DEPARTMENT OF VETERANS’ AFFAIRS

FEE SCHEDULESFOR

MEDICAL SERVICES

EFFECTIVE 1 MARCH 2018

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 December 2017.

All item assessments are based on Medicare assessment rules. A “D” in a fee column indicates a derived fee.

New Items for 1 March 2018Added new items 585, 588, 591, 594. Removed end-dated items 597,599.

Previous Changes

1 December 2017 Added new items 73070, 73071, 73072, 73073, 73074, 73075, 73076. Removed end-dated items 69418, 69419.

16 November 2017 Added new item 31591.

1 November 2017 Added new items 111, 117, 120, 6080, 6081, 12320, 12322, 16407, 16408, 16530, 16531, 16533, 16534, 35414, 38276, 40701, 40702, 40704, 40705, 40707, 40708, 73296, 73297, 80001, 80011, 80021. Amended fees for items 16515, 16520, 16527, 16528, 16590, 30475.

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.

ComplianceDVA 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 informationhttp://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

585 149.30 Y Y 2546 42.65 Y Y

588 129.80 2547 D Y Y

591 100.00 2552 82.50 Y Y

594 48.25 2553 D Y Y

600 124.25 2558 121.40 Y Y

701 68.30 Y Y 2559 D Y Y

703 158.60 Y Y 2598 12.65 Y Y

705 218.85 Y Y 2600 24.15 Y Y

707 309.15 Y Y 2603 43.70 Y Y

715 244.10 Y Y 2606 70.15 Y Y

721 165.90 Y Y 2610 D Y Y

723 131.45 Y Y 2613 D Y Y

729 81.00 Y Y 2616 D Y Y

731 81.00 Y Y 2620 24.15 Y Y

732 82.90 Y Y 2622 43.70 Y Y

735 81.25 Y Y 2624 70.15 Y Y

739 139.10 Y Y 2631 D Y Y

743 231.90 Y Y 2633 D Y Y

747 59.70 Y Y 2635 D Y Y

750 102.35 Y Y 2664 24.15 Y Y

758 170.45 Y Y 2666 43.70 Y Y

900 178.05 Y Y 2668 70.15 Y Y

903 121.90 Y Y 2673 D Y Y

2100 26.35 2675 D Y Y

2677 D Y Y

Item LMO Fee REIVAP

MetroVAP

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 Y2723 D Y Y

2725 152.70 Y Y2727 D Y Y

4001 88.10 Y Y

5000 33.35 Y Y5003 D Y Y5010 D Y Y

5020 56.35 Y Y5023 D Y Y5028 D Y Y5040 6.55 Y Y5043 D Y Y5049 D Y Y

5060 135.45 Y Y5063 D Y Y5067 D Y Y5200 24.15 Y Y5203 35.65 Y Y5207 55.20 Y Y5208 81.65 Y Y5220 D Y Y5223 D Y Y5227 D Y Y5228 D Y Y5260 D Y Y5263 D Y Y5265 D Y Y5267 D Y Y

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 $ 71.0010907 $ 33.45 $ 35.5510910 $ 66.80 $ 71.0010911 $ 66.80 $ 71.0010912 $ 66.80 $ 71.0010913 $ 66.80 $ 71.0010914 $ 66.80 $ 71.0010915 $ 66.80 $ 71.0010916 $ 33.45 $ 35.5510918 $ 33.45 $ 35.5510921 $ 165.80 $ 176.1510922 $ 165.80 $ 176.1510923 $ 165.80 $ 176.1510924 $ 209.20 $ 222.3010925 $ 165.80 $ 176.1510926 $ 165.80 $ 176.1510927 $ 209.20 $ 222.3010928 $ 165.80 $ 176.1510929 $ 209.20 $ 222.3010930 $ 165.80 $ 176.1510931 $ 23.30 $ 24.7510932 $ 11.60 $ 12.3510933 $ 7.70 $ 8.2010940 $ 63.75 $ 67.7510941 $ 38.45 $ 40.8510942 $ 33.45 $ 35.5510943 $ 33.45 $ 35.5510944 $ 72.15 $ 72.1510945 $ 33.45 $ 35.5510946 $ 66.80 $ 71.0010947 $ 33.45 $ 35.5510948 $ 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.

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

Fee2137 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

Fee2179 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 Fee2631 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 Fee2673 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 Fee2723 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 Fee2631 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 Fee2673 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 Fee2723 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

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 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 $203.75 111 $59.40 $58.05112 D 113 $86.70 114 $152.85 116 $104.25 $101.95 117 $104.25 $101.95119 $59.40 $58.05120 $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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

299 $420.30 300 $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 $336.90 350 $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 $26.40 411 $57.75 412 $111.60 413 $164.30 414 D D 415 D D

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 $1,227.30 585 588 $175.25 $175.25591 $135.00 $135.00 594 $48.25 $48.25598 $144.45 $141.45 600 $171.25 $167.75 820 $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 $375.55 835 $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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 2603 2606 2610 2613 2616 2620 2622 2624 2631 2633 2635 2664 2666 2668 2673 2675 2677 2700 2701 2712 2713

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 12320 $129.70 $143.4012321 $129.70 $143.40 12322 $129.70 $143.4012323 $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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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 16407 $99.10 $100.4016408 $74.8016500 $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 $1535.00 $883.20 16518 $729.65 $630.95 16519 $1,824.30 $971.55 16520 $1535.00 16522 $2,305.30 $2,281.10 16525 $1,010.50 $538.10 16527 $1507.80 $883.20

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

16528 $1507.80 $883.20 16530 $1010.50 $538.1016531 $2021.0016533 $130.9016534 $130.9016564 $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 $521.85 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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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 30296 $1,513.60 30297 $1,520.00

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 30405 $1,195.20 30406 $71.70 $73.10 30408 $588.55 30409 $232.95 $244.25

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 30472 $1,239.80 $1,301.10 30473 $236.45 $247.95 30475 $465.50 $488.55 30476 $327.65 $343.80 30478 $327.65 $343.80

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 $792.7530644 $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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 35406 $1,128.10 35408 $846.25 35410 $1,128.10 $1,138.65 35412 $3,963.45 $4,000.60 35414 $4900.0035500 $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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

35720 $960.60 35723 $687.80 35726 $687.80 35729 $310.20 35750 $1,340.45 35730 $217.80 $310.2035753 $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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 38276 $1199.4038285 $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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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 40701 $476.8540702 $223.2040703 $2,011.15 40704 $943.85 40705 $847.5040706 $3,211.05 $3,000.35

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

40707 $265.6040708 $476.8540709 $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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 $3317.8541620 $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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 $1064.9542707 $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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

48421 $1,431.65 48424 $952.15 48427 $1,267.20 48500 $476.35 48503 $467.55 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

48912 $487.45 $461.45 48915 $1,254.70 48918 $2,736.15 48921 $2,700.25 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

49324 $2,738.65 49327 $3,421.45 49330 $3,354.80 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

49712 $1,362.75 49715 $1,950.70 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

50201 $486.85 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 50588 $1,080.60

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 52034 $61.25 $60.20 52035 $679.00 $666.55

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 52129 $1,718.85 $1,687.60 52130 $661.95 $619.45 52131 $947.60 $856.70

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 52382 $3,724.15 $3,656.25 52420 $344.05 $337.65 52424 $675.50 $663.15 52430 $1,554.75 $1,526.50

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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

RMFS In Hospital

% of MBS

RMFS Out of

Hospital% of MBS

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 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 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)

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.

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 130.8020102 196.20 20406 425.10 20756 294.30 20904 228.9020104 130.80 20410 163.50 20770 490.50 20905 327.0020120 163.50 20420 163.50 20790 261.60 20906 130.8020124 130.80 20440 130.80 20791 327.00 20910 130.8020140 163.50 20450 163.50 20792 425.10 20911 163.5020142 196.20 20452 196.20 20793 490.50 20912 163.5020143 196.20 20470 196.20 20794 392.40 20914 228.9020144 261.60 20472 327.00 20798 327.00 20916 228.9020145 261.60 20474 425.10 20799 196.20 20920 130.8020146 163.50 20475 327.00 20800 98.10 20924 130.8020147 196.20 20500 490.50 20802 163.50 20926 130.8020148 130.80 20520 196.20 20803 130.80 20928 196.2020160 196.20 20522 130.80 20804 327.00 20930 130.8020162 228.90 20524 130.80 20805 196.20 20932 130.8020164 130.80 20526 327.00 20806 228.90 20934 196.2020170 196.20 20528 261.60 20810 130.80 20936 261.6020172 228.90 20540 425.10 20815 196.20 20938 130.8020174 294.30 20542 490.50 20820 163.50 20940 130.8020176 327.00 20546 490.50 20830 130.80 20942 163.5020190 163.50 20548 490.50 20832 196.20 20943 130.8020192 327.00 20560 654.00 20840 196.20 20944 196.2020210 490.50 20600 327.00 20841 261.60 20946 261.6020212 163.50 20604 425.10 20842 130.80 20948 130.8020214 294.30 20620 327.00 20844 327.00 20950 163.5020216 654.00 20622 425.10 20845 327.00 20952 130.8020220 327.00 20630 261.60 20846 327.00 20953 163.5020222 196.20 20632 228.90 20847 327.00 20954 327.0020225 392.40 20634 327.00 20848 327.00 20956 130.8020230 392.40 20670 425.10 20850 392.40 20958 163.5020300 163.50 20680 98.10 20855 490.50 20960 228.9020305 490.50 20690 163.50 20860 196.20 21100 98.1020320 196.20 20700 98.10 20862 228.90 21110 163.5020321 327.00 20702 130.80 20863 327.00 21112 130.8020330 261.60 20703 130.80 20864 327.00 21114 163.5020350 327.00 20704 327.00 20866 327.00 21116 196.2020352 163.50 20705 196.20 20867 327.00 21120 196.2020355 392.40 20706 228.90 20868 327.00 21130 98.1020400 98.10 20730 163.50 20880 490.50 21140 490.5020401 130.80 20740 163.50 20882 327.00 21150 327.0020402 163.50 20745 196.20 20884 163.50 21155 327.0020403 163.50 20750 130.80 20886 196.20 21160 130.8020404 196.20 20752 196.20 20900 98.10

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 228.9021195 98.10 21482 163.50 21790 490.50 21942 327.0021199 130.80 21484 163.50 21800 98.10 21943 163.5021200 130.80 21486 228.90 21810 130.80 21945 163.5021202 130.80 21490 98.10 21820 98.10 21949 163.5021210 196.20 21500 261.60 21830 130.80 21952 327.0021212 327.00 21502 196.20 21832 228.90 21955 163.5021214 327.00 21520 130.80 21834 130.80 21959 163.5021216 457.80 21522 163.50 21840 261.60 21962 163.5021220 130.80 21530 490.50 21842 196.20 21965 163.5021230 196.20 21532 261.60 21850 130.80 21969 261.6021232 163.50 21535 327.00 21860 98.10 21970 490.5021234 261.60 21600 98.10 21865 327.00 21973 163.5021260 130.80 21610 163.50 21870 490.50 21976 163.5021270 261.60 21620 130.80 21872 261.60 21980 163.5021272 130.80 21622 163.50 21878 98.10 21981 130.8021274 196.20 21630 163.50 21879 163.50 21990 98.1021275 327.00 21632 196.20 21880 228.90 21992 130.8021280 490.50 21634 294.30 21881 294.30 21997 130.8021300 98.10 21636 490.50 21882 359.70 22001 98.1021321 130.80 21638 327.00 21883 425.10 22002 130.8021340 130.80 21650 261.60 21884 490.50 22007 130.8021360 163.50 21652 327.00 21885 555.90 22008 130.8021380 98.10 21654 261.60 21886 621.30 22012 98.1021382 130.80 21656 327.00 21887 686.70 22014 98.1021390 98.10 21670 130.80 21900 98.10 22015 196.2021392 130.80 21680 98.10 21906 163.50 22018 228.9021400 130.80 21682 130.80 21908 196.20 22020 130.8021402 228.90 21685 327.00 21910 294.30 22025 130.8021403 327.00 21700 98.10 21912 163.50 22031 163.5021404 163.50 21710 130.80 21914 196.20 22036 98.1021420 98.10 21712 163.50 21915 163.50 22040 65.4021430 130.80 21714 163.50 21916 163.50 22045 98.1021432 163.50 21716 163.50 21918 163.50 22050 65.4021440 261.60 21730 98.10 21922 228.90 22051 294.3021445 327.00 21732 130.80 21925 130.80 22055 392.4021460 98.10 21740 163.50 21926 163.50 22060 654.0021461 130.80 21756 196.20 21927 163.50 22065 163.5021462 98.10 21760 228.90 21930 196.20 22070 327.0021464 130.80 21770 261.60 21935 163.50 22075 490.5021472 163.50 21772 196.20 21936 196.20 22900 196.2021474 163.50 21780 130.80 21939 98.10 22905 196.20

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 3,695.1023021 65.40 23260 981.00 23680 2,354.40 24110 3,727.8023022 65.40 23270 1,013.70 23690 2,387.10 24111 3,760.5023023 65.40 23280 1,046.40 23700 2,419.80 24112 3,793.2023031 98.10 23290 1,079.10 23710 2,452.50 24113 3,825.9023032 98.10 23300 1,111.80 23720 2,485.20 24114 3,858.6023033 98.10 23310 1,144.50 23730 2,517.90 24115 3,891.3023041 130.80 23320 1,177.20 23740 2,550.60 24116 3,924.0023042 130.80 23330 1,209.90 23750 2,583.30 24117 3,956.7023043 130.80 23340 1,242.60 23760 2,616.00 24118 3,989.4023051 163.50 23350 1,275.30 23770 2,648.70 24119 4,022.1023052 163.50 23360 1,308.00 23780 2,681.40 24120 4,054.8023053 163.50 23370 1,340.70 23790 2,714.10 24121 4,087.5023061 196.20 23380 1,373.40 23800 2,746.80 24122 4,120.2023062 196.20 23390 1,406.10 23810 2,779.50 24123 4,152.9023063 196.20 23400 1,438.80 23820 2,812.20 24124 4,185.6023071 228.90 23410 1,471.50 23830 2,844.90 24125 4,218.3023072 228.90 23420 1,504.20 23840 2,877.60 24126 4,251.0023073 228.90 23430 1,536.90 23850 2,910.30 24127 4,283.7023081 261.60 23440 1,569.60 23860 2,943.00 24128 4,316.4023082 261.60 23450 1,602.30 23870 2,975.70 24129 4,349.1023083 261.60 23460 1,635.00 23880 3,008.40 24130 4,381.8023091 294.30 23470 1,667.70 23890 3,041.10 24131 4,414.5023101 327.00 23480 1,700.40 23900 3,073.80 24132 4,447.2023111 359.70 23490 1,733.10 23910 3,106.50 24133 4,479.9023112 392.40 23500 1,765.80 23920 3,139.20 24134 4,512.6023113 425.10 23510 1,798.50 23930 3,171.90 24135 4,545.3023114 457.80 23520 1,831.20 23940 3,204.60 24136 4,578.0023115 490.50 23530 1,863.90 23950 3,237.30 25000 32.7023116 523.20 23540 1,896.60 23960 3,270.00 25005 65.4023117 555.90 23550 1,929.30 23970 3,302.70 25010 98.1023118 588.60 23560 1,962.00 23980 3,335.40 25015 32.7023119 621.30 23570 1,994.70 23990 3,368.10 25020 65.4023121 654.00 23580 2,027.40 24100 3,400.80 25025 D23170 686.70 23590 2,060.10 24101 3,433.50 25030 D23180 719.40 23600 2,092.80 24102 3,466.20 25050 D23190 752.10 23610 2,125.50 24103 3,498.90 25200 D23200 784.80 23620 2,158.20 24104 3,531.6023210 817.50 23630 2,190.90 24105 3,564.3023220 850.20 23640 2,223.60 24106 3,597.0023230 882.90 23650 2,256.30 24107 3,629.7023240 915.60 23660 2,289.00 24108 3,662.40

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.

Item 100% MBS Item 100% MBS Item 100% MBS Item 100% MBS

55005 54.55 55121 115.35 55710 35.00 55810 37.8555007 18.95 55122 130.85 55711 17.50 55811 18.9555008 54.55 55123 130.85 55712 115.00 55812 109.1055010 18.95 55125 137.75 55713 50.00 55813 54.5555011 54.55 55130 170.00 55714 35.00 55814 37.8555013 18.95 55131 85.00 55715 40.00 55815 18.9555014 55.65 55135 353.60 55716 17.50 55816 109.1055016 18.95 55136 176.80 55717 19.00 55817 54.5555017 54.55 55220 84.75 55718 100.00 55818 37.8555019 18.95 55221 84.75 55719 57.50 55819 18.9555023 54.75 55222 84.75 55720 20.00 55820 109.1055025 18.95 55223 84.75 55721 115.00 55821 54.5555026 54.55 55224 84.75 55722 50.00 55822 37.8555028 109.10 55226 84.75 55723 38.00 55823 18.9555029 37.85 55227 84.75 55724 57.50 55824 109.1055030 109.10 55228 84.75 55725 40.00 55825 54.5555031 37.85 55229 84.75 55726 19.00 55826 37.8555032 109.10 55230 84.75 55727 20.00 55827 18.9555033 37.85 55232 84.75 55729 27.25 55828 109.1055036 111.30 55233 84.75 55730 13.65 55829 54.5555037 37.85 55235 84.75 55735 63.50 55830 37.8555038 109.10 55236 55.55 55736 127.00 55831 18.9555039 37.85 55238 169.50 55737 28.50 55832 109.1055048 109.50 55244 169.50 55739 57.00 55833 54.5555049 37.85 55246 169.50 55759 150.00 55834 37.8555054 109.10 55248 169.50 55760 75.00 55835 18.9555059 49.15 55252 169.50 55762 60.00 55836 109.1055060 17.05 55274 169.50 55763 30.00 55837 54.5555061 54.55 55276 169.50 55764 160.00 55838 37.8555062 18.95 55278 169.50 55765 80.00 55839 18.9555063 49.15 55280 169.50 55766 65.00 55840 109.1055064 17.05 55282 169.50 55767 32.50 55841 54.5555065 98.25 55284 169.50 55768 150.00 55842 37.8555067 50.25 55292 169.50 55769 75.00 55843 18.9555068 35.00 55294 169.50 55770 60.00 55844 87.3555069 17.85 55296 111.05 55771 30.00 55845 43.7055070 98.25 55600 109.10 55772 160.00 55846 37.8555073 34.05 55601 54.55 55773 80.00 55847 18.9555076 109.10 55603 109.10 55774 65.00 55848 109.1055079 37.85 55604 54.55 55775 32.50 55849 54.5555084 98.25 55700 60.00 55800 109.10 55850 152.8555085 34.05 55701 30.00 55801 54.55 55851 76.4555113 230.65 55702 17.50 55802 37.85 55852 109.1055114 230.65 55703 35.00 55803 18.95 55853 54.5555115 230.65 55704 70.00 55804 109.10 55854 37.8555116 261.65 55705 35.00 55805 54.55 55855 18.9555117 261.65 55706 100.00 55806 37.85 56001 195.0555118 275.50 55707 70.00 55807 18.95 56007 250.0055119 115.35 55708 35.00 55808 109.10 56010 252.1055120 115.35 55709 38.00 55809 54.55 56013 250.00

Item 100% MBS Item 100% MBS Item 100% MBS Item 100% MBS

56016 290.00 56449 126.80 57703 54.00 57968 23.7056022 225.00 56452 181.50 57705 27.00 57969 47.4056028 336.80 56501 385.00 57706 32.50 58100 67.1556030 225.00 56507 480.05 57708 16.25 58102 33.6056036 336.80 56541 193.15 57709 43.40 58103 55.1056041 98.75 56547 243.75 57711 21.70 58105 27.5556047 126.10 56553 520.00 57712 47.15 58106 77.0056050 128.20 56555 260.00 57714 23.60 58108 110.0056053 128.20 56619 220.00 57715 60.90 58109 47.0056056 155.45 56625 334.65 57717 30.45 58111 38.5056062 113.15 56659 112.10 57721 99.25 58112 97.2556068 168.40 56665 167.40 57723 49.65 58114 55.0056070 113.15 56801 466.55 57901 64.50 58115 110.0056076 168.40 56807 560.00 57902 64.50 58117 23.5056101 230.00 56841 233.35 57903 47.30 58120 110.0056107 340.00 56847 283.85 57906 64.50 58121 110.0056141 116.45 57001 466.65 57909 64.50 58123 48.6556147 171.60 57007 567.75 57911 32.25 58124 55.0056219 326.20 57041 233.40 57912 47.15 58126 55.0056220 240.00 57047 283.90 57914 32.25 58127 55.0056221 240.00 57201 155.20 57915 47.15 58300 40.1056223 240.00 57247 77.55 57917 23.65 58302 20.0556224 351.40 57341 470.00 57918 47.15 58306 89.4056225 351.40 57345 241.60 57920 32.25 58308 44.7056226 351.40 57350 510.00 57921 47.15 58500 35.3556227 122.50 57351 510.00 57923 32.25 58502 17.7056228 122.50 57355 264.15 57924 47.15 58503 47.1556229 122.50 57356 264.15 57926 23.60 58505 23.6056230 177.45 57360 700.00 57927 49.65 58506 60.7556231 177.45 57361 350.00 57929 23.60 58508 30.4056232 177.45 57362 113.15 57930 32.90 58509 39.7556233 240.00 57363 56.60 57932 23.60 58511 19.9056234 351.40 57506 29.75 57933 78.25 58521 43.4056235 122.45 57509 39.75 57935 23.60 58523 21.7056236 177.45 57512 40.50 57938 23.60 58524 56.5056237 240.00 57515 54.00 57939 64.50 58526 28.2556238 351.40 57518 32.50 57941 24.85 58527 69.4056239 122.45 57521 43.40 57942 49.65 58529 34.7056240 177.45 57524 49.40 57944 16.45 58700 46.0556259 164.80 57527 65.75 57945 43.40 58702 23.0556301 295.00 57529 14.90 57947 39.15 58706 157.9056307 400.00 57530 19.90 57950 32.25 58708 78.9556341 149.45 57532 20.25 57953 24.85 58715 151.5556347 202.00 57533 27.00 57956 21.70 58717 75.8056401 250.00 57535 16.25 57959 23.70 58718 126.1056407 360.00 57536 21.70 57960 47.40 58720 63.0556409 250.00 57538 24.70 57962 23.70 58721 138.2556412 360.00 57539 32.90 57963 47.40 58723 69.1556441 126.80 57700 40.50 57965 23.70 58900 35.7056447 181.50 57702 20.25 57966 47.40 58902 17.85

Item 100% MBS Item 100% MBS Item 100% MBS Item 100% MBS

58903 47.60 59739 73.75 60051 827.10 61360 403.3558905 23.80 59740 36.90 60052 413.55 61361 461.4058909 89.95 59751 139.15 60054 1,176.10 61364 496.9558911 45.00 59752 69.60 60055 588.05 61368 223.1058912 110.25 59754 219.35 60057 1,376.30 61369 2,015.7558914 55.15 59755 109.70 60058 688.15 61372 223.1058915 78.95 59763 133.90 60060 564.00 61373 489.7058916 138.50 59764 66.95 60061 282.00 61376 143.3558917 39.50 59903 114.55 60063 827.10 61381 574.3558920 69.25 59912 305.20 60064 413.55 61383 624.9558921 135.25 59925 362.45 60066 1,176.10 61384 687.7058923 67.65 59970 168.30 60067 588.05 61386 332.5058927 76.45 59971 57.30 60069 1,376.30 61387 430.7558929 38.25 59972 152.60 60070 688.15 61389 370.5558933 205.60 59973 181.25 60072 48.10 61390 409.9558935 102.80 59974 84.20 60073 24.05 61393 605.5058936 195.95 60000 564.00 60075 96.10 61397 246.8558938 98.00 60001 282.00 60076 48.05 61401 162.3058939 139.30 60003 827.10 60078 144.25 61402 605.0558941 69.65 60004 413.55 60079 72.15 61405 346.0059103 21.30 60006 1,176.10 60100 60.75 61409 873.5059104 10.65 60007 588.05 60101 30.40 61413 225.9559300 89.50 60009 1,376.30 60500 43.40 61417 118.8559301 44.75 60010 688.15 60501 21.70 61421 479.8059303 53.95 60012 564.00 60503 29.75 61425 600.7059304 27.00 60013 282.00 60504 14.90 61426 554.8059306 100.30 60015 827.10 60506 63.75 61429 543.0059307 50.15 60016 413.55 60507 31.90 61430 659.4559309 200.60 60018 1,176.10 60509 98.90 61433 496.9559310 100.30 60019 588.05 60510 49.45 61434 615.4059312 87.00 60021 1,376.30 60918 47.15 61437 542.7559313 43.50 60022 688.15 60927 38.05 61438 672.9559314 52.50 60024 564.00 61109 258.90 61441 489.7059315 26.25 60025 282.00 61110 129.45 61442 752.3559318 47.05 60027 827.10 61302 448.85 61445 286.8059319 23.55 60028 413.55 61303 565.30 61446 333.5559700 96.55 60030 1,176.10 61306 709.70 61449 456.2059701 48.30 60031 588.05 61307 834.90 61450 397.5559703 75.90 60033 1,376.30 61310 367.30 61453 514.7059704 37.95 60034 688.15 61313 303.35 61454 348.1059712 113.70 60036 564.00 61314 420.00 61457 470.4559713 56.85 60037 282.00 61316 381.15 61458 396.9559715 143.55 60039 827.10 61317 492.40 61461 527.8559716 71.80 60040 413.55 61320 228.90 61462 129.0059718 134.65 60042 1,176.10 61328 227.65 61469 348.1059719 67.35 60043 588.05 61340 253.00 61473 175.4059724 226.45 60045 1,376.30 61348 443.35 61480 386.8559725 113.25 60046 688.15 61352 259.35 61484 880.8559733 107.70 60048 564.00 61353 386.60 61485 999.2059734 53.85 60049 282.00 61356 392.80 61495 223.10

Item 100% MBS Item 100% MBS Item 100% MBS Item 100% MBS

61499 253.00 61678 166.25 63040 336.00 63187 179.2061505 100.00 61679 215.40 63043 358.40 63188 179.2061523 953.00 61680 185.30 63046 403.20 63189 179.2061529 953.00 61681 205.00 63049 403.20 63190 179.2061538 901.00 61682 302.75 63052 403.20 63191 179.2061541 953.00 61683 123.45 63055 403.20 63192 179.2061553 999.00 61684 81.15 63058 403.20 63193 179.2061559 918.00 61685 302.55 63061 403.20 63194 179.2061565 953.00 61686 173.00 63064 403.20 63201 448.0061571 953.00 61687 436.75 63067 403.20 63204 448.0061575 953.00 61688 113.00 63070 403.20 63207 224.0061577 953.00 61689 59.45 63073 403.20 63208 224.0061598 953.00 61690 239.90 63074 168.00 63219 448.0061604 953.00 61691 300.35 63075 179.20 63222 448.0061610 953.00 61692 277.40 63076 201.60 63225 448.0061616 953.00 61693 271.50 63077 201.60 63228 448.0061620 953.00 61694 329.75 63078 201.60 63231 448.0061622 953.00 61695 248.50 63079 201.60 63234 448.0061628 953.00 61696 307.70 63080 201.60 63237 448.0061632 953.00 61697 271.40 63081 201.60 63240 448.0061640 999.00 61698 336.50 63082 201.60 63243 448.0061646 999.00 61699 244.85 63083 201.60 63257 224.0061650 878.70 61700 376.20 63084 201.60 63258 224.0061651 224.45 61701 143.40 63085 201.60 63259 224.0061652 282.65 61702 166.80 63101 492.80 63260 224.0061653 354.85 61703 228.10 63104 246.40 63261 224.0061654 417.45 61704 198.80 63111 492.80 63262 224.0061655 183.65 61705 257.35 63114 492.80 63263 224.0061656 151.70 61706 174.05 63117 246.40 63264 224.0061657 210.00 61707 235.25 63119 246.40 63265 224.0061658 190.60 61708 198.50 63125 492.80 63271 492.8061659 246.20 61709 263.95 63128 492.80 63274 492.8061660 114.45 61710 64.50 63131 492.80 63277 492.8061661 113.85 61712 174.05 63134 246.40 63280 492.8061662 126.50 61713 87.70 63135 246.40 63282 246.4061663 221.70 61714 193.45 63136 246.40 63283 246.4061664 129.70 61715 440.45 63151 358.40 63284 246.4061665 193.30 61716 499.60 63154 358.40 63285 246.4061666 196.40 61717 111.55 63157 179.20 63301 380.8061667 201.70 61718 126.50 63158 179.20 63304 380.8061668 230.70 61719 50.00 63161 358.40 63307 380.8061669 248.50 61729 439.35 63164 358.40 63310 190.4061670 111.55 63001 403.20 63167 358.40 63311 190.4061671 1,007.90 63004 403.20 63170 358.40 63313 190.4061672 111.55 63007 403.20 63173 358.40 63322 403.2061673 244.85 63010 336.00 63176 358.40 63325 403.2061674 71.70 63013 201.60 63179 358.40 63328 403.2061675 287.20 63014 201.60 63182 358.40 63331 403.2061676 312.50 63016 201.60 63185 358.40 63334 336.0061677 343.85 63017 168.00 63186 179.20 63337 448.00

Item 100% MBS Item 100% MBS63340 403.20 63491 44.8063341 201.60 63494 44.8063342 201.60 63497 156.8063343 201.60 63498 44.8063345 201.60 63499 156.8063346 168.00 63501 500.0063347 224.00 63502 500.0063348 201.60 63504 500.0063361 403.20 63505 500.0063364 201.60 63507 403.2063385 448.00 63508 201.6063388 448.00 63510 448.0063391 403.20 63511 224.0063392 224.00 63513 403.2063393 224.00 63514 201.6063394 201.60 63516 403.2063401 403.20 63517 201.6063404 403.20 63519 403.2063407 201.60 63520 201.6063408 201.60 63522 448.0063416 403.20 63523 224.0063419 201.60 63551 403.2063425 403.20 63552 201.6063428 403.20 63554 358.4063432 201.60 63555 179.2063433 201.60 63557 492.8063440 403.20 63558 246.4063443 403.20 63560 403.2063446 403.20 63561 201.6063447 201.60 63740 457.2063448 201.60 63741 265.2563449 201.60 63743 403.2063455 179.20 63744 228.6063457 345.00 63746 132.6563458 345.00 63747 201.6063461 358.40 64990 7.0563464 690.00 64991 10.6563467 690.0063470 403.2063473 627.2063476 403.2063479 201.6063481 313.6063482 403.2063484 201.6063486 201.6063487 690.0063488 345.0063489 1,440.0063490 720.00

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.

Item 100% MBS

65060 $7.8565066 $10.4065070 $16.9565072 $10.2065075 $51.9565078 $90.2065079 $90.2065081 $96.6065082 $96.6065084 $165.8565087 $83.1065090 $11.1565093 $22.0065096 $41.0065099 $108.9065102 $164.6065105 $108.9065108 $164.6065109 $12.9065110 $12.9065111 $23.2065114 $9.1065117 $20.2565120 $13.7065123 $20.3565126 $27.8565129 $35.5065137 $25.3565142 $25.3565144 $56.5565147 $37.9065150 $70.9065153 $141.8565156 $212.7565157 $70.9065158 $70.9065159 $70.9065162 $10.4565165 $34.4565166 $34.4565171 $25.3565175 $25.3565176 $48.6565177 $71.9565178 $95.2065179 $118.5065180 $25.3565181 $23.30

Item 100% MBS

66500 $9.7066503 $11.6566506 $13.6566509 $15.6566512 $17.7066517 $19.6566518 $20.0566519 $40.1566536 $11.0566539 $30.6066542 $18.9566545 $15.8066548 $19.9066551 $16.8066554 $16.8066557 $9.7066560 $20.1066563 $24.7066566 $33.7066569 $42.6066572 $51.5566575 $60.4566578 $69.3566581 $78.2566584 $9.7066587 $47.5566590 $30.6066593 $18.0066596 $32.5566605 $30.6066606 $30.6066607 $75.7566610 $75.7566623 $41.5066626 $24.1066629 $20.1066632 $20.1066635 $20.1066638 $49.0566639 $29.2066641 $29.2066642 $29.2066644 $20.1566647 $45.1066650 $24.3566651 $24.3566652 $20.3066653 $44.60

Item 100% MBS

66655 $20.1566656 $20.1566659 $37.3066660 $37.3066662 $79.9566663 $79.9566665 $30.6066666 $30.6066667 $30.6066671 $36.9066674 $39.9566677 $11.1566680 $74.4566683 $74.4566686 $50.6566695 $30.5066696 $30.5066697 $13.2066698 $43.7066701 $56.9066704 $70.1566707 $83.3566711 $30.1566712 $43.0566714 $30.1566715 $12.8566716 $25.0566719 $34.8066722 $37.9066723 $37.9066724 $13.1566725 $51.0566728 $64.2066731 $77.4066734 $90.5566743 $20.1066749 $32.9566750 $39.7566751 $55.2566752 $24.7066755 $38.8566756 $98.3066757 $98.3066758 $24.7066761 $13.1566764 $8.9066767 $17.8566770 $26.70

Item 100% MBS

66773 $24.6566776 $24.6566779 $39.9566780 $39.9566782 $13.1566783 $13.1566785 $39.9566788 $65.8566789 $39.9566790 $25.9066791 $74.4566792 $74.4566800 $18.1566803 $30.5066804 $18.1566805 $12.3566806 $41.8566812 $34.8066815 $59.5566816 $34.8066817 $24.7566819 $30.6066820 $30.6066821 $21.8066822 $52.4566825 $30.6066826 $30.6066827 $21.8066828 $52.4566830 $58.5066831 $30.9566832 $30.9566833 $30.0566834 $30.0566835 $39.0566836 $39.0566837 $39.0566838 $23.6066839 $42.9566840 $23.6066841 $16.8066900 $77.6569300 $12.5069303 $22.0069306 $33.7569309 $48.1569312 $33.7569316 $28.65

Item 100% MBS

69317 $35.8569318 $33.7569319 $42.9569321 $48.1569324 $43.0069325 $43.0069327 $85.0069328 $85.0069330 $128.0069331 $128.0069333 $20.5569336 $33.4569339 $19.1069345 $52.9069354 $30.7569357 $61.4569360 $92.2069363 $28.6569378 $180.2569379 $180.2569380 $770.3069381 $180.2569382 $180.2569383 $180.2569384 $15.6569387 $29.0069390 $42.3569393 $55.7069396 $69.1069400 $15.6569401 $13.3569405 $15.6569408 $29.0069411 $42.3569413 $55.7069415 $69.1069445 $92.2069451 $92.2069471 $34.9069472 $15.6569474 $28.6569475 $15.6569478 $29.2569481 $40.55

Item 100% MBS

69482 $152.1069483 $152.1069484 $17.1069488 $180.2569489 $180.2569491 $204.8069492 $204.8069494 $28.6569495 $35.8569496 $43.0569497 $28.6569498 $7.2069499 $92.2069500 $92.2071057 $32.9071058 $50.5071059 $35.6571060 $44.0571062 $44.0571064 $20.7571066 $14.5571068 $14.5571069 $22.7571071 $30.9571072 $14.5571073 $106.1571074 $14.5571075 $23.0071076 $106.1571077 $27.0571079 $26.8071081 $40.5571083 $20.1571085 $28.9571087 $37.7071089 $29.1571090 $29.1571091 $52.8571092 $23.7071093 $76.4571095 $40.5571096 $40.5571097 $24.4571099 $26.50

Item 100% MBS

71101 $17.4071103 $52.0571106 $11.3071119 $17.3571121 $20.8071123 $24.2571125 $27.6571127 $176.3571129 $217.8571131 $259.3571133 $10.4071134 $104.0571135 $207.9571137 $30.2571139 $104.0571141 $197.3571143 $260.0071145 $424.5071146 $104.0571147 $40.5571148 $40.5571149 $108.2571151 $118.8571153 $34.5571154 $34.5571155 $47.4571156 $12.8571157 $60.3071159 $73.1571163 $24.7571164 $39.9071165 $34.5571166 $47.4571167 $60.3071168 $73.1571169 $34.5571170 $12.8571180 $34.5571183 $47.4571186 $60.3071189 $15.5071192 $28.3571195 $40.0571198 $40.55

Item 100% MBS

71200 $59.6071203 $40.5572813 $71.5072816 $86.3572817 $96.8072818 $107.0572823 $97.1572824 $141.3572825 $180.2572826 $194.6072827 $208.9572828 $223.3072830 $274.1572836 $417.2072838 $466.8572844 $30.7572846 $59.6072847 $89.4072848 $74.5072849 $104.3072850 $119.2072851 $184.3572852 $245.8072855 $184.3572856 $245.8072857 $286.7572858 $180.0072859 $370.0073043 $22.8573045 $48.6073047 $94.7073049 $68.1573051 $170.3573059 $43.0073060 $57.3573061 $51.2073062 $89.0073063 $99.3573064 $71.7073065 $86.0073066 $221.4573067 $129.1573070 $35.0073071 $35.00

Item 100% MBS

73072 $35.0073073 $35.0073074 $35.0073075 $35.0073076 $46.0073287 $394.5573289 $358.9573290 $394.5573291 $230.9573292 $589.9073293 $230.9573294 $230.9573295 $1,200.0073296 $1,200.0073297 $400.0073300 $101.3073305 $202.6573308 $36.4573309 $36.4573311 $36.4573312 $36.4573314 $230.9573315 $230.9573317 $36.4573318 $36.4573320 $40.5573321 $40.5573323 $40.5573324 $40.9573325 $74.5073326 $230.9573327 $51.9573332 $315.4073333 $600.0073334 $340.0073335 $470.0073336 $230.9573337 $397.3573338 $362.6073339 $400.0073340 $200.0073341 $400.0073342 $315.4073343 $230.95

Item 100% MBS

73521 $9.7073523 $41.7573525 $28.3573527 $10.0073529 $28.6573801 $6.9073802 $4.5573803 $6.3573804 $8.1573805 $4.5573806 $10.1573807 $6.9073808 $8.6573809 $2.3573810 $6.9073811 $11.2073828 $6.9073829 $4.5573830 $6.3573831 $8.1573832 $4.5573833 $10.1573834 $6.9073835 $8.6573836 $2.3573837 $6.9073839 $16.8073840 $17.0073844 $20.3573899 $5.9573900 $2.4073920 $2.4073922 $8.2073923 $2.4073924 $14.6573925 $2.4073926 $8.2073927 $2.4073928 $5.9573929 $2.4073930 $5.9573931 $2.4073932 $10.2573933 $2.40

Item 100% MBS

73934 $17.6073935 $2.4073936 $5.9573937 $2.4073938 $7.9573939 $2.4073940 $10.2574990 $7.0574991 $10.6574992 $1.6074993 $3.7574994 $3.2574995 $4.0074996 $3.7074997 $3.3074998 $2.0074999 $1.6075150 $85.5575153 $43.0075156 $76.2575200 $54.9075203 $82.4575206 $27.3575400 $164.7575403 $189.2575406 $215.6575409 $244.2575412 $136.4075415 $164.7575600 $232.0575603 $272.7575606 $272.7575609 $407.1575612 $503.8575615 $186.5075618 $231.6075621 $231.6075800 $82.4575803 $329.7575806 $386.7575809 $457.9575812 $508.8575815 $620.9075818 $732.70

Item 100% MBS

75821 $590.1575824 $681.8075827 $783.7575830 $865.1075833 $1,058.3575836 $1,211.0575839 $27.3575842 $40.7575845 $203.6575848 $244.2575851 $122.1575854 $122.1580000 $99.7580001 $99.7580005 $124.6580010 $146.4580011 $146.4580015 $171.3580020 $37.2080021 $37.2081300 $62.2581325 $62.2582100 $53.4082105 $32.3082110 $53.4082115 $319.0082120 $753.3082125 $753.3082130 $53.4082135 $78.5082140 $53.4082150 $28.3082151 $53.7082152 $78.9582200 $9.6082205 $20.9582210 $39.7582215 $58.5582220 $28.3082221 $53.7082222 $78.9582223 $28.3082224 $53.7082225 $78.95

Item 100% MBS

82300 $153.9582306 $17.5082309 $21.0582312 $29.7082315 $39.3582318 $48.6082324 $26.3082327 $15.8082332 $46.85

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

Item 100% MBSDescription

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

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

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

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