practitioner fee schedule 2020 · 1/1/2020  · 1rwh 1xpehu 7lwoh 'hwdlov 3urfhgxuh lqglfdwhv...

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Note Number Title Details • Procedure: indicates the service level code reimbursed in the fee-for-service delivery system within the practitioner’s scope of practice. • Modifier (Mod): indicates pricing modifiers that have altered the code by some circumstance without significantly changing the base definition. These include: EP: Well child visit for a recipient between the age of 18-20 years FP: Family planning program service TG: Healthy Start Prenatal Risk Screening completed during the first trimester TH: Obstetrical treatment/services, prenatal or postpartum • Fee Schedule Increase (FSI): indicates the base Florida Medicaid rate with a 4% increase included for all ages and certain provider types (independent of increases detailed below). Provider types include (25, 26, 27, 28, 29, 30, 35, and 62 . • Facility: indicates the reimbursement rate for a practitioner if a procedure is performed in one of the following places of service: outpatient hospital-off campus (19), inpatient hospital (21), outpatient hospital-on campus (22), emergency room hospital (23), or ambulatory surgical center (24), according to Medicare’s designation. • PCI: indicates the professional component increase for physician work portion of a test. • TCI: indicates the technical component increase for the technical portion (i.e. staff and equipment costs) of a test. • PA: indicates the need for a prior authorization of the service through the Agency’s Quality Improvement Organization vendor. • Asterisk (*): Indicates reimbursement for a high risk delivery when associated with a high risk diagnosis code. • 4% increase for all FSI, Facility, PCI, and TCI rates for all services. Example: For code 99201, the rate is $29.20 X 1.04 = $30.37 (FSI, Facility, PCI, or TCI) X 1.04 = rate with a 4% pediatric increase. • For codes 99381-99384, 99385 EP, 99391-99394, and 99395 EP the base fee includes the 4% pediatric increase. • 24% increase for all FSI, Facility, PCI, and TCI rates for all services with physician specialty types: 02, 03, 04, 05, 08, 10, 14, 15, 17, 21, 22, 23, 29, 30, 31, 36, 37, 38, 39, 43, 46, 51, 53, 55, 57, 58, 60, and 62. Example: For code 99201, the rate is $29.20 x 1.04 X 1.24 = $37.66 (specialty rate) (FSI, Facility, PCI, or TCI) x 1.04 X 1.24 = pediatric rate with a 24% increase. • A 10.2% increase for all FSI and Facility rates for specific services (CPT codes 99201-99496) with physician specialty types: 01, 19, 23, 35, 36, 37, 38, 39, 43, 49, 59, 101, and 102. Example: For code 99201, the rate is $29.20 x 1.102 = $32.18 (FSI, Facility, PCI, or TCI) x 1.04 X 1.102 = pediatric rate with a 10.2% increase. • When all criteria above are met, the 4%, 24%, and 10.2% increases are applicable. To calculate the rate with all applicable increases, multiply the FSI, Facility, PCI, or TCI rate by 1.04, then multiply by 1.24, and then multiply by 1.102. Example: For code 99201 the rate is $29.20 x 1.04 x 1.24 x 1.102 = $41.50 (FSI, Facility, PCI, or TCI) X 1.04 x 1.24 x 1.102 = rate with 4%, 24%, and 10.2% increases. 5 Primary Care Evaluation and Management (E&M) Rate Increase • Specific E&M services (99212 – 99214) provided to recipients ages 0-19 by provider types 25 and 26 are reimbursed at set rates, and receive the 10.2% increase for the following specialties: 01, 19, 23, 35, 36, 37, 38, 39, 43, 49, 59, 101, and 102. These set rates are: 99212= 1 unit at $26.45, 99213 = 1 unit at $32.56, and 99214 = 1 unit at $48.27. 6 Services not Eligible for Rate Increases • Reimbursement increases detailed above do not apply to the following services: regional perinatal intensive care center services, injectable medications/ immunization/vaccinations, supplies, devices, and laboratory/pathology services. • When the assistant at surgery is a physician, the assistant physician is reimbursed at 16%. • If not a physician, the assistant at surgery is reimbursed at 12.8%. • Services provided by an APRN or a PA within their scope of practice may be billed under a physician’s Medicaid provider number when the physician is in the building and able to render assistance as needed. These services are reimbursed at the physician allowable amount. • Services provided within the APRN’s and PA’s scope of practice that are performed when the physician is not in the building, must be billed under the rendering APRN’s or PA’s Medicaid provider number and are reimbursed at 80% of the allowable amount. Practitioner Fee Schedule 1 Legend 2 Pediatric Rate Increases for Recipients (ages 0-20 years) 8 Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) Reimbursement Rates 3 Rate Increase for Pediatric Physicians 4 Calculating All Rate Increases 7 Assistant at Surgery Reimbursement Page 1 Practitioner_Notes

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Page 1: Practitioner Fee Schedule 2020 · 1/1/2020  · 1rwh 1xpehu 7lwoh 'hwdlov 3urfhgxuh lqglfdwhv wkh vhuylfh ohyho frgh uhlpexuvhg lq wkh ihh iru vhuylfh gholyhu\ v\vwhp zlwklq wkh sudfwlwlrqhu¶v

Note Number

Title Details

• Procedure: indicates the service level code reimbursed in the fee-for-service delivery system within the practitioner’s scope of practice.• Modifier (Mod): indicates pricing modifiers that have altered the code by some circumstance without significantly changing the base definition. These include: EP: Well child visit for a recipient between the age of 18-20 years FP: Family planning program service TG: Healthy Start Prenatal Risk Screening completed during the first trimester TH: Obstetrical treatment/services, prenatal or postpartum• Fee Schedule Increase (FSI): indicates the base Florida Medicaid rate with a 4% increase included for all ages and certain provider types (independent of increases detailed below). Provider types include (25, 26, 27, 28, 29, 30, 35, and 62 . • Facility: indicates the reimbursement rate for a practitioner if a procedure is performed in one of the following places of service: outpatient hospital-off campus (19), inpatient hospital (21), outpatient hospital-on campus (22), emergency room hospital (23), or ambulatory surgical center (24), according to Medicare’s designation.• PCI: indicates the professional component increase for physician work portion of a test.• TCI: indicates the technical component increase for the technical portion (i.e. staff and equipment costs) of a test.• PA: indicates the need for a prior authorization of the service through the Agency’s Quality Improvement Organization vendor.• Asterisk (*): Indicates reimbursement for a high risk delivery when associated with a high risk diagnosis code.• 4% increase for all FSI, Facility, PCI, and TCI rates for all services.Example: For code 99201, the rate is $29.20 X 1.04 = $30.37 (FSI, Facility, PCI, or TCI) X 1.04 = rate with a 4% pediatric increase.• For codes 99381-99384, 99385 EP, 99391-99394, and 99395 EP the base fee includes the 4% pediatric increase.• 24% increase for all FSI, Facility, PCI, and TCI rates for all services with physician specialty types: 02, 03, 04, 05, 08, 10, 14, 15, 17, 21, 22, 23, 29, 30, 31, 36, 37, 38, 39, 43, 46, 51, 53, 55, 57, 58, 60, and 62.Example: For code 99201, the rate is $29.20 x 1.04 X 1.24 = $37.66 (specialty rate) (FSI, Facility, PCI, or TCI) x 1.04 X 1.24 = pediatric rate with a 24% increase.• A 10.2% increase for all FSI and Facility rates for specific services (CPT codes 99201-99496) with physician specialty types: 01, 19, 23, 35, 36, 37, 38, 39, 43, 49, 59, 101, and 102. Example: For code 99201, the rate is $29.20 x 1.102 = $32.18 (FSI, Facility, PCI, or TCI) x 1.04 X 1.102 = pediatric rate with a 10.2% increase.• When all criteria above are met, the 4%, 24%, and 10.2% increases are applicable.To calculate the rate with all applicable increases, multiply the FSI, Facility, PCI, or TCI rate by 1.04, then multiply by 1.24, and then multiply by 1.102.

Example: For code 99201 the rate is $29.20 x 1.04 x 1.24 x 1.102 = $41.50(FSI, Facility, PCI, or TCI) X 1.04 x 1.24 x 1.102 = rate with 4%, 24%, and 10.2% increases.

5

Primary Care Evaluation and Management (E&M) Rate Increase

• Specific E&M services (99212 – 99214) provided to recipients ages 0-19 by provider types 25 and 26 are reimbursed at set rates, and receive the 10.2% increase for the following specialties: 01, 19, 23, 35, 36, 37, 38, 39, 43, 49, 59, 101, and 102. These set rates are: 99212= 1 unit at $26.45, 99213 = 1 unit at $32.56, and 99214 = 1 unit at $48.27.

6Services not Eligible for Rate Increases

• Reimbursement increases detailed above do not apply to the following services: regional perinatal intensive care center services, injectable medications/ immunization/vaccinations, supplies, devices, and laboratory/pathology services.• When the assistant at surgery is a physician, the assistant physician is reimbursed at 16%.• If not a physician, the assistant at surgery is reimbursed at 12.8%.• Services provided by an APRN or a PA within their scope of practice may be billed under a physician’s Medicaid provider number when the physician is in the building and able to render assistance as needed. These services are reimbursed at the physician allowable amount.• Services provided within the APRN’s and PA’s scope of practice that are performed when the physician is not in the building, must be billed under the rendering APRN’s or PA’s Medicaid provider number and are reimbursed at 80% of the allowable amount.

Practitioner Fee Schedule

1 Legend

2

Pediatric Rate Increases for Recipients (ages 0-20 years)

8

Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) Reimbursement Rates

3Rate Increase for Pediatric Physicians

4Calculating All Rate Increases

7Assistant at Surgery Reimbursement

Page 1 Practitioner_Notes

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Note Number

Title Details

Practitioner Fee Schedule

9Modifiers that result in increase or reduction of rate

• 50 - Bilateral procedure - 150% Procedure Code Rate• 51 - Multiple procedures - 1st procedure paid at 100% procedure code rate, 2nd procedure paid at 50% procedure code rate, 3rd procedure and all others paid at 25% procedure code rate• 52 - Reduced services - 50% procedure code rate• 53 - Discontinued procedure - 50% procedure code rate• 54 - Surgical care only - 50% procedure code rate• 55 - Postoperative management only - 25% procedure code rate• 56 - Preoperative management only - 20% procedure code rate• 62 - Two surgeons - 50%procedure code rate• 80 - Assistant Surgeon - 16% Physician procedure code rate 12.8% OPRAC procedure code rate

• Anesthesia time is reported in total minutes and reimbursed through the below calculation. Qualified non-physician providers, within their scope of practice, are reimbursed at 80%.(Anesthesia FSI, Facility, PCI, or TCI rate) + (time/15 x $14.50) = reimbursement rate.

11Reproductive Services Information

Coding:• 59410 TH: Professional services for vaginal delivery which include immediate post-partum care and recovery services in the home setting.• 99211 - 99215 TH: Professional evaluation and management primary code for labor management when recipient transferred from birth center to hospital for delivery.• 99347 - 99350 TH: Professional evaluation and management primary code for labor management when recipient transferred from home to hospital for delivery.• 99354 - 99355 TH: Prolonged services add-on codes for labor management when recipient transferred from birth center or home to hospital for delivery.• 59400 and 59510 Third-party liability delivery only.• 59820 or 59821: Deliveries less than 20 full weeks of gestation.• 99401 and 99402: HIV preventive counseling visits.• H1000 Prenatal visit(s).• H1001 Prenatal visit with completion of Healthy Start Prenatal Risk screening.• H1001 TG: Used when Healthy Start Prenatal Risk Screening is completed during the first trimester of the pregnancy.

10Anesthesia Reimbursement Rates

Page 2 Practitioner_Notes

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Procedure Mod FSI Facility PCI TCI PA00100 72.49 00102 86.99 00103 72.49 00104 57.99 00120 72.49 00124 57.99 00126 57.99 00140 72.49 00142 86.99 00144 86.99 00145 86.99 00148 57.99 00160 72.49 00162 101.48 00164 57.99 00170 72.49 00172 86.99 00174 86.99 00176 101.48 00190 72.49 00192 101.48 00210 159.47 00211 130.48 00212 72.49 00214 130.48 00215 130.48 00216 217.46 00218 188.47 00220 144.98 00222 86.99 00300 72.49 00320 86.99 00322 43.49 00326 116.00 00350 144.98 00352 72.49 00400 43.49 00402 72.49 00404 72.49 00406 188.47 00410 57.99 00450 72.49 00454 43.49 00470 86.99 00472 144.98 00474 188.47 00500 217.46 00520 86.99 00522 57.99

Practitioner Fee Schedule2020

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

00524 57.99 00528 115.98 00529 159.50 00530 57.99 00532 57.99 00534 101.48 00537 144.98 00539 261.00 00540 174.00 00541 217.50 00542 217.50 00546 217.50 00548 246.50 00550 144.98 00560 217.46 00561 217.46 00562 289.95 00563 362.44 00566 362.44 00567 362.44 00580 289.95 00600 144.98 00604 188.47 00620 144.98 00625 144.98 00626 144.98 00630 115.98 00632 101.48 00635 58.00 00640 43.50 00670 188.47 00700 58.00 00702 57.99 00730 72.49 00731 72.49 00732 72.50 00750 57.99 00752 86.99 00754 101.48 00756 101.48 00770 217.46 00790 101.48 00792 188.47 00794 115.98 00796 434.93 00797 145.00 00800 58.00 00802 72.49 00811 72.50

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

00812 72.50 00813 72.49 00820 72.49 00830 57.99 00832 86.99 00834 72.50 00836 87.00 00840 86.99 00842 57.99 00844 101.48 00846 115.98 00848 115.98 00851 87.00 00860 86.99 00862 101.48 00864 115.98 00865 101.48 00866 144.98 00868 144.98 00870 72.49 00872 101.48 00873 72.49 00880 217.46 00882 144.98 00902 72.50 00904 101.48 00906 57.99 00908 86.99 00910 43.49 00912 72.49 00914 72.49 00916 72.49 00918 72.49 00920 43.49 00921 43.50 00922 86.99 00924 57.99 00926 57.99 00928 86.99 00930 57.99 00932 57.99 00934 86.99 00936 115.98 00940 43.49 00942 57.99 00944 86.99 00948 57.99 00950 72.49 00952 57.99

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

01112 72.49 01120 86.99 01130 43.49 01140 217.46 01150 145.00 01160 57.99 01170 115.98 01173 174.00 01200 57.99 01202 57.99 01210 86.99 01212 144.98 01214 116.00 01215 144.98 01220 57.99 01230 86.99 01232 72.49 01234 115.98 01250 57.99 01260 115.98 01270 116.48 01272 57.99 01274 86.99 01320 57.99 01340 57.99 01360 72.49 01380 43.49 01382 43.49 01390 43.49 01392 57.99 01400 57.99 01402 101.48 01404 72.49 01420 43.49 01430 43.49 01432 87.00 01440 116.00 01442 115.98 01444 115.98 01462 43.49 01464 43.49 01470 43.49 01472 72.49 01474 72.49 01480 43.49 01482 57.99 01484 57.99 01486 101.48 01490 43.49

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

01500 115.98 01502 86.99 01520 43.49 01522 72.49 01610 72.49 01620 57.99 01622 57.99 01630 72.49 01634 130.48 01636 217.46 01638 144.98 01650 86.99 01652 144.98 01654 115.98 01656 144.98 01670 57.99 01680 43.49 01710 43.49 01712 72.49 01714 72.49 01716 72.49 01730 43.49 01732 43.49 01740 57.99 01742 72.49 01744 72.49 01756 86.99 01758 72.49 01760 101.48 01770 87.00 01772 86.99 01780 43.49 01782 57.99 01810 43.49 01820 43.49 01829 43.50 01830 43.49 01832 86.99 01840 86.99 01842 86.99 01844 86.99 01850 43.49 01852 57.99 01860 43.49 01916 72.49 01920 101.48 01922 101.48 01924 87.00 01925 116.00

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

01926 145.00 01930 72.50 01931 101.50 01932 101.50 01933 116.00 01935 101.50 01936 101.50 01951 43.49 01952 72.49 01953 14.50 01958 72.50 01960 72.50 01961 101.50 01962 116.00 01963 145.00 01965 58.00 01966 58.00 01967 90.47 01968 61.47 01969 90.47 01991 43.50 01992 72.50 01996 43.49 01999 77.32 Y10004 33.50 27.20 10005 83.06 45.05 10006 38.47 30.90 10007 190.79 58.54 10008 104.40 38.74 10009 301.46 71.38 10010 182.69 52.61 10011 88.62 43.55 10012 88.62 43.55 10021 63.37 37.33 10030 396.74 86.61 10035 290.59 53.53 10036 247.14 27.20 10040 70.38 38.46 10060 77.85 62.46 10061 135.11 113.38 10080 131.71 64.20 10081 196.22 107.28 10120 97.54 63.98 10121 175.62 115.99 10140 109.76 74.21 10160 83.96 58.97 10180 165.21 111.20 11000 36.44 17.84 11001 15.16 8.92

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

11004 377.50 11005 514.19 11006 463.73 11008 180.83 11010 306.89 173.22 11011 341.74 189.11 11012 437.70 263.09 11042 71.33 38.08 11043 150.28 97.27 11044 202.78 142.75 11045 26.93 16.76 11046 47.98 35.25 11047 79.89 62.24 11055 36.19 10.01 11056 44.22 14.58 11057 43.52 18.50 11102 64.27 24.37 11103 34.17 14.14 11104 80.80 30.47 11105 38.93 16.54 11106 97.77 36.78 11107 46.17 19.80 11200 57.03 45.70 11201 11.99 10.23 11300 64.27 21.54 11301 78.08 32.64 11302 90.30 38.30 11303 99.35 45.05 11305 65.75 24.59 11306 79.21 31.55 11307 92.56 40.69 11308 98.90 45.92 11310 74.46 29.16 11311 84.44 39.82 11312 102.07 47.22 11313 119.20 61.37 11400 80.80 50.70 11401 98.45 64.41 11402 109.31 71.16 11403 126.29 92.05 11404 143.49 101.41 11406 205.27 154.29 11420 81.47 50.92 11421 102.75 68.11 11422 115.65 84.43 11423 131.49 96.84 11424 151.86 111.20 11426 217.94 171.70 11440 89.85 63.98

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

11441 110.44 81.17 11442 122.89 90.09 11443 145.98 110.55 11444 183.09 141.23 11446 252.12 201.51 11450 264.11 160.16 11451 329.07 204.77 11462 257.10 152.55 11463 334.72 206.52 11470 280.18 176.48 11471 341.29 218.05 11600 126.96 75.29 11601 147.56 92.27 11602 158.88 100.76 11603 181.05 120.56 11604 202.10 133.18 11606 289.91 199.12 11620 127.64 76.16 11621 148.24 92.92 11622 164.08 105.54 11623 192.82 131.22 11624 218.40 149.07 11626 263.89 183.67 11640 130.59 78.12 11641 153.44 96.84 11642 174.04 113.59 11643 205.04 142.54 11644 253.02 177.14 11646 329.75 245.47 11719 9.05 4.79 11720 21.05 9.14 11721 29.20 15.67 11730 71.06 34.17 11732 21.50 10.88 11740 34.40 19.59 11750 100.71 63.33 11755 78.53 41.46 11760 125.61 71.59 11762 186.92 119.25 11765 108.63 57.45 11770 201.88 116.21 11771 391.30 277.24 11772 474.14 362.98 11900 35.31 18.93 11901 44.58 29.60 11920 113.94 70.29 11921 137.60 82.91 11922 39.61 18.71 11960 636.18

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

11970 398.77 11971 311.64 202.60 11976 93.92 59.41 11981 83.45 47.55 11982 92.51 56.86 11983 135.16 101.44 12001 58.39 28.29 12002 71.52 37.65 12004 83.51 46.79 12005 110.44 60.93 12006 130.36 74.64 12007 148.92 92.05 12011 71.29 35.47 12013 74.46 37.43 12014 90.53 47.87 12015 109.54 60.50 12016 139.41 82.04 12017 101.39 101.68 12018 114.97 115.12 12031 162.27 94.88 12032 194.41 118.82 12034 209.12 128.61 12035 249.63 151.02 12036 279.28 177.36 12037 317.07 207.39 12041 162.72 91.83 12042 193.28 122.73 12044 239.90 134.05 12045 263.21 168.87 12046 317.98 197.59 12047 333.88 220.44 12051 174.94 105.54 12052 196.22 124.91 12053 229.94 134.92 12054 242.61 138.18 12055 315.03 188.45 12056 367.05 241.55 12057 376.42 267.23 13100 219.98 126.43 13101 258.23 155.38 13102 77.63 45.70 13120 229.49 145.37 13121 277.01 163.21 13122 84.64 52.66 13131 251.44 153.20 13132 307.57 191.72 13133 112.71 80.30 13151 274.52 176.05 13152 324.99 211.96

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

13153 123.34 87.48 13160 520.31 14000 404.88 311.19 14001 517.14 404.54 14020 448.11 349.27 14021 557.42 441.54 14040 487.94 388.01 14041 596.80 475.70 14060 495.64 413.47 14061 641.84 509.43 14301 698.42 544.25 14302 142.81 14350 446.53 15002 227.22 140.36 15003 47.07 28.72 15004 258.91 166.47 15005 79.21 57.89 15050 375.24 284.86 15100 562.17 448.07 15101 122.21 70.51 15110 523.47 434.14 15111 73.45 65.72 15115 516.91 428.48 15116 97.78 92.90 15120 551.31 434.14 15121 136.92 84.87 15130 466.89 372.99 15131 57.68 54.80 15135 566.02 473.09 15136 58.28 55.37 15150 459.43 401.28 15151 78.53 69.85 15152 101.16 91.83 15155 499.29 460.91 15156 103.70 95.53 15157 117.46 104.89 15200 541.58 419.78 15201 95.05 49.18 15220 497.45 380.39 15221 87.36 44.18 15240 600.42 494.85 15241 117.23 68.55 15260 645.01 526.19 15261 135.56 86.17 15271 97.09 53.32 15272 16.97 11.10 15273 202.10 126.65 15274 51.15 28.72 15275 101.39 59.84

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

15276 22.18 16.32 15277 221.57 143.62 15278 60.43 36.34 15570 593.41 460.69 15572 572.58 462.86 15574 582.77 470.48 15576 514.87 411.94 15600 214.32 129.70 15610 232.88 149.94 15620 285.16 201.51 15630 295.57 212.61 15650 328.39 237.63 15730 972.04 574.06 15731 726.25 623.90 15733 677.60 15734 986.97 15736 798.90 15738 847.11 15740 647.72 521.84 15750 597.71 15756 1,494.15 15757 1,485.10 15758 1,494.60 15760 546.33 436.97 15770 431.14 15777 141.45 15781 354.64 267.88 Y15820 367.31 315.76 Y15822 291.75 244.16 Y15823 394.70 338.17 Y15830 769.03 Y15832 601.33 Y15833 571.00 Y15834 582.32 Y15835 610.61 Y15836 490.43 Y15837 563.53 Y15838 419.37 Y15839 575.75 Y15840 654.74 15841 937.48 15842 1,703.90 15845 613.78 15847 294.38 Y15850 58.16 24.81 15851 66.31 28.51 15852 30.33 15860 70.84 15876 75.89 Y

Practitioner Fee Schedule 2020 13 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

15920 408.43 15922 462.83 15931 456.71 15933 564.89 15934 618.07 15935 751.83 15936 589.11 15937 681.90 15940 459.20 15941 598.16 15944 594.54 15945 663.11 15946 1,065.73 15950 376.16 15951 516.70 15952 595.44 15953 647.76 15956 763.82 15958 771.29 15999 580.91 Y16020 53.18 33.95 16025 99.35 69.20 16030 125.38 83.56 16035 129.23 16036 53.64 17000 41.87 33.29 17003 3.85 1.39 17004 101.39 60.71 17106 219.98 170.61 17107 288.10 221.31 17108 410.54 326.64 17110 71.74 41.56 17111 84.19 50.92 17250 54.77 23.28 17260 62.01 43.52 17261 93.47 54.19 17262 113.39 69.42 17263 123.34 77.25 17264 132.17 82.48 17266 150.73 97.27 17270 95.51 59.63 17271 105.24 65.72 17272 120.40 76.60 17273 133.98 86.83 17274 157.74 106.20 17276 182.64 127.52 17280 89.17 53.97 17281 114.52 74.84 17282 131.72 86.39

Practitioner Fee Schedule 2020 14 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

17283 157.06 108.15 17284 178.79 126.22 17286 230.39 171.04 17311 426.38 226.54 17312 255.74 120.78 17313 399.68 203.25 17314 244.42 111.85 17315 50.24 31.99 17340 33.95 30.68 17999 157.61 Y19000 70.38 27.42 19001 17.65 13.71 19020 306.43 194.33 19030 108.41 48.31 19081 392.44 104.89 19082 316.39 52.66 19083 388.36 99.23 19084 307.79 48.96 19085 592.50 114.90 19086 470.97 57.23 19100 99.58 44.39 19101 217.72 140.36 19110 317.07 217.83 19112 301.06 199.00 19120 328.61 261.14 19125 363.24 290.08 19126 105.92 19281 157.74 63.11 19282 111.35 31.77 19283 175.17 63.76 19284 133.53 32.42 19285 293.76 54.19 19286 250.76 27.42 19287 500.16 80.95 19288 397.87 40.69 19294 108.86 19296 163.80 132.96 19297 62.96 19298 245.49 205.42 19300 350.45 264.40 19301 431.36 19302 592.95 19303 630.07 19305 747.98 19306 756.29 19307 791.66 19316 506.27 Y19318 717.88 Y19324 346.03 Y

Practitioner Fee Schedule 2020 15 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

19325 422.99 Y19328 326.58 Y19330 414.39 Y19340 393.70 Y19342 606.08 19350 539.09 422.82 19357 981.54 Y19361 1,028.84 Y19364 1,804.21 Y19366 913.87 Y19367 1,165.54 Y19368 1,362.40 Y19369 1,206.70 Y19370 450.60 Y19371 515.10 Y19380 508.54 Y19499 297.13 Y20100 395.38 20101 309.47 132.74 20102 333.59 161.69 20103 375.01 217.83 20150 611.52 20200 137.38 59.41 20205 191.69 96.62 20206 62.37 36.34 20220 77.69 49.89 20225 118.99 74.34 20240 95.28 20245 227.90 20250 257.55 20251 279.73 20500 71.40 54.19 20501 40.94 23.94 20520 136.47 91.83 20525 307.79 154.72 20526 50.92 35.91 20527 53.63 41.35 20550 35.31 24.59 20551 36.21 25.03 20552 35.98 24.16 20553 41.19 27.20 20555 211.23 20560 16.72 10.23 20561 24.86 15.45 20600 32.59 22.63 20604 49.11 28.72 20605 33.72 23.50 20606 54.32 33.08 20610 40.06 28.72

Practitioner Fee Schedule 2020 16 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

20611 60.65 37.65 20612 39.83 25.90 20615 160.69 100.10 20650 137.60 98.80 20660 158.42 20661 326.58 20662 247.96 20663 254.09 20664 566.47 20665 72.20 58.32 20670 238.31 90.96 20680 398.09 263.97 20690 389.72 20692 730.55 20693 288.78 20694 277.24 211.52 20697 1,308.35 20700 55.15 20701 41.13 20702 91.76 20703 65.77 20704 95.60 20705 78.65 20802 1,337.08 20805 2,143.46 20808 2,111.48 20816 1,270.83 20822 1,159.65 20824 1,350.67 20827 1,198.96 20838 1,515.33 20900 263.43 115.99 20902 184.68 20910 305.53 20912 308.47 20920 253.93 20922 386.10 304.22 20924 330.42 20931 72.87 20932 470.24 20933 429.10 20934 470.01 20937 109.76 20938 120.85 20939 45.94 20950 73.99 55.71 20955 1,606.63 20956 1,694.80 20957 1,405.46

Practitioner Fee Schedule 2020 17 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

20962 1,394.76 20969 1,779.09 20970 1,599.42 20972 1,264.60 20973 1,638.62 20974 51.15 31.55 20975 108.25 20982 407.47 229.80 20983 272.05 217.83 20985 95.96 20999 261.31 Y21010 456.40 21011 234.24 160.60 21012 219.98 21013 343.55 251.13 21014 339.48 21015 407.78 21016 658.36 21025 535.24 433.49 21026 363.92 285.07 21029 494.51 389.53 21030 318.43 241.99 21031 244.16 188.23 21032 248.19 185.27 21034 842.58 709.86 21040 320.92 250.16 21044 561.04 21045 785.10 21046 680.54 21047 831.72 21048 690.27 21049 793.51 21050 532.10 21060 485.28 21070 407.83 21076 631.87 509.83 21077 1,456.43 1,354.32 21079 983.76 903.50 21080 1,127.97 880.90 21081 1,018.82 923.46 21082 959.82 775.56 21083 902.42 800.66 21084 1,053.48 926.78 21085 454.22 320.33 21086 1,078.41 857.83 21087 1,078.41 894.41 21089 976.87 Y21100 415.76 234.32 21110 512.83 419.77

Practitioner Fee Schedule 2020 18 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

21116 92.58 29.16 21121 451.95 376.05 Y21125 467.74 444.35 21127 555.57 527.79 21137 432.60 Y21138 498.98 21139 638.02 21141 870.42 21142 894.64 21143 869.13 21145 1,016.85 21146 1,061.21 21147 1,084.44 21150 983.13 21151 1,090.31 21154 1,268.29 21155 1,258.10 21159 1,688.11 21160 1,670.76 21172 1,348.19 21175 1,457.26 21179 1,000.33 21180 1,044.33 21181 472.57 21182 1,194.39 21183 1,435.98 21184 1,313.70 21188 1,019.08 21193 809.77 21194 880.65 21195 894.86 21196 926.55 21198 721.05 21199 647.98 21206 745.04 21208 1,102.62 481.05 Y21210 1,289.88 493.93 21215 2,654.71 505.52 21230 482.16 Y21235 468.48 350.79 Y21240 696.94 21242 590.45 21243 1,074.99 21244 663.56 21245 700.69 614.50 21246 530.56 21247 1,023.21 21248 651.90 579.02 Y21249 887.84 823.92 Y

Practitioner Fee Schedule 2020 19 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

21255 861.38 21256 813.43 21260 725.16 21261 1,269.33 21263 1,205.18 21267 1,061.21 21268 1,048.55 21270 581.00 486.38 21275 552.22 21295 109.96 21296 262.76 21299 559.33 Y21315 176.53 93.79 21320 163.63 83.13 21325 281.77 21330 362.34 21335 460.56 21336 411.90 21338 424.12 21339 482.06 21340 483.31 21343 694.80 21344 897.80 21345 498.48 394.86 21346 620.11 21347 664.61 21348 693.07 21355 258.40 209.62 21356 322.28 234.15 21360 331.33 21365 716.07 21366 838.06 21385 488.39 21386 423.89 21387 450.80 21390 519.85 21395 663.79 21401 310.23 202.38 21406 364.18 21407 418.24 21408 592.27 21421 433.85 351.88 21422 417.56 21423 498.81 21431 426.14 21432 469.84 21433 1,143.13 21435 886.51 21436 1,065.02

Practitioner Fee Schedule 2020 20 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

21440 393.02 314.45 21445 502.43 390.40 21451 487.72 392.57 21452 247.79 235.40 21453 649.76 533.59 21454 331.56 21461 1,300.65 627.82 21462 1,390.95 694.19 21465 545.43 21470 766.09 21480 75.33 20.02 21485 444.83 398.36 21490 546.93 21497 443.58 356.89 21499 608.83 Y21501 303.95 203.90 21502 330.65 21510 292.40 21550 169.74 97.27 21552 291.72 21554 478.21 21555 277.69 191.28 21556 344.46 21557 558.87 21558 879.47 21600 360.75 21601 772.27 21602 1,035.79 21603 1,146.31 21610 780.80 21615 404.43 21616 492.77 21620 330.65 21627 352.15 21630 795.06 21632 789.67 21685 637.54 21700 234.47 21705 351.70 21720 306.93 21725 316.94 21740 673.75 21742 493.04 21743 493.04 21750 444.94 21811 390.17 21812 475.95 21813 650.66 21825 353.96

Practitioner Fee Schedule 2020 21 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

21899 311.10 Y21920 165.66 97.93 21925 296.41 226.75 21930 319.33 228.06 21931 308.25 21932 434.08 21933 483.87 21935 672.84 21936 927.90 22010 627.35 22015 617.40 22100 558.55 22101 568.96 22102 532.69 22103 92.56 22110 632.40 22112 626.30 22114 642.99 22116 88.83 22206 1,606.86 22207 1,572.01 22208 386.71 22210 1,171.20 22212 978.83 22214 982.67 22216 238.99 22220 1,046.39 22222 929.84 22224 1,043.33 22226 238.99 22310 196.90 182.36 22315 573.04 483.32 22318 1,071.16 22319 1,174.43 22325 950.31 22326 979.96 22327 989.69 22328 184.90 22505 78.69 22510 1,174.59 272.02 22511 1,163.28 255.04 22512 553.35 129.70 22513 411.37 322.72 22514 383.27 300.96 22515 173.51 139.06 22532 1,143.30 22533 1,087.23 22534 237.18 22548 1,147.42

Practitioner Fee Schedule 2020 22 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

22551 1,117.56 22552 261.40 22554 822.21 22556 1,090.40 22558 1,004.63 22585 215.23 22586 891.20 22590 1,032.69 22595 984.48 22600 843.94 22610 829.68 22612 1,041.06 22614 257.55 22630 1,031.78 22632 211.83 22633 1,214.65 22634 326.12 22800 891.01 22802 1,381.67 22804 1,591.70 22808 1,190.49 22810 1,346.59 22812 1,289.02 22818 1,281.74 22819 1,716.87 22830 535.24 22840 499.71 22842 501.97 22843 536.37 22844 648.18 22845 479.12 22846 498.13 22847 535.03 22848 236.96 22849 854.35 22850 477.30 22852 458.29 22853 170.19 22854 220.43 22855 726.93 22857 114.78 22858 315.01 22859 220.43 22899 761.24 Y22900 368.90 22901 437.93 22902 298.29 208.26 22903 287.88 22904 690.95

Practitioner Fee Schedule 2020 23 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

22905 873.14 22999 492.85 Y23000 338.71 238.25 23020 450.83 23030 281.54 156.25 23031 259.68 139.50 23035 444.49 23040 468.70 23044 369.58 23065 142.77 102.50 23066 367.77 226.32 23071 274.98 23073 455.35 23075 244.52 205.43 23076 353.74 23077 741.19 23078 941.71 23100 323.01 23101 297.83 23105 389.83 23106 291.29 23107 430.68 23120 381.57 23125 435.78 23130 400.13 23140 359.11 23145 405.91 23146 406.01 23150 435.44 23155 463.22 23156 442.90 23170 366.64 23172 331.86 23174 443.53 23180 434.30 23182 430.23 23184 481.83 23190 347.51 23195 485.29 23200 644.28 23210 744.32 23220 857.20 23330 171.80 104.02 23333 302.59 23334 604.82 23335 831.72 23350 98.45 31.99 23395 839.19 23397 746.62

Practitioner Fee Schedule 2020 24 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

23400 622.85 23405 404.66 23406 502.43 23410 535.92 23412 557.20 23415 455.13 23420 635.27 23430 486.36 23440 494.05 23450 553.23 23455 649.99 23460 698.90 23462 699.32 23465 731.69 23466 725.12 23470 785.78 23472 950.08 23473 1,059.85 23474 1,145.17 23480 536.37 23485 625.54 23490 503.01 23491 644.42 23500 143.03 140.36 23505 232.20 209.13 23515 470.06 23525 229.48 227.63 23530 370.81 23532 394.10 23545 223.15 194.11 23550 373.88 23552 426.38 23570 151.41 149.94 23575 263.89 235.89 23585 640.25 23600 213.87 194.11 23605 304.40 266.79 23615 577.11 23616 809.31 23620 174.49 161.03 23625 247.19 220.01 23630 508.99 23650 207.76 181.92 23655 263.43 23660 376.53 23665 279.05 248.30 23670 570.77 23675 359.85 314.67 23680 607.66

Practitioner Fee Schedule 2020 25 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

23700 127.42 23800 631.43 23802 749.00 23900 889.33 23920 734.85 23921 304.80 23929 339.91 Y23930 231.52 133.18 23931 187.62 97.27 23935 333.59 24000 311.87 24006 464.63 24065 167.70 102.50 24066 404.20 260.48 24071 265.47 24073 455.35 24075 336.76 206.08 24076 355.09 24077 650.71 24079 868.38 24100 256.49 24101 327.03 24102 402.39 24105 230.39 24110 383.16 24115 418.12 24116 562.85 24120 347.17 24125 362.78 24126 379.32 24130 332.46 24134 479.86 24136 368.69 24138 412.38 24140 458.97 24145 346.04 24147 407.15 24149 766.77 24150 781.84 24152 483.56 24155 518.93 24160 428.47 24164 387.71 24200 140.32 88.13 24201 356.45 227.41 24220 115.65 42.43 24300 277.24 24301 489.53 24305 377.95

Practitioner Fee Schedule 2020 26 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

24310 307.57 24320 455.74 24330 441.30 24331 483.63 24332 400.36 24340 402.93 24341 485.91 24342 506.73 24343 462.14 24344 714.49 24345 458.07 24346 719.01 24357 271.13 24358 343.32 24359 432.04 24360 524.28 24361 586.51 24362 618.02 24363 950.31 24365 373.22 24366 446.07 24370 988.33 24371 1,138.69 24400 537.73 24410 594.53 24420 661.12 24430 690.27 24435 702.49 24470 346.24 24495 396.89 24498 566.25 24500 232.66 205.86 24505 324.54 281.59 24515 574.17 24516 561.27 24530 246.69 216.74 24535 401.49 355.58 24538 498.13 24545 607.44 24546 678.50 24560 213.42 183.01 24565 349.66 307.92 24566 468.70 24575 478.21 24576 224.51 193.24 24577 359.62 316.41 24579 543.16 24582 528.68 24586 710.87

Practitioner Fee Schedule 2020 27 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

24587 632.20 24600 241.26 211.30 24605 308.70 24615 466.22 24620 361.88 24635 439.74 24640 65.41 49.18 24650 169.96 151.46 24655 286.97 249.82 24665 427.06 24666 478.66 24670 189.20 165.82 24675 298.51 260.92 24685 426.38 24800 509.99 24802 583.96 24900 482.06 24920 471.86 24925 370.03 24930 506.05 24931 446.88 24935 613.49 24940 532.48 24999 319.44 Y25000 220.43 25001 223.60 25020 413.76 25023 780.57 25024 510.80 25025 786.91 25028 381.03 25031 228.35 25035 380.67 25040 366.18 25065 166.80 99.88 25066 233.11 25071 277.24 25073 349.21 25075 265.64 197.81 25076 337.44 25077 555.17 25078 761.33 25085 290.52 25100 226.32 25101 263.21 25105 316.17 25107 401.04 25109 350.34 25110 222.70

Practitioner Fee Schedule 2020 28 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

25111 209.12 25112 252.34 25115 493.60 25116 391.53 25118 248.04 25119 290.70 25120 326.35 25125 383.24 25126 390.17 25130 293.73 25135 326.55 25136 288.93 25145 338.57 25150 368.45 25151 380.44 25170 656.36 25210 319.56 25215 403.07 25230 281.54 25240 279.50 25246 107.61 46.57 25248 270.90 25250 310.00 25251 461.88 25260 411.45 25263 411.67 25265 475.62 25270 321.15 25272 364.15 25274 408.34 25275 434.15 25280 368.90 25290 283.80 25295 342.87 25300 448.04 25301 419.59 25310 403.98 25312 419.11 25315 503.33 25316 573.02 25320 641.39 25332 517.87 25335 542.75 25337 577.56 25350 440.64 25355 499.71 25360 426.84 25365 598.61 25370 564.80

Practitioner Fee Schedule 2020 29 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

25375 519.08 25390 501.97 25391 651.57 25392 590.84 25393 658.21 25394 503.04 25400 524.38 25405 677.82 25415 633.01 25420 762.92 25425 561.11 25426 719.48 25430 449.17 25431 506.52 25440 500.84 25441 533.53 25442 531.83 25443 455.94 25444 458.30 25445 461.88 25446 721.18 25447 540.45 25449 666.61 25450 356.42 25455 378.25 25490 440.66 25491 474.67 25492 473.12 25500 180.60 157.77 25505 327.93 287.47 25515 436.79 25520 372.97 338.82 25525 514.65 25526 623.73 25530 170.19 149.72 25535 318.88 283.77 25545 406.01 25560 184.45 159.08 25565 336.08 291.17 25574 439.51 25575 588.43 25600 215.23 197.16 25605 352.60 320.54 25606 432.49 25607 479.79 25608 538.18 25609 684.84 25622 198.25 175.61 25624 315.48 275.83

Practitioner Fee Schedule 2020 30 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

25628 469.16 25630 198.48 176.92 25635 299.19 261.79 25645 372.07 25650 211.61 189.32 25651 317.98 25652 405.79 25660 270.22 25670 396.74 25671 346.27 25675 288.10 251.13 25676 412.13 25680 317.46 25685 480.25 25690 299.06 25695 414.16 25800 477.53 25805 492.57 25810 565.57 25820 411.67 25825 505.14 25830 636.86 25900 464.40 25905 458.29 25907 387.00 25909 447.66 25915 601.08 25920 465.99 25922 338.95 25924 434.63 25927 543.16 25929 348.80 25931 488.33 25999 429.23 Y26010 194.92 86.39 26011 282.22 115.77 26020 314.29 26025 274.30 26030 320.24 26034 355.77 26035 560.14 26037 369.35 26040 199.97 26045 305.98 26055 277.78 180.84 26060 167.70 26070 199.81 26075 218.17 26080 255.97

Practitioner Fee Schedule 2020 31 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

26100 203.74 26105 221.34 26110 210.02 26111 271.36 26113 356.68 26115 344.91 206.95 26116 342.42 26117 485.45 26118 687.78 26121 389.95 26123 544.07 26125 178.11 26130 267.85 26135 348.68 26140 324.10 26145 335.18 26160 369.80 196.72 26170 260.84 26180 290.82 26185 354.86 26200 294.44 26205 369.41 26210 289.23 26215 368.67 26230 325.90 26235 321.37 26236 287.42 26250 378.83 26260 389.21 26262 325.28 26320 226.54 26341 66.67 47.66 26350 470.97 26352 527.77 26356 517.36 26357 579.83 26358 641.84 26370 497.45 26372 517.78 26373 510.21 26390 554.03 26392 619.61 26410 374.78 26412 446.98 26415 472.35 26416 484.20 26418 385.42 26420 467.80 26426 327.26

Practitioner Fee Schedule 2020 32 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

26428 455.97 26432 332.69 26433 353.51 26434 429.06 26437 414.16 26440 408.28 26442 628.49 26445 380.44 26449 451.96 26450 276.56 26455 274.52 26460 268.19 26471 383.90 26474 290.76 26476 396.74 26477 386.55 26478 413.03 26479 360.42 26480 495.86 26483 553.35 26485 530.49 26489 612.47 26490 525.43 26492 584.81 26494 466.18 26496 564.44 26497 551.14 26498 752.96 26499 502.56 26500 413.26 26502 443.72 26508 421.18 26510 348.21 26516 448.45 26517 477.40 26518 487.26 26520 428.65 26525 429.78 26530 329.01 26531 408.96 26535 282.45 26536 471.42 26540 437.25 26541 528.68 26542 451.05 26545 460.41 26546 654.96 26548 502.88 26550 1,042.66

Practitioner Fee Schedule 2020 33 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

26551 1,699.47 26553 1,725.57 26554 1,834.38 26555 877.20 26556 1,885.35 26560 373.85 26561 623.51 26562 866.70 26565 449.24 26567 451.96 26568 592.50 26580 985.37 26587 680.09 26590 922.93 26591 295.12 26593 399.45 26596 509.22 26600 192.37 175.40 26605 211.15 183.88 26607 316.17 26608 312.32 26615 374.56 26641 245.17 216.96 26645 280.18 246.34 26650 311.64 26665 407.60 26670 223.15 193.02 26675 298.51 262.88 26676 329.07 26685 374.56 26686 407.37 26700 216.13 192.81 26705 273.84 239.81 26706 287.65 26715 372.75 26720 128.10 115.77 26725 220.66 189.98 26727 306.89 26735 387.23 26740 149.37 136.01 26742 241.93 209.78 26746 483.87 26750 120.40 116.42 26755 206.40 171.26 26756 274.30 26765 326.35 26770 182.87 161.25 26775 249.86 216.74 26776 290.59

Practitioner Fee Schedule 2020 34 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

26785 355.55 26820 459.28 26841 439.17 26842 475.33 26843 430.93 26844 521.25 26850 458.97 26852 525.28 26860 376.59 26861 67.44 26862 479.57 26863 149.82 26910 478.44 26951 433.40 26952 427.97 26989 317.72 Y26990 427.06 26991 462.82 329.90 26992 646.14 27000 263.66 27001 353.51 27003 389.95 27005 472.33 27006 468.48 27025 600.20 27027 584.35 27030 613.77 27033 636.41 27035 584.94 27036 661.30 27040 223.83 124.47 27041 456.26 27043 307.11 27045 483.64 27047 314.58 226.32 27048 398.77 27049 875.40 27050 244.19 27052 373.71 27054 448.34 27057 608.98 27059 1,187.04 27060 300.06 27062 296.25 27065 339.48 27066 529.36 27067 623.57 27070 571.99 27071 617.40

Practitioner Fee Schedule 2020 35 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

27075 1,370.36 27076 1,179.09 27077 1,648.86 27078 744.59 27080 334.72 27086 167.08 104.89 27087 402.62 27090 543.39 27091 1,044.91 27093 140.77 43.52 27095 74.79 52.88 27096 104.33 52.01 27097 449.41 27098 399.43 27100 482.13 27105 505.37 27110 565.05 27111 524.47 27120 850.05 27122 720.14 27125 740.51 27130 887.39 27132 1,096.51 27134 1,253.58 27137 963.44 27138 1,001.46 27140 585.03 27146 836.02 27147 959.59 27151 1,038.35 27156 1,119.60 27158 814.14 27161 798.00 27165 898.03 27170 768.80 27175 389.17 27176 601.33 27177 728.52 27178 589.71 27179 601.24 27181 650.13 27185 450.85 27187 650.89 27197 83.29 27198 200.07 27202 340.34 27215 394.70 27216 585.26 27217 549.27

Practitioner Fee Schedule 2020 36 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

27218 757.49 27220 315.46 299.16 27222 636.63 27226 690.95 27227 1,082.93 27228 1,230.27 27230 314.36 297.70 27232 489.30 27235 593.63 27236 781.48 27238 302.81 27240 623.28 27244 804.33 27245 803.43 27246 253.25 241.99 27248 488.17 27250 120.63 27252 493.83 27253 616.04 27254 833.08 27256 198.48 150.15 27257 236.28 27258 726.48 27259 1,012.55 27266 380.21 27267 284.93 27268 346.19 27269 814.52 27275 119.04 27279 383.03 27280 887.62 27282 498.87 27284 942.01 27286 962.69 27290 1,063.47 27295 824.48 27299 466.85 Y27301 439.74 316.63 27303 418.91 27305 313.90 27306 223.38 27307 313.22 27310 477.76 27323 179.02 110.55 27324 263.66 27325 324.39 27326 301.14 27327 315.49 196.07 27328 404.36

Practitioner Fee Schedule 2020 37 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

27329 681.90 27330 268.41 27331 309.60 27332 391.96 27333 343.09 27334 447.20 27335 499.94 27337 274.07 27339 494.28 27340 242.16 27345 315.49 27347 343.78 27350 426.16 27355 394.93 27356 482.74 27357 532.98 27358 177.22 27360 573.26 27364 1,023.41 27365 1,203.14 27369 101.39 25.68 27372 390.40 252.21 27380 396.74 27381 528.45 27385 384.29 27386 551.99 27390 292.40 27391 368.45 27392 465.31 27393 332.46 27394 427.29 27395 575.07 27396 396.02 27397 535.11 27400 453.77 27403 420.05 27405 441.32 27407 519.40 27409 632.11 27412 1,020.00 27415 897.80 27418 541.35 27420 485.91 27422 486.13 27424 480.29 27425 293.31 27427 464.63 27428 728.74 27429 819.72

Practitioner Fee Schedule 2020 38 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

27430 484.55 27435 528.68 27437 430.46 27438 550.18 27440 491.07 27441 529.05 27442 570.32 27443 495.75 27445 799.93 27446 757.94 27447 886.26 27448 536.83 27450 663.79 27454 847.79 27455 622.37 27457 629.16 27465 818.59 27466 774.69 27468 757.55 27470 770.39 27472 826.51 27475 432.72 27477 478.89 27479 531.29 27485 438.38 27486 920.66 27487 1,151.51 27488 785.32 27495 737.80 27496 355.55 27497 355.38 27498 427.51 27499 457.84 27500 339.48 301.39 27501 329.75 312.06 27502 496.54 27503 523.25 27506 874.49 27507 635.27 27508 341.51 311.19 27509 431.59 27510 444.49 27511 653.83 27513 812.71 27514 633.46 27516 333.59 300.96 27517 448.56 27519 583.67 27520 209.34 185.84

Practitioner Fee Schedule 2020 39 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

27524 491.79 27530 196.90 177.36 27532 401.94 361.89 27535 587.52 27536 777.18 27538 310.51 278.33 27540 529.36 27550 340.61 303.79 27552 410.54 27556 574.40 27557 685.52 27558 781.48 27560 243.07 215.00 27562 317.07 27566 573.67 27570 98.22 27580 954.61 27590 520.98 27591 631.43 27592 443.13 27594 334.72 27596 468.25 27598 466.22 27599 325.51 Y27600 265.02 27601 291.50 27602 317.52 27603 346.95 244.38 27604 309.15 209.13 27605 222.47 116.21 27606 180.83 27607 395.15 27610 423.44 27612 363.92 27613 163.40 100.10 27614 376.59 254.61 27615 671.03 27616 833.53 27618 306.66 191.06 27619 301.23 27620 291.95 27625 376.59 27626 385.01 27630 357.81 225.45 27632 270.22 27634 446.53 27635 379.54 27637 488.62 27638 500.16

Practitioner Fee Schedule 2020 40 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

27640 542.94 27641 432.04 27645 834.17 27646 665.21 27647 543.75 27648 120.44 33.08 27650 428.87 27652 433.63 27654 464.86 27656 413.03 248.51 27658 240.58 27659 306.43 27664 234.92 27665 270.22 27675 320.01 27676 390.40 27680 276.56 27681 347.80 27685 430.46 290.73 27686 353.28 27687 296.25 27690 416.65 27691 485.68 27692 68.12 27695 309.15 27696 364.15 27698 416.20 27700 364.53 27702 569.38 27703 661.95 27704 374.10 27705 494.96 27707 260.04 27709 762.92 27712 720.37 27715 700.91 27720 572.13 27722 571.73 27724 824.48 27725 712.76 27726 626.00 27727 678.28 27730 383.16 27732 273.71 27734 428.87 27740 360.02 27742 396.07 27745 496.99 27750 224.28 199.77

Practitioner Fee Schedule 2020 41 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

27752 348.98 308.79 27756 375.01 27758 584.58 27759 652.93 27760 216.36 191.72 27762 311.41 271.80 27766 394.02 27767 186.49 178.44 27768 288.78 27769 476.40 27780 199.16 175.83 27781 281.31 249.60 27784 464.18 27786 203.91 179.53 27788 276.33 241.55 27792 422.31 27808 216.59 189.32 27810 305.08 265.49 27814 500.84 27816 211.83 181.92 27818 316.62 272.89 27822 565.34 27823 639.58 27824 206.18 190.41 27825 355.77 310.10 27826 555.61 27827 725.35 27828 862.27 27829 457.16 27830 232.45 220.83 27831 240.54 27832 493.83 27840 245.33 27842 321.37 27846 466.44 27848 522.12 27860 111.12 27870 667.86 27871 449.92 27880 596.35 27881 562.17 27882 391.76 27884 375.01 27886 429.10 27888 428.87 27889 421.18 27892 359.62 27893 398.77 27894 550.41

Practitioner Fee Schedule 2020 42 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

27899 311.60 Y28001 182.41 107.50 28002 288.78 200.42 28003 456.71 351.23 28005 376.59 28008 282.90 184.75 28010 151.41 130.35 28011 205.72 176.27 28020 350.79 225.45 28022 318.20 203.69 28024 298.29 189.54 28035 343.55 222.18 28039 323.63 216.31 28041 295.80 28043 256.42 163.65 28045 317.98 216.96 28046 472.51 28047 680.54 28050 254.85 174.40 28052 266.08 183.04 28054 224.92 146.94 28055 241.55 28060 341.06 225.45 28062 379.99 254.61 28070 345.36 221.75 28072 306.25 208.66 28080 343.55 231.11 28086 350.34 222.18 28088 292.81 179.84 28090 305.08 192.15 28092 256.82 168.95 28100 398.77 260.70 28102 342.58 28103 254.38 28104 345.36 221.97 28106 265.49 28107 334.05 217.83 28108 286.52 180.40 28110 302.36 181.71 28111 318.88 203.03 28112 318.43 195.85 28113 362.61 282.58 28114 690.04 518.57 28116 498.13 361.67 28118 391.98 262.01 28119 341.97 226.10 28120 442.00 311.84 28122 388.59 274.63 28124 312.32 207.82

Practitioner Fee Schedule 2020 43 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

28126 261.68 157.18 28130 412.13 28140 384.29 273.32 28150 274.98 174.31 28153 269.77 166.26 28160 271.13 167.34 28171 514.20 28173 451.21 28175 286.56 28190 164.53 83.78 28192 305.53 196.07 28193 345.81 231.32 28200 322.28 203.03 28202 353.72 269.52 28208 314.58 198.25 28210 345.84 265.49 28220 268.05 189.29 28222 304.88 220.88 28225 264.51 164.66 28226 334.87 246.99 28230 284.26 177.57 28232 251.21 151.24 28234 267.28 165.82 28238 434.53 304.01 28240 292.63 184.10 28250 379.08 253.74 28260 457.16 325.77 28261 660.89 563.42 28262 914.55 710.29 28264 575.49 501.66 28270 321.60 209.78 28272 254.61 157.77 28280 335.63 218.27 28285 350.34 238.07 28286 271.19 187.14 28288 397.64 271.15 28289 465.99 287.69 28291 476.63 307.05 28292 472.78 303.14 28295 631.87 344.73 28296 530.89 322.29 28297 591.00 378.65 28298 488.48 312.06 28299 658.59 365.59 28300 425.03 28302 467.57 28304 534.34 378.65 28305 436.79 28306 395.83 251.34

Practitioner Fee Schedule 2020 44 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

28307 419.40 292.79 28308 371.84 238.72 28309 576.66 28310 357.13 225.23 28312 307.24 200.15 28313 342.42 222.62 28315 309.03 205.65 28320 396.02 28322 510.80 360.37 28340 344.07 258.63 28341 434.53 307.49 28344 277.47 174.96 28345 339.25 228.49 28360 632.91 28400 160.46 142.54 28405 251.67 219.35 28406 352.60 28415 730.55 28420 839.64 28430 155.03 131.22 28435 236.73 202.60 28436 304.40 28445 676.92 28450 137.38 119.03 28455 169.85 161.03 28456 192.59 28465 411.45 28470 141.68 127.30 28475 166.80 141.88 28476 238.99 28485 359.62 28490 92.11 77.25 28495 115.42 92.49 28496 293.76 150.81 28505 432.72 311.62 28510 78.53 74.21 28515 105.69 88.79 28525 373.42 252.65 28530 74.68 62.67 28531 220.21 113.59 28540 126.06 109.02 28545 196.22 165.82 28546 365.40 214.35 28555 556.74 408.03 28570 105.94 100.64 28575 238.74 208.26 28576 252.12 28585 564.44 426.96 28600 134.88 115.34

Practitioner Fee Schedule 2020 45 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

28605 216.81 186.49 28606 253.25 28615 530.26 28635 114.06 82.91 28636 203.23 124.91 28645 428.42 304.66 28665 99.81 80.95 28666 108.41 28675 371.61 252.87 28705 802.75 28715 613.77 28725 508.54 28730 480.02 28735 506.50 28737 450.15 28740 547.69 389.53 28750 520.31 365.81 28755 332.69 208.47 28760 510.35 361.24 28800 348.98 28805 472.10 28810 279.96 28820 364.60 246.12 28825 348.53 230.67 28890 194.98 140.35 28899 295.94 Y29000 165.24 135.20 29010 172.68 99.67 29015 153.73 118.96 29035 131.80 88.79 29040 149.70 107.72 29044 165.70 109.60 29046 162.59 116.86 29049 58.76 43.52 29055 140.77 85.52 29058 60.31 57.29 29065 61.11 42.43 29075 55.00 38.30 29085 60.65 41.78 29105 52.28 31.90 29125 41.19 24.59 29126 49.34 30.47 29130 26.71 18.50 29131 33.50 21.33 29200 23.06 11.72 29240 19.92 11.75 29260 19.46 12.19 29305 156.84 98.58 29325 173.81 110.77

Practitioner Fee Schedule 2020 46 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

29345 87.13 62.46 29355 91.21 66.81 29358 95.91 68.01 29365 78.53 54.40 29405 51.15 36.78 29425 49.11 34.60 29435 73.55 51.14 29440 27.29 18.16 29445 84.19 63.98 29450 93.02 70.94 29505 54.54 31.55 29515 45.49 30.90 29520 22.63 11.97 29530 19.69 11.75 29540 18.33 11.10 29550 12.22 7.18 29580 39.94 17.19 29581 47.44 17.41 29584 46.37 10.23 29799 219.10 Y29800 301.53 29804 401.94 29805 306.66 29806 691.18 29807 676.01 29819 382.70 29820 350.34 29821 387.00 29822 376.37 29823 409.64 29824 440.42 29825 382.70 29826 158.88 29827 699.55 29828 600.20 29830 293.55 29834 321.15 29835 332.01 29836 337.77 29837 344.00 29838 386.33 29840 293.99 29843 297.96 29844 325.90 29845 380.44 29846 340.84 29847 344.92 29848 332.46 29850 379.20

Practitioner Fee Schedule 2020 47 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

29851 608.12 29855 510.80 29856 647.27 29860 435.44 29861 471.19 29862 530.72 29863 532.30 29866 686.42 29867 835.57 29868 1,088.77 29870 371.61 257.00 29871 335.18 29873 344.91 29874 351.02 29875 323.86 29876 426.61 29877 405.34 29879 432.04 29880 366.41 29881 353.06 29882 452.18 29883 549.50 29884 403.98 29885 492.69 29886 415.29 29887 490.43 29888 640.93 29889 799.36 29891 437.25 29892 393.72 29893 364.95 266.62 29894 325.67 29895 303.27 29897 326.12 29898 367.54 29899 673.75 29900 263.91 29901 313.54 29902 346.52 29904 373.42 29905 337.67 29906 446.43 29907 512.66 29914 649.99 29915 669.22 29916 669.45 29999 428.34 Y30000 153.93 73.55 30020 164.08 73.99

Practitioner Fee Schedule 2020 48 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

30100 91.21 41.56 30110 154.35 80.52 30115 287.42 30117 599.06 206.08 30118 499.94 30120 310.39 275.88 30124 188.52 30125 406.47 30130 255.29 30140 182.93 111.20 30150 508.54 30160 511.71 30200 71.97 36.12 30210 91.19 61.41 30220 196.90 77.69 30300 122.21 70.29 30310 131.26 30320 297.24 30420 413.84 Y30460 540.45 30462 1,027.82 Y30465 645.91 Y30520 417.33 Y30540 458.07 30545 498.87 30560 188.75 87.48 30580 403.07 302.69 30600 381.80 268.54 30620 413.03 30630 417.56 30801 139.86 89.22 30802 177.89 121.43 30901 72.37 35.69 30903 146.88 49.62 30905 206.14 66.81 30906 187.18 85.30 30915 351.55 30920 550.41 30930 76.27 30999 285.54 Y31000 117.01 65.72 31002 121.99 31020 305.98 230.67 31030 417.78 319.89 31032 374.10 31040 508.31 31050 297.32 31051 383.66 31075 516.91

Practitioner Fee Schedule 2020 49 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

31080 670.95 31081 732.59 31084 748.95 31085 783.74 31086 728.37 31087 700.19 31090 670.08 31200 385.87 31201 495.96 31205 596.12 31225 1,180.48 31230 1,310.16 31231 124.02 39.61 31233 168.61 83.56 31235 192.14 98.80 31237 163.18 98.80 31238 160.91 103.80 31239 394.02 31240 102.30 31241 301.26 31253 325.90 31254 209.62 151.89 31255 210.70 31256 117.01 31257 290.14 31259 307.11 31267 172.23 31276 245.78 31287 130.81 31288 151.86 31290 740.29 31291 790.98 31292 643.20 31293 695.02 31294 795.96 31299 315.77 Y31300 817.69 31360 1,340.48 31365 1,658.69 31367 1,430.29 31368 1,438.51 31370 1,223.05 31375 1,263.76 31380 1,145.45 31382 1,366.74 31390 1,840.88 31395 1,933.89 31400 623.60 31420 531.62

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

31500 89.74 31502 22.86 31505 56.13 30.25 31510 133.58 79.91 31511 136.70 82.48 31512 124.63 82.18 31513 81.25 31515 133.53 68.33 31520 100.49 31525 161.82 99.23 31526 100.94 31527 125.61 31528 92.56 31529 103.88 31530 129.00 31531 136.70 31535 121.99 31536 135.79 31540 155.93 31541 170.19 31545 233.79 31546 323.19 31551 986.52 31552 951.67 31553 1,083.16 31554 1,083.38 31560 202.10 31561 220.43 31570 219.08 142.10 31571 160.69 31572 334.05 112.07 31573 176.98 91.83 31574 645.69 91.83 31575 78.99 41.35 31576 165.46 73.55 31577 147.60 85.45 31578 194.63 91.62 31579 123.57 74.21 31580 820.86 31584 907.98 31587 765.86 31590 564.66 31591 696.15 31592 1,110.77 31599 1,352.55 Y31600 201.20 31601 169.07 31603 172.62 31605 142.59

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

31610 546.55 31611 342.19 31612 55.67 29.81 31613 281.77 31614 469.38 31615 110.44 71.38 31622 155.93 82.48 31623 173.36 83.13 31624 162.04 84.22 31625 221.79 97.93 31626 393.60 124.04 31627 821.76 60.50 31628 235.37 110.11 31629 207.37 116.86 31630 129.45 31631 148.46 31632 41.19 31.12 31633 51.15 39.61 31635 183.09 110.11 31636 143.26 31637 50.24 31638 162.27 31640 163.18 31641 166.80 31643 113.42 31645 170.19 92.05 31646 104.90 94.74 31652 629.39 138.84 31653 666.11 154.07 31654 78.76 42.22 31717 103.66 66.37 31720 35.98 31725 53.57 31730 765.86 94.23 31750 885.58 31755 1,113.26 31760 897.13 31766 1,043.82 31770 860.51 31775 803.75 31780 774.69 31781 890.54 31785 697.74 31786 955.59 31800 460.78 31805 533.21 31820 281.09 203.25 31825 388.14 297.70 31830 298.75 219.57

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

31899 264.56 Y32035 470.98 32036 494.89 32096 523.93 32097 524.38 32098 496.99 32100 529.36 32110 959.59 32120 570.32 32124 605.40 32140 585.13 32141 996.71 32150 655.87 32151 656.55 32160 519.85 32200 742.10 32215 520.98 32220 1,038.80 32225 649.99 32310 596.12 32320 1,044.46 32400 103.20 53.97 32405 106.81 56.36 32440 1,024.09 32442 1,795.97 32445 2,282.13 32480 967.28 32482 1,036.76 32484 937.64 32486 1,541.00 32488 1,541.20 32501 159.33 32503 1,174.82 32504 1,338.90 32505 608.80 32506 102.30 32507 102.30 32540 1,133.85 32550 508.08 129.92 32551 103.20 32552 119.50 99.01 32553 341.74 112.51 32554 176.03 56.36 32555 203.00 70.07 32556 421.10 77.47 32557 397.19 95.75 32560 167.02 48.96 32561 60.20 42.43 32562 54.32 38.08

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

32601 202.10 32604 318.23 32606 302.81 32607 201.88 32608 248.04 32609 168.15 32650 434.76 32651 715.84 32652 1,086.33 32653 694.12 32654 759.52 32655 624.41 32656 523.93 32658 466.22 32659 477.76 32661 521.21 32662 582.77 32663 915.00 32664 553.57 32665 716.89 32666 567.61 32667 102.52 32668 102.52 32669 878.79 32670 1,049.44 32671 1,161.92 32672 895.32 32673 795.96 32674 141.00 32800 612.46 32810 593.18 32815 1,831.14 32820 868.84 32851 1,950.32 32852 1,946.26 32853 2,332.07 32854 2,543.86 32900 928.81 32905 872.68 32906 1,078.63 32940 727.33 32960 81.81 57.94 32994 3,871.07 314.85 Y32997 225.28 32998 1,769.83 282.21 32999 576.10 Y33016 154.81 33017 160.46 33018 182.84

Practitioner Fee Schedule 2020 54 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

33019 148.49 33020 540.67 33025 503.78 33030 1,204.05 33031 1,480.46 33050 650.14 33120 1,373.30 33130 894.86 33140 935.31 33141 86.45 33202 504.24 33203 474.06 33206 298.29 33207 315.03 33208 342.42 33210 107.27 33211 110.90 33212 210.93 33213 220.21 33214 314.36 33215 203.91 33216 244.20 33217 240.58 33218 253.48 33220 230.63 33221 237.41 33222 222.70 33223 268.87 33224 339.02 33225 308.92 33226 330.82 33227 222.24 33228 232.66 33229 246.01 33230 250.99 33231 263.89 33233 151.18 33234 318.88 33235 418.69 33236 486.82 33237 547.46 33238 614.68 33240 239.67 33241 140.32 33243 896.90 33244 568.28 33249 602.46 33250 873.27 33251 1,058.52

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

33254 877.02 33255 975.69 33256 1,269.19 33257 380.21 33258 420.01 33259 551.76 33261 1,055.77 33262 245.10 33263 254.83 33264 266.38 33265 889.43 33266 1,207.35 33270 371.84 33271 303.35 33272 227.90 33273 229.17 33274 319.56 33275 345.70 33285 3,235.44 55.93 33286 86.23 55.06 33300 1,608.22 33305 2,692.28 33310 764.73 33315 1,254.03 33320 689.14 33321 707.44 33322 860.70 33330 932.66 33335 1,225.29 33361 813.47 33362 867.02 33363 898.94 33364 928.15 33365 1,021.82 33366 1,094.98 33367 358.36 33368 430.34 33369 568.01 33390 1,265.34 33391 1,503.66 33404 1,039.50 33405 1,488.27 33406 1,888.85 33410 1,667.74 33411 2,204.34 33412 2,070.13 33413 2,118.79 33414 1,408.60 33415 1,331.43

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

33416 1,324.87 33417 1,091.53 33420 848.25 33422 1,090.17 33425 1,791.53 33426 1,561.60 33427 1,601.65 33430 1,836.57 33440 2,245.90 33460 1,577.21 33463 2,024.87 33464 1,600.52 33465 1,808.06 33468 1,607.76 33470 804.34 33471 930.08 33474 1,427.39 33475 1,529.01 33476 996.25 33477 892.15 33478 1,029.52 33496 1,090.63 33500 1,022.96 33501 730.55 33502 837.54 33503 778.14 33504 872.67 33505 1,291.58 33506 1,346.82 33507 1,129.10 33508 10.86 33510 1,268.29 33511 1,392.08 33512 1,585.58 33513 1,627.45 33514 1,686.93 33516 1,620.10 33517 123.12 33518 270.45 33519 357.58 33521 429.33 33522 481.15 33523 493.36 33530 345.36 33533 1,226.42 33534 1,441.19 33535 1,607.31 33536 1,700.66 33542 1,723.41

Practitioner Fee Schedule 2020 57 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

33545 2,045.35 33548 1,941.81 33572 151.18 33600 1,066.35 33602 1,069.35 33606 1,164.41 33608 1,179.12 33610 1,162.37 33611 1,278.92 33612 1,312.87 33615 1,292.93 33617 1,417.88 33619 1,794.25 33620 1,081.12 33621 609.02 33622 2,254.81 33641 1,074.11 33645 1,134.53 33647 1,190.89 33660 1,151.28 33665 1,254.26 33670 1,294.09 33675 1,292.28 33676 1,380.56 33677 1,377.85 33681 1,205.60 33684 1,237.96 33688 1,231.63 33690 785.10 33692 1,283.00 33694 1,278.92 33697 1,347.27 33702 920.93 33710 1,344.33 33720 1,013.23 33722 966.03 33724 1,008.02 33726 1,332.11 33730 1,314.00 33732 1,079.31 33735 839.50 33736 920.44 33737 792.91 33750 827.19 33755 861.59 33762 793.51 33764 861.59 33766 808.48 33767 931.75

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

33768 273.39 33770 1,305.57 33771 1,429.43 33774 1,178.21 33775 1,210.12 33776 1,283.45 33777 1,174.21 33778 1,540.32 33779 1,525.61 33780 1,553.22 33781 1,517.69 33782 1,896.42 33783 2,048.86 33786 1,493.70 33788 1,004.63 33800 646.14 33802 709.28 33803 752.84 33813 811.58 33814 997.16 33820 633.46 33822 667.86 33824 757.13 33840 810.67 33845 872.68 33851 791.90 33852 915.91 33853 1,200.39 33858 2,227.07 33859 1,598.77 33863 2,068.77 33864 2,113.59 33866 615.05 33871 2,141.19 33875 1,799.46 33877 2,379.74 33880 1,178.21 33881 1,011.42 33883 732.14 33884 260.27 33886 628.03 33889 519.40 33891 582.37 33910 1,743.70 33915 899.66 33916 1,766.19 33917 953.25 33920 1,187.04 33922 909.57

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

33924 187.62 33925 1,125.71 33926 1,585.13 33935 2,461.10 33945 3,193.80 33946 202.55 33947 225.19 33948 156.84 33949 152.31 33951 278.60 33952 281.09 33953 310.51 33954 312.77 33955 544.75 33956 548.37 33957 121.31 33958 121.31 33959 153.67 33962 149.27 33963 307.11 33964 295.64 33965 121.31 33966 155.48 33967 169.96 33968 22.18 33969 179.02 33970 232.43 33971 461.01 33973 302.71 33974 581.64 33975 857.29 33976 1,042.42 33977 738.25 33978 872.68 33979 1,278.70 33981 546.33 33982 465.33 33983 663.30 33984 186.71 33985 337.21 33986 343.78 33987 132.34 33988 510.57 33989 312.83 33990 278.82 33991 371.05 33992 130.81 33993 114.06 33999 1,192.72 Y

Practitioner Fee Schedule 2020 60 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

34001 583.17 34051 617.83 34101 393.34 34111 395.38 34151 914.78 34201 674.88 34203 625.09 34401 955.06 34421 487.94 34451 943.97 34471 708.21 34490 418.91 34501 542.98 34502 1,013.00 34510 722.14 34520 630.37 34530 561.51 34701 818.37 34702 1,286.95 34703 902.56 34704 1,624.44 34705 1,007.79 34706 1,519.50 34707 763.82 34708 1,219.18 34709 213.19 34710 527.55 34711 210.63 34712 434.53 34713 82.15 34714 178.11 34715 210.40 34716 244.42 34717 292.45 34718 815.43 34808 131.49 34812 145.04 34813 156.16 34820 230.39 34830 1,163.01 34831 1,261.73 34832 1,147.03 34833 298.59 34834 130.01 35001 737.80 35002 745.43 35005 691.10 35011 659.49 35013 829.68

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

35021 823.03 35022 943.75 35045 643.65 35081 1,139.06 35082 1,436.89 35091 1,177.31 35092 1,725.35 35102 1,236.60 35103 1,471.97 35111 871.34 35112 1,103.31 35121 1,039.71 35122 1,342.39 35131 905.95 35132 1,074.78 35141 725.12 35142 874.72 35151 814.07 35152 918.63 35180 547.91 35182 1,172.10 35184 628.86 35188 548.50 35189 921.72 35190 501.07 35201 618.75 35206 513.29 35207 492.47 35211 910.70 35216 1,359.95 35221 965.02 35226 547.01 35231 823.57 35236 660.40 35241 851.35 35246 1,024.99 35251 1,147.66 35256 673.98 35261 643.42 35266 568.51 35271 904.37 35276 865.59 35281 1,070.71 35286 614.68 35301 744.59 35302 737.80 35303 814.75 35304 838.96 35305 805.92

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

35306 285.41 35311 923.30 35321 587.07 35331 955.74 35341 904.82 35351 844.39 35355 678.73 35361 921.92 35363 1,037.33 35371 537.51 35372 643.88 35390 99.11 35400 97.77 35500 210.25 35501 910.69 35506 837.60 35508 852.40 35509 856.92 35510 745.45 35511 736.67 35512 731.27 35515 805.92 35516 791.08 35518 753.19 35521 825.40 35522 800.71 35523 843.04 35525 747.08 35526 1,038.11 35531 1,281.87 35533 912.26 35535 1,130.02 35536 1,136.76 35537 1,262.05 35538 1,412.71 35539 1,443.00 35540 1,608.90 35556 921.79 35558 809.09 35560 1,120.95 35563 812.61 35565 861.14 35566 1,099.91 35570 996.59 35571 872.46 35572 227.22 35583 950.54 35585 1,101.94 35587 897.35

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

35600 168.38 35601 920.21 35606 771.52 35612 685.74 35616 694.82 35621 721.73 35623 863.18 35626 1,043.78 35631 1,218.50 35632 975.69 35633 1,304.95 35634 954.81 35636 965.64 35637 1,087.83 35638 1,147.43 35642 616.50 35645 641.61 35646 1,129.33 35647 1,018.21 35650 671.49 35654 901.43 35656 710.87 35661 713.13 35663 812.56 35665 772.42 35666 837.83 35671 738.93 35681 52.87 35682 232.88 35683 246.77 35685 130.81 35686 105.92 35691 573.32 35693 523.12 35694 649.08 35695 621.37 35697 97.09 35700 100.49 35701 337.91 35702 268.95 35703 273.02 35800 471.19 35820 1,318.98 35840 654.20 35860 419.24 35870 783.07 35875 391.53 35876 622.83 35879 608.80

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

35881 671.71 35883 790.76 35884 815.20 35901 309.15 35903 371.39 35905 1,118.96 35907 1,252.44 36000 17.88 5.66 36002 100.26 66.15 36005 53.16 30.03 36010 130.47 69.42 36011 169.10 99.45 36012 192.07 109.68 36013 141.57 76.82 36014 165.30 95.97 36015 182.51 108.81 36100 156.17 96.40 36140 110.20 56.58 36160 110.10 78.56 36200 163.75 88.35 36215 695.25 133.40 36216 737.12 171.91 36217 1,220.76 207.17 36218 141.25 32.64 36221 679.86 126.87 36222 804.56 178.23 36223 1,032.69 199.77 36224 1,333.69 226.97 36225 990.14 199.12 36226 1,260.82 223.71 36227 160.91 74.21 36228 852.54 151.89 36245 864.31 149.94 36246 555.61 159.95 36247 978.37 190.41 36248 88.72 30.68 36251 899.84 163.43 36252 968.87 226.97 36253 1,424.90 225.23 36254 1,394.80 261.57 36260 430.41 36261 238.50 36262 191.84 36299 128.04 Y36420 31.46 36425 26.03 36430 22.41 36440 33.21 36450 90.83

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

36455 83.29 36460 228.58 Y36465 972.04 75.73 36466 1,078.41 97.06 36468 28.64 Y36470 70.16 23.94 Y36471 126.51 48.31 Y36475 881.06 176.05 36476 199.39 85.30 36478 684.84 175.40 36479 172.55 86.17 36481 371.44 208.04 36500 119.72 36510 53.41 33.73 36511 67.68 36512 66.29 36513 63.26 36514 89.93 59.84 36516 53.44 50.77 36522 95.28 61.37 36555 121.08 53.10 36556 123.97 53.53 36557 304.94 201.29 36558 296.13 164.30 36560 365.39 241.12 36561 352.76 211.96 36563 369.20 230.67 36565 346.26 211.30 36566 336.67 227.41 36568 67.10 36569 68.65 36570 252.96 209.13 36571 318.70 196.51 36572 279.28 57.01 36573 257.55 53.32 36575 38.28 21.98 36576 219.98 116.42 36578 198.28 128.17 36580 73.83 41.56 36581 205.85 115.34 36582 300.71 182.80 36583 276.17 206.95 36584 76.54 37.65 36585 213.58 181.83 36589 107.73 86.39 36590 144.84 119.91 36593 20.14 36595 198.20 114.68 36596 42.76 27.42

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

36597 66.57 38.08 36598 77.85 23.28 36600 19.46 9.79 36620 28.97 36625 69.25 36640 74.91 36660 44.58 36680 39.38 36800 80.34 36810 138.28 36815 88.63 36818 455.13 36819 481.38 36820 479.79 36821 437.02 36825 523.02 36830 439.28 36831 363.86 36832 497.22 36833 533.21 36835 266.48 36838 753.64 36860 123.88 80.53 36861 94.14 36901 433.71 106.63 36902 836.92 151.02 36903 3,311.71 200.20 36904 1,222.54 233.72 36905 1,555.94 280.29 36906 4,111.30 323.59 36907 444.94 92.49 36908 1,401.53 131.00 36909 1,285.94 126.87 37140 1,142.81 37145 1,035.66 37160 988.20 37180 1,105.98 37181 1,315.59 37182 537.28 37183 453.18 235.24 37184 476.31 275.06 37185 176.37 103.80 37186 268.96 154.29 37187 441.13 248.30 37188 316.01 176.27 37191 1,540.09 141.01 37192 866.57 218.05 37193 1,020.47 220.44 37195 167.54

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

37197 1,033.37 190.19 37200 142.58 37211 253.93 37212 222.02 37213 152.99 37214 80.80 37215 657.23 37216 639.80 37217 704.09 37218 521.98 37220 1,858.07 253.74 37221 2,221.46 313.15 37222 559.74 117.95 37223 1,290.05 134.70 37224 2,169.77 281.81 37225 2,340.05 381.69 37226 2,156.93 329.47 37227 1,925.69 459.16 37228 2,301.41 343.61 37229 2,722.73 445.02 37230 2,098.35 442.41 37231 2,607.87 479.62 37232 657.91 126.87 37233 807.96 206.30 37234 1,073.71 180.62 37235 2,262.73 272.56 37236 2,169.94 281.37 37237 1,000.88 134.49 37238 1,548.31 193.24 37239 1,017.59 96.40 37241 1,713.24 276.37 37242 2,880.77 301.39 37243 3,635.96 354.71 37244 2,551.31 419.99 37246 1,320.57 220.22 37247 488.86 108.15 37248 971.58 188.02 37249 354.64 92.27 37252 753.41 57.23 37253 121.76 45.92 37500 385.63 37501 385.63 Y37565 473.68 37600 480.25 37605 485.00 37606 341.51 37607 245.78 37609 202.33 129.26 37615 346.72

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

37616 724.67 37617 874.04 37618 254.16 37619 1,140.19 37650 300.78 37660 867.48 37700 160.23 37718 285.03 37722 309.83 37735 384.25 37760 409.64 37761 355.55 37765 368.30 256.76 37766 446.94 313.62 37780 153.22 37785 230.84 162.34 37799 1,954.59 Y38100 760.20 38101 768.58 38102 172.68 38115 841.45 38120 694.12 38129 647.41 Y38200 82.48 38206 55.00 38220 107.95 43.74 38221 101.16 43.52 38222 111.80 48.75 38232 118.25 38240 115.64 38241 104.83 38242 80.00 38300 207.47 128.61 38305 319.79 38308 298.06 38380 370.26 38381 525.74 38382 394.30 38500 219.08 160.60 38505 80.34 43.96 38510 341.74 263.09 38520 304.17 38525 287.42 38530 369.80 38531 283.35 38542 336.54 38550 337.44 38555 668.77 38562 461.92

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

38564 462.37 38570 334.72 38571 433.85 38572 595.67 38573 793.03 38589 306.10 Y38700 522.34 38720 872.00 38724 940.35 38740 459.20 38745 578.24 38746 140.77 38747 176.08 38760 549.73 38765 853.67 38770 525.51 38780 677.14 38790 53.41 38792 30.83 21.11 38794 192.82 38900 91.21 38999 572.28 Y39000 324.54 39010 514.87 39200 570.55 39220 742.32 39401 202.10 39402 264.34 39499 436.45 Y39501 560.82 39503 3,919.83 39540 572.81 39541 618.53 39545 585.03 39560 523.93 39561 805.05 39599 1,083.71 Y40490 80.34 44.18 40500 306.45 231.36 40510 316.17 218.70 40520 302.42 229.18 40525 359.39 40527 401.26 40530 353.28 250.04 40650 300.32 191.28 40652 329.07 222.40 40654 374.10 264.62 40700 661.53 40701 758.11

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

40702 635.51 40720 675.11 40761 712.00 40799 312.28 Y40800 134.89 77.47 40801 194.41 134.05 40804 127.42 73.77 40805 209.61 148.69 40808 110.65 60.62 40810 136.02 77.04 40812 185.35 118.60 40814 246.23 183.01 40816 259.13 191.72 40818 237.18 169.30 40819 186.47 134.52 40820 167.93 104.02 40830 180.60 105.32 40831 230.39 144.50 40840 541.58 392.14 40842 574.18 426.09 40843 672.90 544.91 40844 971.81 744.24 40845 952.80 758.17 40899 178.19 Y41000 102.75 68.11 41005 141.22 81.70 41006 222.02 149.07 41007 217.94 154.05 41008 248.72 162.12 41009 267.28 178.23 41010 135.11 67.24 41015 262.53 194.11 41016 294.44 215.87 41017 293.31 214.57 41018 329.97 249.39 41019 315.25 41100 113.16 65.72 41105 114.29 67.68 41108 100.26 54.84 41110 142.35 81.17 41112 216.59 152.98 41113 235.37 168.87 41114 401.49 41115 164.08 90.53 41116 215.00 134.49 41120 687.78 41130 850.50 41135 1,404.76 41140 1,411.77

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

41145 1,786.56 41150 1,421.73 41153 1,548.47 41155 1,950.41 41250 180.60 96.40 41251 150.34 119.12 41252 207.76 130.79 41510 273.14 41512 414.66 41520 229.94 154.07 41599 228.66 Y41800 189.65 95.10 41805 177.33 117.95 41806 243.77 171.04 41820 145.08 41821 73.84 41822 175.68 117.10 41823 267.76 211.42 41825 140.09 74.64 41826 203.36 136.76 41827 288.78 186.93 41828 183.16 137.24 41830 287.60 193.89 41850 15.60 41872 273.14 185.84 41874 253.48 156.90 41899 190.53 Y42000 101.62 64.85 42100 95.51 67.02 42104 140.32 84.87 42106 172.45 107.78 42107 300.32 211.74 42120 650.44 42140 176.91 97.06 42145 448.11 42160 151.86 90.31 42180 161.86 116.01 42182 211.38 159.73 42200 616.94 42205 604.50 42210 717.43 42215 467.57 42220 339.45 42225 599.83 42226 572.36 42227 504.38 42235 468.48 42260 538.64 413.03 42280 114.97 67.90

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

42281 147.33 100.97 42299 237.34 Y42300 138.05 95.53 42305 281.82 42310 112.82 82.91 42320 165.44 109.46 42330 150.05 102.06 42335 261.40 160.38 42340 316.05 210.00 42400 66.76 33.51 42405 194.86 141.01 42408 307.41 218.05 42409 235.37 139.71 42410 405.34 42415 684.61 42420 769.26 42425 542.48 42426 877.44 42440 267.06 42450 298.51 224.14 42500 282.45 211.30 42505 362.34 281.16 42507 322.73 42509 483.12 42510 397.19 42550 55.64 39.82 42600 296.25 229.54 42650 50.92 35.91 42660 76.85 54.84 42665 209.61 129.92 42699 199.47 Y42700 123.57 84.00 42720 293.08 242.64 42725 521.89 42800 101.62 70.07 42804 127.87 71.16 42806 143.26 82.91 42808 147.79 101.41 42809 130.36 77.47 42810 248.95 176.27 42815 353.51 42820 186.94 42821 195.09 42825 170.19 42826 162.95 42830 134.66 42831 145.75 42835 124.70 42836 155.93

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

42842 651.34 42844 871.54 42845 1,446.17 42860 122.21 42870 379.76 42890 922.93 42892 1,213.07 42894 1,533.08 42900 201.08 42950 517.36 42953 619.21 42955 455.54 42960 107.05 42961 269.77 42962 332.69 42970 269.07 42971 283.28 42972 328.39 42999 219.19 Y43020 342.71 43030 336.99 43045 844.91 43100 372.03 43101 684.30 43107 1,919.47 43108 2,719.66 43112 1,900.76 43113 2,775.63 43116 3,060.98 43117 1,744.99 43118 2,385.85 43121 1,849.05 43122 1,644.53 43123 2,876.60 43124 2,462.80 43130 511.71 43135 873.07 43180 354.87 43191 100.26 43192 103.43 43193 109.76 43194 122.95 43195 119.50 43196 127.42 43197 124.93 52.23 43198 126.73 64.12 43200 103.31 54.84 43201 108.45 64.85 43202 115.53 64.63

Practitioner Fee Schedule 2020 74 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

43204 108.29 43205 92.11 43210 283.12 43211 139.05 43212 124.02 43213 791.89 162.77 43214 125.83 43215 132.94 88.79 43216 134.12 87.05 43217 143.54 100.54 43220 109.57 73.99 43226 110.36 81.61 43227 166.21 103.37 43229 448.56 124.04 43231 133.77 102.36 43232 183.07 128.12 43233 149.82 43235 150.37 77.04 43236 182.88 86.83 43237 127.64 43238 151.63 43239 240.58 86.83 43240 256.42 43241 92.56 43242 171.55 43243 155.03 43244 160.23 43245 161.77 110.55 43246 131.26 43247 172.44 111.20 43248 161.77 104.02 43249 149.36 96.19 43250 162.93 107.50 43251 187.70 123.17 43253 172.00 43254 176.53 43255 242.21 126.00 43257 155.68 43259 147.79 43260 210.70 43261 220.89 43262 233.11 43263 233.11 43264 237.41 43265 283.12 43266 142.35 43270 460.56 141.01 43273 78.53 43274 302.36

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

43275 245.78 43276 314.58 43277 247.14 43278 283.12 43279 849.82 43280 712.45 43281 1,018.88 43282 1,145.62 43283 104.11 43286 2,170.65 43287 2,364.12 43288 2,585.57 43289 1,368.90 Y43300 400.36 43305 707.92 43310 971.36 43312 1,044.91 43313 1,791.08 43314 1,930.27 43320 922.25 43325 896.67 43327 540.90 43328 737.80 43330 881.74 43331 869.83 43332 762.92 43333 833.30 43334 819.72 43335 855.53 43336 936.84 43337 1,015.04 43338 76.27 43340 881.30 43341 874.46 43351 776.57 43352 697.51 43360 1,475.82 43361 1,628.08 43400 912.07 43405 849.24 43410 664.70 43415 1,686.98 43420 600.30 43425 936.62 43450 110.22 49.40 43453 100.63 53.75 43500 516.68 43501 888.98 43502 941.30

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

43510 625.54 43520 451.05 43605 553.35 43610 646.82 43611 806.37 43620 1,310.16 43621 1,498.68 43622 1,528.33 43631 957.33 43632 1,343.20 43633 1,270.32 43634 1,355.76 43635 74.46 43640 777.40 43641 699.17 43644 1,146.75 43645 1,220.99 43647 494.03 43651 431.81 43652 490.68 43653 378.40 43659 693.78 Y43752 26.71 43753 14.71 43754 65.36 22.41 43755 89.75 36.99 43756 131.53 33.01 43757 220.89 47.87 43761 79.21 65.50 43762 145.98 23.94 43763 218.17 53.10 43770 742.55 43771 843.71 Y43772 628.03 Y43773 740.14 Y43774 633.92 Y43775 737.12 43800 615.59 43810 672.16 43820 886.71 43825 751.55 43830 462.59 43831 396.51 43832 686.42 43840 897.80 43842 605.35 43843 819.14 43846 1,072.52 43847 1,192.70

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

43848 1,278.47 43850 945.55 43855 980.61 43860 1,079.99 43865 992.04 43870 468.03 43880 1,050.34 43886 215.27 43887 193.60 43888 270.61 Y43999 823.89 Y44005 720.82 44010 563.31 44015 93.92 44020 642.29 44021 642.29 44025 647.50 44050 616.72 44055 982.90 44100 66.18 44110 555.38 44111 643.88 44120 806.37 44121 159.33 44125 776.95 44126 1,631.30 44127 1,886.36 44128 160.91 44130 866.35 44135 1,769.16 44139 79.66 44140 884.22 44141 1,200.39 44143 1,095.61 44144 1,163.95 44145 1,087.68 44146 1,386.65 44147 1,276.43 44150 1,225.74 44151 1,424.67 44155 1,359.49 44156 1,485.10 44157 1,446.63 44158 1,482.84 44160 817.91 44180 606.31 44186 429.55 44187 719.92 44188 802.07

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

44202 912.97 44203 158.42 44204 1,011.64 44205 878.57 44206 1,149.47 44207 1,192.47 44208 1,298.61 44210 1,161.92 44211 1,385.52 44212 1,335.73 44213 122.89 44227 1,095.38 44238 786.14 Y44300 555.38 44310 684.84 44312 389.72 44314 660.40 44316 933.79 44320 790.08 44322 661.75 44340 408.73 44345 689.82 44346 777.63 44360 93.70 44361 103.43 44363 125.38 44364 133.53 44365 115.21 44366 156.84 44369 160.69 44370 178.57 44372 156.84 44373 125.61 44376 185.58 44377 195.31 44378 251.21 44379 267.06 44380 58.54 35.04 44381 48.38 45.96 44382 70.38 45.70 44384 48.06 44385 129.23 45.26 44386 127.80 55.93 44388 196.67 98.36 44389 190.51 108.15 44390 191.60 138.70 44391 217.23 144.71 44392 204.17 125.78 44394 238.95 141.88

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

44401 168.74 152.33 44402 178.74 44403 207.73 44404 217.23 108.15 44405 215.86 120.16 44406 176.62 44407 188.38 44408 176.62 44500 12.67 44602 929.94 44603 1,067.09 44604 696.61 44605 858.42 44615 709.73 44620 569.42 44625 664.92 44626 1,053.06 44640 920.89 44650 951.89 44660 876.30 44661 1,020.02 44680 685.47 44700 657.68 44701 112.48 44799 134.98 Y44800 506.27 44820 549.95 44850 490.66 44899 528.11 Y44900 516.68 44950 423.89 44955 55.00 44960 578.47 44970 395.83 44979 393.97 Y45000 279.50 45005 189.65 102.06 45020 375.24 45100 195.77 45108 243.74 45110 1,202.43 45111 712.90 45112 1,220.99 45113 1,226.87 45114 1,055.25 45116 919.16 45119 1,261.72 45120 1,053.51 45121 1,151.05

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

45123 729.65 45126 1,814.17 45130 710.19 45135 798.62 45136 1,172.78 45150 255.64 45160 675.33 45171 396.06 45172 532.07 45190 457.62 45300 79.66 30.03 45303 69.87 53.32 45305 74.61 45.70 45307 79.37 61.15 45308 60.94 53.10 45309 115.39 59.99 45315 73.94 71.08 45317 130.81 69.85 45320 119.29 70.30 45321 68.12 45327 75.28 45330 112.71 35.04 45331 77.69 44.83 45332 112.49 66.15 45333 112.12 58.97 45334 141.00 73.55 45335 94.49 41.56 45337 75.59 45338 145.75 75.51 45340 117.46 48.75 45341 80.80 45342 110.67 45346 109.51 100.54 45347 100.49 45349 92.50 45350 92.51 63.54 45378 213.19 116.42 45379 274.98 150.37 45380 274.52 126.00 45381 272.49 126.00 45382 453.09 162.77 45384 306.21 143.62 45385 286.75 159.95 45386 273.19 132.96 45388 63.98 60.78 45389 189.43 45390 217.04 45391 168.15 45392 198.71

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

45393 165.44 45395 1,287.30 45397 1,400.00 45398 316.39 148.63 45399 670.23 Y45400 743.91 45402 993.08 45499 817.69 Y45500 352.79 45505 390.17 45520 100.71 25.03 45540 700.78 45541 618.98 45550 959.14 45560 453.09 45562 740.51 45563 1,093.12 45800 809.22 45805 852.39 45820 704.96 45825 937.64 45900 137.56 45905 109.99 45910 125.38 45915 224.05 144.71 45990 69.48 45999 624.79 Y46020 183.32 148.41 46030 93.47 56.36 46040 356.00 264.62 46045 286.52 46050 141.90 62.02 46060 314.81 46070 129.20 46080 175.17 100.10 46083 124.93 68.11 46200 299.87 207.60 46220 143.29 74.64 46221 177.43 120.12 46230 190.79 108.81 46250 308.25 199.99 46255 336.76 224.14 46257 279.50 46258 310.51 46260 313.90 46261 343.10 46262 363.92 46270 340.84 248.73 46275 359.17 261.79

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

46280 310.28 46285 357.13 261.57 46288 360.75 46320 127.87 70.07 46500 134.99 87.24 46505 193.50 152.33 46600 66.54 25.46 46601 47.72 45.33 46604 63.51 41.13 46606 71.54 47.22 46607 65.04 61.79 46608 70.95 53.10 46610 58.06 50.92 46611 128.67 50.27 46612 175.11 60.06 46614 93.93 40.26 46615 96.15 57.45 46700 429.33 46705 338.53 46706 116.33 46707 301.06 46710 648.02 46712 1,308.10 46715 361.88 46716 779.28 46730 1,300.88 46735 1,298.12 46740 1,406.73 46742 1,645.33 46744 2,157.33 46746 2,238.37 46748 2,442.58 46750 492.24 46751 366.44 46753 406.01 46754 194.59 147.11 46760 644.41 46761 599.03 46900 153.22 85.30 46910 167.25 83.56 46916 158.42 88.35 46917 104.67 80.08 46922 189.88 85.52 46924 348.08 113.16 92.30 255.78 46930 138.51 94.23 46940 138.88 94.29 46942 130.38 85.02 46945 217.94 143.97 46946 230.93 143.09

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

46947 252.34 46948 287.25 46999 200.59 Y47000 200.29 55.71 47001 68.80 47010 797.55 47011 12.70 47015 745.91 47100 557.65 47120 1,539.19 47122 2,265.44 47125 2,032.34 47130 2,182.84 47135 3,554.33 47300 745.04 47350 902.56 47360 1,240.22 47361 1,999.07 47362 958.00 47370 824.02 47371 730.48 47379 777.25 Y47380 953.03 47381 886.55 47382 875.83 467.43 47383 273.55 259.87 47399 1,040.27 Y47400 1,250.62 47420 884.90 47425 795.87 47460 738.95 47480 579.83 47490 217.04 47531 244.56 44.39 47532 546.33 134.05 47533 810.22 168.00 47534 920.89 234.37 47535 637.99 123.60 47536 449.24 83.56 47537 278.76 60.71 47538 2,758.14 149.50 47539 3,041.04 268.10 47540 3,102.60 278.55 47541 712.04 213.97 47542 334.50 86.17 47543 478.11 91.62 47544 592.39 99.01 47550 108.86 47552 199.16

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

47553 197.82 47554 283.02 47555 217.60 47556 246.51 47562 434.30 47563 472.78 47564 735.08 47570 472.99 47579 560.28 Y47600 705.43 47605 742.32 47610 828.78 47612 810.46 47620 879.24 47700 697.29 47701 1,147.89 47711 1,028.39 47712 1,320.57 47715 879.47 47720 762.92 47721 789.17 47740 867.93 47741 859.29 47760 1,486.68 47765 1,938.53 47780 1,632.89 47785 2,146.40 47800 1,040.84 47801 669.54 47802 888.83 47900 910.04 47999 698.92 Y48000 1,245.43 48001 1,525.84 48020 686.17 48100 583.22 48102 348.53 150.59 48105 1,873.46 48120 728.97 48140 1,031.56 48145 1,079.31 48146 1,159.93 48148 726.94 48150 2,057.01 48152 1,844.28 48153 2,048.86 48154 1,796.05 48155 1,164.24 48400 64.41

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

48500 693.32 48510 724.44 48520 721.28 48540 802.64 48545 888.98 48547 1,144.53 48548 1,062.63 48554 1,684.94 48556 746.24 48999 1,026.24 Y49000 506.50 49002 688.91 49010 608.57 49013 287.25 49014 237.53 49020 1,049.21 49040 659.94 49060 724.67 49062 506.50 49082 131.72 46.57 49083 193.73 67.68 49084 71.52 49180 93.74 52.88 49185 726.46 75.51 49203 784.87 49204 1,000.55 49205 1,146.08 49215 1,459.30 49220 552.84 49250 386.78 49255 517.36 49320 215.91 49321 226.77 49322 245.56 49323 421.86 49324 256.64 49325 273.84 49326 124.93 49327 81.03 49329 230.82 Y49400 93.81 58.32 49402 564.21 49405 568.96 124.26 49406 568.74 124.04 49407 467.35 131.66 49411 315.03 115.99 49412 52.94 49418 771.97 127.96 49419 283.35

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

49421 150.50 49422 197.38 49423 80.72 44.61 49424 42.11 24.16 49425 469.38 49426 414.78 49427 26.51 49428 252.10 49429 302.36 49435 79.21 49436 110.29 49440 603.14 129.04 49441 683.25 152.11 49442 571.00 130.57 49446 579.60 93.57 49450 424.57 41.56 49451 460.10 56.80 49452 563.31 87.48 49460 470.74 30.68 49465 98.22 19.37 49491 525.06 49492 632.11 49495 269.09 49496 381.84 49500 271.36 49501 399.00 49505 343.32 49507 386.33 49520 416.43 49521 472.78 49525 378.18 49540 444.49 49550 379.76 49553 415.97 49555 396.96 49557 464.10 49560 486.58 49561 613.10 49565 506.50 49566 618.75 49568 176.53 49570 274.30 49572 340.84 49580 219.30 49582 317.98 49585 293.31 49587 313.68 49590 377.50 49600 483.64

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

49605 3,272.79 49606 749.11 49610 455.58 49611 363.43 49650 282.90 49651 368.45 49652 490.88 49653 612.87 49654 557.42 49655 681.67 49656 604.72 49657 871.78 49659 409.73 Y49900 537.51 49904 918.40 Y49905 233.11 Y49999 609.50 Y50010 480.70 50020 661.75 50040 580.39 50045 529.99 50060 647.37 50065 686.76 50070 673.56 50075 910.55 50080 567.83 50081 835.11 50100 576.42 50120 539.64 50125 598.53 50130 675.11 50135 637.53 50200 154.86 80.52 50205 496.54 50220 685.97 50225 786.00 50230 838.28 50234 851.41 50236 957.33 50240 866.35 50250 693.26 50280 583.79 50290 511.08 50340 576.99 50360 1,591.92 50365 1,891.11 50370 793.47 50380 1,289.67 50382 301.88 161.69

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

50384 249.40 144.71 50385 697.06 137.53 50386 477.76 101.84 50387 109.03 52.88 50389 60.04 33.73 50390 62.69 50391 69.92 62.92 50396 75.10 50400 760.66 50405 912.29 50430 365.92 97.06 50431 118.11 40.91 50432 572.58 129.70 50433 740.74 161.03 50434 589.79 120.99 50435 358.92 62.67 50436 98.45 50437 164.99 50500 812.71 50520 589.07 50525 852.79 50526 824.63 50540 651.90 50541 599.74 50542 761.79 50543 973.17 50544 813.84 50545 874.95 50546 787.13 50548 879.92 50549 812.93 Y50551 234.47 184.54 50553 250.53 196.72 50555 234.56 220.63 50557 262.57 217.40 50561 309.15 247.21 50562 363.53 50570 278.69 50572 301.92 50574 321.22 50575 467.12 50576 320.05 50580 379.57 50590 479.12 357.32 50592 322.52 215.87 50593 2,790.73 289.64 50600 533.53 50605 653.38 50606 318.80 98.69

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

50610 537.27 50620 565.44 50630 507.74 50650 648.64 50660 747.30 50684 55.09 31.55 50686 69.05 56.91 50688 50.70 50690 69.93 43.96 50693 671.49 128.83 50694 745.72 169.30 50695 903.46 216.96 50700 604.72 50705 1,028.50 126.12 50706 558.17 115.34 50715 786.68 50722 625.90 50725 688.93 50727 332.46 50728 397.84 50740 806.82 50750 655.25 50760 739.61 50770 720.78 50780 724.22 50782 702.49 50783 736.67 50785 793.25 50800 529.79 50810 761.99 50815 748.84 50820 858.88 50825 1,083.16 50830 1,164.56 50840 803.66 50845 817.69 50860 617.85 50900 533.16 50920 575.53 50930 672.39 50940 555.48 50945 553.04 50947 906.40 50948 796.39 50949 751.94 Y50951 245.33 192.15 50953 249.58 204.77 50955 242.06 227.70 50957 244.21 229.12

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

50961 252.57 198.90 50970 210.34 50972 203.64 50974 268.44 50976 264.70 50980 202.07 51020 268.44 51030 268.64 51040 188.75 51045 326.58 51050 307.79 51060 331.66 51065 353.25 51080 256.95 51100 40.70 24.37 51101 73.66 33.74 51102 153.44 91.40 51500 415.75 51520 338.76 51525 561.50 51530 503.33 51535 510.12 51550 629.62 51555 827.87 51565 850.73 51570 964.34 51575 1,136.72 51580 1,184.18 51585 1,290.52 51590 1,264.89 51595 1,430.56 51596 1,538.51 51597 1,500.04 51600 133.08 27.85 51605 24.05 51610 77.63 40.26 51700 48.43 19.59 51701 28.97 16.54 51702 39.38 16.10 51703 90.07 48.53 51705 61.33 32.64 51710 85.32 49.62 51715 193.24 126.00 Y51720 53.86 28.33 51725 136.70 49.34 87.36 51726 186.26 55.00 131.26 51727 215.66 67.23 148.43 51728 226.32 68.35 157.97 51729 241.48 82.83 158.65

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

51736 16.86 10.37 6.48 51741 23.79 14.50 9.28 51784 68.88 39.46 29.42 51785 201.56 50.39 151.17 51792 159.33 35.76 123.57 51797 85.23 21.45 63.78 51798 8.78 51800 681.67 51820 677.45 51840 441.85 51841 516.23 51845 380.21 51860 487.72 51865 587.75 51880 304.40 51900 538.64 51920 498.58 51925 671.17 51940 1,072.75 51960 905.27 51980 465.99 51990 488.62 51992 549.91 51999 519.27 Y52000 134.10 50.70 52001 269.09 179.97 52005 189.43 82.91 52007 293.14 103.58 52010 223.95 106.69 52204 248.27 88.57 52214 470.97 110.77 52224 492.02 128.17 52234 160.23 52235 188.07 52240 255.97 52250 156.16 52260 137.60 52265 133.08 102.28 52270 259.59 113.81 52275 278.93 155.81 52276 172.45 52277 210.48 52281 207.31 95.10 52282 220.43 52283 193.24 126.43 52285 209.80 122.73 52287 232.43 106.41 52290 156.40 52300 182.41

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

52301 188.98 52305 181.96 52310 186.30 94.66 52315 300.55 172.13 52317 389.49 218.48 52318 309.15 52320 160.91 52325 208.67 52327 171.78 52330 296.13 165.39 52332 175.60 97.06 52334 132.79 52341 185.35 52342 201.20 52343 210.97 52344 240.58 52345 257.32 52346 291.05 52351 197.12 52352 231.52 52353 255.97 52354 272.26 52355 305.08 52356 271.13 52400 311.87 52402 151.06 52441 757.14 132.09 52442 579.03 35.07 52450 307.57 52500 319.11 52601 476.40 52630 262.53 52640 209.25 52647 490.51 415.61 52648 1,082.25 433.92 52649 539.32 52700 288.10 53000 90.18 53010 192.14 53020 63.37 53025 44.13 53040 256.19 53060 121.76 104.45 53080 256.49 53085 377.36 53200 102.75 89.00 53210 486.79 53215 568.06 53220 285.54

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

53230 397.87 53235 413.48 53240 260.95 53250 241.66 53260 132.85 113.59 53265 138.00 117.95 53270 135.34 115.34 53275 164.87 53400 489.58 53405 496.90 53410 639.58 53415 738.70 53420 526.23 53425 585.60 53430 635.27 53431 754.09 53440 459.80 53442 446.28 53444 451.41 53445 492.69 53446 392.17 53447 460.47 53448 727.53 53450 267.06 53460 298.74 53500 489.98 53502 317.07 53505 321.66 53510 395.58 53515 452.39 53520 363.92 53600 55.00 39.82 53601 52.28 33.51 53605 42.32 53620 81.15 54.62 53621 75.78 45.05 53660 45.72 26.11 53661 45.04 25.46 53665 22.06 53850 1,119.74 349.83 53852 570.42 359.99 53855 477.30 52.01 53899 52.42 Y54000 101.62 67.90 54001 125.61 87.48 54015 199.84 54050 86.68 65.07 54055 81.25 58.10 54056 90.30 67.90

Practitioner Fee Schedule 2020 94 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

54057 89.17 59.19 54060 121.53 81.39 54065 141.90 106.63 54100 128.32 76.16 54105 175.17 133.40 54110 407.83 54111 500.89 54112 532.94 54115 296.02 266.36 54120 412.58 54125 532.53 54130 678.29 54135 858.69 54150 99.58 61.80 54160 142.35 90.74 54161 128.55 54162 167.25 125.13 54163 141.90 54164 125.38 54200 71.74 52.44 54205 334.07 54220 137.38 84.00 54230 64.34 49.62 54231 92.11 72.68 54235 57.26 45.70 54240 66.54 42.55 23.99 54300 421.40 54304 489.53 54308 467.57 54312 535.02 54316 651.12 54318 398.43 54322 511.03 54324 632.79 54326 617.17 54328 613.10 54332 661.75 54336 761.17 54340 372.07 54344 618.53 54348 661.30 54352 925.87 54360 471.19 54380 522.57 54385 568.00 54390 811.58 54406 457.34 54415 301.73 54420 460.10

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

54430 417.56 54435 253.73 54437 440.64 54438 840.50 54440 138.32 54450 44.81 36.12 54500 42.34 54505 137.15 54512 352.15 54520 212.74 54522 384.97 54530 331.10 54535 486.36 54550 321.37 54560 449.02 54600 295.80 54620 195.54 54640 285.17 54650 465.08 54670 265.92 54680 514.87 54690 428.65 54692 495.64 54700 139.86 54800 73.66 54830 242.61 54840 209.80 54860 273.17 54861 370.71 54865 205.41 55000 76.72 53.10 55040 219.98 55041 333.82 55060 248.27 55100 145.52 104.45 55110 253.25 55120 230.62 55150 321.37 55175 236.73 55180 452.64 55200 212.45 178.40 55250 230.62 142.54 55300 106.55 55500 256.87 55520 298.74 55530 229.26 55535 280.86 55540 363.47 55550 279.96

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

55559 279.96 Y55600 240.87 55605 297.40 55650 468.93 55680 197.74 55700 160.46 82.04 55705 173.59 55706 243.29 55720 276.69 55725 338.76 55801 621.96 55810 856.84 55812 914.23 55815 1,101.42 55821 497.30 55831 618.30 55840 765.18 55842 784.83 55845 891.24 55860 498.08 55862 623.34 55865 758.05 55866 943.52 55873 1,057.68 480.06 55875 502.43 55876 94.15 63.33 55899 116.62 Y55920 296.25 56405 81.85 74.64 56420 92.21 64.63 56440 118.82 56441 99.67 92.27 56442 30.78 56501 99.72 78.34 56515 164.08 129.92 56605 58.84 38.08 56606 25.12 18.71 56620 360.30 56625 421.18 56630 612.87 56631 755.18 56632 911.61 56633 791.21 56634 727.73 56637 847.67 56640 826.99 56700 128.55 56740 201.88 56800 162.27 Y

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

56805 761.11 Y56810 174.72 56820 77.63 53.75 56821 103.43 71.81 57000 125.16 57010 293.08 57020 64.09 51.14 57022 115.42 57023 207.31 57061 86.31 67.24 57065 135.49 113.16 57100 62.46 41.35 57105 103.20 85.52 57106 336.99 57107 939.90 57109 971.36 57110 591.60 57111 975.33 57112 958.55 57120 338.53 57130 133.98 105.11 57135 144.39 114.03 57150 34.32 16.97 57155 246.69 176.92 57156 138.73 93.57 57160 44.36 29.38 57170 38.32 30.63 57180 106.68 72.25 57200 207.53 57210 250.53 57220 211.72 57230 268.19 57240 395.83 57250 398.32 57260 507.63 57265 569.87 57267 166.12 57268 324.99 57270 505.75 57280 630.75 57282 343.55 57283 458.29 57284 540.45 57285 449.92 57287 468.03 57288 479.57 57289 414.98 57291 343.58 Y57292 541.58 Y

Practitioner Fee Schedule 2020 98 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

57295 322.05 57296 559.72 57300 385.87 57305 632.79 57307 687.78 57308 430.00 57310 288.99 57311 298.77 57320 358.71 57330 420.49 57335 754.47 57400 86.23 57410 69.48 57415 110.67 57420 81.70 57.01 57421 109.99 77.25 57423 607.21 57425 640.71 57426 562.85 57452 78.08 57.45 57454 106.60 84.65 57455 100.49 69.42 57456 94.37 64.20 57460 198.71 101.41 57461 222.92 117.29 57500 93.02 47.22 57505 77.73 63.11 57510 87.02 71.59 57511 110.18 88.35 57513 100.40 88.13 57520 217.04 179.10 57522 186.71 156.90 57530 235.82 57531 1,025.71 57540 505.65 57545 544.97 57550 265.61 57555 390.39 57556 332.84 57558 85.78 76.82 57700 219.08 57720 211.15 57800 45.49 30.25 58100 63.37 46.53 58110 33.04 25.90 58120 182.87 142.75 58140 609.25 58145 367.54 58146 759.98

Practitioner Fee Schedule 2020 99 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

58150 661.98 58152 822.44 58180 630.07 58200 883.32 58210 1,185.23 58240 1,896.77 58260 547.69 58262 608.12 58263 653.38 58267 636.33 58270 584.58 58275 594.00 58280 683.30 58285 771.84 58290 757.26 58291 820.40 58292 823.42 58293 805.32 58294 735.86 58300 55.22 32.42 58301 65.86 42.43 58340 90.61 35.91 58346 277.09 58353 198.61 142.32 Y58356 314.08 216.61 58520 522.57 58540 601.10 58541 476.63 58542 542.48 58543 520.37 58544 593.63 58545 590.01 58546 735.76 58548 1,221.89 58550 579.15 58552 645.46 58553 740.06 58554 862.95 58555 203.71 96.19 58558 324.40 146.67 58559 188.52 58560 207.31 58561 237.18 58562 255.97 140.80 58563 342.06 156.25 58570 520.31 58571 586.84 58572 676.01 58573 792.79

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

58575 1,242.71 58578 682.58 Y58579 251.31 Y58600 241.26 58605 218.40 58611 50.70 58615 146.32 58660 444.72 58661 426.84 58662 466.89 58670 241.93 58671 241.48 58672 482.28 58673 523.93 58679 404.01 Y58700 518.27 58720 488.17 58740 587.52 58770 552.66 58800 210.08 194.11 58805 274.07 58820 201.55 58822 465.76 58825 462.59 Y58900 280.18 58920 466.44 58925 497.45 58940 354.19 58943 762.24 58950 739.61 58951 936.05 58952 1,063.02 58953 1,303.82 58954 1,412.90 58956 886.04 58957 1,028.84 58958 1,139.06 58960 633.46 58999 113.14 Y59000 78.53 50.70 59001 117.23 59012 132.85 59015 102.07 83.13 59020 45.26 24.22 21.05 59025 TH 31.01 19.01 11.99 59025 31.01 19.01 11.99 59030 68.68 59074 252.80 195.63 59076 315.82

Practitioner Fee Schedule 2020 101 / 137

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

59100 558.10 59120 531.62 59121 532.30 59130 589.58 59135 480.56 59136 587.52 59140 257.84 59150 515.78 59151 503.56 59160 156.39 115.12 59200 55.22 28.29 59300 139.19 92.70 59320 99.13 59325 159.10 59350 175.92 59409 * 1,144.00 59409 702.00 59410 * 1,144.00 59410 TH 1,151.30 59410 832.00 59412 67.90 59414 127.38 59430 45.76 43.47 59514 * 1,144.00 59514 566.36 59515 * 1,144.00 59515 876.12 59525 319.11 59612 * 1,144.00 59612 702.00 59614 * 1,144.00 59614 791.09 59622 * 1,144.00 59622 898.28 59812 223.83 191.28 59820 268.41 234.15 59821 267.51 231.98 59830 296.93 59840 154.80 136.44 59841 258.28 232.41 59850 234.17 59851 260.84 59852 293.26 59855 276.79 59856 324.99 59857 298.97 59866 132.50 59870 332.91 59871 87.13

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

59899 75.83 Y60000 103.40 95.26 60100 71.97 48.96 60200 433.17 60210 461.69 60212 675.56 60220 460.33 60225 608.12 60240 600.42 60252 862.95 60254 1,090.85 60260 711.77 60270 902.94 60271 689.82 60280 288.56 60281 381.57 60300 73.33 30.90 60500 633.01 60502 848.69 60505 907.99 60512 159.10 60520 688.01 60521 733.95 60522 893.05 60540 702.04 60545 809.31 60600 898.48 60605 1,026.54 60650 783.51 60659 783.51 Y60699 536.85 Y61000 73.55 61001 69.93 61020 68.57 61026 69.71 61050 55.22 61055 74.23 61070 36.89 61105 299.87 61107 205.50 61108 584.58 61120 487.04 61140 826.97 61150 882.87 61151 647.95 61154 830.13 61156 836.09 61210 241.03 61215 329.97

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

61250 509.91 61253 439.21 61304 1,073.20 61305 1,311.51 61312 1,357.23 61313 1,295.67 61314 1,194.05 61315 1,350.67 61316 57.48 61320 1,241.35 61321 1,390.50 61322 1,555.26 61323 1,567.25 61330 1,038.01 61333 1,133.56 61340 941.26 61343 1,435.54 61345 1,334.15 61450 1,123.00 61458 1,314.46 61460 1,351.86 61500 857.52 61501 744.36 61510 1,433.95 61512 1,670.68 61514 1,247.92 61516 1,223.02 61517 59.30 61518 1,809.41 61519 1,933.89 61520 2,455.10 61521 2,087.78 61522 1,363.46 61524 1,361.76 61526 2,193.93 61530 2,085.18 61531 717.88 61533 997.16 61534 1,059.39 61535 652.48 61536 1,688.33 61537 1,614.33 61538 1,745.59 61539 1,544.62 61540 1,425.13 61541 1,405.44 61543 1,421.05 61544 1,242.03 61545 2,089.14

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

61546 1,480.99 61548 1,022.96 61550 654.10 61552 746.96 61556 1,049.47 61557 1,098.77 61558 1,133.15 61559 1,562.03 61563 1,295.67 61564 1,398.82 61566 1,467.90 61567 1,673.40 61570 1,221.21 61571 1,300.88 61575 1,607.85 61576 2,185.36 61580 1,596.45 61581 1,733.82 61582 1,985.95 61583 1,886.14 61584 1,875.72 61585 2,128.75 61586 1,612.06 61590 1,984.36 61591 2,006.31 61592 2,076.70 61595 1,544.85 61596 1,586.26 61597 1,923.48 61598 1,865.77 61600 1,388.69 61601 1,575.40 61605 1,408.60 61606 1,919.18 61607 1,749.67 61608 2,131.92 61611 215.27 61613 1,925.18 61615 1,461.69 61616 2,173.79 61618 834.21 61619 919.53 61623 374.78 61624 754.54 61626 579.60 61645 547.46 61650 373.65 61651 160.01 61680 1,474.01

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

61682 2,800.23 61684 1,903.63 61686 3,036.51 61690 1,457.66 61692 2,345.38 61697 2,776.24 61698 3,124.10 61700 2,235.34 61702 2,345.27 61703 796.07 61705 1,703.95 61708 1,263.82 61710 1,274.69 61711 1,696.03 61720 744.07 61735 1,039.93 61750 919.76 61751 900.07 61760 1,032.24 61770 1,018.50 61781 154.12 61782 113.39 61783 152.99 61790 572.81 61791 652.69 61796 661.75 61797 143.71 61798 773.60 61799 198.71 61800 99.58 61850 576.27 61860 914.63 61863 981.09 61864 185.58 61867 1,491.66 61868 319.55 61870 693.45 61880 376.14 61885 337.89 61886 558.78 61888 257.78 62000 673.30 62005 829.68 62010 1,002.14 62100 1,032.69 62115 736.64 62117 916.60 62120 1,284.22 62121 1,019.34

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

62140 669.45 62141 745.27 62142 577.79 62143 679.63 62145 929.71 62146 738.25 62147 928.58 62148 83.06 62160 123.80 62161 987.88 62162 1,234.11 62163 759.62 62164 1,366.51 62165 993.54 62180 1,044.68 62190 494.59 62192 640.93 62194 219.41 62200 898.94 62201 787.59 62220 644.55 62223 679.41 62225 343.32 62230 549.27 62252 52.28 30.10 22.18 62256 393.11 62258 725.12 62263 380.35 199.53 62264 187.47 152.55 62267 172.00 98.80 62268 171.47 62269 173.13 62270 89.85 44.18 62272 118.14 55.27 62273 110.90 70.94 62280 187.33 106.53 62281 154.58 99.67 62282 114.16 89.87 62284 128.10 54.40 62287 363.32 62290 167.59 104.24 62291 122.17 111.64 62292 352.24 62294 433.17 62302 165.86 76.16 62303 169.96 76.16 62304 164.53 75.08 62305 179.02 78.12 62320 105.69 62.24

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

62321 166.80 67.24 62322 96.64 52.88 62323 164.99 62.24 62324 91.89 56.14 62325 157.06 68.11 62326 94.60 54.84 62327 160.01 62.89 62328 167.25 56.36 62329 207.70 70.94 62350 259.13 62351 568.51 62355 176.30 62360 204.59 62361 220.54 62362 249.63 62365 191.92 62368 32.35 22.41 62369 68.82 22.41 62370 71.50 29.16 62380 567.91 63001 808.41 63003 809.09 63005 779.44 63011 711.09 63012 781.70 63015 967.96 63016 996.03 63017 823.57 63020 757.71 63030 636.18 63035 125.61 63040 821.27 63042 849.60 63043 118.39 63044 118.39 63045 841.68 63046 803.20 63047 721.95 63048 138.73 63050 984.94 63051 1,117.33 63055 1,064.37 63056 974.98 63057 210.02 63064 1,166.22 63066 119.94 63075 884.90 63076 161.59 63077 953.23

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

63078 123.06 63081 1,153.09 63082 174.72 63085 1,261.27 63086 125.15 63087 1,579.70 63088 168.15 63090 1,287.30 63091 117.23 63101 1,522.44 63102 1,483.06 63103 193.05 63170 932.75 63172 905.50 63173 1,076.35 63180 870.52 63182 955.01 63185 750.24 63190 815.42 63191 748.01 63194 798.56 63195 899.27 63196 788.00 63197 1,001.68 63198 927.43 63199 1,097.80 63200 1,000.10 63250 1,902.99 63251 1,989.11 63252 1,945.90 63265 1,092.66 63266 1,125.93 63267 898.03 63268 853.18 63270 1,358.14 63271 1,354.29 63272 1,235.47 63273 1,199.34 63275 1,180.02 63276 1,170.74 63277 1,020.47 63278 1,023.64 63280 1,385.75 63281 1,369.68 63282 1,291.82 63283 1,241.81 63285 1,712.10 63286 1,691.73 63287 1,797.19

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

63290 1,828.20 63295 216.13 63300 1,202.88 63301 1,375.25 63302 1,272.68 63303 1,485.53 63304 1,371.94 63305 1,333.15 63306 1,338.69 63307 1,404.63 63308 212.06 63600 541.81 63610 255.44 63620 639.34 63621 144.76 63650 371.98 259.61 63655 543.39 63661 403.05 203.03 63662 549.95 63663 536.18 282.90 63664 572.36 63685 234.69 63688 242.16 63700 813.88 63702 917.05 63704 1,030.28 63706 1,203.11 63707 606.99 63709 725.12 63710 710.64 63740 637.31 63741 441.09 63744 444.49 63746 393.79 64400 79.61 41.21 64405 51.32 34.34 64408 64.57 53.89 64415 72.87 39.82 64416 46.98 64417 88.04 40.02 64418 65.17 35.69 64420 64.91 38.04 64421 91.90 52.31 64425 74.56 56.08 64430 77.75 45.86 64435 82.42 46.56 64445 80.80 41.41 64446 46.98 64447 57.26 37.84

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

64448 42.24 64449 50.27 64450 49.34 26.77 64451 135.38 49.83 64454 136.73 51.36 64455 69.87 21.76 64461 84.87 48.31 64462 47.75 30.90 64463 120.70 52.01 64479 164.31 82.04 64480 77.73 39.17 64483 152.31 69.85 64484 66.99 32.64 64486 71.74 35.25 64487 102.86 40.26 64488 88.04 43.52 64489 135.63 48.96 64490 122.66 66.15 64491 61.56 37.65 64492 62.01 38.08 64493 111.57 56.14 64494 57.26 32.42 64495 57.26 32.86 64505 80.69 60.71 64510 89.40 47.00 64517 123.80 78.34 64520 137.83 51.79 64530 130.36 57.89 64553 133.14 126.48 64555 140.83 133.79 64561 483.42 190.85 64568 408.73 64569 495.64 64570 477.08 64575 221.79 64580 203.01 64581 433.85 64585 144.50 90.09 64590 171.55 100.76 64595 153.90 79.21 64600 263.66 143.41 64605 392.98 221.75 64610 457.04 334.53 64611 78.53 65.72 64612 86.45 72.90 64615 97.77 77.25 64616 86.45 68.33 64617 104.79 68.11 64620 134.89 109.46

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

64624 261.49 92.05 64625 319.57 121.65 64630 157.06 118.38 64632 54.81 42.22 64633 270.22 140.58 64634 120.85 42.65 64635 267.28 138.62 64636 110.22 37.43 64640 97.21 65.14 64642 94.83 67.24 64643 59.97 44.83 64644 110.67 73.34 64645 75.82 51.57 64646 99.81 72.25 64647 115.20 84.65 64650 46.79 25.90 64653 49.15 33.29 64680 216.13 101.41 64681 185.38 163.21 64702 327.93 64704 209.57 64708 328.39 64712 383.61 64713 510.80 64714 478.21 64716 335.18 64718 387.91 64719 262.30 64721 283.80 269.19 64722 234.24 64726 159.72 64727 119.27 64732 260.28 64734 251.09 64736 253.28 64738 292.27 64740 271.19 64742 295.43 64744 323.18 64746 255.05 64755 534.33 64760 316.56 64763 321.67 64766 344.66 64771 371.55 64772 368.22 64774 267.28 64776 254.16 64778 96.40

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

64782 297.16 64783 125.06 64784 476.85 64786 661.30 64787 157.52 64788 262.53 64790 546.11 64792 691.40 64795 126.06 64802 303.90 64804 548.98 64809 417.73 64818 375.19 64820 476.17 64821 408.47 64822 449.32 64823 511.49 64831 449.47 64832 220.21 64834 483.87 64835 533.88 64836 533.88 64837 232.45 64840 541.41 64856 661.53 64857 688.91 64858 770.16 64859 163.63 64861 878.70 64862 801.78 64864 561.95 64865 708.15 64866 750.02 64868 648.63 64872 74.08 64874 114.29 64876 105.96 64885 720.82 64886 831.72 64890 714.52 64891 691.88 64892 687.33 64893 733.50 64895 788.97 64896 868.35 64897 829.09 64898 898.94 64901 379.46 64902 433.51

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

64905 667.86 Y64907 762.34 64999 69.99 Y65091 421.09 65093 437.47 65101 488.94 65103 464.06 65105 578.47 65110 815.42 65112 892.31 65114 884.50 65125 260.80 180.19 65130 441.09 65135 447.47 65140 476.54 65150 343.26 65155 501.27 65175 458.75 65205 28.53 23.63 65210 34.81 28.33 65220 38.47 25.90 65222 43.68 31.77 65235 460.33 65260 622.83 65265 704.91 65270 179.70 86.83 65272 288.69 216.44 65273 243.52 65275 374.78 285.29 65280 430.00 65285 711.09 65286 451.28 305.75 65290 314.58 65400 439.28 370.60 65410 84.41 64.68 65420 339.70 231.98 65426 426.16 294.43 65430 74.23 63.11 65435 52.73 43.09 65436 248.04 227.62 65450 209.12 197.38 65600 228.50 211.61 65710 720.82 65730 797.32 65750 801.62 65755 798.00 65756 756.81 65770 895.31 65772 271.80 250.52

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

65775 321.62 65778 900.75 33.73 65779 779.21 92.92 65780 426.38 65781 851.40 65782 735.99 65785 1,274.78 272.75 65800 76.72 56.14 65810 297.38 65815 412.35 293.34 65820 502.65 65850 540.00 65855 158.20 127.74 65860 198.48 154.72 65865 304.40 65870 379.54 65875 404.43 65880 425.48 65900 628.03 65920 506.27 65930 409.86 66020 123.52 80.52 66030 111.12 67.90 66130 412.44 351.24 66150 511.87 66155 511.48 66160 632.11 66170 700.23 66172 762.69 66179 690.95 66180 729.42 66184 481.42 66185 542.26 66225 558.09 66250 483.42 342.52 66500 234.64 66505 227.46 66600 487.06 66605 613.69 66625 274.52 66630 363.47 66635 366.64 66680 332.46 66682 431.81 66700 265.88 242.85 66710 284.26 241.33 66711 376.65 66720 296.25 250.91 66740 280.98 241.33

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

66761 192.14 145.37 66762 305.76 261.35 66770 308.42 297.98 66820 262.37 66821 212.74 191.72 66825 508.99 66830 454.45 66840 444.49 66850 506.50 66852 539.54 66920 438.01 66930 547.25 66940 501.52 66982 479.79 66983 423.23 66984 374.18 66985 491.56 66986 580.28 Y66987 479.79 66988 374.18 66990 51.60 66999 327.42 Y67005 302.36 67010 346.72 67015 379.08 67025 473.00 388.66 67027 535.20 67028 64.73 60.71 67030 310.05 67031 250.31 218.92 67036 575.75 67039 616.49 67040 666.28 67041 736.44 67042 736.21 67043 776.95 67101 347.98 178.31 67105 258.78 169.09 67107 723.54 67108 766.54 67110 568.28 500.29 67113 856.61 67115 294.15 67120 427.51 341.87 67121 580.05 67141 336.08 299.22 67145 338.35 305.75 67208 384.74 354.93 67210 331.56 307.27

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

67218 891.92 67220 341.51 307.27 67221 180.15 131.00 67225 18.85 17.63 67227 291.34 158.93 67228 322.99 188.02 67229 745.72 67250 465.33 Y67255 437.93 67299 385.37 Y67311 382.25 67312 459.43 67314 434.08 67316 515.10 67318 453.09 67320 205.95 67331 195.77 67332 212.06 67334 192.82 67335 94.37 67340 229.03 67343 420.95 Y67345 156.61 134.49 67399 314.49 Y67400 630.75 67405 542.26 67412 590.92 67413 583.90 67414 895.77 67415 62.24 67420 1,075.21 67430 727.53 67440 726.71 67445 923.09 67450 849.15 67500 46.85 43.78 67505 54.49 47.53 67515 49.35 47.66 67550 656.78 67560 672.84 Y67570 807.50 67599 675.84 Y67700 179.24 71.38 67710 151.18 59.84 67715 162.72 65.94 67800 82.38 63.33 67801 104.33 81.39 67805 129.45 100.76 67808 235.82

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

67810 116.10 43.52 67820 22.44 21.32 67825 85.32 74.64 67830 172.45 84.43 67835 264.57 67840 179.02 97.06 67850 138.51 81.61 67875 113.39 59.19 67880 296.48 226.10 Y67882 361.69 290.30 Y67901 500.84 359.93 Y67902 463.95 Y67903 384.74 297.26 Y67904 473.46 367.33 Y67906 324.75 Y67908 326.82 263.53 Y67909 349.21 270.06 67911 358.94 67912 581.41 299.87 67914 302.03 201.07 67915 186.42 121.95 67916 388.36 264.40 67917 396.06 281.37 67921 260.72 190.63 67922 184.66 121.53 67923 388.36 264.84 67924 413.48 281.37 67930 236.50 147.54 67935 382.93 272.45 67938 166.57 71.38 67950 371.84 285.07 67961 373.20 279.85 67966 496.99 404.11 67971 462.82 67973 562.95 67974 566.95 Y67975 438.60 67999 131.52 Y68020 77.17 67.68 68040 37.64 30.79 68100 114.52 59.19 68110 150.05 90.96 68115 207.99 112.72 68130 351.02 253.30 68135 100.94 92.27 68200 26.93 21.54 68320 472.55 331.64 68325 420.05 68326 412.35

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

68328 453.54 68330 395.15 283.12 68335 413.71 68340 340.70 246.29 68360 338.19 252.21 68362 419.14 68400 175.41 80.73 68420 211.61 103.37 68440 66.08 60.93 68500 580.50 68505 578.15 68510 290.32 179.75 68520 416.21 68525 172.16 68530 277.92 157.33 68540 554.41 68550 595.62 68700 386.33 68705 150.46 101.84 68720 500.84 68745 456.73 68750 522.86 68760 137.38 89.44 68761 95.05 72.25 68770 401.94 68801 58.84 47.44 68810 102.07 78.34 68811 86.45 68815 249.86 136.44 68816 487.85 96.84 68840 83.74 71.16 Y68850 34.46 32.74 68899 332.28 Y69000 120.85 75.51 69005 139.86 97.93 69020 148.24 87.26 69100 63.14 29.81 69105 90.53 38.74 69110 297.83 201.95 69120 252.57 69140 562.85 69145 256.64 155.38 69150 661.98 69155 989.47 69200 52.28 29.38 69205 62.69 69209 9.05 69210 30.78 20.89 69220 56.00 31.77 Y

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

69222 136.24 82.91 69300 399.45 285.73 69310 701.36 Y69320 983.80 69399 214.72 Y69420 120.17 73.77 69421 95.28 69424 81.93 37.65 69433 127.19 80.95 69436 101.39 69440 441.55 69450 349.21 69501 461.46 69502 613.55 69505 774.46 69511 793.47 69530 985.73 69535 1,707.57 69540 131.94 77.91 69550 669.22 69552 1,010.28 69554 1,491.29 69601 661.08 69602 699.10 69603 810.90 69604 665.49 69605 1,003.95 69610 243.29 179.31 69620 453.77 302.48 69631 567.83 69632 691.85 69633 670.35 69635 794.15 69636 888.30 69637 884.22 69641 668.77 69642 859.33 69643 785.10 69644 951.22 69645 936.05 69646 992.18 69650 515.10 69660 594.54 69661 776.04 69662 740.51 69666 519.40 69667 514.60 69670 601.67 69676 500.05 Y

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

69700 411.22 Y69710 566.98 Y69711 543.62 Y69714 681.67 Y69715 843.71 69717 715.39 69718 796.85 69720 713.15 69725 1,208.09 69740 694.24 Y69745 731.42 69799 316.62 Y69801 177.34 77.25 69805 668.32 69806 563.08 69905 550.67 69910 644.33 Y69915 912.26 69930 786.46 69950 1,137.02 69955 1,171.64 69960 1,226.64 Y69970 1,377.15 69979 1,228.11 Y69990 142.58 90785 4.04 3.84 90791 91.21 77.04 90792 100.94 86.17 90832 44.58 38.52 90833 35.17 33.41 90834 59.30 51.36 90836 57.10 50.70 90837 88.72 76.82 90838 76.04 66.59 90845 51.37 48.80 90847 67.22 64.41 90849 19.69 19.28 90853 16.84 15.23 90870 112.93 67.68 90887 56.58 47.00 90935 47.07 90937 67.22 90945 55.22 90947 80.12 90951 529.20 90952 238.23 90953 158.17 90954 522.12 90955 294.21

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

90956 204.82 90957 414.16 90958 281.31 90959 190.33 90960 182.64 90961 153.44 90962 118.36 90963 349.89 90964 305.98 90965 292.40 90966 153.22 90967 11.04 90968 10.18 90969 9.73 Y90970 5.21 90999 62.41 Y91010 129.00 42.77 86.23 91013 16.04 5.93 10.11 91020 154.64 44.60 110.03 91022 107.95 47.98 59.97 91030 89.17 30.33 58.84 91034 122.44 32.59 89.85 91035 310.28 53.64 256.64 91037 106.60 32.36 74.23 91038 149.54 19.46 130.09 91040 177.45 26.86 150.59 Y91065 51.15 6.56 44.58 91110 551.54 82.83 468.70 91111 553.26 33.45 519.82 91112 926.40 69.84 856.57 91117 88.59 91120 312.09 31.91 280.18 Y91122 161.36 57.71 103.65 91299 136.31 Y92002 53.64 29.16 92004 95.73 60.28 92012 56.35 31.99 92014 80.34 48.53 92015 14.37 12.19 92018 91.89 92019 46.85 92020 17.65 12.84 92025 23.54 12.67 10.86 92060 40.51 24.22 16.29 92071 23.99 20.46 92081 21.50 10.41 11.09 92082 30.33 13.81 16.52 92083 40.28 17.65 22.63 92100 52.73 20.46

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

92132 20.14 10.64 9.51 92133 23.76 14.26 9.51 92134 26.03 16.29 9.73 92136 43.52 21.76 21.76 92201 16.07 14.14 92202 10.18 9.14 92230 38.37 20.67 92235 65.23 27.16 38.07 92240 128.78 30.33 98.45 92242 151.86 34.85 117.01 92250 31.61 15.18 16.43 92260 11.23 6.71 92265 47.00 24.62 22.39 92270 61.78 27.38 34.40 92273 83.29 23.76 59.52 92274 56.35 21.05 35.31 92283 33.72 5.88 27.84 92284 34.90 7.10 27.80 92285 14.03 2.04 11.99 92286 31.70 18.15 13.54 92287 95.03 28.13 66.90 92340 22.41 11.75 92341 26.03 15.23 92342 27.84 16.97 92352 21.66 11.67 Y92353 25.07 15.85 92499 52.09 Y92502 60.88 92504 18.56 5.88 92511 71.97 23.50 92512 38.25 17.63 92516 44.41 14.31 92520 50.07 25.46 92526 56.13 92531 5.72 92532 5.72 92533 14.56 92534 5.72 92537 26.71 20.37 6.34 92538 14.48 10.41 4.07 92540 68.80 51.15 17.65 92541 16.86 14.05 2.81 92542 19.01 16.29 2.72 92544 14.15 11.60 2.55 92545 13.53 10.94 2.59 92546 71.29 9.73 61.56 92547 4.55 92548 31.87 22.37 9.49 92549 40.68 28.93 11.75

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

92550 14.26 92552 20.14 92553 24.44 92555 15.16 92556 21.80 92557 24.44 20.24 92567 10.18 6.75 92568 10.18 9.57 92570 21.27 18.50 92571 11.98 92572 15.38 92579 29.87 23.72 92582 46.55 92585 86.45 17.20 69.25 92586 60.65 92587 14.26 11.99 2.26 92588 21.73 18.78 2.94 92601 93.58 78.12 92602 62.71 44.18 92603 99.81 75.73 92604 59.75 42.22 92610 55.90 45.05 92611 59.30 92612 128.32 42.43 92614 90.61 41.18 92616 135.18 62.02 92620 60.43 50.70 92621 14.48 11.75 92626 57.94 47.22 92627 13.81 11.10 92630 71.61 92633 71.61 Y92640 35.28 33.52 92700 36.11 92920 348.76 92921 195.37 92924 415.75 92925 218.48 92928 387.91 92929 238.87 92933 435.44 92934 208.40 92937 387.46 92938 184.15 92941 436.12 92943 436.12 92944 222.01 92950 207.31 116.64 92953 4.01

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

92960 102.07 67.90 92961 162.27 92970 118.73 92971 58.28 92973 115.87 92974 93.36 92975 247.37 92977 34.17 92978 178.44 61.49 116.95 92979 108.56 49.34 59.22 92986 864.08 92987 891.24 92990 712.00 92992 484.12 92993 291.20 92997 418.46 92998 212.06 93000 10.86 93005 5.43 93010 5.43 93015 45.26 93016 14.26 93018 9.51 93024 70.16 36.89 33.27 93025 95.49 22.12 73.37 93050 10.41 5.43 4.98 93224 56.35 93227 16.97 93228 17.20 93229 448.79 93268 127.64 93270 5.66 93271 105.69 93272 16.29 93279 38.07 20.36 17.71 93280 44.22 23.96 20.26 93281 49.11 27.61 21.50 93282 47.07 27.61 19.46 93283 58.84 37.57 21.27 93284 63.60 40.74 22.86 93285 31.91 15.75 16.17 93286 19.82 7.65 12.17 93287 27.86 13.52 14.34 93288 28.41 12.26 16.15 93289 42.32 24.22 18.11 93290 23.85 11.03 12.81 93291 26.95 11.71 15.24 93292 24.66 11.85 12.82 93293 33.04 9.73 23.31

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

93294 20.14 93295 30.44 93296 16.29 93297 17.43 93298 17.65 93303 148.92 40.96 107.95 93304 102.30 23.54 78.76 93306 132.62 47.07 85.55 93307 90.30 28.97 61.33 93308 63.14 16.52 46.62 93312 157.52 70.61 86.91 93313 12.80 93314 151.18 58.62 92.56 93315 428.56 85.71 342.85 93316 17.65 93317 291.39 58.28 233.11 93318 348.75 69.75 279.00 93320 34.17 11.77 22.41 93321 16.97 4.75 12.22 93325 15.84 2.04 13.81 93350 121.31 45.72 75.59 93351 150.05 54.77 95.28 93352 21.50 93355 148.92 93356 25.54 7.40 93451 541.81 86.00 455.80 93452 586.39 155.03 431.36 93453 755.68 207.53 548.14 93454 587.75 156.84 430.91 93455 667.86 182.64 485.23 93456 743.91 204.14 539.77 93457 823.80 230.39 593.41 93458 688.23 193.73 494.51 93459 749.11 219.53 529.58 93460 829.00 245.56 583.45 93461 927.90 271.58 656.32 93462 138.05 93463 63.82 93464 155.93 57.48 98.45 93503 58.35 93505 456.26 146.20 310.06 93530 537.44 135.48 401.96 93531 1,322.86 264.57 1,058.29 93532 1,641.86 328.37 1,313.49 93533 1,096.37 219.27 877.10 93561 25.18 12.53 93562 12.75 4.33 8.41 93563 37.80 93564 40.28

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

93565 29.20 93566 94.60 29.16 93567 80.34 33.29 93568 86.91 29.81 93571 145.41 50.10 95.31 93572 85.65 40.56 45.09 93580 640.03 93581 872.00 93582 436.57 93583 428.97 93590 706.79 93591 585.94 93592 257.55 93600 114.30 72.73 41.57 93602 94.30 71.25 23.05 93603 107.71 71.25 36.46 93609 224.21 170.57 53.64 93610 129.03 101.02 28.01 93612 135.19 100.39 34.80 93613 195.31 93615 29.31 24.81 4.50 93616 46.09 35.96 10.13 93618 229.26 145.47 83.79 93619 422.04 248.40 173.64 93620 1,971.53 394.31 1,577.22 93621 359.42 71.88 287.54 93622 525.31 105.06 420.25 93623 488.07 97.61 390.46 93624 207.72 151.06 56.66 93631 353.14 223.70 93640 279.60 118.25 161.35 93641 357.41 200.98 156.43 93642 219.75 167.48 52.28 93650 388.59 93653 549.73 93654 736.21 93655 280.41 93656 738.25 93657 280.18 93660 101.84 60.43 41.42 93662 430.65 86.13 344.52 93701 16.75 93724 168.33 145.72 22.61 93750 37.12 30.03 93770 4.93 93784 31.11 Y93798 16.29 8.70 93799 302.06 Y93880 127.64 25.57 102.07

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

93882 82.38 16.29 66.08 93886 174.26 30.55 143.71 93888 102.65 16.77 85.88 93890 176.98 33.27 143.71 93892 199.39 38.70 160.69 93893 228.58 38.70 189.88 93922 54.32 8.15 46.17 93923 84.64 14.26 70.38 93924 104.56 15.84 88.72 93925 162.27 25.12 137.15 93926 95.96 15.62 80.34 93930 131.94 25.80 106.14 93931 82.38 15.84 66.54 93970 124.70 22.18 102.52 93971 77.85 14.26 63.60 93975 177.21 36.89 140.32 93976 105.01 25.57 79.44 93978 120.40 25.35 95.05 93979 77.40 15.84 61.56 93980 78.31 39.61 38.70 93981 52.79 15.48 37.31 93985 170.18 24.86 145.32 93986 98.76 16.05 82.72 93990 99.35 16.07 83.29 94002 59.52 94003 43.00 94004 31.91 94010 22.63 5.43 17.20 94011 55.67 94012 90.75 94013 16.60 94016 16.29 94060 37.80 8.37 29.42 94070 37.80 18.33 19.46 94150 16.07 94200 16.01 3.30 12.71 94250 17.43 3.62 13.81 94375 24.89 9.51 15.39 94400 35.66 9.76 25.92 94450 42.55 12.22 30.33 94610 35.98 94617 58.39 21.50 36.89 94618 21.50 14.71 6.79 94621 101.84 45.04 56.81 94640 11.32 94644 33.51 94645 9.54 94660 40.96 23.72 94662 23.31

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

94664 10.64 94667 15.84 94680 34.17 8.15 26.03 94681 33.72 6.56 27.16 94690 32.36 2.49 29.87 94726 34.17 7.92 26.25 94727 27.84 7.92 19.92 94728 26.03 8.15 17.88 94729 35.98 5.88 30.10 94750 56.13 7.02 49.11 94770 9.74 Y94772 18.20 94774 32.71 Y94777 32.71 94799 36.70 Y95004 2.93 95017 5.36 2.39 95018 13.58 4.35 95024 5.21 0.65 95027 3.17 95028 8.15 95044 3.39 95052 4.04 95056 27.38 95060 22.41 95065 16.52 95070 21.05 95071 20.88 95076 76.27 46.35 95079 54.32 42.65 95115 5.88 95117 6.79 95144 8.20 1.96 95145 16.41 1.96 95146 25.66 1.96 95147 24.97 1.96 95148 32.79 1.96 95149 51.51 1.96 95165 9.28 1.96 95170 7.02 1.96 95180 87.59 64.20 95700 156.00 95705 62.40 95706 259.58 95707 324.48 95708 93.60 95709 518.54 95710 648.34 95711 78.00

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

95712 312.00 95713 390.00 95714 124.80 95715 624.00 95716 780.00 95717 66.54 63.11 95718 87.59 82.91 95719 102.97 97.93 95720 135.56 128.39 95721 136.70 128.83 95722 165.89 156.68 95723 169.51 159.51 95724 211.83 199.77 95725 193.50 181.49 95726 267.73 252.43 95782 576.88 81.25 495.64 95783 613.32 88.26 525.06 95805 265.02 38.02 227.00 95808 341.03 46.10 294.93 95810 389.49 78.08 311.41 95811 406.92 81.02 325.90 95812 210.25 37.12 173.13 95813 261.40 56.35 205.04 95816 233.11 37.12 195.99 95819 272.36 36.75 235.61 95822 250.62 37.29 213.34 95829 1,096.20 199.48 896.73 95836 71.89 95851 11.06 4.80 95852 8.86 3.74 95857 32.40 18.58 95860 76.95 33.72 43.23 95861 110.22 53.41 56.81 95863 134.89 63.86 71.03 95864 149.09 64.11 84.99 95865 95.45 52.78 42.67 95866 84.48 42.13 42.35 95867 69.03 27.61 41.42 95868 90.53 40.74 49.79 95869 39.84 8.51 31.34 95870 42.88 9.55 33.33 95872 128.10 98.45 29.65 95873 49.11 12.90 36.21 95874 50.36 12.65 37.71 95885 40.06 11.99 28.06 95886 62.24 29.65 32.59 95887 54.32 24.44 29.87 95905 38.09 1.99 36.10 95907 61.33 34.85 26.48

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

95908 77.85 43.45 34.40 95909 93.24 52.05 41.19 95910 122.66 69.71 52.96 95911 146.88 86.23 60.65 95912 168.15 102.75 65.41 95913 194.63 121.99 72.65 95921 55.00 29.20 25.80 95922 63.14 31.23 31.91 95925 89.40 18.11 71.29 95926 85.10 17.65 67.44 95927 84.87 17.43 67.44 95928 144.39 51.60 92.79 Y95929 148.69 51.60 97.09 95930 56.54 15.94 40.60 95937 60.20 22.41 37.80 95938 223.60 29.87 193.73 95939 335.86 77.17 258.68 95940 21.27 95954 249.63 73.33 176.30 95957 163.85 66.54 97.32 95958 373.20 146.88 226.32 95961 198.93 104.56 94.37 95962 168.38 111.57 56.81 95970 34.63 12.94 95971 32.59 25.46 95972 36.66 25.90 95976 26.71 25.24 95977 34.85 33.08 95983 33.04 31.34 95984 29.20 27.64 95990 56.88 95991 73.33 25.24 Y95992 28.74 23.50 95999 38.66 Y96105 58.18 96116 62.46 52.23 96130 76.50 67.02 96131 58.84 51.57 96132 85.55 66.15 96133 64.27 50.92 96136 30.10 15.23 96137 27.61 11.97 96360 25.76 96361 8.60 96365 45.26 96366 13.81 96367 19.69 96368 13.35 96369 101.62

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

96370 9.73 96371 40.51 96372 11.31 96373 11.77 96374 25.56 96375 10.41 96376 12.53 96377 12.67 96401 50.24 96402 20.14 96405 53.18 18.28 96406 70.06 28.82 96409 69.03 96411 37.57 96413 89.40 96415 19.24 96416 89.40 96417 43.45 96420 66.31 96422 108.86 96423 47.00 96425 107.34 96440 211.66 83.44 96450 114.97 49.18 96521 93.47 96522 78.08 96523 17.65 96542 84.19 26.33 96900 14.26 96910 53.88 96912 63.37 96913 87.52 96920 104.33 40.91 96921 114.29 45.92 Y96922 155.93 74.21 96999 78.85 Y97018 5.09 97597 53.43 16.47 97598 19.90 7.74 Y97602 20.66 97799 24.77 Y98925 20.14 14.80 98926 29.20 22.41 98927 38.02 29.38 98928 46.40 36.78 98929 55.45 45.05 98940 18.11 13.93 98941 26.03 21.33 98942 26.98 25.63

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

99050 7.28 99051 7.28 99151 47.53 14.58 99152 32.36 7.62 99153 6.79 99155 55.00 99156 50.24 99157 40.96 99183 71.52 99188 19.68 6.53 99195 64.50 99201 29.20 16.32 99202 47.89 31.12 99203 68.57 46.57 99204 100.78 79.65 99205 128.08 104.02 99211 TH 13.29 5.66 99211 FP 13.29 5.66 99211 13.29 5.66 99212 TH 23.25 15.89 99212 23.25 15.89 99213 TH 28.34 26.93 99213 28.34 26.93 99214 TH 44.15 41.95 99214 44.15 41.95 99215 TH 64.20 60.98 99215 64.20 60.98 99217 46.40 99218 63.82 99219 86.68 99220 118.14 99221 65.18 99222 88.04 99223 129.23 99224 25.35 99225 46.40 99226 66.76 99231 25.12 99232 46.17 99233 66.54 99234 85.32 99235 107.95 99236 138.96 99238 46.62 99239 68.35 99241 30.55 20.24 99242 57.71 42.65 99243 78.99 59.63 99244 118.36 95.97

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

99245 144.16 118.60 99251 31.91 99252 48.21 99253 74.46 99254 108.41 99255 130.36 99281 14.48 99282 27.84 99283 41.64 99284 76.50 99285 111.12 99291 178.57 136.66 99292 78.99 68.77 99304 57.71 99305 82.61 99306 106.60 99307 28.06 99308 44.13 99309 58.16 99310 85.77 99315 46.85 99316 67.22 99318 61.33 99324 34.85 99325 50.70 99326 88.26 99327 118.59 99328 140.32 99334 38.47 99335 60.88 99336 86.00 99337 124.02 99339 49.56 99340 69.83 99341 34.85 99342 50.02 99343 82.15 99344 116.55 99345 141.90 99347 TH 34.85 99347 34.85 99348 TH 53.64 99348 53.64 99349 TH 82.15 99349 82.15 99350 TH 114.52 99350 114.52 99354 TH 58.06 55.15 99354 58.06 55.15

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

99355 TH 56.41 53.59 99355 56.41 53.59 99356 59.07 99357 59.52 99360 39.61 99381 71.47 47.66 99382 71.47 50.92 99383 FP 77.40 53.97 99383 77.40 53.97 99384 FP 71.47 63.76 99384 71.47 63.76 99385 EP 71.47 61.15 99385 FP 71.47 61.15 99385 71.47 61.15 99386 FP 98.22 74.21 99386 98.22 74.21 99387 106.82 79.86 99391 71.47 43.74 99392 71.47 47.66 99393 FP 71.47 47.66 99393 71.47 47.66 99394 FP 71.47 53.97 99394 71.47 53.97 99395 EP 71.47 55.49 99395 FP 71.47 55.49 99395 71.47 55.49 99396 FP 81.47 60.50 99396 81.47 60.50 99397 87.59 63.76 99401 25.35 15.45 99402 41.87 31.55 99403 FP 44.94 46.67 99406 8.24 7.62 99407 14.60 13.87 99415 6.34 99416 0.47 99460 42.99 99461 52.21 38.74 99462 26.93 99463 57.16 99464 47.75 99465 93.47 99468 650.55 99469 261.62 99471 565.82 99472 269.94 99475 358.26 99476 221.79 99477 231.52

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

99478 91.90 99479 81.73 99480 78.95 99490 26.48 19.80 A4261 55.00 G0101 25.57 17.63 G0127 15.16 4.79 G0166 70.16 G0245 42.32 26.33 G0246 24.67 12.84 G0247 37.19 13.93 G0289 56.58 H1000 52.00 H1001 TG 156.00 YH1001 104.00 YL8603 376.73 L8606 197.76 Q0111 9.35 Q0112 3.64 Q0113 5.00 Q0114 4.00 Q4001 25.12 Q4002 94.96 Q4003 18.05 Q4004 62.48 Q4005 6.65 Q4006 14.99 Q4007 3.33 Q4008 7.50 Q4009 4.44 Q4010 10.00 Q4011 2.22 Q4012 5.00 Q4013 8.08 Q4014 13.64 Q4015 4.04 Q4016 6.82 Q4017 4.68 Q4018 7.46 Q4019 2.34 Q4020 3.73 Q4021 3.46 Q4022 6.24 Q4023 1.74 Q4024 3.12 Q4025 19.40 Q4026 60.57 Q4027 9.70 Q4028 30.29

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Procedure Mod FSI Facility PCI TCI PA

Practitioner Fee Schedule2020

Q4029 14.83 Q4030 39.05 Q4031 7.42 Q4032 19.52 Q4033 13.85 Q4034 34.42 Q4035 6.92 Q4036 17.21 Q4037 8.44 Q4038 21.15 Q4039 4.23 Q4040 10.58 Q4041 10.26 Q4042 17.52 Q4043 5.13 Q4044 8.76 Q4045 5.96 Q4046 9.58 Q4047 2.98 Q4048 4.80 Q4049 1.09 Q4101 26.21 Q4102 6.43 Q4104 9.60 YQ4106 35.67 Q4112 85.97 YQ4121 21.60 Q4124 123.06 Q4132 140.37 Q4133 138.78 Q4186 179.00 Q4187 179.00 S2401 6,350.00 YS2402 6,350.00 S2411 6,350.00 S4005 200.00 S8415 245.00 S8415 245.00

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