ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

217

**90281 - BR

**90283 - BR

**90284 - 33.14

**90287 - BR

**90288 - BR

**90291 - BR

**90296 - BR

**90371 - 150.48

**90375 - 211.70

**90376 - 204.16

**90378 - RNE

**90384 - 119.25

**90385 - 50.97

**90386 - BR

**90389 - 144.00

**90393 - BR

**90396 - BR

**90399 - BR

90460 - 42.66

90461 - 21.79

90470 - 37.52

90471 - 33.42

*90472 - 20.22

90473 - 23.79

*90474 - 20.13

**90476 - BR

**90477 - BR

**90581 - 125.00

**90585 - 158.54

**90586 - 146.96

**90632 - 72.67

**90633 - 67.42

**90634 - 67.42

**90636 - 118.69

**90645 - 24.69

**90646 - 25.34

**90647 - 26.12

**90648 - 24.64

**90649 - BR

**90650 - RNE

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

218

**90656 - 22.68

**90657 - 22.66

**90658 - 22.10

**90660 - BR

**90661 - BR

**90662 - BR

**90663 - BR

**90664 - BR

**90665 - 55.00

**90666 - BR

**90667 - BR

**90668 - BR

**90669 - 107.24

**90670 - RNE

**90675 - 203.56

**90676 - BR

**90680 - 72.97

**90681 - RNE

**90690 - 56.41

**90691 - 69.54

**90692 - BR

**90693 - BR

**90698 - BR

**90700 - 39.94

**90701 - 27.50

**90702 - 22.50

**90703 - 31.75

**90704 - 27.50

**90705 - 26.36

**90706 - 27.50

**90707 - 48.75

**90708 - 31.33

**90710 - 127.31

**90712 - 23.87

**90713 - 31.00

**90714 - 25.12

**90715 - 52.36

**90716 - 70.09

**90717 - 70.00

**90718 - 20.89

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

219

**90719 - 22.68

**90720 - 39.79

**90721 - 45.00

**90723 - BR

**90725 - 22.50

**90727 - 23.62

**90732 - 55.68

**90733 - 108.75

**90734 - 100.65

**90735 - 93.95

**90736 - BR

**90738 - RNE

**90740 - 154.44

**90743 - 53.14

**90744 - 43.75

**90746 - 77.44

**90747 - 121.00

**90748 - 52.07

**90749 - BR

90801 - 251.80

90802 - 240.70

90804 - 99.79

90805 - 120.70

90806 - 151.59

90807 - 176.91

90808 - 234.13

90809 - 260.09

90810 - 117.53

90811 - 144.42

90812 - 170.30

90813 - 197.43

90814 - 250.67

90815 - 282.56

90816 - 96.00

90817 - 114.24

90818 - 148.70

90819 - 172.11

90821 - 234.00

90822 - 256.00

90823 - 107.03

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

220

90824 - 128.49

90826 - 163.83

90827 - 186.24

90828 - 255.00

90829 - 272.87

90845 - 159.66

90846 - 136.21

90847 - 171.55

90849 - 57.00

90853 - 57.00

90857 - 57.00

90862 - 91.25

90865 - 266.19

90867 - BR

90868 - BR

90870 - 236.25

90875 - 112.00

90876 - 165.77

90880 - 164.36

90882 - 102.96

90885 - 92.80

90887 - 130.00

90889 - 152.00

90899 - BR

90901 - 76.00

90911 - 151.00

90935 - 157.00

90937 - 329.00

90940 41.00 100.00

90945 - 146.40

90947 - 267.79

90957 - 1,172.00

90958 - 791.00

90959 - 519.00

90960 - 521.00

90961 - 421.00

90962 - 307.04

90965 - 797.00

90966 - 416.00

90969 - 28.00

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

221

90970 - 15.00

90989 - 526.69

90993 - 109.80

90997 - 371.25

90999 - BR

91010 145.72 318.75

*91013 18.40 42.66

91020 152.89 357.59

91022 134.90 261.63

91030 88.05 210.00

91034 94.57 396.00

91035 155.38 861.90

91037 96.96 288.80

91038 105.33 495.85

91040 92.67 765.00

91065 45.00 131.71

91110 369.28 1,452.13

91111 91.50 1,187.50

91117 - 271.79

91120 90.00 751.82

91122 162.50 324.32

91132 36.52 213.19

91133 59.21 260.82

91299 - BR

92002 - 112.31

92004 - 205.47

92012 - 92.50

92014 - 158.75

92015 - 50.21

92018 - 202.93

92019 - 119.63

92020 - 58.75

92025 30.00 50.00

92060 55.00 82.40

92065 32.35 80.24

92070 - 118.75

92081 36.25 80.24

92082 50.00 111.23

92083 67.50 139.46

92100 - 126.25

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

222

92120 - 107.50

92130 - 116.25

92132 39.17 66.95

92133 54.26 81.89

92134 54.26 81.89

92136 53.75 150.12

92140 - 86.49

92225 - 58.00

92226 - 51.00

92227 - 21.33

92228 32.32 55.42

92230 - 135.74

92235 81.25 182.50

92240 112.27 367.42

92250 65.00 121.19

92260 - 66.25

92265 78.75 135.00

92270 100.00 143.88

92275 111.27 234.09

92283 43.75 80.24

92284 36.25 97.95

92285 22.88 52.28

92286 93.64 196.46

92287 51.04 171.26

92310 - 175.43

92311 - 175.86

92312 - 193.74

92313 - 194.51

92314 - 135.71

92315 - 126.25

92316 - 167.41

92317 - 152.41

92325 - 52.92

92326 - 78.76

92340 - 55.02

92341 - 62.00

92342 - 67.00

92352 - 54.40

92353 - 60.13

92354 - 422.24

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

223

92355 - 205.65

92358 - 80.00

92370 - 48.33

92371 - 47.58

92499 - BR

92502 - 182.09

92504 - 45.00

92506 - 191.25

92507 - 87.50

92508 - 50.00

92511 - 230.00

92512 - 90.46

92516 - 100.17

92520 - 105.94

92526 - 132.50

92531 - 23.32

92532 - 34.00

92533 - 53.00

92534 - 28.44

92540 153.80 215.14

92541 45.06 91.50

92542 39.38 93.96

92543 22.00 62.83

92544 30.62 63.38

92545 26.26 64.83

92546 34.13 152.50

*92547 22.31 27.89

92548 66.00 184.90

92550 - 38.75

92551 - 27.12

92552 - 33.75

92553 - 47.50

92555 - 26.25

92556 - 46.25

92557 - 80.72

92559 - 60.00

92560 - 36.00

92561 - 53.00

92562 - 52.57

92563 - 40.95

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

224

92564 - 36.29

92565 - 23.00

92567 - 28.60

92568 - 26.00

92570 - 57.94

92571 - 35.76

92572 - 52.57

92575 - 81.90

92576 - 43.72

92577 - 35.55

92579 - 63.75

92582 - 77.07

92583 - 62.55

92584 - 125.21

92585 97.63 219.55

92586 - 175.09

92587 20.00 92.94

92588 45.75 135.79

92590 - 83.16

92591 - 113.75

92592 - 31.92

92593 - 51.41

92594 - 30.24

92595 - 54.90

92596 - 55.00

92597 - 167.50

92603 - 152.50

92604 - 106.25

92605 - BR

92606 - BR

92607 - 192.50

*92608 - 70.31

92609 - 105.00

92610 - 185.00

92611 - 173.32

92612 - 265.00

92613 - 54.90

92614 - 210.00

92615 - 54.90

92616 - 293.75

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

225

92617 - 70.00

92620 - 94.52

92621 - 25.00

92625 - 96.25

92626 - 118.95

*92627 - 33.75

92630 - BR

92633 - BR

92640 - 155.74

92700 - BR

92950 - 411.88

92953 - 133.75

92960 - 436.90

92961 - 455.00

92970 - 368.63

92971 - 186.23

*92973 - 397.11

*92974 - 448.35

92975 - 773.00

92977 - 596.00

*92978 281.25 642.60

*92979 219.00 376.49

92980 - 2,303.00

*92981 - 848.03

92982 - 1,828.00

*92984 - 667.00

92986 - 3,118.75

92987 - 3,173.83

92990 - 2,616.25

92992 - 4,116.25

92993 - 4,015.00

92995 - 1,916.00

*92996 - 572.00

92997 - 1,770.00

*92998 - 732.00

93000 26.00 56.00

93005 - 31.00

93010 - 27.04

93015 - 322.00

93016 - 73.00

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

226

93017 - 134.00

93018 - 58.00

93024 115.74 228.66

93025 73.20 599.33

93040 22.00 34.00

93041 - 18.05

93042 - 23.08

93224 155.85 299.56

93225 - 103.29

93226 - 114.38

93227 - 119.00

93228 - 51.00

93229 - RNE

93268 - 389.17

93270 - 72.00

93271 - 337.19

93272 - 48.68

93278 49.00 138.00

93279 70.00 102.00

93280 83.00 121.00

93281 97.00 141.00

93282 91.00 130.00

93283 114.00 159.00

93284 136.00 186.00

93285 57.00 88.00

93286 29.00 50.00

93287 43.00 66.00

93288 46.00 79.00

93289 84.54 122.00

93290 41.00 58.00

93291 47.00 75.00

93292 46.00 68.00

93293 33.00 107.00

93294 - 68.00

93295 - 123.00

93296 - 66.00

93297 - 49.00

93298 - 57.00

93299 - RNE

93303 178.00 419.70

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

227

93304 91.51 241.64

93306 196.00 556.00

93307 151.20 391.49

93308 88.63 223.58

93312 227.25 572.20

93313 - 155.55

93314 150.00 470.00

93315 273.02 601.00

93316 - 111.00

93317 180.41 460.61

93318 238.00 432.80

*93320 72.72 196.48

*93321 30.00 116.00

*93325 71.25 193.46

93350 177.00 405.47

93351 - 506.00

*93352 - 70.00

93451 276.03 1,414.47

93452 483.88 1,570.92

93453 634.64 2,055.85

93454 488.13 1,621.05

93455 562.68 1,890.06

93456 625.19 2,028.14

93457 699.74 2,297.61

93458 595.00 1,954.82

93459 670.02 2,159.07

93460 746.46 2,310.69

93461 823.60 2,647.88

*93462 - 377.21

*93463 - 199.43

*93464 176.94 467.03

**93503 - 404.00

93505 485.66 803.13

93530 521.00 1,697.00

93531 1,024.80 4,070.93

93532 1,191.00 4,357.00

93533 717.59 3,866.00

93561 168.00 232.16

93562 73.00 113.40

*93563 - 102.48

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

228

*93564 - 104.31

*93565 - 80.49

*93566 - 298.32

*93567 - 246.36

*93568 - 269.82

*93571 172.69 435.70

*93572 138.25 457.50

93580 - 1,430.42

93581 - 1,915.53

**93600 256.20 491.40

**93602 226.00 340.20

**93603 224.54 415.80

*93609 544.07 1,163.82

**93610 272.41 453.60

**93612 317.00 491.40

*93613 670.00 960.00

**93615 66.25 132.50

**93616 126.48 215.46

**93618 463.99 1,010.35

**93619 1,051.03 1,833.03

**93620 1,484.00 2,268.00

*93621 1,638.61 2,549.83

*93622 1,638.61 2,552.88

*93623 585.00 647.81

**93624 585.33 791.00

**93631 822.01 1,385.22

**93640 512.56 1,069.86

**93641 870.19 1,497.00

**93642 612.20 1,291.00

**93650 1,316.00 1,754.00

**93651 1,620.00 2,440.00

**93652 1,740.00 2,540.00

**93660 226.80 457.44

*93662 279.03 484.95

93668 - 34.96

93701 16.95 68.04

93720 46.22 91.53

93721 - 73.00

93722 - 27.45

93724 519.00 812.00

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

229

93740 53.75 96.29

93745 - BR

93750 - 89.77

93770 20.00 27.47

93784 128.63 306.28

93786 - 70.82

93788 - 99.00

93790 - 122.51

93797 - 52.00

93798 - 60.00

93799 - BR

93875 58.00 179.22

93880 86.25 383.75

93882 66.84 256.31

93886 105.03 447.50

93888 71.00 340.00

93890 93.92 473.29

93892 107.94 528.75

93893 108.10 518.75

93922 73.85 183.09

93923 112.64 311.25

93924 119.78 354.18

93925 94.94 425.00

93926 63.45 273.75

93930 70.02 402.50

93931 53.00 266.25

93965 72.00 190.42

93970 87.53 351.25

93971 53.00 237.50

93975 167.45 550.00

93976 98.32 337.50

93978 87.53 375.00

93979 54.00 256.25

93980 131.25 347.50

93981 85.44 253.32

93982 - 81.94

93990 35.01 256.20

94002 - 144.30

94003 - 104.44

94004 - 76.41

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

230

94005 - 143.89

94010 38.40 72.74

94014 43.00 79.29

94015 - 51.23

94016 - 43.27

94060 52.00 132.81

94070 53.39 212.00

94150 6.99 33.39

94200 19.55 42.49

94240 28.40 92.50

94250 10.98 41.00

94260 26.25 87.21

94350 34.07 100.00

94360 29.00 83.21

94370 22.88 64.20

94375 35.18 92.93

94400 61.25 125.00

94450 51.25 121.25

94452 27.09 101.12

94453 34.92 137.25

**94610 - 97.50

94620 56.25 171.00

94621 129.03 304.06

94640 - 31.95

94642 - 91.50

94644 - 60.00

*94645 - 25.00

94660 - 111.23

94662 - 78.93

94664 - 38.75

94667 - 43.27

94668 - 36.29

94680 43.75 121.25

94681 65.00 266.25

94690 41.18 164.73

94720 33.00 94.62

94725 54.00 146.40

94750 44.00 127.50

94760 - 42.50

94761 - 50.00

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

231

94762 - 65.70

94770 13.13 67.68

94772 - BR

94774 - RNE

94775 - RNE

94776 - RNE

94777 - RNE

94799 - BR

95004 - 8.36

95010 - 23.76

95012 - 30.00

95015 - 21.25

95024 - 9.68

95027 - 15.00

95028 - 18.75

95044 - 11.44

95052 - 13.35

95056 - 52.92

95060 - 27.45

95065 - 27.45

95070 - 137.31

95071 - 163.96

95075 - 143.06

95115 - 21.00

95117 - 27.44

95120 - 22.68

95125 - 34.02

95130 - 41.79

95131 - 57.20

95132 - 65.92

95133 - 75.69

95134 - 86.26

95144 - 18.38

95145 - 31.54

95146 - 41.25

95147 - 51.25

95148 - 61.25

95149 - 71.37

95165 - 16.28

95170 - 20.00

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

232

95180 - 248.14

95199 - BR

95250 - 226.25

95251 - 53.74

95800 108.05 1,539.56

95801 95.32 2,509.69

95803 85.10 303.82

95805 153.58 770.35

95806 241.00 550.00

95807 215.27 768.13

95808 240.57 1,056.13

95810 420.90 1,088.00

95811 432.00 1,117.00

95812 101.70 522.41

95813 161.44 545.83

95816 102.33 483.67

95819 101.70 539.57

95822 101.70 504.70

95824 71.19 189.00

95827 103.40 928.05

95829 752.13 2,491.25

95830 - 280.00

95831 - 44.39

95832 - 52.52

95833 - 110.00

95834 - 125.00

95851 - 39.45

95852 - 42.00

95857 - 72.78

95860 118.95 169.71

95861 164.70 245.34

95863 210.45 297.46

95864 233.00 360.51

95865 132.50 172.50

95866 106.48 164.05

95867 109.80 150.98

95868 155.55 258.95

95869 64.05 143.00

95870 50.33 138.17

95872 207.50 282.80

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

233

*95873 34.80 96.29

*95874 33.94 91.31

95875 114.00 190.00

**95900 59.48 112.57

**95903 86.93 164.70

**95904 54.90 99.15

**95905 5.49 152.19

*95920 272.00 363.00

95921 83.26 135.40

95922 76.25 145.91

95923 85.81 260.76

95925 82.35 302.00

95926 78.00 270.90

95927 69.00 262.00

95928 144.00 373.85

95929 144.00 391.25

95930 48.68 239.43

95933 59.48 132.73

95934 70.00 100.01

95936 76.00 103.00

95937 62.29 112.00

95950 181.80 479.00

95951 491.66 1,194.00

95953 269.93 706.90

95954 230.87 511.90

95955 136.00 276.16

95956 321.19 1,672.37

95957 181.50 560.59

95958 469.07 758.75

95961 284.00 407.48

*95962 272.15 368.39

95965 665.22 5,370.14

95966 333.15 1,682.61

*95967 289.44 1,250.32

95970 - 61.25

95971 - 93.00

95972 - 160.00

*95973 - 94.00

95974 - 296.00

*95975 - 182.00

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

234

95978 - 357.50

*95979 - 176.41

95980 - 84.19

95981 - 45.00

95982 - 82.08

95990 - 125.07

95991 - 126.15

**95992 - 66.00

95999 - BR

96000 - 183.00

96001 - 218.00

96002 - 44.00

96003 - 40.00

96004 - 214.11

96020 274.78 BR

96040 - 58.08

96101 - 149.09

96102 - 105.08

96103 - 77.50

96105 - 174.19

96110 - 32.94

96111 - 212.93

96116 - 201.00

96118 - 216.50

96119 - 116.21

96120 - 119.01

96125 - 192.33

96150 - 48.00

96151 - 42.68

96152 - 40.73

96153 - 11.00

96154 - 40.18

96155 - 43.97

96360 - 104.00

*96361 - 30.00

96365 - 124.12

*96366 - 40.00

*96367 - 62.00

*96368 - 37.00

96369 - 284.49

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

235

*96370 - 28.00

*96371 - 135.65

96372 - 40.00

96373 - 30.06

96374 - 101.00

*96375 - 44.00

*96376 - 29.00

96379 - BR

96401 - 96.25

96402 - 54.90

96405 - 128.93

96406 - 175.44

96409 - 177.50

*96411 - 102.50

96413 - 247.07

*96415 - 56.47

96416 - 261.75

*96417 - 122.50

96420 - 178.05

96422 - 269.00

*96423 - 132.26

96425 - 286.12

96440 - 647.67

96446 - 312.86

96450 - 373.10

96521 - 221.69

96522 - 159.53

96523 - 41.25

96542 - 201.25

96549 - BR

96567 - 128.11

*96570 - 105.65

*96571 - 51.51

96900 - 31.00

96902 - 44.00

96904 - 101.25

96910 - 102.06

96912 - 131.54

96913 - 167.29

96920 - 224.25

ARIZONA PHYSICIANS’ FEE SCHEDULE

MEDICINE

$ Value $ Value

Code PC Total

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

All rights reserved.

236

96921 - 228.14

96922 - 310.00

96999 - BR