 0.00 0.00 $0.00 $0.00G9100 0.00 0.00 0.00 0.00 $0.00 $0.00G9101 0.00 0.00 0.00 0.00 $0.00 $0.00G9102 0.00 0.00 0.00 0.00 $0.00 $0.00G9103 0.00 0.00 0.00 0.00 $0.00 $0.00G9104 0.00 0.00 0.00 0.00 $0.00 $0.00G9105 0.00 0.00 0.00 0.00 $0.00 $0.00G9106 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 49 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

G9107 0.00 0.00 0.00 0.00 $0.00 $0.00G9108 0.00 0.00 0.00 0.00 $0.00 $0.00G9109 0.00 0.00 0.00 0.00 $0.00 $0.00G9110 0.00 0.00 0.00 0.00 $0.00 $0.00G9111 0.00 0.00 0.00 0.00 $0.00 $0.00G9112 0.00 0.00 0.00 0.00 $0.00 $0.00G9113 0.00 0.00 0.00 0.00 $0.00 $0.00G9114 0.00 0.00 0.00 0.00 $0.00 $0.00G9115 0.00 0.00 0.00 0.00 $0.00 $0.00G9116 0.00 0.00 0.00 0.00 $0.00 $0.00G9117 0.00 0.00 0.00 0.00 $0.00 $0.00G9123 0.00 0.00 0.00 0.00 $0.00 $0.00G9124 0.00 0.00 0.00 0.00 $0.00 $0.00G9125 0.00 0.00 0.00 0.00 $0.00 $0.00G9126 0.00 0.00 0.00 0.00 $0.00 $0.00G9128 0.00 0.00 0.00 0.00 $0.00 $0.00G9129 0.00 0.00 0.00 0.00 $0.00 $0.00G9130 0.00 0.00 0.00 0.00 $0.00 $0.00G9131 0.00 0.00 0.00 0.00 $0.00 $0.00G9132 0.00 0.00 0.00 0.00 $0.00 $0.00G9133 0.00 0.00 0.00 0.00 $0.00 $0.00G9134 0.00 0.00 0.00 0.00 $0.00 $0.00G9135 0.00 0.00 0.00 0.00 $0.00 $0.00G9136 0.00 0.00 0.00 0.00 $0.00 $0.00G9137 0.00 0.00 0.00 0.00 $0.00 $0.00G9138 0.00 0.00 0.00 0.00 $0.00 $0.00G9139 0.00 0.00 0.00 0.00 $0.00 $0.00G9140 0.00 0.00 0.00 0.00 $0.00 $0.00G9141 0.00 0.00 0.00 0.00 $0.00 $0.00G9142 0.00 0.00 0.00 0.00 $0.00 $0.00G9143 0.00 0.00 0.00 0.00 $0.00 $0.00G9147 0.00 0.00 0.00 0.00 $0.00 $0.00G9156 0.00 0.00 0.00 0.00 $0.00 $0.00H0001 0.00 0.00 0.00 0.00 $0.00 $0.00H0002 0.00 0.00 0.00 0.00 $0.00 $0.00H0003 0.00 0.00 0.00 0.00 $0.00 $0.00H0004 0.00 0.00 0.00 0.00 $0.00 $0.00H0005 0.00 0.00 0.00 0.00 $0.00 $0.00H0006 0.00 0.00 0.00 0.00 $0.00 $0.00H0007 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 50 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

H0008 0.00 0.00 0.00 0.00 $0.00 $0.00H0009 0.00 0.00 0.00 0.00 $0.00 $0.00H0010 0.00 0.00 0.00 0.00 $0.00 $0.00H0011 0.00 0.00 0.00 0.00 $0.00 $0.00H0012 0.00 0.00 0.00 0.00 $0.00 $0.00H0013 0.00 0.00 0.00 0.00 $0.00 $0.00H0014 0.00 0.00 0.00 0.00 $0.00 $0.00H0015 0.00 0.00 0.00 0.00 $0.00 $0.00H0016 0.00 0.00 0.00 0.00 $0.00 $0.00H0017 0.00 0.00 0.00 0.00 $0.00 $0.00H0018 0.00 0.00 0.00 0.00 $0.00 $0.00H0019 0.00 0.00 0.00 0.00 $0.00 $0.00H0020 0.00 0.00 0.00 0.00 $0.00 $0.00H0021 0.00 0.00 0.00 0.00 $0.00 $0.00H0022 0.00 0.00 0.00 0.00 $0.00 $0.00H0023 0.00 0.00 0.00 0.00 $0.00 $0.00H0024 0.00 0.00 0.00 0.00 $0.00 $0.00H0025 0.00 0.00 0.00 0.00 $0.00 $0.00H0026 0.00 0.00 0.00 0.00 $0.00 $0.00H0027 0.00 0.00 0.00 0.00 $0.00 $0.00H0028 0.00 0.00 0.00 0.00 $0.00 $0.00H0029 0.00 0.00 0.00 0.00 $0.00 $0.00H0030 0.00 0.00 0.00 0.00 $0.00 $0.00H0031 0.00 0.00 0.00 0.00 $0.00 $0.00H0032 0.00 0.00 0.00 0.00 $0.00 $0.00H0033 0.00 0.00 0.00 0.00 $0.00 $0.00H0034 0.00 0.00 0.00 0.00 $0.00 $0.00H0035 0.00 0.00 0.00 0.00 $0.00 $0.00H0036 0.00 0.00 0.00 0.00 $0.00 $0.00H0037 0.00 0.00 0.00 0.00 $0.00 $0.00H0038 0.00 0.00 0.00 0.00 $0.00 $0.00H0039 0.00 0.00 0.00 0.00 $0.00 $0.00H0040 0.00 0.00 0.00 0.00 $0.00 $0.00H0041 0.00 0.00 0.00 0.00 $0.00 $0.00H0042 0.00 0.00 0.00 0.00 $0.00 $0.00H0043 0.00 0.00 0.00 0.00 $0.00 $0.00H0044 0.00 0.00 0.00 0.00 $0.00 $0.00H0045 0.00 0.00 0.00 0.00 $0.00 $0.00H0046 0.00 0.00 0.00 0.00 $0.00 $0.00H0047 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 51 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

H0048 0.00 0.00 0.00 0.00 $0.00 $0.00H0049 0.00 0.00 0.00 0.00 $0.00 $0.00H0050 0.00 0.00 0.00 0.00 $0.00 $0.00H1000 0.00 0.00 0.00 0.00 $0.00 $0.00H1001 0.00 0.00 0.00 0.00 $0.00 $0.00H1002 0.00 0.00 0.00 0.00 $0.00 $0.00H1003 0.00 0.00 0.00 0.00 $0.00 $0.00H1004 0.00 0.00 0.00 0.00 $0.00 $0.00H1005 0.00 0.00 0.00 0.00 $0.00 $0.00H1010 0.00 0.00 0.00 0.00 $0.00 $0.00H1011 0.00 0.00 0.00 0.00 $0.00 $0.00H2000 0.00 0.00 0.00 0.00 $0.00 $0.00H2001 0.00 0.00 0.00 0.00 $0.00 $0.00H2010 0.00 0.00 0.00 0.00 $0.00 $0.00H2011 0.00 0.00 0.00 0.00 $0.00 $0.00H2012 0.00 0.00 0.00 0.00 $0.00 $0.00H2013 0.00 0.00 0.00 0.00 $0.00 $0.00H2014 0.00 0.00 0.00 0.00 $0.00 $0.00H2015 0.00 0.00 0.00 0.00 $0.00 $0.00H2016 0.00 0.00 0.00 0.00 $0.00 $0.00H2017 0.00 0.00 0.00 0.00 $0.00 $0.00H2018 0.00 0.00 0.00 0.00 $0.00 $0.00H2019 0.00 0.00 0.00 0.00 $0.00 $0.00H2020 0.00 0.00 0.00 0.00 $0.00 $0.00H2021 0.00 0.00 0.00 0.00 $0.00 $0.00H2022 0.00 0.00 0.00 0.00 $0.00 $0.00H2023 0.00 0.00 0.00 0.00 $0.00 $0.00H2024 0.00 0.00 0.00 0.00 $0.00 $0.00H2025 0.00 0.00 0.00 0.00 $0.00 $0.00H2026 0.00 0.00 0.00 0.00 $0.00 $0.00H2027 0.00 0.00 0.00 0.00 $0.00 $0.00H2028 0.00 0.00 0.00 0.00 $0.00 $0.00H2029 0.00 0.00 0.00 0.00 $0.00 $0.00H2030 0.00 0.00 0.00 0.00 $0.00 $0.00H2031 0.00 0.00 0.00 0.00 $0.00 $0.00H2032 0.00 0.00 0.00 0.00 $0.00 $0.00H2033 0.00 0.00 0.00 0.00 $0.00 $0.00H2034 0.00 0.00 0.00 0.00 $0.00 $0.00H2035 0.00 0.00 0.00 0.00 $0.00 $0.00H2036 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 52 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

H2037 0.00 0.00 0.00 0.00 $0.00 $0.00J0120 0.00 0.00 0.00 0.00 $0.00 $0.00J0129 0.00 0.00 0.00 0.00 $0.00 $0.00J0130 0.00 0.00 0.00 0.00 $0.00 $0.00J0131 0.00 0.00 0.00 0.00 $0.00 $0.00J0132 0.00 0.00 0.00 0.00 $0.00 $0.00J0133 0.00 0.00 0.00 0.00 $0.00 $0.00J0135 0.00 0.00 0.00 0.00 $0.00 $0.00J0150 0.00 0.00 0.00 0.00 $0.00 $0.00J0152 0.00 0.00 0.00 0.00 $0.00 $0.00J0171 0.00 0.00 0.00 0.00 $0.00 $0.00J0180 0.00 0.00 0.00 0.00 $0.00 $0.00J0190 0.00 0.00 0.00 0.00 $0.00 $0.00J0200 0.00 0.00 0.00 0.00 $0.00 $0.00J0205 0.00 0.00 0.00 0.00 $0.00 $0.00J0207 0.00 0.00 0.00 0.00 $0.00 $0.00J0210 0.00 0.00 0.00 0.00 $0.00 $0.00J0215 0.00 0.00 0.00 0.00 $0.00 $0.00J0220 0.00 0.00 0.00 0.00 $0.00 $0.00J0221 0.00 0.00 0.00 0.00 $0.00 $0.00J0256 0.00 0.00 0.00 0.00 $0.00 $0.00J0257 0.00 0.00 0.00 0.00 $0.00 $0.00J0270 0.00 0.00 0.00 0.00 $0.00 $0.00J0275 0.00 0.00 0.00 0.00 $0.00 $0.00J0278 0.00 0.00 0.00 0.00 $0.00 $0.00J0280 0.00 0.00 0.00 0.00 $0.00 $0.00J0282 0.00 0.00 0.00 0.00 $0.00 $0.00J0285 0.00 0.00 0.00 0.00 $0.00 $0.00J0287 0.00 0.00 0.00 0.00 $0.00 $0.00J0288 0.00 0.00 0.00 0.00 $0.00 $0.00J0289 0.00 0.00 0.00 0.00 $0.00 $0.00J0290 0.00 0.00 0.00 0.00 $0.00 $0.00J0295 0.00 0.00 0.00 0.00 $0.00 $0.00J0300 0.00 0.00 0.00 0.00 $0.00 $0.00J0330 0.00 0.00 0.00 0.00 $0.00 $0.00J0348 0.00 0.00 0.00 0.00 $0.00 $0.00J0350 0.00 0.00 0.00 0.00 $0.00 $0.00J0360 0.00 0.00 0.00 0.00 $0.00 $0.00J0364 0.00 0.00 0.00 0.00 $0.00 $0.00J0365 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 53 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

J0380 0.00 0.00 0.00 0.00 $0.00 $0.00J0390 0.00 0.00 0.00 0.00 $0.00 $0.00J0395 0.00 0.00 0.00 0.00 $0.00 $0.00J0400 0.00 0.00 0.00 0.00 $0.00 $0.00J0456 0.00 0.00 0.00 0.00 $0.00 $0.00J0461 0.00 0.00 0.00 0.00 $0.00 $0.00J0470 0.00 0.00 0.00 0.00 $0.00 $0.00J0475 0.00 0.00 0.00 0.00 $0.00 $0.00J0476 0.00 0.00 0.00 0.00 $0.00 $0.00J0480 0.00 0.00 0.00 0.00 $0.00 $0.00J0490 0.00 0.00 0.00 0.00 $0.00 $0.00J0500 0.00 0.00 0.00 0.00 $0.00 $0.00J0515 0.00 0.00 0.00 0.00 $0.00 $0.00J0520 0.00 0.00 0.00 0.00 $0.00 $0.00J0558 0.00 0.00 0.00 0.00 $0.00 $0.00J0561 0.00 0.00 0.00 0.00 $0.00 $0.00J0583 0.00 0.00 0.00 0.00 $0.00 $0.00J0585 0.00 0.00 0.00 0.00 $0.00 $0.00J0586 0.00 0.00 0.00 0.00 $0.00 $0.00J0587 0.00 0.00 0.00 0.00 $0.00 $0.00J0588 0.00 0.00 0.00 0.00 $0.00 $0.00J0592 0.00 0.00 0.00 0.00 $0.00 $0.00J0594 0.00 0.00 0.00 0.00 $0.00 $0.00J0595 0.00 0.00 0.00 0.00 $0.00 $0.00J0597 0.00 0.00 0.00 0.00 $0.00 $0.00J0598 0.00 0.00 0.00 0.00 $0.00 $0.00J0600 0.00 0.00 0.00 0.00 $0.00 $0.00J0610 0.00 0.00 0.00 0.00 $0.00 $0.00J0620 0.00 0.00 0.00 0.00 $0.00 $0.00J0630 0.00 0.00 0.00 0.00 $0.00 $0.00J0636 0.00 0.00 0.00 0.00 $0.00 $0.00J0637 0.00 0.00 0.00 0.00 $0.00 $0.00J0638 0.00 0.00 0.00 0.00 $0.00 $0.00J0640 0.00 0.00 0.00 0.00 $0.00 $0.00J0641 0.00 0.00 0.00 0.00 $0.00 $0.00J0670 0.00 0.00 0.00 0.00 $0.00 $0.00J0690 0.00 0.00 0.00 0.00 $0.00 $0.00J0692 0.00 0.00 0.00 0.00 $0.00 $0.00J0694 0.00 0.00 0.00 0.00 $0.00 $0.00J0696 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 54 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

J0697 0.00 0.00 0.00 0.00 $0.00 $0.00J0698 0.00 0.00 0.00 0.00 $0.00 $0.00J0702 0.00 0.00 0.00 0.00 $0.00 $0.00J0706 0.00 0.00 0.00 0.00 $0.00 $0.00J0710 0.00 0.00 0.00 0.00 $0.00 $0.00J0712 0.00 0.00 0.00 0.00 $0.00 $0.00J0713 0.00 0.00 0.00 0.00 $0.00 $0.00J0715 0.00 0.00 0.00 0.00 $0.00 $0.00J0718 0.00 0.00 0.00 0.00 $0.00 $0.00J0720 0.00 0.00 0.00 0.00 $0.00 $0.00J0725 0.00 0.00 0.00 0.00 $0.00 $0.00J0735 0.00 0.00 0.00 0.00 $0.00 $0.00J0740 0.00 0.00 0.00 0.00 $0.00 $0.00J0743 0.00 0.00 0.00 0.00 $0.00 $0.00J0744 0.00 0.00 0.00 0.00 $0.00 $0.00J0745 0.00 0.00 0.00 0.00 $0.00 $0.00J0760 0.00 0.00 0.00 0.00 $0.00 $0.00J0770 0.00 0.00 0.00 0.00 $0.00 $0.00J0775 0.00 0.00 0.00 0.00 $0.00 $0.00J0780 0.00 0.00 0.00 0.00 $0.00 $0.00J0795 0.00 0.00 0.00 0.00 $0.00 $0.00J0800 0.00 0.00 0.00 0.00 $0.00 $0.00J0833 0.00 0.00 0.00 0.00 $0.00 $0.00J0834 0.00 0.00 0.00 0.00 $0.00 $0.00J0840 0.00 0.00 0.00 0.00 $0.00 $0.00J0850 0.00 0.00 0.00 0.00 $0.00 $0.00J0878 0.00 0.00 0.00 0.00 $0.00 $0.00J0881 0.00 0.00 0.00 0.00 $0.00 $0.00J0882 0.00 0.00 0.00 0.00 $0.00 $0.00J0885 0.00 0.00 0.00 0.00 $0.00 $0.00J0886 0.00 0.00 0.00 0.00 $0.00 $0.00J0894 0.00 0.00 0.00 0.00 $0.00 $0.00J0895 0.00 0.00 0.00 0.00 $0.00 $0.00J0897 0.00 0.00 0.00 0.00 $0.00 $0.00J0900 0.00 0.00 0.00 0.00 $0.00 $0.00J0945 0.00 0.00 0.00 0.00 $0.00 $0.00J1000 0.00 0.00 0.00 0.00 $0.00 $0.00J1020 0.00 0.00 0.00 0.00 $0.00 $0.00J1030 0.00 0.00 0.00 0.00 $0.00 $0.00J1040 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 55 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

J1051 0.00 0.00 0.00 0.00 $0.00 $0.00J1055 0.00 0.00 0.00 0.00 $0.00 $0.00J1056 0.00 0.00 0.00 0.00 $0.00 $0.00J1060 0.00 0.00 0.00 0.00 $0.00 $0.00J1070 0.00 0.00 0.00 0.00 $0.00 $0.00J1080 0.00 0.00 0.00 0.00 $0.00 $0.00J1094 0.00 0.00 0.00 0.00 $0.00 $0.00J1100 0.00 0.00 0.00 0.00 $0.00 $0.00J1110 0.00 0.00 0.00 0.00 $0.00 $0.00J1120 0.00 0.00 0.00 0.00 $0.00 $0.00J1160 0.00 0.00 0.00 0.00 $0.00 $0.00J1162 0.00 0.00 0.00 0.00 $0.00 $0.00J1165 0.00 0.00 0.00 0.00 $0.00 $0.00J1170 0.00 0.00 0.00 0.00 $0.00 $0.00J1180 0.00 0.00 0.00 0.00 $0.00 $0.00J1190 0.00 0.00 0.00 0.00 $0.00 $0.00J1200 0.00 0.00 0.00 0.00 $0.00 $0.00J1205 0.00 0.00 0.00 0.00 $0.00 $0.00J1212 0.00 0.00 0.00 0.00 $0.00 $0.00J1230 0.00 0.00 0.00 0.00 $0.00 $0.00J1240 0.00 0.00 0.00 0.00 $0.00 $0.00J1245 0.00 0.00 0.00 0.00 $0.00 $0.00J1250 0.00 0.00 0.00 0.00 $0.00 $0.00J1260 0.00 0.00 0.00 0.00 $0.00 $0.00J1265 0.00 0.00 0.00 0.00 $0.00 $0.00J1267 0.00 0.00 0.00 0.00 $0.00 $0.00J1270 0.00 0.00 0.00 0.00 $0.00 $0.00J1290 0.00 0.00 0.00 0.00 $0.00 $0.00J1300 0.00 0.00 0.00 0.00 $0.00 $0.00J1320 0.00 0.00 0.00 0.00 $0.00 $0.00J1324 0.00 0.00 0.00 0.00 $0.00 $0.00J1325 0.00 0.00 0.00 0.00 $0.00 $0.00J1327 0.00 0.00 0.00 0.00 $0.00 $0.00J1330 0.00 0.00 0.00 0.00 $0.00 $0.00J1335 0.00 0.00 0.00 0.00 $0.00 $0.00J1364 0.00 0.00 0.00 0.00 $0.00 $0.00J1380 0.00 0.00 0.00 0.00 $0.00 $0.00J1410 0.00 0.00 0.00 0.00 $0.00 $0.00J1430 0.00 0.00 0.00 0.00 $0.00 $0.00J1435 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 56 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

J1436 0.00 0.00 0.00 0.00 $0.00 $0.00J1438 0.00 0.00 0.00 0.00 $0.00 $0.00J1440 0.00 0.00 0.00 0.00 $0.00 $0.00J1441 0.00 0.00 0.00 0.00 $0.00 $0.00J1450 0.00 0.00 0.00 0.00 $0.00 $0.00J1451 0.00 0.00 0.00 0.00 $0.00 $0.00J1452 0.00 0.00 0.00 0.00 $0.00 $0.00J1453 0.00 0.00 0.00 0.00 $0.00 $0.00J1455 0.00 0.00 0.00 0.00 $0.00 $0.00J1457 0.00 0.00 0.00 0.00 $0.00 $0.00J1458 0.00 0.00 0.00 0.00 $0.00 $0.00J1459 0.00 0.00 0.00 0.00 $0.00 $0.00J1460 0.00 0.00 0.00 0.00 $0.00 $0.00J1557 0.00 0.00 0.00 0.00 $0.00 $0.00J1559 0.00 0.00 0.00 0.00 $0.00 $0.00J1560 0.00 0.00 0.00 0.00 $0.00 $0.00J1561 0.00 0.00 0.00 0.00 $0.00 $0.00J1562 0.00 0.00 0.00 0.00 $0.00 $0.00J1566 0.00 0.00 0.00 0.00 $0.00 $0.00J1568 0.00 0.00 0.00 0.00 $0.00 $0.00J1569 0.00 0.00 0.00 0.00 $0.00 $0.00J1570 0.00 0.00 0.00 0.00 $0.00 $0.00J1571 0.00 0.00 0.00 0.00 $0.00 $0.00J1572 0.00 0.00 0.00 0.00 $0.00 $0.00J1573 0.00 0.00 0.00 0.00 $0.00 $0.00J1580 0.00 0.00 0.00 0.00 $0.00 $0.00J1590 0.00 0.00 0.00 0.00 $0.00 $0.00J1595 0.00 0.00 0.00 0.00 $0.00 $0.00J1599 0.00 0.00 0.00 0.00 $0.00 $0.00J1600 0.00 0.00 0.00 0.00 $0.00 $0.00J1610 0.00 0.00 0.00 0.00 $0.00 $0.00J1620 0.00 0.00 0.00 0.00 $0.00 $0.00J1626 0.00 0.00 0.00 0.00 $0.00 $0.00J1630 0.00 0.00 0.00 0.00 $0.00 $0.00J1631 0.00 0.00 0.00 0.00 $0.00 $0.00J1640 0.00 0.00 0.00 0.00 $0.00 $0.00J1642 0.00 0.00 0.00 0.00 $0.00 $0.00J1644 0.00 0.00 0.00 0.00 $0.00 $0.00J1645 0.00 0.00 0.00 0.00 $0.00 $0.00J1650 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 57 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

J1652 0.00 0.00 0.00 0.00 $0.00 $0.00J1655 0.00 0.00 0.00 0.00 $0.00 $0.00J1670 0.00 0.00 0.00 0.00 $0.00 $0.00J1675 0.00 0.00 0.00 0.00 $0.00 $0.00J1680 0.00 0.00 0.00 0.00 $0.00 $0.00J1700 0.00 0.00 0.00 0.00 $0.00 $0.00J1710 0.00 0.00 0.00 0.00 $0.00 $0.00J1720 0.00 0.00 0.00 0.00 $0.00 $0.00J1725 0.00 0.00 0.00 0.00 $0.00 $0.00J1730 0.00 0.00 0.00 0.00 $0.00 $0.00J1740 0.00 0.00 0.00 0.00 $0.00 $0.00J1742 0.00 0.00 0.00 0.00 $0.00 $0.00J1743 0.00 0.00 0.00 0.00 $0.00 $0.00J1745 0.00 0.00 0.00 0.00 $0.00 $0.00J1750 0.00 0.00 0.00 0.00 $0.00 $0.00J1756 0.00 0.00 0.00 0.00 $0.00 $0.00J1786 0.00 0.00 0.00 0.00 $0.00 $0.00J1790 0.00 0.00 0.00 0.00 $0.00 $0.00J1800 0.00 0.00 0.00 0.00 $0.00 $0.00J1810 0.00 0.00 0.00 0.00 $0.00 $0.00J1815 0.00 0.00 0.00 0.00 $0.00 $0.00J1817 0.00 0.00 0.00 0.00 $0.00 $0.00J1826 0.00 0.00 0.00 0.00 $0.00 $0.00J1830 0.00 0.00 0.00 0.00 $0.00 $0.00J1835 0.00 0.00 0.00 0.00 $0.00 $0.00J1840 0.00 0.00 0.00 0.00 $0.00 $0.00J1850 0.00 0.00 0.00 0.00 $0.00 $0.00J1885 0.00 0.00 0.00 0.00 $0.00 $0.00J1890 0.00 0.00 0.00 0.00 $0.00 $0.00J1930 0.00 0.00 0.00 0.00 $0.00 $0.00J1931 0.00 0.00 0.00 0.00 $0.00 $0.00J1940 0.00 0.00 0.00 0.00 $0.00 $0.00J1945 0.00 0.00 0.00 0.00 $0.00 $0.00J1950 0.00 0.00 0.00 0.00 $0.00 $0.00J1953 0.00 0.00 0.00 0.00 $0.00 $0.00J1955 0.00 0.00 0.00 0.00 $0.00 $0.00J1956 0.00 0.00 0.00 0.00 $0.00 $0.00J1960 0.00 0.00 0.00 0.00 $0.00 $0.00J1980 0.00 0.00 0.00 0.00 $0.00 $0.00J1990 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 58 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

J2001 0.00 0.00 0.00 0.00 $0.00 $0.00J2010 0.00 0.00 0.00 0.00 $0.00 $0.00J2020 0.00 0.00 0.00 0.00 $0.00 $0.00J2060 0.00 0.00 0.00 0.00 $0.00 $0.00J2150 0.00 0.00 0.00 0.00 $0.00 $0.00J2170 0.00 0.00 0.00 0.00 $0.00 $0.00J2175 0.00 0.00 0.00 0.00 $0.00 $0.00J2180 0.00 0.00 0.00 0.00 $0.00 $0.00J2185 0.00 0.00 0.00 0.00 $0.00 $0.00J2210 0.00 0.00 0.00 0.00 $0.00 $0.00J2248 0.00 0.00 0.00 0.00 $0.00 $0.00J2250 0.00 0.00 0.00 0.00 $0.00 $0.00J2260 0.00 0.00 0.00 0.00 $0.00 $0.00J2265 0.00 0.00 0.00 0.00 $0.00 $0.00J2270 0.00 0.00 0.00 0.00 $0.00 $0.00J2271 0.00 0.00 0.00 0.00 $0.00 $0.00J2275 0.00 0.00 0.00 0.00 $0.00 $0.00J2278 0.00 0.00 0.00 0.00 $0.00 $0.00J2280 0.00 0.00 0.00 0.00 $0.00 $0.00J2300 0.00 0.00 0.00 0.00 $0.00 $0.00J2310 0.00 0.00 0.00 0.00 $0.00 $0.00J2315 0.00 0.00 0.00 0.00 $0.00 $0.00J2320 0.00 0.00 0.00 0.00 $0.00 $0.00J2323 0.00 0.00 0.00 0.00 $0.00 $0.00J2325 0.00 0.00 0.00 0.00 $0.00 $0.00J2353 0.00 0.00 0.00 0.00 $0.00 $0.00J2354 0.00 0.00 0.00 0.00 $0.00 $0.00J2355 0.00 0.00 0.00 0.00 $0.00 $0.00J2357 0.00 0.00 0.00 0.00 $0.00 $0.00J2358 0.00 0.00 0.00 0.00 $0.00 $0.00J2360 0.00 0.00 0.00 0.00 $0.00 $0.00J2370 0.00 0.00 0.00 0.00 $0.00 $0.00J2400 0.00 0.00 0.00 0.00 $0.00 $0.00J2405 0.00 0.00 0.00 0.00 $0.00 $0.00J2410 0.00 0.00 0.00 0.00 $0.00 $0.00J2425 0.00 0.00 0.00 0.00 $0.00 $0.00J2426 0.00 0.00 0.00 0.00 $0.00 $0.00J2430 0.00 0.00 0.00 0.00 $0.00 $0.00J2440 0.00 0.00 0.00 0.00 $0.00 $0.00J2460 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 59 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

J2469 0.00 0.00 0.00 0.00 $0.00 $0.00J2501 0.00 0.00 0.00 0.00 $0.00 $0.00J2503 0.00 0.00 0.00 0.00 $0.00 $0.00J2504 0.00 0.00 0.00 0.00 $0.00 $0.00J2505 0.00 0.00 0.00 0.00 $0.00 $0.00J2507 0.00 0.00 0.00 0.00 $0.00 $0.00J2510 0.00 0.00 0.00 0.00 $0.00 $0.00J2513 0.00 0.00 0.00 0.00 $0.00 $0.00J2515 0.00 0.00 0.00 0.00 $0.00 $0.00J2540 0.00 0.00 0.00 0.00 $0.00 $0.00J2543 0.00 0.00 0.00 0.00 $0.00 $0.00J2545 0.00 0.00 0.00 0.00 $0.00 $0.00J2550 0.00 0.00 0.00 0.00 $0.00 $0.00J2560 0.00 0.00 0.00 0.00 $0.00 $0.00J2562 0.00 0.00 0.00 0.00 $0.00 $0.00J2590 0.00 0.00 0.00 0.00 $0.00 $0.00J2597 0.00 0.00 0.00 0.00 $0.00 $0.00J2650 0.00 0.00 0.00 0.00 $0.00 $0.00J2670 0.00 0.00 0.00 0.00 $0.00 $0.00J2675 0.00 0.00 0.00 0.00 $0.00 $0.00J2680 0.00 0.00 0.00 0.00 $0.00 $0.00J2690 0.00 0.00 0.00 0.00 $0.00 $0.00J2700 0.00 0.00 0.00 0.00 $0.00 $0.00J2710 0.00 0.00 0.00 0.00 $0.00 $0.00J2720 0.00 0.00 0.00 0.00 $0.00 $0.00J2724 0.00 0.00 0.00 0.00 $0.00 $0.00J2725 0.00 0.00 0.00 0.00 $0.00 $0.00J2730 0.00 0.00 0.00 0.00 $0.00 $0.00J2760 0.00 0.00 0.00 0.00 $0.00 $0.00J2765 0.00 0.00 0.00 0.00 $0.00 $0.00J2770 0.00 0.00 0.00 0.00 $0.00 $0.00J2778 0.00 0.00 0.00 0.00 $0.00 $0.00J2780 0.00 0.00 0.00 0.00 $0.00 $0.00J2783 0.00 0.00 0.00 0.00 $0.00 $0.00J2785 0.00 0.00 0.00 0.00 $0.00 $0.00J2788 0.00 0.00 0.00 0.00 $0.00 $0.00J2790 0.00 0.00 0.00 0.00 $0.00 $0.00J2791 0.00 0.00 0.00 0.00 $0.00 $0.00J2792 0.00 0.00 0.00 0.00 $0.00 $0.00J2793 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 60 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

J2794 0.00 0.00 0.00 0.00 $0.00 $0.00J2795 0.00 0.00 0.00 0.00 $0.00 $0.00J2796 0.00 0.00 0.00 0.00 $0.00 $0.00J2800 0.00 0.00 0.00 0.00 $0.00 $0.00J2805 0.00 0.00 0.00 0.00 $0.00 $0.00J2810 0.00 0.00 0.00 0.00 $0.00 $0.00J2820 0.00 0.00 0.00 0.00 $0.00 $0.00J2850 0.00 0.00 0.00 0.00 $0.00 $0.00J2910 0.00 0.00 0.00 0.00 $0.00 $0.00J2916 0.00 0.00 0.00 0.00 $0.00 $0.00J2920 0.00 0.00 0.00 0.00 $0.00 $0.00J2930 0.00 0.00 0.00 0.00 $0.00 $0.00J2940 0.00 0.00 0.00 0.00 $0.00 $0.00J2941 0.00 0.00 0.00 0.00 $0.00 $0.00J2950 0.00 0.00 0.00 0.00 $0.00 $0.00J2993 0.00 0.00 0.00 0.00 $0.00 $0.00J2995 0.00 0.00 0.00 0.00 $0.00 $0.00J2997 0.00 0.00 0.00 0.00 $0.00 $0.00J3000 0.00 0.00 0.00 0.00 $0.00 $0.00J3010 0.00 0.00 0.00 0.00 $0.00 $0.00J3030 0.00 0.00 0.00 0.00 $0.00 $0.00J3070 0.00 0.00 0.00 0.00 $0.00 $0.00J3095 0.00 0.00 0.00 0.00 $0.00 $0.00J3101 0.00 0.00 0.00 0.00 $0.00 $0.00J3105 0.00 0.00 0.00 0.00 $0.00 $0.00J3110 0.00 0.00 0.00 0.00 $0.00 $0.00J3120 0.00 0.00 0.00 0.00 $0.00 $0.00J3130 0.00 0.00 0.00 0.00 $0.00 $0.00J3140 0.00 0.00 0.00 0.00 $0.00 $0.00J3150 0.00 0.00 0.00 0.00 $0.00 $0.00J3230 0.00 0.00 0.00 0.00 $0.00 $0.00J3240 0.00 0.00 0.00 0.00 $0.00 $0.00J3243 0.00 0.00 0.00 0.00 $0.00 $0.00J3246 0.00 0.00 0.00 0.00 $0.00 $0.00J3250 0.00 0.00 0.00 0.00 $0.00 $0.00J3260 0.00 0.00 0.00 0.00 $0.00 $0.00J3262 0.00 0.00 0.00 0.00 $0.00 $0.00J3265 0.00 0.00 0.00 0.00 $0.00 $0.00J3280 0.00 0.00 0.00 0.00 $0.00 $0.00J3285 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 61 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

J3300 0.00 0.00 0.00 0.00 $0.00 $0.00J3301 0.00 0.00 0.00 0.00 $0.00 $0.00J3302 0.00 0.00 0.00 0.00 $0.00 $0.00J3303 0.00 0.00 0.00 0.00 $0.00 $0.00J3305 0.00 0.00 0.00 0.00 $0.00 $0.00J3310 0.00 0.00 0.00 0.00 $0.00 $0.00J3315 0.00 0.00 0.00 0.00 $0.00 $0.00J3320 0.00 0.00 0.00 0.00 $0.00 $0.00J3350 0.00 0.00 0.00 0.00 $0.00 $0.00J3355 0.00 0.00 0.00 0.00 $0.00 $0.00J3357 0.00 0.00 0.00 0.00 $0.00 $0.00J3360 0.00 0.00 0.00 0.00 $0.00 $0.00J3364 0.00 0.00 0.00 0.00 $0.00 $0.00J3365 0.00 0.00 0.00 0.00 $0.00 $0.00J3370 0.00 0.00 0.00 0.00 $0.00 $0.00J3385 0.00 0.00 0.00 0.00 $0.00 $0.00J3396 0.00 0.00 0.00 0.00 $0.00 $0.00J3400 0.00 0.00 0.00 0.00 $0.00 $0.00J3410 0.00 0.00 0.00 0.00 $0.00 $0.00J3411 0.00 0.00 0.00 0.00 $0.00 $0.00J3415 0.00 0.00 0.00 0.00 $0.00 $0.00J3420 0.00 0.00 0.00 0.00 $0.00 $0.00J3430 0.00 0.00 0.00 0.00 $0.00 $0.00J3465 0.00 0.00 0.00 0.00 $0.00 $0.00J3470 0.00 0.00 0.00 0.00 $0.00 $0.00J3471 0.00 0.00 0.00 0.00 $0.00 $0.00J3472 0.00 0.00 0.00 0.00 $0.00 $0.00J3473 0.00 0.00 0.00 0.00 $0.00 $0.00J3475 0.00 0.00 0.00 0.00 $0.00 $0.00J3480 0.00 0.00 0.00 0.00 $0.00 $0.00J3485 0.00 0.00 0.00 0.00 $0.00 $0.00J3486 0.00 0.00 0.00 0.00 $0.00 $0.00J3487 0.00 0.00 0.00 0.00 $0.00 $0.00J3488 0.00 0.00 0.00 0.00 $0.00 $0.00J3490 0.00 0.00 0.00 0.00 $0.00 $0.00J3520 0.00 0.00 0.00 0.00 $0.00 $0.00J3530 0.00 0.00 0.00 0.00 $0.00 $0.00J3535 0.00 0.00 0.00 0.00 $0.00 $0.00J3570 0.00 0.00 0.00 0.00 $0.00 $0.00J3590 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 62 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

J7030 0.00 0.00 0.00 0.00 $0.00 $0.00J7040 0.00 0.00 0.00 0.00 $0.00 $0.00J7042 0.00 0.00 0.00 0.00 $0.00 $0.00J7050 0.00 0.00 0.00 0.00 $0.00 $0.00J7060 0.00 0.00 0.00 0.00 $0.00 $0.00J7070 0.00 0.00 0.00 0.00 $0.00 $0.00J7100 0.00 0.00 0.00 0.00 $0.00 $0.00J7110 0.00 0.00 0.00 0.00 $0.00 $0.00J7120 0.00 0.00 0.00 0.00 $0.00 $0.00J7131 0.00 0.00 0.00 0.00 $0.00 $0.00J7180 0.00 0.00 0.00 0.00 $0.00 $0.00J7183 0.00 0.00 0.00 0.00 $0.00 $0.00J7185 0.00 0.00 0.00 0.00 $0.00 $0.00J7186 0.00 0.00 0.00 0.00 $0.00 $0.00J7187 0.00 0.00 0.00 0.00 $0.00 $0.00J7189 0.00 0.00 0.00 0.00 $0.00 $0.00J7190 0.00 0.00 0.00 0.00 $0.00 $0.00J7191 0.00 0.00 0.00 0.00 $0.00 $0.00J7192 0.00 0.00 0.00 0.00 $0.00 $0.00J7193 0.00 0.00 0.00 0.00 $0.00 $0.00J7194 0.00 0.00 0.00 0.00 $0.00 $0.00J7195 0.00 0.00 0.00 0.00 $0.00 $0.00J7196 0.00 0.00 0.00 0.00 $0.00 $0.00J7197 0.00 0.00 0.00 0.00 $0.00 $0.00J7198 0.00 0.00 0.00 0.00 $0.00 $0.00J7199 0.00 0.00 0.00 0.00 $0.00 $0.00J7300 0.00 0.00 0.00 0.00 $0.00 $0.00J7302 0.00 0.00 0.00 0.00 $0.00 $0.00J7303 0.00 0.00 0.00 0.00 $0.00 $0.00J7304 0.00 0.00 0.00 0.00 $0.00 $0.00J7306 0.00 0.00 0.00 0.00 $0.00 $0.00J7307 0.00 0.00 0.00 0.00 $0.00 $0.00J7308 0.00 0.00 0.00 0.00 $0.00 $0.00J7309 0.00 0.00 0.00 0.00 $0.00 $0.00J7310 0.00 0.00 0.00 0.00 $0.00 $0.00J7311 0.00 0.00 0.00 0.00 $0.00 $0.00J7312 0.00 0.00 0.00 0.00 $0.00 $0.00J7321 0.00 0.00 0.00 0.00 $0.00 $0.00J7323 0.00 0.00 0.00 0.00 $0.00 $0.00J7324 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 63 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

J7325 0.00 0.00 0.00 0.00 $0.00 $0.00J7326 0.00 0.00 0.00 0.00 $0.00 $0.00J7330 0.00 0.00 0.00 0.00 $0.00 $0.00J7335 0.00 0.00 0.00 0.00 $0.00 $0.00J7500 0.00 0.00 0.00 0.00 $0.00 $0.00J7501 0.00 0.00 0.00 0.00 $0.00 $0.00J7502 0.00 0.00 0.00 0.00 $0.00 $0.00J7504 0.00 0.00 0.00 0.00 $0.00 $0.00J7505 0.00 0.00 0.00 0.00 $0.00 $0.00J7506 0.00 0.00 0.00 0.00 $0.00 $0.00J7507 0.00 0.00 0.00 0.00 $0.00 $0.00J7509 0.00 0.00 0.00 0.00 $0.00 $0.00J7510 0.00 0.00 0.00 0.00 $0.00 $0.00J7511 0.00 0.00 0.00 0.00 $0.00 $0.00J7513 0.00 0.00 0.00 0.00 $0.00 $0.00J7515 0.00 0.00 0.00 0.00 $0.00 $0.00J7516 0.00 0.00 0.00 0.00 $0.00 $0.00J7517 0.00 0.00 0.00 0.00 $0.00 $0.00J7518 0.00 0.00 0.00 0.00 $0.00 $0.00J7520 0.00 0.00 0.00 0.00 $0.00 $0.00J7525 0.00 0.00 0.00 0.00 $0.00 $0.00J7599 0.00 0.00 0.00 0.00 $0.00 $0.00J7604 0.00 0.00 0.00 0.00 $0.00 $0.00J7605 0.00 0.00 0.00 0.00 $0.00 $0.00J7606 0.00 0.00 0.00 0.00 $0.00 $0.00J7607 0.00 0.00 0.00 0.00 $0.00 $0.00J7608 0.00 0.00 0.00 0.00 $0.00 $0.00J7609 0.00 0.00 0.00 0.00 $0.00 $0.00J7610 0.00 0.00 0.00 0.00 $0.00 $0.00J7611 0.00 0.00 0.00 0.00 $0.00 $0.00J7612 0.00 0.00 0.00 0.00 $0.00 $0.00J7613 0.00 0.00 0.00 0.00 $0.00 $0.00J7614 0.00 0.00 0.00 0.00 $0.00 $0.00J7615 0.00 0.00 0.00 0.00 $0.00 $0.00J7620 0.00 0.00 0.00 0.00 $0.00 $0.00J7622 0.00 0.00 0.00 0.00 $0.00 $0.00J7624 0.00 0.00 0.00 0.00 $0.00 $0.00J7626 0.00 0.00 0.00 0.00 $0.00 $0.00J7627 0.00 0.00 0.00 0.00 $0.00 $0.00J7628 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 64 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

J7629 0.00 0.00 0.00 0.00 $0.00 $0.00J7631 0.00 0.00 0.00 0.00 $0.00 $0.00J7632 0.00 0.00 0.00 0.00 $0.00 $0.00J7633 0.00 0.00 0.00 0.00 $0.00 $0.00J7634 0.00 0.00 0.00 0.00 $0.00 $0.00J7635 0.00 0.00 0.00 0.00 $0.00 $0.00J7636 0.00 0.00 0.00 0.00 $0.00 $0.00J7637 0.00 0.00 0.00 0.00 $0.00 $0.00J7638 0.00 0.00 0.00 0.00 $0.00 $0.00J7639 0.00 0.00 0.00 0.00 $0.00 $0.00J7640 0.00 0.00 0.00 0.00 $0.00 $0.00J7641 0.00 0.00 0.00 0.00 $0.00 $0.00J7642 0.00 0.00 0.00 0.00 $0.00 $0.00J7643 0.00 0.00 0.00 0.00 $0.00 $0.00J7644 0.00 0.00 0.00 0.00 $0.00 $0.00J7645 0.00 0.00 0.00 0.00 $0.00 $0.00J7647 0.00 0.00 0.00 0.00 $0.00 $0.00J7648 0.00 0.00 0.00 0.00 $0.00 $0.00J7649 0.00 0.00 0.00 0.00 $0.00 $0.00J7650 0.00 0.00 0.00 0.00 $0.00 $0.00J7657 0.00 0.00 0.00 0.00 $0.00 $0.00J7658 0.00 0.00 0.00 0.00 $0.00 $0.00J7659 0.00 0.00 0.00 0.00 $0.00 $0.00J7660 0.00 0.00 0.00 0.00 $0.00 $0.00J7665 0.00 0.00 0.00 0.00 $0.00 $0.00J7667 0.00 0.00 0.00 0.00 $0.00 $0.00J7668 0.00 0.00 0.00 0.00 $0.00 $0.00J7669 0.00 0.00 0.00 0.00 $0.00 $0.00J7670 0.00 0.00 0.00 0.00 $0.00 $0.00J7674 0.00 0.00 0.00 0.00 $0.00 $0.00J7676 0.00 0.00 0.00 0.00 $0.00 $0.00J7680 0.00 0.00 0.00 0.00 $0.00 $0.00J7681 0.00 0.00 0.00 0.00 $0.00 $0.00J7682 0.00 0.00 0.00 0.00 $0.00 $0.00J7683 0.00 0.00 0.00 0.00 $0.00 $0.00J7684 0.00 0.00 0.00 0.00 $0.00 $0.00J7685 0.00 0.00 0.00 0.00 $0.00 $0.00J7686 0.00 0.00 0.00 0.00 $0.00 $0.00J7699 0.00 0.00 0.00 0.00 $0.00 $0.00J7799 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 65 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

J8498 0.00 0.00 0.00 0.00 $0.00 $0.00J8499 0.00 0.00 0.00 0.00 $0.00 $0.00J8501 0.00 0.00 0.00 0.00 $0.00 $0.00J8510 0.00 0.00 0.00 0.00 $0.00 $0.00J8515 0.00 0.00 0.00 0.00 $0.00 $0.00J8520 0.00 0.00 0.00 0.00 $0.00 $0.00J8521 0.00 0.00 0.00 0.00 $0.00 $0.00J8530 0.00 0.00 0.00 0.00 $0.00 $0.00J8540 0.00 0.00 0.00 0.00 $0.00 $0.00J8560 0.00 0.00 0.00 0.00 $0.00 $0.00J8561 0.00 0.00 0.00 0.00 $0.00 $0.00J8562 0.00 0.00 0.00 0.00 $0.00 $0.00J8565 0.00 0.00 0.00 0.00 $0.00 $0.00J8597 0.00 0.00 0.00 0.00 $0.00 $0.00J8600 0.00 0.00 0.00 0.00 $0.00 $0.00J8610 0.00 0.00 0.00 0.00 $0.00 $0.00J8650 0.00 0.00 0.00 0.00 $0.00 $0.00J8700 0.00 0.00 0.00 0.00 $0.00 $0.00J8705 0.00 0.00 0.00 0.00 $0.00 $0.00J8999 0.00 0.00 0.00 0.00 $0.00 $0.00J9000 0.00 0.00 0.00 0.00 $0.00 $0.00J9001 0.00 0.00 0.00 0.00 $0.00 $0.00J9010 0.00 0.00 0.00 0.00 $0.00 $0.00J9015 0.00 0.00 0.00 0.00 $0.00 $0.00J9017 0.00 0.00 0.00 0.00 $0.00 $0.00J9020 0.00 0.00 0.00 0.00 $0.00 $0.00J9025 0.00 0.00 0.00 0.00 $0.00 $0.00J9027 0.00 0.00 0.00 0.00 $0.00 $0.00J9031 0.00 0.00 0.00 0.00 $0.00 $0.00J9033 0.00 0.00 0.00 0.00 $0.00 $0.00J9035 0.00 0.00 0.00 0.00 $0.00 $0.00J9040 0.00 0.00 0.00 0.00 $0.00 $0.00J9041 0.00 0.00 0.00 0.00 $0.00 $0.00J9043 0.00 0.00 0.00 0.00 $0.00 $0.00J9045 0.00 0.00 0.00 0.00 $0.00 $0.00J9050 0.00 0.00 0.00 0.00 $0.00 $0.00J9055 0.00 0.00 0.00 0.00 $0.00 $0.00J9060 0.00 0.00 0.00 0.00 $0.00 $0.00J9065 0.00 0.00 0.00 0.00 $0.00 $0.00J9070 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 66 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

J9098 0.00 0.00 0.00 0.00 $0.00 $0.00J9100 0.00 0.00 0.00 0.00 $0.00 $0.00J9120 0.00 0.00 0.00 0.00 $0.00 $0.00J9130 0.00 0.00 0.00 0.00 $0.00 $0.00J9150 0.00 0.00 0.00 0.00 $0.00 $0.00J9151 0.00 0.00 0.00 0.00 $0.00 $0.00J9155 0.00 0.00 0.00 0.00 $0.00 $0.00J9160 0.00 0.00 0.00 0.00 $0.00 $0.00J9165 0.00 0.00 0.00 0.00 $0.00 $0.00J9171 0.00 0.00 0.00 0.00 $0.00 $0.00J9175 0.00 0.00 0.00 0.00 $0.00 $0.00J9178 0.00 0.00 0.00 0.00 $0.00 $0.00J9179 0.00 0.00 0.00 0.00 $0.00 $0.00J9181 0.00 0.00 0.00 0.00 $0.00 $0.00J9185 0.00 0.00 0.00 0.00 $0.00 $0.00J9190 0.00 0.00 0.00 0.00 $0.00 $0.00J9200 0.00 0.00 0.00 0.00 $0.00 $0.00J9201 0.00 0.00 0.00 0.00 $0.00 $0.00J9202 0.00 0.00 0.00 0.00 $0.00 $0.00J9206 0.00 0.00 0.00 0.00 $0.00 $0.00J9207 0.00 0.00 0.00 0.00 $0.00 $0.00J9208 0.00 0.00 0.00 0.00 $0.00 $0.00J9209 0.00 0.00 0.00 0.00 $0.00 $0.00J9211 0.00 0.00 0.00 0.00 $0.00 $0.00J9212 0.00 0.00 0.00 0.00 $0.00 $0.00J9213 0.00 0.00 0.00 0.00 $0.00 $0.00J9214 0.00 0.00 0.00 0.00 $0.00 $0.00J9215 0.00 0.00 0.00 0.00 $0.00 $0.00J9216 0.00 0.00 0.00 0.00 $0.00 $0.00J9217 0.00 0.00 0.00 0.00 $0.00 $0.00J9218 0.00 0.00 0.00 0.00 $0.00 $0.00J9219 0.00 0.00 0.00 0.00 $0.00 $0.00J9225 0.00 0.00 0.00 0.00 $0.00 $0.00J9226 0.00 0.00 0.00 0.00 $0.00 $0.00J9228 0.00 0.00 0.00 0.00 $0.00 $0.00J9230 0.00 0.00 0.00 0.00 $0.00 $0.00J9245 0.00 0.00 0.00 0.00 $0.00 $0.00J9250 0.00 0.00 0.00 0.00 $0.00 $0.00J9260 0.00 0.00 0.00 0.00 $0.00 $0.00J9261 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 67 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

J9263 0.00 0.00 0.00 0.00 $0.00 $0.00J9264 0.00 0.00 0.00 0.00 $0.00 $0.00J9265 0.00 0.00 0.00 0.00 $0.00 $0.00J9266 0.00 0.00 0.00 0.00 $0.00 $0.00J9268 0.00 0.00 0.00 0.00 $0.00 $0.00J9270 0.00 0.00 0.00 0.00 $0.00 $0.00J9280 0.00 0.00 0.00 0.00 $0.00 $0.00J9293 0.00 0.00 0.00 0.00 $0.00 $0.00J9300 0.00 0.00 0.00 0.00 $0.00 $0.00J9302 0.00 0.00 0.00 0.00 $0.00 $0.00J9303 0.00 0.00 0.00 0.00 $0.00 $0.00J9305 0.00 0.00 0.00 0.00 $0.00 $0.00J9307 0.00 0.00 0.00 0.00 $0.00 $0.00J9310 0.00 0.00 0.00 0.00 $0.00 $0.00J9315 0.00 0.00 0.00 0.00 $0.00 $0.00J9320 0.00 0.00 0.00 0.00 $0.00 $0.00J9328 0.00 0.00 0.00 0.00 $0.00 $0.00J9330 0.00 0.00 0.00 0.00 $0.00 $0.00J9340 0.00 0.00 0.00 0.00 $0.00 $0.00J9351 0.00 0.00 0.00 0.00 $0.00 $0.00J9355 0.00 0.00 0.00 0.00 $0.00 $0.00J9357 0.00 0.00 0.00 0.00 $0.00 $0.00J9360 0.00 0.00 0.00 0.00 $0.00 $0.00J9370 0.00 0.00 0.00 0.00 $0.00 $0.00J9390 0.00 0.00 0.00 0.00 $0.00 $0.00J9395 0.00 0.00 0.00 0.00 $0.00 $0.00J9600 0.00 0.00 0.00 0.00 $0.00 $0.00J9999 0.00 0.00 0.00 0.00 $0.00 $0.00M0064 0.37 1.07 0.07 0.01 $66.05 $19.78M0075 0.00 0.00 0.00 0.00 $0.00 $0.00M0076 0.00 0.00 0.00 0.00 $0.00 $0.00M0100 0.00 0.00 0.00 0.00 $0.00 $0.00M0300 0.00 0.00 0.00 0.00 $0.00 $0.00M0301 0.00 0.00 0.00 0.00 $0.00 $0.00P2028 0.00 0.00 0.00 0.00 $0.00 $0.00P2029 0.00 0.00 0.00 0.00 $0.00 $0.00P2031 0.00 0.00 0.00 0.00 $0.00 $0.00P2033 0.00 0.00 0.00 0.00 $0.00 $0.00P2038 0.00 0.00 0.00 0.00 $0.00 $0.00P3000 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 68 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

P3001 0.42 0.41 0.41 0.03 $38.69 $38.69P7001 0.00 0.00 0.00 0.00 $0.00 $0.00P9010 0.00 0.00 0.00 0.00 $0.00 $0.00P9011 0.00 0.00 0.00 0.00 $0.00 $0.00P9012 0.00 0.00 0.00 0.00 $0.00 $0.00P9016 0.00 0.00 0.00 0.00 $0.00 $0.00P9017 0.00 0.00 0.00 0.00 $0.00 $0.00P9019 0.00 0.00 0.00 0.00 $0.00 $0.00P9020 0.00 0.00 0.00 0.00 $0.00 $0.00P9021 0.00 0.00 0.00 0.00 $0.00 $0.00P9022 0.00 0.00 0.00 0.00 $0.00 $0.00P9023 0.00 0.00 0.00 0.00 $0.00 $0.00P9031 0.00 0.00 0.00 0.00 $0.00 $0.00P9032 0.00 0.00 0.00 0.00 $0.00 $0.00P9033 0.00 0.00 0.00 0.00 $0.00 $0.00P9034 0.00 0.00 0.00 0.00 $0.00 $0.00P9035 0.00 0.00 0.00 0.00 $0.00 $0.00P9036 0.00 0.00 0.00 0.00 $0.00 $0.00P9037 0.00 0.00 0.00 0.00 $0.00 $0.00P9038 0.00 0.00 0.00 0.00 $0.00 $0.00P9039 0.00 0.00 0.00 0.00 $0.00 $0.00P9040 0.00 0.00 0.00 0.00 $0.00 $0.00P9041 0.00 0.00 0.00 0.00 $0.00 $0.00P9043 0.00 0.00 0.00 0.00 $0.00 $0.00P9044 0.00 0.00 0.00 0.00 $0.00 $0.00P9045 0.00 0.00 0.00 0.00 $0.00 $0.00P9046 0.00 0.00 0.00 0.00 $0.00 $0.00P9047 0.00 0.00 0.00 0.00 $0.00 $0.00P9048 0.00 0.00 0.00 0.00 $0.00 $0.00P9050 0.00 0.00 0.00 0.00 $0.00 $0.00P9051 0.00 0.00 0.00 0.00 $0.00 $0.00P9052 0.00 0.00 0.00 0.00 $0.00 $0.00P9053 0.00 0.00 0.00 0.00 $0.00 $0.00P9054 0.00 0.00 0.00 0.00 $0.00 $0.00P9055 0.00 0.00 0.00 0.00 $0.00 $0.00P9056 0.00 0.00 0.00 0.00 $0.00 $0.00P9057 0.00 0.00 0.00 0.00 $0.00 $0.00P9058 0.00 0.00 0.00 0.00 $0.00 $0.00P9059 0.00 0.00 0.00 0.00 $0.00 $0.00P9060 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 69 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

P9603 0.00 0.00 0.00 0.00 $0.00 $0.00P9604 0.00 0.00 0.00 0.00 $0.00 $0.00P9612 0.00 0.00 0.00 0.00 $0.00 $0.00P9615 0.00 0.00 0.00 0.00 $0.00 $0.00Q0035 0.17 0.35 0.35 0.02 $24.58 $24.58Q0035 TC 0.00 0.29 0.29 0.01 $13.93 $13.93Q0035 26 0.17 0.06 0.06 0.01 $10.65 $10.65Q0091 0.37 0.91 0.16 0.03 $59.66 $24.96Q0092 0.00 0.65 0.65 0.01 $30.59 $30.59Q0111 0.00 0.00 0.00 0.00 $0.00 $0.00Q0112 0.00 0.00 0.00 0.00 $0.00 $0.00Q0113 0.00 0.00 0.00 0.00 $0.00 $0.00Q0114 0.00 0.00 0.00 0.00 $0.00 $0.00Q0115 0.00 0.00 0.00 0.00 $0.00 $0.00Q0138 0.00 0.00 0.00 0.00 $0.00 $0.00Q0139 0.00 0.00 0.00 0.00 $0.00 $0.00Q0144 0.00 0.00 0.00 0.00 $0.00 $0.00Q0162 0.00 0.00 0.00 0.00 $0.00 $0.00Q0163 0.00 0.00 0.00 0.00 $0.00 $0.00Q0164 0.00 0.00 0.00 0.00 $0.00 $0.00Q0165 0.00 0.00 0.00 0.00 $0.00 $0.00Q0166 0.00 0.00 0.00 0.00 $0.00 $0.00Q0167 0.00 0.00 0.00 0.00 $0.00 $0.00Q0168 0.00 0.00 0.00 0.00 $0.00 $0.00Q0169 0.00 0.00 0.00 0.00 $0.00 $0.00Q0170 0.00 0.00 0.00 0.00 $0.00 $0.00Q0171 0.00 0.00 0.00 0.00 $0.00 $0.00Q0172 0.00 0.00 0.00 0.00 $0.00 $0.00Q0173 0.00 0.00 0.00 0.00 $0.00 $0.00Q0174 0.00 0.00 0.00 0.00 $0.00 $0.00Q0175 0.00 0.00 0.00 0.00 $0.00 $0.00Q0176 0.00 0.00 0.00 0.00 $0.00 $0.00Q0177 0.00 0.00 0.00 0.00 $0.00 $0.00Q0178 0.00 0.00 0.00 0.00 $0.00 $0.00Q0180 0.00 0.00 0.00 0.00 $0.00 $0.00Q0181 0.00 0.00 0.00 0.00 $0.00 $0.00Q0478 0.00 0.00 0.00 0.00 $0.00 $0.00Q0479 0.00 0.00 0.00 0.00 $0.00 $0.00Q0480 0.00 0.00 0.00 0.00 $0.00 $0.00Q0481 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 70 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

Q0482 0.00 0.00 0.00 0.00 $0.00 $0.00Q0483 0.00 0.00 0.00 0.00 $0.00 $0.00Q0484 0.00 0.00 0.00 0.00 $0.00 $0.00Q0485 0.00 0.00 0.00 0.00 $0.00 $0.00Q0486 0.00 0.00 0.00 0.00 $0.00 $0.00Q0487 0.00 0.00 0.00 0.00 $0.00 $0.00Q0488 0.00 0.00 0.00 0.00 $0.00 $0.00Q0489 0.00 0.00 0.00 0.00 $0.00 $0.00Q0490 0.00 0.00 0.00 0.00 $0.00 $0.00Q0491 0.00 0.00 0.00 0.00 $0.00 $0.00Q0492 0.00 0.00 0.00 0.00 $0.00 $0.00Q0493 0.00 0.00 0.00 0.00 $0.00 $0.00Q0494 0.00 0.00 0.00 0.00 $0.00 $0.00Q0495 0.00 0.00 0.00 0.00 $0.00 $0.00Q0496 0.00 0.00 0.00 0.00 $0.00 $0.00Q0497 0.00 0.00 0.00 0.00 $0.00 $0.00Q0498 0.00 0.00 0.00 0.00 $0.00 $0.00Q0499 0.00 0.00 0.00 0.00 $0.00 $0.00Q0500 0.00 0.00 0.00 0.00 $0.00 $0.00Q0501 0.00 0.00 0.00 0.00 $0.00 $0.00Q0502 0.00 0.00 0.00 0.00 $0.00 $0.00Q0503 0.00 0.00 0.00 0.00 $0.00 $0.00Q0504 0.00 0.00 0.00 0.00 $0.00 $0.00Q0505 0.00 0.00 0.00 0.00 $0.00 $0.00Q0506 0.00 0.00 0.00 0.00 $0.00 $0.00Q0510 0.00 0.00 0.00 0.00 $0.00 $0.00Q0511 0.00 0.00 0.00 0.00 $0.00 $0.00Q0512 0.00 0.00 0.00 0.00 $0.00 $0.00Q0513 0.00 0.00 0.00 0.00 $0.00 $0.00Q0514 0.00 0.00 0.00 0.00 $0.00 $0.00Q0515 0.00 0.00 0.00 0.00 $0.00 $0.00Q1004 0.00 0.00 0.00 0.00 $0.00 $0.00Q1005 0.00 0.00 0.00 0.00 $0.00 $0.00Q2004 0.00 0.00 0.00 0.00 $0.00 $0.00Q2009 0.00 0.00 0.00 0.00 $0.00 $0.00Q2017 0.00 0.00 0.00 0.00 $0.00 $0.00Q2026 0.00 0.00 0.00 0.00 $0.00 $0.00Q2027 0.00 0.00 0.00 0.00 $0.00 $0.00Q2035 0.00 0.00 0.00 0.00 $0.00 $0.00Q2036 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 71 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

Q2037 0.00 0.00 0.00 0.00 $0.00 $0.00Q2038 0.00 0.00 0.00 0.00 $0.00 $0.00Q2039 0.00 0.00 0.00 0.00 $0.00 $0.00Q2043 0.00 0.00 0.00 0.00 $0.00 $0.00Q3001 0.00 0.00 0.00 0.00 $0.00 $0.00Q3014 0.00 0.00 0.00 0.00 $0.00 $0.00Q3025 0.00 0.00 0.00 0.00 $0.00 $0.00Q3026 0.00 0.00 0.00 0.00 $0.00 $0.00Q3031 0.00 0.00 0.00 0.00 $0.00 $0.00Q4001 0.00 0.00 0.00 0.00 $0.00 $0.00Q4002 0.00 0.00 0.00 0.00 $0.00 $0.00Q4003 0.00 0.00 0.00 0.00 $0.00 $0.00Q4004 0.00 0.00 0.00 0.00 $0.00 $0.00Q4005 0.00 0.00 0.00 0.00 $0.00 $0.00Q4006 0.00 0.00 0.00 0.00 $0.00 $0.00Q4007 0.00 0.00 0.00 0.00 $0.00 $0.00Q4008 0.00 0.00 0.00 0.00 $0.00 $0.00Q4009 0.00 0.00 0.00 0.00 $0.00 $0.00Q4010 0.00 0.00 0.00 0.00 $0.00 $0.00Q4011 0.00 0.00 0.00 0.00 $0.00 $0.00Q4012 0.00 0.00 0.00 0.00 $0.00 $0.00Q4013 0.00 0.00 0.00 0.00 $0.00 $0.00Q4014 0.00 0.00 0.00 0.00 $0.00 $0.00Q4015 0.00 0.00 0.00 0.00 $0.00 $0.00Q4016 0.00 0.00 0.00 0.00 $0.00 $0.00Q4017 0.00 0.00 0.00 0.00 $0.00 $0.00Q4018 0.00 0.00 0.00 0.00 $0.00 $0.00Q4019 0.00 0.00 0.00 0.00 $0.00 $0.00Q4020 0.00 0.00 0.00 0.00 $0.00 $0.00Q4021 0.00 0.00 0.00 0.00 $0.00 $0.00Q4022 0.00 0.00 0.00 0.00 $0.00 $0.00Q4023 0.00 0.00 0.00 0.00 $0.00 $0.00Q4024 0.00 0.00 0.00 0.00 $0.00 $0.00Q4025 0.00 0.00 0.00 0.00 $0.00 $0.00Q4026 0.00 0.00 0.00 0.00 $0.00 $0.00Q4027 0.00 0.00 0.00 0.00 $0.00 $0.00Q4028 0.00 0.00 0.00 0.00 $0.00 $0.00Q4029 0.00 0.00 0.00 0.00 $0.00 $0.00Q4030 0.00 0.00 0.00 0.00 $0.00 $0.00Q4031 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 72 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

Q4032 0.00 0.00 0.00 0.00 $0.00 $0.00Q4033 0.00 0.00 0.00 0.00 $0.00 $0.00Q4034 0.00 0.00 0.00 0.00 $0.00 $0.00Q4035 0.00 0.00 0.00 0.00 $0.00 $0.00Q4036 0.00 0.00 0.00 0.00 $0.00 $0.00Q4037 0.00 0.00 0.00 0.00 $0.00 $0.00Q4038 0.00 0.00 0.00 0.00 $0.00 $0.00Q4039 0.00 0.00 0.00 0.00 $0.00 $0.00Q4040 0.00 0.00 0.00 0.00 $0.00 $0.00Q4041 0.00 0.00 0.00 0.00 $0.00 $0.00Q4042 0.00 0.00 0.00 0.00 $0.00 $0.00Q4043 0.00 0.00 0.00 0.00 $0.00 $0.00Q4044 0.00 0.00 0.00 0.00 $0.00 $0.00Q4045 0.00 0.00 0.00 0.00 $0.00 $0.00Q4046 0.00 0.00 0.00 0.00 $0.00 $0.00Q4047 0.00 0.00 0.00 0.00 $0.00 $0.00Q4048 0.00 0.00 0.00 0.00 $0.00 $0.00Q4049 0.00 0.00 0.00 0.00 $0.00 $0.00Q4050 0.00 0.00 0.00 0.00 $0.00 $0.00Q4051 0.00 0.00 0.00 0.00 $0.00 $0.00Q4074 0.00 0.00 0.00 0.00 $0.00 $0.00Q4081 0.00 0.00 0.00 0.00 $0.00 $0.00Q4082 0.00 0.00 0.00 0.00 $0.00 $0.00Q4100 0.00 0.00 0.00 0.00 $0.00 $0.00Q4101 0.00 0.00 0.00 0.00 $0.00 $0.00Q4102 0.00 0.00 0.00 0.00 $0.00 $0.00Q4103 0.00 0.00 0.00 0.00 $0.00 $0.00Q4104 0.00 0.00 0.00 0.00 $0.00 $0.00Q4105 0.00 0.00 0.00 0.00 $0.00 $0.00Q4106 0.00 0.00 0.00 0.00 $0.00 $0.00Q4107 0.00 0.00 0.00 0.00 $0.00 $0.00Q4108 0.00 0.00 0.00 0.00 $0.00 $0.00Q4110 0.00 0.00 0.00 0.00 $0.00 $0.00Q4111 0.00 0.00 0.00 0.00 $0.00 $0.00Q4112 0.00 0.00 0.00 0.00 $0.00 $0.00Q4113 0.00 0.00 0.00 0.00 $0.00 $0.00Q4114 0.00 0.00 0.00 0.00 $0.00 $0.00Q4115 0.00 0.00 0.00 0.00 $0.00 $0.00Q4116 0.00 0.00 0.00 0.00 $0.00 $0.00Q4117 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 73 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

Q4118 0.00 0.00 0.00 0.00 $0.00 $0.00Q4119 0.00 0.00 0.00 0.00 $0.00 $0.00Q4120 0.00 0.00 0.00 0.00 $0.00 $0.00Q4121 0.00 0.00 0.00 0.00 $0.00 $0.00Q4122 0.00 0.00 0.00 0.00 $0.00 $0.00Q4123 0.00 0.00 0.00 0.00 $0.00 $0.00Q4124 0.00 0.00 0.00 0.00 $0.00 $0.00Q4125 0.00 0.00 0.00 0.00 $0.00 $0.00Q4126 0.00 0.00 0.00 0.00 $0.00 $0.00Q4127 0.00 0.00 0.00 0.00 $0.00 $0.00Q4128 0.00 0.00 0.00 0.00 $0.00 $0.00Q4129 0.00 0.00 0.00 0.00 $0.00 $0.00Q4130 0.00 0.00 0.00 0.00 $0.00 $0.00Q5001 0.00 0.00 0.00 0.00 $0.00 $0.00Q5002 0.00 0.00 0.00 0.00 $0.00 $0.00Q5003 0.00 0.00 0.00 0.00 $0.00 $0.00Q5004 0.00 0.00 0.00 0.00 $0.00 $0.00Q5005 0.00 0.00 0.00 0.00 $0.00 $0.00Q5006 0.00 0.00 0.00 0.00 $0.00 $0.00Q5007 0.00 0.00 0.00 0.00 $0.00 $0.00Q5008 0.00 0.00 0.00 0.00 $0.00 $0.00Q5009 0.00 0.00 0.00 0.00 $0.00 $0.00Q5010 0.00 0.00 0.00 0.00 $0.00 $0.00Q9951 0.00 0.00 0.00 0.00 $0.00 $0.00Q9953 0.00 0.00 0.00 0.00 $0.00 $0.00Q9954 0.00 0.00 0.00 0.00 $0.00 $0.00Q9955 0.00 0.00 0.00 0.00 $0.00 $0.00Q9956 0.00 0.00 0.00 0.00 $0.00 $0.00Q9957 0.00 0.00 0.00 0.00 $0.00 $0.00Q9958 0.00 0.00 0.00 0.00 $0.00 $0.00Q9959 0.00 0.00 0.00 0.00 $0.00 $0.00Q9960 0.00 0.00 0.00 0.00 $0.00 $0.00Q9961 0.00 0.00 0.00 0.00 $0.00 $0.00Q9962 0.00 0.00 0.00 0.00 $0.00 $0.00Q9963 0.00 0.00 0.00 0.00 $0.00 $0.00Q9964 0.00 0.00 0.00 0.00 $0.00 $0.00Q9965 0.00 0.00 0.00 0.00 $0.00 $0.00Q9966 0.00 0.00 0.00 0.00 $0.00 $0.00Q9967 0.00 0.00 0.00 0.00 $0.00 $0.00Q9968 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 74 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

R0070 0.00 0.00 0.00 0.00 $0.00 $0.00R0075 0.00 0.00 0.00 0.00 $0.00 $0.00R0076 0.00 0.00 0.00 0.00 $0.00 $0.00S0012 0.00 0.00 0.00 0.00 $0.00 $0.00S0014 0.00 0.00 0.00 0.00 $0.00 $0.00S0017 0.00 0.00 0.00 0.00 $0.00 $0.00S0020 0.00 0.00 0.00 0.00 $0.00 $0.00S0021 0.00 0.00 0.00 0.00 $0.00 $0.00S0023 0.00 0.00 0.00 0.00 $0.00 $0.00S0028 0.00 0.00 0.00 0.00 $0.00 $0.00S0030 0.00 0.00 0.00 0.00 $0.00 $0.00S0032 0.00 0.00 0.00 0.00 $0.00 $0.00S0034 0.00 0.00 0.00 0.00 $0.00 $0.00S0039 0.00 0.00 0.00 0.00 $0.00 $0.00S0040 0.00 0.00 0.00 0.00 $0.00 $0.00S0073 0.00 0.00 0.00 0.00 $0.00 $0.00S0074 0.00 0.00 0.00 0.00 $0.00 $0.00S0077 0.00 0.00 0.00 0.00 $0.00 $0.00S0078 0.00 0.00 0.00 0.00 $0.00 $0.00S0080 0.00 0.00 0.00 0.00 $0.00 $0.00S0081 0.00 0.00 0.00 0.00 $0.00 $0.00S0088 0.00 0.00 0.00 0.00 $0.00 $0.00S0090 0.00 0.00 0.00 0.00 $0.00 $0.00S0091 0.00 0.00 0.00 0.00 $0.00 $0.00S0092 0.00 0.00 0.00 0.00 $0.00 $0.00S0093 0.00 0.00 0.00 0.00 $0.00 $0.00S0104 0.00 0.00 0.00 0.00 $0.00 $0.00S0106 0.00 0.00 0.00 0.00 $0.00 $0.00S0108 0.00 0.00 0.00 0.00 $0.00 $0.00S0109 0.00 0.00 0.00 0.00 $0.00 $0.00S0117 0.00 0.00 0.00 0.00 $0.00 $0.00S0119 0.00 0.00 0.00 0.00 $0.00 $0.00S0122 0.00 0.00 0.00 0.00 $0.00 $0.00S0126 0.00 0.00 0.00 0.00 $0.00 $0.00S0128 0.00 0.00 0.00 0.00 $0.00 $0.00S0132 0.00 0.00 0.00 0.00 $0.00 $0.00S0136 0.00 0.00 0.00 0.00 $0.00 $0.00S0137 0.00 0.00 0.00 0.00 $0.00 $0.00S0138 0.00 0.00 0.00 0.00 $0.00 $0.00S0139 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 75 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

S0140 0.00 0.00 0.00 0.00 $0.00 $0.00S0142 0.00 0.00 0.00 0.00 $0.00 $0.00S0145 0.00 0.00 0.00 0.00 $0.00 $0.00S0148 0.00 0.00 0.00 0.00 $0.00 $0.00S0155 0.00 0.00 0.00 0.00 $0.00 $0.00S0156 0.00 0.00 0.00 0.00 $0.00 $0.00S0157 0.00 0.00 0.00 0.00 $0.00 $0.00S0160 0.00 0.00 0.00 0.00 $0.00 $0.00S0164 0.00 0.00 0.00 0.00 $0.00 $0.00S0166 0.00 0.00 0.00 0.00 $0.00 $0.00S0169 0.00 0.00 0.00 0.00 $0.00 $0.00S0170 0.00 0.00 0.00 0.00 $0.00 $0.00S0171 0.00 0.00 0.00 0.00 $0.00 $0.00S0172 0.00 0.00 0.00 0.00 $0.00 $0.00S0174 0.00 0.00 0.00 0.00 $0.00 $0.00S0175 0.00 0.00 0.00 0.00 $0.00 $0.00S0176 0.00 0.00 0.00 0.00 $0.00 $0.00S0177 0.00 0.00 0.00 0.00 $0.00 $0.00S0178 0.00 0.00 0.00 0.00 $0.00 $0.00S0179 0.00 0.00 0.00 0.00 $0.00 $0.00S0182 0.00 0.00 0.00 0.00 $0.00 $0.00S0183 0.00 0.00 0.00 0.00 $0.00 $0.00S0187 0.00 0.00 0.00 0.00 $0.00 $0.00S0189 0.00 0.00 0.00 0.00 $0.00 $0.00S0190 0.00 0.00 0.00 0.00 $0.00 $0.00S0191 0.00 0.00 0.00 0.00 $0.00 $0.00S0194 0.00 0.00 0.00 0.00 $0.00 $0.00S0195 0.00 0.00 0.00 0.00 $0.00 $0.00S0197 0.00 0.00 0.00 0.00 $0.00 $0.00S0199 0.00 0.00 0.00 0.00 $0.00 $0.00S0201 0.00 0.00 0.00 0.00 $0.00 $0.00S0207 0.00 0.00 0.00 0.00 $0.00 $0.00S0208 0.00 0.00 0.00 0.00 $0.00 $0.00S0209 0.00 0.00 0.00 0.00 $0.00 $0.00S0215 0.00 0.00 0.00 0.00 $0.00 $0.00S0220 0.00 0.00 0.00 0.00 $0.00 $0.00S0221 0.00 0.00 0.00 0.00 $0.00 $0.00S0250 0.00 0.00 0.00 0.00 $0.00 $0.00S0255 0.00 0.00 0.00 0.00 $0.00 $0.00S0257 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 76 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

S0260 0.00 0.00 0.00 0.00 $0.00 $0.00S0265 0.00 0.00 0.00 0.00 $0.00 $0.00S0270 0.00 0.00 0.00 0.00 $0.00 $0.00S0271 0.00 0.00 0.00 0.00 $0.00 $0.00S0272 0.00 0.00 0.00 0.00 $0.00 $0.00S0273 0.00 0.00 0.00 0.00 $0.00 $0.00S0274 0.00 0.00 0.00 0.00 $0.00 $0.00S0280 0.00 0.00 0.00 0.00 $0.00 $0.00S0281 0.00 0.00 0.00 0.00 $0.00 $0.00S0302 0.00 0.00 0.00 0.00 $0.00 $0.00S0310 0.00 0.00 0.00 0.00 $0.00 $0.00S0315 0.00 0.00 0.00 0.00 $0.00 $0.00S0316 0.00 0.00 0.00 0.00 $0.00 $0.00S0317 0.00 0.00 0.00 0.00 $0.00 $0.00S0320 0.00 0.00 0.00 0.00 $0.00 $0.00S0340 0.00 0.00 0.00 0.00 $0.00 $0.00S0341 0.00 0.00 0.00 0.00 $0.00 $0.00S0342 0.00 0.00 0.00 0.00 $0.00 $0.00S0390 0.00 0.00 0.00 0.00 $0.00 $0.00S0395 0.00 0.00 0.00 0.00 $0.00 $0.00S0400 0.00 0.00 0.00 0.00 $0.00 $0.00S0500 0.00 0.00 0.00 0.00 $0.00 $0.00S0504 0.00 0.00 0.00 0.00 $0.00 $0.00S0506 0.00 0.00 0.00 0.00 $0.00 $0.00S0508 0.00 0.00 0.00 0.00 $0.00 $0.00S0510 0.00 0.00 0.00 0.00 $0.00 $0.00S0512 0.00 0.00 0.00 0.00 $0.00 $0.00S0514 0.00 0.00 0.00 0.00 $0.00 $0.00S0515 0.00 0.00 0.00 0.00 $0.00 $0.00S0516 0.00 0.00 0.00 0.00 $0.00 $0.00S0518 0.00 0.00 0.00 0.00 $0.00 $0.00S0580 0.00 0.00 0.00 0.00 $0.00 $0.00S0581 0.00 0.00 0.00 0.00 $0.00 $0.00S0590 0.00 0.00 0.00 0.00 $0.00 $0.00S0592 0.00 0.00 0.00 0.00 $0.00 $0.00S0595 0.00 0.00 0.00 0.00 $0.00 $0.00S0601 0.00 0.00 0.00 0.00 $0.00 $0.00S0610 0.00 0.00 0.00 0.00 $0.00 $0.00S0612 0.00 0.00 0.00 0.00 $0.00 $0.00S0613 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 77 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

S0618 0.00 0.00 0.00 0.00 $0.00 $0.00S0620 0.00 0.00 0.00 0.00 $0.00 $0.00S0621 0.00 0.00 0.00 0.00 $0.00 $0.00S0622 0.00 0.00 0.00 0.00 $0.00 $0.00S0630 0.00 0.00 0.00 0.00 $0.00 $0.00S0800 0.00 0.00 0.00 0.00 $0.00 $0.00S0810 0.00 0.00 0.00 0.00 $0.00 $0.00S0812 0.00 0.00 0.00 0.00 $0.00 $0.00S1001 0.00 0.00 0.00 0.00 $0.00 $0.00S1002 0.00 0.00 0.00 0.00 $0.00 $0.00S1015 0.00 0.00 0.00 0.00 $0.00 $0.00S1016 0.00 0.00 0.00 0.00 $0.00 $0.00S1030 0.00 0.00 0.00 0.00 $0.00 $0.00S1031 0.00 0.00 0.00 0.00 $0.00 $0.00S1040 0.00 0.00 0.00 0.00 $0.00 $0.00S2053 0.00 0.00 0.00 0.00 $0.00 $0.00S2054 0.00 0.00 0.00 0.00 $0.00 $0.00S2055 0.00 0.00 0.00 0.00 $0.00 $0.00S2060 0.00 0.00 0.00 0.00 $0.00 $0.00S2061 0.00 0.00 0.00 0.00 $0.00 $0.00S2065 0.00 0.00 0.00 0.00 $0.00 $0.00S2066 0.00 0.00 0.00 0.00 $0.00 $0.00S2067 0.00 0.00 0.00 0.00 $0.00 $0.00S2068 0.00 0.00 0.00 0.00 $0.00 $0.00S2070 0.00 0.00 0.00 0.00 $0.00 $0.00S2079 0.00 0.00 0.00 0.00 $0.00 $0.00S2080 0.00 0.00 0.00 0.00 $0.00 $0.00S2083 0.00 0.00 0.00 0.00 $0.00 $0.00S2095 0.00 0.00 0.00 0.00 $0.00 $0.00S2102 0.00 0.00 0.00 0.00 $0.00 $0.00S2103 0.00 0.00 0.00 0.00 $0.00 $0.00S2107 0.00 0.00 0.00 0.00 $0.00 $0.00S2112 0.00 0.00 0.00 0.00 $0.00 $0.00S2115 0.00 0.00 0.00 0.00 $0.00 $0.00S2117 0.00 0.00 0.00 0.00 $0.00 $0.00S2118 0.00 0.00 0.00 0.00 $0.00 $0.00S2120 0.00 0.00 0.00 0.00 $0.00 $0.00S2140 0.00 0.00 0.00 0.00 $0.00 $0.00S2142 0.00 0.00 0.00 0.00 $0.00 $0.00S2150 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 78 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

S2152 0.00 0.00 0.00 0.00 $0.00 $0.00S2202 0.00 0.00 0.00 0.00 $0.00 $0.00S2205 0.00 0.00 0.00 0.00 $0.00 $0.00S2206 0.00 0.00 0.00 0.00 $0.00 $0.00S2207 0.00 0.00 0.00 0.00 $0.00 $0.00S2208 0.00 0.00 0.00 0.00 $0.00 $0.00S2209 0.00 0.00 0.00 0.00 $0.00 $0.00S2225 0.00 0.00 0.00 0.00 $0.00 $0.00S2230 0.00 0.00 0.00 0.00 $0.00 $0.00S2235 0.00 0.00 0.00 0.00 $0.00 $0.00S2260 0.00 0.00 0.00 0.00 $0.00 $0.00S2265 0.00 0.00 0.00 0.00 $0.00 $0.00S2266 0.00 0.00 0.00 0.00 $0.00 $0.00S2267 0.00 0.00 0.00 0.00 $0.00 $0.00S2300 0.00 0.00 0.00 0.00 $0.00 $0.00S2325 0.00 0.00 0.00 0.00 $0.00 $0.00S2340 0.00 0.00 0.00 0.00 $0.00 $0.00S2341 0.00 0.00 0.00 0.00 $0.00 $0.00S2342 0.00 0.00 0.00 0.00 $0.00 $0.00S2348 0.00 0.00 0.00 0.00 $0.00 $0.00S2350 0.00 0.00 0.00 0.00 $0.00 $0.00S2351 0.00 0.00 0.00 0.00 $0.00 $0.00S2360 0.00 0.00 0.00 0.00 $0.00 $0.00S2361 0.00 0.00 0.00 0.00 $0.00 $0.00S2400 0.00 0.00 0.00 0.00 $0.00 $0.00S2401 0.00 0.00 0.00 0.00 $0.00 $0.00S2402 0.00 0.00 0.00 0.00 $0.00 $0.00S2403 0.00 0.00 0.00 0.00 $0.00 $0.00S2404 0.00 0.00 0.00 0.00 $0.00 $0.00S2405 0.00 0.00 0.00 0.00 $0.00 $0.00S2409 0.00 0.00 0.00 0.00 $0.00 $0.00S2411 0.00 0.00 0.00 0.00 $0.00 $0.00S2900 0.00 0.00 0.00 0.00 $0.00 $0.00S3000 0.00 0.00 0.00 0.00 $0.00 $0.00S3005 0.00 0.00 0.00 0.00 $0.00 $0.00S3600 0.00 0.00 0.00 0.00 $0.00 $0.00S3601 0.00 0.00 0.00 0.00 $0.00 $0.00S3620 0.00 0.00 0.00 0.00 $0.00 $0.00S3625 0.00 0.00 0.00 0.00 $0.00 $0.00S3626 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 79 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

S3630 0.00 0.00 0.00 0.00 $0.00 $0.00S3645 0.00 0.00 0.00 0.00 $0.00 $0.00S3650 0.00 0.00 0.00 0.00 $0.00 $0.00S3652 0.00 0.00 0.00 0.00 $0.00 $0.00S3655 0.00 0.00 0.00 0.00 $0.00 $0.00S3708 0.00 0.00 0.00 0.00 $0.00 $0.00S3711 0.00 0.00 0.00 0.00 $0.00 $0.00S3713 0.00 0.00 0.00 0.00 $0.00 $0.00S3722 0.00 0.00 0.00 0.00 $0.00 $0.00S3800 0.00 0.00 0.00 0.00 $0.00 $0.00S3818 0.00 0.00 0.00 0.00 $0.00 $0.00S3819 0.00 0.00 0.00 0.00 $0.00 $0.00S3820 0.00 0.00 0.00 0.00 $0.00 $0.00S3822 0.00 0.00 0.00 0.00 $0.00 $0.00S3823 0.00 0.00 0.00 0.00 $0.00 $0.00S3828 0.00 0.00 0.00 0.00 $0.00 $0.00S3829 0.00 0.00 0.00 0.00 $0.00 $0.00S3830 0.00 0.00 0.00 0.00 $0.00 $0.00S3831 0.00 0.00 0.00 0.00 $0.00 $0.00S3833 0.00 0.00 0.00 0.00 $0.00 $0.00S3834 0.00 0.00 0.00 0.00 $0.00 $0.00S3835 0.00 0.00 0.00 0.00 $0.00 $0.00S3837 0.00 0.00 0.00 0.00 $0.00 $0.00S3840 0.00 0.00 0.00 0.00 $0.00 $0.00S3841 0.00 0.00 0.00 0.00 $0.00 $0.00S3842 0.00 0.00 0.00 0.00 $0.00 $0.00S3843 0.00 0.00 0.00 0.00 $0.00 $0.00S3844 0.00 0.00 0.00 0.00 $0.00 $0.00S3845 0.00 0.00 0.00 0.00 $0.00 $0.00S3846 0.00 0.00 0.00 0.00 $0.00 $0.00S3847 0.00 0.00 0.00 0.00 $0.00 $0.00S3848 0.00 0.00 0.00 0.00 $0.00 $0.00S3849 0.00 0.00 0.00 0.00 $0.00 $0.00S3850 0.00 0.00 0.00 0.00 $0.00 $0.00S3851 0.00 0.00 0.00 0.00 $0.00 $0.00S3852 0.00 0.00 0.00 0.00 $0.00 $0.00S3853 0.00 0.00 0.00 0.00 $0.00 $0.00S3854 0.00 0.00 0.00 0.00 $0.00 $0.00S3855 0.00 0.00 0.00 0.00 $0.00 $0.00S3860 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 80 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

S3861 0.00 0.00 0.00 0.00 $0.00 $0.00S3862 0.00 0.00 0.00 0.00 $0.00 $0.00S3865 0.00 0.00 0.00 0.00 $0.00 $0.00S3866 0.00 0.00 0.00 0.00 $0.00 $0.00S3870 0.00 0.00 0.00 0.00 $0.00 $0.00S3890 0.00 0.00 0.00 0.00 $0.00 $0.00S3900 0.00 0.00 0.00 0.00 $0.00 $0.00S3902 0.00 0.00 0.00 0.00 $0.00 $0.00S3904 0.00 0.00 0.00 0.00 $0.00 $0.00S4005 0.00 0.00 0.00 0.00 $0.00 $0.00S4011 0.00 0.00 0.00 0.00 $0.00 $0.00S4013 0.00 0.00 0.00 0.00 $0.00 $0.00S4014 0.00 0.00 0.00 0.00 $0.00 $0.00S4015 0.00 0.00 0.00 0.00 $0.00 $0.00S4016 0.00 0.00 0.00 0.00 $0.00 $0.00S4017 0.00 0.00 0.00 0.00 $0.00 $0.00S4018 0.00 0.00 0.00 0.00 $0.00 $0.00S4020 0.00 0.00 0.00 0.00 $0.00 $0.00S4021 0.00 0.00 0.00 0.00 $0.00 $0.00S4022 0.00 0.00 0.00 0.00 $0.00 $0.00S4023 0.00 0.00 0.00 0.00 $0.00 $0.00S4025 0.00 0.00 0.00 0.00 $0.00 $0.00S4026 0.00 0.00 0.00 0.00 $0.00 $0.00S4027 0.00 0.00 0.00 0.00 $0.00 $0.00S4028 0.00 0.00 0.00 0.00 $0.00 $0.00S4030 0.00 0.00 0.00 0.00 $0.00 $0.00S4031 0.00 0.00 0.00 0.00 $0.00 $0.00S4035 0.00 0.00 0.00 0.00 $0.00 $0.00S4037 0.00 0.00 0.00 0.00 $0.00 $0.00S4040 0.00 0.00 0.00 0.00 $0.00 $0.00S4042 0.00 0.00 0.00 0.00 $0.00 $0.00S4981 0.00 0.00 0.00 0.00 $0.00 $0.00S4989 0.00 0.00 0.00 0.00 $0.00 $0.00S4990 0.00 0.00 0.00 0.00 $0.00 $0.00S4991 0.00 0.00 0.00 0.00 $0.00 $0.00S4993 0.00 0.00 0.00 0.00 $0.00 $0.00S4995 0.00 0.00 0.00 0.00 $0.00 $0.00S5000 0.00 0.00 0.00 0.00 $0.00 $0.00S5001 0.00 0.00 0.00 0.00 $0.00 $0.00S5010 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 81 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

S5011 0.00 0.00 0.00 0.00 $0.00 $0.00S5012 0.00 0.00 0.00 0.00 $0.00 $0.00S5013 0.00 0.00 0.00 0.00 $0.00 $0.00S5014 0.00 0.00 0.00 0.00 $0.00 $0.00S5035 0.00 0.00 0.00 0.00 $0.00 $0.00S5036 0.00 0.00 0.00 0.00 $0.00 $0.00S5100 0.00 0.00 0.00 0.00 $0.00 $0.00S5101 0.00 0.00 0.00 0.00 $0.00 $0.00S5102 0.00 0.00 0.00 0.00 $0.00 $0.00S5105 0.00 0.00 0.00 0.00 $0.00 $0.00S5108 0.00 0.00 0.00 0.00 $0.00 $0.00S5109 0.00 0.00 0.00 0.00 $0.00 $0.00S5110 0.00 0.00 0.00 0.00 $0.00 $0.00S5111 0.00 0.00 0.00 0.00 $0.00 $0.00S5115 0.00 0.00 0.00 0.00 $0.00 $0.00S5116 0.00 0.00 0.00 0.00 $0.00 $0.00S5120 0.00 0.00 0.00 0.00 $0.00 $0.00S5121 0.00 0.00 0.00 0.00 $0.00 $0.00S5125 0.00 0.00 0.00 0.00 $0.00 $0.00S5126 0.00 0.00 0.00 0.00 $0.00 $0.00S5130 0.00 0.00 0.00 0.00 $0.00 $0.00S5131 0.00 0.00 0.00 0.00 $0.00 $0.00S5135 0.00 0.00 0.00 0.00 $0.00 $0.00S5136 0.00 0.00 0.00 0.00 $0.00 $0.00S5140 0.00 0.00 0.00 0.00 $0.00 $0.00S5141 0.00 0.00 0.00 0.00 $0.00 $0.00S5145 0.00 0.00 0.00 0.00 $0.00 $0.00S5146 0.00 0.00 0.00 0.00 $0.00 $0.00S5150 0.00 0.00 0.00 0.00 $0.00 $0.00S5151 0.00 0.00 0.00 0.00 $0.00 $0.00S5160 0.00 0.00 0.00 0.00 $0.00 $0.00S5161 0.00 0.00 0.00 0.00 $0.00 $0.00S5162 0.00 0.00 0.00 0.00 $0.00 $0.00S5165 0.00 0.00 0.00 0.00 $0.00 $0.00S5170 0.00 0.00 0.00 0.00 $0.00 $0.00S5175 0.00 0.00 0.00 0.00 $0.00 $0.00S5180 0.00 0.00 0.00 0.00 $0.00 $0.00S5181 0.00 0.00 0.00 0.00 $0.00 $0.00S5185 0.00 0.00 0.00 0.00 $0.00 $0.00S5190 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 82 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

S5199 0.00 0.00 0.00 0.00 $0.00 $0.00S5497 0.00 0.00 0.00 0.00 $0.00 $0.00S5498 0.00 0.00 0.00 0.00 $0.00 $0.00S5501 0.00 0.00 0.00 0.00 $0.00 $0.00S5502 0.00 0.00 0.00 0.00 $0.00 $0.00S5517 0.00 0.00 0.00 0.00 $0.00 $0.00S5518 0.00 0.00 0.00 0.00 $0.00 $0.00S5520 0.00 0.00 0.00 0.00 $0.00 $0.00S5521 0.00 0.00 0.00 0.00 $0.00 $0.00S5522 0.00 0.00 0.00 0.00 $0.00 $0.00S5523 0.00 0.00 0.00 0.00 $0.00 $0.00S5550 0.00 0.00 0.00 0.00 $0.00 $0.00S5551 0.00 0.00 0.00 0.00 $0.00 $0.00S5552 0.00 0.00 0.00 0.00 $0.00 $0.00S5553 0.00 0.00 0.00 0.00 $0.00 $0.00S5560 0.00 0.00 0.00 0.00 $0.00 $0.00S5561 0.00 0.00 0.00 0.00 $0.00 $0.00S5565 0.00 0.00 0.00 0.00 $0.00 $0.00S5566 0.00 0.00 0.00 0.00 $0.00 $0.00S5570 0.00 0.00 0.00 0.00 $0.00 $0.00S5571 0.00 0.00 0.00 0.00 $0.00 $0.00S8030 0.00 0.00 0.00 0.00 $0.00 $0.00S8035 0.00 0.00 0.00 0.00 $0.00 $0.00S8037 0.00 0.00 0.00 0.00 $0.00 $0.00S8040 0.00 0.00 0.00 0.00 $0.00 $0.00S8042 0.00 0.00 0.00 0.00 $0.00 $0.00S8049 0.00 0.00 0.00 0.00 $0.00 $0.00S8055 0.00 0.00 0.00 0.00 $0.00 $0.00S8080 0.00 0.00 0.00 0.00 $0.00 $0.00S8085 0.00 0.00 0.00 0.00 $0.00 $0.00S8092 0.00 0.00 0.00 0.00 $0.00 $0.00S8096 0.00 0.00 0.00 0.00 $0.00 $0.00S8097 0.00 0.00 0.00 0.00 $0.00 $0.00S8100 0.00 0.00 0.00 0.00 $0.00 $0.00S8101 0.00 0.00 0.00 0.00 $0.00 $0.00S8110 0.00 0.00 0.00 0.00 $0.00 $0.00S8120 0.00 0.00 0.00 0.00 $0.00 $0.00S8121 0.00 0.00 0.00 0.00 $0.00 $0.00S8130 0.00 0.00 0.00 0.00 $0.00 $0.00S8131 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 83 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

S8185 0.00 0.00 0.00 0.00 $0.00 $0.00S8186 0.00 0.00 0.00 0.00 $0.00 $0.00S8189 0.00 0.00 0.00 0.00 $0.00 $0.00S8210 0.00 0.00 0.00 0.00 $0.00 $0.00S8262 0.00 0.00 0.00 0.00 $0.00 $0.00S8265 0.00 0.00 0.00 0.00 $0.00 $0.00S8270 0.00 0.00 0.00 0.00 $0.00 $0.00S8301 0.00 0.00 0.00 0.00 $0.00 $0.00S8415 0.00 0.00 0.00 0.00 $0.00 $0.00S8420 0.00 0.00 0.00 0.00 $0.00 $0.00S8421 0.00 0.00 0.00 0.00 $0.00 $0.00S8422 0.00 0.00 0.00 0.00 $0.00 $0.00S8423 0.00 0.00 0.00 0.00 $0.00 $0.00S8424 0.00 0.00 0.00 0.00 $0.00 $0.00S8425 0.00 0.00 0.00 0.00 $0.00 $0.00S8426 0.00 0.00 0.00 0.00 $0.00 $0.00S8427 0.00 0.00 0.00 0.00 $0.00 $0.00S8428 0.00 0.00 0.00 0.00 $0.00 $0.00S8429 0.00 0.00 0.00 0.00 $0.00 $0.00S8430 0.00 0.00 0.00 0.00 $0.00 $0.00S8431 0.00 0.00 0.00 0.00 $0.00 $0.00S8450 0.00 0.00 0.00 0.00 $0.00 $0.00S8451 0.00 0.00 0.00 0.00 $0.00 $0.00S8452 0.00 0.00 0.00 0.00 $0.00 $0.00S8460 0.00 0.00 0.00 0.00 $0.00 $0.00S8490 0.00 0.00 0.00 0.00 $0.00 $0.00S8940 0.00 0.00 0.00 0.00 $0.00 $0.00S8948 0.00 0.00 0.00 0.00 $0.00 $0.00S8950 0.00 0.00 0.00 0.00 $0.00 $0.00S8990 0.00 0.00 0.00 0.00 $0.00 $0.00S8999 0.00 0.00 0.00 0.00 $0.00 $0.00S9001 0.00 0.00 0.00 0.00 $0.00 $0.00S9007 0.00 0.00 0.00 0.00 $0.00 $0.00S9015 0.00 0.00 0.00 0.00 $0.00 $0.00S9024 0.00 0.00 0.00 0.00 $0.00 $0.00S9025 0.00 0.00 0.00 0.00 $0.00 $0.00S9034 0.00 0.00 0.00 0.00 $0.00 $0.00S9055 0.00 0.00 0.00 0.00 $0.00 $0.00S9056 0.00 0.00 0.00 0.00 $0.00 $0.00S9061 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 84 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

S9083 0.00 0.00 0.00 0.00 $0.00 $0.00S9088 0.00 0.00 0.00 0.00 $0.00 $0.00S9090 0.00 0.00 0.00 0.00 $0.00 $0.00S9097 0.00 0.00 0.00 0.00 $0.00 $0.00S9098 0.00 0.00 0.00 0.00 $0.00 $0.00S9109 0.00 0.00 0.00 0.00 $0.00 $0.00S9117 0.00 0.00 0.00 0.00 $0.00 $0.00S9122 0.00 0.00 0.00 0.00 $0.00 $0.00S9123 0.00 0.00 0.00 0.00 $0.00 $0.00S9124 0.00 0.00 0.00 0.00 $0.00 $0.00S9125 0.00 0.00 0.00 0.00 $0.00 $0.00S9126 0.00 0.00 0.00 0.00 $0.00 $0.00S9127 0.00 0.00 0.00 0.00 $0.00 $0.00S9128 0.00 0.00 0.00 0.00 $0.00 $0.00S9129 0.00 0.00 0.00 0.00 $0.00 $0.00S9131 0.00 0.00 0.00 0.00 $0.00 $0.00S9140 0.00 0.00 0.00 0.00 $0.00 $0.00S9141 0.00 0.00 0.00 0.00 $0.00 $0.00S9145 0.00 0.00 0.00 0.00 $0.00 $0.00S9150 0.00 0.00 0.00 0.00 $0.00 $0.00S9152 0.00 0.00 0.00 0.00 $0.00 $0.00S9208 0.00 0.00 0.00 0.00 $0.00 $0.00S9209 0.00 0.00 0.00 0.00 $0.00 $0.00S9211 0.00 0.00 0.00 0.00 $0.00 $0.00S9212 0.00 0.00 0.00 0.00 $0.00 $0.00S9213 0.00 0.00 0.00 0.00 $0.00 $0.00S9214 0.00 0.00 0.00 0.00 $0.00 $0.00S9325 0.00 0.00 0.00 0.00 $0.00 $0.00S9326 0.00 0.00 0.00 0.00 $0.00 $0.00S9327 0.00 0.00 0.00 0.00 $0.00 $0.00S9328 0.00 0.00 0.00 0.00 $0.00 $0.00S9329 0.00 0.00 0.00 0.00 $0.00 $0.00S9330 0.00 0.00 0.00 0.00 $0.00 $0.00S9331 0.00 0.00 0.00 0.00 $0.00 $0.00S9335 0.00 0.00 0.00 0.00 $0.00 $0.00S9336 0.00 0.00 0.00 0.00 $0.00 $0.00S9338 0.00 0.00 0.00 0.00 $0.00 $0.00S9339 0.00 0.00 0.00 0.00 $0.00 $0.00S9340 0.00 0.00 0.00 0.00 $0.00 $0.00S9341 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 85 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

S9342 0.00 0.00 0.00 0.00 $0.00 $0.00S9343 0.00 0.00 0.00 0.00 $0.00 $0.00S9345 0.00 0.00 0.00 0.00 $0.00 $0.00S9346 0.00 0.00 0.00 0.00 $0.00 $0.00S9347 0.00 0.00 0.00 0.00 $0.00 $0.00S9348 0.00 0.00 0.00 0.00 $0.00 $0.00S9349 0.00 0.00 0.00 0.00 $0.00 $0.00S9351 0.00 0.00 0.00 0.00 $0.00 $0.00S9353 0.00 0.00 0.00 0.00 $0.00 $0.00S9355 0.00 0.00 0.00 0.00 $0.00 $0.00S9357 0.00 0.00 0.00 0.00 $0.00 $0.00S9359 0.00 0.00 0.00 0.00 $0.00 $0.00S9361 0.00 0.00 0.00 0.00 $0.00 $0.00S9363 0.00 0.00 0.00 0.00 $0.00 $0.00S9364 0.00 0.00 0.00 0.00 $0.00 $0.00S9365 0.00 0.00 0.00 0.00 $0.00 $0.00S9366 0.00 0.00 0.00 0.00 $0.00 $0.00S9367 0.00 0.00 0.00 0.00 $0.00 $0.00S9368 0.00 0.00 0.00 0.00 $0.00 $0.00S9370 0.00 0.00 0.00 0.00 $0.00 $0.00S9372 0.00 0.00 0.00 0.00 $0.00 $0.00S9373 0.00 0.00 0.00 0.00 $0.00 $0.00S9374 0.00 0.00 0.00 0.00 $0.00 $0.00S9375 0.00 0.00 0.00 0.00 $0.00 $0.00S9376 0.00 0.00 0.00 0.00 $0.00 $0.00S9377 0.00 0.00 0.00 0.00 $0.00 $0.00S9379 0.00 0.00 0.00 0.00 $0.00 $0.00S9381 0.00 0.00 0.00 0.00 $0.00 $0.00S9401 0.00 0.00 0.00 0.00 $0.00 $0.00S9430 0.00 0.00 0.00 0.00 $0.00 $0.00S9433 0.00 0.00 0.00 0.00 $0.00 $0.00S9434 0.00 0.00 0.00 0.00 $0.00 $0.00S9435 0.00 0.00 0.00 0.00 $0.00 $0.00S9436 0.00 0.00 0.00 0.00 $0.00 $0.00S9437 0.00 0.00 0.00 0.00 $0.00 $0.00S9438 0.00 0.00 0.00 0.00 $0.00 $0.00S9439 0.00 0.00 0.00 0.00 $0.00 $0.00S9441 0.00 0.00 0.00 0.00 $0.00 $0.00S9442 0.00 0.00 0.00 0.00 $0.00 $0.00S9443 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 86 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

S9444 0.00 0.00 0.00 0.00 $0.00 $0.00S9445 0.00 0.00 0.00 0.00 $0.00 $0.00S9446 0.00 0.00 0.00 0.00 $0.00 $0.00S9447 0.00 0.00 0.00 0.00 $0.00 $0.00S9449 0.00 0.00 0.00 0.00 $0.00 $0.00S9451 0.00 0.00 0.00 0.00 $0.00 $0.00S9452 0.00 0.00 0.00 0.00 $0.00 $0.00S9453 0.00 0.00 0.00 0.00 $0.00 $0.00S9454 0.00 0.00 0.00 0.00 $0.00 $0.00S9455 0.00 0.00 0.00 0.00 $0.00 $0.00S9460 0.00 0.00 0.00 0.00 $0.00 $0.00S9465 0.00 0.00 0.00 0.00 $0.00 $0.00S9470 0.00 0.00 0.00 0.00 $0.00 $0.00S9472 0.00 0.00 0.00 0.00 $0.00 $0.00S9473 0.00 0.00 0.00 0.00 $0.00 $0.00S9474 0.00 0.00 0.00 0.00 $0.00 $0.00S9475 0.00 0.00 0.00 0.00 $0.00 $0.00S9476 0.00 0.00 0.00 0.00 $0.00 $0.00S9480 0.00 0.00 0.00 0.00 $0.00 $0.00S9482 0.00 0.00 0.00 0.00 $0.00 $0.00S9484 0.00 0.00 0.00 0.00 $0.00 $0.00S9485 0.00 0.00 0.00 0.00 $0.00 $0.00S9490 0.00 0.00 0.00 0.00 $0.00 $0.00S9494 0.00 0.00 0.00 0.00 $0.00 $0.00S9497 0.00 0.00 0.00 0.00 $0.00 $0.00S9500 0.00 0.00 0.00 0.00 $0.00 $0.00S9501 0.00 0.00 0.00 0.00 $0.00 $0.00S9502 0.00 0.00 0.00 0.00 $0.00 $0.00S9503 0.00 0.00 0.00 0.00 $0.00 $0.00S9504 0.00 0.00 0.00 0.00 $0.00 $0.00S9529 0.00 0.00 0.00 0.00 $0.00 $0.00S9537 0.00 0.00 0.00 0.00 $0.00 $0.00S9538 0.00 0.00 0.00 0.00 $0.00 $0.00S9542 0.00 0.00 0.00 0.00 $0.00 $0.00S9558 0.00 0.00 0.00 0.00 $0.00 $0.00S9559 0.00 0.00 0.00 0.00 $0.00 $0.00S9560 0.00 0.00 0.00 0.00 $0.00 $0.00S9562 0.00 0.00 0.00 0.00 $0.00 $0.00S9590 0.00 0.00 0.00 0.00 $0.00 $0.00S9810 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 87 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

S9900 0.00 0.00 0.00 0.00 $0.00 $0.00S9970 0.00 0.00 0.00 0.00 $0.00 $0.00S9975 0.00 0.00 0.00 0.00 $0.00 $0.00S9976 0.00 0.00 0.00 0.00 $0.00 $0.00S9977 0.00 0.00 0.00 0.00 $0.00 $0.00S9981 0.00 0.00 0.00 0.00 $0.00 $0.00S9982 0.00 0.00 0.00 0.00 $0.00 $0.00S9986 0.00 0.00 0.00 0.00 $0.00 $0.00S9988 0.00 0.00 0.00 0.00 $0.00 $0.00S9989 0.00 0.00 0.00 0.00 $0.00 $0.00S9990 0.00 0.00 0.00 0.00 $0.00 $0.00S9991 0.00 0.00 0.00 0.00 $0.00 $0.00S9992 0.00 0.00 0.00 0.00 $0.00 $0.00S9994 0.00 0.00 0.00 0.00 $0.00 $0.00S9996 0.00 0.00 0.00 0.00 $0.00 $0.00S9999 0.00 0.00 0.00 0.00 $0.00 $0.00T1000 0.00 0.00 0.00 0.00 $0.00 $0.00T1001 0.00 0.00 0.00 0.00 $0.00 $0.00T1002 0.00 0.00 0.00 0.00 $0.00 $0.00T1003 0.00 0.00 0.00 0.00 $0.00 $0.00T1004 0.00 0.00 0.00 0.00 $0.00 $0.00T1005 0.00 0.00 0.00 0.00 $0.00 $0.00T1006 0.00 0.00 0.00 0.00 $0.00 $0.00T1007 0.00 0.00 0.00 0.00 $0.00 $0.00T1009 0.00 0.00 0.00 0.00 $0.00 $0.00T1010 0.00 0.00 0.00 0.00 $0.00 $0.00T1012 0.00 0.00 0.00 0.00 $0.00 $0.00T1013 0.00 0.00 0.00 0.00 $0.00 $0.00T1014 0.00 0.00 0.00 0.00 $0.00 $0.00T1015 0.00 0.00 0.00 0.00 $0.00 $0.00T1016 0.00 0.00 0.00 0.00 $0.00 $0.00T1017 0.00 0.00 0.00 0.00 $0.00 $0.00T1018 0.00 0.00 0.00 0.00 $0.00 $0.00T1019 0.00 0.00 0.00 0.00 $0.00 $0.00T1020 0.00 0.00 0.00 0.00 $0.00 $0.00T1021 0.00 0.00 0.00 0.00 $0.00 $0.00T1022 0.00 0.00 0.00 0.00 $0.00 $0.00T1023 0.00 0.00 0.00 0.00 $0.00 $0.00T1024 0.00 0.00 0.00 0.00 $0.00 $0.00T1025 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 88 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

T1026 0.00 0.00 0.00 0.00 $0.00 $0.00T1027 0.00 0.00 0.00 0.00 $0.00 $0.00T1028 0.00 0.00 0.00 0.00 $0.00 $0.00T1029 0.00 0.00 0.00 0.00 $0.00 $0.00T1030 0.00 0.00 0.00 0.00 $0.00 $0.00T1031 0.00 0.00 0.00 0.00 $0.00 $0.00T1502 0.00 0.00 0.00 0.00 $0.00 $0.00T1503 0.00 0.00 0.00 0.00 $0.00 $0.00T1505 0.00 0.00 0.00 0.00 $0.00 $0.00T1999 0.00 0.00 0.00 0.00 $0.00 $0.00T2001 0.00 0.00 0.00 0.00 $0.00 $0.00T2002 0.00 0.00 0.00 0.00 $0.00 $0.00T2003 0.00 0.00 0.00 0.00 $0.00 $0.00T2004 0.00 0.00 0.00 0.00 $0.00 $0.00T2005 0.00 0.00 0.00 0.00 $0.00 $0.00T2007 0.00 0.00 0.00 0.00 $0.00 $0.00T2010 0.00 0.00 0.00 0.00 $0.00 $0.00T2011 0.00 0.00 0.00 0.00 $0.00 $0.00T2012 0.00 0.00 0.00 0.00 $0.00 $0.00T2013 0.00 0.00 0.00 0.00 $0.00 $0.00T2014 0.00 0.00 0.00 0.00 $0.00 $0.00T2015 0.00 0.00 0.00 0.00 $0.00 $0.00T2016 0.00 0.00 0.00 0.00 $0.00 $0.00T2017 0.00 0.00 0.00 0.00 $0.00 $0.00T2018 0.00 0.00 0.00 0.00 $0.00 $0.00T2019 0.00 0.00 0.00 0.00 $0.00 $0.00T2020 0.00 0.00 0.00 0.00 $0.00 $0.00T2021 0.00 0.00 0.00 0.00 $0.00 $0.00T2022 0.00 0.00 0.00 0.00 $0.00 $0.00T2023 0.00 0.00 0.00 0.00 $0.00 $0.00T2024 0.00 0.00 0.00 0.00 $0.00 $0.00T2025 0.00 0.00 0.00 0.00 $0.00 $0.00T2026 0.00 0.00 0.00 0.00 $0.00 $0.00T2027 0.00 0.00 0.00 0.00 $0.00 $0.00T2028 0.00 0.00 0.00 0.00 $0.00 $0.00T2029 0.00 0.00 0.00 0.00 $0.00 $0.00T2030 0.00 0.00 0.00 0.00 $0.00 $0.00T2031 0.00 0.00 0.00 0.00 $0.00 $0.00T2032 0.00 0.00 0.00 0.00 $0.00 $0.00T2033 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 89 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

T2034 0.00 0.00 0.00 0.00 $0.00 $0.00T2035 0.00 0.00 0.00 0.00 $0.00 $0.00T2036 0.00 0.00 0.00 0.00 $0.00 $0.00T2037 0.00 0.00 0.00 0.00 $0.00 $0.00T2038 0.00 0.00 0.00 0.00 $0.00 $0.00T2039 0.00 0.00 0.00 0.00 $0.00 $0.00T2040 0.00 0.00 0.00 0.00 $0.00 $0.00T2041 0.00 0.00 0.00 0.00 $0.00 $0.00T2042 0.00 0.00 0.00 0.00 $0.00 $0.00T2043 0.00 0.00 0.00 0.00 $0.00 $0.00T2044 0.00 0.00 0.00 0.00 $0.00 $0.00T2045 0.00 0.00 0.00 0.00 $0.00 $0.00T2046 0.00 0.00 0.00 0.00 $0.00 $0.00T2048 0.00 0.00 0.00 0.00 $0.00 $0.00T2049 0.00 0.00 0.00 0.00 $0.00 $0.00T2101 0.00 0.00 0.00 0.00 $0.00 $0.00T4521 0.00 0.00 0.00 0.00 $0.00 $0.00T4522 0.00 0.00 0.00 0.00 $0.00 $0.00T4523 0.00 0.00 0.00 0.00 $0.00 $0.00T4524 0.00 0.00 0.00 0.00 $0.00 $0.00T4525 0.00 0.00 0.00 0.00 $0.00 $0.00T4526 0.00 0.00 0.00 0.00 $0.00 $0.00T4527 0.00 0.00 0.00 0.00 $0.00 $0.00T4528 0.00 0.00 0.00 0.00 $0.00 $0.00T4529 0.00 0.00 0.00 0.00 $0.00 $0.00T4530 0.00 0.00 0.00 0.00 $0.00 $0.00T4531 0.00 0.00 0.00 0.00 $0.00 $0.00T4532 0.00 0.00 0.00 0.00 $0.00 $0.00T4533 0.00 0.00 0.00 0.00 $0.00 $0.00T4534 0.00 0.00 0.00 0.00 $0.00 $0.00T4535 0.00 0.00 0.00 0.00 $0.00 $0.00T4536 0.00 0.00 0.00 0.00 $0.00 $0.00T4537 0.00 0.00 0.00 0.00 $0.00 $0.00T4538 0.00 0.00 0.00 0.00 $0.00 $0.00T4539 0.00 0.00 0.00 0.00 $0.00 $0.00T4540 0.00 0.00 0.00 0.00 $0.00 $0.00T4541 0.00 0.00 0.00 0.00 $0.00 $0.00T4542 0.00 0.00 0.00 0.00 $0.00 $0.00T4543 0.00 0.00 0.00 0.00 $0.00 $0.00T5001 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 90 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

T5999 0.00 0.00 0.00 0.00 $0.00 $0.00V2020 0.00 0.00 0.00 0.00 $0.00 $0.00V2025 0.00 0.00 0.00 0.00 $0.00 $0.00V2100 0.00 0.00 0.00 0.00 $0.00 $0.00V2101 0.00 0.00 0.00 0.00 $0.00 $0.00V2102 0.00 0.00 0.00 0.00 $0.00 $0.00V2103 0.00 0.00 0.00 0.00 $0.00 $0.00V2104 0.00 0.00 0.00 0.00 $0.00 $0.00V2105 0.00 0.00 0.00 0.00 $0.00 $0.00V2106 0.00 0.00 0.00 0.00 $0.00 $0.00V2107 0.00 0.00 0.00 0.00 $0.00 $0.00V2108 0.00 0.00 0.00 0.00 $0.00 $0.00V2109 0.00 0.00 0.00 0.00 $0.00 $0.00V2110 0.00 0.00 0.00 0.00 $0.00 $0.00V2111 0.00 0.00 0.00 0.00 $0.00 $0.00V2112 0.00 0.00 0.00 0.00 $0.00 $0.00V2113 0.00 0.00 0.00 0.00 $0.00 $0.00V2114 0.00 0.00 0.00 0.00 $0.00 $0.00V2115 0.00 0.00 0.00 0.00 $0.00 $0.00V2118 0.00 0.00 0.00 0.00 $0.00 $0.00V2121 0.00 0.00 0.00 0.00 $0.00 $0.00V2199 0.00 0.00 0.00 0.00 $0.00 $0.00V2200 0.00 0.00 0.00 0.00 $0.00 $0.00V2201 0.00 0.00 0.00 0.00 $0.00 $0.00V2202 0.00 0.00 0.00 0.00 $0.00 $0.00V2203 0.00 0.00 0.00 0.00 $0.00 $0.00V2204 0.00 0.00 0.00 0.00 $0.00 $0.00V2205 0.00 0.00 0.00 0.00 $0.00 $0.00V2206 0.00 0.00 0.00 0.00 $0.00 $0.00V2207 0.00 0.00 0.00 0.00 $0.00 $0.00V2208 0.00 0.00 0.00 0.00 $0.00 $0.00V2209 0.00 0.00 0.00 0.00 $0.00 $0.00V2210 0.00 0.00 0.00 0.00 $0.00 $0.00V2211 0.00 0.00 0.00 0.00 $0.00 $0.00V2212 0.00 0.00 0.00 0.00 $0.00 $0.00V2213 0.00 0.00 0.00 0.00 $0.00 $0.00V2214 0.00 0.00 0.00 0.00 $0.00 $0.00V2215 0.00 0.00 0.00 0.00 $0.00 $0.00V2218 0.00 0.00 0.00 0.00 $0.00 $0.00V2219 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 91 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

V2220 0.00 0.00 0.00 0.00 $0.00 $0.00V2221 0.00 0.00 0.00 0.00 $0.00 $0.00V2299 0.00 0.00 0.00 0.00 $0.00 $0.00V2300 0.00 0.00 0.00 0.00 $0.00 $0.00V2301 0.00 0.00 0.00 0.00 $0.00 $0.00V2302 0.00 0.00 0.00 0.00 $0.00 $0.00V2303 0.00 0.00 0.00 0.00 $0.00 $0.00V2304 0.00 0.00 0.00 0.00 $0.00 $0.00V2305 0.00 0.00 0.00 0.00 $0.00 $0.00V2306 0.00 0.00 0.00 0.00 $0.00 $0.00V2307 0.00 0.00 0.00 0.00 $0.00 $0.00V2308 0.00 0.00 0.00 0.00 $0.00 $0.00V2309 0.00 0.00 0.00 0.00 $0.00 $0.00V2310 0.00 0.00 0.00 0.00 $0.00 $0.00V2311 0.00 0.00 0.00 0.00 $0.00 $0.00V2312 0.00 0.00 0.00 0.00 $0.00 $0.00V2313 0.00 0.00 0.00 0.00 $0.00 $0.00V2314 0.00 0.00 0.00 0.00 $0.00 $0.00V2315 0.00 0.00 0.00 0.00 $0.00 $0.00V2318 0.00 0.00 0.00 0.00 $0.00 $0.00V2319 0.00 0.00 0.00 0.00 $0.00 $0.00V2320 0.00 0.00 0.00 0.00 $0.00 $0.00V2321 0.00 0.00 0.00 0.00 $0.00 $0.00V2399 0.00 0.00 0.00 0.00 $0.00 $0.00V2410 0.00 0.00 0.00 0.00 $0.00 $0.00V2430 0.00 0.00 0.00 0.00 $0.00 $0.00V2499 0.00 0.00 0.00 0.00 $0.00 $0.00V2500 0.00 0.00 0.00 0.00 $0.00 $0.00V2501 0.00 0.00 0.00 0.00 $0.00 $0.00V2502 0.00 0.00 0.00 0.00 $0.00 $0.00V2503 0.00 0.00 0.00 0.00 $0.00 $0.00V2510 0.00 0.00 0.00 0.00 $0.00 $0.00V2511 0.00 0.00 0.00 0.00 $0.00 $0.00V2512 0.00 0.00 0.00 0.00 $0.00 $0.00V2513 0.00 0.00 0.00 0.00 $0.00 $0.00V2520 0.00 0.00 0.00 0.00 $0.00 $0.00V2521 0.00 0.00 0.00 0.00 $0.00 $0.00V2522 0.00 0.00 0.00 0.00 $0.00 $0.00V2523 0.00 0.00 0.00 0.00 $0.00 $0.00V2530 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 92 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

V2531 0.00 0.00 0.00 0.00 $0.00 $0.00V2599 0.00 0.00 0.00 0.00 $0.00 $0.00V2600 0.00 0.00 0.00 0.00 $0.00 $0.00V2610 0.00 0.00 0.00 0.00 $0.00 $0.00V2615 0.00 0.00 0.00 0.00 $0.00 $0.00V2623 0.00 0.00 0.00 0.00 $0.00 $0.00V2624 0.00 0.00 0.00 0.00 $0.00 $0.00V2625 0.00 0.00 0.00 0.00 $0.00 $0.00V2626 0.00 0.00 0.00 0.00 $0.00 $0.00V2627 0.00 0.00 0.00 0.00 $0.00 $0.00V2628 0.00 0.00 0.00 0.00 $0.00 $0.00V2629 0.00 0.00 0.00 0.00 $0.00 $0.00V2630 0.00 0.00 0.00 0.00 $0.00 $0.00V2631 0.00 0.00 0.00 0.00 $0.00 $0.00V2632 0.00 0.00 0.00 0.00 $0.00 $0.00V2700 0.00 0.00 0.00 0.00 $0.00 $0.00V2702 0.00 0.00 0.00 0.00 $0.00 $0.00V2710 0.00 0.00 0.00 0.00 $0.00 $0.00V2715 0.00 0.00 0.00 0.00 $0.00 $0.00V2718 0.00 0.00 0.00 0.00 $0.00 $0.00V2730 0.00 0.00 0.00 0.00 $0.00 $0.00V2744 0.00 0.00 0.00 0.00 $0.00 $0.00V2745 0.00 0.00 0.00 0.00 $0.00 $0.00V2750 0.00 0.00 0.00 0.00 $0.00 $0.00V2755 0.00 0.00 0.00 0.00 $0.00 $0.00V2756 0.00 0.00 0.00 0.00 $0.00 $0.00V2760 0.00 0.00 0.00 0.00 $0.00 $0.00V2761 0.00 0.00 0.00 0.00 $0.00 $0.00V2762 0.00 0.00 0.00 0.00 $0.00 $0.00V2770 0.00 0.00 0.00 0.00 $0.00 $0.00V2780 0.00 0.00 0.00 0.00 $0.00 $0.00V2781 0.00 0.00 0.00 0.00 $0.00 $0.00V2782 0.00 0.00 0.00 0.00 $0.00 $0.00V2783 0.00 0.00 0.00 0.00 $0.00 $0.00V2784 0.00 0.00 0.00 0.00 $0.00 $0.00V2785 0.00 0.00 0.00 0.00 $0.00 $0.00V2786 0.00 0.00 0.00 0.00 $0.00 $0.00V2787 0.00 0.00 0.00 0.00 $0.00 $0.00V2788 0.00 0.00 0.00 0.00 $0.00 $0.00V2790 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 93 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

V2797 0.00 0.00 0.00 0.00 $0.00 $0.00V2799 0.00 0.00 0.00 0.00 $0.00 $0.00V5008 0.00 0.00 0.00 0.00 $0.00 $0.00V5010 0.00 0.00 0.00 0.00 $0.00 $0.00V5011 0.00 0.00 0.00 0.00 $0.00 $0.00V5014 0.00 0.00 0.00 0.00 $0.00 $0.00V5020 0.00 0.00 0.00 0.00 $0.00 $0.00V5030 0.00 0.00 0.00 0.00 $0.00 $0.00V5040 0.00 0.00 0.00 0.00 $0.00 $0.00V5050 0.00 0.00 0.00 0.00 $0.00 $0.00V5060 0.00 0.00 0.00 0.00 $0.00 $0.00V5070 0.00 0.00 0.00 0.00 $0.00 $0.00V5080 0.00 0.00 0.00 0.00 $0.00 $0.00V5090 0.00 0.00 0.00 0.00 $0.00 $0.00V5095 0.00 0.00 0.00 0.00 $0.00 $0.00V5100 0.00 0.00 0.00 0.00 $0.00 $0.00V5110 0.00 0.00 0.00 0.00 $0.00 $0.00V5120 0.00 0.00 0.00 0.00 $0.00 $0.00V5130 0.00 0.00 0.00 0.00 $0.00 $0.00V5140 0.00 0.00 0.00 0.00 $0.00 $0.00V5150 0.00 0.00 0.00 0.00 $0.00 $0.00V5160 0.00 0.00 0.00 0.00 $0.00 $0.00V5170 0.00 0.00 0.00 0.00 $0.00 $0.00V5180 0.00 0.00 0.00 0.00 $0.00 $0.00V5190 0.00 0.00 0.00 0.00 $0.00 $0.00V5200 0.00 0.00 0.00 0.00 $0.00 $0.00V5210 0.00 0.00 0.00 0.00 $0.00 $0.00V5220 0.00 0.00 0.00 0.00 $0.00 $0.00V5230 0.00 0.00 0.00 0.00 $0.00 $0.00V5240 0.00 0.00 0.00 0.00 $0.00 $0.00V5241 0.00 0.00 0.00 0.00 $0.00 $0.00V5242 0.00 0.00 0.00 0.00 $0.00 $0.00V5243 0.00 0.00 0.00 0.00 $0.00 $0.00V5244 0.00 0.00 0.00 0.00 $0.00 $0.00V5245 0.00 0.00 0.00 0.00 $0.00 $0.00V5246 0.00 0.00 0.00 0.00 $0.00 $0.00V5247 0.00 0.00 0.00 0.00 $0.00 $0.00V5248 0.00 0.00 0.00 0.00 $0.00 $0.00V5249 0.00 0.00 0.00 0.00 $0.00 $0.00V5250 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 94 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

V5251 0.00 0.00 0.00 0.00 $0.00 $0.00V5252 0.00 0.00 0.00 0.00 $0.00 $0.00V5253 0.00 0.00 0.00 0.00 $0.00 $0.00V5254 0.00 0.00 0.00 0.00 $0.00 $0.00V5255 0.00 0.00 0.00 0.00 $0.00 $0.00V5256 0.00 0.00 0.00 0.00 $0.00 $0.00V5257 0.00 0.00 0.00 0.00 $0.00 $0.00V5258 0.00 0.00 0.00 0.00 $0.00 $0.00V5259 0.00 0.00 0.00 0.00 $0.00 $0.00V5260 0.00 0.00 0.00 0.00 $0.00 $0.00V5261 0.00 0.00 0.00 0.00 $0.00 $0.00V5262 0.00 0.00 0.00 0.00 $0.00 $0.00V5263 0.00 0.00 0.00 0.00 $0.00 $0.00V5264 0.00 0.00 0.00 0.00 $0.00 $0.00V5265 0.00 0.00 0.00 0.00 $0.00 $0.00V5266 0.00 0.00 0.00 0.00 $0.00 $0.00V5267 0.00 0.00 0.00 0.00 $0.00 $0.00V5268 0.00 0.00 0.00 0.00 $0.00 $0.00V5269 0.00 0.00 0.00 0.00 $0.00 $0.00V5270 0.00 0.00 0.00 0.00 $0.00 $0.00V5271 0.00 0.00 0.00 0.00 $0.00 $0.00V5272 0.00 0.00 0.00 0.00 $0.00 $0.00V5273 0.00 0.00 0.00 0.00 $0.00 $0.00V5274 0.00 0.00 0.00 0.00 $0.00 $0.00V5275 0.00 0.00 0.00 0.00 $0.00 $0.00V5298 0.00 0.00 0.00 0.00 $0.00 $0.00V5299 0.00 0.00 0.00 0.00 $0.00 $0.00V5336 0.00 0.00 0.00 0.00 $0.00 $0.00V5362 0.00 0.00 0.00 0.00 $0.00 $0.00V5363 0.00 0.00 0.00 0.00 $0.00 $0.00V5364 0.00 0.00 0.00 0.00 $0.00 $0.000001F 0.00 0.00 0.00 0.00 $0.00 $0.000005F 0.00 0.00 0.00 0.00 $0.00 $0.0000100 0.00 0.00 0.00 0.00 $0.00 $0.0000102 0.00 0.00 0.00 0.00 $0.00 $0.0000103 0.00 0.00 0.00 0.00 $0.00 $0.0000104 0.00 0.00 0.00 0.00 $0.00 $0.000012F 0.00 0.00 0.00 0.00 $0.00 $0.0000120 0.00 0.00 0.00 0.00 $0.00 $0.0000124 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 95 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

00126 0.00 0.00 0.00 0.00 $0.00 $0.000014F 0.00 0.00 0.00 0.00 $0.00 $0.0000140 0.00 0.00 0.00 0.00 $0.00 $0.0000142 0.00 0.00 0.00 0.00 $0.00 $0.0000144 0.00 0.00 0.00 0.00 $0.00 $0.0000145 0.00 0.00 0.00 0.00 $0.00 $0.0000147 0.00 0.00 0.00 0.00 $0.00 $0.0000148 0.00 0.00 0.00 0.00 $0.00 $0.000015F 0.00 0.00 0.00 0.00 $0.00 $0.0000160 0.00 0.00 0.00 0.00 $0.00 $0.0000162 0.00 0.00 0.00 0.00 $0.00 $0.0000164 0.00 0.00 0.00 0.00 $0.00 $0.0000170 0.00 0.00 0.00 0.00 $0.00 $0.0000172 0.00 0.00 0.00 0.00 $0.00 $0.0000174 0.00 0.00 0.00 0.00 $0.00 $0.0000176 0.00 0.00 0.00 0.00 $0.00 $0.000019T 0.00 0.00 0.00 0.00 $0.00 $0.0000190 0.00 0.00 0.00 0.00 $0.00 $0.0000192 0.00 0.00 0.00 0.00 $0.00 $0.0000210 0.00 0.00 0.00 0.00 $0.00 $0.0000211 0.00 0.00 0.00 0.00 $0.00 $0.0000212 0.00 0.00 0.00 0.00 $0.00 $0.0000214 0.00 0.00 0.00 0.00 $0.00 $0.0000215 0.00 0.00 0.00 0.00 $0.00 $0.0000216 0.00 0.00 0.00 0.00 $0.00 $0.0000218 0.00 0.00 0.00 0.00 $0.00 $0.0000220 0.00 0.00 0.00 0.00 $0.00 $0.0000222 0.00 0.00 0.00 0.00 $0.00 $0.000030T 0.00 0.00 0.00 0.00 $0.00 $0.0000300 0.00 0.00 0.00 0.00 $0.00 $0.0000320 0.00 0.00 0.00 0.00 $0.00 $0.0000322 0.00 0.00 0.00 0.00 $0.00 $0.0000326 0.00 0.00 0.00 0.00 $0.00 $0.0000350 0.00 0.00 0.00 0.00 $0.00 $0.0000352 0.00 0.00 0.00 0.00 $0.00 $0.0000400 0.00 0.00 0.00 0.00 $0.00 $0.0000402 0.00 0.00 0.00 0.00 $0.00 $0.0000404 0.00 0.00 0.00 0.00 $0.00 $0.0000406 0.00 0.00 0.00 0.00 $0.00 $0.0000410 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 96 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

0042T 0.00 0.00 0.00 0.00 $0.00 $0.0000450 0.00 0.00 0.00 0.00 $0.00 $0.0000452 0.00 0.00 0.00 0.00 $0.00 $0.0000454 0.00 0.00 0.00 0.00 $0.00 $0.0000470 0.00 0.00 0.00 0.00 $0.00 $0.0000472 0.00 0.00 0.00 0.00 $0.00 $0.0000474 0.00 0.00 0.00 0.00 $0.00 $0.000048T 0.00 0.00 0.00 0.00 $0.00 $0.000050T 0.00 0.00 0.00 0.00 $0.00 $0.0000500 0.00 0.00 0.00 0.00 $0.00 $0.000051T 0.00 0.00 0.00 0.00 $0.00 $0.000052T 0.00 0.00 0.00 0.00 $0.00 $0.0000520 0.00 0.00 0.00 0.00 $0.00 $0.0000522 0.00 0.00 0.00 0.00 $0.00 $0.0000524 0.00 0.00 0.00 0.00 $0.00 $0.0000528 0.00 0.00 0.00 0.00 $0.00 $0.0000529 0.00 0.00 0.00 0.00 $0.00 $0.000053T 0.00 0.00 0.00 0.00 $0.00 $0.0000530 0.00 0.00 0.00 0.00 $0.00 $0.0000532 0.00 0.00 0.00 0.00 $0.00 $0.0000534 0.00 0.00 0.00 0.00 $0.00 $0.0000537 0.00 0.00 0.00 0.00 $0.00 $0.0000539 0.00 0.00 0.00 0.00 $0.00 $0.000054T 0.00 0.00 0.00 0.00 $0.00 $0.0000540 0.00 0.00 0.00 0.00 $0.00 $0.0000541 0.00 0.00 0.00 0.00 $0.00 $0.0000542 0.00 0.00 0.00 0.00 $0.00 $0.0000546 0.00 0.00 0.00 0.00 $0.00 $0.0000548 0.00 0.00 0.00 0.00 $0.00 $0.000055T 0.00 0.00 0.00 0.00 $0.00 $0.0000550 0.00 0.00 0.00 0.00 $0.00 $0.0000560 0.00 0.00 0.00 0.00 $0.00 $0.0000561 0.00 0.00 0.00 0.00 $0.00 $0.0000562 0.00 0.00 0.00 0.00 $0.00 $0.0000563 0.00 0.00 0.00 0.00 $0.00 $0.0000566 0.00 0.00 0.00 0.00 $0.00 $0.0000567 0.00 0.00 0.00 0.00 $0.00 $0.000058T 0.00 0.00 0.00 0.00 $0.00 $0.0000580 0.00 0.00 0.00 0.00 $0.00 $0.000059T 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 97 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

00600 0.00 0.00 0.00 0.00 $0.00 $0.0000604 0.00 0.00 0.00 0.00 $0.00 $0.0000620 0.00 0.00 0.00 0.00 $0.00 $0.0000622 0.00 0.00 0.00 0.00 $0.00 $0.0000625 0.00 0.00 0.00 0.00 $0.00 $0.0000626 0.00 0.00 0.00 0.00 $0.00 $0.0000630 0.00 0.00 0.00 0.00 $0.00 $0.0000632 0.00 0.00 0.00 0.00 $0.00 $0.0000634 0.00 0.00 0.00 0.00 $0.00 $0.0000635 0.00 0.00 0.00 0.00 $0.00 $0.0000640 0.00 0.00 0.00 0.00 $0.00 $0.0000670 0.00 0.00 0.00 0.00 $0.00 $0.0000700 0.00 0.00 0.00 0.00 $0.00 $0.0000702 0.00 0.00 0.00 0.00 $0.00 $0.000071T 0.00 0.00 0.00 0.00 $0.00 $0.000072T 0.00 0.00 0.00 0.00 $0.00 $0.000073T 0.00 13.97 13.97 0.01 $646.92 $646.9200730 0.00 0.00 0.00 0.00 $0.00 $0.0000740 0.00 0.00 0.00 0.00 $0.00 $0.000075T 0.00 0.00 0.00 0.00 $0.00 $0.000075T TC 0.00 0.00 0.00 0.00 $0.00 $0.000075T 26 0.00 0.00 0.00 0.00 $0.00 $0.0000750 0.00 0.00 0.00 0.00 $0.00 $0.0000752 0.00 0.00 0.00 0.00 $0.00 $0.0000754 0.00 0.00 0.00 0.00 $0.00 $0.0000756 0.00 0.00 0.00 0.00 $0.00 $0.000076T 0.00 0.00 0.00 0.00 $0.00 $0.000076T TC 0.00 0.00 0.00 0.00 $0.00 $0.000076T 26 0.00 0.00 0.00 0.00 $0.00 $0.0000770 0.00 0.00 0.00 0.00 $0.00 $0.000078T 0.00 0.00 0.00 0.00 $0.00 $0.000079T 0.00 0.00 0.00 0.00 $0.00 $0.0000790 0.00 0.00 0.00 0.00 $0.00 $0.0000792 0.00 0.00 0.00 0.00 $0.00 $0.0000794 0.00 0.00 0.00 0.00 $0.00 $0.0000796 0.00 0.00 0.00 0.00 $0.00 $0.0000797 0.00 0.00 0.00 0.00 $0.00 $0.000080T 0.00 0.00 0.00 0.00 $0.00 $0.0000800 0.00 0.00 0.00 0.00 $0.00 $0.0000802 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 98 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

0081T 0.00 0.00 0.00 0.00 $0.00 $0.0000810 0.00 0.00 0.00 0.00 $0.00 $0.0000820 0.00 0.00 0.00 0.00 $0.00 $0.0000830 0.00 0.00 0.00 0.00 $0.00 $0.0000832 0.00 0.00 0.00 0.00 $0.00 $0.0000834 0.00 0.00 0.00 0.00 $0.00 $0.0000836 0.00 0.00 0.00 0.00 $0.00 $0.0000840 0.00 0.00 0.00 0.00 $0.00 $0.0000842 0.00 0.00 0.00 0.00 $0.00 $0.0000844 0.00 0.00 0.00 0.00 $0.00 $0.0000846 0.00 0.00 0.00 0.00 $0.00 $0.0000848 0.00 0.00 0.00 0.00 $0.00 $0.000085T 0.00 0.00 0.00 0.00 $0.00 $0.0000851 0.00 0.00 0.00 0.00 $0.00 $0.0000860 0.00 0.00 0.00 0.00 $0.00 $0.0000862 0.00 0.00 0.00 0.00 $0.00 $0.0000864 0.00 0.00 0.00 0.00 $0.00 $0.0000865 0.00 0.00 0.00 0.00 $0.00 $0.0000866 0.00 0.00 0.00 0.00 $0.00 $0.0000868 0.00 0.00 0.00 0.00 $0.00 $0.0000870 0.00 0.00 0.00 0.00 $0.00 $0.0000872 0.00 0.00 0.00 0.00 $0.00 $0.0000873 0.00 0.00 0.00 0.00 $0.00 $0.0000880 0.00 0.00 0.00 0.00 $0.00 $0.0000882 0.00 0.00 0.00 0.00 $0.00 $0.0000902 0.00 0.00 0.00 0.00 $0.00 $0.0000904 0.00 0.00 0.00 0.00 $0.00 $0.0000906 0.00 0.00 0.00 0.00 $0.00 $0.0000908 0.00 0.00 0.00 0.00 $0.00 $0.0000910 0.00 0.00 0.00 0.00 $0.00 $0.0000912 0.00 0.00 0.00 0.00 $0.00 $0.0000914 0.00 0.00 0.00 0.00 $0.00 $0.0000916 0.00 0.00 0.00 0.00 $0.00 $0.0000918 0.00 0.00 0.00 0.00 $0.00 $0.000092T 0.00 0.00 0.00 0.00 $0.00 $0.0000920 0.00 0.00 0.00 0.00 $0.00 $0.0000921 0.00 0.00 0.00 0.00 $0.00 $0.0000922 0.00 0.00 0.00 0.00 $0.00 $0.0000924 0.00 0.00 0.00 0.00 $0.00 $0.0000926 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 99 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

00928 0.00 0.00 0.00 0.00 $0.00 $0.0000930 0.00 0.00 0.00 0.00 $0.00 $0.0000932 0.00 0.00 0.00 0.00 $0.00 $0.0000934 0.00 0.00 0.00 0.00 $0.00 $0.0000936 0.00 0.00 0.00 0.00 $0.00 $0.0000938 0.00 0.00 0.00 0.00 $0.00 $0.0000940 0.00 0.00 0.00 0.00 $0.00 $0.0000942 0.00 0.00 0.00 0.00 $0.00 $0.0000944 0.00 0.00 0.00 0.00 $0.00 $0.0000948 0.00 0.00 0.00 0.00 $0.00 $0.000095T 0.00 0.00 0.00 0.00 $0.00 $0.0000950 0.00 0.00 0.00 0.00 $0.00 $0.0000952 0.00 0.00 0.00 0.00 $0.00 $0.000098T 0.00 0.00 0.00 0.00 $0.00 $0.000099T 0.00 0.00 0.00 0.00 $0.00 $0.000100T 0.00 0.00 0.00 0.00 $0.00 $0.000101T 0.00 0.00 0.00 0.00 $0.00 $0.000102T 0.00 0.00 0.00 0.00 $0.00 $0.000103T 0.00 0.00 0.00 0.00 $0.00 $0.000106T 0.00 0.00 0.00 0.00 $0.00 $0.000107T 0.00 0.00 0.00 0.00 $0.00 $0.000108T 0.00 0.00 0.00 0.00 $0.00 $0.000109T 0.00 0.00 0.00 0.00 $0.00 $0.000110T 0.00 0.00 0.00 0.00 $0.00 $0.000111T 0.00 0.00 0.00 0.00 $0.00 $0.0001112 0.00 0.00 0.00 0.00 $0.00 $0.0001120 0.00 0.00 0.00 0.00 $0.00 $0.0001130 0.00 0.00 0.00 0.00 $0.00 $0.0001140 0.00 0.00 0.00 0.00 $0.00 $0.0001150 0.00 0.00 0.00 0.00 $0.00 $0.0001160 0.00 0.00 0.00 0.00 $0.00 $0.0001170 0.00 0.00 0.00 0.00 $0.00 $0.0001173 0.00 0.00 0.00 0.00 $0.00 $0.0001180 0.00 0.00 0.00 0.00 $0.00 $0.0001190 0.00 0.00 0.00 0.00 $0.00 $0.0001200 0.00 0.00 0.00 0.00 $0.00 $0.0001202 0.00 0.00 0.00 0.00 $0.00 $0.0001210 0.00 0.00 0.00 0.00 $0.00 $0.0001212 0.00 0.00 0.00 0.00 $0.00 $0.0001214 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 100 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

01215 0.00 0.00 0.00 0.00 $0.00 $0.0001220 0.00 0.00 0.00 0.00 $0.00 $0.000123T 0.00 0.00 0.00 0.00 $0.00 $0.0001230 0.00 0.00 0.00 0.00 $0.00 $0.0001232 0.00 0.00 0.00 0.00 $0.00 $0.0001234 0.00 0.00 0.00 0.00 $0.00 $0.000124T 0.00 0.00 0.00 0.00 $0.00 $0.0001250 0.00 0.00 0.00 0.00 $0.00 $0.000126T 0.00 0.00 0.00 0.00 $0.00 $0.0001260 0.00 0.00 0.00 0.00 $0.00 $0.0001270 0.00 0.00 0.00 0.00 $0.00 $0.0001272 0.00 0.00 0.00 0.00 $0.00 $0.0001274 0.00 0.00 0.00 0.00 $0.00 $0.0001320 0.00 0.00 0.00 0.00 $0.00 $0.0001340 0.00 0.00 0.00 0.00 $0.00 $0.0001360 0.00 0.00 0.00 0.00 $0.00 $0.0001380 0.00 0.00 0.00 0.00 $0.00 $0.0001382 0.00 0.00 0.00 0.00 $0.00 $0.0001390 0.00 0.00 0.00 0.00 $0.00 $0.0001392 0.00 0.00 0.00 0.00 $0.00 $0.0001400 0.00 0.00 0.00 0.00 $0.00 $0.0001402 0.00 0.00 0.00 0.00 $0.00 $0.0001404 0.00 0.00 0.00 0.00 $0.00 $0.0001420 0.00 0.00 0.00 0.00 $0.00 $0.0001430 0.00 0.00 0.00 0.00 $0.00 $0.0001432 0.00 0.00 0.00 0.00 $0.00 $0.0001440 0.00 0.00 0.00 0.00 $0.00 $0.0001442 0.00 0.00 0.00 0.00 $0.00 $0.0001444 0.00 0.00 0.00 0.00 $0.00 $0.0001462 0.00 0.00 0.00 0.00 $0.00 $0.0001464 0.00 0.00 0.00 0.00 $0.00 $0.0001470 0.00 0.00 0.00 0.00 $0.00 $0.0001472 0.00 0.00 0.00 0.00 $0.00 $0.0001474 0.00 0.00 0.00 0.00 $0.00 $0.0001480 0.00 0.00 0.00 0.00 $0.00 $0.0001482 0.00 0.00 0.00 0.00 $0.00 $0.0001484 0.00 0.00 0.00 0.00 $0.00 $0.0001486 0.00 0.00 0.00 0.00 $0.00 $0.0001490 0.00 0.00 0.00 0.00 $0.00 $0.0001500 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 101 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

01502 0.00 0.00 0.00 0.00 $0.00 $0.0001520 0.00 0.00 0.00 0.00 $0.00 $0.0001522 0.00 0.00 0.00 0.00 $0.00 $0.000159T 0.00 0.00 0.00 0.00 $0.00 $0.000159T TC 0.00 0.00 0.00 0.00 $0.00 $0.000159T 26 0.00 0.00 0.00 0.00 $0.00 $0.0001610 0.00 0.00 0.00 0.00 $0.00 $0.0001620 0.00 0.00 0.00 0.00 $0.00 $0.0001622 0.00 0.00 0.00 0.00 $0.00 $0.000163T 0.00 0.00 0.00 0.00 $0.00 $0.0001630 0.00 0.00 0.00 0.00 $0.00 $0.0001634 0.00 0.00 0.00 0.00 $0.00 $0.0001636 0.00 0.00 0.00 0.00 $0.00 $0.0001638 0.00 0.00 0.00 0.00 $0.00 $0.000164T 0.00 0.00 0.00 0.00 $0.00 $0.000165T 0.00 0.00 0.00 0.00 $0.00 $0.0001650 0.00 0.00 0.00 0.00 $0.00 $0.0001652 0.00 0.00 0.00 0.00 $0.00 $0.0001654 0.00 0.00 0.00 0.00 $0.00 $0.0001656 0.00 0.00 0.00 0.00 $0.00 $0.0001670 0.00 0.00 0.00 0.00 $0.00 $0.0001680 0.00 0.00 0.00 0.00 $0.00 $0.0001682 0.00 0.00 0.00 0.00 $0.00 $0.000169T 0.00 0.00 0.00 0.00 $0.00 $0.000171T 0.00 0.00 0.00 0.00 $0.00 $0.0001710 0.00 0.00 0.00 0.00 $0.00 $0.0001712 0.00 0.00 0.00 0.00 $0.00 $0.0001714 0.00 0.00 0.00 0.00 $0.00 $0.0001716 0.00 0.00 0.00 0.00 $0.00 $0.000172T 0.00 0.00 0.00 0.00 $0.00 $0.000173T 0.00 0.00 0.00 0.00 $0.00 $0.0001730 0.00 0.00 0.00 0.00 $0.00 $0.0001732 0.00 0.00 0.00 0.00 $0.00 $0.000174T 0.00 0.00 0.00 0.00 $0.00 $0.0001740 0.00 0.00 0.00 0.00 $0.00 $0.0001742 0.00 0.00 0.00 0.00 $0.00 $0.0001744 0.00 0.00 0.00 0.00 $0.00 $0.000175T 0.00 0.00 0.00 0.00 $0.00 $0.0001756 0.00 0.00 0.00 0.00 $0.00 $0.0001758 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 102 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

01760 0.00 0.00 0.00 0.00 $0.00 $0.0001770 0.00 0.00 0.00 0.00 $0.00 $0.0001772 0.00 0.00 0.00 0.00 $0.00 $0.000178T 0.00 0.00 0.00 0.00 $0.00 $0.0001780 0.00 0.00 0.00 0.00 $0.00 $0.0001782 0.00 0.00 0.00 0.00 $0.00 $0.000179T 0.00 0.00 0.00 0.00 $0.00 $0.000180T 0.00 0.00 0.00 0.00 $0.00 $0.000181T 0.00 0.00 0.00 0.00 $0.00 $0.0001810 0.00 0.00 0.00 0.00 $0.00 $0.000182T 0.00 0.00 0.00 0.00 $0.00 $0.000182T TC 0.00 0.00 0.00 0.00 $0.00 $0.000182T 26 0.00 0.00 0.00 0.00 $0.00 $0.0001820 0.00 0.00 0.00 0.00 $0.00 $0.0001829 0.00 0.00 0.00 0.00 $0.00 $0.000183T 0.00 0.00 0.00 0.00 $0.00 $0.0001830 0.00 0.00 0.00 0.00 $0.00 $0.0001832 0.00 0.00 0.00 0.00 $0.00 $0.000184T 0.00 0.00 0.00 0.00 $0.00 $0.0001840 0.00 0.00 0.00 0.00 $0.00 $0.0001842 0.00 0.00 0.00 0.00 $0.00 $0.0001844 0.00 0.00 0.00 0.00 $0.00 $0.000185T 0.00 0.00 0.00 0.00 $0.00 $0.0001850 0.00 0.00 0.00 0.00 $0.00 $0.0001852 0.00 0.00 0.00 0.00 $0.00 $0.000186T 0.00 0.00 0.00 0.00 $0.00 $0.0001860 0.00 0.00 0.00 0.00 $0.00 $0.000188T 0.00 0.00 0.00 0.00 $0.00 $0.000189T 0.00 0.00 0.00 0.00 $0.00 $0.000190T 0.00 0.00 0.00 0.00 $0.00 $0.000191T 0.00 0.00 0.00 0.00 $0.00 $0.0001916 0.00 0.00 0.00 0.00 $0.00 $0.000192T 0.00 0.00 0.00 0.00 $0.00 $0.0001920 0.00 0.00 0.00 0.00 $0.00 $0.0001922 0.00 0.00 0.00 0.00 $0.00 $0.0001924 0.00 0.00 0.00 0.00 $0.00 $0.0001925 0.00 0.00 0.00 0.00 $0.00 $0.0001926 0.00 0.00 0.00 0.00 $0.00 $0.0001930 0.00 0.00 0.00 0.00 $0.00 $0.0001931 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 103 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

01932 0.00 0.00 0.00 0.00 $0.00 $0.0001933 0.00 0.00 0.00 0.00 $0.00 $0.0001935 0.00 0.00 0.00 0.00 $0.00 $0.0001936 0.00 0.00 0.00 0.00 $0.00 $0.000195T 0.00 0.00 0.00 0.00 $0.00 $0.0001951 0.00 0.00 0.00 0.00 $0.00 $0.0001952 0.00 0.00 0.00 0.00 $0.00 $0.0001953 0.00 0.00 0.00 0.00 $0.00 $0.0001958 0.00 0.00 0.00 0.00 $0.00 $0.000196T 0.00 0.00 0.00 0.00 $0.00 $0.0001960 0.00 0.00 0.00 0.00 $0.00 $0.0001961 0.00 0.00 0.00 0.00 $0.00 $0.0001962 0.00 0.00 0.00 0.00 $0.00 $0.0001963 0.00 0.00 0.00 0.00 $0.00 $0.0001965 0.00 0.00 0.00 0.00 $0.00 $0.0001966 0.00 0.00 0.00 0.00 $0.00 $0.0001967 0.00 0.00 0.00 0.00 $0.00 $0.0001968 0.00 0.00 0.00 0.00 $0.00 $0.0001969 0.00 0.00 0.00 0.00 $0.00 $0.000197T 0.00 0.00 0.00 0.00 $0.00 $0.000198T 0.00 0.00 0.00 0.00 $0.00 $0.000199T 0.00 0.00 0.00 0.00 $0.00 $0.0001990 0.00 0.00 0.00 0.00 $0.00 $0.0001991 0.00 0.00 0.00 0.00 $0.00 $0.0001992 0.00 0.00 0.00 0.00 $0.00 $0.0001996 0.00 0.00 0.00 0.00 $0.00 $0.0001999 0.00 0.00 0.00 0.00 $0.00 $0.000200T 0.00 0.00 0.00 0.00 $0.00 $0.000201T 0.00 0.00 0.00 0.00 $0.00 $0.000202T 0.00 0.00 0.00 0.00 $0.00 $0.000205T 0.00 0.00 0.00 0.00 $0.00 $0.000206T 0.00 0.00 0.00 0.00 $0.00 $0.000207T 0.00 0.00 0.00 0.00 $0.00 $0.000208T 0.00 0.00 0.00 0.00 $0.00 $0.000209T 0.00 0.00 0.00 0.00 $0.00 $0.000210T 0.00 0.00 0.00 0.00 $0.00 $0.000211T 0.00 0.00 0.00 0.00 $0.00 $0.000212T 0.00 0.00 0.00 0.00 $0.00 $0.000213T 0.00 0.00 0.00 0.00 $0.00 $0.000214T 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 104 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

0215T 0.00 0.00 0.00 0.00 $0.00 $0.000216T 0.00 0.00 0.00 0.00 $0.00 $0.000217T 0.00 0.00 0.00 0.00 $0.00 $0.000218T 0.00 0.00 0.00 0.00 $0.00 $0.000219T 0.00 0.00 0.00 0.00 $0.00 $0.000220T 0.00 0.00 0.00 0.00 $0.00 $0.000221T 0.00 0.00 0.00 0.00 $0.00 $0.000222T 0.00 0.00 0.00 0.00 $0.00 $0.000223T 0.00 0.00 0.00 0.00 $0.00 $0.000224T 0.00 0.00 0.00 0.00 $0.00 $0.000225T 0.00 0.00 0.00 0.00 $0.00 $0.000226T 0.00 0.00 0.00 0.00 $0.00 $0.000227T 0.00 0.00 0.00 0.00 $0.00 $0.000228T 0.00 0.00 0.00 0.00 $0.00 $0.000229T 0.00 0.00 0.00 0.00 $0.00 $0.000230T 0.00 0.00 0.00 0.00 $0.00 $0.000231T 0.00 0.00 0.00 0.00 $0.00 $0.000232T 0.00 0.00 0.00 0.00 $0.00 $0.000233T 0.00 0.00 0.00 0.00 $0.00 $0.000234T 0.00 0.00 0.00 0.00 $0.00 $0.000235T 0.00 0.00 0.00 0.00 $0.00 $0.000236T 0.00 0.00 0.00 0.00 $0.00 $0.000237T 0.00 0.00 0.00 0.00 $0.00 $0.000238T 0.00 0.00 0.00 0.00 $0.00 $0.000239T 0.00 0.00 0.00 0.00 $0.00 $0.000240T 0.00 0.00 0.00 0.00 $0.00 $0.000240T TC 0.00 0.00 0.00 0.00 $0.00 $0.000240T 26 0.00 0.00 0.00 0.00 $0.00 $0.000241T 0.00 0.00 0.00 0.00 $0.00 $0.000241T TC 0.00 0.00 0.00 0.00 $0.00 $0.000241T 26 0.00 0.00 0.00 0.00 $0.00 $0.000242T 0.00 0.00 0.00 0.00 $0.00 $0.000242T TC 0.00 0.00 0.00 0.00 $0.00 $0.000242T 26 0.00 0.00 0.00 0.00 $0.00 $0.000243T 0.00 0.00 0.00 0.00 $0.00 $0.000243T TC 0.00 0.00 0.00 0.00 $0.00 $0.000243T 26 0.00 0.00 0.00 0.00 $0.00 $0.000244T 0.00 0.00 0.00 0.00 $0.00 $0.000244T TC 0.00 0.00 0.00 0.00 $0.00 $0.000244T 26 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 105 of 387 Effective January 2012

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MRA 2012

0245T 0.00 0.00 0.00 0.00 $0.00 $0.000246T 0.00 0.00 0.00 0.00 $0.00 $0.000247T 0.00 0.00 0.00 0.00 $0.00 $0.000248T 0.00 0.00 0.00 0.00 $0.00 $0.000249T 0.00 0.00 0.00 0.00 $0.00 $0.000250T 0.00 0.00 0.00 0.00 $0.00 $0.000251T 0.00 0.00 0.00 0.00 $0.00 $0.000252T 0.00 0.00 0.00 0.00 $0.00 $0.000253T 0.00 0.00 0.00 0.00 $0.00 $0.000254T 0.00 0.00 0.00 0.00 $0.00 $0.000255T 0.00 0.00 0.00 0.00 $0.00 $0.000255T TC 0.00 0.00 0.00 0.00 $0.00 $0.000255T 26 0.00 0.00 0.00 0.00 $0.00 $0.000256T 0.00 0.00 0.00 0.00 $0.00 $0.000257T 0.00 0.00 0.00 0.00 $0.00 $0.000258T 0.00 0.00 0.00 0.00 $0.00 $0.000259T 0.00 0.00 0.00 0.00 $0.00 $0.000260T 0.00 0.00 0.00 0.00 $0.00 $0.000261T 0.00 0.00 0.00 0.00 $0.00 $0.000262T 0.00 0.00 0.00 0.00 $0.00 $0.000263T 0.00 0.00 0.00 0.00 $0.00 $0.000264T 0.00 0.00 0.00 0.00 $0.00 $0.000265T 0.00 0.00 0.00 0.00 $0.00 $0.000266T 0.00 0.00 0.00 0.00 $0.00 $0.000267T 0.00 0.00 0.00 0.00 $0.00 $0.000268T 0.00 0.00 0.00 0.00 $0.00 $0.000269T 0.00 0.00 0.00 0.00 $0.00 $0.000270T 0.00 0.00 0.00 0.00 $0.00 $0.000271T 0.00 0.00 0.00 0.00 $0.00 $0.000272T 0.00 0.00 0.00 0.00 $0.00 $0.000273T 0.00 0.00 0.00 0.00 $0.00 $0.000274T 0.00 0.00 0.00 0.00 $0.00 $0.000275T 0.00 0.00 0.00 0.00 $0.00 $0.000276T 0.00 0.00 0.00 0.00 $0.00 $0.000277T 0.00 0.00 0.00 0.00 $0.00 $0.000278T 0.00 0.00 0.00 0.00 $0.00 $0.000279T 0.00 0.00 0.00 0.00 $0.00 $0.000280T 0.00 0.00 0.00 0.00 $0.00 $0.000281T 0.00 0.00 0.00 0.00 $0.00 $0.000282T 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 106 of 387 Effective January 2012

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MRA 2012

0283T 0.00 0.00 0.00 0.00 $0.00 $0.000284T 0.00 0.00 0.00 0.00 $0.00 $0.000285T 0.00 0.00 0.00 0.00 $0.00 $0.000286T 0.00 0.00 0.00 0.00 $0.00 $0.000287T 0.00 0.00 0.00 0.00 $0.00 $0.000288T 0.00 0.00 0.00 0.00 $0.00 $0.000289T 0.00 0.00 0.00 0.00 $0.00 $0.000290T 0.00 0.00 0.00 0.00 $0.00 $0.000291T 0.00 0.00 0.00 0.00 $0.00 $0.000292T 0.00 0.00 0.00 0.00 $0.00 $0.000293T 0.00 0.00 0.00 0.00 $0.00 $0.000294T 0.00 0.00 0.00 0.00 $0.00 $0.000295T 0.00 0.00 0.00 0.00 $0.00 $0.000296T 0.00 0.00 0.00 0.00 $0.00 $0.000297T 0.00 0.00 0.00 0.00 $0.00 $0.000298T 0.00 0.00 0.00 0.00 $0.00 $0.000299T 0.00 0.00 0.00 0.00 $0.00 $0.000300T 0.00 0.00 0.00 0.00 $0.00 $0.000301T 0.00 0.00 0.00 0.00 $0.00 $0.000500F 0.00 0.00 0.00 0.00 $0.00 $0.000501F 0.00 0.00 0.00 0.00 $0.00 $0.000502F 0.00 0.00 0.00 0.00 $0.00 $0.000503F 0.00 0.00 0.00 0.00 $0.00 $0.000505F 0.00 0.00 0.00 0.00 $0.00 $0.000507F 0.00 0.00 0.00 0.00 $0.00 $0.000509F 0.00 0.00 0.00 0.00 $0.00 $0.000513F 0.00 0.00 0.00 0.00 $0.00 $0.000514F 0.00 0.00 0.00 0.00 $0.00 $0.000516F 0.00 0.00 0.00 0.00 $0.00 $0.000517F 0.00 0.00 0.00 0.00 $0.00 $0.000518F 0.00 0.00 0.00 0.00 $0.00 $0.000519F 0.00 0.00 0.00 0.00 $0.00 $0.000520F 0.00 0.00 0.00 0.00 $0.00 $0.000521F 0.00 0.00 0.00 0.00 $0.00 $0.000525F 0.00 0.00 0.00 0.00 $0.00 $0.000526F 0.00 0.00 0.00 0.00 $0.00 $0.000528F 0.00 0.00 0.00 0.00 $0.00 $0.000529F 0.00 0.00 0.00 0.00 $0.00 $0.000535F 0.00 0.00 0.00 0.00 $0.00 $0.000540F 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 107 of 387 Effective January 2012

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MRA 2012

0545F 0.00 0.00 0.00 0.00 $0.00 $0.000550F 0.00 0.00 0.00 0.00 $0.00 $0.000551F 0.00 0.00 0.00 0.00 $0.00 $0.000555F 0.00 0.00 0.00 0.00 $0.00 $0.000556F 0.00 0.00 0.00 0.00 $0.00 $0.000557F 0.00 0.00 0.00 0.00 $0.00 $0.000575F 0.00 0.00 0.00 0.00 $0.00 $0.001000F 0.00 0.00 0.00 0.00 $0.00 $0.001002F 0.00 0.00 0.00 0.00 $0.00 $0.0010021 1.27 2.81 0.58 0.22 $196.23 $93.0410022 1.27 2.61 0.49 0.14 $182.91 $84.811003F 0.00 0.00 0.00 0.00 $0.00 $0.001004F 0.00 0.00 0.00 0.00 $0.00 $0.0010040 1.21 1.61 1.22 0.18 $136.07 $118.021005F 0.00 0.00 0.00 0.00 $0.00 $0.001006F 0.00 0.00 0.00 0.00 $0.00 $0.0010060 1.22 1.98 1.43 0.12 $150.57 $125.1210061 2.45 3.06 2.34 0.30 $262.98 $229.671007F 0.00 0.00 0.00 0.00 $0.00 $0.001008F 0.00 0.00 0.00 0.00 $0.00 $0.0010080 1.22 3.70 1.55 0.20 $234.23 $134.7410081 2.50 4.92 2.07 0.45 $358.84 $226.971010F 0.00 0.00 0.00 0.00 $0.00 $0.001011F 0.00 0.00 0.00 0.00 $0.00 $0.001012F 0.00 0.00 0.00 0.00 $0.00 $0.0010120 1.25 2.69 1.31 0.16 $186.76 $122.9010121 2.74 4.80 2.29 0.41 $361.65 $245.5110140 1.58 2.90 1.67 0.20 $212.80 $155.891015F 0.00 0.00 0.00 0.00 $0.00 $0.0010160 1.25 2.35 1.39 0.16 $171.03 $126.601018F 0.00 0.00 0.00 0.00 $0.00 $0.0010180 2.30 4.37 2.46 0.48 $326.26 $237.881019F 0.00 0.00 0.00 0.00 $0.00 $0.001022F 0.00 0.00 0.00 0.00 $0.00 $0.001026F 0.00 0.00 0.00 0.00 $0.00 $0.001030F 0.00 0.00 0.00 0.00 $0.00 $0.001031F 0.00 0.00 0.00 0.00 $0.00 $0.001032F 0.00 0.00 0.00 0.00 $0.00 $0.001033F 0.00 0.00 0.00 0.00 $0.00 $0.001034F 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 108 of 387 Effective January 2012

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MRA 2012

1035F 0.00 0.00 0.00 0.00 $0.00 $0.001036F 0.00 0.00 0.00 0.00 $0.00 $0.001038F 0.00 0.00 0.00 0.00 $0.00 $0.001039F 0.00 0.00 0.00 0.00 $0.00 $0.001040F 0.00 0.00 0.00 0.00 $0.00 $0.001050F 0.00 0.00 0.00 0.00 $0.00 $0.001052F 0.00 0.00 0.00 0.00 $0.00 $0.001055F 0.00 0.00 0.00 0.00 $0.00 $0.001060F 0.00 0.00 0.00 0.00 $0.00 $0.001061F 0.00 0.00 0.00 0.00 $0.00 $0.001065F 0.00 0.00 0.00 0.00 $0.00 $0.001066F 0.00 0.00 0.00 0.00 $0.00 $0.001070F 0.00 0.00 0.00 0.00 $0.00 $0.001071F 0.00 0.00 0.00 0.00 $0.00 $0.001090F 0.00 0.00 0.00 0.00 $0.00 $0.001091F 0.00 0.00 0.00 0.00 $0.00 $0.001100F 0.00 0.00 0.00 0.00 $0.00 $0.0011000 0.60 0.91 0.20 0.05 $70.64 $37.7911001 0.30 0.29 0.09 0.03 $27.94 $18.6911004 10.80 4.40 4.40 1.89 $767.58 $767.5811005 14.24 5.81 5.81 2.97 $1,036.78 $1,036.7811006 13.10 5.38 5.38 2.34 $935.45 $935.4511008 5.00 2.03 2.03 1.05 $363.94 $363.941101F 0.00 0.00 0.00 0.00 $0.00 $0.0011010 4.19 9.50 3.34 0.76 $659.75 $374.7111011 4.94 9.86 2.94 0.98 $720.08 $399.8811012 6.87 12.71 4.39 1.31 $952.35 $567.3711042 1.01 2.04 0.61 0.13 $144.76 $78.5911043 2.70 3.65 1.50 0.45 $308.74 $209.2611044 4.10 4.59 2.13 0.72 $426.62 $312.7911045 0.50 0.59 0.18 0.11 $54.56 $35.5811046 1.03 0.90 0.41 0.18 $95.42 $72.7511047 1.80 1.43 0.74 0.33 $160.93 $129.0011055 0.43 1.00 0.13 0.03 $66.42 $26.1711056 0.50 1.11 0.15 0.03 $74.55 $30.1311057 0.79 1.21 0.23 0.05 $92.75 $47.411110F 0.00 0.00 0.00 0.00 $0.00 $0.0011100 0.81 2.13 0.53 0.11 $139.24 $65.2111101 0.41 0.50 0.27 0.05 $43.44 $32.801111F 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 109 of 387 Effective January 2012

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MRA 2012

1116F 0.00 0.00 0.00 0.00 $0.00 $0.001118F 0.00 0.00 0.00 0.00 $0.00 $0.001119F 0.00 0.00 0.00 0.00 $0.00 $0.0011200 0.82 1.60 1.19 0.11 $115.15 $96.1811201 0.29 0.22 0.16 0.04 $24.78 $22.001121F 0.00 0.00 0.00 0.00 $0.00 $0.001123F 0.00 0.00 0.00 0.00 $0.00 $0.001124F 0.00 0.00 0.00 0.00 $0.00 $0.001125F 0.00 0.00 0.00 0.00 $0.00 $0.001126F 0.00 0.00 0.00 0.00 $0.00 $0.001127F 0.00 0.00 0.00 0.00 $0.00 $0.001128F 0.00 0.00 0.00 0.00 $0.00 $0.001130F 0.00 0.00 0.00 0.00 $0.00 $0.0011300 0.51 1.47 0.30 0.07 $93.67 $39.5311301 0.85 1.78 0.53 0.11 $124.78 $66.9411302 1.05 2.08 0.66 0.14 $148.85 $83.1511303 1.24 2.44 0.77 0.18 $175.77 $98.5011305 0.67 1.32 0.25 0.05 $92.65 $43.1311306 0.99 1.70 0.47 0.11 $127.14 $70.2311307 1.14 2.01 0.60 0.14 $149.51 $84.2711308 1.41 2.09 0.61 0.14 $164.91 $96.4311310 0.73 1.68 0.44 0.10 $114.45 $57.0711311 1.05 1.95 0.67 0.14 $142.84 $83.6111312 1.20 2.26 0.77 0.18 $165.71 $96.7711313 1.62 2.66 1.01 0.24 $205.47 $129.121134F 0.00 0.00 0.00 0.00 $0.00 $0.001135F 0.00 0.00 0.00 0.00 $0.00 $0.001136F 0.00 0.00 0.00 0.00 $0.00 $0.001137F 0.00 0.00 0.00 0.00 $0.00 $0.0011400 0.90 2.55 1.30 0.12 $163.08 $105.2411401 1.28 2.85 1.56 0.20 $197.50 $137.8111402 1.45 3.13 1.65 0.24 $219.85 $151.3711403 1.84 3.41 2.14 0.31 $253.26 $194.5011404 2.11 3.83 2.25 0.37 $287.44 $214.3411406 3.52 4.82 2.94 0.67 $409.59 $322.6011420 1.03 2.40 1.24 0.12 $161.77 $108.1011421 1.47 2.89 1.56 0.22 $208.59 $147.0511422 1.68 3.16 2.02 0.26 $232.22 $179.4711423 2.06 3.51 2.22 0.33 $268.44 $208.7511424 2.48 3.89 2.36 0.41 $308.28 $237.49

Updated December 2011 110 of 387 Effective January 2012

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MRA 2012

11426 4.09 4.86 3.20 0.71 $438.17 $361.3611440 1.05 2.70 1.80 0.16 $178.56 $136.9111441 1.53 3.13 2.09 0.24 $223.32 $175.1911442 1.77 3.45 2.23 0.29 $251.06 $194.6111443 2.34 3.84 2.53 0.38 $298.38 $237.7611444 3.19 4.51 2.97 0.52 $373.32 $302.0711446 4.80 5.71 3.90 0.80 $512.84 $429.0811450 3.22 7.06 3.40 0.65 $499.23 $329.8711451 4.43 8.66 4.07 0.90 $638.40 $426.0111462 3.00 7.22 3.43 0.60 $494.56 $319.1911463 4.43 8.88 4.17 0.88 $647.56 $429.6211470 3.74 7.45 3.71 0.71 $542.85 $369.8011471 4.89 9.01 4.35 0.91 $675.03 $459.401150F 0.00 0.00 0.00 0.00 $0.00 $0.001151F 0.00 0.00 0.00 0.00 $0.00 $0.001152F 0.00 0.00 0.00 0.00 $0.00 $0.001153F 0.00 0.00 0.00 0.00 $0.00 $0.001157F 0.00 0.00 0.00 0.00 $0.00 $0.001158F 0.00 0.00 0.00 0.00 $0.00 $0.001159F 0.00 0.00 0.00 0.00 $0.00 $0.001160F 0.00 0.00 0.00 0.00 $0.00 $0.0011600 1.63 3.66 1.59 0.26 $253.19 $157.4111601 2.07 4.29 2.00 0.31 $303.94 $197.9811602 2.27 4.66 2.21 0.34 $331.25 $217.8911603 2.82 5.02 2.49 0.42 $375.81 $258.7411604 3.17 5.49 2.62 0.52 $417.80 $285.0011606 5.02 7.15 3.43 0.88 $593.07 $420.9411620 1.64 3.74 1.63 0.26 $257.32 $159.6911621 2.08 4.33 2.03 0.31 $306.23 $199.8011622 2.41 4.74 2.29 0.37 $342.55 $229.1811623 3.11 5.20 2.65 0.49 $400.26 $282.2711624 3.62 5.69 2.86 0.60 $450.62 $319.6711626 4.61 6.56 3.29 0.80 $543.94 $392.6311640 1.67 3.91 1.75 0.26 $266.49 $166.5411641 2.17 4.49 2.14 0.33 $318.55 $209.8111642 2.62 4.97 2.45 0.39 $363.30 $246.7011643 3.42 5.45 2.87 0.54 $427.80 $308.4211644 4.34 6.56 3.42 0.71 $527.66 $382.3711646 6.26 7.84 4.44 1.05 $687.36 $530.031170F 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 111 of 387 Effective January 2012

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MRA 2012

11719 0.17 0.47 0.05 0.01 $29.62 $10.1911720 0.32 0.57 0.09 0.03 $41.76 $19.5511721 0.54 0.70 0.16 0.04 $57.82 $32.8311730 1.10 1.64 0.32 0.08 $127.61 $66.5311732 0.44 0.58 0.14 0.03 $47.42 $27.0611740 0.37 0.99 0.54 0.03 $63.36 $42.541175F 0.00 0.00 0.00 0.00 $0.00 $0.0011750 2.50 3.68 2.34 0.22 $289.77 $227.7611752 3.63 5.22 3.62 0.39 $418.62 $344.5911755 1.31 2.48 0.91 0.11 $177.10 $104.4511760 1.63 4.78 2.05 0.26 $305.01 $178.6911762 2.94 4.82 2.22 0.31 $366.16 $245.8511765 1.22 3.38 1.35 0.08 $213.32 $119.3911770 2.66 4.79 2.16 0.52 $363.32 $241.6311771 6.09 9.17 5.25 1.24 $751.20 $569.8111772 7.35 11.19 7.85 1.47 $910.95 $756.401180F 0.00 0.00 0.00 0.00 $0.00 $0.001181F 0.00 0.00 0.00 0.00 $0.00 $0.001182F 0.00 0.00 0.00 0.00 $0.00 $0.001183F 0.00 0.00 0.00 0.00 $0.00 $0.0011900 0.52 1.05 0.34 0.07 $74.67 $41.8211901 0.80 1.15 0.53 0.11 $93.46 $64.7711920 1.61 3.28 1.53 0.31 $237.28 $156.3111921 1.93 3.68 1.74 0.37 $272.71 $182.9411922 0.49 1.25 0.31 0.08 $83.14 $39.6411950 0.84 1.15 0.49 0.10 $94.69 $64.1511951 1.19 1.70 0.80 0.24 $142.42 $100.7811952 1.69 2.26 1.13 0.24 $189.99 $137.7011954 1.85 2.54 1.25 0.35 $215.47 $155.7811960 11.49 13.29 13.29 1.84 $1,206.28 $1,206.2811970 8.01 8.62 8.62 1.57 $825.71 $825.7111971 3.41 9.90 5.37 0.64 $638.36 $428.7511976 1.78 2.20 0.76 0.30 $194.17 $127.5311980 1.48 1.34 0.67 0.23 $137.82 $106.8111981 1.48 2.26 0.69 0.24 $180.89 $108.2511982 1.78 2.45 0.85 0.24 $202.68 $128.6511983 3.30 2.70 1.39 0.35 $285.69 $225.071200F 0.00 0.00 0.00 0.00 $0.00 $0.0012001 0.84 1.77 0.48 0.14 $125.41 $65.7212002 1.14 1.95 0.57 0.19 $149.28 $85.42

Updated December 2011 112 of 387 Effective January 2012

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Treatment

MRA 2012

12004 1.44 2.19 0.66 0.24 $175.92 $105.1312005 1.97 2.70 0.82 0.33 $227.06 $140.0712006 2.39 3.23 1.01 0.41 $273.85 $171.1212007 2.90 3.60 1.25 0.50 $317.64 $208.9012011 1.07 2.04 0.53 0.19 $150.41 $80.5412013 1.22 2.19 0.59 0.20 $164.36 $90.3212014 1.57 2.41 0.69 0.26 $192.75 $113.1612015 1.98 2.91 0.80 0.33 $237.21 $139.5812016 2.68 3.33 1.04 0.46 $293.58 $187.6212017 3.18 1.05 1.05 0.56 $214.83 $214.8312018 3.61 1.31 1.31 0.64 $249.55 $249.5512020 2.67 4.96 2.40 0.42 $366.53 $248.0812021 1.89 2.66 1.93 0.31 $220.72 $186.9512031 2.00 4.59 2.18 0.32 $315.30 $203.7912032 2.52 6.05 2.87 0.38 $408.44 $261.2912034 2.97 5.61 2.59 0.50 $413.67 $273.9312035 3.50 6.96 2.90 0.65 $506.73 $318.8712036 4.23 7.30 3.22 0.81 $562.22 $373.4412037 5.00 7.89 3.68 0.96 $630.51 $435.7112041 2.10 4.63 2.19 0.32 $321.48 $208.5812042 2.79 5.29 2.70 0.41 $386.49 $266.6512044 3.19 6.65 2.59 0.52 $472.34 $284.4812045 3.75 7.12 3.38 0.64 $524.45 $351.4012046 4.30 8.03 3.74 0.84 $600.56 $402.0612047 4.95 9.23 4.07 0.96 $690.35 $451.591205F 0.00 0.00 0.00 0.00 $0.00 $0.0012051 2.33 4.93 2.40 0.36 $347.36 $230.3012052 2.87 5.43 2.81 0.42 $396.94 $275.7112053 3.17 6.41 2.74 0.50 $459.36 $289.5412054 3.50 6.63 2.65 0.59 $488.41 $304.2512055 4.50 8.38 3.49 0.73 $619.82 $393.5612056 5.30 9.89 4.92 0.67 $721.30 $491.3312057 6.00 11.40 5.06 0.76 $826.07 $532.711220F 0.00 0.00 0.00 0.00 $0.00 $0.0013100 3.17 5.53 3.24 0.50 $418.64 $312.6713101 3.96 7.11 3.82 0.61 $531.56 $379.3313102 1.24 1.73 0.75 0.23 $145.46 $100.1213120 3.35 5.69 3.37 0.52 $434.85 $327.5013121 4.42 7.95 4.58 0.67 $593.41 $437.4713122 1.44 1.81 0.84 0.26 $159.36 $114.47

Updated December 2011 113 of 387 Effective January 2012

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MRA 2012

13131 3.83 6.12 3.71 0.59 $479.11 $367.5913132 6.58 9.49 6.31 0.98 $774.01 $626.8613133 2.19 2.40 1.38 0.34 $223.22 $176.0213150 3.85 6.06 3.66 0.61 $478.21 $367.1613151 4.49 6.76 4.20 0.67 $541.38 $422.9213152 6.37 9.16 5.19 0.95 $748.11 $564.4213153 2.38 2.70 1.47 0.38 $247.36 $190.4513160 12.04 9.55 9.55 2.23 $1,076.89 $1,076.891400F 0.00 0.00 0.00 0.00 $0.00 $0.0014000 6.37 10.93 7.49 1.13 $839.17 $680.0014001 8.78 13.35 9.23 1.54 $1,076.40 $885.7614020 7.22 12.24 8.59 1.21 $940.68 $771.7914021 9.72 14.55 10.30 1.55 $1,173.16 $976.5014040 8.60 12.73 9.10 1.32 $1,028.73 $860.7614041 10.83 15.52 10.89 1.62 $1,269.68 $1,055.4514060 9.23 12.34 9.50 1.42 $1,043.06 $911.6514061 11.48 16.83 11.74 1.71 $1,363.04 $1,127.5114301 12.65 17.44 11.84 2.14 $1,463.82 $1,204.7014302 3.73 2.29 2.29 0.63 $299.59 $299.5914350 11.05 8.64 8.64 1.55 $957.31 $957.311450F 0.00 0.00 0.00 0.00 $0.00 $0.001451F 0.00 0.00 0.00 0.00 $0.00 $0.001460F 0.00 0.00 0.00 0.00 $0.00 $0.001461F 0.00 0.00 0.00 0.00 $0.00 $0.001490F 0.00 0.00 0.00 0.00 $0.00 $0.001491F 0.00 0.00 0.00 0.00 $0.00 $0.001493F 0.00 0.00 0.00 0.00 $0.00 $0.001494F 0.00 0.00 0.00 0.00 $0.00 $0.0015002 3.65 5.79 2.40 0.65 $459.09 $302.2315003 0.80 1.25 0.39 0.16 $100.63 $60.8415004 4.58 6.41 2.74 0.67 $529.08 $359.2715005 1.60 1.74 0.79 0.31 $165.59 $121.6315040 2.00 5.17 1.38 0.37 $344.68 $169.3115050 5.57 10.30 6.78 0.90 $763.66 $600.7915100 9.90 13.66 9.47 1.95 $1,160.12 $966.2415101 1.72 3.46 1.22 0.34 $251.90 $148.2615110 10.97 12.31 9.05 2.15 $1,154.18 $1,003.3315111 1.85 1.13 0.78 0.38 $151.76 $135.5615115 11.28 12.44 9.33 1.85 $1,158.36 $1,014.4615116 2.50 2.04 1.58 0.49 $227.62 $206.33

Updated December 2011 114 of 387 Effective January 2012

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MRA 2012

15120 10.15 13.62 9.17 1.76 $1,159.43 $953.5315121 2.00 4.00 1.63 0.37 $290.55 $180.8815130 7.53 10.95 7.77 1.48 $908.15 $761.0115131 1.50 1.19 0.93 0.31 $135.81 $123.7815135 11.03 12.83 9.78 1.88 $1,167.10 $1,025.9815136 1.50 0.94 0.76 0.10 $113.56 $105.2315150 9.39 8.99 7.23 1.99 $923.97 $842.5415151 2.00 1.13 0.84 0.42 $160.29 $146.8715152 2.50 1.91 1.61 0.49 $221.60 $207.7215155 10.14 9.34 7.59 0.76 $910.09 $829.1115156 2.75 1.93 1.66 0.59 $238.44 $225.9515157 3.00 2.11 1.72 0.22 $238.78 $220.7315200 9.15 13.57 9.04 1.65 $1,108.21 $898.6015201 1.32 2.85 0.80 0.26 $202.28 $107.4215220 8.09 13.34 8.90 1.39 $1,038.42 $832.9715221 1.19 2.66 0.73 0.23 $186.33 $97.0315240 10.41 15.45 11.75 1.70 $1,252.32 $1,081.1215241 1.86 3.29 1.15 0.33 $249.59 $150.5715260 11.64 16.43 12.22 1.77 $1,354.51 $1,159.7115261 2.23 3.81 1.63 0.37 $291.72 $190.8515271 1.50 2.49 0.83 0.25 $192.91 $116.1015272 0.33 0.43 0.14 0.04 $36.23 $22.8115273 3.50 4.59 2.03 0.62 $395.54 $277.0915274 0.80 1.15 0.40 0.10 $92.95 $58.2515275 1.83 2.41 0.85 0.31 $206.56 $134.3715276 0.50 0.43 0.17 0.06 $44.61 $32.5815277 4.00 4.17 1.76 0.59 $396.24 $284.7315278 1.00 1.29 0.48 0.13 $109.62 $72.1415570 10.21 14.56 9.47 2.07 $1,221.30 $985.7815572 10.12 14.06 10.06 1.82 $1,181.55 $996.4615574 10.70 14.42 10.24 1.82 $1,223.33 $1,029.9115576 9.37 12.96 9.11 1.54 $1,083.91 $905.7715600 2.01 7.35 3.81 0.38 $446.50 $282.7015610 2.52 7.45 4.23 0.45 $476.78 $327.7815620 3.75 8.67 5.30 0.61 $594.65 $438.7115630 4.08 8.96 5.63 0.65 $624.40 $470.3115650 4.77 9.58 5.95 0.78 $689.59 $521.6215731 14.38 16.99 13.61 2.41 $1,531.67 $1,375.2715732 16.38 19.46 14.71 2.91 $1,758.03 $1,538.2515734 19.86 21.10 15.89 3.99 $2,039.61 $1,798.53

Updated December 2011 115 of 387 Effective January 2012

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Treatment

MRA 2012

15736 17.04 19.21 14.02 3.36 $1,797.95 $1,557.8015738 19.04 19.30 14.38 3.81 $1,911.64 $1,683.9915740 11.80 16.51 11.97 1.77 $1,365.14 $1,155.0715750 12.96 11.92 11.92 2.29 $1,229.46 $1,229.4615756 36.94 26.96 26.96 6.36 $3,171.20 $3,171.2015757 37.15 25.93 25.93 5.92 $3,110.26 $3,110.2615758 36.90 26.32 26.32 5.92 $3,117.48 $3,117.4815760 9.86 13.85 9.73 1.58 $1,148.36 $957.7215770 8.96 9.37 9.37 1.63 $904.62 $904.6215775 3.95 4.30 2.02 0.29 $384.83 $279.3315776 5.53 5.88 2.75 0.38 $530.96 $386.1315777 3.65 1.87 1.87 0.77 $283.81 $283.8115780 8.73 14.57 8.73 1.20 $1,113.39 $843.1715781 5.02 10.35 7.01 0.76 $735.03 $580.4815782 4.44 12.51 7.60 0.63 $803.24 $576.0515783 4.41 9.29 6.05 0.63 $652.95 $503.0315786 2.08 4.80 1.67 0.33 $328.99 $184.1615787 0.33 1.07 0.15 0.04 $65.84 $23.2715788 2.09 11.06 4.94 0.35 $620.10 $336.9215789 4.91 10.83 6.92 0.68 $748.41 $567.4915792 1.86 10.70 5.66 0.30 $590.94 $357.7315793 3.96 9.88 6.27 0.56 $657.19 $490.1515819 10.65 9.63 9.63 2.10 $1,013.77 $1,013.7715820 6.27 9.24 7.68 1.24 $762.24 $690.0515821 6.84 9.74 7.98 1.33 $814.64 $733.2015822 4.62 7.61 6.08 0.82 $593.97 $523.1815823 6.81 10.05 8.30 1.27 $824.63 $743.6615824 0.00 0.00 0.00 0.00 $0.00 $0.0015825 0.00 0.00 0.00 0.00 $0.00 $0.0015826 0.00 0.00 0.00 0.00 $0.00 $0.0015828 0.00 0.00 0.00 0.00 $0.00 $0.0015829 0.00 0.00 0.00 0.00 $0.00 $0.0015830 17.11 14.14 14.14 3.39 $1,567.91 $1,567.9115832 12.85 11.40 11.40 2.57 $1,214.88 $1,214.8815833 11.90 11.75 11.75 2.33 $1,177.71 $1,177.7115834 12.17 11.76 11.76 2.40 $1,193.43 $1,193.4315835 12.99 9.64 9.64 2.56 $1,138.99 $1,138.9915836 10.61 9.56 9.56 2.08 $1,007.78 $1,007.7815837 9.55 13.76 9.40 2.01 $1,152.64 $950.8915838 8.25 7.74 7.74 1.06 $769.44 $769.44

Updated December 2011 116 of 387 Effective January 2012

CPT©1/HCPCS

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Treatment

MRA 2012

15839 10.50 13.39 9.27 1.93 $1,172.60 $981.9615840 14.99 12.93 12.93 2.40 $1,369.73 $1,369.7315841 25.99 18.73 18.73 3.36 $2,163.44 $2,163.4415842 41.01 27.42 27.42 5.28 $3,313.86 $3,313.8615845 14.32 12.98 12.98 1.84 $1,314.53 $1,314.5315847 0.00 0.00 0.00 0.00 $0.00 $0.0015850 0.78 1.69 0.32 0.05 $114.53 $51.1415851 0.86 1.88 0.38 0.12 $130.35 $60.9415852 0.86 0.38 0.38 0.14 $61.96 $61.9615860 1.95 0.94 0.94 0.38 $147.30 $147.3015876 0.00 0.00 0.00 0.00 $0.00 $0.0015877 0.00 0.00 0.00 0.00 $0.00 $0.0015878 0.00 0.00 0.00 0.00 $0.00 $0.0015879 0.00 0.00 0.00 0.00 $0.00 $0.0015920 8.29 8.00 8.00 1.71 $816.27 $816.2715922 10.38 10.77 10.77 2.03 $1,051.26 $1,051.2615931 10.07 7.82 7.82 2.07 $903.36 $903.3615933 11.77 10.58 10.58 2.41 $1,122.01 $1,122.0115934 13.68 10.76 10.76 2.78 $1,231.90 $1,231.9015935 15.78 13.78 13.78 3.18 $1,482.96 $1,482.9615936 13.16 10.65 10.65 2.67 $1,198.69 $1,198.6915937 15.14 12.64 12.64 3.06 $1,396.38 $1,396.3815940 10.20 8.19 8.19 2.07 $926.11 $926.1115941 12.41 11.68 11.68 2.48 $1,204.19 $1,204.1915944 12.44 11.65 11.65 2.50 $1,205.12 $1,205.1215945 13.75 12.94 12.94 2.74 $1,333.77 $1,333.7715946 24.12 19.80 19.80 4.82 $2,206.21 $2,206.2115950 8.03 7.54 7.54 1.59 $777.62 $777.6215951 11.58 12.04 12.04 2.27 $1,174.21 $1,174.2115952 12.31 12.03 12.03 2.63 $1,223.69 $1,223.6915953 13.57 13.29 13.29 2.67 $1,338.61 $1,338.6115956 16.79 14.05 14.05 3.42 $1,551.41 $1,551.4115958 16.75 14.83 14.83 3.39 $1,584.24 $1,584.2415999 0.00 0.00 0.00 0.00 $0.00 $0.0016000 0.89 1.01 0.34 0.12 $91.39 $60.3916020 0.71 1.56 0.77 0.10 $108.03 $71.4716025 1.74 2.27 1.26 0.29 $195.16 $148.4316030 2.08 2.86 1.45 0.37 $241.26 $176.0216035 3.74 1.53 1.53 0.63 $264.86 $264.8616036 1.50 0.69 0.69 0.27 $110.64 $110.64

Updated December 2011 117 of 387 Effective January 2012

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Treatment

MRA 2012

17000 0.65 1.65 0.92 0.08 $108.57 $74.8017003 0.07 0.13 0.05 0.01 $9.56 $5.8517004 1.85 2.93 1.78 0.27 $229.45 $176.2417106 3.69 5.83 3.90 0.53 $456.57 $367.2717107 4.79 7.43 4.89 0.73 $588.43 $470.9017108 7.49 10.07 6.74 1.31 $857.05 $702.9717110 0.70 2.48 1.27 0.08 $149.15 $93.1617111 0.97 2.77 1.43 0.12 $176.30 $114.2917250 0.50 1.72 0.50 0.07 $104.81 $48.3617260 0.96 1.70 0.96 0.12 $126.35 $92.1117261 1.22 2.84 1.32 0.18 $193.42 $123.0817262 1.63 3.29 1.59 0.23 $234.54 $155.8817263 1.84 3.53 1.73 0.26 $256.27 $172.9817264 1.99 3.76 1.81 0.29 $274.94 $184.7117266 2.39 4.10 2.03 0.34 $310.54 $214.7617270 1.37 2.85 1.39 0.20 $201.39 $133.8417271 1.54 3.05 1.53 0.23 $219.54 $149.2117272 1.82 3.41 1.72 0.26 $249.85 $171.6517273 2.10 3.72 1.89 0.30 $278.36 $193.6817274 2.64 4.21 2.23 0.37 $327.99 $236.3717276 3.25 4.66 2.57 0.48 $380.83 $284.1217280 1.22 2.75 1.29 0.18 $189.25 $121.7017281 1.77 3.21 1.68 0.26 $238.43 $167.6417282 2.09 3.63 1.89 0.30 $273.76 $193.2517283 2.69 4.15 2.27 0.38 $327.88 $240.8917284 3.20 4.59 2.57 0.44 $373.39 $279.9217286 4.48 5.50 3.35 0.67 $482.64 $383.1617311 6.20 12.43 4.17 0.87 $887.99 $505.7917312 3.30 7.90 2.22 0.45 $531.39 $268.5717313 5.56 11.46 3.74 0.78 $810.80 $453.5917314 3.06 7.32 2.06 0.42 $492.63 $249.2417315 0.87 1.35 0.59 0.11 $105.75 $70.5817340 0.77 0.61 0.54 0.10 $66.67 $63.4317360 1.46 2.13 1.24 0.22 $172.99 $131.8117380 0.00 0.00 0.00 0.00 $0.00 $0.0017999 0.00 0.00 0.00 0.00 $0.00 $0.0019000 0.84 2.28 0.33 0.11 $147.48 $57.2519001 0.42 0.30 0.16 0.05 $34.62 $28.1419020 3.83 9.05 4.24 0.78 $624.35 $401.7819030 1.53 3.05 0.58 0.14 $214.53 $100.24

Updated December 2011 118 of 387 Effective January 2012

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Treatment

MRA 2012

19100 1.27 2.82 0.50 0.26 $198.73 $91.3819101 3.23 6.02 2.55 0.67 $452.56 $291.9919102 2.00 4.01 0.76 0.22 $283.38 $133.0019103 3.69 11.94 1.40 0.48 $736.74 $249.0419105 3.69 78.45 1.72 0.39 $3,809.68 $259.2719110 4.44 8.69 4.52 0.93 $641.74 $448.7919112 3.81 8.70 4.42 0.80 $608.30 $410.2619120 5.92 7.04 4.77 1.25 $645.79 $540.7519125 6.69 7.65 5.15 1.42 $716.01 $600.3419126 2.93 1.14 1.14 0.63 $211.72 $211.7219260 17.78 13.73 13.73 3.96 $1,606.96 $1,606.9619271 22.19 21.13 21.13 5.05 $2,195.85 $2,195.8519272 25.17 22.19 22.19 5.96 $2,420.28 $2,420.2819290 1.27 3.30 0.48 0.12 $213.82 $83.3319291 0.63 1.31 0.24 0.05 $90.45 $40.9419295 0.00 2.67 2.67 0.01 $124.05 $124.0519296 3.63 116.27 1.76 0.73 $5,574.36 $275.8219297 1.72 0.68 0.68 0.35 $123.78 $123.7819298 6.00 27.28 2.62 0.76 $1,560.86 $419.8019300 5.31 8.72 5.43 1.13 $690.99 $538.7619301 10.13 6.53 6.53 2.15 $850.34 $850.3419302 13.99 9.05 9.05 2.98 $1,176.38 $1,176.3819303 15.85 9.91 9.91 3.38 $1,317.09 $1,317.0919304 7.95 7.02 7.02 1.67 $754.16 $754.1619305 17.46 11.64 11.64 3.73 $1,484.69 $1,484.6919306 18.13 12.74 12.74 3.87 $1,571.73 $1,571.7319307 18.23 12.53 12.53 3.87 $1,566.35 $1,566.3519316 11.09 9.71 9.71 2.19 $1,041.11 $1,041.1119318 16.03 14.04 14.04 3.16 $1,504.80 $1,504.8019324 6.80 6.05 6.05 1.46 $648.78 $648.7819325 8.64 8.99 8.99 1.69 $876.22 $876.2219328 6.48 7.02 7.02 1.28 $670.64 $670.6419330 8.54 8.67 8.67 1.66 $855.56 $855.5619340 13.99 11.36 11.36 2.75 $1,271.56 $1,271.5619342 12.63 12.57 12.57 2.44 $1,252.87 $1,252.8719350 9.11 13.88 9.28 1.78 $1,127.43 $914.5819355 8.52 10.33 6.35 1.82 $939.64 $755.4819357 18.50 22.67 22.67 3.62 $2,034.52 $2,034.5219361 23.36 19.98 19.98 4.60 $2,170.43 $2,170.4319364 42.58 32.09 32.09 8.25 $3,749.04 $3,749.04

Updated December 2011 119 of 387 Effective January 2012

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Facility All OtherMed Services And

Treatment

MRA 2012

19366 21.84 14.55 14.55 4.46 $1,846.21 $1,846.2119367 26.80 21.79 21.79 5.27 $2,437.28 $2,437.2819368 33.90 25.85 25.85 6.67 $3,003.92 $3,003.9219369 31.31 24.02 24.02 6.15 $2,780.60 $2,780.6019370 9.17 9.54 9.54 1.80 $930.23 $930.2319371 10.62 10.79 10.79 2.07 $1,064.61 $1,064.6119380 10.41 10.69 10.69 2.03 $1,048.86 $1,048.8619396 2.17 5.64 1.70 0.45 $377.86 $195.5519499 0.00 0.00 0.00 0.00 $0.00 $0.002000F 0.00 0.00 0.00 0.00 $0.00 $0.0020005 3.58 4.66 2.62 0.59 $400.72 $306.332001F 0.00 0.00 0.00 0.00 $0.00 $0.002002F 0.00 0.00 0.00 0.00 $0.00 $0.002004F 0.00 0.00 0.00 0.00 $0.00 $0.002010F 0.00 0.00 0.00 0.00 $0.00 $0.002026F 0.00 0.00 0.00 0.00 $0.00 $0.002027F 0.00 0.00 0.00 0.00 $0.00 $0.002028F 0.00 0.00 0.00 0.00 $0.00 $0.002029F 0.00 0.00 0.00 0.00 $0.00 $0.002030F 0.00 0.00 0.00 0.00 $0.00 $0.002031F 0.00 0.00 0.00 0.00 $0.00 $0.002035F 0.00 0.00 0.00 0.00 $0.00 $0.002040F 0.00 0.00 0.00 0.00 $0.00 $0.002044F 0.00 0.00 0.00 0.00 $0.00 $0.002050F 0.00 0.00 0.00 0.00 $0.00 $0.0021280 7.13 8.46 8.46 1.40 $771.54 $771.5421282 4.27 6.16 6.16 0.78 $509.68 $509.6822900 8.32 6.07 6.07 1.71 $728.27 $728.2722901 10.11 7.45 7.45 2.10 $889.50 $889.5022902 4.42 7.68 4.47 0.71 $582.95 $434.4222903 6.39 5.25 5.25 1.21 $581.28 $581.2822904 16.69 10.84 10.84 3.55 $1,405.16 $1,405.1622905 21.58 13.26 13.26 4.60 $1,782.38 $1,782.3823350 1.00 3.22 0.39 0.10 $197.40 $66.4523520 2.29 3.91 4.00 0.44 $302.50 $306.6724065 2.13 5.10 2.50 0.34 $345.55 $225.2424066 5.35 11.54 5.57 1.08 $820.67 $544.4325000 3.55 5.78 5.78 0.64 $453.79 $453.7925001 3.79 5.54 5.54 0.67 $454.60 $454.6025020 6.06 9.89 9.89 1.06 $774.06 $774.06

Updated December 2011 120 of 387 Effective January 2012

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Treatment

MRA 2012

25023 13.83 15.97 15.97 2.74 $1,477.44 $1,477.4425024 10.79 10.07 10.07 2.12 $1,041.21 $1,041.2125025 17.94 14.26 14.26 3.54 $1,617.05 $1,617.0525028 5.39 8.90 8.90 1.03 $697.70 $697.7025031 4.26 5.67 5.67 0.83 $489.12 $489.1226440 5.16 12.12 12.12 0.90 $830.12 $830.1226442 9.75 16.67 16.67 1.74 $1,282.22 $1,282.2226445 4.45 11.68 11.68 0.78 $772.90 $772.9026449 8.59 10.86 10.86 1.51 $951.43 $951.4326450 3.79 7.31 7.31 0.68 $537.01 $537.0126455 3.76 7.32 7.32 0.69 $536.69 $536.6926460 3.58 7.24 7.24 0.63 $522.13 $522.1326750 1.80 3.21 3.18 0.33 $243.29 $241.9026755 3.23 5.35 4.15 0.59 $417.48 $361.9626756 4.58 6.83 6.83 0.83 $556.66 $556.6626765 5.86 7.58 7.58 1.09 $660.03 $660.0326770 3.15 4.24 3.63 0.54 $360.11 $331.8926775 3.90 6.57 5.48 0.69 $508.05 $457.6126776 4.99 7.04 7.04 0.91 $588.20 $588.2026785 6.60 7.99 7.99 1.21 $717.17 $717.1726820 8.45 12.75 12.75 1.66 $1,040.45 $1,040.4526841 7.35 12.47 12.47 1.39 $966.11 $966.1126842 8.49 12.84 12.84 1.66 $1,046.35 $1,046.3526843 7.78 12.10 12.10 1.54 $975.24 $975.2426844 8.98 13.35 13.35 1.78 $1,097.27 $1,097.2726850 7.14 11.80 11.80 1.24 $918.38 $918.3826852 8.71 12.95 12.95 1.47 $1,051.30 $1,051.3026860 4.88 10.70 10.70 0.84 $749.23 $749.2326861 1.74 1.01 1.01 0.31 $137.88 $137.8826862 7.56 12.31 12.31 1.31 $963.73 $963.7326863 3.89 2.15 2.15 0.75 $306.15 $306.1526910 7.79 11.69 11.69 1.50 $954.67 $954.6726951 6.04 11.71 11.71 1.14 $861.48 $861.4826952 6.48 11.21 11.21 1.21 $860.96 $860.9626989 0.00 0.00 0.00 0.00 $0.00 $0.0026990 7.95 8.74 8.74 1.58 $829.17 $829.1726991 7.06 12.31 6.94 1.39 $946.14 $697.6626992 13.48 11.95 11.95 2.67 $1,272.70 $1,272.7027000 5.74 5.98 5.98 1.08 $580.29 $580.2927001 7.14 7.33 7.33 1.40 $719.68 $719.68

Updated December 2011 121 of 387 Effective January 2012

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27003 7.81 8.01 8.01 1.54 $787.29 $787.2927005 10.07 9.29 9.29 1.97 $966.29 $966.2927006 10.11 9.55 9.55 1.96 $979.55 $979.5527025 12.89 11.52 11.52 2.57 $1,222.16 $1,222.1627027 13.04 10.66 10.66 0.91 $1,104.42 $1,104.4227030 13.65 11.13 11.13 2.67 $1,242.12 $1,242.1227033 14.11 11.73 11.73 2.78 $1,295.41 $1,295.4127035 17.37 9.43 9.43 3.43 $1,363.27 $1,363.2727036 14.38 12.44 12.44 2.79 $1,340.47 $1,340.4727093 1.30 4.29 0.62 0.14 $261.94 $92.1227095 1.50 5.41 0.72 0.18 $324.46 $107.4527096 1.48 3.44 0.80 0.13 $229.90 $107.7427370 0.96 3.96 0.46 0.12 $230.93 $68.9827613 2.22 4.96 2.34 0.31 $341.44 $220.2127614 5.80 10.16 5.21 1.03 $773.76 $544.7228080 4.86 9.76 5.32 0.48 $686.56 $481.1128090 4.55 8.62 4.03 0.48 $620.38 $407.9928092 3.78 8.18 3.78 0.39 $562.08 $358.4928230 4.36 7.82 3.59 0.39 $570.55 $374.8228232 3.51 7.59 3.44 0.34 $520.55 $328.5228234 3.54 8.12 3.95 0.35 $546.88 $353.9328510 1.17 2.25 2.16 0.14 $161.92 $157.7528515 1.56 2.91 2.40 0.18 $211.38 $187.7928525 5.62 10.46 5.44 0.71 $763.57 $531.2928530 1.11 2.11 1.75 0.11 $151.31 $134.6528630 1.75 2.53 1.23 0.23 $204.57 $144.4228660 1.28 1.87 1.11 0.20 $152.15 $116.9828890 3.45 6.10 2.83 0.35 $449.51 $298.2029000 2.25 6.90 2.69 0.18 $425.90 $231.0929010 2.06 3.93 1.70 0.39 $290.92 $187.7429015 2.41 5.36 2.33 0.41 $373.27 $233.0729020 2.11 4.23 1.85 0.08 $291.20 $181.0729025 2.40 5.46 2.41 0.48 $381.02 $239.9029035 1.77 5.29 2.10 0.34 $338.75 $191.1429040 2.22 4.00 1.76 0.42 $302.62 $198.9729044 2.12 5.70 2.37 0.41 $376.44 $222.3629046 2.41 5.49 2.41 0.48 $382.85 $240.3329049 0.89 1.74 0.93 0.18 $128.22 $90.7429055 1.78 4.27 1.91 0.35 $292.49 $183.2929058 1.31 1.32 0.78 0.23 $129.53 $104.54

Updated December 2011 122 of 387 Effective January 2012

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MRA 2012

29065 0.87 1.78 0.98 0.16 $128.19 $91.1729075 0.77 1.72 0.92 0.14 $120.06 $83.0529085 0.87 1.76 0.95 0.14 $126.25 $88.7729086 0.62 1.55 0.79 0.08 $102.65 $67.4829105 0.87 1.54 0.73 0.14 $116.07 $78.5929125 0.50 1.30 0.57 0.08 $85.88 $52.1029126 0.68 1.46 0.65 0.10 $102.10 $64.6229130 0.50 0.61 0.26 0.07 $53.45 $37.2529131 0.55 0.89 0.36 0.08 $69.08 $44.5529200 0.65 0.83 0.45 0.05 $69.11 $51.5229240 0.71 0.89 0.50 0.05 $74.48 $56.4429260 0.55 0.91 0.49 0.05 $68.48 $49.0429280 0.51 0.91 0.50 0.04 $66.23 $47.2629305 2.03 4.71 2.24 0.39 $325.71 $211.4229325 2.32 5.13 2.47 0.45 $360.76 $237.6829345 1.40 2.31 1.31 0.27 $181.27 $135.0029355 1.53 2.32 1.35 0.29 $188.38 $143.5029358 1.43 2.92 1.33 0.29 $211.81 $138.2429365 1.18 2.17 1.18 0.23 $163.23 $117.4229405 0.80 1.50 0.85 0.11 $109.66 $79.5829425 0.80 1.44 0.79 0.10 $106.37 $76.3029435 1.18 2.09 1.11 0.23 $159.52 $114.1829440 0.57 1.01 0.40 0.08 $75.50 $47.2729445 1.78 2.01 1.11 0.24 $182.32 $140.6829450 2.08 1.94 1.07 0.22 $191.06 $150.8029505 0.69 1.55 0.63 0.11 $107.21 $64.6429515 0.73 1.24 0.62 0.10 $94.09 $65.4029520 0.54 0.86 0.47 0.04 $65.22 $47.1729530 0.57 0.89 0.48 0.05 $68.42 $49.4529540 0.39 0.65 0.35 0.03 $48.50 $34.6229550 0.25 0.64 0.32 0.01 $40.95 $26.1529580 0.55 0.91 0.43 0.07 $69.49 $47.2829581 0.25 1.54 0.11 0.01 $82.60 $16.4329582 0.35 1.69 0.09 0.01 $93.87 $19.8329583 0.25 1.01 0.07 0.01 $58.07 $14.5829584 0.35 1.69 0.09 0.01 $93.87 $19.8329590 0.76 0.73 0.30 0.05 $69.24 $49.3529700 0.57 1.25 0.34 0.10 $87.62 $45.5129705 0.76 1.06 0.50 0.12 $88.07 $62.1629710 1.34 1.58 0.71 0.27 $144.89 $104.63

Updated December 2011 123 of 387 Effective January 2012

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MRA 2012

29715 0.94 1.49 0.55 0.12 $115.77 $72.2729720 0.68 1.62 0.48 0.12 $110.52 $57.7729730 0.75 1.04 0.46 0.11 $86.21 $59.3729740 1.12 1.37 0.61 0.18 $121.07 $85.9029750 1.26 1.50 0.75 0.26 $137.21 $102.5129799 0.00 0.00 0.00 0.00 $0.00 $0.0030000 1.48 5.27 1.86 0.22 $319.15 $161.3730020 1.48 5.28 1.88 0.20 $318.60 $161.283006F 0.00 0.00 0.00 0.00 $0.00 $0.003008F 0.00 0.00 0.00 0.00 $0.00 $0.0030100 0.94 3.21 1.01 0.11 $194.85 $93.053011F 0.00 0.00 0.00 0.00 $0.00 $0.0030110 1.68 5.00 1.99 0.23 $315.83 $176.5630115 4.44 7.89 7.89 0.56 $585.90 $585.9030117 3.26 22.57 6.43 0.41 $1,206.42 $459.6030118 9.92 11.66 11.66 1.31 $1,035.89 $1,035.8930120 5.39 9.24 6.89 0.84 $703.77 $595.0330124 3.20 4.84 4.84 0.41 $383.43 $383.4330125 7.30 9.98 9.98 0.93 $825.33 $825.3330130 3.47 7.46 7.46 0.44 $517.88 $517.883014F 0.00 0.00 0.00 0.00 $0.00 $0.0030140 3.57 9.16 9.16 0.45 $601.39 $601.393015F 0.00 0.00 0.00 0.00 $0.00 $0.0030150 9.55 12.11 12.11 1.42 $1,046.28 $1,046.283016F 0.00 0.00 0.00 0.00 $0.00 $0.0030160 9.99 11.92 11.92 1.28 $1,049.42 $1,049.423017F 0.00 0.00 0.00 0.00 $0.00 $0.003018F 0.00 0.00 0.00 0.00 $0.00 $0.003019F 0.00 0.00 0.00 0.00 $0.00 $0.003020F 0.00 0.00 0.00 0.00 $0.00 $0.0030200 0.78 2.55 0.91 0.10 $156.87 $80.983021F 0.00 0.00 0.00 0.00 $0.00 $0.0030210 1.13 3.23 1.71 0.14 $205.53 $135.203022F 0.00 0.00 0.00 0.00 $0.00 $0.0030220 1.59 7.28 1.95 0.22 $416.92 $170.303023F 0.00 0.00 0.00 0.00 $0.00 $0.003025F 0.00 0.00 0.00 0.00 $0.00 $0.003027F 0.00 0.00 0.00 0.00 $0.00 $0.003028F 0.00 0.00 0.00 0.00 $0.00 $0.0030300 1.09 5.72 2.54 0.14 $319.01 $171.87

Updated December 2011 124 of 387 Effective January 2012

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MRA 2012

30310 2.01 3.91 3.91 0.26 $281.22 $281.2230320 4.64 8.30 8.30 0.60 $615.57 $615.573035F 0.00 0.00 0.00 0.00 $0.00 $0.003037F 0.00 0.00 0.00 0.00 $0.00 $0.003038F 0.00 0.00 0.00 0.00 $0.00 $0.003040F 0.00 0.00 0.00 0.00 $0.00 $0.0030400 10.86 18.16 18.16 1.39 $1,381.44 $1,381.4430410 14.00 22.54 22.54 1.80 $1,740.99 $1,740.993042F 0.00 0.00 0.00 0.00 $0.00 $0.0030420 16.90 21.63 21.63 2.40 $1,855.03 $1,855.0330430 8.24 18.06 18.06 1.62 $1,275.02 $1,275.0230435 12.73 19.50 19.50 1.63 $1,536.66 $1,536.663044F 0.00 0.00 0.00 0.00 $0.00 $0.003045F 0.00 0.00 0.00 0.00 $0.00 $0.0030450 19.66 22.98 22.98 2.52 $2,043.16 $2,043.163046F 0.00 0.00 0.00 0.00 $0.00 $0.0030460 10.32 10.24 10.24 2.01 $1,023.12 $1,023.1230462 20.28 22.48 22.48 4.00 $2,122.17 $2,122.1730465 12.36 15.21 15.21 1.74 $1,327.72 $1,327.723048F 0.00 0.00 0.00 0.00 $0.00 $0.003049F 0.00 0.00 0.00 0.00 $0.00 $0.003050F 0.00 0.00 0.00 0.00 $0.00 $0.0030520 7.01 10.65 10.65 0.90 $842.24 $842.2430540 7.92 11.50 11.50 1.02 $927.09 $927.0930545 11.62 15.03 15.03 0.82 $1,240.54 $1,240.543055F 0.00 0.00 0.00 0.00 $0.00 $0.003056F 0.00 0.00 0.00 0.00 $0.00 $0.0030560 1.31 6.70 2.68 0.18 $375.92 $189.9130580 6.88 11.06 6.99 0.87 $854.05 $665.733060F 0.00 0.00 0.00 0.00 $0.00 $0.0030600 6.16 10.20 5.88 0.78 $778.49 $578.603061F 0.00 0.00 0.00 0.00 $0.00 $0.003062F 0.00 0.00 0.00 0.00 $0.00 $0.0030620 6.16 11.60 11.60 0.88 $848.36 $848.3630630 7.29 10.39 10.39 0.99 $846.92 $846.923066F 0.00 0.00 0.00 0.00 $0.00 $0.003072F 0.00 0.00 0.00 0.00 $0.00 $0.003073F 0.00 0.00 0.00 0.00 $0.00 $0.003074F 0.00 0.00 0.00 0.00 $0.00 $0.003075F 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 125 of 387 Effective January 2012

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MRA 2012

3077F 0.00 0.00 0.00 0.00 $0.00 $0.003078F 0.00 0.00 0.00 0.00 $0.00 $0.003079F 0.00 0.00 0.00 0.00 $0.00 $0.003080F 0.00 0.00 0.00 0.00 $0.00 $0.0030801 1.14 5.61 2.81 0.14 $316.09 $186.5330802 2.08 6.40 3.34 0.27 $399.98 $258.383082F 0.00 0.00 0.00 0.00 $0.00 $0.003083F 0.00 0.00 0.00 0.00 $0.00 $0.003084F 0.00 0.00 0.00 0.00 $0.00 $0.003085F 0.00 0.00 0.00 0.00 $0.00 $0.003088F 0.00 0.00 0.00 0.00 $0.00 $0.003089F 0.00 0.00 0.00 0.00 $0.00 $0.003090F 0.00 0.00 0.00 0.00 $0.00 $0.0030901 1.10 1.60 0.42 0.16 $129.82 $75.2230903 1.54 4.29 0.61 0.23 $276.92 $106.6430905 1.97 5.26 0.74 0.30 $343.99 $134.8430906 2.45 5.61 1.15 0.33 $382.50 $176.133091F 0.00 0.00 0.00 0.00 $0.00 $0.0030915 7.44 8.79 8.79 0.99 $779.38 $779.383092F 0.00 0.00 0.00 0.00 $0.00 $0.0030920 11.14 12.26 12.26 1.46 $1,124.13 $1,124.133093F 0.00 0.00 0.00 0.00 $0.00 $0.0030930 1.31 2.21 2.21 0.18 $168.16 $168.163095F 0.00 0.00 0.00 0.00 $0.00 $0.003096F 0.00 0.00 0.00 0.00 $0.00 $0.0030999 0.00 0.00 0.00 0.00 $0.00 $0.003100F 0.00 0.00 0.00 0.00 $0.00 $0.0031000 1.20 4.06 1.77 0.14 $246.97 $141.0031002 1.96 3.77 3.77 0.26 $272.57 $272.5731020 3.07 11.08 7.24 0.39 $665.52 $487.8331030 6.01 13.76 8.75 0.75 $935.19 $703.3731032 6.69 9.48 9.48 0.87 $772.71 $772.7131040 9.77 11.46 11.46 1.39 $1,024.20 $1,024.2031050 5.37 8.47 8.47 0.68 $659.13 $659.1331051 7.25 11.10 11.10 0.91 $873.97 $873.9731070 4.40 8.14 8.14 0.59 $597.27 $597.2731075 9.51 12.61 12.61 1.22 $1,057.51 $1,057.5131080 12.74 16.21 16.21 1.63 $1,384.86 $1,384.8631081 14.19 23.78 23.78 5.09 $1,973.95 $1,973.9531084 14.95 17.71 17.71 1.92 $1,564.75 $1,564.75

Updated December 2011 126 of 387 Effective January 2012

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MRA 2012

31085 15.64 18.18 18.18 5.62 $1,804.61 $1,804.6131086 14.36 17.20 17.20 1.85 $1,512.04 $1,512.0431087 14.57 15.88 15.88 1.86 $1,460.56 $1,460.5631090 11.17 17.78 17.78 1.47 $1,381.36 $1,381.363110F 0.00 0.00 0.00 0.00 $0.00 $0.003111F 0.00 0.00 0.00 0.00 $0.00 $0.003112F 0.00 0.00 0.00 0.00 $0.00 $0.003115F 0.00 0.00 0.00 0.00 $0.00 $0.003117F 0.00 0.00 0.00 0.00 $0.00 $0.003118F 0.00 0.00 0.00 0.00 $0.00 $0.003119F 0.00 0.00 0.00 0.00 $0.00 $0.003120F 0.00 0.00 0.00 0.00 $0.00 $0.0031200 5.14 10.67 10.67 0.73 $753.51 $753.5131201 8.60 12.28 12.28 1.14 $998.75 $998.7531205 10.58 14.22 14.22 1.59 $1,197.18 $1,197.1831225 26.70 25.12 25.12 3.55 $2,499.54 $2,499.5431230 30.82 26.88 26.88 3.96 $2,780.31 $2,780.3131231 1.10 4.57 1.07 0.12 $265.22 $103.2731233 2.18 5.54 1.64 0.29 $365.53 $185.0731235 2.64 6.06 1.86 0.33 $411.55 $217.2131237 2.98 6.42 2.06 0.38 $445.48 $243.7431238 3.26 6.37 2.21 0.41 $456.83 $264.3431239 9.33 9.63 9.63 1.24 $912.84 $912.8431240 2.61 1.87 1.87 0.34 $216.89 $216.893125F 0.00 0.00 0.00 0.00 $0.00 $0.0031254 4.64 2.94 2.94 0.60 $367.56 $367.5631255 6.95 4.15 4.15 0.88 $537.86 $537.8631256 3.29 2.22 2.22 0.41 $266.10 $266.1031267 5.45 3.36 3.36 0.69 $426.66 $426.6631276 8.84 5.14 5.14 1.14 $678.76 $678.7631287 3.91 2.55 2.55 0.50 $312.80 $312.8031288 4.57 2.90 2.90 0.60 $362.68 $362.6831290 18.61 13.35 13.35 2.64 $1,558.18 $1,558.1831291 19.56 14.07 14.07 3.14 $1,658.09 $1,658.0931292 15.90 11.97 11.97 2.04 $1,346.41 $1,346.4131293 17.47 12.75 12.75 2.23 $1,460.18 $1,460.1831294 20.31 14.24 14.24 2.61 $1,671.48 $1,671.4831295 2.70 60.47 2.00 0.35 $2,932.80 $227.3131296 3.29 60.66 2.31 0.42 $2,970.71 $270.7731297 2.64 60.32 1.97 0.34 $2,922.75 $222.81

Updated December 2011 127 of 387 Effective January 2012

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MRA 2012

31299 0.00 0.00 0.00 0.00 $0.00 $0.003130F 0.00 0.00 0.00 0.00 $0.00 $0.0031300 15.91 19.77 19.77 2.03 $1,707.25 $1,707.253132F 0.00 0.00 0.00 0.00 $0.00 $0.0031320 5.73 13.27 13.27 0.72 $898.87 $898.8731360 29.91 27.89 27.89 3.92 $2,785.58 $2,785.5831365 38.81 32.40 32.40 5.08 $3,438.82 $3,438.8231367 30.57 31.08 31.08 3.97 $2,964.32 $2,964.3231368 34.19 34.21 34.21 4.38 $3,286.83 $3,286.8331370 27.57 30.61 30.61 3.54 $2,790.75 $2,790.7531375 26.07 29.13 29.13 3.36 $2,648.13 $2,648.1331380 25.57 28.86 28.86 3.29 $2,610.42 $2,610.4231382 28.57 31.05 31.05 3.69 $2,862.06 $2,862.0631390 42.51 36.73 36.73 5.84 $3,838.11 $3,838.1131395 43.80 39.95 39.95 5.63 $4,032.30 $4,032.303140F 0.00 0.00 0.00 0.00 $0.00 $0.0031400 11.60 16.86 16.86 1.50 $1,358.94 $1,358.943141F 0.00 0.00 0.00 0.00 $0.00 $0.003142F 0.00 0.00 0.00 0.00 $0.00 $0.0031420 11.43 12.06 12.06 1.47 $1,127.95 $1,127.953150F 0.00 0.00 0.00 0.00 $0.00 $0.0031500 2.33 0.60 0.60 0.31 $144.47 $144.4731502 0.65 0.31 0.31 0.07 $46.06 $46.0631505 0.61 1.82 0.79 0.07 $114.20 $66.5431510 1.92 4.19 1.45 0.26 $290.28 $163.4931511 2.16 3.89 1.40 0.31 $289.33 $174.1231512 2.07 3.93 1.58 0.27 $285.25 $176.5131513 2.10 1.60 1.60 0.27 $178.74 $178.7431515 1.80 4.24 1.26 0.24 $286.37 $148.4831520 2.56 1.81 1.81 0.33 $211.43 $211.4331525 2.63 4.61 1.82 0.34 $344.54 $215.4431526 2.57 1.84 1.84 0.33 $213.26 $213.2631527 3.27 2.18 2.18 0.41 $263.38 $263.3831528 2.37 1.68 1.68 0.31 $196.17 $196.1731529 2.68 1.85 1.85 0.34 $218.99 $218.9931530 3.38 2.14 2.14 0.44 $267.82 $267.8231531 3.58 2.37 2.37 0.45 $287.64 $287.6431535 3.16 2.14 2.14 0.41 $256.76 $256.7631536 3.55 2.36 2.36 0.45 $285.87 $285.8731540 4.12 2.65 2.65 0.53 $328.05 $328.05

Updated December 2011 128 of 387 Effective January 2012

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MRA 2012

31541 4.52 2.87 2.87 0.59 $358.61 $358.6131545 6.30 3.82 3.82 0.80 $490.36 $490.3631546 9.73 5.58 5.58 1.25 $743.27 $743.273155F 0.00 0.00 0.00 0.00 $0.00 $0.0031560 5.45 3.31 3.31 0.69 $424.35 $424.3531561 5.99 3.57 3.57 0.76 $463.33 $463.3331570 3.86 5.86 2.49 0.53 $465.32 $309.3931571 4.26 2.72 2.72 0.54 $337.87 $337.8731575 1.10 2.22 1.06 0.12 $156.48 $102.8031576 1.97 4.56 1.49 0.24 $308.54 $166.4931577 2.47 4.45 1.65 0.33 $329.69 $200.1331578 2.84 5.26 1.95 0.35 $384.22 $231.0631579 2.26 3.85 1.68 0.30 $291.31 $190.9031580 14.66 19.98 19.98 1.88 $1,655.19 $1,655.1931582 23.22 30.71 30.71 2.99 $2,578.96 $2,578.9631584 20.47 22.03 22.03 2.63 $2,039.88 $2,039.8831587 15.27 12.60 12.60 1.95 $1,343.69 $1,343.6931588 14.99 17.24 17.24 1.93 $1,545.25 $1,545.2531590 7.85 18.02 18.02 1.02 $1,225.75 $1,225.7531595 8.84 12.97 12.97 1.14 $1,041.07 $1,041.0731599 0.00 0.00 0.00 0.00 $0.00 $0.003160F 0.00 0.00 0.00 0.00 $0.00 $0.0031600 7.17 3.37 3.37 1.27 $531.13 $531.1331601 4.44 2.78 2.78 0.56 $349.46 $349.4631603 4.14 1.80 1.80 0.69 $297.73 $297.7331605 3.57 1.20 1.20 0.63 $242.22 $242.2231610 9.38 10.62 10.62 1.32 $964.88 $964.8831611 6.00 9.45 9.45 0.76 $735.84 $735.8431612 0.91 1.42 0.39 0.11 $110.72 $63.0631613 4.71 8.14 8.14 0.72 $617.31 $617.3131614 8.63 12.75 12.75 1.18 $1,023.83 $1,023.8331615 2.09 3.11 1.48 0.26 $247.67 $172.2431620 1.40 6.80 0.48 0.12 $381.40 $88.9631622 2.78 6.26 1.22 0.34 $427.38 $194.1731623 2.88 6.80 1.19 0.26 $452.63 $193.0531624 2.88 6.21 1.21 0.26 $425.33 $193.9731625 3.36 6.37 1.37 0.31 $456.07 $224.7131626 4.16 8.80 1.61 0.31 $603.16 $270.4731627 2.00 36.52 0.66 0.14 $1,783.59 $124.3031628 3.80 7.42 1.49 0.30 $523.21 $248.82

Updated December 2011 129 of 387 Effective January 2012

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MRA 2012

31629 4.09 13.82 1.59 0.34 $833.94 $268.0431630 3.81 1.72 1.72 0.49 $269.56 $269.5631631 4.36 1.87 1.87 0.60 $305.92 $305.9231632 1.03 1.02 0.35 0.07 $95.38 $64.3731633 1.32 1.17 0.44 0.10 $116.41 $82.6331634 4.00 60.57 2.00 0.33 $2,992.72 $282.6131635 3.67 6.36 1.53 0.39 $473.11 $249.6131636 4.30 1.79 1.79 0.56 $297.58 $297.5831637 1.58 0.56 0.56 0.11 $99.95 $99.9531638 4.88 2.12 2.12 0.65 $342.56 $342.5631640 4.93 2.10 2.10 0.64 $343.29 $343.2931641 5.02 2.05 2.05 0.59 $342.33 $342.3331643 3.49 1.43 1.43 0.29 $232.10 $232.1031645 3.16 5.91 1.30 0.29 $425.10 $211.7931646 2.72 5.49 1.15 0.26 $385.08 $184.2731656 2.17 6.75 0.90 0.16 $414.47 $143.793170F 0.00 0.00 0.00 0.00 $0.00 $0.0031715 1.11 0.36 0.36 0.08 $68.81 $68.8131717 2.12 5.89 0.95 0.16 $372.51 $143.9331720 1.06 0.37 0.37 0.08 $67.11 $67.1131725 1.96 0.62 0.62 0.20 $123.77 $123.7731730 2.85 29.83 1.05 0.45 $1,526.63 $194.9331750 15.39 23.17 23.17 2.27 $1,854.26 $1,854.2631755 17.54 32.09 32.09 2.25 $2,359.12 $2,359.1231760 23.48 12.41 12.41 5.48 $1,870.12 $1,870.1231766 31.67 16.57 16.57 7.40 $2,515.06 $2,515.0631770 23.54 11.08 11.08 5.50 $1,812.19 $1,812.1931775 24.59 11.55 11.55 5.76 $1,892.65 $1,892.6531780 19.84 12.47 12.47 3.23 $1,600.76 $1,600.7631781 24.85 11.39 11.39 5.81 $1,899.05 $1,899.0531785 18.35 11.14 11.14 2.61 $1,443.13 $1,443.1331786 25.42 12.36 12.36 5.96 $1,976.26 $1,976.2631800 8.18 12.09 12.09 1.05 $967.18 $967.1831805 13.42 8.03 8.03 3.16 $1,113.65 $1,113.6531820 4.64 7.78 4.55 0.67 $595.07 $445.6231825 7.07 10.05 6.37 0.99 $821.65 $651.3731830 4.62 7.88 4.91 0.71 $600.87 $463.4431899 0.00 0.00 0.00 0.00 $0.00 $0.003200F 0.00 0.00 0.00 0.00 $0.00 $0.0032035 11.29 7.75 7.75 2.57 $978.41 $978.41

Updated December 2011 130 of 387 Effective January 2012

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MRA 2012

32036 12.30 8.20 8.20 2.90 $1,059.77 $1,059.7732096 13.75 7.28 7.28 3.22 $1,096.29 $1,096.2932097 13.75 7.28 7.28 3.22 $1,096.29 $1,096.2932098 12.91 6.87 6.87 3.01 $1,030.25 $1,030.253210F 0.00 0.00 0.00 0.00 $0.00 $0.0032100 13.75 7.77 7.77 3.44 $1,130.15 $1,130.1532110 25.28 12.94 12.94 5.74 $1,985.84 $1,985.8432120 14.39 8.55 8.55 3.40 $1,191.93 $1,191.9332124 15.45 8.90 8.90 3.67 $1,267.78 $1,267.7832140 16.66 9.36 9.36 3.89 $1,352.67 $1,352.6732141 27.18 12.38 12.38 6.40 $2,075.81 $2,075.813215F 0.00 0.00 0.00 0.00 $0.00 $0.0032150 16.82 9.46 9.46 3.93 $1,366.27 $1,366.2732151 16.94 9.50 9.50 3.97 $1,375.35 $1,375.353216F 0.00 0.00 0.00 0.00 $0.00 $0.0032160 13.10 7.37 7.37 2.99 $1,060.60 $1,060.603218F 0.00 0.00 0.00 0.00 $0.00 $0.003220F 0.00 0.00 0.00 0.00 $0.00 $0.0032200 18.68 11.24 11.24 4.29 $1,547.52 $1,547.5232201 3.99 22.93 1.48 0.38 $1,253.18 $260.6532215 13.05 7.96 7.96 3.05 $1,088.78 $1,088.7832220 26.65 14.98 14.98 6.30 $2,168.07 $2,168.0732225 16.75 9.36 9.36 3.92 $1,358.10 $1,358.103230F 0.00 0.00 0.00 0.00 $0.00 $0.0032310 15.28 8.86 8.86 3.62 $1,256.02 $1,256.0232320 27.25 14.55 14.55 6.33 $2,175.69 $2,175.6932400 1.76 2.44 0.64 0.18 $198.30 $115.0132405 1.93 4.71 0.89 0.18 $310.70 $133.9432420 2.18 0.81 0.81 0.24 $144.12 $144.1232421 1.54 2.83 0.56 0.14 $204.78 $99.7432422 2.19 3.30 1.20 0.22 $258.76 $161.5932440 27.28 13.69 13.69 6.36 $2,138.72 $2,138.7232442 56.47 22.21 22.21 13.21 $4,145.89 $4,145.8932445 63.84 27.03 27.03 14.94 $4,776.18 $4,776.1832480 25.82 12.87 12.87 6.06 $2,022.27 $2,022.2732482 27.44 14.02 14.02 6.42 $2,163.97 $2,163.9732484 25.38 12.11 12.11 5.91 $1,960.42 $1,960.4232486 42.88 18.00 18.00 10.14 $3,206.21 $3,206.2132488 42.99 18.78 18.78 10.11 $3,245.54 $3,245.5432491 25.24 13.41 13.41 5.88 $2,012.98 $2,012.98

Updated December 2011 131 of 387 Effective January 2012

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MRA 2012

3250F 0.00 0.00 0.00 0.00 $0.00 $0.0032501 4.68 1.65 1.65 1.09 $334.53 $334.5332503 31.74 15.73 15.73 7.50 $2,484.31 $2,484.3132504 36.54 16.90 16.90 8.52 $2,798.26 $2,798.2632505 15.75 8.62 8.62 3.61 $1,264.77 $1,264.7732506 3.00 1.01 1.01 0.71 $212.81 $212.8132507 3.00 1.01 1.01 0.71 $212.81 $212.8132540 30.35 14.36 14.36 7.10 $2,340.36 $2,340.3632550 4.17 18.77 1.82 0.69 $1,084.25 $299.9532551 3.29 1.25 1.25 0.52 $226.81 $226.8132552 2.53 2.56 1.81 0.60 $258.57 $223.8732553 3.80 12.66 1.46 0.88 $795.17 $276.9332560 1.54 5.74 0.60 0.27 $346.04 $108.2132561 1.39 1.15 0.47 0.24 $125.63 $94.1732562 1.24 1.04 0.41 0.23 $113.54 $84.393260F 0.00 0.00 0.00 0.00 $0.00 $0.0032601 5.50 2.57 2.57 1.28 $422.28 $422.2832604 8.77 3.76 3.76 2.04 $657.66 $657.6632606 8.39 3.64 3.64 1.93 $630.05 $630.0532607 5.50 2.51 2.51 1.28 $419.51 $419.5132608 6.84 2.97 2.97 1.60 $515.12 $515.1232609 4.58 2.20 2.20 1.11 $356.66 $356.663265F 0.00 0.00 0.00 0.00 $0.00 $0.0032650 10.83 6.82 6.82 2.48 $910.87 $910.8732651 18.78 9.69 9.69 4.31 $1,481.14 $1,481.1432652 29.13 13.91 13.91 6.72 $2,247.35 $2,247.3532653 18.17 9.39 9.39 4.12 $1,431.17 $1,431.1732654 20.52 10.15 10.15 4.65 $1,595.10 $1,595.1032655 16.17 8.83 8.83 3.77 $1,300.82 $1,300.8232656 13.26 7.80 7.80 3.01 $1,088.44 $1,088.4432658 11.71 7.15 7.15 2.75 $977.99 $977.9932659 11.94 7.39 7.39 2.80 $1,001.61 $1,001.613266F 0.00 0.00 0.00 0.00 $0.00 $0.0032661 13.33 7.69 7.69 3.13 $1,092.49 $1,092.4932662 14.99 8.52 8.52 3.50 $1,221.62 $1,221.6232663 24.64 11.90 11.90 5.74 $1,910.00 $1,910.0032664 14.28 7.97 7.97 3.36 $1,158.30 $1,158.3032665 21.53 10.52 10.52 4.60 $1,653.43 $1,653.4332666 14.50 8.28 8.28 3.39 $1,183.70 $1,183.7032667 3.00 1.01 1.01 0.71 $212.81 $212.81

Updated December 2011 132 of 387 Effective January 2012

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MRA 2012

32668 3.00 1.02 1.02 0.73 $214.29 $214.2932669 23.53 11.29 11.29 5.48 $1,820.46 $1,820.463267F 0.00 0.00 0.00 0.00 $0.00 $0.0032670 28.52 12.99 12.99 6.58 $2,171.24 $2,171.2432671 31.92 13.94 13.94 7.54 $2,411.32 $2,411.3232672 27.00 12.31 12.31 6.36 $2,062.74 $2,062.7432673 21.13 10.35 10.35 4.51 $1,623.66 $1,623.6632674 4.12 1.39 1.39 0.96 $291.63 $291.633268F 0.00 0.00 0.00 0.00 $0.00 $0.003269F 0.00 0.00 0.00 0.00 $0.00 $0.003270F 0.00 0.00 0.00 0.00 $0.00 $0.003271F 0.00 0.00 0.00 0.00 $0.00 $0.003272F 0.00 0.00 0.00 0.00 $0.00 $0.003273F 0.00 0.00 0.00 0.00 $0.00 $0.003274F 0.00 0.00 0.00 0.00 $0.00 $0.003278F 0.00 0.00 0.00 0.00 $0.00 $0.003279F 0.00 0.00 0.00 0.00 $0.00 $0.003280F 0.00 0.00 0.00 0.00 $0.00 $0.0032800 15.71 8.97 8.97 3.69 $1,283.30 $1,283.303281F 0.00 0.00 0.00 0.00 $0.00 $0.0032810 14.95 8.73 8.73 3.51 $1,230.12 $1,230.1232815 50.03 22.06 22.06 11.90 $3,793.33 $3,793.3332820 22.51 12.49 12.49 5.28 $1,821.63 $1,821.633284F 0.00 0.00 0.00 0.00 $0.00 $0.003285F 0.00 0.00 0.00 0.00 $0.00 $0.0032850 0.00 0.00 0.00 0.00 $0.00 $0.0032851 59.64 25.84 25.84 14.05 $4,493.90 $4,493.9032852 65.50 28.24 28.24 15.35 $4,924.93 $4,924.9332853 84.48 33.08 33.08 20.00 $6,207.62 $6,207.6232854 90.00 35.31 35.31 21.21 $6,611.48 $6,611.4832855 0.00 0.00 0.00 0.00 $0.00 $0.0032856 0.00 0.00 0.00 0.00 $0.00 $0.003288F 0.00 0.00 0.00 0.00 $0.00 $0.003290F 0.00 0.00 0.00 0.00 $0.00 $0.0032900 23.81 12.51 12.51 5.48 $1,889.04 $1,889.0432905 23.29 11.58 11.58 5.44 $1,821.45 $1,821.4532906 29.30 13.67 13.67 6.87 $2,251.24 $2,251.243291F 0.00 0.00 0.00 0.00 $0.00 $0.003292F 0.00 0.00 0.00 0.00 $0.00 $0.003293F 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 133 of 387 Effective January 2012

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MRA 2012

3294F 0.00 0.00 0.00 0.00 $0.00 $0.0032940 21.34 10.82 10.82 5.01 $1,679.94 $1,679.9432960 1.84 1.86 0.82 0.42 $187.14 $139.0132997 7.31 2.27 2.27 0.91 $467.99 $467.9932998 5.68 80.13 2.28 0.60 $3,984.30 $382.0732999 0.00 0.00 0.00 0.00 $0.00 $0.003300F 0.00 0.00 0.00 0.00 $0.00 $0.003301F 0.00 0.00 0.00 0.00 $0.00 $0.0033010 2.24 0.90 0.90 0.45 $161.57 $161.5733011 2.24 0.89 0.89 0.49 $163.14 $163.1433015 8.52 5.16 5.16 1.67 $692.79 $692.7933020 14.95 8.01 8.01 3.51 $1,196.80 $1,196.8033025 13.70 7.25 7.25 3.25 $1,094.26 $1,094.2633030 36.00 14.93 14.93 8.55 $2,685.24 $2,685.2433031 45.00 17.33 17.33 10.83 $3,302.15 $3,302.1533050 16.97 9.40 9.40 3.97 $1,372.02 $1,372.0233120 38.45 15.31 15.31 9.20 $2,842.02 $2,842.0233130 24.17 11.89 11.89 6.04 $1,904.43 $1,904.4333140 28.34 12.66 12.66 7.08 $2,173.61 $2,173.6133141 2.54 0.94 0.94 0.61 $184.56 $184.563315F 0.00 0.00 0.00 0.00 $0.00 $0.003316F 0.00 0.00 0.00 0.00 $0.00 $0.003317F 0.00 0.00 0.00 0.00 $0.00 $0.003318F 0.00 0.00 0.00 0.00 $0.00 $0.003319F 0.00 0.00 0.00 0.00 $0.00 $0.003320F 0.00 0.00 0.00 0.00 $0.00 $0.0033202 13.20 7.14 7.14 3.16 $1,062.93 $1,062.9333203 13.97 7.17 7.17 3.28 $1,103.78 $1,103.7833206 7.39 4.73 4.73 1.62 $621.40 $621.4033207 8.05 4.78 4.78 1.77 $659.93 $659.9333208 8.77 5.07 5.07 1.92 $712.17 $712.173321F 0.00 0.00 0.00 0.00 $0.00 $0.0033210 3.30 1.38 1.38 0.71 $242.92 $242.9233211 3.39 1.36 1.36 0.75 $247.93 $247.9333212 5.26 3.56 3.56 1.15 $451.08 $451.0833213 5.53 3.76 3.76 1.22 $475.59 $475.5933214 7.84 4.94 4.94 1.70 $654.68 $654.6833215 4.92 3.15 3.15 1.08 $413.82 $413.8233216 5.87 4.13 4.13 1.28 $510.50 $510.5033217 5.84 4.11 4.11 1.28 $508.27 $508.27

Updated December 2011 134 of 387 Effective January 2012

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MRA 2012

33218 6.07 4.40 4.40 1.32 $533.69 $533.693322F 0.00 0.00 0.00 0.00 $0.00 $0.0033220 6.15 4.41 4.41 1.33 $538.12 $538.1233221 5.80 3.43 3.43 1.29 $475.58 $475.5833222 5.10 4.16 4.16 1.14 $471.41 $471.4133223 6.55 4.43 4.43 1.46 $562.99 $562.9933224 9.04 4.20 4.20 1.99 $687.17 $687.1733225 8.33 3.54 3.54 1.82 $617.23 $617.2333226 8.68 4.07 4.07 1.91 $661.49 $661.4933227 5.50 3.31 3.31 1.23 $453.98 $453.9833228 5.77 3.41 3.41 1.29 $473.36 $473.3633229 6.04 3.51 3.51 1.35 $492.73 $492.733323F 0.00 0.00 0.00 0.00 $0.00 $0.0033230 6.32 3.59 3.59 1.41 $511.62 $511.6233231 6.59 3.69 3.69 1.47 $530.99 $530.9933233 3.39 3.03 3.03 0.73 $324.19 $324.1933234 7.91 4.96 4.96 1.74 $660.67 $660.6733235 10.15 6.69 6.69 2.25 $863.70 $863.7033236 12.73 8.04 8.04 3.18 $1,085.24 $1,085.2433237 13.84 8.01 8.01 3.24 $1,134.98 $1,134.9833238 15.40 9.43 9.43 3.69 $1,291.16 $1,291.163324F 0.00 0.00 0.00 0.00 $0.00 $0.0033240 6.05 4.17 4.17 1.35 $523.70 $523.7033241 3.29 2.71 2.71 0.71 $304.03 $304.0333243 23.57 12.28 12.28 5.57 $1,872.58 $1,872.5833244 13.99 8.54 8.54 3.10 $1,158.88 $1,158.8833249 15.17 8.70 8.70 3.32 $1,228.59 $1,228.593325F 0.00 0.00 0.00 0.00 $0.00 $0.0033250 25.90 12.14 12.14 6.46 $2,012.31 $2,012.3133251 28.92 13.50 13.50 7.01 $2,234.04 $2,234.0433254 23.71 11.98 11.98 5.92 $1,882.57 $1,882.5733255 29.04 13.80 13.80 7.25 $2,265.33 $2,265.3333256 34.90 16.12 16.12 8.75 $2,702.83 $2,702.8333257 9.63 5.82 5.82 2.31 $803.97 $803.9733258 11.00 6.30 6.30 2.63 $901.80 $901.8033259 14.14 8.22 8.22 3.43 $1,167.36 $1,167.3633261 28.92 13.50 13.50 7.23 $2,245.23 $2,245.2333262 6.06 3.50 3.50 1.35 $493.14 $493.1433263 6.33 3.60 3.60 1.41 $512.51 $512.5133264 6.60 3.70 3.70 1.47 $531.89 $531.89

Updated December 2011 135 of 387 Effective January 2012

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MRA 2012

33265 23.71 11.80 11.80 5.65 $1,860.50 $1,860.5033266 33.04 15.17 15.17 7.98 $2,539.13 $2,539.133328F 0.00 0.00 0.00 0.00 $0.00 $0.0033282 4.80 3.82 3.82 1.05 $438.10 $438.1033284 3.14 3.13 3.13 0.68 $315.44 $315.443330F 0.00 0.00 0.00 0.00 $0.00 $0.0033300 44.97 18.14 18.14 10.74 $3,333.75 $3,333.7533305 76.93 28.55 28.55 18.43 $5,591.09 $5,591.093331F 0.00 0.00 0.00 0.00 $0.00 $0.0033310 20.34 10.49 10.49 4.49 $1,594.90 $1,594.9033315 35.00 14.30 14.30 8.41 $2,605.65 $2,605.6533320 18.54 9.46 9.46 4.30 $1,459.60 $1,459.6033321 20.81 10.54 10.54 4.87 $1,636.90 $1,636.9033322 24.42 11.95 11.95 5.87 $1,909.39 $1,909.3933330 25.29 11.71 11.71 6.33 $1,959.37 $1,959.3733332 24.56 11.94 11.94 6.12 $1,927.71 $1,927.7133335 33.91 15.27 15.27 8.18 $2,591.62 $2,591.623340F 0.00 0.00 0.00 0.00 $0.00 $0.0033400 41.50 17.94 17.94 9.89 $3,130.94 $3,130.9433401 24.63 12.95 12.95 5.38 $1,939.83 $1,939.8333403 25.61 13.57 13.57 6.40 $2,062.86 $2,062.8633404 31.37 14.78 14.78 7.34 $2,416.18 $2,416.1833405 41.32 18.48 18.48 9.92 $3,149.65 $3,149.6533406 52.68 22.07 22.07 12.77 $3,952.85 $3,952.853341F 0.00 0.00 0.00 0.00 $0.00 $0.0033410 46.41 19.83 19.83 11.15 $3,495.18 $3,495.1833411 62.07 25.17 25.17 14.93 $4,612.93 $4,612.9333412 59.00 22.78 22.78 14.77 $4,361.21 $4,361.2133413 59.87 24.60 24.60 14.02 $4,444.96 $4,444.9633414 39.37 16.59 16.59 9.84 $2,973.66 $2,973.6633415 37.27 16.59 16.59 8.52 $2,815.54 $2,815.5433416 36.56 16.46 16.46 8.81 $2,793.52 $2,793.5233417 29.33 14.28 14.28 7.04 $2,289.42 $2,289.423342F 0.00 0.00 0.00 0.00 $0.00 $0.0033420 25.79 14.54 14.54 3.54 $1,970.06 $1,970.0633422 29.73 14.19 14.19 7.42 $2,321.91 $2,321.9133425 49.96 20.85 20.85 11.99 $3,738.89 $3,738.8933426 43.28 19.03 19.03 10.41 $3,284.93 $3,284.9333427 44.83 19.16 19.16 10.78 $3,376.91 $3,376.913343F 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 136 of 387 Effective January 2012

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MRA 2012

33430 50.93 22.27 22.27 12.26 $3,860.35 $3,860.353344F 0.00 0.00 0.00 0.00 $0.00 $0.003345F 0.00 0.00 0.00 0.00 $0.00 $0.0033460 44.70 17.93 17.93 11.17 $3,334.21 $3,334.2133463 57.08 22.84 22.84 13.79 $4,230.97 $4,230.9733464 44.62 18.94 18.94 10.74 $3,355.60 $3,355.6033465 50.72 20.74 20.74 12.29 $3,781.98 $3,781.9833468 45.13 17.97 17.97 11.30 $3,361.30 $3,361.3033470 21.54 10.87 10.87 5.05 $1,692.95 $1,692.9533471 22.96 11.68 11.68 5.76 $1,828.06 $1,828.0633472 23.06 12.15 12.15 5.80 $1,856.17 $1,856.1733474 39.40 16.61 16.61 9.23 $2,944.85 $2,944.8533475 42.40 18.23 18.23 10.60 $3,219.46 $3,219.4633476 26.57 13.04 13.04 6.64 $2,092.13 $2,092.1333478 27.54 13.58 13.58 6.89 $2,171.86 $2,171.8633496 29.84 13.99 13.99 6.98 $2,295.04 $2,295.043350F 0.00 0.00 0.00 0.00 $0.00 $0.0033500 27.94 13.16 13.16 6.98 $2,174.33 $2,174.3333501 19.51 9.89 9.89 4.89 $1,551.53 $1,551.5333502 21.85 11.55 11.55 5.46 $1,758.70 $1,758.7033503 22.51 12.25 12.25 4.93 $1,792.72 $1,792.7233504 25.46 12.89 12.89 6.36 $2,022.86 $2,022.8633505 38.40 14.88 14.88 9.60 $2,840.31 $2,840.3133506 37.85 15.57 15.57 8.87 $2,811.27 $2,811.2733507 31.40 13.52 13.52 7.35 $2,359.69 $2,359.6933508 0.31 0.11 0.11 0.07 $22.08 $22.083351F 0.00 0.00 0.00 0.00 $0.00 $0.0033510 34.98 15.80 15.80 8.41 $2,674.19 $2,674.1933511 38.45 17.28 17.28 9.25 $2,935.72 $2,935.7233512 43.98 19.17 19.17 10.60 $3,331.40 $3,331.4033513 45.37 19.39 19.39 10.97 $3,420.61 $3,420.6133514 48.08 20.44 20.44 11.54 $3,615.59 $3,615.5933516 49.76 21.27 21.27 12.43 $3,772.04 $3,772.0433517 3.61 1.23 1.23 0.86 $257.04 $257.0433518 7.93 2.69 2.69 1.91 $565.15 $565.1533519 10.49 3.58 3.58 2.52 $748.26 $748.263352F 0.00 0.00 0.00 0.00 $0.00 $0.0033521 12.59 4.31 4.31 3.05 $899.97 $899.9733522 14.14 4.87 4.87 3.43 $1,012.35 $1,012.3533523 16.08 5.54 5.54 3.87 $1,149.77 $1,149.77

Updated December 2011 137 of 387 Effective January 2012

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MRA 2012

3353F 0.00 0.00 0.00 0.00 $0.00 $0.0033530 10.13 3.42 3.42 2.42 $720.17 $720.1733533 33.75 15.42 15.42 8.13 $2,589.08 $2,589.0833534 39.88 17.79 17.79 9.58 $3,038.05 $3,038.0533535 44.75 19.43 19.43 10.75 $3,384.42 $3,384.4233536 48.43 20.60 20.60 11.70 $3,646.29 $3,646.293354F 0.00 0.00 0.00 0.00 $0.00 $0.0033542 48.21 19.98 19.98 11.64 $3,605.02 $3,605.0233545 57.06 23.20 23.20 13.68 $4,241.16 $4,241.1633548 54.14 23.45 23.45 13.11 $4,097.24 $4,097.2433572 4.44 1.54 1.54 1.08 $318.53 $318.5333600 30.31 14.57 14.57 7.08 $2,347.32 $2,347.3233602 29.34 14.09 14.09 6.25 $2,240.87 $2,240.8733606 31.53 17.03 17.03 6.72 $2,495.69 $2,495.6933608 31.88 15.23 15.23 7.46 $2,465.20 $2,465.2033610 31.40 15.03 15.03 7.35 $2,429.56 $2,429.5633611 35.57 16.94 16.94 8.90 $2,777.43 $2,777.4333612 36.57 15.48 15.48 7.98 $2,706.39 $2,706.3933615 35.89 16.42 16.42 8.41 $2,742.30 $2,742.3033617 39.09 17.16 17.16 9.16 $2,953.31 $2,953.3133619 48.76 21.64 21.64 11.42 $3,694.47 $3,694.4733620 30.00 12.53 12.53 7.50 $2,260.87 $2,260.8733621 16.18 6.93 6.93 3.76 $1,212.83 $1,212.8333622 64.00 26.31 26.31 14.98 $4,751.83 $4,751.8333641 29.58 13.03 13.03 7.12 $2,246.48 $2,246.4833645 31.30 13.58 13.58 7.82 $2,382.04 $2,382.0433647 33.00 14.46 14.46 8.25 $2,518.28 $2,518.2833660 31.83 13.86 13.86 7.96 $2,425.08 $2,425.0833665 34.85 14.95 14.95 8.74 $2,646.02 $2,646.0233670 36.63 14.64 14.64 9.17 $2,730.65 $2,730.6533675 35.95 15.31 15.31 8.98 $2,722.53 $2,722.5333676 36.95 17.62 17.62 9.36 $2,892.07 $2,892.0733677 38.45 18.23 18.23 9.75 $3,005.11 $3,005.1133681 32.34 15.67 15.67 7.80 $2,522.78 $2,522.7833684 34.37 14.88 14.88 8.60 $2,614.86 $2,614.8633688 34.75 14.08 14.08 8.70 $2,599.39 $2,599.3933690 20.36 11.05 11.05 4.76 $1,635.41 $1,635.4133692 36.15 14.58 14.58 9.11 $2,704.03 $2,704.0333694 35.57 15.32 15.32 8.90 $2,702.47 $2,702.4733697 37.57 16.88 16.88 8.19 $2,825.17 $2,825.17

Updated December 2011 138 of 387 Effective January 2012

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MRA 2012

3370F 0.00 0.00 0.00 0.00 $0.00 $0.0033702 27.24 13.16 13.16 6.81 $2,135.36 $2,135.3633710 37.50 16.48 16.48 8.78 $2,833.64 $2,833.643372F 0.00 0.00 0.00 0.00 $0.00 $0.0033720 27.26 13.29 13.29 6.38 $2,120.36 $2,120.3633722 29.21 14.35 14.35 7.29 $2,300.17 $2,300.1733724 27.63 12.80 12.80 6.45 $2,117.28 $2,117.2833726 37.12 16.04 16.04 9.28 $2,822.26 $2,822.2633730 36.14 18.10 18.10 9.05 $2,863.42 $2,863.4233732 28.96 14.21 14.21 7.24 $2,280.32 $2,280.3233735 22.20 11.14 11.14 5.57 $1,760.48 $1,760.4833736 24.32 12.52 12.52 6.07 $1,941.61 $1,941.6133737 22.47 12.36 12.36 5.27 $1,813.37 $1,813.373374F 0.00 0.00 0.00 0.00 $0.00 $0.0033750 22.22 11.50 11.50 7.98 $1,900.60 $1,900.6033755 22.60 12.54 12.54 4.94 $1,810.54 $1,810.543376F 0.00 0.00 0.00 0.00 $0.00 $0.0033762 22.60 12.55 12.55 5.73 $1,851.19 $1,851.1933764 22.60 11.71 11.71 4.83 $1,766.54 $1,766.5433766 23.57 12.66 12.66 5.13 $1,867.78 $1,867.7833767 25.30 11.75 11.75 6.33 $1,961.66 $1,961.6633768 8.00 3.27 3.27 1.99 $599.09 $599.0933770 39.07 17.92 17.92 9.16 $2,987.61 $2,987.6133771 40.63 16.39 16.39 10.32 $3,043.40 $3,043.4033774 31.73 15.41 15.41 7.93 $2,490.94 $2,490.9433775 32.99 16.95 16.95 8.29 $2,635.10 $2,635.1033776 34.75 18.02 18.02 8.72 $2,782.72 $2,782.7233777 34.17 16.89 16.89 8.61 $2,699.71 $2,699.7133778 42.75 18.48 18.48 10.85 $3,258.91 $3,258.9133779 43.23 19.49 19.49 10.99 $3,333.56 $3,333.563378F 0.00 0.00 0.00 0.00 $0.00 $0.0033780 43.90 20.22 20.22 11.14 $3,403.99 $3,403.9933781 43.21 16.70 16.70 10.99 $3,203.59 $3,203.5933782 60.08 22.72 22.72 14.07 $4,369.61 $4,369.6133783 65.08 24.57 24.57 15.24 $4,731.33 $4,731.3333786 41.87 17.30 17.30 10.60 $3,153.47 $3,153.4733788 27.42 12.65 12.65 6.87 $2,122.61 $2,122.613380F 0.00 0.00 0.00 0.00 $0.00 $0.0033800 17.28 6.80 6.80 4.31 $1,282.44 $1,282.4433802 18.37 10.01 10.01 4.60 $1,492.94 $1,492.94

Updated December 2011 139 of 387 Effective January 2012

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MRA 2012

33803 20.31 10.87 10.87 5.08 $1,641.19 $1,641.1933813 21.36 11.66 11.66 5.01 $1,719.67 $1,719.6733814 26.57 15.22 15.22 6.64 $2,193.00 $2,193.003382F 0.00 0.00 0.00 0.00 $0.00 $0.0033820 16.69 8.80 8.80 4.18 $1,342.81 $1,342.8133822 17.71 9.81 9.81 4.45 $1,447.47 $1,447.4733824 20.23 10.69 10.69 4.74 $1,612.10 $1,612.103384F 0.00 0.00 0.00 0.00 $0.00 $0.0033840 21.34 11.65 11.65 5.34 $1,735.13 $1,735.1333845 22.93 12.44 12.44 5.73 $1,860.40 $1,860.4033851 21.98 12.86 12.86 5.48 $1,825.96 $1,825.9633852 24.41 11.78 11.78 6.10 $1,912.79 $1,912.7933853 32.51 15.74 15.74 8.14 $2,550.68 $2,550.683386F 0.00 0.00 0.00 0.00 $0.00 $0.0033860 59.46 23.83 23.83 14.25 $4,403.27 $4,403.2733863 58.79 23.07 23.07 14.07 $4,329.93 $4,329.9333864 60.08 23.74 23.74 14.32 $4,429.53 $4,429.5333870 46.06 19.77 19.77 11.00 $3,469.61 $3,469.6133875 50.72 20.40 20.40 12.12 $3,757.60 $3,757.6033877 69.03 24.70 24.70 16.35 $4,964.92 $4,964.923388F 0.00 0.00 0.00 0.00 $0.00 $0.0033880 34.58 13.15 13.15 7.72 $2,499.15 $2,499.1533881 29.58 11.56 11.56 6.60 $2,152.01 $2,152.0133883 21.09 8.81 8.81 4.70 $1,560.33 $1,560.3333884 8.20 2.57 2.57 1.84 $567.73 $567.7333886 18.09 7.65 7.65 4.30 $1,356.35 $1,356.3533889 15.92 4.91 4.91 3.78 $1,109.11 $1,109.1133891 20.00 5.54 5.54 4.75 $1,364.35 $1,364.353390F 0.00 0.00 0.00 0.00 $0.00 $0.0033910 48.21 18.55 18.55 12.04 $3,559.20 $3,559.2033915 24.95 11.18 11.18 5.44 $1,874.85 $1,874.8533916 78.00 26.52 26.52 19.49 $5,597.43 $5,597.4333917 25.30 13.25 13.25 5.92 $2,010.21 $2,010.2133920 32.74 14.40 14.40 8.18 $2,500.68 $2,500.6833922 24.22 13.83 13.83 6.06 $1,997.38 $1,997.3833924 5.49 1.88 1.88 1.28 $389.92 $389.9233925 31.30 13.63 13.63 7.32 $2,358.92 $2,358.9233926 44.73 17.74 17.74 11.17 $3,326.72 $3,326.7233930 0.00 0.00 0.00 0.00 $0.00 $0.0033933 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 140 of 387 Effective January 2012

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MRA 2012

33935 91.78 34.82 34.82 22.94 $6,753.91 $6,753.913394F 0.00 0.00 0.00 0.00 $0.00 $0.0033940 0.00 0.00 0.00 0.00 $0.00 $0.0033944 0.00 0.00 0.00 0.00 $0.00 $0.0033945 89.50 36.15 36.15 21.34 $6,635.30 $6,635.303395F 0.00 0.00 0.00 0.00 $0.00 $0.0033960 19.33 6.87 6.87 3.82 $1,349.56 $1,349.5633961 10.91 3.95 3.95 1.66 $739.82 $739.8233967 4.84 2.02 2.02 1.08 $358.07 $358.0733968 0.64 0.25 0.25 0.14 $46.41 $46.4133970 6.74 2.55 2.55 1.57 $489.83 $489.8333971 11.99 6.87 6.87 2.80 $979.71 $979.7133973 9.75 3.75 3.75 2.26 $710.84 $710.8433974 15.03 8.26 8.26 3.77 $1,225.06 $1,225.0633975 25.00 8.69 8.69 5.95 $1,787.74 $1,787.7433976 30.75 10.09 10.09 7.68 $2,189.61 $2,189.6133977 20.86 9.32 9.32 4.96 $1,587.19 $1,587.1933978 25.00 10.38 10.38 6.26 $1,881.71 $1,881.7133979 37.50 13.86 13.86 8.98 $2,722.58 $2,722.5833980 33.50 17.07 17.07 8.08 $2,652.06 $2,652.0633981 16.11 5.26 5.26 4.02 $1,145.75 $1,145.7533982 37.86 12.48 12.48 9.07 $2,678.90 $2,678.9033983 44.54 14.54 14.54 10.67 $3,144.98 $3,144.9833999 0.00 0.00 0.00 0.00 $0.00 $0.0034001 17.88 8.06 8.06 4.07 $1,354.53 $1,354.5334051 16.99 7.24 7.24 4.25 $1,287.19 $1,287.1934101 10.93 5.40 5.40 2.46 $848.48 $848.4834111 10.93 5.44 5.44 2.44 $849.31 $849.3134151 26.52 10.89 10.89 5.97 $1,956.40 $1,956.4034201 19.48 8.03 8.03 4.48 $1,443.30 $1,443.3034203 17.86 7.92 7.92 4.11 $1,349.22 $1,349.2234401 26.52 12.24 12.24 5.66 $2,003.10 $2,003.1034421 13.37 6.42 6.42 2.97 $1,027.32 $1,027.3234451 28.52 10.03 10.03 6.78 $2,044.45 $2,044.4534471 21.11 11.04 11.04 4.50 $1,654.21 $1,654.2134490 10.91 5.81 5.81 2.42 $864.55 $864.553450F 0.00 0.00 0.00 0.00 $0.00 $0.0034501 16.85 7.40 7.40 4.00 $1,275.81 $1,275.8134502 28.07 12.84 12.84 5.89 $2,109.70 $2,109.703451F 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 141 of 387 Effective January 2012

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MRA 2012

34510 19.91 10.92 10.92 4.23 $1,582.94 $1,582.943452F 0.00 0.00 0.00 0.00 $0.00 $0.0034520 19.18 7.47 7.47 4.55 $1,407.96 $1,407.9634530 17.93 7.46 7.46 3.82 $1,316.21 $1,316.213455F 0.00 0.00 0.00 0.00 $0.00 $0.003470F 0.00 0.00 0.00 0.00 $0.00 $0.003471F 0.00 0.00 0.00 0.00 $0.00 $0.003472F 0.00 0.00 0.00 0.00 $0.00 $0.003475F 0.00 0.00 0.00 0.00 $0.00 $0.003476F 0.00 0.00 0.00 0.00 $0.00 $0.0034800 21.54 8.79 8.79 4.57 $1,572.29 $1,572.2934802 23.79 9.70 9.70 5.09 $1,738.31 $1,738.3134803 24.82 9.61 9.61 5.34 $1,791.48 $1,791.4834804 23.79 9.66 9.66 5.14 $1,739.01 $1,739.0134805 22.67 9.17 9.17 5.04 $1,662.73 $1,662.7334806 2.06 0.66 0.66 0.45 $142.67 $142.6734808 4.12 1.32 1.32 0.90 $285.33 $285.3334812 6.74 2.13 2.13 1.55 $469.37 $469.3734813 4.79 1.44 1.44 1.10 $330.08 $330.0834820 9.74 3.08 3.08 2.18 $675.34 $675.3434825 12.80 6.08 6.08 2.75 $975.70 $975.7034826 4.12 1.34 1.34 0.88 $285.24 $285.2434830 35.23 11.91 11.91 8.36 $2,502.48 $2,502.4834831 37.98 12.44 12.44 9.02 $2,679.71 $2,679.7134832 37.98 12.67 12.67 9.02 $2,690.35 $2,690.3534833 11.98 4.08 4.08 2.79 $849.67 $849.6734834 5.34 1.92 1.92 1.24 $383.24 $383.243490F 0.00 0.00 0.00 0.00 $0.00 $0.0034900 16.85 7.20 7.20 3.58 $1,245.19 $1,245.193491F 0.00 0.00 0.00 0.00 $0.00 $0.003492F 0.00 0.00 0.00 0.00 $0.00 $0.003493F 0.00 0.00 0.00 0.00 $0.00 $0.003494F 0.00 0.00 0.00 0.00 $0.00 $0.003495F 0.00 0.00 0.00 0.00 $0.00 $0.003496F 0.00 0.00 0.00 0.00 $0.00 $0.003497F 0.00 0.00 0.00 0.00 $0.00 $0.003498F 0.00 0.00 0.00 0.00 $0.00 $0.003500F 0.00 0.00 0.00 0.00 $0.00 $0.0035001 20.81 9.59 9.59 4.82 $1,590.40 $1,590.4035002 22.23 11.97 11.97 4.75 $1,758.48 $1,758.48

Updated December 2011 142 of 387 Effective January 2012

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MRA 2012

35005 19.29 9.22 9.22 4.57 $1,494.72 $1,494.7235011 18.58 8.23 8.23 4.22 $1,400.35 $1,400.3535013 23.23 9.94 9.94 5.28 $1,734.82 $1,734.823502F 0.00 0.00 0.00 0.00 $0.00 $0.0035021 22.17 10.39 10.39 5.20 $1,705.66 $1,705.6635022 25.70 11.94 11.94 6.02 $1,972.01 $1,972.013503F 0.00 0.00 0.00 0.00 $0.00 $0.0035045 18.01 8.32 8.32 4.00 $1,368.63 $1,368.6335081 33.53 13.20 13.20 7.77 $2,458.52 $2,458.5235082 42.09 16.25 16.25 9.66 $3,066.60 $3,066.6035091 35.35 12.38 12.38 8.19 $2,520.78 $2,520.7835092 50.97 18.20 18.20 11.79 $3,649.85 $3,649.853510F 0.00 0.00 0.00 0.00 $0.00 $0.0035102 36.53 13.83 13.83 8.45 $2,652.22 $2,652.2235103 43.62 16.08 16.08 9.99 $3,141.80 $3,141.803511F 0.00 0.00 0.00 0.00 $0.00 $0.0035111 26.28 9.37 9.37 5.61 $1,857.36 $1,857.3635112 32.57 15.96 15.96 6.94 $2,502.42 $2,502.423512F 0.00 0.00 0.00 0.00 $0.00 $0.0035121 31.52 12.04 12.04 7.25 $2,291.32 $2,291.3235122 37.89 18.09 18.09 8.08 $2,889.42 $2,889.423513F 0.00 0.00 0.00 0.00 $0.00 $0.0035131 26.40 10.90 10.90 6.10 $1,958.28 $1,958.2835132 32.57 13.02 13.02 7.44 $2,391.82 $2,391.823514F 0.00 0.00 0.00 0.00 $0.00 $0.0035141 20.91 8.78 8.78 4.83 $1,557.76 $1,557.7635142 25.16 10.45 10.45 5.78 $1,867.46 $1,867.463515F 0.00 0.00 0.00 0.00 $0.00 $0.0035151 23.72 9.75 9.75 5.47 $1,756.92 $1,756.9235152 27.66 9.86 9.86 6.57 $1,988.65 $1,988.653517F 0.00 0.00 0.00 0.00 $0.00 $0.0035180 15.10 9.04 9.04 3.58 $1,254.52 $1,254.5235182 31.71 14.77 14.77 6.76 $2,400.95 $2,400.9535184 18.82 8.94 8.94 4.01 $1,432.91 $1,432.9135188 18.00 11.10 11.10 3.85 $1,489.20 $1,489.2035189 29.98 10.55 10.55 7.50 $2,168.38 $2,168.3835190 13.42 6.90 6.90 3.06 $1,056.27 $1,056.273520F 0.00 0.00 0.00 0.00 $0.00 $0.0035201 16.93 8.23 8.23 3.76 $1,305.47 $1,305.4735206 13.84 6.95 6.95 3.06 $1,076.78 $1,076.78

Updated December 2011 143 of 387 Effective January 2012

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MRA 2012

35207 10.94 9.36 9.36 1.93 $1,005.19 $1,005.1935211 24.58 11.75 11.75 5.91 $1,909.10 $1,909.1035216 36.61 16.37 16.37 8.64 $2,782.88 $2,782.8835221 26.62 11.45 11.45 5.83 $1,979.52 $1,979.5235226 15.30 7.10 7.10 3.52 $1,170.37 $1,170.3735231 21.16 12.02 12.02 4.16 $1,684.43 $1,684.4335236 18.02 8.33 8.33 3.99 $1,369.01 $1,369.0135241 25.58 12.31 12.31 6.30 $1,998.17 $1,998.1735246 28.23 10.42 10.42 6.70 $2,045.86 $2,045.8635251 31.91 12.91 12.91 7.00 $2,335.75 $2,335.7535256 19.06 8.17 8.17 4.36 $1,425.48 $1,425.4835261 18.96 9.02 9.02 4.64 $1,474.73 $1,474.7335266 15.83 7.34 7.34 3.62 $1,209.52 $1,209.5235271 24.58 11.67 11.67 6.14 $1,917.10 $1,917.1035276 25.83 12.38 12.38 6.04 $1,999.02 $1,999.0235281 30.06 12.76 12.76 6.79 $2,237.99 $2,237.9935286 17.19 7.93 7.93 3.96 $1,313.03 $1,313.0335301 19.61 8.51 8.51 4.56 $1,475.22 $1,475.2235302 21.35 8.76 8.76 4.93 $1,580.98 $1,580.9835303 23.60 9.52 9.52 5.43 $1,739.05 $1,739.0535304 24.60 9.48 9.48 5.65 $1,791.71 $1,791.7135305 23.60 9.30 9.30 5.43 $1,728.87 $1,728.8735306 9.25 2.52 2.52 2.19 $628.71 $628.7135311 28.60 12.15 12.15 6.70 $2,141.94 $2,141.9435321 16.59 7.44 7.44 3.77 $1,254.70 $1,254.7035331 27.72 11.25 11.25 6.44 $2,048.95 $2,048.9535341 26.21 10.55 10.55 6.06 $1,931.82 $1,931.8235351 24.61 9.68 9.68 5.65 $1,801.40 $1,801.4035355 19.86 8.03 8.03 4.56 $1,463.84 $1,463.8435361 30.24 10.54 10.54 7.19 $2,163.41 $2,163.4135363 32.35 14.08 14.08 7.57 $2,437.95 $2,437.9535371 15.31 6.77 6.77 3.52 $1,155.53 $1,155.5335372 18.58 7.75 7.75 4.26 $1,380.17 $1,380.1735390 3.19 1.02 1.02 0.73 $222.52 $222.5235400 3.00 0.95 0.95 0.68 $208.51 $208.5135450 10.05 3.59 3.59 2.25 $715.92 $715.9235452 6.90 2.53 2.53 1.58 $496.34 $496.3435458 9.48 3.54 3.54 2.14 $683.32 $683.3235460 6.03 2.33 2.33 1.32 $436.17 $436.1735471 10.05 70.27 4.17 1.99 $3,788.08 $729.54

Updated December 2011 144 of 387 Effective January 2012

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MRA 2012

35472 6.90 52.86 2.79 1.44 $2,818.06 $501.2535475 9.48 57.92 3.74 1.52 $3,168.03 $661.0435476 6.03 45.30 2.49 0.83 $2,399.53 $418.653550F 0.00 0.00 0.00 0.00 $0.00 $0.0035500 6.44 2.00 2.00 1.50 $447.82 $447.8235501 29.09 11.63 11.63 6.70 $2,139.11 $2,139.1135506 25.33 10.32 10.32 6.02 $1,881.02 $1,881.0235508 26.09 9.69 9.69 6.52 $1,910.23 $1,910.2335509 28.09 10.04 10.04 6.67 $2,020.69 $2,020.693551F 0.00 0.00 0.00 0.00 $0.00 $0.0035510 24.39 8.67 8.67 5.78 $1,751.74 $1,751.7435511 22.20 11.38 11.38 5.28 $1,756.84 $1,756.8435512 23.89 8.47 8.47 5.68 $1,715.74 $1,715.7435515 26.09 9.29 9.29 6.19 $1,874.93 $1,874.9335516 24.21 8.24 8.24 5.74 $1,722.01 $1,722.0135518 22.65 8.13 8.13 5.38 $1,631.03 $1,631.033552F 0.00 0.00 0.00 0.00 $0.00 $0.0035521 24.13 8.80 8.80 5.73 $1,743.95 $1,743.9535522 23.15 8.31 8.31 5.48 $1,666.11 $1,666.1135523 24.13 10.29 10.29 5.48 $1,800.18 $1,800.1835525 21.69 9.07 9.07 4.83 $1,604.97 $1,604.9735526 31.55 13.66 13.66 7.89 $2,400.14 $2,400.1435531 39.11 14.62 14.62 8.91 $2,823.93 $2,823.9335533 29.92 10.50 10.50 7.10 $2,143.12 $2,143.1235535 38.13 13.02 13.02 2.71 $2,392.06 $2,392.0635536 33.73 11.40 11.40 8.02 $2,396.61 $2,396.6135537 41.88 13.83 13.83 9.94 $2,959.77 $2,959.7735538 47.03 15.38 15.38 11.16 $3,316.64 $3,316.6435539 44.11 14.26 14.26 10.48 $3,103.73 $3,103.7335540 49.33 18.73 18.73 11.35 $3,580.95 $3,580.953555F 0.00 0.00 0.00 0.00 $0.00 $0.0035556 26.75 10.81 10.81 6.14 $1,971.31 $1,971.3135558 23.13 10.12 10.12 5.34 $1,741.87 $1,741.8735560 34.03 11.65 11.65 8.08 $2,424.23 $2,424.2335563 26.12 13.33 13.33 6.19 $2,063.17 $2,063.1735565 25.13 10.40 10.40 5.74 $1,861.81 $1,861.8135566 32.35 12.36 12.36 7.50 $2,354.80 $2,354.8035570 29.15 11.90 11.90 2.07 $1,918.67 $1,918.6735571 25.52 10.25 10.25 5.89 $1,879.40 $1,879.4035572 6.81 2.32 2.32 1.59 $483.23 $483.23

Updated December 2011 145 of 387 Effective January 2012

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MRA 2012

35583 27.75 10.86 10.86 6.36 $2,028.13 $2,028.1335585 32.35 12.67 12.67 7.40 $2,364.06 $2,364.0635587 26.21 10.71 10.71 6.04 $1,938.20 $1,938.2035600 4.94 1.73 1.73 1.20 $355.09 $355.0935601 27.09 10.73 10.73 6.34 $1,992.51 $1,992.5135606 22.46 8.96 8.96 5.25 $1,654.60 $1,654.6035612 20.35 7.59 7.59 4.84 $1,478.95 $1,478.9535616 21.82 7.71 7.71 4.65 $1,538.51 $1,538.5135621 21.03 8.53 8.53 4.87 $1,553.42 $1,553.4235623 25.92 9.31 9.31 6.14 $1,865.95 $1,865.9535626 29.14 12.23 12.23 6.98 $2,183.28 $2,183.2835631 36.03 13.10 13.10 8.42 $2,595.25 $2,595.2535632 36.13 12.45 12.45 2.57 $2,271.92 $2,271.9235633 39.11 14.35 14.35 2.78 $2,499.61 $2,499.6135634 35.33 13.40 13.40 2.50 $2,277.67 $2,277.6735636 31.75 10.96 10.96 7.54 $2,266.06 $2,266.0635637 33.05 13.17 13.17 7.65 $2,430.23 $2,430.2335638 33.60 13.52 13.52 7.83 $2,479.41 $2,479.4135642 18.94 11.22 11.22 4.49 $1,568.03 $1,568.0335645 18.43 7.02 7.02 4.61 $1,357.70 $1,357.7035646 32.98 13.09 13.09 7.59 $2,420.45 $2,420.4535647 29.73 11.73 11.73 6.90 $2,181.63 $2,181.6335650 20.16 8.60 8.60 4.60 $1,505.24 $1,505.2435654 26.28 10.44 10.44 6.07 $1,930.27 $1,930.2735656 20.47 8.64 8.64 4.71 $1,526.12 $1,526.1235661 20.35 8.93 8.93 4.70 $1,533.83 $1,533.8335663 23.93 9.97 9.97 5.47 $1,776.20 $1,776.2035665 22.35 9.25 9.25 5.12 $1,656.64 $1,656.6435666 23.66 10.67 10.67 5.44 $1,795.37 $1,795.3735671 20.77 9.52 9.52 4.78 $1,583.39 $1,583.3935681 1.60 0.51 0.51 0.37 $111.73 $111.7335682 7.19 2.20 2.20 1.66 $497.70 $497.7035683 8.49 2.35 2.35 2.00 $578.25 $578.2535685 4.04 1.23 1.23 0.93 $279.23 $279.2335686 3.34 1.06 1.06 0.75 $231.88 $231.8835691 18.41 7.07 7.07 4.37 $1,346.94 $1,346.9435693 15.73 10.02 10.02 3.74 $1,335.30 $1,335.3035694 19.28 7.23 7.23 4.57 $1,402.20 $1,402.2035695 20.06 7.49 7.49 4.76 $1,457.69 $1,457.6935697 3.00 0.92 0.92 0.69 $207.63 $207.63

Updated December 2011 146 of 387 Effective January 2012

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MRA 2012

3570F 0.00 0.00 0.00 0.00 $0.00 $0.0035700 3.08 0.97 0.97 0.71 $214.42 $214.4235701 9.19 6.30 6.30 1.80 $781.17 $781.173572F 0.00 0.00 0.00 0.00 $0.00 $0.0035721 7.72 4.61 4.61 1.74 $636.25 $636.253573F 0.00 0.00 0.00 0.00 $0.00 $0.0035741 8.69 5.22 5.22 1.93 $716.16 $716.1635761 5.93 4.66 4.66 1.29 $538.13 $538.1335800 12.00 6.66 6.66 2.53 $956.69 $956.6935820 36.89 15.05 15.05 8.83 $2,743.59 $2,743.5935840 20.75 9.34 9.34 4.45 $1,557.41 $1,557.4135860 15.25 6.56 6.56 3.48 $1,141.18 $1,141.1835870 24.50 8.88 8.88 5.81 $1,767.75 $1,767.7535875 10.72 5.43 5.43 2.44 $839.75 $839.7535876 17.82 7.68 7.68 4.08 $1,334.85 $1,334.8535879 17.41 7.55 7.55 4.01 $1,307.52 $1,307.5235881 19.35 8.17 8.17 4.49 $1,444.66 $1,444.6635883 23.15 9.11 9.11 5.34 $1,696.01 $1,696.0135884 24.65 8.39 8.39 5.84 $1,753.10 $1,753.1035901 8.38 5.26 5.26 1.91 $703.56 $703.5635903 9.53 5.95 5.95 2.15 $797.51 $797.5135905 33.52 11.44 11.44 7.96 $2,386.31 $2,386.3135907 37.27 13.75 13.75 8.59 $2,687.69 $2,687.6936000 0.18 0.55 0.08 0.03 $34.77 $13.0336002 1.96 2.60 0.96 0.30 $220.47 $144.5936005 0.95 9.23 0.36 0.14 $475.36 $64.9336010 2.43 13.35 0.87 0.35 $740.79 $163.3336011 3.14 23.47 1.15 0.44 $1,244.39 $211.6236012 3.51 22.81 1.30 0.52 $1,233.95 $238.6536013 2.52 21.94 0.94 0.45 $1,147.25 $175.5536014 3.02 22.04 1.14 0.33 $1,167.43 $200.3636015 3.51 23.64 1.31 0.37 $1,264.73 $231.4936100 3.02 12.22 1.18 0.67 $730.34 $219.5136120 2.01 11.16 0.69 0.33 $620.25 $135.7936140 2.01 11.63 0.72 0.39 $645.05 $140.2336147 3.72 21.55 1.33 0.50 $1,183.73 $248.1236148 1.00 6.81 0.34 0.12 $364.53 $65.1636160 2.52 12.94 0.97 0.38 $727.25 $173.3836200 3.02 16.33 1.05 0.60 $916.96 $209.9336215 4.67 29.03 1.84 0.82 $1,587.27 $329.15

Updated December 2011 147 of 387 Effective January 2012

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MRA 2012

36216 5.27 32.15 2.12 0.93 $1,763.23 $373.6936217 6.29 56.06 2.55 1.06 $2,920.37 $444.3936218 1.01 4.66 0.41 0.16 $267.52 $70.8636245 4.67 27.65 1.87 0.87 $1,525.96 $333.0836246 5.27 24.28 1.95 0.98 $1,401.61 $368.3736247 6.29 44.07 2.30 1.18 $2,371.68 $438.9336248 1.01 3.53 0.37 0.16 $215.23 $69.0136251 5.35 36.85 1.95 1.00 $1,987.73 $372.8536252 6.99 39.13 2.52 1.30 $2,179.53 $485.5336253 7.55 57.13 2.59 1.41 $3,042.27 $518.6336254 8.15 59.09 2.79 1.52 $3,164.55 $559.4736260 9.91 6.82 6.82 2.12 $852.70 $852.7036261 5.63 4.84 4.84 1.33 $535.49 $535.4936262 4.11 4.00 4.00 0.87 $407.38 $407.3836299 0.00 0.00 0.00 0.00 $0.00 $0.0036400 0.38 0.40 0.14 0.05 $37.51 $25.4836405 0.31 0.41 0.13 0.05 $34.94 $21.9936406 0.18 0.30 0.05 0.03 $23.20 $11.6436410 0.18 0.31 0.07 0.03 $23.67 $12.5636415 0.00 0.00 0.00 0.00 $0.00 $0.0036416 0.00 0.00 0.00 0.00 $0.00 $0.0036420 1.01 0.39 0.39 0.12 $67.90 $67.9036425 0.76 0.31 0.31 0.11 $52.86 $52.8636430 0.00 1.00 1.00 0.01 $46.78 $46.7836440 1.03 0.40 0.40 0.24 $75.34 $75.3436450 2.23 0.86 0.86 0.11 $141.99 $141.9936455 2.43 0.88 0.88 0.14 $153.11 $153.1136460 6.58 2.59 2.59 1.40 $476.10 $476.1036468 0.00 0.00 0.00 0.00 $0.00 $0.0036469 0.00 0.00 0.00 0.00 $0.00 $0.0036470 1.10 3.15 1.13 0.22 $204.60 $111.1336471 1.65 3.27 1.05 0.33 $239.57 $136.8536475 6.72 45.65 2.55 1.42 $2,475.63 $481.3336476 3.38 7.84 1.15 0.72 $545.81 $236.2636478 6.72 34.53 2.61 1.32 $1,956.00 $479.0236479 3.38 8.39 1.22 0.65 $567.70 $235.9336481 6.98 42.95 2.80 0.88 $2,334.49 $476.693650F 0.00 0.00 0.00 0.00 $0.00 $0.0036500 3.51 1.35 1.35 0.53 $241.48 $241.4836510 1.09 1.66 0.48 0.24 $136.24 $81.64

Updated December 2011 148 of 387 Effective January 2012

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MRA 2012

36511 1.74 0.80 0.80 0.27 $126.13 $126.1336512 1.74 0.81 0.81 0.16 $120.99 $120.9936513 1.74 0.88 0.88 0.34 $133.39 $133.3936514 1.74 13.40 0.74 0.27 $709.15 $123.3536515 1.74 62.40 0.78 0.24 $2,974.92 $123.6836516 1.22 60.37 0.51 0.35 $2,864.06 $94.2536522 1.67 39.05 1.17 0.16 $1,887.38 $134.6236555 2.68 5.19 0.70 0.22 $367.43 $159.6836556 2.50 4.19 0.79 0.31 $317.94 $160.6236557 5.14 23.39 3.45 1.09 $1,360.40 $437.7436558 4.84 18.08 2.79 0.72 $1,082.88 $375.3936560 6.29 32.63 3.89 0.59 $1,812.33 $482.4836561 6.04 28.46 3.47 1.10 $1,634.49 $478.1636563 6.24 31.99 3.73 1.31 $1,817.17 $509.5436565 6.04 22.89 3.25 1.29 $1,386.42 $477.6536566 6.54 142.18 3.58 1.27 $6,926.79 $513.5636568 1.92 6.55 0.73 0.18 $395.41 $126.1136569 1.82 5.38 0.71 0.18 $336.94 $120.8536570 5.36 29.35 3.32 0.49 $1,615.18 $410.7436571 5.34 32.41 3.24 1.02 $1,782.87 $433.1336575 0.67 4.14 0.29 0.10 $225.67 $47.5336576 3.24 7.47 2.02 0.56 $514.49 $262.3136578 3.54 11.36 2.41 0.53 $705.95 $291.8236580 1.31 4.98 0.51 0.16 $295.32 $88.4936581 3.48 18.83 1.99 0.44 $1,044.42 $265.2136582 5.24 27.09 3.07 0.88 $1,525.25 $413.8136583 5.29 28.85 3.21 1.14 $1,622.08 $435.6836584 1.20 4.80 0.65 0.11 $279.68 $87.6536585 4.84 28.06 2.87 0.67 $1,542.12 $376.5436589 2.28 2.31 1.53 0.37 $224.48 $188.3836590 3.35 4.69 2.14 0.63 $394.18 $276.1936591 0.00 0.67 0.67 0.01 $31.51 $31.5136592 0.00 0.76 0.76 0.01 $35.68 $35.6836593 0.00 0.87 0.87 0.01 $40.76 $40.7636595 3.59 13.06 1.55 0.39 $779.66 $247.0736596 0.75 3.15 0.50 0.10 $183.33 $60.7136597 1.21 2.36 0.49 0.11 $167.21 $80.6836598 0.74 2.51 0.45 0.07 $151.76 $56.4436600 0.32 0.56 0.10 0.03 $41.30 $20.0236620 1.15 0.26 0.26 0.10 $66.93 $66.93

Updated December 2011 149 of 387 Effective January 2012

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Treatment

MRA 2012

36625 2.11 0.67 0.67 0.42 $143.77 $143.7736640 2.10 1.33 1.33 0.42 $173.88 $173.8836660 1.40 0.52 0.52 0.34 $102.00 $102.0036680 1.20 0.35 0.35 0.22 $79.37 $79.3736800 2.43 2.02 2.02 0.42 $220.10 $220.1036810 3.96 1.72 1.72 0.73 $288.26 $288.2636815 2.62 1.37 1.37 0.56 $205.37 $205.3736818 11.89 6.03 6.03 2.65 $928.88 $928.8836819 13.29 6.47 6.47 2.98 $1,026.67 $1,026.6736820 14.47 6.98 6.98 3.24 $1,114.61 $1,114.6136821 12.11 6.37 6.37 2.71 $957.20 $957.2036822 5.57 4.82 4.82 1.29 $529.94 $529.9436823 22.98 11.82 11.82 5.01 $1,797.25 $1,797.2536825 14.17 6.68 6.68 3.17 $1,084.18 $1,084.1836830 12.03 5.45 5.45 2.71 $911.16 $911.1636831 8.04 4.20 4.20 1.80 $634.19 $634.1936832 10.53 4.94 4.94 2.34 $803.76 $803.7636833 11.98 5.46 5.46 2.69 $908.44 $908.4436835 7.51 5.72 5.72 1.78 $680.54 $680.5436838 21.69 8.90 8.90 4.94 $1,602.70 $1,602.7036860 2.01 3.86 0.97 0.26 $278.90 $145.1836861 2.52 1.64 1.64 0.48 $209.47 $209.4736870 5.20 51.16 3.19 0.68 $2,627.10 $407.463700F 0.00 0.00 0.00 0.00 $0.00 $0.0037140 40.00 17.85 17.85 8.53 $2,992.61 $2,992.6137145 37.00 17.15 17.15 8.07 $2,806.87 $2,806.8737160 38.00 17.01 17.01 8.13 $2,846.76 $2,846.7637180 36.50 16.72 16.72 7.80 $2,751.58 $2,751.5837181 40.00 18.10 18.10 8.52 $3,003.67 $3,003.6737182 16.97 6.50 6.50 1.62 $1,118.29 $1,118.2937183 7.99 160.08 3.13 0.73 $7,790.39 $528.0837184 8.66 59.97 3.54 1.51 $3,226.85 $615.7537185 3.28 19.02 1.18 0.61 $1,053.20 $227.7237186 4.92 39.19 1.85 0.95 $2,074.83 $347.0637187 8.03 57.40 3.19 1.13 $3,061.31 $552.9437188 5.71 49.68 2.39 0.69 $2,581.22 $393.0437191 4.71 73.11 1.67 0.69 $3,622.04 $316.4037192 7.35 44.24 2.53 1.08 $2,420.38 $490.4037193 7.35 41.83 2.52 1.08 $2,308.87 $489.9437195 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 150 of 387 Effective January 2012

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MRA 2012

3720F 0.00 0.00 0.00 0.00 $0.00 $0.0037200 4.55 1.68 1.68 0.42 $296.20 $296.2037201 4.99 2.53 2.53 0.76 $371.89 $371.8937202 5.67 3.13 3.13 1.18 $450.47 $450.4737203 5.02 34.04 2.12 0.68 $1,827.13 $350.1537204 18.11 6.53 6.53 2.22 $1,199.59 $1,199.5937205 8.27 117.83 3.15 1.57 $5,890.28 $583.8737206 4.12 71.39 1.49 0.82 $3,523.51 $289.1337207 8.27 2.98 2.98 1.86 $590.75 $590.7537208 4.12 1.28 1.28 0.93 $285.01 $285.0137209 2.27 0.78 0.78 0.33 $151.21 $151.2137210 10.60 95.96 4.12 1.02 $4,951.28 $701.7037215 19.68 9.32 9.32 4.19 $1,496.91 $1,496.9137216 18.95 9.69 9.69 1.33 $1,336.92 $1,336.9237220 8.15 87.12 2.75 1.67 $4,469.17 $565.2537221 10.00 132.88 3.42 1.89 $6,677.88 $687.5837222 3.73 23.32 1.21 0.76 $1,279.29 $256.2337223 4.25 74.25 1.38 0.84 $3,662.49 $290.6937224 9.00 105.79 3.03 1.81 $5,377.00 $622.1537225 12.00 316.60 4.18 2.52 $15,297.56 $841.4337226 10.49 267.54 3.59 1.29 $12,899.50 $686.1537227 14.50 430.31 5.03 3.05 $20,694.35 $1,016.0237228 11.00 153.37 3.67 2.26 $7,688.13 $761.2937229 14.05 310.44 4.85 2.98 $15,124.73 $984.6437230 13.80 242.99 4.69 2.61 $11,974.07 $947.5837231 15.00 399.21 5.09 2.84 $19,266.28 $1,029.7737232 4.00 32.44 1.30 0.82 $1,716.03 $275.1437233 6.50 37.36 2.20 1.37 $2,079.96 $453.0637234 5.50 112.75 1.79 1.09 $5,510.81 $376.5337235 7.80 117.95 2.54 1.55 $5,874.45 $534.263725F 0.00 0.00 0.00 0.00 $0.00 $0.0037250 2.10 0.74 0.74 0.45 $148.10 $148.1037251 1.60 0.52 0.52 0.35 $111.18 $111.183750F 0.00 0.00 0.00 0.00 $0.00 $0.0037500 11.67 6.91 6.91 2.63 $959.05 $959.0537501 0.00 0.00 0.00 0.00 $0.00 $0.0037565 12.05 7.38 7.38 2.57 $994.21 $994.2137600 12.42 6.56 6.56 2.55 $971.28 $971.2837605 14.28 7.02 7.02 3.39 $1,115.87 $1,115.8737606 8.81 6.29 6.29 1.88 $768.32 $768.32

Updated December 2011 151 of 387 Effective January 2012

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MRA 2012

37607 6.25 3.95 3.95 1.37 $523.21 $523.2137609 3.05 5.65 2.56 0.64 $426.11 $283.1337615 7.80 5.82 5.82 1.65 $691.12 $691.1237616 18.97 9.97 9.97 4.06 $1,489.61 $1,489.6137617 23.79 11.06 11.06 5.02 $1,797.68 $1,797.6837618 6.03 4.37 4.37 1.32 $530.57 $530.5737619 30.00 11.89 11.89 6.89 $2,200.22 $2,200.2237650 8.49 5.98 5.98 1.88 $740.11 $740.1137660 22.28 11.34 11.34 4.75 $1,731.49 $1,731.4937700 3.82 3.10 3.10 0.84 $351.65 $351.6537718 7.13 4.71 4.71 1.57 $606.67 $606.6737722 8.16 4.88 4.88 1.81 $671.36 $671.3637735 10.90 5.98 5.98 2.40 $870.96 $870.9637760 10.78 6.11 6.11 2.29 $866.19 $866.1937761 9.13 5.79 5.79 1.96 $763.12 $763.1237765 7.71 10.86 4.60 1.57 $916.36 $626.7037766 9.66 12.15 5.28 2.01 $1,082.91 $765.0237780 3.93 3.12 3.12 0.86 $358.36 $358.3637785 3.93 6.08 3.23 0.86 $495.32 $363.4537788 23.33 12.84 12.84 4.98 $1,858.08 $1,858.0837790 8.43 5.03 5.03 0.82 $639.64 $639.6437799 0.00 0.00 0.00 0.00 $0.00 $0.0038100 19.55 9.93 9.93 4.08 $1,513.91 $1,513.9138101 19.55 10.16 10.16 4.16 $1,528.62 $1,528.6238102 4.79 1.89 1.89 0.99 $345.31 $345.3138115 21.88 10.85 10.85 4.29 $1,668.09 $1,668.0938120 17.07 10.07 10.07 3.61 $1,389.04 $1,389.0438129 0.00 0.00 0.00 0.00 $0.00 $0.0038200 2.64 1.02 1.02 0.63 $193.61 $193.6138204 2.00 0.82 0.82 0.14 $131.70 $131.7038205 1.50 0.73 0.73 0.08 $102.83 $102.8338206 1.50 0.75 0.75 0.11 $105.28 $105.2838207 0.89 0.41 0.41 0.05 $60.07 $60.0738208 0.56 0.26 0.26 0.04 $38.32 $38.3238209 0.24 0.11 0.11 0.01 $16.00 $16.0038210 1.57 0.72 0.72 0.10 $106.41 $106.4138211 1.42 0.65 0.65 0.10 $96.68 $96.6838212 0.94 0.43 0.43 0.05 $63.16 $63.1638213 0.24 0.11 0.11 0.01 $16.00 $16.0038214 0.81 0.37 0.37 0.05 $54.75 $54.75

Updated December 2011 152 of 387 Effective January 2012

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MRA 2012

38215 0.94 0.43 0.43 0.05 $63.16 $63.1638220 1.08 3.50 0.59 0.11 $214.33 $79.6838221 1.37 3.42 0.74 0.08 $221.66 $97.6638230 3.09 1.66 1.66 0.70 $246.27 $246.2738232 3.09 1.66 1.66 0.70 $246.27 $246.2738240 2.24 1.24 1.24 0.16 $162.55 $162.5538241 2.24 1.25 1.25 0.14 $162.00 $162.0038242 1.71 0.96 0.96 0.10 $123.58 $123.5838300 2.36 5.51 2.72 0.41 $378.04 $248.9538305 6.68 5.53 5.53 1.33 $612.91 $612.9138308 6.81 4.91 4.91 1.46 $596.46 $596.4638380 8.46 7.48 7.48 1.09 $768.04 $768.0438381 13.38 7.58 7.58 3.14 $1,090.07 $1,090.0738382 10.65 7.91 7.91 2.26 $942.32 $942.3238500 3.79 5.11 2.85 0.78 $440.30 $335.7338505 1.14 2.44 0.85 0.12 $168.39 $94.8238510 6.74 7.41 4.47 1.21 $696.39 $560.3538520 7.03 5.26 5.26 1.42 $620.15 $620.1538525 6.43 4.89 4.89 1.36 $573.99 $573.9938530 8.34 5.97 5.97 1.82 $730.10 $730.1038542 7.95 6.09 6.09 1.33 $693.83 $693.8338550 7.11 6.13 6.13 1.52 $668.96 $668.9638555 15.59 10.44 10.44 3.35 $1,328.83 $1,328.8338562 11.06 7.53 7.53 1.96 $927.23 $927.2338564 11.38 6.95 6.95 2.25 $929.01 $929.0138570 9.34 4.99 4.99 1.37 $705.18 $705.1838571 14.76 7.15 7.15 1.48 $1,045.51 $1,045.5138572 16.94 8.54 8.54 2.40 $1,251.07 $1,251.0738589 0.00 0.00 0.00 0.00 $0.00 $0.0038700 12.81 9.37 9.37 1.77 $1,078.52 $1,078.5238720 21.95 14.67 14.67 3.39 $1,802.10 $1,802.1038724 23.95 15.92 15.92 3.35 $1,944.54 $1,944.5438740 10.70 7.15 7.15 2.26 $909.32 $909.3238745 13.87 8.66 8.66 2.95 $1,151.61 $1,151.6138746 4.12 1.53 1.53 0.96 $298.10 $298.1038747 4.88 1.88 1.88 1.03 $350.78 $350.7838760 13.62 8.24 8.24 2.79 $1,113.20 $1,113.2038765 21.91 11.53 11.53 4.23 $1,697.80 $1,697.8038770 14.06 7.76 7.76 1.77 $1,058.17 $1,058.1738780 17.70 10.01 10.01 2.56 $1,360.15 $1,360.15

Updated December 2011 153 of 387 Effective January 2012

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MRA 2012

38790 1.29 0.94 0.94 0.24 $111.59 $111.5938792 0.52 0.60 0.60 0.08 $54.36 $54.3638794 4.62 3.62 3.62 0.42 $389.00 $389.0038900 2.50 0.94 0.94 0.53 $178.75 $178.7538999 0.00 0.00 0.00 0.00 $0.00 $0.0039000 7.57 5.75 5.75 1.67 $678.94 $678.9439010 13.19 7.65 7.65 3.13 $1,084.57 $1,084.5739200 15.09 7.93 7.93 3.54 $1,200.69 $1,200.6939220 19.55 10.28 10.28 4.44 $1,548.41 $1,548.4139400 8.05 5.36 5.36 1.88 $692.37 $692.3739499 0.00 0.00 0.00 0.00 $0.00 $0.0039501 13.98 8.14 8.14 2.95 $1,132.31 $1,132.3139503 108.91 46.83 46.83 23.23 $8,066.44 $8,066.4439540 14.57 7.90 7.90 3.12 $1,155.41 $1,155.4139541 15.75 8.66 8.66 3.40 $1,255.94 $1,255.9439545 14.67 8.87 8.87 3.42 $1,219.89 $1,219.8939560 13.06 7.49 7.49 2.79 $1,054.24 $1,054.2439561 19.99 12.47 12.47 4.38 $1,665.76 $1,665.7639599 0.00 0.00 0.00 0.00 $0.00 $0.004000F 0.00 0.00 0.00 0.00 $0.00 $0.004001F 0.00 0.00 0.00 0.00 $0.00 $0.004003F 0.00 0.00 0.00 0.00 $0.00 $0.004004F 0.00 0.00 0.00 0.00 $0.00 $0.004005F 0.00 0.00 0.00 0.00 $0.00 $0.004008F 0.00 0.00 0.00 0.00 $0.00 $0.004010F 0.00 0.00 0.00 0.00 $0.00 $0.004011F 0.00 0.00 0.00 0.00 $0.00 $0.004012F 0.00 0.00 0.00 0.00 $0.00 $0.004013F 0.00 0.00 0.00 0.00 $0.00 $0.004014F 0.00 0.00 0.00 0.00 $0.00 $0.004015F 0.00 0.00 0.00 0.00 $0.00 $0.004016F 0.00 0.00 0.00 0.00 $0.00 $0.004017F 0.00 0.00 0.00 0.00 $0.00 $0.004018F 0.00 0.00 0.00 0.00 $0.00 $0.004019F 0.00 0.00 0.00 0.00 $0.00 $0.004025F 0.00 0.00 0.00 0.00 $0.00 $0.004030F 0.00 0.00 0.00 0.00 $0.00 $0.004033F 0.00 0.00 0.00 0.00 $0.00 $0.004035F 0.00 0.00 0.00 0.00 $0.00 $0.004037F 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 154 of 387 Effective January 2012

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MRA 2012

4040F 0.00 0.00 0.00 0.00 $0.00 $0.004041F 0.00 0.00 0.00 0.00 $0.00 $0.004042F 0.00 0.00 0.00 0.00 $0.00 $0.004043F 0.00 0.00 0.00 0.00 $0.00 $0.004044F 0.00 0.00 0.00 0.00 $0.00 $0.004045F 0.00 0.00 0.00 0.00 $0.00 $0.004046F 0.00 0.00 0.00 0.00 $0.00 $0.004047F 0.00 0.00 0.00 0.00 $0.00 $0.004048F 0.00 0.00 0.00 0.00 $0.00 $0.004049F 0.00 0.00 0.00 0.00 $0.00 $0.0040490 1.22 2.42 0.80 0.18 $173.98 $99.024050F 0.00 0.00 0.00 0.00 $0.00 $0.0040500 4.47 10.00 5.78 0.67 $690.43 $495.174051F 0.00 0.00 0.00 0.00 $0.00 $0.0040510 4.82 8.93 5.12 0.71 $658.12 $481.824052F 0.00 0.00 0.00 0.00 $0.00 $0.0040520 4.79 9.20 5.24 0.75 $671.35 $488.1140525 7.72 7.73 7.73 1.27 $756.70 $756.7040527 9.32 8.28 8.28 1.20 $847.90 $847.904053F 0.00 0.00 0.00 0.00 $0.00 $0.0040530 5.54 9.87 5.76 0.86 $740.43 $550.264054F 0.00 0.00 0.00 0.00 $0.00 $0.004055F 0.00 0.00 0.00 0.00 $0.00 $0.004056F 0.00 0.00 0.00 0.00 $0.00 $0.004058F 0.00 0.00 0.00 0.00 $0.00 $0.004060F 0.00 0.00 0.00 0.00 $0.00 $0.004062F 0.00 0.00 0.00 0.00 $0.00 $0.004063F 0.00 0.00 0.00 0.00 $0.00 $0.004064F 0.00 0.00 0.00 0.00 $0.00 $0.004065F 0.00 0.00 0.00 0.00 $0.00 $0.0040650 3.78 8.42 4.39 0.65 $586.42 $399.9440652 4.43 9.51 5.46 0.76 $670.60 $483.2140654 5.48 10.71 6.38 0.93 $780.26 $579.914066F 0.00 0.00 0.00 0.00 $0.00 $0.004067F 0.00 0.00 0.00 0.00 $0.00 $0.004069F 0.00 0.00 0.00 0.00 $0.00 $0.004070F 0.00 0.00 0.00 0.00 $0.00 $0.0040700 14.17 12.40 12.40 1.82 $1,280.18 $1,280.1840701 17.23 15.40 15.40 2.20 $1,570.88 $1,570.8840702 14.27 8.95 8.95 1.02 $1,084.18 $1,084.18

Updated December 2011 155 of 387 Effective January 2012

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MRA 2012

40720 14.72 13.31 13.31 2.91 $1,401.56 $1,401.564073F 0.00 0.00 0.00 0.00 $0.00 $0.004075F 0.00 0.00 0.00 0.00 $0.00 $0.0040761 15.84 11.86 11.86 3.13 $1,394.17 $1,394.174077F 0.00 0.00 0.00 0.00 $0.00 $0.004079F 0.00 0.00 0.00 0.00 $0.00 $0.0040799 0.00 0.00 0.00 0.00 $0.00 $0.0040800 1.23 4.83 2.50 0.18 $285.93 $178.1240801 2.63 6.32 3.58 0.37 $425.19 $298.4040804 1.30 5.03 2.54 0.16 $297.20 $181.9840805 2.79 7.47 3.57 0.35 $484.31 $303.8540806 0.31 4.08 0.78 0.04 $204.25 $51.5640808 1.01 4.42 2.11 0.12 $254.38 $147.4940810 1.36 4.63 2.30 0.18 $282.31 $174.4940812 2.37 5.83 3.17 0.31 $388.20 $265.1240814 3.52 7.39 5.08 0.48 $518.85 $411.9640816 3.77 7.73 5.21 0.52 $547.44 $430.8440818 2.83 7.35 4.89 0.37 $481.51 $367.6840819 2.51 6.30 4.17 0.33 $417.03 $318.4740820 1.34 6.47 3.69 0.18 $366.58 $237.9540830 1.82 5.71 2.82 0.31 $358.82 $225.1040831 2.57 6.96 3.74 0.42 $454.74 $305.754084F 0.00 0.00 0.00 0.00 $0.00 $0.0040840 9.15 13.35 7.92 1.18 $1,074.12 $822.8640842 9.15 13.38 8.46 1.18 $1,075.51 $847.8540843 12.79 16.89 10.23 2.52 $1,463.76 $1,155.6040844 16.80 20.52 13.09 3.32 $1,846.13 $1,502.3440845 19.36 21.82 14.82 2.48 $1,974.45 $1,650.554086F 0.00 0.00 0.00 0.00 $0.00 $0.0040899 0.00 0.00 0.00 0.00 $0.00 $0.004090F 0.00 0.00 0.00 0.00 $0.00 $0.004095F 0.00 0.00 0.00 0.00 $0.00 $0.004100F 0.00 0.00 0.00 0.00 $0.00 $0.0041000 1.35 3.30 1.82 0.18 $220.33 $151.8541005 1.31 5.17 2.34 0.16 $304.11 $173.1641006 3.34 6.91 4.03 0.42 $485.79 $352.5241007 3.20 7.13 3.84 0.41 $489.39 $337.1641008 3.46 7.26 4.07 0.44 $508.20 $360.5941009 3.71 7.64 4.48 0.48 $538.64 $392.4341010 1.11 4.99 2.08 0.14 $286.10 $151.45

Updated December 2011 156 of 387 Effective January 2012

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MRA 2012

41015 4.08 8.03 5.51 0.52 $574.75 $458.1541016 4.19 8.26 5.67 0.53 $590.67 $470.8341017 4.19 8.32 5.70 0.53 $593.45 $472.2141018 5.22 8.81 6.31 0.67 $667.86 $552.1841019 8.84 3.90 3.90 0.72 $600.02 $600.024110F 0.00 0.00 0.00 0.00 $0.00 $0.0041100 1.42 3.45 1.64 0.20 $231.32 $147.5741105 1.47 3.46 1.68 0.20 $233.95 $151.5941108 1.10 3.21 1.48 0.14 $203.30 $123.2541110 1.56 4.66 2.22 0.22 $294.39 $181.4941112 2.83 6.78 4.38 0.37 $455.13 $344.0841113 3.29 7.16 4.65 0.42 $495.19 $379.0541114 8.82 9.01 9.01 1.17 $858.50 $858.5041115 1.79 5.52 2.42 0.23 $344.66 $201.2241116 2.52 7.06 3.77 0.34 $453.14 $300.9041120 11.14 19.16 19.16 1.48 $1,444.42 $1,444.4241130 15.74 21.47 21.47 2.08 $1,781.09 $1,781.0941135 30.14 30.26 30.26 4.04 $2,911.32 $2,911.3241140 29.15 32.85 32.85 3.76 $2,974.03 $2,974.0341145 37.93 40.10 40.10 4.87 $3,746.30 $3,746.304115F 0.00 0.00 0.00 0.00 $0.00 $0.0041150 29.86 32.01 32.01 3.96 $2,976.09 $2,976.0941153 33.59 33.21 33.21 4.41 $3,216.09 $3,216.0941155 44.30 39.06 39.06 5.92 $4,027.53 $4,027.534120F 0.00 0.00 0.00 0.00 $0.00 $0.004124F 0.00 0.00 0.00 0.00 $0.00 $0.0041250 1.96 5.35 2.22 0.33 $349.24 $204.4141251 2.32 5.61 2.62 0.30 $375.34 $236.9941252 3.02 5.91 2.86 0.48 $428.70 $287.584130F 0.00 0.00 0.00 0.00 $0.00 $0.004131F 0.00 0.00 0.00 0.00 $0.00 $0.004132F 0.00 0.00 0.00 0.00 $0.00 $0.004133F 0.00 0.00 0.00 0.00 $0.00 $0.004134F 0.00 0.00 0.00 0.00 $0.00 $0.004135F 0.00 0.00 0.00 0.00 $0.00 $0.004136F 0.00 0.00 0.00 0.00 $0.00 $0.004140F 0.00 0.00 0.00 0.00 $0.00 $0.004142F 0.00 0.00 0.00 0.00 $0.00 $0.004144F 0.00 0.00 0.00 0.00 $0.00 $0.004145F 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 157 of 387 Effective January 2012

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Treatment

MRA 2012

4148F 0.00 0.00 0.00 0.00 $0.00 $0.004149F 0.00 0.00 0.00 0.00 $0.00 $0.004150F 0.00 0.00 0.00 0.00 $0.00 $0.0041500 3.80 9.62 9.62 0.49 $634.67 $634.674151F 0.00 0.00 0.00 0.00 $0.00 $0.0041510 3.51 8.56 8.56 0.44 $570.52 $570.5241512 6.86 11.49 11.49 0.49 $853.75 $853.7541520 2.83 7.17 4.41 0.35 $472.16 $344.454153F 0.00 0.00 0.00 0.00 $0.00 $0.0041530 4.51 94.57 7.47 0.31 $4,587.03 $556.794155F 0.00 0.00 0.00 0.00 $0.00 $0.004157F 0.00 0.00 0.00 0.00 $0.00 $0.004158F 0.00 0.00 0.00 0.00 $0.00 $0.004159F 0.00 0.00 0.00 0.00 $0.00 $0.0041599 0.00 0.00 0.00 0.00 $0.00 $0.004163F 0.00 0.00 0.00 0.00 $0.00 $0.004164F 0.00 0.00 0.00 0.00 $0.00 $0.004165F 0.00 0.00 0.00 0.00 $0.00 $0.004167F 0.00 0.00 0.00 0.00 $0.00 $0.004168F 0.00 0.00 0.00 0.00 $0.00 $0.004169F 0.00 0.00 0.00 0.00 $0.00 $0.004171F 0.00 0.00 0.00 0.00 $0.00 $0.004172F 0.00 0.00 0.00 0.00 $0.00 $0.004174F 0.00 0.00 0.00 0.00 $0.00 $0.004175F 0.00 0.00 0.00 0.00 $0.00 $0.004176F 0.00 0.00 0.00 0.00 $0.00 $0.004177F 0.00 0.00 0.00 0.00 $0.00 $0.004178F 0.00 0.00 0.00 0.00 $0.00 $0.004179F 0.00 0.00 0.00 0.00 $0.00 $0.004180F 0.00 0.00 0.00 0.00 $0.00 $0.0041800 1.27 6.31 2.81 0.22 $358.18 $196.2341805 1.34 5.73 3.53 0.18 $332.34 $230.5441806 2.79 7.37 4.53 0.54 $489.35 $357.944181F 0.00 0.00 0.00 0.00 $0.00 $0.004182F 0.00 0.00 0.00 0.00 $0.00 $0.0041820 0.00 0.00 0.00 0.00 $0.00 $0.0041821 0.00 0.00 0.00 0.00 $0.00 $0.0041822 2.41 5.82 2.63 0.31 $389.47 $241.8641823 3.77 8.36 5.30 0.48 $574.56 $432.9741825 1.41 4.65 2.08 0.20 $286.42 $167.50

Updated December 2011 158 of 387 Effective January 2012

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MRA 2012

41826 2.41 6.40 3.52 0.31 $416.31 $283.0441827 3.83 8.68 4.82 0.49 $592.47 $413.8741828 3.14 5.43 2.75 0.39 $407.11 $283.1141830 3.45 7.62 4.46 0.44 $524.42 $378.204185F 0.00 0.00 0.00 0.00 $0.00 $0.0041850 0.00 0.00 0.00 0.00 $0.00 $0.004186F 0.00 0.00 0.00 0.00 $0.00 $0.004187F 0.00 0.00 0.00 0.00 $0.00 $0.0041870 0.00 0.00 0.00 0.00 $0.00 $0.0041872 3.01 8.76 5.09 0.60 $566.25 $396.4341874 3.19 7.35 3.93 0.39 $498.12 $339.874188F 0.00 0.00 0.00 0.00 $0.00 $0.004189F 0.00 0.00 0.00 0.00 $0.00 $0.0041899 0.00 0.00 0.00 0.00 $0.00 $0.004190F 0.00 0.00 0.00 0.00 $0.00 $0.004191F 0.00 0.00 0.00 0.00 $0.00 $0.004192F 0.00 0.00 0.00 0.00 $0.00 $0.004193F 0.00 0.00 0.00 0.00 $0.00 $0.004194F 0.00 0.00 0.00 0.00 $0.00 $0.004195F 0.00 0.00 0.00 0.00 $0.00 $0.004196F 0.00 0.00 0.00 0.00 $0.00 $0.004200F 0.00 0.00 0.00 0.00 $0.00 $0.0042000 1.28 3.28 1.69 0.16 $215.36 $141.794201F 0.00 0.00 0.00 0.00 $0.00 $0.004210F 0.00 0.00 0.00 0.00 $0.00 $0.0042100 1.36 2.96 1.75 0.18 $205.03 $149.0542104 1.69 4.53 2.27 0.23 $294.52 $189.9442106 2.15 5.64 2.89 0.29 $368.86 $241.6142107 4.56 8.62 5.23 0.59 $626.41 $469.5542120 11.86 16.56 16.56 1.57 $1,359.88 $1,359.8842140 1.70 5.81 2.81 0.23 $354.18 $215.3642145 9.78 10.24 10.24 1.25 $961.06 $961.0642160 1.85 4.99 2.39 0.24 $323.24 $202.9442180 2.55 4.51 2.68 0.33 $335.93 $251.2642182 3.87 5.36 3.42 0.49 $440.58 $350.824220F 0.00 0.00 0.00 0.00 $0.00 $0.0042200 12.53 11.70 11.70 1.61 $1,166.06 $1,166.0642205 13.66 10.70 10.70 1.77 $1,176.88 $1,176.884221F 0.00 0.00 0.00 0.00 $0.00 $0.0042210 15.03 15.24 15.24 2.97 $1,507.34 $1,507.34

Updated December 2011 159 of 387 Effective January 2012

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MRA 2012

42215 8.99 9.63 9.63 1.78 $925.58 $925.5842220 7.16 8.06 8.06 0.50 $708.55 $708.5542225 9.77 16.13 16.13 1.25 $1,233.17 $1,233.1742226 10.35 15.71 15.71 1.32 $1,242.42 $1,242.4242227 9.90 14.73 14.73 1.27 $1,175.04 $1,175.0442235 8.01 13.34 13.34 1.03 $1,016.64 $1,016.6442260 10.22 13.05 8.40 1.31 $1,113.20 $898.0442280 1.59 2.98 1.38 0.34 $224.06 $150.0342281 1.98 3.99 2.36 0.26 $283.62 $208.2042299 0.00 0.00 0.00 0.00 $0.00 $0.004230F 0.00 0.00 0.00 0.00 $0.00 $0.0042300 1.98 4.10 2.38 0.27 $289.22 $209.6342305 6.31 5.74 5.74 0.86 $582.69 $582.6942310 1.61 3.09 1.96 0.22 $223.91 $171.6342320 2.40 4.89 2.62 0.31 $346.00 $240.9742330 2.26 4.46 2.42 0.30 $319.53 $225.1442335 3.41 7.48 3.95 0.42 $515.19 $351.8542340 4.72 8.77 4.86 0.61 $641.30 $460.374240F 0.00 0.00 0.00 0.00 $0.00 $0.0042400 0.78 2.37 0.81 0.08 $147.52 $75.3442405 3.34 5.21 3.02 0.42 $407.12 $305.7942408 4.66 8.48 4.61 0.60 $624.77 $445.7042409 2.91 6.86 3.47 0.37 $462.30 $305.4442410 9.57 7.68 7.68 1.44 $843.18 $843.1842415 17.16 12.43 12.43 2.29 $1,435.00 $1,435.004242F 0.00 0.00 0.00 0.00 $0.00 $0.0042420 19.53 13.71 13.71 2.63 $1,614.18 $1,614.1842425 13.42 9.92 9.92 1.84 $1,133.95 $1,133.9542426 22.66 14.85 14.85 3.12 $1,827.45 $1,827.4542440 6.14 5.56 5.56 0.82 $564.96 $564.964245F 0.00 0.00 0.00 0.00 $0.00 $0.0042450 4.74 8.29 5.46 0.64 $621.48 $490.534248F 0.00 0.00 0.00 0.00 $0.00 $0.004250F 0.00 0.00 0.00 0.00 $0.00 $0.0042500 4.42 8.05 5.31 0.60 $594.48 $467.6942505 6.32 9.63 6.52 0.80 $760.06 $616.1642507 6.25 8.55 8.55 0.80 $707.06 $707.0642508 9.33 11.14 11.14 1.20 $980.67 $980.6742509 11.76 12.21 12.21 2.30 $1,191.40 $1,191.4042510 8.35 9.63 9.63 1.08 $862.25 $862.25

Updated December 2011 160 of 387 Effective January 2012

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MRA 2012

4255F 0.00 0.00 0.00 0.00 $0.00 $0.0042550 1.25 2.69 0.48 0.11 $184.21 $81.954256F 0.00 0.00 0.00 0.00 $0.00 $0.004260F 0.00 0.00 0.00 0.00 $0.00 $0.0042600 4.94 9.02 5.00 0.64 $663.92 $477.914261F 0.00 0.00 0.00 0.00 $0.00 $0.004265F 0.00 0.00 0.00 0.00 $0.00 $0.0042650 0.77 1.66 0.90 0.10 $115.25 $80.094266F 0.00 0.00 0.00 0.00 $0.00 $0.0042660 1.13 1.91 1.05 0.14 $144.45 $104.6642665 2.63 6.58 3.33 0.34 $435.69 $285.314267F 0.00 0.00 0.00 0.00 $0.00 $0.004268F 0.00 0.00 0.00 0.00 $0.00 $0.004269F 0.00 0.00 0.00 0.00 $0.00 $0.0042699 0.00 0.00 0.00 0.00 $0.00 $0.004270F 0.00 0.00 0.00 0.00 $0.00 $0.0042700 1.67 3.86 2.24 0.23 $262.65 $187.694271F 0.00 0.00 0.00 0.00 $0.00 $0.0042720 6.31 6.54 4.67 0.83 $618.18 $531.6542725 12.41 10.34 10.34 1.59 $1,096.92 $1,096.924274F 0.00 0.00 0.00 0.00 $0.00 $0.004276F 0.00 0.00 0.00 0.00 $0.00 $0.004279F 0.00 0.00 0.00 0.00 $0.00 $0.004280F 0.00 0.00 0.00 0.00 $0.00 $0.0042800 1.44 3.20 1.77 0.20 $220.62 $154.4542802 1.59 5.37 2.28 0.22 $328.55 $185.5742804 1.29 4.62 2.02 0.16 $277.79 $157.4942806 1.63 4.97 2.20 0.22 $311.77 $183.6042808 2.35 4.25 2.26 0.30 $313.71 $221.6342809 1.86 3.05 1.83 0.27 $235.44 $178.9842810 3.38 8.03 4.98 0.42 $539.34 $398.2142815 7.31 8.56 8.56 1.01 $764.12 $764.1242820 4.22 4.02 4.02 0.53 $395.78 $395.7842821 4.36 4.19 4.19 0.56 $411.23 $411.2342825 3.51 3.38 3.38 0.44 $330.83 $330.8342826 3.45 3.73 3.73 0.44 $344.43 $344.4342830 2.65 3.31 3.31 0.34 $285.25 $285.2542831 2.81 3.62 3.62 0.35 $307.03 $307.0342835 2.38 3.12 3.12 0.30 $262.73 $262.7342836 3.26 3.63 3.63 0.41 $330.04 $330.04

Updated December 2011 161 of 387 Effective January 2012

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MRA 2012

42842 12.23 16.16 16.16 1.58 $1,357.91 $1,357.9142844 17.78 21.25 21.25 2.27 $1,868.95 $1,868.9542845 32.56 30.03 30.03 4.18 $3,012.63 $3,012.6342860 2.30 3.13 3.13 0.30 $259.72 $259.7242870 5.52 11.40 11.40 0.71 $802.73 $802.7342890 19.13 20.88 20.88 2.52 $1,923.03 $1,923.0342892 26.03 26.98 26.98 3.42 $2,549.97 $2,549.9742894 33.92 32.74 32.74 4.42 $3,209.14 $3,209.144290F 0.00 0.00 0.00 0.00 $0.00 $0.0042900 5.29 4.27 4.27 0.68 $461.33 $461.334293F 0.00 0.00 0.00 0.00 $0.00 $0.0042950 8.27 14.71 14.71 1.14 $1,096.89 $1,096.8942953 9.45 18.46 18.46 1.31 $1,330.17 $1,330.1742955 8.01 13.78 13.78 1.03 $1,037.00 $1,037.0042960 2.38 2.42 2.42 0.31 $230.85 $230.8542961 5.77 6.21 6.21 0.73 $574.43 $574.4342962 7.40 7.32 7.32 0.95 $707.59 $707.5942970 5.82 5.44 5.44 0.84 $546.56 $546.5642971 6.60 6.38 6.38 0.84 $623.85 $623.8542972 7.59 6.89 6.89 0.98 $697.45 $697.4542999 0.00 0.00 0.00 0.00 $0.00 $0.004300F 0.00 0.00 0.00 0.00 $0.00 $0.004301F 0.00 0.00 0.00 0.00 $0.00 $0.0043020 8.23 6.84 6.84 1.06 $726.93 $726.9343030 7.99 6.45 6.45 1.17 $704.09 $704.0943045 21.88 12.22 12.22 5.12 $1,773.70 $1,773.704305F 0.00 0.00 0.00 0.00 $0.00 $0.004306F 0.00 0.00 0.00 0.00 $0.00 $0.0043100 9.66 7.93 7.93 1.24 $848.47 $848.4743101 17.07 9.25 9.25 4.00 $1,370.94 $1,370.9443107 44.18 21.63 21.63 9.87 $3,416.76 $3,416.7643108 82.87 30.75 30.75 17.67 $5,911.54 $5,911.5443112 47.48 22.25 22.25 10.77 $3,634.18 $3,634.1843113 80.06 37.02 37.02 17.08 $6,049.92 $6,049.9243116 92.99 49.41 49.41 11.94 $6,921.87 $6,921.8743117 43.65 20.04 20.04 9.87 $3,320.23 $3,320.2343118 67.07 30.09 30.09 14.30 $5,025.13 $5,025.1343121 51.43 22.24 22.24 12.03 $3,868.92 $3,868.9243122 44.18 21.75 21.75 9.64 $3,410.61 $3,410.6143123 83.12 37.28 37.28 17.71 $6,226.56 $6,226.56

Updated December 2011 162 of 387 Effective January 2012

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MRA 2012

43124 69.09 28.81 28.81 16.18 $5,149.04 $5,149.0443130 12.53 9.12 9.12 1.99 $1,066.01 $1,066.0143135 26.17 12.22 12.22 5.97 $2,002.78 $2,002.784320F 0.00 0.00 0.00 0.00 $0.00 $0.0043200 1.59 4.71 1.32 0.23 $298.52 $141.6643201 2.09 6.88 1.45 0.30 $424.14 $172.8943202 1.89 6.42 1.28 0.29 $393.69 $155.8543204 3.76 2.22 2.22 0.59 $295.61 $295.6143205 3.78 2.37 2.37 0.56 $301.90 $301.9043215 2.60 1.62 1.62 0.41 $208.45 $208.4543216 2.40 3.65 1.57 0.35 $290.66 $194.4243217 2.90 8.08 1.72 0.49 $524.42 $230.1443219 2.80 1.85 1.85 0.48 $231.31 $231.314322F 0.00 0.00 0.00 0.00 $0.00 $0.0043220 2.10 1.39 1.39 0.31 $171.06 $171.0643226 2.34 1.52 1.52 0.37 $190.52 $190.5243227 3.59 2.18 2.18 0.54 $283.86 $283.8643228 3.76 2.32 2.32 0.59 $300.24 $300.2443231 3.19 2.03 2.03 0.48 $256.54 $256.5443232 4.47 2.63 2.63 0.69 $350.43 $350.4343234 2.01 6.16 1.27 0.34 $389.40 $163.1343235 2.39 6.19 1.59 0.37 $408.77 $195.9343236 2.92 8.04 1.90 0.42 $519.88 $235.7743237 3.98 2.42 2.42 0.60 $314.91 $314.9143238 5.02 2.97 2.97 0.75 $393.04 $393.0443239 2.87 7.05 1.84 0.42 $471.90 $230.834324F 0.00 0.00 0.00 0.00 $0.00 $0.0043240 6.85 3.96 3.96 1.03 $532.36 $532.3643241 2.59 1.68 1.68 0.39 $209.77 $209.7743242 7.30 4.25 4.25 1.08 $567.82 $567.8243243 4.56 2.74 2.74 0.68 $358.91 $358.9143244 5.04 3.04 3.04 0.73 $396.13 $396.1343245 3.18 1.94 1.94 0.50 $252.96 $252.9643246 4.32 2.51 2.51 0.69 $338.38 $338.3843247 3.38 2.09 2.09 0.52 $269.58 $269.5843248 3.15 2.03 2.03 0.45 $253.28 $253.2843249 2.90 1.87 1.87 0.42 $233.52 $233.524325F 0.00 0.00 0.00 0.00 $0.00 $0.0043250 3.20 1.93 1.93 0.52 $254.38 $254.3843251 3.69 2.27 2.27 0.56 $293.37 $293.37

Updated December 2011 163 of 387 Effective January 2012

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MRA 2012

43255 4.81 2.91 2.91 0.71 $379.13 $379.1343256 4.34 2.57 2.57 0.68 $341.51 $341.5143257 5.50 3.28 3.28 0.80 $430.72 $430.7243258 4.54 2.75 2.75 0.68 $358.51 $358.5143259 5.19 3.12 3.12 0.75 $407.34 $407.344326F 0.00 0.00 0.00 0.00 $0.00 $0.0043260 5.95 3.52 3.52 0.87 $464.88 $464.8843261 6.26 3.69 3.69 0.91 $488.21 $488.2143262 7.38 4.30 4.30 1.09 $574.11 $574.1143263 7.28 4.24 4.24 1.08 $566.49 $566.4943264 8.89 5.11 5.11 1.31 $688.19 $688.1943265 10.00 5.69 5.69 1.48 $771.76 $771.7643267 7.38 4.24 4.24 1.09 $571.33 $571.3343268 7.38 4.47 4.47 1.09 $581.97 $581.9743269 8.20 4.73 4.73 1.21 $635.63 $635.6343271 7.38 4.28 4.28 1.09 $573.18 $573.1843272 7.38 4.29 4.29 1.09 $573.65 $573.6543273 2.24 1.22 1.22 0.33 $170.27 $170.2743279 22.10 11.11 11.11 4.71 $1,711.02 $1,711.024328F 0.00 0.00 0.00 0.00 $0.00 $0.0043280 18.10 9.73 9.73 3.85 $1,430.14 $1,430.1443281 26.60 13.42 13.42 5.66 $2,061.16 $2,061.1643282 30.10 14.89 14.89 6.38 $2,317.42 $2,317.4243283 2.95 1.19 1.19 0.60 $213.38 $213.3843289 0.00 0.00 0.00 0.00 $0.00 $0.004330F 0.00 0.00 0.00 0.00 $0.00 $0.0043300 9.33 7.99 7.99 1.20 $834.92 $834.9243305 18.10 12.43 12.43 2.31 $1,476.73 $1,476.7343310 26.26 12.39 12.39 6.14 $2,023.19 $2,023.1943312 29.25 12.39 12.39 6.86 $2,189.34 $2,189.3443313 48.45 25.24 25.24 11.35 $3,844.05 $3,844.0543314 53.43 25.81 25.81 6.87 $3,858.26 $3,858.2643320 23.31 12.44 12.44 4.98 $1,838.71 $1,838.7143325 22.60 12.20 12.20 4.83 $1,789.22 $1,789.2243327 13.35 7.98 7.98 2.84 $1,092.02 $1,092.0243328 19.91 10.50 10.50 4.98 $1,601.66 $1,601.6643330 22.19 11.45 11.45 4.78 $1,734.21 $1,734.2143331 23.06 12.00 12.00 5.40 $1,828.88 $1,828.8843332 19.62 10.61 10.61 4.18 $1,553.49 $1,553.4943333 21.46 11.33 11.33 4.55 $1,685.33 $1,685.33

Updated December 2011 164 of 387 Effective January 2012

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MRA 2012

43334 22.12 10.82 10.82 4.71 $1,698.46 $1,698.4643335 23.97 11.50 11.50 5.08 $1,828.89 $1,828.8943336 25.81 12.83 12.83 5.85 $2,009.31 $2,009.3143337 27.65 14.78 14.78 6.27 $2,200.61 $2,200.6143338 2.21 1.18 1.18 0.50 $175.77 $175.7743340 22.99 12.41 12.41 4.90 $1,819.39 $1,819.3943341 24.23 12.52 12.52 5.68 $1,917.87 $1,917.8743350 19.49 13.31 13.31 4.15 $1,671.26 $1,671.2643351 22.05 12.38 12.38 5.16 $1,790.51 $1,790.5143352 17.81 10.18 10.18 4.16 $1,454.17 $1,454.1743360 40.11 21.13 21.13 9.40 $3,193.40 $3,193.4043361 45.68 23.39 23.39 9.74 $3,556.56 $3,556.564340F 0.00 0.00 0.00 0.00 $0.00 $0.0043400 25.60 14.63 14.63 3.77 $1,977.69 $1,977.6943401 26.49 13.08 13.08 5.65 $2,040.16 $2,040.1643405 24.73 13.22 13.22 5.28 $1,951.57 $1,951.5743410 16.41 12.13 12.13 3.84 $1,467.47 $1,467.4743415 44.88 20.11 20.11 10.25 $3,396.08 $3,396.0843420 16.78 11.47 11.47 2.15 $1,366.99 $1,366.9943425 25.04 12.78 12.78 5.35 $1,948.20 $1,948.2043450 1.38 3.10 1.07 0.22 $214.41 $120.4843453 1.51 7.15 1.14 0.23 $407.95 $129.8643456 2.57 15.10 1.68 0.38 $829.36 $208.4043458 3.06 8.13 1.90 0.45 $531.63 $243.3643460 3.79 2.32 2.32 0.54 $299.00 $299.0043496 0.00 0.00 0.00 0.00 $0.00 $0.0043499 0.00 0.00 0.00 0.00 $0.00 $0.004350F 0.00 0.00 0.00 0.00 $0.00 $0.0043500 12.79 7.44 7.44 2.71 $1,036.16 $1,036.1643501 22.60 11.95 11.95 4.78 $1,775.10 $1,775.1043502 25.69 13.28 13.28 5.47 $2,005.60 $2,005.6043510 15.14 10.76 10.76 2.22 $1,266.66 $1,266.6643520 11.29 6.53 6.53 2.50 $918.40 $918.4043605 13.72 7.81 7.81 2.87 $1,101.71 $1,101.7143610 16.34 8.80 8.80 3.46 $1,291.03 $1,291.0343611 20.38 10.82 10.82 4.30 $1,602.23 $1,602.2343620 34.04 16.13 16.13 7.25 $2,589.73 $2,589.7343621 39.53 18.05 18.05 8.41 $2,975.40 $2,975.4043622 40.03 18.46 18.46 8.55 $3,023.16 $3,023.1643631 24.51 12.63 12.63 5.20 $1,910.67 $1,910.67

Updated December 2011 165 of 387 Effective January 2012

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MRA 2012

43632 35.14 16.44 16.44 7.42 $2,660.38 $2,660.3843633 33.14 15.72 15.72 7.00 $2,519.06 $2,519.0643634 36.64 17.41 17.41 7.81 $2,790.08 $2,790.0843635 2.06 0.80 0.80 0.42 $147.62 $147.6243640 19.56 10.67 10.67 4.12 $1,550.61 $1,550.6143641 19.81 10.93 10.93 4.22 $1,578.56 $1,578.5643644 29.40 14.98 14.98 6.22 $2,283.13 $2,283.1343645 31.53 15.87 15.87 6.74 $2,443.03 $2,443.0343647 0.00 0.00 0.00 0.00 $0.00 $0.0043648 0.00 0.00 0.00 0.00 $0.00 $0.0043651 10.13 6.80 6.80 2.16 $863.34 $863.3443652 12.13 7.58 7.58 2.59 $1,007.95 $1,007.9543653 8.48 6.39 6.39 1.81 $755.09 $755.0943659 0.00 0.00 0.00 0.00 $0.00 $0.0043752 0.81 0.30 0.30 0.08 $53.04 $53.0443753 0.45 0.12 0.12 0.03 $26.57 $26.5743754 0.45 2.00 0.45 0.04 $114.07 $42.3543755 0.94 2.74 0.69 0.08 $171.57 $76.7243756 0.77 6.10 0.71 0.05 $318.15 $68.7543757 1.26 8.43 0.98 0.08 $448.72 $104.0043760 0.90 12.58 0.41 0.14 $628.20 $65.0843761 2.01 1.23 0.80 0.24 $156.19 $136.3043770 18.00 10.82 10.82 3.81 $1,474.21 $1,474.2143771 20.79 11.86 11.86 4.44 $1,675.24 $1,675.2443772 15.70 8.83 8.83 3.36 $1,259.60 $1,259.6043773 20.79 11.84 11.84 4.44 $1,674.31 $1,674.3143774 15.76 8.95 8.95 3.36 $1,267.75 $1,267.7543775 21.56 11.59 11.59 4.60 $1,704.24 $1,704.2443800 15.43 8.40 8.40 3.31 $1,225.47 $1,225.4743810 16.88 9.16 9.16 3.59 $1,337.69 $1,337.6943820 22.53 11.64 11.64 4.76 $1,756.71 $1,756.7143825 21.76 11.62 11.62 4.64 $1,716.33 $1,716.3343830 10.85 7.31 7.31 2.23 $921.69 $921.6943831 8.49 7.05 7.05 1.81 $786.06 $786.0643832 17.34 9.85 9.85 3.58 $1,389.03 $1,389.0343840 22.83 11.87 11.87 4.82 $1,783.40 $1,783.4043842 21.03 11.07 11.07 1.50 $1,499.52 $1,499.5243843 21.21 11.54 11.54 4.52 $1,682.69 $1,682.6943845 33.30 16.68 16.68 7.06 $2,573.46 $2,573.4643846 27.41 14.29 14.29 5.80 $2,143.63 $2,143.63

Updated December 2011 166 of 387 Effective January 2012

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MRA 2012

43847 30.28 15.71 15.71 6.45 $2,366.73 $2,366.7343848 32.75 16.59 16.59 6.94 $2,539.37 $2,539.3743850 27.58 13.96 13.96 5.88 $2,139.79 $2,139.7943855 28.69 14.46 14.46 6.11 $2,222.71 $2,222.7143860 27.89 13.86 13.86 5.88 $2,148.60 $2,148.6043865 29.05 14.59 14.59 6.19 $2,248.39 $2,248.3943870 11.44 6.98 6.98 2.35 $938.08 $938.0843880 27.18 13.67 13.67 5.70 $2,099.89 $2,099.8943881 0.00 0.00 0.00 0.00 $0.00 $0.0043882 0.00 0.00 0.00 0.00 $0.00 $0.0043886 4.64 4.89 4.89 0.99 $477.63 $477.6343887 4.32 4.30 4.30 0.91 $432.40 $432.4043888 6.44 5.56 5.56 1.37 $605.93 $605.9343999 0.00 0.00 0.00 0.00 $0.00 $0.004400F 0.00 0.00 0.00 0.00 $0.00 $0.0044005 18.46 9.63 9.63 3.84 $1,440.60 $1,440.6044010 14.26 8.01 8.01 3.01 $1,141.48 $1,141.4844015 2.62 1.00 1.00 0.56 $188.25 $188.2544020 16.22 8.80 8.80 3.40 $1,282.78 $1,282.7844021 16.31 8.90 8.90 3.44 $1,293.34 $1,293.3444025 16.51 8.92 8.92 3.43 $1,302.42 $1,302.4244050 15.52 8.53 8.53 3.24 $1,231.82 $1,231.8244055 25.63 12.64 12.64 5.42 $1,970.84 $1,970.8444100 2.01 1.06 1.06 0.31 $151.89 $151.8944110 14.04 7.85 7.85 2.90 $1,118.95 $1,118.9544111 16.52 8.75 8.75 3.44 $1,295.49 $1,295.4944120 20.82 10.52 10.52 4.33 $1,608.94 $1,608.9444121 4.44 1.74 1.74 0.90 $318.63 $318.6344125 20.03 10.39 10.39 4.07 $1,555.47 $1,555.4744126 42.23 20.59 20.59 9.00 $3,239.91 $3,239.9144127 49.30 23.27 23.27 10.51 $3,746.99 $3,746.9944128 4.44 1.75 1.75 0.93 $320.62 $320.6244130 22.11 11.49 11.49 4.56 $1,721.40 $1,721.4044132 0.00 0.00 0.00 0.00 $0.00 $0.0044133 0.00 0.00 0.00 0.00 $0.00 $0.0044135 0.00 0.00 0.00 0.00 $0.00 $0.0044136 0.00 0.00 0.00 0.00 $0.00 $0.0044137 0.00 0.00 0.00 0.00 $0.00 $0.0044139 2.23 0.87 0.87 0.44 $159.24 $159.2444140 22.59 11.95 11.95 4.64 $1,767.55 $1,767.55

Updated December 2011 167 of 387 Effective January 2012

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MRA 2012

44141 29.91 17.09 17.09 6.18 $2,400.82 $2,400.8244143 27.79 15.12 15.12 5.74 $2,195.44 $2,195.4444144 29.91 15.55 15.55 6.18 $2,329.56 $2,329.5644145 28.58 14.30 14.30 5.66 $2,187.65 $2,187.6544146 35.30 19.69 19.69 6.87 $2,789.71 $2,789.7144147 33.69 15.98 15.98 6.78 $2,543.72 $2,543.7244150 30.18 18.36 18.36 6.12 $2,468.23 $2,468.2344151 34.92 20.12 20.12 7.44 $2,822.14 $2,822.1444155 34.42 20.02 20.02 6.46 $2,746.00 $2,746.0044156 37.42 22.02 22.02 7.99 $3,046.33 $3,046.3344157 35.70 20.26 20.26 7.62 $2,871.57 $2,871.5744158 36.70 20.67 20.67 7.83 $2,944.54 $2,944.5444160 20.89 11.12 11.12 4.26 $1,636.17 $1,636.1744180 15.27 8.45 8.45 3.17 $1,213.73 $1,213.7344186 10.38 6.49 6.49 2.22 $862.88 $862.8844187 17.40 11.68 11.68 3.31 $1,462.58 $1,462.5844188 19.35 12.67 12.67 3.84 $1,619.82 $1,619.8244202 23.39 12.30 12.30 4.85 $1,829.08 $1,829.0844203 4.44 1.73 1.73 0.93 $319.69 $319.6944204 26.42 13.41 13.41 5.23 $2,031.03 $2,031.0344205 22.95 11.75 11.75 4.50 $1,766.77 $1,766.7744206 29.79 15.56 15.56 6.06 $2,318.72 $2,318.7244207 31.92 15.44 15.44 6.18 $2,411.54 $2,411.5444208 33.99 17.86 17.86 6.40 $2,624.38 $2,624.3844210 30.09 16.69 16.69 5.81 $2,371.28 $2,371.2844211 37.08 20.75 20.75 7.92 $2,969.28 $2,969.2844212 34.58 19.52 19.52 6.37 $2,725.22 $2,725.2244213 3.50 1.37 1.37 0.67 $249.09 $249.0944227 28.62 14.41 14.41 5.84 $2,203.63 $2,203.6344238 0.00 0.00 0.00 0.00 $0.00 $0.0044300 13.75 7.96 7.96 2.91 $1,111.98 $1,111.9844310 17.59 9.47 9.47 3.46 $1,376.18 $1,376.1844312 9.43 6.19 6.19 1.71 $781.90 $781.9044314 16.74 9.60 9.60 3.16 $1,330.11 $1,330.1144316 23.59 12.57 12.57 5.04 $1,859.90 $1,859.9044320 19.91 11.15 11.15 4.07 $1,585.44 $1,585.4444322 13.32 13.02 13.02 2.84 $1,323.93 $1,323.9344340 9.28 7.01 7.01 1.88 $822.00 $822.0044345 17.22 10.11 10.11 3.44 $1,388.74 $1,388.7444346 19.63 11.04 11.04 3.88 $1,558.56 $1,558.56

Updated December 2011 168 of 387 Effective January 2012

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MRA 2012

44360 2.59 1.73 1.73 0.38 $211.58 $211.5844361 2.87 1.89 1.89 0.41 $232.63 $232.6344363 3.49 2.17 2.17 0.52 $278.04 $278.0444364 3.73 2.33 2.33 0.54 $296.86 $296.8644365 3.31 2.11 2.11 0.49 $265.94 $265.9444366 4.40 2.71 2.71 0.64 $348.55 $348.5544369 4.51 2.77 2.77 0.65 $356.60 $356.6044370 4.79 3.07 3.07 0.69 $384.65 $384.6544372 4.40 2.55 2.55 0.69 $343.69 $343.6944373 3.49 2.13 2.13 0.53 $276.70 $276.7044376 5.25 3.00 3.00 0.82 $407.95 $407.9544377 5.52 3.25 3.25 0.82 $431.21 $431.2144378 7.12 4.13 4.13 1.05 $552.94 $552.9444379 7.46 4.53 4.53 1.09 $588.22 $588.2244380 1.05 0.85 0.85 0.14 $91.94 $91.9444382 1.27 0.99 0.99 0.20 $111.00 $111.0044383 2.94 1.64 1.64 0.33 $220.03 $220.0344385 1.82 5.66 1.08 0.26 $353.96 $142.0444386 2.12 8.16 1.33 0.33 $486.20 $170.1644388 2.82 7.33 1.69 0.45 $484.22 $223.2544389 3.13 8.43 1.91 0.49 $550.58 $248.8944390 3.82 9.17 2.13 0.56 $618.27 $292.5244391 4.31 10.25 2.53 0.65 $694.05 $336.8444392 3.81 8.85 2.11 0.63 $606.59 $294.7344393 4.83 9.67 2.70 0.76 $695.34 $372.8244394 4.42 10.00 2.53 0.69 $689.28 $343.6444397 4.70 2.84 2.84 0.68 $369.60 $369.604450F 0.00 0.00 0.00 0.00 $0.00 $0.0044500 0.49 0.19 0.19 0.04 $32.05 $32.0544602 24.72 11.19 11.19 5.10 $1,848.05 $1,848.0544603 28.16 13.19 13.19 5.76 $2,123.19 $2,123.1944604 18.16 8.99 8.99 3.72 $1,391.88 $1,391.8844605 22.08 11.65 11.65 4.56 $1,727.51 $1,727.5144615 18.16 9.56 9.56 3.73 $1,418.77 $1,418.7744620 14.43 8.08 8.08 2.83 $1,142.92 $1,142.9244625 17.28 9.20 9.20 3.36 $1,345.17 $1,345.1744626 27.90 13.35 13.35 5.70 $2,116.27 $2,116.2744640 24.20 11.94 11.94 4.89 $1,849.55 $1,849.5544650 25.12 12.26 12.26 5.06 $1,912.86 $1,912.8644660 23.91 11.48 11.48 3.85 $1,762.80 $1,762.80

Updated December 2011 169 of 387 Effective January 2012

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MRA 2012

44661 27.35 13.04 13.04 5.10 $2,047.58 $2,047.5844680 17.96 9.63 9.63 3.84 $1,418.94 $1,418.944470F 0.00 0.00 0.00 0.00 $0.00 $0.0044700 17.48 9.28 9.28 3.04 $1,341.25 $1,341.2544701 3.10 1.22 1.22 0.59 $220.75 $220.7544715 0.00 0.00 0.00 0.00 $0.00 $0.0044720 5.00 1.88 1.88 0.35 $321.39 $321.3944721 7.00 2.78 2.78 1.50 $508.17 $508.1744799 0.00 0.00 0.00 0.00 $0.00 $0.004480F 0.00 0.00 0.00 0.00 $0.00 $0.0044800 12.05 7.82 7.82 2.44 $1,007.96 $1,007.964481F 0.00 0.00 0.00 0.00 $0.00 $0.0044820 13.73 7.97 7.97 2.83 $1,107.51 $1,107.5144850 12.11 7.26 7.26 2.52 $988.71 $988.7144899 0.00 0.00 0.00 0.00 $0.00 $0.0044900 12.57 7.34 7.34 2.64 $1,018.44 $1,018.4444901 3.37 23.88 1.27 0.35 $1,268.75 $222.5544950 10.60 5.92 5.92 2.23 $846.55 $846.5544955 1.53 0.62 0.62 0.31 $110.74 $110.7444960 14.50 7.92 7.92 3.08 $1,151.27 $1,151.2744970 9.45 6.06 6.06 1.97 $789.98 $789.9844979 0.00 0.00 0.00 0.00 $0.00 $0.004500F 0.00 0.00 0.00 0.00 $0.00 $0.0045000 6.30 4.95 4.95 1.09 $557.40 $557.4045005 2.02 5.48 2.24 0.38 $360.40 $210.4845020 8.56 6.40 6.40 1.62 $749.35 $749.354510F 0.00 0.00 0.00 0.00 $0.00 $0.0045100 4.04 3.96 3.96 0.72 $394.87 $394.8745108 5.12 4.51 4.51 1.09 $485.92 $485.9245110 30.76 17.61 17.61 5.83 $2,443.90 $2,443.9045111 18.01 10.31 10.31 3.55 $1,437.82 $1,437.8245112 33.18 15.91 15.91 6.08 $2,482.78 $2,482.7845113 33.22 17.69 17.69 7.08 $2,617.75 $2,617.7545114 30.79 15.54 15.54 6.57 $2,387.06 $2,387.0645116 27.72 14.27 14.27 3.96 $2,062.53 $2,062.5345119 33.48 17.74 17.74 5.87 $2,569.77 $2,569.7745120 26.40 14.11 14.11 5.63 $2,082.90 $2,082.9045121 29.08 15.34 15.34 6.19 $2,284.40 $2,284.4045123 18.86 10.59 10.59 3.17 $1,468.26 $1,468.2645126 49.10 24.48 24.48 10.47 $3,792.28 $3,792.28

Updated December 2011 170 of 387 Effective January 2012

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MRA 2012

45130 18.50 10.26 10.26 3.13 $1,435.36 $1,435.3645135 22.36 12.66 12.66 4.76 $1,796.54 $1,796.5445136 30.82 17.90 17.90 4.41 $2,387.68 $2,387.6845150 5.85 4.82 4.82 0.83 $518.67 $518.6745160 16.33 9.79 9.79 3.48 $1,337.42 $1,337.4245171 8.13 8.21 8.21 1.51 $808.88 $808.8845172 12.13 9.77 9.77 2.23 $1,090.97 $1,090.9745190 10.42 7.85 7.85 1.86 $909.23 $909.234525F 0.00 0.00 0.00 0.00 $0.00 $0.004526F 0.00 0.00 0.00 0.00 $0.00 $0.0045300 0.80 2.64 0.65 0.12 $162.92 $70.8445303 1.50 25.93 0.92 0.26 $1,278.02 $120.7745305 1.25 4.26 0.85 0.23 $262.96 $105.1845307 1.70 4.65 1.01 0.33 $305.59 $137.1645308 1.40 4.42 0.90 0.26 $278.39 $115.5245309 1.50 4.78 0.97 0.27 $299.89 $123.6045315 1.80 4.65 1.11 0.33 $309.92 $146.1245317 2.00 4.71 1.14 0.33 $321.36 $156.1745320 1.78 4.94 1.09 0.31 $321.46 $143.3145321 1.75 1.10 1.10 0.33 $143.49 $143.4945327 2.00 1.19 1.19 0.42 $163.07 $163.0745330 0.96 3.10 0.79 0.14 $192.15 $85.2645331 1.15 3.70 0.94 0.18 $230.18 $102.4745332 1.79 6.73 1.24 0.29 $403.70 $149.6745333 1.79 6.85 1.21 0.29 $409.25 $148.2845334 2.73 1.77 1.77 0.39 $220.00 $220.0045335 1.46 6.45 1.07 0.23 $373.40 $124.4645337 2.36 1.50 1.50 0.38 $190.97 $190.9745338 2.34 6.96 1.53 0.35 $441.22 $189.9745339 3.14 6.60 1.94 0.48 $465.83 $250.2145340 1.89 12.30 1.28 0.30 $666.27 $156.3645341 2.60 1.70 1.70 0.38 $210.62 $210.6245342 4.05 2.50 2.50 0.60 $321.64 $321.6445345 2.92 1.83 1.83 0.44 $233.55 $233.5545355 3.51 1.99 1.99 0.59 $274.14 $274.1445378 3.69 7.56 2.20 0.59 $539.67 $291.6645378 53 0.96 3.10 0.79 0.14 $192.15 $85.2645379 4.68 9.72 2.70 0.72 $689.12 $364.2945380 4.43 9.02 2.65 0.67 $643.35 $348.6045381 4.19 9.26 2.53 0.63 $642.03 $330.62

Updated December 2011 171 of 387 Effective January 2012

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Treatment

MRA 2012

45382 5.68 11.92 3.35 0.84 $840.34 $443.7945383 5.86 10.24 3.25 0.91 $773.96 $450.5245384 4.69 8.59 2.66 0.73 $637.77 $363.3845385 5.30 9.79 3.09 0.80 $723.28 $413.2645386 4.57 14.94 2.65 0.72 $925.89 $357.2145387 5.90 3.52 3.52 0.88 $463.22 $463.2245391 5.09 2.99 2.99 0.73 $395.98 $395.9845392 6.54 3.78 3.78 1.02 $510.10 $510.1045395 33.00 19.26 19.26 5.99 $2,625.42 $2,625.4245397 36.50 20.34 20.34 6.02 $2,828.53 $2,828.5345400 19.44 10.76 10.76 3.57 $1,521.60 $1,521.6045402 26.51 13.46 13.46 4.82 $2,016.39 $2,016.3945499 0.00 0.00 0.00 0.00 $0.00 $0.0045500 7.73 6.36 6.36 1.21 $690.69 $690.6945505 8.36 7.29 7.29 1.51 $776.28 $776.2845520 0.55 3.82 0.55 0.07 $204.14 $52.8445540 18.12 9.73 9.73 3.12 $1,393.87 $1,393.8745541 14.85 9.64 9.64 2.59 $1,221.09 $1,221.0945550 24.80 13.55 13.55 4.48 $1,929.18 $1,929.1845560 11.50 7.26 7.26 1.80 $925.66 $925.6645562 17.98 11.10 11.10 3.38 $1,464.42 $1,464.4245563 26.38 15.90 15.90 5.63 $2,164.86 $2,164.8645800 20.31 11.43 11.43 3.39 $1,581.14 $1,581.1445805 23.32 14.22 14.22 4.98 $1,921.50 $1,921.5045820 20.37 11.96 11.96 1.96 $1,535.52 $1,535.5245825 24.17 15.19 15.19 3.46 $1,925.89 $1,925.8945900 2.99 2.35 2.35 0.56 $266.75 $266.7545905 2.35 2.18 2.18 0.41 $223.53 $223.5345910 2.85 2.41 2.41 0.48 $259.39 $259.3945915 3.19 5.81 2.87 0.52 $433.48 $297.4445990 1.80 1.03 1.03 0.31 $141.40 $141.4045999 0.00 0.00 0.00 0.00 $0.00 $0.0046020 3.00 4.43 3.27 0.54 $362.41 $308.7346030 1.26 2.54 1.15 0.23 $183.81 $119.4946040 5.37 8.97 5.59 1.05 $701.09 $544.6946045 5.87 5.47 5.47 1.17 $566.90 $566.9046050 1.24 4.34 1.37 0.24 $266.74 $129.3246060 6.37 6.23 6.23 1.18 $624.24 $624.2446070 2.79 3.96 3.96 0.20 $314.27 $314.2746080 2.52 4.20 1.65 0.49 $328.43 $210.44

Updated December 2011 172 of 387 Effective January 2012

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MRA 2012

46083 1.45 3.50 1.44 0.24 $236.97 $141.6546200 3.59 8.47 5.17 0.63 $579.48 $426.7946220 1.61 4.06 1.56 0.30 $272.87 $157.1946221 2.36 5.01 2.80 0.41 $354.91 $252.6546230 2.62 4.83 1.95 0.48 $361.40 $228.1446250 4.25 8.24 4.05 0.82 $607.09 $413.2246255 4.96 8.75 4.37 0.95 $668.06 $465.3946257 5.76 5.38 5.38 1.08 $553.40 $553.4046258 6.41 5.73 5.73 1.37 $612.50 $612.5046260 6.73 5.76 5.76 1.27 $622.66 $622.6646261 7.76 6.10 6.10 1.39 $689.12 $689.1246262 7.91 6.72 6.72 1.44 $726.85 $726.8546270 4.92 8.69 5.42 0.98 $665.08 $513.7746275 5.42 9.04 5.58 0.98 $702.93 $542.8346280 6.39 6.07 6.07 1.13 $615.16 $615.1646285 5.42 8.90 5.58 0.91 $692.90 $539.2746288 7.81 6.73 6.73 1.33 $717.38 $717.3846320 1.64 3.38 1.30 0.30 $242.70 $146.4646500 1.69 4.83 1.79 0.29 $311.45 $170.7946505 3.18 4.57 3.23 0.59 $379.23 $317.2246600 0.55 1.93 0.55 0.08 $117.20 $53.3446604 1.03 16.53 0.75 0.16 $817.62 $87.4646606 1.20 5.17 0.82 0.23 $302.91 $101.6346608 1.30 5.29 0.82 0.24 $313.30 $106.4746610 1.28 5.12 0.86 0.24 $304.57 $107.4546611 1.30 3.63 0.89 0.23 $235.98 $109.2046612 1.50 5.98 0.97 0.31 $357.45 $125.6346614 1.00 2.61 0.77 0.14 $171.21 $86.0746615 1.50 2.50 0.98 0.29 $195.41 $125.0846700 9.81 7.53 7.53 1.63 $856.30 $856.3046705 7.43 6.92 6.92 0.52 $668.51 $668.5146706 2.44 2.00 2.00 0.42 $219.61 $219.6146707 6.39 6.41 6.41 0.90 $619.19 $619.1946710 17.14 11.15 11.15 3.67 $1,445.10 $1,445.1046712 36.45 20.30 20.30 2.59 $2,650.03 $2,650.0346715 7.62 6.18 6.18 0.53 $643.01 $643.0146716 17.54 14.62 14.62 1.24 $1,499.38 $1,499.3846730 30.65 19.58 19.58 2.18 $2,344.61 $2,344.6146735 36.14 20.63 20.63 2.57 $2,650.86 $2,650.8646740 33.90 21.13 21.13 7.23 $2,814.01 $2,814.01

Updated December 2011 173 of 387 Effective January 2012

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MRA 2012

46742 40.14 22.05 22.05 8.56 $3,194.54 $3,194.5446744 58.94 30.31 30.31 8.42 $4,384.02 $4,384.0246746 65.44 32.86 32.86 4.64 $4,591.30 $4,591.3046748 71.42 35.04 35.04 5.08 $4,973.60 $4,973.6046750 12.15 8.19 8.19 1.97 $1,005.50 $1,005.5046751 9.30 6.86 6.86 1.57 $800.15 $800.1546753 8.89 6.66 6.66 1.51 $770.08 $770.0846754 3.01 5.27 3.30 0.42 $395.61 $304.4546760 17.45 11.85 11.85 2.48 $1,430.39 $1,430.3946761 15.29 9.53 9.53 2.42 $1,226.42 $1,226.4246762 14.82 9.96 9.96 2.12 $1,210.69 $1,210.6946900 1.91 4.78 1.84 0.30 $319.18 $183.1446910 1.91 5.14 1.70 0.34 $337.87 $178.7046916 1.91 4.66 2.09 0.27 $312.10 $193.1846917 1.91 11.41 1.68 0.33 $627.48 $177.2646922 1.91 5.47 1.69 0.35 $353.65 $178.7446924 2.81 12.49 2.15 0.45 $722.55 $244.1046930 1.61 4.23 2.53 0.26 $278.70 $200.0446940 2.35 3.91 1.57 0.37 $301.54 $193.2746942 2.07 3.80 1.44 0.33 $282.29 $173.0946945 2.21 6.29 3.98 0.38 $406.11 $299.2346946 2.63 6.00 3.51 0.44 $413.94 $298.7246947 5.57 4.47 4.47 1.09 $503.57 $503.5746999 0.00 0.00 0.00 0.00 $0.00 $0.0047000 1.90 5.75 0.91 0.20 $358.54 $134.5947001 1.90 0.74 0.74 0.38 $135.88 $135.8847010 19.40 11.58 11.58 3.96 $1,577.65 $1,577.6547011 3.69 1.37 1.37 0.35 $241.04 $241.0447015 18.50 11.40 11.40 3.93 $1,528.81 $1,528.8147100 12.91 8.97 8.97 2.69 $1,111.14 $1,111.1447120 39.01 20.40 20.40 8.26 $3,053.99 $3,053.9947122 59.48 27.61 27.61 12.64 $4,497.15 $4,497.1547125 53.04 25.04 25.04 11.20 $4,026.00 $4,026.0047130 57.19 26.74 26.74 12.04 $4,327.17 $4,327.1747133 0.00 0.00 0.00 0.00 $0.00 $0.0047135 83.64 41.48 41.48 17.71 $6,443.42 $6,443.4247136 70.74 34.81 34.81 15.09 $5,442.70 $5,442.7047140 59.40 30.18 30.18 12.67 $4,614.12 $4,614.1247141 71.50 37.58 37.58 5.08 $5,094.59 $5,094.5947142 79.44 40.69 40.69 16.93 $6,185.25 $6,185.25

Updated December 2011 174 of 387 Effective January 2012

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MRA 2012

47143 0.00 0.00 0.00 0.00 $0.00 $0.0047144 0.00 0.00 0.00 0.00 $0.00 $0.0047145 0.00 0.00 0.00 0.00 $0.00 $0.0047146 6.00 2.36 2.36 1.28 $434.23 $434.2347147 7.00 2.76 2.76 1.48 $506.23 $506.2347300 18.14 11.03 11.03 3.84 $1,491.52 $1,491.5247350 22.49 12.83 12.83 4.70 $1,806.99 $1,806.9947360 31.31 16.30 16.30 6.67 $2,449.84 $2,449.8447361 52.60 24.57 24.57 10.70 $3,959.76 $3,959.7647362 23.54 13.62 13.62 4.94 $1,901.24 $1,901.2447370 20.80 10.94 10.94 4.22 $1,621.91 $1,621.9147371 20.80 11.53 11.53 4.44 $1,660.40 $1,660.4047379 0.00 0.00 0.00 0.00 $0.00 $0.0047380 24.56 12.21 12.21 4.95 $1,880.69 $1,880.6947381 24.88 13.09 13.09 5.31 $1,953.58 $1,953.5847382 15.22 127.60 6.40 1.48 $6,638.84 $1,030.7447399 0.00 0.00 0.00 0.00 $0.00 $0.0047400 36.36 18.72 18.72 7.74 $2,835.00 $2,835.0047420 22.03 12.42 12.42 4.67 $1,766.56 $1,766.5647425 22.31 12.74 12.74 4.76 $1,798.08 $1,798.0847460 20.52 12.26 12.26 4.37 $1,678.49 $1,678.4947480 13.25 9.42 9.42 2.75 $1,149.74 $1,149.7447490 4.76 4.97 4.97 0.44 $458.55 $458.5547500 1.96 0.72 0.72 0.20 $128.39 $128.3947505 0.76 0.28 0.28 0.07 $49.44 $49.4447510 8.03 5.10 5.10 0.80 $624.53 $624.5347511 10.77 5.36 5.36 1.02 $766.45 $766.4547525 1.54 13.41 0.99 0.14 $694.33 $119.6447530 6.05 35.75 3.79 0.61 $1,947.31 $468.4847550 3.02 1.19 1.19 0.63 $217.93 $217.9347552 6.03 2.67 2.67 0.63 $416.81 $416.8147553 6.34 2.36 2.36 0.63 $415.89 $415.8947554 9.05 3.90 3.90 1.51 $649.31 $649.3147555 7.55 2.79 2.79 0.71 $492.27 $492.2747556 8.55 3.17 3.17 0.80 $557.75 $557.7547560 4.88 1.93 1.93 1.05 $354.11 $354.1147561 5.17 2.34 2.34 1.10 $388.19 $388.1947562 11.76 7.61 7.61 2.48 $987.71 $987.7147563 11.47 7.03 7.03 2.43 $945.77 $945.7747564 18.00 10.06 10.06 3.84 $1,440.57 $1,440.57

Updated December 2011 175 of 387 Effective January 2012

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MRA 2012

47570 12.56 7.37 7.37 2.67 $1,020.93 $1,020.9347579 0.00 0.00 0.00 0.00 $0.00 $0.0047600 17.48 10.36 10.36 3.70 $1,424.80 $1,424.8047605 15.98 9.26 9.26 3.40 $1,293.66 $1,293.6647610 20.92 11.21 11.21 4.45 $1,651.30 $1,651.3047612 21.21 11.25 11.25 4.50 $1,668.26 $1,668.2647620 23.07 11.96 11.96 4.94 $1,804.07 $1,804.0747630 9.65 5.30 5.30 1.21 $724.82 $724.8247700 16.50 10.68 10.68 3.52 $1,388.00 $1,388.0047701 28.73 16.16 16.16 6.11 $2,303.11 $2,303.1147711 25.90 13.99 13.99 5.48 $2,048.06 $2,048.0647712 33.72 17.36 17.36 7.20 $2,630.24 $2,630.2447715 21.55 12.57 12.57 4.60 $1,749.15 $1,749.1547720 18.34 11.33 11.33 3.88 $1,516.10 $1,516.1047721 21.99 12.75 12.75 4.70 $1,781.63 $1,781.6347740 21.23 12.44 12.44 4.52 $1,725.20 $1,725.2047741 24.21 13.63 13.63 5.16 $1,941.91 $1,941.9147760 38.32 18.94 18.94 8.11 $2,948.91 $2,948.9147765 52.19 24.81 24.81 11.13 $3,974.98 $3,974.9847780 42.32 20.38 20.38 8.98 $3,233.07 $3,233.0747785 56.19 25.92 25.92 11.99 $4,243.36 $4,243.3647800 26.17 14.30 14.30 5.59 $2,079.69 $2,079.6947801 17.60 9.99 9.99 2.44 $1,348.78 $1,348.7847802 24.93 14.22 14.22 5.32 $2,008.54 $2,008.5447900 22.44 12.54 12.54 4.72 $1,792.42 $1,792.4247999 0.00 0.00 0.00 0.00 $0.00 $0.0048000 31.95 15.79 15.79 6.18 $2,429.03 $2,429.0348001 39.69 19.20 19.20 8.48 $3,039.11 $3,039.1148020 19.09 11.16 11.16 4.08 $1,550.89 $1,550.8948100 14.46 8.39 8.39 2.99 $1,166.71 $1,166.7148102 4.70 10.83 2.03 0.44 $727.10 $319.9148105 49.26 23.64 23.64 10.30 $3,751.70 $3,751.7048120 18.41 9.81 9.81 3.91 $1,450.32 $1,450.3248140 26.32 13.51 13.51 5.58 $2,049.13 $2,049.1348145 27.39 14.34 14.34 5.83 $2,146.60 $2,146.6048146 30.60 17.59 17.59 6.52 $2,471.14 $2,471.1448148 20.39 11.61 11.61 4.34 $1,641.26 $1,641.2648150 52.84 26.16 26.16 11.23 $4,070.69 $4,070.6948152 48.65 25.16 25.16 10.38 $3,799.67 $3,799.6748153 52.79 26.10 26.10 11.21 $4,064.73 $4,064.73

Updated December 2011 176 of 387 Effective January 2012

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MRA 2012

48154 48.88 25.21 25.21 10.43 $3,814.49 $3,814.4948155 29.45 17.13 17.13 6.27 $2,387.32 $2,387.3248160 0.00 0.00 0.00 0.00 $0.00 $0.0048400 1.95 1.00 1.00 0.29 $145.50 $145.5048500 18.16 11.47 11.47 3.87 $1,514.27 $1,514.2748510 17.19 10.74 10.74 3.59 $1,424.23 $1,424.2348511 3.99 23.38 1.49 0.38 $1,274.00 $261.1248520 18.15 9.95 9.95 3.84 $1,441.98 $1,441.9848540 21.94 11.55 11.55 4.67 $1,722.41 $1,722.4148545 22.23 12.17 12.17 4.75 $1,767.73 $1,767.7348547 30.38 15.36 15.36 6.46 $2,355.37 $2,355.3748548 28.09 14.46 14.46 5.97 $2,189.60 $2,189.6048550 0.00 0.00 0.00 0.00 $0.00 $0.0048551 0.00 0.00 0.00 0.00 $0.00 $0.0048552 4.30 1.70 1.70 0.90 $310.71 $310.7148554 37.80 28.90 28.90 7.89 $3,376.06 $3,376.0648556 19.47 13.48 13.48 4.15 $1,678.26 $1,678.2648999 0.00 0.00 0.00 0.00 $0.00 $0.0049000 12.54 7.40 7.40 2.57 $1,016.36 $1,016.3649002 17.63 9.14 9.14 3.66 $1,372.81 $1,372.8149010 16.06 8.33 8.33 3.20 $1,243.92 $1,243.9249020 26.67 14.30 14.30 5.42 $2,092.71 $2,092.7149021 3.37 22.79 1.26 0.31 $1,216.28 $220.0649040 16.52 9.36 9.36 3.39 $1,321.17 $1,321.1749041 3.99 23.04 1.48 0.38 $1,258.27 $260.6549060 18.53 10.01 10.01 3.69 $1,453.58 $1,453.5849061 3.69 22.78 1.37 0.34 $1,231.21 $240.5349062 12.22 7.09 7.09 2.46 $982.56 $982.5649082 1.24 3.46 0.70 0.11 $219.41 $91.7049083 2.00 6.91 0.98 0.18 $415.53 $141.1449084 2.00 0.71 0.71 0.18 $128.65 $128.6549180 1.73 2.85 0.65 0.16 $214.95 $113.1649203 20.13 10.85 10.85 3.93 $1,573.97 $1,573.9749204 26.13 13.25 13.25 5.08 $2,003.43 $2,003.4349205 30.13 14.85 14.85 6.03 $2,299.07 $2,299.0749215 37.81 18.95 18.95 7.54 $2,898.28 $2,898.2849220 15.79 9.18 9.18 3.39 $1,281.22 $1,281.2249250 9.01 6.19 6.19 1.84 $770.32 $770.3249255 12.56 8.00 8.00 2.55 $1,043.97 $1,043.9749320 5.14 3.42 3.42 1.03 $433.30 $433.30

Updated December 2011 177 of 387 Effective January 2012

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MRA 2012

49321 5.44 3.58 3.58 1.13 $458.79 $458.7949322 6.01 3.72 3.72 1.16 $491.48 $491.4849323 10.23 6.54 6.54 2.14 $854.63 $854.6349324 6.32 3.90 3.90 1.33 $521.89 $521.8949325 6.82 4.04 4.04 1.47 $557.15 $557.1549326 3.50 1.30 1.30 0.73 $248.90 $248.9049327 2.38 0.97 0.97 0.48 $172.40 $172.4049329 0.00 0.00 0.00 0.00 $0.00 $0.0049400 1.88 2.18 0.70 0.24 $194.52 $126.0449402 14.09 7.94 7.94 2.90 $1,125.28 $1,125.2849411 3.82 12.13 1.53 0.35 $744.56 $254.0849412 1.50 0.58 0.58 0.30 $107.08 $107.0849418 4.21 41.98 1.93 0.63 $2,156.90 $303.7249419 7.08 4.66 4.66 1.22 $584.38 $584.3849421 4.21 2.30 2.30 0.83 $331.02 $331.0249422 6.29 3.65 3.65 1.29 $506.99 $506.9949423 1.46 15.28 0.58 0.12 $776.38 $96.1949424 0.76 3.61 0.32 0.07 $203.52 $51.2949425 12.22 7.23 7.23 2.67 $999.72 $999.7249426 10.41 6.11 6.11 2.07 $838.97 $838.9749427 0.89 0.34 0.34 0.10 $59.37 $59.3749428 6.87 5.75 5.75 1.47 $638.44 $638.4449429 7.44 4.04 4.04 1.59 $590.11 $590.1149435 2.25 0.83 0.83 0.45 $158.76 $158.7649436 2.72 2.14 2.14 0.59 $246.86 $246.8649440 4.18 27.33 2.01 0.48 $1,470.09 $298.5049441 4.77 30.15 2.28 0.54 $1,629.18 $339.6049442 4.00 24.64 1.99 0.37 $1,332.23 $284.1849446 3.31 26.34 1.24 0.31 $1,377.95 $216.5349450 1.36 19.05 0.50 0.12 $946.49 $88.1549451 1.84 19.57 0.69 0.20 $995.41 $121.8149452 2.86 23.55 1.07 0.27 $1,227.32 $187.1449460 0.96 21.93 0.37 0.10 $1,061.41 $63.7949465 0.62 4.46 0.23 0.05 $235.77 $40.0449491 12.53 7.26 7.26 2.67 $1,014.54 $1,014.5449492 15.43 9.13 9.13 3.29 $1,258.23 $1,258.2349495 6.20 4.36 4.36 1.32 $537.47 $537.4749496 9.42 5.87 5.87 2.20 $791.59 $791.5949500 5.84 4.85 4.85 1.24 $540.48 $540.4849501 9.36 6.26 6.26 1.99 $796.35 $796.35

Updated December 2011 178 of 387 Effective January 2012

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Treatment

MRA 2012

49505 7.96 5.53 5.53 1.66 $685.14 $685.1449507 9.09 6.13 6.13 1.92 $775.08 $775.0849520 9.99 6.32 6.32 2.10 $832.02 $832.0249521 11.48 7.03 7.03 2.41 $945.18 $945.1849525 8.93 5.91 5.91 1.86 $754.92 $754.9249540 10.74 6.59 6.59 2.26 $885.14 $885.1449550 8.99 5.90 5.90 1.89 $758.58 $758.5849553 9.92 6.39 6.39 2.10 $832.22 $832.2249555 9.39 6.10 6.10 1.97 $789.23 $789.2349557 11.62 7.01 7.01 2.45 $952.36 $952.3649560 11.92 7.09 7.09 2.48 $970.58 $970.5849561 15.38 8.49 8.49 3.24 $1,223.90 $1,223.9049565 12.37 7.43 7.43 2.60 $1,011.91 $1,011.9149566 15.53 8.60 8.60 3.29 $1,238.04 $1,238.0449568 4.88 1.92 1.92 1.03 $352.63 $352.6349570 6.05 4.80 4.80 1.28 $549.29 $549.2949572 7.87 5.47 5.47 1.65 $677.96 $677.9649580 4.47 4.24 4.24 0.95 $438.15 $438.1549582 7.13 5.38 5.38 1.52 $635.12 $635.1249585 6.59 4.98 4.98 1.37 $585.59 $585.5949587 7.08 5.33 5.33 1.49 $629.12 $629.1249590 8.90 5.88 5.88 1.88 $753.25 $753.2549600 11.55 7.34 7.34 2.45 $964.59 $964.5949605 87.09 38.91 38.91 18.58 $6,518.21 $6,518.2149606 19.00 9.98 9.98 4.06 $1,491.38 $1,491.3849610 10.91 6.83 6.83 2.31 $906.15 $906.1549611 9.34 5.96 5.96 0.65 $713.44 $713.4449650 6.36 4.77 4.77 1.33 $563.88 $563.8849651 8.38 6.06 6.06 1.78 $733.96 $733.9649652 11.92 7.34 7.34 0.83 $898.21 $898.2149653 14.94 9.08 9.08 1.07 $1,121.76 $1,121.7649654 13.76 8.09 8.09 0.97 $1,019.75 $1,019.7549655 16.84 9.83 9.83 1.19 $1,244.87 $1,244.8749656 15.08 8.51 8.51 1.08 $1,101.96 $1,101.9649657 22.11 11.76 11.76 1.57 $1,581.80 $1,581.8049659 0.00 0.00 0.00 0.00 $0.00 $0.0049900 12.41 8.83 8.83 2.55 $1,075.88 $1,075.8849904 22.35 15.88 15.88 4.75 $1,944.60 $1,944.6049905 6.54 2.55 2.55 1.24 $464.38 $464.3849906 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 179 of 387 Effective January 2012

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MRA 2012

49999 0.00 0.00 0.00 0.00 $0.00 $0.0050010 12.28 7.59 7.59 1.80 $974.72 $974.7250020 18.08 10.46 10.46 2.41 $1,389.80 $1,389.8050021 3.37 24.43 1.25 0.31 $1,292.17 $219.5950040 16.68 9.04 9.04 1.69 $1,226.82 $1,226.8250045 16.82 9.08 9.08 1.62 $1,231.18 $1,231.185005F 0.00 0.00 0.00 0.00 $0.00 $0.0050060 20.95 10.77 10.77 2.01 $1,508.12 $1,508.1250065 22.32 11.18 11.18 2.16 $1,594.07 $1,594.0750070 21.85 12.07 12.07 2.12 $1,612.86 $1,612.8650075 27.09 13.46 13.46 2.63 $1,930.11 $1,930.1150080 15.74 8.49 8.49 1.55 $1,153.53 $1,153.5350081 23.50 12.03 12.03 2.31 $1,692.15 $1,692.155010F 0.00 0.00 0.00 0.00 $0.00 $0.0050100 17.45 5.31 5.31 3.73 $1,191.36 $1,191.3650120 17.21 9.17 9.17 1.66 $1,254.27 $1,254.2750125 17.82 10.89 10.89 1.71 $1,362.82 $1,362.8250130 18.82 9.94 9.94 1.82 $1,367.78 $1,367.7850135 20.59 10.60 10.60 1.99 $1,483.64 $1,483.645015F 0.00 0.00 0.00 0.00 $0.00 $0.005020F 0.00 0.00 0.00 0.00 $0.00 $0.0050200 2.63 14.87 1.32 0.31 $817.75 $190.7850205 12.29 7.34 7.34 2.40 $994.11 $994.1150220 18.68 9.96 9.96 2.25 $1,384.52 $1,384.5250225 21.88 11.13 11.13 2.38 $1,583.89 $1,583.8950230 23.81 11.67 11.67 2.45 $1,696.04 $1,696.0450234 24.05 12.02 12.02 2.44 $1,722.12 $1,722.1250236 26.94 13.83 13.83 2.64 $1,941.24 $1,941.2450240 24.21 12.56 12.56 2.42 $1,753.02 $1,753.0250250 22.22 11.77 11.77 2.18 $1,618.05 $1,618.0550280 17.09 9.32 9.32 1.86 $1,266.19 $1,266.1950290 16.15 8.56 8.56 1.57 $1,175.55 $1,175.5550300 0.00 0.00 0.00 0.00 $0.00 $0.0050320 22.43 15.72 15.72 3.88 $1,896.40 $1,896.4050323 0.00 0.00 0.00 0.00 $0.00 $0.0050325 0.00 0.00 0.00 0.00 $0.00 $0.0050327 4.00 1.56 1.56 0.78 $285.14 $285.1450328 3.50 1.38 1.38 0.67 $249.55 $249.5550329 3.34 1.33 1.33 0.48 $230.64 $230.6450340 14.04 10.56 10.56 3.01 $1,249.94 $1,249.94

Updated December 2011 180 of 387 Effective January 2012

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MRA 2012

50360 40.90 25.68 25.68 8.30 $3,382.21 $3,382.2150365 46.13 28.04 28.04 9.84 $3,796.30 $3,796.3050370 18.88 12.27 12.27 3.76 $1,576.88 $1,576.8850380 30.11 22.33 22.33 6.41 $2,663.64 $2,663.6450382 5.50 30.95 2.09 0.52 $1,696.81 $361.4150384 5.00 24.84 1.89 0.48 $1,390.39 $328.4650385 4.44 31.03 2.06 0.42 $1,649.50 $309.0250386 3.30 19.71 1.62 0.31 $1,070.73 $233.6850387 2.00 14.97 0.74 0.20 $789.50 $131.0550389 1.10 8.12 0.41 0.10 $428.46 $71.7150390 1.96 0.73 0.73 0.18 $127.84 $127.8450391 1.96 1.50 0.77 0.20 $164.49 $130.7150392 3.37 1.61 1.61 0.31 $236.25 $236.2550393 4.15 1.90 1.90 0.38 $287.02 $287.0250394 0.76 2.19 0.64 0.07 $137.82 $66.1050395 3.37 1.64 1.64 0.33 $238.66 $238.6650396 2.09 1.16 1.16 0.20 $154.39 $154.3950398 1.46 13.98 0.58 0.12 $716.22 $96.1950400 21.27 10.89 10.89 2.10 $1,532.11 $1,532.1150405 25.86 12.98 12.98 2.50 $1,848.00 $1,848.005050F 0.00 0.00 0.00 0.00 $0.00 $0.0050500 21.22 11.73 11.73 4.52 $1,691.92 $1,691.9250520 18.88 9.88 9.88 1.84 $1,368.62 $1,368.6250525 24.39 11.99 11.99 5.20 $1,875.86 $1,875.8650526 26.31 13.49 13.49 1.86 $1,858.54 $1,858.5450540 21.10 10.66 10.66 2.03 $1,510.55 $1,510.5550541 16.86 8.68 8.68 1.70 $1,218.47 $1,218.4750542 21.36 11.10 11.10 2.10 $1,545.73 $1,545.7350543 27.41 13.99 13.99 2.72 $1,973.07 $1,973.0750544 23.37 11.28 11.28 2.31 $1,651.81 $1,651.8150545 25.06 12.16 12.16 2.55 $1,777.95 $1,777.9550546 21.87 11.41 11.41 2.30 $1,592.34 $1,592.3450547 26.34 15.92 15.92 4.83 $2,123.36 $2,123.3650548 25.36 12.06 12.06 2.50 $1,783.77 $1,783.7750549 0.00 0.00 0.00 0.00 $0.00 $0.0050551 5.59 4.56 2.61 0.54 $480.62 $390.3950553 5.98 4.80 2.73 0.65 $514.21 $418.4350555 6.52 5.08 2.98 0.63 $549.55 $452.3850557 6.61 5.20 3.02 0.64 $559.51 $458.6350561 7.58 5.81 3.39 0.75 $635.35 $523.37

Updated December 2011 181 of 387 Effective January 2012

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MRA 2012

50562 10.90 5.31 5.31 1.06 $771.80 $771.8050570 9.53 4.14 4.14 0.91 $650.68 $650.6850572 10.33 4.46 4.46 1.01 $705.23 $705.2350574 11.00 4.72 4.72 1.08 $749.85 $749.8550575 13.96 5.90 5.90 1.36 $946.91 $946.9150576 10.97 4.72 4.72 1.06 $747.53 $747.5350580 11.84 5.03 5.03 1.16 $804.65 $804.6550590 9.77 13.42 6.02 0.95 $1,092.51 $750.1150592 6.80 89.05 3.26 0.64 $4,447.60 $477.9750593 9.13 127.80 4.10 0.86 $6,352.74 $628.965060F 0.00 0.00 0.00 0.00 $0.00 $0.0050600 17.17 8.91 8.91 1.66 $1,240.51 $1,240.5150605 16.79 9.29 9.29 2.65 $1,291.99 $1,291.9950610 17.25 9.07 9.07 1.66 $1,251.38 $1,251.385062F 0.00 0.00 0.00 0.00 $0.00 $0.0050620 16.43 8.74 8.74 1.59 $1,197.02 $1,197.0250630 16.21 8.55 8.55 1.57 $1,177.68 $1,177.6850650 18.82 9.95 9.95 1.89 $1,371.80 $1,371.8050660 21.02 10.75 10.75 2.03 $1,511.24 $1,511.2450684 0.76 2.94 0.65 0.07 $172.52 $66.5650686 1.51 2.47 0.98 0.22 $190.89 $121.9550688 1.20 1.05 1.05 0.11 $106.16 $106.1650690 1.16 1.62 0.80 0.10 $130.30 $92.3550700 16.69 9.06 9.06 1.62 $1,224.62 $1,224.6250715 20.64 11.30 11.30 3.01 $1,570.08 $1,570.0850722 17.95 10.11 10.11 3.05 $1,400.53 $1,400.5350725 20.20 10.28 10.28 1.95 $1,449.91 $1,449.9150727 8.28 5.89 5.89 0.84 $673.95 $673.9550728 12.18 7.21 7.21 1.18 $921.27 $921.2750740 20.07 11.57 11.57 4.29 $1,623.00 $1,623.0050750 21.22 10.91 10.91 2.04 $1,527.82 $1,527.8250760 20.07 10.60 10.60 2.67 $1,495.71 $1,495.7150770 21.22 10.58 10.58 2.04 $1,512.55 $1,512.5550780 19.95 10.47 10.47 2.31 $1,466.18 $1,466.1850782 19.66 10.10 10.10 4.19 $1,532.13 $1,532.1350783 20.70 10.34 10.34 2.00 $1,476.89 $1,476.8950785 22.23 11.33 11.33 2.25 $1,601.69 $1,601.6950800 16.41 9.25 9.25 1.74 $1,227.39 $1,227.3950810 22.61 13.48 13.48 4.83 $1,848.88 $1,848.8850815 22.26 11.74 11.74 2.16 $1,617.38 $1,617.38

Updated December 2011 182 of 387 Effective January 2012

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MRA 2012

50820 24.07 12.23 12.23 2.65 $1,743.39 $1,743.3950825 30.68 15.24 15.24 3.17 $2,195.45 $2,195.4550830 33.77 16.10 16.10 3.29 $2,375.21 $2,375.2150840 22.39 11.82 11.82 2.18 $1,627.73 $1,627.7350845 22.46 12.35 12.35 2.18 $1,655.29 $1,655.2950860 17.08 9.20 9.20 1.65 $1,249.52 $1,249.5250900 15.04 8.51 8.51 1.47 $1,120.06 $1,120.0650920 15.81 8.73 8.73 1.54 $1,167.16 $1,167.1650930 20.19 11.66 11.66 4.30 $1,632.87 $1,632.8750940 15.93 8.72 8.72 1.55 $1,172.40 $1,172.4050945 17.97 9.10 9.10 1.74 $1,288.02 $1,288.0250947 25.78 12.58 12.58 2.50 $1,826.03 $1,826.0350948 23.82 11.67 11.67 2.30 $1,688.84 $1,688.8450949 0.00 0.00 0.00 0.00 $0.00 $0.0050951 5.83 4.78 2.72 0.56 $502.21 $406.8950953 6.23 5.01 3.24 0.61 $532.73 $450.8350955 6.74 5.37 3.46 0.65 $573.51 $485.1350957 6.78 5.30 3.08 0.65 $572.01 $469.2850961 6.04 4.86 2.80 0.59 $516.54 $421.2250970 7.13 3.19 3.19 0.68 $491.06 $491.0650972 6.88 3.08 3.08 0.67 $474.63 $474.6350974 9.16 4.00 4.00 0.88 $626.65 $626.6550976 9.03 3.93 3.93 0.87 $617.27 $617.2750980 6.84 3.08 3.08 0.65 $471.88 $471.885100F 0.00 0.00 0.00 0.00 $0.00 $0.0051020 7.69 5.45 5.45 0.78 $624.98 $624.9851030 7.81 5.19 5.19 0.75 $616.62 $616.6251040 4.49 3.67 3.67 0.44 $386.70 $386.7051045 7.81 5.63 5.63 1.06 $652.75 $652.7551050 7.97 5.25 5.25 0.78 $627.85 $627.8551060 9.95 6.30 6.30 0.98 $772.38 $772.3851065 9.95 6.20 6.20 0.98 $767.76 $767.7651080 6.71 4.72 4.72 0.65 $542.14 $542.1451100 0.78 0.96 0.29 0.08 $82.28 $51.2851101 1.02 2.62 0.42 0.12 $171.52 $69.7251102 2.70 3.82 1.35 0.29 $308.47 $194.1851500 11.05 7.71 7.71 1.08 $890.36 $890.3651520 10.21 6.32 6.32 0.99 $785.08 $785.0851525 15.42 8.49 8.49 1.57 $1,140.69 $1,140.6951530 13.71 7.89 7.89 1.65 $1,042.92 $1,042.92

Updated December 2011 183 of 387 Effective January 2012

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MRA 2012

51535 13.90 7.73 7.73 1.33 $1,027.47 $1,027.4751550 17.23 9.25 9.25 2.14 $1,283.25 $1,283.2551555 23.18 11.81 11.81 2.60 $1,682.86 $1,682.8651565 23.68 12.22 12.22 2.42 $1,714.33 $1,714.3351570 27.46 13.42 13.42 2.80 $1,952.93 $1,952.9351575 34.18 16.39 16.39 3.35 $2,409.44 $2,409.4451580 35.37 17.34 17.34 3.44 $2,509.52 $2,509.5251585 39.64 19.02 19.02 3.85 $2,793.09 $2,793.0951590 36.33 17.22 17.22 3.67 $2,557.26 $2,557.2651595 41.32 19.42 19.42 4.11 $2,897.60 $2,897.6051596 44.26 21.06 21.06 4.34 $3,112.54 $3,112.5451597 42.86 20.52 20.52 4.53 $3,036.57 $3,036.5751600 0.88 4.69 0.34 0.08 $259.20 $57.9251605 0.64 0.44 0.44 0.05 $50.63 $50.6351610 1.05 2.07 0.74 0.10 $146.35 $84.8151700 0.88 1.53 0.35 0.08 $112.99 $58.3951701 0.50 1.13 0.26 0.05 $76.49 $36.2351702 0.50 1.62 0.34 0.05 $99.16 $39.9451703 1.47 2.32 0.80 0.14 $178.15 $107.8251705 0.90 1.62 0.52 0.09 $118.52 $67.6351710 1.35 1.24 0.84 0.12 $121.96 $103.4551715 3.73 4.51 1.81 0.39 $390.10 $265.1751720 1.50 1.63 0.74 0.14 $147.52 $106.3451725 1.51 4.23 4.23 0.13 $267.75 $267.7551725 TC 0.00 3.61 3.61 0.01 $167.55 $167.5551725 26 1.51 0.62 0.62 0.12 $100.20 $100.2051726 1.71 6.73 6.73 0.17 $394.13 $394.1351726 TC 0.00 6.04 6.04 0.03 $281.01 $281.0151726 26 1.71 0.69 0.69 0.14 $113.12 $113.1251727 2.11 6.94 6.94 0.23 $424.23 $424.2351727 TC 0.00 6.08 6.08 0.01 $281.84 $281.8451727 26 2.11 0.86 0.86 0.22 $142.39 $142.3951728 2.11 6.94 6.94 0.19 $422.19 $422.1951728 TC 0.00 6.16 6.16 0.01 $285.54 $285.5451728 26 2.11 0.78 0.78 0.18 $136.65 $136.6551729 2.51 7.32 7.32 0.25 $460.15 $460.1551729 TC 0.00 6.33 6.33 0.01 $293.41 $293.4151729 26 2.51 0.99 0.99 0.24 $166.75 $166.7551736 0.17 0.45 0.45 0.02 $29.20 $29.2051736 TC 0.00 0.33 0.33 0.01 $15.78 $15.78

Updated December 2011 184 of 387 Effective January 2012

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MRA 2012

51736 26 0.17 0.12 0.12 0.01 $13.43 $13.4351741 0.17 0.55 0.55 0.02 $33.83 $33.8351741 TC 0.00 0.37 0.37 0.01 $17.63 $17.6351741 26 0.17 0.18 0.18 0.01 $16.20 $16.2051784 1.53 4.26 4.26 0.13 $270.01 $270.0151784 TC 0.00 3.64 3.64 0.01 $168.94 $168.9451784 26 1.53 0.62 0.62 0.12 $101.07 $101.0751785 1.53 5.35 5.35 0.13 $320.44 $320.4451785 TC 0.00 4.70 4.70 0.01 $217.98 $217.9851785 26 1.53 0.65 0.65 0.12 $102.46 $102.4651792 1.10 5.40 5.40 0.11 $303.11 $303.1151792 TC 0.00 4.95 4.95 0.01 $229.55 $229.5551792 26 1.10 0.45 0.45 0.10 $73.56 $73.5651797 0.80 2.77 2.77 0.06 $165.88 $165.8851797 TC 0.00 2.43 2.43 0.01 $112.95 $112.9551797 26 0.80 0.34 0.34 0.05 $52.93 $52.9351798 0.00 0.56 0.56 0.01 $26.42 $26.4251800 18.89 10.10 10.10 1.95 $1,384.83 $1,384.8351820 19.59 10.29 10.29 1.89 $1,420.89 $1,420.8951840 11.36 6.81 6.81 1.50 $883.51 $883.5151841 13.68 7.85 7.85 1.84 $1,049.43 $1,049.4351845 10.15 6.15 6.15 1.20 $785.30 $785.3051860 12.60 7.71 7.71 1.85 $996.68 $996.6851865 15.80 8.84 8.84 1.92 $1,191.15 $1,191.1551880 7.87 5.06 5.06 0.99 $625.41 $625.4151900 14.63 8.46 8.46 1.42 $1,097.45 $1,097.4551920 13.41 7.73 7.73 1.29 $1,004.21 $1,004.2151925 17.53 9.73 9.73 2.97 $1,360.68 $1,360.6851940 30.66 14.52 14.52 2.98 $2,151.61 $2,151.6151960 25.40 13.15 13.15 2.65 $1,843.57 $1,843.5751980 12.57 7.29 7.29 1.22 $943.90 $943.9051990 13.36 7.37 7.37 1.77 $1,009.80 $1,009.8051992 14.87 8.29 8.29 2.23 $1,141.18 $1,141.1851999 0.00 0.00 0.00 0.00 $0.00 $0.005200F 0.00 0.00 0.00 0.00 $0.00 $0.0052000 2.23 3.63 1.28 0.23 $276.27 $167.5352001 5.44 5.09 2.55 0.53 $498.14 $380.6152005 2.37 5.68 1.34 0.24 $377.70 $176.8852007 3.02 10.95 1.60 0.30 $652.76 $220.1252010 3.02 8.13 1.56 0.30 $522.27 $218.27

Updated December 2011 185 of 387 Effective January 2012

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Treatment

MRA 2012

52204 2.59 8.75 1.35 0.26 $530.30 $187.8952214 3.70 14.77 1.97 0.35 $861.51 $269.2452224 3.14 16.51 1.58 0.31 $915.73 $224.9052234 4.62 2.24 2.24 0.44 $326.16 $326.1652235 5.44 2.60 2.60 0.53 $382.92 $382.9252240 9.71 4.29 4.29 0.95 $667.46 $667.4652250 4.49 2.26 2.26 0.45 $321.97 $321.9752260 3.91 1.95 1.95 0.39 $279.45 $279.4552265 2.94 8.17 1.57 0.35 $523.20 $217.8152270 3.36 7.28 1.71 0.33 $499.19 $241.4652275 4.69 9.74 2.24 0.45 $676.74 $329.7052276 4.99 2.41 2.41 0.49 $352.60 $352.6052277 6.16 2.91 2.91 0.60 $432.02 $432.0252281 2.75 5.32 1.50 0.29 $380.04 $203.2952282 6.39 2.99 2.99 0.65 $448.22 $448.2252283 3.73 4.12 1.87 0.37 $371.04 $266.9352285 3.60 4.35 1.85 0.37 $376.05 $260.3752290 4.58 2.23 2.23 0.44 $323.97 $323.9752300 5.30 2.59 2.59 0.56 $377.92 $377.9252301 5.50 2.66 2.66 0.53 $388.30 $388.3052305 5.30 2.46 2.46 0.52 $369.87 $369.8752310 2.81 4.18 1.41 0.29 $329.89 $201.7252315 5.20 6.78 2.44 0.50 $564.41 $363.5952317 6.71 17.89 2.95 0.65 $1,151.53 $460.2452318 9.18 3.99 3.99 0.88 $627.06 $627.0652320 4.69 2.17 2.17 0.45 $326.47 $326.4752325 6.15 2.78 2.78 0.60 $425.57 $425.5752327 5.18 2.10 2.10 0.52 $348.01 $348.0152330 5.03 11.52 2.31 0.49 $775.87 $349.7152332 2.82 11.83 1.52 0.28 $683.79 $206.7452334 4.82 2.32 2.32 0.48 $340.56 $340.5652341 5.35 2.72 2.72 0.52 $384.07 $384.0752342 5.85 2.92 2.92 0.56 $417.01 $417.0152343 6.55 3.20 3.20 0.64 $464.36 $464.3652344 7.05 3.56 3.56 0.68 $504.72 $504.7252345 7.55 3.76 3.76 0.72 $537.66 $537.6652346 8.58 4.20 4.20 0.83 $608.24 $608.2452351 5.85 2.91 2.91 0.56 $416.55 $416.5552352 6.87 3.41 3.41 0.67 $489.47 $489.4752353 7.96 3.84 3.84 0.76 $561.16 $561.16

Updated December 2011 186 of 387 Effective January 2012

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Treatment

MRA 2012

52354 7.33 3.59 3.59 0.71 $519.76 $519.7652355 8.81 4.18 4.18 0.86 $618.80 $618.8052400 8.69 4.67 4.67 0.84 $635.26 $635.2652402 5.27 2.14 2.14 0.50 $352.75 $352.7552450 7.78 5.39 5.39 0.75 $624.58 $624.585250F 0.00 0.00 0.00 0.00 $0.00 $0.0052500 8.14 5.55 5.55 0.78 $649.10 $649.1052601 15.26 8.14 8.14 1.50 $1,114.00 $1,114.0052630 6.55 4.68 4.68 0.64 $532.85 $532.8552640 4.79 3.98 3.98 0.45 $414.55 $414.5552647 11.30 44.16 6.77 1.10 $2,588.81 $858.7252648 12.15 44.71 7.10 1.20 $2,656.16 $915.8952649 14.56 8.74 8.74 1.41 $1,106.86 $1,106.8652700 7.49 4.91 4.91 0.72 $588.28 $588.2853000 2.33 1.84 1.84 0.24 $198.28 $198.2853010 4.45 3.87 3.87 0.42 $393.20 $393.2053020 1.77 0.93 0.93 0.18 $128.86 $128.8653025 1.13 0.81 0.81 0.07 $89.99 $89.9953040 6.55 4.44 4.44 0.64 $521.74 $521.7453060 2.68 2.44 1.87 0.44 $251.38 $225.0053080 6.92 4.98 4.98 0.67 $564.28 $564.2853085 11.18 6.63 6.63 1.46 $865.35 $865.3553200 2.59 1.75 1.34 0.27 $206.91 $187.9353210 13.72 7.88 7.88 1.32 $1,026.10 $1,026.1053215 16.85 9.01 9.01 1.63 $1,229.75 $1,229.7553220 7.63 5.13 5.13 0.73 $605.03 $605.0353230 10.44 6.47 6.47 1.17 $811.14 $811.1453235 10.99 6.73 6.73 1.06 $841.40 $841.4053240 7.08 4.85 4.85 0.68 $565.71 $565.7153250 6.52 4.59 4.59 1.42 $567.06 $567.0653260 3.03 2.62 1.98 0.35 $270.29 $240.6853265 3.17 2.99 2.01 0.34 $292.97 $247.6253270 3.14 2.59 1.94 0.53 $282.82 $252.7553275 4.57 2.78 2.78 0.45 $349.49 $349.4953400 14.13 8.26 8.26 1.42 $1,066.53 $1,066.5353405 15.66 8.72 8.72 1.52 $1,159.18 $1,159.1853410 17.68 9.57 9.57 1.71 $1,295.68 $1,295.6853415 20.70 10.77 10.77 2.04 $1,498.82 $1,498.8253420 15.17 7.94 7.94 1.48 $1,099.83 $1,099.8353425 17.07 9.06 9.06 1.65 $1,242.61 $1,242.61

Updated December 2011 187 of 387 Effective January 2012

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MRA 2012

53430 17.43 9.24 9.24 1.97 $1,282.81 $1,282.8153431 21.18 10.93 10.93 2.04 $1,527.01 $1,527.0153440 13.36 8.03 8.03 1.31 $1,016.94 $1,016.9453442 13.49 8.33 8.33 1.31 $1,036.45 $1,036.4553444 14.19 7.94 7.94 1.37 $1,051.78 $1,051.7853445 13.00 8.45 8.45 1.28 $1,019.25 $1,019.2553446 11.02 6.95 6.95 1.09 $854.41 $854.4153447 14.28 8.31 8.31 1.40 $1,074.33 $1,074.3353448 23.44 12.21 12.21 2.26 $1,695.33 $1,695.3353449 10.56 6.54 6.54 1.05 $813.48 $813.4853450 6.77 4.71 4.71 0.65 $544.27 $544.2753460 7.75 5.07 5.07 0.73 $607.45 $607.4553500 13.00 7.80 7.80 1.50 $1,000.37 $1,000.3753502 8.26 5.32 5.32 0.80 $644.67 $644.6753505 8.26 5.35 5.35 0.80 $646.06 $646.0653510 10.96 6.68 6.68 1.06 $837.79 $837.7953515 14.22 7.93 7.93 1.37 $1,052.62 $1,052.6253520 9.48 6.09 6.09 0.91 $738.75 $738.7553600 1.21 1.16 0.57 0.11 $111.69 $84.3953601 0.98 1.35 0.51 0.08 $108.99 $70.1253605 1.28 0.50 0.50 0.12 $84.69 $84.6953620 1.62 1.72 0.81 0.16 $157.90 $115.8053621 1.35 1.82 0.66 0.12 $148.80 $95.1253660 0.71 1.34 0.45 0.07 $96.32 $55.1453661 0.72 1.30 0.41 0.07 $94.90 $53.7253665 0.76 0.30 0.30 0.08 $50.87 $50.8753850 10.08 52.39 5.77 0.99 $2,911.18 $754.0053852 10.83 49.36 6.54 1.06 $2,807.02 $825.6853855 1.64 20.43 0.59 0.16 $1,024.51 $106.4853860 3.97 40.16 2.23 0.68 $2,064.83 $309.7553899 0.00 0.00 0.00 0.00 $0.00 $0.0054000 1.59 2.73 1.46 0.14 $202.32 $143.5554001 2.24 3.09 1.65 0.23 $251.71 $185.0854015 5.36 3.20 3.20 0.56 $408.74 $408.7454050 1.29 2.41 1.63 0.16 $175.53 $139.4454055 1.25 2.11 1.33 0.14 $158.90 $122.8154056 1.29 2.70 1.81 0.18 $189.97 $148.7954057 1.29 2.66 1.37 0.12 $185.07 $125.3854060 1.98 3.20 1.67 0.22 $245.03 $174.2454065 2.47 3.73 2.31 0.31 $295.36 $229.65

Updated December 2011 188 of 387 Effective January 2012

CPT©1/HCPCS

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MRA 2012

54100 1.90 3.74 1.60 0.24 $267.57 $168.5554105 3.54 4.02 2.42 0.35 $357.16 $283.1354110 10.92 6.50 6.50 1.06 $827.73 $827.7354111 14.42 7.91 7.91 1.40 $1,061.88 $1,061.8854112 16.98 9.18 9.18 1.63 $1,243.24 $1,243.2454115 6.95 5.77 4.94 0.67 $602.13 $563.7354120 11.01 6.63 6.63 1.09 $839.17 $839.1754125 14.56 8.05 8.05 1.48 $1,078.49 $1,078.4954130 21.84 11.39 11.39 2.12 $1,580.96 $1,580.9654135 28.17 15.03 15.03 2.74 $2,055.13 $2,055.1354150 1.90 2.65 0.79 0.23 $216.63 $130.5654160 2.53 3.85 1.49 0.24 $299.95 $190.7554161 3.32 2.19 2.19 0.34 $262.45 $262.4554162 3.32 4.11 2.24 0.33 $350.78 $264.2554163 3.32 2.85 2.85 0.33 $292.48 $292.4854164 2.82 2.63 2.63 0.29 $258.61 $258.6154200 1.11 2.00 1.29 0.10 $145.71 $112.8654205 8.97 5.99 5.99 0.86 $709.48 $709.4854220 2.42 3.42 1.32 0.26 $276.31 $179.1454230 1.34 1.40 0.90 0.12 $128.93 $105.8054231 2.04 1.92 1.22 0.20 $187.39 $155.0054235 1.19 1.37 0.88 0.11 $120.54 $97.8654240 1.31 1.54 1.54 0.09 $132.58 $132.5854240 TC 0.00 1.03 1.03 0.01 $48.17 $48.1754240 26 1.31 0.51 0.51 0.08 $84.42 $84.4254250 2.22 1.21 1.21 0.15 $159.79 $159.7954250 TC 0.00 0.33 0.33 0.01 $15.78 $15.7854250 26 2.22 0.88 0.88 0.14 $144.01 $144.0154300 11.20 6.79 6.79 1.09 $854.80 $854.8054304 13.28 7.73 7.73 1.28 $998.07 $998.0754308 12.62 7.99 7.99 1.22 $978.45 $978.4554312 14.51 8.42 8.42 1.40 $1,089.38 $1,089.3854316 18.05 10.63 10.63 1.74 $1,362.28 $1,362.2854318 12.43 7.48 7.48 0.87 $928.82 $928.8254322 13.98 7.87 7.87 1.36 $1,038.94 $1,038.9454324 17.55 9.55 9.55 1.69 $1,288.11 $1,288.1154326 17.02 9.14 9.14 1.65 $1,244.14 $1,244.1454328 16.89 9.29 9.29 1.63 $1,244.43 $1,244.4354332 18.37 9.95 9.95 1.78 $1,346.72 $1,346.7254336 21.62 11.09 11.09 2.10 $1,556.53 $1,556.53

Updated December 2011 189 of 387 Effective January 2012

CPT©1/HCPCS

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Facility All OtherMed Services And

Treatment

MRA 2012

54340 9.71 6.20 6.20 0.93 $754.82 $754.8254344 17.06 9.46 9.46 1.65 $1,260.68 $1,260.6854348 18.32 10.05 10.05 1.29 $1,324.25 $1,324.2554352 26.13 13.43 13.43 2.55 $1,883.06 $1,883.0654360 12.78 7.41 7.41 1.24 $959.56 $959.5654380 14.18 10.69 10.69 1.37 $1,178.59 $1,178.5954385 16.56 10.53 10.53 2.42 $1,327.70 $1,327.7054390 22.77 12.20 12.20 2.20 $1,662.79 $1,662.7954400 9.17 5.67 5.67 0.88 $704.36 $704.3654401 10.44 8.02 8.02 1.03 $875.74 $875.7454405 14.52 8.03 8.03 1.42 $1,072.78 $1,072.7854406 12.89 7.50 7.50 1.25 $969.00 $969.0054408 13.91 8.14 8.14 1.37 $1,048.91 $1,048.9154410 15.18 8.84 8.84 1.48 $1,141.91 $1,141.9154411 18.35 10.23 10.23 1.78 $1,358.81 $1,358.8154415 8.88 5.93 5.93 0.86 $702.81 $702.8154416 12.08 7.80 7.80 1.18 $944.23 $944.2354417 16.10 8.95 8.95 1.57 $1,191.43 $1,191.4354420 12.39 7.33 7.33 1.21 $937.44 $937.4454430 11.06 6.87 6.87 1.08 $851.93 $851.9354435 6.81 4.91 4.91 0.65 $555.26 $555.2654440 0.00 0.00 0.00 0.00 $0.00 $0.0054450 1.12 0.86 0.48 0.10 $93.40 $75.8154500 1.31 0.78 0.78 0.12 $98.94 $98.9454505 3.50 2.40 2.40 0.34 $279.96 $279.9654512 9.33 5.73 5.73 0.93 $716.61 $716.6154520 5.30 3.80 3.80 0.61 $436.45 $436.4554522 10.25 6.12 6.12 1.01 $778.58 $778.5854530 8.46 5.69 5.69 0.87 $674.02 $674.0254535 13.19 7.47 7.47 1.28 $982.14 $982.1454550 8.41 5.32 5.32 0.82 $652.19 $652.1954560 12.10 8.05 8.05 1.18 $956.67 $956.6754600 7.64 5.04 5.04 0.73 $601.30 $601.3054620 5.21 3.19 3.19 0.50 $398.73 $398.7354640 7.73 5.57 5.57 0.87 $636.84 $636.8454650 12.39 7.42 7.42 1.21 $941.61 $941.6154660 5.74 4.28 4.28 0.54 $474.16 $474.1654670 6.65 4.71 4.71 0.64 $538.57 $538.5754680 14.04 7.82 7.82 1.36 $1,039.22 $1,039.2254690 11.70 7.45 7.45 2.48 $977.71 $977.71

Updated December 2011 190 of 387 Effective January 2012

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Facility All OtherMed Services And

Treatment

MRA 2012

54692 13.74 7.44 7.44 1.32 $1,006.61 $1,006.6154699 0.00 0.00 0.00 0.00 $0.00 $0.0054700 3.47 2.48 2.48 0.39 $284.91 $284.9154800 2.33 1.21 1.21 0.33 $173.71 $173.7154830 6.01 4.42 4.42 0.63 $496.91 $496.9154840 5.27 3.75 3.75 0.52 $428.26 $428.2654860 6.95 4.79 4.79 0.68 $557.30 $557.3054861 9.70 6.12 6.12 0.93 $750.68 $750.6854865 5.77 4.30 4.30 0.56 $477.40 $477.4054900 14.20 7.73 7.73 1.02 $1,024.69 $1,024.6954901 19.10 10.35 10.35 1.36 $1,375.48 $1,375.4855000 1.43 1.95 0.94 0.14 $159.30 $112.5655040 5.45 4.01 4.01 0.61 $452.67 $452.6755041 8.54 5.69 5.69 0.90 $679.01 $679.0155060 6.15 4.47 4.47 0.67 $507.33 $507.3355100 2.45 3.71 2.19 0.30 $293.06 $222.7355110 6.33 4.51 4.51 0.68 $517.48 $517.4855120 5.72 4.33 4.33 0.61 $479.17 $479.1755150 8.14 5.57 5.57 0.86 $654.09 $654.0955175 5.87 4.31 4.31 0.60 $484.23 $484.2355180 11.78 7.51 7.51 1.29 $923.42 $923.4255200 4.55 8.42 3.23 0.44 $609.09 $368.9455250 3.37 8.16 3.04 0.33 $540.35 $303.4455300 3.50 1.64 1.64 0.34 $244.80 $244.8055400 8.61 5.36 5.36 0.83 $663.21 $663.2155450 4.43 5.98 2.74 0.42 $489.97 $340.0555500 6.22 4.63 4.63 0.88 $528.44 $528.4455520 6.66 5.19 5.19 1.36 $597.83 $597.8355530 5.75 4.13 4.13 0.63 $472.23 $472.2355535 7.19 4.84 4.84 0.69 $570.52 $570.5255540 8.30 5.79 5.79 1.65 $711.39 $711.3955550 7.20 4.73 4.73 0.69 $565.86 $565.8655559 0.00 0.00 0.00 0.00 $0.00 $0.0055600 7.01 4.81 4.81 0.68 $560.82 $560.8255605 8.76 5.67 5.67 0.84 $684.56 $684.5655650 12.65 7.33 7.33 1.22 $949.21 $949.2155680 5.67 3.97 3.97 0.54 $456.78 $456.7855700 2.58 3.75 1.28 0.26 $298.51 $184.2255705 4.61 2.85 2.85 0.45 $354.46 $354.4655706 6.28 4.26 4.26 0.44 $491.54 $491.54

Updated December 2011 191 of 387 Effective January 2012

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Facility All OtherMed Services And

Treatment

MRA 2012

55720 7.73 4.91 4.91 0.73 $599.18 $599.1855725 10.05 6.51 6.51 0.98 $786.43 $786.4355801 19.80 10.60 10.60 1.92 $1,445.86 $1,445.8655810 24.29 12.23 12.23 2.48 $1,744.27 $1,744.2755812 29.89 14.85 14.85 2.91 $2,129.96 $2,129.9655815 32.95 16.07 16.07 3.20 $2,333.72 $2,333.7255821 15.76 8.59 8.59 1.55 $1,159.02 $1,159.0255831 17.19 9.15 9.15 1.66 $1,252.48 $1,252.4855840 24.63 12.58 12.58 2.41 $1,771.63 $1,771.6355842 26.49 13.36 13.36 2.60 $1,897.96 $1,897.9655845 30.67 14.74 14.74 3.04 $2,165.27 $2,165.2755860 15.84 8.53 8.53 1.52 $1,158.19 $1,158.1955862 20.04 10.54 10.54 1.93 $1,453.99 $1,453.9955865 24.57 12.60 12.60 2.38 $1,768.43 $1,768.4355866 32.06 16.13 16.13 3.18 $2,296.92 $2,296.9255870 2.58 2.37 1.40 0.26 $234.65 $189.7755873 13.60 182.27 8.81 1.36 $9,092.22 $1,065.9755875 13.46 7.81 7.81 1.29 $1,010.07 $1,010.0755876 1.73 2.13 1.09 0.16 $181.64 $133.5255899 0.00 0.00 0.00 0.00 $0.00 $0.0055920 8.31 3.70 3.70 0.80 $571.88 $571.8855970 0.00 0.00 0.00 0.00 $0.00 $0.0055980 0.00 0.00 0.00 0.00 $0.00 $0.0056405 1.49 1.52 1.48 0.26 $148.10 $146.2556420 1.44 1.97 1.05 0.24 $165.74 $123.1756440 2.89 2.08 2.08 0.49 $246.36 $246.3656441 2.02 1.99 1.81 0.29 $194.34 $186.0156442 0.68 0.65 0.65 0.11 $65.13 $65.1356501 1.58 2.05 1.57 0.27 $177.03 $154.8256515 3.08 3.10 2.35 0.50 $302.30 $267.5956605 1.10 1.18 0.52 0.18 $111.41 $80.8756606 0.55 0.48 0.24 0.08 $50.11 $39.0056620 7.53 6.24 6.24 1.27 $679.53 $679.5356625 9.68 6.69 6.69 1.62 $811.29 $811.2956630 14.80 9.13 9.13 2.56 $1,193.80 $1,193.8056631 18.99 11.39 11.39 3.21 $1,512.95 $1,512.9556632 21.86 13.48 13.48 3.70 $1,758.91 $1,758.9156633 19.62 11.48 11.48 3.32 $1,550.00 $1,550.0056634 20.66 12.35 12.35 3.50 $1,644.46 $1,644.4656637 24.75 13.85 13.85 4.18 $1,925.63 $1,925.63

Updated December 2011 192 of 387 Effective January 2012

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Facility All OtherMed Services And

Treatment

MRA 2012

56640 24.78 13.70 13.70 4.18 $1,919.99 $1,919.9956700 2.84 2.28 2.28 0.48 $252.94 $252.9456740 4.88 3.17 3.17 0.83 $400.30 $400.3056800 3.93 2.61 2.61 0.64 $323.57 $323.5756805 19.88 11.02 11.02 3.38 $1,543.03 $1,543.0356810 4.29 2.76 2.76 0.69 $348.65 $348.6556820 1.50 1.54 0.79 0.26 $149.46 $114.7656821 2.05 1.98 1.03 0.34 $197.72 $153.7657000 3.02 1.99 1.99 0.50 $248.34 $248.3457010 6.84 4.97 4.97 1.16 $585.28 $585.2857020 1.50 1.04 0.68 0.26 $126.33 $109.6757022 2.73 1.83 1.83 0.45 $225.83 $225.8357023 5.18 3.24 3.24 0.87 $418.57 $418.5757061 1.30 1.88 1.41 0.22 $154.50 $132.7557065 2.66 2.63 2.01 0.44 $259.30 $230.6257100 1.20 1.22 0.56 0.20 $118.61 $88.0757105 1.74 2.00 1.70 0.29 $182.67 $168.7957106 7.50 5.66 5.66 1.21 $648.34 $648.3457107 24.56 13.16 13.16 4.15 $1,883.95 $1,883.9557109 28.40 14.68 14.68 4.80 $2,153.69 $2,153.6957110 15.48 8.72 8.72 2.59 $1,205.81 $1,205.8157111 28.40 14.82 14.82 4.80 $2,160.17 $2,160.1757112 30.52 15.68 15.68 2.42 $2,170.73 $2,170.7357120 8.28 5.60 5.60 1.36 $686.98 $686.9857130 2.46 2.45 1.90 0.41 $240.79 $215.3457135 2.70 2.57 2.00 0.44 $258.26 $231.8957150 0.55 0.75 0.24 0.08 $62.60 $39.0057155 5.40 6.77 2.32 0.48 $571.60 $365.6957156 2.69 2.67 1.24 0.23 $251.77 $185.6057160 0.89 1.25 0.38 0.14 $103.51 $63.2657170 0.91 0.81 0.39 0.14 $84.02 $64.5957180 1.63 2.31 1.26 0.27 $191.23 $142.6557200 4.42 3.75 3.75 0.71 $401.10 $401.1057210 5.71 4.29 4.29 0.91 $492.15 $492.1557220 4.85 3.89 3.89 0.80 $430.79 $430.7957230 6.30 4.52 4.52 1.06 $535.98 $535.9857240 11.50 6.67 6.67 1.63 $889.71 $889.7157250 11.50 6.69 6.69 1.86 $902.34 $902.3457260 14.44 7.94 7.94 2.34 $1,111.95 $1,111.9557265 15.94 8.64 8.64 2.57 $1,221.02 $1,221.02

Updated December 2011 193 of 387 Effective January 2012

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Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

57267 4.88 2.07 2.07 0.72 $343.80 $343.8057268 7.57 5.59 5.59 1.22 $648.64 $648.6457270 13.67 7.89 7.89 2.25 $1,071.71 $1,071.7157280 16.72 9.12 9.12 2.60 $1,278.55 $1,278.5557282 7.97 5.72 5.72 1.24 $673.00 $673.0057283 11.66 7.01 7.01 1.92 $927.13 $927.1357284 14.33 7.86 7.86 2.16 $1,094.33 $1,094.3357285 11.60 6.68 6.68 1.80 $903.16 $903.1657287 11.15 7.61 7.61 1.47 $909.91 $909.9157288 12.13 7.44 7.44 1.59 $950.60 $950.6057289 12.80 7.32 7.32 1.24 $956.27 $956.2757291 8.64 8.19 8.19 1.47 $828.02 $828.0257292 14.01 8.15 8.15 2.34 $1,103.04 $1,103.0457295 7.82 5.27 5.27 1.20 $643.65 $643.6557296 16.56 9.04 9.04 2.79 $1,277.58 $1,277.5857300 8.71 6.21 6.21 1.52 $741.97 $741.9757305 15.35 9.00 9.00 2.97 $1,232.47 $1,232.4757307 17.17 10.31 10.31 3.67 $1,407.53 $1,407.5357308 10.59 6.71 6.71 1.80 $860.79 $860.7957310 7.65 5.19 5.19 0.73 $608.67 $608.6757311 8.91 5.67 5.67 0.86 $692.08 $692.0857320 8.88 5.85 5.85 1.05 $708.77 $708.7757330 13.21 7.26 7.26 1.28 $973.29 $973.2957335 20.02 10.17 10.17 3.39 $1,510.27 $1,510.2757400 2.27 1.33 1.33 0.38 $179.21 $179.2157410 1.75 1.15 1.15 0.29 $143.77 $143.7757415 2.49 1.89 1.89 0.37 $214.14 $214.1457420 1.60 1.59 0.82 0.26 $156.11 $120.4857421 2.20 2.07 1.09 0.37 $209.90 $164.5657423 16.08 8.66 8.66 2.72 $1,235.64 $1,235.6457425 17.03 9.21 9.21 2.67 $1,299.70 $1,299.7057426 14.30 8.73 8.73 2.41 $1,146.00 $1,146.0057452 1.50 1.49 0.99 0.24 $146.13 $123.0057454 2.33 1.86 1.35 0.38 $206.33 $182.7357455 1.99 1.94 0.99 0.33 $192.76 $148.8057456 1.85 1.87 0.93 0.31 $182.44 $138.9457460 2.83 5.27 1.57 0.48 $390.86 $219.6657461 3.43 5.65 1.61 0.59 $440.03 $253.0957500 1.20 2.45 0.86 0.20 $175.52 $101.9557505 1.19 1.65 1.35 0.20 $138.07 $124.19

Updated December 2011 194 of 387 Effective January 2012

CPT©1/HCPCS

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Year 2012TransitionalFacility PE

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Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

57510 1.90 1.70 1.23 0.31 $176.74 $154.9957511 1.95 2.06 1.67 0.33 $196.58 $178.5357513 1.95 2.01 1.69 0.33 $194.26 $179.4657520 4.11 4.33 3.34 0.68 $412.99 $367.1857522 3.67 3.56 2.97 0.63 $355.75 $328.4557530 5.27 4.14 4.14 0.87 $464.11 $464.1157531 29.95 16.56 16.56 5.06 $2,321.05 $2,321.0557540 13.29 7.74 7.74 2.23 $1,047.29 $1,047.2957545 14.10 8.09 8.09 2.35 $1,104.67 $1,104.6757550 6.34 4.78 4.78 1.08 $550.76 $550.7657555 9.94 6.34 6.34 1.66 $808.39 $808.3957556 9.36 6.04 6.04 1.46 $759.21 $759.2157558 1.72 1.72 1.39 0.29 $168.85 $153.5857700 4.35 4.22 4.22 0.72 $420.33 $420.3357720 4.61 3.81 3.81 0.76 $414.65 $414.6557800 0.77 0.90 0.55 0.12 $81.10 $64.9158100 1.53 1.48 0.83 0.26 $147.99 $117.9158110 0.77 0.54 0.33 0.12 $64.45 $54.7358120 3.59 3.43 2.30 0.61 $345.26 $292.9758140 15.79 8.83 8.83 2.80 $1,235.02 $1,235.0258145 8.91 5.83 5.83 1.50 $732.04 $732.0458146 20.34 10.73 10.73 3.44 $1,552.59 $1,552.5958150 17.31 9.48 9.48 2.94 $1,338.06 $1,338.0658152 21.86 11.63 11.63 3.74 $1,675.34 $1,675.3458180 16.60 9.15 9.15 2.80 $1,284.91 $1,284.9158200 23.10 12.24 12.24 3.89 $1,764.91 $1,764.9158210 30.91 16.37 16.37 5.27 $2,364.53 $2,364.5358240 49.33 25.72 25.72 8.33 $3,750.76 $3,750.7658260 14.15 8.16 8.16 2.38 $1,111.61 $1,111.6158262 15.94 8.91 8.91 2.69 $1,239.62 $1,239.6258263 17.23 9.47 9.47 2.91 $1,332.60 $1,332.6058267 18.36 10.07 10.07 3.12 $1,420.00 $1,420.0058270 15.30 8.45 8.45 2.57 $1,184.51 $1,184.5158275 17.03 9.47 9.47 2.90 $1,323.43 $1,323.4358280 18.33 10.04 10.04 3.08 $1,415.28 $1,415.2858285 23.38 11.86 11.86 3.93 $1,761.49 $1,761.4958290 20.27 10.67 10.67 3.43 $1,546.27 $1,546.2758291 22.06 11.44 11.44 3.73 $1,674.70 $1,674.7058292 23.35 12.01 12.01 3.93 $1,767.13 $1,767.1358293 24.33 12.42 12.42 4.11 $1,837.71 $1,837.71

Updated December 2011 195 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

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Year 2012TransitionalFacility PE

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Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

58294 21.55 11.21 11.21 3.66 $1,638.41 $1,638.4158300 1.01 1.00 0.42 0.07 $93.58 $66.7558301 1.27 1.36 0.54 0.22 $129.14 $91.1958321 0.92 1.23 0.40 0.05 $99.31 $60.9158322 1.10 1.29 0.47 0.18 $116.50 $78.5558323 0.23 0.22 0.10 0.04 $22.18 $16.6358340 0.88 2.58 0.72 0.12 $163.61 $77.5458345 4.70 2.87 2.87 0.78 $376.08 $376.0858346 7.56 5.02 5.02 0.63 $591.82 $591.8258350 1.06 1.65 1.12 0.18 $131.42 $106.9058353 3.60 26.93 2.35 0.61 $1,433.07 $295.7258356 6.41 50.58 2.87 1.08 $2,673.02 $465.4158400 7.14 4.87 4.87 1.08 $589.58 $589.5858410 13.80 7.89 7.89 2.31 $1,080.39 $1,080.3958520 13.48 7.73 7.73 2.90 $1,089.14 $1,089.1458540 15.71 8.77 8.77 2.65 $1,221.14 $1,221.1458541 14.70 8.58 8.58 2.46 $1,158.93 $1,158.9358542 16.56 9.39 9.39 2.80 $1,294.28 $1,294.2858543 16.87 9.50 9.50 2.86 $1,315.85 $1,315.8558544 18.37 10.16 10.16 3.12 $1,424.60 $1,424.6058545 15.55 8.49 8.49 2.67 $1,202.27 $1,202.2758546 19.94 10.34 10.34 3.39 $1,514.67 $1,514.6758548 31.63 16.86 16.86 5.32 $2,420.94 $2,420.9458550 15.10 8.70 8.70 2.56 $1,186.90 $1,186.9058552 16.91 9.50 9.50 2.87 $1,318.10 $1,318.1058553 20.06 10.44 10.44 3.40 $1,525.01 $1,525.0158554 23.11 12.17 12.17 3.93 $1,764.14 $1,764.1458555 3.33 4.67 1.78 0.56 $388.83 $255.1058558 4.74 5.73 2.43 0.80 $511.16 $358.4758559 6.16 3.05 3.05 1.05 $461.38 $461.3858560 6.99 3.40 3.40 1.18 $520.15 $520.1558561 9.99 4.70 4.70 1.67 $735.18 $735.1858562 5.20 5.65 2.60 0.87 $530.95 $389.8258563 6.16 43.97 3.04 1.05 $2,354.81 $460.9258565 7.12 48.51 4.64 1.20 $2,614.10 $584.1758570 15.88 9.11 9.11 2.69 $1,246.27 $1,246.2758571 17.69 10.07 10.07 3.01 $1,385.38 $1,385.3858572 20.09 10.97 10.97 3.40 $1,550.83 $1,550.8358573 23.11 12.40 12.40 3.89 $1,772.75 $1,772.7558578 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 196 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

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Year 2012Transitional

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Year 2012TransitionalFacility PE

RVUs

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Non-Facility AllOther Med Services

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Facility All OtherMed Services And

Treatment

MRA 2012

58579 0.00 0.00 0.00 0.00 $0.00 $0.0058600 5.91 3.97 3.97 1.01 $491.09 $491.0958605 5.28 3.67 3.67 0.88 $443.30 $443.3058611 1.45 0.62 0.62 0.24 $103.71 $103.7158615 3.94 2.72 2.72 0.67 $330.62 $330.6258660 11.59 6.43 6.43 2.04 $903.36 $903.3658661 11.35 5.92 5.92 1.93 $863.77 $863.7758662 12.15 6.82 6.82 2.07 $947.19 $947.1958670 5.91 4.00 4.00 1.01 $492.48 $492.4858671 5.91 3.99 3.99 1.01 $492.02 $492.0258672 12.91 6.89 6.89 2.18 $988.95 $988.9558673 14.04 7.50 7.50 2.35 $1,074.78 $1,074.7858679 0.00 0.00 0.00 0.00 $0.00 $0.0058700 12.95 7.75 7.75 2.41 $1,042.18 $1,042.1858720 12.16 7.22 7.22 2.15 $970.21 $970.2158740 14.90 8.60 8.60 2.64 $1,177.68 $1,177.6858750 15.64 8.67 8.67 2.64 $1,212.97 $1,212.9758752 15.64 8.67 8.67 1.10 $1,134.64 $1,134.6458760 13.93 7.95 7.95 2.34 $1,090.32 $1,090.3258770 14.77 8.10 8.10 2.48 $1,140.77 $1,140.7758800 4.62 4.14 3.54 0.76 $430.36 $402.5958805 6.42 4.51 4.51 1.09 $542.24 $542.2458820 4.70 3.86 3.86 0.78 $421.88 $421.8858822 11.81 7.67 7.67 2.52 $994.69 $994.6958823 3.37 23.49 1.27 0.38 $1,252.23 $224.0858825 11.78 7.38 7.38 1.97 $951.99 $951.9958900 6.59 5.21 5.21 1.40 $597.76 $597.7658920 11.95 6.93 6.93 2.00 $940.06 $940.0658925 12.43 7.39 7.39 2.23 $993.84 $993.8458940 8.22 5.66 5.66 1.54 $696.32 $696.3258943 19.52 10.71 10.71 3.52 $1,520.21 $1,520.2158950 18.37 10.66 10.66 3.25 $1,454.35 $1,454.3558951 24.26 13.01 13.01 4.18 $1,865.54 $1,865.5458952 27.29 14.81 14.81 4.74 $2,108.57 $2,108.5758953 34.13 17.92 17.92 5.88 $2,606.77 $2,606.7758954 37.13 19.29 19.29 6.36 $2,824.53 $2,824.5358956 22.80 12.79 12.79 3.99 $1,782.45 $1,782.4558957 26.22 14.20 14.20 4.80 $2,037.05 $2,037.0558958 29.22 15.53 15.53 4.94 $2,235.67 $2,235.6758960 15.79 9.13 9.13 2.76 $1,246.86 $1,246.86

Updated December 2011 197 of 387 Effective January 2012

CPT©1/HCPCS

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Non-Facility AllOther Med Services

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Facility All OtherMed Services And

Treatment

MRA 2012

58970 3.52 2.54 1.88 0.26 $283.24 $252.7058974 0.00 0.00 0.00 0.00 $0.00 $0.0058976 3.82 3.00 2.00 0.27 $318.03 $271.7658999 0.00 0.00 0.00 0.00 $0.00 $0.0059000 1.30 2.13 0.77 0.37 $173.69 $110.7759001 3.00 1.60 1.60 0.86 $247.74 $247.7459012 3.44 1.62 1.62 0.99 $274.34 $274.3459015 2.20 1.85 1.16 0.63 $212.95 $181.0259020 0.66 1.27 1.27 0.17 $96.00 $96.0059020 TC 0.00 0.99 0.99 0.01 $46.32 $46.3259020 26 0.66 0.28 0.28 0.16 $49.69 $49.6959025 0.53 0.76 0.76 0.13 $64.74 $64.7459025 TC 0.00 0.53 0.53 0.01 $25.03 $25.0359025 26 0.53 0.23 0.23 0.12 $39.71 $39.7159030 1.99 0.80 0.80 0.12 $129.33 $129.3359050 0.89 0.38 0.38 0.26 $69.36 $69.3659051 0.74 0.31 0.31 0.22 $57.59 $57.5959070 5.24 5.63 2.67 1.51 $564.31 $427.3559072 8.99 4.08 4.08 2.59 $709.98 $709.9859074 5.24 5.90 2.84 1.51 $576.80 $435.2159076 8.99 4.00 4.00 2.59 $706.27 $706.2759100 13.37 7.85 7.85 3.84 $1,137.74 $1,137.7459120 12.67 7.59 7.59 3.66 $1,086.23 $1,086.2359121 12.74 7.53 7.53 3.67 $1,087.00 $1,087.0059130 15.08 8.30 8.30 1.08 $1,092.24 $1,092.2459135 14.92 8.89 8.89 1.06 $1,111.59 $1,111.5959136 14.25 7.91 7.91 4.10 $1,191.86 $1,191.8659140 5.94 4.37 4.37 0.41 $480.38 $480.3859150 12.29 7.32 7.32 3.54 $1,051.17 $1,051.1759151 12.11 6.94 6.94 3.48 $1,022.74 $1,022.7459160 2.76 2.65 1.72 0.78 $281.86 $238.8259200 0.79 1.17 0.34 0.23 $100.06 $61.6559300 2.41 2.69 1.36 0.68 $263.46 $201.9259320 2.48 1.42 1.42 0.69 $208.24 $208.2459325 4.06 2.10 2.10 0.29 $287.80 $287.8059350 4.94 2.09 2.09 1.42 $382.94 $382.9459400 32.16 21.18 21.18 8.96 $2,828.95 $2,828.9559409 14.37 6.16 6.16 3.98 $1,109.98 $1,109.9859410 18.01 8.14 8.14 4.99 $1,410.66 $1,410.6659412 1.71 0.92 0.92 0.49 $141.57 $141.57

Updated December 2011 198 of 387 Effective January 2012

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MRA 2012

59414 1.61 0.69 0.69 0.46 $125.07 $125.0759425 6.31 5.58 2.66 1.74 $620.05 $484.9459426 11.16 10.21 4.72 3.01 $1,108.99 $854.9659430 2.47 2.18 1.07 0.67 $241.95 $190.5959510 35.64 23.30 23.30 10.15 $3,138.33 $3,138.3359514 16.13 6.97 6.97 4.57 $1,253.72 $1,253.7259515 21.47 10.16 10.16 6.09 $1,709.97 $1,709.9759525 8.53 3.68 3.68 2.44 $663.91 $663.9159610 33.87 21.84 21.84 9.75 $2,973.75 $2,973.7559612 16.09 6.86 6.86 4.62 $1,249.44 $1,249.4459614 19.73 8.72 8.72 5.66 $1,546.09 $1,546.0959618 36.16 23.63 23.63 10.40 $3,188.84 $3,188.8459620 16.66 7.27 7.27 4.79 $1,301.75 $1,301.7559622 22.00 10.57 10.57 6.33 $1,764.11 $1,764.1159812 4.44 3.83 3.17 1.25 $433.14 $402.6059820 4.84 5.17 4.47 1.39 $519.59 $487.2059821 5.09 4.93 4.18 1.47 $523.39 $488.6959830 6.59 4.65 4.65 1.89 $596.78 $596.7859840 3.01 2.65 2.40 0.80 $293.70 $282.1459841 5.65 4.21 3.57 1.62 $521.96 $492.3559850 5.90 3.88 3.88 0.41 $455.97 $455.9759851 5.92 4.40 4.40 1.69 $546.01 $546.0159852 8.23 5.94 5.94 0.59 $661.38 $661.3859855 6.43 4.22 4.22 1.85 $567.91 $567.9159856 7.79 4.66 4.66 2.23 $666.52 $666.5259857 9.33 5.18 5.18 0.65 $676.92 $676.9259866 3.99 2.04 2.04 0.29 $281.99 $281.9959870 6.57 5.76 5.76 1.89 $647.27 $647.2759871 2.13 1.30 1.30 0.61 $183.45 $183.4559897 0.00 0.00 0.00 0.00 $0.00 $0.0059898 0.00 0.00 0.00 0.00 $0.00 $0.0059899 0.00 0.00 0.00 0.00 $0.00 $0.0060000 1.81 2.80 2.31 0.24 $220.18 $197.506005F 0.00 0.00 0.00 0.00 $0.00 $0.006010F 0.00 0.00 0.00 0.00 $0.00 $0.0060100 1.56 1.54 0.60 0.16 $146.97 $103.486015F 0.00 0.00 0.00 0.00 $0.00 $0.006020F 0.00 0.00 0.00 0.00 $0.00 $0.0060200 10.02 7.82 7.82 1.70 $882.38 $882.3860210 11.23 7.61 7.61 2.07 $943.90 $943.90

Updated December 2011 199 of 387 Effective January 2012

CPT©1/HCPCS

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Year 2012TransitionalFacility PE

RVUs

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Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

60212 16.43 10.39 10.39 3.06 $1,348.15 $1,348.1560220 11.19 7.89 7.89 1.94 $948.51 $948.5160225 14.79 10.02 10.02 2.64 $1,238.62 $1,238.6260240 15.04 9.41 9.41 2.74 $1,226.31 $1,226.3160252 22.01 12.98 12.98 3.88 $1,751.42 $1,751.4260254 28.42 16.48 16.48 4.53 $2,224.11 $2,224.1160260 18.26 11.00 11.00 3.13 $1,459.21 $1,459.2160270 23.20 12.88 12.88 4.38 $1,823.78 $1,823.7860271 17.62 10.61 10.61 3.01 $1,407.33 $1,407.3360280 6.16 6.23 6.23 0.84 $597.85 $597.8560281 8.82 7.63 7.63 1.14 $793.11 $793.116030F 0.00 0.00 0.00 0.00 $0.00 $0.0060300 0.97 2.27 0.37 0.11 $152.65 $64.746040F 0.00 0.00 0.00 0.00 $0.00 $0.006045F 0.00 0.00 0.00 0.00 $0.00 $0.0060500 15.60 9.79 9.79 3.01 $1,281.89 $1,281.8960502 21.15 12.34 12.34 4.15 $1,698.29 $1,698.2960505 23.06 13.94 13.94 4.33 $1,864.22 $1,864.2260512 4.44 1.88 1.88 0.83 $321.55 $321.5560520 17.16 9.82 9.82 3.47 $1,374.25 $1,374.2560521 19.18 10.20 10.20 4.53 $1,533.26 $1,533.2660522 23.48 12.29 12.29 5.46 $1,863.55 $1,863.5560540 18.02 10.00 10.00 3.04 $1,397.96 $1,397.9660545 20.93 11.02 11.02 3.69 $1,604.28 $1,604.2860600 25.09 12.06 12.06 5.31 $1,915.02 $1,915.0260605 31.96 12.13 12.13 4.11 $2,154.82 $2,154.8260650 20.73 10.52 10.52 3.74 $1,575.03 $1,575.0360659 0.00 0.00 0.00 0.00 $0.00 $0.0060699 0.00 0.00 0.00 0.00 $0.00 $0.006070F 0.00 0.00 0.00 0.00 $0.00 $0.006080F 0.00 0.00 0.00 0.00 $0.00 $0.006090F 0.00 0.00 0.00 0.00 $0.00 $0.006100F 0.00 0.00 0.00 0.00 $0.00 $0.0062267 3.00 3.97 1.34 0.30 $328.92 $207.2262268 4.73 3.54 2.46 0.45 $391.59 $341.6262269 5.01 3.64 2.21 0.56 $413.94 $347.7762270 1.37 3.01 0.70 0.23 $210.32 $103.4462272 1.35 4.20 0.82 0.33 $269.61 $113.2162273 2.15 2.73 0.98 0.20 $229.63 $148.6662284 1.54 4.20 0.80 0.18 $270.21 $112.88

Updated December 2011 200 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

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Year 2012TransitionalFacility PE

RVUs

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Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

62290 3.00 6.81 1.78 0.30 $460.33 $227.5862291 2.91 6.42 1.71 0.27 $436.86 $218.9262292 9.24 6.83 6.83 0.75 $754.45 $754.4562310 1.91 5.18 1.08 0.16 $330.56 $140.8562311 1.54 4.48 0.92 0.12 $280.11 $115.3962318 2.04 5.18 0.79 0.16 $336.20 $133.0662319 1.87 3.41 0.82 0.16 $246.93 $127.0962350 6.05 4.62 4.62 1.05 $529.27 $529.2762351 11.66 10.71 10.71 3.39 $1,173.11 $1,173.1162355 3.55 3.52 3.52 0.60 $347.18 $347.1862360 4.33 3.89 3.89 0.87 $411.82 $411.8262361 5.00 4.32 4.32 0.97 $465.83 $465.8362362 5.60 4.71 4.71 1.12 $517.50 $517.5062365 3.93 3.98 3.98 0.74 $392.05 $392.0562367 0.48 0.67 0.20 0.05 $54.34 $32.5963650 7.15 4.76 4.76 0.64 $562.54 $562.5463685 5.19 4.54 4.54 0.94 $482.71 $482.7163688 5.30 4.50 4.50 1.01 $489.19 $489.1964400 1.11 2.18 0.71 0.18 $158.11 $90.0964402 1.25 2.05 0.77 0.18 $158.16 $98.9364405 0.94 1.72 0.69 0.19 $129.97 $82.3164408 1.41 1.58 0.74 0.16 $142.33 $103.4664410 1.43 2.71 0.81 0.33 $204.13 $116.2164412 1.18 2.99 0.80 0.20 $199.64 $98.3164413 1.40 2.03 0.76 0.20 $164.75 $105.9964415 1.48 2.06 0.37 0.11 $165.03 $86.8364416 1.81 0.43 0.43 0.14 $105.43 $105.4364417 1.44 2.36 0.54 0.11 $177.18 $92.9664418 1.32 2.64 0.74 0.12 $185.44 $97.5364420 1.18 2.40 0.70 0.12 $168.27 $89.6164421 1.68 3.34 0.89 0.20 $237.50 $124.1364425 1.75 2.00 0.85 0.20 $178.52 $125.3164430 1.46 2.53 0.83 0.14 $187.43 $108.7764435 1.45 2.44 0.78 0.24 $187.92 $111.1164445 1.48 2.36 0.54 0.16 $181.45 $97.2464446 1.81 0.45 0.45 0.14 $106.35 $106.3564447 1.50 2.04 0.34 0.11 $164.97 $86.3164448 1.63 0.39 0.39 0.12 $94.76 $94.7664449 1.81 0.53 0.53 0.14 $110.05 $110.0564450 1.27 1.72 0.65 0.11 $140.20 $90.69

Updated December 2011 201 of 387 Effective January 2012

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MRA 2012

64455 0.75 0.59 0.23 0.08 $63.86 $47.2064479 2.29 5.10 1.38 0.27 $348.92 $176.7964480 1.20 2.29 0.57 0.18 $167.10 $87.5164483 1.90 5.05 1.23 0.16 $324.12 $147.3664484 1.00 1.86 0.47 0.08 $133.45 $69.1464505 1.36 1.49 1.00 0.10 $132.95 $110.2764508 1.12 1.17 0.90 0.24 $114.86 $102.3764510 1.22 2.65 0.81 0.10 $180.56 $95.4264517 2.20 3.04 1.31 0.18 $245.12 $165.0764520 1.35 4.35 0.90 0.11 $265.36 $105.7264530 1.58 4.20 1.01 0.14 $269.91 $122.3064550 0.18 0.28 0.07 0.01 $21.26 $11.5564553 2.36 3.69 2.16 0.38 $292.30 $221.5164555 2.32 3.23 1.75 0.26 $263.18 $194.7064561 7.15 18.25 3.90 0.78 $1,193.86 $529.8764565 1.81 3.23 1.67 0.24 $240.07 $167.8964575 4.42 3.95 3.95 0.44 $396.62 $396.6264580 4.19 3.90 3.90 0.88 $406.73 $406.7364581 12.20 6.32 6.32 1.58 $901.30 $901.3064585 2.11 5.61 1.99 0.27 $364.72 $197.2264590 2.45 5.37 2.09 0.29 $369.36 $217.5964595 1.78 5.86 1.83 0.22 $359.45 $172.9864831 9.16 9.36 9.36 1.63 $912.82 $912.8264832 5.65 3.44 3.44 1.01 $455.30 $455.3064834 10.81 9.13 9.13 1.85 $984.84 $984.8465091 7.26 10.07 10.07 1.44 $853.70 $853.7065093 7.04 10.21 10.21 1.39 $848.10 $848.1065101 8.30 11.91 11.91 1.63 $993.56 $993.5665103 8.84 12.22 12.22 1.74 $1,036.89 $1,036.8965105 9.93 13.28 13.28 1.95 $1,143.84 $1,143.8465110 15.70 17.50 17.50 2.00 $1,591.59 $1,591.5965112 18.51 20.16 20.16 2.35 $1,854.21 $1,854.2165114 19.65 20.84 20.84 2.52 $1,943.70 $1,943.7065125 3.27 9.46 4.74 0.64 $611.94 $393.5465130 8.42 11.59 11.59 1.65 $984.97 $984.9765135 8.60 11.71 11.71 1.67 $999.33 $999.3365140 9.46 12.63 12.63 1.22 $1,056.27 $1,056.2765150 6.43 9.43 9.43 0.45 $737.77 $737.7765155 10.10 13.04 13.04 1.97 $1,141.11 $1,141.1165175 7.40 10.60 10.60 0.95 $859.36 $859.36

Updated December 2011 202 of 387 Effective January 2012

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MRA 2012

65205 0.71 0.80 0.46 0.10 $72.86 $57.1365210 0.84 1.05 0.61 0.12 $91.08 $70.7265220 0.71 0.86 0.42 0.11 $76.15 $55.7965222 0.93 1.14 0.64 0.14 $100.16 $77.0265235 9.01 10.29 10.29 1.24 $929.51 $929.5165260 12.54 13.53 13.53 0.88 $1,214.04 $1,214.0465265 14.34 15.01 15.01 3.08 $1,472.40 $1,472.4065270 1.95 5.48 1.88 0.27 $351.77 $185.2065272 4.62 9.23 4.93 0.33 $644.01 $445.0465273 5.16 5.21 5.21 0.37 $483.42 $483.4265275 6.29 9.45 6.22 0.86 $753.49 $604.0365280 9.10 9.10 9.10 1.80 $906.84 $906.8465285 15.36 14.24 14.24 2.71 $1,462.14 $1,462.1465286 6.63 12.81 6.85 0.90 $925.72 $649.9565290 6.53 6.83 6.83 1.28 $664.02 $664.0265400 7.50 11.12 8.94 1.03 $891.83 $790.9565410 1.47 2.47 1.36 0.31 $193.74 $142.3865420 4.36 9.93 5.95 0.56 $676.83 $492.6765426 6.05 11.96 7.00 0.83 $857.71 $628.2065430 1.47 1.66 1.35 0.22 $151.68 $137.3465435 0.92 1.27 0.98 0.16 $106.76 $93.3465436 4.82 5.74 5.30 0.84 $517.13 $496.7765450 3.47 5.45 5.34 0.48 $426.91 $421.8265600 4.20 6.62 5.18 0.60 $518.78 $452.1565710 14.45 15.73 15.73 1.97 $1,454.02 $1,454.0265730 16.35 17.08 17.08 2.23 $1,612.02 $1,612.0265750 16.90 16.69 16.69 2.16 $1,614.24 $1,614.2465755 16.79 16.63 16.63 2.29 $1,613.31 $1,613.3165756 16.84 15.28 15.28 1.20 $1,497.56 $1,497.5665757 0.00 0.00 0.00 0.00 $0.00 $0.0065760 0.00 0.00 0.00 0.00 $0.00 $0.0065765 0.00 0.00 0.00 0.00 $0.00 $0.0065767 0.00 0.00 0.00 0.00 $0.00 $0.0065770 19.74 18.49 18.49 7.08 $2,070.83 $2,070.8365771 0.00 0.00 0.00 0.00 $0.00 $0.0065772 5.09 7.27 5.99 0.65 $589.95 $530.7265775 6.91 8.16 8.16 0.49 $701.83 $701.8365778 1.19 38.37 0.78 0.18 $1,836.14 $96.8065779 3.92 30.90 4.00 0.56 $1,628.08 $383.3865780 10.73 13.59 13.59 1.39 $1,164.35 $1,164.35

Updated December 2011 203 of 387 Effective January 2012

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MRA 2012

65781 18.14 18.21 18.21 1.28 $1,693.52 $1,693.5265782 15.43 15.95 15.95 3.06 $1,562.10 $1,562.1065800 1.91 2.16 1.64 0.27 $196.42 $172.3665805 1.91 2.56 1.64 0.34 $218.49 $175.9265810 5.82 6.88 6.88 0.84 $613.19 $613.1965815 6.00 11.61 7.01 1.06 $851.05 $638.2065820 8.91 11.56 11.56 0.63 $952.92 $952.9265850 11.39 11.47 11.47 1.99 $1,125.36 $1,125.3665855 3.99 5.30 4.12 0.63 $450.13 $395.5365860 3.59 4.91 3.31 1.32 $449.85 $375.8265865 5.77 7.17 7.17 0.39 $601.56 $601.5665870 7.39 8.74 8.74 1.29 $790.16 $790.1665875 7.81 9.38 9.38 1.08 $827.29 $827.2965880 8.36 9.72 9.72 0.60 $842.43 $842.4365900 12.51 13.77 13.77 0.88 $1,223.84 $1,223.8465920 9.99 11.49 11.49 1.29 $1,030.04 $1,030.0465930 8.39 8.99 8.99 1.48 $854.71 $854.7166020 1.64 3.52 1.95 0.11 $239.51 $166.8766030 1.30 3.31 1.73 0.18 $218.63 $145.5266130 7.83 11.30 7.66 1.66 $946.50 $778.0766150 10.53 13.39 13.39 0.73 $1,112.86 $1,112.8666155 10.52 13.37 13.37 0.73 $1,111.50 $1,111.5066160 12.39 14.54 14.54 0.87 $1,253.76 $1,253.7666165 10.24 13.20 13.20 0.72 $1,090.99 $1,090.9966170 15.02 17.69 17.69 1.92 $1,566.86 $1,566.8666172 18.86 22.41 22.41 2.41 $1,976.53 $1,976.5366174 12.85 13.60 13.60 2.27 $1,301.41 $1,301.4166175 13.60 14.09 14.09 4.87 $1,488.83 $1,488.8366180 16.30 15.35 15.35 2.12 $1,524.21 $1,524.2166185 9.58 10.83 10.83 1.67 $1,001.07 $1,001.0766220 9.21 11.00 11.00 1.27 $972.56 $972.5666225 12.63 12.70 12.70 2.48 $1,260.92 $1,260.9266250 7.10 13.57 8.07 1.40 $1,006.68 $752.1966500 3.83 5.87 5.87 0.27 $451.26 $451.2666505 4.22 6.41 6.41 0.30 $494.67 $494.6766600 10.12 12.52 12.52 0.76 $1,056.37 $1,056.3766605 14.22 14.49 14.49 1.02 $1,338.35 $1,338.3566625 5.30 6.42 6.42 0.72 $563.28 $563.2866630 7.28 8.23 8.23 1.22 $758.24 $758.2466635 7.37 8.27 8.27 0.52 $728.38 $728.38

Updated December 2011 204 of 387 Effective January 2012

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MRA 2012

66680 6.39 7.70 7.70 1.36 $702.28 $702.2866682 7.33 10.03 10.03 1.46 $855.90 $855.9066700 5.14 7.18 5.57 0.49 $579.81 $505.3266710 5.14 6.92 5.56 1.02 $594.74 $531.8166711 7.93 9.46 9.46 0.56 $809.73 $809.7366720 5.00 7.94 6.52 0.68 $618.58 $552.8866740 5.14 6.82 5.57 0.35 $556.03 $498.2066761 3.00 5.62 4.03 0.45 $412.89 $339.3266762 5.38 7.64 6.23 0.68 $621.16 $555.9266770 6.13 8.30 7.02 0.42 $670.96 $611.7466820 4.01 6.82 6.82 0.67 $523.36 $523.3666821 3.42 5.64 5.09 0.53 $436.08 $410.6366825 9.01 11.77 11.77 1.17 $994.43 $994.4366830 9.47 9.92 9.92 0.67 $903.32 $903.3266840 9.18 9.76 9.76 1.81 $941.35 $941.3566850 10.55 11.01 11.01 1.46 $1,040.73 $1,040.7366852 11.41 11.56 11.56 2.00 $1,130.90 $1,130.9066920 10.13 10.38 10.38 0.71 $955.23 $955.2366930 11.61 11.69 11.69 0.82 $1,085.56 $1,085.5666940 10.37 10.90 10.90 1.74 $1,042.09 $1,042.0966982 15.02 13.63 13.63 2.33 $1,399.85 $1,399.8566983 10.43 9.80 9.80 0.83 $947.50 $947.5066984 10.52 10.18 10.18 1.65 $1,010.69 $1,010.6966985 9.98 11.00 11.00 1.29 $1,006.93 $1,006.9366986 12.26 12.52 12.52 1.57 $1,190.27 $1,190.2766990 1.51 0.94 0.94 0.10 $113.99 $113.9966999 0.00 0.00 0.00 0.00 $0.00 $0.0067005 5.89 6.98 6.98 1.25 $641.71 $641.7167010 7.06 7.71 7.71 0.98 $712.44 $712.4467015 7.14 8.70 8.70 0.99 $762.22 $762.2267025 8.11 11.79 9.10 1.44 $970.11 $845.6467027 11.62 11.53 11.53 2.03 $1,140.14 $1,140.1467028 1.44 1.76 1.42 0.20 $153.99 $138.2667030 6.11 8.42 8.42 0.42 $675.65 $675.6567031 4.47 6.16 5.25 0.59 $508.68 $466.5767036 13.32 12.75 12.75 1.82 $1,259.55 $1,259.5567039 16.74 16.84 16.84 2.97 $1,655.45 $1,655.4567040 19.61 18.99 18.99 2.69 $1,865.02 $1,865.0267041 19.25 16.62 16.62 2.64 $1,737.21 $1,737.2167042 22.38 18.55 18.55 3.09 $1,985.00 $1,985.00

Updated December 2011 205 of 387 Effective January 2012

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MRA 2012

67043 23.24 19.83 19.83 4.10 $2,132.86 $2,132.8667101 8.80 12.67 9.55 1.55 $1,046.31 $901.9567105 8.53 11.18 8.99 1.17 $946.34 $845.0167107 16.71 16.31 16.31 2.95 $1,628.61 $1,628.6167108 22.89 20.68 20.68 3.14 $2,108.19 $2,108.1967110 10.25 13.52 10.82 1.31 $1,136.25 $1,011.3167112 18.75 17.23 17.23 2.57 $1,740.22 $1,740.2267113 25.35 21.90 21.90 3.48 $2,288.50 $2,288.5067115 6.11 7.50 7.50 0.78 $651.39 $651.3967120 7.10 10.94 8.10 1.40 $884.99 $753.5867121 12.25 12.44 12.44 2.16 $1,216.15 $1,216.1567141 6.15 8.16 7.13 1.09 $699.43 $651.7767145 6.32 8.08 7.23 0.86 $691.40 $652.0767208 7.65 8.68 8.07 0.53 $759.99 $731.7667210 6.36 8.10 7.51 0.94 $698.12 $670.8267218 20.36 17.11 17.11 1.46 $1,747.95 $1,747.9567220 6.36 9.54 8.40 1.13 $774.42 $721.6767221 3.45 4.48 2.34 0.48 $381.16 $282.1467225 0.47 0.34 0.29 0.03 $37.62 $35.3067227 7.53 9.13 7.99 0.53 $775.61 $722.8667228 13.82 14.70 12.51 2.10 $1,385.68 $1,284.3567229 16.30 14.06 14.06 1.17 $1,416.19 $1,416.1967250 9.61 11.72 11.72 1.62 $1,041.00 $1,041.0067255 10.17 12.83 12.83 1.99 $1,135.45 $1,135.4567299 0.00 0.00 0.00 0.00 $0.00 $0.0067311 7.77 8.52 8.52 1.31 $797.46 $797.4667312 9.66 9.71 9.71 1.91 $964.92 $964.9267314 8.79 9.53 9.53 1.48 $897.03 $897.0367316 10.93 10.85 10.85 2.15 $1,084.89 $1,084.8967318 9.12 10.05 10.05 0.64 $892.65 $892.6567320 5.40 3.31 3.31 0.38 $406.41 $406.4167331 5.13 3.11 3.11 0.86 $409.88 $409.8867332 5.56 3.40 3.40 0.93 $445.48 $445.4867334 5.05 3.09 3.09 0.35 $379.54 $379.5467335 2.49 1.54 1.54 0.41 $199.98 $199.9867340 6.00 3.68 3.68 0.42 $451.56 $451.5667343 8.47 9.29 9.29 1.66 $881.22 $881.2267345 3.01 3.40 2.72 0.80 $328.41 $296.9467346 2.87 2.58 2.58 0.61 $274.74 $274.7467399 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 206 of 387 Effective January 2012

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MRA 2012

67400 11.20 14.26 14.26 2.07 $1,250.30 $1,250.3067405 9.20 12.56 12.56 1.18 $1,039.73 $1,039.7367412 10.30 13.02 13.02 1.86 $1,143.26 $1,143.2667413 10.24 13.20 13.20 2.00 $1,156.11 $1,156.1167414 17.94 18.02 18.02 2.29 $1,727.44 $1,727.4467415 1.76 1.08 1.08 0.24 $138.42 $138.4267420 21.87 22.08 22.08 4.31 $2,188.30 $2,188.3067430 15.29 18.79 18.79 1.09 $1,587.23 $1,587.2367440 14.84 18.11 18.11 1.91 $1,577.99 $1,577.9967445 19.12 18.93 18.93 3.77 $1,895.95 $1,895.9567450 15.41 18.85 18.85 1.97 $1,639.97 $1,639.9767500 1.44 0.84 0.63 0.11 $106.84 $97.1367505 1.27 1.14 0.91 0.26 $120.99 $110.3567515 1.40 1.21 0.99 0.26 $129.86 $119.6867550 11.77 14.66 14.66 2.30 $1,305.20 $1,305.2067560 12.18 14.80 14.80 1.57 $1,292.31 $1,292.3167570 14.40 16.75 16.75 5.16 $1,661.32 $1,661.3267599 0.00 0.00 0.00 0.00 $0.00 $0.0067700 1.40 6.10 1.77 0.23 $354.60 $154.2567710 1.07 5.23 1.60 0.22 $299.54 $131.5867715 1.27 5.38 1.72 0.26 $317.18 $147.8367800 1.41 2.08 1.41 0.24 $169.53 $138.5367801 1.91 2.53 1.72 0.37 $218.63 $181.1567805 2.27 3.26 2.22 0.44 $271.56 $223.4467808 4.60 5.43 5.43 0.90 $496.30 $496.3067810 1.48 4.65 0.97 0.22 $290.47 $120.1967820 0.71 0.67 0.75 0.11 $67.35 $71.0667825 1.43 2.10 1.90 0.27 $172.85 $163.6067830 1.75 5.68 2.02 0.34 $355.93 $186.5767835 5.70 6.27 6.27 1.13 $594.52 $594.5267840 2.09 5.59 2.23 0.34 $366.49 $211.0267850 1.74 4.33 2.03 0.24 $287.94 $181.5167875 1.35 3.42 1.30 0.24 $228.94 $130.8467880 4.60 8.01 5.45 0.82 $611.61 $493.1667882 6.02 9.46 6.85 1.18 $758.53 $637.7667900 6.82 10.82 7.07 1.22 $858.15 $684.6367901 7.59 12.77 8.09 1.50 $995.98 $779.4367902 9.82 9.78 9.78 1.93 $976.10 $976.1067903 6.51 9.90 6.72 1.27 $804.70 $657.5567904 7.97 12.11 8.25 1.52 $982.92 $804.31

Updated December 2011 207 of 387 Effective January 2012

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MRA 2012

67906 6.93 6.92 6.92 0.49 $645.32 $645.3267908 5.30 8.25 6.35 1.05 $664.74 $576.8367909 5.57 9.21 6.42 1.10 $723.40 $594.3067911 7.50 7.76 7.76 1.40 $755.17 $755.1767912 6.36 18.57 7.11 0.93 $1,182.08 $651.8167914 3.75 6.97 4.12 0.68 $519.55 $387.6867915 3.26 6.36 3.72 0.45 $458.40 $336.2467916 5.48 9.37 6.33 0.95 $719.28 $578.6167917 6.19 9.94 6.77 1.16 $787.09 $640.4167921 3.47 6.77 3.93 0.68 $498.17 $366.7567922 3.14 6.16 3.57 0.42 $442.42 $322.5867923 6.05 9.57 6.67 1.13 $762.38 $628.1967924 5.93 10.22 6.30 1.13 $787.26 $605.8767930 3.65 6.45 2.90 0.71 $492.68 $328.4267935 6.36 10.01 5.69 1.25 $802.27 $602.3867938 1.38 5.44 1.80 0.22 $322.69 $154.2667950 5.99 9.81 6.69 1.10 $769.36 $624.9967961 5.86 10.02 6.58 1.10 $773.44 $614.2767966 8.97 12.05 8.87 1.70 $1,032.62 $885.4867971 10.01 9.71 9.71 1.96 $982.62 $982.6267973 13.13 12.25 12.25 2.59 $1,267.35 $1,267.3567974 13.10 12.21 12.21 2.59 $1,264.20 $1,264.2067975 9.35 9.32 9.32 1.84 $929.88 $929.8867999 0.00 0.00 0.00 0.00 $0.00 $0.0068020 1.42 1.86 1.61 0.20 $157.75 $146.1868040 0.85 0.92 0.58 0.16 $87.53 $71.8068100 1.35 3.37 1.32 0.20 $224.59 $129.7368110 1.82 4.44 2.24 0.35 $302.09 $200.2968115 2.41 6.24 2.60 0.31 $408.90 $240.4768130 5.10 9.78 6.16 0.35 $691.27 $523.7668135 1.89 2.40 2.24 0.26 $206.15 $198.7568200 0.49 0.67 0.46 0.08 $56.30 $46.5868320 6.64 13.37 8.07 1.29 $971.91 $726.6768325 8.63 9.33 9.33 1.69 $891.52 $891.5268326 8.42 9.17 9.17 1.65 $872.99 $872.9968328 9.45 9.90 9.90 1.86 $962.07 $962.0768330 5.78 10.90 6.79 1.14 $812.73 $622.5668335 8.46 9.18 9.18 1.66 $875.69 $875.6968340 4.97 10.07 5.91 0.99 $731.61 $539.1268360 5.17 9.47 6.05 1.02 $714.04 $555.79

Updated December 2011 208 of 387 Effective January 2012

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MRA 2012

68362 8.61 9.26 9.26 1.69 $887.42 $887.4268371 5.09 6.21 6.21 0.35 $525.64 $525.6468399 0.00 0.00 0.00 0.00 $0.00 $0.0068400 1.74 6.16 1.88 0.34 $377.70 $179.6668420 2.35 6.57 2.27 0.30 $421.06 $222.1068440 0.99 1.87 1.73 0.20 $139.59 $133.1168500 12.77 13.78 13.78 2.99 $1,342.90 $1,342.9068505 12.69 13.81 13.81 2.48 $1,314.88 $1,314.8868510 4.60 7.73 3.32 0.90 $602.73 $398.6768520 8.78 10.05 10.05 1.14 $903.36 $903.3668525 4.42 2.73 2.73 0.86 $361.54 $361.5468530 3.70 8.17 3.31 0.72 $574.94 $350.0668540 12.18 13.13 13.13 1.57 $1,215.03 $1,215.0368550 15.16 11.07 11.07 1.93 $1,267.12 $1,267.1268700 7.87 8.59 8.59 1.54 $816.73 $816.7368705 2.11 4.43 2.42 0.41 $317.24 $224.2468720 9.96 10.66 10.66 1.66 $1,009.15 $1,009.1568745 9.90 10.82 10.82 1.95 $1,028.71 $1,028.7168750 10.10 11.38 11.38 1.97 $1,064.30 $1,064.3068760 1.78 3.79 2.21 0.34 $269.77 $196.6668761 1.41 2.67 1.86 0.22 $195.82 $158.3468770 8.29 8.61 8.61 1.62 $839.92 $839.9268801 1.00 2.47 1.99 0.16 $165.75 $143.5468810 2.15 4.54 3.02 0.39 $323.05 $252.7168811 2.45 3.21 3.21 0.48 $279.08 $279.0868815 3.30 9.17 3.73 0.59 $597.27 $345.5668816 3.06 17.50 3.80 0.60 $972.83 $338.9168840 1.30 2.20 1.88 0.24 $170.32 $155.5168850 0.80 0.86 0.71 0.07 $78.01 $71.0768899 0.00 0.00 0.00 0.00 $0.00 $0.0069000 1.50 3.85 1.85 0.22 $254.31 $161.7769005 2.16 3.99 2.27 0.29 $292.94 $213.3669020 1.53 5.35 2.59 0.20 $324.00 $196.2969090 0.00 0.00 0.00 0.00 $0.00 $0.0069100 0.81 2.10 0.54 0.11 $137.85 $65.6769105 0.85 3.32 0.96 0.10 $195.53 $86.3369110 3.53 9.70 5.72 0.53 $628.71 $444.5569120 4.14 7.37 7.37 0.60 $550.88 $550.8869140 8.14 17.35 17.35 1.05 $1,208.84 $1,208.8469145 2.70 8.93 4.48 0.35 $547.97 $342.06

Updated December 2011 209 of 387 Effective January 2012

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MRA 2012

69150 13.61 15.92 15.92 1.95 $1,425.41 $1,425.4169155 23.35 23.85 23.85 3.01 $2,268.19 $2,268.1969200 0.77 2.87 0.85 0.10 $171.24 $77.7769205 1.21 1.67 1.67 0.16 $137.83 $137.8369210 0.61 0.83 0.28 0.07 $68.39 $42.9469220 0.83 3.24 0.93 0.10 $190.96 $84.0769222 1.45 5.07 2.52 0.18 $306.57 $188.5769300 6.69 13.93 6.71 0.86 $978.11 $644.0369310 10.97 20.42 20.42 1.44 $1,493.32 $1,493.3269320 17.18 26.84 26.84 2.20 $2,098.06 $2,098.0669399 0.00 0.00 0.00 0.00 $0.00 $0.0069400 0.83 3.53 0.93 0.10 $204.38 $84.0769401 0.63 1.92 0.79 0.07 $119.69 $67.4169405 2.68 4.85 2.77 0.34 $357.81 $261.5669420 1.38 4.26 2.08 0.18 $266.05 $165.1869421 1.78 2.51 2.51 0.23 $204.95 $204.9569424 0.85 2.97 0.92 0.10 $179.33 $84.4869433 1.57 4.28 2.15 0.22 $277.24 $178.6969436 2.01 2.60 2.60 0.26 $220.60 $220.6069440 7.71 12.10 12.10 0.99 $944.23 $944.2369450 5.69 10.04 10.04 0.72 $747.68 $747.6869501 9.21 11.66 11.66 1.18 $998.52 $998.5269502 12.56 15.00 15.00 1.69 $1,324.13 $1,324.1369505 13.17 21.51 21.51 1.70 $1,652.29 $1,652.2969511 13.70 21.81 21.81 1.77 $1,692.69 $1,692.6969530 20.38 26.87 26.87 2.61 $2,258.92 $2,258.9269535 37.42 37.56 37.56 5.23 $3,624.99 $3,624.9969540 1.25 4.97 2.46 0.16 $292.26 $176.1269550 11.15 18.90 18.90 1.44 $1,430.79 $1,430.7969552 19.81 24.97 24.97 2.55 $2,143.26 $2,143.2669554 35.97 34.88 34.88 4.61 $3,406.63 $3,406.6369601 13.45 16.37 16.37 1.71 $1,427.09 $1,427.0969602 13.76 17.30 17.30 1.77 $1,486.60 $1,486.6069603 14.20 22.12 22.12 1.82 $1,731.23 $1,731.2369604 14.20 17.60 17.60 1.82 $1,522.09 $1,522.0969605 18.69 26.00 26.00 2.40 $2,134.77 $2,134.7769610 4.47 6.60 3.72 0.59 $529.04 $395.7869620 6.03 14.23 7.92 0.76 $958.32 $666.3469631 10.05 15.35 15.35 1.29 $1,211.24 $1,211.2469632 12.96 17.91 17.91 1.66 $1,474.58 $1,474.58

Updated December 2011 210 of 387 Effective January 2012

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MRA 2012

69633 12.31 17.55 17.55 1.59 $1,426.20 $1,426.2069635 13.51 21.66 21.66 1.74 $1,675.99 $1,675.9969636 15.43 24.29 24.29 1.97 $1,892.56 $1,892.5669637 15.32 24.24 24.24 2.00 $1,887.00 $1,887.0069641 12.89 16.86 16.86 1.67 $1,423.47 $1,423.4769642 17.06 21.05 21.05 2.19 $1,824.44 $1,824.4469643 15.59 19.27 19.27 2.00 $1,668.73 $1,668.7369644 17.23 25.23 25.23 2.22 $2,026.74 $2,026.7469645 16.71 24.98 24.98 2.18 $1,990.61 $1,990.6169646 18.37 25.80 25.80 2.35 $2,109.11 $2,109.1169650 9.80 13.13 13.13 1.25 $1,095.66 $1,095.6669660 12.03 14.37 14.37 1.55 $1,264.89 $1,264.8969661 15.92 18.46 18.46 2.00 $1,645.55 $1,645.5569662 15.60 17.22 17.22 2.00 $1,574.31 $1,574.3169666 9.89 13.11 13.11 1.28 $1,100.15 $1,100.1569667 9.90 13.16 13.16 1.28 $1,102.90 $1,102.9069670 11.73 15.22 15.22 1.51 $1,289.19 $1,289.1969676 9.69 14.20 14.20 1.24 $1,139.89 $1,139.8969700 8.37 11.30 11.30 1.08 $940.38 $940.3869710 0.00 0.00 0.00 0.00 $0.00 $0.0069711 10.62 14.08 14.08 1.36 $1,180.73 $1,180.7369714 14.45 16.05 16.05 1.86 $1,463.23 $1,463.2369715 18.96 18.62 18.62 2.42 $1,806.00 $1,806.0069717 15.43 16.72 16.72 1.97 $1,542.28 $1,542.2869718 19.21 18.77 18.77 2.45 $1,825.30 $1,825.3069720 14.71 19.14 19.14 1.89 $1,619.00 $1,619.0069725 27.64 25.37 25.37 3.55 $2,551.83 $2,551.8369740 16.27 16.81 16.81 2.08 $1,588.43 $1,588.4369745 17.02 18.27 18.27 2.18 $1,693.56 $1,693.5669799 0.00 0.00 0.00 0.00 $0.00 $0.0069801 2.06 3.66 4.00 0.27 $272.33 $288.0669805 14.71 15.13 15.13 1.89 $1,433.45 $1,433.4569806 12.63 14.20 14.20 1.63 $1,287.09 $1,287.0969820 10.52 14.04 14.04 1.36 $1,174.55 $1,174.5569840 10.44 15.65 15.65 0.73 $1,213.53 $1,213.5369905 11.26 15.02 15.02 1.46 $1,257.04 $1,257.0469910 13.91 14.97 14.97 1.80 $1,386.81 $1,386.8169915 22.77 20.55 20.55 2.97 $2,088.33 $2,088.3369930 17.73 16.91 16.91 2.27 $1,665.97 $1,665.9769949 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 211 of 387 Effective January 2012

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MRA 2012

69950 27.63 22.57 22.57 3.55 $2,421.83 $2,421.8369955 29.42 26.34 26.34 3.78 $2,685.52 $2,685.5269960 29.42 24.66 24.66 3.78 $2,607.78 $2,607.7869970 32.41 27.91 27.91 4.16 $2,907.02 $2,907.0269979 0.00 0.00 0.00 0.00 $0.00 $0.0069990 3.46 1.81 1.81 1.16 $292.64 $292.6470010 1.19 1.37 1.37 0.22 $126.13 $126.1370015 1.19 3.33 3.33 0.08 $209.70 $209.7070015 TC 0.00 2.85 2.85 0.01 $132.38 $132.3870015 26 1.19 0.48 0.48 0.07 $77.32 $77.3270030 0.17 0.67 0.67 0.02 $39.38 $39.3870030 TC 0.00 0.61 0.61 0.01 $28.73 $28.7370030 26 0.17 0.06 0.06 0.01 $10.65 $10.657010F 0.00 0.00 0.00 0.00 $0.00 $0.0070100 0.18 0.83 0.83 0.02 $47.22 $47.2270100 TC 0.00 0.76 0.76 0.01 $35.68 $35.6870100 26 0.18 0.07 0.07 0.01 $11.55 $11.5570110 0.25 0.92 0.92 0.02 $54.42 $54.4270110 TC 0.00 0.82 0.82 0.01 $38.45 $38.4570110 26 0.25 0.10 0.10 0.01 $15.97 $15.9770120 0.18 0.89 0.89 0.02 $50.00 $50.0070120 TC 0.00 0.81 0.81 0.01 $37.99 $37.9970120 26 0.18 0.08 0.08 0.01 $12.01 $12.0170130 0.34 1.35 1.35 0.02 $78.21 $78.2170130 TC 0.00 1.21 1.21 0.01 $56.50 $56.5070130 26 0.34 0.14 0.14 0.01 $21.72 $21.7270134 0.34 1.32 1.32 0.02 $76.82 $76.8270134 TC 0.00 1.15 1.15 0.01 $53.72 $53.7270134 26 0.34 0.17 0.17 0.01 $23.10 $23.1070140 0.19 0.70 0.70 0.02 $41.64 $41.6470140 TC 0.00 0.61 0.61 0.01 $28.73 $28.7370140 26 0.19 0.09 0.09 0.01 $12.90 $12.9070150 0.26 1.00 1.00 0.02 $58.55 $58.5570150 TC 0.00 0.90 0.90 0.01 $42.15 $42.1570150 26 0.26 0.10 0.10 0.01 $16.40 $16.4070160 0.17 0.81 0.81 0.02 $45.86 $45.8670160 TC 0.00 0.74 0.74 0.01 $34.75 $34.7570160 26 0.17 0.07 0.07 0.01 $11.11 $11.1170170 0.00 0.00 0.00 0.00 $0.00 $0.0070170 TC 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 212 of 387 Effective January 2012

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MRA 2012

70170 26 0.30 0.11 0.11 0.03 $19.61 $19.6170190 0.21 0.85 0.85 0.02 $49.45 $49.4570190 TC 0.00 0.76 0.76 0.01 $35.68 $35.6870190 26 0.21 0.09 0.09 0.01 $13.77 $13.777020F 0.00 0.00 0.00 0.00 $0.00 $0.0070200 0.28 1.01 1.01 0.02 $59.88 $59.8870200 TC 0.00 0.90 0.90 0.01 $42.15 $42.1570200 26 0.28 0.11 0.11 0.01 $17.73 $17.7370210 0.17 0.74 0.74 0.02 $42.62 $42.6270210 TC 0.00 0.67 0.67 0.01 $31.51 $31.5170210 26 0.17 0.07 0.07 0.01 $11.11 $11.1170220 0.25 0.91 0.91 0.02 $53.95 $53.9570220 TC 0.00 0.81 0.81 0.01 $37.99 $37.9970220 26 0.25 0.10 0.10 0.01 $15.97 $15.9770240 0.19 0.69 0.69 0.02 $41.18 $41.1870240 TC 0.00 0.61 0.61 0.01 $28.73 $28.7370240 26 0.19 0.08 0.08 0.01 $12.44 $12.447025F 0.00 0.00 0.00 0.00 $0.00 $0.0070250 0.24 0.85 0.85 0.02 $50.74 $50.7470250 TC 0.00 0.75 0.75 0.01 $35.21 $35.2170250 26 0.24 0.10 0.10 0.01 $15.53 $15.5370260 0.34 1.06 1.06 0.02 $64.79 $64.7970260 TC 0.00 0.92 0.92 0.01 $43.08 $43.0870260 26 0.34 0.14 0.14 0.01 $21.72 $21.7270300 0.10 0.32 0.32 0.02 $20.16 $20.1670300 TC 0.00 0.26 0.26 0.01 $12.54 $12.5470300 26 0.10 0.06 0.06 0.01 $7.62 $7.6270310 0.16 0.95 0.95 0.02 $51.91 $51.9170310 TC 0.00 0.88 0.88 0.01 $41.23 $41.2370310 26 0.16 0.07 0.07 0.01 $10.68 $10.6870320 0.22 1.30 1.30 0.02 $70.70 $70.7070320 TC 0.00 1.19 1.19 0.01 $55.57 $55.5770320 26 0.22 0.11 0.11 0.01 $15.13 $15.1370328 0.18 0.73 0.73 0.02 $42.59 $42.5970328 TC 0.00 0.66 0.66 0.01 $31.05 $31.0570328 26 0.18 0.07 0.07 0.01 $11.55 $11.5570330 0.24 1.20 1.20 0.02 $66.94 $66.9470330 TC 0.00 1.09 1.09 0.01 $50.94 $50.9470330 26 0.24 0.11 0.11 0.01 $16.00 $16.0070332 0.54 1.67 1.67 0.04 $102.70 $102.70

Updated December 2011 213 of 387 Effective January 2012

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MRA 2012

70332 TC 0.00 1.47 1.47 0.01 $68.53 $68.5370332 26 0.54 0.20 0.20 0.03 $34.17 $34.1770336 1.48 10.62 10.62 0.09 $560.09 $560.0970336 TC 0.00 10.08 10.08 0.01 $466.93 $466.9370336 26 1.48 0.54 0.54 0.08 $93.17 $93.1770350 0.17 0.45 0.45 0.02 $29.20 $29.2070350 TC 0.00 0.35 0.35 0.01 $16.70 $16.7070350 26 0.17 0.10 0.10 0.01 $12.50 $12.5070355 0.20 0.41 0.41 0.02 $28.65 $28.6570355 TC 0.00 0.31 0.31 0.01 $14.85 $14.8570355 26 0.20 0.10 0.10 0.01 $13.80 $13.8070360 0.17 0.62 0.62 0.02 $37.07 $37.0770360 TC 0.00 0.56 0.56 0.01 $26.42 $26.4270360 26 0.17 0.06 0.06 0.01 $10.65 $10.6570370 0.32 2.24 2.24 0.02 $118.53 $118.5370370 TC 0.00 2.11 2.11 0.01 $98.14 $98.1470370 26 0.32 0.13 0.13 0.01 $20.39 $20.3970371 0.84 1.92 1.92 0.04 $127.26 $127.2670371 TC 0.00 1.59 1.59 0.01 $74.08 $74.0870371 26 0.84 0.33 0.33 0.03 $53.18 $53.1870373 0.44 1.93 1.93 0.02 $109.38 $109.3870373 TC 0.00 1.77 1.77 0.01 $82.41 $82.4170373 26 0.44 0.16 0.16 0.01 $26.97 $26.9770380 0.17 1.02 1.02 0.02 $55.58 $55.5870380 TC 0.00 0.93 0.93 0.01 $43.54 $43.5470380 26 0.17 0.09 0.09 0.01 $12.04 $12.0470390 0.38 2.65 2.65 0.04 $141.12 $141.1270390 TC 0.00 2.51 2.51 0.01 $116.65 $116.6570390 26 0.38 0.14 0.14 0.03 $24.47 $24.4770450 0.85 4.52 4.52 0.05 $248.51 $248.5170450 TC 0.00 4.20 4.20 0.01 $194.85 $194.8570450 26 0.85 0.32 0.32 0.04 $53.66 $53.6670460 1.13 5.89 5.89 0.06 $324.54 $324.5470460 TC 0.00 5.46 5.46 0.01 $253.15 $253.1570460 26 1.13 0.43 0.43 0.05 $71.39 $71.3970470 1.27 6.22 6.22 0.08 $346.89 $346.8970470 TC 0.00 5.74 5.74 0.01 $266.11 $266.1170470 26 1.27 0.48 0.48 0.07 $80.79 $80.7970480 1.28 7.54 7.54 0.08 $408.40 $408.4070480 TC 0.00 7.05 7.05 0.01 $326.72 $326.72

Updated December 2011 214 of 387 Effective January 2012

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MRA 2012

70480 26 1.28 0.49 0.49 0.07 $81.68 $81.6870481 1.38 8.85 8.85 0.09 $473.86 $473.8670481 TC 0.00 8.33 8.33 0.01 $385.95 $385.9570481 26 1.38 0.52 0.52 0.08 $87.91 $87.9170482 1.45 10.00 10.00 0.09 $530.11 $530.1170482 TC 0.00 9.46 9.46 0.01 $438.24 $438.2470482 26 1.45 0.54 0.54 0.08 $91.87 $91.8770486 1.14 6.17 6.17 0.06 $337.93 $337.9370486 TC 0.00 5.73 5.73 0.01 $265.64 $265.6470486 26 1.14 0.44 0.44 0.05 $72.29 $72.2970487 1.30 7.49 7.49 0.08 $406.96 $406.9670487 TC 0.00 7.00 7.00 0.01 $324.41 $324.4170487 26 1.30 0.49 0.49 0.07 $82.55 $82.5570488 1.42 9.22 9.22 0.09 $492.71 $492.7170488 TC 0.00 8.69 8.69 0.01 $402.61 $402.6170488 26 1.42 0.53 0.53 0.08 $90.11 $90.1170490 1.28 5.82 5.82 0.08 $328.82 $328.8270490 TC 0.00 5.33 5.33 0.01 $247.14 $247.1470490 26 1.28 0.49 0.49 0.07 $81.68 $81.6870491 1.38 7.20 7.20 0.08 $397.00 $397.0070491 TC 0.00 6.68 6.68 0.01 $309.60 $309.6070491 26 1.38 0.52 0.52 0.07 $87.40 $87.4070492 1.45 8.87 8.87 0.09 $477.82 $477.8270492 TC 0.00 8.33 8.33 0.01 $385.95 $385.9570492 26 1.45 0.54 0.54 0.08 $91.87 $91.8770496 1.75 14.65 14.65 0.11 $759.28 $759.2870496 TC 0.00 13.99 13.99 0.01 $647.85 $647.8570496 26 1.75 0.66 0.66 0.10 $111.43 $111.4370498 1.75 15.08 15.08 0.11 $779.18 $779.1870498 TC 0.00 14.42 14.42 0.01 $667.74 $667.7470498 26 1.75 0.66 0.66 0.10 $111.43 $111.4370540 1.35 12.21 12.21 0.09 $628.03 $628.0370540 TC 0.00 11.71 11.71 0.01 $542.35 $542.3570540 26 1.35 0.50 0.50 0.08 $85.69 $85.6970542 1.62 13.60 13.60 0.11 $705.06 $705.0670542 TC 0.00 13.00 13.00 0.01 $602.04 $602.0470542 26 1.62 0.60 0.60 0.10 $103.03 $103.0370543 2.15 17.12 17.12 0.13 $891.92 $891.9270543 TC 0.00 16.33 16.33 0.01 $756.12 $756.1270543 26 2.15 0.79 0.79 0.12 $135.79 $135.79

Updated December 2011 215 of 387 Effective January 2012

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MRA 2012

70544 1.20 13.91 13.91 0.08 $699.69 $699.6970544 TC 0.00 13.46 13.46 0.01 $623.32 $623.3270544 26 1.20 0.45 0.45 0.07 $76.37 $76.3770545 1.20 13.66 13.66 0.08 $688.12 $688.1270545 TC 0.00 13.22 13.22 0.01 $612.22 $612.2270545 26 1.20 0.44 0.44 0.07 $75.90 $75.9070546 1.80 21.42 21.42 0.12 $1,075.21 $1,075.2170546 TC 0.00 20.75 20.75 0.01 $960.64 $960.6470546 26 1.80 0.67 0.67 0.11 $114.57 $114.5770547 1.20 13.89 13.89 0.08 $698.76 $698.7670547 TC 0.00 13.44 13.44 0.01 $622.40 $622.4070547 26 1.20 0.45 0.45 0.07 $76.37 $76.3770548 1.20 14.75 14.75 0.08 $738.56 $738.5670548 TC 0.00 14.30 14.30 0.01 $662.19 $662.1970548 26 1.20 0.45 0.45 0.07 $76.37 $76.3770549 1.80 21.48 21.48 0.11 $1,077.48 $1,077.4870549 TC 0.00 20.81 20.81 0.01 $963.42 $963.4270549 26 1.80 0.67 0.67 0.10 $114.06 $114.0670551 1.48 12.68 12.68 0.09 $655.41 $655.4170551 TC 0.00 12.13 12.13 0.01 $561.78 $561.7870551 26 1.48 0.55 0.55 0.08 $93.63 $93.6370552 1.78 14.02 14.02 0.12 $731.94 $731.9470552 TC 0.00 13.35 13.35 0.01 $618.23 $618.2370552 26 1.78 0.67 0.67 0.11 $113.71 $113.7170553 2.36 16.83 16.83 0.15 $888.61 $888.6170553 TC 0.00 15.95 15.95 0.01 $738.54 $738.5470553 26 2.36 0.88 0.88 0.14 $150.07 $150.0770554 2.11 13.67 13.67 0.13 $730.55 $730.5570554 TC 0.00 12.86 12.86 0.01 $595.56 $595.5670554 26 2.11 0.81 0.81 0.12 $134.99 $134.9970555 0.00 0.00 0.00 0.00 $0.00 $0.0070555 TC 0.00 0.00 0.00 0.00 $0.00 $0.0070555 26 2.54 0.98 0.98 0.24 $167.58 $167.5870557 0.00 0.00 0.00 0.00 $0.00 $0.0070557 TC 0.00 0.00 0.00 0.00 $0.00 $0.0070557 26 2.90 1.11 1.11 1.05 $230.40 $230.4070558 0.00 0.00 0.00 0.00 $0.00 $0.0070558 TC 0.00 0.00 0.00 0.00 $0.00 $0.0070558 26 3.20 1.21 1.21 0.30 $209.87 $209.8770559 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 216 of 387 Effective January 2012

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70559 TC 0.00 0.00 0.00 0.00 $0.00 $0.0070559 26 3.20 1.25 1.25 0.30 $211.72 $211.7271010 0.18 0.50 0.50 0.02 $31.95 $31.9571010 TC 0.00 0.43 0.43 0.01 $20.41 $20.4171010 26 0.18 0.07 0.07 0.01 $11.55 $11.5571015 0.21 0.68 0.68 0.02 $41.58 $41.5871015 TC 0.00 0.60 0.60 0.01 $28.27 $28.2771015 26 0.21 0.08 0.08 0.01 $13.31 $13.3171020 0.22 0.67 0.67 0.02 $41.55 $41.5571020 TC 0.00 0.59 0.59 0.01 $27.81 $27.8171020 26 0.22 0.08 0.08 0.01 $13.74 $13.7471021 0.27 0.84 0.84 0.02 $51.58 $51.5871021 TC 0.00 0.73 0.73 0.01 $34.29 $34.2971021 26 0.27 0.11 0.11 0.01 $17.29 $17.2971022 0.31 1.09 1.09 0.02 $64.88 $64.8871022 TC 0.00 0.96 0.96 0.01 $44.93 $44.9371022 26 0.31 0.13 0.13 0.01 $19.95 $19.9571023 0.38 1.63 1.63 0.02 $92.90 $92.9071023 TC 0.00 1.48 1.48 0.01 $68.99 $68.9971023 26 0.38 0.15 0.15 0.01 $23.91 $23.9171030 0.31 1.05 1.05 0.02 $63.03 $63.0371030 TC 0.00 0.93 0.93 0.01 $43.54 $43.5471030 26 0.31 0.12 0.12 0.01 $19.49 $19.4971034 0.46 2.13 2.13 0.02 $119.50 $119.5071034 TC 0.00 1.94 1.94 0.01 $90.28 $90.2871034 26 0.46 0.19 0.19 0.01 $29.23 $29.2371035 0.18 0.87 0.87 0.02 $49.07 $49.0771035 TC 0.00 0.80 0.80 0.01 $37.53 $37.5371035 26 0.18 0.07 0.07 0.01 $11.55 $11.5571040 0.58 2.28 2.28 0.02 $131.64 $131.6471040 TC 0.00 2.07 2.07 0.01 $96.29 $96.2971040 26 0.58 0.21 0.21 0.01 $35.35 $35.3571060 0.74 3.46 3.46 0.05 $194.70 $194.7071060 TC 0.00 3.18 3.18 0.01 $147.65 $147.6571060 26 0.74 0.28 0.28 0.04 $47.05 $47.0571100 0.22 0.74 0.74 0.02 $44.79 $44.7971100 TC 0.00 0.65 0.65 0.01 $30.59 $30.5971100 26 0.22 0.09 0.09 0.01 $14.20 $14.2071101 0.27 0.89 0.89 0.02 $53.90 $53.9071101 TC 0.00 0.79 0.79 0.01 $37.06 $37.06

Updated December 2011 217 of 387 Effective January 2012

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MRA 2012

71101 26 0.27 0.10 0.10 0.01 $16.83 $16.8371110 0.27 0.93 0.93 0.02 $55.75 $55.7571110 TC 0.00 0.82 0.82 0.01 $38.45 $38.4571110 26 0.27 0.11 0.11 0.01 $17.29 $17.2971111 0.32 1.25 1.25 0.02 $72.72 $72.7271111 TC 0.00 1.12 1.12 0.01 $52.33 $52.3371111 26 0.32 0.13 0.13 0.01 $20.39 $20.3971120 0.20 0.73 0.73 0.02 $43.46 $43.4671120 TC 0.00 0.65 0.65 0.01 $30.59 $30.5971120 26 0.20 0.08 0.08 0.01 $12.87 $12.8771130 0.22 0.88 0.88 0.02 $51.27 $51.2771130 TC 0.00 0.79 0.79 0.01 $37.06 $37.0671130 26 0.22 0.09 0.09 0.01 $14.20 $14.2071250 1.02 5.84 5.84 0.06 $317.46 $317.4671250 TC 0.00 5.44 5.44 0.01 $252.23 $252.2371250 26 1.02 0.40 0.40 0.05 $65.24 $65.2471260 1.24 7.28 7.28 0.08 $394.64 $394.6471260 TC 0.00 6.81 6.81 0.01 $315.62 $315.6271260 26 1.24 0.47 0.47 0.07 $79.02 $79.0271270 1.38 9.06 9.06 0.08 $483.07 $483.0771270 TC 0.00 8.54 8.54 0.01 $395.67 $395.6771270 26 1.38 0.52 0.52 0.07 $87.40 $87.4071275 1.92 11.08 11.08 0.12 $601.96 $601.9671275 TC 0.00 10.36 10.36 0.01 $479.88 $479.8871275 26 1.92 0.72 0.72 0.11 $122.08 $122.0871550 1.46 14.13 14.13 0.09 $721.64 $721.6471550 TC 0.00 13.59 13.59 0.01 $629.34 $629.3471550 26 1.46 0.54 0.54 0.08 $92.30 $92.3071551 1.73 15.72 15.72 0.11 $807.92 $807.9271551 TC 0.00 15.07 15.07 0.01 $697.82 $697.8271551 26 1.73 0.65 0.65 0.10 $110.10 $110.1071552 2.26 20.16 20.16 0.13 $1,037.35 $1,037.3571552 TC 0.00 19.31 19.31 0.01 $894.01 $894.0171552 26 2.26 0.85 0.85 0.12 $143.34 $143.3471555 1.81 13.42 13.42 0.11 $704.97 $704.9771555 TC 0.00 12.73 12.73 0.01 $589.54 $589.5471555 26 1.81 0.69 0.69 0.10 $115.42 $115.4272010 0.45 1.83 1.83 0.04 $106.21 $106.2172010 TC 0.00 1.64 1.64 0.01 $76.39 $76.3972010 26 0.45 0.19 0.19 0.03 $29.81 $29.81

Updated December 2011 218 of 387 Effective January 2012

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72020 0.15 0.54 0.54 0.02 $32.50 $32.5072020 TC 0.00 0.48 0.48 0.01 $22.72 $22.7272020 26 0.15 0.06 0.06 0.01 $9.78 $9.7872040 0.22 0.93 0.93 0.04 $54.60 $54.6072040 TC 0.00 0.84 0.84 0.01 $39.38 $39.3872040 26 0.22 0.09 0.09 0.03 $15.22 $15.2272050 0.31 1.25 1.25 0.04 $73.30 $73.3072050 TC 0.00 1.13 1.13 0.01 $52.80 $52.8072050 26 0.31 0.12 0.12 0.03 $20.51 $20.5172052 0.36 1.65 1.65 0.04 $93.98 $93.9872052 TC 0.00 1.50 1.50 0.01 $69.92 $69.9272052 26 0.36 0.15 0.15 0.03 $24.06 $24.0672069 0.22 0.88 0.88 0.04 $52.28 $52.2872069 TC 0.00 0.79 0.79 0.01 $37.06 $37.0672069 26 0.22 0.09 0.09 0.03 $15.22 $15.2272070 0.22 0.77 0.77 0.02 $46.18 $46.1872070 TC 0.00 0.68 0.68 0.01 $31.97 $31.9772070 26 0.22 0.09 0.09 0.01 $14.20 $14.2072072 0.22 0.88 0.88 0.02 $51.27 $51.2772072 TC 0.00 0.80 0.80 0.01 $37.53 $37.5372072 26 0.22 0.08 0.08 0.01 $13.74 $13.7472074 0.22 1.09 1.09 0.02 $60.98 $60.9872074 TC 0.00 1.01 1.01 0.01 $47.24 $47.2472074 26 0.22 0.08 0.08 0.01 $13.74 $13.7472080 0.22 0.84 0.84 0.04 $50.43 $50.4372080 TC 0.00 0.75 0.75 0.01 $35.21 $35.2172080 26 0.22 0.09 0.09 0.03 $15.22 $15.2272090 0.28 1.19 1.19 0.05 $69.74 $69.7472090 TC 0.00 1.07 1.07 0.01 $50.02 $50.0272090 26 0.28 0.12 0.12 0.04 $19.72 $19.7272100 0.22 0.85 0.85 0.04 $50.90 $50.9072100 TC 0.00 0.76 0.76 0.01 $35.68 $35.6872100 26 0.22 0.09 0.09 0.03 $15.22 $15.2272110 0.31 1.16 1.16 0.04 $69.14 $69.1472110 TC 0.00 1.04 1.04 0.01 $48.63 $48.6372110 26 0.31 0.12 0.12 0.03 $20.51 $20.5172114 0.32 1.60 1.60 0.05 $90.44 $90.4472114 TC 0.00 1.46 1.46 0.01 $68.07 $68.0772114 26 0.32 0.14 0.14 0.04 $22.37 $22.3772120 0.22 1.06 1.06 0.04 $60.61 $60.61

Updated December 2011 219 of 387 Effective January 2012

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MRA 2012

72120 TC 0.00 0.96 0.96 0.01 $44.93 $44.9372120 26 0.22 0.10 0.10 0.03 $15.68 $15.6872125 1.07 5.91 5.91 0.06 $322.87 $322.8772125 TC 0.00 5.50 5.50 0.01 $255.00 $255.0072125 26 1.07 0.41 0.41 0.05 $67.87 $67.8772126 1.22 7.31 7.31 0.08 $395.16 $395.1672126 TC 0.00 6.85 6.85 0.01 $317.47 $317.4772126 26 1.22 0.46 0.46 0.07 $77.69 $77.6972127 1.27 8.98 8.98 0.08 $474.60 $474.6072127 TC 0.00 8.51 8.51 0.01 $394.28 $394.2872127 26 1.27 0.47 0.47 0.07 $80.32 $80.3272128 1.00 5.87 5.87 0.06 $317.98 $317.9872128 TC 0.00 5.48 5.48 0.01 $254.08 $254.0872128 26 1.00 0.39 0.39 0.05 $63.91 $63.9172129 1.22 7.31 7.31 0.08 $395.16 $395.1672129 TC 0.00 6.85 6.85 0.01 $317.47 $317.4772129 26 1.22 0.46 0.46 0.07 $77.69 $77.6972130 1.27 9.05 9.05 0.08 $477.84 $477.8472130 TC 0.00 8.57 8.57 0.01 $397.06 $397.0672130 26 1.27 0.48 0.48 0.07 $80.79 $80.7972131 1.00 5.85 5.85 0.06 $317.06 $317.0672131 TC 0.00 5.46 5.46 0.01 $253.15 $253.1572131 26 1.00 0.39 0.39 0.05 $63.91 $63.9172132 1.22 7.29 7.29 0.08 $394.24 $394.2472132 TC 0.00 6.83 6.83 0.01 $316.54 $316.5472132 26 1.22 0.46 0.46 0.07 $77.69 $77.6972133 1.27 9.04 9.04 0.08 $477.38 $477.3872133 TC 0.00 8.56 8.56 0.01 $396.59 $396.5972133 26 1.27 0.48 0.48 0.07 $80.79 $80.7972141 1.60 11.05 11.05 0.11 $586.21 $586.2172141 TC 0.00 10.45 10.45 0.01 $484.05 $484.0572141 26 1.60 0.60 0.60 0.10 $102.16 $102.1672142 1.92 14.13 14.13 0.12 $743.09 $743.0972142 TC 0.00 13.40 13.40 0.01 $620.55 $620.5572142 26 1.92 0.73 0.73 0.11 $122.55 $122.5572146 1.60 11.15 11.15 0.11 $590.83 $590.8372146 TC 0.00 10.55 10.55 0.01 $488.67 $488.6772146 26 1.60 0.60 0.60 0.10 $102.16 $102.1672147 1.92 12.39 12.39 0.12 $662.58 $662.5872147 TC 0.00 11.66 11.66 0.01 $540.03 $540.03

Updated December 2011 220 of 387 Effective January 2012

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MRA 2012

72147 26 1.92 0.73 0.73 0.11 $122.55 $122.5572148 1.48 11.10 11.10 0.11 $583.32 $583.3272148 TC 0.00 10.54 10.54 0.01 $488.21 $488.2172148 26 1.48 0.56 0.56 0.10 $95.11 $95.1172149 1.78 13.88 13.88 0.12 $725.46 $725.4672149 TC 0.00 13.20 13.20 0.01 $611.29 $611.2972149 26 1.78 0.68 0.68 0.11 $114.17 $114.1772156 2.57 16.58 16.58 0.17 $887.16 $887.1672156 TC 0.00 15.62 15.62 0.01 $723.27 $723.2772156 26 2.57 0.96 0.96 0.16 $163.89 $163.8972157 2.57 15.36 15.36 0.17 $830.71 $830.7172157 TC 0.00 14.40 14.40 0.01 $666.82 $666.8272157 26 2.57 0.96 0.96 0.16 $163.89 $163.8972158 2.36 16.47 16.47 0.17 $872.97 $872.9772158 TC 0.00 15.58 15.58 0.01 $721.42 $721.4272158 26 2.36 0.89 0.89 0.16 $151.55 $151.5572159 1.80 14.07 14.07 0.08 $733.08 $733.0872159 TC 0.00 13.40 13.40 0.01 $620.55 $620.5572159 26 1.80 0.67 0.67 0.07 $112.54 $112.5472170 0.17 0.59 0.59 0.04 $36.70 $36.7072170 TC 0.00 0.52 0.52 0.01 $24.57 $24.5772170 26 0.17 0.07 0.07 0.03 $12.13 $12.1372190 0.21 1.04 1.04 0.04 $59.25 $59.2572190 TC 0.00 0.95 0.95 0.01 $44.47 $44.4772190 26 0.21 0.09 0.09 0.03 $14.79 $14.7972191 1.81 11.57 11.57 0.13 $620.38 $620.3872191 TC 0.00 10.89 10.89 0.01 $504.40 $504.4072191 26 1.81 0.68 0.68 0.12 $115.98 $115.9872192 1.09 5.54 5.54 0.06 $306.61 $306.6172192 TC 0.00 5.13 5.13 0.01 $237.88 $237.8872192 26 1.09 0.41 0.41 0.05 $68.73 $68.7372193 1.16 6.90 6.90 0.08 $373.59 $373.5972193 TC 0.00 6.46 6.46 0.01 $299.42 $299.4272193 26 1.16 0.44 0.44 0.07 $74.17 $74.1772194 1.22 9.14 9.14 0.08 $479.84 $479.8472194 TC 0.00 8.68 8.68 0.01 $402.14 $402.1472194 26 1.22 0.46 0.46 0.07 $77.69 $77.6972195 1.46 12.59 12.59 0.11 $651.40 $651.4072195 TC 0.00 12.04 12.04 0.01 $557.62 $557.6272195 26 1.46 0.55 0.55 0.10 $93.78 $93.78

Updated December 2011 221 of 387 Effective January 2012

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MRA 2012

72196 1.73 13.88 13.88 0.11 $722.79 $722.7972196 TC 0.00 13.22 13.22 0.01 $612.22 $612.2272196 26 1.73 0.66 0.66 0.10 $110.57 $110.5772197 2.26 17.43 17.43 0.13 $911.03 $911.0372197 TC 0.00 16.59 16.59 0.01 $768.15 $768.1572197 26 2.26 0.84 0.84 0.12 $142.87 $142.8772198 1.80 13.44 13.44 0.11 $705.46 $705.4672198 TC 0.00 12.77 12.77 0.01 $591.40 $591.4072198 26 1.80 0.67 0.67 0.10 $114.06 $114.0672200 0.17 0.71 0.71 0.02 $41.23 $41.2372200 TC 0.00 0.64 0.64 0.01 $30.12 $30.1272200 26 0.17 0.07 0.07 0.01 $11.11 $11.1172202 0.19 0.83 0.83 0.02 $47.65 $47.6572202 TC 0.00 0.76 0.76 0.01 $35.68 $35.6872202 26 0.19 0.07 0.07 0.01 $11.98 $11.9872220 0.17 0.68 0.68 0.02 $39.85 $39.8572220 TC 0.00 0.61 0.61 0.01 $28.73 $28.7372220 26 0.17 0.07 0.07 0.01 $11.11 $11.1172240 0.91 3.13 3.13 0.06 $187.30 $187.3072240 TC 0.00 2.79 2.79 0.01 $129.61 $129.6172240 26 0.91 0.34 0.34 0.05 $57.70 $57.7072255 0.91 2.94 2.94 0.05 $178.00 $178.0072255 TC 0.00 2.59 2.59 0.01 $120.35 $120.3572255 26 0.91 0.35 0.35 0.04 $57.65 $57.6572265 0.83 3.07 3.07 0.05 $180.55 $180.5572265 TC 0.00 2.75 2.75 0.01 $127.76 $127.7672265 26 0.83 0.32 0.32 0.04 $52.80 $52.8072270 1.33 4.77 4.77 0.08 $282.40 $282.4072270 TC 0.00 4.26 4.26 0.01 $197.63 $197.6372270 26 1.33 0.51 0.51 0.07 $84.77 $84.7772275 0.76 2.73 2.73 0.05 $161.79 $161.7972275 TC 0.00 2.40 2.40 0.01 $111.56 $111.5672275 26 0.76 0.33 0.33 0.04 $50.23 $50.2372285 1.16 2.75 2.75 0.06 $180.55 $180.5572285 TC 0.00 2.24 2.24 0.01 $104.16 $104.1672285 26 1.16 0.51 0.51 0.05 $76.39 $76.3972291 0.00 0.00 0.00 0.00 $0.00 $0.0072291 TC 0.00 0.00 0.00 0.00 $0.00 $0.0072291 26 1.31 0.57 0.57 0.22 $94.31 $94.3172292 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 222 of 387 Effective January 2012

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MRA 2012

72292 TC 0.00 0.00 0.00 0.00 $0.00 $0.0072292 26 1.38 0.56 0.56 0.20 $95.87 $95.8772295 0.83 2.63 2.63 0.05 $160.19 $160.1972295 TC 0.00 2.25 2.25 0.01 $104.62 $104.6272295 26 0.83 0.38 0.38 0.04 $55.57 $55.5773000 0.16 0.69 0.69 0.02 $39.88 $39.8873000 TC 0.00 0.62 0.62 0.01 $29.20 $29.2073000 26 0.16 0.07 0.07 0.01 $10.68 $10.6873010 0.17 0.74 0.74 0.04 $43.64 $43.6473010 TC 0.00 0.66 0.66 0.01 $31.05 $31.0573010 26 0.17 0.08 0.08 0.03 $12.59 $12.5973020 0.15 0.55 0.55 0.02 $32.96 $32.9673020 TC 0.00 0.49 0.49 0.01 $23.18 $23.1873020 26 0.15 0.06 0.06 0.01 $9.78 $9.7873030 0.18 0.71 0.71 0.04 $42.68 $42.6873030 TC 0.00 0.63 0.63 0.01 $29.66 $29.6673030 26 0.18 0.08 0.08 0.03 $13.03 $13.0373040 0.54 2.65 2.65 0.05 $148.56 $148.5673040 TC 0.00 2.43 2.43 0.01 $112.95 $112.9573040 26 0.54 0.22 0.22 0.04 $35.61 $35.6173050 0.20 0.97 0.97 0.04 $55.58 $55.5873050 TC 0.00 0.87 0.87 0.01 $40.76 $40.7673050 26 0.20 0.10 0.10 0.03 $14.82 $14.8273060 0.17 0.69 0.69 0.02 $40.31 $40.3173060 TC 0.00 0.62 0.62 0.01 $29.20 $29.2073060 26 0.17 0.07 0.07 0.01 $11.11 $11.1173070 0.15 0.69 0.69 0.02 $39.44 $39.4473070 TC 0.00 0.62 0.62 0.01 $29.20 $29.2073070 26 0.15 0.07 0.07 0.01 $10.25 $10.2573080 0.17 0.83 0.83 0.02 $46.79 $46.7973080 TC 0.00 0.76 0.76 0.01 $35.68 $35.6873080 26 0.17 0.07 0.07 0.01 $11.11 $11.1173085 0.54 2.45 2.45 0.04 $138.79 $138.7973085 TC 0.00 2.21 2.21 0.01 $102.77 $102.7773085 26 0.54 0.24 0.24 0.03 $36.02 $36.0273090 0.16 0.65 0.65 0.02 $38.02 $38.0273090 TC 0.00 0.59 0.59 0.01 $27.81 $27.8173090 26 0.16 0.06 0.06 0.01 $10.22 $10.2273092 0.16 0.66 0.66 0.02 $38.49 $38.4973092 TC 0.00 0.60 0.60 0.01 $28.27 $28.27

Updated December 2011 223 of 387 Effective January 2012

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MRA 2012

73092 26 0.16 0.06 0.06 0.01 $10.22 $10.2273100 0.16 0.76 0.76 0.04 $44.13 $44.1373100 TC 0.00 0.68 0.68 0.01 $31.97 $31.9773100 26 0.16 0.08 0.08 0.03 $12.16 $12.1673110 0.17 0.93 0.93 0.02 $51.41 $51.4173110 TC 0.00 0.86 0.86 0.01 $40.30 $40.3073110 26 0.17 0.07 0.07 0.01 $11.11 $11.1173115 0.54 2.81 2.81 0.05 $155.96 $155.9673115 TC 0.00 2.57 2.57 0.01 $119.43 $119.4373115 26 0.54 0.24 0.24 0.04 $36.53 $36.5373120 0.16 0.66 0.66 0.02 $38.49 $38.4973120 TC 0.00 0.59 0.59 0.01 $27.81 $27.8173120 26 0.16 0.07 0.07 0.01 $10.68 $10.6873130 0.17 0.78 0.78 0.02 $44.47 $44.4773130 TC 0.00 0.71 0.71 0.01 $33.36 $33.3673130 26 0.17 0.07 0.07 0.01 $11.11 $11.1173140 0.13 0.84 0.84 0.02 $45.52 $45.5273140 TC 0.00 0.78 0.78 0.01 $36.60 $36.6073140 26 0.13 0.06 0.06 0.01 $8.92 $8.9273200 1.00 5.74 5.74 0.08 $312.99 $312.9973200 TC 0.00 5.35 5.35 0.01 $248.06 $248.0673200 26 1.00 0.39 0.39 0.07 $64.93 $64.9373201 1.16 7.12 7.12 0.08 $383.77 $383.7773201 TC 0.00 6.68 6.68 0.01 $309.60 $309.6073201 26 1.16 0.44 0.44 0.07 $74.17 $74.1773202 1.22 9.43 9.43 0.08 $493.26 $493.2673202 TC 0.00 8.97 8.97 0.01 $415.56 $415.5673202 26 1.22 0.46 0.46 0.07 $77.69 $77.6973206 1.81 10.05 10.05 0.09 $548.01 $548.0173206 TC 0.00 9.36 9.36 0.01 $433.61 $433.6173206 26 1.81 0.69 0.69 0.08 $114.40 $114.4073218 1.35 12.61 12.61 0.08 $646.03 $646.0373218 TC 0.00 12.10 12.10 0.01 $560.39 $560.3973218 26 1.35 0.51 0.51 0.07 $85.64 $85.6473219 1.62 13.75 13.75 0.11 $712.00 $712.0073219 TC 0.00 13.14 13.14 0.01 $608.52 $608.5273219 26 1.62 0.61 0.61 0.10 $103.49 $103.4973220 2.15 17.42 17.42 0.13 $905.80 $905.8073220 TC 0.00 16.61 16.61 0.01 $769.08 $769.0873220 26 2.15 0.81 0.81 0.12 $136.72 $136.72

Updated December 2011 224 of 387 Effective January 2012

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MRA 2012

73221 1.35 11.92 11.92 0.11 $615.63 $615.6373221 TC 0.00 11.40 11.40 0.01 $528.00 $528.0073221 26 1.35 0.52 0.52 0.10 $87.63 $87.6373222 1.62 12.78 12.78 0.11 $667.12 $667.1273222 TC 0.00 12.17 12.17 0.01 $563.63 $563.6373222 26 1.62 0.61 0.61 0.10 $103.49 $103.4973223 2.15 16.33 16.33 0.13 $855.36 $855.3673223 TC 0.00 15.52 15.52 0.01 $718.64 $718.6473223 26 2.15 0.81 0.81 0.12 $136.72 $136.7273225 1.73 13.53 13.53 0.08 $705.06 $705.0673225 TC 0.00 12.90 12.90 0.01 $597.41 $597.4173225 26 1.73 0.63 0.63 0.07 $107.65 $107.6573500 0.17 0.61 0.61 0.04 $37.62 $37.6273500 TC 0.00 0.54 0.54 0.01 $25.50 $25.5073500 26 0.17 0.07 0.07 0.03 $12.13 $12.1373510 0.21 0.93 0.93 0.04 $54.16 $54.1673510 TC 0.00 0.84 0.84 0.01 $39.38 $39.3873510 26 0.21 0.09 0.09 0.03 $14.79 $14.7973520 0.26 0.94 0.94 0.04 $56.79 $56.7973520 TC 0.00 0.83 0.83 0.01 $38.91 $38.9173520 26 0.26 0.11 0.11 0.03 $17.88 $17.8873525 0.54 2.54 2.54 0.05 $143.47 $143.4773525 TC 0.00 2.29 2.29 0.01 $106.47 $106.4773525 26 0.54 0.25 0.25 0.04 $36.99 $36.9973530 0.00 0.00 0.00 0.00 $0.00 $0.0073530 TC 0.00 0.00 0.00 0.00 $0.00 $0.0073530 26 0.29 0.11 0.11 0.03 $19.18 $19.1873540 0.20 1.09 1.09 0.04 $61.13 $61.1373540 TC 0.00 0.99 0.99 0.01 $46.32 $46.3273540 26 0.20 0.10 0.10 0.03 $14.82 $14.8273550 0.17 0.65 0.65 0.04 $39.48 $39.4873550 TC 0.00 0.58 0.58 0.01 $27.35 $27.3573550 26 0.17 0.07 0.07 0.03 $12.13 $12.1373560 0.17 0.73 0.73 0.04 $43.18 $43.1873560 TC 0.00 0.65 0.65 0.01 $30.59 $30.5973560 26 0.17 0.08 0.08 0.03 $12.59 $12.5973562 0.18 0.90 0.90 0.04 $51.48 $51.4873562 TC 0.00 0.82 0.82 0.01 $38.45 $38.4573562 26 0.18 0.08 0.08 0.03 $13.03 $13.0373564 0.22 1.05 1.05 0.04 $60.15 $60.15

Updated December 2011 225 of 387 Effective January 2012

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MRA 2012

73564 TC 0.00 0.95 0.95 0.01 $44.47 $44.4773564 26 0.22 0.10 0.10 0.03 $15.68 $15.6873565 0.17 0.86 0.86 0.04 $49.19 $49.1973565 TC 0.00 0.77 0.77 0.01 $36.14 $36.1473565 26 0.17 0.09 0.09 0.03 $13.05 $13.0573580 0.54 3.47 3.47 0.06 $187.01 $187.0173580 TC 0.00 3.21 3.21 0.01 $149.04 $149.0473580 26 0.54 0.26 0.26 0.05 $37.97 $37.9773590 0.17 0.64 0.64 0.02 $38.00 $38.0073590 TC 0.00 0.57 0.57 0.01 $26.88 $26.8873590 26 0.17 0.07 0.07 0.01 $11.11 $11.1173592 0.16 0.79 0.79 0.02 $44.50 $44.5073592 TC 0.00 0.72 0.72 0.01 $33.82 $33.8273592 26 0.16 0.07 0.07 0.01 $10.68 $10.6873600 0.16 0.69 0.69 0.02 $39.88 $39.8873600 TC 0.00 0.62 0.62 0.01 $29.20 $29.2073600 26 0.16 0.07 0.07 0.01 $10.68 $10.6873610 0.17 0.81 0.81 0.02 $45.86 $45.8673610 TC 0.00 0.74 0.74 0.01 $34.75 $34.7573610 26 0.17 0.07 0.07 0.01 $11.11 $11.1173615 0.54 2.67 2.67 0.05 $149.48 $149.4873615 TC 0.00 2.42 2.42 0.01 $112.49 $112.4973615 26 0.54 0.25 0.25 0.04 $36.99 $36.9973620 0.16 0.64 0.64 0.02 $37.56 $37.5673620 TC 0.00 0.59 0.59 0.01 $27.81 $27.8173620 26 0.16 0.05 0.05 0.01 $9.75 $9.7573630 0.17 0.76 0.76 0.02 $43.55 $43.5573630 TC 0.00 0.70 0.70 0.01 $32.90 $32.9073630 26 0.17 0.06 0.06 0.01 $10.65 $10.6573650 0.16 0.67 0.67 0.02 $38.95 $38.9573650 TC 0.00 0.61 0.61 0.01 $28.73 $28.7373650 26 0.16 0.06 0.06 0.01 $10.22 $10.2273660 0.13 0.75 0.75 0.02 $41.35 $41.3573660 TC 0.00 0.70 0.70 0.01 $32.90 $32.9073660 26 0.13 0.05 0.05 0.01 $8.45 $8.4573700 1.00 5.75 5.75 0.08 $313.45 $313.4573700 TC 0.00 5.37 5.37 0.01 $248.99 $248.9973700 26 1.00 0.38 0.38 0.07 $64.46 $64.4673701 1.16 7.21 7.21 0.08 $387.94 $387.9473701 TC 0.00 6.77 6.77 0.01 $313.77 $313.77

Updated December 2011 226 of 387 Effective January 2012

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MRA 2012

73701 26 1.16 0.44 0.44 0.07 $74.17 $74.1773702 1.22 9.42 9.42 0.08 $492.80 $492.8073702 TC 0.00 8.96 8.96 0.01 $415.10 $415.1073702 26 1.22 0.46 0.46 0.07 $77.69 $77.6973706 1.90 11.22 11.22 0.12 $607.58 $607.5873706 TC 0.00 10.50 10.50 0.01 $486.36 $486.3673706 26 1.90 0.72 0.72 0.11 $121.22 $121.2273718 1.35 12.41 12.41 0.09 $637.29 $637.2973718 TC 0.00 11.91 11.91 0.01 $551.60 $551.6073718 26 1.35 0.50 0.50 0.08 $85.69 $85.6973719 1.62 13.79 13.79 0.11 $713.86 $713.8673719 TC 0.00 13.18 13.18 0.01 $610.37 $610.3773719 26 1.62 0.61 0.61 0.10 $103.49 $103.4973720 2.15 17.52 17.52 0.13 $910.42 $910.4273720 TC 0.00 16.72 16.72 0.01 $774.17 $774.1773720 26 2.15 0.80 0.80 0.12 $136.26 $136.2673721 1.35 12.21 12.21 0.11 $629.05 $629.0573721 TC 0.00 11.69 11.69 0.01 $541.42 $541.4273721 26 1.35 0.52 0.52 0.10 $87.63 $87.6373722 1.62 13.10 13.10 0.12 $682.44 $682.4473722 TC 0.00 12.48 12.48 0.01 $577.98 $577.9873722 26 1.62 0.62 0.62 0.11 $104.46 $104.4673723 2.15 16.35 16.35 0.13 $856.29 $856.2973723 TC 0.00 15.55 15.55 0.01 $720.03 $720.0373723 26 2.15 0.80 0.80 0.12 $136.26 $136.2673725 1.82 13.46 13.46 0.11 $707.25 $707.2573725 TC 0.00 12.78 12.78 0.01 $591.86 $591.8673725 26 1.82 0.68 0.68 0.10 $115.39 $115.3974000 0.18 0.54 0.54 0.02 $33.80 $33.8074000 TC 0.00 0.47 0.47 0.01 $22.26 $22.2674000 26 0.18 0.07 0.07 0.01 $11.55 $11.5574010 0.23 0.90 0.90 0.02 $52.63 $52.6374010 TC 0.00 0.81 0.81 0.01 $37.99 $37.9974010 26 0.23 0.09 0.09 0.01 $14.64 $14.6474020 0.27 0.91 0.91 0.02 $54.82 $54.8274020 TC 0.00 0.81 0.81 0.01 $37.99 $37.9974020 26 0.27 0.10 0.10 0.01 $16.83 $16.8374022 0.32 1.10 1.10 0.02 $65.78 $65.7874022 TC 0.00 0.98 0.98 0.01 $45.85 $45.8574022 26 0.32 0.12 0.12 0.01 $19.92 $19.92

Updated December 2011 227 of 387 Effective January 2012

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MRA 2012

74150 1.19 5.55 5.55 0.08 $312.43 $312.4374150 TC 0.00 5.10 5.10 0.01 $236.49 $236.4974150 26 1.19 0.45 0.45 0.07 $75.93 $75.9374160 1.27 7.95 7.95 0.08 $426.94 $426.9474160 TC 0.00 7.47 7.47 0.01 $346.16 $346.1674160 26 1.27 0.48 0.48 0.07 $80.79 $80.7974170 1.40 10.83 10.83 0.09 $566.34 $566.3474170 TC 0.00 10.30 10.30 0.01 $477.10 $477.1074170 26 1.40 0.53 0.53 0.08 $89.24 $89.2474174 2.20 14.16 14.16 0.15 $758.14 $758.1474174 TC 0.00 13.40 13.40 0.01 $620.55 $620.5574174 26 2.20 0.76 0.76 0.14 $137.59 $137.5974175 1.90 12.33 12.33 0.13 $659.45 $659.4574175 TC 0.00 11.62 11.62 0.01 $538.18 $538.1874175 26 1.90 0.71 0.71 0.12 $121.26 $121.2674176 1.74 4.79 4.79 0.11 $302.61 $302.6174176 TC 0.00 4.18 4.18 0.01 $193.92 $193.9274176 26 1.74 0.61 0.61 0.10 $108.69 $108.6974177 1.82 8.58 8.58 0.11 $481.45 $481.4574177 TC 0.00 7.94 7.94 0.01 $367.90 $367.9074177 26 1.82 0.64 0.64 0.10 $113.54 $113.5474178 2.01 11.21 11.21 0.13 $612.39 $612.3974178 TC 0.00 10.50 10.50 0.01 $486.36 $486.3674178 26 2.01 0.71 0.71 0.12 $126.03 $126.0374181 1.46 11.05 11.05 0.09 $579.12 $579.1274181 TC 0.00 10.50 10.50 0.01 $486.36 $486.3674181 26 1.46 0.55 0.55 0.08 $92.76 $92.7674182 1.73 15.33 15.33 0.11 $789.88 $789.8874182 TC 0.00 14.68 14.68 0.01 $679.77 $679.7774182 26 1.73 0.65 0.65 0.10 $110.10 $110.1074183 2.26 17.47 17.47 0.13 $912.88 $912.8874183 TC 0.00 16.63 16.63 0.01 $770.00 $770.0074183 26 2.26 0.84 0.84 0.12 $142.87 $142.8774185 1.80 13.41 13.41 0.11 $704.07 $704.0774185 TC 0.00 12.74 12.74 0.01 $590.01 $590.0174185 26 1.80 0.67 0.67 0.10 $114.06 $114.0674190 0.00 0.00 0.00 0.00 $0.00 $0.0074190 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074190 26 0.48 0.18 0.18 0.04 $31.16 $31.1674210 0.36 1.99 1.99 0.02 $108.69 $108.69

Updated December 2011 228 of 387 Effective January 2012

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MRA 2012

74210 TC 0.00 1.85 1.85 0.01 $86.11 $86.1174210 26 0.36 0.14 0.14 0.01 $22.58 $22.5874220 0.46 2.22 2.22 0.04 $124.68 $124.6874220 TC 0.00 2.05 2.05 0.01 $95.37 $95.3774220 26 0.46 0.17 0.17 0.03 $29.32 $29.3274230 0.53 2.19 2.19 0.04 $126.33 $126.3374230 TC 0.00 1.99 1.99 0.01 $92.59 $92.5974230 26 0.53 0.20 0.20 0.03 $33.74 $33.7474235 0.00 0.00 0.00 0.00 $0.00 $0.0074235 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074235 26 1.19 0.62 0.62 0.10 $85.32 $85.3274240 0.69 2.69 2.69 0.05 $156.90 $156.9074240 TC 0.00 2.42 2.42 0.01 $112.49 $112.4974240 26 0.69 0.27 0.27 0.04 $44.42 $44.4274241 0.69 2.86 2.86 0.04 $164.26 $164.2674241 TC 0.00 2.60 2.60 0.01 $120.81 $120.8174241 26 0.69 0.26 0.26 0.03 $43.45 $43.4574245 0.91 4.38 4.38 0.06 $245.14 $245.1474245 TC 0.00 4.04 4.04 0.01 $187.45 $187.4574245 26 0.91 0.34 0.34 0.05 $57.70 $57.7074246 0.69 3.11 3.11 0.05 $176.34 $176.3474246 TC 0.00 2.85 2.85 0.01 $132.38 $132.3874246 26 0.69 0.26 0.26 0.04 $43.96 $43.9674247 0.69 3.54 3.54 0.05 $196.23 $196.2374247 TC 0.00 3.28 3.28 0.01 $152.28 $152.2874247 26 0.69 0.26 0.26 0.04 $43.96 $43.9674249 0.91 4.81 4.81 0.06 $265.04 $265.0474249 TC 0.00 4.47 4.47 0.01 $207.34 $207.3474249 26 0.91 0.34 0.34 0.05 $57.70 $57.7074250 0.47 2.74 2.74 0.04 $149.18 $149.1874250 TC 0.00 2.56 2.56 0.01 $118.96 $118.9674250 26 0.47 0.18 0.18 0.03 $30.21 $30.2174251 0.69 10.84 10.84 0.05 $534.02 $534.0274251 TC 0.00 10.58 10.58 0.01 $490.06 $490.0674251 26 0.69 0.26 0.26 0.04 $43.96 $43.9674260 0.50 9.10 9.10 0.04 $444.76 $444.7674260 TC 0.00 8.91 8.91 0.01 $412.79 $412.7974260 26 0.50 0.19 0.19 0.03 $31.98 $31.9874261 2.40 13.36 13.36 0.13 $728.76 $728.7674261 TC 0.00 12.51 12.51 0.01 $579.36 $579.36

Updated December 2011 229 of 387 Effective January 2012

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MRA 2012

74261 26 2.40 0.85 0.85 0.12 $149.40 $149.4074262 2.50 15.89 15.89 0.15 $851.18 $851.1874262 TC 0.00 14.95 14.95 0.01 $692.27 $692.2774262 26 2.50 0.94 0.94 0.14 $158.91 $158.9174263 2.28 21.36 21.36 0.13 $1,093.74 $1,093.7474263 TC 0.00 20.43 20.43 0.01 $945.83 $945.8374263 26 2.28 0.93 0.93 0.12 $147.90 $147.9074270 0.69 3.94 3.94 0.05 $214.74 $214.7474270 TC 0.00 3.68 3.68 0.01 $170.79 $170.7974270 26 0.69 0.26 0.26 0.04 $43.96 $43.9674280 0.99 5.43 5.43 0.06 $297.19 $297.1974280 TC 0.00 5.06 5.06 0.01 $234.64 $234.6474280 26 0.99 0.37 0.37 0.05 $62.55 $62.5574283 2.02 4.00 4.00 0.06 $275.64 $275.6474283 TC 0.00 3.23 3.23 0.01 $149.97 $149.9774283 26 2.02 0.77 0.77 0.05 $125.68 $125.6874290 0.32 1.74 1.74 0.02 $95.39 $95.3974290 TC 0.00 1.62 1.62 0.01 $75.47 $75.4774290 26 0.32 0.12 0.12 0.01 $19.92 $19.9274291 0.20 1.79 1.79 0.02 $92.51 $92.5174291 TC 0.00 1.71 1.71 0.01 $79.63 $79.6374291 26 0.20 0.08 0.08 0.01 $12.87 $12.8774300 0.00 0.00 0.00 0.00 $0.00 $0.0074300 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074300 26 0.36 0.14 0.14 0.03 $23.60 $23.6074301 0.00 0.00 0.00 0.00 $0.00 $0.0074301 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074301 26 0.21 0.08 0.08 0.03 $14.32 $14.3274305 0.00 0.00 0.00 0.00 $0.00 $0.0074305 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074305 26 0.42 0.16 0.16 0.04 $27.63 $27.6374320 0.54 2.53 2.53 0.04 $142.49 $142.4974320 TC 0.00 2.33 2.33 0.01 $108.32 $108.3274320 26 0.54 0.20 0.20 0.03 $34.17 $34.1774327 0.70 3.33 3.33 0.13 $191.02 $191.0274327 TC 0.00 3.07 3.07 0.01 $142.56 $142.5674327 26 0.70 0.26 0.26 0.12 $48.46 $48.4674328 0.00 0.00 0.00 0.00 $0.00 $0.0074328 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074328 26 0.70 0.29 0.29 0.05 $46.29 $46.29

Updated December 2011 230 of 387 Effective January 2012

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MRA 2012

74329 0.00 0.00 0.00 0.00 $0.00 $0.0074329 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074329 26 0.70 0.29 0.29 0.05 $46.29 $46.2974330 0.00 0.00 0.00 0.00 $0.00 $0.0074330 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074330 26 0.90 0.36 0.36 0.07 $59.21 $59.2174340 0.00 0.00 0.00 0.00 $0.00 $0.0074340 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074340 26 0.54 0.20 0.20 0.04 $34.68 $34.6874355 0.00 0.00 0.00 0.00 $0.00 $0.0074355 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074355 26 0.76 0.32 0.32 0.07 $51.29 $51.2974360 0.00 0.00 0.00 0.00 $0.00 $0.0074360 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074360 26 0.54 0.27 0.27 0.04 $37.92 $37.9274363 0.00 0.00 0.00 0.00 $0.00 $0.0074363 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074363 26 0.88 0.33 0.33 0.08 $57.46 $57.4674400 0.49 2.84 2.84 0.04 $154.67 $154.6774400 TC 0.00 2.66 2.66 0.01 $123.59 $123.5974400 26 0.49 0.18 0.18 0.03 $31.08 $31.0874410 0.49 2.88 2.88 0.04 $156.52 $156.5274410 TC 0.00 2.69 2.69 0.01 $124.98 $124.9874410 26 0.49 0.19 0.19 0.03 $31.54 $31.5474415 0.49 3.58 3.58 0.04 $188.91 $188.9174415 TC 0.00 3.40 3.40 0.01 $157.83 $157.8374415 26 0.49 0.18 0.18 0.03 $31.08 $31.0874420 0.00 0.00 0.00 0.00 $0.00 $0.0074420 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074420 26 0.36 0.14 0.14 0.03 $23.60 $23.6074425 0.00 0.00 0.00 0.00 $0.00 $0.0074425 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074425 26 0.36 0.13 0.13 0.03 $23.14 $23.1474430 0.32 1.17 1.17 0.02 $69.02 $69.0274430 TC 0.00 1.05 1.05 0.01 $49.09 $49.0974430 26 0.32 0.12 0.12 0.01 $19.92 $19.9274440 0.38 2.07 2.07 0.04 $114.28 $114.2874440 TC 0.00 1.93 1.93 0.01 $89.81 $89.8174440 26 0.38 0.14 0.14 0.03 $24.47 $24.4774445 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 231 of 387 Effective January 2012

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Treatment

MRA 2012

74445 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074445 26 1.14 0.45 0.45 0.10 $75.29 $75.2974450 0.00 0.00 0.00 0.00 $0.00 $0.0074450 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074450 26 0.33 0.13 0.13 0.03 $21.84 $21.8474455 0.33 2.30 2.30 0.02 $121.74 $121.7474455 TC 0.00 2.17 2.17 0.01 $100.92 $100.9274455 26 0.33 0.13 0.13 0.01 $20.82 $20.8274470 0.00 0.00 0.00 0.00 $0.00 $0.0074470 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074470 26 0.54 0.20 0.20 0.04 $34.68 $34.6874475 0.54 2.57 2.57 0.04 $144.34 $144.3474475 TC 0.00 2.37 2.37 0.01 $110.17 $110.1774475 26 0.54 0.20 0.20 0.03 $34.17 $34.1774480 0.54 2.57 2.57 0.04 $144.34 $144.3474480 TC 0.00 2.37 2.37 0.01 $110.17 $110.1774480 26 0.54 0.20 0.20 0.03 $34.17 $34.1774485 0.54 2.57 2.57 0.04 $144.34 $144.3474485 TC 0.00 2.37 2.37 0.01 $110.17 $110.1774485 26 0.54 0.20 0.20 0.03 $34.17 $34.1774710 0.34 0.77 0.77 0.02 $51.37 $51.3774710 TC 0.00 0.64 0.64 0.01 $30.12 $30.1274710 26 0.34 0.13 0.13 0.01 $21.25 $21.2574740 0.38 1.98 1.98 0.02 $109.10 $109.1074740 TC 0.00 1.83 1.83 0.01 $85.19 $85.1974740 26 0.38 0.15 0.15 0.01 $23.91 $23.9174742 0.00 0.00 0.00 0.00 $0.00 $0.0074742 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074742 26 0.61 0.24 0.24 0.05 $40.07 $40.0774775 0.00 0.00 0.00 0.00 $0.00 $0.0074775 TC 0.00 0.00 0.00 0.00 $0.00 $0.0074775 26 0.62 0.23 0.23 0.05 $40.04 $40.0475557 2.35 9.73 9.73 0.11 $557.62 $557.6275557 TC 0.00 8.79 8.79 0.01 $407.23 $407.2375557 26 2.35 0.94 0.94 0.10 $150.38 $150.3875559 2.95 14.19 14.19 0.13 $791.00 $791.0075559 TC 0.00 12.99 12.99 0.01 $601.57 $601.5775559 26 2.95 1.20 1.20 0.12 $189.42 $189.4275561 2.60 13.70 13.70 0.12 $752.65 $752.6575561 TC 0.00 12.67 12.67 0.01 $586.77 $586.77

Updated December 2011 232 of 387 Effective January 2012

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MRA 2012

75561 26 2.60 1.03 1.03 0.11 $165.88 $165.8875563 3.00 16.63 16.63 0.12 $905.56 $905.5675563 TC 0.00 15.37 15.37 0.01 $711.70 $711.7075563 26 3.00 1.26 1.26 0.11 $193.85 $193.8575565 0.25 1.67 1.67 0.02 $89.12 $89.1275565 TC 0.00 1.58 1.58 0.01 $73.62 $73.6275565 26 0.25 0.09 0.09 0.01 $15.50 $15.5075571 0.58 2.76 2.76 0.02 $153.85 $153.8575571 TC 0.00 2.55 2.55 0.01 $118.50 $118.5075571 26 0.58 0.21 0.21 0.01 $35.35 $35.3575572 1.75 7.40 7.40 0.06 $421.27 $421.2775572 TC 0.00 6.77 6.77 0.01 $313.77 $313.7775572 26 1.75 0.63 0.63 0.05 $107.50 $107.5075573 2.55 10.00 10.00 0.09 $577.76 $577.7675573 TC 0.00 9.08 9.08 0.01 $420.65 $420.6575573 26 2.55 0.92 0.92 0.08 $157.10 $157.1075574 2.40 11.15 11.15 0.09 $624.47 $624.4775574 TC 0.00 10.29 10.29 0.01 $476.64 $476.6475574 26 2.40 0.86 0.86 0.08 $147.83 $147.8375600 0.49 6.68 6.68 0.04 $332.35 $332.3575600 TC 0.00 6.48 6.48 0.01 $300.35 $300.3575600 26 0.49 0.20 0.20 0.03 $32.01 $32.0175605 1.14 4.26 4.26 0.08 $250.57 $250.5775605 TC 0.00 3.82 3.82 0.01 $177.27 $177.2775605 26 1.14 0.44 0.44 0.07 $73.30 $73.3075625 1.14 4.28 4.28 0.11 $253.02 $253.0275625 TC 0.00 3.87 3.87 0.01 $179.58 $179.5875625 26 1.14 0.41 0.41 0.10 $73.44 $73.4475630 1.79 4.59 4.59 0.11 $295.52 $295.5275630 TC 0.00 3.92 3.92 0.01 $181.89 $181.8975630 26 1.79 0.67 0.67 0.10 $113.63 $113.6375635 2.40 12.21 12.21 0.15 $676.57 $676.5775635 TC 0.00 11.29 11.29 0.03 $523.93 $523.9375635 26 2.40 0.92 0.92 0.12 $152.64 $152.6475650 1.49 4.49 4.49 0.11 $277.90 $277.9075650 TC 0.00 3.93 3.93 0.01 $182.36 $182.3675650 26 1.49 0.56 0.56 0.10 $95.54 $95.5475658 1.31 4.87 4.87 0.09 $286.67 $286.6775658 TC 0.00 4.42 4.42 0.01 $205.03 $205.0375658 26 1.31 0.45 0.45 0.08 $81.64 $81.64

Updated December 2011 233 of 387 Effective January 2012

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MRA 2012

75660 1.31 5.31 5.31 0.05 $304.99 $304.9975660 TC 0.00 4.78 4.78 0.01 $221.69 $221.6975660 26 1.31 0.53 0.53 0.04 $83.31 $83.3175662 1.66 6.16 6.16 0.10 $362.03 $362.0375662 TC 0.00 5.48 5.48 0.03 $255.09 $255.0975662 26 1.66 0.68 0.68 0.07 $106.93 $106.9375665 1.31 5.49 5.49 0.12 $316.88 $316.8875665 TC 0.00 4.97 4.97 0.01 $230.48 $230.4875665 26 1.31 0.52 0.52 0.11 $86.40 $86.4075671 1.66 6.36 6.36 0.13 $372.81 $372.8175671 TC 0.00 5.71 5.71 0.03 $265.74 $265.7475671 26 1.66 0.65 0.65 0.10 $107.07 $107.0775676 1.31 5.10 5.10 0.12 $298.84 $298.8475676 TC 0.00 4.59 4.59 0.01 $212.89 $212.8975676 26 1.31 0.51 0.51 0.11 $85.94 $85.9475680 1.66 5.68 5.68 0.11 $340.33 $340.3375680 TC 0.00 5.03 5.03 0.01 $233.25 $233.2575680 26 1.66 0.65 0.65 0.10 $107.07 $107.0775685 1.31 5.22 5.22 0.09 $302.86 $302.8675685 TC 0.00 4.70 4.70 0.01 $217.98 $217.9875685 26 1.31 0.52 0.52 0.08 $84.88 $84.8875705 2.18 5.69 5.69 0.08 $361.79 $361.7975705 TC 0.00 4.81 4.81 0.01 $223.07 $223.0775705 26 2.18 0.88 0.88 0.07 $138.71 $138.7175710 1.14 4.93 4.93 0.06 $280.55 $280.5575710 TC 0.00 4.51 4.51 0.01 $209.19 $209.1975710 26 1.14 0.42 0.42 0.05 $71.36 $71.3675716 1.31 5.78 5.78 0.13 $330.81 $330.8175716 TC 0.00 5.30 5.30 0.03 $246.76 $246.7675716 26 1.31 0.48 0.48 0.10 $84.04 $84.0475726 1.14 4.87 4.87 0.09 $279.30 $279.3075726 TC 0.00 4.45 4.45 0.01 $206.42 $206.4275726 26 1.14 0.42 0.42 0.08 $72.89 $72.8975731 1.14 4.71 4.71 0.05 $269.87 $269.8775731 TC 0.00 4.24 4.24 0.01 $196.70 $196.7075731 26 1.14 0.47 0.47 0.04 $73.17 $73.1775733 1.31 5.70 5.70 0.07 $324.06 $324.0675733 TC 0.00 5.15 5.15 0.03 $239.82 $239.8275733 26 1.31 0.55 0.55 0.04 $84.23 $84.2375736 1.14 4.82 4.82 0.06 $275.46 $275.46

Updated December 2011 234 of 387 Effective January 2012

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MRA 2012

75736 TC 0.00 4.40 4.40 0.01 $204.10 $204.1075736 26 1.14 0.42 0.42 0.05 $71.36 $71.3675741 1.31 4.26 4.26 0.09 $258.44 $258.4475741 TC 0.00 3.78 3.78 0.01 $175.41 $175.4175741 26 1.31 0.48 0.48 0.08 $83.03 $83.0375743 1.66 4.68 4.68 0.11 $294.06 $294.0675743 TC 0.00 4.06 4.06 0.01 $188.37 $188.3775743 26 1.66 0.62 0.62 0.10 $105.68 $105.6875746 1.14 4.67 4.67 0.08 $269.54 $269.5475746 TC 0.00 4.24 4.24 0.01 $196.70 $196.7075746 26 1.14 0.43 0.43 0.07 $72.84 $72.8475756 1.14 5.09 5.09 0.23 $296.61 $296.6175756 TC 0.00 4.64 4.64 0.01 $215.21 $215.2175756 26 1.14 0.45 0.45 0.22 $81.40 $81.4075774 0.36 3.49 3.49 0.04 $179.12 $179.1275774 TC 0.00 3.36 3.36 0.01 $155.98 $155.9875774 26 0.36 0.13 0.13 0.03 $23.14 $23.1475791 1.71 8.18 8.18 0.11 $458.17 $458.1775791 TC 0.00 7.62 7.62 0.01 $353.10 $353.1075791 26 1.71 0.56 0.56 0.10 $105.07 $105.0775801 0.00 0.00 0.00 0.00 $0.00 $0.0075801 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075801 26 0.81 0.32 0.32 0.18 $59.05 $59.0575803 0.00 0.00 0.00 0.00 $0.00 $0.0075803 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075803 26 1.17 0.45 0.45 0.10 $76.59 $76.5975805 0.00 0.00 0.00 0.00 $0.00 $0.0075805 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075805 26 0.81 0.31 0.31 0.07 $52.99 $52.9975807 0.00 0.00 0.00 0.00 $0.00 $0.0075807 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075807 26 1.17 0.45 0.45 0.10 $76.59 $76.5975809 0.47 2.58 2.58 0.04 $141.77 $141.7775809 TC 0.00 2.39 2.39 0.01 $111.10 $111.1075809 26 0.47 0.19 0.19 0.03 $30.68 $30.6875810 0.00 0.00 0.00 0.00 $0.00 $0.0075810 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075810 26 1.14 0.44 0.44 0.10 $74.83 $74.8375820 0.70 3.03 3.03 0.05 $173.07 $173.0775820 TC 0.00 2.76 2.76 0.01 $128.22 $128.22

Updated December 2011 235 of 387 Effective January 2012

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MRA 2012

75820 26 0.70 0.27 0.27 0.04 $44.85 $44.8575822 1.06 3.51 3.51 0.08 $212.40 $212.4075822 TC 0.00 3.12 3.12 0.01 $144.88 $144.8875822 26 1.06 0.39 0.39 0.07 $67.52 $67.5275825 1.14 4.08 4.08 0.09 $242.75 $242.7575825 TC 0.00 3.67 3.67 0.01 $170.32 $170.3275825 26 1.14 0.41 0.41 0.08 $72.42 $72.4275827 1.14 4.18 4.18 0.08 $246.87 $246.8775827 TC 0.00 3.78 3.78 0.01 $175.41 $175.4175827 26 1.14 0.40 0.40 0.07 $71.45 $71.4575831 1.14 4.20 4.20 0.25 $256.44 $256.4475831 TC 0.00 3.79 3.79 0.01 $175.88 $175.8875831 26 1.14 0.41 0.41 0.24 $80.56 $80.5675833 1.49 4.78 4.78 0.09 $290.30 $290.3075833 TC 0.00 4.27 4.27 0.01 $198.09 $198.0975833 26 1.49 0.51 0.51 0.08 $92.21 $92.2175840 1.14 4.16 4.16 0.25 $254.59 $254.5975840 TC 0.00 3.74 3.74 0.01 $173.56 $173.5675840 26 1.14 0.42 0.42 0.24 $81.03 $81.0375842 1.49 4.87 4.87 0.09 $294.47 $294.4775842 TC 0.00 4.30 4.30 0.01 $199.48 $199.4875842 26 1.49 0.57 0.57 0.08 $94.99 $94.9975860 1.14 4.25 4.25 0.09 $250.62 $250.6275860 TC 0.00 3.81 3.81 0.01 $176.80 $176.8075860 26 1.14 0.44 0.44 0.08 $73.81 $73.8175870 1.14 4.20 4.20 0.08 $247.79 $247.7975870 TC 0.00 3.77 3.77 0.01 $174.95 $174.9575870 26 1.14 0.43 0.43 0.07 $72.84 $72.8475872 1.14 6.96 6.96 0.08 $375.50 $375.5075872 TC 0.00 6.39 6.39 0.01 $296.18 $296.1875872 26 1.14 0.57 0.57 0.07 $79.32 $79.3275880 0.70 3.19 3.19 0.05 $180.47 $180.4775880 TC 0.00 2.93 2.93 0.01 $136.08 $136.0875880 26 0.70 0.26 0.26 0.04 $44.39 $44.3975885 1.44 4.31 4.31 0.09 $266.39 $266.3975885 TC 0.00 3.77 3.77 0.01 $174.95 $174.9575885 26 1.44 0.54 0.54 0.08 $91.44 $91.4475887 1.44 4.34 4.34 0.06 $266.25 $266.2575887 TC 0.00 3.81 3.81 0.01 $176.80 $176.8075887 26 1.44 0.53 0.53 0.05 $89.45 $89.45

Updated December 2011 236 of 387 Effective January 2012

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MRA 2012

75889 1.14 4.21 4.21 0.08 $248.26 $248.2675889 TC 0.00 3.79 3.79 0.01 $175.88 $175.8875889 26 1.14 0.42 0.42 0.07 $72.38 $72.3875891 1.14 4.22 4.22 0.08 $248.72 $248.7275891 TC 0.00 3.80 3.80 0.01 $176.34 $176.3475891 26 1.14 0.42 0.42 0.07 $72.38 $72.3875893 0.54 3.97 3.97 0.02 $208.11 $208.1175893 TC 0.00 3.77 3.77 0.01 $174.95 $174.9575893 26 0.54 0.20 0.20 0.01 $33.16 $33.1675894 0.00 0.00 0.00 0.00 $0.00 $0.0075894 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075894 26 1.31 0.48 0.48 0.16 $87.10 $87.1075896 0.00 0.00 0.00 0.00 $0.00 $0.0075896 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075896 26 1.31 0.49 0.49 0.16 $87.56 $87.5675898 0.00 0.00 0.00 0.00 $0.00 $0.0075898 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075898 26 1.65 0.63 0.63 0.20 $110.80 $110.8075900 0.00 0.00 0.00 0.00 $0.00 $0.0075900 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075900 26 0.49 0.17 0.17 0.05 $31.64 $31.6475901 0.49 4.65 4.65 0.04 $238.42 $238.4275901 TC 0.00 4.47 4.47 0.01 $207.34 $207.3475901 26 0.49 0.18 0.18 0.03 $31.08 $31.0875902 0.39 1.87 1.87 0.05 $105.97 $105.9775902 TC 0.00 1.73 1.73 0.01 $80.56 $80.5675902 26 0.39 0.14 0.14 0.04 $25.41 $25.4175945 0.00 0.00 0.00 0.00 $0.00 $0.0075945 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075945 26 0.40 0.14 0.14 0.05 $26.35 $26.3575946 0.00 0.00 0.00 0.00 $0.00 $0.0075946 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075946 26 0.40 0.13 0.13 0.07 $26.90 $26.9075952 0.00 0.00 0.00 0.00 $0.00 $0.0075952 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075952 26 4.49 1.47 1.47 0.86 $306.27 $306.2775953 0.00 0.00 0.00 0.00 $0.00 $0.0075953 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075953 26 1.36 0.45 0.45 0.27 $93.47 $93.4775954 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 237 of 387 Effective January 2012

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MRA 2012

75954 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075954 26 2.25 0.74 0.74 0.41 $152.56 $152.5675956 0.00 0.00 0.00 0.00 $0.00 $0.0075956 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075956 26 7.00 2.26 2.26 1.44 $481.06 $481.0675957 0.00 0.00 0.00 0.00 $0.00 $0.0075957 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075957 26 6.00 1.95 1.95 1.21 $411.69 $411.6975958 0.00 0.00 0.00 0.00 $0.00 $0.0075958 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075958 26 4.00 1.28 1.28 0.82 $274.22 $274.2275959 0.00 0.00 0.00 0.00 $0.00 $0.0075959 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075959 26 3.50 1.01 1.01 0.83 $240.57 $240.5775960 0.82 3.85 3.85 0.06 $216.72 $216.7275960 TC 0.00 3.55 3.55 0.01 $164.77 $164.7775960 26 0.82 0.30 0.30 0.05 $51.95 $51.9575961 4.24 5.63 5.63 0.28 $458.42 $458.4275961 TC 0.00 4.10 4.10 0.01 $190.22 $190.2275961 26 4.24 1.53 1.53 0.27 $268.20 $268.2075962 0.54 4.69 4.69 0.04 $242.44 $242.4475962 TC 0.00 4.50 4.50 0.01 $208.73 $208.7375962 26 0.54 0.19 0.19 0.03 $33.71 $33.7175964 0.36 3.00 3.00 0.05 $156.95 $156.9575964 TC 0.00 2.87 2.87 0.01 $133.31 $133.3175964 26 0.36 0.13 0.13 0.04 $23.64 $23.6475966 1.31 5.04 5.04 0.08 $294.03 $294.0375966 TC 0.00 4.54 4.54 0.01 $210.58 $210.5875966 26 1.31 0.50 0.50 0.07 $83.44 $83.4475968 0.36 2.91 2.91 0.02 $151.26 $151.2675968 TC 0.00 2.77 2.77 0.01 $128.68 $128.6875968 26 0.36 0.14 0.14 0.01 $22.58 $22.5875970 0.00 0.00 0.00 0.00 $0.00 $0.0075970 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075970 26 0.83 0.31 0.31 0.07 $53.86 $53.8675978 0.54 4.81 4.81 0.04 $247.99 $247.9975978 TC 0.00 4.62 4.62 0.01 $214.28 $214.2875978 26 0.54 0.19 0.19 0.03 $33.71 $33.7175980 0.00 0.00 0.00 0.00 $0.00 $0.0075980 TC 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 238 of 387 Effective January 2012

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MRA 2012

75980 26 1.44 0.53 0.53 0.12 $93.01 $93.0175982 0.00 0.00 0.00 0.00 $0.00 $0.0075982 TC 0.00 0.00 0.00 0.00 $0.00 $0.0075982 26 1.44 0.53 0.53 0.12 $93.01 $93.0175984 0.72 2.63 2.63 0.05 $155.43 $155.4375984 TC 0.00 2.36 2.36 0.01 $109.71 $109.7175984 26 0.72 0.27 0.27 0.04 $45.72 $45.7275989 1.19 2.64 2.64 0.06 $176.76 $176.7675989 TC 0.00 2.20 2.20 0.01 $102.31 $102.3175989 26 1.19 0.44 0.44 0.05 $74.45 $74.4576000 0.17 1.74 1.74 0.02 $88.89 $88.8976000 TC 0.00 1.67 1.67 0.01 $77.78 $77.7876000 26 0.17 0.07 0.07 0.01 $11.11 $11.1176001 0.00 0.00 0.00 0.00 $0.00 $0.0076001 TC 0.00 0.00 0.00 0.00 $0.00 $0.0076001 26 0.67 0.28 0.28 0.08 $46.05 $46.0576010 0.18 0.61 0.61 0.02 $37.04 $37.0476010 TC 0.00 0.54 0.54 0.01 $25.50 $25.5076010 26 0.18 0.07 0.07 0.01 $11.55 $11.5576080 0.54 1.24 1.24 0.04 $82.80 $82.8076080 TC 0.00 1.04 1.04 0.01 $48.63 $48.6376080 26 0.54 0.20 0.20 0.03 $34.17 $34.1776098 0.16 0.37 0.37 0.02 $25.07 $25.0776098 TC 0.00 0.31 0.31 0.01 $14.85 $14.8576098 26 0.16 0.06 0.06 0.01 $10.22 $10.2276100 0.58 2.71 2.71 0.06 $153.57 $153.5776100 TC 0.00 2.43 2.43 0.01 $112.95 $112.9576100 26 0.58 0.28 0.28 0.05 $40.62 $40.6276101 0.58 4.25 4.25 0.09 $226.36 $226.3676101 TC 0.00 3.90 3.90 0.01 $180.97 $180.9776101 26 0.58 0.35 0.35 0.08 $45.39 $45.3976102 0.58 5.95 5.95 0.11 $306.04 $306.0476102 TC 0.00 5.61 5.61 0.01 $260.09 $260.0976102 26 0.58 0.34 0.34 0.10 $45.94 $45.9476120 0.38 1.87 1.87 0.04 $105.02 $105.0276120 TC 0.00 1.73 1.73 0.01 $80.56 $80.5676120 26 0.38 0.14 0.14 0.03 $24.47 $24.4776125 0.00 0.00 0.00 0.00 $0.00 $0.0076125 TC 0.00 0.00 0.00 0.00 $0.00 $0.0076125 26 0.27 0.12 0.12 0.03 $18.77 $18.77

Updated December 2011 239 of 387 Effective January 2012

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Treatment

MRA 2012

76140 0.00 0.00 0.00 0.00 $0.00 $0.0076376 0.20 1.74 1.74 0.02 $90.19 $90.1976376 TC 0.00 1.66 1.66 0.01 $77.32 $77.3276376 26 0.20 0.08 0.08 0.01 $12.87 $12.8776377 0.79 1.73 1.73 0.05 $116.81 $116.8176377 TC 0.00 1.43 1.43 0.01 $66.68 $66.6876377 26 0.79 0.30 0.30 0.04 $50.14 $50.1476380 0.98 4.29 4.29 0.05 $243.50 $243.5076380 TC 0.00 3.91 3.91 0.01 $181.43 $181.4376380 26 0.98 0.38 0.38 0.04 $62.07 $62.0776390 1.40 12.79 12.79 0.06 $655.51 $655.5176390 TC 0.00 12.22 12.22 0.01 $565.95 $565.9576390 26 1.40 0.57 0.57 0.05 $89.56 $89.5676496 0.00 0.00 0.00 0.00 $0.00 $0.0076496 TC 0.00 0.00 0.00 0.00 $0.00 $0.0076496 26 0.00 0.00 0.00 0.00 $0.00 $0.0076497 0.00 0.00 0.00 0.00 $0.00 $0.0076497 TC 0.00 0.00 0.00 0.00 $0.00 $0.0076497 26 0.00 0.00 0.00 0.00 $0.00 $0.0076498 0.00 0.00 0.00 0.00 $0.00 $0.0076498 TC 0.00 0.00 0.00 0.00 $0.00 $0.0076498 26 0.00 0.00 0.00 0.00 $0.00 $0.0076499 0.00 0.00 0.00 0.00 $0.00 $0.0076499 TC 0.00 0.00 0.00 0.00 $0.00 $0.0076499 26 0.00 0.00 0.00 0.00 $0.00 $0.0076506 0.63 3.03 3.03 0.05 $170.04 $170.0476506 TC 0.00 2.79 2.79 0.01 $129.61 $129.6176506 26 0.63 0.24 0.24 0.04 $40.43 $40.4376510 1.55 3.25 3.25 0.27 $231.26 $231.2676510 TC 0.00 2.31 2.31 0.01 $107.40 $107.4076510 26 1.55 0.94 0.94 0.26 $123.87 $123.8776511 0.94 2.01 2.01 0.02 $134.74 $134.7476511 TC 0.00 1.45 1.45 0.01 $67.60 $67.6076511 26 0.94 0.56 0.56 0.01 $67.14 $67.1476512 0.94 1.74 1.74 0.05 $123.78 $123.7876512 TC 0.00 1.18 1.18 0.01 $55.11 $55.1176512 26 0.94 0.56 0.56 0.04 $68.67 $68.6776513 0.66 2.02 2.02 0.02 $123.08 $123.0876513 TC 0.00 1.68 1.68 0.01 $78.24 $78.2476513 26 0.66 0.34 0.34 0.01 $44.83 $44.83

Updated December 2011 240 of 387 Effective January 2012

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MRA 2012

76514 0.17 0.24 0.24 0.02 $19.49 $19.4976514 TC 0.00 0.14 0.14 0.01 $6.99 $6.9976514 26 0.17 0.10 0.10 0.01 $12.50 $12.5076516 0.54 1.66 1.66 0.02 $101.22 $101.2276516 TC 0.00 1.34 1.34 0.01 $62.51 $62.5176516 26 0.54 0.32 0.32 0.01 $38.71 $38.7176519 0.54 1.82 1.82 0.04 $109.64 $109.6476519 TC 0.00 1.49 1.49 0.01 $69.45 $69.4576519 26 0.54 0.33 0.33 0.03 $40.19 $40.1976529 0.57 1.66 1.66 0.04 $103.54 $103.5476529 TC 0.00 1.31 1.31 0.01 $61.12 $61.1276529 26 0.57 0.35 0.35 0.03 $42.41 $42.4176536 0.56 3.02 3.02 0.04 $166.03 $166.0376536 TC 0.00 2.81 2.81 0.01 $130.53 $130.5376536 26 0.56 0.21 0.21 0.03 $35.50 $35.5076604 0.55 2.04 2.04 0.04 $120.25 $120.2576604 TC 0.00 1.84 1.84 0.01 $85.65 $85.6576604 26 0.55 0.20 0.20 0.03 $34.61 $34.6176645 0.54 2.32 2.32 0.05 $133.29 $133.2976645 TC 0.00 2.12 2.12 0.01 $98.60 $98.6076645 26 0.54 0.20 0.20 0.04 $34.68 $34.6876700 0.81 3.36 3.36 0.05 $193.10 $193.1076700 TC 0.00 3.05 3.05 0.01 $141.64 $141.6476700 26 0.81 0.31 0.31 0.04 $51.47 $51.4776705 0.59 2.60 2.60 0.04 $147.90 $147.9076705 TC 0.00 2.38 2.38 0.01 $110.63 $110.6376705 26 0.59 0.22 0.22 0.03 $37.26 $37.2676770 0.74 3.21 3.21 0.05 $183.13 $183.1376770 TC 0.00 2.93 2.93 0.01 $136.08 $136.0876770 26 0.74 0.28 0.28 0.04 $47.05 $47.0576775 0.58 2.68 2.68 0.04 $151.17 $151.1776775 TC 0.00 2.46 2.46 0.01 $114.34 $114.3476775 26 0.58 0.22 0.22 0.03 $36.83 $36.8376776 0.76 3.78 3.78 0.05 $210.37 $210.3776776 TC 0.00 3.50 3.50 0.01 $162.46 $162.4676776 26 0.76 0.28 0.28 0.04 $47.91 $47.9176800 1.13 2.76 2.76 0.05 $179.20 $179.2076800 TC 0.00 2.34 2.34 0.01 $108.78 $108.7876800 26 1.13 0.42 0.42 0.04 $70.42 $70.4276801 0.99 2.84 2.84 0.04 $176.33 $176.33

Updated December 2011 241 of 387 Effective January 2012

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MRA 2012

76801 TC 0.00 2.44 2.44 0.01 $113.41 $113.4176801 26 0.99 0.40 0.40 0.03 $62.92 $62.9276802 0.83 1.17 1.17 0.04 $92.13 $92.1376802 TC 0.00 0.84 0.84 0.01 $39.38 $39.3876802 26 0.83 0.33 0.33 0.03 $52.75 $52.7576805 0.99 3.45 3.45 0.04 $204.56 $204.5676805 TC 0.00 3.05 3.05 0.01 $141.64 $141.6476805 26 0.99 0.40 0.40 0.03 $62.92 $62.9276810 0.98 1.91 1.91 0.04 $132.87 $132.8776810 TC 0.00 1.51 1.51 0.01 $70.38 $70.3876810 26 0.98 0.40 0.40 0.03 $62.49 $62.4976811 1.90 3.72 3.72 0.06 $257.49 $257.4976811 TC 0.00 2.91 2.91 0.01 $135.16 $135.1676811 26 1.90 0.81 0.81 0.05 $122.33 $122.3376812 1.78 4.42 4.42 0.06 $284.68 $284.6876812 TC 0.00 3.67 3.67 0.01 $170.32 $170.3276812 26 1.78 0.75 0.75 0.05 $114.35 $114.3576813 1.18 2.53 2.53 0.05 $170.73 $170.7376813 TC 0.00 2.04 2.04 0.01 $94.90 $94.9076813 26 1.18 0.49 0.49 0.04 $75.82 $75.8276814 0.99 1.39 1.39 0.04 $109.24 $109.2476814 TC 0.00 0.97 0.97 0.01 $45.39 $45.3976814 26 0.99 0.42 0.42 0.03 $63.85 $63.8576815 0.65 2.07 2.07 0.02 $124.96 $124.9676815 TC 0.00 1.81 1.81 0.01 $84.26 $84.2676815 26 0.65 0.26 0.26 0.01 $40.70 $40.7076816 0.85 2.69 2.69 0.04 $163.33 $163.3376816 TC 0.00 2.33 2.33 0.01 $108.32 $108.3276816 26 0.85 0.36 0.36 0.03 $55.00 $55.0076817 0.75 2.30 2.30 0.04 $140.95 $140.9576817 TC 0.00 2.00 2.00 0.01 $93.05 $93.0576817 26 0.75 0.30 0.30 0.03 $47.90 $47.9076818 1.05 2.60 2.60 0.04 $167.83 $167.8376818 TC 0.00 2.15 2.15 0.01 $99.99 $99.9976818 26 1.05 0.45 0.45 0.03 $67.83 $67.8376819 0.77 1.92 1.92 0.04 $124.23 $124.2376819 TC 0.00 1.60 1.60 0.01 $74.54 $74.5476819 26 0.77 0.32 0.32 0.03 $49.69 $49.6976820 0.50 0.78 0.78 0.02 $58.77 $58.7776820 TC 0.00 0.57 0.57 0.01 $26.88 $26.88

Updated December 2011 242 of 387 Effective January 2012

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MRA 2012

76820 26 0.50 0.21 0.21 0.01 $31.89 $31.8976821 0.70 2.18 2.18 0.04 $133.23 $133.2376821 TC 0.00 1.88 1.88 0.01 $87.50 $87.5076821 26 0.70 0.30 0.30 0.03 $45.73 $45.7376825 1.67 4.86 4.86 0.05 $299.77 $299.7776825 TC 0.00 4.17 4.17 0.01 $193.46 $193.4676825 26 1.67 0.69 0.69 0.04 $106.30 $106.3076826 0.83 3.00 3.00 0.04 $176.80 $176.8076826 TC 0.00 2.66 2.66 0.01 $123.59 $123.5976826 26 0.83 0.34 0.34 0.03 $53.21 $53.2176827 0.58 1.31 1.31 0.02 $86.76 $86.7676827 TC 0.00 1.07 1.07 0.01 $50.02 $50.0276827 26 0.58 0.24 0.24 0.01 $36.74 $36.7476828 0.56 0.81 0.81 0.02 $62.76 $62.7676828 TC 0.00 0.58 0.58 0.01 $27.35 $27.3576828 26 0.56 0.23 0.23 0.01 $35.41 $35.4176830 0.69 3.06 3.06 0.04 $173.52 $173.5276830 TC 0.00 2.79 2.79 0.01 $129.61 $129.6176830 26 0.69 0.27 0.27 0.03 $43.91 $43.9176831 0.72 3.07 3.07 0.04 $175.28 $175.2876831 TC 0.00 2.77 2.77 0.01 $128.68 $128.6876831 26 0.72 0.30 0.30 0.03 $46.60 $46.6076856 0.69 3.02 3.02 0.04 $171.66 $171.6676856 TC 0.00 2.76 2.76 0.01 $128.22 $128.2276856 26 0.69 0.26 0.26 0.03 $43.45 $43.4576857 0.38 2.56 2.56 0.04 $136.95 $136.9576857 TC 0.00 2.41 2.41 0.01 $112.02 $112.0276857 26 0.38 0.15 0.15 0.03 $24.93 $24.9376870 0.64 3.04 3.04 0.05 $170.93 $170.9376870 TC 0.00 2.80 2.80 0.01 $130.07 $130.0776870 26 0.64 0.24 0.24 0.04 $40.86 $40.8676872 0.69 3.35 3.35 0.05 $187.44 $187.4476872 TC 0.00 3.08 3.08 0.01 $143.02 $143.0276872 26 0.69 0.27 0.27 0.04 $44.42 $44.4276873 1.55 3.55 3.55 0.09 $235.99 $235.9976873 TC 0.00 2.94 2.94 0.01 $136.55 $136.5576873 26 1.55 0.61 0.61 0.08 $99.44 $99.4476881 0.63 2.94 2.94 0.05 $165.87 $165.8776881 TC 0.00 2.72 2.72 0.01 $126.37 $126.3776881 26 0.63 0.22 0.22 0.04 $39.51 $39.51

Updated December 2011 243 of 387 Effective January 2012

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MRA 2012

76882 0.49 0.48 0.48 0.05 $45.98 $45.9876882 TC 0.00 0.31 0.31 0.01 $14.85 $14.8576882 26 0.49 0.17 0.17 0.04 $31.13 $31.1376885 0.74 3.67 3.67 0.05 $204.42 $204.4276885 TC 0.00 3.38 3.38 0.01 $156.91 $156.9176885 26 0.74 0.29 0.29 0.04 $47.51 $47.5176886 0.62 2.48 2.48 0.02 $142.63 $142.6376886 TC 0.00 2.25 2.25 0.01 $104.62 $104.6276886 26 0.62 0.23 0.23 0.01 $38.01 $38.0176930 0.67 1.88 1.88 0.02 $117.03 $117.0376930 TC 0.00 1.60 1.60 0.01 $74.54 $74.5476930 26 0.67 0.28 0.28 0.01 $42.49 $42.4976932 0.00 0.00 0.00 0.00 $0.00 $0.0076932 TC 0.00 0.00 0.00 0.00 $0.00 $0.0076932 26 0.67 0.28 0.28 0.04 $44.01 $44.0176936 1.99 6.69 6.69 0.24 $407.97 $407.9776936 TC 0.00 5.99 5.99 0.01 $277.67 $277.6776936 26 1.99 0.70 0.70 0.23 $130.29 $130.2976937 0.30 0.70 0.70 0.04 $47.42 $47.4276937 TC 0.00 0.59 0.59 0.01 $27.81 $27.8176937 26 0.30 0.11 0.11 0.03 $19.61 $19.6176940 0.00 0.00 0.00 0.00 $0.00 $0.0076940 TC 0.00 0.00 0.00 0.00 $0.00 $0.0076940 26 2.00 0.76 0.76 0.29 $136.56 $136.5676941 0.00 0.00 0.00 0.00 $0.00 $0.0076941 TC 0.00 0.00 0.00 0.00 $0.00 $0.0076941 26 1.34 0.50 0.50 0.11 $86.78 $86.7876942 0.67 5.35 5.35 0.05 $279.12 $279.1276942 TC 0.00 5.09 5.09 0.01 $236.03 $236.0376942 26 0.67 0.26 0.26 0.04 $43.09 $43.0976945 0.00 0.00 0.00 0.00 $0.00 $0.0076945 TC 0.00 0.00 0.00 0.00 $0.00 $0.0076945 26 0.67 0.29 0.29 0.04 $44.48 $44.4876946 0.38 0.64 0.64 0.02 $47.09 $47.0976946 TC 0.00 0.48 0.48 0.01 $22.72 $22.7276946 26 0.38 0.16 0.16 0.01 $24.37 $24.3776948 0.38 0.64 0.64 0.04 $48.11 $48.1176948 TC 0.00 0.48 0.48 0.01 $22.72 $22.7276948 26 0.38 0.16 0.16 0.03 $25.39 $25.3976950 0.58 1.00 1.00 0.04 $73.43 $73.43

Updated December 2011 244 of 387 Effective January 2012

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MRA 2012

76950 TC 0.00 0.77 0.77 0.01 $36.14 $36.1476950 26 0.58 0.23 0.23 0.03 $37.29 $37.2976965 1.34 1.61 1.61 0.09 $137.12 $137.1276965 TC 0.00 1.08 1.08 0.01 $50.48 $50.4876965 26 1.34 0.53 0.53 0.08 $86.64 $86.6476970 0.40 2.58 2.58 0.05 $139.25 $139.2576970 TC 0.00 2.43 2.43 0.01 $112.95 $112.9576970 26 0.40 0.15 0.15 0.04 $26.30 $26.3076975 0.00 0.00 0.00 0.00 $0.00 $0.0076975 TC 0.00 0.00 0.00 0.00 $0.00 $0.0076975 26 0.81 0.38 0.38 0.08 $56.74 $56.7476977 0.05 0.19 0.19 0.02 $11.97 $11.9776977 TC 0.00 0.17 0.17 0.01 $8.37 $8.3776977 26 0.05 0.02 0.02 0.01 $3.60 $3.6076998 0.00 0.00 0.00 0.00 $0.00 $0.0076998 TC 0.00 0.00 0.00 0.00 $0.00 $0.0076998 26 1.20 0.45 0.45 0.26 $86.03 $86.0376999 0.00 0.00 0.00 0.00 $0.00 $0.0076999 TC 0.00 0.00 0.00 0.00 $0.00 $0.0076999 26 0.00 0.00 0.00 0.00 $0.00 $0.0077001 0.38 3.09 3.09 0.04 $161.47 $161.4777001 TC 0.00 2.95 2.95 0.01 $137.01 $137.0177001 26 0.38 0.14 0.14 0.03 $24.47 $24.4777002 0.54 1.72 1.72 0.04 $105.01 $105.0177002 TC 0.00 1.49 1.49 0.01 $69.45 $69.4577002 26 0.54 0.23 0.23 0.03 $35.56 $35.5677003 0.60 1.26 1.26 0.04 $86.33 $86.3377003 TC 0.00 1.01 1.01 0.01 $47.24 $47.2477003 26 0.60 0.25 0.25 0.03 $39.09 $39.0977011 1.21 9.35 9.35 0.05 $487.60 $487.6077011 TC 0.00 8.84 8.84 0.01 $409.55 $409.5577011 26 1.21 0.51 0.51 0.04 $78.05 $78.0577012 1.16 3.11 3.11 0.05 $196.70 $196.7077012 TC 0.00 2.68 2.68 0.01 $124.52 $124.5277012 26 1.16 0.43 0.43 0.04 $72.18 $72.1877013 0.00 0.00 0.00 0.00 $0.00 $0.0077013 TC 0.00 0.00 0.00 0.00 $0.00 $0.0077013 26 3.99 1.48 1.48 0.37 $260.15 $260.1577014 0.85 3.32 3.32 0.05 $192.99 $192.9977014 TC 0.00 2.98 2.98 0.01 $138.40 $138.40

Updated December 2011 245 of 387 Effective January 2012

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MRA 2012

77014 26 0.85 0.34 0.34 0.04 $54.59 $54.5977021 1.50 10.62 10.62 0.13 $562.99 $562.9977021 TC 0.00 10.06 10.06 0.01 $466.00 $466.0077021 26 1.50 0.56 0.56 0.12 $96.99 $96.9977022 0.00 0.00 0.00 0.00 $0.00 $0.0077022 TC 0.00 0.00 0.00 0.00 $0.00 $0.0077022 26 4.24 1.52 1.52 0.38 $273.33 $273.3377031 1.59 2.57 2.57 0.13 $194.41 $194.4177031 TC 0.00 1.97 1.97 0.01 $91.66 $91.6677031 26 1.59 0.60 0.60 0.12 $102.74 $102.7477032 0.56 0.99 0.99 0.04 $72.10 $72.1077032 TC 0.00 0.78 0.78 0.01 $36.60 $36.6077032 26 0.56 0.21 0.21 0.03 $35.50 $35.5077051 0.06 0.24 0.24 0.02 $14.72 $14.7277051 TC 0.00 0.22 0.22 0.01 $10.69 $10.6977051 26 0.06 0.02 0.02 0.01 $4.03 $4.0377052 0.06 0.24 0.24 0.02 $14.72 $14.7277052 TC 0.00 0.22 0.22 0.01 $10.69 $10.6977052 26 0.06 0.02 0.02 0.01 $4.03 $4.0377053 0.36 1.49 1.49 0.02 $85.56 $85.5677053 TC 0.00 1.36 1.36 0.01 $63.44 $63.4477053 26 0.36 0.13 0.13 0.01 $22.12 $22.1277054 0.45 2.06 2.06 0.04 $116.85 $116.8577054 TC 0.00 1.89 1.89 0.01 $87.96 $87.9677054 26 0.45 0.17 0.17 0.03 $28.89 $28.8977055 0.70 1.83 1.83 0.05 $117.54 $117.5477055 TC 0.00 1.56 1.56 0.01 $72.69 $72.6977055 26 0.70 0.27 0.27 0.04 $44.85 $44.8577056 0.87 2.37 2.37 0.06 $150.40 $150.4077056 TC 0.00 2.04 2.04 0.01 $94.90 $94.9077056 26 0.87 0.33 0.33 0.05 $55.50 $55.5077057 0.70 1.64 1.64 0.05 $108.75 $108.7577057 TC 0.00 1.37 1.37 0.01 $63.90 $63.9077057 26 0.70 0.27 0.27 0.04 $44.85 $44.8577058 1.63 18.91 18.91 0.11 $951.20 $951.2077058 TC 0.00 18.31 18.31 0.01 $847.74 $847.7477058 26 1.63 0.60 0.60 0.10 $103.46 $103.4677059 1.63 19.31 19.31 0.11 $969.71 $969.7177059 TC 0.00 18.71 18.71 0.01 $866.25 $866.2577059 26 1.63 0.60 0.60 0.10 $103.46 $103.46

Updated December 2011 246 of 387 Effective January 2012

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MRA 2012

77071 0.41 1.00 1.00 0.07 $67.59 $67.5977072 0.19 0.48 0.48 0.02 $31.46 $31.4677072 TC 0.00 0.41 0.41 0.01 $19.48 $19.4877072 26 0.19 0.07 0.07 0.01 $11.98 $11.9877073 0.27 0.84 0.84 0.05 $53.11 $53.1177073 TC 0.00 0.72 0.72 0.01 $33.82 $33.8277073 26 0.27 0.12 0.12 0.04 $19.28 $19.2877074 0.45 1.59 1.59 0.04 $95.10 $95.1077074 TC 0.00 1.42 1.42 0.01 $66.21 $66.2177074 26 0.45 0.17 0.17 0.03 $28.89 $28.8977075 0.54 2.53 2.53 0.04 $142.49 $142.4977075 TC 0.00 2.32 2.32 0.01 $107.86 $107.8677075 26 0.54 0.21 0.21 0.03 $34.64 $34.6477076 0.70 2.47 2.47 0.05 $147.16 $147.1677076 TC 0.00 2.20 2.20 0.01 $102.31 $102.3177076 26 0.70 0.27 0.27 0.04 $44.85 $44.8577077 0.31 0.89 0.89 0.05 $57.15 $57.1577077 TC 0.00 0.75 0.75 0.01 $35.21 $35.2177077 26 0.31 0.14 0.14 0.04 $21.94 $21.9477078 0.25 4.12 4.12 0.02 $202.49 $202.4977078 TC 0.00 4.03 4.03 0.01 $186.98 $186.9877078 26 0.25 0.09 0.09 0.01 $15.50 $15.5077080 0.20 1.45 1.45 0.02 $76.77 $76.7777080 TC 0.00 1.37 1.37 0.01 $63.90 $63.9077080 26 0.20 0.08 0.08 0.01 $12.87 $12.8777081 0.22 0.61 0.61 0.02 $38.77 $38.7777081 TC 0.00 0.52 0.52 0.01 $24.57 $24.5777081 26 0.22 0.09 0.09 0.01 $14.20 $14.2077082 0.17 0.66 0.66 0.02 $38.92 $38.9277082 TC 0.00 0.59 0.59 0.01 $27.81 $27.8177082 26 0.17 0.07 0.07 0.01 $11.11 $11.1177084 1.60 12.74 12.74 0.11 $664.40 $664.4077084 TC 0.00 12.14 12.14 0.01 $562.24 $562.2477084 26 1.60 0.60 0.60 0.10 $102.16 $102.1677261 1.39 0.60 0.60 0.10 $93.06 $93.0677262 2.11 0.85 0.85 0.18 $139.89 $139.8977263 3.14 1.25 1.25 0.26 $207.09 $207.0977280 0.70 4.77 4.77 0.04 $253.07 $253.0777280 TC 0.00 4.49 4.49 0.01 $208.27 $208.2777280 26 0.70 0.28 0.28 0.03 $44.81 $44.81

Updated December 2011 247 of 387 Effective January 2012

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Treatment

MRA 2012

77285 1.05 8.62 8.62 0.06 $447.40 $447.4077285 TC 0.00 8.20 8.20 0.01 $379.93 $379.9377285 26 1.05 0.42 0.42 0.05 $67.46 $67.4677290 1.56 14.11 14.11 0.08 $724.54 $724.5477290 TC 0.00 13.49 13.49 0.01 $624.71 $624.7177290 26 1.56 0.62 0.62 0.07 $99.83 $99.8377295 4.56 9.85 9.85 0.28 $667.55 $667.5577295 TC 0.00 8.04 8.04 0.04 $374.06 $374.0677295 26 4.56 1.81 1.81 0.24 $293.49 $293.4977299 0.00 0.00 0.00 0.00 $0.00 $0.0077299 TC 0.00 0.00 0.00 0.00 $0.00 $0.0077299 26 0.00 0.00 0.00 0.00 $0.00 $0.0077300 0.62 1.33 1.33 0.04 $90.43 $90.4377300 TC 0.00 1.08 1.08 0.01 $50.48 $50.4877300 26 0.62 0.25 0.25 0.03 $39.95 $39.9577301 7.99 49.69 49.69 0.63 $2,677.39 $2,677.3977301 TC 0.00 46.52 46.52 0.22 $2,163.74 $2,163.7477301 26 7.99 3.17 3.17 0.41 $513.65 $513.6577305 0.70 1.09 1.09 0.04 $82.79 $82.7977305 TC 0.00 0.81 0.81 0.01 $37.99 $37.9977305 26 0.70 0.28 0.28 0.03 $44.81 $44.8177310 1.05 1.50 1.50 0.06 $117.94 $117.9477310 TC 0.00 1.08 1.08 0.01 $50.48 $50.4877310 26 1.05 0.42 0.42 0.05 $67.46 $67.4677315 1.56 2.40 2.40 0.08 $182.70 $182.7077315 TC 0.00 1.78 1.78 0.01 $82.87 $82.8777315 26 1.56 0.62 0.62 0.07 $99.83 $99.8377321 0.95 1.89 1.89 0.05 $131.15 $131.1577321 TC 0.00 1.51 1.51 0.01 $70.38 $70.3877321 26 0.95 0.38 0.38 0.04 $60.77 $60.7777326 0.93 3.23 3.23 0.07 $193.30 $193.3077326 TC 0.00 2.86 2.86 0.03 $133.86 $133.8677326 26 0.93 0.37 0.37 0.04 $59.44 $59.4477327 1.39 4.46 4.46 0.10 $271.67 $271.6777327 TC 0.00 3.91 3.91 0.03 $182.45 $182.4577327 26 1.39 0.55 0.55 0.07 $89.22 $89.2277328 2.09 5.75 5.75 0.14 $363.72 $363.7277328 TC 0.00 4.92 4.92 0.04 $229.69 $229.6977328 26 2.09 0.83 0.83 0.10 $134.03 $134.0377331 0.87 0.90 0.90 0.05 $81.88 $81.88

Updated December 2011 248 of 387 Effective January 2012

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MRA 2012

77331 TC 0.00 0.55 0.55 0.01 $25.96 $25.9677331 26 0.87 0.35 0.35 0.04 $55.92 $55.9277332 0.54 1.69 1.69 0.04 $103.63 $103.6377332 TC 0.00 1.48 1.48 0.01 $68.99 $68.9977332 26 0.54 0.21 0.21 0.03 $34.64 $34.6477333 0.84 0.71 0.71 0.05 $71.78 $71.7877333 TC 0.00 0.38 0.38 0.01 $18.09 $18.0977333 26 0.84 0.33 0.33 0.04 $53.69 $53.6977334 1.24 3.06 3.06 0.06 $198.36 $198.3677334 TC 0.00 2.57 2.57 0.01 $119.43 $119.4377334 26 1.24 0.49 0.49 0.05 $78.93 $78.9377336 0.00 1.36 1.36 0.01 $63.44 $63.4477338 4.29 9.88 9.88 0.27 $656.73 $656.7377338 TC 0.00 8.21 8.21 0.04 $381.92 $381.9277338 26 4.29 1.67 1.67 0.23 $274.81 $274.8177370 0.00 3.29 3.29 0.04 $154.27 $154.2777371 0.00 0.00 0.00 0.00 $0.00 $0.0077372 0.00 24.56 24.56 0.05 $1,138.97 $1,138.9777373 0.00 46.82 46.82 0.07 $2,169.99 $2,169.9977399 0.00 0.00 0.00 0.00 $0.00 $0.0077399 TC 0.00 0.00 0.00 0.00 $0.00 $0.0077399 26 0.00 0.00 0.00 0.00 $0.00 $0.0077401 0.00 0.64 0.64 0.01 $30.12 $30.1277402 0.00 5.38 5.38 0.01 $249.45 $249.4577403 0.00 3.92 3.92 0.01 $181.89 $181.8977404 0.00 4.38 4.38 0.01 $203.18 $203.1877406 0.00 4.46 4.46 0.01 $206.88 $206.8877407 0.00 7.42 7.42 0.01 $343.84 $343.8477408 0.00 5.37 5.37 0.01 $248.99 $248.9977409 0.00 5.98 5.98 0.01 $277.21 $277.2177411 0.00 5.95 5.95 0.01 $275.82 $275.8277412 0.00 7.14 7.14 0.01 $330.89 $330.8977413 0.00 7.07 7.07 0.01 $327.65 $327.6577414 0.00 7.94 7.94 0.01 $367.90 $367.9077416 0.00 7.97 7.97 0.01 $369.29 $369.2977417 0.00 0.41 0.41 0.01 $19.48 $19.4877418 0.00 13.97 13.97 0.01 $646.92 $646.9277421 0.39 2.13 2.13 0.02 $116.47 $116.4777421 TC 0.00 1.98 1.98 0.01 $92.13 $92.1377421 26 0.39 0.15 0.15 0.01 $24.34 $24.34

Updated December 2011 249 of 387 Effective January 2012

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MRA 2012

77422 0.00 7.42 7.42 0.01 $343.84 $343.8477423 0.00 7.68 7.68 0.01 $355.87 $355.8777424 0.00 0.00 0.00 0.00 $0.00 $0.0077425 0.00 0.00 0.00 0.00 $0.00 $0.0077427 3.37 1.56 1.56 0.27 $231.90 $231.9077431 1.81 0.91 0.91 0.14 $127.64 $127.6477432 7.92 3.18 3.18 0.65 $523.29 $523.2977435 11.87 5.03 4.76 0.99 $797.30 $784.8177469 5.75 2.52 2.52 0.47 $389.60 $389.6077470 2.09 2.90 2.90 0.11 $230.32 $230.3277470 TC 0.00 2.07 2.07 0.01 $96.29 $96.2977470 26 2.09 0.83 0.83 0.10 $134.03 $134.0377499 0.00 0.00 0.00 0.00 $0.00 $0.0077499 TC 0.00 0.00 0.00 0.00 $0.00 $0.0077499 26 0.00 0.00 0.00 0.00 $0.00 $0.0077520 0.00 0.00 0.00 0.00 $0.00 $0.0077522 0.00 0.00 0.00 0.00 $0.00 $0.0077523 0.00 0.00 0.00 0.00 $0.00 $0.0077525 0.00 0.00 0.00 0.00 $0.00 $0.0077600 1.56 10.58 10.58 0.10 $562.22 $562.2277600 TC 0.00 9.96 9.96 0.03 $462.39 $462.3977600 26 1.56 0.62 0.62 0.07 $99.83 $99.8377605 2.09 18.21 18.21 0.41 $954.00 $954.0077605 TC 0.00 17.41 17.41 0.03 $807.11 $807.1177605 26 2.09 0.80 0.80 0.38 $146.88 $146.8877610 1.56 17.82 17.82 0.10 $897.22 $897.2277610 TC 0.00 17.22 17.22 0.03 $798.32 $798.3277610 26 1.56 0.60 0.60 0.07 $98.90 $98.9077615 2.09 26.84 26.84 0.17 $1,341.11 $1,341.1177615 TC 0.00 26.01 26.01 0.07 $1,207.08 $1,207.0877615 26 2.09 0.83 0.83 0.10 $134.03 $134.0377620 1.56 14.46 14.46 0.08 $740.73 $740.7377620 TC 0.00 13.84 13.84 0.04 $642.43 $642.4377620 26 1.56 0.62 0.62 0.04 $98.30 $98.3077750 5.00 5.00 5.00 0.29 $462.70 $462.7077750 TC 0.00 3.02 3.02 0.03 $141.27 $141.2777750 26 5.00 1.98 1.98 0.26 $321.44 $321.4477761 3.85 6.73 6.73 0.24 $490.39 $490.3977761 TC 0.00 5.23 5.23 0.04 $244.03 $244.0377761 26 3.85 1.50 1.50 0.20 $246.36 $246.36

Updated December 2011 250 of 387 Effective January 2012

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MRA 2012

77762 5.76 8.31 8.31 0.35 $651.84 $651.8477762 TC 0.00 6.03 6.03 0.05 $281.56 $281.5677762 26 5.76 2.28 2.28 0.30 $370.28 $370.2877763 8.66 11.25 11.25 0.51 $921.64 $921.6477763 TC 0.00 7.83 7.83 0.07 $365.87 $365.8777763 26 8.66 3.42 3.42 0.44 $555.77 $555.7777776 4.70 7.20 7.20 0.36 $555.07 $555.0777776 TC 0.00 5.34 5.34 0.05 $249.63 $249.6377776 26 4.70 1.86 1.86 0.31 $305.43 $305.4377777 7.52 8.59 8.59 0.54 $750.70 $750.7077777 TC 0.00 5.56 5.56 0.05 $259.81 $259.8177777 26 7.52 3.03 3.03 0.49 $490.89 $490.8977778 11.32 12.46 12.46 0.68 $1,101.50 $1,101.5077778 TC 0.00 8.01 8.01 0.08 $374.70 $374.7077778 26 11.32 4.45 4.45 0.60 $726.80 $726.8077785 1.42 5.34 5.34 0.10 $313.69 $313.6977785 TC 0.00 4.77 4.77 0.03 $222.24 $222.2477785 26 1.42 0.57 0.57 0.07 $91.45 $91.4577786 3.25 13.04 13.04 0.21 $754.85 $754.8577786 TC 0.00 11.77 11.77 0.05 $547.16 $547.1677786 26 3.25 1.27 1.27 0.16 $207.69 $207.6977787 4.89 22.13 22.13 0.34 $1,253.11 $1,253.1177787 TC 0.00 20.16 20.16 0.08 $936.90 $936.9077787 26 4.89 1.97 1.97 0.26 $316.21 $316.2177789 1.14 2.08 2.08 0.06 $148.68 $148.6877789 TC 0.00 1.62 1.62 0.01 $75.47 $75.4777789 26 1.14 0.46 0.46 0.05 $73.21 $73.2177790 1.05 1.57 1.57 0.05 $120.67 $120.6777790 TC 0.00 1.16 1.16 0.01 $54.18 $54.1877790 26 1.05 0.41 0.41 0.04 $66.49 $66.4977799 0.00 0.00 0.00 0.00 $0.00 $0.0077799 TC 0.00 0.00 0.00 0.00 $0.00 $0.0077799 26 0.00 0.00 0.00 0.00 $0.00 $0.0078000 0.19 1.98 1.98 0.02 $100.87 $100.8778000 TC 0.00 1.91 1.91 0.01 $88.89 $88.8978000 26 0.19 0.07 0.07 0.01 $11.98 $11.9878001 0.26 2.49 2.49 0.04 $128.51 $128.5178001 TC 0.00 2.39 2.39 0.03 $112.11 $112.1178001 26 0.26 0.10 0.10 0.01 $16.40 $16.4078003 0.33 2.09 2.09 0.02 $112.02 $112.02

Updated December 2011 251 of 387 Effective January 2012

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MRA 2012

78003 TC 0.00 1.97 1.97 0.01 $91.66 $91.6678003 26 0.33 0.12 0.12 0.01 $20.36 $20.3678006 0.49 6.69 6.69 0.06 $333.83 $333.8378006 TC 0.00 6.51 6.51 0.03 $302.75 $302.7578006 26 0.49 0.18 0.18 0.03 $31.08 $31.0878007 0.50 6.32 6.32 0.06 $317.15 $317.1578007 TC 0.00 6.14 6.14 0.03 $285.63 $285.6378007 26 0.50 0.18 0.18 0.03 $31.51 $31.5178010 0.39 4.59 4.59 0.04 $231.32 $231.3278010 TC 0.00 4.45 4.45 0.03 $207.43 $207.4378010 26 0.39 0.14 0.14 0.01 $23.88 $23.8878011 0.45 4.86 4.86 0.06 $247.42 $247.4278011 TC 0.00 4.69 4.69 0.03 $218.54 $218.5478011 26 0.45 0.17 0.17 0.03 $28.89 $28.8978015 0.67 5.77 5.77 0.07 $299.57 $299.5778015 TC 0.00 5.54 5.54 0.03 $257.87 $257.8778015 26 0.67 0.23 0.23 0.04 $41.70 $41.7078016 0.82 8.03 8.03 0.06 $410.13 $410.1378016 TC 0.00 7.83 7.83 0.03 $363.83 $363.8378016 26 0.82 0.20 0.20 0.03 $46.30 $46.3078018 0.86 8.56 8.56 0.07 $436.90 $436.9078018 TC 0.00 8.27 8.27 0.03 $384.19 $384.1978018 26 0.86 0.29 0.29 0.04 $52.71 $52.7178020 0.60 1.86 1.86 0.04 $114.09 $114.0978020 TC 0.00 1.67 1.67 0.01 $77.78 $77.7878020 26 0.60 0.19 0.19 0.03 $36.31 $36.3178070 0.82 3.85 3.85 0.07 $217.23 $217.2378070 TC 0.00 3.56 3.56 0.03 $166.25 $166.2578070 26 0.82 0.29 0.29 0.04 $50.97 $50.9778075 0.74 11.91 11.91 0.08 $587.22 $587.2278075 TC 0.00 11.67 11.67 0.04 $542.02 $542.0278075 26 0.74 0.24 0.24 0.04 $45.20 $45.2078099 0.00 0.00 0.00 0.00 $0.00 $0.0078099 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078099 26 0.00 0.00 0.00 0.00 $0.00 $0.0078102 0.55 4.41 4.41 0.06 $230.93 $230.9378102 TC 0.00 4.22 4.22 0.03 $196.79 $196.7978102 26 0.55 0.19 0.19 0.03 $34.14 $34.1478103 0.75 5.80 5.80 0.07 $304.42 $304.4278103 TC 0.00 5.55 5.55 0.03 $258.33 $258.33

Updated December 2011 252 of 387 Effective January 2012

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MRA 2012

78103 26 0.75 0.25 0.25 0.04 $46.09 $46.0978104 0.80 6.54 6.54 0.07 $340.83 $340.8378104 TC 0.00 6.26 6.26 0.03 $291.19 $291.1978104 26 0.80 0.28 0.28 0.04 $49.65 $49.6578110 0.19 2.30 2.30 0.04 $116.69 $116.6978110 TC 0.00 2.23 2.23 0.03 $104.71 $104.7178110 26 0.19 0.07 0.07 0.01 $11.98 $11.9878111 0.22 2.22 2.22 0.04 $114.29 $114.2978111 TC 0.00 2.16 2.16 0.03 $101.47 $101.4778111 26 0.22 0.06 0.06 0.01 $12.82 $12.8278120 0.23 2.34 2.34 0.04 $120.27 $120.2778120 TC 0.00 2.25 2.25 0.03 $105.64 $105.6478120 26 0.23 0.09 0.09 0.01 $14.64 $14.6478121 0.32 2.56 2.56 0.04 $134.35 $134.3578121 TC 0.00 2.44 2.44 0.03 $114.43 $114.4378121 26 0.32 0.12 0.12 0.01 $19.92 $19.9278122 0.45 2.55 2.55 0.04 $139.52 $139.5278122 TC 0.00 2.41 2.41 0.03 $113.04 $113.0478122 26 0.45 0.14 0.14 0.01 $26.48 $26.4878130 0.61 3.92 3.92 0.08 $211.88 $211.8878130 TC 0.00 3.69 3.69 0.04 $172.78 $172.7878130 26 0.61 0.23 0.23 0.04 $39.10 $39.1078135 0.64 10.04 10.04 0.07 $495.85 $495.8578135 TC 0.00 9.79 9.79 0.03 $454.52 $454.5278135 26 0.64 0.25 0.25 0.04 $41.33 $41.3378140 0.61 3.35 3.35 0.07 $184.99 $184.9978140 TC 0.00 3.12 3.12 0.03 $145.89 $145.8978140 26 0.61 0.23 0.23 0.04 $39.10 $39.1078185 0.40 5.78 5.78 0.04 $286.81 $286.8178185 TC 0.00 5.63 5.63 0.03 $262.03 $262.0378185 26 0.40 0.15 0.15 0.01 $24.78 $24.7878190 1.09 11.09 11.09 0.07 $563.93 $563.9378190 TC 0.00 10.64 10.64 0.03 $493.85 $493.8578190 26 1.09 0.45 0.45 0.04 $70.07 $70.0778191 0.61 4.26 4.26 0.08 $227.61 $227.6178191 TC 0.00 4.03 4.03 0.04 $188.51 $188.5178191 26 0.61 0.23 0.23 0.04 $39.10 $39.1078195 1.20 9.40 9.40 0.10 $492.02 $492.0278195 TC 0.00 8.97 8.97 0.03 $416.58 $416.5878195 26 1.20 0.43 0.43 0.07 $75.44 $75.44

Updated December 2011 253 of 387 Effective January 2012

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MRA 2012

78199 0.00 0.00 0.00 0.00 $0.00 $0.0078199 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078199 26 0.00 0.00 0.00 0.00 $0.00 $0.0078201 0.44 5.02 5.02 0.07 $254.90 $254.9078201 TC 0.00 4.88 4.88 0.03 $227.33 $227.3378201 26 0.44 0.14 0.14 0.04 $27.57 $27.5778202 0.51 5.60 5.60 0.04 $283.25 $283.2578202 TC 0.00 5.44 5.44 0.03 $253.24 $253.2478202 26 0.51 0.16 0.16 0.01 $30.00 $30.0078205 0.71 5.80 5.80 0.07 $302.69 $302.6978205 TC 0.00 5.56 5.56 0.03 $258.80 $258.8078205 26 0.71 0.24 0.24 0.04 $43.90 $43.9078206 0.96 9.34 9.34 0.07 $477.32 $477.3278206 TC 0.00 9.00 9.00 0.03 $417.97 $417.9778206 26 0.96 0.34 0.34 0.04 $59.35 $59.3578215 0.49 5.25 5.25 0.06 $267.20 $267.2078215 TC 0.00 5.07 5.07 0.03 $236.12 $236.1278215 26 0.49 0.18 0.18 0.03 $31.08 $31.0878216 0.57 3.10 3.10 0.06 $171.19 $171.1978216 TC 0.00 2.91 2.91 0.03 $136.18 $136.1878216 26 0.57 0.19 0.19 0.03 $35.01 $35.0178226 0.74 8.84 8.84 0.07 $444.66 $444.6678226 TC 0.00 8.59 8.59 0.03 $399.00 $399.0078226 26 0.74 0.25 0.25 0.04 $45.66 $45.6678227 0.90 12.23 12.23 0.08 $608.96 $608.9678227 TC 0.00 11.93 11.93 0.04 $554.05 $554.0578227 26 0.90 0.30 0.30 0.04 $54.90 $54.9078230 0.45 4.58 4.58 0.06 $234.47 $234.4778230 TC 0.00 4.41 4.41 0.03 $205.58 $205.5878230 26 0.45 0.17 0.17 0.03 $28.89 $28.8978231 0.52 3.20 3.20 0.04 $172.63 $172.6378231 TC 0.00 3.00 3.00 0.03 $140.34 $140.3478231 26 0.52 0.20 0.20 0.01 $32.29 $32.2978232 0.47 2.64 2.64 0.06 $145.57 $145.5778232 TC 0.00 2.53 2.53 0.03 $118.59 $118.5978232 26 0.47 0.11 0.11 0.03 $26.98 $26.9878258 0.74 6.15 6.15 0.06 $319.68 $319.6878258 TC 0.00 5.87 5.87 0.03 $273.14 $273.1478258 26 0.74 0.28 0.28 0.03 $46.54 $46.5478261 0.69 6.79 6.79 0.07 $347.63 $347.63

Updated December 2011 254 of 387 Effective January 2012

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MRA 2012

78261 TC 0.00 6.53 6.53 0.03 $303.68 $303.6878261 26 0.69 0.26 0.26 0.04 $43.96 $43.9678262 0.68 6.77 6.77 0.04 $344.75 $344.7578262 TC 0.00 6.52 6.52 0.03 $303.22 $303.2278262 26 0.68 0.25 0.25 0.01 $41.53 $41.5378264 0.80 7.80 7.80 0.07 $399.13 $399.1378264 TC 0.00 7.51 7.51 0.03 $349.02 $349.0278264 26 0.80 0.29 0.29 0.04 $50.11 $50.1178267 0.00 0.00 0.00 0.00 $0.00 $0.0078268 0.00 0.00 0.00 0.00 $0.00 $0.0078270 0.20 2.24 2.24 0.02 $113.33 $113.3378270 TC 0.00 2.16 2.16 0.01 $100.46 $100.4678270 26 0.20 0.08 0.08 0.01 $12.87 $12.8778271 0.20 2.42 2.42 0.02 $121.66 $121.6678271 TC 0.00 2.34 2.34 0.01 $108.78 $108.7878271 26 0.20 0.08 0.08 0.01 $12.87 $12.8778272 0.27 2.37 2.37 0.04 $123.39 $123.3978272 TC 0.00 2.27 2.27 0.03 $106.56 $106.5678272 26 0.27 0.10 0.10 0.01 $16.83 $16.8378278 0.99 9.38 9.38 0.08 $480.98 $480.9878278 TC 0.00 9.02 9.02 0.03 $418.89 $418.8978278 26 0.99 0.36 0.36 0.05 $62.09 $62.0978282 0.00 0.00 0.00 0.00 $0.00 $0.0078282 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078282 26 0.38 0.14 0.14 0.03 $24.47 $24.4778290 0.68 9.15 9.15 0.07 $456.40 $456.4078290 TC 0.00 8.90 8.90 0.03 $413.34 $413.3478290 26 0.68 0.25 0.25 0.04 $43.06 $43.0678291 0.88 6.64 6.64 0.08 $349.43 $349.4378291 TC 0.00 6.33 6.33 0.03 $294.42 $294.4278291 26 0.88 0.31 0.31 0.05 $55.01 $55.0178299 0.00 0.00 0.00 0.00 $0.00 $0.0078299 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078299 26 0.00 0.00 0.00 0.00 $0.00 $0.0078300 0.62 4.64 4.64 0.06 $244.61 $244.6178300 TC 0.00 4.41 4.41 0.03 $205.58 $205.5878300 26 0.62 0.23 0.23 0.03 $39.03 $39.0378305 0.83 6.13 6.13 0.07 $323.16 $323.1678305 TC 0.00 5.83 5.83 0.03 $271.29 $271.2978305 26 0.83 0.30 0.30 0.04 $51.87 $51.87

Updated December 2011 255 of 387 Effective January 2012

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Treatment

MRA 2012

78306 0.86 6.63 6.63 0.07 $347.59 $347.5978306 TC 0.00 6.32 6.32 0.03 $293.96 $293.9678306 26 0.86 0.31 0.31 0.04 $53.63 $53.6378315 1.02 9.34 9.34 0.08 $480.43 $480.4378315 TC 0.00 8.97 8.97 0.03 $416.58 $416.5878315 26 1.02 0.37 0.37 0.05 $63.85 $63.8578320 1.04 5.92 5.92 0.08 $323.05 $323.0578320 TC 0.00 5.56 5.56 0.03 $258.80 $258.8078320 26 1.04 0.36 0.36 0.05 $64.25 $64.2578350 0.22 0.74 0.74 0.02 $44.79 $44.7978350 TC 0.00 0.65 0.65 0.01 $30.59 $30.5978350 26 0.22 0.09 0.09 0.01 $14.20 $14.2078351 0.30 0.12 0.13 0.01 $19.06 $19.5278399 0.00 0.00 0.00 0.00 $0.00 $0.0078399 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078399 26 0.00 0.00 0.00 0.00 $0.00 $0.0078414 0.00 0.00 0.00 0.00 $0.00 $0.0078414 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078414 26 0.45 0.19 0.19 0.03 $29.81 $29.8178428 0.78 4.81 4.81 0.06 $259.41 $259.4178428 TC 0.00 4.51 4.51 0.03 $210.21 $210.2178428 26 0.78 0.30 0.30 0.03 $49.20 $49.2078445 0.49 4.66 4.66 0.04 $238.89 $238.8978445 TC 0.00 4.50 4.50 0.03 $209.75 $209.7578445 26 0.49 0.16 0.16 0.01 $29.14 $29.1478451 1.38 9.14 9.14 0.08 $486.77 $486.7778451 TC 0.00 8.65 8.65 0.03 $401.77 $401.7778451 26 1.38 0.49 0.49 0.05 $85.00 $85.0078452 1.62 13.08 13.08 0.09 $679.99 $679.9978452 TC 0.00 12.50 12.50 0.04 $580.43 $580.4378452 26 1.62 0.58 0.58 0.05 $99.56 $99.5678453 1.00 8.05 8.05 0.08 $419.87 $419.8778453 TC 0.00 7.71 7.71 0.03 $358.28 $358.2878453 26 1.00 0.34 0.34 0.05 $61.59 $61.5978454 1.34 11.62 11.62 0.09 $600.30 $600.3078454 TC 0.00 11.16 11.16 0.04 $518.42 $518.4278454 26 1.34 0.46 0.46 0.05 $81.88 $81.8878456 1.00 10.27 10.27 0.06 $521.58 $521.5878456 TC 0.00 9.84 9.84 0.03 $456.84 $456.8478456 26 1.00 0.43 0.43 0.03 $64.74 $64.74

Updated December 2011 256 of 387 Effective January 2012

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MRA 2012

78457 0.77 5.23 5.23 0.07 $278.92 $278.9278457 TC 0.00 4.95 4.95 0.03 $230.57 $230.5778457 26 0.77 0.28 0.28 0.04 $48.35 $48.3578458 0.90 4.69 4.69 0.08 $260.07 $260.0778458 TC 0.00 4.43 4.43 0.03 $206.51 $206.5178458 26 0.90 0.26 0.26 0.05 $53.56 $53.5678459 0.00 0.00 0.00 0.00 $0.00 $0.0078459 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078459 26 1.50 0.53 0.53 0.10 $94.59 $94.5978466 0.69 4.51 4.51 0.06 $241.63 $241.6378466 TC 0.00 4.24 4.24 0.03 $197.72 $197.7278466 26 0.69 0.27 0.27 0.03 $43.91 $43.9178468 0.80 5.52 5.52 0.06 $293.13 $293.1378468 TC 0.00 5.19 5.19 0.03 $241.67 $241.6778468 26 0.80 0.33 0.33 0.03 $51.45 $51.4578469 0.92 6.26 6.26 0.06 $332.56 $332.5678469 TC 0.00 5.89 5.89 0.03 $274.06 $274.0678469 26 0.92 0.37 0.37 0.03 $58.50 $58.5078472 0.98 6.24 6.24 0.07 $334.75 $334.7578472 TC 0.00 5.86 5.86 0.03 $272.68 $272.6878472 26 0.98 0.38 0.38 0.04 $62.07 $62.0778473 1.47 7.86 7.86 0.08 $431.44 $431.4478473 TC 0.00 7.27 7.27 0.03 $337.92 $337.9278473 26 1.47 0.59 0.59 0.05 $93.52 $93.5278481 0.98 4.92 4.92 0.04 $272.14 $272.1478481 TC 0.00 4.51 4.51 0.01 $209.19 $209.1978481 26 0.98 0.41 0.41 0.03 $62.95 $62.9578483 1.47 6.54 6.54 0.08 $370.36 $370.3678483 TC 0.00 5.93 5.93 0.03 $275.92 $275.9278483 26 1.47 0.61 0.61 0.05 $94.45 $94.4578491 0.00 0.00 0.00 0.00 $0.00 $0.0078491 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078491 26 1.50 0.56 0.56 0.10 $95.98 $95.9878492 0.00 0.00 0.00 0.00 $0.00 $0.0078492 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078492 26 1.87 0.74 0.74 0.12 $121.35 $121.3578494 1.19 6.12 6.12 0.07 $338.29 $338.2978494 TC 0.00 5.65 5.65 0.03 $262.96 $262.9678494 26 1.19 0.47 0.47 0.04 $75.33 $75.3378496 0.50 1.35 1.35 0.02 $85.14 $85.14

Updated December 2011 257 of 387 Effective January 2012

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MRA 2012

78496 TC 0.00 1.14 1.14 0.01 $53.26 $53.2678496 26 0.50 0.21 0.21 0.01 $31.89 $31.8978499 0.00 0.00 0.00 0.00 $0.00 $0.0078499 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078499 26 0.00 0.00 0.00 0.00 $0.00 $0.0078579 0.49 4.59 4.59 0.05 $236.16 $236.1678579 TC 0.00 4.43 4.43 0.02 $206.00 $206.0078579 26 0.49 0.16 0.16 0.03 $30.16 $30.1678580 0.74 5.82 5.82 0.06 $304.41 $304.4178580 TC 0.00 5.55 5.55 0.03 $258.33 $258.3378580 26 0.74 0.27 0.27 0.03 $46.08 $46.0878582 1.07 8.30 8.30 0.08 $434.47 $434.4778582 TC 0.00 7.95 7.95 0.03 $369.38 $369.3878582 26 1.07 0.35 0.35 0.05 $65.09 $65.0978597 0.75 4.99 4.99 0.04 $265.42 $265.4278597 TC 0.00 4.75 4.75 0.02 $220.81 $220.8178597 26 0.75 0.24 0.24 0.02 $44.61 $44.6178598 0.85 7.97 7.97 0.06 $408.66 $408.6678598 TC 0.00 7.70 7.70 0.03 $357.82 $357.8278598 26 0.85 0.27 0.27 0.03 $50.84 $50.8478599 0.00 0.00 0.00 0.00 $0.00 $0.0078599 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078599 26 0.00 0.00 0.00 0.00 $0.00 $0.0078600 0.44 4.95 4.95 0.04 $250.14 $250.1478600 TC 0.00 4.78 4.78 0.03 $222.70 $222.7078600 26 0.44 0.17 0.17 0.01 $27.44 $27.4478601 0.51 5.83 5.83 0.06 $294.91 $294.9178601 TC 0.00 5.65 5.65 0.03 $262.96 $262.9678601 26 0.51 0.18 0.18 0.03 $31.95 $31.9578605 0.53 5.34 5.34 0.06 $273.10 $273.1078605 TC 0.00 5.14 5.14 0.03 $239.36 $239.3678605 26 0.53 0.20 0.20 0.03 $33.74 $33.7478606 0.64 9.29 9.29 0.04 $459.62 $459.6278606 TC 0.00 9.05 9.05 0.03 $420.28 $420.2878606 26 0.64 0.24 0.24 0.01 $39.34 $39.3478607 1.23 9.60 9.60 0.08 $501.56 $501.5678607 TC 0.00 9.18 9.18 0.03 $426.30 $426.3078607 26 1.23 0.42 0.42 0.05 $75.26 $75.2678608 0.00 0.00 0.00 0.00 $0.00 $0.0078608 TC 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 258 of 387 Effective January 2012

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MRA 2012

78608 26 1.50 0.50 0.50 0.11 $93.71 $93.7178609 1.50 0.61 0.61 0.10 $98.29 $98.2978609 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078609 26 1.50 0.61 0.61 0.10 $98.29 $98.2978610 0.30 4.97 4.97 0.04 $245.00 $245.0078610 TC 0.00 4.85 4.85 0.03 $225.94 $225.9478610 26 0.30 0.12 0.12 0.01 $19.06 $19.0678630 0.68 9.53 9.53 0.06 $473.48 $473.4878630 TC 0.00 9.28 9.28 0.03 $430.93 $430.9378630 26 0.68 0.25 0.25 0.03 $42.55 $42.5578635 0.61 9.33 9.33 0.04 $460.17 $460.1778635 TC 0.00 9.09 9.09 0.03 $422.13 $422.1378635 26 0.61 0.24 0.24 0.01 $38.04 $38.0478645 0.57 9.01 9.01 0.06 $444.65 $444.6578645 TC 0.00 8.81 8.81 0.03 $409.18 $409.1878645 26 0.57 0.20 0.20 0.03 $35.47 $35.4778647 0.90 9.33 9.33 0.08 $474.77 $474.7778647 TC 0.00 9.03 9.03 0.03 $419.36 $419.3678647 26 0.90 0.30 0.30 0.05 $55.41 $55.4178650 0.61 9.28 9.28 0.07 $459.38 $459.3878650 TC 0.00 9.07 9.07 0.03 $421.21 $421.2178650 26 0.61 0.21 0.21 0.04 $38.18 $38.1878660 0.53 4.96 4.96 0.06 $255.52 $255.5278660 TC 0.00 4.74 4.74 0.03 $220.85 $220.8578660 26 0.53 0.22 0.22 0.03 $34.66 $34.6678699 0.00 0.00 0.00 0.00 $0.00 $0.0078699 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078699 26 0.00 0.00 0.00 0.00 $0.00 $0.0078700 0.45 4.79 4.79 0.06 $244.19 $244.1978700 TC 0.00 4.62 4.62 0.03 $215.30 $215.3078700 26 0.45 0.17 0.17 0.03 $28.89 $28.8978701 0.49 5.87 5.87 0.06 $295.89 $295.8978701 TC 0.00 5.69 5.69 0.03 $264.81 $264.8178701 26 0.49 0.18 0.18 0.03 $31.08 $31.0878707 0.96 6.00 6.00 0.07 $322.78 $322.7878707 TC 0.00 5.66 5.66 0.03 $263.42 $263.4278707 26 0.96 0.34 0.34 0.04 $59.35 $59.3578708 1.21 3.85 3.85 0.08 $234.63 $234.6378708 TC 0.00 3.42 3.42 0.03 $159.77 $159.7778708 26 1.21 0.43 0.43 0.05 $74.86 $74.86

Updated December 2011 259 of 387 Effective January 2012

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MRA 2012

78709 1.41 9.53 9.53 0.10 $507.13 $507.1378709 TC 0.00 9.03 9.03 0.03 $419.36 $419.3678709 26 1.41 0.50 0.50 0.07 $87.78 $87.7878710 0.66 5.67 5.67 0.04 $292.98 $292.9878710 TC 0.00 5.46 5.46 0.03 $254.17 $254.1778710 26 0.66 0.21 0.21 0.01 $38.82 $38.8278725 0.38 2.70 2.70 0.04 $143.43 $143.4378725 TC 0.00 2.57 2.57 0.03 $120.44 $120.4478725 26 0.38 0.13 0.13 0.01 $22.99 $22.9978730 0.15 2.13 2.13 0.02 $106.07 $106.0778730 TC 0.00 2.06 2.06 0.01 $95.83 $95.8378730 26 0.15 0.07 0.07 0.01 $10.25 $10.2578740 0.57 6.27 6.27 0.06 $317.87 $317.8778740 TC 0.00 6.04 6.04 0.03 $281.01 $281.0178740 26 0.57 0.23 0.23 0.03 $36.86 $36.8678761 0.71 5.60 5.60 0.07 $293.44 $293.4478761 TC 0.00 5.33 5.33 0.03 $248.15 $248.1578761 26 0.71 0.27 0.27 0.04 $45.28 $45.2878799 0.00 0.00 0.00 0.00 $0.00 $0.0078799 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078799 26 0.00 0.00 0.00 0.00 $0.00 $0.0078800 0.66 4.94 4.94 0.07 $260.73 $260.7378800 TC 0.00 4.69 4.69 0.03 $218.54 $218.5478800 26 0.66 0.25 0.25 0.04 $42.19 $42.1978801 0.79 6.53 6.53 0.07 $339.94 $339.9478801 TC 0.00 6.24 6.24 0.03 $290.26 $290.2678801 26 0.79 0.29 0.29 0.04 $49.68 $49.6878802 0.86 8.83 8.83 0.07 $449.39 $449.3978802 TC 0.00 8.53 8.53 0.03 $396.22 $396.2278802 26 0.86 0.30 0.30 0.04 $53.17 $53.1778803 1.09 9.22 9.22 0.08 $477.91 $477.9178803 TC 0.00 8.86 8.86 0.03 $411.49 $411.4978803 26 1.09 0.36 0.36 0.05 $66.42 $66.4278804 1.07 16.17 16.17 0.10 $799.65 $799.6578804 TC 0.00 15.80 15.80 0.05 $733.63 $733.6378804 26 1.07 0.37 0.37 0.05 $66.02 $66.0278805 0.73 4.68 4.68 0.07 $251.73 $251.7378805 TC 0.00 4.42 4.42 0.03 $206.05 $206.0578805 26 0.73 0.26 0.26 0.04 $45.69 $45.6978806 0.86 9.15 9.15 0.07 $464.20 $464.20

Updated December 2011 260 of 387 Effective January 2012

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MRA 2012

78806 TC 0.00 8.85 8.85 0.03 $411.03 $411.0378806 26 0.86 0.30 0.30 0.04 $53.17 $53.1778807 1.09 9.25 9.25 0.07 $478.79 $478.7978807 TC 0.00 8.89 8.89 0.03 $412.88 $412.8878807 26 1.09 0.36 0.36 0.04 $65.91 $65.9178808 0.18 1.05 1.05 0.03 $57.91 $57.9178811 0.00 0.00 0.00 0.00 $0.00 $0.0078811 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078811 26 1.54 0.56 0.56 0.18 $101.78 $101.7878812 0.00 0.00 0.00 0.00 $0.00 $0.0078812 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078812 26 1.93 0.69 0.69 0.16 $123.67 $123.6778813 0.00 0.00 0.00 0.00 $0.00 $0.0078813 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078813 26 2.00 0.73 0.73 0.18 $129.57 $129.5778814 0.00 0.00 0.00 0.00 $0.00 $0.0078814 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078814 26 2.20 0.79 0.79 0.20 $142.03 $142.0378815 0.00 0.00 0.00 0.00 $0.00 $0.0078815 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078815 26 2.44 0.87 0.87 0.22 $157.15 $157.1578816 0.00 0.00 0.00 0.00 $0.00 $0.0078816 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078816 26 2.50 0.84 0.84 0.22 $158.36 $158.3678999 0.00 0.00 0.00 0.00 $0.00 $0.0078999 TC 0.00 0.00 0.00 0.00 $0.00 $0.0078999 26 0.00 0.00 0.00 0.00 $0.00 $0.0079005 1.80 2.15 2.15 0.08 $181.53 $181.5379005 TC 0.00 1.50 1.50 0.01 $69.92 $69.9279005 26 1.80 0.65 0.65 0.07 $111.61 $111.6179101 1.96 2.52 2.52 0.08 $205.58 $205.5879101 TC 0.00 1.62 1.62 0.01 $75.47 $75.4779101 26 1.96 0.90 0.90 0.07 $130.11 $130.1179200 1.99 2.71 2.71 0.12 $217.70 $217.7079200 TC 0.00 1.94 1.94 0.01 $90.28 $90.2879200 26 1.99 0.77 0.77 0.11 $127.43 $127.4379300 0.00 0.00 0.00 0.00 $0.00 $0.0079300 TC 0.00 0.00 0.00 0.00 $0.00 $0.0079300 26 1.60 0.73 0.73 0.14 $110.21 $110.2179403 2.25 3.28 3.28 0.14 $256.36 $256.36

Updated December 2011 261 of 387 Effective January 2012

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MRA 2012

79403 TC 0.00 2.47 2.47 0.03 $115.82 $115.8279403 26 2.25 0.81 0.81 0.11 $140.54 $140.5479440 1.99 2.55 2.55 0.06 $207.25 $207.2579440 TC 0.00 1.67 1.67 0.01 $77.78 $77.7879440 26 1.99 0.88 0.88 0.05 $129.47 $129.4779445 0.00 0.00 0.00 0.00 $0.00 $0.0079445 TC 0.00 0.00 0.00 0.00 $0.00 $0.0079445 26 2.40 0.82 0.82 0.20 $152.08 $152.0879999 0.00 0.00 0.00 0.00 $0.00 $0.0079999 TC 0.00 0.00 0.00 0.00 $0.00 $0.0079999 26 0.00 0.00 0.00 0.00 $0.00 $0.0080047 0.00 0.00 0.00 0.00 $0.00 $0.0080048 0.00 0.00 0.00 0.00 $0.00 $0.0080050 0.00 0.00 0.00 0.00 $0.00 $0.0080051 0.00 0.00 0.00 0.00 $0.00 $0.0080053 0.00 0.00 0.00 0.00 $0.00 $0.0080055 0.00 0.00 0.00 0.00 $0.00 $0.0080061 0.00 0.00 0.00 0.00 $0.00 $0.0080069 0.00 0.00 0.00 0.00 $0.00 $0.0080074 0.00 0.00 0.00 0.00 $0.00 $0.0080076 0.00 0.00 0.00 0.00 $0.00 $0.0080100 0.00 0.00 0.00 0.00 $0.00 $0.0080101 0.00 0.00 0.00 0.00 $0.00 $0.0080102 0.00 0.00 0.00 0.00 $0.00 $0.0080103 0.00 0.00 0.00 0.00 $0.00 $0.0080104 0.00 0.00 0.00 0.00 $0.00 $0.0080150 0.00 0.00 0.00 0.00 $0.00 $0.0080152 0.00 0.00 0.00 0.00 $0.00 $0.0080154 0.00 0.00 0.00 0.00 $0.00 $0.0080156 0.00 0.00 0.00 0.00 $0.00 $0.0080157 0.00 0.00 0.00 0.00 $0.00 $0.0080158 0.00 0.00 0.00 0.00 $0.00 $0.0080160 0.00 0.00 0.00 0.00 $0.00 $0.0080162 0.00 0.00 0.00 0.00 $0.00 $0.0080164 0.00 0.00 0.00 0.00 $0.00 $0.0080166 0.00 0.00 0.00 0.00 $0.00 $0.0080168 0.00 0.00 0.00 0.00 $0.00 $0.0080170 0.00 0.00 0.00 0.00 $0.00 $0.0080172 0.00 0.00 0.00 0.00 $0.00 $0.0080173 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 262 of 387 Effective January 2012

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MRA 2012

80174 0.00 0.00 0.00 0.00 $0.00 $0.0080176 0.00 0.00 0.00 0.00 $0.00 $0.0080178 0.00 0.00 0.00 0.00 $0.00 $0.0080182 0.00 0.00 0.00 0.00 $0.00 $0.0080184 0.00 0.00 0.00 0.00 $0.00 $0.0080185 0.00 0.00 0.00 0.00 $0.00 $0.0080186 0.00 0.00 0.00 0.00 $0.00 $0.0080188 0.00 0.00 0.00 0.00 $0.00 $0.0080190 0.00 0.00 0.00 0.00 $0.00 $0.0080192 0.00 0.00 0.00 0.00 $0.00 $0.0080194 0.00 0.00 0.00 0.00 $0.00 $0.0080195 0.00 0.00 0.00 0.00 $0.00 $0.0080196 0.00 0.00 0.00 0.00 $0.00 $0.0080197 0.00 0.00 0.00 0.00 $0.00 $0.0080198 0.00 0.00 0.00 0.00 $0.00 $0.0080200 0.00 0.00 0.00 0.00 $0.00 $0.0080201 0.00 0.00 0.00 0.00 $0.00 $0.0080202 0.00 0.00 0.00 0.00 $0.00 $0.0080299 0.00 0.00 0.00 0.00 $0.00 $0.0080400 0.00 0.00 0.00 0.00 $0.00 $0.0080402 0.00 0.00 0.00 0.00 $0.00 $0.0080406 0.00 0.00 0.00 0.00 $0.00 $0.0080408 0.00 0.00 0.00 0.00 $0.00 $0.0080410 0.00 0.00 0.00 0.00 $0.00 $0.0080412 0.00 0.00 0.00 0.00 $0.00 $0.0080414 0.00 0.00 0.00 0.00 $0.00 $0.0080415 0.00 0.00 0.00 0.00 $0.00 $0.0080416 0.00 0.00 0.00 0.00 $0.00 $0.0080417 0.00 0.00 0.00 0.00 $0.00 $0.0080418 0.00 0.00 0.00 0.00 $0.00 $0.0080420 0.00 0.00 0.00 0.00 $0.00 $0.0080422 0.00 0.00 0.00 0.00 $0.00 $0.0080424 0.00 0.00 0.00 0.00 $0.00 $0.0080426 0.00 0.00 0.00 0.00 $0.00 $0.0080428 0.00 0.00 0.00 0.00 $0.00 $0.0080430 0.00 0.00 0.00 0.00 $0.00 $0.0080432 0.00 0.00 0.00 0.00 $0.00 $0.0080434 0.00 0.00 0.00 0.00 $0.00 $0.0080435 0.00 0.00 0.00 0.00 $0.00 $0.0080436 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 263 of 387 Effective January 2012

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Treatment

MRA 2012

80438 0.00 0.00 0.00 0.00 $0.00 $0.0080439 0.00 0.00 0.00 0.00 $0.00 $0.0080440 0.00 0.00 0.00 0.00 $0.00 $0.0080500 0.37 0.18 0.12 0.03 $25.88 $23.1180502 1.33 0.45 0.40 0.07 $82.00 $79.6881000 0.00 0.00 0.00 0.00 $0.00 $0.0081001 0.00 0.00 0.00 0.00 $0.00 $0.0081002 0.00 0.00 0.00 0.00 $0.00 $0.0081003 0.00 0.00 0.00 0.00 $0.00 $0.0081005 0.00 0.00 0.00 0.00 $0.00 $0.0081007 0.00 0.00 0.00 0.00 $0.00 $0.0081015 0.00 0.00 0.00 0.00 $0.00 $0.0081020 0.00 0.00 0.00 0.00 $0.00 $0.0081025 0.00 0.00 0.00 0.00 $0.00 $0.0081050 0.00 0.00 0.00 0.00 $0.00 $0.0081099 0.00 0.00 0.00 0.00 $0.00 $0.0081200 0.00 0.00 0.00 0.00 $0.00 $0.0081205 0.00 0.00 0.00 0.00 $0.00 $0.0081206 0.00 0.00 0.00 0.00 $0.00 $0.0081207 0.00 0.00 0.00 0.00 $0.00 $0.0081208 0.00 0.00 0.00 0.00 $0.00 $0.0081209 0.00 0.00 0.00 0.00 $0.00 $0.0081210 0.00 0.00 0.00 0.00 $0.00 $0.0081211 0.00 0.00 0.00 0.00 $0.00 $0.0081212 0.00 0.00 0.00 0.00 $0.00 $0.0081213 0.00 0.00 0.00 0.00 $0.00 $0.0081214 0.00 0.00 0.00 0.00 $0.00 $0.0081215 0.00 0.00 0.00 0.00 $0.00 $0.0081216 0.00 0.00 0.00 0.00 $0.00 $0.0081217 0.00 0.00 0.00 0.00 $0.00 $0.0081220 0.00 0.00 0.00 0.00 $0.00 $0.0081221 0.00 0.00 0.00 0.00 $0.00 $0.0081222 0.00 0.00 0.00 0.00 $0.00 $0.0081223 0.00 0.00 0.00 0.00 $0.00 $0.0081224 0.00 0.00 0.00 0.00 $0.00 $0.0081225 0.00 0.00 0.00 0.00 $0.00 $0.0081226 0.00 0.00 0.00 0.00 $0.00 $0.0081227 0.00 0.00 0.00 0.00 $0.00 $0.0081228 0.00 0.00 0.00 0.00 $0.00 $0.0081229 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 264 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

81240 0.00 0.00 0.00 0.00 $0.00 $0.0081241 0.00 0.00 0.00 0.00 $0.00 $0.0081242 0.00 0.00 0.00 0.00 $0.00 $0.0081243 0.00 0.00 0.00 0.00 $0.00 $0.0081244 0.00 0.00 0.00 0.00 $0.00 $0.0081245 0.00 0.00 0.00 0.00 $0.00 $0.0081250 0.00 0.00 0.00 0.00 $0.00 $0.0081251 0.00 0.00 0.00 0.00 $0.00 $0.0081255 0.00 0.00 0.00 0.00 $0.00 $0.0081256 0.00 0.00 0.00 0.00 $0.00 $0.0081257 0.00 0.00 0.00 0.00 $0.00 $0.0081260 0.00 0.00 0.00 0.00 $0.00 $0.0081261 0.00 0.00 0.00 0.00 $0.00 $0.0081262 0.00 0.00 0.00 0.00 $0.00 $0.0081263 0.00 0.00 0.00 0.00 $0.00 $0.0081264 0.00 0.00 0.00 0.00 $0.00 $0.0081265 0.00 0.00 0.00 0.00 $0.00 $0.0081266 0.00 0.00 0.00 0.00 $0.00 $0.0081267 0.00 0.00 0.00 0.00 $0.00 $0.0081268 0.00 0.00 0.00 0.00 $0.00 $0.0081270 0.00 0.00 0.00 0.00 $0.00 $0.0081275 0.00 0.00 0.00 0.00 $0.00 $0.0081280 0.00 0.00 0.00 0.00 $0.00 $0.0081281 0.00 0.00 0.00 0.00 $0.00 $0.0081282 0.00 0.00 0.00 0.00 $0.00 $0.0081290 0.00 0.00 0.00 0.00 $0.00 $0.0081291 0.00 0.00 0.00 0.00 $0.00 $0.0081292 0.00 0.00 0.00 0.00 $0.00 $0.0081293 0.00 0.00 0.00 0.00 $0.00 $0.0081294 0.00 0.00 0.00 0.00 $0.00 $0.0081295 0.00 0.00 0.00 0.00 $0.00 $0.0081296 0.00 0.00 0.00 0.00 $0.00 $0.0081297 0.00 0.00 0.00 0.00 $0.00 $0.0081298 0.00 0.00 0.00 0.00 $0.00 $0.0081299 0.00 0.00 0.00 0.00 $0.00 $0.0081300 0.00 0.00 0.00 0.00 $0.00 $0.0081301 0.00 0.00 0.00 0.00 $0.00 $0.0081302 0.00 0.00 0.00 0.00 $0.00 $0.0081303 0.00 0.00 0.00 0.00 $0.00 $0.0081304 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 265 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

81310 0.00 0.00 0.00 0.00 $0.00 $0.0081315 0.00 0.00 0.00 0.00 $0.00 $0.0081316 0.00 0.00 0.00 0.00 $0.00 $0.0081317 0.00 0.00 0.00 0.00 $0.00 $0.0081318 0.00 0.00 0.00 0.00 $0.00 $0.0081319 0.00 0.00 0.00 0.00 $0.00 $0.0081330 0.00 0.00 0.00 0.00 $0.00 $0.0081331 0.00 0.00 0.00 0.00 $0.00 $0.0081332 0.00 0.00 0.00 0.00 $0.00 $0.0081340 0.00 0.00 0.00 0.00 $0.00 $0.0081341 0.00 0.00 0.00 0.00 $0.00 $0.0081342 0.00 0.00 0.00 0.00 $0.00 $0.0081350 0.00 0.00 0.00 0.00 $0.00 $0.0081355 0.00 0.00 0.00 0.00 $0.00 $0.0081370 0.00 0.00 0.00 0.00 $0.00 $0.0081371 0.00 0.00 0.00 0.00 $0.00 $0.0081372 0.00 0.00 0.00 0.00 $0.00 $0.0081373 0.00 0.00 0.00 0.00 $0.00 $0.0081374 0.00 0.00 0.00 0.00 $0.00 $0.0081375 0.00 0.00 0.00 0.00 $0.00 $0.0081376 0.00 0.00 0.00 0.00 $0.00 $0.0081377 0.00 0.00 0.00 0.00 $0.00 $0.0081378 0.00 0.00 0.00 0.00 $0.00 $0.0081379 0.00 0.00 0.00 0.00 $0.00 $0.0081380 0.00 0.00 0.00 0.00 $0.00 $0.0081381 0.00 0.00 0.00 0.00 $0.00 $0.0081382 0.00 0.00 0.00 0.00 $0.00 $0.0081383 0.00 0.00 0.00 0.00 $0.00 $0.0081400 0.00 0.00 0.00 0.00 $0.00 $0.0081401 0.00 0.00 0.00 0.00 $0.00 $0.0081402 0.00 0.00 0.00 0.00 $0.00 $0.0081403 0.00 0.00 0.00 0.00 $0.00 $0.0081404 0.00 0.00 0.00 0.00 $0.00 $0.0081405 0.00 0.00 0.00 0.00 $0.00 $0.0081406 0.00 0.00 0.00 0.00 $0.00 $0.0081407 0.00 0.00 0.00 0.00 $0.00 $0.0081408 0.00 0.00 0.00 0.00 $0.00 $0.0082000 0.00 0.00 0.00 0.00 $0.00 $0.0082003 0.00 0.00 0.00 0.00 $0.00 $0.0082009 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 266 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

82010 0.00 0.00 0.00 0.00 $0.00 $0.0082013 0.00 0.00 0.00 0.00 $0.00 $0.0082016 0.00 0.00 0.00 0.00 $0.00 $0.0082017 0.00 0.00 0.00 0.00 $0.00 $0.0082024 0.00 0.00 0.00 0.00 $0.00 $0.0082030 0.00 0.00 0.00 0.00 $0.00 $0.0082040 0.00 0.00 0.00 0.00 $0.00 $0.0082042 0.00 0.00 0.00 0.00 $0.00 $0.0082043 0.00 0.00 0.00 0.00 $0.00 $0.0082044 0.00 0.00 0.00 0.00 $0.00 $0.0082045 0.00 0.00 0.00 0.00 $0.00 $0.0082055 0.00 0.00 0.00 0.00 $0.00 $0.0082075 0.00 0.00 0.00 0.00 $0.00 $0.0082085 0.00 0.00 0.00 0.00 $0.00 $0.0082088 0.00 0.00 0.00 0.00 $0.00 $0.0082101 0.00 0.00 0.00 0.00 $0.00 $0.0082103 0.00 0.00 0.00 0.00 $0.00 $0.0082104 0.00 0.00 0.00 0.00 $0.00 $0.0082105 0.00 0.00 0.00 0.00 $0.00 $0.0082106 0.00 0.00 0.00 0.00 $0.00 $0.0082107 0.00 0.00 0.00 0.00 $0.00 $0.0082108 0.00 0.00 0.00 0.00 $0.00 $0.0082120 0.00 0.00 0.00 0.00 $0.00 $0.0082127 0.00 0.00 0.00 0.00 $0.00 $0.0082128 0.00 0.00 0.00 0.00 $0.00 $0.0082131 0.00 0.00 0.00 0.00 $0.00 $0.0082135 0.00 0.00 0.00 0.00 $0.00 $0.0082136 0.00 0.00 0.00 0.00 $0.00 $0.0082139 0.00 0.00 0.00 0.00 $0.00 $0.0082140 0.00 0.00 0.00 0.00 $0.00 $0.0082143 0.00 0.00 0.00 0.00 $0.00 $0.0082145 0.00 0.00 0.00 0.00 $0.00 $0.0082150 0.00 0.00 0.00 0.00 $0.00 $0.0082154 0.00 0.00 0.00 0.00 $0.00 $0.0082157 0.00 0.00 0.00 0.00 $0.00 $0.0082160 0.00 0.00 0.00 0.00 $0.00 $0.0082163 0.00 0.00 0.00 0.00 $0.00 $0.0082164 0.00 0.00 0.00 0.00 $0.00 $0.0082172 0.00 0.00 0.00 0.00 $0.00 $0.0082175 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 267 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

82180 0.00 0.00 0.00 0.00 $0.00 $0.0082190 0.00 0.00 0.00 0.00 $0.00 $0.0082205 0.00 0.00 0.00 0.00 $0.00 $0.0082232 0.00 0.00 0.00 0.00 $0.00 $0.0082239 0.00 0.00 0.00 0.00 $0.00 $0.0082240 0.00 0.00 0.00 0.00 $0.00 $0.0082247 0.00 0.00 0.00 0.00 $0.00 $0.0082248 0.00 0.00 0.00 0.00 $0.00 $0.0082252 0.00 0.00 0.00 0.00 $0.00 $0.0082261 0.00 0.00 0.00 0.00 $0.00 $0.0082270 0.00 0.00 0.00 0.00 $0.00 $0.0082271 0.00 0.00 0.00 0.00 $0.00 $0.0082272 0.00 0.00 0.00 0.00 $0.00 $0.0082274 0.00 0.00 0.00 0.00 $0.00 $0.0082286 0.00 0.00 0.00 0.00 $0.00 $0.0082300 0.00 0.00 0.00 0.00 $0.00 $0.0082306 0.00 0.00 0.00 0.00 $0.00 $0.0082308 0.00 0.00 0.00 0.00 $0.00 $0.0082310 0.00 0.00 0.00 0.00 $0.00 $0.0082330 0.00 0.00 0.00 0.00 $0.00 $0.0082331 0.00 0.00 0.00 0.00 $0.00 $0.0082340 0.00 0.00 0.00 0.00 $0.00 $0.0082355 0.00 0.00 0.00 0.00 $0.00 $0.0082360 0.00 0.00 0.00 0.00 $0.00 $0.0082365 0.00 0.00 0.00 0.00 $0.00 $0.0082370 0.00 0.00 0.00 0.00 $0.00 $0.0082373 0.00 0.00 0.00 0.00 $0.00 $0.0082374 0.00 0.00 0.00 0.00 $0.00 $0.0082375 0.00 0.00 0.00 0.00 $0.00 $0.0082376 0.00 0.00 0.00 0.00 $0.00 $0.0082378 0.00 0.00 0.00 0.00 $0.00 $0.0082379 0.00 0.00 0.00 0.00 $0.00 $0.0082380 0.00 0.00 0.00 0.00 $0.00 $0.0082382 0.00 0.00 0.00 0.00 $0.00 $0.0082383 0.00 0.00 0.00 0.00 $0.00 $0.0082384 0.00 0.00 0.00 0.00 $0.00 $0.0082387 0.00 0.00 0.00 0.00 $0.00 $0.0082390 0.00 0.00 0.00 0.00 $0.00 $0.0082397 0.00 0.00 0.00 0.00 $0.00 $0.0082415 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 268 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

82435 0.00 0.00 0.00 0.00 $0.00 $0.0082436 0.00 0.00 0.00 0.00 $0.00 $0.0082438 0.00 0.00 0.00 0.00 $0.00 $0.0082441 0.00 0.00 0.00 0.00 $0.00 $0.0082465 0.00 0.00 0.00 0.00 $0.00 $0.0082480 0.00 0.00 0.00 0.00 $0.00 $0.0082482 0.00 0.00 0.00 0.00 $0.00 $0.0082485 0.00 0.00 0.00 0.00 $0.00 $0.0082486 0.00 0.00 0.00 0.00 $0.00 $0.0082487 0.00 0.00 0.00 0.00 $0.00 $0.0082488 0.00 0.00 0.00 0.00 $0.00 $0.0082489 0.00 0.00 0.00 0.00 $0.00 $0.0082491 0.00 0.00 0.00 0.00 $0.00 $0.0082492 0.00 0.00 0.00 0.00 $0.00 $0.0082495 0.00 0.00 0.00 0.00 $0.00 $0.0082507 0.00 0.00 0.00 0.00 $0.00 $0.0082520 0.00 0.00 0.00 0.00 $0.00 $0.0082523 0.00 0.00 0.00 0.00 $0.00 $0.0082525 0.00 0.00 0.00 0.00 $0.00 $0.0082528 0.00 0.00 0.00 0.00 $0.00 $0.0082530 0.00 0.00 0.00 0.00 $0.00 $0.0082533 0.00 0.00 0.00 0.00 $0.00 $0.0082540 0.00 0.00 0.00 0.00 $0.00 $0.0082541 0.00 0.00 0.00 0.00 $0.00 $0.0082542 0.00 0.00 0.00 0.00 $0.00 $0.0082543 0.00 0.00 0.00 0.00 $0.00 $0.0082544 0.00 0.00 0.00 0.00 $0.00 $0.0082550 0.00 0.00 0.00 0.00 $0.00 $0.0082552 0.00 0.00 0.00 0.00 $0.00 $0.0082553 0.00 0.00 0.00 0.00 $0.00 $0.0082554 0.00 0.00 0.00 0.00 $0.00 $0.0082565 0.00 0.00 0.00 0.00 $0.00 $0.0082570 0.00 0.00 0.00 0.00 $0.00 $0.0082575 0.00 0.00 0.00 0.00 $0.00 $0.0082585 0.00 0.00 0.00 0.00 $0.00 $0.0082595 0.00 0.00 0.00 0.00 $0.00 $0.0082600 0.00 0.00 0.00 0.00 $0.00 $0.0082607 0.00 0.00 0.00 0.00 $0.00 $0.0082608 0.00 0.00 0.00 0.00 $0.00 $0.0082610 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 269 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

82615 0.00 0.00 0.00 0.00 $0.00 $0.0082626 0.00 0.00 0.00 0.00 $0.00 $0.0082627 0.00 0.00 0.00 0.00 $0.00 $0.0082633 0.00 0.00 0.00 0.00 $0.00 $0.0082634 0.00 0.00 0.00 0.00 $0.00 $0.0082638 0.00 0.00 0.00 0.00 $0.00 $0.0082646 0.00 0.00 0.00 0.00 $0.00 $0.0082649 0.00 0.00 0.00 0.00 $0.00 $0.0082651 0.00 0.00 0.00 0.00 $0.00 $0.0082652 0.00 0.00 0.00 0.00 $0.00 $0.0082654 0.00 0.00 0.00 0.00 $0.00 $0.0082656 0.00 0.00 0.00 0.00 $0.00 $0.0082657 0.00 0.00 0.00 0.00 $0.00 $0.0082658 0.00 0.00 0.00 0.00 $0.00 $0.0082664 0.00 0.00 0.00 0.00 $0.00 $0.0082666 0.00 0.00 0.00 0.00 $0.00 $0.0082668 0.00 0.00 0.00 0.00 $0.00 $0.0082670 0.00 0.00 0.00 0.00 $0.00 $0.0082671 0.00 0.00 0.00 0.00 $0.00 $0.0082672 0.00 0.00 0.00 0.00 $0.00 $0.0082677 0.00 0.00 0.00 0.00 $0.00 $0.0082679 0.00 0.00 0.00 0.00 $0.00 $0.0082690 0.00 0.00 0.00 0.00 $0.00 $0.0082693 0.00 0.00 0.00 0.00 $0.00 $0.0082696 0.00 0.00 0.00 0.00 $0.00 $0.0082705 0.00 0.00 0.00 0.00 $0.00 $0.0082710 0.00 0.00 0.00 0.00 $0.00 $0.0082715 0.00 0.00 0.00 0.00 $0.00 $0.0082725 0.00 0.00 0.00 0.00 $0.00 $0.0082726 0.00 0.00 0.00 0.00 $0.00 $0.0082728 0.00 0.00 0.00 0.00 $0.00 $0.0082731 0.00 0.00 0.00 0.00 $0.00 $0.0082735 0.00 0.00 0.00 0.00 $0.00 $0.0082742 0.00 0.00 0.00 0.00 $0.00 $0.0082746 0.00 0.00 0.00 0.00 $0.00 $0.0082747 0.00 0.00 0.00 0.00 $0.00 $0.0082757 0.00 0.00 0.00 0.00 $0.00 $0.0082759 0.00 0.00 0.00 0.00 $0.00 $0.0082760 0.00 0.00 0.00 0.00 $0.00 $0.0082775 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 270 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

82776 0.00 0.00 0.00 0.00 $0.00 $0.0082784 0.00 0.00 0.00 0.00 $0.00 $0.0082785 0.00 0.00 0.00 0.00 $0.00 $0.0082787 0.00 0.00 0.00 0.00 $0.00 $0.0082800 0.00 0.00 0.00 0.00 $0.00 $0.0082803 0.00 0.00 0.00 0.00 $0.00 $0.0082805 0.00 0.00 0.00 0.00 $0.00 $0.0082810 0.00 0.00 0.00 0.00 $0.00 $0.0082820 0.00 0.00 0.00 0.00 $0.00 $0.0082930 0.00 0.00 0.00 0.00 $0.00 $0.0082938 0.00 0.00 0.00 0.00 $0.00 $0.0082941 0.00 0.00 0.00 0.00 $0.00 $0.0082943 0.00 0.00 0.00 0.00 $0.00 $0.0082945 0.00 0.00 0.00 0.00 $0.00 $0.0082946 0.00 0.00 0.00 0.00 $0.00 $0.0082947 0.00 0.00 0.00 0.00 $0.00 $0.0082948 0.00 0.00 0.00 0.00 $0.00 $0.0082950 0.00 0.00 0.00 0.00 $0.00 $0.0082951 0.00 0.00 0.00 0.00 $0.00 $0.0082952 0.00 0.00 0.00 0.00 $0.00 $0.0082953 0.00 0.00 0.00 0.00 $0.00 $0.0082955 0.00 0.00 0.00 0.00 $0.00 $0.0082960 0.00 0.00 0.00 0.00 $0.00 $0.0082962 0.00 0.00 0.00 0.00 $0.00 $0.0082963 0.00 0.00 0.00 0.00 $0.00 $0.0082965 0.00 0.00 0.00 0.00 $0.00 $0.0082975 0.00 0.00 0.00 0.00 $0.00 $0.0082977 0.00 0.00 0.00 0.00 $0.00 $0.0082978 0.00 0.00 0.00 0.00 $0.00 $0.0082979 0.00 0.00 0.00 0.00 $0.00 $0.0082980 0.00 0.00 0.00 0.00 $0.00 $0.0082985 0.00 0.00 0.00 0.00 $0.00 $0.0083001 0.00 0.00 0.00 0.00 $0.00 $0.0083002 0.00 0.00 0.00 0.00 $0.00 $0.0083003 0.00 0.00 0.00 0.00 $0.00 $0.0083008 0.00 0.00 0.00 0.00 $0.00 $0.0083009 0.00 0.00 0.00 0.00 $0.00 $0.0083010 0.00 0.00 0.00 0.00 $0.00 $0.0083012 0.00 0.00 0.00 0.00 $0.00 $0.0083013 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 271 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

83014 0.00 0.00 0.00 0.00 $0.00 $0.0083015 0.00 0.00 0.00 0.00 $0.00 $0.0083018 0.00 0.00 0.00 0.00 $0.00 $0.0083020 0.00 0.00 0.00 0.00 $0.00 $0.0083020 26 0.37 0.17 0.17 0.03 $25.42 $25.4283021 0.00 0.00 0.00 0.00 $0.00 $0.0083026 0.00 0.00 0.00 0.00 $0.00 $0.0083030 0.00 0.00 0.00 0.00 $0.00 $0.0083033 0.00 0.00 0.00 0.00 $0.00 $0.0083036 0.00 0.00 0.00 0.00 $0.00 $0.0083037 0.00 0.00 0.00 0.00 $0.00 $0.0083045 0.00 0.00 0.00 0.00 $0.00 $0.0083050 0.00 0.00 0.00 0.00 $0.00 $0.0083051 0.00 0.00 0.00 0.00 $0.00 $0.0083055 0.00 0.00 0.00 0.00 $0.00 $0.0083060 0.00 0.00 0.00 0.00 $0.00 $0.0083065 0.00 0.00 0.00 0.00 $0.00 $0.0083068 0.00 0.00 0.00 0.00 $0.00 $0.0083069 0.00 0.00 0.00 0.00 $0.00 $0.0083070 0.00 0.00 0.00 0.00 $0.00 $0.0083071 0.00 0.00 0.00 0.00 $0.00 $0.0083080 0.00 0.00 0.00 0.00 $0.00 $0.0083088 0.00 0.00 0.00 0.00 $0.00 $0.0083090 0.00 0.00 0.00 0.00 $0.00 $0.0083150 0.00 0.00 0.00 0.00 $0.00 $0.0083491 0.00 0.00 0.00 0.00 $0.00 $0.0083497 0.00 0.00 0.00 0.00 $0.00 $0.0083498 0.00 0.00 0.00 0.00 $0.00 $0.0083499 0.00 0.00 0.00 0.00 $0.00 $0.0083500 0.00 0.00 0.00 0.00 $0.00 $0.0083505 0.00 0.00 0.00 0.00 $0.00 $0.0083516 0.00 0.00 0.00 0.00 $0.00 $0.0083518 0.00 0.00 0.00 0.00 $0.00 $0.0083519 0.00 0.00 0.00 0.00 $0.00 $0.0083520 0.00 0.00 0.00 0.00 $0.00 $0.0083525 0.00 0.00 0.00 0.00 $0.00 $0.0083527 0.00 0.00 0.00 0.00 $0.00 $0.0083528 0.00 0.00 0.00 0.00 $0.00 $0.0083540 0.00 0.00 0.00 0.00 $0.00 $0.0083550 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 272 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

83570 0.00 0.00 0.00 0.00 $0.00 $0.0083582 0.00 0.00 0.00 0.00 $0.00 $0.0083586 0.00 0.00 0.00 0.00 $0.00 $0.0083593 0.00 0.00 0.00 0.00 $0.00 $0.0083605 0.00 0.00 0.00 0.00 $0.00 $0.0083615 0.00 0.00 0.00 0.00 $0.00 $0.0083625 0.00 0.00 0.00 0.00 $0.00 $0.0083630 0.00 0.00 0.00 0.00 $0.00 $0.0083631 0.00 0.00 0.00 0.00 $0.00 $0.0083632 0.00 0.00 0.00 0.00 $0.00 $0.0083633 0.00 0.00 0.00 0.00 $0.00 $0.0083634 0.00 0.00 0.00 0.00 $0.00 $0.0083655 0.00 0.00 0.00 0.00 $0.00 $0.0083661 0.00 0.00 0.00 0.00 $0.00 $0.0083662 0.00 0.00 0.00 0.00 $0.00 $0.0083663 0.00 0.00 0.00 0.00 $0.00 $0.0083664 0.00 0.00 0.00 0.00 $0.00 $0.0083670 0.00 0.00 0.00 0.00 $0.00 $0.0083690 0.00 0.00 0.00 0.00 $0.00 $0.0083695 0.00 0.00 0.00 0.00 $0.00 $0.0083698 0.00 0.00 0.00 0.00 $0.00 $0.0083700 0.00 0.00 0.00 0.00 $0.00 $0.0083701 0.00 0.00 0.00 0.00 $0.00 $0.0083704 0.00 0.00 0.00 0.00 $0.00 $0.0083718 0.00 0.00 0.00 0.00 $0.00 $0.0083719 0.00 0.00 0.00 0.00 $0.00 $0.0083721 0.00 0.00 0.00 0.00 $0.00 $0.0083727 0.00 0.00 0.00 0.00 $0.00 $0.0083735 0.00 0.00 0.00 0.00 $0.00 $0.0083775 0.00 0.00 0.00 0.00 $0.00 $0.0083785 0.00 0.00 0.00 0.00 $0.00 $0.0083788 0.00 0.00 0.00 0.00 $0.00 $0.0083789 0.00 0.00 0.00 0.00 $0.00 $0.0083805 0.00 0.00 0.00 0.00 $0.00 $0.0083825 0.00 0.00 0.00 0.00 $0.00 $0.0083835 0.00 0.00 0.00 0.00 $0.00 $0.0083840 0.00 0.00 0.00 0.00 $0.00 $0.0083857 0.00 0.00 0.00 0.00 $0.00 $0.0083858 0.00 0.00 0.00 0.00 $0.00 $0.0083861 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 273 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

83864 0.00 0.00 0.00 0.00 $0.00 $0.0083866 0.00 0.00 0.00 0.00 $0.00 $0.0083872 0.00 0.00 0.00 0.00 $0.00 $0.0083873 0.00 0.00 0.00 0.00 $0.00 $0.0083874 0.00 0.00 0.00 0.00 $0.00 $0.0083876 0.00 0.00 0.00 0.00 $0.00 $0.0083880 0.00 0.00 0.00 0.00 $0.00 $0.0083883 0.00 0.00 0.00 0.00 $0.00 $0.0083885 0.00 0.00 0.00 0.00 $0.00 $0.0083887 0.00 0.00 0.00 0.00 $0.00 $0.0083890 0.00 0.00 0.00 0.00 $0.00 $0.0083891 0.00 0.00 0.00 0.00 $0.00 $0.0083892 0.00 0.00 0.00 0.00 $0.00 $0.0083893 0.00 0.00 0.00 0.00 $0.00 $0.0083894 0.00 0.00 0.00 0.00 $0.00 $0.0083896 0.00 0.00 0.00 0.00 $0.00 $0.0083897 0.00 0.00 0.00 0.00 $0.00 $0.0083898 0.00 0.00 0.00 0.00 $0.00 $0.0083900 0.00 0.00 0.00 0.00 $0.00 $0.0083901 0.00 0.00 0.00 0.00 $0.00 $0.0083902 0.00 0.00 0.00 0.00 $0.00 $0.0083903 0.00 0.00 0.00 0.00 $0.00 $0.0083904 0.00 0.00 0.00 0.00 $0.00 $0.0083905 0.00 0.00 0.00 0.00 $0.00 $0.0083906 0.00 0.00 0.00 0.00 $0.00 $0.0083907 0.00 0.00 0.00 0.00 $0.00 $0.0083908 0.00 0.00 0.00 0.00 $0.00 $0.0083909 0.00 0.00 0.00 0.00 $0.00 $0.0083912 0.00 0.00 0.00 0.00 $0.00 $0.0083912 26 0.37 0.14 0.14 0.03 $24.03 $24.0383913 0.00 0.00 0.00 0.00 $0.00 $0.0083914 0.00 0.00 0.00 0.00 $0.00 $0.0083915 0.00 0.00 0.00 0.00 $0.00 $0.0083916 0.00 0.00 0.00 0.00 $0.00 $0.0083918 0.00 0.00 0.00 0.00 $0.00 $0.0083919 0.00 0.00 0.00 0.00 $0.00 $0.0083921 0.00 0.00 0.00 0.00 $0.00 $0.0083925 0.00 0.00 0.00 0.00 $0.00 $0.0083930 0.00 0.00 0.00 0.00 $0.00 $0.0083935 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 274 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

83937 0.00 0.00 0.00 0.00 $0.00 $0.0083945 0.00 0.00 0.00 0.00 $0.00 $0.0083950 0.00 0.00 0.00 0.00 $0.00 $0.0083951 0.00 0.00 0.00 0.00 $0.00 $0.0083970 0.00 0.00 0.00 0.00 $0.00 $0.0083986 0.00 0.00 0.00 0.00 $0.00 $0.0083987 0.00 0.00 0.00 0.00 $0.00 $0.0083992 0.00 0.00 0.00 0.00 $0.00 $0.0083993 0.00 0.00 0.00 0.00 $0.00 $0.0084022 0.00 0.00 0.00 0.00 $0.00 $0.0084030 0.00 0.00 0.00 0.00 $0.00 $0.0084035 0.00 0.00 0.00 0.00 $0.00 $0.0084060 0.00 0.00 0.00 0.00 $0.00 $0.0084061 0.00 0.00 0.00 0.00 $0.00 $0.0084066 0.00 0.00 0.00 0.00 $0.00 $0.0084075 0.00 0.00 0.00 0.00 $0.00 $0.0084078 0.00 0.00 0.00 0.00 $0.00 $0.0084080 0.00 0.00 0.00 0.00 $0.00 $0.0084081 0.00 0.00 0.00 0.00 $0.00 $0.0084085 0.00 0.00 0.00 0.00 $0.00 $0.0084087 0.00 0.00 0.00 0.00 $0.00 $0.0084100 0.00 0.00 0.00 0.00 $0.00 $0.0084105 0.00 0.00 0.00 0.00 $0.00 $0.0084106 0.00 0.00 0.00 0.00 $0.00 $0.0084110 0.00 0.00 0.00 0.00 $0.00 $0.0084112 0.00 0.00 0.00 0.00 $0.00 $0.0084119 0.00 0.00 0.00 0.00 $0.00 $0.0084120 0.00 0.00 0.00 0.00 $0.00 $0.0084126 0.00 0.00 0.00 0.00 $0.00 $0.0084127 0.00 0.00 0.00 0.00 $0.00 $0.0084132 0.00 0.00 0.00 0.00 $0.00 $0.0084133 0.00 0.00 0.00 0.00 $0.00 $0.0084134 0.00 0.00 0.00 0.00 $0.00 $0.0084135 0.00 0.00 0.00 0.00 $0.00 $0.0084138 0.00 0.00 0.00 0.00 $0.00 $0.0084140 0.00 0.00 0.00 0.00 $0.00 $0.0084143 0.00 0.00 0.00 0.00 $0.00 $0.0084144 0.00 0.00 0.00 0.00 $0.00 $0.0084145 0.00 0.00 0.00 0.00 $0.00 $0.0084146 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 275 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

84150 0.00 0.00 0.00 0.00 $0.00 $0.0084152 0.00 0.00 0.00 0.00 $0.00 $0.0084153 0.00 0.00 0.00 0.00 $0.00 $0.0084154 0.00 0.00 0.00 0.00 $0.00 $0.0084155 0.00 0.00 0.00 0.00 $0.00 $0.0084156 0.00 0.00 0.00 0.00 $0.00 $0.0084157 0.00 0.00 0.00 0.00 $0.00 $0.0084160 0.00 0.00 0.00 0.00 $0.00 $0.0084163 0.00 0.00 0.00 0.00 $0.00 $0.0084165 0.00 0.00 0.00 0.00 $0.00 $0.0084165 26 0.37 0.16 0.16 0.03 $24.96 $24.9684166 0.00 0.00 0.00 0.00 $0.00 $0.0084166 26 0.37 0.16 0.16 0.03 $24.96 $24.9684181 0.00 0.00 0.00 0.00 $0.00 $0.0084181 26 0.37 0.16 0.16 0.03 $24.96 $24.9684182 0.00 0.00 0.00 0.00 $0.00 $0.0084182 26 0.37 0.13 0.13 0.03 $23.57 $23.5784202 0.00 0.00 0.00 0.00 $0.00 $0.0084203 0.00 0.00 0.00 0.00 $0.00 $0.0084206 0.00 0.00 0.00 0.00 $0.00 $0.0084207 0.00 0.00 0.00 0.00 $0.00 $0.0084210 0.00 0.00 0.00 0.00 $0.00 $0.0084220 0.00 0.00 0.00 0.00 $0.00 $0.0084228 0.00 0.00 0.00 0.00 $0.00 $0.0084233 0.00 0.00 0.00 0.00 $0.00 $0.0084234 0.00 0.00 0.00 0.00 $0.00 $0.0084235 0.00 0.00 0.00 0.00 $0.00 $0.0084238 0.00 0.00 0.00 0.00 $0.00 $0.0084244 0.00 0.00 0.00 0.00 $0.00 $0.0084252 0.00 0.00 0.00 0.00 $0.00 $0.0084255 0.00 0.00 0.00 0.00 $0.00 $0.0084260 0.00 0.00 0.00 0.00 $0.00 $0.0084270 0.00 0.00 0.00 0.00 $0.00 $0.0084275 0.00 0.00 0.00 0.00 $0.00 $0.0084285 0.00 0.00 0.00 0.00 $0.00 $0.0084295 0.00 0.00 0.00 0.00 $0.00 $0.0084300 0.00 0.00 0.00 0.00 $0.00 $0.0084302 0.00 0.00 0.00 0.00 $0.00 $0.0084305 0.00 0.00 0.00 0.00 $0.00 $0.0084307 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 276 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

84311 0.00 0.00 0.00 0.00 $0.00 $0.0084315 0.00 0.00 0.00 0.00 $0.00 $0.0084375 0.00 0.00 0.00 0.00 $0.00 $0.0084376 0.00 0.00 0.00 0.00 $0.00 $0.0084377 0.00 0.00 0.00 0.00 $0.00 $0.0084378 0.00 0.00 0.00 0.00 $0.00 $0.0084379 0.00 0.00 0.00 0.00 $0.00 $0.0084392 0.00 0.00 0.00 0.00 $0.00 $0.0084402 0.00 0.00 0.00 0.00 $0.00 $0.0084403 0.00 0.00 0.00 0.00 $0.00 $0.0084425 0.00 0.00 0.00 0.00 $0.00 $0.0084430 0.00 0.00 0.00 0.00 $0.00 $0.0084431 0.00 0.00 0.00 0.00 $0.00 $0.0084432 0.00 0.00 0.00 0.00 $0.00 $0.0084436 0.00 0.00 0.00 0.00 $0.00 $0.0084437 0.00 0.00 0.00 0.00 $0.00 $0.0084439 0.00 0.00 0.00 0.00 $0.00 $0.0084442 0.00 0.00 0.00 0.00 $0.00 $0.0084443 0.00 0.00 0.00 0.00 $0.00 $0.0084445 0.00 0.00 0.00 0.00 $0.00 $0.0084446 0.00 0.00 0.00 0.00 $0.00 $0.0084449 0.00 0.00 0.00 0.00 $0.00 $0.0084450 0.00 0.00 0.00 0.00 $0.00 $0.0084460 0.00 0.00 0.00 0.00 $0.00 $0.0084466 0.00 0.00 0.00 0.00 $0.00 $0.0084478 0.00 0.00 0.00 0.00 $0.00 $0.0084479 0.00 0.00 0.00 0.00 $0.00 $0.0084480 0.00 0.00 0.00 0.00 $0.00 $0.0084481 0.00 0.00 0.00 0.00 $0.00 $0.0084482 0.00 0.00 0.00 0.00 $0.00 $0.0084484 0.00 0.00 0.00 0.00 $0.00 $0.0084485 0.00 0.00 0.00 0.00 $0.00 $0.0084488 0.00 0.00 0.00 0.00 $0.00 $0.0084490 0.00 0.00 0.00 0.00 $0.00 $0.0084510 0.00 0.00 0.00 0.00 $0.00 $0.0084512 0.00 0.00 0.00 0.00 $0.00 $0.0084520 0.00 0.00 0.00 0.00 $0.00 $0.0084525 0.00 0.00 0.00 0.00 $0.00 $0.0084540 0.00 0.00 0.00 0.00 $0.00 $0.0084545 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 277 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

84550 0.00 0.00 0.00 0.00 $0.00 $0.0084560 0.00 0.00 0.00 0.00 $0.00 $0.0084577 0.00 0.00 0.00 0.00 $0.00 $0.0084578 0.00 0.00 0.00 0.00 $0.00 $0.0084580 0.00 0.00 0.00 0.00 $0.00 $0.0084583 0.00 0.00 0.00 0.00 $0.00 $0.0084585 0.00 0.00 0.00 0.00 $0.00 $0.0084586 0.00 0.00 0.00 0.00 $0.00 $0.0084588 0.00 0.00 0.00 0.00 $0.00 $0.0084590 0.00 0.00 0.00 0.00 $0.00 $0.0084591 0.00 0.00 0.00 0.00 $0.00 $0.0084597 0.00 0.00 0.00 0.00 $0.00 $0.0084600 0.00 0.00 0.00 0.00 $0.00 $0.0084620 0.00 0.00 0.00 0.00 $0.00 $0.0084630 0.00 0.00 0.00 0.00 $0.00 $0.0084681 0.00 0.00 0.00 0.00 $0.00 $0.0084702 0.00 0.00 0.00 0.00 $0.00 $0.0084703 0.00 0.00 0.00 0.00 $0.00 $0.0084704 0.00 0.00 0.00 0.00 $0.00 $0.0084830 0.00 0.00 0.00 0.00 $0.00 $0.0084999 0.00 0.00 0.00 0.00 $0.00 $0.0085002 0.00 0.00 0.00 0.00 $0.00 $0.0085004 0.00 0.00 0.00 0.00 $0.00 $0.0085007 0.00 0.00 0.00 0.00 $0.00 $0.0085008 0.00 0.00 0.00 0.00 $0.00 $0.0085009 0.00 0.00 0.00 0.00 $0.00 $0.0085013 0.00 0.00 0.00 0.00 $0.00 $0.0085014 0.00 0.00 0.00 0.00 $0.00 $0.0085018 0.00 0.00 0.00 0.00 $0.00 $0.0085025 0.00 0.00 0.00 0.00 $0.00 $0.0085027 0.00 0.00 0.00 0.00 $0.00 $0.0085032 0.00 0.00 0.00 0.00 $0.00 $0.0085041 0.00 0.00 0.00 0.00 $0.00 $0.0085044 0.00 0.00 0.00 0.00 $0.00 $0.0085045 0.00 0.00 0.00 0.00 $0.00 $0.0085046 0.00 0.00 0.00 0.00 $0.00 $0.0085048 0.00 0.00 0.00 0.00 $0.00 $0.0085049 0.00 0.00 0.00 0.00 $0.00 $0.0085055 0.00 0.00 0.00 0.00 $0.00 $0.0085060 0.45 0.20 0.20 0.03 $30.27 $30.27

Updated December 2011 278 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

85097 0.94 1.46 0.37 0.05 $110.82 $60.3885130 0.00 0.00 0.00 0.00 $0.00 $0.0085170 0.00 0.00 0.00 0.00 $0.00 $0.0085175 0.00 0.00 0.00 0.00 $0.00 $0.0085210 0.00 0.00 0.00 0.00 $0.00 $0.0085220 0.00 0.00 0.00 0.00 $0.00 $0.0085230 0.00 0.00 0.00 0.00 $0.00 $0.0085240 0.00 0.00 0.00 0.00 $0.00 $0.0085244 0.00 0.00 0.00 0.00 $0.00 $0.0085245 0.00 0.00 0.00 0.00 $0.00 $0.0085246 0.00 0.00 0.00 0.00 $0.00 $0.0085247 0.00 0.00 0.00 0.00 $0.00 $0.0085250 0.00 0.00 0.00 0.00 $0.00 $0.0085260 0.00 0.00 0.00 0.00 $0.00 $0.0085270 0.00 0.00 0.00 0.00 $0.00 $0.0085280 0.00 0.00 0.00 0.00 $0.00 $0.0085290 0.00 0.00 0.00 0.00 $0.00 $0.0085291 0.00 0.00 0.00 0.00 $0.00 $0.0085292 0.00 0.00 0.00 0.00 $0.00 $0.0085293 0.00 0.00 0.00 0.00 $0.00 $0.0085300 0.00 0.00 0.00 0.00 $0.00 $0.0085301 0.00 0.00 0.00 0.00 $0.00 $0.0085302 0.00 0.00 0.00 0.00 $0.00 $0.0085303 0.00 0.00 0.00 0.00 $0.00 $0.0085305 0.00 0.00 0.00 0.00 $0.00 $0.0085306 0.00 0.00 0.00 0.00 $0.00 $0.0085307 0.00 0.00 0.00 0.00 $0.00 $0.0085335 0.00 0.00 0.00 0.00 $0.00 $0.0085337 0.00 0.00 0.00 0.00 $0.00 $0.0085345 0.00 0.00 0.00 0.00 $0.00 $0.0085347 0.00 0.00 0.00 0.00 $0.00 $0.0085348 0.00 0.00 0.00 0.00 $0.00 $0.0085360 0.00 0.00 0.00 0.00 $0.00 $0.0085362 0.00 0.00 0.00 0.00 $0.00 $0.0085366 0.00 0.00 0.00 0.00 $0.00 $0.0085370 0.00 0.00 0.00 0.00 $0.00 $0.0085378 0.00 0.00 0.00 0.00 $0.00 $0.0085379 0.00 0.00 0.00 0.00 $0.00 $0.0085380 0.00 0.00 0.00 0.00 $0.00 $0.0085384 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 279 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

85385 0.00 0.00 0.00 0.00 $0.00 $0.0085390 0.00 0.00 0.00 0.00 $0.00 $0.0085390 26 0.37 0.17 0.17 0.03 $25.42 $25.4285396 0.37 0.16 0.16 0.03 $24.96 $24.9685397 0.00 0.00 0.00 0.00 $0.00 $0.0085400 0.00 0.00 0.00 0.00 $0.00 $0.0085410 0.00 0.00 0.00 0.00 $0.00 $0.0085415 0.00 0.00 0.00 0.00 $0.00 $0.0085420 0.00 0.00 0.00 0.00 $0.00 $0.0085421 0.00 0.00 0.00 0.00 $0.00 $0.0085441 0.00 0.00 0.00 0.00 $0.00 $0.0085445 0.00 0.00 0.00 0.00 $0.00 $0.0085460 0.00 0.00 0.00 0.00 $0.00 $0.0085461 0.00 0.00 0.00 0.00 $0.00 $0.0085475 0.00 0.00 0.00 0.00 $0.00 $0.0085520 0.00 0.00 0.00 0.00 $0.00 $0.0085525 0.00 0.00 0.00 0.00 $0.00 $0.0085530 0.00 0.00 0.00 0.00 $0.00 $0.0085536 0.00 0.00 0.00 0.00 $0.00 $0.0085540 0.00 0.00 0.00 0.00 $0.00 $0.0085547 0.00 0.00 0.00 0.00 $0.00 $0.0085549 0.00 0.00 0.00 0.00 $0.00 $0.0085555 0.00 0.00 0.00 0.00 $0.00 $0.0085557 0.00 0.00 0.00 0.00 $0.00 $0.0085576 0.00 0.00 0.00 0.00 $0.00 $0.0085576 26 0.37 0.17 0.17 0.03 $25.42 $25.4285597 0.00 0.00 0.00 0.00 $0.00 $0.0085598 0.00 0.00 0.00 0.00 $0.00 $0.0085610 0.00 0.00 0.00 0.00 $0.00 $0.0085611 0.00 0.00 0.00 0.00 $0.00 $0.0085612 0.00 0.00 0.00 0.00 $0.00 $0.0085613 0.00 0.00 0.00 0.00 $0.00 $0.0085635 0.00 0.00 0.00 0.00 $0.00 $0.0085651 0.00 0.00 0.00 0.00 $0.00 $0.0085652 0.00 0.00 0.00 0.00 $0.00 $0.0085660 0.00 0.00 0.00 0.00 $0.00 $0.0085670 0.00 0.00 0.00 0.00 $0.00 $0.0085675 0.00 0.00 0.00 0.00 $0.00 $0.0085705 0.00 0.00 0.00 0.00 $0.00 $0.0085730 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 280 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

85732 0.00 0.00 0.00 0.00 $0.00 $0.0085810 0.00 0.00 0.00 0.00 $0.00 $0.0085999 0.00 0.00 0.00 0.00 $0.00 $0.0086000 0.00 0.00 0.00 0.00 $0.00 $0.0086001 0.00 0.00 0.00 0.00 $0.00 $0.0086003 0.00 0.00 0.00 0.00 $0.00 $0.0086005 0.00 0.00 0.00 0.00 $0.00 $0.0086021 0.00 0.00 0.00 0.00 $0.00 $0.0086022 0.00 0.00 0.00 0.00 $0.00 $0.0086023 0.00 0.00 0.00 0.00 $0.00 $0.0086038 0.00 0.00 0.00 0.00 $0.00 $0.0086039 0.00 0.00 0.00 0.00 $0.00 $0.0086060 0.00 0.00 0.00 0.00 $0.00 $0.0086063 0.00 0.00 0.00 0.00 $0.00 $0.0086077 0.94 0.51 0.41 0.05 $66.86 $62.2386078 0.94 0.52 0.42 0.05 $67.32 $62.7086079 0.94 0.52 0.42 0.05 $67.32 $62.7086140 0.00 0.00 0.00 0.00 $0.00 $0.0086141 0.00 0.00 0.00 0.00 $0.00 $0.0086146 0.00 0.00 0.00 0.00 $0.00 $0.0086147 0.00 0.00 0.00 0.00 $0.00 $0.0086148 0.00 0.00 0.00 0.00 $0.00 $0.0086155 0.00 0.00 0.00 0.00 $0.00 $0.0086156 0.00 0.00 0.00 0.00 $0.00 $0.0086157 0.00 0.00 0.00 0.00 $0.00 $0.0086160 0.00 0.00 0.00 0.00 $0.00 $0.0086161 0.00 0.00 0.00 0.00 $0.00 $0.0086162 0.00 0.00 0.00 0.00 $0.00 $0.0086171 0.00 0.00 0.00 0.00 $0.00 $0.0086185 0.00 0.00 0.00 0.00 $0.00 $0.0086200 0.00 0.00 0.00 0.00 $0.00 $0.0086215 0.00 0.00 0.00 0.00 $0.00 $0.0086225 0.00 0.00 0.00 0.00 $0.00 $0.0086226 0.00 0.00 0.00 0.00 $0.00 $0.0086235 0.00 0.00 0.00 0.00 $0.00 $0.0086243 0.00 0.00 0.00 0.00 $0.00 $0.0086255 0.00 0.00 0.00 0.00 $0.00 $0.0086255 26 0.37 0.17 0.17 0.03 $25.42 $25.4286256 0.00 0.00 0.00 0.00 $0.00 $0.0086256 26 0.37 0.16 0.16 0.01 $23.94 $23.94

Updated December 2011 281 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

86277 0.00 0.00 0.00 0.00 $0.00 $0.0086280 0.00 0.00 0.00 0.00 $0.00 $0.0086294 0.00 0.00 0.00 0.00 $0.00 $0.0086300 0.00 0.00 0.00 0.00 $0.00 $0.0086301 0.00 0.00 0.00 0.00 $0.00 $0.0086304 0.00 0.00 0.00 0.00 $0.00 $0.0086305 0.00 0.00 0.00 0.00 $0.00 $0.0086308 0.00 0.00 0.00 0.00 $0.00 $0.0086309 0.00 0.00 0.00 0.00 $0.00 $0.0086310 0.00 0.00 0.00 0.00 $0.00 $0.0086316 0.00 0.00 0.00 0.00 $0.00 $0.0086317 0.00 0.00 0.00 0.00 $0.00 $0.0086318 0.00 0.00 0.00 0.00 $0.00 $0.0086320 0.00 0.00 0.00 0.00 $0.00 $0.0086320 26 0.37 0.16 0.16 0.01 $23.94 $23.9486325 0.00 0.00 0.00 0.00 $0.00 $0.0086325 26 0.37 0.16 0.16 0.01 $23.94 $23.9486327 0.00 0.00 0.00 0.00 $0.00 $0.0086327 26 0.42 0.19 0.19 0.03 $28.51 $28.5186329 0.00 0.00 0.00 0.00 $0.00 $0.0086331 0.00 0.00 0.00 0.00 $0.00 $0.0086332 0.00 0.00 0.00 0.00 $0.00 $0.0086334 0.00 0.00 0.00 0.00 $0.00 $0.0086334 26 0.37 0.16 0.16 0.03 $24.96 $24.9686335 0.00 0.00 0.00 0.00 $0.00 $0.0086335 26 0.37 0.16 0.16 0.03 $24.96 $24.9686336 0.00 0.00 0.00 0.00 $0.00 $0.0086337 0.00 0.00 0.00 0.00 $0.00 $0.0086340 0.00 0.00 0.00 0.00 $0.00 $0.0086341 0.00 0.00 0.00 0.00 $0.00 $0.0086343 0.00 0.00 0.00 0.00 $0.00 $0.0086344 0.00 0.00 0.00 0.00 $0.00 $0.0086352 0.00 0.00 0.00 0.00 $0.00 $0.0086353 0.00 0.00 0.00 0.00 $0.00 $0.0086355 0.00 0.00 0.00 0.00 $0.00 $0.0086356 0.00 0.00 0.00 0.00 $0.00 $0.0086357 0.00 0.00 0.00 0.00 $0.00 $0.0086359 0.00 0.00 0.00 0.00 $0.00 $0.0086360 0.00 0.00 0.00 0.00 $0.00 $0.0086361 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 282 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

86367 0.00 0.00 0.00 0.00 $0.00 $0.0086376 0.00 0.00 0.00 0.00 $0.00 $0.0086378 0.00 0.00 0.00 0.00 $0.00 $0.0086382 0.00 0.00 0.00 0.00 $0.00 $0.0086384 0.00 0.00 0.00 0.00 $0.00 $0.0086386 0.00 0.00 0.00 0.00 $0.00 $0.0086403 0.00 0.00 0.00 0.00 $0.00 $0.0086406 0.00 0.00 0.00 0.00 $0.00 $0.0086430 0.00 0.00 0.00 0.00 $0.00 $0.0086431 0.00 0.00 0.00 0.00 $0.00 $0.0086480 0.00 0.00 0.00 0.00 $0.00 $0.0086481 0.00 0.00 0.00 0.00 $0.00 $0.0086485 0.00 0.00 0.00 0.00 $0.00 $0.0086486 0.00 0.15 0.15 0.01 $7.45 $7.4586490 0.00 0.18 0.18 0.01 $8.84 $8.8486510 0.00 0.18 0.18 0.01 $8.84 $8.8486580 0.00 0.22 0.22 0.01 $10.69 $10.6986590 0.00 0.00 0.00 0.00 $0.00 $0.0086592 0.00 0.00 0.00 0.00 $0.00 $0.0086593 0.00 0.00 0.00 0.00 $0.00 $0.0086602 0.00 0.00 0.00 0.00 $0.00 $0.0086603 0.00 0.00 0.00 0.00 $0.00 $0.0086606 0.00 0.00 0.00 0.00 $0.00 $0.0086609 0.00 0.00 0.00 0.00 $0.00 $0.0086611 0.00 0.00 0.00 0.00 $0.00 $0.0086612 0.00 0.00 0.00 0.00 $0.00 $0.0086615 0.00 0.00 0.00 0.00 $0.00 $0.0086617 0.00 0.00 0.00 0.00 $0.00 $0.0086618 0.00 0.00 0.00 0.00 $0.00 $0.0086619 0.00 0.00 0.00 0.00 $0.00 $0.0086622 0.00 0.00 0.00 0.00 $0.00 $0.0086625 0.00 0.00 0.00 0.00 $0.00 $0.0086628 0.00 0.00 0.00 0.00 $0.00 $0.0086631 0.00 0.00 0.00 0.00 $0.00 $0.0086632 0.00 0.00 0.00 0.00 $0.00 $0.0086635 0.00 0.00 0.00 0.00 $0.00 $0.0086638 0.00 0.00 0.00 0.00 $0.00 $0.0086641 0.00 0.00 0.00 0.00 $0.00 $0.0086644 0.00 0.00 0.00 0.00 $0.00 $0.0086645 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 283 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

86648 0.00 0.00 0.00 0.00 $0.00 $0.0086651 0.00 0.00 0.00 0.00 $0.00 $0.0086652 0.00 0.00 0.00 0.00 $0.00 $0.0086653 0.00 0.00 0.00 0.00 $0.00 $0.0086654 0.00 0.00 0.00 0.00 $0.00 $0.0086658 0.00 0.00 0.00 0.00 $0.00 $0.0086663 0.00 0.00 0.00 0.00 $0.00 $0.0086664 0.00 0.00 0.00 0.00 $0.00 $0.0086665 0.00 0.00 0.00 0.00 $0.00 $0.0086666 0.00 0.00 0.00 0.00 $0.00 $0.0086668 0.00 0.00 0.00 0.00 $0.00 $0.0086671 0.00 0.00 0.00 0.00 $0.00 $0.0086674 0.00 0.00 0.00 0.00 $0.00 $0.0086677 0.00 0.00 0.00 0.00 $0.00 $0.0086682 0.00 0.00 0.00 0.00 $0.00 $0.0086684 0.00 0.00 0.00 0.00 $0.00 $0.0086687 0.00 0.00 0.00 0.00 $0.00 $0.0086688 0.00 0.00 0.00 0.00 $0.00 $0.0086689 0.00 0.00 0.00 0.00 $0.00 $0.0086692 0.00 0.00 0.00 0.00 $0.00 $0.0086694 0.00 0.00 0.00 0.00 $0.00 $0.0086695 0.00 0.00 0.00 0.00 $0.00 $0.0086696 0.00 0.00 0.00 0.00 $0.00 $0.0086698 0.00 0.00 0.00 0.00 $0.00 $0.0086701 0.00 0.00 0.00 0.00 $0.00 $0.0086702 0.00 0.00 0.00 0.00 $0.00 $0.0086703 0.00 0.00 0.00 0.00 $0.00 $0.0086704 0.00 0.00 0.00 0.00 $0.00 $0.0086705 0.00 0.00 0.00 0.00 $0.00 $0.0086706 0.00 0.00 0.00 0.00 $0.00 $0.0086707 0.00 0.00 0.00 0.00 $0.00 $0.0086708 0.00 0.00 0.00 0.00 $0.00 $0.0086709 0.00 0.00 0.00 0.00 $0.00 $0.0086710 0.00 0.00 0.00 0.00 $0.00 $0.0086713 0.00 0.00 0.00 0.00 $0.00 $0.0086717 0.00 0.00 0.00 0.00 $0.00 $0.0086720 0.00 0.00 0.00 0.00 $0.00 $0.0086723 0.00 0.00 0.00 0.00 $0.00 $0.0086727 0.00 0.00 0.00 0.00 $0.00 $0.0086729 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 284 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

86732 0.00 0.00 0.00 0.00 $0.00 $0.0086735 0.00 0.00 0.00 0.00 $0.00 $0.0086738 0.00 0.00 0.00 0.00 $0.00 $0.0086741 0.00 0.00 0.00 0.00 $0.00 $0.0086744 0.00 0.00 0.00 0.00 $0.00 $0.0086747 0.00 0.00 0.00 0.00 $0.00 $0.0086750 0.00 0.00 0.00 0.00 $0.00 $0.0086753 0.00 0.00 0.00 0.00 $0.00 $0.0086756 0.00 0.00 0.00 0.00 $0.00 $0.0086757 0.00 0.00 0.00 0.00 $0.00 $0.0086759 0.00 0.00 0.00 0.00 $0.00 $0.0086762 0.00 0.00 0.00 0.00 $0.00 $0.0086765 0.00 0.00 0.00 0.00 $0.00 $0.0086768 0.00 0.00 0.00 0.00 $0.00 $0.0086771 0.00 0.00 0.00 0.00 $0.00 $0.0086774 0.00 0.00 0.00 0.00 $0.00 $0.0086777 0.00 0.00 0.00 0.00 $0.00 $0.0086778 0.00 0.00 0.00 0.00 $0.00 $0.0086780 0.00 0.00 0.00 0.00 $0.00 $0.0086784 0.00 0.00 0.00 0.00 $0.00 $0.0086787 0.00 0.00 0.00 0.00 $0.00 $0.0086788 0.00 0.00 0.00 0.00 $0.00 $0.0086789 0.00 0.00 0.00 0.00 $0.00 $0.0086790 0.00 0.00 0.00 0.00 $0.00 $0.0086793 0.00 0.00 0.00 0.00 $0.00 $0.0086800 0.00 0.00 0.00 0.00 $0.00 $0.0086803 0.00 0.00 0.00 0.00 $0.00 $0.0086804 0.00 0.00 0.00 0.00 $0.00 $0.0086805 0.00 0.00 0.00 0.00 $0.00 $0.0086806 0.00 0.00 0.00 0.00 $0.00 $0.0086807 0.00 0.00 0.00 0.00 $0.00 $0.0086808 0.00 0.00 0.00 0.00 $0.00 $0.0086812 0.00 0.00 0.00 0.00 $0.00 $0.0086813 0.00 0.00 0.00 0.00 $0.00 $0.0086816 0.00 0.00 0.00 0.00 $0.00 $0.0086817 0.00 0.00 0.00 0.00 $0.00 $0.0086821 0.00 0.00 0.00 0.00 $0.00 $0.0086822 0.00 0.00 0.00 0.00 $0.00 $0.0086825 0.00 0.00 0.00 0.00 $0.00 $0.0086826 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 285 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

86849 0.00 0.00 0.00 0.00 $0.00 $0.0086850 0.00 0.00 0.00 0.00 $0.00 $0.0086860 0.00 0.00 0.00 0.00 $0.00 $0.0086870 0.00 0.00 0.00 0.00 $0.00 $0.0086880 0.00 0.00 0.00 0.00 $0.00 $0.0086885 0.00 0.00 0.00 0.00 $0.00 $0.0086886 0.00 0.00 0.00 0.00 $0.00 $0.0086890 0.00 0.00 0.00 0.00 $0.00 $0.0086891 0.00 0.00 0.00 0.00 $0.00 $0.0086900 0.00 0.00 0.00 0.00 $0.00 $0.0086901 0.00 0.00 0.00 0.00 $0.00 $0.0086902 0.00 0.00 0.00 0.00 $0.00 $0.0086904 0.00 0.00 0.00 0.00 $0.00 $0.0086905 0.00 0.00 0.00 0.00 $0.00 $0.0086906 0.00 0.00 0.00 0.00 $0.00 $0.0086910 0.00 0.00 0.00 0.00 $0.00 $0.0086911 0.00 0.00 0.00 0.00 $0.00 $0.0086920 0.00 0.00 0.00 0.00 $0.00 $0.0086921 0.00 0.00 0.00 0.00 $0.00 $0.0086922 0.00 0.00 0.00 0.00 $0.00 $0.0086923 0.00 0.00 0.00 0.00 $0.00 $0.0086927 0.00 0.00 0.00 0.00 $0.00 $0.0086930 0.00 0.00 0.00 0.00 $0.00 $0.0086931 0.00 0.00 0.00 0.00 $0.00 $0.0086932 0.00 0.00 0.00 0.00 $0.00 $0.0086940 0.00 0.00 0.00 0.00 $0.00 $0.0086941 0.00 0.00 0.00 0.00 $0.00 $0.0086945 0.00 0.00 0.00 0.00 $0.00 $0.0086950 0.00 0.00 0.00 0.00 $0.00 $0.0086960 0.00 0.00 0.00 0.00 $0.00 $0.0086965 0.00 0.00 0.00 0.00 $0.00 $0.0086970 0.00 0.00 0.00 0.00 $0.00 $0.0086971 0.00 0.00 0.00 0.00 $0.00 $0.0086972 0.00 0.00 0.00 0.00 $0.00 $0.0086975 0.00 0.00 0.00 0.00 $0.00 $0.0086976 0.00 0.00 0.00 0.00 $0.00 $0.0086977 0.00 0.00 0.00 0.00 $0.00 $0.0086978 0.00 0.00 0.00 0.00 $0.00 $0.0086985 0.00 0.00 0.00 0.00 $0.00 $0.0086999 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 286 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

87001 0.00 0.00 0.00 0.00 $0.00 $0.0087003 0.00 0.00 0.00 0.00 $0.00 $0.0087015 0.00 0.00 0.00 0.00 $0.00 $0.0087040 0.00 0.00 0.00 0.00 $0.00 $0.0087045 0.00 0.00 0.00 0.00 $0.00 $0.0087046 0.00 0.00 0.00 0.00 $0.00 $0.0087070 0.00 0.00 0.00 0.00 $0.00 $0.0087071 0.00 0.00 0.00 0.00 $0.00 $0.0087073 0.00 0.00 0.00 0.00 $0.00 $0.0087075 0.00 0.00 0.00 0.00 $0.00 $0.0087076 0.00 0.00 0.00 0.00 $0.00 $0.0087077 0.00 0.00 0.00 0.00 $0.00 $0.0087081 0.00 0.00 0.00 0.00 $0.00 $0.0087084 0.00 0.00 0.00 0.00 $0.00 $0.0087086 0.00 0.00 0.00 0.00 $0.00 $0.0087088 0.00 0.00 0.00 0.00 $0.00 $0.0087101 0.00 0.00 0.00 0.00 $0.00 $0.0087102 0.00 0.00 0.00 0.00 $0.00 $0.0087103 0.00 0.00 0.00 0.00 $0.00 $0.0087106 0.00 0.00 0.00 0.00 $0.00 $0.0087107 0.00 0.00 0.00 0.00 $0.00 $0.0087109 0.00 0.00 0.00 0.00 $0.00 $0.0087110 0.00 0.00 0.00 0.00 $0.00 $0.0087116 0.00 0.00 0.00 0.00 $0.00 $0.0087118 0.00 0.00 0.00 0.00 $0.00 $0.0087140 0.00 0.00 0.00 0.00 $0.00 $0.0087143 0.00 0.00 0.00 0.00 $0.00 $0.0087147 0.00 0.00 0.00 0.00 $0.00 $0.0087149 0.00 0.00 0.00 0.00 $0.00 $0.0087150 0.00 0.00 0.00 0.00 $0.00 $0.0087152 0.00 0.00 0.00 0.00 $0.00 $0.0087153 0.00 0.00 0.00 0.00 $0.00 $0.0087158 0.00 0.00 0.00 0.00 $0.00 $0.0087164 0.00 0.00 0.00 0.00 $0.00 $0.0087164 26 0.37 0.16 0.16 0.03 $24.96 $24.9687166 0.00 0.00 0.00 0.00 $0.00 $0.0087168 0.00 0.00 0.00 0.00 $0.00 $0.0087169 0.00 0.00 0.00 0.00 $0.00 $0.0087172 0.00 0.00 0.00 0.00 $0.00 $0.0087176 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 287 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

87177 0.00 0.00 0.00 0.00 $0.00 $0.0087181 0.00 0.00 0.00 0.00 $0.00 $0.0087184 0.00 0.00 0.00 0.00 $0.00 $0.0087185 0.00 0.00 0.00 0.00 $0.00 $0.0087186 0.00 0.00 0.00 0.00 $0.00 $0.0087187 0.00 0.00 0.00 0.00 $0.00 $0.0087188 0.00 0.00 0.00 0.00 $0.00 $0.0087190 0.00 0.00 0.00 0.00 $0.00 $0.0087197 0.00 0.00 0.00 0.00 $0.00 $0.0087205 0.00 0.00 0.00 0.00 $0.00 $0.0087206 0.00 0.00 0.00 0.00 $0.00 $0.0087207 0.00 0.00 0.00 0.00 $0.00 $0.0087207 26 0.37 0.17 0.17 0.03 $25.42 $25.4287209 0.00 0.00 0.00 0.00 $0.00 $0.0087210 0.00 0.00 0.00 0.00 $0.00 $0.0087220 0.00 0.00 0.00 0.00 $0.00 $0.0087230 0.00 0.00 0.00 0.00 $0.00 $0.0087250 0.00 0.00 0.00 0.00 $0.00 $0.0087252 0.00 0.00 0.00 0.00 $0.00 $0.0087253 0.00 0.00 0.00 0.00 $0.00 $0.0087254 0.00 0.00 0.00 0.00 $0.00 $0.0087255 0.00 0.00 0.00 0.00 $0.00 $0.0087260 0.00 0.00 0.00 0.00 $0.00 $0.0087265 0.00 0.00 0.00 0.00 $0.00 $0.0087267 0.00 0.00 0.00 0.00 $0.00 $0.0087269 0.00 0.00 0.00 0.00 $0.00 $0.0087270 0.00 0.00 0.00 0.00 $0.00 $0.0087271 0.00 0.00 0.00 0.00 $0.00 $0.0087272 0.00 0.00 0.00 0.00 $0.00 $0.0087273 0.00 0.00 0.00 0.00 $0.00 $0.0087274 0.00 0.00 0.00 0.00 $0.00 $0.0087275 0.00 0.00 0.00 0.00 $0.00 $0.0087276 0.00 0.00 0.00 0.00 $0.00 $0.0087277 0.00 0.00 0.00 0.00 $0.00 $0.0087278 0.00 0.00 0.00 0.00 $0.00 $0.0087279 0.00 0.00 0.00 0.00 $0.00 $0.0087280 0.00 0.00 0.00 0.00 $0.00 $0.0087281 0.00 0.00 0.00 0.00 $0.00 $0.0087283 0.00 0.00 0.00 0.00 $0.00 $0.0087285 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 288 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

87290 0.00 0.00 0.00 0.00 $0.00 $0.0087299 0.00 0.00 0.00 0.00 $0.00 $0.0087300 0.00 0.00 0.00 0.00 $0.00 $0.0087301 0.00 0.00 0.00 0.00 $0.00 $0.0087305 0.00 0.00 0.00 0.00 $0.00 $0.0087320 0.00 0.00 0.00 0.00 $0.00 $0.0087324 0.00 0.00 0.00 0.00 $0.00 $0.0087327 0.00 0.00 0.00 0.00 $0.00 $0.0087328 0.00 0.00 0.00 0.00 $0.00 $0.0087329 0.00 0.00 0.00 0.00 $0.00 $0.0087332 0.00 0.00 0.00 0.00 $0.00 $0.0087335 0.00 0.00 0.00 0.00 $0.00 $0.0087336 0.00 0.00 0.00 0.00 $0.00 $0.0087337 0.00 0.00 0.00 0.00 $0.00 $0.0087338 0.00 0.00 0.00 0.00 $0.00 $0.0087339 0.00 0.00 0.00 0.00 $0.00 $0.0087340 0.00 0.00 0.00 0.00 $0.00 $0.0087341 0.00 0.00 0.00 0.00 $0.00 $0.0087350 0.00 0.00 0.00 0.00 $0.00 $0.0087380 0.00 0.00 0.00 0.00 $0.00 $0.0087385 0.00 0.00 0.00 0.00 $0.00 $0.0087389 0.00 0.00 0.00 0.00 $0.00 $0.0087390 0.00 0.00 0.00 0.00 $0.00 $0.0087391 0.00 0.00 0.00 0.00 $0.00 $0.0087400 0.00 0.00 0.00 0.00 $0.00 $0.0087420 0.00 0.00 0.00 0.00 $0.00 $0.0087425 0.00 0.00 0.00 0.00 $0.00 $0.0087427 0.00 0.00 0.00 0.00 $0.00 $0.0087430 0.00 0.00 0.00 0.00 $0.00 $0.0087449 0.00 0.00 0.00 0.00 $0.00 $0.0087450 0.00 0.00 0.00 0.00 $0.00 $0.0087451 0.00 0.00 0.00 0.00 $0.00 $0.0087470 0.00 0.00 0.00 0.00 $0.00 $0.0087471 0.00 0.00 0.00 0.00 $0.00 $0.0087472 0.00 0.00 0.00 0.00 $0.00 $0.0087475 0.00 0.00 0.00 0.00 $0.00 $0.0087476 0.00 0.00 0.00 0.00 $0.00 $0.0087477 0.00 0.00 0.00 0.00 $0.00 $0.0087480 0.00 0.00 0.00 0.00 $0.00 $0.0087481 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 289 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

87482 0.00 0.00 0.00 0.00 $0.00 $0.0087485 0.00 0.00 0.00 0.00 $0.00 $0.0087486 0.00 0.00 0.00 0.00 $0.00 $0.0087487 0.00 0.00 0.00 0.00 $0.00 $0.0087490 0.00 0.00 0.00 0.00 $0.00 $0.0087491 0.00 0.00 0.00 0.00 $0.00 $0.0087492 0.00 0.00 0.00 0.00 $0.00 $0.0087493 0.00 0.00 0.00 0.00 $0.00 $0.0087495 0.00 0.00 0.00 0.00 $0.00 $0.0087496 0.00 0.00 0.00 0.00 $0.00 $0.0087497 0.00 0.00 0.00 0.00 $0.00 $0.0087498 0.00 0.00 0.00 0.00 $0.00 $0.0087500 0.00 0.00 0.00 0.00 $0.00 $0.0087501 0.00 0.00 0.00 0.00 $0.00 $0.0087502 0.00 0.00 0.00 0.00 $0.00 $0.0087503 0.00 0.00 0.00 0.00 $0.00 $0.0087510 0.00 0.00 0.00 0.00 $0.00 $0.0087511 0.00 0.00 0.00 0.00 $0.00 $0.0087512 0.00 0.00 0.00 0.00 $0.00 $0.0087515 0.00 0.00 0.00 0.00 $0.00 $0.0087516 0.00 0.00 0.00 0.00 $0.00 $0.0087517 0.00 0.00 0.00 0.00 $0.00 $0.0087520 0.00 0.00 0.00 0.00 $0.00 $0.0087521 0.00 0.00 0.00 0.00 $0.00 $0.0087522 0.00 0.00 0.00 0.00 $0.00 $0.0087525 0.00 0.00 0.00 0.00 $0.00 $0.0087526 0.00 0.00 0.00 0.00 $0.00 $0.0087527 0.00 0.00 0.00 0.00 $0.00 $0.0087528 0.00 0.00 0.00 0.00 $0.00 $0.0087529 0.00 0.00 0.00 0.00 $0.00 $0.0087530 0.00 0.00 0.00 0.00 $0.00 $0.0087531 0.00 0.00 0.00 0.00 $0.00 $0.0087532 0.00 0.00 0.00 0.00 $0.00 $0.0087533 0.00 0.00 0.00 0.00 $0.00 $0.0087534 0.00 0.00 0.00 0.00 $0.00 $0.0087535 0.00 0.00 0.00 0.00 $0.00 $0.0087536 0.00 0.00 0.00 0.00 $0.00 $0.0087537 0.00 0.00 0.00 0.00 $0.00 $0.0087538 0.00 0.00 0.00 0.00 $0.00 $0.0087539 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 290 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

87540 0.00 0.00 0.00 0.00 $0.00 $0.0087541 0.00 0.00 0.00 0.00 $0.00 $0.0087542 0.00 0.00 0.00 0.00 $0.00 $0.0087550 0.00 0.00 0.00 0.00 $0.00 $0.0087551 0.00 0.00 0.00 0.00 $0.00 $0.0087552 0.00 0.00 0.00 0.00 $0.00 $0.0087555 0.00 0.00 0.00 0.00 $0.00 $0.0087556 0.00 0.00 0.00 0.00 $0.00 $0.0087557 0.00 0.00 0.00 0.00 $0.00 $0.0087560 0.00 0.00 0.00 0.00 $0.00 $0.0087561 0.00 0.00 0.00 0.00 $0.00 $0.0087562 0.00 0.00 0.00 0.00 $0.00 $0.0087580 0.00 0.00 0.00 0.00 $0.00 $0.0087581 0.00 0.00 0.00 0.00 $0.00 $0.0087582 0.00 0.00 0.00 0.00 $0.00 $0.0087590 0.00 0.00 0.00 0.00 $0.00 $0.0087591 0.00 0.00 0.00 0.00 $0.00 $0.0087592 0.00 0.00 0.00 0.00 $0.00 $0.0087620 0.00 0.00 0.00 0.00 $0.00 $0.0087621 0.00 0.00 0.00 0.00 $0.00 $0.0087622 0.00 0.00 0.00 0.00 $0.00 $0.0087640 0.00 0.00 0.00 0.00 $0.00 $0.0087641 0.00 0.00 0.00 0.00 $0.00 $0.0087650 0.00 0.00 0.00 0.00 $0.00 $0.0087651 0.00 0.00 0.00 0.00 $0.00 $0.0087652 0.00 0.00 0.00 0.00 $0.00 $0.0087653 0.00 0.00 0.00 0.00 $0.00 $0.0087660 0.00 0.00 0.00 0.00 $0.00 $0.0087797 0.00 0.00 0.00 0.00 $0.00 $0.0087798 0.00 0.00 0.00 0.00 $0.00 $0.0087799 0.00 0.00 0.00 0.00 $0.00 $0.0087800 0.00 0.00 0.00 0.00 $0.00 $0.0087801 0.00 0.00 0.00 0.00 $0.00 $0.0087802 0.00 0.00 0.00 0.00 $0.00 $0.0087803 0.00 0.00 0.00 0.00 $0.00 $0.0087804 0.00 0.00 0.00 0.00 $0.00 $0.0087807 0.00 0.00 0.00 0.00 $0.00 $0.0087808 0.00 0.00 0.00 0.00 $0.00 $0.0087809 0.00 0.00 0.00 0.00 $0.00 $0.0087810 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 291 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

87850 0.00 0.00 0.00 0.00 $0.00 $0.0087880 0.00 0.00 0.00 0.00 $0.00 $0.0087899 0.00 0.00 0.00 0.00 $0.00 $0.0087900 0.00 0.00 0.00 0.00 $0.00 $0.0087901 0.00 0.00 0.00 0.00 $0.00 $0.0087902 0.00 0.00 0.00 0.00 $0.00 $0.0087903 0.00 0.00 0.00 0.00 $0.00 $0.0087904 0.00 0.00 0.00 0.00 $0.00 $0.0087905 0.00 0.00 0.00 0.00 $0.00 $0.0087906 0.00 0.00 0.00 0.00 $0.00 $0.0087999 0.00 0.00 0.00 0.00 $0.00 $0.0088000 0.00 0.00 0.00 0.00 $0.00 $0.0088005 0.00 0.00 0.00 0.00 $0.00 $0.0088007 0.00 0.00 0.00 0.00 $0.00 $0.0088012 0.00 0.00 0.00 0.00 $0.00 $0.0088014 0.00 0.00 0.00 0.00 $0.00 $0.0088016 0.00 0.00 0.00 0.00 $0.00 $0.0088020 0.00 0.00 0.00 0.00 $0.00 $0.0088025 0.00 0.00 0.00 0.00 $0.00 $0.0088027 0.00 0.00 0.00 0.00 $0.00 $0.0088028 0.00 0.00 0.00 0.00 $0.00 $0.0088029 0.00 0.00 0.00 0.00 $0.00 $0.0088036 0.00 0.00 0.00 0.00 $0.00 $0.0088037 0.00 0.00 0.00 0.00 $0.00 $0.0088040 0.00 0.00 0.00 0.00 $0.00 $0.0088045 0.00 0.00 0.00 0.00 $0.00 $0.0088099 0.00 0.00 0.00 0.00 $0.00 $0.0088104 0.56 1.41 1.41 0.02 $90.52 $90.5288104 TC 0.00 1.18 1.18 0.01 $55.11 $55.1188104 26 0.56 0.23 0.23 0.01 $35.41 $35.4188106 0.37 1.75 1.75 0.02 $98.02 $98.0288106 TC 0.00 1.58 1.58 0.01 $73.62 $73.6288106 26 0.37 0.17 0.17 0.01 $24.40 $24.4088108 0.44 1.62 1.62 0.02 $95.04 $95.0488108 TC 0.00 1.44 1.44 0.01 $67.14 $67.1488108 26 0.44 0.18 0.18 0.01 $27.90 $27.9088112 1.18 1.78 1.78 0.05 $136.02 $136.0288112 TC 0.00 1.35 1.35 0.01 $62.98 $62.9888112 26 1.18 0.43 0.43 0.04 $73.05 $73.0588120 1.20 12.65 12.65 0.06 $640.37 $640.37

Updated December 2011 292 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

88120 TC 0.00 12.36 12.36 0.03 $573.44 $573.4488120 26 1.20 0.29 0.29 0.03 $66.93 $66.9388121 1.00 10.95 10.95 0.04 $552.03 $552.0388121 TC 0.00 10.63 10.63 0.01 $492.37 $492.3788121 26 1.00 0.32 0.32 0.03 $59.65 $59.6588125 0.26 0.37 0.37 0.02 $29.40 $29.4088125 TC 0.00 0.26 0.26 0.01 $12.54 $12.5488125 26 0.26 0.11 0.11 0.01 $16.86 $16.8688130 0.00 0.00 0.00 0.00 $0.00 $0.0088140 0.00 0.00 0.00 0.00 $0.00 $0.0088141 0.42 0.41 0.41 0.03 $38.69 $38.6988142 0.00 0.00 0.00 0.00 $0.00 $0.0088143 0.00 0.00 0.00 0.00 $0.00 $0.0088147 0.00 0.00 0.00 0.00 $0.00 $0.0088148 0.00 0.00 0.00 0.00 $0.00 $0.0088150 0.00 0.00 0.00 0.00 $0.00 $0.0088152 0.00 0.00 0.00 0.00 $0.00 $0.0088153 0.00 0.00 0.00 0.00 $0.00 $0.0088154 0.00 0.00 0.00 0.00 $0.00 $0.0088155 0.00 0.00 0.00 0.00 $0.00 $0.0088160 0.50 1.12 1.12 0.02 $74.50 $74.5088160 TC 0.00 0.92 0.92 0.01 $43.08 $43.0888160 26 0.50 0.20 0.20 0.01 $31.42 $31.4288161 0.50 1.16 1.16 0.02 $76.35 $76.3588161 TC 0.00 0.97 0.97 0.01 $45.39 $45.3988161 26 0.50 0.19 0.19 0.01 $30.96 $30.9688162 0.76 1.72 1.72 0.04 $114.54 $114.5488162 TC 0.00 1.40 1.40 0.01 $65.29 $65.2988162 26 0.76 0.32 0.32 0.03 $49.26 $49.2688164 0.00 0.00 0.00 0.00 $0.00 $0.0088165 0.00 0.00 0.00 0.00 $0.00 $0.0088166 0.00 0.00 0.00 0.00 $0.00 $0.0088167 0.00 0.00 0.00 0.00 $0.00 $0.0088172 0.69 0.84 0.84 0.02 $69.78 $69.7888172 TC 0.00 0.55 0.55 0.01 $25.96 $25.9688172 26 0.69 0.29 0.29 0.01 $43.82 $43.8288173 1.39 2.64 2.64 0.05 $184.91 $184.9188173 TC 0.00 2.08 2.08 0.01 $96.75 $96.7588173 26 1.39 0.56 0.56 0.04 $88.16 $88.1688174 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 293 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

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Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

88175 0.00 0.00 0.00 0.00 $0.00 $0.0088177 0.42 0.37 0.37 0.02 $36.33 $36.3388177 TC 0.00 0.19 0.19 0.01 $9.30 $9.3088177 26 0.42 0.18 0.18 0.01 $27.03 $27.0388182 0.77 2.17 2.17 0.06 $136.82 $136.8288182 TC 0.00 1.97 1.97 0.03 $92.68 $92.6888182 26 0.77 0.20 0.20 0.03 $44.14 $44.1488184 0.00 2.42 2.42 0.01 $112.49 $112.4988185 0.00 1.46 1.46 0.01 $68.07 $68.0788187 1.36 0.52 0.52 0.08 $87.04 $87.0488188 1.69 0.67 0.67 0.10 $109.30 $109.3088189 2.23 0.66 0.66 0.12 $133.24 $133.2488199 0.00 0.00 0.00 0.00 $0.00 $0.0088199 TC 0.00 0.00 0.00 0.00 $0.00 $0.0088199 26 0.00 0.00 0.00 0.00 $0.00 $0.0088230 0.00 0.00 0.00 0.00 $0.00 $0.0088233 0.00 0.00 0.00 0.00 $0.00 $0.0088235 0.00 0.00 0.00 0.00 $0.00 $0.0088237 0.00 0.00 0.00 0.00 $0.00 $0.0088239 0.00 0.00 0.00 0.00 $0.00 $0.0088240 0.00 0.00 0.00 0.00 $0.00 $0.0088241 0.00 0.00 0.00 0.00 $0.00 $0.0088245 0.00 0.00 0.00 0.00 $0.00 $0.0088248 0.00 0.00 0.00 0.00 $0.00 $0.0088249 0.00 0.00 0.00 0.00 $0.00 $0.0088261 0.00 0.00 0.00 0.00 $0.00 $0.0088262 0.00 0.00 0.00 0.00 $0.00 $0.0088263 0.00 0.00 0.00 0.00 $0.00 $0.0088264 0.00 0.00 0.00 0.00 $0.00 $0.0088267 0.00 0.00 0.00 0.00 $0.00 $0.0088269 0.00 0.00 0.00 0.00 $0.00 $0.0088271 0.00 0.00 0.00 0.00 $0.00 $0.0088272 0.00 0.00 0.00 0.00 $0.00 $0.0088273 0.00 0.00 0.00 0.00 $0.00 $0.0088274 0.00 0.00 0.00 0.00 $0.00 $0.0088275 0.00 0.00 0.00 0.00 $0.00 $0.0088280 0.00 0.00 0.00 0.00 $0.00 $0.0088283 0.00 0.00 0.00 0.00 $0.00 $0.0088285 0.00 0.00 0.00 0.00 $0.00 $0.0088289 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 294 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

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Year 2012TransitionalFacility PE

RVUs

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Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

88291 0.52 0.31 0.31 0.03 $38.40 $38.4088299 0.00 0.00 0.00 0.00 $0.00 $0.0088300 0.08 0.73 0.73 0.02 $38.26 $38.2688300 TC 0.00 0.69 0.69 0.01 $32.44 $32.4488300 26 0.08 0.04 0.04 0.01 $5.83 $5.8388302 0.13 1.49 1.49 0.02 $75.59 $75.5988302 TC 0.00 1.44 1.44 0.01 $67.14 $67.1488302 26 0.13 0.05 0.05 0.01 $8.45 $8.4588304 0.22 1.58 1.58 0.02 $83.66 $83.6688304 TC 0.00 1.49 1.49 0.01 $69.45 $69.4588304 26 0.22 0.09 0.09 0.01 $14.20 $14.2088305 0.75 2.34 2.34 0.02 $141.78 $141.7888305 TC 0.00 2.04 2.04 0.01 $94.90 $94.9088305 26 0.75 0.30 0.30 0.01 $46.88 $46.8888307 1.59 5.25 5.25 0.05 $314.35 $314.3588307 TC 0.00 4.56 4.56 0.01 $211.51 $211.5188307 26 1.59 0.69 0.69 0.04 $102.84 $102.8488309 2.80 7.53 7.53 0.11 $475.31 $475.3188309 TC 0.00 6.33 6.33 0.03 $294.42 $294.4288309 26 2.80 1.20 1.20 0.08 $180.89 $180.8988311 0.24 0.30 0.30 0.02 $25.30 $25.3088311 TC 0.00 0.20 0.20 0.01 $9.76 $9.7688311 26 0.24 0.10 0.10 0.01 $15.53 $15.5388312 0.54 2.19 2.19 0.02 $125.74 $125.7488312 TC 0.00 1.98 1.98 0.01 $92.13 $92.1388312 26 0.54 0.21 0.21 0.01 $33.62 $33.6288313 0.24 1.67 1.67 0.02 $88.69 $88.6988313 TC 0.00 1.58 1.58 0.01 $73.62 $73.6288313 26 0.24 0.09 0.09 0.01 $15.07 $15.0788314 0.45 1.88 1.88 0.02 $107.50 $107.5088314 TC 0.00 1.70 1.70 0.01 $79.17 $79.1788314 26 0.45 0.18 0.18 0.01 $28.33 $28.3388319 0.53 2.31 2.31 0.04 $131.88 $131.8888319 TC 0.00 2.10 2.10 0.01 $97.68 $97.6888319 26 0.53 0.21 0.21 0.03 $34.20 $34.2088321 1.63 0.91 0.64 0.10 $117.80 $105.3188323 1.83 2.15 2.15 0.05 $181.30 $181.3088323 TC 0.00 1.63 1.63 0.01 $75.93 $75.9388323 26 1.83 0.52 0.52 0.04 $105.37 $105.3788325 2.50 3.17 1.04 0.12 $261.08 $162.52

Updated December 2011 295 of 387 Effective January 2012

CPT©1/HCPCS

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Year 2012Transitional

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Year 2012TransitionalFacility PE

RVUs

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Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

88329 0.67 0.85 0.30 0.04 $70.39 $44.9488331 1.19 1.51 1.51 0.02 $122.44 $122.4488331 TC 0.00 0.98 0.98 0.01 $45.85 $45.8588331 26 1.19 0.53 0.53 0.01 $76.58 $76.5888332 0.59 0.59 0.59 0.02 $53.88 $53.8888332 TC 0.00 0.33 0.33 0.01 $15.78 $15.7888332 26 0.59 0.26 0.26 0.01 $38.10 $38.1088333 1.20 1.61 1.61 0.05 $129.02 $129.0288333 TC 0.00 1.09 1.09 0.01 $50.94 $50.9488333 26 1.20 0.52 0.52 0.04 $78.08 $78.0888334 0.73 1.00 1.00 0.04 $79.93 $79.9388334 TC 0.00 0.68 0.68 0.01 $31.97 $31.9788334 26 0.73 0.32 0.32 0.03 $47.96 $47.9688342 0.85 2.21 2.21 0.04 $141.12 $141.1288342 TC 0.00 1.89 1.89 0.01 $87.96 $87.9688342 26 0.85 0.32 0.32 0.03 $53.15 $53.1588346 0.86 2.16 2.16 0.02 $138.22 $138.2288346 TC 0.00 1.82 1.82 0.01 $84.72 $84.7288346 26 0.86 0.34 0.34 0.01 $53.50 $53.5088347 0.86 1.29 1.29 0.02 $97.96 $97.9688347 TC 0.00 1.08 1.08 0.01 $50.48 $50.4888347 26 0.86 0.21 0.21 0.01 $47.48 $47.4888348 1.51 19.05 19.05 0.12 $952.99 $952.9988348 TC 0.00 18.47 18.47 0.08 $858.70 $858.7088348 26 1.51 0.58 0.58 0.04 $94.28 $94.2888349 0.76 10.71 10.71 0.07 $532.05 $532.0588349 TC 0.00 10.37 10.37 0.04 $481.87 $481.8788349 26 0.76 0.34 0.34 0.03 $50.18 $50.1888355 1.85 3.79 3.79 0.06 $258.56 $258.5688355 TC 0.00 3.28 3.28 0.01 $152.28 $152.2888355 26 1.85 0.51 0.51 0.05 $106.28 $106.2888356 3.02 4.81 4.81 0.18 $362.55 $362.5588356 TC 0.00 4.24 4.24 0.04 $198.23 $198.2388356 26 3.02 0.57 0.57 0.14 $164.32 $164.3288358 0.95 1.23 1.23 0.04 $100.10 $100.1088358 TC 0.00 0.98 0.98 0.01 $45.85 $45.8588358 26 0.95 0.25 0.25 0.03 $54.25 $54.2588360 1.10 2.40 2.40 0.04 $160.74 $160.7488360 TC 0.00 2.03 2.03 0.01 $94.44 $94.4488360 26 1.10 0.37 0.37 0.03 $66.30 $66.30

Updated December 2011 296 of 387 Effective January 2012

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MRA 2012

88361 1.18 3.22 3.22 0.05 $202.65 $202.6588361 TC 0.00 2.80 2.80 0.01 $130.07 $130.0788361 26 1.18 0.42 0.42 0.04 $72.59 $72.5988362 2.17 6.57 6.57 0.14 $405.13 $405.1388362 TC 0.00 5.69 5.69 0.04 $265.32 $265.3288362 26 2.17 0.88 0.88 0.10 $139.81 $139.8188363 0.37 0.64 0.06 0.03 $47.17 $20.3388365 1.20 3.63 3.63 0.04 $221.98 $221.9888365 TC 0.00 3.20 3.20 0.01 $148.58 $148.5888365 26 1.20 0.43 0.43 0.03 $73.41 $73.4188367 1.30 6.40 6.40 0.06 $355.50 $355.5088367 TC 0.00 5.98 5.98 0.01 $277.21 $277.2188367 26 1.30 0.42 0.42 0.05 $78.29 $78.2988368 1.40 5.05 5.05 0.05 $296.86 $296.8688368 TC 0.00 4.69 4.69 0.01 $217.52 $217.5288368 26 1.40 0.36 0.36 0.04 $79.34 $79.3488371 0.00 0.00 0.00 0.00 $0.00 $0.0088371 26 0.37 0.15 0.15 0.03 $24.49 $24.4988372 0.00 0.00 0.00 0.00 $0.00 $0.0088372 26 0.37 0.08 0.08 0.03 $21.26 $21.2688380 1.56 3.76 3.76 0.05 $244.10 $244.1088380 TC 0.00 3.17 3.17 0.01 $147.19 $147.1988380 26 1.56 0.59 0.59 0.04 $96.91 $96.9188381 1.18 3.52 3.52 0.04 $216.03 $216.0388381 TC 0.00 3.24 3.24 0.01 $150.43 $150.4388381 26 1.18 0.28 0.28 0.03 $65.60 $65.6088384 0.00 0.00 0.00 0.00 $0.00 $0.0088384 TC 0.00 0.00 0.00 0.00 $0.00 $0.0088384 26 0.00 0.00 0.00 0.00 $0.00 $0.0088385 1.50 14.60 14.60 0.07 $744.10 $744.1088385 TC 0.00 14.31 14.31 0.03 $663.67 $663.6788385 26 1.50 0.29 0.29 0.04 $80.43 $80.4388386 1.88 16.35 16.35 0.08 $842.05 $842.0588386 TC 0.00 15.83 15.83 0.03 $734.00 $734.0088386 26 1.88 0.52 0.52 0.05 $108.04 $108.0488387 0.62 0.38 0.38 0.02 $45.46 $45.4688387 TC 0.00 0.18 0.18 0.01 $8.84 $8.8488387 26 0.62 0.20 0.20 0.01 $36.62 $36.6288388 0.45 0.43 0.43 0.02 $40.41 $40.4188388 TC 0.00 0.23 0.23 0.01 $11.15 $11.15

Updated December 2011 297 of 387 Effective January 2012

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MRA 2012

88388 26 0.45 0.20 0.20 0.01 $29.26 $29.2688399 0.00 0.00 0.00 0.00 $0.00 $0.0088399 TC 0.00 0.00 0.00 0.00 $0.00 $0.0088399 26 0.00 0.00 0.00 0.00 $0.00 $0.0088720 0.00 0.00 0.00 0.00 $0.00 $0.0088738 0.00 0.00 0.00 0.00 $0.00 $0.0088740 0.00 0.00 0.00 0.00 $0.00 $0.0088741 0.00 0.00 0.00 0.00 $0.00 $0.0088749 0.00 0.00 0.00 0.00 $0.00 $0.0089049 1.40 6.27 0.41 0.10 $355.86 $84.7089050 0.00 0.00 0.00 0.00 $0.00 $0.0089051 0.00 0.00 0.00 0.00 $0.00 $0.0089055 0.00 0.00 0.00 0.00 $0.00 $0.0089060 0.00 0.00 0.00 0.00 $0.00 $0.0089060 26 0.37 0.16 0.16 0.03 $24.96 $24.9689125 0.00 0.00 0.00 0.00 $0.00 $0.0089160 0.00 0.00 0.00 0.00 $0.00 $0.0089190 0.00 0.00 0.00 0.00 $0.00 $0.0089220 0.00 0.47 0.47 0.01 $22.26 $22.2689230 0.00 0.07 0.07 0.01 $3.75 $3.7589240 0.00 0.00 0.00 0.00 $0.00 $0.0089250 0.00 0.00 0.00 0.00 $0.00 $0.0089251 0.00 0.00 0.00 0.00 $0.00 $0.0089253 0.00 0.00 0.00 0.00 $0.00 $0.0089254 0.00 0.00 0.00 0.00 $0.00 $0.0089255 0.00 0.00 0.00 0.00 $0.00 $0.0089257 0.00 0.00 0.00 0.00 $0.00 $0.0089258 0.00 0.00 0.00 0.00 $0.00 $0.0089259 0.00 0.00 0.00 0.00 $0.00 $0.0089260 0.00 0.00 0.00 0.00 $0.00 $0.0089261 0.00 0.00 0.00 0.00 $0.00 $0.0089264 0.00 0.00 0.00 0.00 $0.00 $0.0089268 0.00 0.00 0.00 0.00 $0.00 $0.0089272 0.00 0.00 0.00 0.00 $0.00 $0.0089280 0.00 0.00 0.00 0.00 $0.00 $0.0089281 0.00 0.00 0.00 0.00 $0.00 $0.0089290 0.00 0.00 0.00 0.00 $0.00 $0.0089291 0.00 0.00 0.00 0.00 $0.00 $0.0089300 0.00 0.00 0.00 0.00 $0.00 $0.0089310 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 298 of 387 Effective January 2012

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MRA 2012

89320 0.00 0.00 0.00 0.00 $0.00 $0.0089321 0.00 0.00 0.00 0.00 $0.00 $0.0089322 0.00 0.00 0.00 0.00 $0.00 $0.0089325 0.00 0.00 0.00 0.00 $0.00 $0.0089329 0.00 0.00 0.00 0.00 $0.00 $0.0089330 0.00 0.00 0.00 0.00 $0.00 $0.0089331 0.00 0.00 0.00 0.00 $0.00 $0.0089335 0.00 0.00 0.00 0.00 $0.00 $0.0089342 0.00 0.00 0.00 0.00 $0.00 $0.0089343 0.00 0.00 0.00 0.00 $0.00 $0.0089344 0.00 0.00 0.00 0.00 $0.00 $0.0089346 0.00 0.00 0.00 0.00 $0.00 $0.0089352 0.00 0.00 0.00 0.00 $0.00 $0.0089353 0.00 0.00 0.00 0.00 $0.00 $0.0089354 0.00 0.00 0.00 0.00 $0.00 $0.0089356 0.00 0.00 0.00 0.00 $0.00 $0.0089398 0.00 0.00 0.00 0.00 $0.00 $0.0090281 0.00 0.00 0.00 0.00 $0.00 $0.0090283 0.00 0.00 0.00 0.00 $0.00 $0.0090284 0.00 0.00 0.00 0.00 $0.00 $0.0090287 0.00 0.00 0.00 0.00 $0.00 $0.0090288 0.00 0.00 0.00 0.00 $0.00 $0.0090291 0.00 0.00 0.00 0.00 $0.00 $0.0090296 0.00 0.00 0.00 0.00 $0.00 $0.0090371 0.00 0.00 0.00 0.00 $0.00 $0.0090375 0.00 0.00 0.00 0.00 $0.00 $0.0090376 0.00 0.00 0.00 0.00 $0.00 $0.0090378 0.00 0.00 0.00 0.00 $0.00 $0.0090384 0.00 0.00 0.00 0.00 $0.00 $0.0090385 0.00 0.00 0.00 0.00 $0.00 $0.0090386 0.00 0.00 0.00 0.00 $0.00 $0.0090389 0.00 0.00 0.00 0.00 $0.00 $0.0090393 0.00 0.00 0.00 0.00 $0.00 $0.0090396 0.00 0.00 0.00 0.00 $0.00 $0.0090399 0.00 0.00 0.00 0.00 $0.00 $0.0090460 0.17 0.54 0.54 0.01 $32.86 $32.8690461 0.15 0.21 0.21 0.01 $16.72 $16.7290471 0.17 0.53 0.53 0.01 $32.40 $32.4090472 0.15 0.19 0.19 0.01 $15.80 $15.8090473 0.17 0.47 0.47 0.01 $29.62 $29.62

Updated December 2011 299 of 387 Effective January 2012

CPT©1/HCPCS

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MRA 2012

90474 0.15 0.18 0.18 0.01 $15.34 $15.3490476 0.00 0.00 0.00 0.00 $0.00 $0.0090477 0.00 0.00 0.00 0.00 $0.00 $0.0090581 0.00 0.00 0.00 0.00 $0.00 $0.0090585 0.00 0.00 0.00 0.00 $0.00 $0.0090586 0.00 0.00 0.00 0.00 $0.00 $0.0090632 0.00 0.00 0.00 0.00 $0.00 $0.0090633 0.00 0.00 0.00 0.00 $0.00 $0.0090634 0.00 0.00 0.00 0.00 $0.00 $0.0090636 0.00 0.00 0.00 0.00 $0.00 $0.0090644 0.00 0.00 0.00 0.00 $0.00 $0.0090645 0.00 0.00 0.00 0.00 $0.00 $0.0090646 0.00 0.00 0.00 0.00 $0.00 $0.0090647 0.00 0.00 0.00 0.00 $0.00 $0.0090648 0.00 0.00 0.00 0.00 $0.00 $0.0090649 0.00 0.00 0.00 0.00 $0.00 $0.0090650 0.00 0.00 0.00 0.00 $0.00 $0.0090654 0.00 0.00 0.00 0.00 $0.00 $0.0090655 0.00 0.00 0.00 0.00 $0.00 $0.0090656 0.00 0.00 0.00 0.00 $0.00 $0.0090657 0.00 0.00 0.00 0.00 $0.00 $0.0090658 0.00 0.00 0.00 0.00 $0.00 $0.0090660 0.00 0.00 0.00 0.00 $0.00 $0.0090661 0.00 0.00 0.00 0.00 $0.00 $0.0090662 0.00 0.00 0.00 0.00 $0.00 $0.0090664 0.00 0.00 0.00 0.00 $0.00 $0.0090665 0.00 0.00 0.00 0.00 $0.00 $0.0090666 0.00 0.00 0.00 0.00 $0.00 $0.0090667 0.00 0.00 0.00 0.00 $0.00 $0.0090668 0.00 0.00 0.00 0.00 $0.00 $0.0090669 0.00 0.00 0.00 0.00 $0.00 $0.0090670 0.00 0.00 0.00 0.00 $0.00 $0.0090675 0.00 0.00 0.00 0.00 $0.00 $0.0090676 0.00 0.00 0.00 0.00 $0.00 $0.0090680 0.00 0.00 0.00 0.00 $0.00 $0.0090681 0.00 0.00 0.00 0.00 $0.00 $0.0090690 0.00 0.00 0.00 0.00 $0.00 $0.0090691 0.00 0.00 0.00 0.00 $0.00 $0.0090692 0.00 0.00 0.00 0.00 $0.00 $0.0090693 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 300 of 387 Effective January 2012

CPT©1/HCPCS

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MRA 2012

90696 0.00 0.00 0.00 0.00 $0.00 $0.0090698 0.00 0.00 0.00 0.00 $0.00 $0.0090700 0.00 0.00 0.00 0.00 $0.00 $0.0090701 0.00 0.00 0.00 0.00 $0.00 $0.0090702 0.00 0.00 0.00 0.00 $0.00 $0.0090703 0.00 0.00 0.00 0.00 $0.00 $0.0090704 0.00 0.00 0.00 0.00 $0.00 $0.0090705 0.00 0.00 0.00 0.00 $0.00 $0.0090706 0.00 0.00 0.00 0.00 $0.00 $0.0090707 0.00 0.00 0.00 0.00 $0.00 $0.0090708 0.00 0.00 0.00 0.00 $0.00 $0.0090710 0.00 0.00 0.00 0.00 $0.00 $0.0090712 0.00 0.00 0.00 0.00 $0.00 $0.0090713 0.00 0.00 0.00 0.00 $0.00 $0.0090714 0.00 0.00 0.00 0.00 $0.00 $0.0090715 0.00 0.00 0.00 0.00 $0.00 $0.0090716 0.00 0.00 0.00 0.00 $0.00 $0.0090717 0.00 0.00 0.00 0.00 $0.00 $0.0090718 0.00 0.00 0.00 0.00 $0.00 $0.0090719 0.00 0.00 0.00 0.00 $0.00 $0.0090720 0.00 0.00 0.00 0.00 $0.00 $0.0090721 0.00 0.00 0.00 0.00 $0.00 $0.0090723 0.00 0.00 0.00 0.00 $0.00 $0.0090725 0.00 0.00 0.00 0.00 $0.00 $0.0090727 0.00 0.00 0.00 0.00 $0.00 $0.0090732 0.00 0.00 0.00 0.00 $0.00 $0.0090733 0.00 0.00 0.00 0.00 $0.00 $0.0090734 0.00 0.00 0.00 0.00 $0.00 $0.0090735 0.00 0.00 0.00 0.00 $0.00 $0.0090736 0.00 0.00 0.00 0.00 $0.00 $0.0090738 0.00 0.00 0.00 0.00 $0.00 $0.0090740 0.00 0.00 0.00 0.00 $0.00 $0.0090743 0.00 0.00 0.00 0.00 $0.00 $0.0090744 0.00 0.00 0.00 0.00 $0.00 $0.0090746 0.00 0.00 0.00 0.00 $0.00 $0.0090747 0.00 0.00 0.00 0.00 $0.00 $0.0090748 0.00 0.00 0.00 0.00 $0.00 $0.0090749 0.00 0.00 0.00 0.00 $0.00 $0.0090801 2.80 1.57 0.61 0.11 $199.53 $155.1190802 3.01 1.75 0.66 0.12 $217.47 $167.03

Updated December 2011 301 of 387 Effective January 2012

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MRA 2012

90804 1.21 0.56 0.19 0.04 $80.36 $63.2490805 1.37 0.69 0.27 0.05 $93.82 $74.3890806 1.86 0.48 0.27 0.07 $106.34 $96.6390807 2.02 0.82 0.40 0.08 $129.52 $110.0890808 2.79 0.63 0.42 0.10 $155.10 $145.3890809 2.95 1.00 0.62 0.12 $180.17 $162.5890810 1.32 0.49 0.22 0.05 $82.40 $69.9090811 1.48 0.85 0.31 0.07 $107.00 $82.0290812 1.97 0.60 0.30 0.07 $116.66 $102.7890813 2.13 0.96 0.43 0.08 $140.76 $116.2490814 2.90 0.77 0.42 0.11 $166.85 $150.6590815 3.06 1.16 0.64 0.14 $193.35 $169.2990816 1.25 0.24 0.29 0.04 $67.29 $69.6090817 1.41 0.38 0.40 0.05 $81.21 $82.1390818 1.89 0.30 0.38 0.07 $99.31 $103.0290819 2.05 0.50 0.53 0.08 $116.01 $117.4090821 2.83 0.41 0.53 0.10 $146.65 $152.2090822 2.99 0.66 0.72 0.12 $166.17 $168.9490823 1.36 0.29 0.33 0.04 $74.37 $76.2290824 1.52 0.40 0.43 0.07 $87.91 $89.3090826 2.01 0.32 0.40 0.07 $105.44 $109.1490827 2.16 0.50 0.54 0.08 $120.77 $122.6290828 2.94 0.41 0.53 0.10 $151.42 $156.9790829 3.10 0.68 0.74 0.12 $171.86 $174.6390845 2.10 0.47 0.40 0.08 $116.79 $113.5590846 1.83 0.51 0.41 0.07 $106.43 $101.8190847 2.21 0.71 0.46 0.08 $132.66 $121.0990849 0.59 0.33 0.20 0.03 $42.35 $36.3490853 0.59 0.30 0.22 0.03 $40.97 $37.2690857 0.63 0.40 0.22 0.03 $47.33 $39.0090862 0.95 0.73 0.31 0.04 $76.97 $57.5390865 2.84 1.72 0.70 0.11 $208.21 $161.0190867 3.52 6.52 1.43 0.15 $461.80 $226.2890868 0.48 4.49 0.20 0.02 $229.57 $31.0690869 3.00 9.29 0.27 0.13 $566.43 $149.0690870 2.50 2.34 0.52 0.11 $222.17 $137.9590875 1.20 0.84 0.50 0.08 $94.92 $79.1990876 1.90 1.11 0.78 0.12 $139.77 $124.5090880 2.19 0.57 0.38 0.08 $125.31 $116.5290882 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 302 of 387 Effective January 2012

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MRA 2012

90885 0.97 0.40 0.40 0.07 $64.09 $64.0990887 1.48 0.97 0.61 0.10 $114.08 $97.4290889 0.00 0.00 0.00 0.00 $0.00 $0.0090901 0.41 0.73 0.18 0.01 $52.05 $26.6090911 0.89 1.55 0.35 0.07 $113.84 $58.3190935 1.48 0.58 0.58 0.08 $95.02 $95.0290937 2.11 0.83 0.83 0.11 $135.40 $135.4090940 0.00 0.00 0.00 0.00 $0.00 $0.0090945 1.56 0.81 0.81 0.08 $109.13 $109.1390947 2.52 0.94 0.94 0.15 $160.29 $160.2990951 18.46 7.87 7.87 1.02 $1,215.71 $1,215.7190952 0.00 0.00 0.00 0.00 $0.00 $0.0090953 0.00 0.00 0.00 0.00 $0.00 $0.0090954 15.98 6.45 6.45 0.90 $1,036.47 $1,036.4790955 8.79 3.91 3.91 0.49 $586.62 $586.6290956 5.95 2.83 2.83 0.34 $405.99 $405.9990957 12.52 5.41 5.41 0.72 $829.31 $829.3190958 8.34 3.82 3.82 0.48 $562.45 $562.4590959 5.50 2.68 2.68 0.31 $378.03 $378.0390960 5.18 2.80 2.80 0.31 $369.72 $369.7290961 4.26 2.38 2.38 0.26 $307.89 $307.8990962 3.15 1.90 1.90 0.20 $234.54 $234.5490963 10.56 4.66 4.66 0.60 $703.59 $703.5990964 9.14 3.95 3.95 0.52 $605.16 $605.1690965 8.69 3.80 3.80 0.49 $577.20 $577.2090966 4.26 2.35 2.35 0.26 $306.50 $306.5090967 0.35 0.17 0.17 0.01 $23.54 $23.5490968 0.30 0.13 0.13 0.01 $19.52 $19.5290969 0.29 0.13 0.13 0.01 $19.09 $19.0990970 0.14 0.08 0.08 0.01 $10.28 $10.2890989 0.00 0.00 0.00 0.00 $0.00 $0.0090993 0.00 0.00 0.00 0.00 $0.00 $0.0090997 1.84 0.65 0.65 0.10 $114.87 $114.8790999 0.00 0.00 0.00 0.00 $0.00 $0.0091010 1.28 4.14 4.14 0.08 $251.08 $251.0891010 TC 0.00 3.48 3.48 0.01 $161.53 $161.5391010 26 1.28 0.66 0.66 0.07 $89.55 $89.5591013 0.18 0.51 0.51 0.02 $32.41 $32.4191013 TC 0.00 0.42 0.42 0.01 $19.94 $19.9491013 26 0.18 0.09 0.09 0.01 $12.47 $12.47

Updated December 2011 303 of 387 Effective January 2012

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Treatment

MRA 2012

91020 1.44 5.69 5.69 0.08 $329.73 $329.7391020 TC 0.00 4.94 4.94 0.01 $229.09 $229.0991020 26 1.44 0.75 0.75 0.07 $100.64 $100.6491022 1.44 3.86 3.86 0.06 $244.04 $244.0491022 TC 0.00 3.08 3.08 0.01 $143.02 $143.0291022 26 1.44 0.78 0.78 0.05 $101.01 $101.0191030 0.91 3.27 3.27 0.05 $193.27 $193.2791030 TC 0.00 2.78 2.78 0.01 $129.14 $129.1491030 26 0.91 0.49 0.49 0.04 $64.13 $64.1391034 0.97 4.85 4.85 0.05 $268.98 $268.9891034 TC 0.00 4.35 4.35 0.01 $201.79 $201.7991034 26 0.97 0.50 0.50 0.04 $67.19 $67.1991035 1.59 13.12 13.12 0.08 $680.03 $680.0391035 TC 0.00 12.30 12.30 0.01 $569.65 $569.6591035 26 1.59 0.82 0.82 0.07 $110.38 $110.3891037 0.97 3.89 3.89 0.08 $226.08 $226.0891037 TC 0.00 3.38 3.38 0.01 $156.91 $156.9191037 26 0.97 0.51 0.51 0.07 $69.18 $69.1891038 1.10 10.62 10.62 0.06 $542.11 $542.1191038 TC 0.00 10.04 10.04 0.01 $465.07 $465.0791038 26 1.10 0.58 0.58 0.05 $77.03 $77.0391040 0.97 8.39 8.39 0.04 $432.27 $432.2791040 TC 0.00 7.98 7.98 0.01 $369.75 $369.7591040 26 0.97 0.41 0.41 0.03 $62.52 $62.5291065 0.20 2.40 2.40 0.02 $120.73 $120.7391065 TC 0.00 2.30 2.30 0.01 $106.93 $106.9391065 26 0.20 0.10 0.10 0.01 $13.80 $13.8091110 3.64 23.81 23.81 0.17 $1,268.05 $1,268.0591110 TC 0.00 21.87 21.87 0.01 $1,012.47 $1,012.4791110 26 3.64 1.94 1.94 0.16 $255.59 $255.5991111 1.00 21.45 21.45 0.05 $1,038.39 $1,038.3991111 TC 0.00 20.91 20.91 0.01 $968.04 $968.0491111 26 1.00 0.54 0.54 0.04 $70.34 $70.3491117 2.45 1.31 1.62 0.38 $186.08 $200.4291120 0.97 10.94 10.94 0.09 $552.81 $552.8191120 TC 0.00 10.51 10.51 0.01 $486.82 $486.8291120 26 0.97 0.43 0.43 0.08 $65.99 $65.9991122 1.77 4.78 4.78 0.11 $303.45 $303.4591122 TC 0.00 4.04 4.04 0.01 $187.45 $187.4591122 26 1.77 0.74 0.74 0.10 $116.00 $116.00

Updated December 2011 304 of 387 Effective January 2012

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MRA 2012

91132 0.52 4.14 4.14 0.04 $216.12 $216.1291132 TC 0.00 3.86 3.86 0.01 $179.12 $179.1291132 26 0.52 0.28 0.28 0.03 $37.01 $37.0191133 0.66 4.75 4.75 0.05 $250.92 $250.9291133 TC 0.00 4.39 4.39 0.01 $203.64 $203.6491133 26 0.66 0.36 0.36 0.04 $47.28 $47.2891299 0.00 0.00 0.00 0.00 $0.00 $0.0091299 TC 0.00 0.00 0.00 0.00 $0.00 $0.0091299 26 0.00 0.00 0.00 0.00 $0.00 $0.0092002 0.88 1.36 0.44 0.07 $104.61 $62.0492004 1.82 2.31 0.94 0.12 $191.83 $128.4492012 0.92 1.44 0.52 0.07 $110.05 $67.4892014 1.42 2.00 0.78 0.10 $159.14 $102.6992015 0.38 0.27 0.16 0.03 $30.48 $25.3992018 2.50 1.44 1.44 0.16 $183.07 $183.0792019 1.31 0.59 0.59 0.07 $87.61 $87.6192020 0.37 0.38 0.21 0.03 $35.14 $27.2792025 0.35 0.70 0.70 0.02 $48.57 $48.5792025 TC 0.00 0.50 0.50 0.01 $23.64 $23.6492025 26 0.35 0.20 0.20 0.01 $24.92 $24.9292060 0.69 1.11 1.11 0.04 $83.29 $83.2992060 TC 0.00 0.73 0.73 0.01 $34.29 $34.2992060 26 0.69 0.38 0.38 0.03 $49.00 $49.0092065 0.37 1.13 1.13 0.02 $69.33 $69.3392065 TC 0.00 0.99 0.99 0.01 $46.32 $46.3292065 26 0.37 0.14 0.14 0.01 $23.01 $23.0192071 0.61 0.46 0.34 0.03 $49.24 $43.6892072 1.97 1.43 0.73 0.11 $157.10 $124.7192081 0.30 1.10 1.10 0.04 $65.93 $65.9392081 TC 0.00 0.94 0.94 0.01 $44.00 $44.0092081 26 0.30 0.16 0.16 0.03 $21.93 $21.9392082 0.40 1.60 1.60 0.05 $93.91 $93.9192082 TC 0.00 1.39 1.39 0.01 $64.83 $64.8392082 26 0.40 0.21 0.21 0.04 $29.08 $29.0892083 0.50 2.09 2.09 0.04 $120.40 $120.4092083 TC 0.00 1.81 1.81 0.01 $84.26 $84.2692083 26 0.50 0.28 0.28 0.03 $36.14 $36.1492100 0.92 1.81 0.48 0.05 $126.15 $64.6192132 0.35 0.70 0.70 0.04 $49.59 $49.5992132 TC 0.00 0.48 0.48 0.01 $22.72 $22.72

Updated December 2011 305 of 387 Effective January 2012

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MRA 2012

92132 26 0.35 0.22 0.22 0.03 $26.87 $26.8792133 0.50 0.78 0.78 0.04 $59.79 $59.7992133 TC 0.00 0.47 0.47 0.01 $22.26 $22.2692133 26 0.50 0.31 0.31 0.03 $37.53 $37.5392134 0.50 0.78 0.78 0.04 $59.79 $59.7992134 TC 0.00 0.47 0.47 0.01 $22.26 $22.2692134 26 0.50 0.31 0.31 0.03 $37.53 $37.5392136 0.54 2.00 2.00 0.02 $116.95 $116.9592136 TC 0.00 1.67 1.67 0.01 $77.78 $77.7892136 26 0.54 0.33 0.33 0.01 $39.17 $39.1792140 0.50 1.27 0.24 0.03 $81.95 $34.2992225 0.38 0.36 0.21 0.03 $34.64 $27.7092226 0.33 0.35 0.20 0.01 $31.00 $24.0692227 0.00 0.35 0.35 0.01 $16.70 $16.7092228 0.37 0.62 0.62 0.02 $45.73 $45.7392228 TC 0.00 0.39 0.39 0.01 $18.55 $18.5592228 26 0.37 0.23 0.23 0.01 $27.18 $27.1892230 0.60 1.05 0.31 0.04 $76.61 $42.3792235 0.81 3.18 3.18 0.04 $184.27 $184.2792235 TC 0.00 2.68 2.68 0.01 $124.52 $124.5292235 26 0.81 0.50 0.50 0.03 $59.75 $59.7592240 1.10 6.16 6.16 0.04 $334.72 $334.7292240 TC 0.00 5.48 5.48 0.01 $254.08 $254.0892240 26 1.10 0.68 0.68 0.03 $80.64 $80.6492250 0.44 1.79 1.79 0.02 $102.90 $102.9092250 TC 0.00 1.56 1.56 0.01 $72.69 $72.6992250 26 0.44 0.23 0.23 0.01 $30.21 $30.2192260 0.20 0.33 0.11 0.01 $24.44 $14.2692265 0.81 1.58 1.58 0.02 $109.21 $109.2192265 TC 0.00 1.10 1.10 0.01 $51.41 $51.4192265 26 0.81 0.48 0.48 0.01 $57.81 $57.8192270 0.81 1.85 1.85 0.04 $122.73 $122.7392270 TC 0.00 1.49 1.49 0.01 $69.45 $69.4592270 26 0.81 0.36 0.36 0.03 $53.27 $53.2792275 1.01 3.39 3.39 0.05 $203.16 $203.1692275 TC 0.00 2.78 2.78 0.01 $129.14 $129.1492275 26 1.01 0.61 0.61 0.04 $74.01 $74.0192283 0.17 1.35 1.35 0.02 $70.85 $70.8592283 TC 0.00 1.27 1.27 0.01 $59.27 $59.2792283 26 0.17 0.08 0.08 0.01 $11.57 $11.57

Updated December 2011 306 of 387 Effective January 2012

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MRA 2012

92284 0.24 1.53 1.53 0.02 $82.21 $82.2192284 TC 0.00 1.43 1.43 0.01 $66.68 $66.6892284 26 0.24 0.10 0.10 0.01 $15.53 $15.5392285 0.05 0.66 0.66 0.02 $33.72 $33.7292285 TC 0.00 0.61 0.61 0.01 $28.73 $28.7392285 26 0.05 0.05 0.05 0.01 $4.99 $4.9992286 0.66 2.92 2.92 0.02 $164.72 $164.7292286 TC 0.00 2.56 2.56 0.01 $118.96 $118.9692286 26 0.66 0.36 0.36 0.01 $45.76 $45.7692287 0.81 2.73 0.49 0.04 $163.44 $59.8092310 1.17 1.52 0.48 0.08 $125.09 $76.9692311 1.08 1.77 0.49 0.08 $132.75 $73.5392312 1.26 2.03 0.56 0.05 $151.06 $83.0492313 0.92 1.96 0.50 0.05 $133.09 $65.5392314 0.69 1.56 0.28 0.04 $104.11 $44.8892315 0.45 1.73 0.20 0.04 $101.58 $30.7892316 0.68 2.27 0.41 0.04 $136.53 $50.4692317 0.45 1.70 0.16 0.01 $98.66 $27.4192325 0.00 1.09 1.09 0.01 $50.94 $50.9492326 0.00 1.04 1.04 0.01 $48.63 $48.6392340 0.37 0.64 0.15 0.03 $47.17 $24.4992341 0.47 0.68 0.19 0.03 $53.35 $30.6892342 0.53 0.71 0.22 0.04 $57.85 $35.1792352 0.37 0.79 0.15 0.03 $54.11 $24.4992353 0.50 0.84 0.20 0.03 $62.05 $32.4492354 0.00 1.02 1.02 0.01 $47.71 $47.7192355 0.00 0.89 0.89 0.01 $41.69 $41.6992358 0.00 0.37 0.37 0.01 $17.63 $17.6392370 0.32 0.56 0.13 0.03 $41.30 $21.4092371 0.00 0.35 0.35 0.01 $16.70 $16.7092499 0.00 0.00 0.00 0.00 $0.00 $0.0092499 TC 0.00 0.00 0.00 0.00 $0.00 $0.0092499 26 0.00 0.00 0.00 0.00 $0.00 $0.0092502 1.51 1.28 1.28 0.07 $128.20 $128.2092504 0.18 0.72 0.09 0.01 $41.62 $12.4792506 0.86 3.95 3.95 0.05 $222.57 $222.5792507 1.30 0.83 0.83 0.07 $98.28 $98.2892508 0.33 0.32 0.32 0.01 $29.61 $29.6192511 0.61 3.61 0.82 0.03 $194.99 $65.8992512 0.55 1.24 0.25 0.03 $82.73 $36.92

Updated December 2011 307 of 387 Effective January 2012

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MRA 2012

92516 0.43 1.64 0.22 0.03 $96.04 $30.3392520 0.75 1.28 0.40 0.04 $93.75 $53.0392526 1.34 1.03 1.03 0.07 $109.27 $109.2792531 0.00 0.00 0.00 0.00 $0.00 $0.0092532 0.00 0.00 0.00 0.00 $0.00 $0.0092533 0.00 0.00 0.00 0.00 $0.00 $0.0092534 0.00 0.00 0.00 0.00 $0.00 $0.0092540 1.50 1.39 1.39 0.05 $131.84 $131.8492540 TC 0.00 0.64 0.64 0.01 $30.12 $30.1292540 26 1.50 0.75 0.75 0.04 $101.72 $101.7292541 0.40 0.68 0.68 0.02 $49.81 $49.8192541 TC 0.00 0.50 0.50 0.01 $23.64 $23.6492541 26 0.40 0.18 0.18 0.01 $26.17 $26.1792542 0.33 0.71 0.71 0.02 $48.17 $48.1792542 TC 0.00 0.55 0.55 0.01 $25.96 $25.9692542 26 0.33 0.16 0.16 0.01 $22.21 $22.2192543 0.10 0.45 0.45 0.02 $26.17 $26.1792543 TC 0.00 0.40 0.40 0.01 $19.02 $19.0292543 26 0.10 0.05 0.05 0.01 $7.15 $7.1592544 0.26 0.60 0.60 0.02 $40.04 $40.0492544 TC 0.00 0.48 0.48 0.01 $22.72 $22.7292544 26 0.26 0.12 0.12 0.01 $17.32 $17.3292545 0.23 0.57 0.57 0.02 $37.36 $37.3692545 TC 0.00 0.46 0.46 0.01 $21.79 $21.7992545 26 0.23 0.11 0.11 0.01 $15.56 $15.5692546 0.29 2.67 2.67 0.02 $137.12 $137.1292546 TC 0.00 2.54 2.54 0.01 $118.04 $118.0492546 26 0.29 0.13 0.13 0.01 $19.09 $19.0992547 0.00 0.16 0.16 0.01 $7.91 $7.9192548 0.50 2.58 2.58 0.02 $142.06 $142.0692548 TC 0.00 2.35 2.35 0.01 $109.25 $109.2592548 26 0.50 0.23 0.23 0.01 $32.81 $32.8192550 0.35 0.25 0.25 0.01 $27.24 $27.2492551 0.00 0.34 0.34 0.01 $16.24 $16.2492552 0.00 0.86 0.86 0.01 $40.30 $40.3092553 0.00 1.05 1.05 0.01 $49.09 $49.0992555 0.00 0.63 0.63 0.01 $29.66 $29.6692556 0.00 0.99 0.99 0.01 $46.32 $46.3292557 0.60 0.52 0.38 0.03 $51.58 $45.1092558 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 308 of 387 Effective January 2012

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MRA 2012

92559 0.00 0.00 0.00 0.00 $0.00 $0.0092560 0.00 0.00 0.00 0.00 $0.00 $0.0092561 0.00 1.05 1.05 0.01 $49.09 $49.0992562 0.00 1.13 1.13 0.01 $52.80 $52.8092563 0.00 0.86 0.86 0.01 $40.30 $40.3092564 0.00 0.74 0.74 0.01 $34.75 $34.7592565 0.00 0.45 0.45 0.01 $21.33 $21.3392567 0.20 0.23 0.13 0.01 $19.81 $15.1992568 0.29 0.17 0.17 0.01 $20.94 $20.9492570 0.55 0.36 0.29 0.03 $42.01 $38.7792571 0.00 0.71 0.71 0.01 $33.36 $33.3692572 0.00 0.92 0.92 0.01 $43.08 $43.0892575 0.00 1.91 1.91 0.01 $88.89 $88.8992576 0.00 0.99 0.99 0.01 $46.32 $46.3292577 0.00 0.51 0.51 0.01 $24.11 $24.1192579 0.70 0.53 0.39 0.03 $56.37 $49.9092582 0.00 1.86 1.86 0.01 $86.57 $86.5792583 0.00 1.36 1.36 0.01 $63.44 $63.4492584 0.00 2.08 2.08 0.01 $96.75 $96.7592585 0.50 3.13 3.13 0.02 $167.51 $167.5192585 TC 0.00 2.89 2.89 0.01 $134.23 $134.2392585 26 0.50 0.24 0.24 0.01 $33.27 $33.2792586 0.00 2.35 2.35 0.01 $109.25 $109.2592587 0.35 0.44 0.44 0.04 $37.56 $37.5692587 TC 0.00 0.29 0.29 0.01 $13.93 $13.9392587 26 0.35 0.15 0.15 0.03 $23.63 $23.6392588 0.55 0.68 0.68 0.03 $56.82 $56.8292588 TC 0.00 0.42 0.42 0.01 $19.94 $19.9492588 26 0.55 0.26 0.26 0.02 $36.87 $36.8792590 0.00 0.00 0.00 0.00 $0.00 $0.0092591 0.00 0.00 0.00 0.00 $0.00 $0.0092592 0.00 0.00 0.00 0.00 $0.00 $0.0092593 0.00 0.00 0.00 0.00 $0.00 $0.0092594 0.00 0.00 0.00 0.00 $0.00 $0.0092595 0.00 0.00 0.00 0.00 $0.00 $0.0092596 0.00 1.26 1.26 0.01 $58.81 $58.8192597 1.26 1.11 1.11 0.07 $109.50 $109.5092601 2.30 1.82 1.26 0.11 $189.44 $163.5392602 1.30 1.32 0.74 0.07 $120.95 $94.1292603 2.25 1.92 1.25 0.11 $191.90 $160.90

Updated December 2011 309 of 387 Effective January 2012

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MRA 2012

92604 1.25 1.26 0.70 0.05 $114.99 $89.0892605 1.75 0.83 0.71 0.09 $118.79 $113.2492606 1.40 0.91 0.57 0.07 $106.31 $90.5892607 1.85 2.24 2.24 0.10 $188.87 $188.8792608 0.70 0.61 0.61 0.04 $60.58 $60.5892609 1.50 1.40 1.40 0.07 $133.32 $133.3292610 1.30 1.26 0.60 0.07 $118.18 $87.6492611 1.34 1.47 1.47 0.08 $130.14 $130.1492612 1.27 3.65 0.64 0.07 $227.47 $88.1992613 0.71 0.36 0.36 0.04 $49.45 $49.4592614 1.27 3.13 0.66 0.07 $203.41 $89.1192615 0.63 0.33 0.33 0.03 $44.09 $44.0992616 1.88 4.02 0.94 0.10 $272.54 $130.0292617 0.79 0.39 0.39 0.04 $54.30 $54.3092618 0.65 0.28 0.26 0.03 $42.64 $41.7192620 1.50 1.02 0.77 0.07 $115.74 $104.1792621 0.35 0.26 0.17 0.01 $27.70 $23.5492625 1.15 0.76 0.58 0.05 $87.53 $79.2092626 1.40 1.11 0.78 0.07 $115.57 $100.3092627 0.33 0.30 0.19 0.01 $28.69 $23.6092630 0.00 0.00 0.00 0.00 $0.00 $0.0092633 0.00 0.00 0.00 0.00 $0.00 $0.0092640 1.76 1.20 0.78 0.37 $150.59 $131.1592700 0.00 0.00 0.00 0.00 $0.00 $0.0092950 4.00 4.41 1.07 0.32 $393.61 $239.0692953 0.23 0.08 0.08 0.01 $14.17 $14.1792960 2.25 4.02 1.24 0.14 $290.60 $161.9792961 4.59 2.20 2.20 0.44 $323.01 $323.0192970 3.51 1.44 1.44 0.24 $230.89 $230.8992971 1.77 0.91 0.91 0.11 $124.38 $124.3892973 3.28 1.40 1.40 0.71 $242.98 $242.9892974 3.00 1.28 1.28 0.65 $222.25 $222.2592975 7.24 3.10 3.10 1.58 $537.44 $537.4492977 0.00 3.56 3.56 0.03 $166.25 $166.2592978 0.00 0.00 0.00 0.00 $0.00 $0.0092978 TC 0.00 0.00 0.00 0.00 $0.00 $0.0092978 26 1.80 0.77 0.77 0.12 $119.71 $119.7192979 0.00 0.00 0.00 0.00 $0.00 $0.0092979 TC 0.00 0.00 0.00 0.00 $0.00 $0.0092979 26 1.44 0.62 0.62 0.10 $96.15 $96.15

Updated December 2011 310 of 387 Effective January 2012

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MRA 2012

92980 14.82 6.55 6.55 3.24 $1,109.88 $1,109.8892981 4.16 1.78 1.78 0.90 $308.35 $308.3592982 10.96 4.90 4.90 2.38 $822.57 $822.5792984 2.97 1.27 1.27 0.64 $219.98 $219.9892986 22.85 12.91 12.91 4.98 $1,840.53 $1,840.5392987 23.63 13.21 13.21 5.14 $1,896.34 $1,896.3492990 18.27 10.57 10.57 3.99 $1,483.49 $1,483.4992992 0.00 0.00 0.00 0.00 $0.00 $0.0092993 0.00 0.00 0.00 0.00 $0.00 $0.0092995 12.07 5.38 5.38 2.63 $905.58 $905.5892996 3.26 1.39 1.39 0.71 $241.65 $241.6592997 11.98 5.01 5.01 2.61 $883.55 $883.5592998 5.99 2.48 2.48 1.31 $440.87 $440.8793000 0.17 0.37 0.37 0.02 $25.50 $25.5093005 0.00 0.30 0.30 0.01 $14.39 $14.3993010 0.17 0.07 0.07 0.01 $11.11 $11.1193015 0.75 1.82 1.82 0.03 $118.23 $118.2393016 0.45 0.19 0.19 0.01 $28.79 $28.7993017 0.00 1.50 1.50 0.01 $69.92 $69.9293018 0.30 0.13 0.13 0.01 $19.52 $19.5293024 1.17 2.14 2.14 0.05 $152.25 $152.2593024 TC 0.00 1.65 1.65 0.01 $76.86 $76.8693024 26 1.17 0.49 0.49 0.04 $75.39 $75.3993025 0.75 4.52 4.52 0.04 $243.67 $243.6793025 TC 0.00 4.20 4.20 0.01 $194.85 $194.8593025 26 0.75 0.32 0.32 0.03 $48.82 $48.8293040 0.15 0.21 0.21 0.02 $17.23 $17.2393041 0.00 0.16 0.16 0.01 $7.91 $7.9193042 0.15 0.05 0.05 0.01 $9.32 $9.3293224 0.52 2.36 2.36 0.03 $133.25 $133.2593225 0.00 0.85 0.85 0.01 $39.84 $39.8493226 0.00 1.26 1.26 0.01 $58.81 $58.8193227 0.52 0.25 0.25 0.01 $34.60 $34.6093228 0.52 0.20 0.20 0.03 $33.31 $33.3193229 0.00 20.37 20.37 0.01 $943.06 $943.0693268 0.52 6.45 6.45 0.03 $322.50 $322.5093270 0.00 0.35 0.35 0.01 $16.70 $16.7093271 0.00 5.90 5.90 0.01 $273.51 $273.5193272 0.52 0.20 0.20 0.01 $32.29 $32.2993278 0.25 0.70 0.70 0.02 $44.24 $44.24

Updated December 2011 311 of 387 Effective January 2012

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MRA 2012

93278 TC 0.00 0.59 0.59 0.01 $27.81 $27.8193278 26 0.25 0.11 0.11 0.01 $16.43 $16.4393279 0.65 0.80 0.80 0.04 $67.21 $67.2193279 TC 0.00 0.52 0.52 0.01 $24.57 $24.5793279 26 0.65 0.28 0.28 0.03 $42.64 $42.6493280 0.77 0.93 0.93 0.04 $78.42 $78.4293280 TC 0.00 0.59 0.59 0.01 $27.81 $27.8193280 26 0.77 0.34 0.34 0.03 $50.61 $50.6193281 0.90 1.07 1.07 0.04 $90.53 $90.5393281 TC 0.00 0.68 0.68 0.01 $31.97 $31.9793281 26 0.90 0.39 0.39 0.03 $58.56 $58.5693282 0.85 0.97 0.97 0.04 $83.74 $83.7493282 TC 0.00 0.61 0.61 0.01 $28.73 $28.7393282 26 0.85 0.36 0.36 0.03 $55.00 $55.0093283 1.15 1.19 1.19 0.05 $107.42 $107.4293283 TC 0.00 0.70 0.70 0.01 $32.90 $32.9093283 26 1.15 0.49 0.49 0.04 $74.52 $74.5293284 1.25 1.35 1.35 0.05 $119.16 $119.1693284 TC 0.00 0.80 0.80 0.01 $37.53 $37.5393284 26 1.25 0.55 0.55 0.04 $81.63 $81.6393285 0.52 0.70 0.70 0.02 $55.93 $55.9393285 TC 0.00 0.47 0.47 0.01 $22.26 $22.2693285 26 0.52 0.23 0.23 0.01 $33.68 $33.6893286 0.30 0.44 0.44 0.02 $34.37 $34.3793286 TC 0.00 0.33 0.33 0.01 $15.78 $15.7893286 26 0.30 0.11 0.11 0.01 $18.59 $18.5993287 0.45 0.54 0.54 0.02 $45.50 $45.5093287 TC 0.00 0.37 0.37 0.01 $17.63 $17.6393287 26 0.45 0.17 0.17 0.01 $27.87 $27.8793288 0.43 0.67 0.67 0.02 $50.65 $50.6593288 TC 0.00 0.48 0.48 0.01 $22.72 $22.7293288 26 0.43 0.19 0.19 0.01 $27.93 $27.9393289 0.92 0.97 0.97 0.04 $86.77 $86.7793289 TC 0.00 0.59 0.59 0.01 $27.81 $27.8193289 26 0.92 0.38 0.38 0.03 $58.96 $58.9693290 0.43 0.43 0.43 0.02 $39.54 $39.5493290 TC 0.00 0.27 0.27 0.01 $13.00 $13.0093290 26 0.43 0.16 0.16 0.01 $26.54 $26.5493291 0.43 0.62 0.62 0.02 $48.33 $48.3393291 TC 0.00 0.43 0.43 0.01 $20.41 $20.41

Updated December 2011 312 of 387 Effective January 2012

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MRA 2012

93291 26 0.43 0.19 0.19 0.01 $27.93 $27.9393292 0.43 0.51 0.51 0.02 $43.24 $43.2493292 TC 0.00 0.32 0.32 0.01 $15.32 $15.3293292 26 0.43 0.19 0.19 0.01 $27.93 $27.9393293 0.32 1.26 1.26 0.02 $73.18 $73.1893293 TC 0.00 1.14 1.14 0.01 $53.26 $53.2693293 26 0.32 0.12 0.12 0.01 $19.92 $19.9293294 0.65 0.28 0.28 0.04 $43.15 $43.1593295 1.29 0.55 0.55 0.08 $85.40 $85.4093296 0.00 0.86 0.86 0.01 $40.30 $40.3093297 0.52 0.19 0.19 0.03 $32.84 $32.8493298 0.52 0.23 0.23 0.03 $34.69 $34.6993299 0.00 0.00 0.00 0.00 $0.00 $0.0093303 1.30 4.76 4.76 0.05 $279.11 $279.1193303 TC 0.00 4.21 4.21 0.01 $195.31 $195.3193303 26 1.30 0.55 0.55 0.04 $83.80 $83.8093304 0.75 3.17 3.17 0.04 $181.20 $181.2093304 TC 0.00 2.87 2.87 0.01 $133.31 $133.3193304 26 0.75 0.30 0.30 0.03 $47.90 $47.9093306 1.30 4.91 4.91 0.05 $286.05 $286.0593306 TC 0.00 4.35 4.35 0.01 $201.79 $201.7993306 26 1.30 0.56 0.56 0.04 $84.26 $84.2693307 0.92 2.93 2.93 0.04 $177.46 $177.4693307 TC 0.00 2.53 2.53 0.01 $117.58 $117.5893307 26 0.92 0.40 0.40 0.03 $59.89 $59.8993308 0.53 2.44 2.44 0.02 $136.88 $136.8893308 TC 0.00 2.22 2.22 0.01 $103.23 $103.2393308 26 0.53 0.22 0.22 0.01 $33.65 $33.6593312 2.20 6.97 6.97 0.10 $422.90 $422.9093312 TC 0.00 6.12 6.12 0.03 $284.71 $284.7193312 26 2.20 0.85 0.85 0.07 $138.19 $138.1993313 0.95 0.21 0.21 0.07 $54.43 $54.4393314 1.25 7.10 7.10 0.07 $386.24 $386.2493314 TC 0.00 6.61 6.61 0.03 $307.38 $307.3893314 26 1.25 0.49 0.49 0.04 $78.86 $78.8693315 0.00 0.00 0.00 0.00 $0.00 $0.0093315 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093315 26 2.78 1.13 1.13 0.23 $184.41 $184.4193316 0.95 0.27 0.27 0.07 $57.21 $57.2193317 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 313 of 387 Effective January 2012

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93317 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093317 26 1.83 0.66 0.66 0.23 $121.51 $121.5193318 0.00 0.00 0.00 0.00 $0.00 $0.0093318 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093318 26 2.20 0.78 0.78 0.31 $147.16 $147.1693320 0.38 1.19 1.19 0.02 $72.54 $72.5493320 TC 0.00 1.03 1.03 0.01 $48.17 $48.1793320 26 0.38 0.16 0.16 0.01 $24.37 $24.3793321 0.15 0.62 0.62 0.02 $36.20 $36.2093321 TC 0.00 0.56 0.56 0.01 $26.42 $26.4293321 26 0.15 0.06 0.06 0.01 $9.78 $9.7893325 0.07 0.74 0.74 0.02 $38.29 $38.2993325 TC 0.00 0.71 0.71 0.01 $33.36 $33.3693325 26 0.07 0.03 0.03 0.01 $4.93 $4.9393350 1.46 4.58 4.58 0.06 $278.22 $278.2293350 TC 0.00 3.95 3.95 0.01 $183.28 $183.2893350 26 1.46 0.63 0.63 0.05 $94.94 $94.9493351 1.75 5.30 5.30 0.08 $325.12 $325.1293351 TC 0.00 4.53 4.53 0.03 $211.14 $211.1493351 26 1.75 0.77 0.77 0.05 $113.98 $113.9893352 0.19 0.83 0.83 0.01 $47.14 $47.1493451 2.72 20.22 20.22 0.62 $1,084.98 $1,084.9893451 TC 0.00 19.22 19.22 0.03 $890.86 $890.8693451 26 2.72 1.00 1.00 0.59 $194.11 $194.1193452 4.75 20.09 20.09 1.09 $1,190.81 $1,190.8193452 TC 0.00 18.35 18.35 0.03 $850.61 $850.6193452 26 4.75 1.74 1.74 1.06 $340.20 $340.2093453 6.24 26.30 26.30 1.41 $1,558.97 $1,558.9793453 TC 0.00 24.02 24.02 0.04 $1,113.48 $1,113.4893453 26 6.24 2.28 2.28 1.37 $445.50 $445.5093454 4.79 20.85 20.85 1.09 $1,227.70 $1,227.7093454 TC 0.00 19.10 19.10 0.03 $885.31 $885.3193454 26 4.79 1.75 1.75 1.06 $342.39 $342.3993455 5.54 24.42 24.42 1.25 $1,433.52 $1,433.5293455 TC 0.00 22.39 22.39 0.04 $1,038.05 $1,038.0593455 26 5.54 2.03 2.03 1.21 $395.47 $395.4793456 6.15 25.92 25.92 1.37 $1,535.46 $1,535.4693456 TC 0.00 23.67 23.67 0.04 $1,097.28 $1,097.2893456 26 6.15 2.25 2.25 1.33 $438.18 $438.1893457 6.89 29.48 29.48 1.54 $1,740.89 $1,740.89

Updated December 2011 314 of 387 Effective January 2012

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MRA 2012

93457 TC 0.00 26.96 26.96 0.04 $1,249.51 $1,249.5193457 26 6.89 2.52 2.52 1.50 $491.37 $491.3793458 5.85 25.08 25.08 1.33 $1,481.56 $1,481.5693458 TC 0.00 22.94 22.94 0.04 $1,063.50 $1,063.5093458 26 5.85 2.14 2.14 1.29 $418.06 $418.0693459 6.60 27.55 27.55 1.47 $1,635.46 $1,635.4693459 TC 0.00 25.13 25.13 0.04 $1,164.84 $1,164.8493459 26 6.60 2.42 2.42 1.43 $470.62 $470.6293460 7.35 29.10 29.10 1.63 $1,747.81 $1,747.8193460 TC 0.00 26.41 26.41 0.04 $1,224.06 $1,224.0693460 26 7.35 2.69 2.69 1.59 $523.75 $523.7593461 8.10 33.76 33.76 1.82 $2,005.59 $2,005.5993461 TC 0.00 30.79 30.79 0.05 $1,427.24 $1,427.2493461 26 8.10 2.97 2.97 1.77 $578.35 $578.3593462 3.73 1.39 1.39 0.80 $266.59 $266.5993463 2.00 0.74 0.74 0.39 $140.72 $140.7293464 1.80 5.68 5.68 0.36 $359.11 $359.1193464 TC 0.00 5.08 5.08 0.01 $235.57 $235.5793464 26 1.80 0.60 0.60 0.35 $123.54 $123.5493503 2.91 0.76 0.76 0.27 $174.96 $174.9693505 4.37 18.54 18.54 0.86 $1,090.92 $1,090.9293505 TC 0.00 16.68 16.68 0.03 $773.33 $773.3393505 26 4.37 1.86 1.86 0.83 $317.59 $317.5993530 0.00 0.00 0.00 0.00 $0.00 $0.0093530 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093530 26 4.22 1.78 1.78 0.91 $311.46 $311.4693531 0.00 0.00 0.00 0.00 $0.00 $0.0093531 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093531 26 8.34 3.45 3.45 1.82 $613.50 $613.5093532 0.00 0.00 0.00 0.00 $0.00 $0.0093532 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093532 26 9.99 4.08 4.08 2.18 $732.44 $732.4493533 0.00 0.00 0.00 0.00 $0.00 $0.0093533 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093533 26 6.69 2.74 2.74 1.47 $491.36 $491.3693561 0.00 0.00 0.00 0.00 $0.00 $0.0093561 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093561 26 0.50 0.19 0.19 0.04 $32.49 $32.4993562 0.00 0.00 0.00 0.00 $0.00 $0.0093562 TC 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 315 of 387 Effective January 2012

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MRA 2012

93562 26 0.16 0.05 0.05 0.01 $9.75 $9.7593563 1.11 0.41 0.41 0.10 $72.14 $72.1493564 1.13 0.42 0.42 0.11 $73.98 $73.9893565 0.86 0.32 0.32 0.08 $56.13 $56.1393566 0.86 4.34 0.31 0.08 $242.14 $55.6793567 0.97 3.21 0.36 0.08 $194.62 $62.7593568 0.88 3.82 0.33 0.08 $218.95 $57.4693571 0.00 0.00 0.00 0.00 $0.00 $0.0093571 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093571 26 1.80 0.77 0.77 0.11 $119.20 $119.2093572 0.00 0.00 0.00 0.00 $0.00 $0.0093572 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093572 26 1.44 0.60 0.60 0.11 $95.74 $95.7493580 17.97 7.99 7.99 3.92 $1,347.56 $1,347.5693581 24.39 10.26 10.26 5.32 $1,801.92 $1,801.9293600 0.00 0.00 0.00 0.00 $0.00 $0.0093600 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093600 26 2.12 0.89 0.89 0.45 $155.91 $155.9193602 0.00 0.00 0.00 0.00 $0.00 $0.0093602 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093602 26 2.12 0.89 0.89 0.45 $155.91 $155.9193603 0.00 0.00 0.00 0.00 $0.00 $0.0093603 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093603 26 2.12 0.89 0.89 0.45 $155.91 $155.9193609 0.00 0.00 0.00 0.00 $0.00 $0.0093609 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093609 26 4.99 2.12 2.12 1.09 $369.70 $369.7093610 0.00 0.00 0.00 0.00 $0.00 $0.0093610 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093610 26 3.02 1.26 1.26 0.65 $222.19 $222.1993612 0.00 0.00 0.00 0.00 $0.00 $0.0093612 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093612 26 3.02 1.24 1.24 0.65 $221.26 $221.2693613 6.99 2.98 2.98 1.52 $518.01 $518.0193615 0.00 0.00 0.00 0.00 $0.00 $0.0093615 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093615 26 0.99 0.41 0.41 0.05 $64.40 $64.4093616 0.00 0.00 0.00 0.00 $0.00 $0.0093616 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093616 26 1.49 0.36 0.36 0.11 $86.80 $86.80

Updated December 2011 316 of 387 Effective January 2012

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MRA 2012

93618 0.00 0.00 0.00 0.00 $0.00 $0.0093618 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093618 26 4.25 1.82 1.82 0.91 $314.61 $314.6193619 0.00 0.00 0.00 0.00 $0.00 $0.0093619 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093619 26 7.31 3.16 3.16 1.59 $543.76 $543.7693620 0.00 0.00 0.00 0.00 $0.00 $0.0093620 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093620 26 11.57 4.95 4.95 2.52 $858.43 $858.4393621 0.00 0.00 0.00 0.00 $0.00 $0.0093621 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093621 26 2.10 0.89 0.89 0.45 $155.04 $155.0493622 0.00 0.00 0.00 0.00 $0.00 $0.0093622 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093622 26 3.10 1.31 1.31 0.67 $228.99 $228.9993623 0.00 0.00 0.00 0.00 $0.00 $0.0093623 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093623 26 2.85 1.21 1.21 0.63 $211.49 $211.4993624 0.00 0.00 0.00 0.00 $0.00 $0.0093624 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093624 26 4.80 2.06 2.06 1.05 $356.66 $356.6693631 0.00 0.00 0.00 0.00 $0.00 $0.0093631 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093631 26 7.59 2.77 2.77 1.81 $549.04 $549.0493640 0.00 0.00 0.00 0.00 $0.00 $0.0093640 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093640 26 3.51 1.49 1.49 0.76 $259.65 $259.6593641 0.00 0.00 0.00 0.00 $0.00 $0.0093641 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093641 26 5.92 2.52 2.52 1.29 $438.67 $438.6793642 4.88 6.72 6.72 0.21 $533.02 $533.0293642 TC 0.00 4.61 4.61 0.03 $214.84 $214.8493642 26 4.88 2.11 2.11 0.18 $318.19 $318.1993650 10.49 4.76 4.76 2.27 $790.14 $790.1493651 16.23 6.90 6.90 3.54 $1,202.41 $1,202.4193652 17.65 7.53 7.53 3.85 $1,308.85 $1,308.8593660 1.89 2.67 2.67 0.08 $209.49 $209.4993660 TC 0.00 1.86 1.86 0.01 $86.57 $86.5793660 26 1.89 0.81 0.81 0.07 $122.91 $122.9193662 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 317 of 387 Effective January 2012

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MRA 2012

93662 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093662 26 2.80 1.19 1.19 0.20 $186.53 $186.5393668 0.00 0.55 0.55 0.01 $25.96 $25.9693701 0.00 0.75 0.75 0.01 $35.21 $35.2193724 4.88 3.16 3.16 0.19 $367.28 $367.2893724 TC 0.00 1.08 1.08 0.01 $50.48 $50.4893724 26 4.88 2.08 2.08 0.18 $316.80 $316.8093740 0.16 0.08 0.08 0.03 $12.16 $12.1693745 0.00 0.00 0.00 0.00 $0.00 $0.0093745 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093745 26 0.00 0.00 0.00 0.00 $0.00 $0.0093750 0.92 0.59 0.33 0.05 $69.70 $57.6793770 0.16 0.07 0.07 0.03 $11.70 $11.7093784 0.38 1.32 1.32 0.03 $79.07 $79.0793786 0.00 0.91 0.91 0.01 $42.62 $42.6293788 0.00 0.25 0.25 0.01 $12.08 $12.0893790 0.38 0.16 0.16 0.01 $24.37 $24.3793797 0.18 0.31 0.08 0.01 $22.65 $12.0193798 0.28 0.45 0.12 0.01 $33.46 $18.1993799 0.00 0.00 0.00 0.00 $0.00 $0.0093799 TC 0.00 0.00 0.00 0.00 $0.00 $0.0093799 26 0.00 0.00 0.00 0.00 $0.00 $0.0093880 0.60 6.76 6.76 0.05 $341.33 $341.3393880 TC 0.00 6.53 6.53 0.01 $302.66 $302.6693880 26 0.60 0.23 0.23 0.04 $38.67 $38.6793882 0.40 4.79 4.79 0.06 $242.02 $242.0293882 TC 0.00 4.65 4.65 0.01 $215.67 $215.6793882 26 0.40 0.14 0.14 0.05 $26.35 $26.3593886 0.94 9.48 9.48 0.05 $481.92 $481.9293886 TC 0.00 9.10 9.10 0.01 $421.58 $421.5893886 26 0.94 0.38 0.38 0.04 $60.34 $60.3493888 0.62 5.73 5.73 0.05 $294.54 $294.5493888 TC 0.00 5.48 5.48 0.01 $254.08 $254.0893888 26 0.62 0.25 0.25 0.04 $40.46 $40.4693890 1.00 7.32 7.32 0.05 $384.57 $384.5793890 TC 0.00 6.92 6.92 0.01 $320.71 $320.7193890 26 1.00 0.40 0.40 0.04 $63.86 $63.8693892 1.15 8.40 8.40 0.06 $441.55 $441.5593892 TC 0.00 7.94 7.94 0.01 $367.90 $367.9093892 26 1.15 0.46 0.46 0.05 $73.65 $73.65

Updated December 2011 318 of 387 Effective January 2012

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MRA 2012

93893 1.15 8.49 8.49 0.06 $445.71 $445.7193893 TC 0.00 8.02 8.02 0.01 $371.61 $371.6193893 26 1.15 0.47 0.47 0.05 $74.11 $74.1193922 0.25 2.79 2.79 0.02 $140.94 $140.9493922 TC 0.00 2.70 2.70 0.01 $125.44 $125.4493922 26 0.25 0.09 0.09 0.01 $15.50 $15.5093923 0.45 4.24 4.24 0.05 $218.23 $218.2393923 TC 0.00 4.08 4.08 0.01 $189.30 $189.3093923 26 0.45 0.16 0.16 0.04 $28.93 $28.9393924 0.50 5.42 5.42 0.05 $274.99 $274.9993924 TC 0.00 5.23 5.23 0.01 $242.51 $242.5193924 26 0.50 0.19 0.19 0.04 $32.49 $32.4993925 0.58 8.68 8.68 0.07 $430.32 $430.3293925 TC 0.00 8.47 8.47 0.03 $393.45 $393.4593925 26 0.58 0.21 0.21 0.04 $36.88 $36.8893926 0.39 5.64 5.64 0.06 $280.92 $280.9293926 TC 0.00 5.51 5.51 0.01 $255.46 $255.4693926 26 0.39 0.13 0.13 0.05 $25.45 $25.4593930 0.46 6.94 6.94 0.05 $343.59 $343.5993930 TC 0.00 6.77 6.77 0.01 $313.77 $313.7793930 26 0.46 0.17 0.17 0.04 $29.83 $29.8393931 0.31 4.60 4.60 0.04 $228.31 $228.3193931 TC 0.00 4.49 4.49 0.01 $208.27 $208.2793931 26 0.31 0.11 0.11 0.03 $20.04 $20.0493965 0.35 3.35 3.35 0.04 $172.21 $172.2193965 TC 0.00 3.22 3.22 0.01 $149.50 $149.5093965 26 0.35 0.13 0.13 0.03 $22.70 $22.7093970 0.68 6.91 6.91 0.08 $353.26 $353.2693970 TC 0.00 6.67 6.67 0.01 $309.14 $309.1493970 26 0.68 0.24 0.24 0.07 $44.12 $44.1293971 0.45 4.06 4.06 0.05 $209.90 $209.9093971 TC 0.00 3.90 3.90 0.01 $180.97 $180.9793971 26 0.45 0.16 0.16 0.04 $28.93 $28.9393975 1.80 9.23 9.23 0.17 $513.71 $513.7193975 TC 0.00 8.56 8.56 0.03 $397.61 $397.6193975 26 1.80 0.67 0.67 0.14 $116.10 $116.1093976 1.21 5.11 5.11 0.09 $293.44 $293.4493976 TC 0.00 4.66 4.66 0.01 $216.13 $216.1393976 26 1.21 0.45 0.45 0.08 $77.31 $77.3193978 0.65 6.44 6.44 0.08 $330.21 $330.21

Updated December 2011 319 of 387 Effective January 2012

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Treatment

MRA 2012

93978 TC 0.00 6.21 6.21 0.01 $287.85 $287.8593978 26 0.65 0.23 0.23 0.07 $42.36 $42.3693979 0.44 4.51 4.51 0.05 $230.29 $230.2993979 TC 0.00 4.35 4.35 0.01 $201.79 $201.7993979 26 0.44 0.16 0.16 0.04 $28.50 $28.5093980 1.25 3.77 3.77 0.08 $232.66 $232.6693980 TC 0.00 3.28 3.28 0.01 $152.28 $152.2893980 26 1.25 0.49 0.49 0.07 $80.38 $80.3893981 0.44 2.97 2.97 0.04 $158.52 $158.5293981 TC 0.00 2.80 2.80 0.01 $130.07 $130.0793981 26 0.44 0.17 0.17 0.03 $28.45 $28.4593982 0.30 0.93 0.93 0.05 $58.57 $58.5793990 0.25 6.06 6.06 0.05 $293.78 $293.7893990 TC 0.00 5.98 5.98 0.01 $277.21 $277.2193990 26 0.25 0.08 0.08 0.04 $16.57 $16.5793998 0.00 0.00 0.00 0.00 $0.00 $0.0094002 1.99 0.54 0.54 0.16 $119.33 $119.3394003 1.37 0.46 0.46 0.10 $85.72 $85.7294004 1.00 0.34 0.34 0.07 $62.61 $62.6194005 1.50 1.08 1.08 0.10 $120.04 $120.0494010 0.17 0.87 0.87 0.02 $48.64 $48.6494010 TC 0.00 0.81 0.81 0.01 $37.99 $37.9994010 26 0.17 0.06 0.06 0.01 $10.65 $10.6594011 2.00 0.81 0.81 0.14 $131.24 $131.2494012 3.10 1.34 1.34 0.23 $207.99 $207.9994013 0.66 0.27 0.27 0.04 $43.12 $43.1294014 0.52 0.85 0.85 0.02 $62.87 $62.8794015 0.00 0.68 0.68 0.01 $31.97 $31.9794016 0.52 0.17 0.17 0.01 $30.90 $30.9094060 0.26 1.51 1.51 0.02 $82.15 $82.1594060 TC 0.00 1.41 1.41 0.01 $65.75 $65.7594060 26 0.26 0.10 0.10 0.01 $16.40 $16.4094070 0.60 1.15 1.15 0.04 $81.24 $81.2494070 TC 0.00 0.94 0.94 0.01 $44.00 $44.0094070 26 0.60 0.21 0.21 0.03 $37.23 $37.2394150 0.07 0.65 0.65 0.02 $34.13 $34.1394150 TC 0.00 0.62 0.62 0.01 $29.20 $29.2094150 26 0.07 0.03 0.03 0.01 $4.93 $4.9394200 0.11 0.61 0.61 0.02 $34.01 $34.0194200 TC 0.00 0.57 0.57 0.01 $26.88 $26.88

Updated December 2011 320 of 387 Effective January 2012

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MRA 2012

94200 26 0.11 0.04 0.04 0.01 $7.12 $7.1294250 0.11 0.65 0.65 0.02 $35.86 $35.8694250 TC 0.00 0.61 0.61 0.01 $28.73 $28.7394250 26 0.11 0.04 0.04 0.01 $7.12 $7.1294375 0.31 0.82 0.82 0.02 $52.39 $52.3994375 TC 0.00 0.71 0.71 0.01 $33.36 $33.3694375 26 0.31 0.11 0.11 0.01 $19.03 $19.0394400 0.40 1.25 1.25 0.02 $76.18 $76.1894400 TC 0.00 1.11 1.11 0.01 $51.87 $51.8794400 26 0.40 0.14 0.14 0.01 $24.31 $24.3194450 0.40 1.46 1.46 0.02 $85.90 $85.9094450 TC 0.00 1.31 1.31 0.01 $61.12 $61.1294450 26 0.40 0.15 0.15 0.01 $24.78 $24.7894452 0.31 1.38 1.38 0.02 $78.30 $78.3094452 TC 0.00 1.28 1.28 0.01 $59.74 $59.7494452 26 0.31 0.10 0.10 0.01 $18.56 $18.5694453 0.40 1.91 1.91 0.02 $106.72 $106.7294453 TC 0.00 1.78 1.78 0.01 $82.87 $82.8794453 26 0.40 0.13 0.13 0.01 $23.85 $23.8594610 1.16 0.52 0.52 0.07 $77.87 $77.8794620 0.64 1.08 1.08 0.04 $79.73 $79.7394620 TC 0.00 0.86 0.86 0.01 $40.30 $40.3094620 26 0.64 0.22 0.22 0.03 $39.43 $39.4394621 1.42 3.33 3.33 0.06 $218.65 $218.6594621 TC 0.00 2.80 2.80 0.01 $130.07 $130.0794621 26 1.42 0.53 0.53 0.05 $88.58 $88.5894640 0.00 0.51 0.51 0.01 $24.11 $24.1194642 0.00 0.00 0.00 0.00 $0.00 $0.0094644 0.00 1.27 1.27 0.01 $59.27 $59.2794645 0.00 0.41 0.41 0.01 $19.48 $19.4894660 0.76 0.98 0.28 0.05 $80.81 $48.4294662 0.76 0.25 0.25 0.05 $47.03 $47.0394664 0.00 0.49 0.49 0.01 $23.18 $23.1894667 0.00 0.70 0.70 0.01 $32.90 $32.9094668 0.00 0.69 0.69 0.01 $32.44 $32.4494680 0.26 1.47 1.47 0.02 $80.30 $80.3094680 TC 0.00 1.37 1.37 0.01 $63.90 $63.9094680 26 0.26 0.10 0.10 0.01 $16.40 $16.4094681 0.20 1.37 1.37 0.02 $73.07 $73.0794681 TC 0.00 1.30 1.30 0.01 $60.66 $60.66

Updated December 2011 321 of 387 Effective January 2012

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MRA 2012

94681 26 0.20 0.07 0.07 0.01 $12.41 $12.4194690 0.07 1.44 1.44 0.02 $70.68 $70.6894690 TC 0.00 1.41 1.41 0.01 $65.75 $65.7594690 26 0.07 0.03 0.03 0.01 $4.93 $4.9394726 0.26 1.29 1.29 0.03 $72.48 $72.4894726 TC 0.00 1.20 1.20 0.02 $56.54 $56.5494726 26 0.26 0.09 0.09 0.01 $15.94 $15.9494727 0.26 0.96 0.96 0.02 $56.70 $56.7094727 TC 0.00 0.87 0.87 0.01 $40.76 $40.7694727 26 0.26 0.09 0.09 0.01 $15.94 $15.9494728 0.26 0.96 0.96 0.02 $56.70 $56.7094728 TC 0.00 0.87 0.87 0.01 $40.76 $40.7694728 26 0.26 0.09 0.09 0.01 $15.94 $15.9494729 0.17 1.38 1.38 0.02 $72.24 $72.2494729 TC 0.00 1.32 1.32 0.01 $61.59 $61.5994729 26 0.17 0.06 0.06 0.01 $10.65 $10.6594750 0.23 2.10 2.10 0.02 $108.15 $108.1594750 TC 0.00 2.02 2.02 0.01 $93.98 $93.9894750 26 0.23 0.08 0.08 0.01 $14.17 $14.1794760 0.00 0.08 0.08 0.01 $4.21 $4.2194761 0.00 0.13 0.13 0.01 $6.52 $6.5294762 0.00 0.44 0.44 0.01 $20.87 $20.8794770 0.15 0.28 0.28 0.03 $20.98 $20.9894772 0.00 0.00 0.00 0.00 $0.00 $0.0094772 TC 0.00 0.00 0.00 0.00 $0.00 $0.0094772 26 0.00 0.00 0.00 0.00 $0.00 $0.0094774 0.00 0.00 0.00 0.00 $0.00 $0.0094775 0.00 0.00 0.00 0.00 $0.00 $0.0094776 0.00 0.00 0.00 0.00 $0.00 $0.0094777 0.00 0.00 0.00 0.00 $0.00 $0.0094780 0.48 0.98 0.18 0.03 $67.67 $30.6594781 0.17 0.40 0.06 0.01 $26.38 $10.6594799 0.00 0.00 0.00 0.00 $0.00 $0.0094799 TC 0.00 0.00 0.00 0.00 $0.00 $0.0094799 26 0.00 0.00 0.00 0.00 $0.00 $0.0095004 0.01 0.17 0.17 0.01 $8.81 $8.8195010 0.11 0.24 0.04 0.01 $16.38 $7.1295012 0.00 0.59 0.59 0.01 $27.81 $27.8195015 0.06 0.14 0.02 0.01 $9.59 $4.0395024 0.01 0.21 0.01 0.01 $10.66 $1.40

Updated December 2011 322 of 387 Effective January 2012

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MRA 2012

95027 0.01 0.13 0.13 0.01 $6.96 $6.9695028 0.00 0.39 0.39 0.01 $18.55 $18.5595044 0.00 0.17 0.17 0.01 $8.37 $8.3795052 0.00 0.19 0.19 0.01 $9.30 $9.3095056 0.00 1.28 1.28 0.01 $59.74 $59.7495060 0.00 0.93 0.93 0.01 $43.54 $43.5495065 0.00 0.73 0.73 0.01 $34.29 $34.2995070 0.00 1.00 1.00 0.01 $46.78 $46.7895071 0.00 1.99 1.99 0.01 $92.59 $92.5995075 0.95 0.86 0.37 0.04 $82.98 $60.3195115 0.00 0.28 0.28 0.01 $13.46 $13.4695117 0.00 0.34 0.34 0.01 $16.24 $16.2495120 0.00 0.00 0.00 0.00 $0.00 $0.0095125 0.00 0.00 0.00 0.00 $0.00 $0.0095130 0.00 0.00 0.00 0.00 $0.00 $0.0095131 0.00 0.00 0.00 0.00 $0.00 $0.0095132 0.00 0.00 0.00 0.00 $0.00 $0.0095133 0.00 0.00 0.00 0.00 $0.00 $0.0095134 0.00 0.00 0.00 0.00 $0.00 $0.0095144 0.06 0.30 0.02 0.01 $16.99 $4.0395145 0.06 0.53 0.02 0.01 $27.63 $4.0395146 0.06 0.99 0.02 0.01 $48.92 $4.0395147 0.06 0.91 0.02 0.01 $45.21 $4.0395148 0.06 1.37 0.02 0.01 $66.50 $4.0395149 0.06 1.86 0.02 0.01 $89.17 $4.0395165 0.06 0.31 0.03 0.01 $17.45 $4.5095170 0.06 0.21 0.02 0.01 $12.82 $4.0395180 2.01 1.91 0.91 0.07 $179.01 $132.7495199 0.00 0.00 0.00 0.00 $0.00 $0.0095250 0.00 4.63 4.63 0.01 $214.75 $214.7595251 0.85 0.34 0.34 0.04 $54.59 $54.5995800 1.05 3.63 3.63 0.05 $215.99 $215.9995800 TC 0.00 3.24 3.24 0.01 $150.43 $150.4395800 26 1.05 0.39 0.39 0.04 $65.57 $65.5795801 1.00 1.49 1.49 0.05 $114.81 $114.8195801 TC 0.00 1.12 1.12 0.01 $52.33 $52.3395801 26 1.00 0.37 0.37 0.04 $62.47 $62.4795803 0.90 3.91 3.91 0.05 $222.45 $222.4595803 TC 0.00 3.56 3.56 0.01 $165.24 $165.2495803 26 0.90 0.35 0.35 0.04 $57.22 $57.22

Updated December 2011 323 of 387 Effective January 2012

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MRA 2012

95805 1.20 10.99 10.99 0.08 $564.58 $564.5895805 TC 0.00 10.49 10.49 0.04 $487.42 $487.4295805 26 1.20 0.50 0.50 0.04 $77.15 $77.1595806 1.25 4.07 4.07 0.08 $246.54 $246.5495806 TC 0.00 3.55 3.55 0.03 $165.79 $165.7995806 26 1.25 0.52 0.52 0.05 $80.75 $80.7595807 1.28 13.21 13.21 0.15 $674.32 $674.3295807 TC 0.00 12.72 12.72 0.10 $593.66 $593.6695807 26 1.28 0.49 0.49 0.05 $80.66 $80.6695808 1.74 17.82 17.82 0.17 $908.58 $908.5895808 TC 0.00 17.07 17.07 0.10 $794.94 $794.9495808 26 1.74 0.75 0.75 0.07 $113.64 $113.6495810 2.50 16.76 16.76 0.21 $894.49 $894.4995810 TC 0.00 15.79 15.79 0.11 $736.22 $736.2295810 26 2.50 0.97 0.97 0.10 $158.27 $158.2795811 2.60 17.93 17.93 0.23 $953.98 $953.9895811 TC 0.00 16.92 16.92 0.12 $789.02 $789.0295811 26 2.60 1.01 1.01 0.11 $164.96 $164.9695812 1.08 9.63 9.63 0.07 $495.94 $495.9495812 TC 0.00 9.16 9.16 0.03 $425.37 $425.3795812 26 1.08 0.47 0.47 0.04 $70.57 $70.5795813 1.73 10.65 10.65 0.11 $573.33 $573.3395813 TC 0.00 9.91 9.91 0.04 $460.58 $460.5895813 26 1.73 0.74 0.74 0.07 $112.74 $112.7495816 1.08 8.74 8.74 0.08 $455.27 $455.2795816 TC 0.00 8.27 8.27 0.03 $384.19 $384.1995816 26 1.08 0.47 0.47 0.05 $71.08 $71.0895819 1.08 10.09 10.09 0.07 $517.22 $517.2295819 TC 0.00 9.62 9.62 0.03 $446.66 $446.6695819 26 1.08 0.47 0.47 0.04 $70.57 $70.5795822 1.08 9.10 9.10 0.07 $471.42 $471.4295822 TC 0.00 8.63 8.63 0.03 $400.85 $400.8595822 26 1.08 0.47 0.47 0.04 $70.57 $70.5795824 0.00 0.00 0.00 0.00 $0.00 $0.0095824 TC 0.00 0.00 0.00 0.00 $0.00 $0.0095824 26 0.74 0.32 0.32 0.05 $49.41 $49.4195827 1.08 18.51 18.51 0.13 $909.88 $909.8895827 TC 0.00 18.04 18.04 0.08 $838.81 $838.8195827 26 1.08 0.47 0.47 0.05 $71.08 $71.0895829 6.20 42.72 42.72 0.21 $2,255.98 $2,255.98

Updated December 2011 324 of 387 Effective January 2012

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MRA 2012

95829 TC 0.00 40.01 40.01 0.05 $1,853.86 $1,853.8695829 26 6.20 2.71 2.71 0.16 $402.11 $402.1195830 1.70 4.07 0.70 0.14 $269.09 $113.1595831 0.28 0.52 0.12 0.03 $37.72 $19.2195832 0.29 0.46 0.13 0.03 $35.37 $20.1095833 0.47 0.61 0.15 0.01 $49.09 $27.8195834 0.60 0.79 0.24 0.03 $64.07 $38.6295851 0.16 0.36 0.05 0.01 $24.10 $9.7595852 0.11 0.35 0.05 0.01 $21.47 $7.5995857 0.53 0.91 0.26 0.04 $67.10 $37.0295860 0.96 1.82 1.82 0.04 $127.83 $127.8395860 TC 0.00 1.36 1.36 0.01 $63.44 $63.4495860 26 0.96 0.46 0.46 0.03 $64.40 $64.4095861 1.54 2.50 2.50 0.06 $185.44 $185.4495861 TC 0.00 1.78 1.78 0.01 $82.87 $82.8795861 26 1.54 0.72 0.72 0.05 $102.57 $102.5795863 1.87 3.01 3.01 0.08 $224.35 $224.3595863 TC 0.00 2.16 2.16 0.01 $100.46 $100.4695863 26 1.87 0.85 0.85 0.07 $123.90 $123.9095864 1.99 3.30 3.30 0.08 $242.97 $242.9795864 TC 0.00 2.39 2.39 0.01 $111.10 $111.1095864 26 1.99 0.91 0.91 0.07 $131.87 $131.8795865 1.57 2.03 2.03 0.05 $164.49 $164.4995865 TC 0.00 1.28 1.28 0.01 $59.74 $59.7495865 26 1.57 0.75 0.75 0.04 $104.75 $104.7595866 1.25 1.96 1.96 0.06 $147.89 $147.8995866 TC 0.00 1.40 1.40 0.01 $65.29 $65.2995866 26 1.25 0.56 0.56 0.05 $82.60 $82.6095867 0.79 1.86 1.86 0.04 $122.32 $122.3295867 TC 0.00 1.51 1.51 0.01 $70.38 $70.3895867 26 0.79 0.35 0.35 0.03 $51.94 $51.9495868 1.18 2.37 2.37 0.05 $163.32 $163.3295868 TC 0.00 1.85 1.85 0.01 $86.11 $86.1195868 26 1.18 0.52 0.52 0.04 $77.21 $77.2195869 0.37 1.61 1.61 0.02 $91.54 $91.5495869 TC 0.00 1.45 1.45 0.01 $67.60 $67.6095869 26 0.37 0.16 0.16 0.01 $23.94 $23.9495870 0.37 1.53 1.53 0.02 $87.84 $87.8495870 TC 0.00 1.36 1.36 0.01 $63.44 $63.4495870 26 0.37 0.17 0.17 0.01 $24.40 $24.40

Updated December 2011 325 of 387 Effective January 2012

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MRA 2012

95872 2.88 2.44 2.44 0.12 $243.76 $243.7695872 TC 0.00 1.21 1.21 0.01 $56.50 $56.5095872 26 2.88 1.23 1.23 0.11 $187.27 $187.2795873 0.37 1.57 1.57 0.02 $89.69 $89.6995873 TC 0.00 1.37 1.37 0.01 $63.90 $63.9095873 26 0.37 0.20 0.20 0.01 $25.79 $25.7995874 0.37 1.47 1.47 0.02 $85.06 $85.0695874 TC 0.00 1.29 1.29 0.01 $60.20 $60.2095874 26 0.37 0.18 0.18 0.01 $24.87 $24.8795875 1.10 2.12 2.12 0.06 $148.80 $148.8095875 TC 0.00 1.64 1.64 0.01 $76.39 $76.3995875 26 1.10 0.48 0.48 0.05 $72.40 $72.4095885 0.35 1.27 1.27 0.02 $74.94 $74.9495885 TC 0.00 1.11 1.11 0.01 $51.87 $51.8795885 26 0.35 0.16 0.16 0.01 $23.07 $23.0795886 0.92 1.61 1.61 0.04 $116.39 $116.3995886 TC 0.00 1.17 1.17 0.01 $54.65 $54.6595886 26 0.92 0.44 0.44 0.03 $61.74 $61.7495887 0.73 1.53 1.53 0.03 $103.94 $103.9495887 TC 0.00 1.19 1.19 0.01 $55.57 $55.5795887 26 0.73 0.34 0.34 0.02 $48.37 $48.3795900 0.42 1.45 1.45 0.02 $86.30 $86.3095900 TC 0.00 1.25 1.25 0.01 $58.35 $58.3595900 26 0.42 0.20 0.20 0.01 $27.96 $27.9695903 0.60 1.57 1.57 0.04 $100.67 $100.6795903 TC 0.00 1.30 1.30 0.01 $60.66 $60.6695903 26 0.60 0.27 0.27 0.03 $40.01 $40.0195904 0.34 1.31 1.31 0.02 $76.36 $76.3695904 TC 0.00 1.15 1.15 0.01 $53.72 $53.7295904 26 0.34 0.16 0.16 0.01 $22.64 $22.6495905 0.05 1.91 1.91 0.02 $91.56 $91.5695905 TC 0.00 1.89 1.89 0.01 $87.96 $87.9695905 26 0.05 0.02 0.02 0.01 $3.60 $3.6095920 2.11 2.69 2.69 0.09 $220.45 $220.4595920 TC 0.00 1.75 1.75 0.01 $81.48 $81.4895920 26 2.11 0.94 0.94 0.08 $138.97 $138.9795921 0.90 1.53 1.53 0.04 $111.82 $111.8295921 TC 0.00 1.15 1.15 0.01 $53.72 $53.7295921 26 0.90 0.38 0.38 0.03 $58.10 $58.1095922 0.96 2.10 2.10 0.04 $140.79 $140.79

Updated December 2011 326 of 387 Effective January 2012

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MRA 2012

95922 TC 0.00 1.69 1.69 0.01 $78.71 $78.7195922 26 0.96 0.41 0.41 0.03 $62.08 $62.0895923 0.90 3.69 3.69 0.05 $212.27 $212.2795923 TC 0.00 3.29 3.29 0.01 $152.74 $152.7495923 26 0.90 0.40 0.40 0.04 $59.53 $59.5395925 0.54 4.33 4.33 0.02 $224.76 $224.7695925 TC 0.00 4.09 4.09 0.01 $189.76 $189.7695925 26 0.54 0.24 0.24 0.01 $35.01 $35.0195926 0.54 4.16 4.16 0.04 $217.92 $217.9295926 TC 0.00 3.93 3.93 0.01 $182.36 $182.3695926 26 0.54 0.23 0.23 0.03 $35.56 $35.5695927 0.54 4.24 4.24 0.02 $220.60 $220.6095927 TC 0.00 4.00 4.00 0.01 $185.59 $185.5995927 26 0.54 0.24 0.24 0.01 $35.01 $35.0195928 1.50 5.89 5.89 0.10 $342.60 $342.6095928 TC 0.00 5.23 5.23 0.03 $243.53 $243.5395928 26 1.50 0.66 0.66 0.07 $99.08 $99.0895929 1.50 6.01 6.01 0.10 $348.16 $348.1695929 TC 0.00 5.35 5.35 0.03 $249.08 $249.0895929 26 1.50 0.66 0.66 0.07 $99.08 $99.0895930 0.35 4.07 4.07 0.02 $204.50 $204.5095930 TC 0.00 3.91 3.91 0.01 $181.43 $181.4395930 26 0.35 0.16 0.16 0.01 $23.07 $23.0795933 0.59 1.75 1.75 0.04 $108.57 $108.5795933 TC 0.00 1.49 1.49 0.01 $69.45 $69.4595933 26 0.59 0.26 0.26 0.03 $39.11 $39.1195934 0.51 1.28 1.28 0.02 $82.34 $82.3495934 TC 0.00 1.05 1.05 0.01 $49.09 $49.0995934 26 0.51 0.23 0.23 0.01 $33.24 $33.2495936 0.55 0.89 0.89 0.02 $66.02 $66.0295936 TC 0.00 0.64 0.64 0.01 $30.12 $30.1295936 26 0.55 0.25 0.25 0.01 $35.90 $35.9095937 0.65 1.34 1.34 0.05 $92.70 $92.7095937 TC 0.00 1.06 1.06 0.01 $49.56 $49.5695937 26 0.65 0.28 0.28 0.04 $43.15 $43.1595938 0.86 7.76 7.76 0.07 $399.88 $399.8895938 TC 0.00 7.38 7.38 0.03 $343.01 $343.0195938 26 0.86 0.38 0.38 0.04 $56.87 $56.8795939 2.25 11.20 11.20 0.15 $623.34 $623.3495939 TC 0.00 10.19 10.19 0.04 $473.54 $473.54

Updated December 2011 327 of 387 Effective January 2012

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MRA 2012

95939 26 2.25 1.01 1.01 0.11 $149.80 $149.8095950 1.51 7.15 7.15 0.10 $401.34 $401.3495950 TC 0.00 6.50 6.50 0.03 $302.29 $302.2995950 26 1.51 0.65 0.65 0.07 $99.05 $99.0595951 0.00 0.00 0.00 0.00 $0.00 $0.0095951 TC 0.00 0.00 0.00 0.00 $0.00 $0.0095951 26 5.99 2.61 2.61 0.48 $404.67 $404.6795953 3.08 9.36 9.36 0.18 $575.68 $575.6895953 TC 0.00 8.01 8.01 0.03 $372.16 $372.1695953 26 3.08 1.35 1.35 0.15 $203.52 $203.5295954 2.45 9.32 9.32 0.15 $545.01 $545.0195954 TC 0.00 8.42 8.42 0.04 $391.64 $391.6495954 26 2.45 0.90 0.90 0.11 $153.37 $153.3795955 1.01 4.64 4.64 0.05 $261.00 $261.0095955 TC 0.00 4.20 4.20 0.01 $194.85 $194.8595955 26 1.01 0.44 0.44 0.04 $66.15 $66.1595956 3.61 30.71 30.71 0.32 $1,593.66 $1,593.6695956 TC 0.00 29.27 29.27 0.16 $1,362.50 $1,362.5095956 26 3.61 1.44 1.44 0.16 $231.15 $231.1595957 1.98 9.27 9.27 0.11 $520.30 $520.3095957 TC 0.00 8.42 8.42 0.01 $390.11 $390.1195957 26 1.98 0.85 0.85 0.10 $130.19 $130.1995958 4.24 10.05 10.05 0.26 $661.93 $661.9395958 TC 0.00 8.24 8.24 0.04 $383.31 $383.3195958 26 4.24 1.81 1.81 0.22 $278.61 $278.6195961 2.97 4.84 4.84 0.15 $360.24 $360.2495961 TC 0.00 3.51 3.51 0.01 $162.92 $162.9295961 26 2.97 1.33 1.33 0.14 $197.32 $197.3295962 3.21 3.58 3.58 0.15 $312.34 $312.3495962 TC 0.00 2.18 2.18 0.01 $101.38 $101.3895962 26 3.21 1.40 1.40 0.14 $210.96 $210.9695965 0.00 0.00 0.00 0.00 $0.00 $0.0095965 TC 0.00 0.00 0.00 0.00 $0.00 $0.0095965 26 7.99 3.56 3.56 0.64 $543.40 $543.4095966 0.00 0.00 0.00 0.00 $0.00 $0.0095966 TC 0.00 0.00 0.00 0.00 $0.00 $0.0095966 26 3.99 1.78 1.78 0.31 $270.97 $270.9795967 0.00 0.00 0.00 0.00 $0.00 $0.0095967 TC 0.00 0.00 0.00 0.00 $0.00 $0.0095967 26 3.49 1.52 1.52 0.29 $236.27 $236.27

Updated December 2011 328 of 387 Effective January 2012

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95970 0.45 1.38 0.19 0.04 $85.38 $30.3295971 0.78 0.84 0.32 0.07 $76.22 $52.1695972 1.50 1.54 0.64 0.14 $143.36 $101.7195973 0.92 0.82 0.41 0.08 $81.87 $62.8995974 3.00 2.33 1.26 0.26 $251.00 $201.4895975 1.70 1.19 0.74 0.12 $134.81 $113.9995978 3.50 2.91 1.53 0.38 $305.60 $241.7495979 1.64 1.16 0.72 0.14 $131.84 $111.4895980 0.80 0.38 0.38 0.16 $60.38 $60.3895981 0.30 0.61 0.18 0.03 $42.75 $22.8595982 0.65 0.79 0.33 0.05 $67.26 $45.9795990 0.00 2.49 2.49 0.03 $116.74 $116.7495991 0.77 2.60 0.32 0.05 $156.20 $50.7195992 0.75 0.44 0.31 0.05 $55.39 $49.3895999 0.00 0.00 0.00 0.00 $0.00 $0.0096000 1.80 0.89 0.89 0.11 $124.75 $124.7596001 2.15 0.62 0.62 0.12 $127.93 $127.9396002 0.41 0.18 0.18 0.03 $27.62 $27.6296003 0.37 0.15 0.15 0.03 $24.49 $24.4996004 2.14 0.99 0.99 0.14 $145.63 $145.6396020 0.00 0.00 0.00 0.00 $0.00 $0.0096020 TC 0.00 0.00 0.00 0.00 $0.00 $0.0096020 26 3.43 1.31 1.31 0.31 $224.97 $224.9796040 0.00 1.33 1.33 0.03 $63.07 $63.0796101 1.86 0.47 0.31 0.07 $105.88 $98.4896102 0.50 1.65 0.13 0.03 $99.53 $29.2096103 0.51 1.32 0.17 0.03 $84.70 $31.4896105 1.75 1.20 1.20 0.04 $133.37 $133.3796110 0.00 0.00 0.00 0.00 $0.00 $0.0096111 2.60 0.89 0.73 0.16 $161.95 $154.5596116 1.86 0.66 0.49 0.10 $116.20 $108.3396118 1.86 0.80 0.29 0.07 $121.15 $97.5596119 0.55 1.48 0.10 0.01 $92.82 $28.9696120 0.51 2.06 0.17 0.03 $118.94 $31.4896125 1.70 1.14 1.14 0.07 $129.95 $129.9596150 0.50 0.09 0.08 0.01 $26.33 $25.8796151 0.48 0.09 0.08 0.01 $25.47 $25.0096152 0.46 0.08 0.07 0.01 $24.14 $23.6796153 0.10 0.02 0.02 0.01 $5.77 $5.7796154 0.45 0.08 0.07 0.01 $23.70 $23.24

Updated December 2011 329 of 387 Effective January 2012

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MRA 2012

96155 0.44 0.19 0.18 0.03 $29.38 $28.9296360 0.17 1.48 1.48 0.03 $77.37 $77.3796361 0.09 0.35 0.35 0.01 $20.60 $20.6096365 0.21 1.89 1.89 0.03 $98.08 $98.0896366 0.18 0.44 0.44 0.01 $28.67 $28.6796367 0.19 0.75 0.75 0.01 $43.44 $43.4496368 0.17 0.38 0.38 0.01 $25.46 $25.4696369 0.21 5.26 5.26 0.03 $254.01 $254.0196370 0.18 0.27 0.27 0.01 $20.80 $20.8096371 0.00 2.52 2.52 0.01 $117.11 $117.1196372 0.17 0.53 0.53 0.01 $32.40 $32.4096373 0.17 0.40 0.40 0.01 $26.38 $26.3896374 0.18 1.43 1.43 0.03 $75.49 $75.4996375 0.10 0.55 0.55 0.01 $30.29 $30.2996376 0.00 0.00 0.00 0.00 $0.00 $0.0096379 0.00 0.00 0.00 0.00 $0.00 $0.0096401 0.21 1.90 1.90 0.04 $99.05 $99.0596402 0.19 0.79 0.79 0.01 $45.29 $45.2996405 0.52 1.94 0.34 0.03 $113.82 $39.7896406 0.80 2.71 0.46 0.04 $162.09 $57.9796409 0.24 2.97 2.97 0.05 $150.37 $150.3796411 0.20 1.60 1.60 0.03 $84.22 $84.2296413 0.28 3.74 3.74 0.05 $187.73 $187.7396415 0.19 0.70 0.70 0.01 $41.13 $41.1396416 0.21 3.78 3.78 0.07 $187.56 $187.5696417 0.21 1.85 1.85 0.03 $96.23 $96.2396420 0.17 2.90 2.90 0.08 $145.62 $145.6296422 0.17 4.81 4.81 0.08 $234.00 $234.0096423 0.17 2.11 2.11 0.04 $107.03 $107.0396425 0.17 5.03 5.03 0.10 $245.20 $245.2096440 2.37 21.40 1.24 0.54 $1,120.34 $187.5196446 0.37 5.21 0.18 0.07 $260.66 $27.9296450 1.53 3.86 0.76 0.11 $250.48 $107.0496521 0.21 3.76 3.76 0.05 $185.62 $185.6296522 0.21 3.00 3.00 0.05 $150.45 $150.4596523 0.04 0.69 0.69 0.01 $34.17 $34.1796542 0.75 2.82 0.44 0.04 $165.01 $54.8896549 0.00 0.00 0.00 0.00 $0.00 $0.0096567 0.00 4.00 4.00 0.01 $185.59 $185.5996570 1.10 0.42 0.42 0.18 $76.24 $76.24

Updated December 2011 330 of 387 Effective January 2012

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MRA 2012

96571 0.55 0.19 0.19 0.04 $34.65 $34.6596900 0.00 0.62 0.62 0.01 $29.20 $29.2096902 0.41 0.19 0.17 0.03 $28.08 $27.1596904 0.00 2.08 2.08 0.01 $96.75 $96.7596910 0.00 2.11 2.11 0.01 $98.14 $98.1496912 0.00 2.71 2.71 0.01 $125.90 $125.9096913 0.00 3.78 3.78 0.01 $175.41 $175.4196920 1.15 3.96 0.77 0.04 $235.09 $87.4896921 1.17 4.02 0.76 0.04 $238.73 $87.8896922 2.10 5.19 1.36 0.08 $335.19 $157.9796999 0.00 0.00 0.00 0.00 $0.00 $0.0097001 1.20 0.91 0.91 0.05 $96.63 $96.6397002 0.60 0.57 0.57 0.03 $53.89 $53.8997003 1.20 1.17 1.17 0.05 $108.66 $108.6697004 0.60 0.86 0.86 0.03 $67.31 $67.3197005 0.00 0.00 0.00 0.00 $0.00 $0.0097006 0.00 0.00 0.00 0.00 $0.00 $0.0097010 0.06 0.10 0.10 0.01 $7.73 $7.7397012 0.25 0.20 0.20 0.01 $20.59 $20.5997014 0.18 0.26 0.26 0.01 $20.34 $20.3497016 0.18 0.35 0.35 0.01 $24.50 $24.5097018 0.06 0.23 0.23 0.01 $13.75 $13.7597022 0.17 0.47 0.47 0.01 $29.62 $29.6297024 0.06 0.12 0.12 0.01 $8.66 $8.6697026 0.06 0.10 0.10 0.01 $7.73 $7.7397028 0.08 0.12 0.12 0.01 $9.53 $9.5397032 0.25 0.28 0.28 0.01 $24.29 $24.2997033 0.26 0.63 0.63 0.01 $40.92 $40.9297034 0.21 0.28 0.28 0.01 $22.56 $22.5697035 0.21 0.14 0.14 0.01 $16.08 $16.0897036 0.28 0.62 0.62 0.01 $41.33 $41.3397039 0.00 0.00 0.00 0.00 $0.00 $0.0097110 0.45 0.44 0.44 0.01 $40.36 $40.3697112 0.45 0.48 0.48 0.01 $42.21 $42.2197113 0.44 0.75 0.75 0.01 $54.27 $54.2797116 0.40 0.39 0.39 0.01 $35.88 $35.8897124 0.35 0.38 0.38 0.01 $33.25 $33.2597139 0.00 0.00 0.00 0.00 $0.00 $0.0097140 0.43 0.40 0.40 0.01 $37.64 $37.6497150 0.27 0.30 0.30 0.01 $26.09 $26.09

Updated December 2011 331 of 387 Effective January 2012

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MRA 2012

97530 0.44 0.54 0.54 0.01 $44.56 $44.5697532 0.44 0.30 0.30 0.01 $33.45 $33.4597533 0.44 0.38 0.38 0.01 $37.15 $37.1597535 0.45 0.52 0.52 0.01 $44.06 $44.0697537 0.45 0.39 0.39 0.01 $38.05 $38.0597542 0.45 0.41 0.41 0.01 $38.97 $38.9797545 0.00 0.00 0.00 0.00 $0.00 $0.0097546 0.00 0.00 0.00 0.00 $0.00 $0.0097597 0.51 1.65 0.14 0.05 $100.98 $31.1197598 0.24 0.46 0.06 0.03 $33.21 $14.7097602 0.00 0.00 0.00 0.00 $0.00 $0.0097605 0.55 0.57 0.16 0.08 $54.27 $35.3097606 0.60 0.58 0.17 0.10 $57.92 $38.9497750 0.45 0.47 0.47 0.03 $42.77 $42.7797755 0.62 0.38 0.38 0.03 $45.97 $45.9797760 0.45 0.60 0.60 0.03 $48.78 $48.7897761 0.45 0.46 0.46 0.03 $42.30 $42.3097762 0.25 1.04 1.04 0.01 $59.46 $59.4697799 0.00 0.00 0.00 0.00 $0.00 $0.0097802 0.53 0.44 0.37 0.03 $44.84 $41.6197803 0.45 0.39 0.32 0.03 $39.07 $35.8397804 0.25 0.18 0.17 0.01 $19.67 $19.2097810 0.60 0.41 0.25 0.04 $47.00 $39.5997811 0.50 0.26 0.20 0.03 $35.22 $32.4497813 0.65 0.43 0.27 0.04 $50.09 $42.6997814 0.55 0.31 0.23 0.04 $40.20 $36.5098925 0.46 0.41 0.19 0.03 $40.42 $30.2498926 0.71 0.54 0.28 0.03 $57.27 $45.2498927 0.96 0.68 0.35 0.04 $75.09 $59.8298928 1.21 0.79 0.44 0.06 $92.02 $75.8398929 1.46 0.92 0.50 0.09 $110.39 $90.9698940 0.45 0.30 0.15 0.01 $33.88 $26.9498941 0.65 0.38 0.22 0.03 $47.27 $39.8698942 0.87 0.45 0.29 0.03 $60.04 $52.6398943 0.40 0.27 0.17 0.03 $31.35 $26.7298960 0.00 0.79 0.79 0.01 $37.06 $37.0698961 0.00 0.38 0.38 0.01 $18.09 $18.0998962 0.00 0.28 0.28 0.01 $13.46 $13.4698966 0.25 0.14 0.10 0.01 $17.82 $15.9798967 0.50 0.24 0.20 0.03 $34.29 $32.44

Updated December 2011 332 of 387 Effective January 2012

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MRA 2012

98968 0.75 0.34 0.31 0.05 $50.76 $49.3898969 0.00 0.00 0.00 0.00 $0.00 $0.0099000 0.00 0.00 0.00 0.00 $0.00 $0.0099001 0.00 0.00 0.00 0.00 $0.00 $0.0099002 0.00 0.00 0.00 0.00 $0.00 $0.0099024 0.00 0.00 0.00 0.00 $0.00 $0.0099026 0.00 0.00 0.00 0.00 $0.00 $0.0099027 0.00 0.00 0.00 0.00 $0.00 $0.0099050 0.00 0.00 0.00 0.00 $0.00 $0.0099051 0.00 0.00 0.00 0.00 $0.00 $0.0099053 0.00 0.00 0.00 0.00 $0.00 $0.0099056 0.00 0.00 0.00 0.00 $0.00 $0.0099058 0.00 0.00 0.00 0.00 $0.00 $0.0099060 0.00 0.00 0.00 0.00 $0.00 $0.0099070 0.00 0.00 0.00 0.00 $0.00 $0.0099071 0.00 0.00 0.00 0.00 $0.00 $0.0099075 0.00 0.00 0.00 0.00 $0.00 $0.0099078 0.00 0.00 0.00 0.00 $0.00 $0.0099080 0.00 0.00 0.00 0.00 $0.00 $0.0099082 0.00 0.00 0.00 0.00 $0.00 $0.0099090 0.00 0.00 0.00 0.00 $0.00 $0.0099091 1.10 0.45 0.45 0.07 $72.03 $72.0399100 0.00 0.00 0.00 0.00 $0.00 $0.0099116 0.00 0.00 0.00 0.00 $0.00 $0.0099135 0.00 0.00 0.00 0.00 $0.00 $0.0099140 0.00 0.00 0.00 0.00 $0.00 $0.0099143 0.00 0.00 0.00 0.00 $0.00 $0.0099144 0.00 0.00 0.00 0.00 $0.00 $0.0099145 0.00 0.00 0.00 0.00 $0.00 $0.0099148 0.00 0.00 0.00 0.00 $0.00 $0.0099149 0.00 0.00 0.00 0.00 $0.00 $0.0099150 0.00 0.00 0.00 0.00 $0.00 $0.0099170 1.75 2.07 0.74 0.12 $177.69 $116.1599172 0.00 0.00 0.00 0.00 $0.00 $0.0099173 0.00 0.08 0.08 0.01 $4.21 $4.2199174 0.00 0.84 0.84 0.01 $39.38 $39.3899175 0.00 0.55 0.55 0.01 $25.96 $25.9699183 2.34 3.75 0.91 0.26 $288.11 $156.7099190 0.00 0.00 0.00 0.00 $0.00 $0.0099191 0.00 0.00 0.00 0.00 $0.00 $0.00

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MRA 2012

99192 0.00 0.00 0.00 0.00 $0.00 $0.0099195 0.00 2.69 2.69 0.05 $127.01 $127.0199199 0.00 0.00 0.00 0.00 $0.00 $0.0099201 0.48 0.73 0.24 0.04 $56.61 $33.9399202 0.93 1.13 0.44 0.07 $96.13 $64.2199203 1.42 1.53 0.64 0.14 $139.43 $98.2599204 2.43 2.06 1.07 0.23 $212.28 $166.4899205 3.17 2.42 1.34 0.27 $263.03 $213.0699211 0.18 0.39 0.08 0.01 $26.35 $12.0199212 0.48 0.73 0.22 0.04 $56.61 $33.0199213 0.97 1.03 0.42 0.07 $93.24 $65.0199214 1.50 1.46 0.64 0.10 $137.62 $99.6899215 2.11 1.86 0.90 0.14 $184.59 $140.1799217 1.28 0.70 0.70 0.08 $91.91 $91.9199218 1.92 0.73 0.73 0.12 $123.05 $123.0599219 2.60 1.04 1.04 0.17 $169.40 $169.4099220 3.56 1.43 1.43 0.24 $232.59 $232.5999221 1.92 0.79 0.79 0.18 $128.88 $128.8899222 2.61 1.08 1.08 0.22 $174.23 $174.2399223 3.86 1.59 1.59 0.29 $255.53 $255.5399224 0.76 0.32 0.32 0.06 $50.78 $50.7899225 1.39 0.60 0.60 0.07 $91.54 $91.5499226 2.00 0.85 0.85 0.11 $131.56 $131.5699231 0.76 0.31 0.31 0.05 $49.81 $49.8199232 1.39 0.58 0.58 0.08 $91.12 $91.1299233 2.00 0.82 0.82 0.12 $130.68 $130.6899234 2.56 1.08 1.08 0.22 $172.06 $172.0699235 3.24 1.38 1.38 0.22 $215.40 $215.4099236 4.20 1.74 1.74 0.29 $277.20 $277.2099238 1.28 0.70 0.70 0.07 $91.40 $91.4099239 1.90 1.02 1.02 0.11 $135.10 $135.1099241 0.64 0.66 0.24 0.07 $61.82 $42.3999242 1.34 1.10 0.51 0.14 $116.07 $88.7799243 1.88 1.46 0.71 0.18 $158.15 $123.4599244 3.02 1.96 1.14 0.22 $232.71 $194.7699245 3.77 2.30 1.38 0.29 $284.49 $241.9299251 1.00 0.32 0.32 0.07 $61.69 $61.6999252 1.50 0.52 0.52 0.12 $95.14 $95.1499253 2.27 0.84 0.84 0.15 $144.83 $144.8399254 3.29 1.23 1.23 0.18 $208.59 $208.59

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MRA 2012

99255 4.00 1.44 1.44 0.24 $252.11 $252.1199281 0.45 0.12 0.12 0.03 $26.57 $26.5799282 0.88 0.23 0.23 0.07 $52.32 $52.3299283 1.34 0.33 0.33 0.10 $78.40 $78.4099284 2.56 0.59 0.59 0.22 $149.39 $149.3999285 3.80 0.84 0.84 0.30 $218.74 $218.7499288 0.00 0.00 0.00 0.00 $0.00 $0.0099291 4.50 3.01 1.54 0.34 $351.51 $283.4999292 2.25 1.08 0.77 0.18 $156.60 $142.2599304 1.64 0.86 0.86 0.14 $117.96 $117.9699305 2.35 1.18 1.18 0.20 $166.57 $166.5799306 3.06 1.44 1.44 0.23 $210.89 $210.8999307 0.76 0.45 0.45 0.04 $55.78 $55.7899308 1.16 0.71 0.71 0.07 $86.66 $86.6699309 1.55 0.92 0.92 0.08 $113.78 $113.7899310 2.35 1.30 1.30 0.14 $169.07 $169.0799315 1.28 0.69 0.69 0.08 $91.44 $91.4499316 1.90 0.94 0.94 0.10 $130.89 $130.8999318 1.71 0.89 0.89 0.10 $120.34 $120.3499324 1.01 0.53 0.53 0.07 $71.84 $71.8499325 1.52 0.70 0.70 0.10 $103.32 $103.3299326 2.63 1.18 1.18 0.16 $176.67 $176.6799327 3.46 1.59 1.59 0.22 $234.65 $234.6599328 4.09 1.79 1.79 0.24 $272.21 $272.2199334 1.07 0.58 0.58 0.07 $76.75 $76.7599335 1.72 0.86 0.86 0.10 $119.39 $119.3999336 2.46 1.19 1.19 0.14 $168.75 $168.7599337 3.58 1.64 1.64 0.23 $242.67 $242.6799339 1.25 0.90 0.90 0.08 $99.86 $99.8699340 1.80 1.20 1.20 0.12 $139.60 $139.6099341 1.01 0.51 0.51 0.07 $70.91 $70.9199342 1.52 0.68 0.68 0.11 $102.90 $102.9099343 2.53 1.07 1.07 0.18 $168.26 $168.2699344 3.38 1.58 1.58 0.22 $230.72 $230.7299345 4.09 1.84 1.84 0.26 $275.54 $275.5499347 1.00 0.53 0.53 0.07 $71.40 $71.4099348 1.56 0.75 0.75 0.10 $107.37 $107.3799349 2.33 1.15 1.15 0.14 $161.27 $161.2799350 3.28 1.53 1.53 0.22 $224.07 $224.0799354 1.77 0.95 0.75 0.11 $126.23 $116.97

Updated December 2011 335 of 387 Effective January 2012

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MRA 2012

99355 1.77 0.90 0.70 0.11 $123.91 $114.6699356 1.71 0.78 0.78 0.11 $115.76 $115.7699357 1.71 0.77 0.77 0.11 $115.30 $115.3099358 2.10 0.90 0.90 0.14 $139.74 $139.7499359 1.00 0.45 0.45 0.07 $67.70 $67.7099360 1.20 0.49 0.49 0.08 $78.73 $78.7399363 1.65 1.90 0.67 0.11 $164.99 $108.0799364 0.63 0.57 0.26 0.04 $55.70 $41.3699366 0.82 0.36 0.33 0.05 $54.72 $53.3399367 1.10 0.45 0.45 0.07 $72.03 $72.0399368 0.72 0.29 0.29 0.04 $46.64 $46.6499374 1.10 0.84 0.45 0.07 $90.08 $72.0399375 1.73 1.22 0.78 0.11 $136.99 $116.6399377 1.10 0.84 0.45 0.07 $90.08 $72.0399378 1.73 1.25 0.81 0.11 $138.38 $118.0299379 1.10 0.84 0.45 0.07 $90.08 $72.0399380 1.73 1.18 0.71 0.11 $135.14 $113.3999381 1.50 1.57 0.58 0.10 $142.71 $96.9099382 1.60 1.62 0.63 0.09 $148.85 $103.0499383 1.70 1.63 0.66 0.10 $154.15 $109.2799384 2.00 1.74 0.77 0.13 $173.76 $128.8899385 1.92 1.72 0.75 0.13 $169.37 $124.4999386 2.33 1.89 0.91 0.15 $196.02 $150.6799387 2.50 2.07 0.99 0.17 $212.73 $162.7599391 1.37 1.36 0.53 0.09 $126.85 $88.4599392 1.50 1.42 0.58 0.10 $135.77 $96.9099393 1.50 1.41 0.58 0.10 $135.31 $96.9099394 1.70 1.49 0.66 0.10 $147.67 $109.2799395 1.75 1.51 0.68 0.10 $150.76 $112.3699396 1.90 1.57 0.74 0.12 $161.06 $122.6599397 2.00 1.75 0.80 0.13 $174.23 $130.2799401 0.48 0.54 0.20 0.03 $47.31 $31.5799402 0.98 0.75 0.40 0.07 $80.72 $64.5299403 1.46 0.96 0.60 0.10 $112.75 $96.1099404 1.95 1.16 0.80 0.12 $144.25 $127.5999406 0.24 0.15 0.09 0.01 $17.85 $15.0799407 0.50 0.25 0.20 0.03 $34.75 $32.4499408 0.65 0.32 0.27 0.04 $45.00 $42.6999409 1.30 0.59 0.53 0.08 $87.68 $84.9199411 0.15 0.31 0.06 0.01 $21.35 $9.78

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99412 0.25 0.35 0.10 0.01 $27.53 $15.9799420 0.00 0.30 0.30 0.01 $14.39 $14.3999429 0.00 0.00 0.00 0.00 $0.00 $0.0099441 0.25 0.14 0.10 0.01 $17.82 $15.9799442 0.50 0.24 0.20 0.03 $34.29 $32.4499443 0.75 0.34 0.31 0.05 $50.76 $49.3899444 0.00 0.00 0.00 0.00 $0.00 $0.0099450 0.00 0.00 0.00 0.00 $0.00 $0.0099455 0.00 0.00 0.00 0.00 $0.00 $0.0099456 0.00 0.00 0.00 0.00 $0.00 $0.0099460 1.92 0.74 0.74 0.08 $121.48 $121.4899461 1.26 1.41 0.51 0.08 $123.89 $82.2599462 0.84 0.34 0.34 0.05 $54.66 $54.6699463 2.13 1.00 1.00 0.11 $144.14 $144.1499464 1.50 0.54 0.54 0.07 $93.53 $93.5399465 2.93 1.10 1.10 0.22 $189.01 $189.0199466 4.79 2.01 2.01 1.02 $352.39 $352.3999467 2.40 0.95 0.95 0.14 $155.04 $155.0499468 18.46 6.46 6.46 1.52 $1,175.90 $1,175.9099469 7.99 3.49 3.49 0.42 $528.97 $528.9799471 15.98 5.75 5.75 0.87 $1,002.55 $1,002.5599472 7.99 3.02 3.02 0.48 $510.27 $510.2799475 11.25 3.96 3.96 0.86 $714.32 $714.3299476 6.75 2.48 2.48 0.52 $433.61 $433.6199477 7.00 2.55 2.55 0.38 $440.55 $440.5599478 2.75 1.03 1.03 0.18 $175.94 $175.9499479 2.50 0.98 0.98 0.16 $161.78 $161.7899480 2.40 0.87 0.87 0.16 $152.36 $152.3699499 0.00 0.00 0.00 0.00 $0.00 $0.0099500 0.00 0.00 0.00 0.00 $0.00 $0.0099501 0.00 0.00 0.00 0.00 $0.00 $0.0099502 0.00 0.00 0.00 0.00 $0.00 $0.0099503 0.00 0.00 0.00 0.00 $0.00 $0.0099504 0.00 0.00 0.00 0.00 $0.00 $0.0099505 0.00 0.00 0.00 0.00 $0.00 $0.0099506 0.00 0.00 0.00 0.00 $0.00 $0.0099507 0.00 0.00 0.00 0.00 $0.00 $0.0099509 0.00 0.00 0.00 0.00 $0.00 $0.0099510 0.00 0.00 0.00 0.00 $0.00 $0.0099511 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 337 of 387 Effective January 2012

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99512 0.00 0.00 0.00 0.00 $0.00 $0.0099600 0.00 0.00 0.00 0.00 $0.00 $0.0099601 0.00 0.00 0.00 0.00 $0.00 $0.0099602 0.00 0.00 0.00 0.00 $0.00 $0.0099605 0.00 0.00 0.00 0.00 $0.00 $0.0099606 0.00 0.00 0.00 0.00 $0.00 $0.0099607 0.00 0.00 0.00 0.00 $0.00 $0.00

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20100 10.38 5.30 5.30 1.96 $1,049.85 $1,049.8520101 3.23 9.07 2.16 0.69 $785.75 $363.3020102 3.98 9.19 2.61 0.80 $843.40 $441.1320103 5.34 10.83 4.03 0.99 $1,034.27 $618.552014F 0.00 0.00 0.00 0.00 $0.00 $0.002015F 0.00 0.00 0.00 0.00 $0.00 $0.0020150 14.75 11.62 11.62 2.93 $1,751.54 $1,751.542016F 0.00 0.00 0.00 0.00 $0.00 $0.002018F 0.00 0.00 0.00 0.00 $0.00 $0.002019F 0.00 0.00 0.00 0.00 $0.00 $0.00

Maryland Workers' Compensation Commission Calendar Year 2012 Medical Fee Guide RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MARYLAND WORKERS' COMPENATION COMMISSION REIMBURSEMENT Orthopedic & Neurological/Surgical Codes /Procedures

MRA 2012

1/ The five character codes included in the Maryland Workers' Compensation Commission Guide of Medical and Surgical Fees are obtained from Current Procedural Terminology (CPT®), copyright 2011 by the American Medical Association (AMA).CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.

The responsibility for the content of the Maryland Workers' Compensation Commission Guide of Medical and Surgical Fees is with the MD WCC and no endorsement of the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in the Maryland Workers' Compensation Commission Guide of Medical and Surgical Fees. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use.

The AMA does not directly or indirectly practice medicine or dispense medical services.The AMA assumes no liability for data

CPT is a registered trademark of the American Medical Association

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2020F 0.00 0.00 0.00 0.00 $0.00 $0.0020200 1.46 4.26 1.00 0.33 $366.18 $166.8820205 2.35 5.30 1.58 0.56 $496.16 $268.7320206 0.99 6.16 0.65 0.10 $439.98 $103.122021F 0.00 0.00 0.00 0.00 $0.00 $0.002022F 0.00 0.00 0.00 0.00 $0.00 $0.0020220 1.27 3.51 0.76 0.11 $294.67 $126.5420225 1.87 15.12 1.17 0.23 $1,046.86 $194.022024F 0.00 0.00 0.00 0.00 $0.00 $0.0020240 3.28 2.72 2.72 0.52 $388.97 $388.9720245 8.95 7.87 7.87 1.65 $1,104.29 $1,104.2920250 5.19 4.83 4.83 1.22 $674.33 $674.3320251 5.72 5.16 5.16 1.32 $731.56 $731.5620500 1.28 1.77 1.17 0.12 $189.54 $152.8520501 0.76 2.75 0.29 0.07 $216.33 $65.9320520 1.90 3.68 2.09 0.30 $353.89 $256.6820525 3.54 10.01 3.17 0.64 $857.59 $439.4320526 0.94 1.12 0.58 0.14 $131.68 $98.6720527 1.00 1.08 0.60 0.15 $133.34 $104.0020550 0.75 0.85 0.37 0.08 $100.27 $70.9220551 0.75 0.89 0.41 0.08 $102.71 $73.3720552 0.66 0.85 0.36 0.07 $94.45 $64.4920553 0.75 0.99 0.41 0.07 $108.16 $72.7020555 6.00 2.83 2.83 0.86 $574.22 $574.222060F 0.00 0.00 0.00 0.00 $0.00 $0.0020600 0.66 0.86 0.40 0.07 $95.06 $66.9320605 0.68 0.92 0.43 0.08 $100.54 $70.5820610 0.79 1.14 0.55 0.12 $122.98 $86.9120612 0.70 0.95 0.44 0.08 $103.52 $72.3420615 2.33 4.19 2.06 0.29 $409.01 $278.7920650 2.28 3.27 1.90 0.29 $349.90 $266.1420660 4.00 2.06 2.06 1.10 $428.81 $428.8120661 5.26 7.85 7.85 1.65 $891.87 $891.8720662 6.38 5.79 5.79 0.61 $760.13 $760.1320663 5.74 5.10 5.10 1.14 $716.94 $716.9420664 10.06 11.66 11.66 3.61 $1,531.25 $1,531.2520665 1.36 1.60 1.15 0.11 $183.05 $155.5420670 1.79 9.31 2.27 0.30 $691.79 $261.3920680 5.96 11.12 5.47 1.06 $1,092.19 $746.7720690 8.78 6.65 6.65 1.62 $1,017.95 $1,017.95

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20692 16.27 13.21 13.21 2.80 $1,927.00 $1,927.0020693 6.06 6.21 6.21 1.08 $799.08 $799.0820694 4.28 7.42 4.86 0.76 $749.67 $593.1620696 17.56 13.55 13.55 1.25 $1,917.44 $1,917.4420697 0.00 57.19 57.19 0.01 $3,497.03 $3,497.0320802 42.62 21.78 21.78 3.05 $3,975.87 $3,975.8720805 51.46 23.16 23.16 10.14 $5,042.72 $5,042.7220808 63.09 42.39 42.39 12.43 $7,037.91 $7,037.9120816 31.95 26.51 26.51 3.99 $3,717.53 $3,717.5320822 26.66 21.32 21.32 5.27 $3,183.49 $3,183.4920824 31.95 26.50 26.50 6.29 $3,871.50 $3,871.5020827 27.48 22.09 22.09 5.42 $3,287.58 $3,287.5820838 42.88 29.36 29.36 3.06 $4,454.84 $4,454.8420900 3.00 8.82 2.94 0.56 $748.56 $389.0820902 4.58 3.85 3.85 0.87 $555.98 $555.9820910 5.53 7.04 7.04 0.71 $794.62 $794.6220912 6.54 6.86 6.86 0.99 $860.24 $860.2420920 5.51 5.64 5.64 0.69 $706.54 $706.5420922 6.93 9.55 6.38 1.28 $1,066.51 $872.7120924 6.68 7.01 7.01 1.20 $891.54 $891.5420926 5.79 5.92 5.92 1.17 $771.95 $771.9520930 0.00 0.00 0.00 0.00 $0.00 $0.0020931 1.81 0.96 0.96 0.56 $199.92 $199.9220936 0.00 0.00 0.00 0.00 $0.00 $0.0020937 2.79 1.51 1.51 0.68 $297.70 $297.7020938 3.02 1.62 1.62 0.83 $327.67 $327.6720950 1.26 5.90 1.18 0.23 $448.28 $159.7120955 40.26 28.12 28.12 6.67 $4,471.70 $4,471.7020956 41.18 28.52 28.52 8.13 $4,646.94 $4,646.9420957 42.61 28.22 28.22 8.41 $4,729.26 $4,729.2620962 39.21 19.88 19.88 7.73 $3,979.09 $3,979.0920969 45.43 31.03 31.03 6.67 $4,945.51 $4,945.5120970 44.58 29.05 29.05 8.81 $4,919.64 $4,919.6420972 44.51 17.71 17.71 3.43 $3,860.76 $3,860.7620973 47.27 30.20 30.20 3.38 $4,778.96 $4,778.9620974 0.62 1.42 0.71 0.12 $130.36 $86.9620975 2.60 2.02 2.02 0.59 $311.96 $311.9620979 0.62 0.86 0.28 0.08 $93.44 $57.9820982 7.27 103.11 3.13 0.80 $6,773.58 $661.2220985 2.50 1.36 1.36 0.49 $259.16 $259.16

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20999 0.00 0.00 0.00 0.00 $0.00 $0.0021010 11.04 9.23 9.23 1.42 $1,291.59 $1,291.5921011 2.99 6.97 4.28 0.45 $627.49 $463.0421012 4.45 4.84 4.84 0.72 $598.98 $598.9821013 5.42 9.36 5.80 0.82 $937.56 $719.9121014 7.13 7.22 7.22 1.16 $927.45 $927.4521015 9.89 8.57 8.57 1.86 $1,215.00 $1,215.0021016 15.26 12.75 12.75 2.91 $1,848.47 $1,848.4721025 10.03 14.64 10.56 1.44 $1,565.88 $1,316.4421026 5.70 11.55 8.12 0.83 $1,088.14 $878.4521029 8.39 12.92 9.13 1.65 $1,380.97 $1,149.2721030 4.91 9.47 6.54 0.76 $911.06 $731.9321031 3.30 7.67 4.82 0.41 $685.34 $511.1121032 3.34 7.80 4.68 0.42 $696.25 $505.5121034 17.38 19.59 14.85 2.44 $2,356.38 $2,066.6021040 4.91 9.55 6.55 0.75 $915.28 $731.8721044 12.80 11.61 11.61 1.78 $1,562.03 $1,562.0321045 18.37 15.65 15.65 2.52 $2,177.55 $2,177.5521046 14.21 16.32 16.32 1.82 $1,933.36 $1,933.3621047 20.07 15.72 15.72 2.59 $2,283.83 $2,283.8321048 14.71 16.52 16.52 1.89 $1,978.91 $1,978.9121049 19.32 14.80 14.80 2.46 $2,175.92 $2,175.9221050 11.76 11.89 11.89 2.30 $1,554.57 $1,554.5721060 11.07 11.08 11.08 2.34 $1,468.25 $1,468.2521070 8.62 8.72 8.72 1.10 $1,100.40 $1,100.4021073 3.45 7.27 3.38 0.68 $687.62 $449.8021076 13.40 13.66 9.11 1.70 $1,716.32 $1,438.1521077 33.70 33.71 23.10 4.33 $4,280.72 $3,632.0721079 22.31 23.48 15.47 2.87 $2,905.27 $2,415.5721080 25.06 26.44 16.98 3.23 $3,267.82 $2,689.4821081 22.85 24.58 15.64 2.95 $3,008.80 $2,462.2521082 20.84 24.00 15.32 2.67 $2,839.48 $2,308.8221083 19.27 23.55 14.29 1.37 $2,634.74 $2,068.6221084 22.48 26.49 16.45 2.90 $3,101.03 $2,487.2321085 8.99 11.47 6.33 3.35 $1,440.92 $1,126.6821086 24.88 25.03 16.86 3.20 $3,169.30 $2,669.8221087 24.88 24.84 16.51 3.20 $3,157.69 $2,648.4321088 0.00 0.00 0.00 0.00 $0.00 $0.0021089 0.00 0.00 0.00 0.00 $0.00 $0.0021100 4.73 15.86 6.07 0.64 $1,283.35 $684.83

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21110 5.99 16.44 12.72 0.76 $1,398.99 $1,171.5621116 0.81 3.54 0.37 0.05 $266.14 $72.3421120 5.10 14.15 9.99 1.01 $1,224.85 $970.5321121 7.81 14.01 10.26 0.54 $1,339.81 $1,110.5521122 8.71 9.71 9.71 0.61 $1,133.14 $1,133.1421123 11.34 12.68 12.68 0.80 $1,478.01 $1,478.0121125 10.80 77.23 10.42 2.14 $5,483.48 $1,399.0021127 12.44 106.90 11.17 1.59 $7,354.28 $1,501.7521137 10.24 10.22 10.22 2.00 $1,345.31 $1,345.3121138 12.87 11.63 11.63 1.82 $1,569.94 $1,569.9421139 15.02 15.31 15.31 1.06 $1,866.90 $1,866.9021141 19.57 17.66 17.66 3.85 $2,458.50 $2,458.5021142 20.28 17.60 17.60 4.00 $2,505.55 $2,505.5521143 21.05 17.90 17.90 4.49 $2,600.90 $2,600.9021145 23.94 19.55 19.55 1.69 $2,678.99 $2,678.9921146 24.87 21.88 21.88 4.90 $3,090.41 $3,090.4121147 26.47 20.23 20.23 1.88 $2,878.14 $2,878.1421150 25.96 20.89 20.89 1.84 $2,886.61 $2,886.6121151 29.02 23.93 23.93 3.74 $3,375.30 $3,375.3021154 31.29 28.74 28.74 4.01 $3,817.43 $3,817.4321155 35.22 26.27 26.27 2.50 $3,789.87 $3,789.8721159 43.14 25.28 25.28 5.53 $4,386.29 $4,386.2921160 47.19 26.71 26.71 3.36 $4,559.67 $4,559.6721172 28.20 21.65 21.65 3.62 $3,180.91 $3,180.9121175 33.56 22.08 22.08 12.03 $4,079.22 $4,079.2221179 22.65 15.70 15.70 4.46 $2,555.96 $2,555.9621180 25.58 17.50 17.50 3.29 $2,755.06 $2,755.0621181 10.28 9.36 9.36 1.31 $1,248.65 $1,248.6521182 32.58 21.06 21.06 4.18 $3,433.17 $3,433.1721183 35.70 26.19 26.19 7.02 $4,116.24 $4,116.2421184 38.62 24.13 24.13 7.62 $4,197.75 $4,197.7521188 23.15 21.25 21.25 2.98 $2,824.41 $2,824.4121193 18.90 15.92 15.92 4.04 $2,326.55 $2,326.5521194 21.82 16.39 16.39 2.80 $2,439.07 $2,439.0721195 19.16 18.30 18.30 2.45 $2,380.07 $2,380.0721196 20.83 20.19 20.19 2.67 $2,605.98 $2,605.9821198 15.71 16.49 16.49 2.18 $2,053.81 $2,053.8121199 16.73 11.23 11.23 2.15 $1,788.59 $1,788.5921206 15.59 16.73 16.73 3.09 $2,122.77 $2,122.7721208 11.42 42.71 11.47 2.25 $3,415.95 $1,506.07

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MRA 2012

21209 7.82 15.38 10.13 1.54 $1,491.35 $1,170.3921210 11.69 52.62 11.75 1.51 $3,987.53 $1,488.9121215 12.23 103.13 12.10 2.40 $7,166.22 $1,601.0321230 11.17 9.66 9.66 2.19 $1,377.07 $1,377.0721235 7.50 13.19 8.41 1.10 $1,309.57 $1,017.3421240 16.07 14.18 14.18 2.04 $1,923.78 $1,923.7821242 14.59 13.17 13.17 1.88 $1,766.57 $1,766.5721243 24.53 21.50 21.50 3.16 $2,930.77 $2,930.7721244 13.62 16.00 16.00 1.93 $1,887.43 $1,887.4321245 13.12 18.72 11.91 1.67 $2,007.62 $1,591.2921246 12.92 10.06 10.06 1.65 $1,465.40 $1,465.4021247 24.37 20.48 20.48 4.82 $2,970.83 $2,970.8321248 12.74 17.70 11.78 1.63 $1,920.83 $1,558.9021249 18.77 22.76 15.00 2.40 $2,627.05 $2,152.6421255 18.46 20.48 20.48 2.35 $2,466.56 $2,466.5621256 17.66 15.39 15.39 2.26 $2,103.54 $2,103.5421260 17.90 17.15 17.15 1.27 $2,158.34 $2,158.3421261 34.07 23.58 23.58 6.72 $3,843.22 $3,843.2221263 31.01 22.02 22.02 2.20 $3,268.92 $3,268.9221267 20.69 21.33 21.33 4.08 $2,762.43 $2,762.4321268 27.07 20.92 20.92 5.34 $3,187.21 $3,187.2121270 10.63 16.39 9.55 1.51 $1,711.91 $1,293.7421275 11.76 11.01 11.01 2.30 $1,500.77 $1,500.7721295 1.90 3.18 3.18 0.37 $328.03 $328.0321296 4.78 7.30 7.30 0.61 $760.87 $760.8721299 0.00 0.00 0.00 0.00 $0.00 $0.0021310 0.58 3.00 0.14 0.10 $223.32 $48.4821315 1.83 6.23 2.44 0.29 $505.11 $273.4021320 1.88 5.55 1.91 0.27 $465.05 $242.5221325 4.18 9.26 9.26 0.67 $850.39 $850.3921330 5.79 10.54 10.54 0.73 $1,024.82 $1,024.8221335 9.02 11.59 11.59 1.22 $1,306.82 $1,306.8221336 6.77 11.72 11.72 0.91 $1,165.15 $1,165.1521337 3.39 8.19 4.90 0.52 $729.68 $528.5421338 6.87 14.37 14.37 1.36 $1,363.13 $1,363.1321339 8.50 13.53 13.53 1.66 $1,425.23 $1,425.2321340 11.49 11.30 11.30 1.48 $1,447.93 $1,447.9321343 14.32 19.20 19.20 2.83 $2,183.61 $2,183.6121344 21.57 17.76 17.76 7.74 $2,840.53 $2,840.5321345 9.06 13.38 8.74 1.17 $1,415.18 $1,131.51

Updated December 2011 343 of 387 Effective January 2012

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MRA 2012

21346 11.45 14.57 14.57 1.48 $1,645.56 $1,645.5621347 13.53 17.92 17.92 1.71 $1,984.87 $1,984.8721348 17.52 12.90 12.90 2.25 $1,942.63 $1,942.6321355 4.45 7.98 4.63 0.56 $780.20 $575.3921356 4.83 9.31 5.68 0.71 $893.34 $671.4121360 7.19 7.69 7.69 0.91 $942.81 $942.8121365 16.77 13.55 13.55 2.80 $1,976.41 $1,976.4121366 18.60 13.47 13.47 3.67 $2,134.73 $2,134.7321385 9.57 9.80 9.80 1.22 $1,228.86 $1,228.8621386 9.57 8.07 8.07 1.88 $1,167.46 $1,167.4621387 10.11 10.05 10.05 1.97 $1,325.46 $1,325.4621390 11.23 10.56 10.56 1.89 $1,415.37 $1,415.3721395 14.70 12.59 12.59 1.88 $1,737.41 $1,737.4121400 1.50 3.85 2.81 0.27 $339.37 $275.7921401 3.68 10.05 4.65 0.72 $873.43 $543.3021406 7.42 8.21 8.21 0.95 $990.46 $990.4621407 9.02 8.70 8.70 1.59 $1,155.00 $1,155.0021408 12.78 11.71 11.71 2.52 $1,616.73 $1,616.7321421 6.02 16.20 12.31 1.18 $1,414.26 $1,176.4421422 8.73 9.91 9.91 1.13 $1,181.46 $1,181.4621423 10.85 10.79 10.79 2.14 $1,424.48 $1,424.4821431 7.90 10.71 10.71 1.55 $1,211.09 $1,211.0921432 8.82 10.74 10.74 1.71 $1,276.34 $1,276.3421433 26.29 17.73 17.73 5.19 $2,937.46 $2,937.4621435 20.26 17.84 17.84 2.60 $2,424.99 $2,424.9921436 30.30 25.06 25.06 5.97 $3,667.52 $3,667.5221440 3.44 12.75 9.67 0.67 $1,021.40 $833.1021445 6.26 15.38 11.21 0.80 $1,352.33 $1,097.3921450 3.71 13.43 10.07 0.65 $1,077.08 $871.6721451 5.65 15.79 12.25 0.72 $1,337.10 $1,120.6821452 2.40 15.17 7.61 0.48 $1,097.05 $634.8721453 6.64 18.98 15.34 1.05 $1,610.97 $1,388.4321454 7.36 9.06 9.06 0.93 $1,037.64 $1,037.6421461 9.31 52.00 17.28 1.40 $3,806.01 $1,683.3821462 11.01 53.31 18.11 1.42 $3,984.74 $1,832.7621465 13.12 12.44 12.44 2.59 $1,685.52 $1,685.5221470 17.54 15.30 15.30 2.90 $2,134.18 $2,134.1821480 0.61 2.15 0.24 0.10 $173.08 $56.3121485 4.77 14.90 11.63 0.61 $1,224.93 $1,025.0221490 12.95 11.94 11.94 2.56 $1,643.21 $1,643.21

Updated December 2011 344 of 387 Effective January 2012

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MRA 2012

21495 6.79 13.61 13.61 0.86 $1,278.48 $1,278.4821497 4.64 15.99 12.45 0.90 $1,303.62 $1,087.2021499 0.00 0.00 0.00 0.00 $0.00 $0.0021501 3.98 8.64 4.77 0.75 $806.42 $569.8221502 7.55 6.53 6.53 1.61 $939.55 $939.5521510 6.20 7.60 7.60 1.46 $917.61 $917.6121550 2.11 5.28 2.25 0.30 $463.73 $278.4821552 6.49 5.42 5.42 1.28 $788.84 $788.8421554 11.13 8.38 8.38 2.08 $1,289.14 $1,289.1421555 3.96 7.55 4.38 0.78 $740.65 $546.8521556 7.66 6.44 6.44 1.44 $928.92 $928.9221557 14.75 9.87 9.87 2.79 $1,635.14 $1,635.1421558 21.58 14.26 14.26 4.08 $2,381.14 $2,381.1421600 7.26 8.05 8.05 1.57 $1,013.19 $1,013.1921610 15.91 13.32 13.32 5.72 $2,109.38 $2,109.3821615 10.45 6.40 6.40 2.46 $1,154.71 $1,154.7121616 12.69 9.32 9.32 3.04 $1,500.41 $1,500.4121620 7.28 6.46 6.46 1.62 $920.49 $920.4921627 7.30 7.41 7.41 1.65 $981.73 $981.7321630 19.18 13.96 13.96 4.04 $2,222.75 $2,222.7521632 19.68 11.99 11.99 4.94 $2,191.42 $2,191.4221685 15.26 12.51 12.51 1.96 $1,769.94 $1,769.9421700 6.31 3.76 3.76 1.50 $691.84 $691.8421705 9.92 6.24 6.24 2.34 $1,106.53 $1,106.5321720 5.80 7.02 7.02 2.07 $900.26 $900.2621725 7.19 5.49 5.49 1.42 $842.59 $842.5921740 17.57 14.36 14.36 3.47 $2,116.74 $2,116.7421742 0.00 0.00 0.00 0.00 $0.00 $0.0021743 0.00 0.00 0.00 0.00 $0.00 $0.0021750 11.40 6.68 6.68 2.71 $1,243.00 $1,243.0021800 1.01 2.00 2.09 0.18 $192.18 $197.6821805 2.88 4.34 4.34 0.67 $475.20 $475.2021810 7.03 6.55 6.55 1.63 $912.35 $912.3521820 1.36 2.47 2.56 0.26 $246.32 $251.8221825 7.76 6.88 6.88 1.82 $987.08 $987.0821899 0.00 0.00 0.00 0.00 $0.00 $0.0021920 2.11 5.22 2.34 0.34 $462.75 $286.6721925 4.63 7.40 4.74 0.93 $779.91 $617.2921930 4.94 7.92 4.81 1.02 $835.49 $645.3621931 6.88 5.59 5.59 1.42 $830.96 $830.96

Updated December 2011 345 of 387 Effective January 2012

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MRA 2012

21932 9.82 7.62 7.62 2.08 $1,167.70 $1,167.7021933 11.13 8.37 8.37 2.35 $1,306.67 $1,306.6721935 15.72 11.43 11.43 3.21 $1,814.26 $1,814.2621936 22.55 14.38 14.38 4.60 $2,478.94 $2,478.9422010 12.75 11.70 11.70 3.29 $1,666.15 $1,666.1522015 12.64 11.53 11.53 3.08 $1,635.35 $1,635.3522100 11.00 11.97 11.97 3.96 $1,627.53 $1,627.5322101 11.08 12.01 12.01 3.97 $1,635.23 $1,635.2322102 11.08 10.30 10.30 2.67 $1,443.31 $1,443.3122103 2.34 1.24 1.24 0.64 $252.75 $252.7522110 14.00 12.80 12.80 5.04 $1,922.56 $1,922.5622112 14.07 12.15 12.15 5.05 $1,887.50 $1,887.5022114 14.07 12.42 12.42 2.78 $1,751.44 $1,751.4422116 2.32 1.24 1.24 0.60 $248.92 $248.9222206 37.18 24.80 24.80 7.32 $4,136.13 $4,136.1322207 36.68 24.53 24.53 9.20 $4,217.37 $4,217.3722208 9.66 5.15 5.15 2.59 $1,041.81 $1,041.8122210 25.38 20.00 20.00 6.75 $3,129.00 $3,129.0022212 20.99 17.29 17.29 4.97 $2,592.43 $2,592.4322214 21.02 17.44 17.44 5.12 $2,613.40 $2,613.4022216 6.03 3.26 3.26 1.51 $645.92 $645.9222220 22.94 18.30 18.30 6.42 $2,863.24 $2,863.2422222 23.09 17.23 17.23 4.55 $2,680.73 $2,680.7322224 23.09 18.04 18.04 5.38 $2,786.03 $2,786.0322226 6.03 3.23 3.23 1.58 $648.79 $648.7922305 2.13 3.02 2.52 0.41 $334.10 $303.5322310 3.89 4.22 3.53 0.78 $533.06 $490.8822315 10.11 13.20 10.02 2.55 $1,557.02 $1,362.6122318 22.72 17.78 17.78 7.68 $2,903.54 $2,903.5422319 25.33 19.35 19.35 9.11 $3,245.02 $3,245.0222325 19.87 16.77 16.77 5.69 $2,544.93 $2,544.9322326 20.84 16.66 16.66 6.30 $2,634.72 $2,634.7222327 20.77 17.20 17.20 5.62 $2,618.02 $2,618.0222328 4.60 2.45 2.45 1.36 $504.47 $504.4722505 1.87 1.34 1.34 0.29 $208.44 $208.4422520 9.22 55.88 4.78 1.06 $4,015.22 $891.1822521 8.65 56.20 4.67 1.01 $3,998.80 $848.4722522 4.30 1.82 1.82 0.54 $393.67 $393.6722523 9.04 214.18 5.96 1.78 $13,731.10 $1,001.4122524 8.54 213.01 5.73 1.68 $13,624.24 $952.01

Updated December 2011 346 of 387 Effective January 2012

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MRA 2012

22525 4.47 134.18 2.23 0.95 $8,522.89 $456.0222526 6.10 59.79 3.10 0.54 $4,040.74 $574.9522527 3.03 50.98 1.10 0.24 $3,306.26 $256.8022532 25.99 19.03 19.03 7.57 $3,159.73 $3,159.7322533 24.79 18.37 18.37 6.38 $2,970.72 $2,970.7222534 5.99 3.19 3.19 1.59 $644.72 $644.7222548 27.06 20.97 20.97 9.72 $3,484.07 $3,484.0722551 25.00 18.41 18.41 7.57 $3,065.16 $3,065.1622552 6.50 3.40 3.40 1.78 $699.52 $699.5222554 17.69 14.55 14.55 5.47 $2,269.65 $2,269.6522556 24.70 17.80 17.80 6.63 $2,947.52 $2,947.5222558 23.53 16.28 16.28 5.66 $2,722.43 $2,722.4322585 5.52 2.89 2.89 1.59 $599.48 $599.4822590 21.76 17.77 17.77 7.05 $2,805.64 $2,805.6422595 20.64 17.14 17.14 6.57 $2,670.76 $2,670.7622600 17.40 15.26 15.26 5.32 $2,286.38 $2,286.3822610 17.28 14.96 14.96 4.86 $2,230.25 $2,230.2522612 23.53 17.36 17.36 6.23 $2,826.77 $2,826.7722614 6.43 3.44 3.44 1.77 $697.29 $697.2922630 22.09 17.24 17.24 6.27 $2,739.71 $2,739.7122632 5.22 2.78 2.78 1.50 $569.54 $569.5422633 27.75 19.66 19.66 7.35 $3,284.19 $3,284.1922634 8.16 4.36 4.36 2.25 $884.81 $884.8122800 19.50 15.55 15.55 4.90 $2,396.07 $2,396.0722802 32.11 22.44 22.44 7.51 $3,714.44 $3,714.4422804 37.50 25.33 25.33 8.53 $4,268.18 $4,268.1822808 27.51 19.05 19.05 7.27 $3,227.78 $3,227.7822810 31.50 20.59 20.59 7.93 $3,594.66 $3,594.6622812 34.25 24.01 24.01 6.75 $3,881.83 $3,881.8322818 34.33 22.89 22.89 6.76 $3,818.61 $3,818.6122819 39.38 27.38 27.38 14.15 $4,878.83 $4,878.8322830 11.22 9.79 9.79 2.90 $1,435.60 $1,435.6022840 12.52 6.69 6.69 3.48 $1,359.47 $1,359.4722841 0.00 0.00 0.00 0.00 $0.00 $0.0022842 12.56 6.72 6.72 3.44 $1,360.90 $1,360.9022843 13.44 7.20 7.20 3.50 $1,444.65 $1,444.6522844 16.42 8.97 8.97 3.69 $1,736.19 $1,736.1922845 11.94 6.32 6.32 3.66 $1,315.75 $1,315.7522846 12.40 6.57 6.57 3.77 $1,364.76 $1,364.7622847 13.78 7.51 7.51 4.95 $1,580.52 $1,580.52

Updated December 2011 347 of 387 Effective January 2012

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MRA 2012

22848 5.99 3.27 3.27 1.39 $636.17 $636.1722849 19.17 14.14 14.14 5.14 $2,307.11 $2,307.1122850 9.82 8.86 8.86 2.61 $1,279.13 $1,279.1322851 6.70 3.56 3.56 1.89 $728.14 $728.1422852 9.37 8.57 8.57 2.41 $1,222.20 $1,222.2022855 15.86 12.47 12.47 4.75 $1,989.36 $1,989.3622856 24.05 17.84 17.84 7.28 $2,956.45 $2,956.4522857 27.13 15.99 15.99 5.78 $2,918.82 $2,918.8222861 33.36 16.55 16.55 9.12 $3,534.11 $3,534.1122862 32.63 22.77 22.77 6.42 $3,691.12 $3,691.1222864 29.40 19.27 19.27 8.04 $3,401.16 $3,401.1622865 31.75 22.66 22.66 6.25 $3,622.60 $3,622.6022899 0.00 0.00 0.00 0.00 $0.00 $0.0022999 0.00 0.00 0.00 0.00 $0.00 $0.0023000 4.48 11.37 5.40 0.86 $1,009.33 $644.3523020 9.36 9.08 9.08 1.80 $1,211.81 $1,211.8123030 3.47 8.65 3.33 0.68 $773.13 $447.8923031 2.79 8.84 3.03 0.53 $735.75 $380.5523035 9.16 9.04 9.04 1.80 $1,197.92 $1,197.9223040 9.75 9.43 9.43 1.91 $1,262.92 $1,262.9223044 7.59 7.73 7.73 1.50 $1,007.81 $1,007.8123065 2.30 3.77 2.33 0.38 $387.66 $299.6323066 4.30 10.66 5.09 0.84 $954.27 $613.7523071 5.91 5.23 5.23 1.21 $739.32 $739.3223073 10.13 8.28 8.28 2.04 $1,223.10 $1,223.1023075 4.21 7.84 4.04 0.86 $778.06 $545.7523076 7.41 6.99 6.99 1.51 $952.94 $952.9423077 17.66 12.67 12.67 3.59 $2,026.64 $2,026.6423078 22.55 14.60 14.60 4.82 $2,507.18 $2,507.1823100 6.20 7.14 7.14 1.22 $873.36 $873.3623101 5.72 6.44 6.44 1.13 $797.04 $797.0423105 8.48 8.55 8.55 1.66 $1,119.63 $1,119.6323106 6.13 7.05 7.05 1.21 $863.18 $863.1823107 8.87 8.77 8.77 1.71 $1,158.76 $1,158.7623120 7.39 8.28 8.28 1.46 $1,027.30 $1,027.3023125 9.64 9.16 9.16 1.89 $1,238.77 $1,238.7723130 7.77 8.52 8.52 1.52 $1,067.75 $1,067.7523140 7.12 6.96 6.96 1.42 $928.46 $928.4623145 9.40 9.06 9.06 1.85 $1,216.24 $1,216.2423146 8.08 8.35 8.35 1.59 $1,079.80 $1,079.80

Updated December 2011 348 of 387 Effective January 2012

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MRA 2012

23150 8.91 8.68 8.68 1.71 $1,155.55 $1,155.5523155 10.86 10.20 10.20 2.14 $1,388.98 $1,388.9823156 9.11 8.90 8.90 1.80 $1,186.50 $1,186.5023170 7.21 7.56 7.56 1.42 $970.29 $970.2923172 7.31 7.69 7.69 1.46 $986.65 $986.6523174 10.05 10.14 10.14 1.97 $1,327.53 $1,327.5323180 8.99 8.98 8.98 1.81 $1,185.19 $1,185.1923182 8.61 9.00 9.00 1.69 $1,156.60 $1,156.6023184 9.90 9.80 9.80 1.91 $1,294.13 $1,294.1323190 7.47 7.64 7.64 1.48 $994.09 $994.0923195 10.36 9.69 9.69 2.03 $1,321.79 $1,321.7923200 22.71 15.79 15.79 4.48 $2,566.24 $2,566.2423210 27.21 17.81 17.81 5.36 $3,006.43 $3,006.4323220 30.21 19.07 19.07 5.96 $3,295.49 $3,295.4923330 1.90 4.75 2.21 0.35 $422.66 $267.3823331 7.63 8.22 8.22 1.50 $1,040.05 $1,040.0523332 12.37 11.14 11.14 2.40 $1,550.35 $1,550.3523395 18.54 15.70 15.70 3.59 $2,262.25 $2,262.2523397 16.76 13.44 13.44 3.31 $2,003.39 $2,003.3923400 13.87 11.88 11.88 2.74 $1,704.30 $1,704.3023405 8.54 8.25 8.25 1.66 $1,104.72 $1,104.7223406 11.01 9.67 9.67 2.16 $1,366.51 $1,366.5123410 11.39 10.55 10.55 2.22 $1,446.09 $1,446.0923412 11.93 10.87 10.87 2.31 $1,502.61 $1,502.6123415 9.23 8.87 8.87 1.81 $1,192.20 $1,192.2023420 13.54 12.31 12.31 2.65 $1,705.65 $1,705.6523430 10.17 9.78 9.78 1.97 $1,312.39 $1,312.3923440 10.64 9.51 9.51 2.07 $1,329.50 $1,329.5023450 13.70 11.41 11.41 2.71 $1,663.82 $1,663.8223455 14.67 11.97 11.97 2.86 $1,763.65 $1,763.6523460 15.82 13.07 13.07 3.13 $1,914.87 $1,914.8723462 15.72 12.66 12.66 3.12 $1,883.41 $1,883.4123465 16.30 13.40 13.40 3.21 $1,967.89 $1,967.8923466 15.80 14.07 14.07 3.12 $1,974.19 $1,974.1923470 17.89 14.16 14.16 3.51 $2,125.52 $2,125.5223472 22.65 16.97 16.97 4.42 $2,630.91 $2,630.9123480 11.54 10.24 10.24 2.26 $1,438.41 $1,438.4123485 13.91 11.58 11.58 2.72 $1,686.90 $1,686.9023490 12.16 11.49 11.49 2.40 $1,559.73 $1,559.7323491 14.54 12.35 12.35 2.87 $1,780.11 $1,780.11

Updated December 2011 349 of 387 Effective January 2012

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Treatment

MRA 2012

23500 2.21 3.73 3.80 0.41 $382.08 $386.3623505 3.83 5.58 5.02 0.72 $608.74 $574.5023515 9.69 9.51 9.51 1.89 $1,263.03 $1,263.0323525 3.79 6.38 5.58 0.73 $656.03 $607.1223530 7.48 7.55 7.55 1.48 $989.16 $989.1623532 8.20 8.42 8.42 1.61 $1,092.30 $1,092.3023540 2.36 3.72 3.78 0.42 $390.73 $394.4023545 3.43 5.74 4.86 0.60 $587.56 $533.7623550 7.59 7.64 7.64 1.47 $1,000.29 $1,000.2923552 8.82 8.77 8.77 1.70 $1,155.23 $1,155.2323570 2.36 3.92 4.10 0.44 $404.30 $415.3023575 4.23 6.50 5.78 0.83 $695.27 $651.2523585 14.23 11.79 11.79 2.76 $1,720.74 $1,720.7423600 3.11 5.72 5.09 0.60 $568.02 $529.5123605 5.06 7.52 6.40 0.98 $815.22 $746.7423615 12.30 11.26 11.26 2.40 $1,553.68 $1,553.6823616 18.37 14.77 14.77 3.58 $2,194.99 $2,194.9923620 2.55 4.79 4.39 0.49 $471.72 $447.2723625 4.10 6.09 5.36 0.78 $659.40 $614.7723630 10.57 10.21 10.21 2.07 $1,368.29 $1,368.2923650 3.53 4.81 4.07 0.61 $537.10 $491.8623655 4.76 5.88 5.88 0.88 $691.06 $691.0623660 7.66 7.93 7.93 1.50 $1,024.04 $1,024.0423665 4.66 6.77 5.95 0.88 $739.75 $689.6223670 12.28 10.83 10.83 2.40 $1,526.25 $1,526.2523675 6.27 8.47 7.10 1.20 $957.33 $873.5823680 13.15 11.47 11.47 2.57 $1,626.59 $1,626.5923700 2.57 2.65 2.65 0.49 $342.04 $342.0423800 14.73 12.44 12.44 2.93 $1,800.52 $1,800.5223802 18.42 15.40 15.40 3.62 $2,239.06 $2,239.0623900 20.72 15.46 15.46 4.10 $2,406.63 $2,406.6323920 16.23 13.30 13.30 3.20 $1,957.10 $1,957.1023921 5.72 5.41 5.41 1.36 $749.53 $749.5323929 0.00 0.00 0.00 0.00 $0.00 $0.0023930 2.99 6.80 2.74 0.61 $627.85 $379.6423931 1.84 6.20 2.50 0.34 $507.21 $281.0023935 6.38 7.16 7.16 1.24 $886.23 $886.2324000 6.08 6.71 6.71 1.17 $836.84 $836.8424006 9.74 9.34 9.34 1.82 $1,250.80 $1,250.8024071 5.70 5.15 5.15 1.16 $719.05 $719.05

Updated December 2011 350 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

24073 10.13 8.33 8.33 2.01 $1,224.14 $1,224.1424075 4.24 9.36 4.57 0.84 $871.36 $578.5224076 7.41 6.93 6.93 1.48 $947.25 $947.2524077 15.72 11.31 11.31 3.18 $1,804.90 $1,804.9024079 20.61 14.32 14.32 4.38 $2,349.45 $2,349.4524100 5.07 6.05 6.05 1.01 $727.93 $727.9324101 6.30 7.10 7.10 1.21 $875.97 $875.9724102 8.26 8.22 8.22 1.55 $1,079.47 $1,079.4724105 3.78 5.67 5.67 0.72 $611.38 $611.3824110 7.58 8.07 8.07 1.50 $1,028.02 $1,028.0224115 10.12 9.42 9.42 1.99 $1,288.86 $1,288.8624116 12.23 10.61 10.61 2.41 $1,510.61 $1,510.6124120 6.82 7.34 7.34 1.29 $925.78 $925.7824125 8.14 8.33 8.33 1.59 $1,082.02 $1,082.0224126 8.62 8.64 8.64 1.69 $1,135.16 $1,135.1624130 6.42 7.24 7.24 1.20 $890.72 $890.7224134 10.22 9.69 9.69 2.00 $1,311.77 $1,311.7724136 8.40 8.14 8.14 1.65 $1,089.31 $1,089.3124138 8.50 9.51 9.51 1.66 $1,179.47 $1,179.4724140 9.55 9.39 9.39 1.78 $1,240.29 $1,240.2924145 7.81 8.06 8.06 1.54 $1,043.26 $1,043.2624147 7.84 8.95 8.95 1.51 $1,097.37 $1,097.3724149 16.22 15.19 15.19 2.98 $2,057.29 $2,057.2924150 23.46 16.32 16.32 4.63 $2,651.65 $2,651.6524152 19.99 14.27 14.27 3.93 $2,280.67 $2,280.6724155 12.09 10.49 10.49 2.38 $1,493.24 $1,493.2424160 8.00 8.23 8.23 1.50 $1,061.84 $1,061.8424164 6.43 6.84 6.84 1.27 $871.55 $871.5524200 1.81 3.86 1.95 0.31 $360.41 $243.6424201 4.70 10.62 5.07 0.93 $980.77 $641.4724220 1.31 3.30 0.55 0.12 $284.79 $116.6724300 4.04 7.19 7.19 0.72 $719.19 $719.1924301 10.38 9.68 9.68 2.03 $1,322.33 $1,322.3324305 7.62 8.00 8.00 1.36 $1,016.62 $1,016.6224310 6.12 6.67 6.67 1.18 $837.36 $837.3624320 10.86 9.82 9.82 2.14 $1,365.75 $1,365.7524330 9.79 9.28 9.28 1.92 $1,256.71 $1,256.7124331 10.95 8.50 8.50 2.16 $1,291.55 $1,291.5524332 7.91 8.41 8.41 1.55 $1,071.05 $1,071.0524340 8.08 8.35 8.35 1.58 $1,079.13 $1,079.13

Updated December 2011 351 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

24341 9.49 10.53 10.53 1.85 $1,311.26 $1,311.2624342 10.86 9.92 9.92 2.07 $1,367.16 $1,367.1624343 9.16 9.83 9.83 1.67 $1,237.48 $1,237.4824344 15.21 14.10 14.10 3.01 $1,934.86 $1,934.8624345 9.16 9.71 9.71 1.67 $1,230.14 $1,230.1424346 15.21 13.96 13.96 3.01 $1,926.30 $1,926.3024357 5.44 6.52 6.52 1.03 $779.19 $779.1924358 6.66 7.42 7.42 1.25 $918.82 $918.8224359 8.98 8.65 8.65 1.67 $1,155.03 $1,155.0324360 12.67 11.20 11.20 2.48 $1,576.57 $1,576.5724361 14.41 12.28 12.28 2.84 $1,766.38 $1,766.3824362 15.32 12.74 12.74 3.04 $1,860.03 $1,860.0324363 22.65 17.15 17.15 4.21 $2,627.80 $2,627.8024365 8.62 8.39 8.39 1.69 $1,119.88 $1,119.8824366 9.36 8.86 8.86 1.77 $1,196.34 $1,196.3424400 11.33 10.58 10.58 2.19 $1,442.48 $1,442.4824410 15.11 9.92 9.92 2.99 $1,672.24 $1,672.2424420 13.73 12.60 12.60 2.71 $1,738.28 $1,738.2824430 15.25 12.88 12.88 2.95 $1,858.53 $1,858.5324435 14.99 13.72 13.72 2.93 $1,893.66 $1,893.6624470 8.93 8.65 8.65 1.77 $1,158.89 $1,158.8924495 8.41 9.11 9.11 1.80 $1,159.27 $1,159.2724498 12.28 10.76 10.76 2.41 $1,522.64 $1,522.6424500 3.41 6.30 5.35 0.64 $623.34 $565.2624505 5.39 8.14 6.78 1.05 $876.71 $793.5724515 12.12 11.26 11.26 2.34 $1,539.35 $1,539.3524516 12.19 10.70 10.70 2.38 $1,511.80 $1,511.8024530 3.69 6.66 5.60 0.69 $664.74 $599.9324535 7.11 9.47 8.12 1.37 $1,077.97 $995.4424538 9.77 10.09 10.09 1.92 $1,305.09 $1,305.0924545 13.15 11.52 11.52 2.56 $1,628.98 $1,628.9824546 14.91 12.81 12.81 2.90 $1,831.43 $1,831.4324560 2.98 5.78 4.77 0.56 $561.56 $499.8224565 5.78 8.44 7.19 1.14 $923.42 $847.0024566 9.06 10.08 10.08 1.80 $1,255.77 $1,255.7724575 9.71 9.93 9.93 1.88 $1,289.18 $1,289.1824576 3.06 6.17 5.17 0.59 $592.00 $530.8624577 6.01 8.67 7.34 1.18 $953.34 $872.0324579 11.44 10.86 10.86 2.20 $1,466.56 $1,466.5624582 10.14 11.40 11.40 1.99 $1,411.06 $1,411.06

Updated December 2011 352 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

24586 15.78 13.12 13.12 3.05 $1,910.26 $1,910.2624587 15.79 13.07 13.07 2.93 $1,899.71 $1,899.7124600 4.37 5.45 4.54 0.76 $634.39 $578.7524605 5.64 6.93 6.93 1.09 $819.73 $819.7324615 9.83 9.17 9.17 1.84 $1,246.90 $1,246.9024620 7.22 7.54 7.54 1.36 $965.60 $965.6024635 8.80 9.72 9.72 1.67 $1,210.15 $1,210.1524640 1.25 2.47 1.22 0.23 $238.01 $161.5924650 2.31 4.85 4.20 0.42 $456.95 $417.2124655 4.62 7.33 6.20 0.86 $770.35 $701.2724665 8.36 9.12 9.12 1.59 $1,142.91 $1,142.9124666 9.86 9.76 9.76 1.86 $1,286.03 $1,286.0324670 2.69 5.25 4.41 0.50 $508.53 $457.1824675 4.91 7.48 6.33 0.93 $800.82 $730.5224685 8.37 9.16 9.16 1.62 $1,147.94 $1,147.9424800 11.41 10.41 10.41 2.25 $1,440.70 $1,440.7024802 14.32 12.19 12.19 2.83 $1,755.05 $1,755.0524900 10.18 9.12 9.12 2.01 $1,275.30 $1,275.3024920 10.13 7.73 7.73 1.99 $1,186.12 $1,186.1224925 7.30 7.75 7.75 1.44 $988.40 $988.4024930 10.83 9.57 9.57 2.14 $1,348.75 $1,348.7524931 13.44 8.09 8.09 0.95 $1,327.67 $1,327.6724935 16.45 10.02 10.02 3.24 $1,771.85 $1,771.8524940 0.00 0.00 0.00 0.00 $0.00 $0.0024999 0.00 0.00 0.00 0.00 $0.00 $0.0025035 7.65 8.47 8.47 1.48 $1,055.14 $1,055.1425040 7.50 7.73 7.73 1.36 $993.25 $993.2525065 2.04 5.14 2.50 0.33 $453.18 $291.7825066 4.27 5.60 5.60 0.80 $640.52 $640.5225071 5.91 5.52 5.52 1.17 $754.36 $754.3625073 7.13 7.26 7.26 1.36 $943.34 $943.3425075 3.96 9.56 4.74 0.76 $862.19 $567.5125076 6.74 7.20 7.20 1.28 $911.97 $911.9725077 12.93 10.40 10.40 2.61 $1,551.28 $1,551.2825078 17.69 13.23 13.23 3.78 $2,075.36 $2,075.3625085 5.64 6.58 6.58 1.10 $799.01 $799.0125100 4.02 5.32 5.32 0.78 $607.75 $607.7525101 4.83 6.11 6.11 0.90 $710.47 $710.4725105 6.02 7.09 7.09 1.10 $851.94 $851.9425107 7.70 9.05 9.05 1.36 $1,085.39 $1,085.39

Updated December 2011 353 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

25109 6.94 7.49 7.49 1.24 $938.46 $938.4625110 4.04 5.35 5.35 0.75 $608.71 $608.7125111 3.53 5.17 5.17 0.67 $563.14 $563.1425112 4.67 5.81 5.81 0.87 $680.96 $680.9625115 10.09 10.82 10.82 1.80 $1,359.97 $1,359.9725116 7.56 9.15 9.15 1.33 $1,081.48 $1,081.4825118 4.51 5.91 5.91 0.80 $673.21 $673.2125119 6.21 7.33 7.33 1.22 $885.55 $885.5525120 6.27 7.60 7.60 1.17 $902.13 $902.1325125 7.67 8.98 8.98 1.51 $1,089.48 $1,089.4825126 7.74 8.62 8.62 1.52 $1,072.15 $1,072.1525130 5.43 6.74 6.74 0.99 $789.38 $789.3825135 7.08 8.23 8.23 1.39 $1,001.79 $1,001.7925136 6.14 7.09 7.09 1.21 $866.20 $866.2025145 6.54 7.71 7.71 1.28 $931.70 $931.7025150 7.38 7.95 7.95 1.36 $999.83 $999.8325151 7.68 8.43 8.43 1.51 $1,056.43 $1,056.4325170 22.21 15.85 15.85 4.37 $2,533.89 $2,533.8925210 6.12 7.19 7.19 1.08 $862.43 $862.4325215 8.14 8.66 8.66 1.40 $1,089.42 $1,089.4225230 5.37 6.40 6.40 0.90 $759.11 $759.1125240 5.31 6.44 6.44 0.91 $758.79 $758.7925246 1.45 3.25 0.59 0.14 $291.09 $128.4725248 5.31 6.09 6.09 1.05 $746.80 $746.8025250 6.77 7.37 7.37 1.32 $926.77 $926.7725251 9.82 9.29 9.29 1.93 $1,259.71 $1,259.7125259 4.04 7.27 7.27 0.72 $724.08 $724.0825260 8.04 9.43 9.43 1.48 $1,136.15 $1,136.1525263 8.04 9.15 9.15 1.58 $1,125.75 $1,125.7525265 10.10 10.27 10.27 1.97 $1,338.34 $1,338.3425270 6.17 7.60 7.60 1.16 $895.73 $895.7325272 7.21 8.23 8.23 1.32 $1,004.53 $1,004.5325274 8.94 9.48 9.48 1.77 $1,210.21 $1,210.2125275 8.96 9.18 9.18 1.77 $1,193.01 $1,193.0125280 7.39 8.32 8.32 1.28 $1,017.64 $1,017.6425290 5.43 7.10 7.10 0.98 $810.71 $810.7125295 6.72 7.88 7.88 1.18 $945.68 $945.6825300 9.02 9.72 9.72 1.78 $1,230.13 $1,230.1325301 8.59 8.78 8.78 1.57 $1,133.94 $1,133.9425310 8.08 9.12 9.12 1.39 $1,113.44 $1,113.44

Updated December 2011 354 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

25312 9.82 9.97 9.97 1.78 $1,291.20 $1,291.2025315 10.68 10.26 10.26 2.10 $1,379.66 $1,379.6625316 12.90 11.73 11.73 1.61 $1,563.66 $1,563.6625320 12.75 13.99 13.99 2.26 $1,736.93 $1,736.9325332 11.74 10.94 10.94 2.18 $1,487.28 $1,487.2825335 13.39 11.73 11.73 0.95 $1,547.35 $1,547.3525337 11.73 12.39 12.39 2.01 $1,563.93 $1,563.9325350 9.09 9.54 9.54 1.61 $1,211.71 $1,211.7125355 10.53 10.29 10.29 2.07 $1,370.89 $1,370.8925360 8.74 9.28 9.28 1.65 $1,178.47 $1,178.4725365 12.91 11.75 11.75 2.55 $1,628.63 $1,628.6325370 14.10 10.23 10.23 2.78 $1,619.27 $1,619.2725375 13.55 8.83 8.83 0.95 $1,379.21 $1,379.2125390 10.70 10.46 10.46 1.88 $1,378.25 $1,378.2525391 14.28 12.54 12.54 2.83 $1,774.16 $1,774.1625392 14.58 12.72 12.72 2.90 $1,807.04 $1,807.0425393 16.56 13.81 13.81 3.28 $2,012.54 $2,012.5425394 10.85 9.93 9.93 2.14 $1,371.91 $1,371.9125400 11.28 10.76 10.76 2.07 $1,442.55 $1,442.5525405 15.01 13.15 13.15 2.74 $1,847.19 $1,847.1925415 13.80 12.38 12.38 2.72 $1,729.51 $1,729.5125420 17.04 14.36 14.36 3.38 $2,080.36 $2,080.3625425 13.72 12.62 12.62 2.71 $1,738.93 $1,738.9325426 16.45 13.21 13.21 3.24 $1,966.88 $1,966.8825430 9.71 9.69 9.69 1.21 $1,229.48 $1,229.4825431 10.89 10.00 10.00 2.15 $1,379.15 $1,379.1525440 10.68 10.07 10.07 1.89 $1,353.93 $1,353.9325441 13.29 11.56 11.56 1.65 $1,578.28 $1,578.2825442 11.12 10.60 10.60 1.39 $1,377.91 $1,377.9125443 10.66 10.12 10.12 2.10 $1,369.96 $1,369.9625444 11.42 11.13 11.13 0.80 $1,387.83 $1,387.8325445 9.88 9.46 9.46 1.80 $1,264.80 $1,264.8025446 17.30 14.15 14.15 2.95 $2,053.50 $2,053.5025447 11.14 11.13 11.13 1.96 $1,449.77 $1,449.7725449 14.94 12.73 12.73 2.95 $1,831.62 $1,831.6225450 8.06 8.30 8.30 1.58 $1,074.93 $1,074.9325455 9.71 9.47 9.47 0.68 $1,180.41 $1,180.4125490 9.73 8.93 8.93 1.25 $1,186.85 $1,186.8525491 10.15 9.98 9.98 1.99 $1,324.82 $1,324.8225492 12.66 11.75 11.75 2.48 $1,609.62 $1,609.62

Updated December 2011 355 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

25500 2.60 4.80 4.13 0.45 $472.51 $431.5525505 5.45 8.18 6.96 1.03 $881.25 $806.6625515 8.80 9.11 9.11 1.67 $1,172.85 $1,172.8525520 6.50 8.60 7.76 1.28 $983.82 $932.4725525 10.55 10.52 10.52 2.01 $1,382.07 $1,382.0725526 13.15 12.46 12.46 2.60 $1,689.14 $1,689.1425530 2.24 4.92 4.18 0.41 $456.55 $411.3125535 5.36 7.88 6.85 1.02 $857.08 $794.1125545 7.94 8.81 8.81 1.51 $1,094.54 $1,094.5425560 2.59 4.88 4.10 0.48 $478.84 $431.1625565 5.85 8.26 6.86 1.10 $913.74 $828.1525574 8.80 9.14 9.14 1.70 $1,176.70 $1,176.7025575 12.29 11.71 11.71 2.34 $1,576.59 $1,576.5925600 2.78 5.99 5.40 0.52 $560.27 $524.2025605 6.25 8.78 7.83 1.20 $975.14 $917.0625606 8.31 9.51 9.51 1.61 $1,165.23 $1,165.2325607 9.56 10.07 10.07 1.82 $1,285.12 $1,285.1225608 11.07 10.92 10.92 2.07 $1,440.32 $1,440.3225609 14.38 13.55 13.55 2.69 $1,832.22 $1,832.2225622 2.79 5.52 4.70 0.52 $532.10 $481.9725624 4.77 8.10 6.86 0.88 $827.35 $751.5525628 9.67 9.69 9.69 1.74 $1,262.81 $1,262.8125630 3.03 5.30 4.54 0.56 $535.08 $488.6225635 4.61 7.60 6.38 0.90 $788.97 $714.3925645 7.42 7.72 7.72 1.47 $995.45 $995.4525650 3.23 5.49 4.87 0.60 $560.83 $522.9325651 5.82 7.26 7.26 1.10 $850.88 $850.8825652 8.06 8.67 8.67 1.47 $1,090.16 $1,090.1625660 4.98 6.01 6.01 0.90 $712.94 $712.9425670 8.09 8.11 8.11 1.50 $1,059.66 $1,059.6625671 6.46 7.72 7.72 1.27 $927.06 $927.0625675 4.89 6.99 5.90 0.87 $765.69 $699.0525676 8.29 8.60 8.60 1.54 $1,103.75 $1,103.7525680 6.23 6.49 6.49 1.08 $825.93 $825.9325685 10.09 9.42 9.42 1.97 $1,285.80 $1,285.8025690 5.72 7.07 7.07 1.14 $836.23 $836.2325695 8.51 8.33 8.33 1.66 $1,107.90 $1,107.9025800 10.07 9.65 9.65 1.81 $1,287.96 $1,287.9625805 11.73 10.80 10.80 2.30 $1,486.21 $1,486.2125810 11.95 11.45 11.45 2.12 $1,526.45 $1,526.45

Updated December 2011 356 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

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Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

25820 7.64 9.05 9.05 1.37 $1,082.63 $1,082.6325825 9.69 10.85 10.85 1.69 $1,331.51 $1,331.5125830 10.88 14.94 14.94 2.15 $1,680.58 $1,680.5825900 9.61 9.76 9.76 1.82 $1,269.03 $1,269.0325905 9.59 9.36 9.36 1.89 $1,248.14 $1,248.1425907 8.09 7.32 7.32 1.59 $1,017.41 $1,017.4125909 9.31 9.22 9.22 1.84 $1,220.19 $1,220.1925915 17.52 10.50 10.50 3.10 $1,853.03 $1,853.0325920 9.03 9.52 9.52 1.78 $1,218.48 $1,218.4825922 7.65 8.53 8.53 0.53 $994.96 $994.9625924 8.81 7.92 7.92 1.71 $1,103.36 $1,103.3625927 9.09 12.71 12.71 1.80 $1,418.28 $1,418.2825929 7.82 8.23 8.23 1.54 $1,054.23 $1,054.2325931 8.04 10.45 10.45 1.70 $1,213.29 $1,213.2925999 0.00 0.00 0.00 0.00 $0.00 $0.0026010 1.59 5.78 2.15 0.27 $462.51 $240.5926011 2.24 8.84 2.79 0.39 $694.86 $324.9926020 5.08 6.68 6.68 0.93 $761.65 $761.6526025 5.08 6.34 6.34 0.91 $739.51 $739.5126030 6.25 7.07 7.07 1.16 $867.91 $867.9126034 6.63 7.89 7.89 1.22 $943.82 $943.8226035 11.37 11.30 11.30 2.23 $1,491.47 $1,491.4726037 7.57 7.75 7.75 1.44 $1,003.85 $1,003.8526040 3.46 5.06 5.06 0.56 $545.02 $545.0226045 5.73 6.84 6.84 1.09 $819.38 $819.3826055 3.11 12.88 5.34 0.56 $1,003.07 $542.1026060 2.91 4.35 4.35 0.54 $468.79 $468.7926070 3.81 4.64 4.64 0.65 $545.42 $545.4226075 3.91 4.92 4.92 0.67 $569.61 $569.6126080 4.47 6.11 6.11 0.78 $681.80 $681.8026100 3.79 5.16 5.16 0.73 $581.44 $581.4426105 3.83 5.23 5.23 0.75 $589.36 $589.3626110 3.65 5.09 5.09 0.64 $563.10 $563.1026111 5.42 5.99 5.99 0.99 $742.95 $742.9526113 7.13 7.88 7.88 1.25 $973.85 $973.8526115 3.96 10.97 5.25 0.71 $945.03 $595.3326116 6.74 7.48 7.48 1.20 $923.71 $923.7126117 10.13 9.76 9.76 1.85 $1,300.81 $1,300.8126118 14.81 13.76 13.76 2.94 $1,886.47 $1,886.4726121 7.73 8.38 8.38 1.40 $1,048.84 $1,048.84

Updated December 2011 357 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

26123 10.88 11.58 11.58 1.92 $1,459.71 $1,459.7126125 4.60 2.71 2.71 0.82 $484.07 $484.0726130 5.59 6.83 6.83 1.06 $808.74 $808.7426135 7.13 7.74 7.74 1.27 $966.63 $966.6326140 6.34 7.31 7.31 1.14 $886.39 $886.3926145 6.49 7.34 7.34 1.18 $899.50 $899.5026160 3.57 12.67 5.51 0.65 $1,022.61 $584.8726170 4.91 6.12 6.12 0.86 $712.97 $712.9726180 5.35 6.73 6.73 0.90 $778.14 $778.1426185 6.52 8.45 8.45 1.28 $975.80 $975.8026200 5.65 6.53 6.53 1.03 $791.82 $791.8226205 7.93 8.10 8.10 1.57 $1,054.59 $1,054.5926210 5.32 6.66 6.66 0.95 $775.50 $775.5026215 7.27 7.70 7.70 1.44 $983.63 $983.6326230 6.47 7.02 7.02 1.13 $875.43 $875.4326235 6.33 7.02 7.02 1.10 $865.40 $865.4026236 5.46 6.47 6.47 0.98 $773.92 $773.9226250 15.21 11.96 11.96 3.01 $1,804.03 $1,804.0326260 11.16 9.55 9.55 2.19 $1,369.78 $1,369.7826262 8.29 8.53 8.53 1.62 $1,104.85 $1,104.8526320 4.10 5.33 5.33 0.71 $608.24 $608.2426340 2.80 6.37 6.37 0.52 $584.64 $584.6426341 0.91 1.85 1.14 0.14 $174.59 $131.1926350 6.21 13.48 13.48 1.13 $1,255.49 $1,255.4926352 7.87 14.30 14.30 1.55 $1,428.86 $1,428.8626356 10.62 19.40 19.40 1.92 $1,922.91 $1,922.9126357 8.77 14.80 14.80 1.71 $1,521.69 $1,521.6926358 9.36 15.50 15.50 1.85 $1,607.66 $1,607.6626370 7.28 13.64 13.64 1.36 $1,341.97 $1,341.9726372 9.01 14.99 14.99 1.78 $1,551.75 $1,551.7526373 8.41 14.63 14.63 1.65 $1,486.66 $1,486.6626390 9.43 12.97 12.97 1.86 $1,457.67 $1,457.6726392 10.50 16.08 16.08 2.07 $1,723.15 $1,723.1526410 4.77 10.88 10.88 0.87 $996.64 $996.6426412 6.48 12.33 12.33 1.16 $1,202.65 $1,202.6526415 8.51 10.25 10.25 1.17 $1,192.35 $1,192.3526416 9.56 13.59 13.59 1.88 $1,504.35 $1,504.3526418 4.47 11.59 11.59 0.82 $1,019.52 $1,019.5226420 6.94 12.58 12.58 1.37 $1,258.38 $1,258.3826426 6.32 7.76 7.76 1.14 $912.76 $912.76

Updated December 2011 358 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

26428 7.40 13.11 13.11 1.47 $1,323.83 $1,323.8326432 4.16 9.65 9.65 0.73 $877.12 $877.1226433 4.70 9.98 9.98 0.86 $936.94 $936.9426434 6.26 11.25 11.25 1.24 $1,129.41 $1,129.4126437 5.99 11.10 11.10 1.03 $1,090.67 $1,090.6726471 5.90 10.99 10.99 1.03 $1,078.79 $1,078.7926474 5.49 7.38 7.38 1.08 $837.99 $837.9926476 5.35 10.69 10.69 1.06 $1,030.99 $1,030.9926477 5.32 10.72 10.72 1.02 $1,028.42 $1,028.4226478 5.97 11.14 11.14 1.09 $1,096.00 $1,096.0026479 5.91 11.08 11.08 1.17 $1,094.28 $1,094.2826480 6.90 13.90 13.90 1.21 $1,326.03 $1,326.0326483 8.48 14.71 14.71 1.57 $1,490.18 $1,490.1826485 7.89 14.35 14.35 1.40 $1,422.98 $1,422.9826489 9.86 15.03 15.03 1.93 $1,612.92 $1,612.9226490 8.60 12.78 12.78 1.69 $1,387.12 $1,387.1226492 9.84 13.82 13.82 1.93 $1,537.80 $1,537.8026494 8.66 12.84 12.84 1.69 $1,394.22 $1,394.2226496 9.78 13.57 13.57 1.65 $1,500.27 $1,500.2726497 9.76 13.44 13.44 1.92 $1,509.32 $1,509.3226498 14.21 16.22 16.22 2.80 $1,993.12 $1,993.1226499 9.17 13.10 13.10 1.81 $1,447.37 $1,447.3726500 6.13 11.07 11.07 1.14 $1,104.24 $1,104.2426502 7.31 11.83 11.83 1.46 $1,239.75 $1,239.7526508 6.18 10.86 10.86 1.10 $1,091.58 $1,091.5826510 5.60 10.83 10.83 0.98 $1,048.48 $1,048.4826516 7.32 11.88 11.88 1.29 $1,231.95 $1,231.9526517 9.08 13.42 13.42 1.80 $1,461.11 $1,461.1126518 9.27 13.18 13.18 1.82 $1,458.66 $1,458.6626520 5.47 12.59 12.59 0.99 $1,149.31 $1,149.3126525 5.50 12.63 12.63 0.95 $1,150.79 $1,150.7926530 6.88 7.61 7.61 1.22 $941.01 $941.0126531 8.13 8.73 8.73 1.39 $1,092.46 $1,092.4626535 5.41 5.79 5.79 0.83 $719.40 $719.4026536 6.56 12.79 12.79 1.13 $1,233.33 $1,233.3326540 6.60 11.43 11.43 1.18 $1,155.84 $1,155.8426541 8.81 13.01 13.01 1.52 $1,401.77 $1,401.7726542 6.95 11.64 11.64 1.25 $1,193.42 $1,193.4226545 7.11 11.89 11.89 1.27 $1,219.20 $1,219.2026546 10.83 16.23 16.23 1.85 $1,736.43 $1,736.43

Updated December 2011 359 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

26548 8.22 12.56 12.56 1.50 $1,339.15 $1,339.1526550 21.68 20.89 20.89 4.26 $2,804.29 $2,804.2926551 48.48 29.05 29.05 9.55 $5,192.59 $5,192.5926553 48.17 27.07 27.07 3.43 $4,642.47 $4,642.4726554 57.01 32.56 32.56 4.06 $5,526.41 $5,526.4126555 17.08 19.46 19.46 3.38 $2,394.44 $2,394.4426556 49.75 30.51 30.51 3.96 $4,978.83 $4,978.8326560 5.52 10.41 10.41 1.09 $1,025.62 $1,025.6226561 11.10 14.25 14.25 2.35 $1,664.43 $1,664.4326562 16.68 19.75 19.75 1.18 $2,241.42 $2,241.4226565 6.91 11.62 11.62 1.36 $1,197.30 $1,197.3026567 6.99 11.60 11.60 1.24 $1,192.59 $1,192.5926568 9.27 15.05 15.05 1.82 $1,572.98 $1,572.9826580 19.75 20.63 20.63 3.89 $2,653.07 $2,653.0726587 14.50 9.57 9.57 3.10 $1,623.33 $1,623.3326590 18.67 14.79 14.79 3.70 $2,221.45 $2,221.4526591 3.38 8.83 8.83 0.61 $774.28 $774.2826593 5.50 11.05 11.05 0.93 $1,052.85 $1,052.8526596 9.14 11.00 11.00 1.81 $1,317.27 $1,317.2726600 2.60 5.40 4.86 0.48 $511.20 $478.1926605 3.03 5.77 4.93 0.56 $563.81 $512.4626607 5.48 6.76 6.76 1.06 $798.17 $798.1726608 5.55 7.39 7.39 1.03 $838.67 $838.6726615 7.07 8.37 8.37 1.29 $1,003.06 $1,003.0626641 4.13 5.70 4.80 0.72 $633.24 $578.2226645 4.58 6.83 5.82 0.88 $738.84 $677.0926650 5.35 7.62 7.62 1.02 $840.62 $840.6226665 7.94 8.90 8.90 1.47 $1,097.35 $1,097.3526670 3.83 5.12 4.24 0.67 $577.26 $523.4626675 4.83 7.31 6.26 0.95 $787.20 $723.0026676 5.74 7.87 7.87 1.06 $880.91 $880.9126685 7.07 8.38 8.38 1.39 $1,010.39 $1,010.3926686 8.17 8.42 8.42 1.61 $1,090.58 $1,090.5826700 3.83 4.80 4.21 0.65 $556.35 $520.2826705 4.38 6.76 5.74 0.82 $719.08 $656.7226706 5.31 6.61 6.61 0.95 $771.87 $771.8726715 7.03 8.39 8.39 1.31 $1,003.34 $1,003.3426720 1.76 3.65 3.23 0.33 $346.06 $320.3826725 3.48 5.74 4.76 0.64 $593.11 $533.2026727 5.42 7.33 7.33 0.99 $824.88 $824.88

Updated December 2011 360 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

26735 7.42 8.60 8.60 1.37 $1,042.53 $1,042.5326740 2.07 4.21 3.79 0.35 $399.38 $373.7026742 3.99 6.05 5.05 0.72 $646.63 $585.4926746 9.80 10.00 10.00 1.78 $1,291.89 $1,291.8927040 2.92 6.62 2.48 0.48 $604.11 $351.0027041 10.18 7.92 7.92 1.81 $1,188.50 $1,188.5027043 6.88 5.60 5.60 1.42 $831.57 $831.5727045 11.13 8.75 8.75 2.26 $1,323.86 $1,323.8627047 4.94 8.14 5.03 1.02 $848.94 $658.8127048 8.85 7.03 7.03 1.81 $1,057.96 $1,057.9627049 21.55 13.58 13.58 4.33 $2,354.65 $2,354.6527050 4.74 5.75 5.75 0.93 $685.33 $685.3327052 7.42 7.95 7.95 1.47 $1,009.51 $1,009.5127054 9.21 9.02 9.02 1.81 $1,200.23 $1,200.2327057 14.91 11.66 11.66 1.06 $1,637.46 $1,637.4627059 29.35 17.99 17.99 5.78 $3,168.15 $3,168.1527060 5.87 6.36 6.36 1.17 $803.43 $803.4327062 5.75 6.45 6.45 1.13 $799.37 $799.3727065 6.55 7.09 7.09 1.28 $894.37 $894.3727066 11.20 10.40 10.40 2.20 $1,424.70 $1,424.7027067 14.72 12.70 12.70 2.91 $1,814.50 $1,814.5027070 11.56 11.19 11.19 2.27 $1,498.31 $1,498.3127071 12.39 12.04 12.04 2.44 $1,609.21 $1,609.2127075 32.71 22.76 22.76 6.44 $3,696.43 $3,696.4327076 40.21 24.61 24.61 7.93 $4,338.94 $4,338.9427077 45.21 28.86 28.86 8.91 $4,950.81 $4,950.8127078 32.21 20.05 20.05 6.34 $3,495.42 $3,495.4227080 6.89 6.52 6.52 1.42 $888.39 $888.3927086 1.92 5.17 2.14 0.31 $446.80 $261.5627087 8.83 8.01 8.01 1.70 $1,109.34 $1,109.3427090 11.69 10.39 10.39 2.29 $1,458.19 $1,458.1927091 24.35 17.90 17.90 4.80 $2,810.61 $2,810.6127097 9.27 8.74 8.74 1.82 $1,187.22 $1,187.2227098 9.32 8.75 8.75 1.84 $1,192.03 $1,192.0327100 11.35 10.57 10.57 2.23 $1,445.70 $1,445.7027105 12.04 10.97 10.97 2.35 $1,517.71 $1,517.7127110 13.77 11.83 11.83 2.72 $1,694.17 $1,694.1727111 12.60 9.19 9.19 2.46 $1,448.33 $1,448.3327120 19.25 14.91 14.91 3.80 $2,268.70 $2,268.7027122 16.09 13.14 13.14 3.16 $1,936.62 $1,936.62

Updated December 2011 361 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

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Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

27125 16.64 13.37 13.37 3.28 $1,990.22 $1,990.2227130 21.79 16.39 16.39 4.29 $2,537.49 $2,537.4927132 25.69 18.72 18.72 5.06 $2,954.91 $2,954.9127134 30.28 20.47 20.47 5.96 $3,385.09 $3,385.0927137 22.70 16.34 16.34 4.46 $2,597.95 $2,597.9527138 23.70 16.89 16.89 4.67 $2,702.92 $2,702.9227140 12.78 11.00 11.00 2.52 $1,573.32 $1,573.3227146 18.92 14.95 14.95 3.74 $2,248.23 $2,248.2327147 22.07 16.77 16.77 4.34 $2,580.11 $2,580.1127151 24.12 17.41 17.41 4.76 $2,764.80 $2,764.8027156 26.23 18.98 18.98 5.16 $3,008.43 $3,008.4327158 21.04 15.84 15.84 4.15 $2,451.53 $2,451.5327161 17.89 14.35 14.35 3.51 $2,137.14 $2,137.1427165 20.29 16.11 16.11 3.99 $2,414.36 $2,414.3627170 17.61 13.55 13.55 3.47 $2,069.51 $2,069.5127175 9.38 8.29 8.29 1.85 $1,168.02 $1,168.0227176 12.92 11.40 11.40 2.56 $1,608.48 $1,608.4827177 16.09 13.41 13.41 3.17 $1,953.79 $1,953.7927178 12.92 11.36 11.36 2.56 $1,606.03 $1,606.0327179 13.97 11.88 11.88 2.75 $1,710.69 $1,710.6927181 16.18 13.52 13.52 3.20 $1,967.69 $1,967.6927185 9.79 8.95 8.95 0.69 $1,153.87 $1,153.8727187 14.23 12.12 12.12 2.80 $1,743.61 $1,743.6127193 6.09 6.48 6.65 1.20 $825.37 $835.7627194 10.20 8.57 8.57 1.66 $1,219.30 $1,219.3027200 1.92 2.94 3.13 0.35 $313.15 $324.7727202 7.31 7.65 7.65 1.46 $984.20 $984.2027215 10.45 6.83 6.83 0.73 $1,064.72 $1,064.7227216 15.73 9.80 9.80 1.13 $1,575.38 $1,575.3827217 14.65 9.40 9.40 1.05 $1,483.74 $1,483.7427218 20.93 12.04 12.04 1.50 $2,034.81 $2,034.8127220 6.83 7.33 7.19 1.33 $928.43 $919.8727222 14.11 11.85 11.85 2.76 $1,717.54 $1,717.5427226 15.57 12.33 12.33 3.08 $1,851.96 $1,851.9627227 25.41 18.50 18.50 5.01 $2,922.07 $2,922.0727228 29.33 20.74 20.74 5.78 $3,335.13 $3,335.1327230 5.81 6.91 6.80 1.14 $831.60 $824.8827232 11.72 8.49 8.49 2.25 $1,341.06 $1,341.0627235 13.00 11.16 11.16 2.56 $1,598.39 $1,598.3927236 17.61 14.10 14.10 3.47 $2,103.14 $2,103.14

Updated December 2011 362 of 387 Effective January 2012

CPT©1/HCPCS

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Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

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Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

27238 5.75 6.54 6.54 1.13 $804.88 $804.8827240 13.81 11.66 11.66 2.69 $1,684.05 $1,684.0527244 18.18 14.42 14.42 3.57 $2,162.05 $2,162.0527245 18.18 14.63 14.63 3.57 $2,174.88 $2,174.8827246 4.83 5.48 5.52 0.93 $673.97 $676.4227248 10.78 9.00 9.00 2.12 $1,309.70 $1,309.7027250 3.82 1.19 1.19 0.67 $336.42 $336.4227252 11.03 9.10 9.10 2.14 $1,331.46 $1,331.4627253 13.58 11.43 11.43 2.67 $1,655.48 $1,655.4827254 18.94 14.69 14.69 3.73 $2,232.81 $2,232.8127256 4.28 3.75 1.91 0.75 $524.63 $412.1427257 5.38 3.45 3.45 0.98 $584.71 $584.7127258 16.18 13.19 13.19 3.20 $1,947.51 $1,947.5127259 23.26 17.76 17.76 4.57 $2,724.20 $2,724.2027265 5.24 5.51 5.51 0.93 $699.27 $699.2727266 7.78 7.71 7.71 1.52 $1,018.80 $1,018.8027267 5.50 6.07 6.07 1.09 $759.14 $759.1427268 7.12 7.05 7.05 1.40 $932.61 $932.6127269 18.89 13.71 13.71 3.70 $2,168.01 $2,168.0127275 2.32 2.55 2.55 0.39 $314.89 $314.8927280 14.64 12.67 12.67 3.04 $1,816.83 $1,816.8327282 11.85 10.55 10.55 2.31 $1,478.47 $1,478.4727284 25.06 17.06 17.06 4.95 $2,809.97 $2,809.9727286 25.17 18.53 18.53 4.97 $2,907.48 $2,907.4827290 24.55 18.00 18.00 4.85 $2,831.53 $2,831.5327295 19.66 13.41 13.41 4.01 $2,214.58 $2,214.5827299 0.00 0.00 0.00 0.00 $0.00 $0.0027301 6.78 11.51 6.54 1.37 $1,183.80 $879.9627303 8.63 8.41 8.41 1.69 $1,121.67 $1,121.6727305 6.18 6.59 6.59 1.22 $838.59 $838.5927306 4.74 4.78 4.78 0.93 $626.03 $626.0327307 6.06 6.68 6.68 1.20 $835.88 $835.8827310 10.00 9.47 9.47 1.96 $1,283.04 $1,283.0427323 2.33 5.24 2.53 0.41 $481.26 $315.5927324 5.04 5.37 5.37 1.05 $687.33 $687.3327325 7.20 6.36 6.36 1.42 $896.35 $896.3527326 6.47 7.10 7.10 1.27 $889.73 $889.7327327 3.96 8.51 4.51 0.80 $800.68 $556.1427328 8.85 7.19 7.19 1.81 $1,067.74 $1,067.7427329 15.72 11.68 11.68 3.18 $1,827.52 $1,827.52

Updated December 2011 363 of 387 Effective January 2012

CPT©1/HCPCS

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Year 2012TransitionalFacility PE

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And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

27330 5.11 5.91 5.91 0.95 $717.63 $717.6327331 6.02 6.72 6.72 1.18 $834.69 $834.6927332 8.46 8.64 8.64 1.65 $1,123.32 $1,123.3227333 7.55 8.06 8.06 1.50 $1,025.69 $1,025.6927334 9.19 9.03 9.03 1.81 $1,199.69 $1,199.6927335 10.55 9.81 9.81 2.07 $1,342.69 $1,342.6927337 5.91 5.30 5.30 1.21 $743.60 $743.6027339 11.13 8.76 8.76 2.26 $1,324.47 $1,324.4727340 4.32 5.67 5.67 0.84 $650.35 $650.3527345 6.09 6.82 6.82 1.20 $846.16 $846.1627347 6.73 7.39 7.39 1.32 $925.70 $925.7027350 8.66 8.75 8.75 1.69 $1,144.18 $1,144.1827355 8.00 8.09 8.09 1.58 $1,058.66 $1,058.6627356 10.09 9.55 9.55 1.97 $1,293.75 $1,293.7527357 11.16 10.49 10.49 2.20 $1,427.92 $1,427.9227358 4.73 2.61 2.61 0.91 $491.45 $491.4527360 11.46 11.32 11.32 2.26 $1,499.86 $1,499.8627364 24.49 16.62 16.62 4.97 $2,751.79 $2,751.7927365 32.21 20.50 20.50 6.36 $3,524.27 $3,524.2727372 5.21 11.49 5.61 1.03 $1,069.87 $710.3927380 7.45 8.50 8.50 1.47 $1,044.85 $1,044.8527381 10.76 10.58 10.58 2.12 $1,405.15 $1,405.1527385 6.93 8.65 8.65 1.36 $1,016.87 $1,016.8727386 11.13 11.07 11.07 2.19 $1,460.99 $1,460.9927390 5.53 6.44 6.44 1.09 $783.48 $783.4827391 7.49 7.87 7.87 1.48 $1,009.30 $1,009.3027392 9.63 9.24 9.24 1.89 $1,243.09 $1,243.0927393 6.59 7.02 7.02 1.29 $893.05 $893.0527394 8.79 8.59 8.59 1.70 $1,142.51 $1,142.5127395 12.24 11.08 11.08 2.41 $1,539.91 $1,539.9127396 8.15 8.25 8.25 1.61 $1,079.04 $1,079.0427397 12.66 11.64 11.64 2.48 $1,602.89 $1,602.8927400 9.33 9.12 9.12 1.84 $1,215.23 $1,215.2327403 8.62 8.50 8.50 1.67 $1,125.26 $1,125.2627405 9.08 8.98 8.98 1.80 $1,189.67 $1,189.6727407 10.85 10.06 10.06 2.14 $1,379.85 $1,379.8527409 13.71 11.87 11.87 2.71 $1,692.51 $1,692.5127412 24.74 18.94 18.94 4.89 $2,902.56 $2,902.5627415 20.00 16.35 16.35 3.93 $2,408.40 $2,408.4027416 14.16 11.69 11.69 2.79 $1,712.64 $1,712.64

Updated December 2011 364 of 387 Effective January 2012

CPT©1/HCPCS

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Year 2012Transitional

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Year 2012TransitionalFacility PE

RVUs

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Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

27418 11.60 10.60 10.60 2.26 $1,463.86 $1,463.8627420 10.26 9.54 9.54 2.00 $1,304.88 $1,304.8827422 10.21 9.61 9.61 1.99 $1,305.63 $1,305.6327424 10.24 9.64 9.64 2.00 $1,309.85 $1,309.8527425 5.39 6.61 6.61 1.06 $783.85 $783.8527427 9.79 9.38 9.38 1.92 $1,262.83 $1,262.8327428 15.58 14.02 14.02 3.09 $1,956.52 $1,956.5227429 17.54 15.68 15.68 3.47 $2,195.73 $2,195.7327430 10.16 9.57 9.57 1.99 $1,300.32 $1,300.3227435 10.88 10.66 10.66 2.15 $1,418.92 $1,418.9227437 8.93 8.65 8.65 1.77 $1,158.89 $1,158.8927438 11.89 10.48 10.48 2.33 $1,477.82 $1,477.8227440 11.09 9.89 9.89 2.18 $1,385.88 $1,385.8827441 11.54 10.12 10.12 2.26 $1,431.08 $1,431.0827442 12.37 10.73 10.73 2.42 $1,526.63 $1,526.6327443 11.41 10.27 10.27 2.25 $1,432.14 $1,432.1427445 18.66 14.50 14.50 3.70 $2,203.15 $2,203.1527446 16.38 12.98 12.98 3.23 $1,948.14 $1,948.1427447 23.25 17.55 17.55 4.57 $2,710.79 $2,710.7927448 11.60 10.17 10.17 2.29 $1,439.59 $1,439.5927450 14.61 12.38 12.38 2.90 $1,787.97 $1,787.9727454 19.17 15.10 15.10 3.78 $2,274.40 $2,274.4027455 13.36 11.64 11.64 2.63 $1,653.04 $1,653.0427457 14.03 11.48 11.48 2.76 $1,690.34 $1,690.3427465 18.60 14.30 14.30 3.69 $2,186.81 $2,186.8127466 17.28 14.02 14.02 3.42 $2,076.00 $2,076.0027468 19.97 15.47 15.47 3.93 $2,352.88 $2,352.8827470 17.14 14.16 14.16 3.39 $2,074.53 $2,074.5327472 18.72 14.88 14.88 3.70 $2,229.81 $2,229.8127475 8.93 8.66 8.66 1.77 $1,159.50 $1,159.5027477 10.14 9.32 9.32 1.99 $1,283.89 $1,283.8927479 13.16 11.25 11.25 0.93 $1,503.49 $1,503.4927485 9.13 8.70 8.70 1.81 $1,176.09 $1,176.0927486 21.12 16.22 16.22 4.15 $2,479.34 $2,479.3427487 27.11 19.50 19.50 5.34 $3,102.68 $3,102.6827488 17.60 14.30 14.30 3.47 $2,114.79 $2,114.7927495 16.54 13.41 13.41 3.25 $1,984.93 $1,984.9327496 6.78 7.54 7.54 1.33 $938.41 $938.4127497 7.79 7.46 7.46 1.54 $1,005.44 $1,005.4427498 8.66 8.39 8.39 1.69 $1,122.17 $1,122.17

Updated December 2011 365 of 387 Effective January 2012

CPT©1/HCPCS

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Year 2012TransitionalFacility PE

RVUs

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Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

27499 9.43 7.53 7.53 1.86 $1,125.09 $1,125.0927500 6.30 7.59 6.45 1.22 $906.60 $836.9027501 6.45 7.01 6.86 1.27 $883.08 $873.9127502 11.36 9.30 9.30 2.19 $1,365.94 $1,365.9427503 11.27 10.03 10.03 2.20 $1,406.09 $1,406.0927506 19.65 15.85 15.85 3.87 $2,353.77 $2,353.7727507 14.48 11.36 11.36 2.86 $1,715.48 $1,715.4827508 6.20 7.92 7.01 1.20 $919.70 $864.0727509 8.14 9.16 9.16 1.59 $1,132.76 $1,132.7627510 9.80 8.69 8.69 1.88 $1,218.53 $1,218.5327511 15.11 11.44 11.44 2.98 $1,764.50 $1,764.5027513 19.25 13.76 13.76 3.80 $2,198.40 $2,198.4027514 14.60 11.33 11.33 2.87 $1,721.19 $1,721.1927516 5.59 8.04 7.14 1.10 $885.41 $830.3827517 9.12 9.12 9.12 1.80 $1,200.52 $1,200.5227519 13.25 10.54 10.54 2.61 $1,578.15 $1,578.1527520 3.04 5.78 4.93 0.59 $567.01 $515.0527524 10.37 9.71 9.71 2.03 $1,323.59 $1,323.5927530 2.65 5.87 5.19 0.51 $544.82 $503.2427532 7.55 8.98 7.88 1.48 $1,080.59 $1,013.3427535 13.41 10.48 10.48 2.63 $1,584.98 $1,584.9827536 17.39 14.21 14.21 3.43 $2,094.58 $2,094.5827538 5.09 7.73 6.84 0.99 $830.44 $776.0327540 11.30 10.45 10.45 2.22 $1,434.83 $1,434.8327550 5.98 7.40 6.34 1.10 $868.60 $803.8027552 8.18 8.54 8.54 1.61 $1,098.49 $1,098.4927556 13.00 10.41 10.41 2.57 $1,553.21 $1,553.2127557 15.90 12.01 12.01 3.14 $1,855.31 $1,855.3127558 18.39 13.29 13.29 3.62 $2,108.34 $2,108.3427560 3.99 6.26 5.42 0.76 $662.16 $610.8027562 5.98 6.83 6.83 1.18 $839.13 $839.1327566 12.71 10.98 10.98 2.50 $1,566.75 $1,566.7527570 1.79 2.26 2.26 0.34 $263.47 $263.4727580 21.10 17.12 17.12 4.15 $2,533.22 $2,533.2227590 13.47 7.98 7.98 2.95 $1,457.09 $1,457.0927591 13.94 9.10 9.10 2.91 $1,549.77 $1,549.7727592 10.98 7.36 7.36 2.34 $1,235.67 $1,235.6727594 7.29 6.49 6.49 1.55 $918.19 $918.1927596 11.29 8.01 8.01 2.40 $1,297.18 $1,297.1827598 11.22 8.51 8.51 2.33 $1,319.04 $1,319.04

Updated December 2011 366 of 387 Effective January 2012

CPT©1/HCPCS

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Facility All OtherMed Services And

Treatment

MRA 2012

27599 0.00 0.00 0.00 0.00 $0.00 $0.0027600 6.03 5.13 5.13 1.27 $744.11 $744.1127601 6.05 5.65 5.65 1.27 $777.04 $777.0427602 7.82 5.50 5.50 1.74 $900.77 $900.7727603 5.23 9.56 5.33 1.01 $951.68 $693.0727604 4.59 8.56 4.54 0.78 $838.45 $592.6927605 2.92 6.95 2.25 0.34 $614.87 $327.5327606 4.18 3.56 3.56 0.72 $505.28 $505.2827607 8.62 7.86 7.86 1.58 $1,080.08 $1,080.0827610 9.13 8.43 8.43 1.63 $1,147.48 $1,147.4827612 8.15 7.11 7.11 1.16 $979.10 $979.1027615 15.72 11.28 11.28 3.14 $1,800.38 $1,800.3827616 19.63 14.05 14.05 3.91 $2,245.27 $2,245.2727618 3.96 8.34 4.45 0.73 $785.59 $547.7727619 6.91 6.21 6.21 1.22 $857.14 $857.1427620 6.15 6.22 6.22 1.05 $802.83 $802.8327625 8.49 7.11 7.11 1.27 $1,005.96 $1,005.9627626 9.10 8.03 8.03 1.52 $1,113.92 $1,113.9227630 4.94 10.74 5.13 0.78 $991.76 $648.7927632 5.91 5.32 5.32 1.13 $739.45 $739.4527634 10.13 8.42 8.42 1.80 $1,215.53 $1,215.5327635 8.03 7.88 7.88 1.50 $1,042.16 $1,042.1627637 10.31 10.00 10.00 2.01 $1,336.54 $1,336.5427638 10.99 9.60 9.60 2.16 $1,361.09 $1,361.0927640 12.24 10.32 10.32 2.20 $1,479.34 $1,479.3427641 9.84 8.29 8.29 1.67 $1,182.25 $1,182.2527645 27.21 18.23 18.23 5.36 $3,032.11 $3,032.1127646 23.21 16.19 16.19 4.57 $2,625.36 $2,625.3627647 20.26 8.25 8.25 2.03 $1,800.38 $1,800.3827648 0.96 3.74 0.44 0.12 $291.66 $89.9127650 9.21 8.91 8.91 1.51 $1,173.34 $1,173.3427652 10.78 8.25 8.25 1.51 $1,222.85 $1,222.8527654 10.53 8.81 8.81 1.51 $1,242.78 $1,242.7827656 4.71 12.41 5.71 0.91 $1,089.43 $679.8227658 5.12 5.12 5.12 0.78 $658.48 $658.4827659 7.10 6.33 6.33 0.99 $859.89 $859.8927664 4.73 5.21 5.21 0.75 $639.65 $639.6527665 5.57 5.78 5.78 0.88 $731.31 $731.3127675 7.35 6.05 6.05 1.02 $859.10 $859.1027676 8.73 7.77 7.77 1.70 $1,088.94 $1,088.94

Updated December 2011 367 of 387 Effective January 2012

CPT©1/HCPCS

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Year 2012TransitionalFacility PE

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Facility All OtherMed Services And

Treatment

MRA 2012

27680 5.88 5.85 5.85 0.98 $760.05 $760.0527681 7.05 7.40 7.40 1.39 $949.33 $949.3327685 6.69 11.62 6.07 0.91 $1,154.46 $815.1627686 7.75 7.36 7.36 1.29 $980.23 $980.2327687 6.41 6.05 6.05 0.99 $803.28 $803.2827690 9.17 8.11 8.11 1.32 $1,109.37 $1,109.3727691 10.49 9.80 9.80 1.82 $1,321.85 $1,321.8527692 1.87 0.96 0.96 0.34 $188.57 $188.5727695 6.70 6.45 6.45 1.08 $850.39 $850.3927696 8.58 6.84 6.84 1.16 $987.21 $987.2127698 9.61 7.84 7.84 1.51 $1,130.82 $1,130.8227700 9.66 6.61 6.61 1.20 $1,037.65 $1,037.6527702 14.42 11.64 11.64 2.65 $1,715.05 $1,715.0527703 16.94 13.39 13.39 3.18 $2,001.89 $2,001.8927704 7.81 7.72 7.72 1.42 $1,014.41 $1,014.4127705 10.86 9.58 9.58 2.01 $1,342.34 $1,342.3427707 4.78 6.15 6.15 0.90 $710.06 $710.0627709 17.48 13.58 13.58 3.38 $2,057.86 $2,057.8627712 15.87 13.41 13.41 3.14 $1,939.19 $1,939.1927715 15.50 12.68 12.68 3.08 $1,869.35 $1,869.3527720 12.36 11.05 11.05 2.40 $1,544.28 $1,544.2827722 12.45 11.14 11.14 2.44 $1,557.62 $1,557.6227724 19.31 14.33 14.33 3.80 $2,236.68 $2,236.6827725 17.41 14.90 14.90 3.44 $2,138.58 $2,138.5827726 14.34 11.18 11.18 2.78 $1,691.09 $1,691.0927727 14.84 12.20 12.20 2.94 $1,792.82 $1,792.8227730 7.70 7.90 7.90 1.52 $1,025.84 $1,025.8427732 5.46 4.73 4.73 1.08 $674.26 $674.2627734 8.83 8.26 8.26 0.63 $1,052.71 $1,052.7127740 9.61 6.82 6.82 1.89 $1,094.00 $1,094.0027742 10.63 9.52 9.52 2.08 $1,330.22 $1,330.2227745 10.49 9.71 9.71 2.04 $1,331.13 $1,331.1327750 3.37 6.07 5.22 0.64 $606.99 $555.0227752 6.27 8.27 7.09 1.21 $945.78 $873.6427756 7.45 8.00 8.00 1.46 $1,013.61 $1,013.6127758 12.54 11.19 11.19 2.45 $1,566.50 $1,566.5027759 14.45 12.12 12.12 2.84 $1,758.89 $1,758.8927760 3.21 5.95 5.07 0.59 $587.14 $533.3427762 5.47 7.60 6.41 1.01 $845.59 $772.8427766 7.89 8.51 8.51 1.51 $1,073.34 $1,073.34

Updated December 2011 368 of 387 Effective January 2012

CPT©1/HCPCS

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Year 2012TransitionalFacility PE

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Facility All OtherMed Services And

Treatment

MRA 2012

27767 2.64 5.02 5.06 0.50 $491.61 $494.0527768 5.14 6.50 6.50 1.02 $760.12 $760.1227769 10.14 9.20 9.20 1.99 $1,276.56 $1,276.5627780 2.83 5.53 4.71 0.53 $535.68 $485.5527781 4.59 6.97 6.08 0.87 $747.30 $692.8927784 9.67 9.45 9.45 1.88 $1,257.55 $1,257.5527786 3.02 5.66 4.76 0.54 $555.17 $500.1527788 4.64 6.90 5.85 0.84 $743.86 $679.6727792 8.75 8.88 8.88 1.66 $1,155.26 $1,155.2627808 3.03 6.14 5.14 0.56 $586.43 $525.3027810 5.32 7.49 6.26 1.01 $830.28 $755.0827814 10.62 10.09 10.09 2.04 $1,361.80 $1,361.8027816 3.07 5.64 4.69 0.54 $556.81 $498.7327818 5.69 7.47 6.06 1.05 $852.92 $766.7227822 11.21 11.49 11.49 2.16 $1,489.23 $1,489.2327823 13.16 12.48 12.48 2.55 $1,687.57 $1,687.5727824 3.31 5.20 4.91 0.61 $548.35 $530.6227825 6.69 8.04 6.58 1.28 $960.46 $871.2027826 11.10 11.24 11.24 2.14 $1,466.30 $1,466.3027827 14.79 14.26 14.26 2.90 $1,913.21 $1,913.2127828 18.43 16.20 16.20 3.59 $2,286.52 $2,286.5227829 8.80 9.59 9.59 1.69 $1,203.54 $1,203.5427830 3.96 6.22 5.47 0.76 $657.99 $612.1427831 4.73 5.91 5.91 0.91 $693.19 $693.1927832 10.17 9.75 9.75 1.99 $1,311.90 $1,311.9027840 4.77 5.09 5.09 0.83 $639.98 $639.9827842 6.46 6.79 6.79 1.21 $866.17 $866.1727846 10.28 9.40 9.40 1.95 $1,294.11 $1,294.1127848 11.68 10.16 10.16 2.25 $1,440.86 $1,440.8627860 2.39 2.42 2.42 0.39 $310.95 $310.9527870 15.41 12.42 12.42 2.80 $1,829.48 $1,829.4827871 9.54 9.02 9.02 1.85 $1,221.80 $1,221.8027880 15.37 8.89 8.89 3.32 $1,646.33 $1,646.3327881 13.47 9.91 9.91 2.80 $1,565.00 $1,565.0027882 9.79 6.41 6.41 2.15 $1,096.71 $1,096.7127884 8.76 6.73 6.73 1.86 $1,037.83 $1,037.8327886 10.02 7.77 7.77 2.14 $1,192.35 $1,192.3527888 10.37 8.01 8.01 1.93 $1,212.94 $1,212.9427889 10.86 6.71 6.71 2.41 $1,193.77 $1,193.7727892 7.94 6.93 6.93 1.63 $987.67 $987.67

Updated December 2011 369 of 387 Effective January 2012

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Facility All OtherMed Services And

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MRA 2012

27893 7.90 8.06 8.06 1.67 $1,057.15 $1,057.1527894 12.67 10.23 10.23 2.67 $1,530.03 $1,530.0327899 0.00 0.00 0.00 0.00 $0.00 $0.0028001 2.78 4.96 1.97 0.23 $477.80 $295.0128002 5.34 7.34 3.76 0.60 $794.70 $575.8328003 9.06 10.51 6.49 1.06 $1,232.33 $986.5628005 9.44 6.80 6.80 1.02 $1,024.57 $1,024.5728008 4.59 7.60 3.66 0.41 $754.90 $514.0228010 2.97 3.57 2.94 0.27 $406.39 $367.8728011 4.28 4.89 3.92 0.49 $576.85 $517.5528020 5.15 9.57 4.65 0.67 $924.86 $624.0728022 4.81 8.72 4.18 0.49 $841.34 $563.7828024 4.52 8.28 3.95 0.42 $793.13 $528.4228035 5.23 9.48 4.62 0.65 $922.59 $625.4728039 5.42 9.65 4.61 0.54 $936.47 $628.3428041 7.13 6.05 6.05 0.73 $827.02 $827.0228043 3.96 7.06 3.44 0.39 $684.48 $463.1728045 5.45 8.72 4.34 0.56 $882.67 $614.9028046 12.38 7.79 7.79 1.66 $1,296.38 $1,296.3828047 17.45 11.63 11.63 1.33 $1,799.14 $1,799.1428050 4.39 8.77 4.16 0.39 $813.63 $531.8028052 4.06 8.08 3.69 0.49 $759.28 $490.9028054 3.57 7.22 3.19 0.27 $663.88 $417.5028055 6.29 4.27 4.27 0.53 $656.68 $656.6828060 5.40 8.99 4.47 0.54 $894.97 $618.6428062 6.69 9.79 4.68 0.60 $1,021.75 $709.3428070 5.24 9.56 4.60 0.56 $922.01 $618.7728072 4.72 9.72 4.65 0.64 $907.40 $597.4428086 4.92 10.23 4.92 0.72 $955.41 $630.7728088 3.98 9.23 4.25 0.54 $828.37 $523.9128100 5.83 10.86 5.35 0.76 $1,048.69 $711.8328102 7.92 5.38 5.38 0.61 $823.21 $823.2128103 6.67 4.59 4.59 0.50 $695.97 $695.9728104 5.26 9.20 4.39 0.54 $899.80 $605.7328106 7.35 4.85 4.85 0.56 $754.82 $754.8228107 5.73 9.14 4.26 0.42 $914.96 $616.6228108 4.30 7.96 3.72 0.38 $758.29 $499.0728110 4.22 8.83 3.87 0.41 $808.92 $505.6828111 5.15 9.04 4.06 0.60 $887.75 $583.3028112 4.63 9.19 4.12 0.52 $861.78 $551.83

Updated December 2011 370 of 387 Effective January 2012

CPT©1/HCPCS

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Treatment

MRA 2012

28113 6.11 10.58 5.80 0.63 $1,038.86 $746.6328114 12.00 17.80 10.99 1.65 $1,885.93 $1,469.6028116 9.14 12.05 6.75 0.95 $1,323.66 $999.6428118 6.13 10.35 5.24 0.75 $1,034.01 $721.6128119 5.56 9.22 4.53 0.53 $917.52 $630.7928120 7.31 11.30 6.09 1.01 $1,177.10 $858.5928122 6.76 10.26 5.68 0.72 $1,062.55 $782.5528124 5.00 8.43 4.28 0.42 $829.78 $576.0628126 3.64 7.53 3.36 0.34 $691.54 $436.6028130 9.50 8.10 8.10 1.86 $1,163.94 $1,163.9428140 7.14 9.77 5.12 0.90 $1,066.44 $782.1628150 4.23 7.94 3.71 0.42 $755.75 $497.1528153 3.80 7.87 3.63 0.37 $723.50 $464.2828160 3.88 8.05 3.74 0.38 $739.75 $476.2628171 16.41 7.06 7.06 1.25 $1,454.85 $1,454.8528173 14.16 6.74 6.74 1.57 $1,328.02 $1,328.0228175 8.29 5.10 5.10 0.80 $840.04 $840.0428190 2.01 5.22 1.73 0.20 $447.61 $234.2528192 4.78 8.54 4.04 0.49 $828.61 $553.5028193 5.90 9.20 4.52 0.56 $937.77 $651.6628200 4.74 8.78 4.11 0.45 $838.31 $552.8128202 7.07 9.59 4.75 0.64 $1,033.96 $738.0628208 4.51 8.55 4.04 0.49 $813.77 $538.0528210 6.52 9.48 4.81 0.64 $995.75 $710.2528220 4.67 7.99 3.81 0.41 $783.32 $527.7728222 5.76 8.55 4.10 0.50 $885.99 $613.9328225 3.78 7.72 3.47 0.35 $711.84 $452.0128226 4.67 8.72 4.12 0.35 $823.91 $542.6928238 7.96 11.05 5.70 0.86 $1,188.94 $861.8628240 4.48 7.91 3.66 0.44 $769.57 $509.7428250 6.06 9.80 4.94 0.76 $997.05 $699.9328260 8.19 11.18 6.08 1.03 $1,221.48 $909.6828261 13.11 14.01 8.28 1.28 $1,692.89 $1,342.5828262 17.21 21.96 13.93 3.01 $2,529.85 $2,038.9328264 10.65 16.06 9.52 0.82 $1,646.50 $1,246.6828270 4.93 8.89 4.42 0.50 $859.27 $585.9928272 3.92 7.21 3.25 0.31 $685.98 $443.8928280 5.33 9.51 4.62 0.60 $926.79 $627.8328285 5.62 9.16 4.73 0.53 $917.28 $646.4528286 4.70 8.14 3.77 0.39 $792.86 $525.70

Updated December 2011 371 of 387 Effective January 2012

CPT©1/HCPCS

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Facility All OtherMed Services And

Treatment

MRA 2012

28288 6.02 11.00 6.03 0.67 $1,062.08 $758.2328289 8.31 12.20 6.87 1.01 $1,289.36 $963.5128290 5.83 10.66 5.18 0.69 $1,031.76 $696.7428292 9.05 13.09 7.73 0.87 $1,376.71 $1,049.0328293 11.48 17.94 8.39 0.95 $1,817.68 $1,233.8328294 8.75 12.11 6.00 0.93 $1,303.66 $930.1228296 8.35 11.81 6.26 0.76 $1,251.00 $911.7028297 9.43 13.42 6.77 1.18 $1,439.47 $1,032.9228298 8.13 11.94 5.83 0.87 $1,253.75 $880.2128299 11.57 13.44 7.18 1.14 $1,560.49 $1,177.7828300 9.73 8.07 8.07 1.61 $1,158.47 $1,158.4728302 9.74 9.06 9.06 1.92 $1,240.40 $1,240.4028304 9.41 12.98 6.89 1.21 $1,413.45 $1,041.1328305 10.77 7.38 7.38 0.82 $1,122.71 $1,122.7128306 6.00 11.19 5.14 0.83 $1,083.30 $713.4328307 6.50 12.78 5.88 1.28 $1,239.37 $817.5328308 5.48 10.26 4.91 0.61 $981.90 $654.8228309 14.16 9.82 9.82 2.10 $1,551.94 $1,551.9428310 5.57 9.59 4.28 0.54 $941.38 $616.7528312 4.69 9.61 4.21 0.50 $889.55 $559.4228313 5.15 9.38 4.72 0.69 $914.59 $629.6928315 5.00 8.47 4.05 0.49 $836.93 $566.7128320 9.37 7.40 7.40 1.39 $1,082.12 $1,082.1228322 8.53 13.20 7.18 1.31 $1,383.25 $1,015.2128340 7.15 9.35 4.57 0.54 $1,017.14 $724.9128341 8.72 10.32 5.17 0.67 $1,175.04 $860.1928344 4.40 9.47 4.50 0.34 $853.64 $549.8028345 6.09 8.95 4.39 0.45 $925.97 $647.1928360 14.92 13.33 13.33 3.18 $1,882.61 $1,882.6128400 2.31 4.58 3.96 0.37 $437.08 $399.1828405 4.74 5.84 4.87 0.65 $672.01 $612.7128406 6.56 7.85 7.85 1.17 $934.01 $934.0128415 16.19 13.85 13.85 2.83 $1,963.57 $1,963.5728420 17.52 15.55 15.55 3.46 $2,185.96 $2,185.9628430 2.22 4.29 3.52 0.35 $412.86 $365.7828435 3.54 4.17 3.41 0.69 $503.92 $457.4628436 4.90 7.18 7.18 0.98 $785.27 $785.2728445 15.76 12.99 12.99 2.78 $1,883.02 $1,883.0228446 17.71 14.55 14.55 3.50 $2,138.39 $2,138.3928450 2.03 4.00 3.30 0.30 $380.89 $338.10

Updated December 2011 372 of 387 Effective January 2012

CPT©1/HCPCS

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Facility All OtherMed Services And

Treatment

MRA 2012

28455 3.24 4.78 3.98 0.44 $507.24 $458.3328456 2.86 5.68 5.68 0.56 $548.58 $548.5828465 8.80 8.12 8.12 1.27 $1,085.45 $1,085.4528470 2.03 3.85 3.22 0.33 $373.74 $335.2228475 3.01 4.18 3.38 0.38 $453.36 $404.4628476 3.60 6.08 6.08 0.53 $613.37 $613.3728485 7.44 7.12 7.12 0.95 $924.96 $924.9628490 1.17 2.88 2.30 0.16 $253.79 $218.3328495 1.68 3.32 2.54 0.20 $312.57 $264.8828496 2.48 9.80 3.90 0.35 $764.60 $403.9028505 7.44 11.21 6.25 0.93 $1,173.66 $870.4328531 2.57 7.43 2.59 0.50 $634.94 $339.0428540 2.19 3.52 2.97 0.22 $355.33 $321.7028545 2.60 5.25 4.34 0.50 $503.38 $447.7428546 3.40 12.28 5.67 0.67 $990.38 $586.2728555 9.65 14.80 8.54 1.61 $1,565.33 $1,182.6228570 1.76 2.89 2.24 0.12 $285.48 $245.7428575 3.49 6.30 5.35 0.68 $630.61 $572.5328576 4.60 5.85 5.85 0.90 $681.41 $681.4128585 11.13 13.27 7.86 1.65 $1,559.19 $1,228.4528600 2.02 4.01 3.17 0.29 $380.26 $328.9128605 2.89 5.77 4.90 0.56 $555.80 $502.6128606 5.09 5.62 5.62 0.84 $691.36 $691.3628615 10.70 10.87 10.87 1.77 $1,395.92 $1,395.9228635 1.96 3.09 1.81 0.22 $315.88 $237.6228636 2.77 5.64 2.63 0.39 $529.56 $345.5428645 7.44 10.76 5.88 0.80 $1,137.42 $839.0728665 1.97 2.30 1.68 0.24 $269.50 $231.5928666 2.66 2.43 2.43 0.52 $335.75 $335.7528675 5.62 10.81 5.71 0.75 $1,032.94 $721.1528705 20.33 14.10 14.10 3.46 $2,258.14 $2,258.1428715 13.42 11.90 11.90 2.28 $1,648.85 $1,648.8528725 11.22 8.75 8.75 1.73 $1,293.39 $1,293.3928730 10.70 9.82 9.82 1.65 $1,323.66 $1,323.6628735 12.23 9.31 9.31 1.78 $1,388.79 $1,388.7928737 11.03 7.78 7.78 1.28 $1,192.96 $1,192.9628740 9.29 14.44 7.86 1.36 $1,505.92 $1,103.6428750 8.57 14.45 7.79 1.31 $1,461.96 $1,054.8028755 4.88 9.39 4.30 0.52 $888.32 $577.1428760 9.14 12.83 6.78 1.05 $1,378.07 $1,008.20

Updated December 2011 373 of 387 Effective January 2012

CPT©1/HCPCS

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And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

28800 8.79 6.26 6.26 1.31 $973.85 $973.8528805 12.71 7.40 7.40 2.14 $1,323.69 $1,323.6928810 6.64 5.26 5.26 1.18 $780.92 $780.9228820 5.82 10.15 5.04 0.85 $1,010.76 $698.3628825 5.37 10.06 5.00 0.75 $972.78 $663.4428899 0.00 0.00 0.00 0.00 $0.00 $0.0029800 6.84 7.00 7.00 1.33 $908.83 $908.8329804 8.87 8.47 8.47 1.74 $1,142.44 $1,142.4429805 6.03 6.63 6.63 1.18 $829.76 $829.7629806 15.14 13.13 13.13 2.98 $1,869.53 $1,869.5329807 14.67 12.89 12.89 2.87 $1,820.57 $1,820.5729819 7.79 7.92 7.92 1.52 $1,032.21 $1,032.2129820 7.21 7.26 7.26 1.40 $950.60 $950.6029821 7.89 7.96 7.96 1.55 $1,042.40 $1,042.4029822 7.60 7.82 7.82 1.50 $1,013.88 $1,013.8829823 8.36 8.49 8.49 1.63 $1,107.08 $1,107.0829824 8.98 9.16 9.16 1.77 $1,192.93 $1,192.9329825 7.79 7.91 7.91 1.52 $1,031.60 $1,031.6029826 3.00 1.65 1.65 0.59 $312.23 $312.2329827 15.59 13.06 13.06 3.08 $1,897.73 $1,897.7329828 13.16 11.38 11.38 2.59 $1,623.01 $1,623.0129830 5.88 6.28 6.28 1.17 $799.11 $799.1129834 6.42 6.84 6.84 1.22 $867.61 $867.6129835 6.62 6.95 6.95 1.29 $890.49 $890.4929836 7.72 7.89 7.89 1.52 $1,026.37 $1,026.3729837 7.01 7.20 7.20 1.36 $932.80 $932.8029838 7.88 8.00 8.00 1.50 $1,040.91 $1,040.9129840 5.68 6.54 6.54 1.13 $800.87 $800.8729843 6.15 6.81 6.81 1.21 $849.65 $849.6529844 6.51 6.99 6.99 1.18 $879.25 $879.2529845 7.69 7.86 7.86 1.37 $1,012.74 $1,012.7429846 6.89 7.23 7.23 1.22 $918.36 $918.3629847 7.22 7.29 7.29 1.42 $954.35 $954.3529848 6.39 7.41 7.41 1.17 $897.38 $897.3829850 8.27 6.50 6.50 1.62 $979.59 $979.5929851 13.26 11.50 11.50 2.61 $1,637.41 $1,637.4129855 10.76 10.23 10.23 2.12 $1,383.75 $1,383.7529856 14.28 12.20 12.20 2.83 $1,753.37 $1,753.3729860 9.00 8.71 8.71 1.78 $1,167.24 $1,167.2429861 10.10 9.25 9.25 1.97 $1,275.98 $1,275.98

Updated December 2011 374 of 387 Effective January 2012

CPT©1/HCPCS

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RVUs

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Facility All OtherMed Services And

Treatment

MRA 2012

29862 11.17 10.66 10.66 2.19 $1,438.21 $1,438.2129863 11.17 10.66 10.66 2.20 $1,438.88 $1,438.8829866 14.67 13.23 13.23 2.91 $1,844.04 $1,844.0429867 18.39 15.48 15.48 3.62 $2,242.23 $2,242.2329868 25.10 19.15 19.15 4.95 $2,940.03 $2,940.0329870 5.19 11.16 5.88 1.02 $1,047.88 $725.0829871 6.69 7.08 7.08 1.31 $903.79 $903.7929873 6.24 7.88 7.88 1.22 $920.89 $920.8929874 7.19 7.22 7.22 1.40 $947.01 $947.0129875 6.45 6.84 6.84 1.27 $872.69 $872.6929876 8.87 8.66 8.66 1.74 $1,154.05 $1,154.0529877 8.30 8.37 8.37 1.62 $1,095.64 $1,095.6429879 8.99 8.72 8.72 1.77 $1,166.61 $1,166.6129880 7.39 8.01 8.01 1.45 $1,010.12 $1,010.1229881 7.03 7.76 7.76 1.37 $968.85 $968.8529882 9.60 9.04 9.04 1.89 $1,229.15 $1,229.1529883 11.77 10.68 10.68 2.30 $1,481.17 $1,481.1729884 8.28 8.35 8.35 1.62 $1,093.27 $1,093.2729885 10.21 9.83 9.83 2.00 $1,319.75 $1,319.7529886 8.49 8.48 8.48 1.66 $1,115.92 $1,115.9229887 10.16 9.80 9.80 1.99 $1,314.38 $1,314.3829888 14.30 12.03 12.03 2.80 $1,742.11 $1,742.1129889 17.41 14.80 14.80 3.42 $2,131.13 $2,131.1329891 9.67 8.91 8.91 1.65 $1,209.08 $1,209.0829892 10.27 6.52 6.52 2.01 $1,121.50 $1,121.5029893 6.32 10.93 5.69 0.50 $1,063.54 $743.1929894 7.35 6.53 6.53 1.22 $901.89 $901.8929895 7.13 6.10 6.10 1.13 $856.96 $856.9629897 7.32 6.64 6.64 1.24 $908.24 $908.2429898 8.49 7.03 7.03 1.29 $1,002.41 $1,002.4129899 15.41 12.39 12.39 2.87 $1,832.35 $1,832.3529900 5.88 7.49 7.49 0.41 $822.00 $822.0029901 6.59 7.84 7.84 1.29 $943.18 $943.1829902 7.16 7.85 7.85 2.57 $1,062.45 $1,062.4529904 8.65 8.27 8.27 1.69 $1,114.26 $1,114.2629905 9.18 9.15 9.15 1.81 $1,206.46 $1,206.4629906 9.65 9.66 9.66 1.89 $1,269.91 $1,269.9129907 12.18 11.03 11.03 2.40 $1,532.75 $1,532.7529914 14.67 12.49 12.49 2.91 $1,798.80 $1,798.8029915 15.00 12.67 12.67 2.95 $1,831.38 $1,831.38

Updated December 2011 375 of 387 Effective January 2012

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Facility All OtherMed Services And

Treatment

MRA 2012

29916 15.00 12.67 12.67 2.95 $1,831.38 $1,831.3829999 0.00 0.00 0.00 0.00 $0.00 $0.0061000 1.58 1.51 1.51 0.14 $192.16 $192.1661001 1.49 1.42 1.42 0.53 $207.71 $207.716101F 0.00 0.00 0.00 0.00 $0.00 $0.006102F 0.00 0.00 0.00 0.00 $0.00 $0.0061020 1.51 2.06 2.06 0.50 $245.97 $245.9761026 1.69 1.74 1.74 0.38 $228.64 $228.6461050 1.51 1.44 1.44 0.12 $182.53 $182.5361055 2.10 1.61 1.61 0.29 $238.11 $238.1161070 0.89 1.43 1.43 0.20 $151.81 $151.816110F 0.00 0.00 0.00 0.00 $0.00 $0.0061105 5.45 6.25 6.25 1.92 $823.07 $823.0761107 4.99 2.59 2.59 1.78 $563.58 $563.5861108 11.64 10.94 10.94 4.14 $1,613.29 $1,613.2961120 9.60 8.92 8.92 3.46 $1,327.33 $1,327.3361140 17.23 13.92 13.92 6.11 $2,247.82 $2,247.8261150 18.90 14.35 14.35 6.78 $2,414.72 $2,414.7261151 13.49 11.00 11.00 4.85 $1,770.56 $1,770.5661154 17.07 14.36 14.36 6.10 $2,264.89 $2,264.8961156 17.45 13.09 13.09 6.26 $2,219.75 $2,219.7561210 5.83 3.03 3.03 2.08 $658.72 $658.7261215 5.85 7.03 7.03 2.07 $903.73 $903.7361250 11.49 9.94 9.94 4.12 $1,542.22 $1,542.2261253 13.49 9.43 9.43 1.71 $1,463.54 $1,463.5461304 23.41 16.97 16.97 8.15 $2,925.10 $2,925.1061305 28.64 20.52 20.52 10.28 $3,584.63 $3,584.6361312 30.17 20.56 20.56 10.79 $3,708.92 $3,708.9261313 28.09 20.58 20.58 10.03 $3,540.02 $3,540.0261314 25.90 18.87 18.87 9.27 $3,259.05 $3,259.0561315 29.65 20.93 20.93 10.66 $3,693.04 $3,693.0461316 1.39 0.72 0.72 0.49 $156.51 $156.5161320 27.42 19.21 19.21 9.69 $3,395.06 $3,395.0661321 30.53 21.35 21.35 10.97 $3,789.92 $3,789.9261322 34.26 23.58 23.58 12.24 $4,225.10 $4,225.1061323 35.06 22.99 22.99 12.45 $4,248.93 $4,248.9361330 25.30 18.81 18.81 9.09 $3,208.95 $3,208.9561332 28.60 20.57 20.57 10.26 $3,584.05 $3,584.0561333 29.27 21.02 21.02 10.51 $3,666.72 $3,666.7261334 19.60 9.80 9.80 7.02 $2,192.75 $2,192.75

Updated December 2011 376 of 387 Effective January 2012

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Facility All OtherMed Services And

Treatment

MRA 2012

61340 20.11 15.36 15.36 7.23 $2,575.97 $2,575.9761343 31.86 21.71 21.71 11.35 $3,913.59 $3,913.5961345 29.23 20.64 20.64 10.49 $3,639.85 $3,639.8561440 28.66 20.30 20.30 10.28 $3,572.33 $3,572.3361450 27.69 19.20 19.20 9.94 $3,426.71 $3,426.7161458 28.84 20.27 20.27 10.25 $3,578.78 $3,578.7861460 30.24 20.97 20.97 10.85 $3,742.03 $3,742.0361470 27.62 15.24 15.24 9.91 $3,178.59 $3,178.5961480 28.05 18.56 18.56 1.97 $2,872.52 $2,872.5261490 27.22 19.05 19.05 9.79 $3,380.56 $3,380.566150F 0.00 0.00 0.00 0.00 $0.00 $0.0061500 19.18 14.59 14.59 5.78 $2,378.21 $2,378.2161501 16.35 13.20 13.20 4.67 $2,056.65 $2,056.6561510 30.83 22.82 22.82 11.01 $3,899.65 $3,899.6561512 37.14 25.12 25.12 13.28 $4,553.98 $4,553.9861514 27.23 19.43 19.43 9.72 $3,399.65 $3,399.6561516 26.58 19.09 19.09 9.23 $3,308.73 $3,308.7361517 1.38 0.71 0.71 0.49 $155.32 $155.3261518 39.89 27.48 27.48 14.30 $4,924.21 $4,924.2161519 43.43 28.35 28.35 15.49 $5,259.99 $5,259.9961520 57.09 36.06 36.06 17.97 $6,679.86 $6,679.8661521 46.99 30.33 30.33 16.86 $5,676.88 $5,676.8861522 31.54 21.87 21.87 11.32 $3,903.04 $3,903.0461524 29.89 20.90 20.90 10.74 $3,710.32 $3,710.3261526 54.08 34.12 34.12 19.41 $6,485.76 $6,485.7661530 45.56 27.26 27.26 16.37 $5,374.41 $5,374.4161531 16.41 13.83 13.83 5.89 $2,180.60 $2,180.6061533 21.46 15.90 15.90 7.69 $2,717.16 $2,717.1661534 23.01 17.38 17.38 8.26 $2,934.67 $2,934.6761535 13.15 11.67 11.67 4.72 $1,783.32 $1,783.3261536 37.72 25.13 25.13 13.54 $4,605.26 $4,605.2661537 36.45 23.15 23.15 13.01 $4,375.91 $4,375.9161538 39.45 25.06 25.06 14.18 $4,743.02 $4,743.0261539 34.28 23.18 23.18 12.30 $4,205.82 $4,205.8261540 31.43 21.92 21.92 11.28 $3,897.12 $3,897.1261541 30.94 21.49 21.49 11.11 $3,831.36 $3,831.3661542 33.16 19.95 19.95 11.90 $3,917.37 $3,917.3761543 31.31 21.54 21.54 11.23 $3,863.66 $3,863.6661544 27.36 18.27 18.27 9.83 $3,343.57 $3,343.5761545 46.43 31.06 31.06 16.66 $5,676.01 $5,676.01

Updated December 2011 377 of 387 Effective January 2012

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Facility All OtherMed Services And

Treatment

MRA 2012

61546 33.44 22.79 22.79 11.99 $4,113.07 $4,113.0761548 23.37 16.08 16.08 6.67 $2,768.93 $2,768.9361550 15.59 13.36 13.36 1.10 $1,782.99 $1,782.9961552 20.40 15.89 15.89 1.46 $2,237.16 $2,237.1661556 24.09 17.44 17.44 8.66 $3,027.03 $3,027.0361557 23.31 18.12 18.12 8.37 $3,004.47 $3,004.4761558 26.50 19.56 19.56 9.51 $3,351.71 $3,351.7161559 34.02 18.66 18.66 2.41 $3,249.90 $3,249.9061563 28.44 19.95 19.95 10.21 $3,533.63 $3,533.6361564 34.74 24.04 24.04 12.45 $4,294.81 $4,294.8161566 32.45 22.51 22.51 11.64 $4,015.76 $4,015.7661567 37.00 25.69 25.69 13.30 $4,582.16 $4,582.1661570 26.51 19.09 19.09 9.51 $3,323.55 $3,323.5561571 28.42 20.25 20.25 10.19 $3,549.48 $3,549.4861575 36.56 24.11 24.11 13.12 $4,448.29 $4,448.2961576 55.31 48.04 48.04 7.10 $6,579.81 $6,579.8161580 34.51 33.17 33.17 5.89 $4,398.91 $4,398.9161581 39.13 36.16 36.16 5.04 $4,789.01 $4,789.0161582 35.14 42.20 42.20 12.62 $5,439.35 $5,439.3561583 38.50 34.41 34.41 12.94 $5,176.92 $5,176.9261584 37.70 34.16 34.16 12.70 $5,099.72 $5,099.7261585 42.57 37.19 37.19 15.28 $5,737.10 $5,737.1061586 27.48 34.15 34.15 9.87 $4,323.96 $4,323.9661590 47.04 35.48 35.48 8.45 $5,429.35 $5,429.3561591 47.02 35.61 35.61 9.60 $5,513.44 $5,513.4461592 43.08 36.27 36.27 14.51 $5,658.29 $5,658.2961595 33.74 29.37 29.37 7.15 $4,207.21 $4,207.2161596 39.43 29.34 29.34 5.06 $4,390.57 $4,390.5761597 40.82 30.61 30.61 14.66 $5,192.99 $5,192.9961598 36.53 33.18 33.18 13.11 $5,000.40 $5,000.4061600 30.01 27.30 27.30 6.22 $3,804.67 $3,804.6761601 31.14 29.72 29.72 10.17 $4,282.77 $4,282.7761605 32.57 27.72 27.72 4.95 $3,891.51 $3,891.5161606 42.05 33.11 33.11 13.68 $5,350.36 $5,350.3661607 40.93 29.79 29.79 14.69 $5,151.17 $5,151.1761608 45.54 35.10 35.10 15.38 $5,786.03 $5,786.0361609 9.88 4.15 4.15 3.55 $1,057.79 $1,057.7961610 29.63 12.75 12.75 10.64 $3,190.46 $3,190.4661611 7.41 3.23 3.23 0.52 $656.53 $656.5361612 27.84 11.85 11.85 1.96 $2,449.61 $2,449.61

Updated December 2011 378 of 387 Effective January 2012

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And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

61613 45.03 35.77 35.77 16.17 $5,850.90 $5,850.9061615 35.77 27.90 27.90 4.60 $4,062.14 $4,062.1461616 46.74 37.23 37.23 14.41 $5,919.74 $5,919.7461618 18.69 14.08 14.08 5.76 $2,317.64 $2,317.6461619 22.10 15.48 15.48 6.33 $2,636.71 $2,636.7161623 9.95 4.60 4.60 1.85 $975.05 $975.0561624 20.12 8.62 8.62 3.77 $1,931.94 $1,931.9461626 16.60 6.44 6.44 2.14 $1,487.64 $1,487.6461630 22.07 10.78 10.78 4.18 $2,203.15 $2,203.1561635 24.28 12.21 12.21 4.07 $2,409.67 $2,409.6761640 12.32 5.03 5.03 0.87 $1,071.12 $1,071.1261641 4.33 1.77 1.77 0.31 $376.87 $376.8761642 8.66 3.54 3.54 0.61 $753.07 $753.0761680 32.55 22.71 22.71 11.68 $4,036.40 $4,036.4061682 63.41 37.96 37.96 22.76 $7,479.68 $7,479.6861684 41.64 27.43 27.43 14.94 $5,064.33 $5,064.3361686 67.50 41.65 41.65 24.24 $8,038.83 $8,038.8361690 31.34 22.04 22.04 11.26 $3,897.96 $3,897.9661692 54.59 34.16 34.16 19.60 $6,530.17 $6,530.1761697 63.40 38.95 38.95 22.52 $7,523.50 $7,523.5061698 69.63 42.13 42.13 24.99 $8,240.49 $8,240.4961700 50.62 32.64 32.64 18.06 $6,106.51 $6,106.5161702 60.04 37.29 37.29 21.54 $7,163.84 $7,163.8461703 18.80 14.66 14.66 6.75 $2,425.93 $2,425.9361705 38.10 25.00 25.00 13.68 $4,628.48 $4,628.4861708 37.20 20.75 20.75 3.08 $3,604.71 $3,604.7161710 31.29 20.76 20.76 6.52 $3,498.27 $3,498.2761711 38.23 25.23 25.23 13.72 $4,652.67 $4,652.6761720 17.62 13.23 13.23 6.33 $2,242.74 $2,242.7461735 22.35 16.11 16.11 8.02 $2,803.12 $2,803.1261750 19.83 14.66 14.66 7.06 $2,505.72 $2,505.7261751 18.79 15.16 15.16 6.70 $2,452.57 $2,452.5761760 22.39 16.07 16.07 8.03 $2,803.64 $2,803.6461770 23.19 16.20 16.20 8.19 $2,868.13 $2,868.1361781 3.75 1.98 1.98 1.25 $419.69 $419.6961782 3.18 1.68 1.68 0.87 $343.19 $343.1961783 3.75 1.98 1.98 1.25 $419.69 $419.6961790 11.60 10.02 10.02 4.07 $1,550.05 $1,550.0561791 15.41 12.25 12.25 5.20 $1,980.39 $1,980.3961796 13.93 10.66 10.66 4.63 $1,760.17 $1,760.17

Updated December 2011 379 of 387 Effective January 2012

CPT©1/HCPCS

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Year 2012TransitionalFacility PE

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And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

61797 3.48 1.78 1.78 1.16 $385.96 $385.9661798 19.85 12.94 12.94 6.60 $2,370.79 $2,370.7961799 4.81 2.47 2.47 1.59 $533.17 $533.1761800 2.25 1.50 1.50 0.73 $269.55 $269.5561850 13.34 10.92 10.92 4.80 $1,753.72 $1,753.7261860 22.26 16.06 16.06 7.99 $2,792.90 $2,792.9061863 20.71 16.36 16.36 7.40 $2,682.87 $2,682.8761864 4.49 2.36 2.36 1.61 $509.47 $509.4761867 33.03 22.74 22.74 11.83 $4,075.79 $4,075.7961868 7.91 4.13 4.13 2.84 $896.09 $896.0961870 16.34 12.85 12.85 5.87 $2,115.34 $2,115.3461875 16.46 12.83 12.83 1.17 $1,805.09 $1,805.0961880 6.95 7.38 7.38 2.46 $1,014.30 $1,014.3061885 6.05 7.56 7.56 2.07 $947.58 $947.5861886 9.93 11.52 11.52 3.52 $1,509.21 $1,509.2161888 5.23 4.56 4.56 1.71 $693.05 $693.0562000 13.93 7.29 7.29 5.01 $1,579.68 $1,579.6862005 17.63 13.51 13.51 6.33 $2,260.43 $2,260.4362010 21.43 16.09 16.09 7.69 $2,727.06 $2,727.0662100 23.53 16.46 16.46 7.51 $2,857.78 $2,857.7862115 22.91 11.89 11.89 1.62 $2,147.03 $2,147.0362116 25.02 18.47 18.47 8.98 $3,164.74 $3,164.7462117 28.35 15.01 15.01 3.66 $2,786.24 $2,786.2462120 24.59 22.67 22.67 3.17 $3,006.41 $3,006.4162121 23.03 18.51 18.51 8.27 $3,005.57 $3,005.5762140 14.55 11.54 11.54 4.75 $1,857.52 $1,857.5262141 16.07 12.45 12.45 5.31 $2,037.79 $2,037.7962142 11.83 10.40 10.40 4.08 $1,587.12 $1,587.1262143 14.15 11.66 11.66 5.01 $1,859.44 $1,859.4462145 20.09 14.54 14.54 7.21 $2,523.35 $2,523.3562146 17.28 13.30 13.30 6.21 $2,219.50 $2,219.5062147 20.67 15.14 15.14 7.40 $2,605.99 $2,605.9962148 2.00 1.04 1.04 0.71 $225.77 $225.7762160 3.00 1.56 1.56 1.08 $339.66 $339.6662161 21.23 15.95 15.95 7.62 $2,702.35 $2,702.3562162 26.80 19.56 19.56 9.61 $3,375.60 $3,375.6062163 16.53 13.79 13.79 5.92 $2,187.04 $2,187.0462164 29.43 21.59 21.59 10.57 $3,714.75 $3,714.7562165 23.23 16.38 16.38 6.37 $2,759.10 $2,759.1062180 22.58 16.67 16.67 8.11 $2,856.57 $2,856.57

Updated December 2011 380 of 387 Effective January 2012

CPT©1/HCPCS

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Year 2012Transitional

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Year 2012TransitionalFacility PE

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Facility All OtherMed Services And

Treatment

MRA 2012

62190 12.17 10.75 10.75 4.37 $1,647.47 $1,647.4762192 13.35 10.88 10.88 4.63 $1,740.43 $1,740.4362194 5.78 6.06 6.06 0.45 $731.54 $731.5462200 19.29 14.49 14.49 6.93 $2,455.68 $2,455.6862201 16.04 13.78 13.78 5.73 $2,145.61 $2,145.6162220 14.10 11.28 11.28 4.83 $1,821.25 $1,821.2562223 14.05 12.33 12.33 4.85 $1,883.92 $1,883.9262225 6.19 7.01 7.01 2.20 $930.71 $930.7162230 11.43 9.51 9.51 3.97 $1,502.42 $1,502.4262252 0.74 1.67 1.67 0.25 $161.25 $161.2562252 TC 0.00 1.29 1.29 0.01 $79.54 $79.5462252 26 0.74 0.38 0.38 0.24 $81.72 $81.7262256 7.38 7.68 7.68 2.63 $1,068.68 $1,068.6862258 15.64 12.23 12.23 5.43 $2,007.79 $2,007.7962263 5.00 14.68 4.61 0.40 $1,210.53 $594.8962264 4.42 7.97 2.25 0.35 $763.75 $414.0662280 2.63 6.73 1.79 0.50 $595.58 $293.5762281 2.66 4.43 1.56 0.27 $441.22 $265.7662282 2.33 6.06 1.56 0.29 $523.33 $248.2262287 9.03 6.61 6.61 0.82 $976.05 $976.0562294 12.87 9.93 9.93 1.02 $1,412.24 $1,412.2462351 11.66 10.71 10.71 3.39 $1,549.96 $1,549.9662355 3.55 3.52 3.52 0.60 $458.71 $458.7162368 0.67 0.91 0.29 0.04 $96.67 $58.7762369 0.67 2.95 0.32 0.04 $221.39 $60.6062370 0.90 2.87 0.42 0.06 $231.00 $81.2263001 17.61 13.25 13.25 5.69 $2,200.38 $2,200.3863003 17.74 13.23 13.23 5.63 $2,202.56 $2,202.5663005 16.43 13.30 13.30 5.08 $2,094.90 $2,094.9063011 15.91 12.11 12.11 4.01 $1,920.47 $1,920.4763012 16.85 13.27 13.27 5.10 $2,118.45 $2,118.4563015 20.85 16.03 16.03 7.01 $2,644.50 $2,644.5063016 22.03 15.98 15.98 6.78 $2,693.52 $2,693.5263017 17.33 14.02 14.02 5.57 $2,223.36 $2,223.3663020 16.20 13.32 13.32 5.06 $2,081.62 $2,081.6263030 13.18 11.56 11.56 3.87 $1,721.19 $1,721.1963035 3.15 1.67 1.67 0.88 $341.53 $341.5363040 20.31 15.01 15.01 6.27 $2,501.49 $2,501.4963042 18.76 14.50 14.50 5.20 $2,309.69 $2,309.6963043 0.00 0.00 0.00 0.00 $0.00 $0.00

Updated December 2011 381 of 387 Effective January 2012

CPT©1/HCPCS

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Facility All OtherMed Services And

Treatment

MRA 2012

63044 0.00 0.00 0.00 0.00 $0.00 $0.0063045 17.95 13.98 13.98 5.73 $2,267.16 $2,267.1663046 17.25 13.40 13.40 5.14 $2,151.98 $2,151.9863047 15.37 12.81 12.81 4.41 $1,959.24 $1,959.2463048 3.47 1.84 1.84 1.01 $378.98 $378.9863050 22.01 15.98 15.98 7.91 $2,768.32 $2,768.3263051 25.51 17.90 17.90 7.24 $3,040.99 $3,040.9963055 23.55 16.89 16.89 7.66 $2,895.29 $2,895.2963056 21.86 15.73 15.73 6.19 $2,628.85 $2,628.8563057 5.25 2.79 2.79 1.51 $572.54 $572.5463064 26.22 18.15 18.15 7.95 $3,144.63 $3,144.6363066 3.26 1.72 1.72 1.17 $370.37 $370.3763075 19.60 14.99 14.99 6.11 $2,448.88 $2,448.8863076 4.04 2.14 2.14 1.25 $446.07 $446.0763077 22.88 15.46 15.46 5.87 $2,649.21 $2,649.2163078 3.28 1.71 1.71 0.75 $342.68 $342.6863081 26.10 18.39 18.39 7.89 $3,148.40 $3,148.4063082 4.36 2.31 2.31 1.31 $478.81 $478.8163085 29.47 18.66 18.66 7.93 $3,360.48 $3,360.4863086 3.19 1.63 1.63 0.87 $340.70 $340.7063087 37.53 23.28 23.28 9.73 $4,225.22 $4,225.2263088 4.32 2.27 2.27 1.06 $457.28 $457.2863090 30.93 19.89 19.89 7.20 $3,470.18 $3,470.1863091 3.03 1.58 1.58 0.68 $315.72 $315.7263101 34.10 23.92 23.92 10.63 $4,128.52 $4,128.5263102 34.10 23.48 23.48 8.60 $3,965.18 $3,965.1863103 4.82 2.55 2.55 1.29 $518.47 $518.4763170 22.21 16.74 16.74 7.98 $2,830.94 $2,830.9463172 19.76 14.81 14.81 7.08 $2,512.23 $2,512.2363173 24.31 18.02 18.02 8.75 $3,081.13 $3,081.1363180 20.53 15.69 15.69 7.36 $2,628.92 $2,628.9263182 22.82 16.36 16.36 8.19 $2,856.73 $2,856.7363185 16.49 12.69 12.69 5.92 $2,117.50 $2,117.5063190 18.89 14.14 14.14 4.29 $2,233.96 $2,233.9663191 18.92 13.82 13.82 3.74 $2,179.14 $2,179.1463194 22.10 12.47 12.47 2.84 $2,218.13 $2,218.1363195 21.64 15.93 15.93 7.77 $2,734.68 $2,734.6863196 25.27 13.87 13.87 1.80 $2,415.25 $2,415.2563197 24.08 17.86 17.86 8.66 $3,052.14 $3,052.1463198 29.90 14.68 14.68 2.12 $2,751.28 $2,751.28

Updated December 2011 382 of 387 Effective January 2012

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Facility All OtherMed Services And

Treatment

MRA 2012

63199 31.47 21.80 21.80 2.23 $3,283.82 $3,283.8263200 21.44 16.14 16.14 7.58 $2,723.30 $2,723.3063250 43.86 28.14 28.14 15.75 $5,289.24 $5,289.2463251 44.64 29.13 29.13 16.03 $5,413.23 $5,413.2363252 44.63 29.10 29.10 16.03 $5,410.82 $5,410.8263265 23.82 17.48 17.48 8.08 $2,975.04 $2,975.0463266 24.68 17.83 17.83 8.40 $3,067.17 $3,067.1763267 19.45 15.05 15.05 6.26 $2,454.05 $2,454.0563268 20.02 15.67 15.67 7.19 $2,587.08 $2,587.0863270 29.80 20.86 20.86 10.71 $3,700.71 $3,700.7163271 29.92 20.74 20.74 10.57 $3,690.83 $3,690.8363272 27.50 19.38 19.38 9.47 $3,395.25 $3,395.2563273 26.47 18.88 18.88 9.50 $3,307.75 $3,307.7563275 25.86 18.50 18.50 8.82 $3,203.90 $3,203.9063276 25.69 18.40 18.40 8.71 $3,180.66 $3,180.6663277 22.39 16.54 16.54 7.00 $2,763.14 $2,763.1463278 22.12 16.78 16.78 7.95 $2,826.21 $2,826.2163280 30.29 21.37 21.37 10.83 $3,768.00 $3,768.0063281 29.99 21.36 21.36 10.67 $3,739.46 $3,739.4663282 28.15 20.26 20.26 9.95 $3,518.51 $3,518.5163283 26.76 19.75 19.75 9.60 $3,384.25 $3,384.2563285 38.05 25.57 25.57 13.66 $4,659.12 $4,659.1263286 37.62 25.06 25.06 13.20 $4,572.41 $4,572.4163287 40.08 26.71 26.71 14.40 $4,894.73 $4,894.7363290 40.82 27.09 27.09 14.66 $4,977.79 $4,977.7963295 5.25 2.71 2.71 1.88 $592.52 $592.5263300 26.80 18.84 18.84 8.68 $3,269.07 $3,269.0763301 31.57 21.84 21.84 11.34 $3,904.27 $3,904.2763302 31.15 21.68 21.68 11.17 $3,859.03 $3,859.0363303 33.55 20.01 20.01 12.03 $3,952.09 $3,952.0963304 33.85 23.42 23.42 12.14 $4,185.13 $4,185.1363305 36.24 24.13 24.13 13.01 $4,423.80 $4,423.8063306 35.55 17.01 17.01 12.77 $3,932.89 $3,932.8963307 34.96 23.48 23.48 12.56 $4,280.56 $4,280.5663308 5.24 2.70 2.70 1.57 $570.50 $570.5063600 15.12 10.49 10.49 1.58 $1,612.90 $1,612.9063610 8.72 9.92 3.37 0.68 $1,151.26 $750.8263615 17.32 12.77 12.77 6.21 $2,189.39 $2,189.3963620 15.60 11.29 11.29 5.19 $1,931.91 $1,931.9163621 4.00 2.06 2.06 1.32 $443.60 $443.60

Updated December 2011 383 of 387 Effective January 2012

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Facility All OtherMed Services And

Treatment

MRA 2012

63655 10.92 10.13 10.13 3.42 $1,474.17 $1,474.1763661 5.08 11.88 3.77 0.71 $1,064.77 $568.9563662 11.00 10.54 10.54 1.55 $1,378.13 $1,378.1363663 7.75 16.29 5.11 1.09 $1,512.73 $829.2363664 11.52 10.52 10.52 1.61 $1,410.70 $1,410.7063700 17.47 14.44 14.44 6.26 $2,303.43 $2,303.4363702 19.41 15.63 15.63 6.97 $2,534.93 $2,534.9363704 22.43 17.84 17.84 8.04 $2,914.81 $2,914.8163706 25.35 19.65 19.65 9.12 $3,265.18 $3,265.1863707 12.65 10.79 10.79 3.50 $1,618.91 $1,618.9163709 15.65 12.35 12.35 4.50 $1,953.20 $1,953.2063710 15.40 12.41 12.41 4.86 $1,966.75 $1,966.7563740 12.63 11.07 11.07 4.26 $1,685.96 $1,685.9663741 9.12 7.31 7.31 2.19 $1,116.07 $1,116.0763744 8.94 7.92 7.92 3.06 $1,201.54 $1,201.5463746 7.33 7.65 7.65 2.63 $1,063.98 $1,063.9864490 1.82 3.92 1.24 0.20 $357.26 $193.4264491 1.16 1.62 0.55 0.11 $172.83 $107.4164492 1.16 1.64 0.57 0.11 $174.05 $108.6364493 1.52 3.66 1.08 0.14 $320.16 $162.4364494 1.00 1.56 0.46 0.08 $157.98 $90.7364495 1.00 1.58 0.49 0.08 $159.21 $92.5764566 0.60 3.28 0.22 0.05 $238.23 $51.1564568 9.00 8.48 8.48 1.25 $1,117.56 $1,117.5664569 11.00 6.39 6.39 3.16 $1,232.62 $1,232.6264570 9.10 4.22 4.22 3.27 $998.61 $998.6164600 3.49 8.04 2.44 0.53 $726.90 $384.5464605 5.65 11.16 3.80 0.44 $1,035.22 $585.2664610 7.20 12.84 5.01 2.15 $1,341.58 $862.8864611 1.03 1.67 1.36 0.29 $180.54 $161.5964612 2.01 2.47 2.05 0.65 $309.73 $284.0664613 2.01 2.28 1.80 0.59 $294.09 $264.7464614 2.20 2.60 1.97 0.42 $313.10 $274.5864620 2.89 3.44 1.91 0.29 $395.21 $301.6764630 3.05 3.38 2.21 0.34 $404.06 $332.5364632 1.23 1.17 0.71 0.10 $148.65 $120.5364633 3.84 9.12 2.75 0.33 $799.52 $410.0864634 1.32 4.66 0.64 0.11 $367.84 $122.0764635 3.78 8.96 2.68 0.32 $785.63 $401.7064636 1.16 4.23 0.55 0.09 $331.05 $106.07

Updated December 2011 384 of 387 Effective January 2012

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Treatment

MRA 2012

64640 2.81 3.41 1.94 0.24 $385.43 $295.5664650 0.70 2.40 0.37 0.11 $194.18 $70.0864653 0.88 2.66 0.43 0.24 $229.12 $92.7964680 2.67 6.60 1.92 0.30 $576.48 $290.3664681 3.78 7.09 1.78 0.30 $669.96 $345.3364702 6.26 7.29 7.29 1.06 $875.21 $875.2164704 4.69 4.06 4.06 0.54 $552.94 $552.9464708 6.36 7.02 7.02 1.16 $871.15 $871.1564712 8.07 6.99 6.99 1.33 $978.61 $978.6164713 11.40 8.66 8.66 2.34 $1,339.18 $1,339.1864714 10.55 7.35 7.35 1.71 $1,168.10 $1,168.1064716 6.99 7.75 7.75 1.13 $949.82 $949.8264718 7.26 8.61 8.61 1.48 $1,041.37 $1,041.3764719 4.97 5.80 5.80 0.93 $701.55 $701.5564721 4.97 6.62 6.54 0.98 $755.04 $750.1564722 4.82 4.85 4.85 0.84 $628.84 $628.8464726 4.27 3.31 3.31 0.39 $472.96 $472.9664727 3.10 1.76 1.76 0.60 $325.35 $325.3564732 4.89 6.16 6.16 1.77 $775.44 $775.4464734 5.55 6.87 6.87 0.71 $785.38 $785.3864736 5.23 6.74 6.74 1.88 $837.75 $837.7564738 6.36 6.20 6.20 2.27 $895.62 $895.6264740 6.22 6.64 6.64 0.80 $815.71 $815.7164742 6.85 5.98 5.98 0.87 $816.12 $816.1264744 5.72 6.44 6.44 2.04 $858.21 $858.2164746 6.56 4.86 4.86 1.54 $776.08 $776.0864752 7.69 5.85 5.85 1.81 $919.43 $919.4364755 15.05 8.51 8.51 3.21 $1,597.39 $1,597.3964760 7.59 5.67 5.67 1.61 $889.26 $889.2664761 7.04 5.45 5.45 1.01 $804.01 $804.0164763 7.56 6.08 6.08 1.61 $912.61 $912.6164766 9.47 6.98 6.98 0.91 $1,029.90 $1,029.9064771 8.15 8.38 8.38 1.05 $1,049.35 $1,049.3564772 7.84 7.45 7.45 1.81 $1,025.83 $1,025.8364774 5.80 5.42 5.42 1.05 $733.89 $733.8964776 5.60 5.06 5.06 0.84 $686.32 $686.3264778 3.11 1.68 1.68 0.61 $321.71 $321.7164782 6.86 5.51 5.51 0.91 $790.65 $790.6564783 3.71 2.27 2.27 0.45 $381.36 $381.3664784 10.62 8.99 8.99 2.00 $1,291.86 $1,291.86

Updated December 2011 385 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

64786 16.25 12.18 12.18 3.21 $1,890.44 $1,890.4464787 4.29 2.25 2.25 0.68 $428.80 $428.8064788 5.24 5.35 5.35 1.08 $699.57 $699.5764790 12.10 9.61 9.61 2.75 $1,464.88 $1,464.8864792 15.86 13.31 13.31 5.69 $2,103.89 $2,103.8964795 3.01 1.88 1.88 0.82 $342.32 $342.3264802 10.37 4.74 4.74 0.82 $938.42 $938.4264804 15.91 6.24 6.24 1.27 $1,377.45 $1,377.4564809 14.71 5.93 5.93 1.17 $1,283.09 $1,283.0964818 11.34 6.39 6.39 2.07 $1,178.82 $1,178.8264820 10.74 9.70 9.70 1.91 $1,336.09 $1,336.0964821 9.33 9.59 9.59 1.84 $1,243.96 $1,243.9664822 9.33 9.03 9.03 1.84 $1,209.72 $1,209.7264823 10.94 9.85 9.85 2.15 $1,372.84 $1,372.8464835 11.73 9.80 9.80 2.30 $1,425.08 $1,425.0864836 11.73 9.81 9.81 2.30 $1,425.69 $1,425.6964837 6.25 3.45 3.45 0.76 $619.72 $619.7264840 14.02 10.74 10.74 1.08 $1,531.62 $1,531.6264856 15.07 12.03 12.03 2.84 $1,788.87 $1,788.8764857 15.82 12.40 12.40 2.91 $1,859.12 $1,859.1264858 17.82 10.76 10.76 3.51 $1,913.65 $1,913.6564859 4.25 2.74 2.74 0.83 $466.54 $466.5464861 20.89 14.13 14.13 4.12 $2,336.39 $2,336.3964862 21.09 16.35 16.35 7.57 $2,715.43 $2,715.4364864 13.41 10.86 10.86 1.70 $1,545.71 $1,545.7164865 16.09 15.44 15.44 2.04 $2,001.95 $2,001.9564866 16.83 14.81 14.81 2.16 $2,013.86 $2,013.8664868 14.90 13.86 13.86 1.91 $1,828.51 $1,828.5164870 17.08 10.02 10.02 4.00 $1,858.99 $1,858.9964872 1.99 1.23 1.23 0.26 $206.57 $206.5764874 2.98 1.63 1.63 0.37 $295.08 $295.0864876 3.37 1.42 1.42 0.65 $323.38 $323.3864885 17.60 12.92 12.92 2.25 $1,948.43 $1,948.4364886 20.82 14.80 14.80 2.67 $2,275.89 $2,275.8964890 16.24 13.56 13.56 3.20 $1,973.57 $1,973.5764891 17.35 12.15 12.15 3.43 $1,966.35 $1,966.3564892 15.74 13.20 13.20 3.12 $1,917.56 $1,917.5664893 16.87 13.90 13.90 3.35 $2,040.49 $2,040.4964895 20.39 16.09 16.09 4.01 $2,420.20 $2,420.2064896 21.96 17.56 17.56 7.89 $2,860.71 $2,860.71

Updated December 2011 386 of 387 Effective January 2012

CPT©1/HCPCS

ModPhysician

WorkRVUs2

Year 2012Transitional

Non- Facility PE RVUs

Year 2012TransitionalFacility PE

RVUs

Malpractice RVUs

Non-Facility AllOther Med Services

And Treatmen

Facility All OtherMed Services And

Treatment

MRA 2012

64897 19.38 15.57 15.57 3.82 $2,317.84 $2,317.8464898 20.97 16.97 16.97 4.14 $2,515.94 $2,515.9464901 10.20 6.51 6.51 2.00 $1,116.21 $1,116.2164902 11.81 7.51 7.51 2.31 $1,290.33 $1,290.3364905 15.11 12.57 12.57 2.98 $1,833.58 $1,833.5864907 20.03 11.33 11.33 1.42 $1,934.52 $1,934.5264910 11.39 11.04 11.04 1.97 $1,459.25 $1,459.2564911 14.39 13.26 13.26 2.84 $1,825.15 $1,825.1564999 0.00 0.00 0.00 0.00 $0.00 $0.00

1/ The five character codes included in the Maryland Workers' Compensation Commission Guide of Medical and Surgical Fees are obtained from Current Procedural Terminology (CPT®), copyright 2011 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.The responsibility for the content of the Maryland Workers' Compensation Commission Guide of Medical and Surgical Fees is with the MD WCC and no endorsement of the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in the Maryland Workers' Compensation Commission Guide of Medical and Surgical Fees. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services .The AMA assumes no liability for data contained or not contained herein.Any use of CPT outside of the Maryland Workers

CPT is a registered trademark of the American Medical Association.

Updated December 2011 387 of 387 Effective January 2012