RMFS

DEPARTMENT OF VETERANS’ AFFAIRS

FEE SCHEDULES

FOR

MEDICAL SERVICES

EFFECTIVE 1 MAY 2017

CONTENTS

1. LOCAL MEDICAL OFFICER FEE SCHEDULE 2. OPTOMETRIC WORKSHEET 3. DERIVED FEES – READY RECKONER FOR LOCAL MEDICAL OFFICERS 4. REPATRIATION MEDICAL FEE SCHEDULE 5. RELATIVE VALUE GUIDE FEE SCHEDULE 6. DIAGNOSTIC IMAGING FEE SCHEDULE 7. PATHOLOGY FEE SCHEDULE 8. CO-ORDINATED VETERANS’ CARE (CVC) PROGRAM FEE SCHEDULE NOTES FOR CLAIMING DVA FEES

The fee schedules list the fees that will be implemented on the Medicare Australia payment system from 1 November 2016.

All item assessments are based on Medicare assessment rules.

A “D” in a fee column indicates a derived fee.

RMFS

IMPORTANT INFORMATION Changes to holders of Repatriation Health Card – For Specific Conditions (White Card)

For treatment provided under the Veterans’ Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA)

As from 1 September 2012 dental providers will no longer be required to contact DVA for prior financial authorisation of treatment for White Card holders where the service is related to the White Card holders accepted condition(s) unless otherwise specified in this fee schedule. Providers can contact DVA (see telephone numbers listed below) if they require treatment status for White Card holders. Compliance DVA is placing a greater emphasis on the existing compliance model for the provision of all health services. DVA will maintain its commitment to working with service providers to maximise voluntary compliance. Therefore treatment must be based on assessed clinical need. It is important dental providers continue to document the clinical reasons for treatment provision to DVA entitled persons. DVA has compliance monitoring systems which monitor the servicing and claiming patterns of health care providers. This information assists DVA to establish internal benchmarks, the current utilisation and projected future delivery of services. Further information http://www.dva.gov.au/providers/fee-schedules Or

Medical & Allied Health section on: Non-metropolitan callers: 1800 550 457 (Select Option 3, then Option 1) Metropolitan callers: 1300 550 457 (Select Option 3, then Option 1)

1. LOCAL MEDICAL OFFICER FEE SCHEDULE

EXPLANITORY NOTES

The Local Medical Officer Fee Schedule lists fees for medical attendances and consultations provided by general practitioners participating in DVA’s Local Medical Officer (LMO) Scheme. LMOs will be paid at 115% of the listed MBS fee plus the relevant Veterans Access Payment (VAP) or where applicable the Rural Enhancement Initiative (REI) loading. The VAP can be claimed using the Medicare Bulk Billing Incentive item numbers as follows:

Item 64990 and 74990 are to be used when claiming the $ 7.05 VAP; and Item 10990 is to be used when claiming the $7.20 VAP. Item 64991 and 74991 to be used when claiming the $10.65 VAP; and

Item 10991 and 10992 to be used when claiming $10.85 VAP

Please note that VAP is not payable on items provided to inpatients of a hospital or day surgery, Coordinated Veterans’ Care Program UP items and Telehealth consultation items. Items 10990, 10991 and 10992 are VAP incentives and are paid at 100% of the MBS fee. Derived fees are indicated by a ‘D’ in the column of the Schedule. Please refer to the derived fees section of the booklet for benefit calculation. The REI loading is available to LMOs who provide services to veterans in designated rural public hospitals by State or Territory governments. The REI only applies to those In Hospital items indicated in the Local Medical Officer Fee Schedule. The REI loading is an additional 10% of the LMO fee. DVA Practice Nurse Incentive Payments may be payable see: www.dva.gov.au/service_providers/doctors/Pages/index.aspx, for more information.

For items not listed in the LMO Schedule please refer to the appropriate schedule in this booklet. For derived fees for Local Medical Officers, please use the Derived Fees for Local Medical Officers’ Fee

Schedule. For all specialist attendances and consultations, investigative and general medical procedures claim from the

Repatriation Medical Fee Schedule. For In Hospital anaesthetic services please use Relative Value Guide Fee Schedule. For diagnostic imaging services claim from the Diagnostic Imaging Fee Schedule. For pathology services claim from the Pathology Fee Schedule.

Item LMO Fee REI

VAP VAP

Item LMO Fee REI

VAP VAP

Metro Regional Metro Regional

3 19.50 Y Y 2122 D

4 D Y Y Y 2125 D

20 D Y Y 2126 57.45

23 42.65 Y Y 2137 D

24 D Y Y Y 2138 D

35 D Y Y 2143

111.40

36 82.50 Y Y 2147 D

37 D Y Y Y 2179 D

43 D Y Y 2195

163.90

44 121.40 Y Y 2199 D

47 D Y Y Y 2220 D

51 D Y Y 2497 111.40 Y Y

52 12.65 Y Y 2501

42.65 Y Y

53 24.15 Y Y 2503 D Y Y

54 43.70 Y Y 2504

82.50 Y Y

57 70.15 Y Y 2506 D Y Y

58 D Y Y 2507

121.40 Y Y

59 D Y Y 2509 D Y Y

60 D Y Y 2517

42.65 Y Y

65 D Y Y 2518 D Y Y

92 D Y Y 2521

82.50 Y Y

93 D Y Y 2522 D Y Y

95 D Y Y 2525

121.40 Y Y

96 D Y Y 2526 D Y Y

597 149.30 Y Y 2546

42.65 Y Y

598 2547 D Y Y

599 175.95 Y Y 2552

82.50 Y Y

600 2553 D Y Y

701 68.30 Y Y 2558

121.40 Y Y

703 158.60 Y Y 2559 D Y Y

705 218.85 Y Y 2598 12.65 Y Y

707 309.15 Y Y 2600 24.15 Y Y

715 244.10 Y Y 2603 43.70 Y Y

721 165.90 Y Y 2606 70.15 Y Y

723 131.45 Y Y 2610 D Y Y

729 81.00 Y Y 2613 D Y Y

731 81.00 Y Y 2616 D Y Y

732 82.90 Y Y 2620 24.15 Y Y

735 81.25 Y Y 2622 43.70 Y Y

739 139.10 Y Y 2624 70.15 Y Y

743 231.90 Y Y 2631 D Y Y

747 59.70 Y Y 2633 D Y Y

750 102.35 Y Y 2635 D Y Y

758 170.45 Y Y 2664 24.15 Y Y

900 178.05 Y Y 2666 43.70 Y Y

903 121.90 Y Y 2668 70.15 Y Y

2100 26.35 2673 D Y Y

2675 D Y Y

2677 D Y Y

Item LMO Fee REI

VAP Metro

VAP Regional

2700

82.50 Y Y

2701

121.40 Y Y

2712

82.50 Y Y

2713

82.50 Y Y

2715

104.75 Y Y

2717

154.25 Y Y

2721

106.70 Y Y

2723 D Y Y

2725

152.70 Y Y

2727 D Y Y

4001

88.10 Y Y

5000

33.35 Y Y

5003 D Y Y

5010 D Y Y

5020

56.35 Y Y

5023 D Y Y

5028 D Y Y

5040 6.55 Y Y

5043 D Y Y

5049 D Y Y

5060

135.45 Y Y

5063 D Y Y

5067 D Y Y

5200 24.15 Y Y

5203 35.65 Y Y

5207 55.20 Y Y

5208 81.65 Y Y

5220 D Y Y

5223 D Y Y

5227 D Y Y

5228 D Y Y

5260 D Y Y

5263 D Y Y

5265 D Y Y

5267 D Y Y

RMFS

2. MBS OPTOMETRIC WORKSHEET WITH LMO FEES

From 1 January 2015 the period for comprehensive eye examinations for asymptomatic patients under the Medicare Benefit Schedule (MBS) will be:

extended from two years to three years for patients aged under 65 years old; and reduced from two years to one year for patients aged 65 years and over.

Changes to MBS items are as follows:

Item 10900 has been removed and replaced with two new MBS items. New item 10910 has been introduced for comprehensive eye examinations within 36 months for

asymptomatic patients under 65 years. New item 10911 has been introduced for comprehensive eye examinations within 12 months for

asymptomatic patients at least 65 years of age. Items 10907, 10912-10914, 10921-10929 have been amended accordingly to recognise these new items.

Item MBS Fee DVA Fee

10905 $ 66.80 $ 71.00

10907 $ 33.45 $ 35.55

10910 $ 66.80 $ 71.00

10911 $ 66.80 $ 71.00

10912 $ 66.80 $ 71.00

10913 $ 66.80 $ 71.00

10914 $ 66.80 $ 71.00

10915 $ 66.80 $ 71.00

10916 $ 33.45 $ 35.55

10918 $ 33.45 $ 35.55

10921 $ 165.80 $ 176.15

10922 $ 165.80 $ 176.15

10923 $ 165.80 $ 176.15

10924 $ 209.20 $ 222.30

10925 $ 165.80 $ 176.15

10926 $ 165.80 $ 176.15

10927 $ 209.20 $ 222.30

10928 $ 165.80 $ 176.15

10929 $ 209.20 $ 222.30

10930 $ 165.80 $ 176.15

10931 $ 23.30 $ 24.75

10932 $ 11.60 $ 12.35

10933 $ 7.70 $ 8.20

10940 $ 63.75 $ 67.75

10941 $ 38.45 $ 40.85

10942 $ 33.45 $ 35.55

10943 $ 33.45 $ 35.55

10944 $ 72.15 $ 72.15

10945 $ 33.45 $ 35.55

10946 $ 66.80 $ 71.00

10947 $ 33.45 $ 35.55

10948 $ 66.80 $ 71.00

3. DERIVED FEES – READY RECKONER FOR LOCAL MEDICAL OFFICERS

EXPLANITORY NOTES

Derived fees are indicated by a ‘D’ in the column of the Schedule. Derived Fees Ready Reckoner for Local Medical Officers is a quick reference table for all derived fees. The derived fees are calculated at 115% of the listed MBS fee. LMOs will be paid the relevant Veterans Access Payment (VAP) and where applicable the Rural Enhancement Initiative (REI) loading. The VAP can be claimed using the Medicare Bulk Billing Incentive item numbers as follows:

Item 64990 and 74990 are to be used when claiming the $ 7.05VAP; and

Item 10990 is to be used when claiming the $7.20 VAP.

Item 64991 and 74991 when claiming the $10.65 VAP; and

Item 10991 and 10992 to be used when claiming $10.85 VAP. Please note that VAP is not payable on items provided to inpatients of a hospital or day surgery, Coordinated Veterans’ Care Program UP items and Telehealth consultation items. Items 10990, 10991 and 10992 are VAP incentives and are paid at 100% of the MBS fee. The REI loading is available to LMOs who provide services to veterans in designated rural public hospitals by State or Territory governments. The REI only applies to those In Hospital items indicated in the Local Medical Officer Fee Schedule. The REI loading of 10% is added to 100% of the MBS fee prior to the LMO fee calculation. For items not listed in the Derived Fees schedule please refer to the appropriate schedule in this booklet.

For medical attendances and consultations provided by general practitioners participating in DVA’s Local Medical Officer Scheme, please use the Local Medical Fee Schedule for the relevant fees.

For all specialist attendances and consultations, investigative and general medical procedures claim from the Repatriation Medical Fee Schedule.

For In Hospital anaesthetic services please use Relative Value Guide Fee Schedule.

For diagnostic imaging services claim from the Diagnostic Imaging Fee Schedule.

For pathology services claim from the Pathology Fee Schedule.

RMFS

Item Nos.

Patients LMO Fee Item Nos.

Patients LMO Fee Item Nos.

Patients LMO Fee

4 1 $49.35 20 1 $73.20 24 1 $72.45

2 $34.40 2 $46.35 2 $57.50

3 $29.45 3 $37.40 3 $52.60

4 $27.00 4 $32.90 4 $50.10

5 $25.50 5 $30.25 5 $48.60

6 $24.45 6 $28.50 6 $47.60

7+ $21.80 7+ $23.30 7+ $44.95

Item No. Patients LMO Fee Item Nos.

Patients LMO Fee Item Nos.

Patients LMO Fee

35 1 $96.35 37 1 $112.30 43 1 $136.20

2 $69.50 2 $97.35 2 $109.35

3 $60.50 3 $92.45 3 $100.35

4 $56.05 4 $89.95 4 $95.90

5 $53.40 5 $88.45 5 $93.25

6 $51.60 6 $87.40 6 $91.45

$46.45 7+ $84.80 7+ $86.25

Item Nos.

Patients LMO Fee Item Nos.

Patients LMO Fee Item Nos.

Patients LMO Fee

47 1 $151.25 51 1 $175.10 58 1 $27.60

2 $136.30 2 $148.25 2 $18.70

3 $131.35 3 $139.30 3 $15.70

4 $128.90 4 $134.80 4 $14.25

5 $127.40 5 $132.15 5 $13.35

6 $126.35 6 $130.40 6 $12.80

7+ $123.70 7+ $125.20 7+ $10.60

Item No. Patients LMO Fee Item Nos.

Patients LMO Fee Item No. Patients LMO Fee

59 1 $38.55 60 1 $58.65 65 1 $83.95

2 $28.50 2 $49.75 2 $75.05

3 $25.15 3 $46.75 3 $72.05

4 $23.45 4 $45.30 4 $70.60

5 $22.45 5 $44.40 5 $69.70

6 $21.75 6 $43.85 6 $69.15

7+ $19.25 7+ $41.65 7+ $66.95

Item Nos.

Patients LMO Fee Item Nos.

Patients LMO Fee Item Nos.

Patients LMO Fee

92 1 $41.95 93 1 $54.70 95 1 $73.00

2 $25.85 2 $36.55 2 $56.90

3 $20.50 3 $30.50 3 $51.55

4 $17.85 4 $27.50 4 $48.90

5 $16.25 5 $25.65 5 $47.30

6 $15.15 6 $24.45 6 $46.20

7+ $11.25 7+ $19.85 7+ $42.30

Item No. Patients LMO Fee

Item Nos.

Patients LMO Fee

Item Nos.

Patients LMO Fee

96 1 $98.30 2122 1 $56.20 2125 1 $80.05

2 $82.20 2 $41.25 2 $53.20

3 $76.85 3 $36.30 3 $44.25

4 $74.20 4 $33.85 4 $39.75

5 $72.60 5 $32.35 5 $37.10

6 $71.50 6 $31.30 6 $35.35

7+ $67.60 7+ $28.65 7+ $30.15

Item Nos.

Patients LMO Fee Item Nos.

Patients LMO Fee

Item Nos.

Patients LMO Fee

2137 1 $87.30 2138 1 $111.15 2147 1 $141.25

2 $72.35 2 $84.30 2 $126.30

3 $67.40 3 $75.35 3 $121.35

4 $64.95 4 $70.85 4 $118.90

5 $63.45 5 $68.20 5 $117.40

6 $62.40 6 $66.45 6 $116.35

7+ $59.75 7+ $61.25 7+ $113.70

Item Nos.

Patients LMO Fee

Item Nos.

Patients LMO Fee

Item Nos.

Patients LMO Fee

2179 1 $165.10 2199 1 $193.75 2220 1 $217.60

2 $138.25 2 $178.80 2 $190.75

3 $129.30 3 $173.85 3 $181.80

4 $124.80 4 $171.35 4 $177.30

5 $122.15 5 $169.90 5 $174.65

6 $120.35 6 $168.85 6 $172.85

7+ $115.20 7+ $166.20 7+ $167.70

Item No. Patients LMO Fee

Item No. Patients LMO Fee

Item No. Patients LMO Fee

2503, 2518, 2547 1 $72.45

2506, 2522, 2553 1 $112.30

2509, 2526, 2559 1 $151.25

2 $57.50 2 $97.35 2 $136.30

3 $52.60 3 $92.45 3 $131.35

4 $50.10 4 $89.95 4 $128.90

5 $48.60 5 $88.45 5 $127.40

6 $47.60 6 $87.40 6 $126.35

7+ $44.95 7+ $84.80 7+ $123.70

Item No. Patients LMO Fee Item No. Patients LMO Fee

Item No. Patients LMO Fee

2610 1 $38.55 2613 1 $58.65 2616 1 $83.95

2 $28.50 2 $49.75 2 $75.05

3 $25.15 3 $46.75 3 $72.05

4 $23.45 4 $45.30 4 $70.60

5 $22.45 5 $44.40 5 $69.70

6 $21.75 6 $43.85 6 $69.15

7+ $19.25 7+ $41.65 7+ $66.95

Item No. Patients LMO Fee Item No. Patients LMO Fee Item No. Patients LMO Fee

2631 1 $38.55 2633 1 $58.65 2635 1 $83.95

2 $28.50 2 $49.75 2 $75.05

3 $25.15 3 $46.75 3 $72.05

4 $23.45 4 $45.30 4 $70.60

5 $22.45 5 $44.40 5 $69.70

6 $21.75 6 $43.85 6 $69.15

7+ $19.25 7+ $41.65 7+ $66.95

Item No. Patients LMO Fee Item No. Patients LMO Fee Item No. Patients LMO Fee

2673 1 $38.55 2675 1 $58.65 2677 1 $83.95

2 $28.50 2 $49.75 2 $75.05

3 $25.15 3 $46.75 3 $72.05

4 $23.45 4 $45.30 4 $70.60

5 $22.45 5 $44.40 5 $69.70

6 $21.75 6 $43.85 6 $69.15

7+ $19.25 7+ $41.65 7+ $66.95

Item No. Patients LMO Fee Item No. Patients LMO Fee Item No. Patients LMO Fee

2723 1 $136.55 2727 1 $182.55 5003 1 $63.20

2 $121.60 2 $167.60 2 $48.25

3 $116.65 3 $162.65 3 $43.30

4 $114.15 4 $160.15 4 $40.85

5 $112.65 5 $158.65 5 $39.35

6 $111.65 6 $157.65 6 $38.30

7+ $109.00 7+ $155.00 7+ $35.65

Item No. Patients LMO Fee Item No. Patients LMO Fee Item No. Patients LMO Fee

5010 1 $87.10 5023 1 $86.20 5028 1 $110.10

2 $60.25 2 $71.25 2 $83.25

3 $51.25 3 $66.30 3 $74.25

4 $46.75 4 $63.85 4 $69.75

5 $44.15 5 $62.35 5 $67.15

6 $42.35 6 $61.30 6 $65.35

7+ $37.15 7+ $58.65 7+ $60.15

Item No. Patients LMO Fee Item No. Patients LMO Fee Item No. Patients LMO Fee

5043 1 $126.40 5049 1 $150.25 5063 1 $165.30

2 $111.45 2 $123.40 2 $150.35

3 $106.50 3 $114.45 3 $145.40

4 $104.05 4 $109.95 4 $142.90

5 $102.55 5 $107.30 5 $141.40

6 $101.50 6 $105.55 6 $140.40

7+ $98.85 7+ $100.35 7+ $137.75

Item No. Patients LMO Fee Item No. Patients LMO Fee Item No. Patients LMO Fee

2631 1 $38.55 2633 1 $58.65 2635 1 $83.95

2 $28.50 2 $49.75 2 $75.05

3 $25.15 3 $46.75 3 $72.05

4 $23.45 4 $45.30 4 $70.60

5 $22.45 5 $44.40 5 $69.70

6 $21.75 6 $43.85 6 $69.15

7+ $19.25 7+ $41.65 7+ $66.95

Item No. Patients LMO Fee Item No. Patients LMO Fee Item No. Patients LMO Fee

2673 1 $38.55 2675 1 $58.65 2677 1 $83.95

2 $28.50 2 $49.75 2 $75.05

3 $25.15 3 $46.75 3 $72.05

4 $23.45 4 $45.30 4 $70.60

5 $22.45 5 $44.40 5 $69.70

6 $21.75 6 $43.85 6 $69.15

7+ $19.25 7+ $41.65 7+ $66.95

Item No. Patients LMO Fee Item No. Patients LMO Fee Item No. Patients LMO Fee

2723 1 $136.55 2727 1 $182.55 5003 1 $63.20

2 $121.60 2 $167.60 2 $48.25

3 $116.65 3 $162.65 3 $43.30

4 $114.15 4 $160.15 4 $40.85

5 $112.65 5 $158.65 5 $39.35

6 $111.65 6 $157.65 6 $38.30

7+ $109.00 7+ $155.00 7+ $35.65

Item No. Patients LMO Fee Item No. Patients LMO Fee Item No. Patients LMO Fee

5010 1 $87.10 5023 1 $86.20 5028 1 $110.10

2 $60.25 2 $71.25 2 $83.25

3 $51.25 3 $66.30 3 $74.25

4 $46.75 4 $63.85 4 $69.75

5 $44.15 5 $62.35 5 $67.15

6 $42.35 6 $61.30 6 $65.35

7+ $37.15 7+ $58.65 7+ $60.15

Item No. Patients LMO Fee Item No. Patients LMO Fee Item No. Patients LMO Fee

5043 1 $126.40 5049 1 $150.25 5063 1 $165.30

2 $111.45 2 $123.40 2 $150.35

3 $106.50 3 $114.45 3 $145.40

4 $104.05 4 $109.95 4 $142.90

5 $102.55 5 $107.30 5 $141.40

6 $101.50 6 $105.55 6 $140.40

7+ $98.85 7+ $100.35 7+ $137.75

RMFS

4. REPATRIATION MEDICAL FEE SCHEDULE

EXPLANITORY NOTES

The fees listed in the Repatriation Medical Fee Schedule (RMFS) are for specialist consultations and procedures. In Hospital items have been calculated with consideration given to private health industry rates. Out of Hospital items have been calculated based on the Medicare Benefits Schedule (MBS) at a rate of 135% of the MBS for consultations and 140% of the MBS for procedures. All medical practitioners, including LMOs and general practitioners, who have the appropriate qualifications updated with Medicare Australia, are eligible to claim for services listed in the RMFS. Items listed on the RMFS do not attract the Veterans Access Payment (VAP) or the Rural Enhancement Initiative (REI) loading. When claiming an RMFS item using the DVA treatment service voucher, electronic funds transfer or your own stationery, please ensure that you have correctly indicated whether you have performed the service In Hospital or Out of Hospital and claimed at the appropriate rate. Whether a service is considered In Hospital or Out of Hospital is assessed as per Medicare assessment rules. For items not listed in the RMFS please refer to the appropriate schedule in this booklet.

For medical attendances and consultations provided by general practitioners participating in DVA’s Local Medical Officer Scheme, please use the Local Medical Fee Schedule for the relevant fees.

For derived fees for Local Medical Officers, please use the Derived Fees for Local Medical Officers Fee Schedule.

For In Hospital anaesthetic services please use Relative Value Guide Fee Schedule.

For diagnostic imaging services please use the Diagnostic Imaging Fee Schedule.

For pathology services please use the Pathology Fee Schedule.

RMFS

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

99 D

104 $118.10 $115.50

105 $59.40 $58.05

106 $98.00 $95.85

107 $169.45

108 $107.30

109 $265.95 $260.30

110 $208.15 $203.75

112 D

113 $86.70

114 $152.85

116 $104.25 $101.95

119 $59.40 $58.05

122 $247.20

128 $149.55

131 $107.70

132 $363.00 $356.30

133 $181.75 $178.35

135 $363.00 $356.30

137 $363.00 $356.30

139 $178.90

141 $622.55 $611.10

143 $389.20 $382.00

145 $740.95

147 $463.20

149 D

160 $305.45 $299.05

161 $508.95 $498.40

162 $712.25 $697.50

163 $916.00 $897.15

164 $1,017.95 $996.85

170 $140.95 $158.70

171 $148.50 $167.20

172 $180.70 $203.45

173 $29.95 $29.25

193 $50.05

195 D

197 $96.80

199 $142.50

288 D

289 $356.35 $356.30

291 $611.10

293 $382.00

296 $351.45

297 $358.85

299 $420.30

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

300 $58.55

302 $116.75

304 $179.70

306 $247.95

308 $287.80

310 $29.20

312 $58.55

314 $90.00

316 $124.15

318 $143.95

319 $247.95

320 $59.90

322 $119.25

324 $183.55

326 $253.35

328 $293.80

330 $107.40

332 $168.30

334 $245.25

336 $296.70

338 $336.90

342 $68.15 $66.60

344 $90.40 $88.40

346 $133.60 $130.70

348 $174.90 $171.15

350 $241.45 $236.25

352 $174.90 $171.15

353 $68.80 $77.25

355 $137.20 $154.55

356 $201.20 $226.55

357 $277.55 $312.50

358 $338.15 $380.70

359 $447.55 $439.25

361 $411.70 $404.10

364 $59.90 $58.55

366 $119.25 $116.75

367 $174.90 $179.70

369 $241.45 $248.15

370 $293.80 $287.80

384 $86.70

385 $118.10 $115.50

386 $59.40 $58.05

387 $173.05 $169.45

388 $109.60 $107.30

389 D

410 $26.40

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

411 $57.75

412 $111.60

413 $164.30

414 D D

415 D D

416 D D

417 D D

501 $46.20

503 $78.05

507 $131.05

511 $185.40

515 $287.05

519 $197.40

520 $379.15

530 $621.45

532 $863.70

534 $1,106.15

536 $1,227.30

597

598 $144.45 $141.45

599

600 $171.25 $167.75

701

703

705

707

715

721

723

729

731

732

735

739

743

747

750

758

820 $187.80

822 $281.75

823 $375.55

825 $134.90

826 $215.10

828 $295.35

830 $191.85 $187.80

832 $287.80 $281.75

834 $383.40 $375.55

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

835 $137.85 $134.90

837 $219.75 $215.10

838 $301.65 $295.35

855 $191.85 $187.80

857 $287.80 $281.75

858 $383.40 $375.55

861 $191.85 $187.80

864 $287.80 $281.75

866 $383.40 $375.55

871 $110.80 $108.45

872 $51.60 $50.50

880 $67.10

900

903

2100 $26.35

2122 D

2125 D

2126 $57.45

2137 D

2138 D

2143 $111.40

2147 D

2179 D

2195 $163.90

2199 D

2220 D

2497

2501

2503

2504

2506

2507

2509

2517

2518

2521

2522

2525

2526

2546

2547

2552

2553

2558

2559

2598

2600

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

2603

2606

2610

2613

2616

2620

2622

2624

2631

2633

2635

2664

2666

2668

2673

2675

2677

2700

2701

2712

2713

2715

2717

2721

2723

2725

2727

2799 $152.85

2801 $208.15 $203.75

2806 $104.25 $101.95

2814 $59.40 $58.05

2820 D

2824 $247.20

2832 $149.55

2840 $107.70

2946 $191.85 $187.80

2949 $287.80 $281.75

2954 $383.40 $375.55

2958 $137.90 $134.90

2972 $219.75 $215.10

2974 $301.70 $295.35

2978 $191.85

2984 $287.80

2988 $383.40

2992 $134.90

2996 $215.10

3000 $295.35

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

3003 $152.85

3005 $208.15 $203.75

3010 $104.25 $101.95

3014 $59.40 $58.05

3015 D

3018 $247.20

3023 $149.55

3028 $107.70

3032 $191.85 $187.80

3040 $287.80 $281.75

3044 $383.40 $375.55

3051 $137.90 $134.90

3055 $219.75 $215.10

3062 $301.70 $295.35

3069 $191.85

3074 $287.80

3078 $383.40

3083 $134.90

3088 $215.10

3093 $295.35

4001

5000

5003

5010

5020

5023

5028

5040

5043

5049

5060

5063

5067

5200

5203

5207

5208

5220

5223

5227

5228

5260

5263

5265

5267

6004 $131.25

6007 $178.75 $175.00

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

6009 $59.40 $58.05

6011 $118.10 $115.50

6013 $163.45 $160.00

6015 $208.15 $203.75

6016 D

6018 $208.15 $203.75

6019 $104.25 $101.95

6023 $363.00 $356.30

6024 $181.75 $178.35

6025 $130.20

6026 D

6028 $68.15 $66.60

6029 $57.65

6031 $104.25 $101.95

6032 $152.95 $153.00

6034 $203.75

6035 $46.15

6037 $81.55

6038 $122.40

6042 $163.05

6051 $208.15 $203.75

6052 $104.25 $101.95

6057 $363.00 $356.30

6058 $181.75 $178.35

6059 $130.20

6060 D

6062 $247.20

6063 $149.55

6064 $57.65 $57.65

6065 $104.25 $101.95

6067 $153.00 $153.00

6068 $208.15 $203.75

6071 $46.15

6072 $81.55

6074 $122.40

6075 $163.05

10801 $167.85 $164.25

10802 $167.85 $164.25

10803 $167.85 $164.25

10804 $167.85 $164.25

10805 $167.85 $164.25

10806 $167.85 $164.25

10807 $167.85 $164.25

10808 $167.85 $164.25

10809 $167.85 $164.25

10816 $167.85 $164.25

10950

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

10952

10956

10983

10984

10987

10988

10989

10990

10991

10992

10997

11000 $154.50 $172.35

11003 $393.60 $456.00

11004 $392.60 $456.00

11005 $392.60 $456.00

11006 $201.30 $233.80

11009 $274.55 $318.85

11012 $135.25 $156.80

11015 $180.70 $209.90

11018 $269.95 $313.55

11021 $218.30 $209.90

11024 $137.35 $159.40

11027 $203.55 $236.50

11200 $53.55 $57.15

11204 $142.35 $151.55

11205 $142.35 $151.55

11210 $156.20 $151.55

11211 $142.35 $151.55

11215 $183.80 $172.20

11218 $283.05 $212.75

11221 $103.50 $94.85

11222 $89.20 $94.85

11224 $53.60 $57.20

11225 $53.60 $57.20

11235 $161.40 $171.85

11237 $107.20 $114.05

11240 $106.05 $114.05

11241 $136.40 $145.15

11242 $105.40 $112.15

11243 $105.40 $112.15

11244 $101.30 $107.80

11300 $253.30 $269.45

11303 $253.30 $269.45

11304 $416.75 $443.75

11306 $28.90 $30.70

11309 $36.80 $36.85

11312 $52.30 $52.05

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

11315 $72.95 $68.90

11318 $90.75 $85.05

11324 $44.45 $46.00

11327 $29.20 $27.65

11330 $10.40 $11.10

11332 $76.90 $82.00

11333 $58.65 $62.45

11336 $58.65 $62.45

11339 $58.65 $62.45

11503 $173.70 $194.15

11506 $25.30 $28.80

11509 $43.10 $49.95

11512 $74.45 $86.45

11600 $96.90 $97.05

11602 $74.50 $80.85

11604 $90.90 $106.00

11605 $90.90 $106.00

11610 $76.65 $89.25

11611 $77.90 $89.25

11612 $134.90 $157.40

11614 $95.95 $106.00

11615 $102.45 $106.30

11627 $300.65 $320.15

11700 $38.35 $43.75

11701 $19.05 $21.80

11702 $20.05 $21.80

11708 $154.30 $179.10

11709 $201.95 $234.45

11710 $62.60 $72.70

11711 $34.20 $39.65

11712 $183.40 $213.05

11713 $89.30 $97.65

11715 $145.30 $169.05

11718 $42.00 $48.65

11719 $92.10 $93.60

11720 $92.10 $93.60

11721 $84.15 $97.65

11722 $42.00 $48.65

11724 $203.55 $236.50

11725 $248.90 $265.30

11726 $124.45 $132.65

11727 $124.45 $132.65

11800 $209.50 $244.25

11801 $315.60 $368.20

11810 $209.50 $244.25

11820 $2,447.05 $2,854.90

11823 $2,447.05 $2,854.90

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

11830 $224.15 $261.55

11833 $299.90 $349.65

11900 $34.40 $38.60

11903 $134.05 $155.55

11906 $134.05 $155.55

11909 $199.05 $231.25

11912 $216.65 $231.25

11915 $199.05 $231.25

11917 $521.35 $599.70

11919 $515.00 $599.70

11921 $98.55 $105.10

12000 $56.30 $54.55

12003 $113.55 $82.40

12012 $25.05 $29.15

12017 $84.10 $98.45

12021 $138.70 $161.70

12022 $162.80 $189.95

12024 $185.40 $216.30

12200 $44.75 $52.10

12201 $2,871.65 $3,350.10

12203 $705.75 $823.20

12207 $705.75 $823.20

12210 $842.30 $982.60

12213 $758.95 $885.25

12215 $842.30 $982.60

12217 $758.95 $885.25

12250 $402.50 $469.45

12306 $122.95 $143.40

12309 $122.95 $143.40

12312 $122.95 $143.40

12315 $129.25 $143.40

12318 $122.95 $143.40

12321 $129.70 $143.40

12323 $129.80 $143.40

12325 $70.00

12326 $70.00

12500 $260.05 $303.35

12503 $509.90 $594.65

12506 $364.10 $424.65

12509 $260.05 $303.35

12512 $126.20 $147.10

12515 $275.95 $321.80

12518 $126.20 $147.10

12521 $152.05 $177.35

12524 $190.05 $221.70

12527 $102.10 $118.95

12530 $152.05 $177.35

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

12533 $101.65 $118.55

13015 $305.85 $356.65

13020 $310.60 $362.40

13025 $138.95 $162.00

13030 $196.25 $228.85

13100 $195.45 $191.35

13103 $85.50 $99.70

13104 $207.15

13106 $145.80 $169.90

13109 $273.30 $318.85

13110 $274.35 $319.90

13112 $183.80 $191.35

13200 $4,258.65 $4,355.05

13201 $3,983.45 $4,073.65

13202 $637.40 $651.80

13203 $674.25 $681.45

13206 $1,172.30 $651.80

13209 $122.25 $118.60

13210 D

13212 $467.05 $496.25

13215 $161.50 $155.55

13218 $1,130.65 $1,111.00

13221 $71.55 $71.15

13251 $580.00 $585.15

13290 $275.70 $285.95

13292 $551.25 $572.20

13300 $68.50 $79.75

13303 $101.30 $118.20

13306 $401.00 $467.75

13309 $341.90 $398.80

13312 $45.65 $39.85

13318 $273.00 $318.45

13319 $273.00 $318.45

13400 $116.30 $135.55

13506 $221.45 $258.30

13700 $401.70 $466.55

13703 $144.05 $167.30

13706 $100.65 $116.70

13709 $64.05 $67.85

13750 $164.85 $191.35

13755 $180.45 $191.35

13757 $87.95 $102.15

13760 $918.95 $1,067.65

13815 $102.75 $119.35

13818 $137.10 $159.20

13830 $90.85 $105.50

13839 $29.10 $32.30

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

13842 $83.60 $97.05

13847 $188.00 $218.55

13848 $162.60 $183.50

13851 $594.50 $691.15

13854 $189.00 $160.80

13857 $176.50 $205.00

13870 $434.70

13873 $322.45

13876 $98.10

13881 $175.75

13882 $138.45

13885 $184.50

13888 $92.40

13915 $78.20 $91.10

13918 $117.55 $137.15

13921 $133.15 $155.15

13924 $78.45 $91.35

13927 $101.30 $118.20

13930 $141.45 $164.95

13933 $156.95 $183.00

13936 $102.35 $119.25

13939 $117.55 $137.15

13942 $78.45 $91.35

13945 $63.20 $73.50

13948 $78.45 $91.35

14050 $63.65 $73.85

14053 $63.65 $73.85

14100 $216.75 $213.50

14106 $222.45 $213.50

14109 $274.65 $262.30

14112 $296.60 $310.45

14115 $309.35 $359.10

14118 $433.90 $456.05

14124 $183.90 $213.50

14200 $82.55 $83.75

14201 $312.00 $331.60

14202 $157.90 $167.90

14203 $67.25 $71.65

14206 $46.95 $49.85

14209 $116.65 $124.20

14212 $244.65 $259.45

14218 $128.80 $137.15

14221 $63.25 $73.50

14224 $89.20 $98.50

14227 $122.00 $137.15

14230 $371.35

14233 $450.95

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

14236 $822.20

14239 $198.75

14242 $590.10

14245 $122.00 $137.15

15000 $56.00 $59.60

15003 D D

15006 $142.70 $132.10

15009 D D

15012 $85.75 $74.85

15100 $63.00 $66.80

15103 D D

15106 $74.15 $78.85

15109 D D

15112 $157.75 $168.35

15115 D D

15211 $66.90 $76.60

15214 D D

15215 $74.70 $83.55

15218 $74.70 $83.55

15221 $102.40 $83.55

15224 $73.25 $83.55

15227 $90.30 $83.55

15230 D D

15233 D D

15236 D D

15239 D D

15242 D D

15245 $89.60 $83.55

15248 $74.70 $83.55

15251 $84.40 $83.55

15254 $88.65 $83.55

15257 $89.80 $83.55

15260 D D

15263 D D

15266 D D

15269 D D

15272 D D

15275 $227.25 $256.10

15303 $430.30 $499.80

15304 $430.30 $499.80

15307 $815.70 $947.55

15308 $815.70 $947.55

15311 $401.65 $466.50

15312 $398.80 $463.15

15315 $788.55 $915.95

15316 $1,114.85 $915.95

15319 $489.35 $568.50

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

15320 $489.35 $568.50

15323 $870.00 $1,010.80

15324 $870.00 $1,010.80

15327 $1,323.40 $1,099.65

15328 $946.65 $1,099.65

15331 $902.35 $1,044.15

15332 $1,121.65 $1,044.15

15335 $815.70 $947.55

15336 $815.70 $947.55

15338 $1,268.75 $1,309.85

15339 $91.95 $106.70

15342 $229.45 $266.45

15345 $637.40 $710.95

15348 $70.55 $81.80

15351 $140.65 $163.25

15354 $170.70 $198.10

15357 $48.20 $56.10

15500 $305.80 $339.75

15503 $388.65 $436.20

15506 $562.25 $651.45

15509 $262.35 $294.45

15512 $338.15 $379.55

15513 $528.25 $429.20

15515 $493.55 $549.50

15518 $99.50 $107.80

15521 $428.90 $475.90

15524 $768.20 $892.30

15527 $103.00 $110.55

15530 $482.65 $493.05

15533 $848.55 $934.80

15536 $362.85 $373.70

15539 $790.25 $878.25

15550 $794.30 $922.05

15553 $856.90 $994.80

15555 $856.90 $994.80

15556 $801.20 $930.20

15559 $1,045.00 $1,213.20

15562 $1,351.50 $1,569.05

15565 $4,054.50 $4,639.40

15600 $2,042.95 $2,383.25

15700 $59.70 $64.35

15705 $99.40 $107.25

15710 $99.40 $107.25

15715 $99.40 $107.25

15800 $125.00 $134.85

15850 $356.00 $279.30

15900 $350.00

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

16003 $812.40 $910.70

16006 $600.00 $699.80

16009 $409.45 $477.65

16012 $354.40 $413.25

16015 $4,902.95 $5,720.00

16018 $2,930.95 $3,419.45

16399 D

16400 $38.15

16401 $118.10 $119.80

16404 $59.40 $60.20

16406 $193.45 $187.55

16500 $68.15 $66.05

16501 $191.65 $196.80

16502 $60.90

16505 $61.95

16508 $58.05

16509 $58.60 $66.05

16511 $361.80 $307.95

16512 $105.30 $88.90

16514 $49.15 $51.35

16515 $937.95 $630.95

16518 $729.65 $630.95

16519 $1,824.30 $971.55

16520 $2,132.00

16522 $2,305.30 $2,281.10

16525 $1,010.50 $538.10

16527 $921.35 $630.95

16528 $2,094.20 $1,135.50

16564 $299.30 $305.20

16567 $430.45 $446.35

16570 $547.00 $582.50

16571 $418.90 $446.35

16573 $362.65 $363.75

16590 $453.75

16591 $199.75

16600 $116.45 $88.90

16603 $160.25 $170.60

16606 $366.35 $340.55

16609 $652.00 $694.40

16612 $512.70 $546.35

16615 $273.20 $291.00

16618 $273.20 $291.00

16621 $273.20 $291.00

16624 $393.35 $418.75

16627 $800.50 $852.55

16633 D D

16636 D D

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

17609 D

17610 $69.45 $60.20

17615 $138.40 $119.80

17620 $191.70 $165.90

17625 $244.10 $211.30

17640 $69.45 $60.20

17645 $138.40 $119.80

17650 $191.70 $165.90

17655 $244.10 $211.30

17680 $138.40 $119.80

17690 $55.40

18213 $131.65 $124.15

18216 $302.45 $265.90

18219 D D

18222 $61.05 $52.75

18225 $83.60 $70.10

18226 $466.50 $398.75

18227 D D

18228 $95.15 $87.50

18230 $320.90 $333.85

18232 $271.40 $265.90

18233 $267.45 $265.90

18234 $167.45 $174.80

18236 $87.70 $87.50

18238 $68.90 $52.75

18240 $130.30 $131.05

18242 $57.75 $52.75

18244 $160.65 $141.15

18248 $129.35 $124.15

18250 $95.95 $87.50

18252 $143.80 $141.15

18254 $147.40 $141.15

18256 $83.20 $87.50

18258 $104.50 $87.50

18260 $128.05 $124.15

18262 $90.65 $87.50

18264 $145.10 $141.15

18266 $98.65 $87.50

18268 $155.40 $124.15

18270 $151.55 $124.15

18272 $105.15 $87.50

18274 $135.05 $124.15

18276 $169.40 $174.80

18278 $128.25 $124.15

18280 $199.05 $174.80

18282 $154.70 $141.15

18284 $215.70 $206.75

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

18286 $199.85 $206.75

18288 $205.40 $206.75

18290 $383.20 $349.65

18292 $237.85 $174.80

18294 $232.20 $246.40

18296 $246.80 $210.80

18298 $332.95 $246.40

18350 $178.05 $174.80

18351 $178.05 $174.80

18353 $383.20 $349.65

18354 $211.15 $174.80

18360 $227.65 $174.80

18361 $227.65 $174.80

18362 $378.50 $345.40

18365 $191.65 $174.80

18366 $195.85 $219.00

18368 $409.65 $373.90

18369 $61.40 $63.10

18370 $69.20 $63.10

18372 $191.65 $174.80

18374 $191.65 $174.80

18375 $329.70

18377 $178.05 $174.80

18379 $329.70

30001 D D

30003 $46.45 $50.85

30006 $62.25 $65.10

30009 $98.65

30010 $98.65

30013 $207.45

30014 $207.45

30017 $438.75 $456.50

30020 $795.05

30023 $435.00 $456.50

30024 $435.00 $456.50

30026 $69.65 $73.10

30029 $120.10 $126.00

30032 $110.25 $115.50

30035 $152.95 $164.60

30038 $149.85 $126.00

30041 $250.25 $201.60

30042 $250.25 $259.85

30045 $157.00 $164.60

30048 $196.55 $209.65

30049 $243.65 $259.85

30052 $338.90 $355.60

30055 $99.45 $103.50

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

30058 $187.25 $202.10

30061 $32.95 $32.90

30062 $81.10 $85.05

30064 $133.75 $153.90

30067 $383.05 $313.05

30068 $383.05 $387.55

30071 $69.65 $73.10

30072 $69.65 $73.10

30074 $205.40 $164.60

30075 $205.40 $209.65

30078 $61.75 $67.85

30081 $137.85 $153.90

30084 $72.40 $82.35

30087 $39.40 $41.25

30090 $159.45 $180.00

30093 $228.95 $240.20

30094 $252.75 $265.20

30096 $279.65 $257.50

30097 $132.05 $136.05

30099 $120.10 $126.00

30102 $229.20 $209.65

30103 $229.20 $257.50

30104 $197.20 $177.70

30105 $256.40 $230.95

30106 $296.10 $217.60

30107 $296.10 $307.95

30110 $495.70 $398.10

30111 $495.70 $520.10

30114 $447.80

30165 $817.95

30168 $606.85

30171 $1,292.35

30172 $1,292.35

30176 $1,315.05

30177 $1,315.05

30179 $1,577.10

30180 $182.10 $191.10

30183 $328.75 $345.10

30185 $252.25 $255.50

30186 $62.75 $66.45

30187 $360.30 $359.75

30189 $179.55

30190 $596.40 $556.85

RMFS

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

30192 $52.95 $55.40

30195 $84.70 $88.90

30196 $168.50 $176.85

30197 $734.15 $616.10

30202 $64.60 $67.70

30203 $227.20 $238.35

30205 $168.50 $176.85

30207 $59.65 $62.45

30210 $267.30

30213 $146.55 $153.75

30214 $146.55 $153.75

30216 $36.60 $38.30

30219 $38.30

30223 $201.05

30224 $317.15 $332.65

30225 $345.20 $374.75

30226 $199.85 $209.65

30229 $364.25 $382.15

30232 $298.40 $313.05

30235 $394.50 $414.00

30238 $199.85 $209.65

30241 $495.90 $498.90

30244 $475.50

30246 $1,014.25

30247 $986.20

30250 $1,695.50

30251 $2,588.55 $2,690.45

30253 $1,180.30

30255 $1,714.70

30256 $681.30

30259 $266.85 $277.90

30262 $78.65 $82.35

30265 $217.70 $164.60

30266 $217.70 $209.65

30269 $199.85 $209.65

30272 $398.30 $414.00

30275 $2,548.40

30278 $59.70 $65.10

30281 $148.85 $167.30

30282 $302.60 $217.60

30283 $302.60 $286.60

30286 $598.90 $557.00

30287 $778.60 $724.10

30289 $623.30

30293 $594.25 $623.60

30294 $3,202.45

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

30296 $1,513.60

30297 $1,520.00

30299 $850.50

30300 $1,020.55

30302 $680.30

30303 $816.35

30306 $1,218.20

30308 $1,235.05

30309 $1,623.65

30310 $593.15

30313 $498.70 $382.15

30314 $694.60

30315 $1,770.00

30317 $2,051.80

30318 $1,210.85

30320 $1,780.65

30321 $1,210.85

30323 $2,086.85

30324 $2,095.55

30326 $903.00

30329 $329.45 $345.75

30330 $982.50

30332 $461.50

30335 $1,273.05

30336 $1,489.40

30373 $606.25

30375 $695.40

30376 $673.75

30378 $698.65

30379 $1,238.25

30382 $1,784.40

30384 $1,464.60

30385 $790.65

30387 $866.80

30388 $1,964.30

30390 $293.50

30391 $379.50

30392 $899.90

30393 $698.65

30394 $657.45

30396 $1,223.60

30397 $310.15

30399 $426.45

30400 $843.80

30402 $619.90

30403 $695.40

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

30405 $1,195.20

30406 $71.70 $73.10

30408 $588.55

30409 $232.95 $244.25

30411 $118.60

30412 $69.85 $73.30

30414 $920.25

30415 $2,047.60

30416 $999.25

30417 $1,529.30

30418 $2,119.50

30419 $1,090.25 $1,143.95

30421 $3,131.25

30422 $900.90

30425 $1,651.20

30427 $2,071.30

30428 $2,796.30 $2,338.00

30430 $3,099.40 $3,252.65

30431 $695.40 $729.75

30433 $968.75

30434 $784.70

30436 $871.95

30437 $1,084.85

30438 $1,488.10 $1,611.20

30439 $247.85

30440 $702.20 $737.00

30441 $181.75

30442 $247.85

30443 $986.20

30445 $1,082.45

30446 $1,071.40

30448 $1,400.80

30449 $1,558.75

30450 $699.45 $734.20

30451 $357.25 $374.75

30452 $503.75

30454 $1,143.65

30455 $1,267.45

30457 $1,800.25 $1,931.30

30458 $1,401.65

30460 $1,282.50

30461 $1,972.50

30463 $3,057.70

30464 $4,086.30

30466 $1,675.60

30467 $2,072.65

30469 $2,694.30 $2,409.30

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

30472 $1,239.80 $1,301.10

30473 $236.45 $247.95

30475 $427.35 $448.35

30476 $327.65 $343.80

30478 $327.65 $343.80

30479 $576.80 $666.55

30481 $476.35 $499.80

30482 $338.75 $355.40

30483 $236.40 $247.90

30484 $486.90 $510.90

30485 $729.55 $788.65

30487 $241.55 $253.30

30488 $120.10 $126.00

30490 $635.10 $737.00

30491 $740.95 $777.50

30492 $1,049.75

30493 $444.70 $466.50

30494 $561.00

30495 $1,049.75

30496 $784.70 $823.45

30497 $935.60

30499 $1,113.00

30500 $1,191.40 $1,250.35

30502 $1,315.05

30503 $1,472.40 $1,545.35

30505 $719.70

30506 $1,288.45

30508 $1,356.20

30509 $1,356.20 $1,423.20

30515 $939.50

30517 $1,230.20

30518 $1,317.35

30520 $900.90

30521 $2,071.95

30523 $2,013.15

30524 $2,301.15

30526 $2,976.50

30527 $1,233.75

30529 $1,743.55

30530 $1,046.20

30532 $1,201.40

30533 $1,559.55

30535 $2,859.65

30536 $2,653.40

30538 $1,765.70

30539 $1,107.65

30541 $2,458.45

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

30542 $1,375.45

30544 $965.30

30545 $2,450.70

30547 $1,616.55 $1,768.70

30548 $1,816.45 $1,321.35

30550 $2,750.75

30551 $1,898.45

30553 $1,325.45 $1,473.75

30554 $3,060.80

30556 $2,111.55

30557 $1,559.45

30559 $1,136.75 $1,189.40

30560 $1,374.30

30562 $790.95

30563 $794.00 $833.00

30564 $1,030.25

30565 $1,162.30

30566 $1,291.20

30568 $875.60

30569 $494.10

30571 $605.15

30572 $634.60

30574 $164.60

30575 $669.70

30577 $1,464.05

30578 $1,444.75

30580 $1,305.80

30581 $1,067.75

30583 $1,593.30

30584 $2,503.35

30586 $935.60

30587 $968.75

30589 $1,669.05

30590 $1,947.60

30593 $2,570.75 $2,642.85

30594 $3,085.75

30596 $1,197.10

30597 $960.90

30599 $1,865.50

30600 $1,036.95

30601 $1,277.05

30602 $2,072.65

30603 $2,189.20 $2,297.30

30605 $2,753.55

30606 $1,481.95

30608 $1,678.60

30609 $683.55

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

30611 $800.15 $788.70

30614 $601.15

30615 $693.95

30618 $637.35 $731.15

30619 $1,285.40

30620 $490.35

30621 $490.35

30622 $904.05

30623 $875.90

30626 $908.25

30627 $381.55

30628 $47.65 $49.85

30631 $310.45 $331.35

30634 $472.45

30635 $472.45

30636 $307.35 $326.45

30637 $1,028.25

30638 $541.00

30639 $1,032.20 $1082.90

30640 $1,195.20

30641 $541.00

30643 $1,030.60

30642 $521.25 $792.75

30644 $792.75

30645 $786.70

30646 $825.00

30649 $294.85 $262.75

30654 $62.25 $65.10

30658 $227.20 $198.80

30663 $226.80 $202.10

30666 $84.30 $66.45

30672 $622.55

30675 $512.35 $419.25

30676 $512.35 $530.70

30679 $117.90 $134.85

30680 $1,408.95 $1,638.00

30682 $1,408.95 $1,638.00

30684 $1,733.70 $2,015.80

30686 $1,733.70 $2,015.80

30687 $576.80 $666.55

30688 $485.50 $510.90

30690 $749.35 $788.65

30692 $485.50 $510.90

30694 $749.35 $788.65

30696 $749.35 $788.65

30710 $749.35 $788.65

31000 $746.10 $813.30

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

31001 $1,114.45 $1,016.50

31002 $1,175.55 $1,219.85

31206 $127.20 $133.65

31211 $164.45 $172.35

31216 $200.65 $201.00

31220 $295.45 $300.40

31221 $295.45 $300.40

31225 $493.75 $533.85

31245 $561.80 $516.60

31250 $627.45 $516.60

31340 D D

31345 $292.70 $295.35

31346 $281.35 $295.35

31350 $615.50 $606.70

31355 $939.95 $1,000.25

31356 $295.35 $309.90

31357 $146.20 $153.60

31358 $360.95 $379.20

31360 $224.20 $235.30

31361 $249.10 $261.40

31362 $179.10 $187.50

31363 $325.65 $342.05

31364 $224.20 $235.30

31365 $211.35 $221.65

31366 $127.45 $133.65

31367 $286.35 $299.05

31368 $169.20 $175.80

31369 $328.15 $344.30

31370 $200.65 $201.00

31371 $475.25 $499.80

31372 $410.75 $432.20

31373 $474.30 $499.55

31374 $374.70 $394.70

31375 $406.60 $424.80

31376 $468.40 $492.25

31400 $348.35 $365.50

31403 $401.95

31406 $738.55 $703.05

31409 $2,631.10

31412 $2,974.15

31420 $237.30 $257.50

31423 $490.25 $562.45

31426 $1,072.00

31429 $1,882.65

31432 $2,279.65

31435 $1,304.10

31438 $2,117.15

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

31450 $593.25

31452 $1,068.00

31454 $784.10

31456 $296.60

31458 $393.25

31460 $494.15

31462 $695.40

31464 $1,321.55

31466 $1,735.55

31468 $2,141.95

31470 $988.75

31472 $1,409.05

31500 $361.05 $364.10

31503 $459.35 $485.45

31506 $526.00

31509 $451.80 $485.45

31512 $865.20

31515 $562.00

31516 $1,082.05

31519 $979.85

31524 $1,384.25

31525 $924.30

31530 $792.70 $833.95

31533 $177.20 $193.10

31536 $252.75 $265.20

31539 $507.35

31542 $262.05 $275.75

31545 $774.20 $833.95

31548 $171.75 $193.10

31551 $282.80

31554 $584.90

31557 $475.20 $485.45

31560 $467.15 $485.45

31563 $375.30 $363.65

31566 $234.70 $181.95

31569 $1,133.40

31572 $1,394.80

31575 $1,133.40

31578 $1,133.40

31581 $1,394.80

31584 $2,079.30

31587 $128.80 $137.15

31590 $307.35 $352.40

32000 $1,284.65

32003 $1,453.35

32004 $1,486.30

32005 $1,802.35

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

32006 $1,534.65

32009 $1,922.35

32012 $2,073.55

32015 $2,531.75

32018 $1,936.25

32021 $843.15

32023 $740.95 $777.50

32024 $1,981.60

32025 $2,558.05

32026 $2,718.90

32028 $3,093.75

32029 $562.05

32030 $1,390.00

32033 $2,038.25

32036 $2,767.00

32039 $2,176.35

32042 $1,715.85

32045 $617.05

32046 $1,012.45

32047 $1,162.30

32051 $3,201.75

32054 $2,554.85

32057 $751.40

32060 $3,490.30

32063 $2,836.40

32066 $751.40

32069 $2,260.15

32072 $62.00 $67.00

32075 $91.65 $105.10

32084 $143.70 $155.90

32087 $264.25 $286.60

32088 $430.65 $468.10

32089 $593.35 $656.90

32090 $430.65 $468.10

32093 $593.35 $656.90

32094 $711.65

32095 $164.95 $178.95

32096 $453.50

32099 $444.60

32102 $889.50

32103 $939.40

32104 $1,308.85

32105 $692.45 $677.55

32106 $1,820.45 $1,910.45

32108 $1,333.60

32111 $871.35

32112 $1,055.70

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

32114 $232.95 $244.25

32115 $169.55

32117 $1,333.60

32120 $342.85

32123 $444.60 $466.50

32126 $645.80

32129 $846.60

32131 $712.00

32132 $60.35 $63.15

32135 $90.15 $94.50

32138 $502.50 $514.85

32139 $560.10

32142 $90.15 $94.50

32145 $180.45

32147 $60.35 $63.15

32150 $319.05 $359.75

32153 $97.60

32156 $175.80 $184.45

32159 $433.20

32162 $636.75

32165 $846.60 $888.60

32166 $279.25 $288.70

32168 $173.05

32171 $113.25

32174 $118.60 $124.35

32175 $209.85

32177 $212.60

32180 $342.30

32183 $749.30

32186 $749.30

32200 $394.50 $414.00

32203 $847.00

32206 $731.45

32209 $1,229.90

32210 $340.85 $357.65

32212 $181.75

32213 $881.45

32214 $445.40

32215 $167.25 $175.60

32216 $791.60

32217 $208.55

32218 $208.55

32220 $1,205.85

32221 $1,205.85

32500 $166.25 $153.75

32501 $156.65 $153.75

32504 $381.25 $374.75

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

32507 $767.60 $747.05

32508 $796.00

32511 $1,255.05

32514 $1,354.55

32517 $1,843.85

32520 $759.80 $747.05

32522 $1,129.45 $1,110.65

32523 $759.80 $747.05

32526 $1,129.45 $1,110.65

32700 $2,174.30

32703 $1,763.50

32708 $1,971.70

32710 $1,948.60

32711 $2,866.55

32712 $1,551.05

32715 $1,633.30

32718 $1,691.85

32721 $3,154.50

32724 $3,051.55

32730 $2,312.90

32733 $2,640.90

32736 $588.85

32739 $1,713.95

32742 $2,088.55

32745 $2,403.50

32748 $2,642.25

32751 $1,707.35

32754 $2,202.30

32757 $588.85

32760 $578.65

32763 $1,574.35

32766 $1,123.50

32769 $389.70

33050 $2,286.25

33055 $1,714.35

33070 $1,199.10 $1,178.80

33075 $1,525.45

33080 $1,629.15

33100 $2,114.95 $2,010.85

33103 $2,869.15

33109 $3,884.15 $3,411.10

33112 $3,275.15

33115 $2,144.20

33116 $2,210.45 $1,958.60

33118 $2,358.70

33119 $2,285.10 $2,176.40

33121 $2,738.15

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

33124 $1,525.65

33127 $2,259.05 $2,221.45

33130 $1,970.15

33133 $1,478.65

33136 $3,378.10

33139 $2,182.90

33142 $2,078.20 $2,074.10

33145 $3,629.30

33148 $4,507.60

33151 $5,403.00

33154 $3,171.30

33157 $3,473.85

33160 $3,850.05

33163 $3,857.05

33166 $2,998.25 $2,948.00

33169 $2,246.25

33172 $1,696.20

33175 $1,567.00

33178 $2,133.05

33181 $3,277.70

33500 $1,631.60

33506 $1,809.65

33509 $2,024.00

33512 $2,404.60

33515 $2,473.70

33518 $1,810.95 $1,779.30

33521 $1,812.45

33524 $2,312.90

33527 $2,687.55

33530 $2,276.80

33533 $2,687.55

33536 $1,916.75

33539 $1,381.20

33542 $2,159.70

33545 $389.70

33548 $792.65

33551 $389.70

33554 $388.00

33800 $1,585.65 $1,652.85

33803 $1,606.10

33806 $1,156.50 $1,137.05

33810 $843.75 $829.45

33811 $3,295.15

33812 $1,212.90 $1,305.45

33815 $1,220.90

33818 $1,265.05

33821 $1,638.60

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

33824 $1,552.35

33827 $1,737.30

33830 $2,087.90

33833 $1,895.20

33836 $2,216.60

33839 $3,405.05

33842 $1,328.30

33845 $805.50

33848 $859.35

34100 $969.10

34103 $588.85

34106 $415.50 $408.40

34109 $453.50 $473.70

34112 $1,399.20

34115 $1,292.30

34118 $2,113.50 $1,937.15

34121 $1,573.90

34124 $1,723.75

34127 $2,259.05

34130 $706.95 $694.85

34133 $986.80

34136 $1,483.15

34139 $1,178.75

34142 $1,513.15

34145 $1,365.60

34148 $2,241.70

34151 $2,706.60

34154 $2,918.85 $3,274.25

34157 $1,691.85

34160 $3,169.10

34163 $4,069.00

34166 $3,828.50

34169 $2,451.60

34172 $2,334.55

34175 $1,520.95

34500 $439.15 $431.80

34503 $588.85

34506 $299.90

34509 $1,295.50

34512 $1,366.40

34515 $1,092.10

34518 $1,779.15

34521 $1,124.85

34524 $704.90

34527 $716.65 $772.25

34528 $330.35 $381.40

34529 $931.65 $1003.95

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

34530 $253.05

34533 $1,766.65 $1,736.95

34534 $429.50 $495.75

34538 $350.10 $381.40

34539 $246.55 $285.95

34540 $329.00 $1137.05

34800 $1,156.50 $1,137.05

34803 $2,377.50

34806 $1,381.20

34809 $1,381.20

34812 $1,670.10

34815 $1,785.30

34818 $1,709.25

34821 $2,066.70 $2,032.05

34824 $607.35

34827 $856.60

34830 $1,190.25 $989.80

34833 $1,371.60

35000 $941.00 $989.80

35003 $1,396.25

35006 $1,638.25

35009 $1,722.95

35012 $1,007.00

35100 $452.60

35103 $334.05

35200 $244.40

35202 $1,163.55

35300 $734.05 $721.50

35303 $809.30 $925.15

35306 $754.25 $853.90

35307 $1,596.70

35309 $935.35 $1,067.30

35312 $1,230.50

35315 $1,230.50

35317 $507.00 $498.15

35319 $787.25 $892.95

35320 $1,219.70 $1,199.40

35321 $1,157.95 $1,138.65

35324 $434.25

35327 $581.80

35330 $734.05 $721.50

35331 $843.75

35360 $1,179.00

35361 $890.10

35362 $843.50

35363 $675.75

35404 $395.50

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

35406 $1,128.10

35408 $846.25

35410 $1,128.10 $1,138.65

35412 $3,963.45 $4,000.60

35500 $112.80 $113.85

35502 $98.55 $112.25

35503 $66.55 $75.00

35506 $76.70 $75.20

35507 $218.20

35508 $386.70

35509 $116.65 $125.25

35512 $354.95 $251.20

35513 $354.95 $310.40

35516 $211.65 $162.90

35517 $211.65 $204.40

35518 $297.00 $291.00

35520 $92.60 $81.65

35523 $106.05 $81.65

35526 $207.70 $162.90

35527 $207.70 $204.40

35530 $338.85

35533 $459.65 $489.80

35534 $459.65

35536 $525.25 $487.85

35539 $408.50 $382.15

35542 $507.70 $447.45

35545 $241.65 $257.05

35548 $1,402.35

35551 $973.85

35554 $60.25 $60.90

35557 $269.15 $300.30

35560 $859.25

35561 $1,749.45

35562 $1,612.75

35564 $744.55

35565 $877.75

35566 $623.50

35568 $889.30

35569 $196.80 $225.20

35570 $788.70

35571 $788.70

35572 $149.15

35573 $1,209.25

35577 $1,158.35

35578 $984.40

35595 $1,946.95

35596 $973.85

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

35597 $2,214.85

35599 $948.60

35602 $1,116.10

35605 $521.10 $512.35

35608 $91.10 $89.60

35611 $91.10 $89.60

35612 $720.50 $708.40

35613 $576.65

35614 $90.95 $89.50

35615 $76.70 $75.20

35616 $660.00

35617 $330.00 $243.20

35618 $330.00 $305.20

35620 $76.05 $74.70

35622 $859.05

35623 $1,158.40

35626 $116.50 $115.95

35627 $152.75

35630 $242.90

35633 $348.75 $305.20

35634 $851.80 $960.00

35635 $449.30

35636 $653.75

35637 $614.50

35638 $1,158.95

35639 $260.75

35640 $260.75

35641 $2,210.85

35643 $325.45 $305.20

35644 $297.40 $285.15

35645 $449.50 $446.20

35646 $306.95 $285.15

35647 $314.80 $285.15

35648 $511.50 $446.20

35649 $782.10

35653 $1,030.35

35657 $957.20

35658 $592.45

35661 $1,380.25

35664 $2,366.00

35667 $1,852.90

35670 $1,518.05

35673 $1,085.15

35674 $309.35 $291.00

35676 $798.75

35677 $798.75

35678 $1,009.10

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

35680 $882.20 $814.90

35683 $684.55

35684 $684.55

35687 $536.00

35688 $536.00

35691 $226.85

35694 $793.40

35697 $1,347.40

35700 $1,310.50

35703 $96.10 $94.50

35706 $96.10 $94.50

35709 $62.15 $60.90

35710 $659.90

35712 $569.75

35713 $569.75

35716 $672.50

35717 $672.50

35720 $960.60

35723 $687.80

35726 $687.80

35729 $310.20

35750 $1,340.45

35730 $217.80 $310.20

35753 $1,483.45

35754 $1,890.45

35756 $1,271.35

35759 $798.35

36500 $1,367.25

36502 $894.95

36503 $1,805.95

36506 $1,367.25

36509 $978.30

36516 $1,307.20

36519 $1,864.90

36522 $1,760.55

36525 $2,313.90

36526 $2,295.00 $1,807.55

36527 $2,316.05 $2,230.80

36528 $2,040.30

36529 $2,457.25

36531 $1,625.90

36532 $2,457.70

36533 $3,026.15

36537 $976.00

36540 $1,522.25 $1,551.15

36543 $1,842.30 $1,807.55

36546 $1,001.35 $968.00

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

36549 $1,231.90

36552 $1,179.55

36558 $960.90 $909.75

36561 $208.25 $241.50

36564 $1,366.50

36567 $1,761.45

36570 $2,018.40

36573 $1,310.30

36576 $1,655.40

36579 $1,096.45

36585 $1,096.45

36588 $1,275.80

36591 $1,708.15

36594 $1,367.25

36597 $1,367.25

36600 $1,878.65 $1,551.15

36603 $1,859.40

36604 $395.95 $374.75

36605 $1,017.85

36606 $3,424.20

36607 $1,289.55

36608 $394.50

36609 $932.35

36612 $794.70

36615 $1,096.45

36618 $960.90

36621 $703.20

36624 $825.25 $781.35

36627 $932.25

36630 $547.80

36633 $906.20 $1,038.10

36636 $591.45

36639 $1,262.30

36642 $615.95

36645 $1,734.05

36648 $1,417.30

36649 $395.95 $374.75

36650 $220.70

36652 $842.25

36654 $1,130.60

36656 $1,582.70

36658 $750.15 $737.00

36660 $364.15 $357.65

36662 $869.70 $854.45

36663 $942.05 $925.35

36664 $845.95 $831.00

36665 $178.70 $175.60

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

36666 $475.95 $467.60

36667 $222.85 $218.85

36668 $222.85 $218.85

36800 $35.50 $38.65

36803 $634.65 $652.90

36806 $898.45

36809 $1,269.35

36811 $437.95 $452.80

36812 $205.75 $233.40

36815 $308.75 $333.10

36818 $409.00 $387.25

36821 $478.05 $452.50

36824 $315.30 $298.45

36825 $719.20

36827 $340.00 $321.80

36830 $300.65

36833 $409.00 $387.25

36836 $297.40 $321.80

36840 $462.65 $452.50

36842 $401.40

36845 $938.65 $968.00

36848 $340.00

36851 $329.70

36854 $689.65

36857 $559.70

36860 $439.90 $233.40

36863 $759.70

37000 $1,096.45

37004 $960.90

37008 $615.95 $583.05

37011 $138.05 $130.70

37014 $1,576.55

37020 $1,096.45

37023 $615.95

37026 $615.95

37029 $1,647.85

37038 $1,023.10

37040 $1,346.95

37041 $69.05 $65.25

37042 $1,346.95

37043 $935.65

37044 $987.55

37045 $2,112.55

37047 $2,037.80

37050 $1,096.45

37053 $1,266.80

37200 $1,643.40

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

37201 $1,568.55

37202 $615.25 $582.50

37203 $1,560.55

37206 $825.25

37207 $1,281.30

37208 $615.25

37209 $1,909.10

37210 $3,067.55

37211 $3,530.90

37212 $374.65

37215 $500.70 $583.05

37217 $204.60 $193.65

37218 $204.60 $193.65

37219 $436.75 $393.20

37220 $1,544.10

37221 $689.65

37223 $305.05

37224 $425.85 $452.50

37227 $818.70 $792.20

37230 $1,507.70 $1,459.05

37233 $807.50 $781.35

37245 $1,880.60

37300 $69.05 $65.25

37303 $109.70 $103.70

37306 $1,206.30

37309 $1,452.70

37315 $204.60 $193.65

37318 $409.00 $387.25

37321 $138.05 $130.70

37324 $287.60

37327 $398.25

37330 $960.90

37333 $823.70

37336 $1,096.45

37338 $1,236.20

37339 $306.15 $335.80

37340 $532.80

37341 $1,236.20

37342 $1,338.10

37343 $2,669.25

37345 $1,039.90

37348 $1,036.95

37351 $409.00

37354 $478.05

37369 $325.90

37372 $678.05

37375 $1,712.05

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

37381 $1,017.60

37384 $1,712.05

37387 $478.05

37390 $1,347.50

37393 $294.20 $321.80

37396 $1,080.45

37402 $689.65

37405 $1,574.15

37408 $689.65

37411 $1,213.30 $1,294.60

37415 $69.05 $65.25

37417 $883.45

37418 $1,101.45 $1,038.10

37420 $542.05

37423 $1,266.05

37426 $1,441.10

37429 $478.05

37432 $1,635.95

37435 $127.30 $130.70

37438 $376.05 $387.25

37444 $1,478.15 $1,399.55

37601 $379.40 $387.25

37604 $405.20 $387.25

37605 $547.15 $522.85

37606 $812.35 $776.40

37607 $1,367.25

37610 $2,530.70

37613 $398.65 $387.25

37616 $1,223.80

37619 $409.00 $387.25

37622 $345.00 $270.50

37623 $345.00 $321.80

37800 $713.90

37801 $928.10

37803 $699.15

37804 $908.90

37806 $808.75 $843.15

37807 $1,051.40 $1096.15

37809 $780.80

37810 $1,015.05

37812 $684.25

37813 $889.55

37815 $137.20

37816 $178.40

37818 $726.70 $688.05

37819 $944.75 $894.50

37821 $1,092.60

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

37822 $1,420.40

37824 $1,770.05

37825 $2,301.10

37827 $951.65

37828 $1,237.15

37830 $965.00 $968.00

37831 $1,254.50 $1,258.50

37833 $488.10

37834 $634.55

37836 $1,027.75

37839 $1,139.40

37842 $2,261.05

37845 $1,027.75

37848 $1,849.65

37851 $1,370.50

37854 $453.55

38200 $585.75 $623.60

38203 $980.40 $744.20

38206 $844.85 $899.75

38209 $1,084.70 $1,155.25

38212 $1,804.20 $1,921.45

38213 $537.30 $572.20

38215 $583.25 $496.90

38218 $826.90 $745.15

38220 $291.70 $248.40

38222 $583.25 $496.90

38225 $874.85 $745.30

38228 $1,114.20 $993.90

38231 $1,458.05 $1,242.15

38234 $1,066.50 $993.65

38237 $1,458.00 $1,242.10

38240 $1,599.70 $1,490.45

38241 $586.65 $657.60

38243 $583.25 $621.05

38246 $1,375.55 $1,242.10

38256 $351.45 $374.15

38270 $1,199.40 $1,277.25

38272 $1,199.40 $1,277.25

38273 $1,199.40

38274 $1,199.40

38275 $392.15 $417.50

38285 $253.80

38286 $228.40

38287 $2,592.60 $2,937.85

38290 $3,512.45

38293 $3,498.20 $4,015.30

38300 $677.60 $721.50

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

38303 $868.80 $925.15

38306 $1,002.35 $1,067.30

38309 $1,164.15 $1,239.65

38312 $1,488.70 $1,585.30

38315 $1,598.40 $1,702.20

38318 $2,085.45 $2,220.90

38350 $839.75

38353 $336.00

38356 $1,100.85

38358 $4,146.25

38359 $193.20 $187.00

38362 $506.10 $538.95

38365 $319.20

38368 $1,529.60

38371 $359.70

38384 $1,314.95 $1,473.75

38387 $359.70 $403.00

38390 $1,383.85 $1,473.75

38393 $378.50 $403.00

38415 $577.40 $559.10

38418 $1,162.55

38421 $2,036.95

38424 $1,385.75

38427 $1,710.95

38430 $881.90

38436 $361.10

38438 $2,008.75

38440 $1,658.65

38441 $2,426.45

38446 $1,710.95

38447 $1,944.25

38448 $524.90

38449 $2,892.55

38450 $1,238.65

38452 $829.45

38453 $2,214.65

38455 $3,365.15

38456 $1,908.25

38457 $1,908.80

38458 $1,014.65

38460 $398.40

38462 $433.25

38464 $479.00

38466 $1,320.25

38468 $2,053.90

38469 $2,083.75

38470 $1,385.75

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

38473 $829.45

38475 $1,202.70

38477 $2,896.35

38478 $1,403.05

38480 $2,717.50

38481 $3,358.60

38483 $2,487.90

38485 $1,181.35

38487 $2,496.40

38488 $2,760.70

38489 $3,283.25

38490 $801.65

38493 $2,830.20

38496 $902.15

38497 $2,618.35

38498 $2,933.60

38500 $3,190.35

38501 $3,169.90

38503 $3,471.00

38504 $3,541.05

38505 $401.00

38506 $2,351.10

38507 $2,760.20

38508 $3,259.55

38509 $3,160.70

38512 $2,556.90

38515 $4,144.75

38518 $4,146.30

38550 $3,102.85

38553 $4,248.00

38556 $4,289.70

38559 $3,596.95

38562 $4,426.45

38565 $5,126.10

38568 $2,269.15

38571 $2,966.30

38572 $2,872.75

38577 $801.65

38588 $601.60

38600 $1,863.85

38603 $1,385.75

38609 $692.80

38612 $955.10 $751.95

38613 $974.70

38615 $2,030.25

38618 $2,760.70

38621 $1,102.40

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

38624 $1,148.70

38627 $923.65

38637 $801.65

38640 $1,385.75

38643 $1,543.15

38647 $3,085.90

38650 $2,494.40

38653 $2,760.70

38654 $1,617.65

38656 $1,257.20

38670 $2,760.20

38673 $3,164.10

38677 $2,906.30

38680 $3,447.35 $3,338.40

38700 $1,414.10

38703 $2,781.65

38706 $2,453.90

38709 $3,085.90

38712 $3,705.50

38715 $2,466.90

38718 $3,085.90

38721 $2,162.45

38724 $2,567.00

38727 $2,114.60

38730 $3,085.90

38733 $2,102.90

38736 $3,085.90

38739 $2,781.65

38742 $2,781.65

38745 $2,603.05

38748 $3,085.90

38751 $3,085.90

38754 $4,192.00

38757 $3,085.90

38760 $3,085.90

38763 $3,085.90

38766 $3,085.90

38800 $55.80 $53.90

38803 $111.20 $107.70

38806 $193.20 $187.00

38809 $238.05 $230.40

38812 $302.55 $292.85

39000 $103.05 $105.45

39003 $122.15 $119.95

39006 $306.85 $223.20

39009 $84.70

39012 $338.80

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

39013 $152.30 $152.85

39015 $536.05

39018 $536.05

39100 $328.65 $332.65

39106 $1,617.75

39109 $727.05 $621.20

39112 $2,642.05

39115 $92.15 $105.45

39118 $442.80 $417.00

39121 $900.60 $884.45

39124 $2,304.85

39125 $448.80

39126 $516.05

39127 $636.50

39128 $930.70

39130 $917.30

39131 $200.40 $178.95

39133 $227.40

39134 $485.65

39135 $225.00

39136 $227.40

39137 $803.40

39138 $909.75

39139 $1,565.55

39140 $422.85 $410.00

39300 $503.90

39303 $765.15

39306 $1,000.35

39309 $1,018.35

39312 $529.90

39315 $1,595.45

39318 $1,121.45

39321 $618.30

39323 $356.55 $387.55

39324 $394.50 $387.55

39327 $675.70

39330 $367.20

39331 $446.85 $387.55

39333 $568.15 $558.00

39500 $1,811.85

39503 $1,663.00

39600 $696.40

39603 $1,582.80

39606 $1,015.70

39609 $1,197.45

39612 $1,597.40

39615 $1,752.45

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

39640 $5,538.15

39642 $4,523.70

39646 $5,208.40

39650 $4,766.90

39653 $6,704.45

39654 $4,876.00

39656 $4,641.35

39658 $5,313.30

39660 $4,321.80

39662 $4,321.80

39700 $793.60

39703 $739.80

39706 $1,586.45

39709 $2,504.85

39712 $4,530.65

39715 $3,444.05

39718 $1,243.65

39721 $1,039.40

39800 $4,190.30

39803 $4,175.90

39806 $1,793.95

39812 $900.60

39815 $2,604.90 $2,558.15

39818 $2,853.30

39821 $2,999.10

39900 $739.80

39903 $2,530.85

39906 $1,075.75

40000 $1,307.90

40003 $1,279.95

40006 $954.10

40009 $699.85

40012 $1,609.90

40015 $910.60

40018 $195.75 $223.20

40100 $986.30

40103 $1,232.55

40106 $1,861.35

40109 $1,689.95

40112 $1,937.05

40115 $1,029.25

40118 $1,648.10

40300 $1,486.70

40301 $1,714.95

40303 $1,989.00

40306 $2,333.45

40309 $1,666.50

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

40312 $2,685.90

40315 $2,782.95

40316 $3,257.45

40318 $3,487.60

40321 $1,554.35

40324 $911.30

40327 $911.30

40330 $1,361.50

40331 $1,361.50

40332 $2,658.95

40333 $1,136.35

40334 $1,615.10

40335 $3,064.55

40336 $450.60

40339 $2,261.95

40342 $2,499.10

40345 $1,885.80

40348 $2,470.65

40351 $2,470.65

40600 $1,361.50

40700 $2,714.30

40703 $2,011.15

40706 $3,211.05 $3,000.35

40709 $739.80

40712 $1,490.00

40800 $799.40 $894.15

40801 $3,263.35

40803 $1,704.50 $1,674.00

40850 $3,898.40

40851 $6,692.60

40852 $629.45

40854 $977.05

40856 $366.00

40858 $789.30

40860 $3,655.90

40862 $266.05 $265.60

40903 $790.50

40905 $838.95 $842.40

41500 $128.55 $115.50

41503 $371.90 $334.35

41506 $193.50 $201.60

41509 $273.30 $228.15

41512 $911.95

41515 $598.60

41518 $1,329.75

41521 $1,455.30

41524 $444.65

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

41527 $868.50

41530 $1,388.25

41533 $1,877.75

41536 $1,814.00

41539 $1,545.15

41542 $1,966.55

41545 $811.25

41548 $1,076.80

41551 $2,498.40

41554 $3,317.85

41557 $1,696.30

41560 $1,867.30

41563 $2,300.95

41564 $3,261.85

41566 $1,455.85

41569 $1,675.90

41572 $1,607.80

41575 $3,790.90

41576 $6,176.75

41578 $3,790.90

41579 $3,038.90

41581 $5,101.60

41584 $2,883.55

41587 $3,504.60

41590 $1,721.75

41593 $2,422.70

41596 $2,707.35

41599 $2,485.90

41603 $661.70 $705.40

41604 $245.00 $261.10

41608 $2,055.80

41611 $1,091.60

41614 $1,802.45 $1,525.90

41615 $1,426.90 $1,525.90

41617 $2,884.25

41618 $1876.95 $3317.85

41620 $1,218.55

41623 $1,779.90

41626 $224.20 $201.60

41629 $634.00

41632 $353.15 $334.35

41635 $1,543.90 $1,602.05

41638 $2,364.15

41641 $74.05 $66.45

41644 $242.35 $199.95

41647 $171.15 $153.90

41650 $144.95 $153.90

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

41653 $112.25 $100.75

41656 $196.40 $172.00

41659 $99.80 $108.60

41662 $128.55 $115.50

41665 $342.25

41668 $342.25

41671 $802.95

41672 $1,031.00

41674 $156.55 $140.70

41677 $140.15 $126.00

41683 $182.45 $164.10

41686 $112.25 $100.75

41689 $212.55

41692 $277.25

41698 $50.60 $45.60

41701 $143.40

41704 $56.75 $50.85

41707 $698.15

41710 $888.85

41713 $1,130.70

41716 $460.30

41719 $164.80 $164.60

41722 $914.80 $822.65

41725 $698.15

41728 $1,418.90

41729 $861.70

41731 $1,445.65

41734 $1,656.55

41737 $752.10

41740 $91.60

41743 $525.30

41746 $1,209.60 $1,087.95

41749 $944.10

41752 $460.30

41755 $72.50 $65.10

41764 $191.10 $172.00

41767 $1,196.95 $1,031.80

41770 $1,048.75

41773 $872.90

41776 $822.70

41779 $1,099.60

41782 $1,362.75

41785 $1,838.45 $1,653.65

41786 $1,116.10

41787 $823.40

41788 $564.60 $307.95

41789 $564.60

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

41792 $623.75

41793 $623.75

41796 $194.15

41797 $194.15

41800 $253.90

41801 $253.90

41804 $140.15

41807 $96.90 $98.15

41810 $55.55 $49.85

41813 $477.40

41816 $289.10 $259.85

41819 $473.10 $488.55

41820 $608.15 $586.25

41822 $371.90

41825 $570.60

41828 $81.40 $73.10

41831 $486.85 $499.80

41832 $355.45 $319.90

41834 $2,362.35

41837 $1,835.00

41840 $2,568.90

41843 $2,080.00

41846 $289.10 $259.85

41855 $447.05

41858 $747.85

41861 $905.00

41864 $651.90

41867 $896.70

41868 $588.45

41870 $639.35

41873 $914.80 $822.65

41876 $739.05 $822.65

41879 $1,584.75

41880 $306.30

41881 $625.30

41884 $128.80

41885 $349.05

41886 $277.25 $249.30

41889 $277.25 $249.30

41892 $365.90 $329.10

41895 $493.00 $514.85

41898 $340.00 $359.75

41901 $794.50

41904 $323.95 $345.10

41905 $647.40

41907 $191.10 $172.00

41910 $607.50

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

42503 $163.70

42506 $777.85 $673.75

42509 $972.95

42510 $983.75

42512 $685.80 $673.75

42515 $901.15

42518 $478.05

42521 $1,731.55

42524 $291.35 $286.45

42527 $578.15

42530 $842.00

42533 $597.50

42536 $1,183.75

42539 $2,015.65

42542 $705.20

42543 $1,272.15

42545 $2,013.20

42548 $1,081.45

42551 $844.85 $884.45

42554 $1,027.35

42557 $1,368.40

42563 $738.95 $726.60

42569 $1,466.90

42572 $185.45 $164.30

42573 $343.00 $318.45

42574 $729.70 $676.55

42575 $121.65 $115.85

42576 $445.90 $414.00

42581 $167.30 $164.30

42584 $394.10 $387.55

42587 $74.25 $72.75

42590 $432.55 $473.70

42593 $344.85

42596 $717.80 $705.40

42599 $835.55 $884.45

42602 $899.90 $884.45

42605 $663.65 $652.55

42608 $491.50 $421.05

42610 $142.75 $134.75

42611 $199.30 $202.10

42614 $69.10 $67.65

42615 $109.25 $101.15

42617 $195.05 $191.75

42620 $65.10 $73.75

42622 $117.90 $115.85

42623 $1,243.95

42626 $1,633.30 $1,579.30

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

42629 $1,152.00

42632 $153.95 $164.30

42635 $401.70 $421.05

42638 $551.20 $526.40

42641 $716.70 $684.25

42644 $102.80 $101.05

42647 $260.50 $286.45

42650 $102.80 $101.05

42651 $250.20 $225.15

42653 $2,020.85

42656 $2,457.95

42662 $1,183.50

42665 $833.50 $842.35

42667 $183.80 $198.75

42668 $97.70 $105.45

42672 $1,302.65 $1,263.25

42673 $642.40 $631.55

42676 $168.40 $162.00

42677 $86.85 $85.35

42680 $428.40 $421.05

42683 $179.20

42686 $389.70 $383.15

42689 $167.30 $164.30

42692 $344.70 $387.55

42695 $629.45 $631.55

42698 $1,002.40 $832.65

42701 $573.00 $464.40

42702 $1,366.90 $1,064.95

42703 $815.45 $800.90

42704 $719.75 $652.55

42705 $1366.90 $1064.95

42707 $980.90 $1,115.95

42710 $1,284.95 $1,263.25

42713 $525.85 $526.40

42716 $1,505.25 $1,674.00

42719 $650.95 $726.60

42725 $2,075.15

42731 $2,144.65

42734 $428.40 $421.05

42738 $428.40 $421.05

42739 $428.40 $421.05

42740 $428.40 $421.05

42741 $428.40 $421.05

42743 $830.75 $884.45

42744 $427.95 $420.80

42746 $1,495.35

42749 $1,717.25

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

42752 $1,771.20

42755 $235.95 $231.65

42758 $1,011.75

42761 $722.55 $726.60

42764 $636.05 $726.60

42767 $1,880.95

42770 $391.25 $412.75

42773 $1,284.95 $1,263.25

42776 $1,905.95

42779 $2,353.45

42782 $713.00 $631.55

42783 $642.40 $631.55

42785 $488.70 $494.70

42786 $503.35 $494.70

42788 $439.35 $494.70

42789 $503.35 $494.70

42791 $459.30 $494.70

42792 $503.35 $494.70

42794 $96.40 $94.75

42801 $1,375.25

42802 $687.35

42805 $835.05 $821.10

42806 $503.35 $494.70

42807 $506.70 $498.15

42808 $575.50 $498.15

42809 $642.40 $631.55

42810 $808.55 $794.80

42811 $642.40 $631.55

42812 $219.10 $231.65

42815 $899.90

42818 $716.60 $821.10

42821 $128.60 $126.50

42824 $99.75 $97.90

42833 $939.20

42836 $1,120.05

42839 $1,041.30

42842 $1,132.10

42845 $255.75 $265.20

42848 $1,176.30

42851 $1,239.65

42854 $578.15 $568.50

42857 $529.50 $568.50

42860 $1,335.35 $1,263.25

42863 $1,129.65 $1,084.40

42866 $1,044.20 $1,052.60

42869 $781.45 $768.60

42872 $446.40 $337.00

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

43021 $546.15 $637.10

43022 $655.55 $764.65

43023 $104.05 $123.90

43500 $175.75

43503 $247.20

43506 $462.65

43509 $507.60

43512 $496.65

43515 $518.85 $498.90

43518 $738.25

43521 $661.25

43524 $815.35 $822.65

43801 $1,235.55

43804 $1,395.35

43805 $588.60

43807 $1,341.10

43810 $1,677.75

43813 $2,024.45

43816 $2,041.10

43819 $1,333.15

43822 $1,331.45

43825 $1,737.20

43828 $1,537.75

43831 $1,231.45

43832 $810.30

43834 $1,456.65

43835 $902.15

43837 $1,672.75

43838 $1,660.20

43840 $1,613.05

43841 $781.50

43843 $2,640.60

43846 $2,727.35

43849 $642.00

43852 $2,122.65

43855 $2,244.00

43858 $824.80

43861 $2,151.55

43864 $1,603.25

43867 $951.60

43870 $1,333.15

43873 $1,588.20

43876 $1,507.25

43879 $1,776.40

43882 $2,283.80 $2,335.30

43900 $1,522.35

43903 $2,537.35

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

43906 $2,220.20

43909 $2,220.20

43912 $2,195.95

43915 $1,578.90

43930 $572.05

43933 $699.15

43936 $1,248.55

43939 $956.85

43942 $317.30

43945 $1,284.40

43948 $216.05

43951 $1,195.90

43954 $1,362.40

43957 $1,586.05

43960 $511.05

43963 $2,146.95

43966 $2,270.55

43969 $3,488.95

43972 $2,287.65

43975 $2,988.10

43978 $2,537.35

43981 $697.90

43984 $1,776.40

43987 $1,967.15

43990 $2,163.95

43993 $2,601.00

43996 $2,602.20

43999 $326.40

44101 $458.00

44102 $352.30

44104 $80.75 $82.15

44105 $62.10 $63.15

44108 $623.55

44111 $740.25 $805.95

44114 $817.10

44130 $581.70 $648.65

44133 $568.30

44136 $218.85 $237.30

44325 $421.40 $414.00

44328 $480.00

44331 $816.65

44334 $1,703.25 $1,671.95

44338 $192.95 $201.60

44342 $266.05

44346 $382.40

44350 $400.70 $403.50

44354 $458.40

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

44358 $241.80

44359 $346.85

44361 $580.75

44364 $428.95

44367 $688.45

44370 $1,000.95

44373 $2,054.45 $2,069.80

44376 D D

45000 $745.55 $757.90

45003 $906.70 $842.35

45006 $1,465.45

45009 $539.85

45012 $869.65

45015 $428.40

45018 $674.50 $663.15

45019 $561.55

45020 $564.95

45021 $252.75 $248.30

45024 $567.50 $558.00

45025 $271.95 $248.30

45026 $612.35 $558.00

45027 $171.50

45030 $163.95 $180.95

45033 $361.15 $337.00

45035 $1,057.60

45036 $1,615.50

45039 $297.15 $337.00

45042 $547.75 $431.80

45045 $439.15 $431.80

45048 $1,055.90

45051 $625.45

45054 $350.35

45200 $342.85 $398.10

45201 $586.70 $579.55

45202 $581.10 $579.55

45203 $588.35 $568.50

45206 $514.80 $537.00

45207 $502.60 $537.00

45209 $658.40 $663.25

45212 $331.80 $329.10

45215 $1,443.95

45218 $604.40

45221 $372.50 $366.20

45224 $206.15 $164.60

45227 $635.00 $623.60

45230 $270.00 $311.85

45233 $634.35 $663.25

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

45236 $527.50

45239 $372.50 $366.20

45240 $342.65 $366.20

45400 $291.60 $286.60

45403 $614.45 $570.50

45406 $603.80 $631.55

45409 $750.75

45412 $1,329.30

45415 $1,284.95

45418 $1,214.85

45439 $404.90 $398.10

45442 $756.55 $821.10

45445 $748.35 $779.25

45448 $481.85 $526.40

45451 $672.80 $663.25

45460 $1,783.50

45461 $1,271.20

45462 $959.35

45464 $2,650.75

45465 $1,939.55 $1,908.20

45466 $1,462.55 $1,439.15

45468 $2,607.90

45469 $1,967.40 $1,935.80

45471 $3,277.80 $3,225.15

45472 $2,472.70 $2,432.65

45474 $3,946.20 $3,882.65

45475 $2,977.55 $2,929.45

45477 $4,614.55 $4,540.20

45478 $3,480.80 $3,424.50

45480 $5,282.90 $5,197.65

45481 $3,985.70 $3,921.55

45483 $6,018.85 $5,921.95

45484 $4,541.35 $4,468.10

45485 $1,005.35

45486 $642.40

45487 $531.60 $568.50

45488 $642.40

45489 $1,119.70 $947.55

45490 $1,285.05

45491 $1,606.10

45492 $1,726.30

45493 $488.50

45494 $2,333.15 $2,294.20

45496 $592.00

45497 $462.65

45498 $372.50

45499 $277.65

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

45500 $1,781.50

45501 $2,695.15

45502 $2,528.50

45503 $2,891.10

45504 $3,265.00

45505 $2,528.50

45506 $271.65 $307.95

45512 $413.05 $414.00

45515 $266.05 $261.10

45518 $310.25 $316.00

45519 $610.85

45520 $1,282.15

45522 $1,164.35

45524 $1,056.15

45527 $1,325.95

45528 $1,583.70

45530 $1,565.50

45533 $1,772.60

45536 $651.85

45539 $1,844.40

45542 $961.25

45545 $843.50 $871.60

45546 $281.80 $277.00

45548 $438.90 $387.55

45551 $631.80

45552 $1,172.30 $894.15

45553 $843.00 $894.15

45554 $995.95 $979.25

45555 $909.60

45556 $1,090.45

45557 $1,090.45

45558 $1,635.85

45559 $1,500.25 $1,591.55

45560 $674.50 $663.15

45561 $2,526.90

45562 $1,565.50 $1,539.20

45563 $1,663.45 $1,539.20

45564 $4,080.05

45565 $2,673.60

45566 $1,530.20

45568 $640.30

45569 $894.25

45570 $1,207.40 $1,280.95

45572 $415.30 $408.40

45575 $1,025.55 $1,008.30

45578 $1,187.75

45581 $394.10 $387.55

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

45584 $899.65 $884.45

45585 $899.65 $884.45

45586 $899.65

45587 $1,268.55 $1,247.20

45588 $1,836.25

45590 $766.35

45593 $790.95

45596 $1,627.10

45597 $1,716.30

45599 $1,333.65 $1,311.20

45602 $995.95

45605 $836.90

45608 $1,366.20

45611 $674.70

45614 $808.85 $822.65

45617 $334.85 $329.10

45620 $574.80 $456.50

45623 $1,083.50 $1,012.30

45624 $1,413.00 $1,312.40

45625 $323.65

45626 $464.40 $456.50

45629 $906.80 $663.25

45632 $895.80 $716.75

45635 $836.90 $822.65

45638 $1,443.95

45639 $1,822.50

45641 $1,552.90 $1,516.10

45644 $2,258.40

45645 $318.60

45646 $1,221.85 $1,260.65

45647 $1,657.05

45650 $210.75 $206.95

45652 $507.35 $498.90

45653 $658.15 $498.90

45656 $764.70 $703.15

45659 $742.25 $729.75

45660 $4,791.40

45661 $2,054.50

45662 $998.65

45665 $453.95 $456.50

45668 $396.30 $456.50

45669 $500.65 $456.50

45671 $1,575.20 $1,167.70

45674 $359.80 $339.60

45675 $688.20

45676 $819.40

45677 $771.00

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

45680 $1,051.80

45683 $1,023.80

45686 $1,146.15

45689 $372.65

45692 $374.85 $421.05

45695 $713.20

45698 $653.75

45701 $1,353.90

45704 $428.40 $421.05

45707 $1,465.35

45710 $695.95

45713 $792.65

45714 $1,161.05

45716 $1,386.95

45720 $1,376.55 $1,353.55

45723 $2,056.25

45726 $1,915.80

45729 $2,432.70

45731 $1,972.00

45732 $2,627.60

45735 $2,411.10

45738 $2,593.60

45741 $2,412.70

45744 $2,861.60

45747 $2,753.00 $2,707.00

45752 $3,485.55

45753 $3,034.35 $3,050.05

45754 $3,718.50

45755 $523.70 $514.85

45758 $937.15

45761 $1,044.10

45767 $3,576.25 $3,516.35

45770 $2,739.50

45773 $2,496.70 $2,454.80

45776 $2,496.70

45779 $2,419.20

45782 $1,229.30 $1,380.00

45785 $2,756.10

45788 $2,347.95

45791 $1,268.55

45794 $957.60

45797 $266.05

45799 $42.15 $41.25

45801 $171.05 $177.70

45803 $465.00 $456.50

45805 $246.05 $241.50

45807 $351.60 $345.10

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

45809 $558.40 $520.10

45811 $716.40 $703.15

45813 $838.15 $822.65

45815 $523.60 $498.90

45817 $662.50 $650.30

45819 $821.70 $822.60

45821 $543.05 $533.15

45823 $155.30

45825 $467.20 $473.70

45827 $461.20 $452.80

45829 $351.45 $345.40

45831 $399.85 $452.80

45833 $578.95 $568.50

45835 $718.60 $705.40

45837 $1,089.70 $821.10

45839 $836.35 $821.10

45841 $676.55 $663.15

45843 $414.30 $406.70

45845 $718.60 $705.40

45847 $266.05 $261.10

45849 $828.25 $813.30

45851 $203.90

45853 $1,270.45 $1,247.20

45855 $582.75 $572.20

45857 $931.40 $915.35

45859 $469.65 $461.45

45861 $1,244.05 $1,221.25

45863 $1,378.95 $1,353.80

45865 $414.30 $406.70

45867 $445.65 $437.25

45869 $1,694.40 $1,663.50

45871 $1,908.75 $1,873.85

45873 $2,144.80 $2,105.70

45875 $670.10 $659.00

45877 $670.10 $659.00

45879 $445.65 $437.25

45882 $61.30 $60.20

45885 $632.40 $621.20

45888 $589.35 $579.00

45891 $858.60 $843.45

45894 $291.80 $286.60

45897 $1,523.65 $1,496.75

45900 $343.75 $337.65 F

45939 $637.20 $625.95

45945 $169.40 $166.20

45975 $184.15 $180.90

45978 $224.95 $221.00

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

45981 $122.10 $119.95

45984 $878.85 $863.35

45987 $878.85 $863.35

45990 $1,200.25 $1,179.15

45993 $1,200.25 $1,179.15

45996 $340.40 $334.35

46300 $444.65

46303 $574.60

46306 $898.25

46307 $883.45

46309 $944.80

46312 $1,186.85

46315 $1,400.85

46318 $1,932.30

46321 $2,388.85 $1,895.50

46324 $1,277.55

46325 $1,425.80

46327 $289.40 $284.45

46330 $496.60

46333 $912.40

46336 $373.60 $368.65

46339 $689.85 $652.70

46342 $663.95

46345 $754.25

46348 $382.55 $342.25

46351 $631.15

46354 $851.70

46357 $1,022.80

46360 $1,035.20

46363 $297.75 $294.85

46366 $182.40 $179.10

46369 $299.95 $294.85

46372 $736.65 $599.15

46375 $903.50 $710.80

46378 $1,147.30

46381 $428.40

46384 $428.40

46387 $982.85 $868.85

46390 $1,282.25

46393 $1,715.20

46396 $426.10 $461.45

46399 $824.25

46402 $742.95

46405 $899.85

46408 $1,075.00

46411 $578.40

46414 $749.50 $737.00

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

46417 $661.65

46420 $291.35 $286.45

46423 $466.50 $458.05

46426 $481.75

46429 $624.05 $579.15

46432 $647.35

46435 $849.95

46438 $226.45 $189.65

46441 $465.90 $458.05

46442 $438.20

46444 $880.85

46447 $997.70

46450 $321.40

46453 $451.55

46456 $139.25 $136.95

46459 $259.85 $263.30

46462 $393.20 $421.15

46464 $331.75 $316.00

46465 $283.25 $316.00

46468 $562.35

46471 $803.30 $789.70

46474 $1,044.25

46477 $1,285.05

46480 $581.45 $526.55

46483 $500.50 $421.15

46486 $321.40

46489 $383.65

46492 $514.45

46494 $312.25 $307.95

46495 $289.40 $284.45

46498 $312.50 $307.95

46500 $397.90 $368.65

46501 $484.95 $460.90

46502 $495.85 $424.15

46503 $512.25 $529.80

46504 $1,739.55 $1,547.80

46507 $1,763.80

46510 $518.95

46513 $80.90 $79.10

46516 $167.90

46519 $226.80 $197.75

46522 $635.80

46525 $74.40

46528 $236.60 $237.30

46531 $121.25 $119.25

46534 $291.00 $329.70

47000 $104.70 $98.95

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

47003 $102.90 $118.75

47006 $251.90 $238.35

47009 $257.75 $237.30

47012 $501.40

47015 $102.85 $118.75

47018 $279.10 $276.65

47021 $389.90

47024 $331.40 $276.65

47027 $398.15

47030 $316.25 $276.65

47033 $389.90 $369.05

47036 $107.75 $118.75

47039 $167.90 $158.00

47042 $163.00 $158.00

47045 $222.90 $211.05

47048 $441.05 $454.75

47051 $610.40

47054 $427.90 $454.75

47057 $165.85 $177.80

47060 $250.60 $237.30

47063 $375.95 $355.90

47066 $501.40

47069 $104.70 $98.95

47072 $125.45 $131.60

47301 $130.20 $121.55

47304 $148.35

47307 $300.00

47310 $495.00

47313 $480.00

47316 $952.00

47319 $975.00

47348 $139.20 $131.60

47351 $425.50 $329.70

47354 $250.60 $237.30

47357 $626.80 $527.20

47361 $195.05 $184.60

47362 $263.00 $276.65

47364 $421.40

47367 $340.00

47370 $611.00

47373 $436.45

47378 $284.35 $237.30

47381 $391.15

47384 $506.55

47385 $488.80

47386 $666.90

47387 $475.40 $382.15

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

47390 $624.50

47393 $794.90

47396 $279.05 $263.50

47399 $584.25

47402 $417.50 $395.30

47405 $279.05 $263.50

47408 $544.75

47411 $153.10 $158.00

47414 $334.25 $316.40

47417 $388.65 $369.05

47420 $765.90

47423 $319.35 $303.10

47426 $488.90

47429 $640.45

47432 $682.45

47435 $608.90 $579.95

47438 $974.75

47441 $1,420.55

47444 $353.20 $316.40

47447 $524.10

47450 $583.75

47451 $791.30

47453 $370.25 $369.05

47456 $630.55

47459 $789.05

47462 $156.45 $158.00

47465 $333.50 $316.40

47466 $167.90 $158.00

47467 $322.45

47468 $640.45 $606.15

47471 $63.60 $60.20

47474 $259.95 $263.50

47477 $324.10 $329.70

47480 $871.35

47483 $807.80

47486 $1,298.45

47489 $2,088.25

47492 $341.00 $329.70

47495 $759.80 $659.00

47498 $1,122.55

47501 $1,432.90

47504 $2,481.30 $1,977.10

47507 $2,408.60

47510 $2,582.55

47513 $556.85

47516 $589.15 $606.15

47519 $1,415.95

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

47522 $1,104.80

47525 $1,324.65

47528 $1,096.75

47531 $1,448.25

47534 $1,612.60

47537 $598.70 $606.15

47540 $320.10 $303.10

47543 $335.45 $316.40

47546 $501.40 $474.40

47549 $609.30

47552 $555.20 $527.20

47555 $945.05

47558 $1,275.00

47561 $469.80 $382.15

47564 $650.90 $573.40

47565 $1,091.20

47566 $1,398.40

47567 $723.65 $665.50

47570 $923.60 $764.40

47573 $1,171.95

47576 $136.75 $158.00

47579 $223.95 $224.10

47582 $418.95

47585 $665.55

47588 $2,160.25

47591 $2,787.45

47594 $293.90 $303.10

47597 $506.95 $454.75

47600 $660.30

47603 $873.80

47606 $309.05 $329.70

47609 $522.10 $494.30

47612 $524.80 $573.40

47615 $691.40 $659.00

47618 $833.50

47621 $770.55 $573.40

47624 $1,012.85

47627 $236.90 $224.10

47630 $444.50 $474.40

47633 $164.60 $158.00

47636 $274.40 $237.30

47639 $315.60 $316.40

47642 $222.90 $211.05

47645 $336.15 $316.40

47648 $427.80

47651 $348.15 $329.70

47654 $522.10 $494.30

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

47657 $856.95

47663 $208.80 $197.75

47666 $299.55 $329.70

47672 $165.30 $158.00

47678 $250.60 $237.30

47681 $63.60 $60.20

47684 $1,112.70 $1,054.55

47687 $1,949.00

47690 $1,407.90

47693 $1,610.75

47696 $519.65

47699 $2,531.30

47702 $3,051.35

47703 $63.60 $60.20

47705 $417.50

47708 $320.10 $303.10

47711 $452.85

47714 $355.05

47717 $626.80

47720 $626.80 $593.25

47723 $626.80 $593.25

47726 $208.80

47729 $348.15

47732 $556.85

47735 $66.00 $60.30

47738 $390.50 $329.70

47741 $732.05

47753 $601.50

47756 $590.80

47762 $453.70 $334.35

47765 $643.25

47768 $649.20

47771 $993.55

47774 $644.25

47777 $644.25

47780 $710.10

47783 $837.45 $792.90

47786 $1,190.95

47789 $1,063.25

47900 $238.50 $237.30

47903 $319.55 $329.70

47904 $83.90 $79.10

47906 $135.95

47912 $83.90 $79.10

47915 $237.15 $237.30

47916 $118.25 $119.25

47918 $321.90 $329.70

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

47920 $563.20

47921 $167.90 $158.00

47924 $55.95 $52.75

47927 $193.65

47930 $325.45

47933 $306.40 $289.80

47936 $375.95

47948 $245.25

47951 $279.05 $263.50

47954 $550.10 $527.20

47957 $417.50

47960 $195.05 $184.60

47963 $320.10 $303.10

47966 $640.45

47969 $389.90

47972 $311.45

47975 $545.85

47978 $371.20

47981 $222.45 $210.80

47982 $500.20

48200 $1,113.90

48203 $1,404.85

48206 $836.20

48209 $1,072.10

48212 $836.20

48215 $1,030.90

48218 $982.10

48221 $1,410.35

48224 $556.85

48227 $733.35

48230 $702.05

48233 $1,130.05

48236 $1,180.65

48239 $654.30

48242 $1,123.65

48400 $413.20

48403 $738.80

48406 $487.45

48409 $742.40

48412 $806.90

48415 $1,179.45

48418 $769.75

48421 $1,431.65

48424 $952.15

48427 $1,267.20

48500 $476.35

48503 $467.55

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

48506 $654.10

48509 $302.20

48512 $1,664.60

48600 $139.20

48603 $208.80

48606 $2,304.70

48612 $4,214.20

48613 $5,473.30

48615 $589.00

48618 $3,594.90

48621 $2,367.00

48624 $2,923.95

48627 $4,373.55

48630 $4,594.60

48632 $2,161.35

48636 $1,069.10 $1,133.40

48639 $1,815.55

48640 $5,532.35

48642 $1,183.50

48645 $1,601.10

48648 $1,601.10

48651 $2,315.80

48654 $1,601.10

48657 $2,635.65

48660 $1,900.70

48663 $1,197.20

48666 $778.05

48669 $2,158.00

48672 $1,320.55

48675 $868.10

48678 $836.20

48681 $1,392.25

48684 $1,392.25

48687 $1,949.00

48690 $2,227.60

48691 $2,399.25 $2,511.15

48692 $1,617.20 $1,692.55

48693 $782.25 $818.60

48694 $1,900.70

48900 $406.05 $395.30

48903 $749.10

48906 $691.95

48909 $1,322.30

48912 $487.45 $461.45

48915 $1,254.70

48918 $2,736.15

48921 $2,700.25

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

48924 $2,917.50

48927 $542.90

48930 $1,283.30

48933 $1,815.50

48936 $1,191.70

48939 $1,623.00

48942 $2,167.80

48945 $403.80

48948 $860.70

48951 $1,548.45

48954 $1,734.85

48957 $1,878.40

48960 $1,608.20

49100 $487.45

49103 $1,252.35

49106 $1,449.00 $1,318.05

49109 $1,231.80

49112 $1,031.20

49115 $1,849.90

49116 $2,128.60

49117 $2,554.10

49118 $403.80

49121 $965.30

49200 $1,322.55

49203 $979.00

49206 $835.35

49209 $1,278.00

49210 $1,419.30

49211 $1,703.15

49212 $348.15

49215 $1,118.15

49218 $439.05

49221 $1,102.50

49224 $1,162.00

49227 $1,287.60

49300 $821.50

49303 $747.35

49306 $1,733.30

49309 $1,047.40

49312 $1,715.15

49315 $1,301.60

49318 $2,206.50

49319 $4,305.25

49321 $2,576.65

49324 $2,738.65

49327 $3,421.45

49330 $3,354.80

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

49333 $3,987.20

49336 $529.00

49339 $4,509.85

49342 $4,641.55

49345 $4,608.05

49346 $1,261.50

49360 $481.10

49363 $556.75 $579.90

49366 $974.95

49500 $556.85

49503 $688.55

49506 $1,116.80

49509 $1,113.90

49512 $1,558.90

49515 $1,443.85

49517 $2,092.05

49518 $2,219.40

49519 $3,948.65

49521 $2,634.75

49524 $3,049.55

49527 $2,568.40

49530 $2,943.75

49533 $3,354.50

49534 $730.10

49536 $1,537.30

49539 $1,710.35

49542 $2,341.20

49545 $1,113.90

49548 $1,380.10

49551 $2,295.85

49554 $2,482.75

49557 $401.25

49558 $459.50

49559 $679.60

49560 $939.35

49561 $1,143.75

49562 $1,297.10

49563 $1,303.60

49564 $1,554.10

49566 $1,215.90

49569 $978.25

49700 $403.80

49703 $1,029.65

49706 $487.45

49709 $1,044.20

49712 $1,362.75

49715 $1,950.70

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

49716 $1,993.00

49717 $2,391.55

49718 $618.45

49721 $348.15 $329.70

49724 $1,109.65

49727 $417.50

49728 $754.75

49800 $195.05 $184.60

49803 $224.45 $237.30

49806 $195.05 $184.60

49809 $320.10

49812 $640.45

49815 $1,341.40

49818 $387.70

49821 $656.45

49824 $1,262.10

49827 $696.10

49830 $1,218.30

49833 $801.25

49836 $1,488.35

49837 $957.25

49838 $2,008.85

49839 $765.90

49842 $1,713.65

49845 $728.90

49848 $236.90 $224.10

49851 $306.40

49854 $578.40

49857 $538.20

49860 $417.50

49863 $626.80

49866 $452.50

49878 $83.90 $79.10

50100 $344.20 $382.15

50102 $1,010.00

50103 $487.45

50104 $462.00 $437.25

50106 $599.95

50109 $696.10

50112 $444.30

50115 $197.25

50118 $640.45

50121 $1,253.15

50127 $1,107.95

50130 $462.00

50200 $278.50 $263.50

50201 $486.85

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

50203 $653.05 $579.95

50206 $1,019.55

50209 $1,050.35

50212 $2,370.60

50215 $2,534.30

50218 $4,134.10

50221 $3,536.85

50224 $4,742.50 $3,954.10

50227 $5,043.30

50230 $2,675.25

50233 $3,354.95

50236 $2,329.50

50239 $1,661.95

50300 $1,412.65

50303 $2,337.35

50306 $3,649.40 $3,455.10

50309 $379.95

50312 $1,066.35

50315 $995.20

50318 $1,179.45

50321 $1,406.25

50324 $2,050.05

50327 $2,693.50

50330 $298.25

50333 $939.55

50336 $1,376.25

50339 $830.50

50342 $1,067.45

50345 $451.95

50348 $298.60

50349 $473.45 $448.25

50351 $2,361.00

50352 $92.55 $79.10

50353 $549.35

50354 $1,937.50 $1,834.25

50357 $830.50

50360 $1,001.00

50363 $738.25

50366 $1,309.00

50369 $963.65

50372 $1,645.50

50375 $738.25

50378 $1,291.80

50381 $963.65

50384 $1,809.30

50387 $963.65

50390 $338.35

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

50393 $1,250.70

50394 $4,698.00

50396 $760.05

50399 $1,363.55

50402 $672.35

50405 $1,021.35

50408 $1,619.95

50411 $1,937.50 $1,834.25

50414 $2,613.95 $2,474.65

50417 $1,937.50 $1,834.25

50420 $1,599.30

50423 $1,476.35 $1,397.55

50426 $752.70

50450 $1,676.60

50451 $1,676.60

50455 $1,898.55

50456 $1,898.55

50460 $2,834.55

50461 $2,834.55

50465 $3,992.40

50466 $3,992.40

50470 $5,063.35

50471 $5,063.35

50475 $5,842.60

50476 $5,842.60

50500 $378.05 $387.35

50504 $504.40 $516.70

50508 $540.20 $553.35

50512 $720.70

50516 $486.40

50520 $648.35

50524 $558.25

50528 $900.50

50532 $783.60

50536 $1,044.55

50540 $720.70

50544 $360.30 $369.05

50548 $720.70

50552 $621.50

50556 $828.30

50560 $648.35

50564 $864.65

50568 $756.70

50572 $1,008.70

50576 $828.30 $848.70

50580 $864.65

50584 $828.30

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

50588 $1,080.60

50600 $594.10

50604 $2,521.25

50608 $4,682.80

50612 $6,660.65

50616 $846.40

50620 $4,682.80

50624 $4,682.80

50628 $5,784.45

50632 $4,862.70

50636 $5,403.00

50640 $2,986.80

50644 $2,881.70

50650 $566.85 $580.65

50654 $678.85

50658 $270.25 $276.85

50950 $1,208.55 $1,143.95

50952 $1,208.55 $1,143.95

51300 $124.75 $120.85

51303 D D

51306 $203.60 $174.55

51309 D D

51312 D D

51315 $385.40 $381.40

51318 $241.65 $251.65

51700 $113.85 $119.80

51703 $63.50 $60.20

51800 $123.05 $120.85

51803 D D

51900 $413.95 $456.50

51902 $115.70 $103.50

51904 $621.80 $636.80

51906 $986.70 $968.45

52000 $117.75 $115.50

52003 $167.70 $164.60

52006 $167.70 $164.60

52009 $255.90 $259.85

52010 $309.80 $355.60

52012 $33.55 $32.90

52015 $156.90 $153.90

52018 $354.70 $387.55

52021 $42.15 $41.25

52024 $74.55 $73.10

52025 $262.35 $257.50

52027 $274.70 $209.65

52030 $123.20 $126.00

52033 $258.35 $257.50

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

52034 $61.25 $60.20

52035 $679.00 $666.55

52036 $170.90 $177.70

52039 $411.35 $456.50

52042 $246.05 $241.50

52045 $307.60 $345.10

52048 $547.55 $520.10

52051 $642.20 $703.15

52054 $1,023.45 $822.65

52055 $38.30

52056 $43.45 $38.30

52057 $209.85

52058 $338.90 $332.65

52059 $381.75 $374.75

52060 $246.60 $265.20

52061 $318.95 $313.05

52062 $421.85 $414.00

52063 $512.00 $498.90

52064 $312.10 $237.30

52066 $635.30 $623.60

52069 $377.90 $277.90

52072 $83.95 $82.35

52073 $213.65 $209.65

52075 $210.35 $209.65

52078 $520.60 $414.00

52081 $66.45 $65.10

52084 $162.35 $167.30

52087 $333.95 $286.60

52090 $463.35 $498.90

52092 $662.50 $650.30

52094 $804.90 $822.60

52095 $543.05 $533.15

52096 $161.15 $158.00

52097 $280.90

52098 $268.55 $263.50

52099 $178.50 $197.75

52102 $201.55

52105 $376.05 $369.05

52106 $208.00

52108 $442.45 $456.50

52111 $481.15 $456.50

52114 $933.65 $822.65

52117 $1,154.45 $979.25

52120 $1,175.85 $1,158.25

52122 $1,347.75 $1,158.25

52123 $1,335.65 $1,311.20

52126 $1,284.10 $1,260.65

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

52129 $1,718.85 $1,687.60

52130 $661.95 $619.45

52131 $947.60 $856.70

52132 $340.75 $348.55

52133 $129.85 $127.50

52135 $195.50

52138 $635.30 $628.00

52141 $648.30 $621.20

52144 $589.75 $579.00

52147 $556.60 $546.35

52148 $983.70 $965.75

52158 $1,583.80 $1,554.95

52180 $327.95 $263.50

52182 $647.20 $579.95

52184 $951.05 $856.70

52186 $1,074.20 $1,054.55

52300 $352.45 $398.10

52303 $578.95 $568.50

52306 $859.25 $843.45

52309 $292.00 $286.60

52312 $405.60 $398.10

52315 $628.55 $663.25

52318 $201.55 $197.75

52319 $335.40 $329.70

52321 $678.05 $663.25

52324 $675.75 $663.25

52327 $335.40 $329.10

52330 $1,315.25 $1,094.75

52333 $1,115.20 $1,094.75

52336 $670.30 $684.25

52337 $1,335.30 $1,496.75

52339 $793.95 $779.25

52342 $1,513.20

52345 $1,554.75

52348 $2,096.45

52351 $1,973.15

52354 $2,116.80

52357 $3,018.85

52360 $2,297.40

52363 $2,584.45

52366 $2,527.35

52369 $2,841.60

52372 $2,757.30

52375 $3,088.40

52378 $1,258.30 $1,048.15

52379 $1,747.90 $1,791.25

52380 $3,106.85 $3,050.05

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

52382 $3,724.15 $3,656.25

52420 $344.05 $337.65

52424 $675.50 $663.15

52430 $1,554.75 $1,526.50

52440 $772.05 $757.90

52442 $965.30 $947.55

52444 $1,072.30 $1,052.60

52446 $1,265.55 $1,242.50

52450 $429.00 $421.05

52452 $697.00 $684.25

52456 $1,179.65 $1,158.25

52458 $429.00 $421.05

52460 $1,115.20 $1,094.75

52480 $716.40 $703.15

52482 $689.15 $676.55

52484 $820.40 $805.45

52600 $489.45 $473.70

52603 $391.85 $452.80

52606 $351.45 $345.40

52609 $461.20 $452.80

52612 $578.95 $568.50

52615 $718.60 $705.40

52618 $772.00 $821.10

52621 $836.35 $821.10

52624 $845.50 $663.15

52626 $414.30 $406.70

52627 $707.25 $705.40

52630 $266.05 $261.10

52633 $718.60 $705.40

52636 $288.95 $261.10

52800 $394.60 $387.55

52803 $649.30 $558.00

52806 $394.60 $387.55

52809 $675.75 $663.25

52812 $1,007.35 $947.55

52815 $1,301.70 $1,000.10

52818 $801.85 $663.25

52821 $1,469.10 $1,442.30

52824 $568.85 $621.20

52826 $338.90 $332.65

52828 $504.05 $494.70

52830 $664.70 $652.55

52832 $911.55 $894.90

53000 $46.45 $45.60

53003 $131.30

53004 $47.95 $49.85

53006 $668.50 $729.75

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

53009 $421.85 $414.00

53012 $167.70 $164.60

53015 $743.00 $822.65

53016 $689.15 $676.55

53017 $863.80 $844.00

53019 $828.25 $813.30

53052 $175.25 $172.00

53054 $175.20 $172.00

53056 $102.70 $100.75

53058 $175.20 $172.00

53060 $143.40 $140.70

53062 $128.40 $126.00

53064 $232.50 $228.15

53068 $192.45 $191.10

53070 $253.95 $249.30

53200 $100.90 $98.95

53203 $169.60 $166.20

53206 $189.05

53209 $2,351.60 $2,308.75

53212 $1,270.45 $1,247.20

53215 $582.75 $572.20

53218 $931.40 $915.35

53220 $469.65 $461.45

53221 $1,289.20 $1,221.25

53224 $1,196.05 $1,353.80

53225 $458.90 $406.70

53226 $445.65 $437.25

53227 $1,655.15 $1,663.50

53230 $1,770.40 $1,873.85

53233 $2,144.80 $2,105.70

53236 $670.10 $659.00

53239 $670.10 $659.00

53242 $445.65 $437.25

53400 $184.30 $180.90

53403 $225.20 $221.00

53406 $557.35 $569.35

53409 $489.10 $569.35

53410 $157.75 $119.95

53411 $393.75 $334.35

53412 $621.70 $548.95

53413 $683.30 $672.50

53414 $786.90 $772.60

53415 $633.95 $609.95

53416 $621.50 $609.95

53418 $944.20 $792.90

53419 $807.75 $792.90

53422 $1,102.55 $1,006.25

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

53423 $1,200.90 $1,006.25

53424 $965.60 $863.35

53425 $957.20 $863.35

53427 $1,201.10 $1,179.15

53429 $1,313.15 $1,179.15

53439 $340.75 $334.35

53453 $689.15 $676.55

53455 $809.55 $794.75

RMFS In Hospital

% of MBS

RMFS Out of

Hospital % of MBS

53458 $61.30 $60.30

53459 $312.30 $329.70

53460 $685.00 $672.50

53600 $59.95 $54.55

53700 $216.70 $174.80

53702 $95.90 $87.50

53704 $57.80 $52.75

END OF REPATRIATION MEDICAL FEE SCHEDULE (RMFS)

RMFS

5. RELATIVE VALUE GUIDE FEE SCHEDULE

EXPLANITORY NOTES

The Relative Value Guide (RVG) lists fees for In Hospital anaesthetic services. The RVG basic unit cost has been reviewed to $32.70. In addition all medical practitioners will be paid RVG fees where they have qualifications updated with Medicare Australia. For items not listed in the RVG Fee Schedule please refer to the appropriate schedule in this booklet.

For medical attendances and consultations provided by general practitioners participating in DVA’s Local

Medical Officer Scheme, please use the Local Medical Officer Fee Schedule for the relevant fees. For derived fees for Local Medical Officers, please use the Derived Fees for Local Medical Officers’ Fee

Schedule. For all specialist attendances and consultations, investigative and general medical procedures claim from the

Repatriation Medical Fee Schedule. For diagnostic imaging services claim from the Diagnostic Imaging Fee Schedule. For pathology services claim from the Pathology Fee Schedule.

RMFS

Item Relative

Value Guide

Item Relative

Value Guide

Item Relative

Value Guide

Item Relative

Value Guide

20100 163.50 20405 261.60 20754 228.90 20902 130.80

20102 196.20 20406 425.10 20756 294.30 20904 228.90

20104 130.80 20410 163.50 20770 490.50 20905 327.00

20120 163.50 20420 163.50 20790 261.60 20906 130.80

20124 130.80 20440 130.80 20791 327.00 20910 130.80

20140 163.50 20450 163.50 20792 425.10 20911 163.50

20142 196.20 20452 196.20 20793 490.50 20912 163.50

20143 196.20 20470 196.20 20794 392.40 20914 228.90

20144 261.60 20472 327.00 20798 327.00 20916 228.90

20145 261.60 20474 425.10 20799 196.20 20920 130.80

20146 163.50 20475 327.00 20800 98.10 20924 130.80

20147 196.20 20500 490.50 20802 163.50 20926 130.80

20148 130.80 20520 196.20 20803 130.80 20928 196.20

20160 196.20 20522 130.80 20804 327.00 20930 130.80

20162 228.90 20524 130.80 20805 196.20 20932 130.80

20164 130.80 20526 327.00 20806 228.90 20934 196.20

20170 196.20 20528 261.60 20810 130.80 20936 261.60

20172 228.90 20540 425.10 20815 196.20 20938 130.80

20174 294.30 20542 490.50 20820 163.50 20940 130.80

20176 327.00 20546 490.50 20830 130.80 20942 163.50

20190 163.50 20548 490.50 20832 196.20 20943 130.80

20192 327.00 20560 654.00 20840 196.20 20944 196.20

20210 490.50 20600 327.00 20841 261.60 20946 261.60

20212 163.50 20604 425.10 20842 130.80 20948 130.80

20214 294.30 20620 327.00 20844 327.00 20950 163.50

20216 654.00 20622 425.10 20845 327.00 20952 130.80

20220 327.00 20630 261.60 20846 327.00 20953 163.50

20222 196.20 20632 228.90 20847 327.00 20954 327.00

20225 392.40 20634 327.00 20848 327.00 20956 130.80

20230 392.40 20670 425.10 20850 392.40 20958 163.50

20300 163.50 20680 98.10 20855 490.50 20960 228.90

20305 490.50 20690 163.50 20860 196.20 21100 98.10

20320 196.20 20700 98.10 20862 228.90 21110 163.50

20321 327.00 20702 130.80 20863 327.00 21112 130.80

20330 261.60 20703 130.80 20864 327.00 21114 163.50

20350 327.00 20704 327.00 20866 327.00 21116 196.20

20352 163.50 20705 196.20 20867 327.00 21120 196.20

20355 392.40 20706 228.90 20868 327.00 21130 98.10

20400 98.10 20730 163.50 20880 490.50 21140 490.50

20401 130.80 20740 163.50 20882 327.00 21150 327.00

20402 163.50 20745 196.20 20884 163.50 21155 327.00

20403 163.50 20750 130.80 20886 196.20 21160 130.80

20404 196.20 20752 196.20 20900 98.10

RMFS

Item Relative

Value Guide

Item Relative

Value Guide

Item Relative

Value Guide

Item Relative

Value Guide

21170 261.60 21480 130.80 21785 327.00 21941 228.90

21195 98.10 21482 163.50 21790 490.50 21942 327.00

21199 130.80 21484 163.50 21800 98.10 21943 163.50

21200 130.80 21486 228.90 21810 130.80 21945 163.50

21202 130.80 21490 98.10 21820 98.10 21949 163.50

21210 196.20 21500 261.60 21830 130.80 21952 327.00

21212 327.00 21502 196.20 21832 228.90 21955 163.50

21214 327.00 21520 130.80 21834 130.80 21959 163.50

21216 457.80 21522 163.50 21840 261.60 21962 163.50

21220 130.80 21530 490.50 21842 196.20 21965 163.50

21230 196.20 21532 261.60 21850 130.80 21969 261.60

21232 163.50 21535 327.00 21860 98.10 21970 490.50

21234 261.60 21600 98.10 21865 327.00 21973 163.50

21260 130.80 21610 163.50 21870 490.50 21976 163.50

21270 261.60 21620 130.80 21872 261.60 21980 163.50

21272 130.80 21622 163.50 21878 98.10 21981 130.80

21274 196.20 21630 163.50 21879 163.50 21990 98.10

21275 327.00 21632 196.20 21880 228.90 21992 130.80

21280 490.50 21634 294.30 21881 294.30 21997 130.80

21300 98.10 21636 490.50 21882 359.70 22001 98.10

21321 130.80 21638 327.00 21883 425.10 22002 130.80

21340 130.80 21650 261.60 21884 490.50 22007 130.80

21360 163.50 21652 327.00 21885 555.90 22008 130.80

21380 98.10 21654 261.60 21886 621.30 22012 98.10

21382 130.80 21656 327.00 21887 686.70 22014 98.10

21390 98.10 21670 130.80 21900 98.10 22015 196.20

21392 130.80 21680 98.10 21906 163.50 22018 228.90

21400 130.80 21682 130.80 21908 196.20 22020 130.80

21402 228.90 21685 327.00 21910 294.30 22025 130.80

21403 327.00 21700 98.10 21912 163.50 22031 163.50

21404 163.50 21710 130.80 21914 196.20 22036 98.10

21420 98.10 21712 163.50 21915 163.50 22040 65.40

21430 130.80 21714 163.50 21916 163.50 22045 98.10

21432 163.50 21716 163.50 21918 163.50 22050 65.40

21440 261.60 21730 98.10 21922 228.90 22051 294.30

21445 327.00 21732 130.80 21925 130.80 22055 392.40

21460 98.10 21740 163.50 21926 163.50 22060 654.00

21461 130.80 21756 196.20 21927 163.50 22065 163.50

21462 98.10 21760 228.90 21930 196.20 22070 327.00

21464 130.80 21770 261.60 21935 163.50 22075 490.50

21472 163.50 21772 196.20 21936 196.20 22900 196.20

21474 163.50 21780 130.80 21939 98.10 22905 196.20

RMFS

Item

Relative

Value Guide

Item Relative

Value Guide Item

Relative Value Guide

Item Relative

Value Guide

23010 32.70 23250 948.30 23670 2,321.70 24109 3,695.10

23021 65.40 23260 981.00 23680 2,354.40 24110 3,727.80

23022 65.40 23270 1,013.70 23690 2,387.10 24111 3,760.50

23023 65.40 23280 1,046.40 23700 2,419.80 24112 3,793.20

23031 98.10 23290 1,079.10 23710 2,452.50 24113 3,825.90

23032 98.10 23300 1,111.80 23720 2,485.20 24114 3,858.60

23033 98.10 23310 1,144.50 23730 2,517.90 24115 3,891.30

23041 130.80 23320 1,177.20 23740 2,550.60 24116 3,924.00

23042 130.80 23330 1,209.90 23750 2,583.30 24117 3,956.70

23043 130.80 23340 1,242.60 23760 2,616.00 24118 3,989.40

23051 163.50 23350 1,275.30 23770 2,648.70 24119 4,022.10

23052 163.50 23360 1,308.00 23780 2,681.40 24120 4,054.80

23053 163.50 23370 1,340.70 23790 2,714.10 24121 4,087.50

23061 196.20 23380 1,373.40 23800 2,746.80 24122 4,120.20

23062 196.20 23390 1,406.10 23810 2,779.50 24123 4,152.90

23063 196.20 23400 1,438.80 23820 2,812.20 24124 4,185.60

23071 228.90 23410 1,471.50 23830 2,844.90 24125 4,218.30

23072 228.90 23420 1,504.20 23840 2,877.60 24126 4,251.00

23073 228.90 23430 1,536.90 23850 2,910.30 24127 4,283.70

23081 261.60 23440 1,569.60 23860 2,943.00 24128 4,316.40

23082 261.60 23450 1,602.30 23870 2,975.70 24129 4,349.10

23083 261.60 23460 1,635.00 23880 3,008.40 24130 4,381.80

23091 294.30 23470 1,667.70 23890 3,041.10 24131 4,414.50

23101 327.00 23480 1,700.40 23900 3,073.80 24132 4,447.20

23111 359.70 23490 1,733.10 23910 3,106.50 24133 4,479.90

23112 392.40 23500 1,765.80 23920 3,139.20 24134 4,512.60

23113 425.10 23510 1,798.50 23930 3,171.90 24135 4,545.30

23114 457.80 23520 1,831.20 23940 3,204.60 24136 4,578.00

23115 490.50 23530 1,863.90 23950 3,237.30 25000 32.70

23116 523.20 23540 1,896.60 23960 3,270.00 25005 65.40

23117 555.90 23550 1,929.30 23970 3,302.70 25010 98.10

23118 588.60 23560 1,962.00 23980 3,335.40 25015 32.70

23119 621.30 23570 1,994.70 23990 3,368.10 25020 65.40

23121 654.00 23580 2,027.40 24100 3,400.80 25025 D

23170 686.70 23590 2,060.10 24101 3,433.50 25030 D

23180 719.40 23600 2,092.80 24102 3,466.20 25050 D

23190 752.10 23610 2,125.50 24103 3,498.90 25200 D

23200 784.80 23620 2,158.20 24104 3,531.60

23210 817.50 23630 2,190.90 24105 3,564.30

23220 850.20 23640 2,223.60 24106 3,597.00

23230 882.90 23650 2,256.30 24107 3,629.70

23240 915.60 23660 2,289.00 24108 3,662.40

RMFS

6. DIAGNOSTIC IMAGING FEE SCHEDULE

EXPLANITORY NOTES

All medical practitioners will be paid 100% of the MBS for diagnostic imaging services, where they have the appropriate qualifications updated with Medicare Australia. Local Medical Officers claiming from the Diagnostic Imaging Fee Schedule can also claim the relevant Veterans Access Payment (VAP) on these items. For items not listed in the Diagnostic Imaging Fee Schedule please refer to the appropriate schedule in this booklet.

For medical attendances and consultations provided by general practitioners participating in DVA’s Local Medical Officer Scheme, please use the Local Medical Fee Schedule for the relevant fees.

For derived fees for Local Medical Officers, please use the Derived Fees for Local Medical Officers Fee Schedule.

For all specialist attendances and consultations, investigative and general medical procedures claim from the Repatriation Medical Fee Schedule.

For In Hospital anaesthetic services please use Relative Value Guide Fee Schedule. For pathology services please use the Pathology Fee Schedule.

RMFS

Item 100% MBS

Item 100% MBS

Item 100% MBS

Item 100% MBS

55005 54.55 55121 115.35 55710 35.00 55810 37.85

55007 18.95 55122 130.85 55711 17.50 55811 18.95

55008 54.55 55123 130.85 55712 115.00 55812 109.10

55010 18.95 55125 137.75 55713 50.00 55813 54.55

55011 54.55 55130 170.00 55714 35.00 55814 37.85

55013 18.95 55131 85.00 55715 40.00 55815 18.95

55014 55.65 55135 353.60 55716 17.50 55816 109.10

55016 18.95 55136 176.80 55717 19.00 55817 54.55

55017 54.55 55220 84.75 55718 100.00 55818 37.85

55019 18.95 55221 84.75 55719 57.50 55819 18.95

55023 54.75 55222 84.75 55720 20.00 55820 109.10

55025 18.95 55223 84.75 55721 115.00 55821 54.55

55026 54.55 55224 84.75 55722 50.00 55822 37.85

55028 109.10 55226 84.75 55723 38.00 55823 18.95

55029 37.85 55227 84.75 55724 57.50 55824 109.10

55030 109.10 55228 84.75 55725 40.00 55825 54.55

55031 37.85 55229 84.75 55726 19.00 55826 37.85

55032 109.10 55230 84.75 55727 20.00 55827 18.95

55033 37.85 55232 84.75 55729 27.25 55828 109.10

55036 111.30 55233 84.75 55730 13.65 55829 54.55

55037 37.85 55235 84.75 55735 63.50 55830 37.85

55038 109.10 55236 55.55 55736 127.00 55831 18.95

55039 37.85 55238 169.50 55737 28.50 55832 109.10

55048 109.50 55244 169.50 55739 57.00 55833 54.55

55049 37.85 55246 169.50 55759 150.00 55834 37.85

55054 109.10 55248 169.50 55760 75.00 55835 18.95

55059 49.15 55252 169.50 55762 60.00 55836 109.10

55060 17.05 55274 169.50 55763 30.00 55837 54.55

55061 54.55 55276 169.50 55764 160.00 55838 37.85

55062 18.95 55278 169.50 55765 80.00 55839 18.95

55063 49.15 55280 169.50 55766 65.00 55840 109.10

55064 17.05 55282 169.50 55767 32.50 55841 54.55

55065 98.25 55284 169.50 55768 150.00 55842 37.85

55067 50.25 55292 169.50 55769 75.00 55843 18.95

55068 35.00 55294 169.50 55770 60.00 55844 87.35

55069 17.85 55296 111.05 55771 30.00 55845 43.70

55070 98.25 55600 109.10 55772 160.00 55846 37.85

55073 34.05 55601 54.55 55773 80.00 55847 18.95

55076 109.10 55603 109.10 55774 65.00 55848 109.10

55079 37.85 55604 54.55 55775 32.50 55849 54.55

55084 98.25 55700 60.00 55800 109.10 55850 152.85

55085 34.05 55701 30.00 55801 54.55 55851 76.45

55113 230.65 55702 17.50 55802 37.85 55852 109.10

55114 230.65 55703 35.00 55803 18.95 55853 54.55

55115 230.65 55704 70.00 55804 109.10 55854 37.85

55116 261.65 55705 35.00 55805 54.55 55855 18.95

55117 261.65 55706 100.00 55806 37.85 56001 195.05

55118 275.50 55707 70.00 55807 18.95 56007 250.00

55119 115.35 55708 35.00 55808 109.10 56010 252.10

55120 115.35 55709 38.00 55809 54.55 56013 250.00

RMFS

Item 100% MBS

Item 100% MBS

Item 100% MBS

Item 100% MBS

56016 290.00 56449 126.80 57703 54.00 57968 23.70

56022 225.00 56452 181.50 57705 27.00 57969 47.40

56028 336.80 56501 385.00 57706 32.50 58100 67.15

56030 225.00 56507 480.05 57708 16.25 58102 33.60

56036 336.80 56541 193.15 57709 43.40 58103 55.10

56041 98.75 56547 243.75 57711 21.70 58105 27.55

56047 126.10 56553 520.00 57712 47.15 58106 77.00

56050 128.20 56555 260.00 57714 23.60 58108 110.00

56053 128.20 56619 220.00 57715 60.90 58109 47.00

56056 155.45 56625 334.65 57717 30.45 58111 38.50

56062 113.15 56659 112.10 57721 99.25 58112 97.25

56068 168.40 56665 167.40 57723 49.65 58114 55.00

56070 113.15 56801 466.55 57901 64.50 58115 110.00

56076 168.40 56807 560.00 57902 64.50 58117 23.50

56101 230.00 56841 233.35 57903 47.30 58120 110.00

56107 340.00 56847 283.85 57906 64.50 58121 110.00

56141 116.45 57001 466.65 57909 64.50 58123 48.65

56147 171.60 57007 567.75 57911 32.25 58124 55.00

56219 326.20 57041 233.40 57912 47.15 58126 55.00

56220 240.00 57047 283.90 57914 32.25 58127 55.00

56221 240.00 57201 155.20 57915 47.15 58300 40.10

56223 240.00 57247 77.55 57917 23.65 58302 20.05

56224 351.40 57341 470.00 57918 47.15 58306 89.40

56225 351.40 57345 241.60 57920 32.25 58308 44.70

56226 351.40 57350 510.00 57921 47.15 58500 35.35

56227 122.50 57351 510.00 57923 32.25 58502 17.70

56228 122.50 57355 264.15 57924 47.15 58503 47.15

56229 122.50 57356 264.15 57926 23.60 58505 23.60

56230 177.45 57360 700.00 57927 49.65 58506 60.75

56231 177.45 57361 350.00 57929 23.60 58508 30.40

56232 177.45 57362 113.15 57930 32.90 58509 39.75

56233 240.00 57363 56.60 57932 23.60 58511 19.90

56234 351.40 57506 29.75 57933 78.25 58521 43.40

56235 122.45 57509 39.75 57935 23.60 58523 21.70

56236 177.45 57512 40.50 57938 23.60 58524 56.50

56237 240.00 57515 54.00 57939 64.50 58526 28.25

56238 351.40 57518 32.50 57941 24.85 58527 69.40

56239 122.45 57521 43.40 57942 49.65 58529 34.70

56240 177.45 57524 49.40 57944 16.45 58700 46.05

56259 164.80 57527 65.75 57945 43.40 58702 23.05

56301 295.00 57529 14.90 57947 39.15 58706 157.90

56307 400.00 57530 19.90 57950 32.25 58708 78.95

56341 149.45 57532 20.25 57953 24.85 58715 151.55

56347 202.00 57533 27.00 57956 21.70 58717 75.80

56401 250.00 57535 16.25 57959 23.70 58718 126.10

56407 360.00 57536 21.70 57960 47.40 58720 63.05

56409 250.00 57538 24.70 57962 23.70 58721 138.25

56412 360.00 57539 32.90 57963 47.40 58723 69.15

56441 126.80 57700 40.50 57965 23.70 58900 35.70

56447 181.50 57702 20.25 57966 47.40 58902 17.85

RMFS

Item 100% MBS

Item 100% MBS

Item 100% MBS

Item 100% MBS

58903 47.60 59739 73.75 60051 827.10 61360 403.35

58905 23.80 59740 36.90 60052 413.55 61361 461.40

58909 89.95 59751 139.15 60054 1,176.10 61364 496.95

58911 45.00 59752 69.60 60055 588.05 61368 223.10

58912 110.25 59754 219.35 60057 1,376.30 61369 2,015.75

58914 55.15 59755 109.70 60058 688.15 61372 223.10

58915 78.95 59763 133.90 60060 564.00 61373 489.70

58916 138.50 59764 66.95 60061 282.00 61376 143.35

58917 39.50 59903 114.55 60063 827.10 61381 574.35

58920 69.25 59912 305.20 60064 413.55 61383 624.95

58921 135.25 59925 362.45 60066 1,176.10 61384 687.70

58923 67.65 59970 168.30 60067 588.05 61386 332.50

58927 76.45 59971 57.30 60069 1,376.30 61387 430.75

58929 38.25 59972 152.60 60070 688.15 61389 370.55

58933 205.60 59973 181.25 60072 48.10 61390 409.95

58935 102.80 59974 84.20 60073 24.05 61393 605.50

58936 195.95 60000 564.00 60075 96.10 61397 246.85

58938 98.00 60001 282.00 60076 48.05 61401 162.30

58939 139.30 60003 827.10 60078 144.25 61402 605.05

58941 69.65 60004 413.55 60079 72.15 61405 346.00

59103 21.30 60006 1,176.10 60100 60.75 61409 873.50

59104 10.65 60007 588.05 60101 30.40 61413 225.95

59300 89.50 60009 1,376.30 60500 43.40 61417 118.85

59301 44.75 60010 688.15 60501 21.70 61421 479.80

59303 53.95 60012 564.00 60503 29.75 61425 600.70

59304 27.00 60013 282.00 60504 14.90 61426 554.80

59306 100.30 60015 827.10 60506 63.75 61429 543.00

59307 50.15 60016 413.55 60507 31.90 61430 659.45

59309 200.60 60018 1,176.10 60509 98.90 61433 496.95

59310 100.30 60019 588.05 60510 49.45 61434 615.40

59312 87.00 60021 1,376.30 60918 47.15 61437 542.75

59313 43.50 60022 688.15 60927 38.05 61438 672.95

59314 52.50 60024 564.00 61109 258.90 61441 489.70

59315 26.25 60025 282.00 61110 129.45 61442 752.35

59318 47.05 60027 827.10 61302 448.85 61445 286.80

59319 23.55 60028 413.55 61303 565.30 61446 333.55

59700 96.55 60030 1,176.10 61306 709.70 61449 456.20

59701 48.30 60031 588.05 61307 834.90 61450 397.55

59703 75.90 60033 1,376.30 61310 367.30 61453 514.70

59704 37.95 60034 688.15 61313 303.35 61454 348.10

59712 113.70 60036 564.00 61314 420.00 61457 470.45

59713 56.85 60037 282.00 61316 381.15 61458 396.95

59715 143.55 60039 827.10 61317 492.40 61461 527.85

59716 71.80 60040 413.55 61320 228.90 61462 129.00

59718 134.65 60042 1,176.10 61328 227.65 61469 348.10

59719 67.35 60043 588.05 61340 253.00 61473 175.40

59724 226.45 60045 1,376.30 61348 443.35 61480 386.85

59725 113.25 60046 688.15 61352 259.35 61484 880.85

59733 107.70 60048 564.00 61353 386.60 61485 999.20

59734 53.85 60049 282.00 61356 392.80 61495 223.10

RMFS

Item 100% MBS

Item 100% MBS

Item 100% MBS

Item 100% MBS

61499 253.00 61678 166.25 63040 336.00 63187 179.20

61505 100.00 61679 215.40 63043 358.40 63188 179.20

61523 953.00 61680 185.30 63046 403.20 63189 179.20

61529 953.00 61681 205.00 63049 403.20 63190 179.20

61538 901.00 61682 302.75 63052 403.20 63191 179.20

61541 953.00 61683 123.45 63055 403.20 63192 179.20

61553 999.00 61684 81.15 63058 403.20 63193 179.20

61559 918.00 61685 302.55 63061 403.20 63194 179.20

61565 953.00 61686 173.00 63064 403.20 63201 448.00

61571 953.00 61687 436.75 63067 403.20 63204 448.00

61575 953.00 61688 113.00 63070 403.20 63207 224.00

61577 953.00 61689 59.45 63073 403.20 63208 224.00

61598 953.00 61690 239.90 63074 168.00 63219 448.00

61604 953.00 61691 300.35 63075 179.20 63222 448.00

61610 953.00 61692 277.40 63076 201.60 63225 448.00

61616 953.00 61693 271.50 63077 201.60 63228 448.00

61620 953.00 61694 329.75 63078 201.60 63231 448.00

61622 953.00 61695 248.50 63079 201.60 63234 448.00

61628 953.00 61696 307.70 63080 201.60 63237 448.00

61632 953.00 61697 271.40 63081 201.60 63240 448.00

61640 999.00 61698 336.50 63082 201.60 63243 448.00

61646 999.00 61699 244.85 63083 201.60 63257 224.00

61650 878.70 61700 376.20 63084 201.60 63258 224.00

61651 224.45 61701 143.40 63085 201.60 63259 224.00

61652 282.65 61702 166.80 63101 492.80 63260 224.00

61653 354.85 61703 228.10 63104 246.40 63261 224.00

61654 417.45 61704 198.80 63111 492.80 63262 224.00

61655 183.65 61705 257.35 63114 492.80 63263 224.00

61656 151.70 61706 174.05 63117 246.40 63264 224.00

61657 210.00 61707 235.25 63119 246.40 63265 224.00

61658 190.60 61708 198.50 63125 492.80 63271 492.80

61659 246.20 61709 263.95 63128 492.80 63274 492.80

61660 114.45 61710 64.50 63131 492.80 63277 492.80

61661 113.85 61712 174.05 63134 246.40 63280 492.80

61662 126.50 61713 87.70 63135 246.40 63282 246.40

61663 221.70 61714 193.45 63136 246.40 63283 246.40

61664 129.70 61715 440.45 63151 358.40 63284 246.40

61665 193.30 61716 499.60 63154 358.40 63285 246.40

61666 196.40 61717 111.55 63157 179.20 63301 380.80

61667 201.70 61718 126.50 63158 179.20 63304 380.80

61668 230.70 61719 50.00 63161 358.40 63307 380.80

61669 248.50 61729 439.35 63164 358.40 63310 190.40

61670 111.55 63001 403.20 63167 358.40 63311 190.40

61671 1,007.90 63004 403.20 63170 358.40 63313 190.40

61672 111.55 63007 403.20 63173 358.40 63322 403.20

61673 244.85 63010 336.00 63176 358.40 63325 403.20

61674 71.70 63013 201.60 63179 358.40 63328 403.20

61675 287.20 63014 201.60 63182 358.40 63331 403.20

61676 312.50 63016 201.60 63185 358.40 63334 336.00

61677 343.85 63017 168.00 63186 179.20 63337 448.00

RMFS

Item 100% MBS Item 100% MBS

63340 403.20 63491 44.80

63341 201.60 63494 44.80

63342 201.60 63497 156.80

63343 201.60 63498 44.80

63345 201.60 63499 156.80

63346 168.00 63501 500.00

63347 224.00 63502 500.00

63348 201.60 63504 500.00

63361 403.20 63505 500.00

63364 201.60 63507 403.20

63385 448.00 63508 201.60

63388 448.00 63510 448.00

63391 403.20 63511 224.00

63392 224.00 63513 403.20

63393 224.00 63514 201.60

63394 201.60 63516 403.20

63401 403.20 63517 201.60

63404 403.20 63519 403.20

63407 201.60 63520 201.60

63408 201.60 63522 448.00

63416 403.20 63523 224.00

63419 201.60 63551 403.20

63425 403.20 63552 201.60

63428 403.20 63554 358.40

63432 201.60 63555 179.20

63433 201.60 63557 492.80

63440 403.20 63558 246.40

63443 403.20 63560 403.20

63446 403.20 63561 201.60

63447 201.60 63740 457.20

63448 201.60 63741 265.25

63449 201.60 63743 403.20

63455 179.20 63744 228.60

63457 345.00 63746 132.65

63458 345.00 63747 201.60

63461 358.40 64990 7.05

63464 690.00 64991 10.65

63467 690.00

63470 403.20

63473 627.20

63476 403.20

63479 201.60

63481 313.60

63482 403.20

63484 201.60

63486 201.60

63487 690.00

63488 345.00

63489 1,440.00

63490 720.00

RMFS

7. PATHOLOGY FEE SCHEDULE

EXPLANITORY NOTES

All medical practitioners will be paid 100% of the MBS for pathology services, where they have the appropriate qualifications updated with Medicare Australia.

Local Medical Officers claiming the Pathology Fee Schedule can also claim the relevant Veterans Access Payment on these items if they do not receive the bulk billing incentive.

In addition, DVA does not apply the coning or super coning rule to “Out of Hospital” pathology services.

For items not listed in the Pathology Fee schedule please refer to the appropriate schedule in this booklet.

For medical attendances and consultations provided by general practitioners participating in DVA’s Local Medical Officer Scheme, please use the Local Medical Fee Schedule for the relevant fees.

For derived fees for Local Medical Officers, please use the Derived Fees for Local Medical Officers Fee Schedule.

For all specialist attendances and consultations, investigative and general medical procedures claim from the Repatriation Medical Fee Schedule.

For In Hospital anaesthetic services please use Relative Value Guide Fee Schedule. For diagnostic imaging services please use the Diagnostic Imaging Fee Schedule.

RMFS

Item 100% MBS

Item 100% MBS

Item 100% MBS

Item 100% MBS

65060 7.85 66518 20.05 66680 74.45 66815 59.55

65066 10.40 66519 40.15 66683 74.45 66816 34.80

65070 16.95 66536 11.05 66686 50.65 66817 24.75

65072 10.20 66539 30.60 66695 30.50 66819 30.60

65075 51.95 66542 18.95 66696 30.50 66820 30.60

65078 90.20 66545 15.80 66697 13.20 66821 21.80

65079 90.20 66548 19.90 66698 43.70 66822 52.45

65081 96.60 66551 16.80 66701 56.90 66825 30.60

65082 96.60 66554 16.80 66704 70.15 66826 30.60

65084 165.85 66557 9.70 66707 83.35 66827 21.80

65087 83.10 66560 20.10 66711 30.15 66828 52.45

65090 11.15 66563 24.70 66712 43.05 66830 58.50

65093 22.00 66566 33.70 66714 30.15 66831 30.95

65096 41.00 66569 42.60 66715 12.85 66832 30.95

65099 108.90 66572 51.55 66716 25.05 66833 30.05

65102 164.60 66575 60.45 66719 34.80 66834 30.05

65105 108.90 66578 69.35 66722 37.90 66835 39.05

65108 164.60 66581 78.25 66723 37.90 66836 39.05

65109 12.90 66584 9.70 66724 13.15 66837 39.05

65110 12.90 66587 47.55 66725 51.05 66838 23.60

65111 23.20 66590 30.60 66728 64.20 66839 42.95

65114 9.10 66593 18.00 66731 77.40 66840 23.60

65117 20.25 66596 32.55 66734 90.55 66841 16.80

65120 13.70 66605 30.60 66743 20.10 66900 77.65

65123 20.35 66606 30.60 66749 32.95 69300 12.50

65126 27.85 66607 75.75 66750 39.75 69303 22.00

65129 35.50 66610 75.75 66751 55.25 69306 33.75

65137 25.35 66623 41.50 66752 24.70 69309 48.15

65142 25.35 66626 24.10 66755 38.85 69312 33.75

65144 56.55 66629 20.10 66756 98.30 69316 28.65

65147 37.90 66632 20.10 66757 98.30 69317 35.85

65150 70.90 66635 20.10 66758 24.70 69318 33.75

65153 141.85 66638 49.05 66761 13.15 69319 42.95

65156 212.75 66639 29.20 66764 8.90 69321 48.15

65157 70.90 66641 29.20 66767 17.85 69324 43.00

65158 70.90 66642 29.20 66770 26.70 69325 43.00

65159 70.90 66644 20.15 66773 24.65 69327 85.00

65162 10.45 66647 45.10 66776 24.65 69328 85.00

65165 34.45 66650 24.35 66779 39.95 69330 128.00

65166 34.45 66651 24.35 66780 39.95 69331 128.00

65171 25.35 66652 20.30 66782 13.15 69333 20.55

65175 25.35 66653 44.60 66783 13.15 69336 33.45

65176 48.65 66655 20.15 66785 39.95 69339 19.10

65177 71.95 66656 20.15 66788 65.85 69345 52.90

65178 95.20 66659 37.30 66789 39.95 69354 30.75

65179 118.50 66660 37.30 66790 25.90 69357 61.45

65180 25.35 66662 79.95 66791 74.45 69360 92.20

65181 23.30 66663 79.95 66792 74.45 69363 28.65

66500 9.70 66665 30.60 66800 18.15 69378 180.25

66503 11.65 66666 30.60 66803 30.50 69379 180.25

66506 13.65 66667 30.60 66804 18.15 69380 770.30

66509 15.65 66671 36.90 66805 12.35 69381 180.25

Item 100% MBS

Item 100% MBS

Item 100% MBS

Item 100% MBS

66512 17.70 66674 39.95 66806 41.85 69382 180.25

66517 19.65 66677 11.15 66812 34.80 69383 180.25

69384 15.65 71085 28.95 71195 40.05 73295 1200.00

69387 29.00 71087 37.70 71198 40.55 73300 101.30

69390 42.35 71089 29.15 71200 59.60 73305 202.65

69393 55.70 71090 29.15 71203 40.55 73308 36.45

69396 69.10 71091 52.85 72813 71.50 73309 36.45

69400 15.65 71092 23.70 72816 86.35 73311 36.45

69401 13.35 71093 76.45 72817 96.80 73312 36.45

69405 15.65 71095 40.55 72818 107.05 73314 230.95

69408 29.00 71096 40.55 72823 97.15 73315 230.95

69411 42.35 71097 24.45 72824 141.35 73317 36.45

69413 55.70 71099 26.50 72825 180.25 73318 36.45

69415 69.10 71101 17.40 72826 194.60 73320 40.55

69418 63.55 71103 52.05 72827 208.95 73321 40.55

69419 63.55 71106 11.30 72828 223.30 73323 40.55

69445 92.20 71119 17.35 72830 274.15 73324 40.95

69451 92.20 71121 20.80 72836 417.20 73325 74.50

69471 34.90 71123 24.25 72838 466.85 73326 230.95

69472 15.65 71125 27.65 72844 30.75 73327 51.95

69474 28.65 71127 176.35 72846 59.60 73332 315.40

69475 15.65 71129 217.85 72847 89.40 73333 600.00

69478 29.25 71131 259.35 72848 74.50 73334 340.00

69481 40.55 71133 10.40 72849 104.30 73335 470.00

69482 152.10 71134 104.05 72850 119.20 73336 230.95

69483 152.10 71135 207.95 72851 184.35 73337 397.35

69484 17.10 71137 30.25 72852 245.80 73338 362.60

69488 180.25 71139 104.05 72855 184.35 73339 400.00

69489 180.25 71141 197.35 72856 245.80 73340 200.00

69491 204.80 71143 260.00 72857 286.75 73341 400.00

69492 204.80 71145 424.50 72858 180.00 73342 315.40

69494 28.65 71146 104.05 72859 370.00 73521 9.70

69495 35.85 71147 40.55 73043 22.85 73523 41.75

69496 43.05 71148 40.55 73045 48.60 73525 28.35

69497 28.65 71149 108.25 73047 94.70 73527 10.00

69498 7.20 71151 118.85 73049 68.15 73529 28.65

69499 92.20 71153 34.55 73051 170.35 73801 6.90

69500 92.20 71154 34.55 73053 19.45 73802 4.55

71057 32.90 71155 47.45 73055 19.45 73803 6.35

71058 50.50 71156 12.85 73057 19.45 73804 8.15

71059 35.65 71157 60.30 73059 43.00 73805 4.55

71060 44.05 71159 73.15 73060 57.35 73806 10.15

71062 44.05 71163 24.75 73061 51.20 73807 6.90

71064 20.75 71164 39.90 73062 89.00 73808 8.65

71066 14.55 71165 34.55 73063 99.35 73809 2.35

71068 14.55 71166 47.45 73064 71.70 73810 6.90

71069 22.75 71167 60.30 73065 86.00 73811 11.20

71071 30.95 71168 73.15 73066 221.45 73828 6.90

71072 14.55 71169 34.55 73067 129.15 73829 4.55

71073 106.15 71170 12.85 73069 36.00 73830 6.35

71074 14.55 71180 34.55 73287 394.55 73831 8.15

71075 23.00 71183 47.45 73289 358.95 73832 4.55

71076 106.15 71186 60.30 73290 394.55 73833 10.15

73291 230.95 73834 6.90

RMFS

Item 100% MBS

73839 16.80

73840 17.00

73844 20.35

73899 5.95

73900 2.40

73920 2.40

73922 8.20

73923 2.40

73924 14.65

73925 2.40

73926 8.20

73927 2.40

73928 5.95

73929 2.40

73930 5.95

73931 2.40

73932 10.25

73933 2.40

73934 17.60

73935 2.40

73936 5.95

73937 2.40

73938 7.95

73939 2.40

73940 10.25

74990 7.05

74991 10.65

74992 1.60

74993 3.75

74994 3.25

74995 4.00

74996 3.70

74997 3.30

74998 2.00

74999 1.60

8. CO-ORDINATED VETERANS’ CARE (CVC) PROGRAM

Item 100% MBS Description

UP01 $424.15 Co-ordinated Veterans Care - LMO/GP Initial payment WITH Practice Nurse

UP02 $265.05 Co-ordinated Veterans Care - LMO/GP Initial payment WITHOUT Practice Nurse

UP03 $442.65 Co-ordinated Veterans Care - LMO/GP Quarterly Care WITH Practice Nurse

UP04 $198.80 Co-ordinated Veterans Care - LMO/GP Quarterly Care WITHOUT Practice Nurse