10.12.2012 Views

fee schedule 2009 new - DE Medical Assistance Program

fee schedule 2009 new - DE Medical Assistance Program

fee schedule 2009 new - DE Medical Assistance Program

SHOW MORE
SHOW LESS

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

Fee Schedule Modifiers<br />

Procedure Code Procedure Code Modifier 1 Pricing Action Code Modifier Price<br />

11975 26 5 113.32<br />

11977 26 5 206.80<br />

11980 26 5 96.40<br />

11981 26 5 124.43<br />

11983 26 5 215.64<br />

51725 26 3 75.22<br />

51725 TC 3 173.90<br />

51726 26 3 85.60<br />

51726 TC 3 265.48<br />

51736 26 3 30.93<br />

51736 TC 3 21.54<br />

51741 26 3 57.30<br />

51741 TC 3 24.99<br />

51772 26 3 80.76<br />

51772 TC 3 189.15<br />

51784 26 3 76.39<br />

51784 TC 3 139.67<br />

51785 26 3 76.09<br />

51785 TC 3 157.38<br />

51792 26 3 55.16<br />

51792 TC 3 205.29<br />

51795 26 3 76.39<br />

51795 TC 3 257.51<br />

51797 26 3 46.64<br />

51797 TC 3 147.05<br />

58300 26 5 78.35<br />

59020 26 3 35.72<br />

59020 TC 3 30.50<br />

59025 26 3 29.03<br />

59025 TC 3 14.76<br />

62252 26 3 43.24<br />

62252 TC 3 51.74<br />

70010 26 3 57.65<br />

70010 TC 3 139.10<br />

70015 26 3 58.93<br />

70015 TC 3 77.91<br />

70030 26 3 8.43<br />

70030 TC 3 19.48<br />

70100 26 3 8.82<br />

70100 TC 3 22.23<br />

70110 26 3 11.91<br />

70110 TC 3 27.54<br />

70120 26 3 8.82<br />

70120 TC 3 25.97<br />

70130 26 3 16.47<br />

70130 TC 3 37.28<br />

70134 26 3 16.47

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!