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ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
29
10021 $ 288.75 XXX
10022 $ 329.82 XXX
10030 $ 1,524.81 XXX
10035 RNE 0
10036 RNE ZZZ
10040 $ 184.65 10
10060 $ 222.06 10
10061 $ 428.17 10
10080 $ 322.54 10
10081 $ 489.97 10
10120 $ 288.13 10
10121 $ 593.06 10
10140 $ 297.72 10
10160 $ 238.63 10
10180 $ 561.59 10
11000 $ 127.74 0
11001 $ 62.00 ZZZ
11004 $ 1,341.40 0
11005 $ 1,813.48 0
11006 $ 1,625.72 0
11008 $ 715.00 ZZZ
11010 $ 1,119.72 10
11011 $ 1,207.85 0
11012 $ 1,625.55 0
11042 $ 271.64 0
11043 $ 534.52 0
11044 $ 732.51 0
11045 $ 97.37 ZZZ
11046 $ 194.74 ZZZ
11047 $ 350.53 ZZZ
11055 $ 100.49 0
11056 $ 131.86 0
11057 $ 148.70 0
11100 $ 189.31 0
11101 $ 74.12 ZZZ
11200 $ 182.92 10
11201 $ 44.13 ZZZ
11300 $ 169.74 0
11301 $ 232.43 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
30
11302 $ 287.11 0
11303 $ 335.94 0
11305 $ 183.60 0
11306 $ 248.05 0
11307 $ 291.01 0
11308 $ 340.59 0
11310 $ 199.23 0
11311 $ 253.30 0
11312 $ 312.50 0
11313 $ 402.35 0
11400 $ 239.10 10
11401 $ 285.07 10
11402 $ 312.31 10
11403 $ 358.96 10
11404 $ 428.13 10
11406 $ 567.54 10
11420 $ 248.65 10
11421 $ 303.47 10
11422 $ 365.16 10
11423 $ 445.58 10
11424 $ 530.77 10
11426 $ 672.70 10
11440 $ 293.30 10
11441 $ 368.93 10
11442 $ 421.74 10
11443 $ 508.53 10
11444 $ 621.35 10
11446 $ 760.88 10
11450 $ 812.82 90
11451 $ 1,032.12 90
11462 $ 789.58 90
11463 $ 1,048.55 90
11470 $ 876.71 90
11471 $ 1,083.63 90
11600 $ 350.49 10
11601 $ 416.11 10
11602 $ 457.04 10
11603 $ 515.42 10
11604 $ 599.08 10
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
31
11606 $ 819.04 10
11620 $ 372.26 10
11621 $ 494.28 10
11622 $ 580.71 10
11623 $ 682.90 10
11624 $ 769.85 10
11626 $ 930.00 10
11640 $ 453.79 10
11641 $ 539.13 10
11642 $ 615.54 10
11643 $ 727.47 10
11644 $ 897.11 10
11646 $ 1,175.61 10
11719 $ 32.93 0
11720 $ 72.98 0
11721 $ 106.82 0
11730 $ 204.72 0
11732 $ 86.73 ZZZ
11740 $ 112.61 0
11750 $ 485.52 10
11752 $ 737.80 10
11755 $ 302.22 0
11760 $ 497.69 10
11762 $ 641.22 10
11765 $ 297.45 10
11770 $ 503.42 10
11771 $ 1,221.33 90
11772 $ 1,482.62 90
11900 $ 107.97 0
11901 $ 132.83 0
11920 $ 404.31 0
11921 $ 616.76 0
11922 $ 314.06 ZZZ
11950 $ 179.88 0
11951 $ 327.00 0
11952 $ 555.00 0
11954 $ 385.94 0
11960 $ 2,029.42 90
11970 $ 1,466.91 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
32
11971 $ 896.05 90
11976 $ 298.10 0
11980 $ 230.63 0
11981 $ 288.85 XXX
11982 $ 339.96 XXX
11983 $ 510.68 XXX
12001 $ 219.00 0
12002 $ 278.00 0
12004 $ 327.00 0
12005 $ 390.79 0
12006 $ 459.78 0
12007 $ 534.51 0
12011 $ 251.75 0
12013 $ 282.72 0
12014 $ 331.58 0
12015 $ 398.99 0
12016 $ 490.28 0
12017 $ 603.69 0
12018 $ 657.00 0
12020 $ 513.79 10
12021 $ 358.02 10
12031 $ 432.45 10
12032 $ 553.36 10
12034 $ 584.76 10
12035 $ 696.87 10
12036 $ 779.89 10
12037 $ 889.56 10
12041 $ 468.67 10
12042 $ 529.91 10
12044 $ 655.75 10
12045 $ 738.67 10
12046 $ 871.84 10
12047 $ 983.38 10
12051 $ 500.67 10
12052 $ 546.27 10
12053 $ 661.07 10
12054 $ 741.53 10
12055 $ 911.42 10
12056 $ 1,057.51 10
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
33
12057 $ 1,398.51 10
13100 $ 516.76 10
13101 $ 722.64 10
13102 $ 276.77 ZZZ
13120 $ 638.89 10
13121 $ 816.71 10
13122 $ 292.96 ZZZ
13131 $ 702.89 10
13132 $ 995.66 10
13133 $ 369.58 ZZZ
13151 $ 812.63 10
13152 $ 1,151.55 10
13153 $ 439.46 ZZZ
13160 $ 1,485.61 90
14000 $ 1,326.25 90
14001 $ 1,684.07 90
14020 $ 1,483.15 90
14021 $ 1,854.67 90
14040 $ 1,622.48 90
14041 $ 2,007.49 90
14060 $ 1,655.11 90
14061 $ 2,160.38 90
14301 $ 2,363.48 90
14302 $ 848.00 ZZZ
14350 $ 1,492.28 90
15002 $ 720.75 0
15003 $ 176.83 ZZZ
15004 $ 918.50 0
15005 $ 297.94 ZZZ
15040 $ 510.56 0
15050 $ 1,037.11 90
15100 $ 1,643.78 90
15101 $ 421.40 ZZZ
15110 $ 1,833.82 90
15111 $ 272.00 ZZZ
15115 $ 1,771.85 90
15116 $ 380.87 ZZZ
15120 $ 1,819.78 90
15121 $ 558.75 ZZZ
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
34
15130 $ 1,469.73 90
15131 $ 224.23 ZZZ
15135 $ 1,903.88 90
15136 $ 222.00 ZZZ
15150 $ 1,498.59 90
15151 $ 293.00 ZZZ
15152 $ 366.00 ZZZ
15155 $ 1,595.00 90
15156 $ 407.00 ZZZ
15157 $ 444.00 ZZZ
15200 $ 1,586.74 90
15201 $ 341.97 ZZZ
15220 $ 1,536.10 90
15221 $ 358.00 ZZZ
15240 $ 1,992.09 90
15241 $ 447.27 ZZZ
15260 $ 2,156.70 90
15261 $ 575.87 ZZZ
15271 $ 384.13 0
15272 $ 78.89 ZZZ
15273 $ 676.72 0
15274 $ 162.68 ZZZ
15275 $ 367.02 0
15276 $ 97.71 ZZZ
15277 $ 736.41 0
15278 $ 195.21 ZZZ
15570 $ 1,953.93 90
15572 $ 1,896.77 90
15574 $ 1,952.85 90
15576 $ 1,721.00 90
15600 $ 690.31 90
15610 $ 760.01 90
15620 $ 938.10 90
15630 $ 985.02 90
15650 $ 1,078.05 90
15731 $ 2,415.87 90
15732 $ 2,780.87 90
15734 $ 3,221.71 90
15736 $ 2,830.63 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
35
15738 $ 3,006.35 90
15740 $ 2,176.45 90
15750 $ 1,986.37 90
15756 $ 5,291.00 90
15757 $ 5,291.00 90
15758 $ 5,291.00 90
15760 $ 1,824.76 90
15770 $ 1,462.01 90
15775 $ 673.54 0
15776 $ 1,110.54 0
15777 $ 514.28 ZZZ
15780 $ 1,798.97 90
15781 $ 1,087.16 90
15782 $ 1,205.21 90
15783 $ 836.12 90
15786 $ 446.45 10
15787 $ 111.01 ZZZ
15788 $ 1,022.46 90
15789 $ 1,233.02 90
15792 $ 966.51 90
15793 $ 1,094.60 90
15819 $ 1,859.18 90
15820 $ 1,207.65 90
15821 $ 1,288.91 90
15822 $ 983.23 90
15823 $ 1,293.68 90
15824 $ 1,762.75 0
15825 $ 1,889.94 0
15826 $ 1,498.65 0
15828 $ 4,345.23 0
15829 $ 4,565.78 0
15830 $ 2,529.78 90
15832 $ 1,992.19 90
15833 $ 1,868.78 90
15834 $ 1,914.89 90
15835 $ 2,012.54 90
15836 $ 1,672.94 90
15837 $ 1,823.27 90
15838 $ 1,229.57 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
36
15839 $ 1,887.98 90
15840 $ 2,389.44 90
15841 $ 3,472.22 90
15842 $ 5,618.00 90
15845 $ 2,440.14 90
15847 $ 1,636.30 YYY
15850 $ 243.65 XXX
15851 $ 238.36 0
15852 $ 174.62 0
15860 $ 271.15 0
15876 $ 856.25 0
15877 $ 1,431.25 0
15878 $ 856.25 0
15879 $ 1,431.25 0
15920 $ 1,296.53 90
15922 $ 1,683.18 90
15931 $ 1,382.50 90
15933 $ 1,826.67 90
15934 $ 1,838.86 90
15935 $ 2,361.11 90
15936 $ 1,913.60 90
15937 $ 2,270.14 90
15940 $ 1,506.17 90
15941 $ 1,938.14 90
15944 $ 1,918.74 90
15945 $ 2,100.08 90
15946 $ 3,526.25 90
15950 $ 1,137.33 90
15951 $ 1,698.03 90
15952 $ 1,757.07 90
15953 $ 2,072.31 90
15956 $ 2,465.54 90
15958 $ 2,645.52 90
15999 BR YYY
16000 $ 124.79 0
16020 $ 149.63 0
16025 $ 269.08 0
16030 $ 398.21 0
16035 $ 573.00 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
37
16036 $ 257.00 ZZZ
17000 $ 154.69 10
17003 $ 19.00 ZZZ
17004 $ 425.22 10
17106 $ 726.08 90
17107 $ 1,034.01 90
17108 $ 1,651.02 90
17110 $ 203.35 10
17111 $ 240.10 10
17250 $ 163.84 0
17260 $ 213.88 10
17261 $ 323.97 10
17262 $ 396.38 10
17263 $ 432.35 10
17264 $ 464.43 10
17266 $ 526.18 10
17270 $ 340.71 10
17271 $ 369.58 10
17272 $ 421.58 10
17273 $ 470.97 10
17274 $ 555.39 10
17276 $ 643.48 10
17280 $ 310.34 10
17281 $ 402.80 10
17282 $ 463.29 10
17283 $ 554.25 10
17284 $ 633.98 10
17286 $ 814.88 10
17311 $ 1,499.36 0
17312 $ 756.80 ZZZ
17313 $ 1,402.10 0
17314 $ 730.92 ZZZ
17315 $ 202.75 ZZZ
17340 $ 126.17 10
17360 $ 221.38 10
17380 $ 147.50 0
17999 BR YYY
19000 $ 240.15 0
19001 $ 58.94 ZZZ
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
38
19020 $ 896.73 90
19030 $ 303.06 0
19081 $ 1,256.09 0
19082 $ 1,056.93 ZZZ
19083 $ 1,224.14 0
19084 $ 1,016.86 ZZZ
19085 $ 1,459.07 0
19086 $ 1,543.78 ZZZ
19100 $ 275.10 0
19101 $ 680.18 10
19105 $ 3,976.14 0
19110 $ 1,034.31 90
19112 $ 977.29 90
19120 $ 1,055.22 90
19125 $ 1,170.23 90
19126 $ 387.14 ZZZ
19260 $ 2,597.99 90
19271 $ 3,517.82 90
19272 $ 3,869.79 90
19281 $ 452.20 0
19282 $ 317.62 ZZZ
19283 $ 590.68 0
19284 $ 383.40 ZZZ
19285 $ 891.71 0
19286 $ 785.31 ZZZ
19287 $ 1,601.03 0
19288 $ 1,313.98 ZZZ
19296 $ 8,545.45 0
19297 $ 236.00 ZZZ
19298 $ 2,740.91 0
19300 $ 1,174.02 90
19301 $ 1,401.35 90
19302 $ 2,058.00 90
19303 $ 2,283.30 90
19304 $ 1,291.87 90
19305 $ 2,563.96 90
19306 $ 2,738.70 90
19307 $ 2,702.40 90
19316 $ 1,812.03 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
39
19318 $ 2,436.75 90
19324 $ 1,116.24 90
19325 $ 1,522.00 90
19328 $ 980.21 90
19330 $ 1,335.23 90
19340 $ 2,165.89 90
19342 $ 1,990.25 90
19350 $ 1,681.92 90
19355 $ 1,488.61 90
19357 $ 3,246.58 90
19361 $ 3,602.53 90
19364 $ 5,958.26 90
19366 $ 3,423.26 90
19367 $ 3,901.65 90
19368 $ 4,834.39 90
19369 $ 4,548.53 90
19370 $ 1,441.50 90
19371 $ 1,647.24 90
19380 $ 1,667.44 90
19396 $ 486.33 0
19499 BR YYY
20005 $ 606.26 10
20100 $ 1,451.41 10
20101 $ 860.65 10
20102 $ 1,023.23 10
20103 $ 1,300.28 10
20150 $ 2,351.00 90
20200 $ 373.89 0
20205 $ 536.94 0
20206 $ 437.47 0
20220 $ 310.73 0
20225 $ 995.65 0
20240 $ 497.51 10
20245 $ 1,068.69 10
20250 $ 1,071.58 10
20251 $ 1,138.26 10
20500 $ 192.42 10
20501 $ 223.08 0
20520 $ 437.38 10
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
40
20525 $ 895.12 10
20526 $ 143.66 0
20527 $ 198.04 0
20550 $ 109.21 0
20551 $ 124.33 0
20552 $ 123.48 0
20553 $ 170.64 0
20555 $ 832.91 0
20600 $ 90.15 0
20604 $ 146.46 0
20605 $ 103.21 0
20606 $ 175.78 0
20610 $ 126.54 0
20611 $ 197.91 0
20612 $ 124.33 0
20615 $ 561.61 10
20650 $ 420.99 10
20660 $ 472.03 0
20661 $ 982.22 90
20662 $ 997.53 90
20663 $ 946.38 90
20664 $ 1,909.46 90
20665 $ 195.02 10
20670 $ 707.91 10
20680 $ 1,184.93 90
20690 $ 1,261.68 90
20692 $ 2,310.04 90
20693 $ 961.35 90
20694 $ 812.66 90
20696 $ 2,545.50 90
20697 $ 3,828.13 0
20802 $ 6,299.88 90
20805 $ 7,301.11 90
20808 $ 8,854.84 90
20816 $ 4,591.33 90
20822 $ 4,017.35 90
20824 $ 4,817.16 90
20827 $ 4,240.44 90
20838 $ 6,299.88 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
41
20900 $ 776.16 0
20902 $ 894.00 0
20910 $ 969.19 90
20912 $ 1,035.26 90
20920 $ 760.15 90
20922 $ 1,180.37 90
20924 $ 975.89 90
20926 $ 824.70 90
20930 $ 274.41 XXX
20931 $ 286.03 ZZZ
20936 BR XXX
20937 $ 482.00 ZZZ
20938 $ 529.00 ZZZ
20950 $ 469.34 0
20955 $ 6,700.00 90
20956 $ 6,330.00 90
20957 $ 6,558.00 90
20962 $ 5,508.49 90
20969 $ 6,498.75 90
20970 $ 6,437.85 90
20972 $ 6,253.40 90
20973 $ 6,683.56 90
20974 $ 309.43 0
20975 $ 540.00 0
20979 $ 155.58 0
20982 $ 6,884.60 0
20983 $ 13,802.30 0
20985 $ 353.26 ZZZ
20999 BR YYY
21010 $ 1,640.93 90
21011 $ 746.59 90
21012 $ 763.44 90
21013 $ 1,113.13 90
21014 $ 1,179.03 90
21015 $ 1,528.86 90
21016 $ 2,411.21 90
21025 $ 1,865.55 90
21026 $ 1,340.55 90
21029 $ 1,655.25 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
42
21030 $ 1,183.94 90
21031 $ 857.09 90
21032 $ 869.70 90
21034 $ 2,853.15 90
21040 $ 1,135.34 90
21044 $ 1,948.17 90
21045 $ 3,383.11 90
21046 $ 2,214.48 90
21047 $ 2,875.08 90
21048 $ 2,275.12 90
21049 $ 2,626.06 90
21050 $ 1,939.88 90
21060 $ 1,824.52 90
21070 $ 1,626.88 90
21073 $ 763.94 90
21076 $ 2,391.59 10
21077 $ 6,808.09 90
21079 $ 3,732.34 90
21080 $ 4,494.20 90
21081 $ 4,523.15 90
21082 $ 3,712.54 90
21083 $ 3,536.05 90
21084 $ 4,142.99 90
21085 $ 1,867.62 10
21086 $ 4,146.43 90
21087 $ 4,784.35 90
21088 $ 1,665.39 90
21089 BR YYY
21100 $ 2,025.34 90
21110 $ 1,647.85 90
21116 $ 283.37 0
21120 $ 1,353.87 90
21121 $ 1,747.62 90
21122 $ 1,765.19 90
21123 $ 2,145.82 90
21125 $ 5,608.73 90
21127 $ 7,937.24 90
21137 $ 1,675.62 90
21138 $ 2,094.01 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
43
21139 $ 2,443.97 90
21141 $ 3,003.20 90
21142 $ 3,127.09 90
21143 $ 3,252.72 90
21145 $ 3,529.66 90
21146 $ 3,825.17 90
21147 $ 4,064.50 90
21150 $ 3,975.63 90
21151 $ 4,613.73 90
21154 $ 4,975.47 90
21155 $ 5,545.90 90
21159 $ 6,578.86 90
21160 $ 7,083.95 90
21172 $ 4,597.80 90
21175 $ 5,544.03 90
21179 $ 3,398.46 90
21180 $ 3,827.85 90
21181 $ 1,600.40 90
21182 $ 4,603.76 90
21183 $ 5,121.63 90
21184 $ 5,213.51 90
21188 $ 3,589.19 90
21193 $ 2,951.09 90
21194 $ 3,819.90 90
21195 $ 3,364.78 90
21196 $ 3,620.02 90
21198 $ 2,596.08 90
21199 $ 2,841.00 90
21206 $ 2,642.32 90
21208 $ 3,661.12 90
21209 $ 1,945.60 90
21210 $ 4,441.47 90
21215 $ 7,607.04 90
21230 $ 1,809.03 90
21235 $ 1,568.09 90
21240 $ 2,607.63 90
21242 $ 2,614.51 90
21243 $ 3,703.96 90
21244 $ 2,554.81 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
44
21245 $ 2,388.89 90
21246 $ 2,329.33 90
21247 $ 3,818.94 90
21248 $ 2,415.40 90
21249 $ 3,571.59 90
21255 $ 2,940.31 90
21256 $ 3,347.94 90
21260 $ 3,640.96 90
21261 $ 5,799.65 90
21263 $ 5,687.16 90
21267 $ 3,909.65 90
21268 $ 5,102.09 90
21270 $ 2,071.96 90
21275 $ 1,810.10 90
21280 $ 1,286.81 90
21282 $ 915.05 90
21295 $ 613.10 90
21296 $ 1,074.46 90
21299 BR YYY
21310 $ 247.60 0
21315 $ 516.79 10
21320 $ 598.59 10
21325 $ 1,012.35 90
21330 $ 1,283.40 90
21335 $ 1,798.00 90
21336 $ 1,392.07 90
21337 $ 732.79 90
21338 $ 1,646.95 90
21339 $ 1,910.52 90
21340 $ 1,897.00 90
21343 $ 2,623.54 90
21344 $ 3,454.34 90
21345 $ 1,761.37 90
21346 $ 2,008.42 90
21347 $ 2,503.80 90
21348 $ 2,769.00 90
21355 $ 1,119.94 10
21356 $ 1,179.67 10
21360 $ 1,324.00 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
45
21365 $ 2,432.29 90
21366 $ 2,870.96 90
21385 $ 1,599.00 90
21386 $ 1,783.00 90
21387 $ 1,998.00 90
21390 $ 2,072.00 90
21395 $ 2,438.08 90
21400 $ 373.62 90
21401 $ 1,046.88 90
21406 $ 1,482.77 90
21407 $ 1,668.46 90
21408 $ 2,074.13 90
21421 $ 1,785.31 90
21422 $ 1,708.00 90
21423 $ 2,040.39 90
21431 $ 1,677.73 90
21432 $ 1,807.00 90
21433 $ 3,765.00 90
21435 $ 2,986.19 90
21436 $ 4,464.49 90
21440 $ 1,479.59 90
21445 $ 1,873.17 90
21450 $ 1,196.35 90
21451 $ 1,651.37 90
21452 $ 1,128.41 90
21453 $ 1,856.27 90
21454 $ 1,393.25 90
21461 $ 4,129.04 90
21462 $ 4,384.81 90
21465 $ 2,086.20 90
21470 $ 2,685.05 90
21480 $ 257.81 0
21485 $ 1,527.85 90
21490 $ 1,996.46 90
21495 $ 1,729.69 90
21497 $ 1,601.97 90
21499 BR YYY
21501 $ 971.69 90
21502 $ 1,120.31 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
46
21510 $ 959.48 90
21550 $ 488.84 10
21552 $ 1,012.08 90
21554 $ 1,652.98 90
21555 $ 830.73 90
21556 $ 1,143.52 90
21557 $ 2,072.49 90
21558 $ 3,142.81 90
21600 $ 1,203.34 90
21610 $ 2,630.05 90
21615 $ 1,677.65 90
21616 $ 2,099.61 90
21620 $ 1,371.02 90
21627 $ 1,168.11 90
21630 $ 2,801.58 90
21632 $ 3,219.30 90
21685 $ 1,958.43 90
21700 $ 939.00 90
21705 $ 1,363.03 90
21720 $ 1,055.23 90
21725 $ 1,157.03 90
21740 $ 2,927.00 90
21742 $ 3,623.08 90
21743 $ 4,349.48 90
21750 $ 1,728.83 90
21811 $ 1,307.52 0
21812 $ 1,566.47 0
21813 $ 2,149.82 0
21820 $ 308.72 90
21825 $ 1,193.08 90
21899 BR YYY
21920 $ 467.65 10
21925 $ 851.33 90
21930 $ 905.31 90
21931 $ 1,065.14 90
21932 $ 1,502.80 90
21933 $ 1,670.87 90
21935 $ 2,236.34 90
21936 $ 3,273.03 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
47
22010 $ 2,068.65 90
22015 $ 2,014.00 90
22100 $ 1,989.51 90
22101 $ 1,814.76 90
22102 $ 1,714.69 90
22103 $ 365.16 ZZZ
22110 $ 2,272.13 90
22112 $ 2,415.33 90
22114 $ 2,155.28 90
22116 $ 360.41 ZZZ
22206 $ 5,371.72 90
22207 $ 5,381.66 90
22208 $ 1,384.33 ZZZ
22210 $ 3,889.18 90
22212 $ 3,220.67 90
22214 $ 3,219.17 90
22216 $ 913.28 ZZZ
22220 $ 3,476.39 90
22222 $ 3,386.08 90
22224 $ 3,431.21 90
22226 $ 914.55 ZZZ
22305 $ 409.81 90
22310 $ 662.31 90
22315 $ 1,910.35 90
22318 $ 3,739.25 90
22319 $ 4,155.37 90
22325 $ 3,118.10 90
22326 $ 3,284.18 90
22327 $ 3,275.30 90
22328 $ 725.20 ZZZ
22505 $ 302.27 10
22510 $ 3,348.65 10
22511 $ 3,315.40 10
22512 $ 1,880.06 ZZZ
22513 $ 13,930.00 10
22514 $ 13,914.70 10
22515 $ 8,509.55 ZZZ
22526 $ 5,056.91 10
22527 $ 3,721.58 ZZZ
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
48
22532 $ 4,059.00 90
22533 $ 3,785.00 90
22534 $ 891.67 ZZZ
22548 $ 4,580.00 90
22551 $ 4,600.44 90
22552 $ 1,078.12 ZZZ
22554 $ 4,277.00 90
22556 $ 4,000.00 90
22558 $ 4,444.00 90
22585 $ 852.80 ZZZ
22586 $ 4,319.81 90
22590 $ 3,471.52 90
22595 $ 5,394.00 90
22600 $ 3,667.00 90
22610 $ 3,832.00 90
22612 $ 4,000.00 90
22614 $ 1,058.00 ZZZ
22630 $ 4,600.00 90
22632 $ 870.13 ZZZ
22633 $ 4,247.59 90
22634 $ 1,221.79 ZZZ
22800 $ 4,369.00 90
22802 $ 4,819.67 90
22804 $ 5,879.00 90
22808 $ 4,012.57 90
22810 $ 4,415.31 90
22812 $ 5,023.30 90
22818 $ 4,870.55 90
22819 $ 6,083.87 90
22830 $ 1,861.68 90
22840 $ 1,918.80 ZZZ
22841 BR XXX
22842 $ 3,837.60 ZZZ
22843 $ 1,992.75 ZZZ
22844 $ 2,395.13 ZZZ
22845 $ 1,873.86 ZZZ
22846 $ 1,978.00 ZZZ
22847 $ 2,198.00 ZZZ
22848 $ 900.47 ZZZ
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
49
22849 $ 2,993.75 90
22850 $ 1,605.29 90
22851 $ 1,052.24 ZZZ
22852 $ 2,360.00 90
22855 $ 2,597.97 90
22856 $ 3,791.70 90
22857 $ 4,054.98 90
22858 $ 1,368.90 ZZZ
22861 $ 4,987.86 90
22862 $ 4,483.00 90
22864 $ 4,576.27 90
22865 $ 4,455.80 90
22899 BR YYY
22900 $ 1,217.37 90
22901 $ 1,500.16 90
22902 $ 941.11 90
22903 $ 987.72 90
22904 $ 2,446.53 90
22905 $ 3,088.58 90
22999 BR YYY
23000 $ 1,256.90 90
23020 $ 1,481.06 90
23030 $ 867.83 10
23031 $ 797.26 10
23035 $ 1,511.92 90
23040 $ 1,550.54 90
23044 $ 1,228.15 90
23065 $ 530.97 10
23066 $ 1,061.79 90
23071 $ 949.35 90
23073 $ 1,563.39 90
23075 $ 894.19 90
23076 $ 1,163.41 90
23077 $ 2,576.00 90
23078 $ 3,339.75 90
23100 $ 1,208.30 90
23101 $ 1,162.46 90
23105 $ 1,493.21 90
23106 $ 1,178.63 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
50
23107 $ 1,472.06 90
23120 $ 1,255.60 90
23125 $ 1,702.65 90
23130 $ 1,315.35 90
23140 $ 1,140.99 90
23145 $ 1,500.39 90
23146 $ 1,338.31 90
23150 $ 1,488.37 90
23155 $ 1,713.17 90
23156 $ 1,460.54 90
23170 $ 1,201.76 90
23172 $ 1,222.01 90
23174 $ 1,646.90 90
23180 $ 1,435.61 90
23182 $ 1,408.51 90
23184 $ 1,611.23 90
23190 $ 1,227.88 90
23195 $ 1,776.38 90
23200 $ 3,091.01 90
23210 $ 3,761.18 90
23220 $ 4,022.80 90
23330 $ 576.92 10
23333 $ 1,421.35 90
23334 $ 2,380.03 90
23335 $ 2,799.54 90
23350 $ 240.98 0
23395 $ 2,525.80 90
23397 $ 2,519.63 90
23400 $ 2,165.59 90
23405 $ 1,344.04 90
23406 $ 1,678.06 90
23410 $ 1,859.99 90
23412 $ 2,022.88 90
23415 $ 1,503.80 90
23420 $ 2,248.65 90
23430 $ 1,644.53 90
23440 $ 1,627.33 90
23450 $ 2,119.72 90
23455 $ 2,328.10 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
51
23460 $ 2,444.42 90
23462 $ 2,422.25 90
23465 $ 2,455.38 90
23466 $ 2,500.96 90
23470 $ 2,699.99 90
23472 $ 3,445.94 90
23473 $ 3,669.49 90
23474 $ 3,972.72 90
23480 $ 1,774.69 90
23485 $ 2,063.73 90
23490 $ 1,648.58 90
23491 $ 2,000.76 90
23500 $ 468.13 90
23505 $ 727.21 90
23515 $ 1,551.02 90
23520 $ 488.59 90
23525 $ 728.60 90
23530 $ 1,251.30 90
23532 $ 1,371.94 90
23540 $ 431.96 90
23545 $ 649.09 90
23550 $ 1,440.00 90
23552 $ 1,566.00 90
23570 $ 443.66 90
23575 $ 766.58 90
23585 $ 2,115.55 90
23600 $ 623.71 90
23605 $ 995.60 90
23615 $ 1,991.00 90
23616 $ 3,953.00 90
23620 $ 514.95 90
23625 $ 728.52 90
23630 $ 1,685.92 90
23650 $ 652.30 90
23655 $ 863.02 90
23660 $ 1,404.00 90
23665 $ 815.16 90
23670 $ 1,890.72 90
23675 $ 1,060.12 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
52
23680 $ 2,055.69 90
23700 $ 454.50 10
23800 $ 2,364.08 90
23802 $ 2,797.26 90
23900 $ 3,050.92 90
23920 $ 2,479.74 90
23921 $ 999.41 90
23929 BR YYY
23930 $ 692.76 10
23931 $ 639.41 10
23935 $ 1,090.11 90
24000 $ 1,160.07 90
24006 $ 1,593.17 90
24065 $ 475.84 10
24066 $ 1,193.31 90
24071 $ 919.58 90
24073 $ 1,561.13 90
24075 $ 937.00 90
24076 $ 1,169.68 90
24077 $ 2,332.62 90
24079 $ 3,078.38 90
24100 $ 900.97 90
24101 $ 1,187.55 90
24102 $ 1,439.99 90
24105 $ 754.42 90
24110 $ 1,268.28 90
24115 $ 1,593.26 90
24116 $ 1,863.40 90
24120 $ 1,137.52 90
24125 $ 1,330.69 90
24126 $ 1,400.38 90
24130 $ 1,094.74 90
24134 $ 1,613.29 90
24136 $ 1,452.66 90
24138 $ 1,506.03 90
24140 $ 1,526.95 90
24145 $ 1,276.72 90
24147 $ 1,341.99 90
24149 $ 2,551.86 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
53
24150 $ 3,520.51 90
24152 $ 2,933.14 90
24155 $ 1,868.66 90
24160 $ 2,336.02 90
24164 $ 1,508.33 90
24200 $ 408.04 10
24201 $ 1,053.81 90
24220 $ 296.43 0
24300 $ 897.57 90
24301 $ 1,878.00 90
24305 $ 1,241.49 90
24310 $ 1,015.30 90
24320 $ 1,755.90 90
24330 $ 1,550.20 90
24331 $ 1,754.01 90
24332 $ 1,319.99 90
24340 $ 1,415.82 90
24341 $ 1,631.62 90
24342 $ 1,716.02 90
24343 $ 1,520.22 90
24344 $ 2,372.15 90
24345 $ 1,521.93 90
24346 $ 2,370.45 90
24357 $ 1,003.87 90
24358 $ 1,188.49 90
24359 $ 1,487.48 90
24360 $ 2,158.99 90
24361 $ 2,265.67 90
24362 $ 2,404.60 90
24363 $ 3,535.00 90
24365 $ 1,375.72 90
24366 $ 1,570.10 90
24370 $ 3,471.54 90
24371 $ 4,013.79 90
24400 $ 1,785.92 90
24410 $ 2,442.20 90
24420 $ 2,235.59 90
24430 $ 2,333.17 90
24435 $ 2,405.26 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
54
24470 $ 1,427.25 90
24495 $ 1,411.21 90
24498 $ 1,871.99 90
24500 $ 685.28 90
24505 $ 1,071.30 90
24515 $ 1,889.77 90
24516 $ 1,962.32 90
24530 $ 727.85 90
24535 $ 1,180.10 90
24538 $ 1,604.98 90
24545 $ 2,031.86 90
24546 $ 2,968.00 90
24560 $ 612.25 90
24565 $ 1,018.53 90
24566 $ 1,501.12 90
24575 $ 1,582.58 90
24576 $ 618.56 90
24577 $ 1,049.30 90
24579 $ 1,801.87 90
24582 $ 1,663.56 90
24586 $ 2,411.25 90
24587 $ 2,455.02 90
24600 $ 696.79 90
24605 $ 905.13 90
24615 $ 1,561.91 90
24620 $ 1,178.67 90
24635 $ 1,711.71 90
24640 $ 340.00 10
24650 $ 498.91 90
24655 $ 832.32 90
24665 $ 1,402.97 90
24666 $ 1,609.30 90
24670 $ 556.50 90
24675 $ 933.97 90
24685 $ 1,425.96 90
24800 $ 2,310.00 90
24802 $ 2,610.00 90
24900 $ 1,575.75 90
24920 $ 1,580.72 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
55
24925 $ 1,026.43 90
24930 $ 1,666.92 90
24931 $ 1,794.52 90
24935 $ 2,331.72 90
24940 $ 2,078.51 90
24999 BR YYY
25000 $ 736.90 90
25001 $ 737.39 90
25020 $ 1,236.44 90
25023 $ 2,124.01 90
25024 $ 1,675.15 90
25025 $ 2,636.39 90
25028 $ 1,037.11 90
25031 $ 694.82 90
25035 $ 1,168.61 90
25040 $ 1,211.72 90
25065 $ 471.29 10
25066 $ 771.19 90
25071 $ 963.82 90
25073 $ 1,201.59 90
25075 $ 912.27 90
25076 $ 1,108.76 90
25077 $ 1,995.76 90
25078 $ 2,718.11 90
25085 $ 988.61 90
25100 $ 763.04 90
25101 $ 891.79 90
25105 $ 1,076.78 90
25107 $ 1,326.38 90
25109 $ 1,158.16 90
25110 $ 746.42 90
25111 $ 688.06 90
25112 $ 840.42 90
25115 $ 1,667.88 90
25116 $ 1,340.02 90
25118 $ 858.99 90
25119 $ 1,132.45 90
25120 $ 1,105.60 90
25125 $ 1,314.83 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
56
25126 $ 1,312.32 90
25130 $ 987.96 90
25135 $ 1,231.29 90
25136 $ 1,083.22 90
25145 $ 1,201.39 90
25150 $ 1,230.72 90
25151 $ 1,274.54 90
25170 $ 3,119.14 90
25210 $ 1,048.20 90
25215 $ 1,372.79 90
25230 $ 931.50 90
25240 $ 935.29 90
25246 $ 299.03 0
25248 $ 908.48 90
25250 $ 1,215.91 90
25251 $ 3,285.00 90
25259 $ 894.57 90
25260 $ 1,386.90 90
25263 $ 1,358.14 90
25265 $ 1,646.63 90
25270 $ 1,073.89 90
25272 $ 1,216.28 90
25274 $ 1,468.12 90
25275 $ 1,445.88 90
25280 $ 1,242.45 90
25290 $ 978.30 90
25295 $ 1,141.51 90
25300 $ 1,506.72 90
25301 $ 1,403.34 90
25310 $ 1,357.95 90
25312 $ 1,573.78 90
25315 $ 1,696.55 90
25316 $ 2,042.00 90
25320 $ 2,126.99 90
25332 $ 1,857.41 90
25335 $ 2,153.00 90
25337 $ 1,917.35 90
25350 $ 1,478.04 90
25355 $ 1,856.00 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
57
25360 $ 1,424.98 90
25365 $ 2,014.88 90
25370 $ 2,177.14 90
25375 $ 2,067.98 90
25390 $ 1,695.81 90
25391 $ 2,195.32 90
25392 $ 2,221.73 90
25393 $ 2,502.45 90
25394 $ 1,700.94 90
25400 $ 1,896.00 90
25405 $ 2,286.93 90
25415 $ 2,093.87 90
25420 $ 2,591.66 90
25425 $ 2,124.70 90
25426 $ 2,480.86 90
25430 $ 1,577.93 90
25431 $ 1,689.38 90
25440 $ 1,696.27 90
25441 $ 2,032.91 90
25442 $ 1,726.98 90
25443 $ 1,718.78 90
25444 $ 1,792.67 90
25445 $ 1,618.34 90
25446 $ 2,772.67 90
25447 $ 1,833.13 90
25449 $ 2,108.69 90
25450 $ 1,242.66 90
25455 $ 1,480.00 90
25490 $ 1,359.55 90
25491 $ 1,430.64 90
25492 $ 1,953.33 90
25500 $ 527.57 90
25505 $ 962.72 90
25515 $ 1,470.53 90
25520 $ 1,212.31 90
25525 $ 2,203.00 90
25526 $ 3,612.00 90
25530 $ 561.20 90
25535 $ 937.86 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
58
25545 $ 1,375.76 90
25560 $ 593.02 90
25565 $ 1,114.63 90
25574 $ 1,531.00 90
25575 $ 1,956.76 90
25600 $ 680.22 90
25605 $ 1,051.16 90
25606 $ 1,483.55 90
25607 $ 1,622.01 90
25608 $ 1,821.30 90
25609 $ 2,319.05 90
25622 $ 649.84 90
25624 $ 912.98 90
25628 $ 1,472.45 90
25630 $ 653.59 90
25635 $ 920.95 90
25645 $ 1,225.76 90
25650 $ 711.79 90
25651 $ 1,038.53 90
25652 $ 1,343.55 90
25660 $ 784.94 90
25670 $ 1,298.45 90
25671 $ 1,142.57 90
25675 $ 834.01 90
25676 $ 1,350.24 90
25680 $ 904.47 90
25685 $ 1,618.95 90
25690 $ 1,021.57 90
25695 $ 1,399.43 90
25800 $ 1,654.17 90
25805 $ 2,155.00 90
25810 $ 2,155.00 90
25820 $ 1,375.11 90
25825 $ 1,679.03 90
25830 $ 2,045.86 90
25900 $ 1,523.00 90
25905 $ 1,491.80 90
25907 $ 1,151.96 90
25909 $ 1,480.18 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
59
25915 $ 2,433.14 90
25920 $ 1,499.58 90
25922 $ 1,132.45 90
25924 $ 1,444.67 90
25927 $ 1,747.23 90
25929 $ 1,106.39 90
25931 $ 1,575.89 90
25999 BR YYY
26010 $ 488.19 10
26011 $ 805.90 10
26020 $ 933.60 90
26025 $ 918.20 90
26030 $ 1,116.88 90
26034 $ 1,158.17 90
26035 $ 1,874.26 90
26037 $ 1,500.00 90
26040 $ 669.53 90
26045 $ 1,020.40 90
26055 $ 1,134.91 90
26060 $ 566.85 90
26070 $ 692.42 90
26075 $ 725.92 90
26080 $ 838.90 90
26100 $ 725.82 90
26105 $ 743.46 90
26110 $ 689.49 90
26111 $ 941.09 90
26113 $ 1,233.59 90
26115 $ 964.14 90
26116 $ 1,135.47 90
26117 $ 1,697.09 90
26118 $ 2,468.51 90
26121 $ 1,407.00 90
26123 $ 1,822.71 90
26125 $ 662.32 ZZZ
26130 $ 1,012.30 90
26135 $ 1,207.88 90
26140 $ 1,106.37 90
26145 $ 1,133.46 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
60
26160 $ 1,094.45 90
26170 $ 872.36 90
26180 $ 953.09 90
26185 $ 1,171.43 90
26200 $ 983.11 90
26205 $ 1,318.72 90
26210 $ 951.59 90
26215 $ 1,236.69 90
26230 $ 1,075.46 90
26235 $ 1,061.96 90
26236 $ 950.02 90
26250 $ 2,156.30 90
26260 $ 1,736.40 90
26262 $ 1,365.02 90
26320 $ 764.89 90
26340 $ 716.74 90
26341 $ 234.87 10
26350 $ 1,519.53 90
26352 $ 1,732.46 90
26356 $ 2,162.50 90
26357 $ 1,881.75 90
26358 $ 1,986.25 90
26370 $ 1,636.79 90
26372 $ 1,884.95 90
26373 $ 1,773.78 90
26390 $ 1,737.86 90
26392 $ 2,065.84 90
26410 $ 1,104.54 90
26412 $ 1,462.32 90
26415 $ 1,629.13 90
26416 $ 1,854.95 90
26418 $ 1,105.18 90
26420 $ 1,450.00 90
26426 $ 1,109.86 90
26428 $ 1,600.03 90
26432 $ 1,058.08 90
26433 $ 1,141.40 90
26434 $ 1,374.51 90
26437 $ 1,321.13 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
61
26440 $ 1,299.50 90
26442 $ 1,831.42 90
26445 $ 1,236.97 90
26449 $ 1,519.71 90
26450 $ 862.00 90
26455 $ 858.20 90
26460 $ 833.04 90
26471 $ 1,300.96 90
26474 $ 1,147.76 90
26476 $ 1,111.31 90
26477 $ 1,109.95 90
26478 $ 1,255.83 90
26479 $ 1,253.45 90
26480 $ 1,591.20 90
26483 $ 1,791.95 90
26485 $ 1,715.40 90
26489 $ 1,980.85 90
26490 $ 1,691.91 90
26492 $ 1,877.17 90
26494 $ 1,734.15 90
26496 $ 1,832.20 90
26497 $ 1,843.64 90
26498 $ 2,472.15 90
26499 $ 1,845.05 90
26500 $ 1,291.30 90
26502 $ 1,503.34 90
26508 $ 1,347.08 90
26510 $ 1,301.58 90
26516 $ 1,481.99 90
26517 $ 1,753.23 90
26518 $ 1,798.79 90
26520 $ 1,395.27 90
26525 $ 1,380.68 90
26530 $ 1,166.09 90
26531 $ 1,357.41 90
26535 $ 925.21 90
26536 $ 1,509.37 90
26540 $ 1,392.26 90
26541 $ 1,706.06 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
62
26542 $ 1,468.53 90
26545 $ 1,487.92 90
26546 $ 2,098.29 90
26548 $ 1,610.17 90
26550 $ 3,515.73 90
26551 $ 7,009.36 90
26553 $ 6,535.52 90
26554 $ 7,788.42 90
26555 $ 2,622.86 90
26556 $ 6,825.23 90
26560 $ 1,288.92 90
26561 $ 2,025.40 90
26562 $ 2,845.89 90
26565 $ 1,441.12 90
26567 $ 1,424.50 90
26568 $ 1,874.46 90
26580 $ 3,420.99 90
26587 $ 1,806.20 90
26590 $ 2,646.88 90
26591 $ 955.00 90
26593 $ 1,237.81 90
26596 $ 1,626.47 90
26600 $ 561.51 90
26605 $ 619.52 90
26607 $ 981.30 90
26608 $ 1,024.44 90
26615 $ 1,241.22 90
26641 $ 710.70 90
26645 $ 911.48 90
26650 $ 1,057.13 90
26665 $ 1,367.39 90
26670 $ 646.01 90
26675 $ 867.17 90
26676 $ 962.49 90
26685 $ 1,242.31 90
26686 $ 1,380.74 90
26700 $ 614.85 90
26705 $ 797.62 90
26706 $ 934.34 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
63
26715 $ 1,231.07 90
26720 $ 378.38 90
26725 $ 644.75 90
26727 $ 902.27 90
26735 $ 1,285.02 90
26740 $ 490.96 90
26742 $ 785.50 90
∆26746 Open treatment
of articular fracture,
involving
metacarpophalangeal or
interphalangeal joint,
with or without internal
or external fixation, each.
$ 1,450.88 90
26750 $ 351.60 90
26755 $ 600.81 90
26756 $ 801.67 90
26765 $ 972.36 90
26770 $ 523.20 90
26775 $ 731.76 90
26776 $ 851.14 90
26785 $ 1,054.19 90
26820 $ 1,673.75 90
26841 $ 1,539.02 90
26842 $ 1,668.76 90
26843 $ 1,570.09 90
26844 $ 1,723.97 90
26850 $ 1,466.87 90
26852 $ 1,685.98 90
26860 $ 1,180.27 90
26861 $ 316.00 ZZZ
26862 $ 1,540.24 90
26863 $ 582.33 ZZZ
26910 $ 1,524.23 90
26951 $ 1,321.91 90
26952 $ 1,368.21 90
26989 BR YYY
26990 $ 1,205.65 90
26991 $ 1,346.70 90
26992 $ 1,852.72 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
64
27000 $ 789.92 90
27001 $ 1,036.42 90
27003 $ 1,293.43 90
27005 $ 1,427.08 90
27006 $ 1,560.76 90
27025 $ 1,967.77 90
27027 $ 1,929.05 90
27030 $ 2,049.04 90
27033 $ 2,144.54 90
27035 $ 2,391.15 90
27036 $ 2,213.99 90
27040 $ 636.40 10
27041 $ 1,324.87 90
27043 $ 1,065.39 90
27045 $ 1,684.04 90
27047 $ 896.39 90
27048 $ 1,307.69 90
27049 $ 3,024.83 90
27050 $ 861.21 90
27052 $ 1,350.44 90
27054 $ 1,920.00 90
27057 $ 2,194.92 90
27059 $ 4,179.59 90
27060 $ 1,000.18 90
27062 $ 928.49 90
27065 $ 1,099.92 90
27066 $ 1,747.93 90
27067 $ 2,269.35 90
27070 $ 1,637.91 90
27071 $ 1,974.18 90
27075 $ 4,552.02 90
27076 $ 5,502.14 90
27077 $ 6,166.38 90
27078 $ 3,760.88 90
27080 $ 1,108.43 90
27086 $ 540.20 10
27087 $ 1,209.00 90
27090 $ 1,832.12 90
27091 $ 3,853.28 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
65
27093 $ 347.13 0
27095 $ 569.71 0
27096 $ 532.40 0
27097 $ 1,312.96 90
27098 $ 1,532.70 90
27100 $ 1,833.85 90
27105 $ 1,929.15 90
27110 $ 2,164.14 90
27111 $ 2,006.88 90
27120 $ 2,909.83 90
27122 $ 2,526.48 90
27125 $ 3,129.00 90
27130 $ 4,281.00 90
27132 $ 3,912.51 90
27134 $ 4,623.00 90
27137 $ 3,445.72 90
27138 $ 3,519.02 90
27140 $ 1,978.67 90
27146 $ 2,781.19 90
27147 $ 3,218.78 90
27151 $ 3,477.89 90
27156 $ 3,747.72 90
27158 $ 3,094.37 90
27161 $ 2,685.59 90
27165 $ 3,035.24 90
27170 $ 2,666.49 90
27175 $ 1,466.96 90
27176 $ 2,140.64 90
27177 $ 2,491.81 90
27178 $ 2,207.97 90
27179 $ 2,121.04 90
27181 $ 2,555.87 90
27185 $ 1,196.15 90
27187 $ 3,005.15 90
27193 $ 1,012.91 90
27194 $ 1,526.23 90
27200 $ 372.98 90
27202 $ 1,062.87 90
27215 $ 2,025.00 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
66
27216 $ 3,520.00 90
27217 $ 3,500.00 90
27218 $ 5,012.00 90
27220 $ 1,022.97 90
27222 $ 1,895.45 90
27226 $ 3,094.00 90
27227 $ 7,294.00 90
27228 $ 9,531.00 90
27230 $ 914.86 90
27232 $ 1,631.13 90
27235 $ 2,430.00 90
27236 $ 2,744.09 90
27238 $ 887.12 90
27240 $ 2,071.47 90
27244 $ 2,720.47 90
27245 $ 3,584.00 90
27246 $ 742.35 90
27248 $ 1,621.04 90
27250 $ 654.96 0
27252 $ 1,472.77 90
27253 $ 2,097.31 90
27254 $ 2,859.76 90
27256 $ 828.31 10
27257 $ 1,348.00 10
27258 $ 2,457.86 90
27259 $ 3,396.79 90
27265 $ 827.36 90
27266 $ 1,171.33 90
27267 $ 989.61 90
27268 $ 1,222.11 90
27269 $ 2,812.28 90
27275 $ 544.00 10
27279 $ 1,390.82 90
27280 $ 2,575.09 90
27282 $ 2,046.00 90
27284 $ 3,551.90 90
27286 $ 3,705.05 90
27290 $ 4,694.00 90
27295 $ 2,862.54 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
67
27299 BR YYY
27301 $ 1,279.06 90
27303 $ 1,344.11 90
27305 $ 1,035.26 90
27306 $ 686.40 90
27307 $ 905.93 90
27310 $ 1,610.10 90
27323 $ 503.79 10
27324 $ 764.55 90
27325 $ 1,242.00 90
27326 $ 1,174.00 90
27327 $ 878.46 90
27328 $ 1,319.25 90
27329 $ 2,238.12 90
27330 $ 1,126.98 90
27331 $ 1,266.00 90
27332 $ 1,547.79 90
27333 $ 1,920.00 90
27334 $ 1,716.28 90
27335 $ 1,977.00 90
27337 $ 950.42 90
27339 $ 1,700.03 90
27340 $ 874.87 90
27345 $ 1,079.14 90
27347 $ 1,140.05 90
27350 $ 1,466.60 90
27355 $ 1,343.36 90
27356 $ 1,622.87 90
27357 $ 1,783.27 90
27358 $ 967.19 ZZZ
27360 $ 1,835.47 90
27364 $ 3,612.11 90
27365 $ 4,016.31 90
27370 $ 286.02 0
27372 $ 1,268.48 90
27380 $ 1,312.66 90
27381 $ 1,772.50 90
27385 $ 1,329.69 90
27386 $ 1,869.86 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
68
27390 $ 972.32 90
27391 $ 1,258.95 90
27392 $ 1,571.40 90
27393 $ 1,092.16 90
27394 $ 1,389.01 90
27395 $ 1,900.69 90
27396 $ 1,539.10 90
27397 $ 2,030.67 90
27400 $ 1,562.98 90
27403 $ 1,617.50 90
27405 $ 1,532.34 90
27407 $ 1,795.64 90
27409 $ 2,190.20 90
27412 $ 3,951.00 90
27415 $ 3,298.00 90
27416 $ 2,215.27 90
27418 $ 2,026.89 90
27420 $ 1,800.00 90
27422 $ 1,800.00 90
27424 $ 1,800.00 90
27425 $ 1,800.00 90
27427 $ 1,809.44 90
27428 $ 2,643.97 90
27429 $ 3,474.00 90
27430 $ 1,664.63 90
27435 $ 1,746.74 90
27437 $ 1,517.54 90
27438 $ 1,978.25 90
27440 $ 2,418.00 90
27441 $ 2,347.00 90
27442 $ 2,276.00 90
27443 $ 2,703.00 90
27445 $ 3,940.00 90
27446 $ 3,200.00 90
27447 $ 4,281.00 90
27448 $ 1,880.62 90
27450 $ 2,292.89 90
27454 $ 2,818.56 90
27455 $ 2,086.23 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
69
27457 $ 2,148.77 90
27465 $ 2,689.19 90
27466 $ 2,706.74 90
27468 $ 3,602.72 90
27470 $ 2,613.34 90
27472 $ 2,904.34 90
27475 $ 1,529.83 90
27477 $ 1,755.52 90
27479 $ 2,124.04 90
27485 $ 1,534.65 90
27486 $ 3,180.85 90
27487 $ 4,552.00 90
27488 $ 2,602.75 90
27495 $ 2,581.89 90
27496 $ 1,170.24 90
27497 $ 1,311.68 90
27498 $ 1,485.91 90
27499 $ 1,808.43 90
27500 $ 1,118.24 90
27501 $ 1,101.95 90
27502 $ 1,579.05 90
27503 $ 1,766.82 90
27506 $ 2,960.10 90
27507 $ 2,283.31 90
27508 $ 1,130.03 90
27509 $ 1,470.00 90
27510 $ 1,481.71 90
27511 $ 2,451.00 90
27513 $ 2,891.00 90
27514 $ 2,400.65 90
27516 $ 1,093.58 90
27517 $ 1,501.54 90
27519 $ 2,208.34 90
27520 $ 631.45 90
27524 $ 1,674.16 90
27530 $ 621.97 90
27532 $ 1,186.33 90
27535 $ 1,985.79 90
27536 $ 2,631.49 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
70
27538 $ 1,016.60 90
27540 $ 1,875.63 90
27550 $ 972.67 90
27552 $ 1,207.79 90
27556 $ 2,058.43 90
27557 $ 2,438.61 90
27558 $ 3,040.00 90
27560 $ 693.18 90
27562 $ 918.20 90
27566 $ 1,969.70 90
27570 $ 386.01 10
27580 $ 3,102.44 90
27590 $ 1,804.04 90
27591 $ 2,089.60 90
27592 $ 1,613.37 90
27594 $ 1,047.72 90
27596 $ 1,641.26 90
27598 $ 1,655.36 90
27599 BR YYY
27600 $ 899.00 90
27601 $ 999.58 90
27602 $ 1,246.77 90
27603 $ 1,118.62 90
27604 $ 943.80 90
27605 $ 693.48 10
27606 $ 571.53 10
27607 $ 1,178.28 90
27610 $ 1,426.59 90
27612 $ 1,259.36 90
27613 $ 574.17 10
27614 $ 1,231.89 90
27615 $ 2,305.01 90
27616 $ 2,923.75 90
27618 $ 860.43 90
27619 $ 1,064.77 90
27620 $ 1,040.64 90
27625 $ 1,328.36 90
27626 $ 1,499.31 90
27630 $ 1,076.54 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
71
27632 $ 943.12 90
27634 $ 1,540.94 90
27635 $ 1,324.41 90
27637 $ 1,683.09 90
27638 $ 1,707.24 90
27640 $ 1,842.86 90
27641 $ 1,479.59 90
27645 $ 3,824.28 90
27646 $ 2,996.62 90
27647 $ 2,209.18 90
27648 $ 304.23 0
27650 $ 1,494.03 90
27652 $ 1,607.45 90
27654 $ 1,629.55 90
27656 $ 1,367.88 90
27658 $ 830.65 90
27659 $ 1,073.26 90
27664 $ 796.44 90
27665 $ 909.22 90
27675 $ 1,092.23 90
27676 $ 1,337.43 90
27680 $ 927.57 90
27681 $ 1,177.59 90
27685 $ 1,421.81 90
27686 $ 1,209.48 90
27687 $ 986.54 90
27690 $ 1,354.26 90
27691 $ 1,617.93 90
27692 $ 287.10 ZZZ
27695 $ 1,116.16 90
27696 $ 1,357.10 90
27698 $ 1,573.70 90
27700 $ 1,800.16 90
27702 $ 2,873.90 90
27703 $ 2,825.46 90
27704 $ 1,343.71 90
27705 $ 1,699.32 90
27707 $ 879.65 90
27709 $ 2,531.51 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
72
27712 $ 2,401.29 90
27715 $ 2,459.53 90
27720 $ 2,012.66 90
27722 $ 2,027.51 90
27724 $ 2,798.57 90
27725 $ 2,817.70 90
27726 $ 2,185.52 90
27727 $ 2,372.31 90
27730 $ 1,298.43 90
27732 $ 949.49 90
27734 $ 1,451.01 90
27740 $ 1,755.60 90
27742 $ 2,063.00 90
27745 $ 1,707.75 90
27750 $ 742.50 90
27752 $ 1,156.26 90
27756 $ 1,440.00 90
27758 $ 2,050.00 90
27759 $ 2,235.00 90
27760 $ 638.53 90
27762 $ 911.68 90
27766 $ 1,349.88 90
27767 $ 606.44 90
27768 $ 984.33 90
27769 $ 1,644.47 90
27780 $ 585.35 90
27781 $ 808.66 90
27784 $ 1,546.18 90
27786 $ 636.25 90
27788 $ 848.44 90
27792 $ 1,423.19 90
27808 $ 653.59 90
27810 $ 1,003.51 90
27814 $ 1,713.97 90
27816 $ 639.99 90
27818 $ 1,061.30 90
27822 $ 1,867.12 90
27823 $ 2,109.22 90
27824 $ 671.16 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
73
27825 $ 1,169.56 90
27826 $ 1,808.30 90
27827 $ 2,618.00 90
27828 $ 3,038.00 90
27829 $ 1,434.70 90
27830 $ 726.68 90
27831 $ 777.57 90
27832 $ 1,628.57 90
27840 $ 706.11 90
27842 $ 958.17 90
27846 $ 1,614.89 90
27848 $ 1,797.64 90
27860 $ 367.20 10
27870 $ 2,303.63 90
27871 $ 1,562.00 90
27880 $ 2,015.29 90
27881 $ 1,962.11 90
27882 $ 1,359.37 90
27884 $ 1,256.75 90
27886 $ 1,756.68 90
27888 $ 1,529.59 90
27889 $ 1,480.47 90
27892 $ 1,279.50 90
27893 $ 1,372.60 90
27894 $ 2,013.68 90
27899 BR YYY
28001 $ 518.74 10
28002 $ 829.47 10
28003 $ 1,375.05 90
28005 $ 1,201.36 90
28008 $ 836.16 90
28010 $ 462.84 90
28011 $ 622.69 90
28020 $ 1,174.95 90
28022 $ 964.20 90
28024 $ 896.55 90
28035 $ 1,227.69 90
28039 $ 1,048.40 90
28041 $ 1,044.81 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
74
28043 $ 796.31 90
28045 $ 1,071.51 90
28046 $ 1,646.73 90
28047 $ 2,436.43 90
28050 $ 1,027.15 90
28052 $ 927.81 90
28054 $ 748.23 90
28055 $ 989.00 90
28060 $ 1,119.95 90
28062 $ 1,302.80 90
28070 $ 1,145.02 90
28072 $ 990.33 90
28080 $ 1,106.00 90
28086 $ 1,205.24 90
28088 $ 997.43 90
28090 $ 965.97 90
28092 $ 819.54 90
28100 $ 1,317.34 90
28102 $ 1,307.31 90
28103 $ 927.23 90
28104 $ 1,110.08 90
28106 $ 1,044.64 90
28107 $ 1,100.42 90
28108 $ 913.53 90
28110 $ 897.62 90
28111 $ 1,070.35 90
28112 $ 957.74 90
28113 $ 1,234.75 90
28114 $ 2,334.75 90
28116 $ 1,580.14 90
28118 $ 1,283.81 90
28119 $ 1,116.92 90
28120 $ 1,381.51 90
28122 $ 1,166.84 90
28124 $ 924.91 90
28126 $ 813.72 90
28130 $ 1,495.92 90
28140 $ 1,291.98 90
28150 $ 878.77 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
75
28153 $ 888.52 90
28160 $ 911.88 90
28171 $ 1,914.28 90
28173 $ 1,721.01 90
28175 $ 1,111.58 90
28190 $ 482.34 10
28192 $ 913.47 90
28193 $ 1,111.10 90
28200 $ 1,060.67 90
28202 $ 1,288.02 90
28208 $ 922.65 90
28210 $ 1,121.29 90
28220 $ 972.39 90
28222 $ 1,091.00 90
28225 $ 786.00 90
28226 $ 1,066.57 90
28230 $ 840.52 90
28232 $ 746.30 90
28234 $ 784.69 90
28238 $ 1,460.48 90
28240 $ 866.81 90
28250 $ 1,254.11 90
28260 $ 1,485.21 90
28261 $ 2,139.31 90
28262 $ 3,187.47 90
28264 $ 1,999.39 90
28270 $ 949.40 90
28272 $ 765.03 90
28280 $ 1,001.13 90
28285 $ 1,100.19 90
28286 $ 976.53 90
28288 $ 1,171.26 90
28289 $ 1,422.64 90
28290 $ 1,273.06 90
28292 $ 1,604.25 90
28293 $ 2,031.68 90
28294 $ 1,658.87 90
28296 $ 1,577.45 90
28297 $ 1,757.25 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
76
28298 $ 1,474.15 90
28299 $ 1,943.60 90
28300 $ 1,420.42 90
28302 $ 1,545.70 90
28304 $ 1,680.25 90
28305 $ 1,550.00 90
28306 $ 1,325.11 90
28307 $ 1,513.87 90
28308 $ 1,164.56 90
28309 $ 1,765.42 90
28310 $ 1,062.96 90
28312 $ 993.31 90
28313 $ 1,013.52 90
28315 $ 934.70 90
28320 $ 1,400.02 90
28322 $ 1,532.08 90
28340 $ 1,317.36 90
28341 $ 1,534.68 90
28344 $ 1,103.51 90
28345 $ 1,184.54 90
28360 $ 2,440.76 90
28400 $ 526.95 90
28405 $ 819.54 90
28406 $ 1,113.86 90
28415 $ 2,199.89 90
28420 $ 2,716.54 90
28430 $ 509.15 90
28435 $ 689.64 90
28436 $ 921.35 90
28445 $ 2,156.37 90
28446 $ 2,748.50 90
28450 $ 463.91 90
28455 $ 620.07 90
28456 $ 689.35 90
28465 $ 1,273.55 90
28470 $ 471.34 90
28475 $ 551.87 90
28476 $ 726.87 90
28485 $ 1,132.49 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
77
28490 $ 278.65 90
28495 $ 343.40 90
28496 $ 848.97 90
28505 $ 1,302.53 90
28510 $ 237.86 90
28515 $ 311.02 90
28525 $ 1,084.66 90
28530 $ 280.00 90
28531 $ 689.36 90
28540 $ 427.64 90
28545 $ 632.95 90
28546 $ 1,228.25 90
28555 $ 1,789.55 90
28570 $ 418.17 90
28575 $ 784.60 90
28576 $ 863.26 90
28585 $ 1,839.23 90
28600 $ 463.60 90
28605 $ 647.13 90
28606 $ 832.49 90
28615 $ 1,524.53 90
28630 $ 359.15 10
28635 $ 418.42 10
28636 $ 731.93 10
28645 $ 1,271.96 90
28660 $ 267.85 10
28665 $ 359.04 10
28666 $ 537.00 10
28675 $ 1,139.52 90
28705 $ 2,775.97 90
28715 $ 2,088.42 90
28725 $ 1,722.31 90
28730 $ 1,633.88 90
28735 $ 1,742.38 90
28737 $ 1,528.04 90
28740 $ 1,811.14 90
28750 $ 1,580.42 90
28755 $ 1,024.19 90
28760 $ 1,534.70 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
78
28800 $ 1,225.42 90
28805 $ 1,588.42 90
28810 $ 953.57 90
28820 $ 1,099.80 90
28825 $ 1,048.64 90
28890 $ 744.10 90
28899 BR YYY
29000 $ 689.88 0
29010 $ 524.76 0
29015 $ 643.87 0
29035 $ 401.71 0
29040 $ 586.78 0
29044 $ 525.89 0
29046 $ 498.88 0
29049 $ 212.50 0
29055 $ 436.29 0
29058 $ 261.95 0
29065 $ 181.87 0
29075 $ 163.17 0
29085 $ 179.42 0
29086 $ 163.84 0
29105 $ 163.82 0
29125 $ 120.26 0
29126 $ 175.97 0
29130 $ 93.71 0
29131 $ 131.65 0
29200 $ 87.33 0
29240 $ 113.87 0
29260 $ 76.83 0
29280 $ 76.68 0
29305 $ 462.19 0
29325 $ 507.69 0
29345 $ 255.47 0
29355 $ 279.63 0
29358 $ 300.33 0
29365 $ 229.47 0
29405 $ 167.24 0
29425 $ 183.68 0
29435 $ 269.58 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
79
29440 $ 81.26 0
29445 $ 313.87 0
29450 $ 236.99 0
29505 $ 157.34 0
29515 $ 135.21 0
29520 $ 95.15 0
29530 $ 87.10 0
29540 $ 64.53 0
29550 $ 61.23 0
29580 $ 105.72 0
29581 $ 163.28 0
29582 $ 172.49 0
29583 $ 108.46 0
29584 $ 172.49 0
29700 $ 116.36 0
29705 $ 124.81 0
29710 $ 228.17 0
29720 $ 154.25 0
29730 $ 120.91 0
29740 $ 185.92 0
29750 $ 170.53 0
29799 BR YYY
29800 $ 1,112.10 90
29804 $ 1,533.78 90
29805 $ 1,020.48 90
29806 $ 2,521.00 90
29807 $ 2,450.00 90
29819 $ 2,100.00 90
29820 $ 1,780.00 90
29821 $ 2,130.00 90
29822 $ 1,878.00 90
29823 $ 2,130.00 90
29824 $ 1,543.00 90
29825 $ 1,544.47 90
29826 $ 2,448.00 ZZZ
29827 $ 2,450.00 90
29828 $ 2,082.37 90
29830 $ 1,008.78 90
29834 $ 2,206.38 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
80
29835 $ 1,874.00 90
29836 $ 2,366.00 90
29837 $ 1,711.00 90
29838 $ 2,265.00 90
29840 $ 1,031.00 90
29843 $ 1,461.00 90
29844 $ 1,478.00 90
29845 $ 1,742.00 90
29846 $ 1,901.00 90
29847 $ 1,901.00 90
29848 $ 1,312.00 90
29850 $ 1,636.00 90
29851 $ 2,371.00 90
29855 $ 1,869.00 90
29856 $ 2,202.61 90
29860 $ 1,452.09 90
29861 $ 2,219.00 90
29862 $ 2,259.00 90
29863 $ 2,532.00 90
29866 $ 2,586.00 90
29867 $ 3,080.00 90
29868 $ 4,169.00 90
29870 $ 1,258.39 90
29871 $ 1,406.00 90
29873 $ 1,244.69 90
29874 $ 1,720.00 90
29875 $ 1,937.00 90
29876 $ 2,135.00 90
29877 $ 2,135.00 90
29879 $ 2,135.00 90
29880 $ 2,800.00 90
29881 $ 2,135.00 90
29882 $ 2,765.00 90
29883 $ 3,062.00 90
29884 $ 2,135.00 90
29885 $ 2,577.00 90
29886 $ 2,061.00 90
29887 $ 2,135.00 90
29888 $ 4,072.00 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
81
29889 $ 3,804.00 90
29891 $ 2,040.00 90
29892 $ 1,935.00 90
29893 $ 1,255.49 90
29894 $ 1,743.00 90
29895 $ 1,628.00 90
29897 $ 1,628.00 90
29898 $ 2,206.38 90
29899 $ 2,185.78 90
29900 $ 965.04 90
29901 $ 1,141.39 90
29902 $ 1,245.91 90
29904 $ 1,434.06 90
29905 $ 1,554.24 90
29906 $ 1,600.03 90
29907 $ 1,970.74 90
29914 $ 2,815.21 90
29915 $ 2,865.12 90
29916 $ 2,783.63 90
29999 BR YYY
30000 $ 425.59 10
30020 $ 392.98 10
30100 $ 261.54 0
30110 $ 437.50 10
30115 $ 925.63 90
30117 $ 1,558.28 90
30118 $ 1,645.64 90
30120 $ 1,209.47 90
30124 $ 516.25 90
30125 $ 1,371.20 90
30130 $ 725.10 90
30140 $ 944.44 90
30150 $ 1,763.00 90
30160 $ 1,712.54 90
30200 $ 210.08 0
30210 $ 292.98 10
30220 $ 457.04 10
30300 $ 384.80 10
30310 $ 473.13 10
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
82
30320 $ 1,152.00 90
30400 $ 2,160.24 90
30410 $ 2,573.27 90
30420 $ 2,942.60 90
30430 $ 1,766.76 90
30435 $ 2,627.74 90
30450 $ 3,204.57 90
30460 $ 1,852.89 90
30462 $ 3,317.51 90
30465 $ 2,161.78 90
30520 $ 1,384.08 90
30540 $ 1,597.18 90
30545 $ 2,101.10 90
30560 $ 460.69 10
30580 $ 1,406.78 90
30600 $ 1,244.25 90
30620 $ 1,381.65 90
30630 $ 1,351.09 90
30801 $ 387.56 10
30802 $ 524.78 10
30901 $ 201.66 0
30903 $ 365.24 0
30905 $ 572.26 0
30906 $ 589.76 0
30915 $ 1,428.06 90
30920 $ 1,906.00 90
30930 $ 226.14 10
30999 BR YYY
31000 $ 322.26 10
31002 $ 355.74 10
31020 $ 976.56 90
31030 $ 1,508.03 90
31032 $ 1,374.22 90
31040 $ 1,914.02 90
31050 $ 1,077.63 90
31051 $ 1,418.88 90
31070 $ 1,047.64 90
31075 $ 1,733.78 90
31080 $ 2,213.31 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
83
31081 $ 3,226.24 90
31084 $ 2,559.84 90
31085 $ 3,262.01 90
31086 $ 2,408.30 90
31087 $ 2,323.36 90
31090 $ 2,459.37 90
31200 $ 1,214.38 90
31201 $ 1,585.15 90
31205 $ 1,914.22 90
31225 $ 4,208.69 90
31230 $ 4,658.94 90
31231 $ 388.77 0
31233 $ 539.88 0
31235 $ 685.77 0
31237 $ 600.43 0
31238 $ 742.37 0
31239 $ 1,635.43 10
31240 $ 455.93 0
31254 $ 1,000.00 0
31255 $ 1,300.00 0
31256 $ 880.00 0
31267 $ 870.98 0
31276 $ 1,283.82 0
31287 $ 730.00 0
31288 $ 859.20 0
31290 $ 2,745.87 10
31291 $ 2,921.00 10
31292 $ 2,323.62 10
31293 $ 2,528.58 10
31294 $ 2,893.70 10
31295 $ 3,853.85 0
31296 $ 5,474.44 0
31297 $ 5,375.59 0
31299 BR YYY
31300 $ 2,860.18 90
31320 $ 1,493.08 90
31360 $ 4,694.93 90
31365 $ 5,806.23 90
31367 $ 4,974.66 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
84
31368 $ 5,523.34 90
31370 $ 4,676.93 90
31375 $ 4,435.67 90
31380 $ 4,376.34 90
31382 $ 4,804.73 90
31390 $ 6,445.78 90
31395 $ 6,790.15 90
31400 $ 2,271.49 90
31420 $ 1,893.46 90
31500 $ 259.06 0
31502 $ 98.27 0
31505 $ 190.09 0
31510 $ 389.87 0
31511 $ 389.05 0
31512 $ 378.61 0
31513 $ 299.00 0
31515 $ 360.09 0
31520 Not Covered 0
31525 $ 581.63 0
31526 $ 448.78 0
31527 $ 512.44 0
31528 $ 380.34 0
31529 $ 392.60 0
31530 $ 523.85 0
31531 $ 602.30 0
31535 $ 521.01 0
31536 $ 563.65 0
31540 $ 706.27 0
31541 $ 687.39 0
31545 $ 949.00 0
31546 $ 1,447.00 0
31560 $ 1,422.00 0
31561 $ 1,863.00 0
31570 $ 811.30 0
31571 $ 725.00 0
31575 $ 267.16 0
31576 $ 436.97 0
31577 $ 582.74 0
31578 $ 674.91 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
85
31579 $ 434.29 0
31580 $ 2,784.97 90
31582 $ 4,262.02 90
31584 $ 3,396.85 90
31587 $ 2,392.19 90
31588 $ 2,453.01 90
31590 $ 2,068.21 90
31595 $ 1,775.88 90
31599 BR YYY
31600 $ 806.89 0
31601 Not Covered 0
31603 $ 610.94 0
31605 $ 534.79 0
31610 $ 1,540.39 90
31611 $ 1,040.34 90
31612 $ 154.45 0
31613 $ 977.69 90
31614 $ 1,627.60 90
31615 $ 423.41 0
31622 $ 567.36 0
31623 $ 610.63 0
31624 $ 577.74 0
31625 $ 677.63 0
31626 $ 983.88 0
31627 $ 2,671.40 ZZZ
31628 $ 861.77 0
31629 $ 1,079.00 0
31630 $ 716.00 0
31631 $ 645.00 0
31632 $ 140.36 ZZZ
31633 $ 173.41 ZZZ
31634 $ 3,668.45 0
31635 $ 735.41 0
31636 $ 591.00 0
31637 $ 213.00 ZZZ
31638 $ 653.00 0
31640 $ 747.00 0
31641 $ 962.78 0
31643 $ 466.00 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
86
31645 $ 597.00 0
31646 $ 535.54 0
31647 $ 539.09 0
31648 $ 557.82 0
31649 $ 175.89 ZZZ
31651 $ 186.42 ZZZ
31652 RNE 0
31653 RNE 0
31654 RNE ZZZ
31660 $ 565.52 0
31661 $ 597.83 0
31717 $ 459.56 0
31720 $ 127.40 0
31725 $ 288.70 0
31730 $ 1,746.51 0
31750 $ 3,001.40 90
31755 $ 3,752.19 90
31760 $ 3,016.81 90
31766 $ 3,913.27 90
31770 $ 2,982.94 90
31775 $ 3,110.63 90
31780 $ 2,725.81 90
31781 $ 3,320.15 90
31785 $ 2,511.23 90
31786 $ 3,595.54 90
31800 $ 1,889.06 90
31805 $ 2,386.33 90
31820 $ 850.45 90
31825 $ 1,286.23 90
31830 $ 859.97 90
31899 BR YYY
32035 $ 1,568.33 90
32036 $ 1,686.67 90
32096 $ 1,881.35 90
32097 $ 1,881.35 90
32098 $ 1,818.52 90
32100 $ 1,840.68 90
32110 $ 3,176.77 90
32120 $ 1,890.44 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
87
32124 $ 2,012.68 90
32140 $ 2,169.85 90
32141 $ 3,259.10 90
32150 $ 2,186.20 90
32151 $ 2,193.57 90
32160 $ 1,754.83 90
32200 $ 2,479.39 90
32215 $ 1,733.89 90
32220 $ 3,440.10 90
32225 $ 2,158.00 90
32310 $ 2,426.95 90
32320 $ 3,473.35 90
32400 $ 278.18 0
32405 $ 764.12 0
32440 $ 3,402.69 90
32442 $ 6,617.19 90
32445 $ 6,939.26 90
32480 $ 3,211.51 90
32482 $ 3,469.97 90
32484 $ 3,253.03 90
32486 $ 5,120.90 90
32488 $ 5,234.79 90
32491 $ 3,410.00 90
32501 $ 823.00 ZZZ
32503 $ 4,634.00 90
32504 $ 5,300.00 90
32505 $ 2,221.17 90
32506 $ 406.04 ZZZ
32507 $ 406.04 ZZZ
32540 $ 3,775.02 90
32550 $ 1,446.76 0
32551 $ 425.11 0
32552 $ 441.01 10
32553 $ 1,069.68 0
32554 $ 528.41 0
32555 $ 759.36 0
32556 $ 1,115.05 0
32557 $ 1,340.43 0
32560 $ 499.11 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
88
32561 $ 220.38 0
32562 $ 196.13 0
32601 $ 757.62 0
32604 $ 1,174.01 0
32606 $ 1,122.81 0
32607 $ 789.41 0
32608 $ 975.31 0
32609 $ 669.06 0
32650 $ 1,654.21 90
32651 $ 2,478.64 90
32652 $ 3,614.37 90
32653 $ 2,302.91 90
32654 $ 2,521.62 90
32655 $ 2,191.14 90
32656 $ 1,967.78 90
32658 $ 2,046.80 90
32659 $ 1,962.69 90
32661 $ 2,002.23 90
32662 $ 2,279.42 90
32663 $ 3,344.85 90
32664 $ 2,244.14 90
32665 $ 2,792.16 90
32666 $ 2,069.68 90
32667 $ 413.63 ZZZ
32668 $ 414.91 ZZZ
32669 $ 3,130.19 90
32670 $ 3,718.12 90
32671 $ 4,153.68 90
32672 $ 3,547.35 90
32673 $ 2,800.94 90
32674 $ 540.73 ZZZ
32701 $ 557.01 XXX
32800 $ 2,068.90 90
32810 $ 2,158.53 90
32815 $ 6,101.51 90
32820 $ 3,302.16 90
32850 BR XXX
32851 $ 7,178.04 90
32852 $ 7,863.04 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
89
32853 $ 10,017.51 90
32854 $ 10,641.99 90
32855 BR XXX
32856 BR XXX
32900 $ 2,911.57 90
32905 $ 2,860.90 90
32906 $ 3,610.89 90
32940 $ 2,694.47 90
32960 $ 269.05 0
32997 $ 809.97 0
32998 $ 5,245.05 0
32999 BR YYY
33010 $ 286.31 0
33011 $ 281.15 0
33015 $ 990.53 90
33020 $ 1,998.43 90
33025 $ 1,931.23 90
33030 $ 4,169.43 90
33031 $ 5,372.84 90
33050 $ 2,315.53 90
33120 $ 4,977.88 90
33130 $ 3,237.66 90
33140 $ 3,632.43 90
33141 $ 1,567.00 ZZZ
33202 $ 1,712.27 90
33203 $ 1,768.42 90
33206 $ 1,093.00 90
33207 $ 1,265.90 90
33208 $ 1,265.68 90
33210 $ 448.89 0
33211 $ 457.02 0
33212 $ 838.00 90
33213 $ 818.39 90
33214 $ 1,466.00 90
33215 $ 670.14 90
33216 $ 964.00 90
33217 $ 846.76 90
33218 $ 895.42 90
33220 $ 902.75 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
90
33221 $ 838.45 90
33222 $ 899.00 90
33223 $ 1,235.00 90
33224 $ 1,232.11 0
33225 $ 1,127.00 ZZZ
33226 $ 1,146.76 0
33227 $ 794.99 90
33228 $ 829.37 90
33229 $ 866.91 90
33230 $ 896.74 90
33231 $ 938.07 90
33233 $ 535.54 90
33234 $ 1,719.00 90
33235 $ 1,910.00 90
33236 $ 1,771.00 90
33237 $ 2,459.66 90
33238 $ 2,136.77 90
33240 $ 1,348.00 90
33241 $ 976.70 90
33243 $ 3,672.00 90
33244 $ 2,696.00 90
33249 $ 2,360.00 90
33250 $ 3,211.19 90
33251 $ 3,650.36 90
33254 $ 3,015.69 90
33255 $ 3,640.13 90
33256 $ 4,309.75 90
33257 $ 1,434.45 ZZZ
33258 $ 1,614.20 ZZZ
33259 $ 2,083.76 ZZZ
33261 $ 3,579.43 90
33262 $ 870.78 90
33263 $ 904.52 90
33264 $ 939.11 90
33265 $ 3,000.78 90
33266 $ 4,082.72 90
33270 $ 1,334.44 90
33271 $ 1,062.15 90
33272 $ 857.41 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
91
33273 $ 859.08 90
33282 $ 756.12 90
33284 $ 576.00 90
33300 $ 4,721.81 90
33305 $ 7,308.56 90
33310 $ 2,683.84 90
33315 $ 4,359.52 90
33320 $ 2,926.41 90
33321 $ 3,599.07 90
33322 $ 3,954.08 90
33330 $ 4,046.74 90
33335 $ 5,197.97 90
33361 $ 3,477.21 0
33362 $ 3,801.23 0
33363 $ 3,980.43 0
33364 $ 4,140.65 0
33365 $ 4,559.44 0
33366 $ 4,098.85 0
33367 $ 1,597.60 ZZZ
33368 $ 1,922.39 ZZZ
33369 $ 2,537.86 ZZZ
33400 $ 4,954.46 90
33401 $ 3,797.46 90
33403 $ 3,985.81 90
33404 $ 4,426.01 90
33405 $ 5,226.31 90
33406 $ 6,408.38 90
33410 $ 5,515.12 90
33411 $ 7,301.58 90
33412 $ 6,956.58 90
33413 $ 7,186.30 90
33414 $ 5,412.00 90
33415 $ 4,683.98 90
33416 $ 4,695.41 90
33417 $ 4,608.95 90
33418 $ 4,029.27 90
33419 $ 1,235.42 ZZZ
33420 $ 3,334.90 90
33422 $ 4,309.91 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
92
33425 $ 5,946.31 90
33426 $ 5,318.23 90
33427 $ 5,536.83 90
33430 $ 6,088.36 90
33460 $ 5,327.05 90
33463 $ 6,735.00 90
33464 $ 5,314.19 90
33465 $ 6,005.44 90
33468 $ 5,483.41 90
33470 $ 3,078.00 90
33471 $ 3,473.04 90
33474 $ 4,760.00 90
33475 $ 5,313.33 90
33476 $ 4,181.18 90
33477 RNE 0
33478 $ 4,491.00 90
33496 $ 4,175.50 90
33500 $ 4,128.00 90
33501 $ 2,578.04 90
33502 $ 2,914.05 90
33503 $ 3,525.00 90
33504 $ 4,087.85 90
33505 $ 4,868.85 90
33506 $ 4,845.37 90
33507 $ 4,470.00 90
33508 $ 39.00 ZZZ
33510 $ 4,452.18 90
33511 $ 4,887.84 90
33512 $ 5,499.00 90
33513 $ 5,725.29 90
33514 $ 6,102.02 90
33516 $ 6,441.73 90
33517 $ 448.41 ZZZ
33518 $ 964.99 ZZZ
33519 $ 1,308.30 ZZZ
33521 $ 1,653.38 ZZZ
33522 $ 1,960.62 ZZZ
33523 $ 2,292.94 ZZZ
33530 $ 1,264.94 ZZZ
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
93
33533 $ 4,441.15 90
33534 $ 5,106.18 90
33535 $ 5,680.86 90
33536 $ 6,180.30 90
33542 $ 5,716.16 90
33545 $ 6,749.71 90
33548 $ 6,452.04 90
33572 $ 659.86 ZZZ
33600 $ 4,701.13 90
33602 $ 4,438.72 90
33606 $ 4,952.16 90
33608 $ 5,031.33 90
33610 $ 4,952.16 90
33611 $ 5,227.21 90
33612 $ 5,261.12 90
33615 $ 5,170.89 90
33617 $ 5,425.02 90
33619 $ 6,422.37 90
33620 $ 4,557.95 90
33621 $ 2,457.70 90
33622 $ 9,883.17 90
33641 $ 3,788.37 90
33645 $ 4,096.74 90
33647 $ 4,627.04 90
33660 $ 4,378.76 90
33665 $ 4,669.25 90
33670 $ 5,183.75 90
33675 $ 4,529.38 90
33676 $ 4,779.68 90
33677 $ 4,912.70 90
33681 $ 4,602.84 90
33684 $ 4,813.28 90
33688 $ 4,838.73 90
33690 $ 3,021.81 90
33692 $ 5,272.83 90
33694 $ 5,323.46 90
33697 $ 5,478.76 90
33702 $ 4,236.73 90
33710 $ 5,027.00 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
94
33720 $ 4,261.69 90
33722 $ 4,438.72 90
33724 $ 3,374.95 90
33726 $ 4,611.25 90
33730 $ 5,281.70 90
33732 $ 4,472.92 90
33735 $ 3,485.88 90
33736 $ 3,726.39 90
33737 $ 3,546.39 90
33750 $ 3,361.43 90
33755 $ 3,341.57 90
33762 $ 3,357.49 90
33764 $ 3,322.86 90
33766 $ 3,411.25 90
33767 $ 3,793.64 90
33768 $ 1,072.00 ZZZ
33770 $ 5,533.98 90
33771 $ 5,644.50 90
33774 $ 4,697.58 90
33775 $ 4,830.29 90
33776 $ 5,220.01 90
33777 $ 4,931.47 90
33778 $ 5,956.12 90
33779 $ 5,981.77 90
33780 $ 6,076.70 90
33781 $ 5,988.92 90
33782 $ 7,630.75 90
33783 $ 8,235.41 90
33786 $ 5,678.55 90
33788 $ 4,226.66 90
33800 $ 2,391.75 90
33802 $ 2,995.55 90
33803 $ 3,149.74 90
33813 $ 3,239.47 90
33814 $ 4,238.81 90
33820 $ 2,830.12 90
33822 $ 2,940.41 90
33824 $ 3,137.80 90
33840 $ 3,774.07 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
95
33845 $ 3,936.09 90
33851 $ 3,878.18 90
33852 $ 4,071.94 90
33853 $ 5,239.96 90
33860 $ 6,988.73 90
33863 $ 6,875.18 90
33864 $ 7,362.74 90
33870 $ 6,316.37 90
33875 $ 6,032.62 90
33877 $ 7,958.71 90
33880 $ 4,613.00 90
33881 $ 3,963.00 90
33883 $ 2,932.00 90
33884 $ 1,090.00 ZZZ
33886 $ 2,533.00 90
33889 $ 2,180.00 0
33891 $ 2,782.00 0
33910 $ 5,738.65 90
33915 $ 3,064.87 90
33916 $ 8,136.65 90
33917 $ 4,207.42 90
33920 $ 5,306.04 90
33922 $ 3,747.55 90
33924 $ 782.35 ZZZ
33925 $ 4,571.00 90
33926 $ 6,175.00 90
33930 BR XXX
33933 BR XXX
33935 $ 18,811.00 90
33940 BR XXX
33944 BR XXX
33945 $ 14,377.00 90
33946 $ 797.00 XXX
33947 $ 869.82 XXX
33948 $ 617.37 XXX
33949 $ 604.52 XXX
33951 Not Covered
33952 $ 1,012.23 0
33953 Not Covered
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
96
33954 $ 1,134.86 0
33955 Not Covered
33956 $ 2,129.03 0
33957 Not Covered
33958 $ 609.01 0
33959 Not Covered
33962 $ 718.33 XXX
33963 Not Covered
33964 $ 1,351.97 0
33965 Not Covered
33966 $ 695.60 0
33967 $ 800.00 0
33968 $ 259.00 0
33969 Not Covered
33970 $ 1,067.00 0
33971 $ 1,414.81 90
33973 $ 1,332.86 0
33974 $ 2,170.59 90
33975 $ 3,125.66 XXX
33976 $ 3,869.46 XXX
33977 $ 2,851.01 XXX
33978 $ 3,335.79 XXX
33979 $ 4,741.10 XXX
33980 $ 4,883.00 XXX
33981 BR XXX
33982 BR XXX
33983 BR XXX
33984 $ 788.39 0
33985 Not Covered
33986 $ 1,432.72 0
33987 $ 590.00 ZZZ
33988 $ 1,931.49 0
33989 $ 1,257.28 0
33990 $ 1,068.79 XXX
33991 $ 1,552.52 XXX
33992 $ 515.40 XXX
33993 $ 455.71 XXX
33999 BR YYY
34001 $ 2,168.72 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
97
34051 $ 2,282.15 90
34101 $ 1,404.24 90
34111 $ 1,365.23 90
34151 $ 3,094.88 90
34201 $ 2,279.07 90
34203 $ 2,131.34 90
34401 $ 2,873.86 90
34421 $ 1,752.23 90
34451 $ 3,241.79 90
34471 $ 2,176.70 90
34490 $ 1,480.00 90
34501 $ 2,060.02 90
34502 $ 3,662.72 90
34510 $ 2,608.75 90
34520 $ 2,448.54 90
34530 $ 2,413.82 90
34800 $ 3,422.00 90
34802 $ 3,482.00 90
34803 $ 3,376.00 90
34804 $ 3,482.00 90
34805 $ 2,847.62 90
34806 $ 245.51 ZZZ
34808 $ 619.65 ZZZ
34812 $ 910.00 0
34813 $ 812.00 ZZZ
34820 $ 1,313.00 0
34825 $ 1,695.00 90
34826 $ 563.12 ZZZ
34830 $ 4,076.36 90
34831 $ 4,445.00 90
34832 $ 4,445.00 90
34833 $ 1,618.00 0
34834 $ 722.00 0
34839 $ 802.19 YYY
34841 BR 90
34842 BR 90
34843 BR 90
34844 BR 90
34845 BR 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
98
34846 BR 90
34847 BR 90
34848 BR 90
34900 $ 1,997.80 90
35001 $ 2,757.36 90
35002 $ 2,823.35 90
35005 $ 2,538.52 90
35011 $ 2,270.84 90
35013 $ 2,779.84 90
35021 $ 2,918.20 90
35022 $ 3,148.02 90
35045 $ 2,260.43 90
35081 $ 3,863.75 90
35082 $ 4,857.63 90
35091 $ 4,241.58 90
35092 $ 5,789.29 90
35102 $ 4,181.58 90
35103 $ 5,001.64 90
35111 $ 3,133.17 90
35112 $ 4,096.87 90
35121 $ 3,712.64 90
35122 $ 4,750.22 90
35131 $ 3,121.08 90
35132 $ 3,697.81 90
35141 $ 2,511.29 90
35142 $ 2,947.24 90
35151 $ 2,779.60 90
35152 $ 3,097.12 90
35180 $ 2,149.75 90
35182 $ 3,794.90 90
35184 $ 2,550.55 90
35188 $ 2,435.39 90
35189 $ 3,456.25 90
35190 $ 2,067.61 90
35201 $ 2,280.94 90
35206 $ 2,110.71 90
35207 $ 2,086.59 90
35211 $ 3,279.40 90
35216 $ 4,483.39 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
99
35221 $ 3,207.26 90
35226 $ 1,890.05 90
35231 $ 2,806.71 90
35236 $ 2,506.32 90
35241 $ 3,588.49 90
35246 $ 3,458.76 90
35251 $ 3,750.25 90
35256 $ 2,373.70 90
35261 $ 2,342.88 90
35266 $ 2,081.00 90
35271 $ 3,242.04 90
35276 $ 3,205.32 90
35281 $ 3,570.45 90
35286 $ 2,162.40 90
35301 $ 2,580.34 90
35302 $ 2,517.84 90
35303 $ 2,771.46 90
35304 $ 2,892.78 90
35305 $ 2,782.82 90
35306 $ 1,079.98 ZZZ
35311 $ 3,671.61 90
35321 $ 2,105.80 90
35331 $ 3,242.98 90
35341 $ 3,337.80 90
35351 $ 2,946.47 90
35355 $ 2,561.00 90
35361 $ 3,562.70 90
35363 $ 3,976.62 90
35371 $ 1,936.04 90
35372 $ 2,235.00 90
35390 $ 512.51 ZZZ
35400 $ 511.97 ZZZ
35450 $ 1,448.15 0
35452 $ 906.33 0
35458 $ 1,413.71 0
35460 $ 825.78 0
35471 $ 4,792.61 0
35472 $ 3,435.43 0
35475 $ 2,979.76 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
100
35476 $ 2,645.77 0
35500 $ 646.11 ZZZ
35501 $ 3,142.46 90
35506 $ 3,146.15 90
35508 $ 3,088.34 90
35509 $ 3,219.59 90
35510 $ 2,619.25 90
35511 $ 2,802.98 90
35512 $ 2,669.66 90
35515 $ 3,331.54 90
35516 $ 2,809.11 90
35518 $ 3,003.00 90
35521 $ 2,983.17 90
35522 $ 2,503.43 90
35523 $ 2,989.33 90
35525 $ 2,374.34 90
35526 $ 3,828.90 90
35531 $ 4,479.99 90
35533 $ 3,754.00 90
35535 $ 4,374.00 90
35536 $ 4,152.08 90
35537 $ 5,177.44 90
35538 $ 5,389.97 90
35539 $ 5,163.28 90
35540 $ 5,778.89 90
35556 $ 3,191.22 90
35558 $ 2,999.00 90
35560 $ 3,866.47 90
35563 $ 3,312.25 90
35565 $ 3,022.71 90
35566 $ 3,775.97 90
35570 $ 3,592.00 90
35571 $ 3,218.00 90
35572 $ 917.00 ZZZ
35583 $ 3,209.08 90
35585 $ 3,737.89 90
35587 $ 3,183.74 90
35600 $ 684.00 ZZZ
35601 $ 3,142.87 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
101
35606 $ 2,811.11 90
35612 $ 2,545.66 90
35616 $ 2,605.05 90
35621 $ 2,580.87 90
35623 $ 2,909.49 90
35626 $ 3,584.22 90
35631 $ 4,099.21 90
35632 $ 3,996.41 90
35633 $ 4,636.00 90
35634 $ 4,320.00 90
35636 $ 3,547.25 90
35637 $ 3,841.22 90
35638 $ 3,907.62 90
35642 $ 2,923.73 90
35645 $ 2,915.52 90
35646 $ 3,971.74 90
35647 $ 3,931.00 90
35650 $ 2,518.77 90
35654 $ 3,230.92 90
35656 $ 2,607.37 90
35661 $ 2,442.56 90
35663 $ 2,855.70 90
35665 $ 2,731.61 90
35666 $ 2,973.93 90
35671 $ 2,632.05 90
35681 $ 1,211.00 ZZZ
35682 $ 874.55 ZZZ
35683 $ 1,009.95 ZZZ
35685 $ 490.22 ZZZ
35686 $ 451.00 ZZZ
35691 $ 2,644.40 90
35693 $ 2,328.75 90
35694 $ 2,529.43 90
35695 $ 2,565.13 90
35697 $ 332.56 ZZZ
35700 $ 515.63 ZZZ
35701 $ 1,239.19 90
35721 $ 1,008.92 90
35741 $ 1,127.92 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
102
35761 $ 903.24 90
35800 $ 1,566.55 90
35820 $ 4,184.06 90
35840 $ 2,466.80 90
35860 $ 1,639.79 90
35870 $ 3,331.48 90
35875 $ 1,428.25 90
35876 $ 2,162.65 90
35879 $ 2,239.00 90
35881 $ 2,620.00 90
35883 $ 2,757.71 90
35884 $ 2,899.04 90
35901 $ 1,330.96 90
35903 $ 1,518.36 90
35905 $ 3,846.64 90
35907 $ 4,282.58 90
36000 $ 86.00 XXX
36002 $ 382.56 0
36005 $ 602.57 0
36010 $ 907.31 XXX
36011 $ 1,522.13 XXX
36012 $ 1,546.88 XXX
36013 $ 1,401.19 XXX
36014 $ 1,506.70 XXX
36015 $ 1,548.56 XXX
36100 $ 908.29 XXX
36120 $ 843.68 XXX
36140 $ 803.75 XXX
36147 $ 1,547.98 XXX
36148 $ 585.51 ZZZ
36160 $ 914.27 XXX
36200 $ 1,151.43 0
36215 $ 2,083.75 XXX
36216 $ 2,194.67 XXX
36217 $ 3,620.69 XXX
36218 $ 357.95 ZZZ
36221 $ 2,169.99 0
36222 $ 2,689.08 0
36223 $ 2,941.89 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
103
36224 $ 3,431.00 0
36225 $ 2,920.60 0
36226 $ 3,418.24 0
36227 $ 596.10 ZZZ
36228 $ 2,347.07 ZZZ
36245 $ 2,406.25 XXX
36246 $ 1,720.84 0
36247 $ 2,919.02 0
36248 $ 311.66 ZZZ
36251 $ 2,737.29 0
36252 $ 3,005.28 0
36253 $ 4,204.41 0
36254 $ 4,356.70 0
36260 $ 1,466.08 90
36261 $ 899.48 90
36262 $ 693.85 90
36299 BR YYY
36400 Not Covered XXX
36405 $ 65.79 XXX
36406 $ 64.95 XXX
36410 $ 38.67 XXX
36415 $ 18.00 XXX
36416 $ 11.00 XXX
36420 Not Covered XXX
36425 $ 95.67 XXX
36430 $ 77.43 XXX
36440 Not Covered XXX
36450 $ 624.91 XXX
36455 $ 864.00 XXX
36460 $ 957.94 XXX
36468 BR 0
36470 $ 214.93 10
36471 $ 310.33 10
36475 $ 3,677.43 0
36476 $ 760.74 ZZZ
36478 $ 3,045.24 0
36479 $ 779.10 ZZZ
36481 $ 2,945.61 0
36500 $ 424.04 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
104
36510 $ 209.63 0
36511 $ 232.74 0
36512 $ 235.26 0
36513 $ 242.98 0
36514 $ 919.30 0
36515 $ 3,455.66 0
36516 $ 3,861.45 0
36522 $ 1,781.06 0
36555 Not Covered 0
36556 $ 607.74 0
36557 Not Covered 10
36558 $ 1,444.88 10
36560 Not Covered 10
36561 $ 2,300.36 10
36563 $ 2,750.92 10
36565 $ 1,878.94 10
36566 $ 7,866.93 10
36568 Not Covered 0
36569 $ 539.15 0
36570 Not Covered 10
36571 $ 2,617.38 10
36575 $ 308.10 0
36576 $ 744.02 10
36578 $ 974.63 10
36580 $ 472.22 0
36581 $ 1,422.17 10
36582 $ 2,124.56 10
36583 $ 2,495.55 10
36584 $ 452.78 0
36585 $ 2,466.64 10
36589 $ 321.25 10
36590 $ 627.00 10
36591 $ 53.53 XXX
36592 $ 61.07 XXX
36593 $ 73.11 XXX
36595 $ 1,239.14 0
36596 $ 290.45 0
36597 $ 269.23 0
36598 $ 322.00 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
105
36600 $ 71.72 XXX
36620 $ 126.04 0
36625 $ 239.76 0
36640 $ 305.12 0
36660 $ 179.00 0
36680 $ 162.04 0
36800 $ 370.15 0
36810 $ 662.27 0
36815 $ 448.14 0
36818 $ 1,534.44 90
36819 $ 1,839.00 90
36820 $ 1,832.38 90
36821 $ 1,608.32 90
36823 $ 2,830.75 90
36825 $ 1,819.82 90
36830 $ 1,562.40 90
36831 $ 1,245.59 90
36832 $ 1,592.68 90
36833 $ 1,789.95 90
36835 $ 1,475.74 90
36838 $ 2,434.98 90
36860 $ 405.00 0
36861 $ 427.00 0
36870 $ 3,472.00 90
37140 $ 5,008.38 90
37145 $ 4,670.00 90
37160 $ 4,795.83 90
37180 $ 4,545.68 90
37181 $ 5,040.35 90
37182 $ 2,275.00 0
37183 $ 8,407.68 0
37184 $ 4,884.22 0
37185 $ 1,581.92 ZZZ
37186 $ 3,101.25 ZZZ
37187 $ 4,573.86 0
37188 $ 3,882.86 0
37191 $ 4,976.28 0
37192 $ 3,342.06 0
37193 $ 3,190.06 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
106
37195 $ 1,445.31 XXX
37197 $ 2,958.98 0
37200 $ 659.38 0
37211 $ 996.29 0
37212 $ 878.93 0
37213 $ 634.85 0
37214 $ 349.65 0
37215 $ 2,691.00 90
37216 $ 4,584.72 90
37217 $ 2,576.24 90
37218 $ 1,828.65 90
37220 $ 5,933.54 0
37221 $ 8,820.86 0
37222 $ 1,702.79 ZZZ
37223 $ 4,904.54 ZZZ
37224 $ 7,135.43 0
37225 $ 20,532.77 0
37226 $ 17,016.03 0
37227 $ 27,736.98 0
37228 $ 10,180.60 0
37229 $ 20,232.70 0
37230 $ 15,799.02 0
37231 $ 25,393.70 0
37232 $ 2,300.88 ZZZ
37233 $ 2,783.51 ZZZ
37234 $ 7,335.16 ZZZ
37235 $ 7,801.63 ZZZ
37236 $ 6,877.34 90
37237 $ 4,442.72 ZZZ
37238 $ 8,027.24 90
37239 $ 3,989.13 ZZZ
37241 $ 8,900.23 90
37242 $ 14,973.07 ZZZ
37243 $ 18,899.20 90
37244 $ 13,252.62 ZZZ
37252 RNE ZZZ
37253 RNE ZZZ
37500 $ 1,526.49 90
37501 BR YYY
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
107
37565 $ 1,591.30 90
37600 $ 1,569.37 90
37605 $ 1,750.62 90
37606 $ 1,229.18 90
37607 $ 932.47 90
37609 $ 570.20 10
37615 $ 1,107.75 90
37616 $ 2,422.21 90
37617 $ 2,928.17 90
37618 $ 1,061.68 90
37619 $ 3,938.27 90
37650 $ 1,063.39 90
37660 $ 2,419.03 90
37700 $ 660.00 90
37718 $ 1,004.60 90
37722 $ 1,110.20 90
37735 $ 1,728.64 90
37760 $ 1,786.96 90
37761 $ 1,493.00 90
37765 $ 1,264.77 90
37766 $ 1,503.15 90
37780 $ 516.00 90
37785 $ 691.75 90
37788 $ 2,701.40 90
37790 $ 1,786.68 90
37799 BR YYY
38100 $ 2,507.57 90
38101 $ 2,524.80 90
38102 $ 805.54 ZZZ
38115 $ 2,757.16 90
38120 $ 2,399.25 90
38129 BR YYY
38200 $ 350.12 0
38204 $ 257.17 XXX
38205 $ 204.65 0
38206 $ 205.99 0
38207 $ 114.00 XXX
38208 $ 88.00 XXX
38209 $ 71.00 XXX
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
108
38210 $ 198.71 XXX
38211 $ 148.84 XXX
38212 $ 106.95 XXX
38213 $ 71.00 XXX
38214 $ 86.87 XXX
38215 $ 123.00 XXX
38220 $ 341.12 XXX
38221 $ 352.79 XXX
38230 $ 708.07 0
38232 $ 519.59 0
38240 $ 553.28 XXX
38241 $ 499.00 XXX
38242 $ 270.33 0
38243 $ 304.18 0
38300 $ 465.75 10
38305 $ 865.05 90
38308 $ 1,001.50 90
38380 $ 1,193.19 90
38381 $ 1,814.26 90
38382 $ 1,554.38 90
38500 $ 605.16 10
38505 $ 286.50 0
38510 $ 990.04 10
38520 $ 1,002.69 90
38525 $ 944.24 90
38530 $ 1,185.55 90
38542 $ 1,121.92 90
38550 $ 1,095.90 90
38555 $ 2,175.78 90
38562 $ 1,615.69 90
38564 $ 1,617.29 90
38570 $ 1,429.00 10
38571 $ 1,996.00 10
38572 $ 2,349.93 10
38589 BR YYY
38700 $ 1,745.25 90
38720 $ 2,914.59 90
38724 $ 3,152.31 90
38740 $ 1,500.87 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
109
38745 $ 1,894.19 90
38746 $ 585.40 ZZZ
38747 $ 672.52 ZZZ
38760 $ 1,789.99 90
38765 $ 2,797.41 90
38770 $ 2,062.99 90
38780 $ 2,751.08 90
38790 $ 288.82 0
38792 $ 175.47 0
38794 $ 684.73 90
38900 $ 371.01 ZZZ
38999 BR YYY
39000 $ 1,079.61 90
39010 $ 1,814.97 90
39200 $ 2,009.19 90
39220 $ 2,575.81 90
39401 RNE 0
39402 RNE 0
39499 BR YYY
39501 $ 2,400.00 90
39503 $ 9,678.17 90
39540 $ 2,500.00 90
39541 $ 2,111.76 90
39545 $ 1,991.00 90
39560 $ 2,183.00 90
39561 $ 2,910.00 90
39599 BR YYY
40490 $ 192.50 0
40500 $ 1,169.09 90
40510 $ 1,075.24 90
40520 $ 1,065.78 90
40525 $ 1,309.53 90
40527 $ 1,781.93 90
40530 $ 1,169.00 90
40650 $ 848.71 90
40652 $ 1,005.14 90
40654 $ 1,233.52 90
40700 $ 2,264.54 90
40701 $ 2,642.00 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
110
40702 $ 2,137.13 90
40720 $ 2,350.88 90
40761 $ 2,555.38 90
40799 BR YYY
40800 $ 389.90 10
40801 $ 596.53 10
40804 $ 379.85 10
40805 $ 649.20 10
40806 $ 269.51 0
40808 $ 279.15 10
40810 $ 295.45 10
40812 $ 414.73 10
40814 $ 672.50 90
40816 $ 796.10 90
40818 $ 584.80 90
40819 $ 618.04 90
40820 $ 493.75 10
40830 $ 483.71 10
40831 $ 626.84 10
40840 $ 1,680.90 90
40842 $ 1,659.17 90
40843 $ 2,167.52 90
40844 $ 2,598.37 90
40845 $ 3,118.43 90
40899 BR YYY
41000 $ 306.08 10
41005 $ 426.71 10
41006 $ 697.11 90
41007 $ 691.73 90
41008 $ 720.75 90
41009 $ 773.81 90
41010 $ 397.46 10
41015 $ 824.61 90
41016 $ 837.94 90
41017 $ 824.03 90
41018 $ 981.13 90
41019 $ 1,171.74 0
41100 $ 316.02 10
41105 $ 321.48 10
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
111
41108 $ 278.86 10
41110 $ 305.86 10
41112 $ 522.00 90
41113 $ 635.00 90
41114 $ 1,381.75 90
41115 $ 467.00 10
41116 $ 762.76 90
41120 $ 2,125.51 90
41130 $ 2,620.51 90
41135 $ 4,692.99 90
41140 $ 4,342.81 90
41145 $ 5,982.67 90
41150 $ 4,709.31 90
41153 $ 5,443.83 90
41155 $ 6,424.23 90
41250 $ 482.73 10
41251 $ 547.48 10
41252 $ 746.16 10
41500 $ 980.08 90
41510 $ 1,163.57 90
41512 $ 1,421.02 90
41520 $ 693.06 90
41530 $ 5,688.94 10
41599 BR YYY
41800 $ 489.96 10
41805 $ 473.95 10
41806 $ 652.03 10
41820 $ 509.28 0
41821 $ 114.15 0
41822 $ 506.13 10
41823 $ 711.94 90
41825 $ 301.08 10
41826 $ 464.54 10
41827 $ 709.51 90
41828 $ 555.55 10
41830 $ 565.94 10
41850 $ 213.72 0
41870 $ 584.22 0
41872 $ 724.79 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
112
41874 $ 740.50 90
41899 BR YYY
42000 $ 297.84 10
42100 $ 225.44 10
42104 $ 332.99 10
42106 $ 478.11 10
42107 $ 1,476.60 90
42120 $ 2,282.20 90
42140 $ 491.29 90
42145 $ 1,578.65 90
42160 $ 332.75 10
42180 $ 455.01 10
42182 $ 644.75 10
42200 $ 1,944.84 90
42205 $ 2,075.35 90
42210 $ 2,488.52 90
42215 $ 1,701.16 90
42220 $ 1,612.99 90
42225 $ 2,066.09 90
42226 $ 2,046.20 90
42227 $ 1,970.00 90
42235 $ 1,432.83 90
42260 $ 1,634.67 90
42280 $ 310.08 10
42281 $ 382.95 10
42299 BR YYY
42300 $ 458.50 10
42305 $ 854.19 90
42310 $ 333.80 10
42320 $ 580.25 10
42330 $ 340.84 10
42335 $ 736.79 90
42340 $ 1,075.68 90
42400 $ 213.56 0
42405 $ 589.90 10
42408 $ 879.02 90
42409 $ 689.40 90
42410 $ 1,421.00 90
42415 $ 2,443.16 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
113
42420 $ 2,806.00 90
42425 $ 1,936.35 90
42426 $ 3,383.61 90
42440 $ 1,151.09 90
42450 $ 1,126.49 90
42500 $ 959.23 90
42505 $ 1,254.42 90
42507 $ 1,330.33 90
42509 $ 2,220.45 90
42510 $ 1,494.49 90
42550 $ 249.98 0
42600 $ 1,129.89 90
42650 $ 156.75 0
42660 $ 221.15 0
42665 $ 476.57 90
42699 BR YYY
42700 $ 372.94 10
42720 $ 832.30 10
42725 $ 1,600.07 90
42800 $ 296.18 10
42804 $ 364.01 10
42806 $ 410.99 10
42808 $ 519.17 10
42809 $ 351.06 10
42810 $ 842.65 90
42815 $ 1,286.90 90
42820 Not Covered 90
42821 $ 686.96 90
42825 Not Covered 90
42826 $ 618.90 90
42830 Not Covered 90
42831 $ 514.28 90
42835 Not Covered 90
42836 $ 553.10 90
42842 $ 2,289.28 90
42844 $ 3,133.67 90
42845 $ 4,691.70 90
42860 $ 432.30 90
42870 $ 1,276.64 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
114
42890 $ 2,880.23 90
42892 $ 3,830.56 90
42894 $ 4,719.41 90
42900 $ 806.81 10
42950 $ 1,762.43 90
42953 $ 2,121.20 90
42955 $ 1,493.30 90
42960 $ 354.24 10
42961 $ 808.51 90
42962 $ 1,014.55 90
42970 $ 797.66 90
42971 $ 893.47 90
42972 $ 1,030.99 90
42999 BR YYY
43020 $ 1,322.02 90
43030 $ 1,288.83 90
43045 $ 2,846.73 90
43100 $ 1,488.50 90
43101 $ 2,353.17 90
43107 $ 5,569.68 90
43108 $ 10,105.92 90
43112 $ 5,875.65 90
43113 $ 9,688.63 90
43116 $ 10,303.98 90
43117 $ 5,376.31 90
43118 $ 8,209.26 90
43121 $ 6,267.74 90
43122 $ 5,578.11 90
43123 $ 10,151.37 90
43124 $ 8,352.83 90
43130 $ 1,805.98 90
43135 $ 3,390.75 90
43180 $ 1,195.90 90
43191 $ 316.66 0
43192 $ 367.64 0
43193 $ 416.15 0
43194 $ 417.46 0
43195 $ 429.33 0
43196 $ 479.23 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
115
43197 $ 402.29 0
43198 $ 477.27 0
43200 $ 591.02 0
43201 $ 639.60 0
43202 $ 732.99 0
43204 $ 577.68 0
43205 $ 588.52 0
43206 BR YYY
43210 RNE YYY
43211 $ 552.08 0
43212 $ 452.47 0
43213 $ 2,412.42 0
43214 $ 458.33 0
43215 $ 721.56 0
43216 $ 708.62 0
43217 $ 936.73 0
43220 $ 1,625.64 0
43226 $ 671.78 0
43227 $ 790.80 0
43229 $ 1,372.04 0
43231 $ 746.93 0
43232 $ 979.80 0
43233 $ 474.99 0
43235 $ 724.24 0
43236 $ 843.79 0
43237 $ 447.95 0
43238 $ 538.26 0
43239 $ 853.31 0
43240 $ 973.71 0
43241 $ 421.80 0
43242 $ 983.71 0
43243 $ 695.61 0
43244 $ 722.31 0
43245 $ 1,094.64 0
43246 $ 691.69 0
43247 $ 763.95 0
43248 $ 753.51 0
43249 $ 1,554.54 0
43250 $ 821.30 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
116
43251 $ 885.90 0
43252 $ 1,108.64 YYY
43253 $ 551.03 0
43254 $ 571.92 0
43255 $ 908.89 0
43257 $ 766.40 0
43259 $ 808.24 0
43260 $ 864.78 0
43261 $ 891.21 0
43262 $ 1,095.43 0
43263 $ 985.37 0
43264 $ 1,270.67 0
43265 $ 1,350.18 0
43266 $ 993.95 0
43270 $ 1,509.35 0
43273 $ 295.92 ZZZ
43274 $ 980.60 0
43275 $ 808.41 0
43276 $ 1,020.30 0
43277 $ 813.41 0
43278 $ 972.59 0
43279 $ 2,917.47 90
43280 $ 2,390.72 90
43281 $ 3,493.33 90
43282 $ 3,929.68 90
43283 $ 436.32 ZZZ
43289 BR YYY
43300 $ 1,732.96 90
43305 $ 2,452.59 90
43310 $ 3,387.00 90
43312 $ 3,571.07 90
43313 $ 6,829.59 90
43314 $ 6,667.00 90
43320 $ 3,025.79 90
43325 $ 2,913.79 90
43327 $ 2,188.42 90
43328 $ 3,211.01 90
43330 $ 2,890.35 90
43331 $ 2,934.42 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
117
43332 $ 3,136.09 90
43333 $ 3,398.56 90
43334 $ 3,434.36 90
43335 $ 3,677.68 90
43336 $ 3,983.02 90
43337 $ 4,433.56 90
43338 $ 357.67 ZZZ
43340 $ 2,975.95 90
43341 $ 3,216.08 90
43351 $ 2,861.05 90
43352 $ 2,334.39 90
43360 $ 5,160.98 90
43361 $ 5,579.49 90
43400 $ 3,266.35 90
43401 $ 3,406.78 90
43405 $ 3,295.63 90
43410 $ 2,283.97 90
43415 $ 5,025.73 90
43420 $ 2,211.22 90
43425 $ 3,154.17 90
43450 $ 401.20 0
43453 $ 1,396.35 0
43460 $ 523.15 0
43496 BR 90
43499 BR YYY
43500 $ 1,698.45 90
43501 $ 2,918.28 90
43502 $ 3,306.42 90
43510 $ 2,049.05 90
43520 $ 1,570.92 90
43605 $ 1,830.28 90
43610 $ 2,125.57 90
43611 $ 2,770.55 90
43620 $ 4,260.00 90
43621 $ 4,929.16 90
43622 $ 5,025.50 90
43631 $ 3,143.58 90
43632 $ 4,406.87 90
43633 $ 4,164.19 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
118
43634 $ 4,607.00 90
43635 $ 289.38 ZZZ
43640 $ 2,553.50 90
43641 $ 2,626.43 90
43644 $ 3,938.27 90
43645 $ 4,188.07 90
43647 BR YYY
43648 BR YYY
43651 $ 1,670.99 90
43652 $ 2,381.36 90
43653 $ 1,419.82 90
43659 BR YYY
43752 $ 100.86 0
43753 $ 57.83 0
43754 $ 219.06 0
43755 $ 311.36 0
43756 $ 382.47 0
43757 $ 554.31 0
43760 $ 835.94 0
43761 $ 274.93 0
43770 $ 2,530.70 90
43771 $ 2,875.41 90
43772 $ 2,150.37 90
43773 $ 2,891.62 90
43774 $ 2,169.60 90
43775 $ 3,503.09 YYY
43800 $ 2,013.42 90
43810 $ 2,206.92 90
43820 $ 2,907.37 90
43825 $ 2,836.39 90
43830 $ 1,540.05 90
43831 $ 1,355.29 90
43832 $ 2,254.06 90
43840 $ 2,945.18 90
43842 $ 2,638.02 90
43843 $ 2,918.84 90
43845 $ 4,546.14 90
43846 $ 3,668.95 90
43847 $ 4,070.48 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
119
43848 $ 4,378.14 90
43850 $ 3,527.52 90
43855 $ 3,619.03 90
43860 $ 3,547.95 90
43865 $ 3,703.98 90
43870 $ 1,543.52 90
43880 $ 3,612.17 90
43881 BR YYY
43882 BR YYY
43886 $ 818.52 90
43887 $ 737.80 90
43888 $ 1,038.08 90
43999 BR YYY
44005 $ 2,370.70 90
44010 $ 1,912.00 90
44015 $ 665.73 ZZZ
44020 $ 2,112.28 90
44021 $ 2,113.58 90
44025 $ 2,137.76 90
44050 $ 2,027.11 90
44055 $ 3,155.52 90
44100 $ 276.11 0
44110 $ 1,847.51 90
44111 $ 2,181.98 90
44120 $ 2,651.88 90
44121 $ 625.92 ZZZ
44125 $ 2,559.83 90
44126 $ 5,616.33 90
44127 $ 6,495.62 90
44128 $ 616.32 ZZZ
44130 $ 2,846.39 90
44132 $ 2,695.39 XXX
44133 $ 4,620.68 XXX
44135 $ 7,701.13 XXX
44136 $ 8,663.78 XXX
44137 $ 3,850.57 XXX
44139 $ 310.68 ZZZ
44140 $ 2,907.92 90
44141 $ 3,959.39 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
120
44143 $ 3,609.87 90
44144 $ 3,802.79 90
44145 $ 3,596.18 90
44146 $ 4,599.57 90
44147 $ 4,216.04 90
44150 $ 4,057.43 90
44151 $ 4,655.58 90
44155 $ 4,515.35 90
44156 $ 5,026.83 90
44157 $ 4,707.39 90
44158 $ 4,609.21 90
44160 $ 2,692.20 90
44180 $ 1,989.51 90
44186 $ 1,414.00 90
44187 $ 2,402.86 90
44188 $ 2,657.06 90
44202 $ 3,016.45 90
44203 $ 573.83 ZZZ
44204 $ 3,334.84 90
44205 $ 2,901.38 90
44206 $ 3,804.53 90
44207 $ 3,951.22 90
44208 $ 4,315.52 90
44210 $ 3,865.38 90
44211 $ 4,733.15 90
44212 $ 4,449.47 90
44213 $ 437.86 ZZZ
44227 $ 3,619.48 90
44238 BR YYY
44300 $ 1,822.99 90
44310 $ 2,263.94 90
44312 $ 1,082.33 90
44314 $ 2,174.61 90
44316 $ 3,071.15 90
44320 $ 2,573.11 90
44322 $ 2,166.25 90
44340 $ 1,113.61 90
44345 $ 2,280.16 90
44346 $ 2,564.13 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
121
44360 $ 451.74 0
44361 $ 510.57 0
44363 $ 531.04 0
44364 $ 607.01 0
44365 $ 578.85 0
44366 $ 696.93 0
44369 $ 764.25 0
44370 $ 762.44 0
44372 $ 725.21 0
44373 $ 661.03 0
44376 $ 857.73 0
44377 $ 904.79 0
44378 $ 1,084.49 0
44379 $ 1,023.81 0
44380 $ 338.07 0
44381 $ 1,335.34 0
44382 $ 411.36 0
44384 $ 798.64 0
44385 $ 614.29 0
44386 $ 772.34 0
44388 $ 817.72 0
44389 $ 951.07 0
44390 $ 1,074.01 0
44391 $ 1,364.52 0
44392 $ 1,018.76 0
44394 $ 1,134.07 0
44401 $ 3,701.60 0
44402 $ 798.64 0
44403 $ 488.75 0
44404 $ 655.08 0
44405 $ 1,032.50 0
44406 $ 373.17 0
44407 $ 446.62 0
44408 $ 376.95 0
44500 $ 97.70 0
44602 $ 3,023.75 90
44603 $ 3,514.42 90
44604 $ 2,309.58 90
44605 $ 2,832.22 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
122
44615 $ 2,327.97 90
44620 $ 1,882.07 90
44625 $ 2,386.00 90
44626 $ 3,486.24 90
44640 $ 2,947.72 90
44650 $ 3,115.40 90
44660 $ 2,883.89 90
44661 $ 3,363.92 90
44680 $ 2,341.10 90
44700 $ 2,346.60 90
44701 $ 390.27 ZZZ
44705 BR XXX
44715 BR XXX
44720 $ 639.81 XXX
44721 $ 906.36 XXX
44799 BR YYY
44800 $ 1,747.48 90
44820 $ 1,915.21 90
44850 $ 1,627.25 90
44899 BR YYY
44900 $ 1,675.56 90
44950 $ 1,391.18 90
44955 $ 192.42 ZZZ
44960 $ 1,893.71 90
44970 $ 1,809.50 90
44979 BR YYY
45000 $ 912.48 90
45005 $ 528.93 10
45020 $ 1,151.91 90
45100 $ 648.21 90
45108 $ 832.98 90
45110 $ 4,008.11 90
45111 $ 2,384.30 90
45112 $ 4,079.59 90
45113 $ 4,166.31 90
45114 $ 3,944.47 90
45116 $ 3,458.19 90
45119 $ 4,228.39 90
45120 $ 3,538.61 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
123
45121 $ 3,661.97 90
45123 $ 2,453.79 90
45126 $ 5,972.60 90
45130 $ 2,358.31 90
45135 $ 3,013.01 90
45136 $ 3,917.69 90
45150 $ 961.85 90
45160 $ 2,323.58 90
45171 $ 1,173.62 90
45172 $ 1,583.69 90
45190 $ 1,568.83 90
45300 $ 227.59 0
45303 $ 1,725.00 0
45305 $ 359.98 0
45307 $ 499.38 0
45308 $ 448.94 0
45309 $ 510.91 0
45315 $ 524.30 0
45317 $ 555.63 0
45320 $ 559.79 0
45321 $ 291.95 0
45327 $ 463.19 0
45330 $ 303.10 0
45331 $ 411.28 0
45332 $ 556.38 0
45333 $ 595.15 0
45334 $ 503.25 0
45335 $ 521.20 0
45337 $ 366.96 0
45338 $ 608.26 0
45340 $ 904.61 0
45341 $ 449.00 0
45342 $ 602.66 0
45346 $ 3,545.60 0
45347 $ 549.07 0
45349 $ 322.95 0
45350 $ 895.40 0
45378 $ 875.99 0
45379 $ 1,150.14 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
124
45380 $ 1,060.69 0
45381 $ 1,133.23 0
45382 $ 1,556.67 0
45384 $ 1,107.67 0
45385 $ 1,201.01 0
45386 $ 1,605.33 0
45388 $ 3,724.00 0
45389 $ 798.64 0
45390 $ 535.73 0
45391 $ 673.33 0
45392 $ 856.16 0
45393 $ 409.90 0
45395 $ 4,294.68 90
45397 $ 4,676.42 90
45398 $ 1,124.38 0
45399 BR XXX
45400 $ 2,470.18 90
45402 $ 3,296.48 90
45499 BR YYY
45500 $ 1,167.41 90
45505 $ 1,304.51 90
45520 $ 281.75 0
45540 $ 2,296.65 90
45541 $ 2,068.77 90
45550 $ 3,164.30 90
45560 $ 1,439.46 90
45562 $ 2,457.82 90
45563 $ 3,575.54 90
45800 $ 2,644.02 90
45805 $ 3,076.13 90
45820 $ 2,498.54 90
45825 $ 3,104.29 90
45900 $ 470.63 10
45905 $ 389.15 10
45910 $ 409.43 10
45915 $ 682.26 10
45990 $ 249.63 0
45999 BR YYY
46020 $ 643.80 10
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
125
46030 $ 255.90 10
46040 $ 963.46 90
46045 $ 839.49 90
46050 $ 372.13 10
46060 $ 1,036.53 90
46070 $ 454.88 90
46080 $ 453.13 10
46083 $ 323.32 10
46200 $ 912.51 90
46220 $ 365.56 10
46221 $ 495.60 10
46230 $ 500.96 10
46250 $ 993.97 90
46255 $ 1,088.55 90
46257 $ 938.52 90
46258 $ 1,030.98 90
46260 $ 1,067.17 90
46261 $ 1,144.05 90
46262 $ 1,210.20 90
46270 $ 1,091.41 90
46275 $ 1,155.58 90
46280 $ 1,041.35 90
46285 $ 964.49 90
46288 $ 1,272.16 90
46320 $ 352.50 10
46500 $ 398.32 10
46505 $ 654.27 10
46600 $ 163.67 0
46601 $ 210.62 0
46604 $ 1,110.94 0
46606 $ 415.06 0
46607 $ 293.79 0
46608 $ 454.01 0
46610 $ 416.89 0
46611 $ 406.18 0
46612 $ 522.16 0
46614 $ 320.00 0
46615 $ 381.00 0
46700 $ 1,412.51 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
126
46705 Not Covered 90
46706 $ 359.38 10
46707 $ 1,053.21 90
46710 $ 2,397.53 90
46712 $ 4,602.97 90
46715 $ 1,222.14 90
46716 $ 2,433.56 90
46730 $ 4,405.62 90
46735 $ 4,627.76 90
46740 $ 4,852.11 90
46742 $ 5,331.32 90
46744 $ 7,976.59 90
46746 $ 7,956.21 90
46748 $ 8,690.03 90
46750 $ 1,628.07 90
46751 Not Covered 90
46753 $ 1,438.26 90
46754 $ 578.67 10
46760 $ 2,363.56 90
46761 $ 2,086.39 90
46762 $ 2,355.61 90
46900 $ 352.06 10
46910 $ 358.41 10
46916 $ 323.24 10
46917 $ 666.86 10
46922 $ 373.19 10
46924 $ 1,020.92 10
46930 $ 439.42 90
46940 $ 440.38 10
46942 $ 428.13 10
46945 $ 589.94 90
46946 $ 673.97 90
46947 $ 824.80 90
46999 BR YYY
47000 $ 661.55 0
47001 $ 257.21 ZZZ
47010 $ 2,607.94 90
47015 $ 2,499.78 90
47100 $ 1,829.26 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
127
47120 $ 5,053.30 90
47122 $ 7,451.79 90
47125 $ 6,664.94 90
47130 $ 7,162.37 90
47133 $ 6,732.05 XXX
47135 $ 15,184.00 90
47140 $ 6,698.08 90
47141 $ 8,304.92 90
47142 $ 9,157.28 90
47143 BR XXX
47144 BR 90
47145 BR XXX
47146 $ 772.12 XXX
47147 $ 897.79 XXX
47300 $ 2,457.17 90
47350 $ 2,970.12 90
47360 $ 4,042.73 90
47361 $ 6,564.41 90
47362 $ 3,014.77 90
47370 $ 2,703.32 90
47371 $ 2,684.20 90
47379 BR YYY
47380 $ 3,271.31 90
47381 $ 3,208.66 90
47382 $ 6,418.02 10
47383 $ 13,612.02 10
47399 BR YYY
47400 $ 4,670.15 90
47420 $ 2,908.26 90
47425 $ 2,950.86 90
47460 $ 2,795.93 90
47480 $ 1,894.80 90
47490 $ 970.00 10
47531 RNE 0
47532 RNE 0
47533 RNE 0
47534 RNE 0
47535 RNE 0
47536 RNE 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
128
47537 RNE 0
47538 RNE 0
47539 RNE 0
47540 RNE 0
47541 RNE 0
47542 RNE ZZZ
47543 RNE ZZZ
47544 RNE ZZZ
47550 $ 480.33 ZZZ
47552 $ 726.72 0
47553 $ 745.00 0
47554 $ 1,149.86 0
47555 $ 857.78 0
47556 $ 997.78 0
47562 $ 1,687.93 90
47563 $ 1,868.26 90
47564 $ 2,590.92 90
47570 $ 2,261.79 90
47579 BR YYY
47600 $ 2,311.56 90
47605 $ 2,433.59 90
47610 $ 2,719.05 90
47612 $ 2,813.79 90
47620 $ 2,987.98 90
47700 $ 2,373.66 90
47701 $ 4,419.46 90
47711 $ 3,537.48 90
47712 $ 4,523.69 90
47715 $ 2,886.46 90
47720 $ 2,496.34 90
47721 $ 2,938.44 90
47740 $ 2,833.88 90
47741 $ 3,265.65 90
47760 $ 4,754.37 90
47765 $ 5,912.51 90
47780 $ 5,325.77 90
47785 $ 7,043.28 90
47800 $ 3,420.28 90
47801 $ 2,157.21 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
129
47802 $ 3,284.53 90
47900 $ 3,007.86 90
47999 BR YYY
48000 $ 3,891.84 90
48001 $ 4,543.46 90
48020 $ 2,551.64 90
48100 $ 1,938.97 90
48102 $ 984.64 10
48105 $ 6,179.78 90
48120 $ 2,399.72 90
48140 $ 3,390.55 90
48145 $ 3,537.60 90
48146 $ 4,073.59 90
48148 $ 2,704.55 90
48150 $ 6,751.27 90
48152 $ 6,247.68 90
48153 $ 6,713.46 90
48154 $ 6,296.76 90
48155 $ 3,940.03 90
48160 $ 5,462.88 XXX
48400 $ 262.84 ZZZ
48500 $ 2,466.55 90
48510 $ 2,437.21 90
48520 $ 2,371.59 90
48540 $ 2,831.29 90
48545 $ 2,905.49 90
48547 $ 3,886.50 90
48548 $ 3,613.97 90
48550 BR XXX
48551 BR XXX
48552 $ 552.40 XXX
48554 $ 6,043.42 90
48556 $ 3,108.84 90
48999 BR YYY
49000 $ 1,667.99 90
49002 $ 2,267.34 90
49010 $ 2,020.71 90
49020 $ 3,097.18 90
49040 $ 2,166.79 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
130
49060 $ 2,380.58 90
49062 $ 1,651.73 90
49082 $ 355.71 0
49083 $ 556.16 0
49084 $ 269.83 0
49180 $ 388.74 0
49185 RNE 0
49203 $ 2,688.40 90
49204 $ 3,427.54 90
49205 $ 3,935.86 90
49215 $ 4,302.84 90
49220 $ 2,362.33 90
49250 $ 1,268.67 90
49255 $ 1,709.89 90
49320 $ 932.84 10
49321 $ 937.11 10
49322 $ 967.30 10
49323 $ 1,532.97 90
49324 $ 1,005.77 10
49325 $ 1,049.77 10
49326 $ 485.14 ZZZ
49327 $ 359.39 ZZZ
49329 BR YYY
49400 $ 262.93 0
49402 $ 1,853.79 90
49405 $ 1,712.95 0
49406 $ 1,712.27 0
49407 $ 1,450.57 0
49411 $ 991.75 0
49412 $ 229.61 ZZZ
49418 $ 2,660.46 0
49419 $ 1,006.14 90
49421 $ 715.00 0
49422 $ 791.38 10
49423 $ 1,020.48 0
49424 $ 338.66 0
49425 $ 1,625.07 90
49426 $ 1,991.13 90
49427 $ 190.62 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
131
49428 $ 1,051.07 10
49429 $ 1,081.30 10
49435 $ 298.99 ZZZ
49436 $ 487.26 10
49440 $ 1,990.30 10
49441 $ 2,303.05 10
49442 $ 1,902.00 10
49446 $ 1,933.10 0
49450 $ 1,346.00 0
49451 $ 1,428.27 0
49452 $ 1,749.56 0
49460 $ 1,449.00 0
49465 $ 309.00 0
49491 Not Covered 90
49492 Not Covered 90
49495 Not Covered 90
49496 Not Covered 90
49500 Not Covered 90
49501 Not Covered 90
49505 $ 1,149.56 90
49507 $ 1,332.21 90
49520 $ 1,403.90 90
49521 $ 1,699.00 90
49525 $ 1,250.71 90
49540 $ 1,453.59 90
49550 $ 1,247.39 90
49553 $ 1,407.74 90
49555 $ 1,297.82 90
49557 $ 1,615.64 90
49560 $ 1,615.66 90
49561 $ 2,012.33 90
49565 $ 1,699.54 90
49566 $ 2,029.91 90
49568 $ 523.23 ZZZ
49570 $ 898.59 90
49572 $ 1,126.57 90
49580 Not Covered 90
49582 Not Covered 90
49585 $ 989.67 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
132
49587 $ 1,177.66 90
49590 $ 1,248.05 90
49600 Not Covered 90
49605 Not Covered 90
49606 Not Covered 90
49610 Not Covered 90
49611 Not Covered 90
49650 $ 1,053.65 90
49651 $ 1,334.13 90
49652 $ 1,651.00 90
49653 $ 2,062.00 90
49654 $ 1,896.00 90
49655 $ 2,283.00 90
49656 $ 1,988.01 90
49657 $ 2,857.09 90
49659 BR YYY
49900 $ 1,610.65 90
49904 $ 3,097.02 90
49905 $ 1,088.75 ZZZ
49906 $ 5,545.70 90
49999 BR YYY
50010 $ 1,641.32 90
50020 $ 2,211.79 90
50040 $ 2,017.68 90
50045 $ 2,100.00 90
50060 $ 2,716.00 90
50065 $ 2,891.00 90
50070 $ 2,847.00 90
50075 $ 3,529.00 90
50080 $ 2,103.00 90
50081 $ 2,977.00 90
50100 $ 2,425.73 90
50120 $ 2,189.00 90
50125 $ 2,254.00 90
50130 $ 2,490.00 90
50135 $ 2,762.00 90
50200 $ 910.00 0
50205 $ 1,643.71 90
50220 $ 2,411.00 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
133
50225 $ 2,849.00 90
50230 $ 3,143.04 90
50234 $ 3,086.00 90
50236 $ 3,427.00 90
50240 $ 3,054.00 90
50250 $ 2,850.00 90
50280 $ 2,252.00 90
50290 $ 2,067.00 90
50300 $ 3,651.00 XXX
50320 $ 3,328.71 90
50323 $ 5,063.80 XXX
50325 $ 5,425.50 XXX
50327 $ 507.86 XXX
50328 $ 444.85 XXX
50329 $ 421.37 XXX
50340 $ 2,355.37 90
50360 $ 5,245.44 90
50365 $ 6,133.27 90
50370 $ 2,594.79 90
50380 $ 4,318.20 90
50382 $ 2,586.00 0
50384 $ 2,225.00 0
50385 $ 2,325.00 0
50386 $ 1,505.00 0
50387 $ 1,203.22 0
50389 $ 708.00 0
50390 $ 293.79 0
50391 $ 288.85 0
50395 $ 539.80 0
50396 $ 217.88 0
50400 $ 2,670.00 90
50405 $ 3,290.00 90
50430 RNE 0
50431 RNE 0
50432 RNE 0
50433 RNE 0
50434 RNE 0
50435 RNE 0
50500 $ 2,672.96 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
134
50520 $ 2,330.00 90
50525 $ 3,255.12 90
50526 $ 3,131.43 90
50540 $ 2,739.00 90
50541 $ 2,276.13 90
50542 $ 2,638.00 90
50543 $ 3,234.78 90
50544 $ 2,978.00 90
50545 $ 2,973.00 90
50546 $ 2,752.00 90
50547 $ 3,970.05 90
50548 $ 3,135.00 90
50549 BR YYY
50551 $ 823.82 0
50553 $ 915.76 0
50555 $ 984.00 0
50557 $ 995.00 0
50561 $ 1,126.12 0
50562 $ 1,382.00 90
50570 $ 1,189.07 0
50572 $ 1,368.00 0
50574 $ 1,423.00 0
50575 $ 1,840.00 0
50576 $ 1,482.00 0
50580 $ 1,482.95 0
50590 $ 2,875.00 90
50592 $ 8,108.00 10
50593 $ 8,452.39 10
50600 $ 2,117.00 90
50605 $ 2,113.05 90
50606 RNE ZZZ
50610 $ 2,227.00 90
50620 $ 2,124.00 90
50630 $ 2,135.00 90
50650 $ 2,390.00 90
50660 $ 2,714.00 90
50684 $ 270.43 0
50686 $ 277.12 0
50688 $ 185.87 10
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
135
50690 $ 181.03 0
50693 RNE 0
50694 RNE 0
50695 RNE 0
50700 $ 2,190.00 90
50705 RNE ZZZ
50706 RNE ZZZ
50715 $ 2,749.24 90
50722 $ 2,336.79 90
50725 $ 2,605.00 90
50727 $ 1,284.24 90
50728 $ 1,601.48 90
50740 $ 2,649.77 90
50750 $ 2,694.00 90
50760 $ 2,543.00 90
50770 $ 2,698.00 90
50780 $ 2,558.00 90
50782 $ 2,707.82 90
50783 $ 2,671.85 90
50785 $ 2,849.00 90
50800 $ 2,220.00 90
50810 $ 3,157.36 90
50815 $ 3,005.00 90
50820 $ 3,153.00 90
50825 $ 4,263.00 90
50830 $ 4,546.30 90
50840 $ 2,869.00 90
50845 $ 2,892.00 90
50860 $ 2,147.00 90
50900 $ 1,968.44 90
50920 $ 2,017.00 90
50930 $ 2,523.14 90
50940 $ 2,011.00 90
50945 $ 2,455.90 90
50947 $ 3,131.00 90
50948 $ 2,883.00 90
50949 BR YYY
50951 $ 685.81 0
50953 $ 725.10 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
136
50955 $ 796.74 0
50957 $ 783.76 0
50961 $ 705.99 0
50970 $ 802.00 0
50972 $ 658.77 0
50974 $ 1,022.00 0
50976 $ 1,006.00 0
50980 $ 709.00 0
51020 $ 1,186.95 90
51030 $ 1,202.71 90
51040 $ 982.94 90
51045 $ 1,097.45 90
51050 $ 1,168.87 90
51060 $ 2,016.87 90
51065 $ 1,978.03 90
51080 $ 912.00 90
51100 $ 138.64 0
51101 $ 234.00 0
51102 $ 643.00 0
51500 $ 1,426.02 90
51520 $ 1,427.67 90
51525 $ 1,989.00 90
51530 $ 1,762.33 90
51535 $ 1,681.63 90
51550 $ 2,150.00 90
51555 $ 2,728.81 90
51565 $ 2,990.00 90
51570 $ 3,290.00 90
51575 $ 4,389.00 90
51580 $ 4,342.00 90
51585 $ 5,063.00 90
51590 $ 4,534.00 90
51595 $ 5,410.00 90
51596 $ 5,702.00 90
51597 $ 5,532.00 90
51600 $ 338.43 0
51605 $ 104.00 0
51610 $ 196.01 0
51700 $ 151.93 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
137
51701 $ 109.00 0
51702 $ 156.00 0
51703 $ 246.00 0
51705 $ 175.00 0
51710 $ 352.00 0
51715 $ 662.41 0
51720 $ 203.11 0
51725 $ 496.00 0
51725 26 $ 182.92 0
51725 TC $ 313.08 0
51726 $ 692.00 0
51726 26 $ 208.08 0
51726 TC $ 483.92 0
51727 $ 931.00 0
51727 26 $ 258.95 0
51727 TC $ 672.05 0
51728 $ 982.50 0
51728 26 $ 250.07 0
51728 TC $ 732.43 0
51729 $ 1,210.00 0
51729 26 $ 309.64 0
51729 TC $ 900.36 0
51736 $ 104.00 XXX
51736 26 $ 55.46 XXX
51736 TC $ 48.54 XXX
51741 $ 166.00 XXX
51741 26 $ 110.92 XXX
51741 TC $ 55.08 XXX
51784 $ 474.53 0
51784 26 $ 204.64 0
51784 TC $ 269.89 0
51785 $ 575.41 0
51785 26 $ 208.40 0
51785 TC $ 367.01 0
51792 $ 621.54 0
51792 26 $ 274.70 0
51792 TC $ 346.84 0
51797 $ 539.00 ZZZ
51797 26 $ 184.91 ZZZ
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
138
51797 TC $ 354.09 ZZZ
51798 $ 40.54 XXX
51798 26 $ -
51798 TC $ 40.54
51800 $ 2,403.00 90
51820 $ 2,815.14 90
51840 $ 1,537.00 90
51841 $ 1,845.00 90
51845 $ 1,769.46 90
51860 $ 1,617.00 90
51865 $ 2,064.00 90
51880 $ 1,047.00 90
51900 $ 2,467.42 90
51920 $ 1,887.13 90
51925 $ 2,587.69 90
51940 $ 4,299.17 90
51960 $ 3,377.00 90
51980 $ 1,715.00 90
51990 $ 1,655.41 90
51992 $ 1,900.96 90
51999 BR YYY
52000 $ 415.21 0
52001 $ 676.17 0
52005 $ 588.58 0
52007 $ 949.00 0
52010 $ 695.61 0
52204 $ 799.00 0
52214 $ 1,227.31 0
52224 $ 1,660.83 0
52234 $ 675.00 0
52235 $ 905.23 0
52240 $ 1,431.00 0
52250 $ 591.76 0
52260 $ 459.93 0
52265 $ 770.00 0
52270 $ 714.00 0
52275 $ 990.00 0
52276 $ 666.00 0
52277 $ 838.00 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
139
52281 $ 595.89 0
52282 $ 811.44 0
52283 $ 572.93 0
52285 $ 508.38 0
52287 $ 672.12 0
52290 $ 569.90 0
52300 $ 699.00 0
52301 $ 721.00 0
52305 $ 696.00 0
52310 $ 545.71 0
52315 $ 949.28 0
52317 $ 1,713.00 0
52318 $ 1,266.00 0
52320 $ 684.00 0
52325 $ 916.00 0
52327 $ 969.62 0
52330 $ 1,397.47 0
52332 $ 896.63 0
52334 $ 643.00 0
52341 $ 811.40 0
52342 $ 847.00 0
52343 $ 915.33 0
52344 $ 958.16 0
52345 $ 993.77 0
52346 $ 1,123.72 0
52351 $ 820.66 0
52352 $ 1,007.21 0
52353 $ 1,123.01 0
52354 $ 1,139.08 0
52355 $ 1,237.00 0
52356 $ 1,431.29 0
52400 $ 1,422.96 90
52402 $ 623.17 0
52441 $ 2,284.65 0
52442 $ 1,780.13 ZZZ
52450 $ 1,088.00 90
52500 $ 1,199.00 90
52601 $ 1,962.55 90
52630 $ 1,608.17 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
140
52640 $ 985.10 90
52647 $ 3,552.00 90
52648 $ 3,882.00 90
52649 $ 2,491.00 90
52700 $ 947.17 90
53000 $ 349.20 10
53010 $ 697.68 90
53020 $ 231.95 0
53025 Not Covered 0
53040 $ 775.87 90
53060 $ 335.34 10
53080 $ 916.85 90
53085 $ 1,534.93 90
53200 $ 304.83 0
53210 $ 1,786.00 90
53215 $ 2,214.00 90
53220 $ 1,088.00 90
53230 $ 1,412.35 90
53235 $ 1,451.00 90
53240 $ 922.14 90
53250 $ 882.48 90
53260 $ 375.07 10
53265 $ 433.07 10
53270 $ 428.48 10
53275 $ 639.41 10
53400 $ 1,756.78 90
53405 $ 2,035.00 90
53410 $ 2,161.00 90
53415 $ 2,628.00 90
53420 $ 2,056.89 90
53425 $ 2,127.00 90
53430 $ 2,071.89 90
53431 $ 2,486.66 90
53440 $ 2,046.00 90
53442 $ 1,516.38 90
53444 $ 1,721.00 90
53445 $ 2,521.52 90
53446 $ 1,474.00 90
53447 $ 1,849.00 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
141
53448 $ 2,814.00 90
53449 $ 1,443.00 90
53450 $ 878.70 90
53460 $ 1,113.00 90
53500 $ 1,473.40 90
53502 $ 1,165.46 90
53505 $ 1,167.00 90
53510 $ 1,429.00 90
53515 $ 1,916.00 90
53520 $ 1,210.58 90
53600 $ 151.33 0
53601 $ 147.79 0
53605 $ 163.94 0
53620 $ 211.48 0
53621 $ 199.63 0
53660 $ 128.89 0
53661 $ 126.33 0
53665 $ 112.51 0
53850 $ 4,077.00 90
53852 $ 3,843.21 90
53855 $ 1,144.38 0
53860 $ 2,945.07 90
53899 BR YYY
54000 $ 276.24 10
54001 $ 383.66 10
54015 $ 562.96 10
54050 $ 242.08 10
54055 $ 224.10 10
54056 $ 260.34 10
54057 $ 310.61 10
54060 $ 394.38 10
54065 $ 504.42 10
54100 $ 359.84 0
54105 $ 481.85 10
54110 $ 1,464.00 90
54111 $ 2,118.59 90
54112 $ 2,375.99 90
54115 $ 988.50 90
54120 $ 1,393.00 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
142
54125 $ 1,956.00 90
54130 $ 2,889.00 90
54135 $ 3,670.00 90
54150 Not Covered 0
54160 Not Covered 10
54161 Not Covered 10
54162 Not Covered 10
54163 Not Covered 10
54164 $ 480.42 10
54200 $ 194.76 10
54205 $ 1,203.30 90
54220 $ 393.72 0
54230 $ 211.02 0
54231 $ 322.53 0
54235 $ 196.56 0
54240 $ 232.24 0
54240 26 $ 158.53 0
54240 TC $ 73.71 0
54250 $ 284.78 0
54250 26 $ 251.16 0
54250 TC $ 33.62 0
54300 $ 1,538.00 90
54304 $ 1,818.00 90
54308 $ 1,687.00 90
54312 $ 2,000.00 90
54316 $ 2,414.00 90
54318 $ 1,722.00 90
54322 $ 1,860.00 90
54324 $ 2,343.00 90
54326 $ 2,211.00 90
54328 $ 2,239.00 90
54332 $ 2,464.00 90
54336 $ 2,922.00 90
54340 $ 1,332.00 90
54344 $ 2,453.00 90
54348 $ 2,462.00 90
54352 $ 3,492.00 90
54360 $ 1,402.61 90
54380 $ 1,963.49 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
143
54385 $ 2,333.02 90
54390 $ 2,670.92 90
54400 $ 1,484.25 90
54401 $ 1,756.82 90
54405 $ 2,412.34 90
54406 $ 1,574.00 90
54408 $ 1,698.12 90
54410 $ 1,907.00 90
54411 $ 2,204.94 90
54415 $ 1,157.00 90
54416 $ 1,550.48 90
54417 $ 1,931.13 90
54420 $ 1,603.00 90
54430 $ 1,492.00 90
54435 $ 804.79 90
54437 RNE 90
54438 RNE 90
54440 $ 1,160.59 90
54450 $ 165.88 0
54500 $ 136.35 0
54505 $ 482.53 10
54512 $ 1,182.85 90
54520 $ 799.00 90
54522 $ 1,309.00 90
54530 $ 1,228.00 90
54535 $ 1,694.00 90
54550 $ 1,154.00 90
54560 $ 1,584.00 90
54600 $ 1,167.32 90
54620 $ 745.60 10
54640 $ 1,221.21 90
54650 $ 2,113.67 90
54660 $ 772.30 90
54670 $ 927.00 90
54680 $ 1,744.00 90
54690 $ 1,671.51 90
54692 $ 1,787.00 90
54699 BR YYY
54700 $ 391.77 10
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
144
54800 $ 282.00 0
54830 $ 829.25 90
54840 $ 853.57 90
54860 $ 952.00 90
54861 $ 1,337.00 90
54865 $ 844.00 90
54900 $ 1,897.80 90
54901 $ 2,835.36 90
55000 $ 214.34 0
55040 $ 869.87 90
55041 $ 1,274.76 90
55060 $ 831.00 90
55100 $ 394.47 10
55110 $ 833.66 90
55120 $ 708.78 90
55150 $ 957.12 90
55175 $ 896.75 90
55180 $ 1,514.00 90
55200 $ 914.41 90
55250 $ 880.00 90
55300 $ 480.10 0
55400 $ 1,828.18 90
55450 $ 662.19 10
55500 $ 850.22 90
55520 $ 974.56 90
55530 $ 880.85 90
55535 $ 1,036.99 90
55540 $ 1,182.31 90
55550 $ 1,009.29 90
55559 BR YYY
55600 $ 935.00 90
55605 $ 1,167.29 90
55650 $ 2,026.77 90
55680 $ 2,015.82 90
55700 $ 397.29 0
55705 $ 745.11 10
55706 $ 940.37 10
55720 $ 1,093.00 90
55725 $ 1,587.79 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
145
55801 $ 2,591.00 90
55810 $ 3,210.00 90
55812 $ 3,857.00 90
55815 $ 4,345.00 90
55821 $ 2,145.00 90
55831 $ 2,326.00 90
55840 $ 3,235.00 90
55842 $ 3,493.00 90
55845 $ 4,072.00 90
55860 $ 2,032.00 90
55862 $ 2,629.00 90
55865 $ 3,532.00 90
55866 $ 4,041.00 90
55870 Not Covered 0
55873 $ 10,529.50 90
55875 $ 1,996.60 90
55876 $ 347.00 0
55899 BR YYY
55920 $ 1,117.69 0
55970 Not Covered XXX
55980 Not Covered XXX
56405 $ 270.90 10
56420 $ 259.23 10
56440 $ 505.85 10
56441 $ 282.41 10
56442 $ 117.70 0
56501 $ 275.95 10
56515 $ 573.27 10
56605 $ 191.14 0
56606 $ 87.91 ZZZ
56620 $ 1,205.20 90
56625 $ 1,639.94 90
56630 $ 2,096.57 90
56631 $ 2,679.38 90
56632 $ 3,173.06 90
56633 $ 2,731.45 90
56634 $ 2,972.75 90
56637 $ 3,423.02 90
56640 $ 3,457.26 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
146
56700 $ 464.44 10
56740 $ 744.83 10
56800 $ 574.93 10
56805 $ 2,537.31 90
56810 $ 619.78 10
56820 $ 244.09 0
56821 $ 323.82 0
57000 $ 451.59 10
57010 $ 922.10 90
57020 $ 177.11 0
57022 $ 424.30 10
57023 $ 714.15 10
57061 $ 218.82 10
57065 $ 491.26 10
57100 $ 173.37 0
57105 $ 311.56 10
57106 $ 1,075.75 90
57107 $ 3,121.59 90
57109 $ 3,748.68 90
57110 $ 1,942.98 90
57111 $ 3,505.54 90
57112 $ 4,007.73 90
57120 $ 1,275.55 90
57130 $ 487.68 10
57135 $ 478.72 10
57150 $ 90.00 0
57155 $ 1,056.97 0
57156 $ 483.28 0
57160 $ 160.78 0
57170 $ 150.34 0
57180 $ 311.84 10
57200 $ 741.37 90
57210 $ 854.41 90
57220 $ 870.74 90
57230 $ 920.07 90
57240 $ 1,429.13 90
57250 $ 1,437.72 90
57260 $ 1,800.79 90
57265 $ 1,962.23 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
147
57267 $ 602.32 ZZZ
57268 $ 1,116.16 90
57270 $ 1,714.78 90
57280 $ 2,029.92 90
57282 $ 1,439.90 90
57283 $ 1,498.52 90
57284 $ 1,842.89 90
57285 $ 1,552.00 90
57287 $ 1,637.38 90
57288 $ 1,813.70 90
57289 $ 1,602.98 90
57291 $ 2,395.20 90
57292 $ 3,085.47 90
57295 $ 1,036.00 90
57296 $ 2,063.34 90
57300 $ 1,330.03 90
57305 $ 2,051.01 90
57307 $ 2,336.54 90
57308 $ 1,502.23 90
57310 $ 1,538.71 90
57311 $ 1,137.26 90
57320 $ 1,658.87 90
57330 $ 1,776.00 90
57335 Not Covered 90
57400 $ 329.85 0
57410 $ 252.53 0
57415 $ 340.30 10
57420 $ 268.30 0
57421 $ 359.15 0
57423 $ 2,170.00 90
57425 $ 2,087.23 90
57426 $ 1,940.98 90
57452 $ 253.42 0
57454 $ 348.05 0
57455 $ 326.91 0
57456 $ 308.74 0
57460 $ 653.73 0
57461 $ 740.93 0
57500 $ 233.77 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
148
57505 $ 236.74 10
57510 $ 243.09 10
57511 $ 354.77 10
57513 $ 364.98 10
57520 $ 702.33 90
57522 $ 609.36 90
57530 $ 776.11 90
57531 $ 4,149.12 90
57540 $ 1,696.13 90
57545 $ 1,828.96 90
57550 $ 1,207.86 90
57555 $ 1,593.66 90
57556 $ 1,547.77 90
57558 $ 334.58 10
57700 $ 999.78 90
57720 $ 678.02 90
57800 $ 123.65 0
58100 $ 214.24 0
58110 $ 106.24 ZZZ
58120 $ 610.57 10
58140 $ 2,076.89 90
58145 $ 1,269.55 90
58146 $ 2,575.06 90
58150 $ 2,238.99 90
58152 $ 2,785.02 90
58180 $ 2,053.01 90
58200 $ 3,048.02 90
58210 $ 4,037.62 90
58240 $ 6,569.20 90
58260 $ 2,064.46 90
58262 $ 2,230.82 90
58263 $ 2,425.29 90
58267 $ 2,501.03 90
58270 $ 2,182.15 90
58275 $ 2,303.81 90
58280 $ 2,385.44 90
58285 $ 3,196.77 90
58290 $ 2,668.07 90
58291 $ 2,850.30 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
149
58292 $ 3,058.96 90
58293 $ 3,120.97 90
58294 $ 2,818.12 90
58300 Not Covered XXX
58301 Not Covered 0
58321 Not Covered 0
58322 Not Covered 0
58323 Not Covered 0
58340 $ 225.96 0
58345 $ 704.48 10
58346 $ 999.46 90
58350 $ 237.87 10
58353 $ 1,864.82 10
58356 $ 3,447.31 10
58400 $ 1,228.54 90
58410 $ 1,892.62 90
58520 $ 1,755.80 90
58540 $ 2,117.82 90
58541 $ 1,863.83 90
58542 $ 2,057.22 90
58543 $ 2,100.23 90
58544 $ 2,249.00 90
58545 $ 2,621.92 90
58546 $ 2,556.68 90
58548 $ 4,258.37 90
58550 $ 2,035.16 90
58552 $ 2,334.83 90
58553 $ 2,419.73 90
58554 $ 2,827.50 90
58555 $ 605.24 0
58558 $ 848.17 0
58559 $ 797.61 0
58560 $ 956.12 0
58561 $ 1,208.97 0
58562 $ 905.10 0
58563 $ 3,167.08 0
58565 $ 3,834.08 90
58570 $ 2,156.00 90
58571 $ 2,371.86 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
150
58572 $ 2,676.00 90
58573 $ 3,034.76 90
58578 BR YYY
58579 BR YYY
58600 $ 1,083.61 90
58605 $ 837.84 90
58611 $ 351.93 ZZZ
58615 $ 894.01 10
58660 $ 1,507.47 90
58661 $ 1,640.67 10
58662 $ 1,619.60 90
58670 $ 1,209.62 90
58671 $ 1,209.86 90
58672 $ 1,690.16 90
58673 $ 1,826.80 90
58679 BR YYY
58700 $ 1,762.12 90
58720 $ 1,700.52 90
58740 $ 2,020.06 90
58750 $ 2,355.05 90
58752 $ 2,038.00 90
58760 $ 1,942.96 90
58770 $ 1,979.09 90
58800 $ 724.41 90
58805 $ 1,288.68 90
58820 $ 714.99 90
58822 $ 1,664.81 90
58825 $ 1,704.04 90
58900 $ 1,102.38 90
58920 $ 1,614.12 90
58925 $ 1,686.85 90
58940 $ 1,256.99 90
58943 $ 2,630.18 90
58950 $ 2,545.44 90
58951 $ 3,299.25 90
58952 $ 3,704.46 90
58953 $ 4,576.12 90
58954 $ 4,963.17 90
58956 $ 3,098.34 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
151
58957 $ 3,619.00 90
58958 $ 3,913.63 90
58960 $ 2,565.77 90
58970 Not Covered 0
58974 Not Covered 0
58976 Not Covered 0
58999 Not Covered YYY
59000 $ 231.58 0
59001 $ 418.04 0
59012 $ 497.89 0
59015 $ 369.06 0
59020 $ 172.28 0
59020 26 $ 93.02 0
59020 TC $ 81.82 0
59025 $ 121.56 0
59025 26 $ 73.51 0
59025 TC $ 48.04 0
59030 $ 255.49 0
59050 $ 157.29 XXX
59051 $ 124.31 XXX
59070 $ 739.03 0
59072 $ 953.67 0
59074 $ 711.91 0
59076 $ 953.67 0
59100 $ 1,941.50 90
59120 $ 1,782.36 90
59121 $ 1,758.62 90
59130 $ 1,902.14 90
59135 $ 2,015.00 90
59136 $ 2,229.25 90
59140 $ 1,266.75 90
59150 $ 1,667.18 90
59151 $ 1,918.22 90
59160 $ 495.14 10
59200 $ 212.92 0
59300 $ 417.97 0
59320 $ 380.08 0
59325 $ 598.44 0
59350 $ 905.95 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
152
59400 $ 4,234.04 MMM
59409 $ 1,954.84 MMM
59410 $ 2,442.16 MMM
59412 $ 307.37 MMM
59414 $ 242.15 MMM
59425 $ 990.59 MMM
59426 $ 1,668.66 MMM
59430 $ 398.55 MMM
59510 $ 5,006.32 MMM
59514 $ 2,230.44 MMM
59515 $ 2,932.73 MMM
59525 $ 1,150.18 ZZZ
59610 $ 4,841.83 MMM
59612 $ 2,231.30 MMM
59614 $ 2,725.96 MMM
59618 $ 5,601.15 MMM
59620 $ 2,337.93 MMM
59622 $ 3,133.12 MMM
59812 Not Covered 90
59820 Not Covered 90
59821 Not Covered 90
59830 Not Covered 90
59840 Not Covered 10
59841 Not Covered 10
59850 Not Covered 90
59851 Not Covered 90
59852 Not Covered 90
59855 Not Covered 90
59856 Not Covered 90
59857 Not Covered 90
59866 $ 585.81 0
59870 $ 1,064.46 90
59871 $ 328.89 0
59897 BR YYY
59898 BR YYY
59899 BR YYY
60000 $ 325.89 10
60100 $ 259.15 0
60200 $ 1,440.96 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
153
60210 $ 1,637.21 90
60212 $ 2,345.00 90
60220 $ 1,844.42 90
60225 $ 2,170.30 90
60240 $ 2,422.09 90
60252 $ 3,103.27 90
60254 $ 3,869.91 90
60260 $ 2,513.95 90
60270 $ 3,120.10 90
60271 $ 2,419.57 90
60280 $ 1,348.30 90
60281 $ 1,423.91 90
60300 $ 219.07 0
60500 $ 2,226.27 90
60502 $ 2,948.27 90
60505 $ 3,183.13 90
60512 $ 638.47 ZZZ
60520 $ 2,392.19 90
60521 $ 2,645.97 90
60522 $ 3,113.09 90
60540 $ 2,402.67 90
60545 $ 2,769.73 90
60600 $ 3,326.03 90
60605 $ 4,499.13 90
60650 $ 2,751.65 90
60659 BR YYY
60699 BR YYY
61000 $ 277.69 0
61001 $ 262.19 0
61020 $ 304.89 0
61026 $ 314.73 0
61050 $ 261.28 0
61055 $ 377.28 0
61070 $ 195.25 0
61105 $ 1,246.98 90
61107 $ 960.31 0
61108 $ 2,365.65 90
61120 $ 1,657.56 90
61140 $ 2,850.32 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
154
61150 $ 2,983.52 90
61151 $ 2,643.38 90
61154 $ 2,835.42 90
61156 $ 2,794.93 90
61210 $ 914.37 0
61215 $ 1,352.25 90
61250 $ 1,883.43 90
61253 $ 2,358.10 90
61304 $ 3,764.43 90
61305 $ 4,508.32 90
61312 $ 4,657.63 90
61313 $ 4,373.71 90
61314 $ 4,376.00 90
61315 $ 4,987.13 90
61316 $ 208.83 ZZZ
61320 $ 4,190.79 90
61321 $ 4,686.57 90
61322 $ 4,867.46 90
61323 $ 5,030.08 90
61330 $ 3,794.93 90
61332 $ 4,224.65 90
61333 $ 4,461.02 90
61340 $ 3,215.00 90
61343 $ 5,027.34 90
61345 $ 4,171.98 90
61450 $ 4,280.42 90
61458 $ 4,512.29 90
61460 $ 4,720.92 90
61480 $ 4,219.62 90
61500 $ 3,351.44 90
61501 $ 3,086.46 90
61510 $ 5,105.77 90
61512 $ 5,918.26 90
61514 $ 4,328.09 90
61516 $ 4,243.54 90
61517 $ 225.35 ZZZ
61518 $ 6,409.87 90
61519 $ 6,847.47 90
61520 $ 8,710.20 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
155
61521 $ 7,358.95 90
61522 $ 4,915.99 90
61524 $ 4,727.41 90
61526 $ 8,517.66 90
61530 $ 7,196.40 90
61531 $ 3,429.54 90
61533 $ 3,700.32 90
61534 $ 3,831.71 90
61535 $ 2,618.61 90
61536 $ 5,789.03 90
61537 $ 4,831.45 90
61538 $ 5,926.02 90
61539 $ 5,231.31 90
61540 $ 4,334.87 90
61541 $ 5,418.37 90
61543 $ 4,873.49 90
61544 $ 4,296.44 90
61545 $ 7,389.88 90
61546 $ 5,414.36 90
61548 $ 3,861.87 90
61550 $ 2,418.10 90
61552 $ 2,843.87 90
61556 $ 3,969.81 90
61557 $ 3,948.24 90
61558 $ 4,188.15 90
61559 $ 5,489.54 90
61563 $ 4,653.68 90
61564 $ 5,634.38 90
61566 $ 4,429.48 90
61567 $ 4,991.34 90
61570 $ 4,619.62 90
61571 $ 4,759.33 90
61575 $ 5,486.81 90
61576 $ 6,888.17 90
61580 $ 5,443.10 90
61581 $ 5,783.50 90
61582 $ 6,500.05 90
61583 $ 6,365.81 90
61584 $ 6,277.65 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
156
61585 $ 7,115.38 90
61586 $ 5,298.16 90
61590 $ 6,722.84 90
61591 $ 6,914.74 90
61592 $ 6,977.61 90
61595 $ 5,121.84 90
61596 $ 5,503.48 90
61597 $ 6,367.45 90
61598 $ 6,263.08 90
61600 $ 4,618.33 90
61601 $ 5,282.33 90
61605 $ 4,764.46 90
61606 $ 6,644.99 90
61607 $ 6,149.38 90
61608 $ 7,176.38 90
61610 $ 4,721.90 ZZZ
61611 $ 1,012.58 ZZZ
61612 $ 4,225.97 ZZZ
61613 $ 7,197.90 90
61615 $ 5,828.23 90
61616 $ 7,311.99 90
61618 $ 2,827.46 90
61619 $ 3,227.46 90
61623 $ 1,421.20 0
61624 $ 2,876.39 0
61626 $ 2,185.54 0
61630 $ 2,788.15 XXX
61635 $ 3,503.45 XXX
61640 $ 1,575.12 0
61641 $ 605.00 ZZZ
61642 $ 1,066.00 ZZZ
61645 RNE 0
61650 RNE ZZZ
61651 RNE ZZZ
61680 $ 5,675.29 90
61682 $ 9,376.32 90
61684 $ 6,772.50 90
61686 $ 10,112.55 90
61690 $ 5,787.55 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
157
61692 $ 8,421.45 90
61697 $ 9,341.12 90
61698 $ 9,688.89 90
61700 $ 7,524.07 90
61702 $ 8,919.09 90
61703 $ 3,140.81 90
61705 $ 5,873.91 90
61708 $ 5,538.65 90
61710 $ 4,777.93 90
61711 $ 5,844.59 90
61720 $ 3,203.57 90
61735 $ 3,609.65 90
61750 $ 3,178.43 90
61751 $ 3,181.95 90
61760 $ 3,567.23 90
61770 $ 3,777.79 90
61781 $ 640.74 ZZZ
61782 $ 524.37 ZZZ
61783 $ 579.85 ZZZ
61790 $ 2,606.42 90
61791 $ 3,246.56 90
61796 $ 3,711.00 90
61797 $ 1,131.92 ZZZ
61798 $ 3,924.32 90
61799 $ 1,015.00 ZZZ
61800 $ 598.00 ZZZ
61850 $ 2,332.00 90
61860 $ 3,573.86 90
61863 $ 2,980.68 90
61864 $ 602.09 ZZZ
61867 $ 4,508.77 90
61868 $ 1,002.12 ZZZ
61870 $ 2,279.20 90
61880 $ 1,316.58 90
61885 $ 1,005.71 90
61886 $ 1,651.61 90
61888 $ 908.87 10
62000 $ 2,282.61 90
62005 $ 2,841.06 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
158
62010 $ 3,461.06 90
62100 $ 3,662.21 90
62115 $ 3,224.72 90
62117 $ 4,540.78 90
62120 $ 3,684.71 90
62121 $ 3,702.09 90
62140 $ 2,410.24 90
62141 $ 2,783.83 90
62142 $ 2,087.03 90
62143 $ 2,618.93 90
62145 $ 3,400.81 90
62146 $ 2,864.38 90
62147 $ 3,388.15 90
62148 $ 293.25 ZZZ
62160 $ 443.88 ZZZ
62161 $ 3,207.21 90
62162 $ 4,017.23 90
62163 $ 2,477.47 90
62164 $ 4,402.44 90
62165 $ 3,391.69 90
62180 $ 3,695.61 90
62190 $ 2,380.17 90
62192 $ 2,438.25 90
62194 $ 1,090.71 10
62200 $ 3,810.19 90
62201 $ 2,750.54 90
62220 $ 2,697.28 90
62223 $ 2,794.35 90
62225 $ 1,204.86 90
62230 $ 2,157.38 90
62252 $ 208.30 XXX
62252 26 $ 112.17 XXX
62252 TC $ 96.13 XXX
62256 $ 1,329.01 90
62258 $ 2,613.28 90
62263 $ 1,243.69 10
62264 $ 833.04 10
62267 $ 570.43 0
62268 $ 1,414.13 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
159
62269 $ 1,547.73 0
62270 $ 363.75 0
62272 $ 415.21 0
62273 $ 325.03 0
62280 $ 740.62 10
62281 $ 544.54 10
62282 $ 672.37 10
62284 $ 423.57 0
62287 $ 1,522.24 90
62290 $ 653.25 0
62291 $ 649.85 0
62292 $ 1,369.81 90
62294 $ 1,535.64 90
62302 $ 550.94 0
62303 $ 570.28 0
62304 $ 543.94 0
62305 $ 592.98 0
62310 $ 449.84 0
62311 $ 415.38 0
62318 $ 442.69 0
62319 $ 351.65 0
62350 $ 977.28 10
62351 $ 1,906.27 90
62355 $ 689.04 10
62360 $ 616.12 10
62361 $ 955.39 10
62362 $ 952.07 10
62365 $ 735.92 10
62367 $ 94.05 XXX
62368 $ 133.31 XXX
62369 $ 249.49 XXX
62370 $ 298.79 XXX
63001 $ 5,177.00 90
63003 $ 4,813.00 90
63005 $ 3,774.00 90
63011 $ 3,086.00 90
63012 $ 4,400.00 90
63015 $ 5,336.00 90
63016 $ 5,086.00 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
160
63017 $ 4,900.00 90
63020 $ 4,500.00 90
63030 $ 3,800.00 90
63035 $ 839.00 ZZZ
63040 $ 5,000.00 90
63042 $ 5,000.00 90
63043 $ 1,239.55 ZZZ
63044 $ 1,118.88 ZZZ
63045 $ 5,000.00 90
63046 $ 5,000.00 90
63047 $ 5,000.00 90
63048 $ 1,318.38 ZZZ
63050 $ 3,674.27 90
63051 $ 4,037.28 90
AZ063-054
Arthroscopic discectomy,
transpedicular approach,
removal of herniated
intervertebral disk;
lumbar. Additional
levels will use modifier
“-50”. Second level will
be valued at 50% of the
listed value and the third
level at 25% of the listed
value.
$ 4,747.26 90
63055 $ 3,745.43 90
63056 $ 3,436.80 90
63057 $ 900.00 ZZZ
63064 $ 5,031.00 90
63066 $ 859.00 ZZZ
63075 $ 4,186.00 90
63076 $ 929.00 ZZZ
63077 $ 4,212.50 90
63078 $ 900.00 ZZZ
63081 $ 4,446.73 90
63082 $ 1,005.02 ZZZ
63085 $ 4,623.09 90
63086 $ 1,077.36 ZZZ
63087 $ 5,422.23 90
63088 $ 1,077.36 ZZZ
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
161
63090 $ 4,516.95 90
63091 $ 959.79 ZZZ
63101 $ 4,529.92 90
63102 $ 4,431.85 90
63103 $ 569.86 ZZZ
63170 $ 3,953.51 90
63172 $ 3,335.59 90
63173 $ 3,892.80 90
63180 $ 3,829.88 90
63182 $ 4,197.51 90
63185 $ 3,089.13 90
63190 $ 3,321.75 90
63191 $ 3,336.21 90
63194 $ 3,543.18 90
63195 $ 3,637.61 90
63196 $ 3,817.53 90
63197 $ 3,891.20 90
63198 $ 4,017.00 90
63199 $ 4,364.32 90
63200 $ 3,663.35 90
63250 $ 6,616.63 90
63251 $ 6,768.07 90
63252 $ 6,888.26 90
63265 $ 3,946.29 90
63266 $ 4,003.98 90
63267 $ 3,422.50 90
63268 $ 3,495.86 90
63270 $ 4,605.82 90
63271 $ 4,611.06 90
63272 $ 4,266.59 90
63273 $ 4,159.10 90
63275 $ 4,153.55 90
63276 $ 4,123.27 90
63277 $ 3,610.45 90
63278 $ 3,649.70 90
63280 $ 4,778.66 90
63281 $ 4,736.70 90
63282 $ 4,445.77 90
63283 $ 4,270.89 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
162
63285 $ 5,804.34 90
63286 $ 5,755.25 90
63287 $ 6,098.45 90
63290 $ 6,193.75 90
63295 $ 793.03 ZZZ
63300 $ 4,487.49 90
63301 $ 5,115.94 90
63302 $ 5,094.14 90
63303 $ 5,334.37 90
63304 $ 5,359.48 90
63305 $ 5,678.62 90
63306 $ 5,590.76 90
63307 $ 5,412.46 90
63308 $ 782.68 ZZZ
63600 $ 2,275.63 90
63610 $ 2,334.63 0
63615 $ 2,889.01 90
63620 $ 3,417.22 90
63621 $ 830.46 ZZZ
63650 $ 2,321.02 10
63655 $ 1,965.06 90
63661 $ 1,426.82 10
63662 $ 1,996.60 90
63663 $ 1,943.10 10
63664 $ 2,095.03 90
63685 $ 1,049.81 10
63688 $ 938.42 10
63700 $ 2,766.34 90
63702 $ 3,147.90 90
63704 $ 3,462.87 90
63706 $ 3,787.64 90
63707 $ 2,720.88 90
63709 $ 2,886.09 90
63710 $ 2,895.12 90
63740 $ 2,805.24 90
63741 $ 1,923.87 90
63744 $ 1,646.13 90
63746 $ 1,355.70 90
64400 $ 291.33 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
163
64402 $ 298.23 0
64405 $ 187.87 0
64408 $ 235.44 0
64410 $ 253.41 0
64413 $ 254.77 0
64415 $ 272.15 0
64416 $ 404.00 0
64417 $ 293.30 0
64418 $ 305.20 0
64420 $ 263.79 0
64421 $ 328.25 0
64425 $ 293.30 0
64430 $ 298.40 0
64435 $ 295.68 0
64445 $ 297.38 0
64446 $ 410.00 0
64447 $ 251.03 0
64448 $ 377.00 0
64449 $ 294.26 0
64450 $ 161.07 0
64455 $ 111.47 0
64461 RNE 0
64462 RNE ZZZ
64463 RNE 0
64479 $ 502.78 0
64480 $ 275.04 ZZZ
64483 $ 432.21 0
64484 $ 230.03 ZZZ
64486 $ 282.26 0
64487 $ 346.45 0
64488 $ 347.44 0
64489 $ 460.88 0
64490 $ 435.56 0
64491 $ 216.35 ZZZ
64492 $ 217.27 ZZZ
64493 $ 394.07 0
64494 $ 202.56 ZZZ
64495 $ 203.55 ZZZ
64505 $ 244.84 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
164
64508 $ 266.88 0
64510 $ 266.71 0
64517 $ 349.16 0
64520 $ 349.00 0
64530 $ 356.88 0
64550 $ 75.27 0
64553 $ 498.13 10
64555 $ 520.14 10
64561 $ 1,628.73 10
64565 $ 444.37 10
64566 $ 244.22 0
64568 $ 1,701.88 90
64569 $ 1,795.72 90
64570 $ 1,583.20 90
64575 $ 730.20 90
64580 $ 697.34 90
64581 $ 1,599.96 90
64585 $ 623.24 10
64590 $ 664.47 10
64595 $ 589.09 10
64600 $ 732.61 10
64605 $ 1,368.56 10
64610 $ 1,396.96 10
64611 $ 275.84 10
64612 $ 335.35 10
64615 $ 347.50 10
64616 $ 289.52 10
64617 $ 441.37 10
64620 $ 414.82 10
64630 $ 433.59 10
64632 $ 197.77 10
64633 $ 983.94 10
64634 $ 461.25 ZZZ
64635 $ 978.50 10
64636 $ 431.63 ZZZ
64640 $ 345.26 10
64642 $ 301.94 10
64643 $ 178.63 10
64644 $ 372.33 10
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
165
64645 $ 218.76 10
64646 $ 312.97 10
64647 $ 330.23 10
64650 $ 162.48 0
64653 $ 203.02 0
64680 $ 576.60 10
64681 $ 753.75 10
64702 $ 1,035.13 90
64704 $ 785.32 90
64708 $ 1,114.13 90
64712 $ 1,360.48 90
64713 $ 1,675.14 90
64714 $ 1,429.52 90
64716 $ 2,100.00 90
64718 $ 1,411.00 90
64719 $ 886.16 90
64721 $ 968.37 90
64722 $ 1,408.20 90
64726 $ 616.34 90
∆64727 List separately
in addition to code for
primary neuroplasty and
value at 50% of the listed
value of the primary
procedure as an
additional charge.
BR ZZZ
64732 $ 970.73 90
64734 $ 1,073.91 90
64736 $ 1,102.89 90
64738 $ 1,180.99 90
64740 $ 1,008.45 90
64742 $ 1,186.48 90
64744 $ 1,079.56 90
64746 $ 962.45 90
64755 $ 2,327.18 90
64760 $ 1,403.30 90
64763 $ 1,168.80 90
64766 $ 1,361.12 90
64771 $ 1,330.76 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
166
64772 $ 1,356.05 90
64774 $ 899.74 90
64776 $ 840.40 90
64778 $ 404.97 ZZZ
64782 $ 991.82 90
64783 $ 544.65 ZZZ
64784 $ 1,591.72 90
64786 $ 2,352.53 90
64787 $ 622.04 ZZZ
64788 $ 885.18 90
64790 $ 1,822.52 90
64792 $ 2,468.03 90
64795 $ 469.40 0
64802 $ 1,704.77 90
64804 $ 2,351.40 90
64809 $ 2,388.23 90
64818 $ 1,503.97 90
64820 $ 1,710.70 90
64821 $ 1,496.47 90
64822 $ 1,493.09 90
64823 $ 1,715.47 90
64831 $ 1,328.51 90
64832 $ 660.25 ZZZ
64834 $ 1,598.42 90
64835 $ 1,756.60 90
64836 $ 1,785.64 90
64837 $ 893.39 ZZZ
64840 $ 2,142.72 90
64856 $ 2,197.16 90
64857 $ 2,280.07 90
64858 $ 2,525.51 90
64859 $ 629.74 ZZZ
64861 $ 2,777.75 90
64862 $ 2,977.78 90
64864 $ 1,900.04 90
64865 $ 2,418.71 90
64866 $ 2,828.02 90
64868 $ 2,709.10 90
64872 $ 351.57 ZZZ
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
167
64874 $ 427.16 ZZZ
64876 $ 432.35 ZZZ
64885 $ 2,924.20 90
64886 $ 3,263.08 90
64890 $ 2,413.36 90
64891 $ 2,528.41 90
64892 $ 2,322.83 90
64893 $ 2,512.23 90
64895 $ 2,950.40 90
64896 $ 3,505.82 90
64897 $ 2,791.98 90
64898 $ 3,044.12 90
64901 $ 1,327.84 ZZZ
64902 $ 1,453.94 ZZZ
64905 $ 2,000.08 90
64907 $ 2,746.70 90
64910 $ 1,786.13 90
64911 $ 2,197.10 90
64999 BR YYY
65091 $ 1,376.36 90
65093 $ 1,514.79 90
65101 $ 1,649.40 90
65103 $ 1,778.49 90
65105 $ 2,053.94 90
65110 $ 2,646.10 90
65112 $ 3,045.53 90
65114 $ 3,317.10 90
65125 $ 968.83 90
65130 $ 1,581.26 90
65135 $ 1,654.11 90
65140 $ 1,858.41 90
65150 $ 1,331.93 90
65155 $ 1,858.63 90
65175 $ 1,393.70 90
65205 $ 126.71 0
65210 $ 152.96 0
65220 $ 130.72 0
65222 $ 154.51 0
65235 $ 1,712.01 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
168
65260 $ 2,255.93 90
65265 $ 2,476.10 90
65270 $ 540.22 10
65272 $ 953.02 90
65273 $ 808.86 90
65275 $ 1,226.30 90
65280 $ 1,589.31 90
65285 $ 2,379.52 90
65286 $ 1,492.77 90
65290 $ 1,197.86 90
65400 $ 1,441.73 90
65410 $ 488.71 0
65420 $ 1,093.24 90
65426 $ 1,381.85 90
65430 $ 210.62 0
65435 $ 179.98 0
65436 $ 738.50 90
65450 $ 618.13 90
65600 $ 835.91 90
65710 $ 2,515.42 90
65730 $ 2,933.20 90
65750 $ 3,208.51 90
65755 $ 2,752.63 90
65756 $ 2,904.95 90
65757 BR ZZZ
65760 $ 3,651.11 XXX
65765 $ 4,021.43 XXX
65767 $ 3,048.21 XXX
65770 $ 3,342.36 90
65771 $ 1,489.50 XXX
65772 $ 1,385.82 90
65775 $ 1,737.83 90
65778 $ 2,638.56 10
65779 $ 2,244.57 10
65780 $ 1,622.79 90
65781 $ 2,547.50 90
65782 $ 2,197.58 90
65785 RNE 90
65800 $ 302.82 0
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
169
65810 $ 1,055.25 90
65815 $ 1,522.64 90
65820 $ 1,588.49 90
65850 $ 1,935.32 90
65855 $ 963.96 10
65860 $ 729.38 90
65865 $ 1,177.58 90
65870 $ 1,335.64 90
65875 $ 1,403.49 90
65880 $ 1,448.15 90
65900 $ 2,055.79 90
65920 $ 2,134.74 90
65930 $ 1,438.07 90
66020 $ 422.51 10
66030 $ 375.19 10
66130 $ 1,323.59 90
66150 $ 1,856.04 90
66155 $ 1,860.20 90
66160 $ 2,102.78 90
66170 $ 2,521.53 90
66172 $ 3,180.64 90
66174 $ 3,085.56 90
66175 $ 3,583.21 90
66179 $ 2,083.63 90
66180 $ 2,493.89 90
66183 $ 2,188.79 90
66184 $ 1,496.81 90
66185 $ 1,795.41 90
66220 $ 1,886.42 90
66225 $ 2,336.46 90
66250 $ 1,587.88 90
66500 $ 832.93 90
66505 $ 872.57 90
66600 $ 1,783.87 90
66605 $ 2,483.76 90
66625 $ 1,086.17 90
66630 $ 1,261.60 90
66635 $ 1,243.52 90
66680 $ 1,324.99 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
170
66682 $ 1,642.94 90
66700 $ 1,048.14 90
66710 $ 1,056.77 90
66711 $ 1,362.43 90
66720 $ 1,084.25 90
66740 $ 1,027.34 90
66761 $ 1,036.21 10
66762 $ 1,023.05 90
66770 $ 1,119.95 90
66820 $ 848.40 90
66821 $ 768.10 90
66825 $ 1,611.79 90
66830 $ 1,750.27 90
66840 $ 1,750.09 90
66850 $ 1,942.93 90
66852 $ 1,914.18 90
66920 $ 1,869.54 90
66930 $ 2,187.72 90
66940 $ 1,941.75 90
66982 $ 2,862.27 90
66983 $ 2,318.50 90
66984 $ 2,355.94 90
66985 $ 1,914.28 90
66986 $ 2,175.80 90
66990 $ 205.64 ZZZ
66999 BR YYY
67005 $ 1,693.61 90
67010 $ 2,987.00 90
67015 $ 1,321.28 90
67025 $ 1,556.64 90
67027 $ 1,628.22 90
67028 $ 638.53 0
67030 $ 1,483.21 90
67031 $ 1,109.30 90
67036 $ 3,204.97 90
67039 $ 3,251.85 90
67040 $ 3,555.14 90
67041 $ 3,040.89 90
67042 $ 3,472.37 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
171
67043 $ 3,712.74 90
67101 $ 2,197.21 90
67105 $ 1,981.38 90
67107 $ 2,869.31 90
67108 $ 3,953.82 90
67110 $ 1,852.84 90
67113 $ 3,960.67 90
67115 $ 1,132.86 90
67120 $ 1,778.00 90
67121 $ 1,992.70 90
67141 $ 1,173.67 90
67145 $ 1,347.09 90
67208 $ 1,392.66 90
67210 $ 1,464.96 90
67218 $ 3,082.48 90
67220 $ 1,954.00 90
67221 $ 718.54 0
67225 $ 78.39 ZZZ
67227 $ 1,457.10 90
67228 $ 2,106.83 90
67229 $ 2,689.85 90
67250 $ 1,966.71 90
67255 $ 2,226.18 90
67299 BR YYY
67311 $ 1,620.97 90
67312 $ 1,948.23 90
67314 $ 1,711.63 90
67316 $ 2,117.62 90
67318 $ 1,772.71 90
67320 $ 1,676.08 ZZZ
67331 $ 1,427.66 ZZZ
67332 $ 1,753.22 ZZZ
67334 $ 1,285.05 ZZZ
67335 $ 499.92 ZZZ
67340 $ 1,618.79 ZZZ
67343 $ 1,684.78 90
67345 $ 551.04 10
67346 $ 450.47 0
67399 BR YYY
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
172
67400 $ 2,032.34 90
67405 $ 1,777.31 90
67412 $ 2,129.10 90
67413 $ 2,239.13 90
67414 $ 2,940.33 90
67415 $ 334.99 0
67420 $ 3,506.37 90
67430 $ 2,714.31 90
67440 $ 2,658.65 90
67445 $ 3,181.55 90
67450 $ 2,751.09 90
67500 $ 184.57 0
67505 $ 201.97 0
67515 $ 180.85 0
67550 $ 2,114.91 90
67560 $ 2,098.39 90
67570 $ 2,299.40 90
67599 BR YYY
67700 $ 492.88 10
67710 $ 411.35 10
67715 $ 448.54 10
67800 $ 286.16 10
67801 $ 363.15 10
67805 $ 434.32 10
67808 $ 786.86 90
67810 $ 318.10 0
67820 $ 95.46 0
67825 $ 265.69 10
67830 $ 490.14 10
67835 $ 1,315.55 90
67840 $ 548.38 10
67850 $ 424.73 10
67875 $ 361.42 0
67880 $ 970.74 90
67882 $ 1,201.55 90
67900 $ 1,356.91 90
67901 $ 1,689.77 90
67902 $ 1,759.17 90
67903 $ 1,659.17 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
173
67904 $ 1,822.70 90
67906 $ 1,473.82 90
67908 $ 1,320.80 90
67909 $ 1,370.64 90
67911 $ 1,761.42 90
67912 $ 1,669.01 90
67914 $ 993.97 90
67915 $ 565.38 90
67916 $ 1,254.03 90
67917 $ 1,429.90 90
67921 $ 973.74 90
67922 $ 562.66 90
67923 $ 1,252.54 90
67924 $ 1,401.12 90
67930 $ 824.28 10
67935 $ 1,259.21 90
67938 $ 442.63 10
67950 $ 1,381.50 90
67961 $ 1,496.42 90
67966 $ 1,811.36 90
67971 $ 1,816.03 90
67973 $ 2,147.84 90
67974 $ 2,232.71 90
67975 $ 1,469.17 90
67999 BR YYY
68020 $ 219.72 10
68040 $ 144.71 0
68100 $ 326.97 0
68110 $ 434.93 10
68115 $ 705.14 10
68130 $ 1,140.05 90
68135 $ 354.34 10
68200 $ 103.49 0
68320 $ 1,660.91 90
68325 $ 1,641.92 90
68326 $ 1,627.00 90
68328 $ 1,822.55 90
68330 $ 1,335.61 90
68335 $ 1,630.14 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
174
68340 $ 1,153.54 90
68360 $ 1,125.60 90
68362 $ 1,461.44 90
68371 $ 770.03 10
68399 BR YYY
68400 $ 521.94 10
68420 $ 591.55 10
68440 $ 233.50 10
68500 $ 2,167.50 90
68505 $ 2,128.90 90
68510 $ 819.07 0
68520 $ 1,565.02 90
68525 $ 562.79 0
68530 $ 998.94 10
68540 $ 2,086.53 90
68550 $ 2,604.50 90
68700 $ 1,456.19 90
68705 $ 434.89 10
68720 $ 1,734.48 90
68745 $ 1,735.79 90
68750 $ 2,061.88 90
68760 $ 369.88 10
68761 $ 332.81 10
68770 $ 1,350.29 90
68801 $ 218.48 10
68810 $ 430.82 10
68811 $ 482.63 10
68815 $ 976.58 10
68816 $ 1,275.01 10
68840 $ 235.32 10
68850 $ 135.93 0
68899 BR YYY
69000 $ 347.13 10
69005 $ 493.08 10
69020 $ 445.14 10
69090 $ 95.95 XXX
69100 $ 185.92 0
69105 $ 267.69 0
69110 $ 983.34 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
175
69120 $ 916.82 90
69140 $ 1,933.41 90
69145 $ 760.62 90
69150 $ 2,405.77 90
69155 $ 3,834.45 90
69200 $ 208.16 0
69205 $ 260.32 10
69209 RNE 0
69210 $ 111.81 0
69220 $ 228.32 0
69222 $ 410.18 10
69300 $ 1,746.45 YYY
69310 $ 2,364.90 90
69320 $ 3,496.65 90
69399 BR YYY
69420 $ 357.53 10
69421 $ 345.58 10
69424 $ 237.27 0
69433 $ 464.89 10
69436 $ 406.31 10
69440 $ 1,525.14 90
69450 $ 1,343.83 90
69501 $ 1,644.42 90
69502 $ 2,169.96 90
69505 $ 2,652.57 90
69511 $ 2,759.60 90
69530 $ 3,618.60 90
69535 $ 6,079.90 90
69540 $ 399.05 10
69550 $ 2,420.77 90
69552 $ 3,648.07 90
69554 $ 5,792.00 90
69601 $ 2,329.27 90
69602 $ 2,447.77 90
69603 $ 2,808.75 90
69604 $ 2,632.45 90
69605 $ 3,373.80 90
69610 $ 718.96 10
69620 $ 1,708.65 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
176
69631 $ 2,232.62 90
69632 $ 2,559.29 90
69633 $ 2,518.08 90
69635 $ 2,740.42 90
69636 $ 3,071.39 90
69637 $ 3,076.60 90
69641 $ 2,638.16 90
69642 $ 3,138.36 90
69643 $ 2,952.26 90
69644 $ 3,338.92 90
69645 $ 3,234.36 90
69646 $ 3,444.14 90
69650 $ 1,800.66 90
69660 $ 2,273.83 90
69661 $ 2,831.24 90
69662 $ 2,672.09 90
69666 $ 1,961.77 90
69667 $ 1,937.99 90
69670 $ 2,142.29 90
69676 $ 1,892.55 90
69700 $ 1,438.78 90
69710 $ 1,395.13 XXX
69711 $ 1,672.26 90
69714 $ 2,332.55 90
69715 $ 2,887.22 90
69717 $ 2,445.58 90
69718 $ 2,919.17 90
69720 $ 2,716.11 90
69725 $ 4,265.08 90
69740 $ 2,881.31 90
69745 $ 3,320.22 90
69799 BR YYY
69801 $ 1,896.48 0
69805 $ 2,592.13 90
69806 $ 2,699.22 90
69820 $ 2,270.21 90
69840 $ 2,020.23 90
69905 $ 2,422.80 90
69910 $ 2,948.18 90
ARIZONA PHYSICIANS' FEE SCHEDULE
Surgery Codes 2016
Code Modifier Total $ Value Follow-up Days
The codes listed herein are CPT only copyright 2015 American Medical Association.
All rights reserved.
177
69915 $ 3,770.58 90
69930 $ 3,157.64 90
69949 BR YYY
69950 $ 4,061.23 90
69955 $ 4,404.81 90
69960 $ 4,270.22 90
69970 $ 4,969.62 90
69979 BR YYY
69990 $ 429.80 ZZZ