ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

28

10021 179 0

10022 225 0

10040 118 10

10060 156 10

10061 327 10

10080 169 10

10081 270 10

10120 217 10

10121 371 10

10140 169 10

10160 135 10

10180 321 10

11000 124 0

*11001 62 0

11004 776 0

11005 1070 0

11006 987 0

*11008 715 -

11010 729 10

11011 858 0

11012 1176 0

11040 100 0

11041 155 0

11042 252 0

11043 495 10

11044 678 10

11055 60 0

11056 78 0

11057 96 0

11100 114 0

*11101 44 0

11200 109 10

*11201 26 0

11300 70 0

11301 119 0

11302 147 0

11303 172 0

11305 94 0

11306 127 0

11307 149 0

11308 174 0

11310 102 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

29

11311 102 0

11312 160 0

11313 206 0

11400 165 10

11401 195 10

11402 217 10

11403 251 10

11404 286 10

11406 394 10

11420 163 10

11421 209 10

11422 233 10

11423 274 10

11424 314 10

11426 451 10

11440 185 10

11441 227 10

11442 254 10

11443 308 10

11444 390 10

11446 522 10

11450 486 60

11451 645 60

11462 478 60

11463 662 60

11470 525 60

11471 683 90

11600 202 10

11601 270 10

11602 309 10

11603 356 10

11604 454 10

11606 523 10

11620 248 10

11621 288 10

11622 325 10

11623 387 10

11624 441 10

11626 551 10

11640 256 10

11641 311 10

11642 360 10

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

30

11643 429 10

11644 536 10

11646 714 10

11719 24 0

11720 59 0

11721 106 0

11730 156 0

*11732 80 0

11740 58 0

11750 283 10

11752 402 10

11755 178 0

11760 263 10

11762 507 10

11765 160 10

11770 320 10

11771 713 60

11772 890 60

11900 71 0

11901 90 0

11920 295 0

11921 448 0

*11922 201 0

11950 142 0

11951 327 0

11952 555 0

11954 247 0

11960 1288 90

11970 924 90

11971 607 30

11975 185 -

11976 236 0

11977 451 -

11980 187 0

11981 212 0

11982 259 0

11983 465 0

12001 219 10

12002 278 10

12004 327 10

12005 373 10

12006 415 10

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

31

12007 469 10

12011 228 10

12013 264 10

12014 311 10

12015 371 10

12016 439 10

12017 639 10

12018 657 10

12020 270 10

12021 222 10

12031 286 10

12032 391 10

12034 404 10

12035 489 10

12036 573 10

12037 645 10

12041 362 10

12042 370 10

12044 420 10

12045 526 10

12046 624 10

12047 654 10

12051 358 10

12052 377 10

12053 455 10

12054 501 10

12055 653 10

12056 747 10

12057 2787 10

13100 175 10

13101 455 10

*13102 146 0

13120 371 10

13121 566 10

*13122 188 0

13131 489 10

13132 752 10

*13133 232 0

13150 371 10

13151 555 10

13152 766 10

*13153 259 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

32

13160 740 90

14000 884 60

14001 1150 60

14020 982 90

14021 1284 90

14040 1036 60

14041 1407 60

14060 1066 60

14061 1528 90

14301 2059.09 90

*14302 848.00 -

14350 1085 60

15002 542 -

*15003 111 -

15004 672 -

*15005 223 -

15040 380 0

15050 531 30

15100 1135 45

*15101 293 45

15110 1670 90

*15111 272 -

15115 1717 90

*15116 370 -

15120 1173 45

*15121 447 45

15130 1,342 90

*15131 220 -

15135 1,862 90

*15136 222 -

15150 1,485 90

*15151 293 -

*15152 366 -

15155 1,595 90

*15156 407 -

*15157 444 -

15170 742 90

*15171 221 -

15175 1,108 90

*15176 349 -

15200 891 45

*15201 268 45

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

33

15220 948 45

*15221 358 45

15240 1214 45

*15241 447 45

15260 1489 45

*15261 536 45

15300 629 90

*15301 144 -

15320 732 90

*15321 215 -

15330 628 90

*15331 144 -

15335 702 90

*15336 206 -

15340 645 10

*15341 71 -

15360 692 90

*15361 164 -

15365 731 90

*15366 206 -

15400 483 30

*15401 149 0

15420 826 90

*15421 218 -

15430 1221 90

*15431 554 -

15570 1268 90

15572 1172 90

15574 1265 90

15576 1126 90

15600 487 45

15610 455 45

15620 768 45

15630 768 45

15650 695 45

15731 1559 90

15732 2205 90

15734 2246 90

15736 2062 90

15738 2177 90

15740 1320 90

15750 1355 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

34

15756 5291 90

15757 5291 90

15758 5291 90

15760 1171 60

15770 1110 90

15775 481 0

15776 634 0

15780 1182 60

15781 718 60

15782 674 60

15783 371 60

15786 84 10

*15787 49 30

15788 510 60

15789 772 60

15792 517 60

15793 578 60

15819 1046 60

15820 759 60

15821 814 60

15822 603 30

15823 934 60

15824 1294 0

15825 1112 30

15826 1011 0

15828 3422 30

15829 3422 30

*15830 1677 90

15832 1275 90

15833 1189 90

15834 1197 90

15835 1239 90

15836 1047 90

15837 1082 90

15838 818 60

15839 1159 60

15840 1657 90

15841 2413 90

15842 3834 90

15845 1626 90

*15847 1120 -

15850 150 30

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

35

15851 150 0

15852 150 0

15860 196 0

15876 548 30

15877 916 30

15878 548 30

15879 916 30

15920 834 90

15922 1,124 90

15931 947 90

15933 1,173 90

15934 1,308 90

15935 1,575 90

15936 1,285 90

15937 1,566 90

15940 985 90

15941 1,303 90

15944 1,265 90

15945 1,405 90

15946 2,321 90

15950 640 90

15951 1,171 60

15952 1,210 90

15953 1,364 90

15956 1,900 90

15958 1,951 90

15999 BR -

16000 84 0

16020 101 0

16025 169 0

16030 251 0

16035 573 10

*16036 257 0

17000 99 10

*17003 19 0

**17004 348 10

17106 545 30

17107 967 30

17108 1,313 30

17110 135 30

17111 122.93 10

17250 85 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

36

17260 131 10

17261 176 10

17262 216 10

17263 239 10

17264 259 10

17266 298 10

17270 187 10

17271 204 10

17272 234 10

17273 263 10

17274 316 10

17276 374 10

17280 174 10

17281 224 10

17282 260 10

17283 318 10

17284 374 10

17286 486 10

17311 986 0

*17312 479 -

17313 806 0

*17314 443 -

*17315 117 -

17340 110 10

17360 84 10

17380 118 0

17999 BR -

19000 113 0

*19001 40 0

19020 601 30

19030 197 0

19100 171 0

19101 456 10

19102 260 0

19103 484 0

19105 3,535 0

19110 615 30

19112 585 30

19120 634 30

19125 697 30

*19126 241 30

19260 1,726 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

37

19271 2,365 90

19272 2,608 90

19290 203 0

*19291 95 0

*19295 149 0

19296 6,301 0

*19297 233 -

19298 2,821 0

19300 879 90

19301 964 90

19302 2,058 90

19303 1,922 90

19304 1,278 90

19305 2,545 90

19306 2,647 90

19307 2,662 90

19316 1,266 90

19318 1,920 90

19324 1,155 90

19325 1,522 90

19328 693 90

19330 886 30

19340 1,294 90

19342 1,408 90

19350 1,319 90

19355 1,073 90

19357 2,206 90

19361 2,304 90

19364 4,046 90

19366 2,171 90

19367 2,685 90

19368 3,247 90

19369 2,996 90

19370 968 90

19371 1,117 90

19380 1,091 90

19396 249 0

19499 BR -

20000 219 10

20005 427 10

20100 886 10

20101 492 10

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

38

20102 593 10

20103 818 10

20150 2,351 90

20200 135 0

20205 287 0

20206 155 0

20220 169 0

20225 299 0

20240 345 10

20245 792 10

20250 576 10

20251 657 10

20500 84 10

20501 97 0

20520 279 10

20525 613 10

20526 101 0

20550 67 0

20551 98 0

20552 98 0

20553 98 0

20555 593 0

20600 79 0

20605 84 0

20610 101 0

20612 89 0

20615 331 10

20650 280 10

**20660 354 0

20661 643 21

20662 739 21

20663 646 21

20664 1,062 21

20665 84 10

20670 109 10

20680 827 21

**20690 413 21

**20692 621 21

20693 684 21

20694 422 21

20696 2,142 90

**20697 2,162 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

39

20802 4,596 180

20805 5,626 180

20808 6,994 180

20816 2,998 180

20822 3,375 180

20824 3,967 180

20827 3,639 180

20838 4,596 180

**20900 523 30

**20902 894 30

**20910 631 30

**20912 714 30

**20920 439 30

**20922 856 30

**20924 439 60

**20926 439 60

**20930 330 0

**20931 210 0

**20936 BR 0

**20937 482 0

**20938 529 0

20950 227 0

20955 6,700 90

20956 6,330 90

20957 6,558 90

20962 4,367 90

20969 4,890 90

20970 4,790 90

20972 4,827 90

20973 5,148 90

**20974 252 0

**20975 540 0

20979 82 0

20982 1,010 0

*20985 268 -

20999 BR -

21010 1,114 90

21011 589.15 90

21012 719.17 90

21013 931.82 90

21014 1,110.54 90

21015 682 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

40

21016 2,369.55 90

21025 1,399 90

21026 808 90

21029 1,051 90

21030 675 90

21031 517 90

21032 526 90

21034 1,933 90

21040 679 90

21044 1,878 90

21045 2,532 90

21046 1,561 90

21047 1,946 90

21048 1,592 90

21049 1,851 90

21050 1,249 90

21060 1,422 90

21070 842 90

21073 533 90

21076 1,689 10

21077 4,247 90

21079 2,812 90

21080 3,159 90

21081 2,879 90

21082 2,626 90

21083 2,429 90

21084 2,834 90

21085 1,132 10

21086 3,137 90

21087 3,137 90

21088 1,551 90

21089 BR 90

21100 641 90

21110 968 90

21116 110 0

21120 914 90

21121 1,053 90

21122 1,020 90

21123 1,314 90

21125 1,826 90

21127 2,140 90

21137 1,062 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

41

21138 1,341 90

21139 1,500 90

21141 1,959 90

21142 1,950 90

21143 1,998 90

21145 2,255 90

21146 2,327 90

21147 2,416 90

21150 2,491 90

21151 2,901 90

21154 3,189 90

21155 3,511 90

21159 4,281 90

21160 4,563 90

21172 2,727 90

21175 3,273 90

21179 2,182 90

21180 2,481 90

21181 1,062 90

21182 3,174 90

21183 3,473 90

21184 3,770 90

21188 2,413 90

21193 1,850 90

21194 2,074 90

21195 1,981 90

21196 2,132 90

21198 2,570 90

21199 2,841 90

21206 1,641 90

21208 2,002 90

21209 1,118 90

21210 2,030 90

21215 2,109 90

21230 1,219 90

21235 1,011 90

21240 1,760 90

21242 1,647 90

21243 2,469 90

21244 1,498 90

21245 1,603 90

21246 1,275 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

42

21247 2,781 90

21248 1,490 90

21249 2,396 90

21255 2,055 90

21256 1,989 90

21260 2,030 90

21261 3,331 90

21263 3,493 90

21267 2,329 90

21268 2,791 90

21270 1,296 90

21275 1,182 90

21280 753 90

21282 501 90

21295 258 90

21296 572 90

21299 BR 90

21310 130 0

21315 351 10

21320 429 30

21325 717 90

21330 1,140 90

21335 1,798 90

21336 946 90

21337 315 90

21338 1,110 90

21339 1,454 90

21340 1,897 90

21343 1,720 90

21344 2,743 90

21345 1,544 90

21346 1,764 90

21347 2,234 90

21348 2,769 90

21355 612 10

21356 870 10

21360 1,324 90

21365 1,849 90

21366 2,822 90

21385 1,599 90

21386 1,783 90

21387 1,998 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

43

21390 2,072 90

21395 2,181 90

21400 241 90

21401 670 90

21406 1,186 90

21407 1,508 90

21408 2,001 90

21421 1,089 90

21422 1,708 90

21423 1,958 90

21431 1,261 90

21432 1,807 90

21433 2,587 90

21435 2,825 90

21436 3,868 90

21440 681 90

21445 1,103 90

21450 324 90

21451 1,047 90

21452 189 90

21453 1,023 90

21454 1,371 90

21461 2,127 90

21462 2,331 90

21465 1,953 90

21470 2,461 90

21480 165 30

21485 1,023 90

21490 1,528 90

21495 1,107 90

21497 826 90

21499 BR -

21501 609 21

21502 778 30

21510 693 90

21550 287 10

21552 958.86 90

21554 1,574.78 90

21555 597 90

21556 584 90

21557 1,017 90

21558 3,142.81 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

44

21600 782 60

21610 1,535 60

21615 1,394 60

21616 1,636 90

21620 780 60

21627 808 90

21630 1,863 90

21632 1,846 90

21685 1,353 90

21700 939 60

21705 1,138 90

21720 754 60

21725 853 90

21740 2,927 90

21742 1,385 90

21743 1,823 90

21750 1,060 90

21800 137 30

21805 983 60

21810 1,808 90

21820 187 90

21825 840 90

21899 BR -

21920 168 10

21925 556 60

21930 556 60

21931 1,003.56 90

21932 1,440.58 90

21933 1,588.50 90

21935 1,695 90

21936 3,271.86 90

22010 2,031 90

22015 2,014 90

22100 1,152 90

22101 1,155 90

22102 1,158 90

*22103 272 -

22110 1,437 90

22112 1,433 90

22114 1,438 90

*22116 269 -

22206 4,149 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

45

22207 4,098 90

*22208 1,040 -

22210 2,553 90

22212 2,109 90

22214 2,136 90

*22216 661 -

22220 2,302 90

22222 2,141 90

22224 2,292 90

*22226 661 -

22305 267 90

22310 397 90

22315 1,208 90

22318 3,707 90

22319 4,090 90

22325 2,880 90

22326 2,880 90

22327 2,880 90

*22328 536 -

22505 178 10

22520 1,466 10

22521 1,382 10

*22522 628 0

22523 1,526 10

22524 1,462 10

*22525 700 -

22526 5,520 10

*22527 404 -

22532 4,059 90

22533 3,785 90

*22534 956 -

22548 4,580 90

22554 4,277 90

22556 4,000 90

22558 4,444 90

*22585 839 -

22590 2,207 90

22595 5,394 90

22600 3,667 90

22610 3,832 90

22612 4,000 90

*22614 1,058 -

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

46

22630 4,600 90

*22632 608 -

22800 4,369 90

22802 4,438 180

22804 5,879 90

22808 2,679 90

22810 3,019 90

22812 3,369 90

22818 4,409 90

22819 4,896 90

22830 1,800 90

**22840 2,813 0

**22841 BR 0

**22842 5,000 0

**22843 1,042 0

**22844 1,549 0

**22845 1,702 0

**22846 1,978 0

**22847 2,198 0

**22848 697 0

22849 1,916 90

22850 1,391 90

**22851 780 0

22852 2,360 90

22855 2,705 90

22856 3,319 90

22857 3,680 90

22861 4,498 90

22862 4,483 90

22864 4,191 90

22865 4,365 90

22899 BR 90

22900 573 60

22901 1,418.00 90

22902 794.84 90

22903 940.50 90

22904 2,361.58 90

22905 3,062.58 90

22999 BR -

23000 762 60

23020 1,038 60

23030 632 10

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

47

23031 545 10

23035 1,039 30

23040 1,057 60

23044 840 45

23065 289 10

23066 710 0

23071 891.67 90

23073 1,476.80 90

23075 364 10

23076 809 15

23077 1,715 90

23078 3,187.06 90

23100 1,038 60

23101 660 60

23105 1,422 90

23106 700 90

23107 1,064 90

23120 846 60

23125 1,422 90

23130 889 90

23140 742 60

23145 1,000 90

23146 907 90

23150 945 30

23155 1,157 90

23156 991 90

23170 788 90

23172 799 90

23174 1,238 90

23180 1,061 90

23182 1,013 60

23184 1,238 60

23190 816 60

23195 1,181 90

23200 1,293 90

23210 1,347 90

23220 1,584 90

23330 325 10

23331 1,038 90

23332 1,306 90

23350 129 0

23395 1,890 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

48

23397 2,100 90

23400 2,063 90

23405 930 90

23406 1,165 90

23410 1,593 90

23412 1,735 90

23415 1,093 60

23420 1,977 90

23430 1,351 90

23440 1,138 90

23450 1,835 90

23455 2,063 90

23460 2,333 90

23462 2,077 90

23465 1,807 90

23466 1,632 90

23470 1,849 90

23472 2,845 90

23480 1,222 90

23485 1,437 90

23490 1,220 90

23491 1,566 90

23500 297 -

23505 489 90

23515 1,053 90

23520 303 -

23525 404 90

23530 1,190 90

23532 1,314 90

23540 287 -

23545 439 60

23550 1,440 60

23552 1,566 90

23570 270 60

23575 472 90

23585 1,503 90

23600 338 60

23605 663 90

23615 1,991 90

23616 3,953 90

23620 219 90

23625 444 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

49

23630 1,068 90

23650 419 30

23655 580 30

23660 1,404 90

23665 506 90

23670 1,550 90

23675 759 90

23680 2,019 90

23700 306 10

23800 2,314 90

23802 2,610 90

23900 2,845 90

23920 2,063 90

23921 644 90

23929 BR -

23930 540 10

23931 390 10

23935 734 60

24000 953 60

24006 786 60

24065 270 10

24066 841 30

24071 865.15 90

24073 1,484.96 90

24075 624 21

24076 681 30

24077 1,258 90

24079 2,938.10 90

24100 578 60

24101 1,152 60

24102 1,323 90

24105 484 60

24110 896 60

24115 1,181 90

24116 1,284 90

24120 762 60

24125 953 90

24126 929 90

24130 754 60

24134 1,139 60

24136 927 30

24138 967 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

50

24140 1,138 60

24145 754 30

24147 967 60

24149 2,351 90

24150 1,583 90

24152 1,380 60

24155 1,422 90

24160 889 60

24164 727 30

24200 298 10

24201 833 30

24220 168 0

24300 571 90

24301 1,878 60

24305 851 60

24310 697 30

24320 1,209 90

24330 1,138 90

24331 1,494 90

24332 873 90

24340 953 90

24341 1,415 90

24342 1,323 90

24343 1,030 90

24344 1,601 90

24345 1,024 90

24346 1,592 90

24357 783 90

24358 920 90

24359 1,131 90

24360 1,613 90

24361 1,577 90

24362 1,920 90

24363 3,535 90

24365 953 60

24366 1,185 60

24400 1,494 90

24410 1,707 90

24420 1,494 90

24430 1,920 90

24435 2,262 120

24470 994 120

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

51

24495 999 60

24498 1,297 90

24500 219 90

24505 709 90

24515 1,294 90

24516 1,800 90

24530 422 90

24535 887 90

24538 1,102 90

24545 1,665 90

24546 2,968 90

24560 371 60

24565 674 90

24566 1,016 90

24575 1,179 90

24576 237 60

24577 742 60

24579 1,267 90

24582 1,141 90

24586 2,156 90

24587 2,430 90

24600 472 60

24605 590 60

24615 1,206 90

24620 1,000 90

24635 1,260 90

24640 176 10

24650 355 60

24655 590 90

24665 954 90

24666 1,206 90

24670 371 60

24675 645 90

24685 1,044 90

24800 2,310 90

24802 2,610 90

24900 1,200 90

24920 1,035 90

24925 794 90

24930 1,083 90

24931 1,362 90

24935 2,029 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

52

24940 1,645 90

24999 BR -

25000 575 60

25001 506 90

25020 784 60

25023 1,364 60

25024 1,168 90

25025 1,810 90

25028 711 60

25031 422 60

25035 1,038 60

25040 912 60

25065 247 10

25066 620 15

25071 906.29 90

25073 1,129.36 90

25075 537 30

25076 765 60

25077 1,411 90

25078 2,564.49 90

25085 768 60

25100 661 60

25101 796 60

25105 1,004 60

25107 960 60

25109 647 90

25110 649 30

25111 512 30

25112 642 30

25115 1,335 60

25116 1,157 60

25118 747 60

25119 1,001 60

25120 961 60

25125 1,095 90

25126 1,102 90

25130 900 60

25135 1,157 90

25136 1,076 90

25145 1,092 90

25150 927 60

25151 1,000 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

53

25170 1,501 60

25210 779 60

25215 1,272 60

25230 692 60

25240 792 60

25246 229 0

25248 745 60

25250 1,037 30

25251 3,285 60

25259 605 90

25260 1,154 60

25263 1,042 60

25265 1,348 90

25270 946 60

25272 1,057 60

25274 1,192 90

25275 1,040 90

25280 1,064 60

25290 975 60

25295 997 60

25300 1,277 90

25301 1,095 90

25310 1,288 90

25312 1,520 90

25315 1,392 90

25316 2,042 90

25320 1,497 90

25332 1,764 90

25335 1,849 90

25337 1,391 90

25350 1,364 90

25355 1,856 90

25360 1,330 90

25365 1,899 90

25370 1,743 90

25375 1,825 90

25390 1,478 90

25391 1,757 90

25392 1,759 90

25393 2,302 90

25394 1,199 90

25400 1,896 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

54

25405 2,251 90

25415 1,546 90

25420 2,037 90

25425 1,862 90

25426 2,113 90

25430 1,094 90

25431 1,226 90

25440 1,656 90

25441 1,551 90

25442 1,377 90

25443 1,523 90

25444 1,643 90

25445 1,486 90

25446 2,372 90

25447 1,537 90

25449 1,623 90

25450 1,074 90

25455 1,184 90

25490 1,290 90

25491 1,352 90

25492 1,605 90

25500 353 60

25505 721 90

25515 1,259 90

25520 1,000 90

25525 2,203 90

25526 3,612 90

25530 373 60

25535 669 90

25545 1,309 90

25560 365 60

25565 787 60

25574 1,531 90

25575 1,780 90

25600 427 60

25605 917 90

25606 1,044 90

25607 1,085 90

25608 1,331 90

25609 1,711 90

25622 439 60

25624 627 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

55

25628 1,177 90

25630 449 60

25635 593 60

25645 884 90

25650 656 90

25651 720 90

25652 919 90

25660 456 60

25670 948 90

25671 799 90

25675 598 60

25676 982 90

25680 693 60

25685 1,562 120

25690 706 90

25695 1,185 60

25800 1,568 90

25805 2,155 90

25810 2,155 90

25820 1,095 90

25825 1,559 90

25830 1,401 90

25900 1,095 90

25905 1,220 90

25907 970 30

25909 1,105 90

25915 2,042 90

25920 1,060 90

25922 930 30

25924 1,095 90

25927 1,157 90

25929 885 30

25931 1,095 90

25999 BR -

26010 279 10

26011 437 10

26020 653 30

26025 699 30

26030 933 30

26034 817 30

26035 1,480 60

26037 1,500 30

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

56

26040 471 30

26045 800 60

26055 679 30

26060 401 15

26070 628 30

26075 571 30

26080 585 30

26100 642 30

26105 613 30

26110 491 30

26111 879.31 90

26113 1,156.80 90

26115 665 30

26116 704 30

26117 1,500 90

26118 2,410.64 90

26121 1,407 90

26123 1,750 90

*26125 570 90

26130 904 90

26135 1,119 90

26140 1,015 90

26145 1,032 90

26160 904 30

26170 633 30

26180 714 30

26185 719 90

26200 907 60

26205 1,078 90

26210 701 30

26215 1,216 90

26230 808 60

26235 791 60

26236 697 60

26250 980 90

26260 987 90

26262 1,050 90

26320 695 30

26340 475 0

26350 1,274 90

26352 1,408 90

26356 1,320 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

57

26357 1,497 90

26358 1,625 90

26370 1,260 60

26372 1,455 60

26373 1,153 60

26390 1,338 90

26392 1,448 60

26410 898 60

26412 1,056 60

26415 1,162 60

26416 1,399 60

26418 880 90

26420 1,169 90

26426 964 90

26428 1,255 120

26432 770 30

26433 873 30

26434 1,051 90

26437 1,007 60

26440 1,031 60

26442 1,056 60

26445 965 60

26449 1,280 60

26450 645 30

26455 641 30

26460 480 30

26471 961 90

26474 917 90

26476 879 90

26477 880 90

26478 853 90

26479 858 90

26480 1,129 90

26483 1,498 90

26485 1,325 90

26489 1,627 90

26490 1,275 90

26492 1,627 90

26494 1,537 90

26496 1,750 90

26497 1,525 90

26498 1,965 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

58

26499 1,845 90

26500 1,010 90

26502 1,102 90

26508 1,026 90

26510 1,287 90

26516 961 90

26517 1,221 90

26518 1,400 90

26520 1,077 90

26525 1,082 90

26530 990 90

26531 1,137 90

26535 882 90

26536 1,137 90

26540 1,004 90

26541 1,392 90

26542 1,176 90

26545 1,309 90

26546 1,316 90

26548 1,061 90

26550 2,437 90

26551 6,576 90

26553 6,466 90

26554 7,758 90

26555 2,112 90

26556 6,466 90

26560 1,137 90

26561 1,537 90

26562 2,730 90

26565 980 90

26567 1,082 90

26568 1,342 90

26580 2,650 90

26587 1,157 60

26590 2,086 90

26591 850 90

26593 957 90

26596 1,549 90

26600 299 30

26605 471 60

26607 685 60

26608 782 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

59

26615 795 60

26641 387 60

26645 587 45

26650 882 60

26665 1,067 60

26670 365 30

26675 648 45

26676 747 45

26685 852 60

26686 1,364 60

26700 348 30

26705 455 45

26706 661 45

26715 823 45

26720 282 -

26725 422 45

26727 582 45

26735 747 90

26740 328 30

26742 563 60

∆26746

Open treatment of articular

fracture, involving

metacarpophalangeal or

interphalangeal joint, with

or without internal or

external fixation, each.

1,028 60

26750 191 30

26755 319 30

26756 317 60

26765 530 60

26770 287 30

26775 366 45

26776 528 60

26785 557 60

26820 1,295 90

26841 1,025 90

26842 1,274 90

26843 1,076 90

26844 1,263 90

26850 1,056 90

26852 1,271 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

60

26860 1,021 90

*26861 316 90

26862 966 90

*26863 442 90

26910 978 90

26951 863 45

26952 1,023 45

26989 BR -

26990 825 30

26991 620 30

26992 1,506 30

27000 516 30

27001 634 30

27003 1,049 45

27005 873 60

27006 1,056 60

27025 1,287 90

27027 1,849 10

27030 1,858 90

27033 1,889 90

27035 2,189 90

27036 1,940 90

27040 282 10

27041 867 60

27043 1,001.87 90

27045 1,592.13 90

27047 686 30

27048 796 30

27049 1,544 90

27050 677 90

27052 1,323 90

27054 1,920 90

27057 2,026 90

27059 4,151.38 90

27060 686 60

27062 709 60

27065 767 90

27066 1,256 90

27067 1,809 90

27070 1,203 90

27071 1,421 90

27075 3,618 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

61

27076 2,710 90

27077 4,220 90

27078 1,579 90

27080 754 90

27086 322 10

27087 899 30

27090 1,673 90

27091 3,698 90

27093 324 0

27095 532 0

27096 418 0

27097 1,167 90

27098 1,494 90

27100 1,675 90

27105 1,759 90

27110 1,942 90

27111 1,816 90

27120 2,731 90

27122 2,449 90

27125 3,129 90

27130 4,281 90

27132 3,808 90

27134 4,623 90

27137 3,326 90

27138 3,435 90

27140 1,604 90

27146 1,997 90

27147 2,434 90

27151 2,870 90

27156 3,046 90

27158 2,667 90

27161 2,332 90

27165 2,603 90

27170 2,475 90

27175 1,310 90

27176 1,956 90

27177 2,205 90

27178 1,991 90

27179 1,591 90

27181 2,276 90

27185 1,029 90

27187 2,272 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

62

27193 718 90

27194 1,162 90

27200 254 90

27202 998 90

27215 2,025 90

27216 3,520 90

27217 3,500 90

27218 5,012 90

27220 697 60

27222 1,408 90

27226 3,094 90

27227 7,294 90

27228 9,531 90

27230 648 60

27232 1,215 90

27235 2,430 90

27236 2,520 90

27238 693 60

27240 1,489 90

27244 2,423 90

27245 3,584 90

27246 589 60

27248 1,250 90

27250 748 60

27252 1,095 90

27253 1,985 90

27254 2,538 90

27256 623 10

27257 1,348 10

27258 2,225 90

27259 2,786 90

27265 704 90

27266 900 90

27267 922 90

27268 1,206 90

27269 2,728 90

27275 544 10

27280 1,733 90

27282 2,046 90

27284 3,520 90

27286 3,696 90

27290 4,694 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

63

27295 2,845 90

27299 BR -

27301 665 30

27303 1,071 30

27305 731 45

27306 510 30

27307 634 90

27310 1,333 60

27323 282 10

27324 546 30

27325 1,242 90

27326 1,174 90

27327 595 15

27328 655 15

27329 1,607 60

27330 953 90

27331 1,266 90

27332 1,508 90

27333 1,920 90

27334 1,512 90

27335 1,977 90

27337 893.47 90

27339 1,608.85 90

27340 614 60

27345 891 60

27347 782 90

27350 1,201 60

27355 1,101 60

27356 1,291 90

27357 1,457 90

*27358 619 90

27360 1,330 90

27364 3,574.03 90

27365 1,918 90

27370 195 0

27372 782 30

27380 1,152 90

27381 1,654 90

27385 1,291 90

27386 1,753 90

27390 731 30

27391 956 45

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

64

27392 1,192 45

27393 786 30

27394 1,018 60

27395 1,419 60

27396 1,422 90

27397 1,636 90

27400 1,494 90

27403 1,312 90

27405 1,384 90

27407 1,546 90

27409 1,986 90

27412 3,951 90

27415 3,298 90

27416 2,135 90

27418 1,865 90

27420 1,800 90

27422 1,800 90

27424 1,800 90

27425 1,800 90

27427 1,750 90

27428 2,456 90

27429 3,474 90

27430 1,445 90

27435 1,323 90

27437 1,422 90

27438 1,878 90

27440 2,418 90

27441 2,347 90

27442 2,276 90

27443 2,703 90

27445 3,940 90

27446 3,200 90

27447 4,281 90

27448 1,828 90

27450 2,206 90

27454 2,220 90

27455 1,899 90

27457 2,047 90

27465 1,984 90

27466 2,489 90

27468 2,845 90

27470 1,986 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

65

27472 2,284 90

27475 1,353 90

27477 1,636 90

27479 1,920 90

27485 1,283 90

27486 2,682 90

27487 4,552 90

27488 2,560 90

27495 2,521 90

27496 734 90

27497 850 90

27498 965 90

27499 1,180 90

27500 787 90

27501 844 90

27502 1,239 90

27503 1,606 90

27506 2,450 90

27507 2,250 90

27508 797 60

27509 1,470 90

27510 1,088 90

27511 2,451 90

27513 2,891 90

27514 2,194 90

27516 768 90

27517 1,203 90

27519 2,092 90

27520 451 60

27524 1,368 90

27530 581 60

27532 915 90

27535 1,905 90

27536 2,450 90

27538 706 60

27540 1,674 90

27550 458 60

27552 796 60

27556 2,049 90

27557 2,411 90

27558 3,040 90

27560 398 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

66

27562 704 60

27566 1,742 90

27570 325 10

27580 2,430 90

27590 1,540 90

27591 1,489 90

27592 1,342 90

27594 796 90

27596 1,351 90

27598 1,555 90

27599 BR -

27600 663 30

27601 682 30

27602 848 60

27603 794 60

27604 414 30

27605 581 10

27606 476 10

27607 845 30

27610 1,101 60

27612 1,079 60

27613 371 10

27614 686 30

27615 1,585 90

27616 2,916.50 90

27618 651 30

27619 1,056 30

27620 926 60

27625 1,244 90

27626 1,341 90

27630 611 45

27632 882.06 90

27634 1,439.78 90

27635 1,209 60

27637 1,393 90

27638 1,507 90

27640 1,582 90

27641 1,225 90

27645 1,934 90

27646 1,511 90

27647 1,619 90

27648 229 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

67

27650 1,311 90

27652 1,403 90

27654 1,467 90

27656 628 60

27658 680 90

27659 957 90

27664 610 90

27665 756 90

27675 820 30

27676 981 60

27680 687 60

27681 823 60

27685 776 90

27686 893 90

27687 738 90

27690 976 90

27691 1,156 90

*27692 260 90

27695 1,039 90

27696 1,323 90

27698 1,501 90

27700 1,555 90

27702 2,678 120

27703 2,549 90

27704 1,140 30

27705 1,511 90

27707 670 180

27709 1,706 90

27712 1,797 90

27715 2,276 90

27720 1,824 90

27722 1,774 90

27724 2,196 90

27725 2,460 90

27726 1,608 90

27727 2,001 90

27730 1,046 90

27732 783 90

27734 1,237 90

27740 1,707 90

27742 2,063 90

27745 1,450 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

68

27750 509 60

27752 810 90

27756 1,440 90

27758 2,050 90

27759 2,235 90

27760 462 60

27762 648 90

27766 1,133 90

27767 452 90

27768 696 90

27769 1,203 90

27780 352 60

27781 544 90

27784 954 90

27786 456 60

27788 593 90

27792 1,076 90

27808 427 60

27810 780 90

27814 1,445 90

27816 323 90

27818 863 90

27822 1,653 90

27823 1,872 90

27824 461 90

27825 867 90

27826 1,638 90

27827 2,618 90

27828 3,038 90

27829 1,050 90

27830 498 90

27831 583 60

27832 939 90

27840 447 45

27842 591 45

27846 1,296 90

27848 1,485 90

27860 278 10

27870 2,282 90

27871 1,562 90

27880 1,511 90

27881 1,720 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

69

27882 1,188 90

27884 925 45

27886 1,233 90

27888 1,442 90

27889 1,370 90

27892 1,155 90

27893 1,155 90

27894 1,810 90

27899 BR -

28001 251 10

28002 654 10

28003 869 45

28005 925 45

28008 616 90

28010 357 60

28011 452 60

28020 761 60

28022 561 60

28024 581 60

28035 912 60

28039 855.68 90

28041 960.37 90

28043 509 21

28045 709 30

28046 1,164 90

28047 2,147.26 90

28050 619 60

28052 588 60

28054 552 60

28055 989 90

28060 749 60

28062 1,046 90

28070 720 90

28072 598 90

28080 566 90

28086 826 60

28088 655 60

28090 625 45

28092 509 45

28100 780 60

28102 868 90

28103 912 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

70

28104 719 60

28106 912 90

28107 823 90

28108 624 60

28110 571 60

28111 759 60

28112 641 60

28113 666 60

28114 1,290 90

28116 912 60

28118 850 60

28119 761 60

28120 774 60

28122 918 60

28124 694 60

28126 557 60

28130 1,095 90

28140 893 90

28150 557 60

28153 575 60

28160 595 60

28171 999 90

28173 1,116 90

28175 813 90

28190 299 10

28192 506 30

28193 614 30

28200 694 90

28202 936 90

28208 528 90

28210 811 90

28220 637 60

28222 760 60

28225 519 60

28226 642 60

28230 534 60

28232 380 60

28234 369 60

28238 1,018 60

28240 627 60

28250 792 60

28260 937 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

71

28261 1,160 60

28262 1,889 90

28264 1,280 90

28270 563 60

28272 445 60

28280 562 60

28285 674 60

28286 625 60

28288 586 60

28289 687 90

28290 839 90

28292 1,038 90

28293 1,389 90

28294 1,107 90

28296 1,241 90

28297 1,095 90

28298 1,055 90

28299 1,365 90

28300 1,068 90

28302 1,064 90

28304 1,175 90

28305 1,550 90

28306 804 90

28307 935 90

28308 788 90

28309 1,056 90

28310 721 90

28312 659 90

28313 593 90

28315 690 90

28320 1,020 90

28322 995 90

28340 955 90

28341 1,140 90

28344 565 90

28345 835 90

28360 1,818 90

28400 371 -

28405 607 90

28406 832 90

28415 1,836 90

28420 1,914 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

72

28430 347 -

28435 521 90

28436 663 90

28445 1,712 90

28446 2,081 90

28450 321 90

28455 431 90

28456 616 90

28465 952 90

28470 321 -

28475 399 60

28476 512 60

28485 784 90

28490 157 -

28495 229 30

28496 454 30

28505 747 60

28510 149 -

28515 213 30

28525 634 60

28530 280 60

28531 563 60

28540 303 45

28545 449 45

28546 644 45

28555 983 90

28570 268 45

28575 448 45

28576 756 45

28585 1,317 90

28600 307 45

28605 369 45

28606 629 45

28615 1,067 90

28630 210 10

28635 350 10

28636 546 10

28645 647 90

28660 158 10

28665 250 10

28666 537 10

28675 606 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

73

28705 2,317 90

28715 1,934 90

28725 1,694 90

28730 1,334 90

28735 1,372 90

28737 1,176 90

28740 892 90

28750 994 90

28755 641 90

28760 852 90

28800 955 90

28805 1,103 90

28810 750 90

28820 634 60

28825 493 60

28890 543 90

28899 BR -

29000 432 0

29010 346 0

29015 366 0

29020 340 0

29025 392 0

29035 294 0

29040 270 0

29044 333 0

29046 366 0

29049 136 0

29055 239 0

29058 154 0

29065 132 0

29075 105 0

29085 105 0

29086 104 0

29105 108 0

29125 88 0

29126 118 0

29130 53 0

29131 112 0

29200 64 0

29220 80 0

29240 77 0

29260 54 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

74

29280 53 0

29305 310 0

29325 336 0

29345 191 0

29355 207 0

29358 236 0

29365 161 0

29405 130 0

29425 146 0

29435 178 0

29440 56 0

29445 259 0

29450 111 0

29505 99 0

29515 96 0

29520 78 0

29530 71 0

29540 53 0

29550 53 0

29580 79 0

29581 155.42 0

29590 118 0

29700 84 0

29705 99 0

29710 127 0

29715 123 0

29720 72 0

29730 67 0

29740 96 0

29750 129 0

29799 BR -

29800 820 0

29804 1,347 60

29805 735 90

29806 2,521 90

29807 2,450 90

29819 2,100 90

29820 1,780 90

29821 2,130 90

29822 1,878 90

29823 2,130 90

29824 1,543 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

75

29825 2,130 90

29826 2,448 90

29827 2,450 90

29828 1,598 90

29830 989 0

29834 2,315 60

29835 1,874 60

29836 2,366 60

29837 1,711 60

29838 2,265 60

29840 1,031 0

29843 1,461 60

29844 1,478 60

29845 1,742 60

29846 1,901 60

29847 1,901 60

29848 1,312 90

29850 1,636 90

29851 2,371 90

29855 1,869 90

29856 2,134 90

29860 1,147 0

29861 2,219 90

29862 2,259 90

29863 2,532 90

29866 2,586 90

29867 3,080 90

29868 4,169 90

29870 905 0

29871 1,406 60

29873 1,088 90

29874 1,720 60

29875 1,937 60

29876 2,135 60

29877 2,135 60

29879 2,135 60

29880 2,800 60

29881 2,135 60

29882 2,765 60

29883 3,062 60

29884 2,135 60

29885 2,577 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

76

29886 2,061 60

29887 2,135 60

29888 4,072 60

29889 3,804 60

29891 2,040 90

29892 1,935 90

29893 894 90

29894 1,743 60

29895 1,628 60

29897 1,628 60

29898 2,420 60

29899 1,660 90

29900 724 90

29901 799 90

29902 837 90

29904 1,076 90

29905 1,160 90

29906 1,222 90

29907 1,493 90

29999 BR -

30000 278 10

30020 164 10

30100 149 0

30110 224 10

30115 600 15

30117 579 7

30118 1,192 60

30120 953 60

30124 340 30

30125 969 30

30130 382 30

30140 683 90

30150 1,763 90

30160 1,264 90

30200 124 0

30210 150 10

30220 234 10

30300 229 10

30310 341 10

30320 1,152 10

30400 1,511 90

30410 1,960 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

77

30420 2,140 90

30430 1,003 45

30435 1,673 60

30450 2,285 90

30460 1,412 60

30462 2,620 60

30465 2,080 60

30520 1,095 90

30540 1,101 60

30545 1,920 60

30560 211 10

30580 953 90

30600 910 90

30620 1,067 90

30630 1,001 90

30801 176 10

30802 282 10

30901 139 0

30903 187 0

30905 293 0

30906 339 0

30915 953 30

30920 1,906 60

30930 124 10

30999 BR -

31000 165 10

31002 229 10

31020 500 90

31030 1,133 90

31032 1,112 90

31040 1,542 90

31050 861 90

31051 1,169 90

31070 953 30

31075 1,494 90

31080 1,563 90

31081 1,746 90

31084 2,148 90

31085 2,183 90

31086 2,116 90

31087 2,116 90

31090 2,418 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

78

31200 726 90

31201 1,126 90

31205 1,341 90

31225 2,713 90

31230 3,169 90

31231 267 0

31233 388 0

31235 409 0

31237 511 0

31238 527 0

31239 1,329 10

31240 409 0

31254 1,000 0

31255 1,300 0

31256 880 0

31267 756 0

31276 1,106 0

31287 691 0

31288 819 0

31290 2,292 10

31291 2,408 10

31292 1,679 10

31293 1,837 10

31294 2,099 10

31299 BR -

31300 1,941 90

31320 801 60

31360 2,701 120

31365 3,803 120

31367 2,831 90

31368 3,741 90

31370 2,791 90

31375 2,607 90

31380 2,918 90

31382 2,704 90

31390 3,872 90

31395 4,553 90

31400 1,920 90

31420 1,494 90

**31500 199 0

31502 91 0

31505 130 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

79

31510 306 0

31511 311 0

31512 310 0

31513 299 0

31515 219 0

31525 378 0

31526 400 0

31527 482 0

31528 294 0

31529 297 0

31530 462 0

31531 597 0

31535 444 0

31536 497 0

31540 656 0

31541 625 0

31545 949 0

31546 1,447 0

31560 1,422 0

31561 1,863 0

31570 782 0

31571 725 0

31575 213 0

31576 356 0

31577 446 0

31578 626 0

31579 359 0

31580 1,862 90

31582 2,941 90

31584 2,371 90

31587 1,531 90

31588 1,761 90

31590 1,819 120

31595 1,382 60

31599 BR -

31600 605 0

31603 498 0

31605 455 0

31610 1,105 60

31611 826 90

31612 121 0

31613 507 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

80

31614 1,083 90

31615 389 0

*31620 455 -

31622 519 0

31623 570 0

31624 530 0

31625 567 0

31626 665.50 0

31627 1,583.87 -

31628 678 0

31629 1,079 0

31630 716 0

31631 645 0

*31632 123 -

*31633 148 -

31635 716 0

31636 591 0

*31637 213 -

31638 653 0

31640 747 0

31641 1,048 0

31643 466 0

31645 500 0

31646 484 0

31656 403 0

31715 80 0

31717 196 0

31720 87 0

31725 161 0

31730 576 0

31750 2,073 90

31755 2,274 90

31760 2,274 90

31766 2,936 90

31770 2,274 90

31775 2,307 90

31780 2,622 90

31781 3,063 90

31785 1,971 90

31786 2,834 90

31800 1,209 30

31805 1,765 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

81

31820 603 60

31825 887 90

31830 620 30

31899 BR -

32035 1,057 90

32036 1,212 90

32095 1,000 90

32100 1,552 90

32110 1,845 90

32120 1,382 90

32124 1,469 90

32140 1,575 90

32141 2,033 90

32150 1,588 90

32151 1,622 90

32160 1,365 90

32200 1,572 90

32201 616 0

32215 1,280 90

32220 2,464 90

32225 1,586 90

32310 2,333 90

32320 2,557 90

32400 211 0

32402 1,123 60

32405 276 0

32420 208 0

32421 229 0

32422 330 0

32440 3,174 90

32442 3,388 90

32445 4,147 90

32480 2,432 90

32482 2,716 90

32484 2,762 90

32486 3,123 90

32488 3,350 90

32491 3,410 90

32500 2,357 90

*32501 823 -

32503 4,634 90

32504 5,300 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

82

32540 1,980 90

32550 746 0

32551 333 0

32552 359.63 10

32553 601.27 0

32560 334 0

32561 174.71 0

32562 155.70 0

32601 638 0

32602 702 0

32603 828 0

32604 919 0

32605 740 0

32606 873 0

32650 1,268 60

32651 1,905 90

32652 2,657 90

32653 1,649 90

32654 1,819 90

32655 1,972 90

32656 1,764 90

32657 2,047 90

32658 1,937 90

32659 1,774 90

32660 2,638 90

32661 1,733 90

32662 1,919 90

32663 2,748 90

32664 1,923 90

32665 2,308 90

32800 1,310 90

32810 1,484 90

32815 3,548 90

32820 3,072 90

32850 1,546 -

32851 5,879 90

32852 6,520 90

32853 7,054 90

32854 7,642 90

32855 3,629 -

32856 4,185 -

32900 2,110 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

83

32905 2,179 90

32906 2,693 90

32940 1,995 90

32960 198 0

32997 620 0

32998 4,757 0

32999 BR -

33010 259 0

33011 205 0

33015 686 60

33020 1,517 90

33025 1,517 90

33030 2,707 90

33031 2,855 90

33050 1,733 90

33120 4,086 90

33130 2,677 90

33140 3,046 90

*33141 1,567 0

33202 1,382 90

33203 1,426 90

33206 996 90

33207 1,143 90

33208 1,164 90

33210 380 0

33211 393 0

33212 838 90

33213 800 90

33214 1,466 90

33215 525 90

33216 964 60

33217 717 60

33218 756 60

33220 714 60

33222 899 60

33223 1,235 60

33224 1,220 90

*33225 1,127 -

33226 950 90

33233 418 15

33234 1,719 15

33235 1,910 15

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

84

33236 1,771 90

33237 1,901 90

33238 2,074 90

33240 1,348 15

33241 964 15

33243 3,672 90

33244 2,696 60

33249 2,360 90

33250 2,500 90

33251 3,098 90

33254 2,547 90

33255 2,938 90

33256 3,456 90

*33257 1,106 -

*33258 1,248 -

*33259 1,630 -

33261 3,000 90

33265 2,209 90

33266 3,283 90

33282 742 90

33284 576 60

33300 2,074 90

33305 3,002 90

33310 2,183 90

33315 3,456 90

33320 1,784 90

33321 3,456 90

33322 3,888 90

33330 3,888 90

33332 4,061 90

33335 4,838 90

33400 3,668 90

33401 3,457 90

33403 3,730 90

33404 4,222 90

33405 5,021 90

33406 5,710 90

33410 5,330 90

33411 5,291 90

33412 5,647 90

33413 5,970 90

33414 5,412 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

85

33415 3,821 90

33416 3,821 90

33417 3,912 90

33420 2,911 90

33422 3,912 90

33425 4,198 90

33426 4,094 90

33427 4,225 90

33430 4,094 90

33460 3,705 90

33463 4,516 90

33464 3,931 90

33465 4,257 90

33468 4,436 90

33470 2,735 90

33471 3,085 90

33472 4,007 90

33474 4,007 90

33475 4,933 90

33476 4,170 90

33478 4,491 90

33496 4,108 90

33500 4,128 90

33501 2,120 90

33502 2,547 90

33503 2,820 90

33504 3,639 90

33505 4,179 90

33506 4,194 90

33507 4,470 90

*33508 39 -

33510 3,821 90

33511 4,094 90

33512 4,367 90

33513 4,711 90

33514 4,912 90

33516 5,762 90

**33517 351 -

**33518 693 -

**33519 1,103 -

**33521 1,501 -

**33522 1,723 -

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

86

**33523 2,080 -

*33530 1,190 -

33533 4,003 90

33534 4,276 90

33535 4,570 90

33536 5,632 90

33542 4,185 90

33545 4,845 90

33548 5,885 90

*33572 610 -

33600 4,053 90

33602 3,912 90

33606 4,358 90

33608 4,579 90

33610 4,358 90

33611 4,470 90

33612 4,884 90

33615 4,628 90

33617 5,149 90

33619 6,331 90

33641 3,093 90

33645 3,366 90

33647 3,366 90

33660 3,957 90

33665 4,061 90

33670 4,147 90

33675 3,802 90

33676 3,931 90

33677 4,061 90

33681 3,411 90

33684 4,003 90

33688 4,003 90

33690 2,183 90

33692 4,003 90

33694 4,267 90

33697 4,967 90

33702 3,684 90

33710 4,003 90

33720 3,730 90

33722 3,912 90

33724 2,678 90

33726 3,629 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

87

33730 4,194 90

33732 3,932 90

33735 2,365 90

33736 3,388 90

33737 2,547 90

33750 2,729 90

33755 2,729 90

33762 2,729 90

33764 3,027 90

33766 2,729 90

33767 3,378 90

*33768 1,072 -

33770 5,016 90

33771 5,098 90

33774 4,003 90

33775 4,139 90

33776 4,321 90

33777 4,257 90

33778 5,114 90

33779 4,749 90

33780 5,076 90

33781 4,911 90

33782 7,630.75 90

33783 8,235.41 90

33786 4,871 90

33788 2,944 90

33800 2,050 90

33802 2,183 90

33803 2,547 90

33813 2,547 90

33814 3,548 90

33820 2,140 90

33822 2,232 90

33824 2,554 90

33840 2,729 90

33845 3,002 90

33851 3,002 90

33852 3,184 90

33853 4,411 90

33860 5,232 90

33861 5,295 90

33863 5,199 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

88

33864 5,936 90

33870 6,038 90

33875 4,594 90

33877 5,658 90

33880 4,613 90

33881 3,963 90

33883 2,932 90

*33884 1,090 -

33886 2,533 90

33889 2,180 0

33891 2,782 0

33910 3,283 90

33915 2,409 90

33916 3,318 90

33917 3,722 90

33920 4,439 90

33922 3,366 90

*33924 691 -

33925 4,571 90

33926 6,175 90

33930 2,183 -

33933 4,730 -

33935 18,811 120

33940 1,910 -

33944 3,257 -

33945 14,377 120

33960 3,110 0

*33961 1,091 -

33967 800 0

33968 259 0

33970 1,067 0

33971 1,144 15

33973 1,056 15

33974 1,910 60

33975 2,360 15

33976 2,869 15

33977 2,359 90

33978 2,696 90

33979 3,352 0

33980 4,883 90

33981 BR -

33982 BR -

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

89

33983 BR -

33999 BR -

34001 1,583 60

34051 1,901 90

34101 1,071 90

34111 1,180 60

34151 2,164 90

34201 1,627 60

34203 1,646 60

34401 2,384 90

34421 1,779 90

34451 2,142 90

34471 1,752 90

34490 1,480 90

34501 1,338 90

34502 3,366 90

34510 1,618 90

34520 2,160 90

34530 1,936 90

34800 3,422 90

34802 3,482 90

34803 3,376 90

34804 3,482 90

34805 2,856 90

*34806 194 -

*34808 564 90

34812 910 0

*34813 812 0

34820 1,313 0

34825 1,695 90

*34826 556 0

34830 4,046 90

34831 4,445 90

34832 4,445 90

34833 1,618 0

34834 722 0

34900 1,546 90

35001 2,546 90

35002 2,409 90

35005 2,143 90

35011 1,901 90

35013 2,102 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

90

35021 2,830 90

35022 2,354 90

35045 1,782 90

35081 2,921 90

35082 3,696 90

35091 3,569 90

35092 4,412 90

35102 3,173 90

35103 3,820 90

35111 2,615 90

35112 2,729 90

35121 2,820 90

35122 3,323 90

35131 2,618 90

35132 2,894 90

35141 2,052 90

35142 2,270 90

35151 2,147 90

35152 2,274 90

35180 1,775 90

35182 2,365 90

35184 1,725 90

35188 1,685 90

35189 2,765 90

35190 1,764 90

35201 2,055 60

35206 1,996 60

35207 1,996 60

35211 2,825 60

35216 2,398 90

35221 2,398 90

35226 1,593 90

35231 2,246 90

35236 2,246 90

35241 3,120 90

35246 2,575 90

35251 2,808 90

35256 1,918 90

35261 1,746 90

35266 2,081 90

35271 2,765 90

35276 2,312 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

91

35281 2,580 90

35286 1,728 90

35301 2,419 60

35302 1,987 90

35303 2,160 90

35304 2,333 90

35305 2,246 90

*35306 864 -

35311 3,566 60

35321 1,920 60

35331 2,494 90

35341 3,267 90

35351 2,713 90

35355 2,561 90

35361 3,307 90

35363 3,653 90

35371 1,834 90

35372 1,728 90

*35390 388 -

*35400 431 0

35450 1,259 90

35452 773 90

35454 832 90

35456 968 90

35458 1,199 90

35459 1,223 90

35460 734 90

35470 2,777 60

35471 3,078 60

35472 2,071 60

35473 1,969 60

35474 2,742 60

35475 1,939 60

35476 1,516 60

35480 1,415 90

35481 820 90

35482 873 90

35483 1,046 90

35484 1,197 90

35485 982 90

35490 1,323 60

35491 722 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

92

35492 899 60

35493 1,082 60

35494 1,226 60

35495 888 60

*35500 528 0

35501 2,575 90

35506 2,975 90

35508 2,895 90

35509 2,843 90

35510 2,595 90

35511 2,574 90

35512 2,544 90

35515 2,895 90

35516 2,574 90

35518 3,003 90

35521 2,574 90

35522 2,469 90

35523 2,432 90

35525 2,354 90

35526 2,911 90

35531 3,437 90

35533 3,754 90

35535 4,374 90

35536 2,973 90

35537 4,061 90

35538 4,486 90

35539 4,147 90

35540 4,666 90

35548 2,949 90

35549 3,472 90

35551 3,535 90

35556 2,787 90

35558 2,999 90

35560 3,368 90

35563 2,682 90

35565 2,682 90

35566 3,252 90

35570 3,592 90

35571 3,218 90

*35572 917 -

35583 2,425 90

35585 2,857 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

93

35587 2,383 90

**35600 684 0

35601 2,420 90

35606 2,183 90

35612 2,183 90

35616 2,183 90

35621 2,183 90

35623 2,331 90

35626 2,664 90

35631 3,190 90

35632 3,596 90

35633 4,636 90

35634 4,320 90

35636 2,814 90

35637 2,886 90

35638 2,933 90

35642 2,765 90

35645 2,765 90

35646 2,911 90

35647 3,931 90

35650 2,141 90

35651 3,374 90

35654 2,547 90

35656 2,274 90

35661 1,863 90

35663 2,183 90

35665 2,183 90

35666 2,365 90

35671 2,323 90

*35681 1,211 -

*35682 810 0

*35683 912 0

*35685 415 90

*35686 451 90

35691 2,254 90

35693 1,863 90

35694 2,166 90

35695 2,166 90

*35697 324 -

*35700 330 -

35701 856 90

35721 775 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

94

35741 820 90

35761 770 90

35800 899 90

35820 2,354 90

35840 1,263 90

35860 826 90

35870 2,881 90

35875 1,228 90

35876 1,679 90

35879 2,239 90

35881 2,620 90

35883 2,246 90

35884 2,419 90

35901 1,132 90

35903 1,260 90

35905 2,957 90

35907 3,284 90

36000 86 0

36002 323 0

36005 422 0

36010 352 0

36011 528 0

36012 792 0

36013 528 0

36014 792 0

36015 792 0

36100 704 0

36120 621 0

36140 528 0

36147 1,211.50 -

*36148 434.51 -

36160 528 0

36200 704 0

36215 1,092 0

36216 1,320 0

36217 1,876 0

*36218 264 0

36245 1,232 0

36246 1,320 0

36247 1,753 0

*36248 264 0

36260 1,276 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

95

36261 582 60

36262 448 60

36299 BR -

36405 52 0

36406 60 0

36410 27 0

36415 18 0

36416 10 0

36425 93 0

36430 63 0

36450 605 0

36455 864 0

36460 938 0

36468 99 0

36469 164 0

36470 102 10

36471 148 10

36475 3,154 0

*36476 653 0

36478 2,735 -

*36479 664 -

36481 864 0

36500 306 0

36510 141 0

36511 180 0

36512 180 0

36513 180 0

36514 508 0

36515 2,069 0

36516 2,473 0

36522 440 0

36556 411 0

36558 1,278 10

36561 1,710 10

36563 1,792 10

36565 1,383 10

36566 2,543 10

36569 450 0

36571 1,981 10

36575 220 0

36576 557 10

36578 706 10

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

96

36580 394 0

36581 866 10

36582 1,552 10

36583 1,371 10

36584 410 0

36585 1,704 10

36589 234 10

36590 627 10

36591 40 -

36592 49 -

36593 62 -

36595 1,060 0

36596 231 0

36597 201 0

36598 322 0

36600 41 0

**36620 113 0

36625 174 0

36640 265 0

**36660 179 0

36680 147 0

36800 370 0

36810 573 0

36815 382 0

36818 1,438 90

36819 1,839 30

36820 1,663 90

36821 1,331 30

36822 836 30

36823 2,094 30

36825 1,583 30

36830 1,419 30

36831 764 30

36832 974 30

36833 1,171 30

36835 1,422 30

36838 2,042 90

36860 405 30

36861 427 0

36870 2,534 90

37140 2,820 90

37145 2,729 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

97

37160 2,820 90

37180 2,820 90

37181 3,314 90

37182 2,275 0

37183 1,530 0

37184 3,682 0

*37185 1,206 -

*37186 2,481 -

37187 3,579 0

37188 3,083 0

37195 709 0

37200 422 0

37201 1,037 0

37202 743 0

37203 1,373 0

37204 2,246 0

37205 2,203 0

*37206 1,299 0

37207 1,486 0

*37208 768 0

37209 562 0

37210 1,936 0

37215 2,691 90

37216 2,598 90

*37250 254 0

*37251 176 0

37500 1,166 0

37501 BR 0

37565 1,092 30

37600 819 90

37605 1,002 90

37606 885 90

37607 625 60

37609 356 10

37615 800 90

37616 1,497 90

37617 1,761 90

37618 723 90

37620 1,429 90

37650 764 30

37660 1,221 90

37700 660 30

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

98

37718 719 90

37722 864 90

37735 1,668 60

37760 1,728 120

37761 1,493.00 90

37765 913 90

37766 1,114 90

37780 422 30

37785 359 30

37788 1,778 90

37790 1,728 90

37799 BR -

38100 2,400 45

38101 2,400 45

*38102 583 0

38115 2,400 45

38120 2,088 90

38129 BR 15

38200 289 0

38204 250 0

38205 198 0

38206 198 0

38207 102 0

38208 88 0

38209 71 0

38210 109 0

38211 121 0

38212 88 0

38213 71 0

38214 74 0

38215 123 0

38220 299 10

38221 320 10

38230 665 10

38240 552 30

38241 499 30

38242 225 0

38300 163 0

38305 491 30

38308 622 60

38380 868 90

38381 1,563 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

99

38382 1,124 90

38500 351 10

38505 178 0

38510 510 10

38520 622 30

38525 553 30

38530 819 30

38542 600 60

38550 725 60

38555 1,525 60

38562 1,275 60

38564 1,385 90

38570 1,429 10

38571 1,996 10

38572 2,326 10

38589 BR -

38700 1,352 90

38720 2,101 90

38724 2,101 90

38740 801 90

38745 1,307 90

*38746 555 -

*38747 594 -

38760 1,181 90

38765 1,984 90

38770 1,801 90

38780 2,631 90

38790 273 0

**38792 173 0

38794 498 90

38999 BR -

39000 778 90

39010 1318 90

39200 1,707 90

39220 1,848 90

39400 809 10

39499 BR -

39501 2,400 90

39502 2,500 90

39503 4,577 90

39520 2,250 90

39530 2,160 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

100

39531 1,999 90

39540 2,500 90

39541 1,728 90

39545 1,991 90

39560 2,183 90

39561 2,910 90

39599 BR -

40490 154 0

40500 1029 30

40510 979 30

40520 917 30

40525 1268 90

40527 1711 90

40530 1001 30

40650 642 30

40652 806 30

40654 1074 30

40700 2001 90

40701 2642 90

40702 1937 90

40720 2090 90

40761 2360 90

40799 BR -

40800 257 10

40801 448 10

40804 270 10

40805 473 10

40806 203 0

40808 164 10

40810 188 10

40812 300 10

40814 538 30

40816 606 60

40818 389 60

40819 410 0

40820 316 0

40830 291 10

40831 424 10

40840 1346 90

40842 1337 90

40843 1714 90

40844 2153 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

101

40845 2898 120

40899 BR -

41000 212 10

41005 284 30

41006 499 30

41007 500 30

41008 508 30

41009 557 30

41010 316 30

41015 557 30

41016 618 30

41017 568 30

41018 718 30

41019 1158 0

41100 233 10

41105 246 10

41108 192 10

41110 218 10

41112 400 30

41113 508 30

41114 1169 30

41115 329 10

41116 650 30

41120 1548 120

41130 1890 120

41135 3697 120

41140 3294 120

41145 4822 120

41150 3764 120

41153 4737 120

41155 5152 120

41250 299 10

41251 360 10

41252 610 10

41500 775 90

41510 1056 90

41512 1236 90

41520 479 30

41530 5090 90

41599 BR -

41800 280 10

41805 286 10

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

102

41806 429 10

41820 506 0

41821 114 0

41822 402 10

41823 546 60

41825 207 0

41826 335 60

41827 540 90

41828 429 10

41830 421 10

41850 192 0

41870 523 0

41872 539 90

41874 543 90

41899 BR -

42000 211 10

42100 177 10

42104 262 10

42106 369 10

42107 1358 90

42120 1931 90

42140 353 90

42145 1460 90

42160 251 10

42180 368 10

42182 558 10

42200 1851 90

42205 2058 90

42210 2338 90

42215 1547 90

42220 1491 90

42225 2004 90

42226 2008 90

42227 1970 90

42235 1212 90

42260 1190 90

42280 255 10

42281 281 10

42299 BR -

42300 368 10

42305 693 60

42310 269 10

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

103

42320 457 10

42330 269 15

42335 542 90

42340 967 90

42400 175 0

42405 479 10

42408 702 15

42409 552 15

42410 1223 90

42415 2441 90

42420 2806 90

42425 1875 90

42426 3359 90

42440 1110 60

42450 1026 60

42500 831 60

42505 1145 60

42507 1230 60

42508 1530 60

42509 2047 60

42510 1338 60

42550 238 0

42600 1034 60

42650 109 0

42660 146 0

42665 344 0

42699 BR -

42700 298 10

42720 592 10

42725 1230 90

42800 217 10

42802 329 10

42804 253 10

42806 300 10

42808 433 10

42809 249 10

42810 708 30

42815 1211 30

42821 653 30

42826 577 30

42831 470 30

42836 518 30

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

104

42842 2058 60

42844 2918 60

42845 3807 60

42860 393 60

42870 1012 60

42890 2212 90

42892 2896 90

42894 3592 90

42900 749 10

42950 1558 90

42953 1876 90

42955 1120 30

42960 288 10

42961 602 60

42962 922 60

42970 606 60

42971 716 60

42972 877 60

42999 BR -

43020 1241 90

43030 1243 90

43045 2734 90

43100 1395 90

43101 2190 90

43107 5019 90

43108 8167 90

43112 5313 90

43113 8169 90

43116 8225 90

43117 5001 90

43118 6736 90

43121 5364 90

43122 5013 90

43123 7964 90

43124 6741 90

43130 1746 90

43135 3015 90

43200 407 0

43201 556 0

43202 534 0

43204 557 0

43205 542 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

105

43215 405 0

43216 436 0

43217 721 0

43219 427 0

43220 349 0

43226 375 0

43227 544 0

43228 570 0

43231 461 0

43232 651 0

43234 503 0

43235 573 0

43236 689 0

43237 421 0

43238 519 0

43239 663 0

43240 866 0

43241 407 0

43242 909 0

43243 671 0

43244 673 0

43245 506 0

43246 667 0

43247 505 0

43248 477 0

43249 435 0

43250 512 0

43251 536 0

43255 669 0

43256 759 0

43257 693 0

43258 670 0

43259 746 0

43260 809 0

43261 840 0

43262 1054 0

43263 918 0

43264 1204 0

43265 1251 0

43267 999 0

43268 1050 0

43269 1006 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

106

43271 1007 0

43272 988 0

*43273 285 -

43279 2820 90

43280 2224 60

43281 3368.75 90

43282 3818.50 90

43289 BR -

43300 1666 90

43305 2413 90

43310 3387 90

43312 3553 90

43313 5855 90

43314 6667 90

43320 2602 90

43324 2566 90

43325 2529 90

43326 2595 90

43330 2457 90

43331 2712 90

43340 2599 90

43341 2801 90

43350 2146 90

43351 2320 90

43352 2073 90

43360 4503 90

43361 5089 90

43400 3039 90

43401 2887 90

43405 2805 90

43410 1913 90

43415 3094 90

43420 1909 90

43425 2868 90

43450 291 0

43453 512 0

43456 875 0

43458 637 0

43460 443 0

43496 BR 90

43499 BR -

43500 1561 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

107

43501 2462 60

43502 2788 60

43510 1784 60

43520 1450 60

43600 210 0

43605 1613 60

43610 1860 60

43611 2459 90

43620 3639 90

43621 4134 90

43622 4198 90

43631 2790 90

43632 3618 90

43633 3447 90

43634 3867 90

*43635 265 -

43640 2210 60

43641 2294 90

43644 3585 90

43645 3845 90

43647 RNE -

43648 RNE -

43651 1548 90

43652 2210 90

43653 1295 90

43659 BR -

43752 95 0

43760 428 0

43761 249 0

43770 2292 90

43771 2620 90

43772 1985 90

43773 2622 90

43774 1987 90

43775 3036.25 90

43800 1778 60

43810 1899 60

43820 2382 60

43825 2375 60

43830 1356 60

43831 1209 30

43832 1998 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

108

43840 2416 60

43842 2634 60

43843 2594 60

43845 4227 90

43846 3290 60

43847 3575 60

43848 3865 60

43850 2965 60

43855 3100 60

43860 3011 60

43865 3145 60

43870 1292 60

43880 3043 60

43881 RNE -

43882 RNE -

43886 668 90

43887 638 90

43888 901 90

43999 BR -

44005 2012 90

44010 1691 60

*44015 624 60

44020 1792 60

44021 1796 60

44025 1863 60

44050 1719 90

44055 2532 60

44100 254 0

44110 1681 60

44111 2016 60

44120 2231 60

*44121 574 -

44125 2230 60

44126 4912 90

44127 5712 90

*44128 527 -

44130 2329 60

44132 2079 -

44133 3564 -

44135 5940 -

44136 6683 -

44137 2970 -

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

109

*44139 285 -

44140 2584 90

44141 3161 90

44143 2985 90

44144 3029 90

44145 3187 90

44146 3681 90

44147 3447 90

44150 3367 90

44151 3935 90

44155 3769 90

44156 4541 90

44157 4291 90

44158 4399 90

44160 2398 60

44180 1834 90

44186 1291 90

44187 2154 90

44188 2375 90

44202 2780 90

*44203 497 90

44204 2991 90

44205 2630 90

44206 3168 90

44207 3513 90

44208 3798 90

44210 3448 90

44211 4359 90

44212 3983 90

*44213 405 -

44227 3321 90

44238 BR -

44300 1536 60

44310 1922 60

44312 786 60

44314 1910 90

44316 2690 60

44320 2061 60

44322 1798 60

44340 773 60

44345 1919 90

44346 2146 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

110

44360 436 0

44361 493 0

44363 489 0

44364 597 0

44365 569 0

44366 671 0

44369 752 0

44370 704 0

44372 701 0

44373 636 0

44376 793 0

44377 837 0

44378 1003 0

44379 880 0

44380 273 0

44382 317 0

44383 576 0

44385 498 0

44386 681 0

44388 676 0

44389 811 0

44390 902 0

44391 1032 0

44392 871 0

44393 1018 0

44394 962 0

44397 691 0

**44500 91 0

44602 2401 60

44603 2893 60

44604 2044 60

44605 2617 60

44615 2201 60

44620 1718 60

44625 2386 90

44626 3295 90

44640 2373 60

44650 2516 60

44660 2483 60

44661 2931 90

44680 2069 90

44700 2156 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

111

*44701 345 -

44715 BR -

44720 571 -

44721 686 -

44799 BR -

44800 1551 60

44820 1659 60

44850 1372 60

44899 BR -

44900 1388 60

44901 1541 0

44950 1228 45

*44955 177 45

44960 1585 90

44970 1676 45

44979 BR -

45000 732 10

45005 408 10

45020 899 30

45100 550 60

45108 747 90

45110 3514 90

45111 2242 90

45112 3655 90

45113 3735 90

45114 3389 90

45116 2946 90

45119 3691 90

45120 3254 90

45121 3268 90

45123 2196 90

45126 5301 90

45130 2043 90

45135 2688 90

45136 3457 60

45150 891 90

45160 2040 90

45170 1015 60

45171 982.68 90

45172 1349.49 90

45190 1367 90

45300 147 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

112

45303 1104 0

45305 244 0

45307 360 0

45308 330 0

45309 373 0

45315 401 0

45317 387 0

45320 416 0

45321 281 0

45327 413 0

45330 226 0

45331 300 0

45332 406 0

45333 407 0

45334 384 0

45335 357 0

45337 348 0

45338 497 0

45339 597 0

45340 659 0

45341 430 0

45342 556 0

45345 456 0

45355 418 0

45378 756 0

45379 960 0

45380 907 0

45381 962 0

45382 1195 0

45383 1080 0

45384 909 0

45385 1023 0

45386 1450 0

45387 771 0

45391 626 0

45392 791 0

45395 3935 90

45397 4269 90

45400 2284 90

45402 3075 90

45499 BR -

45500 1047 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

113

45505 1111 90

45520 169 0

45540 2022 90

45541 1814 90

45550 2689 90

45560 1187 90

45562 2038 90

45563 2958 90

45800 2286 90

45805 2605 90

45820 2265 90

45825 2733 90

45900 360 10

45905 334 10

45910 351 10

45915 535 10

45990 221 0

45999 BR -

46020 485 10

46030 171 10

46040 644 60

46045 580 60

46050 250 10

46060 893 90

46070 375 30

46080 352 10

46083 250 10

46200 692 60

46220 225 10

46221 338 10

46230 352 10

46250 770 90

46255 888 90

46257 872 90

46258 953 90

46260 997 90

46261 1070 90

46262 1108 90

46270 832 90

46275 910 90

46280 942 90

46285 598 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

114

46288 1146 60

46320 272 10

46500 254 10

46505 505 10

46600 126 0

46604 641 0

46606 271 0

46608 355 0

46610 326 0

46611 311 0

46612 422 0

46614 320 0

46615 381 0

46700 1176 90

46706 300 0

46707 974.61 90

46710 2189 90

46712 4506 90

46715 1111 90

46716 2200 90

46730 3712 90

46735 4327 90

46740 3938 90

46742 4798 90

46744 6600 90

46746 7301 90

46748 7882 90

46750 1389 90

46753 1314 90

46754 454 10

46760 1966 90

46761 1927 90

46762 2166 90

46900 237 10

46910 232 10

46916 238 10

46917 504 10

46922 239 10

46924 735 10

46930 385 90

46940 341 10

46942 329 10

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

115

46945 406 30

46946 533 30

46947 721 90

46999 BR -

47000 449 0

*47001 235 -

47010 2179 60

47011 555 0

47015 2069 60

47100 1519 45

47120 4278 90

47122 6368 90

47125 5704 90

47130 6133 90

47133 5707 -

47135 15184 90

47136 13123 90

47140 5289 90

47141 6360 90

47142 6996 90

47143 BR -

47144 BR 90

47145 BR 90

47146 699 -

47147 816 -

47300 2038 90

47350 2503 90

47360 3403 90

47361 5598 90

47362 2542 90

47370 2292 90

47371 2335 90

47379 BR -

47380 2906 90

47381 2944 90

47382 1797 90

47399 BR -

47400 3835 60

47420 2460 60

47425 2660 60

47460 2497 60

47480 1582 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

116

47490 970 60

47500 241 0

47505 191 0

47510 985 60

47511 1267 60

47525 939 10

47530 2131 60

*47550 442 0

47552 686 0

47553 745 0

47554 1096 0

47555 823 0

47556 920 0

47560 576 0

47561 635 0

47562 1654 60

47563 1781 60

47564 2150 60

47570 2108 60

47579 BR 60

47600 1932 60

47605 1909 60

47610 2420 60

47612 2588 60

47620 2658 60

47630 1191 60

47700 2171 90

47701 4182 90

47711 3157 90

47712 4119 90

47715 2431 60

47720 2070 60

47721 2469 90

47740 2360 90

47741 2939 90

47760 3762 60

47765 4188 60

47780 4217 90

47785 5704 90

47800 2923 90

47801 1941 60

47802 2763 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

117

47900 2641 60

47999 BR -

48000 3126 60

48001 3652 90

48020 2273 60

48100 1716 60

48102 794 10

48105 5695 90

48120 2086 60

48140 2941 90

48145 3134 90

48146 3525 90

48148 2409 90

48150 5870 90

48152 5467 60

48153 5865 90

48154 5475 90

48155 3523 90

48160 4153 -

*48400 233 0

48500 2058 60

48510 2169 60

48511 1492 0

48520 2144 60

48540 2539 90

48545 2413 60

48547 3257 60

48548 3392 90

48550 BR -

48551 BR -

48552 483 -

48554 5497 90

48556 2834 90

48999 BR -

49000 1466 90

49002 1854 90

49010 1755 90

49020 2293 90

49021 1558 60

49040 1822 90

49041 1316 0

49060 1935 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

118

49061 1298 0

49062 1541 60

49080 275 0

49081 248 0

49180 379 0

49203 2686 90

49204 3427 90

49205 3926 90

49215 3339 60

49220 2207 90

49250 1100 60

49255 1440 60

49320 841 10

49321 841 10

49322 873 10

49323 1419 60

49324 922 10

49325 953 10

*49326 454 -

49329 BR -

49400 262 0

49402 1732 90

49411 553.07 0

49419 894 0

49420 286 0

49421 715 60

49422 735 10

49423 835 0

49424 300 0

49425 1577 60

49426 1821 60

49427 177 0

49428 808 30

49429 931 30

*49435 276 -

49436 447 10

49440 1960 10

49441 2236 10

49442 1902 10

49446 1867 0

49450 1346 0

49451 1360 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

119

49452 1685 0

49460 1449 0

49465 303 0

49505 1009 45

49507 1286 60

49520 1267 45

49521 1699 60

49525 1112 45

49540 1273 45

49550 1089 45

49553 1300 60

49555 1203 45

49557 1489 60

49560 1409 45

49561 1765 60

49565 1521 45

49566 1859 60

*49568 523 45

49570 773 45

49572 998 45

49585 896 45

49587 1131 60

49590 1097 45

49650 973 60

49651 1227 60

49652 1651 90

49653 2062 90

49654 1896 90

49655 2283 90

49656 1906 90

49657 2751 90

49659 BR 15

49900 1288 60

49904 2748 0

*49905 983 30

49906 4269 90

49999 BR -

50010 1618 90

50020 2065 90

50021 1373 0

50040 1973 90

50045 2100 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

120

50060 2716 90

50065 2891 90

50070 2847 90

50075 3529 90

50080 2103 90

50081 2977 90

50100 2256 90

50120 2189 90

50125 2254 90

50130 2490 90

50135 2762 90

50200 354 0

50205 1542 60

50220 2411 90

50225 2849 90

50230 3108 90

50234 3086 90

50236 3427 90

50240 3054 90

50250 2850 90

50280 2252 90

50290 2067 90

50300 3651 0

50320 3111 90

50323 4158 -

50325 4455 -

50327 451 -

50328 395 -

50329 385 -

50340 2151 90

50360 4746 90

50365 5532 90

50370 2192 90

50380 3875 90

50382 2586 0

50384 2225 0

50385 2325 0

50386 1505 0

50387 1197 0

50389 708 0

50390 291 0

50391 283 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

121

50392 497 0

50393 613 0

50394 170 0

50395 522 0

50396 193 0

50398 875 0

50400 2670 90

50405 3290 90

50500 2602 90

50520 2330 90

50525 2917 90

50526 2866 90

50540 2739 90

50541 2256 60

50542 2638 60

50543 3126 60

50544 2978 15

50545 2973 90

50546 2752 90

50547 3758 60

50548 3135 90

50549 BR 15

50551 782 0

50553 896 0

50555 984 0

50557 995 0

50561 1126 0

50562 1382 0

50570 1166 0

50572 1368 0

50574 1423 0

50575 1840 0

50576 1482 0

50580 1447 0

50590 2875 90

50592 8108 10

50593 7900 10

50600 2117 90

50605 1980 90

50610 2227 90

50620 2124 90

50630 2135 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

122

50650 2390 90

50660 2714 90

50684 305 0

50686 192 0

50688 167 10

50690 171 0

50700 2190 90

50715 2498 90

50722 2286 90

50725 2605 90

50727 1273 90

50728 1601 90

50740 2522 90

50750 2694 90

50760 2543 90

50770 2698 90

50780 2558 90

50782 2578 90

50783 2669 90

50785 2849 90

50800 2220 90

50810 2966 120

50815 3005 90

50820 3153 120

50825 4263 120

50830 4543 120

50840 2869 120

50845 2892 90

50860 2147 90

50900 1960 90

50920 2017 90

50930 2494 90

50940 2011 90

50945 2417 60

50947 3131 60

50948 2883 60

50949 BR -

50951 633 0

50953 695 0

50955 789 0

50957 748 0

50961 686 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

123

50970 802 0

50972 650 0

50974 1022 0

50976 1006 0

50980 709 0

51020 1176 90

51030 1186 90

51040 941 30

51045 1058 30

51050 1150 30

51060 1890 90

51065 1886 90

51080 912 90

51100 126 0

51101 234 0

51102 643 10

51500 1299 90

51520 1418 90

51525 1989 90

51530 1556 90

51535 1453 90

51550 2150 90

51555 2420 90

51565 2990 90

51570 3290 90

51575 4389 90

51580 4342 90

51585 5063 90

51590 4534 90

51595 5410 90

51596 5702 90

51597 5532 90

51600 293 0

51605 104 0

51610 189 0

51700 123 0

51701 109 0

51702 156 0

51703 246 0

51705 175 10

51710 352 10

51715 616 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

124

51720 187 0

51725 PC – 185 T - 496 0

51726 PC – 212 T - 692 0

51727 PC – 245 T – 931 0

51728 PC – 240.25 T – 982.50 0

51729 PC – 291.25 T – 1210 0

51736 PC – 72 T - 104 0

51741 PC – 134 T - 166 0

51784 PC – 194 T - 460 0

51785 PC – 194 T - 495 0

51792 PC – 259 T - 606 0

51797 PC – 175 T - 539 0

51798 37 0

51800 2403 90

51820 2713 90

51840 1537 90

51841 1845 90

51845 1699 90

51860 1617 90

51865 2064 90

51880 1047 90

51900 2401 90

51920 1815 90

51925 2500 90

51940 4126 90

51960 3377 90

51980 1715 90

51990 1634 60

51992 1836 60

51999 BR -

52000 366 0

52001 647 0

52005 533 0

52007 949 0

52010 693 0

52204 799 0

52214 1224 0

52224 1680 0

52234 675 0

52235 876 0

52240 1431 0

52250 560 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

125

52260 428 0

52265 770 0

52270 714 0

52275 990 0

52276 666 0

52277 838 0

52281 543 0

52282 805 0

52283 507 0

52285 506 0

52290 527 0

52300 699 0

52301 721 0

52305 696 0

52310 482 0

52315 930 0

52317 1713 0

52318 1266 0

52320 684 0

52325 916 0

52327 1123 0

52330 1638 0

52332 743 0

52334 643 0

52341 791 0

52342 828 0

52343 896 0

52344 938 0

52345 975 0

52346 1101 0

52351 804 0

52352 985 0

52353 1120 0

52354 1065 0

52355 1177 0

52400 1390 60

52402 617 90

52450 1088 90

52500 1199 90

52601 1949 90

52630 1538 90

52640 950 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

126

52647 3552 90

52648 3882 90

52649 2491 90

52700 944 60

53000 343 10

53010 692 30

53020 226 15

53040 693 30

53060 299 15

53080 861 0

53085 1486 60

53200 281 7

53210 1786 60

53215 2214 90

53220 1088 90

53230 1405 60

53235 1451 60

53240 880 15

53250 872 15

53260 330 15

53265 388 10

53270 367 10

53275 557 10

53400 1744 60

53405 2035 90

53410 2161 60

53415 2628 60

53420 2017 60

53425 2127 60

53430 2059 90

53431 2457 90

53440 2046 90

53442 1205 90

53444 1721 90

53445 2427 90

53446 1474 90

53447 1849 90

53448 2814 90

53449 1443 90

53450 795 30

53460 1113 60

53500 1355 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

127

53502 1165 30

53505 1167 30

53510 1429 90

53515 1916 90

53520 1098 90

53600 136 0

53601 130 0

53605 160 0

53620 196 0

53621 185 0

53660 111 0

53661 111 0

53665 108 0

53850 4077 90

53852 3651 90

53855 585.92 0

53899 BR -

54000 179 10

54001 305 10

54015 437 10

54050 153 10

54055 186 10

54056 191 10

54057 261 10

54060 329 10

54065 390 10

54100 261 0

54105 417 7

54110 1464 30

54111 2043 90

54112 2325 90

54115 988 30

54120 1393 30

54125 1956 90

54130 2889 90

54135 3670 90

54164 442 10

54200 151 10

54205 1130 90

54220 351 0

54230 196 0

54231 311 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

128

54235 171 0

54240 PC – 164 T – 231 0

54250 PC – 263 T - 284 0

54300 1538 60

54304 1818 90

54308 1687 90

54312 2000 90

54316 2414 90

54318 1722 90

54322 1860 90

54324 2343 90

54326 2211 90

54328 2239 90

54332 2464 90

54336 2922 90

54340 1332 90

54344 2453 90

54348 2462 90

54352 3492 90

54360 1355 60

54380 1743 60

54385 2134 90

54390 2579 90

54400 1434 90

54401 1728 90

54405 2325 90

54406 1574 90

54408 1679 90

54410 1907 90

54411 2174 90

54415 1146 90

54416 1519 90

54417 1911 90

54420 1603 60

54430 1492 60

54435 747 60

54440 1114 90

54450 145 0

54500 135 0

54505 472 10

54512 1180 60

54520 799 30

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

129

54522 1309 60

54530 1228 30

54535 1694 45

54550 1154 30

54560 1584 60

54600 1162 30

54620 663 30

54640 1188 30

54650 2029 45

54660 741 60

54670 927 60

54680 1744 60

54690 1543 60

54692 1787 60

54699 BR -

54700 367 10

54800 282 0

54830 791 30

54840 826 45

54860 952 45

54861 1337 45

54865 844 90

54900 1862 90

54901 2731 90

55000 178 0

55040 843 45

55041 1265 45

55060 831 45

55100 365 10

55110 815 15

55120 607 10

55150 901 30

55175 889 30

55180 1514 60

55200 814 30

55250 880 30

55300 454 0

55400 1704 90

55450 554 10

55500 838 45

55520 840 30

55530 863 45

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

130

55535 1031 45

55540 1085 45

55550 1005 60

55559 BR -

55600 935 60

55605 1138 60

55650 1951 45

55680 1810 45

55700 352 0

55705 715 30

55706 927 10

55720 1093 60

55725 1571 60

55801 2591 90

55810 3210 90

55812 3857 90

55815 4345 90

55821 2145 90

55831 2326 90

55840 3235 90

55842 3493 90

55845 4072 90

55860 2032 90

55862 2629 90

55865 3532 90

55866 4041 90

55873 2936 90

55875 1889 90

55876 347 0

55899 BR -

55920 1090 0

56405 244 10

56420 219 10

56440 470 10

56441 277 10

56442 112 0

56501 235 10

56515 498 10

56605 162 0

*56606 86 0

56620 1123 60

56625 1530 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

131

56630 1960 90

56631 2637 90

56632 3124 90

56633 2513 90

56634 2928 90

56637 3306 90

56640 3211 90

56700 407 10

56740 635 10

56800 542 10

56805 2176 90

56810 560 10

56820 225 0

56821 296 0

57000 413 10

57010 830 60

57020 165 0

57022 384 10

57023 604 10

57061 190 10

57065 461 10

57100 144 0

57105 274 10

57106 1001 90

57107 2908 90

57109 3411 90

57110 1880 90

57111 3415 90

57112 3629 90

57120 1209 90

57130 451 10

57135 421 10

57150 90 0

57155 912 30

57160 135 0

57170 144 0

57180 260 10

57200 698 30

57210 812 30

57220 817 30

57230 874 30

57240 1276 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

132

57250 1248 60

57260 1577 60

57265 1767 60

*57267 590 -

57268 1073 60

57270 1549 60

57280 1879 60

57282 1386 60

57283 1443 90

57284 1797 90

57285 1552 90

57287 1589 90

57288 1750 60

57289 1528 60

57291 2223 90

57292 2840 90

57295 1036 90

57296 2063 90

57300 1230 90

57305 1823 90

57307 2037 90

57308 1417 90

57310 1437 60

57311 1055 90

57320 1563 60

57330 1773 90

57400 290 0

57410 215 0

57415 299 10

57420 253 0

57421 336 0

57423 2170 90

57425 1667 90

57426 1869.53 90

57452 231 0

57454 300 0

57455 309 0

57456 292 0

57460 578 0

57461 695 0

57500 212 0

57505 196 10

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

133

57510 212 10

57511 301 10

57513 344 45

57520 672 45

57522 587 45

57530 746 45

57531 3678 90

57540 1528 60

57545 1738 60

57550 1102 60

57555 1533 60

57556 1481 60

57558 315 10

57700 931 45

57720 645 45

57800 105 0

58100 180 0

*58110 101 -

58120 525 10

58140 1923 45

58145 1238 45

58146 2517 45

58150 2036 60

58152 2654 90

58180 1883 90

58200 2883 90

58210 3651 90

58240 5808 120

58260 1958 60

58262 2120 60

58263 2309 60

58267 2379 90

58270 2077 60

58275 2190 60

58280 2269 60

58285 2844 90

58290 2550 90

58291 2725 90

58292 2923 90

58293 2981 90

58294 2684 90

58300 192 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

134

58301 122 0

58340 216 0

58345 634 10

58346 981 30

58350 211 10

58353 1710 10

58356 2970 10

58400 1154 60

58410 1794 60

58520 1516 60

58540 2035 60

58541 1861 90

58542 2054 90

58543 2093 90

58544 2249 90

58545 2459 10

58546 2476 10

58548 4034 90

58550 1936 10

58552 2209 10

58553 2364 10

58554 2678 10

58555 473 0

58558 678 0

58559 753 0

58560 875 0

58561 1072 0

58562 706 0

58563 2907 0

58565 3834 90

58570 2156 90

58571 2355 90

58572 2676 90

58573 3022 90

58578 BR -

58579 BR -

58600 1007 45

58605 786 45

*58611 323 45

58615 817 45

58660 1474 60

58661 1450 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

135

58662 1577 60

58670 1113 60

58671 1113 60

58672 1668 15

58673 1798 60

58679 BR -

58700 1574 90

58720 1619 90

58740 1934 45

58750 2203 45

58752 2038 45

58760 1866 45

58770 1872 45

58800 693 30

58805 1197 45

58820 683 30

58822 1471 45

58823 1337 0

58825 1554 45

58900 1030 45

58920 1495 45

58925 1544 45

58940 1168 45

58943 2501 45

58950 2326 60

58951 3120 60

58952 3439 90

58953 4229 90

58954 4593 90

58956 2975 90

58957 3619 90

58958 3750 90

58960 2382 90

58999 BR -

59000 195 0

59012 478 0

59015 321 0

59020 164 0

59025 110 0

59030 252 0

59050 151 0

59051 119 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

136

59070 708 0

59072 885 0

59074 673 0

59076 885 0

59100 1859 45

59120 1658 45

59121 1663 45

59130 1846 60

59135 2015 60

59136 2079 60

59140 1200 60

59150 1517 60

59151 1828 60

59160 471 10

59200 197 0

59300 353 0

59320 350 0

59325 561 0

59350 827 0

59400 3326 45

59409 1817 45

59410 2040 45

59412 284 0

59414 227 0

59425 806 0

59426 1356 0

59430 275 45

59510 3904 45

59514 2129 45

59515 2398 45

*59525 1063 45

59610 4005 45

59612 1998 45

59614 2233 45

59618 4503 45

59620 2315 45

59622 2687 45

59866 559 0

59870 947 90

59871 302 0

59897 BR -

59898 BR 15

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

137

59899 BR 0

60000 239.20 10

60100 185.70 0

60200 1361.34 60

60210 1623.33 60

60212 2345.00 60

60220 1844.42 60

60225 2144.43 60

60240 2362.97 60

60252 3075.78 60

60254 3823.11 60

60260 2426.42 60

60270 3120.10 60

60271 2403.79 60

60280 1281.32 60

60281 1377.33 60

60300 158.86 0

60500 2094.25 60

60502 2867.87 60

60505 3130.55 60

*60512 599.53 30

60520 2392.19 90

60521 2645.97 90

60522 3096.14 90

60540 2387.55 60

60545 2761.09 90

60600 3326.03 90

60605 4148.92 90

60650 2751.65 60

60659 BR -

60699 BR -

61000 235.57 0

61001 244.89 0

61020 268.41 0

61026 283.92 0

61050 237.45 0

61055 349.92 0

61070 173.22 0

61105 1213.24 60

**61107 908.57 60

61108 2257.38 60

61120 1548.01 60

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

138

61140 2697.72 60

61150 2809.86 60

61151 2643.38 60

61154 2691.67 90

61156 2693.01 90

**61210 869.61 0

61215 1319.98 90

61250 1738.33 90

61253 2205.24 90

61304 3756.75 90

61305 4465.52 90

61312 4492.67 90

61313 4093.47 90

61314 4244.04 90

61315 4987.13 90

*61316 207.17 -

61320 3905.96 90

61321 4295.47 90

61322 3924.89 90

61323 4583.00 90

61330 3431.89 90

61332 4161.86 90

61333 4237.51 90

61334 3452.08 90

61340 3003.46 90

61343 4855.18 90

61345 3601.71 90

61440 4115.41 90

61450 3997.58 90

61458 4447.74 90

61460 4470.06 90

61470 4026.72 90

61480 3661.82 90

61490 3846.30 90

61500 3257.46 90

61501 2990.76 90

61510 4845.50 90

61512 5521.59 90

61514 4159.95 90

61516 4104.53 90

*61517 185.56 -

61518 6051.33 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

139

61519 6459.43 90

61520 8262.67 90

61521 7148.41 90

61522 4627.93 90

61524 4536.39 90

61526 7875.23 90

61530 6858.07 90

61531 3295.00 90

61533 3583.13 90

61534 3699.20 90

61535 2513.71 90

61536 5484.45 90

61537 3714.93 90

61538 5334.99 90

61539 4839.17 90

61540 3804.02 90

61541 5262.00 90

61542 5176.63 90

61543 4673.00 90

61544 4129.37 90

61545 7280.11 90

61546 5137.75 90

61548 3717.07 90

61550 2330.75 90

61552 2843.87 90

61556 3656.63 90

61557 3741.48 90

61558 4188.15 90

61559 4693.42 90

61563 4376.23 90

61564 5365.26 90

61566 3785.69 90

61567 4331.52 90

61570 4469.81 90

61571 4631.79 90

61575 5213.95 90

61576 5586.03 90

61580 4863.26 90

61581 5443.25 90

61582 5617.99 90

61583 5699.64 90

61584 5562.05 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

140

61585 6179.87 90

61586 4381.33 90

61590 6407.79 90

61591 6588.71 90

61592 6313.05 90

61595 4724.62 90

61596 5352.53 90

61597 5908.73 90

61598 5333.18 90

61600 4188.04 90

61601 4554.78 90

61605 4508.30 90

61606 6075.78 90

61607 5772.25 90

61608 6560.02 90

*61609 1373.54 0

*61610 4360.20 0

*61611 1012.58 0

*61612 4043.09 0

61613 6514.38 90

61615 4879.97 90

61616 6723.42 90

61618 2599.35 90

61619 3100.20 90

61623 1231.01 0

61624 2542.91 0

61626 2041.12 0

61630 2636.76 90

61635 3189.88 90

61640 1450.22 0

*61641 605.00 -

*61642 941.70 -

61680 5519.59 90

61682 9118.58 90

61684 6772.50 90

61686 9771.70 90

61690 5610.08 90

61692 8421.45 90

61697 8137.49 90

61698 7835.89 90

61700 6653.37 90

61702 7379.33 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

141

61703 3140.81 90

61705 5576.71 90

61708 4763.30 90

61710 4149.40 90

61711 5721.19 90

61720 3129.30 90

61735 3378.53 90

61750 3004.46 90

61751 3041.66 90

61760 3364.57 90

61770 3414.18 90

61790 2480.95 90

61791 3084.72 90

*61795 941.31 0

61796 3711.00 90

*61797 1131.92 -

61798 3890.00 90

*61799 1015.00 -

*61800 598.00 -

61850 2246.63 90

61860 3102.14 90

61863 2325.65 90

*61864 585.99 -

61867 3584.55 90

*61868 932.47 -

61870 1927.97 90

61875 2298.98 90

61880 1215.23 90

61885 924.81 90

61886 1184.37 90

61888 791.99 10

62000 1971.83 90

62005 2641.60 90

62010 3251.73 90

62100 3549.55 90

62115 3079.48 90

62116 3911.28 90

62117 4052.28 90

62120 3558.61 90

62121 3613.61 90

62140 2338.52 90

62141 2696.60 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

142

62142 2010.55 90

62143 2517.56 90

62145 3297.81 90

62146 2759.31 90

62147 3258.91 90

*62148 283.92 -

*62160 428.00 -

62161 2611.20 0

62162 3304.39 0

62163 2054.84 0

62164 3796.39 0

62165 2858.60 0

62180 3686.65 90

62190 2284.08 90

62192 2351.28 90

62194 795.99 10

62200 3682.86 90

62201 2605.82 90

62220 2584.77 90

62223 2685.00 90

62225 1134.37 7

62230 2074.27 30

62252 PC - 94.64 Total - 196.30 -

62256 1229.15 30

62258 2529.72 90

62263 856.97 10

62264 666.43 0

62267 466.00 0

62268 1317.90 0

62269 1434.50 0

62270 274.00 0

62272 289.49 0

62273 264.60 0

62280 525.28 10

62281 468.22 10

62282 465.36 10

**62284 345.41 0

62287 1446.74 90

62290 505.98 0

62291 474.50 0

62292 1353.81 90

62294 1147.84 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

143

62310 370.44 0

62311 325.85 0

62318 386.72 0

62319 351.65 0

62350 887.14 90

62351 1811.83 90

62355 674.16 90

62360 512.87 90

62361 764.31 90

62362 877.11 90

62365 698.37 90

62367 69.16 0

62368 114.46 0

63001 5177.00 90

63003 4813.00 90

63005 3774.00 90

63011 3086.00 90

63012 4400.00 90

63015 5336.00 90

63016 5086.00 90

63017 4900.00 90

63020 4500.00 90

63030 3800.00 90

*63035 839.00 -

63040 5000.00 90

63042 5000.00 90

*63043 1078.24 -

*63044 1002.87 -

63045 5000.00 90

63046 5000.00 90

63047 5000.00 90

*63048 1318.38 -

63050 3674.27 90

63051 4037.28 90

∆63054

Arthroscopic discectomy,

transpedicular approach,

removal of herniated

intervertebral disk; lumbar.

Additional levels will use

modifier “-50”. Second

level will be valued at 50%

4747.26 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

144

of the listed value and the

third level at 25% of the

listed value.

63055 3718.00 90

63056 3352.05 90

*63057 900.00 -

63064 5031.00 90

*63066 859.00 -

63075 4186.00 90

*63076 929.00 -

63077 4212.50 90

*63078 900.00 -

63081 4446.73 90

*63082 1005.02 -

63085 4623.09 90

*63086 1077.36 -

63087 5389.66 90

*63088 1077.36 -

63090 4516.95 90

*63091 959.79 -

63101 3939.80 90

63102 3939.80 90

*63103 471.81 -

63170 3807.49 90

63172 3233.58 90

63173 3675.00 90

63180 3621.04 90

63182 3962.51 90

63185 2983.04 90

63190 3237.14 90

63191 3112.99 90

63194 3379.10 90

63195 3515.71 90

63196 3817.53 90

63197 3774.85 90

63198 3987.94 90

63199 4223.35 90

63200 3535.37 90

63250 6185.60 90

63251 6335.41 90

63252 6682.84 90

63265 3830.78 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

145

63266 3889.96 90

63267 3301.07 90

63268 3362.93 90

63270 4391.78 90

63271 4454.49 90

63272 4077.49 90

63273 3924.82 90

63275 4068.15 90

63276 3966.50 90

63277 3522.41 90

63278 3521.79 90

63280 4637.69 90

63281 4580.70 90

63282 4255.39 90

63283 3988.01 90

63285 5396.45 90

63286 5482.31 90

63287 5575.44 90

63290 5738.61 90

*63295 687.00 -

63300 4487.49 90

63301 5115.94 90

63302 5088.38 90

63303 5255.72 90

63304 5213.19 90

63305 5551.04 90

63306 5590.76 90

63307 5382.62 90

*63308 734.83 -

63600 2096.44 90

63610 2334.63 0

63615 2737.99 90

63620 3417.22 90

*63621 830.46 90

63650 1113.51 90

63655 1965.06 90

63661 921.17 10

63662 1601.09 90

63663 1307.06 10

63664 1676.02 90

63685 1045.63 90

63688 848.82 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

146

63700 2697.93 90

63702 2958.56 90

63704 3266.35 90

63706 3639.73 90

63707 2562.22 90

63709 2791.39 90

63710 2744.96 90

63740 2687.44 90

63741 1805.05 60

63744 1555.32 60

63746 1279.55 30

64400 210.23 0

64402 269.00 0

64405 170.00 0

64408 212.00 0

64410 227.93 0

64412 221.21 0

64413 204.48 0

64415 240.44 0

64416 404.00 0

64417 233.00 0

64418 233.00 0

64420 247.35 0

64421 328.25 0

64425 233.00 0

64430 233.00 0

64435 233.00 0

64445 233.00 0

64446 410.00 0

64447 187.00 0

64448 377.00 0

64449 235.41 10

64450 161.07 0

64455 103.00 0

64479 435.12 0

*64480 236.50 0

64483 401.62 0

*64484 284.00 0

64490 312.35 0

*64491 164.96 -

*64492 166.90 -

64493 277.71 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

147

*64494 150.00 -

*64495 151.95 -

64505 244.84 0

64508 266.88 0

64510 231.90 0

64517 268.20 0

64520 349.00 0

64530 335.89 0

64550 71.10 0

64553 398.50 10

64555 398.30 10

64560 398.30 10

64561 1628.73 10

64565 398.30 10

64573 1203.31 30

64575 649.74 30

64577 760.99 30

64580 676.89 30

64581 1599.96 90

64585 613.40 10

64590 547.62 10

64595 541.88 10

64600 595.13 10

64605 875.88 10

64610 1074.43 10

64612 323.43 10

64613 312.03 10

64614 405.32 10

64620 414.82 10

64622 482.80 10

*64623 187.37 -

64626 598.92 10

*64627 289.38 -

64630 355.40 10

64632 176.00 10

64640 366.75 10

64650 114.17 0

64653 133.82 0

64680 484.42 10

64681 603.00 10

64702 839.48 90

64704 768.25 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

148

64708 1072.26 90

64712 1312.98 90

64713 1675.14 90

64714 1414.80 90

64716 2100.00 90

64718 1411.00 90

64719 846.00 90

64721 958.57 90

64722 1408.20 90

64726 616.34 90

*64727

List separately in addition

to code for primary

neuroplasty and value at

50% of the listed value of

the primary procedure as an

additional charge.

BR -

64732 914.11 30

64734 944.06 30

64736 1068.91 30

64738 1146.34 60

64740 985.95 30

64742 1118.75 30

64744 949.53 30

64746 929.45 30

64752 1384.76 60

64755 2260.75 60

64760 1336.79 60

64761 950.04 45

64763 1087.17 45

64766 1361.12 45

64771 1288.12 30

64772 1356.05 30

64774 772.33 30

64776 755.61 30

*64778 397.06 -

64782 966.08 30

*64783

List separately in addition

to code for primary

procedure and value at 25%

of the listed value of the

519.70 -

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

149

appropriate nerve.

64784 1514.27 30

64786 2285.19 60

*64787 605.69 60

64788 821.67 30

64790 1646.97 90

64792 2066.64 90

64795 469.40 0

64802 1704.77 60

64804 2351.40 60

64809 2323.03 60

64818 1503.97 60

64820 1710.70 90

64821 1419.14 90

64822 1410.69 90

64823 1614.89 90

64831 1074.41 90

*64832 547.99 -

64834 1329.56 90

64835 1623.30 90

64836 1690.15 90

*64837 843.26 -

64840 1876.30 90

64856 1974.21 90

64857 2036.92 90

64858 2433.37 90

*64859 595.75 -

64861 2497.12 90

64862 2809.97 90

64864 1797.17 90

64865 2190.50 90

64866 2779.45 90

64868 2617.47 90

64870 2669.53 90

*64872

List separately in addition

to code for primary

neurorrhaphy and value at

25% of the listed value of

the primary neurorrhaphy as

an additional charge.

325.80 -

*64874 398.71 -

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

150

List separately and value at

25% of the listed procedure

as an additional charge.

*64876

List separately and value at

25% of the listed procedure

as an additional charge.

429.21 -

64885 2924.20 90

64886 3263.08 90

64890 2326.22 90

64891 2355.89 90

64892 2214.24 90

64893 2430.82 90

64895 2798.49 90

64896 3258.80 90

64897 2681.03 90

64898 2915.91 90

*64901 1234.09 -

*64902 1366.96 -

64905 1719.36 90

64907 2335.75 90

64910 1613.45 90

64911 1976.57 90

64999 BR -

65091 1282.07 60

65093 1418.24 60

65101 1535.72 60

65103 1658.28 30

65105 1919.41 90

65110 2488.48 90

65112 2860.95 90

65114 3134.90 90

65125 678.34 90

65130 1472.26 90

65135 1543.73 90

65140 1740.87 90

65150 1250.29 90

65155 1705.08 90

65175 1237.68 30

65205 93.28 0

65210 110.27 0

65220 101.33 0

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

151

65222 132.23 0

65235 1598.28 45

65260 2234.98 45

65265 2321.01 45

65270 383.63 10

65272 730.42 30

65273 721.43 30

65275 925.00 30

65280 1491.46 60

65285 2116.00 60

65286 1116.97 30

65290 1125.87 60

65400 1224.13 30

65410 402.57 0

65420 790.43 30

65426 1045.18 30

65430 173.70 0

65435 140.62 0

65436 572.40 30

65450 483.27 30

65600 715.84 30

65710 2364.33 90

65730 2761.20 90

65750 3032.14 90

65755 2613.28 90

65756 2904.95 90

*65757 BR 0

65760 3449.10 90

65765 3707.03 90

65767 2735.25 90

65770 3135.08 90

65771 1489.50 90

65772 1250.33 90

65775 1636.45 90

65780 1435.65 90

65781 2199.13 90

65782 1896.50 90

65800 282.55 0

65805 286.64 0

65810 993.41 90

65815 1242.47 90

65820 1468.77 45

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

152

65850 1848.36 45

65855 938.01 45

65860 641.13 30

65865 1108.87 60

65870 1266.51 60

65875 1332.00 60

65880 1384.65 60

65900 1928.06 60

65920 2003.43 60

65930 1367.45 60

66020 293.90 10

66030 287.18 10

66130 1044.44 45

66150 1727.41 45

66155 1698.13 45

66160 1964.53 45

66165 1736.23 45

66170 2220.22 45

66172 2771.02 45

66180 2413.20 60

66185 1517.50 60

66220 1755.41 90

66225 2196.12 90

66250 1184.83 90

66500 817.50 30

66505 812.23 30

66600 1650.52 60

66605 2340.40 60

66625 1018.11 60

66630 1179.64 60

66635 1163.18 60

66680 1235.08 45

66682 1522.18 45

66700 922.00 30

66710 937.57 45

66711 1244.00 90

66720 953.15 30

66740 953.00 45

66761 1001.64 45

66762 926.01 30

66770 970.76 30

66820 766.84 45

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

153

66821 768.10 45

66825 1446.14 45

66830 1738.60 90

66840 1639.41 90

66850 1826.61 90

66852 1833.77 90

66920 1764.31 90

66930 2065.29 90

66940 1824.39 90

66982 2862.27 90

66983 2318.50 90

66984 2245.24 90

66985 1794.57 90

66986 2082.00 90

*66990 178.30 -

66999 BR -

67005 1646.90 90

67010 2987.00 90

67015 1272.16 60

67025 1380.96 60

67027 1342.79 60

67028 585.80 0

67030 1384.23 45

67031 1076.34 60

67036 3032.21 60

67039 3073.91 60

67040 3358.82 60

67041 2843.16 90

67042 3248.26 90

67043 3436.47 90

67101 1939.06 90

67105 1877.60 90

67107 2700.46 90

67108 3741.04 90

67110 1674.81 90

67112 2904.12 90

67113 3643.69 90

67115 1056.18 30

67120 1778.00 30

67121 1839.20 60

67141 1054.40 30

67145 1229.65 30

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

154

67208 1287.26 90

67210 1464.96 90

67218 2800.70 90

67220 1954.00 90

67221 625.85 0

*67225 75.00 0

67227 1326.57 90

67228 2028.07 90

67229 2467.87 90

67250 1846.27 90

67255 2084.87 90

67299 BR -

67311 1521.93 30

67312 1832.90 30

67314 1605.15 30

67316 1989.37 30

67318 1668.60 30

*67320 1626.78 30

*67331 1388.74 30

*67332 1701.32 30

*67334 1246.12 30

*67335 489.54 0

*67340 1569.49 30

67343 1662.76 30

67345 437.30 10

67346 417.90 0

67399 BR -

67400 1842.51 60

67405 1669.40 60

67412 2004.91 60

67413 2106.23 60

67414 2804.84 60

67415 321.36 60

67420 3165.24 60

67430 2543.93 60

67440 2469.79 60

67445 3025.98 60

67450 2559.62 60

67500 169.12 0

67505 164.98 0

67515 147.67 0

67550 1942.02 30

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

155

67560 1828.83 30

67570 1926.61 -

67599 BR 10

67700 383.14 10

67710 320.81 10

67715 341.18 10

67800 209.55 10

67801 289.72 10

67805 351.97 10

67808 672.37 30

67810 310.83 0

67820 93.60 0

67825 231.21 10

67830 382.14 10

67835 1236.59 30

67840 428.72 10

67850 335.11 10

67875 274.18 0

67880 806.70 30

67882 1023.17 30

67900 1061.66 60

67901 1381.10 60

67902 1647.18 60

67903 1501.10 60

67904 1571.86 60

67906 1388.19 60

67908 1167.35 60

67909 1204.84 60

67911 1654.01 60

67912 1304.41 90

67914 716.45 30

67915 529.77 30

67916 998.33 30

67917 1220.75 30

67921 675.47 15

67922 514.76 15

67923 1038.83 30

67924 1163.43 30

67930 602.42 30

67935 968.69 30

67938 340.35 10

67950 1180.34 45

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

156

67961 1274.66 60

67966 1576.87 60

67971 1717.92 60

67973 2088.60 60

67974 2114.38 60

67975 1311.46 60

67999 BR -

68020 180.47 10

68040 116.63 0

68100 262.40 0

68110 335.42 10

68115 487.31 10

68130 904.28 30

68135 304.23 10

68200 86.33 0

68320 1342.06 60

68325 1541.69 60

68326 1525.22 60

68328 1717.55 60

68330 1193.79 60

68335 1528.34 60

68340 864.19 60

68360 858.78 60

68362 1367.33 60

68371 678.64 10

68399 BR -

68400 407.68 10

68420 460.43 10

68440 202.36 10

68500 1963.20 45

68505 1938.49 45

68510 659.07 0

68520 1470.75 45

68525 510.86 0

68530 782.91 10

68540 1953.25 45

68550 2409.43 60

68700 1365.37 30

68705 354.82 10

68720 1633.85 60

68745 1621.31 90

68750 1937.55 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

157

68760 305.23 10

68761 234.47 10

68770 1170.09 60

68801 185.65 10

68810 366.12 10

68811 419.29 10

68815 645.81 10

68816 998.02 10

68840 188.08 10

68850 121.97 0

68899 BR 0

69000 264.69 10

69005 378.82 10

69020 349.20 10

69090 95.95 0

69100 153.35 0

69105 211.72 0

69110 733.31 30

69120 868.69 90

69140 1857.08 90

69145 599.90 90

69150 2326.03 90

69155 3721.14 90

69200 166.53 0

69205 235.00 10

69210 76.60 0

69220 178.88 0

69222 315.08 10

69300 1117.73 90

69310 2204.42 90

69320 3344.89 90

69399 BR -

69400 176.51 0

69401 117.70 0

69405 397.87 10

69420 274.61 10

69421 302.31 10

69424 185.72 0

69433 301.39 10

69436 370.54 10

69440 1422.33 90

69450 1280.02 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

158

69501 1626.17 90

69502 2129.88 90

69505 2521.97 90

69511 2656.14 90

69530 3405.50 90

69535 5535.34 90

69540 264.54 10

69550 2312.63 90

69552 3630.47 90

69554 5630.45 90

69601 2276.51 90

69602 2425.73 90

69603 2686.68 90

69604 2622.75 90

69605 3125.66 90

69610 601.84 10

69620 1502.84 90

69631 2138.19 90

69632 2465.57 90

69633 2420.62 90

69635 2580.41 90

69636 2936.68 90

69637 2923.21 90

69641 2544.71 90

69642 3038.66 90

69643 2855.62 90

69644 3205.72 90

69645 3110.47 90

69646 3342.54 90

69650 1768.78 90

69660 2203.16 90

69661 2749.41 90

69662 2657.87 90

69666 1888.91 90

69667 1867.92 90

69670 2050.00 90

69676 1822.31 90

69700 1277.58 90

69710 1350.76 90

69711 1425.64 90

69714 2123.00 90

69715 2709.50 90

ARIZONA PHYSICIANS’ FEE SCHEDULE

SURGERY (includes corrections made on January 24, 2012)

Code $ Value F-up Days

The codes listed herein are CPT only copyright 2010 American Medical Association.

All rights reserved.

159

69717 2237.82 90

69718 2741.38 90

69720 2611.18 90

69725 4129.82 90

69740 2804.44 90

69745 3226.46 90

69799 BR -

69801 1877.28 90

69802 2549.16 90

69805 2592.13 90

69806 2699.22 90

69820 2191.37 90

69840 2020.23 90

69905 2422.80 90

69910 2948.18 90

69915 3642.51 90

69930 3050.61 90

69949 BR -

69950 3956.26 90

69955 4205.76 90

69960 4101.77 90

69970 4953.08 -

69979 BR -

*69990

List separately in addition

to code for primary

procedure and value at 25%

of listed value for primary

procedure.

426.37 0