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Department of Health and Mental Hygiene Professional Services Fee Schedule January 2017 Maryland Medical Assistance

Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

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Page 1: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Department of Health and Mental Hygiene

Professional Services Fee Schedule January 2017

Maryland Medical Assistance

Page 2: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Professional Services Fee Schedule January 2017

Maryland Medical Assistance FS-2

Overview

Professional Services Fee Schedule – January 2017

Introduction This Fee Schedule includes the current CPT codes and their

maximum reimbursement that the Physicians’ Services program

pays for each procedure. To clarify and assist providers in using

and navigating this Fee Schedule, it also contains information on

the limitations on its use, abbreviations in the schedule, and

electronic format information. All rates are based upon the

Medicare Part-B Fee Schedule.

In This Chapter This chapter contains:

TOPIC PAGE

Limitations of the Fee Schedule FS-2

Abbreviations Used in the Fee Schedule FS-3

Electronic Formats FS-5

Special Note FS-5 Fee Schedule FS-6

HCPCS Level II Fee Schedule

Fee Schedule

FS-97

Limitations of the Fee Schedule

All reimbursement rates and additional documentation

requirements only apply to professional services when recipients

have coverage under fee-for-service. Recipients with Managed

Care Organization (MCO) coverage through the HealthChoice

program may have different requirements.

This fee schedule does not contain reimbursement rates for all

of the HCPCS Level-II codes (beginning with Alpha characters A

through W) outside of the injectables that pertain to professional

services, digital mammography codes (G0202, G0204, and

G0206) and other replacement codes (G0453 and G0455).

Page 3: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Professional Services Fee Schedule January 2017

Maryland Medical Assistance FS-3

J- codes are now published in this fee schedule. All

providers must bill J-codes at their exact acquisition

costs, NOT usual and customary charges or average

wholesale price (AWP).

Limitations (cont.)

There are separate fee schedules for Durable Medical Equipment

(DME), Durable Medical Supplies (DMS), and Oxygen providers,

as well as laboratory and pathology codes in the 80000 series.

These schedules are available online at:

http://mmcp.dhmh.maryland.gov.

This fee schedule does not contain any CPT Category II

(Performance Measurement) or CPT Category III (Emerging

Technology & Procedures) codes. The Program does not

reimburse providers for these procedures.

Abbreviations Used in the Fee Schedule

The following abbreviations are used in the fee schedule:

Abbreviation Details

NFAC Non-Facility Fee. The Non-Facility Fee is the

fee schedule amount for services rendered in an

office, home, or school setting. For many

procedures, the Non-Facility and Facility rates are

identical. Certain procedures may have higher

non-facility rates compared to facility rates to

accommodate overhead and indirect expenses

providers incur by operating their own facility.

FAC Facility Fee. The Facility Fee is the fee schedule

amount for services rendered in a hospital

(inpatient or outpatient), psychiatric hospital

(inpatient or outpatient), nursing facility or skilled

nursing facility.

Page 4: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Professional Services Fee Schedule January 2017

Maryland Medical Assistance FS-4

26 Modifier 26. The Modifier -26 Fee is the amount for only the professional component

of a procedure, where applicable.

TC Modifier TC. The Modifier -TC Fee is the

amount for only the technical component of a

procedure, where applicable.

NOTE The NOTE column is used to designate whether

a code requires additional documentation, and

may contain one of four abbreviations, listed

below. The documentation for each of these

forms may be found at:

https://mmcp.dhmh.maryland.gov/Pages/Provid

er-Information.aspx.

A Abortion Form Required. Certain services

require the Certification for Abortion Form

(DHMH 521) to be completed and kept in the

patient’s Medical Record.

H Hysterectomy Form Required. Certain services

require the Document for Hysterectomy Form

(DHMH 2990) to be completed and kept in the

patient’s Medical Record.

S Sterilization Form Required. Certain services

require the Sterilization Consent Form (HHS-

687) to be completed and kept in the patient’s

Medical Record.

P Prior Authorization Required. Certain services

require prior authorization. Requests for

preauthorization are made in writing and must

document that the services are medically

necessary.

INVOICE /

REPORT

Rates with INVOICE / REPORT require

additional documentation in order to be

Abbreviations (cont.)

Page 5: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Maryland Medical Assistance FS-5

Professional Services Fee Schedule January 2017

priced. Documentation may include (but is not

limited to) medical notes, surgery notes, or

invoices from a manufacturer or wholesaler.

N.C.

Rates with N.C. are considered non-covered

services by the Program

N/A Rates with N/A are not considered an appropriate service for the designated Place of Service.

Electronic Formats The fee schedule is available in both PDF and Excel (.xls) versions

for your convenience. The reimbursement rates between these

two versions should be identical; if there are discrepancies,

please use the PDF version as the official rate.

To conveniently locate a specific code, please use the “Find”

search functions on your computer (On Windows: CTRL + F. On

Mac: CMD + F).

Special Note Please use G0453 in place of 95941, and G0455 in place of

44705. The rates for both of these replacement codes in this Fee

Schedule.

Page 6: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Maryland Medical Assistance FS-6

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

00100 1.1486 1.1486

00102 1.1486 1.1486

00103 1.1486 1.1486

00104 1.1486 1.1486

00120 1.1486 1.1486

00124 1.1486 1.1486

00126 1.1486 1.1486

00140 1.1486 1.1486

00142 1.1486 1.1486

00144 1.1486 1.1486

00145 1.1486 1.1486

00147 1.1486 1.1486

00148 1.1486 1.1486

00160 1.1486 1.1486

00162 1.1486 1.1486

00164 1.1486 1.1486

00170 1.5393 1.5393

00172 1.1486 1.1486

00174 1.1486 1.1486

00176 1.1486 1.1486

00190 1.1486 1.1486

00192 1.1486 1.1486

00210 1.1486 1.1486

00211 1.1486 1.1486

00212 1.1486 1.1486

00214 1.1486 1.1486

00215 1.1486 1.1486

00216 1.1486 1.1486

00218 1.1486 1.1486

00220 1.1486 1.1486

00222 1.1486 1.1486

00300 1.1486 1.1486

00320 1.1486 1.1486

00322 1.1486 1.1486

00326 1.1486 1.1486

00350 1.1486 1.1486

00352 1.1486 1.1486

00400 1.1486 1.1486

00402 1.1486 1.1486

00404 1.1486 1.1486

00406 1.1486 1.1486

CODE NOTE NFAC FAC 26 TC

00410 1.1486 1.1486

00450 1.1486 1.1486

00454 1.1486 1.1486

00470 1.1486 1.1486

00472 1.1486 1.1486

00474 1.1486 1.1486

00500 1.1486 1.1486

00520 1.1486 1.1486

00522 1.1486 1.1486

00524 1.1486 1.1486

00528 1.1486 1.1486

00529 1.1486 1.1486

00530 1.1486 1.1486

00532 1.1486 1.1486

00534 1.1486 1.1486

00537 1.1486 1.1486

00539 1.1486 1.1486

00540 1.1486 1.1486

00541 1.1486 1.1486

00542 1.1486 1.1486

00546 1.1486 1.1486

00548 1.1486 1.1486

00550 1.1486 1.1486

00560 1.1486 1.1486

00561 1.1486 1.1486

00562 1.1486 1.1486

00563 1.1486 1.1486

00566 1.1486 1.1486

00567 1.1486 1.1486

00580 1.1486 1.1486

00600 1.1486 1.1486

00604 1.1486 1.1486

00620 1.1486 1.1486

00625 1.0940 1.0940

00626 1.0940 1.0940

00630 1.1486 1.1486

00632 1.1486 1.1486

00635 1.1486 1.1486

00640 1.1486 1.1486

00670 1.1486 1.1486

00700 1.1486 1.1486

Page 7: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Maryland Medical Assistance FS-7

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

00702 1.1486 1.1486

00730 1.1486 1.1486

00740 1.1486 1.1486

00750 1.1486 1.1486

00752 1.1486 1.1486

00754 1.1486 1.1486

00756 1.1486 1.1486

00770 1.1486 1.1486

00790 1.1486 1.1486

00792 1.1486 1.1486

00794 1.1486 1.1486

00796 1.1486 1.1486

00797 1.1486 1.1486

00800 1.1486 1.1486

00802 P 1.1486 1.1486

00810 1.1486 1.1486

00820 1.1486 1.1486

00830 1.1486 1.1486

00832 1.1486 1.1486

00834 1.1486 1.1486

00836 1.1486 1.1486

00840 1.1486 1.1486

00842 1.1486 1.1486

00844 1.1486 1.1486

00846 H 1.1486 1.1486

00848 1.1486 1.1486

00851 S 1.1486 1.1486

00860 1.1486 1.1486

00862 1.1486 1.1486

00864 1.1486 1.1486

00865 1.1486 1.1486

00866 1.1486 1.1486

00868 1.1486 1.1486

00870 1.1486 1.1486

00872 1.1486 1.1486

00873 1.1486 1.1486

00880 1.1486 1.1486

00882 1.1486 1.1486

00902 1.1486 1.1486

00904 1.1486 1.1486

00906 1.1486 1.1486

00908 1.1486 1.1486

00910 1.1486 1.1486

CODE NOTE NFAC FAC 26 TC

00912 1.1486 1.1486

00914 1.1486 1.1486

00916 1.1486 1.1486

00918 1.1486 1.1486

00920 1.1486 1.1486

00921 S 1.1486 1.1486

00922 1.1486 1.1486

00924 1.1486 1.1486

00926 1.1486 1.1486

00928 1.1486 1.1486

00930 1.1486 1.1486

00932 1.1486 1.1486

00934 1.1486 1.1486

00936 1.1486 1.1486

00938 1.1486 1.1486

00940 1.1486 1.1486

00942 1.1486 1.1486

00944 H 1.1486 1.1486

00948 1.1486 1.1486

00950 1.1486 1.1486

00952 1.1486 1.1486

01112 1.1486 1.1486

01120 1.1486 1.1486

01130 1.1486 1.1486

01140 1.1486 1.1486

01150 1.1486 1.1486

01160 1.1486 1.1486

01170 1.1486 1.1486

01173 1.1486 1.1486

01180 1.1486 1.1486

01190 1.1486 1.1486

01200 1.1486 1.1486

01202 1.1486 1.1486

01210 1.1486 1.1486

01212 1.1486 1.1486

01214 1.1486 1.1486

01215 1.1486 1.1486

01220 1.1486 1.1486

01230 1.1486 1.1486

01232 1.1486 1.1486

01234 1.1486 1.1486

01250 1.1486 1.1486

01260 1.1486 1.1486

Page 8: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Maryland Medical Assistance FS-8

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

01270 1.1486 1.1486

01272 1.1486 1.1486

01274 1.1486 1.1486

01320 1.1486 1.1486

01340 1.1486 1.1486

01360 1.1486 1.1486

01380 1.1486 1.1486

01382 1.1486 1.1486

01390 1.1486 1.1486

01392 1.1486 1.1486

01400 1.1486 1.1486

01402 1.1486 1.1486

01404 1.1486 1.1486

01420 1.1486 1.1486

01430 1.1486 1.1486

01432 1.1486 1.1486

01440 1.1486 1.1486

01442 1.1486 1.1486

01444 1.1486 1.1486

01462 1.1486 1.1486

01464 1.1486 1.1486

01470 1.1486 1.1486

01472 1.1486 1.1486

01474 1.1486 1.1486

01480 1.1486 1.1486

01482 1.1486 1.1486

01484 1.1486 1.1486

01486 1.1486 1.1486

01490 1.1486 1.1486

01500 1.1486 1.1486

01502 1.1486 1.1486

01520 1.1486 1.1486

01522 1.1486 1.1486

01610 1.1486 1.1486

01620 1.1486 1.1486

01622 1.1486 1.1486

01630 1.1486 1.1486

01634 1.1486 1.1486

01636 1.1486 1.1486

01638 1.1486 1.1486

01650 1.1486 1.1486

01652 1.1486 1.1486

01654 1.1486 1.1486

CODE NOTE NFAC FAC 26 TC

01656 1.1486 1.1486

01670 1.1486 1.1486

01680 1.1486 1.1486

01682 1.1486 1.1486

01710 1.1486 1.1486

01712 1.1486 1.1486

01714 1.1486 1.1486

01716 1.1486 1.1486

01730 1.1486 1.1486

01732 1.1486 1.1486

01740 1.1486 1.1486

01742 1.1486 1.1486

01744 1.1486 1.1486

01756 1.1486 1.1486

01758 1.1486 1.1486

01760 1.1486 1.1486

01770 1.1486 1.1486

01772 1.1486 1.1486

01780 1.1486 1.1486

01782 1.1486 1.1486

01810 1.1486 1.1486

01820 1.1486 1.1486

01829 1.1486 1.1486

01830 1.1486 1.1486

01832 1.1486 1.1486

01840 1.1486 1.1486

01842 1.1486 1.1486

01844 1.1486 1.1486

01850 1.1486 1.1486

01852 1.1486 1.1486

01860 1.1486 1.1486

01916 1.1486 1.1486

01920 1.1486 1.1486

01922 1.1486 1.1486

01924 1.1486 1.1486

01925 1.1486 1.1486

01926 1.1486 1.1486

01930 1.1486 1.1486

01931 1.1486 1.1486

01932 1.1486 1.1486

01933 1.1486 1.1486

01935 1.2943 1.2943

01936 1.2943 1.2943

Page 9: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Maryland Medical Assistance FS-9

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

01951 1.1486 1.1486

01952 1.1486 1.1486

01953 1.1486 1.1486

01958 1.2479 1.2479

01960 1.2479 1.2479

01961 1.2479 1.2479

01962 H 1.2479 1.2479

01963 H 1.2479 1.2479

01965 1.2479 1.2479

01966 A 1.2479 1.2479

01967 1.2479 1.2479

01968 1.2479 1.2479

01969 H 1.2479 1.2479

01990 1.1486 1.1486

01991 1.1486 1.1486

01992 1.1486 1.1486

01996 1.1486 1.1486

01999 REPORT REPORT

10021 103.10 55.22

10022 112.07 51.65

10030 649.73 129.95

10035 471.14 74.96

10036 410.56 37.77

10040 80.70 70.44

10060 93.07 77.39

10061 163.48 142.67

10080 143.14 82.14

10081 214.01 134.78

10120 121.33 82.28

10121 217.74 147.62

10140 129.70 94.07

10160 103.10 76.31

10180 196.99 143.41

11000 42.94 23.50

11001 16.93 11.90

11004 464.61 464.61

11005 630.91 630.91

11006 566.22 566.22

11008 221.87 221.87

11010 404.71 228.86

11011 429.49 240.81

11012 568.64 342.62

11042 92.58 48.98

CODE NOTE NFAC FAC 26 TC

11043 187.00 128.88

11044 252.62 223.59

11045 32.37 20.69

11046 58.28 44.88

11047 99.02 79.92

11055 37.89 16.96

11056 46.19 23.79

11057 51.64 31.24

11100 82.38 39.06

11101 25.95 19.96

11200 70.39 58.99

11201 14.98 13.27

11300 78.39 28.23

11301 96.21 42.91

11302 113.42 50.43

11303 125.12 59.57

11305 78.83 30.95

11306 97.77 41.34

11307 114.85 53.29

11308 120.02 58.17

11310 91.23 37.93

11311 88.24 52.33

11312 128.49 62.65

11313 148.79 80.39

11400 99.10 64.61

11401 118.83 83.21

11402 132.34 91.30

11403 153.02 118.25

11404 173.86 130.25

11406 250.13 197.98

11420 97.39 65.18

11421 124.49 88.01

11422 139.67 108.60

11423 160.34 125.57

11424 186.09 144.20

11426 265.45 220.13

11440 107.07 82.28

11441 133.57 104.79

11442 149.55 116.20

11443 178.19 142.57

11444 223.84 181.66

11446 310.38 260.51

11450 305.43 203.11

Page 10: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Maryland Medical Assistance FS-10

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

11451 388.63 261.23

11462 298.46 194.15

11463 393.50 262.39

11470 329.10 225.07

11471 407.63 280.23

11600 153.38 95.52

11601 182.48 119.49

11602 197.88 131.19

11603 226.00 157.30

11604 251.28 173.18

11606 359.18 257.15

11620 154.85 96.71

11621 183.64 120.36

11622 204.57 137.88

11623 239.60 170.33

11624 270.38 193.14

11626 325.14 236.50

11640 159.93 100.07

11641 189.77 125.36

11642 216.57 147.88

11643 254.86 185.03

11644 313.81 228.59

11646 409.79 317.44

11719 14.02 6.85

11720 25.40 12.49

11721 35.32 21.42

11730 82.95 43.75

11732 31.83 17.30

11740 39.31 25.91

11750 141.90 111.52

11755 105.34 61.42

11760 150.09 97.47

11762 220.54 148.03

11765 133.12 74.68

11770 221.36 148.40

11771 458.00 348.55

11772 554.97 462.63

11900 44.30 24.93

11901 55.61 38.79

11920 142.37 91.10

11921 161.06 107.21

11922 48.96 23.88

11950 61.91 42.53

CODE NOTE NFAC FAC 26 TC

11951 79.42 58.05

11952 102.40 74.38

11954 125.60 91.97

11960 762.45 762.45

11970 488.59 488.59

11971 375.55 255.28

11976 112.83 74.35

11980 75.47 57.79

11981 112.44 66.27

11982 127.45 80.42

11983 178.37 139.62

12001 88.44 43.48

12002 113.25 57.47

12004 132.79 71.87

12005 165.27 93.29

12006 205.54 114.91

12007 231.38 144.22

12011 113.41 54.10

12013 124.53 56.66

12014 131.12 73.06

12015 158.75 92.20

12016 216.91 125.69

12017 153.39 153.39

12018 173.49 173.49

12020 223.31 150.64

12021 128.91 109.81

12031 189.45 123.04

12032 242.02 156.80

12034 248.65 166.57

12035 303.67 192.52

12036 335.69 223.68

12037 383.95 263.96

12041 188.98 120.86

12042 230.25 161.27

12044 286.14 172.14

12045 319.16 216.27

12046 380.19 249.08

12047 437.22 296.70

12051 205.50 137.67

12052 234.13 164.01

12053 275.07 174.74

12054 286.60 178.01

12055 371.36 244.53

Page 11: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Maryland Medical Assistance FS-11

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

12056 389.23 273.22

12057 432.93 314.65

13100 266.77 165.59

13101 315.67 203.95

13102 96.75 59.70

13120 278.99 190.06

13121 340.34 219.92

13122 106.18 68.84

13131 307.08 201.05

13132 379.17 318.40

13133 142.17 105.69

13151 336.21 231.05

13152 403.24 298.96

13153 154.50 113.74

13160 642.93 642.93

14000 496.45 403.81

14001 640.28 527.70

14020 555.48 456.58

14021 694.32 577.46

14040 606.64 507.45

14041 751.90 628.42

14060 618.27 540.46

14061 809.18 680.89

14301 858.91 708.71

14302 177.77 177.77

14350 545.36 545.36

15002 277.03 182.12

15003 60.32 36.66

15004 318.27 215.37

15005 99.50 73.28

15040 203.42 102.53

15050 446.99 355.50

15100 685.04 574.75

15101 148.84 89.55

15110 632.05 551.11

15111 92.34 83.22

15115 636.06 555.12

15116 130.15 118.75

15120 677.64 558.78

15121 202.65 128.22

15130 532.87 449.36

15131 71.76 65.77

15135 666.96 585.17

CODE NOTE NFAC FAC 26 TC

15136 68.54 64.26

15150 546.96 501.64

15151 96.41 89.00

15152 118.03 110.91

15155 570.10 527.91

15156 130.12 123.28

15157 146.20 136.51

15200 663.45 540.33

15201 116.94 63.08

15220 615.41 494.56

15221 109.10 57.51

15240 744.47 644.43

15241 147.25 89.39

15260 807.02 690.45

15261 171.45 112.45

15271 123.76 74.49

15272 23.24 14.64

15273 253.76 177.76

15274 59.63 37.37

15275 132.51 86.20

15276 28.62 20.90

15277 260.27 182.67

15278 70.03 46.44

15570 729.59 590.79

15572 710.26 600.53

15574 726.79 614.21

15576 641.91 537.60

15600 258.73 166.21

15610 285.20 194.85

15620 349.08 260.73

15630 366.56 278.21

15650 403.67 307.63

15731 895.83 806.05

15732 1,075.29 929.59

15734 1,200.98 1,058.47

15736 1,053.36 913.13

15738 1,116.72 985.05

15740 811.75 684.64

15750 735.14 735.14

15756 1,856.40 1,856.40

15757 1,828.61 1,828.61

15758 1,834.57 1,834.57

15760 679.54 568.10

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Maryland Medical Assistance FS-12

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

15770 535.33 535.33

15775 N.C. N.C.

15776 N.C. N.C.

15777 182.07 182.07

15780 P 686.71 517.99

15781 P 443.32 347.56

15782 P 511.01 359.38

15783 N.C. N.C.

15786 P 195.31 108.38

15787 P 39.45 13.41

15788 P 368.52 197.50

15789 P 444.69 340.66

15792 P 350.75 207.39

15793 P 395.43 295.96

15819 P 634.87 634.87

15820 P 465.38 418.36

15821 P 480.00 430.41

15822 P 353.30 309.69

15823 P 479.65 429.48

15824 P 218.00 218.00

15825 P 205.00 205.00

15826 P 185.00 185.00

15828 P 656.00 656.00

15829 656.00 656.00

15830 P 941.61 941.61

15832 P 732.71 732.71

15833 P 684.00 684.00

15834 P 711.15 711.15

15835 P 731.64 731.64

15836 P 631.24 631.24

15837 P 682.44 570.71

15838 P 453.27 453.27

15839 P 703.52 590.09

15840 801.76 801.76

15841 1,267.48 1,267.48

15842 1,942.96 1,942.96

15845 792.99 792.99

15847 P 312.72 312.72

15850 N.C. N.C.

15851 78.50 36.03

15852 37.36 37.36

15860 87.94 87.94

15876 N.C. N.C.

CODE NOTE NFAC FAC 26 TC

15877 N.C. N.C.

15878 N.C. N.C.

15879 N.C. N.C.

15920 498.37 498.37

15922 626.37 626.37

15931 552.06 552.06

15933 678.04 678.04

15934 747.71 747.71

15935 884.52 884.52

15936 713.76 713.76

15937 826.54 826.54

15940 561.02 561.02

15941 719.60 719.60

15944 712.59 712.59

15945 787.02 787.02

15946 1,310.17 1,310.17

15950 475.03 475.03

15951 695.25 695.25

15952 719.01 719.01

15953 797.09 797.09

15956 920.49 920.49

15958 939.48 939.48

15999 REPORT REPORT REPORT REPORT

16000 54.58 36.34

16020 65.11 43.16

16025 117.04 88.82

16030 147.83 107.07

16035 154.32 154.32

16036 65.13 65.13

17000 53.00 42.46

17003 5.47 2.43

17004 123.69 96.08

17106 273.93 232.37

17107 423.96 347.52

17108 537.14 448.67

17110 88.50 56.00

17111 104.95 68.75

17250 63.15 29.52

17260 75.37 56.27

17261 114.03 73.27

17262 139.12 93.23

17263 151.94 103.20

17264 162.28 109.83

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Maryland Medical Assistance FS-13

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

17266 184.83 129.25

17270 119.84 80.22

17271 129.85 88.81

17272 147.99 102.10

17273 165.28 115.69

17274 195.33 141.46

17276 225.21 168.78

17280 112.36 73.03

17281 141.53 100.20

17282 162.45 115.14

17283 194.42 143.97

17284 221.92 168.06

17286 284.12 225.12

17311 527.20 303.47

17312 310.24 161.46

17313 493.00 272.11

17314 297.72 149.80

17315 63.81 42.72

17340 40.77 38.77

17360 102.03 78.66

17380 N.C. N.C.

17999 REPORT REPORT REPORT REPORT

19000 90.02 34.72

19001 21.33 17.34

19020 378.93 246.11

19030 131.28 61.74

19081 560.46 151.32

19082 459.58 72.60

19083 556.79 139.20

19084 447.68 67.15

19085 844.09 168.82

19086 673.43 74.08

19100 120.65 56.24

19101 273.03 177.83

19105 1,891.10 159.36

19110 389.02 275.58

19112 368.89 251.75

19120 395.48 332.49

19125 438.40 369.14

19126 130.37 130.37

19260 968.18 968.18

19271 1,310.15 1,310.15

19272 1,432.76 1,432.76

CODE NOTE NFAC FAC 26 TC

19281 200.15 84.06

19282 139.37 40.33

19283 227.75 84.27

19284 167.56 41.01

19285 415.51 69.87

19286 363.25 35.89

19287 721.07 115.37

19288 574.44 51.70

19296 3,383.91 169.78

19297 76.63 76.63

19298 974.95 250.54

19300 419.59 332.09

19301 524.53 524.53

19302 723.93 723.93

19303 812.83 812.83

19304 464.00 464.00

19305 908.71 908.71

19306 954.54 954.54

19307 962.94 962.94

19316 P 617.96 617.96

19318 P 883.96 883.96

19324 P 397.42 397.42

19325 P 514.69 514.69

19328 397.20 397.20

19330 508.34 508.34

19340 805.07 805.07

19342 739.67 739.67

19350 659.10 540.25

19355 559.28 458.39

19357 1,209.77 1,209.77

19361 1,263.96 1,263.96

19364 2,210.66 2,210.66

19366 1,131.93 1,131.93

19367 1,434.28 1,434.28

19368 1,766.72 1,766.72

19369 1,623.34 1,623.34

19370 550.47 550.47

19371 629.02 629.02

19380 620.69 620.69

19396 234.38 117.24

19499 REPORT REPORT REPORT REPORT

20005 284.10 225.06

20100 560.97 560.97

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Maryland Medical Assistance FS-14

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

20101 369.21 190.29

20102 431.37 229.10

20103 526.64 335.05

20150 873.00 873.00

20200 179.71 87.88

20205 244.71 138.90

20206 249.31 60.66

20220 170.72 75.97

20225 578.61 116.01

20240 168.51 168.51

20245 390.98 390.98

20250 359.58 359.58

20251 400.20 400.20

20500 110.56 90.73

20501 124.99 37.95

20520 177.88 134.82

20525 436.68 237.25

20526 72.19 55.72

20527 81.44 63.52

20550 55.68 39.49

20551 54.91 41.14

20552 49.68 33.24

20553 55.25 36.75

20555 308.81 308.81

20600 52.12 38.75

20604 77.19 48.52

20605 54.87 40.05

20606 84.75 54.90

20610 66.20 47.91

20611 97.57 64.97

20612 56.15 41.59

20615 203.48 151.25

20650 186.37 149.30

20660 243.83 221.47

20661 441.58 441.58

20662 444.42 444.42

20663 424.01 424.01

20664 718.49 718.49

20665 115.09 97.04

20670 370.27 143.07

20680 552.55 380.32

20690 477.55 477.55

20692 897.03 897.03

CODE NOTE NFAC FAC 26 TC

20693 440.42 440.42

20694 401.45 322.16

20696 1,047.65 1,047.65

20697 1,702.50 1,702.50

20802 2,278.94 2,278.94

20805 2,882.28 2,882.28

20808 3,872.92 3,872.92

20816 2,189.48 2,189.48

20822 1,863.05 1,863.05

20824 2,156.51 2,156.51

20827 1,927.89 1,927.89

20838 2,227.10 2,227.10

20900 405.93 209.66

20902 316.55 316.55

20910 409.47 409.47

20912 459.59 459.59

20920 383.50 383.50

20922 566.36 459.71

20924 484.08 484.08

20926 415.06 415.06

20930 61.00 61.00

20931 110.40 110.40

20936 94.00 94.00

20937 166.89 166.89

20938 182.11 182.11

20950 232.24 88.14

20955 2,418.90 2,418.90

20956 2,577.68 2,577.68

20957 2,418.15 2,418.15

20962 2,356.19 2,356.19

20969 2,687.89 2,687.89

20970 2,700.06 2,700.06

20972 2,398.41 2,398.41

20973 2,608.16 2,608.16

20974 62.04 46.20

20975 172.21 172.21

20979 50.93 35.26

20982 1,888.51 388.24

20983 7,004.92 406.63

20985 143.57 143.57

20999 REPORT REPORT REPORT REPORT

21010 685.11 685.11

21011 319.30 248.73

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Maryland Medical Assistance FS-15

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

21012 340.02 340.02

21013 494.51 399.56

21014 524.39 418.86

21015 567.77 567.77

21016 1,052.94 818.52

21025 835.49 712.34

21026 551.15 456.35

21029 701.95 592.02

21030 459.05 379.36

21031 354.65 273.51

21032 361.52 269.26

21034 1,251.03 1,113.17

21040 460.68 374.35

21044 826.77 826.77

21045 1,145.50 1,145.50

21046 1,022.01 1,022.01

21047 1,236.57 1,236.57

21048 1,038.35 1,038.35

21049 1,183.44 1,183.44

21050 807.67 807.67

21060 745.14 745.14

21070 609.93 609.93

21073 344.25 223.52

21076 924.64 808.32

21077 2,272.11 2,036.95

21079 1,556.42 1,350.51

21080 1,770.63 1,522.03

21081 1,613.16 1,382.96

21082 1,504.63 1,284.35

21083 1,429.17 1,189.07

21084 1,611.17 1,345.81

21085 657.69 548.64

21086 1,663.01 1,497.54

21087 1,653.19 1,488.53

21088 1,273.04 1,273.04

21089 REPORT REPORT REPORT REPORT

21100 674.60 373.80

21110 685.14 593.13

21116 140.94 41.06

21120 581.14 467.18

21121 710.84 609.83

21122 680.26 680.26

21123 797.85 797.85

CODE NOTE NFAC FAC 26 TC

21125 2,820.54 693.29

21127 3,553.23 819.38

21137 686.41 686.41

21138 851.99 851.99

21139 918.75 918.75

21141 1,264.40 1,264.40

21142 1,236.52 1,236.52

21143 1,299.79 1,299.79

21145 1,459.33 1,459.33

21146 1,451.35 1,451.35

21147 1,556.15 1,556.15

21150 1,604.29 1,604.29

21151 1,771.84 1,771.84

21154 1,952.49 1,952.49

21155 2,266.89 2,266.89

21159 2,672.25 2,672.25

21160 2,754.14 2,754.14

21172 1,682.30 1,682.30

21175 1,958.93 1,958.93

21179 1,389.07 1,389.07

21180 1,576.16 1,576.16

21181 676.02 676.02

21182 1,909.98 1,909.98

21183 2,195.03 2,195.03

21184 2,291.33 2,291.33

21188 1,543.15 1,543.15

21193 1,176.70 1,176.70

21194 1,336.53 1,336.53

21195 1,267.62 1,267.62

21196 1,381.46 1,381.46

21198 1,081.54 1,081.54

21199 957.73 957.73

21206 1,051.88 1,051.88

21208 1,550.68 778.75

21209 759.93 604.30

21210 1,843.41 782.65

21215 3,259.21 817.07

21230 729.84 729.84

21235 674.98 528.17

21240 1,059.62 1,059.62

21242 969.05 969.05

21243 1,584.29 1,584.29

21244 982.21 982.21

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Maryland Medical Assistance FS-16

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

21245 1,065.50 859.11

21246 810.98 810.98

21247 1,537.56 1,537.56

21248 989.20 829.64

21249 1,387.19 1,180.36

21255 1,322.28 1,322.28

21256 1,084.62 1,084.62

21260 1,163.37 1,163.37

21261 2,072.57 2,072.57

21263 1,818.43 1,818.43

21267 1,461.47 1,461.47

21268 1,728.79 1,728.79

21270 847.91 652.47

21275 756.96 756.96

21280 486.63 486.63

21282 325.27 325.27

21295 163.81 163.81

21296 381.99 381.99

21299 REPORT REPORT REPORT REPORT

21310 106.65 26.87

21315 242.38 138.69

21320 233.53 129.84

21325 438.61 438.61

21330 538.80 538.80

21335 692.34 692.34

21336 599.89 599.89

21337 362.50 266.44

21338 691.72 691.72

21339 769.28 769.28

21340 747.71 747.71

21343 1,085.71 1,085.71

21344 1,421.05 1,421.05

21345 750.49 616.15

21346 898.71 898.71

21347 1,043.83 1,043.83

21348 1,111.62 1,111.62

21355 406.21 296.78

21356 456.42 350.80

21360 497.91 497.91

21365 1,032.14 1,032.14

21366 1,166.73 1,166.73

21385 672.30 672.30

21386 624.66 624.66

CODE NOTE NFAC FAC 26 TC

21387 703.51 703.51

21390 712.12 712.12

21395 905.27 905.27

21400 163.02 132.89

21401 438.73 268.77

21406 507.97 507.97

21407 598.90 598.90

21408 818.19 818.19

21421 684.64 580.35

21422 633.22 633.22

21423 752.49 752.49

21431 690.77 690.77

21432 628.61 628.61

21433 1,575.63 1,575.63

21435 1,240.59 1,240.59

21436 1,776.79 1,776.79

21440 475.75 403.29

21445 683.74 577.90

21450 501.36 428.80

21451 665.88 577.71

21452 559.25 305.63

21453 766.19 697.16

21454 519.05 519.05

21461 1,735.86 859.70

21462 1,852.31 946.35

21465 860.00 860.00

21470 1,112.82 1,112.82

21480 84.47 30.45

21485 588.62 516.57

21490 869.86 869.86

21497 600.47 516.40

21499 REPORT REPORT REPORT REPORT

21501 405.89 296.10

21502 495.98 495.98

21510 438.94 438.94

21550 237.73 147.94

21552 481.20 359.24

21554 743.25 743.25

21555 400.75 305.45

21556 424.60 424.60

21557 770.20 770.20

21558 1,394.48 1,394.48

21600 518.71 518.71

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Maryland Medical Assistance FS-17

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

21610 1,015.43 1,015.43

21615 644.68 644.68

21616 793.46 793.46

21620 498.72 498.72

21627 524.28 524.28

21630 1,196.80 1,196.80

21632 1,182.65 1,182.65

21685 927.59 927.59

21700 396.99 396.99

21705 591.15 591.15

21720 403.28 403.28

21725 503.24 503.24

21740 1,024.35 1,024.35

21742 803.78 803.78

21743 REPORT REPORT REPORT REPORT

21750 680.65 680.65

21811 571.72 592.93

21812 683.69 704.88

21813 934.22 950.76

21820 121.18 122.69

21825 541.90 541.90

21899 REPORT REPORT REPORT REPORT

21920 233.08 144.32

21925 391.42 311.61

21930 436.70 343.46

21931 474.66 474.66

21932 681.68 681.68

21933 751.09 751.09

21935 1,087.49 1,087.49

21936 1,452.40 1,452.40

22010 844.58 844.58

22015 838.73 838.73

22100 769.30 769.30

22101 766.00 766.00

22102 768.11 768.11

22103 139.08 139.08

22110 947.41 947.41

22112 940.44 940.44

22114 944.31 944.31

22116 139.80 139.80

22206 2,217.30 2,217.30

22207 2,189.30 2,189.30

22208 559.51 559.51

CODE NOTE NFAC FAC 26 TC

22210 1,673.33 1,673.33

22212 1,378.23 1,378.23

22214 1,392.39 1,392.39

22216 365.44 365.44

22220 1,515.18 1,515.18

22222 1,373.72 1,373.72

22224 1,488.80 1,488.80

22226 363.82 363.82

22310 262.58 243.44

22315 806.64 708.96

22318 1,511.71 1,511.71

22319 1,660.16 1,660.16

22325 1,308.76 1,308.76

22326 1,374.79 1,374.79

22327 1,353.22 1,353.22

22328 274.10 274.10

22505 118.95 118.95

22510 1,863.03 479.39

22511 1,847.01 449.35

22512 1,054.99 217.64

22513 7,997.25 547.71

22514 7,951.85 511.92

22515 4,854.20 228.08

22526 1,861.50 334.24

22527 1,574.45 151.82

22532 1,626.07 1,626.07

22533 1,510.12 1,510.12

22534 359.51 359.51

22548 1,753.57 1,753.57

22551 1,844.50 1,844.50

22552 428.47 428.47

22554 1,235.29 1,235.29

22556 1,562.63 1,562.63

22558 1,416.90 1,416.90

22585 334.35 334.35

22586 1,646.97 1,646.97

22590 1,454.06 1,454.06

22595 1,382.55 1,382.55

22600 1,183.44 1,183.44

22610 1,168.24 1,168.24

22612 1,509.53 1,509.53

22614 389.32 389.32

22630 1,457.63 1,457.63

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Maryland Medical Assistance FS-18

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

22632 316.79 316.79

22633 2,006.97 2,006.97

22634 540.78 540.78

22800 1,287.25 1,287.25

22802 2,045.16 2,045.16

22804 2,366.85 2,366.85

22808 1,735.09 1,735.09

22810 1,937.88 1,937.88

22812 2,120.48 2,120.48

22818 2,131.75 2,131.75

22819 2,417.54 2,417.54

22830 771.98 771.98

22840 762.10 762.10

22841 200.00 200.00

22842 762.12 762.12

22843 805.78 805.78

22844 988.68 988.68

22845 730.09 730.09

22846 758.70 758.70

22847 831.71 831.71

22848 359.74 359.74

22849 1,243.39 1,243.39

22850 682.36 682.36

22852 652.62 652.62

22853 266.68 266.68

22854 345.21 345.21

22855 1,054.73 1,054.73

22856 1,612.07 1,612.07

22857 1,646.93 1,646.93

22858 565.48 565.48

22859 345.21 345.21

22861 1,943.36 1,943.36

22862 1,916.66 1,916.66

22864 1,809.21 1,809.21

22865 1,910.87 1,910.87

22867 998.44 998.44

22868 248.92 248.92

22869 548.20 548.20

22870 144.92 144.92

22899 REPORT REPORT REPORT REPORT

22900 454.83 454.83

22901 670.16 670.16

22902 425.49 338.90

CODE NOTE NFAC FAC 26 TC

22903 443.64 443.64

22904 1,048.07 1,048.07

22905 1,359.40 1,359.40

22999 REPORT REPORT REPORT REPORT

23000 495.64 339.36

23020 658.81 658.81

23030 396.06 245.48

23031 361.60 203.40

23035 654.77 654.77

23040 686.03 686.03

23044 545.18 545.18

23065 195.91 153.57

23066 471.12 320.55

23071 421.92 421.92

23073 698.32 698.32

23075 376.97 262.96

23076 528.60 528.60

23077 1,107.53 1,107.53

23078 1,414.43 1,414.43

23100 463.61 463.61

23101 426.84 426.84

23105 607.43 607.43

23106 452.55 452.55

23107 632.39 632.39

23120 535.91 535.91

23125 669.51 669.51

23130 575.30 575.30

23140 485.79 485.79

23145 656.01 656.01

23146 573.67 573.67

23150 617.42 617.42

23155 750.65 750.65

23156 641.46 641.46

23170 504.30 504.30

23172 515.46 515.46

23174 715.93 715.93

23180 654.32 654.32

23182 630.81 630.81

23184 712.86 712.86

23190 528.48 528.48

23195 711.89 711.89

23200 1,214.46 1,214.46

23210 1,420.99 1,420.99

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Maryland Medical Assistance FS-19

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

23220 1,565.30 1,565.30

23330 208.03 140.17

23333 474.57 474.57

23334 1,117.79 1,117.79

23335 1,331.95 1,331.95

23350 143.37 50.06

23395 1,224.25 1,224.25

23397 1,095.97 1,095.97

23400 933.53 933.53

23405 603.17 603.17

23406 753.00 753.00

23410 806.34 806.34

23412 843.37 843.37

23415 671.02 671.02

23420 941.06 941.06

23430 710.97 710.97

23440 733.88 733.88

23450 917.87 917.87

23455 976.71 976.71

23460 1,057.22 1,057.22

23462 1,033.50 1,033.50

23465 1,076.03 1,076.03

23466 1,057.93 1,057.93

23470 1,173.06 1,173.06

23472 1,444.66 1,444.66

23473 1,760.15 1,760.15

23474 1,901.48 1,901.48

23480 790.11 790.11

23485 926.41 926.41

23490 779.84 779.84

23491 979.50 979.50

23500 192.04 190.68

23505 317.85 301.45

23515 648.67 648.67

23520 199.58 200.72

23525 309.03 289.22

23530 513.86 513.86

23532 592.17 592.17

23540 196.36 192.45

23545 282.80 260.69

23550 544.75 544.75

23552 627.87 627.87

23570 205.97 208.65

CODE NOTE NFAC FAC 26 TC

23575 351.14 331.30

23585 865.78 865.78

23600 288.03 266.69

23605 426.69 394.69

23615 817.62 817.62

23616 1,255.64 1,255.64

23620 237.36 224.02

23625 345.71 325.14

23630 686.54 686.54

23650 265.02 241.91

23655 353.56 353.56

23660 551.86 551.86

23665 384.13 362.00

23670 764.06 764.06

23675 502.71 466.11

23680 841.29 841.29

23700 186.19 186.19

23800 978.57 978.57

23802 1,156.60 1,156.60

23900 1,271.46 1,271.46

23920 1,029.31 1,029.31

23921 374.46 374.46

23929 REPORT REPORT REPORT REPORT

23930 328.07 204.72

23931 256.21 148.32

23935 471.65 471.65

24000 447.27 447.27

24006 676.50 676.50

24065 227.68 152.34

24066 544.31 373.34

24071 409.24 409.24

24073 702.12 702.12

24075 440.57 291.61

24076 444.57 444.57

24077 833.98 833.98

24079 1,304.37 1,304.37

24100 377.39 377.39

24101 471.37 471.37

24102 585.16 585.16

24105 316.05 316.05

24110 553.28 553.28

24115 639.12 639.12

24116 831.32 831.32

Page 20: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Maryland Medical Assistance FS-20

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

24120 495.38 495.38

24125 560.44 560.44

24126 598.78 598.78

24130 478.43 478.43

24134 719.56 719.56

24136 569.36 569.36

24138 625.17 625.17

24140 685.06 685.06

24145 574.37 574.37

24147 597.31 597.31

24149 1,086.80 1,086.80

24150 1,253.72 1,253.72

24152 1,072.81 1,072.81

24155 802.55 802.55

24160 1,017.37 1,017.37

24164 586.80 586.80

24200 181.83 126.94

24201 510.97 343.63

24220 164.17 65.72

24300 367.63 367.63

24301 717.68 717.68

24305 549.03 549.03

24310 449.83 449.83

24320 727.97 727.97

24330 685.53 685.53

24331 754.57 754.57

24332 569.50 569.50

24340 584.74 584.74

24341 680.38 680.38

24342 753.35 753.35

24343 667.39 667.39

24344 1,036.46 1,036.46

24345 663.21 663.21

24346 1,033.27 1,033.27

24357 418.10 418.10

24358 493.72 493.72

24359 607.32 607.32

24360 856.98 856.98

24361 962.46 962.46

24362 936.98 936.98

24363 1,406.22 1,406.22

24365 611.25 611.25

24366 654.76 654.76

CODE NOTE NFAC FAC 26 TC

24370 1,662.84 1,662.84

24371 1,915.17 1,915.17

24400 786.95 786.95

24410 1,005.06 1,005.06

24420 932.86 932.86

24430 983.26 983.26

24435 1,009.41 1,009.41

24470 602.93 602.93

24495 589.56 589.56

24498 837.29 837.29

24500 313.12 283.69

24505 456.74 418.60

24515 839.38 839.38

24516 829.00 829.00

24530 337.52 306.27

24535 572.07 533.57

24538 710.79 710.79

24545 852.12 852.12

24546 1,021.43 1,021.43

24560 281.34 249.21

24565 469.87 435.57

24566 655.20 655.20

24575 708.42 708.42

24576 296.11 266.38

24577 488.58 451.59

24579 797.97 797.97

24582 739.56 739.56

24586 1,051.24 1,051.24

24587 1,042.53 1,042.53

24600 328.67 299.71

24605 429.65 429.65

24615 684.23 684.23

24620 518.40 518.40

24635 732.14 732.14

24640 108.32 78.84

24650 228.55 205.47

24655 395.27 362.86

24665 617.53 617.53

24666 698.80 698.80

24670 256.97 230.66

24675 418.52 386.13

24685 621.86 621.86

24800 758.06 758.06

Page 21: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Maryland Medical Assistance FS-21

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

24802 947.95 947.95

24900 674.00 674.00

24920 666.13 666.13

24925 512.58 512.58

24930 702.09 702.09

24931 745.07 745.07

24935 976.12 976.12

24940 327.00 327.00

24999 REPORT REPORT REPORT REPORT

25000 327.80 327.80

25001 309.87 309.87

25020 542.91 542.91

25023 1,044.29 1,044.29

25024 709.11 709.11

25025 1,074.25 1,074.25

25028 483.26 483.26

25031 355.28 355.28

25035 616.17 616.17

25040 544.24 544.24

25065 227.90 152.99

25066 356.05 356.05

25071 428.74 428.74

25073 534.47 534.47

25075 383.34 311.24

25076 420.82 420.82

25077 715.35 715.35

25078 1,138.91 1,138.91

25085 438.29 438.29

25100 325.12 325.12

25101 383.85 383.85

25105 466.38 466.38

25107 577.47 577.47

25109 481.54 481.54

25110 341.14 341.14

25111 295.76 295.76

25112 361.56 361.56

25115 761.49 761.49

25116 617.82 617.82

25118 362.56 362.56

25119 480.60 480.60

25120 528.19 528.19

25125 612.54 612.54

25126 621.41 621.41

CODE NOTE NFAC FAC 26 TC

25130 425.27 425.27

25135 530.73 530.73

25136 471.25 471.25

25145 541.87 541.87

25150 551.32 551.32

25151 609.96 609.96

25170 1,189.74 1,189.74

25210 465.79 465.79

25215 600.47 600.47

25230 412.75 412.75

25240 418.96 418.96

25246 166.62 73.16

25248 415.85 415.85

25250 495.75 495.75

25251 674.45 674.45

25259 368.36 368.36

25260 646.43 646.43

25263 645.26 645.26

25265 765.74 765.74

25270 519.53 519.53

25272 584.73 584.73

25274 692.75 692.75

25275 636.11 636.11

25280 591.65 591.65

25290 482.05 482.05

25295 551.10 551.10

25300 648.71 648.71

25301 618.91 618.91

25310 641.03 641.03

25312 741.32 741.32

25315 795.38 795.38

25316 917.79 917.79

25320 911.40 911.40

25332 806.32 806.32

25335 868.91 868.91

25337 840.49 840.49

25350 707.10 707.10

25355 795.79 795.79

25360 686.27 686.27

25365 935.36 935.36

25370 1,018.62 1,018.62

25375 970.21 970.21

25390 798.85 798.85

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Maryland Medical Assistance FS-22

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

25391 1,015.54 1,015.54

25392 1,028.66 1,028.66

25393 1,161.09 1,161.09

25394 730.40 730.40

25400 839.27 839.27

25405 1,065.55 1,065.55

25415 1,001.79 1,001.79

25420 1,191.43 1,191.43

25425 1,030.04 1,030.04

25426 1,078.70 1,078.70

25430 666.52 666.52

25431 753.48 753.48

25440 745.49 745.49

25441 895.23 895.23

25442 765.44 765.44

25443 734.99 734.99

25444 784.40 784.40

25445 689.97 689.97

25446 1,124.04 1,124.04

25447 770.21 770.21

25449 987.45 987.45

25450 568.55 568.55

25455 647.01 647.01

25490 725.85 725.85

25491 767.67 767.67

25492 927.36 927.36

25500 233.79 212.23

25505 458.96 424.63

25515 638.27 638.27

25520 506.62 483.37

25525 776.06 776.06

25526 946.53 946.53

25530 227.13 204.26

25535 444.97 417.52

25545 599.69 599.69

25560 236.86 209.41

25565 480.05 440.40

25574 619.99 619.99

25575 844.88 844.88

25600 262.20 247.95

25605 562.25 528.29

25606 626.34 626.34

25607 662.68 662.68

CODE NOTE NFAC FAC 26 TC

25608 756.84 756.84

25609 963.96 963.96

25622 265.22 238.25

25624 420.65 384.81

25628 674.16 674.16

25630 271.71 243.34

25635 398.00 348.05

25645 537.21 537.21

25650 282.85 258.07

25651 442.41 442.41

25652 583.10 583.10

25660 368.26 368.26

25670 579.28 579.28

25671 488.67 488.67

25675 389.79 359.70

25676 600.39 600.39

25680 421.88 421.88

25685 693.52 693.52

25690 432.94 432.94

25695 601.52 601.52

25800 711.72 711.72

25805 820.25 820.25

25810 825.95 825.95

25820 582.26 582.26

25825 715.65 715.65

25830 894.25 894.25

25900 711.86 711.86

25905 705.07 705.07

25907 614.55 614.55

25909 694.51 694.51

25915 1,113.16 1,113.16

25920 648.46 648.46

25922 536.33 536.33

25924 635.51 635.51

25927 739.29 739.29

25929 532.69 532.69

25931 674.15 674.15

25999 REPORT REPORT REPORT REPORT

26010 231.73 123.07

26011 354.73 172.90

26020 398.70 398.70

26025 389.93 389.93

26030 460.63 460.63

Page 23: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Maryland Medical Assistance FS-23

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

26034 499.84 499.84

26035 760.38 760.38

26037 538.00 538.00

26040 286.32 286.32

26045 437.50 437.50

26055 518.24 273.89

26060 245.17 245.17

26070 275.58 275.58

26075 294.74 294.74

26080 356.54 356.54

26100 299.14 299.14

26105 306.75 306.75

26110 294.02 294.02

26111 416.05 416.05

26113 547.36 547.36

26115 557.40 333.52

26116 448.86 448.86

26117 610.96 610.96

26118 1,072.77 1,072.77

26121 563.76 563.76

26123 763.49 763.49

26125 270.98 270.98

26130 428.21 428.21

26135 519.63 519.63

26140 471.96 471.96

26145 480.15 480.15

26160 518.70 298.36

26170 376.79 376.79

26180 412.42 412.42

26185 485.66 485.66

26200 424.20 424.20

26205 569.55 569.55

26210 410.57 410.57

26215 520.45 520.45

26230 474.86 474.86

26235 465.87 465.87

26236 412.62 412.62

26250 864.63 864.63

26260 645.55 645.55

26262 504.73 504.73

26320 320.80 320.80

26340 288.17 288.17

26341 106.64 80.12

CODE NOTE NFAC FAC 26 TC

26350 668.17 668.17

26352 759.06 759.06

26356 877.39 877.39

26357 816.13 816.13

26358 862.53 862.53

26370 723.77 723.77

26372 839.45 839.45

26373 796.79 796.79

26390 782.35 782.35

26392 914.98 914.98

26410 531.46 531.46

26412 645.24 645.24

26415 674.74 674.74

26416 718.22 718.22

26418 533.49 533.49

26420 670.90 670.90

26426 539.88 539.88

26428 704.50 704.50

26432 464.88 464.88

26433 498.77 498.77

26434 598.28 598.28

26437 583.05 583.05

26440 585.36 585.36

26442 884.00 884.00

26445 543.33 543.33

26449 709.61 709.61

26450 376.58 376.58

26455 373.95 373.95

26460 363.54 363.54

26471 574.41 574.41

26474 550.18 550.18

26476 536.33 536.33

26477 541.35 541.35

26478 587.66 587.66

26479 581.68 581.68

26480 706.80 706.80

26483 798.23 798.23

26485 764.38 764.38

26489 824.20 824.20

26490 738.13 738.13

26492 822.89 822.89

26494 748.02 748.02

26496 811.57 811.57

Page 24: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Maryland Medical Assistance FS-24

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

26497 811.56 811.56

26498 1,085.30 1,085.30

26499 775.86 775.86

26500 586.26 586.26

26502 662.74 662.74

26508 590.46 590.46

26510 558.41 558.41

26516 660.40 660.40

26517 778.35 778.35

26518 784.46 784.46

26520 612.01 612.01

26525 614.64 614.64

26530 504.01 504.01

26531 586.02 586.02

26535 366.92 366.92

26536 629.10 629.10

26540 619.90 619.90

26541 757.31 757.31

26542 640.71 640.71

26545 652.32 652.32

26546 914.22 914.22

26548 718.15 718.15

26550 1,405.21 1,405.21

26551 2,954.49 2,954.49

26553 2,632.97 2,632.97

26554 3,386.83 3,386.83

26555 1,299.86 1,299.86

26556 2,726.31 2,726.31

26560 534.18 534.18

26561 853.65 853.65

26562 1,170.41 1,170.41

26565 634.66 634.66

26567 641.43 641.43

26568 845.99 845.99

26580 1,226.26 1,226.26

26587 897.40 897.40

26590 1,206.13 1,206.13

26591 408.01 408.01

26593 557.06 557.06

26596 692.88 692.88

26600 245.99 220.75

26605 285.88 261.12

26607 410.35 410.35

CODE NOTE NFAC FAC 26 TC

26608 444.24 444.24

26615 497.88 497.88

26641 324.80 292.35

26645 374.29 342.92

26650 445.84 445.84

26665 562.07 562.07

26670 293.60 263.54

26675 400.31 370.57

26676 465.72 465.72

26685 523.01 523.01

26686 585.59 585.59

26700 279.45 258.35

26705 366.61 337.24

26706 403.38 403.38

26715 502.72 502.72

26720 170.95 155.80

26725 306.51 275.64

26727 436.40 436.40

26735 520.62 520.62

26740 199.52 187.33

26742 335.47 305.34

26746 620.08 620.08

26750 159.43 154.57

26755 280.48 243.85

26756 384.64 384.64

26765 419.60 419.60

26770 237.00 215.43

26775 341.34 305.87

26776 409.20 409.20

26785 454.39 454.39

26820 741.14 741.14

26841 686.79 686.79

26842 745.67 745.67

26843 689.44 689.44

26844 769.28 769.28

26850 653.41 653.41

26852 748.26 748.26

26860 524.08 524.08

26861 102.75 102.75

26862 681.00 681.00

26863 229.07 229.07

26910 670.77 670.77

26951 577.19 577.19

Page 25: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Maryland Medical Assistance FS-25

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

26952 607.48 607.48

26989 REPORT REPORT REPORT REPORT

26990 584.79 584.79

26991 653.56 489.45

26992 919.86 919.86

27000 426.05 426.05

27001 517.09 517.09

27003 552.12 552.12

27005 695.69 695.69

27006 704.65 704.65

27025 842.12 842.12

27027 833.46 833.46

27030 906.69 906.69

27033 937.44 937.44

27035 1,050.49 1,050.49

27036 954.31 954.31

27040 316.20 187.29

27041 645.84 645.84

27043 473.90 473.90

27045 752.54 752.54

27047 511.32 402.31

27048 491.95 491.95

27049 1,069.18 1,069.18

27050 329.32 329.32

27052 523.15 523.15

27054 646.65 646.65

27057 915.81 915.81

27059 1,841.60 1,841.60

27060 404.89 404.89

27062 427.14 427.14

27065 469.93 469.93

27066 767.94 767.94

27067 963.06 963.06

27070 805.20 805.20

27071 869.19 869.19

27075 2,185.63 2,185.63

27076 2,032.07 2,032.07

27077 2,547.69 2,547.69

27078 1,657.04 1,657.04

27080 458.42 458.42

27086 227.83 140.16

27087 598.75 598.75

27090 797.57 797.57

CODE NOTE NFAC FAC 26 TC

27091 1,515.96 1,515.96

27093 184.83 68.50

27095 223.02 77.03

27096 168.60 66.04

27097 631.21 631.21

27098 588.78 588.78

27100 779.33 779.33

27105 806.80 806.80

27110 900.99 900.99

27111 820.89 820.89

27120 1,228.48 1,228.48

27122 1,059.25 1,059.25

27125 1,068.22 1,068.22

27130 1,379.08 1,379.08

27132 1,613.10 1,613.10

27134 1,874.61 1,874.61

27137 1,429.83 1,429.83

27138 1,487.39 1,487.39

27140 863.50 863.50

27146 1,214.42 1,214.42

27147 1,394.71 1,394.71

27151 1,386.78 1,386.78

27156 1,652.42 1,652.42

27158 1,289.20 1,289.20

27161 1,173.17 1,173.17

27165 1,299.08 1,299.08

27170 1,130.02 1,130.02

27175 612.49 612.49

27176 869.55 869.55

27177 1,060.09 1,060.09

27178 847.88 847.88

27179 934.65 934.65

27181 1,043.95 1,043.95

27185 625.49 625.49

27187 957.08 957.08

27197 115.95 115.95

27198 294.52 294.52

27200 159.28 162.70

27202 608.45 608.45

27215 661.68 661.68

27216 977.55 977.55

27217 923.05 923.05

27218 1,262.23 1,262.23

Page 26: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Maryland Medical Assistance FS-26

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

27220 492.87 488.78

27222 935.33 935.33

27226 961.15 961.15

27227 1,597.75 1,597.75

27228 1,829.51 1,829.51

27230 441.60 432.41

27232 737.75 737.75

27235 873.68 873.68

27236 1,127.86 1,127.86

27238 425.30 425.30

27240 907.08 907.08

27244 1,112.52 1,112.52

27245 1,236.71 1,236.71

27246 361.78 362.47

27248 728.39 728.39

27250 197.14 197.14

27252 718.03 718.03

27253 908.92 908.92

27254 1,219.88 1,219.88

27256 276.07 233.09

27257 317.20 317.20

27258 1,060.66 1,060.66

27259 1,473.54 1,473.54

27265 367.09 367.09

27266 551.24 551.24

27267 394.39 394.39

27268 486.44 486.44

27269 1,151.74 1,151.74

27275 171.67 171.67

27279 608.95 608.95

27280 1,104.83 1,104.83

27282 777.42 777.42

27284 1,510.31 1,510.31

27286 1,546.55 1,546.55

27290 1,492.83 1,492.83

27295 1,202.68 1,202.68

27299 REPORT REPORT REPORT REPORT

27301 616.61 465.36

27303 608.33 608.33

27305 444.83 444.83

27306 360.83 360.83

27307 443.91 443.91

27310 689.60 689.60

CODE NOTE NFAC FAC 26 TC

27323 244.64 165.23

27324 359.76 359.76

27325 484.80 484.80

27326 463.50 463.50

27327 419.54 326.61

27328 499.82 499.82

27329 971.26 971.26

27330 380.08 380.08

27331 449.29 449.29

27332 607.46 607.46

27333 552.17 552.17

27334 647.80 647.80

27335 731.40 731.40

27337 422.67 422.67

27339 760.55 760.55

27340 343.47 343.47

27345 454.53 454.53

27347 478.29 478.29

27350 618.92 618.92

27355 574.76 574.76

27356 700.74 700.74

27357 778.66 778.66

27358 280.62 280.62

27360 813.44 813.44

27364 1,586.83 1,586.83

27365 1,659.71 1,659.71

27370 157.88 49.68

27372 554.11 382.95

27380 562.74 562.74

27381 768.41 768.41

27385 602.97 602.97

27386 796.88 796.88

27390 415.04 415.04

27391 543.99 543.99

27392 670.89 670.89

27393 482.38 482.38

27394 623.41 623.41

27395 841.11 841.11

27396 585.83 585.83

27397 847.44 847.44

27400 643.10 643.10

27403 613.21 613.21

27405 644.76 644.76

Page 27: Physicians’ Services Fee schedule 2015 · 2020. 3. 22. · Professional Services Fee Schedule January 2017 Maryland Medical Assistance FS-3 J- codes are now published in this fee

Maryland Medical Assistance FS-27

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

27407 739.31 739.31

27409 918.07 918.07

27412 1,579.65 1,579.65

27415 1,335.04 1,335.04

27416 906.09 906.09

27418 797.11 797.11

27420 716.13 716.13

27422 713.80 713.80

27424 714.57 714.57

27425 417.44 417.44

27427 686.28 686.28

27428 1,047.44 1,047.44

27429 1,171.41 1,171.41

27430 708.23 708.23

27435 755.06 755.06

27437 630.41 630.41

27438 801.25 801.25

27440 706.99 706.99

27441 747.09 747.09

27442 833.79 833.79

27443 783.95 783.95

27445 1,211.26 1,211.26

27446 1,078.60 1,078.60

27447 1,481.55 1,481.55

27448 788.78 788.78

27450 979.87 979.87

27454 1,237.20 1,237.20

27455 906.48 906.48

27457 932.64 932.64

27465 1,139.09 1,139.09

27466 1,134.01 1,134.01

27468 1,279.14 1,279.14

27470 1,130.61 1,130.61

27472 1,223.82 1,223.82

27475 625.00 625.00

27477 699.20 699.20

27479 904.00 904.00

27485 642.16 642.16

27486 1,351.41 1,351.41

27487 1,704.47 1,704.47

27488 1,143.33 1,143.33

27495 1,089.12 1,089.12

27496 477.43 477.43

CODE NOTE NFAC FAC 26 TC

27497 517.69 517.69

27498 564.33 564.33

27499 628.79 628.79

27500 482.00 445.13

27501 473.80 464.37

27502 755.40 755.40

27503 764.44 764.44

27506 1,267.88 1,267.88

27507 947.86 947.86

27508 485.59 458.06

27509 612.83 612.83

27510 664.11 664.11

27511 989.58 989.58

27513 1,246.31 1,246.31

27514 1,009.75 1,009.75

27516 453.28 428.12

27517 634.38 634.38

27519 910.82 910.82

27520 285.85 259.15

27524 724.40 724.40

27530 333.48 309.49

27532 577.11 546.47

27535 881.78 881.78

27536 1,133.16 1,133.16

27538 430.87 404.59

27540 807.72 807.72

27550 452.98 419.55

27552 590.67 590.67

27556 895.55 895.55

27557 1,070.89 1,070.89

27558 1,193.06 1,193.06

27560 329.98 287.64

27562 426.00 426.00

27566 859.95 859.95

27570 140.04 140.04

27580 1,388.88 1,388.88

27590 779.14 779.14

27591 872.89 872.89

27592 660.81 660.81

27594 483.99 483.99

27596 699.47 699.47

27598 708.79 708.79

27599 REPORT REPORT REPORT REPORT

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Maryland Medical Assistance FS-28

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

27600 404.04 404.04

27601 415.98 415.98

27602 495.80 495.80

27603 487.67 366.39

27604 428.38 325.05

27605 340.75 194.36

27606 287.15 287.15

27607 580.93 580.93

27610 626.60 626.60

27612 544.84 544.84

27613 227.44 154.95

27614 523.36 392.99

27615 846.32 846.32

27616 1,295.29 1,295.29

27618 455.96 333.85

27619 516.10 516.10

27620 443.34 443.34

27625 573.31 573.31

27626 620.36 620.36

27630 501.07 356.21

27632 416.88 416.88

27634 679.04 679.04

27635 571.04 571.04

27637 718.65 718.65

27638 752.32 752.32

27640 835.14 835.14

27641 668.51 668.51

27645 1,427.56 1,427.56

27646 1,192.00 1,192.00

27647 807.82 807.82

27648 152.16 49.67

27650 653.82 653.82

27652 718.39 718.39

27654 678.64 678.64

27656 503.68 333.23

27658 369.31 369.31

27659 485.39 485.39

27664 352.38 352.38

27665 403.79 403.79

27675 494.53 494.53

27676 598.93 598.93

27680 418.93 418.93

27681 499.64 499.64

CODE NOTE NFAC FAC 26 TC

27685 587.83 461.15

27686 545.10 545.10

27687 448.29 448.29

27690 593.86 593.86

27691 705.47 705.47

27692 109.29 109.29

27695 477.24 477.24

27696 569.36 569.36

27698 639.76 639.76

27700 595.67 595.67

27702 965.29 965.29

27703 1,104.54 1,104.54

27704 538.21 538.21

27705 742.47 742.47

27707 376.73 376.73

27709 1,023.20 1,023.20

27712 1,038.53 1,038.53

27715 1,021.16 1,021.16

27720 846.59 846.59

27722 843.55 843.55

27724 1,234.25 1,234.25

27725 1,144.69 1,144.69

27726 849.50 849.50

27727 944.73 944.73

27730 563.02 563.02

27732 382.84 382.84

27734 575.87 575.87

27740 641.23 641.23

27742 632.22 632.22

27745 728.23 728.23

27750 309.41 284.25

27752 499.25 466.45

27756 541.72 541.72

27758 849.93 849.93

27759 964.39 964.39

27760 297.42 270.35

27762 446.28 413.12

27766 585.96 585.96

27767 234.90 236.05

27768 375.06 375.06

27769 642.90 642.90

27780 265.92 241.00

27781 386.55 361.00

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Maryland Medical Assistance FS-29

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

27784 641.09 641.09

27786 282.06 254.00

27788 389.91 360.20

27792 655.46 655.46

27808 295.02 265.28

27810 436.54 402.62

27814 748.19 748.19

27816 278.90 251.46

27818 449.29 410.79

27822 820.13 820.13

27823 934.74 934.74

27824 280.05 269.30

27825 512.63 469.62

27826 774.23 774.23

27827 1,048.25 1,048.25

27828 1,245.86 1,245.86

27829 609.98 609.98

27830 324.07 302.49

27831 356.95 356.95

27832 643.84 643.84

27840 325.36 325.36

27842 456.30 456.30

27846 710.00 710.00

27848 808.63 808.63

27860 170.09 170.09

27870 1,006.69 1,006.69

27871 668.53 668.53

27880 865.49 865.49

27881 859.28 859.28

27882 608.19 608.19

27884 561.33 561.33

27886 636.74 636.74

27888 680.60 680.60

27889 662.68 662.68

27892 524.08 524.08

27893 522.13 522.13

27894 792.95 792.95

27899 REPORT REPORT REPORT REPORT

28001 248.07 177.35

28002 457.02 348.02

28003 632.22 545.92

28005 596.04 596.04

28008 392.79 300.56

CODE NOTE NFAC FAC 26 TC

28010 218.42 207.85

28011 309.46 293.99

28020 471.99 353.95

28022 430.93 326.95

28024 412.44 309.82

28035 469.03 356.84

28039 481.34 342.14

28041 450.11 450.11

28043 323.86 255.81

28045 438.55 325.36

28046 784.64 659.57

28047 943.74 943.74

28050 410.20 307.53

28052 383.70 279.64

28054 359.55 254.81

28055 383.45 383.45

28060 462.23 357.58

28062 547.02 414.70

28070 459.17 351.13

28072 450.10 340.10

28080 435.89 336.16

28086 495.79 355.88

28088 415.43 296.24

28090 416.84 308.67

28092 381.89 270.91

28100 547.02 401.79

28102 528.51 528.51

28103 430.88 430.88

28104 461.25 351.06

28106 459.14 459.14

28107 508.74 379.01

28108 386.10 289.19

28110 408.21 288.93

28111 470.06 337.32

28112 442.29 316.15

28113 517.45 405.47

28114 957.89 788.15

28116 673.57 557.11

28118 525.27 406.77

28119 469.26 360.53

28120 545.30 397.09

28122 605.87 484.12

28124 428.22 333.75

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Maryland Medical Assistance FS-30

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

28126 345.19 251.26

28130 623.25 623.25

28140 580.15 454.72

28150 389.08 286.99

28153 358.28 257.71

28160 369.08 272.27

28171 668.70 668.70

28173 682.51 600.73

28175 499.17 388.68

28190 224.99 132.72

28192 431.01 319.34

28193 488.08 378.55

28200 424.99 318.66

28202 576.24 442.67

28208 406.36 304.16

28210 530.30 410.61

28220 402.82 308.44

28222 466.83 367.02

28225 353.03 255.59

28226 415.42 319.13

28230 389.18 293.64

28232 346.27 249.56

28234 356.45 261.38

28238 625.51 496.47

28240 395.00 301.50

28250 502.60 396.35

28260 619.17 513.73

28261 891.13 776.35

28262 1,269.81 1,098.00

28264 784.20 686.10

28270 427.50 333.45

28272 351.96 259.57

28280 481.41 363.56

28285 431.88 318.38

28286 408.86 307.05

28288 518.35 415.92

28289 669.07 512.14

28291 733.01 733.01

28292 693.79 531.50

28295 942.50 942.50

28296 737.37 538.09

28297 848.41 602.96

28298 687.91 507.14

CODE NOTE NFAC FAC 26 TC

28299 832.60 636.29

28300 651.60 651.60

28302 646.53 646.53

28304 720.40 584.39

28305 664.50 664.50

28306 543.40 396.85

28307 652.38 447.47

28308 486.94 361.55

28309 870.96 870.96

28310 483.85 355.19

28312 441.32 319.91

28313 455.68 366.91

28315 426.48 324.30

28320 618.17 618.17

28322 719.25 570.22

28340 567.28 440.66

28341 646.99 518.76

28344 453.65 299.63

28345 515.24 399.26

28360 928.90 928.90

28400 223.97 206.05

28405 366.47 343.97

28406 504.60 504.60

28415 1,109.89 1,109.89

28420 1,167.41 1,167.41

28430 209.19 186.70

28435 296.52 275.17

28436 404.05 404.05

28445 1,044.65 1,044.65

28446 1,110.02 1,110.02

28450 193.46 173.63

28455 268.69 251.14

28456 258.66 258.66

28465 587.66 587.66

28470 193.41 174.73

28475 245.72 227.41

28476 320.13 320.13

28485 503.34 503.34

28490 124.13 108.87

28495 156.93 139.40

28496 381.91 214.56

28505 603.30 446.14

28510 107.74 105.83

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Maryland Medical Assistance FS-31

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

28515 141.68 130.80

28525 509.35 362.25

28530 103.99 96.37

28531 337.10 185.00

28540 184.43 172.61

28545 238.43 211.35

28546 456.70 284.20

28555 784.04 606.14

28570 159.50 143.87

28575 302.11 287.49

28576 336.93 336.93

28585 803.64 679.88

28600 192.70 173.64

28605 263.71 236.92

28606 373.63 373.63

28615 734.38 734.38

28630 135.52 104.57

28635 163.06 133.24

28636 283.57 195.07

28645 539.75 429.80

28660 99.51 79.56

28665 142.28 132.11

28666 190.18 190.18

28675 515.81 361.48

28705 1,272.12 1,272.12

28715 943.53 943.53

28725 784.77 784.77

28730 809.28 809.28

28735 774.48 774.48

28737 686.46 686.46

28740 789.00 608.95

28750 768.34 582.79

28755 459.64 331.81

28760 706.91 563.20

28800 557.80 557.80

28805 706.23 706.23

28810 428.18 428.18

28820 488.67 339.04

28825 435.80 297.00

28890 321.30 216.97

28899 REPORT REPORT REPORT REPORT

29000 243.40 160.91

29010 228.91 152.53

CODE NOTE NFAC FAC 26 TC

29015 219.40 154.22

29035 219.92 133.18

29040 205.86 146.82

29044 239.04 154.35

29046 255.03 179.31

29049 79.51 57.87

29055 190.13 127.03

29058 102.51 79.37

29065 86.81 65.08

29075 80.47 58.49

29085 85.65 61.94

29086 65.02 45.06

29105 79.15 55.47

29125 61.26 39.43

29126 70.11 48.04

29130 37.37 26.60

29131 45.65 29.43

29200 32.51 19.53

29240 30.94 19.53

29260 31.44 21.21

29280 31.39 21.16

29305 215.51 150.04

29325 233.67 166.07

29345 124.93 97.36

29355 129.31 103.97

29358 140.52 98.90

29365 111.90 84.42

29405 82.24 62.37

29425 86.52 62.53

29435 109.23 83.20

29440 47.88 31.36

29445 136.92 108.36

29450 143.22 121.11

29505 69.49 44.91

29515 65.18 46.86

29520 34.09 19.93

29530 30.94 19.53

29540 28.24 19.58

29550 20.69 12.43

29580 48.88 35.04

29581 69.02 13.95

29582 75.75 16.01

29583 46.86 11.76

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Maryland Medical Assistance FS-32

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

29584 75.75 16.01

29700 59.39 32.94

29705 62.95 45.89

29710 109.73 78.83

29720 73.74 42.81

29730 61.05 43.90

29740 87.58 64.63

29750 94.02 73.26

29799 20.00 20.00

29800 493.71 493.71

29804 614.42 614.42

29805 448.90 448.90

29806 1,021.15 1,021.15

29807 995.75 995.75

29819 563.04 563.04

29820 519.62 519.62

29821 567.46 567.46

29822 551.11 551.11

29823 603.02 603.02

29824 640.34 640.34

29825 562.28 562.28

29826 195.75 195.75

29827 1,051.57 1,051.57

29828 857.85 857.85

29830 433.08 433.08

29834 471.96 471.96

29835 484.65 484.65

29836 555.81 555.81

29837 508.10 508.10

29838 567.45 567.45

29840 422.97 422.97

29843 453.75 453.75

29844 473.30 473.30

29845 537.31 537.31

29846 497.49 497.49

29847 516.03 516.03

29848 466.18 466.18

29850 524.29 524.29

29851 901.27 901.27

29855 757.72 757.72

29856 965.95 965.95

29860 621.29 621.29

29861 678.52 678.52

CODE NOTE NFAC FAC 26 TC

29862 763.22 763.22

29863 752.68 752.68

29866 1,007.55 1,007.55

29867 1,218.29 1,218.29

29868 1,635.54 1,635.54

29870 469.11 389.07

29871 489.88 489.88

29873 488.70 488.70

29874 510.79 510.79

29875 473.83 473.83

29876 617.85 617.85

29877 584.93 584.93

29879 625.32 625.32

29880 624.01 624.01

29881 600.60 600.60

29882 657.29 657.29

29883 807.32 807.32

29884 582.56 582.56

29885 706.49 706.49

29886 595.53 595.53

29887 702.52 702.52

29888 949.17 949.17

29889 1,158.78 1,158.78

29891 663.19 663.19

29892 679.34 679.34

29893 538.25 406.76

29894 498.18 498.18

29895 484.18 484.18

29897 507.57 507.57

29898 566.44 566.44

29899 1,011.08 1,011.08

29900 435.79 435.79

29901 477.84 477.84

29902 510.51 510.51

29904 576.59 576.59

29905 621.89 621.89

29906 655.05 655.05

29907 800.93 800.93

29914 1,090.53 1,090.53

29915 1,110.88 1,110.88

29916 1,110.88 1,110.88

29999 REPORT REPORT REPORT REPORT

30000 182.66 93.44

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Maryland Medical Assistance FS-33

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

30020 185.22 94.30

30100 112.13 54.56

30110 183.24 103.15

30115 342.50 342.50

30117 700.38 270.59

30118 609.11 609.11

30120 415.83 350.56

30124 226.49 226.49

30125 479.92 479.92

30130 302.75 302.75

30140 350.27 350.27

30150 609.20 609.20

30160 610.93 610.93

30200 89.84 47.09

30210 119.01 79.10

30220 241.52 99.01

30300 161.27 88.25

30310 163.95 163.95

30320 358.48 358.48

30400 P 801.14 801.14

30410 P 931.29 931.29

30420 P 1,084.68 1,084.68

30430 P 680.16 680.16

30435 P 1,000.99 1,000.99

30450 P 1,179.22 1,179.22

30460 647.82 647.82

30462 1,113.91 1,113.91

30465 775.88 775.88

30520 493.44 493.44

30540 548.37 548.37

30545 701.44 701.44

30560 213.97 109.09

30580 522.66 409.51

30600 452.43 338.70

30620 496.21 496.21

30630 492.48 492.48

30801 182.79 108.69

30802 231.15 150.78

30901 75.46 44.96

30903 176.31 63.73

30905 216.47 84.22

30906 277.09 108.65

30915 454.61 454.61

CODE NOTE NFAC FAC 26 TC

30920 661.42 661.42

30930 97.65 97.65

30999 REPORT REPORT REPORT REPORT

31000 146.84 84.14

31002 151.04 151.04

31020 387.73 287.12

31030 549.97 420.29

31032 455.49 455.49

31040 603.94 603.94

31050 383.36 383.36

31051 511.33 511.33

31070 347.96 347.96

31075 621.69 621.69

31080 829.01 829.01

31081 1,205.77 1,205.77

31084 942.20 942.20

31085 1,286.82 1,286.82

31086 897.63 897.63

31087 863.14 863.14

31090 812.35 812.35

31200 454.77 454.77

31201 586.22 586.22

31205 711.52 711.52

31225 1,486.62 1,486.62

31230 1,633.73 1,633.73

31231 167.19 56.55

31233 208.49 108.44

31235 237.73 127.99

31237 232.12 135.98

31238 238.27 147.68

31239 487.37 487.37

31240 127.56 127.56

31254 216.55 216.55

31255 316.80 316.80

31256 156.81 156.81

31267 251.33 251.33

31276 399.43 399.43

31287 183.90 183.90

31288 213.22 213.22

31290 916.96 916.96

31291 980.53 980.53

31292 792.27 792.27

31293 860.69 860.69

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Maryland Medical Assistance FS-34

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

31294 996.02 996.02

31295 1,726.42 145.19

31296 2,063.92 173.08

31297 2,027.51 142.01

31299 REPORT REPORT REPORT REPORT

31300 1,041.75 1,041.75

31320 457.11 457.11

31360 1,681.62 1,681.62

31365 2,071.29 2,071.29

31367 1,777.87 1,777.87

31368 1,979.03 1,979.03

31370 1,676.37 1,676.37

31375 1,589.41 1,589.41

31380 1,567.90 1,567.90

31382 1,724.69 1,724.69

31390 2,310.08 2,310.08

31395 2,444.26 2,444.26

31400 786.35 786.35

31420 661.05 661.05

31500 111.63 111.63

31502 27.85 27.85

31505 65.83 39.32

31510 169.25 97.15

31511 168.62 103.36

31512 164.45 103.73

31513 105.47 105.47

31515 149.11 82.47

31520 125.05 125.05

31525 201.62 127.80

31526 125.60 125.60

31527 155.46 155.46

31528 115.61 115.61

31529 129.17 129.17

31530 158.14 158.14

31531 169.23 169.23

31535 151.32 151.32

31536 168.43 168.43

31540 193.34 193.34

31541 210.71 210.71

31545 289.17 289.17

31546 439.27 439.27

31551 1,240.89 1,240.89

31552 1,256.48 1,256.48

CODE NOTE NFAC FAC 26 TC

31553 1,370.53 1,370.53

31554 1,444.95 1,444.95

31560 249.79 249.79

31561 273.68 273.68

31570 269.64 183.57

31571 199.70 199.70

31572 437.95 437.95

31573 231.82 231.82

31574 908.21 908.21

31575 90.76 56.85

31576 211.99 95.13

31577 219.30 112.02

31578 240.94 124.48

31579 166.66 104.33

31580 998.51 998.51

31584 1,106.01 1,106.01

31587 928.33 928.33

31590 701.04 701.04

31591 912.68 912.68

31592 1,471.91 1,471.91

31595 605.25 605.25

31599 REPORT REPORT REPORT REPORT

31600 318.00 318.00

31601 183.11 183.11

31603 178.31 178.31

31605 147.22 147.22

31610 568.65 568.65

31611 428.43 428.43

31612 66.37 38.44

31613 363.31 363.31

31614 602.06 602.06

31615 133.95 91.77

31622 236.42 107.59

31623 259.89 108.45

31624 240.83 108.47

31625 263.90 126.61

31626 675.96 160.60

31627 1,127.06 78.10

31628 307.65 140.84

31629 430.27 150.07

31630 159.24 159.24

31631 182.94 182.94

31632 55.43 38.81

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Maryland Medical Assistance FS-35

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

31633 65.50 50.06

31634 1,529.18 169.43

31635 266.35 141.54

31636 175.24 175.24

31637 58.44 58.44

31638 199.87 199.87

31640 200.84 200.84

31641 204.87 204.87

31643 140.41 140.41

31645 229.68 118.56

31646 209.77 103.10

31647 190.37 190.37

31648 199.62 199.62

31649 62.26 62.26

31651 72.98 72.98

31652 794.13 202.03

31653 843.50 222.94

31654 100.14 58.29

31660 191.19 191.19

31661 201.84 201.84

31717 266.59 85.49

31720 41.14 41.14

31725 67.30 67.30

31730 996.09 119.67

31750 1,124.38 1,124.38

31755 1,424.41 1,424.41

31760 1,123.08 1,123.08

31766 1,438.46 1,438.46

31770 1,077.14 1,077.14

31775 1,014.10 1,014.10

31780 941.25 941.25

31781 1,120.30 1,120.30

31785 861.70 861.70

31786 1,196.29 1,196.29

31800 587.40 587.40

31805 660.31 660.31

31820 345.16 260.52

31825 477.15 380.81

31830 352.47 273.81

31899 REPORT REPORT REPORT REPORT

32035 583.90 583.90

32036 623.56 623.56

32096 N.C. N.C.

CODE NOTE NFAC FAC 26 TC

32097 703.30 703.30

32098 660.94 660.94

32100 683.15 683.15

32110 1,180.28 1,180.28

32120 703.67 703.67

32124 748.26 748.26

32140 795.89 795.89

32141 1,228.74 1,228.74

32150 811.15 811.15

32151 808.45 808.45

32160 637.71 637.71

32200 909.92 909.92

32215 642.97 642.97

32220 1,277.22 1,277.22

32225 801.08 801.08

32310 737.31 737.31

32320 1,288.69 1,288.69

32400 119.81 69.08

32405 311.74 72.60

32440 1,261.76 1,261.76

32442 2,481.86 2,481.86

32445 2,863.09 2,863.09

32480 1,192.39 1,192.39

32482 1,275.82 1,275.82

32484 1,157.87 1,157.87

32486 1,896.79 1,896.79

32488 1,937.75 1,937.75

32491 1,188.38 1,188.38

32501 197.42 197.42

32503 1,458.37 1,458.37

32504 1,676.12 1,676.12

32505 811.10 811.10

32506 136.53 136.53

32507 136.53 136.53

32540 1,399.90 1,399.90

32550 635.49 167.14

32551 128.39 128.39

32552 147.09 127.14

32553 429.68 150.35

32554 199.78 75.38

32555 287.22 94.31

32556 516.75 103.40

32557 507.90 140.95

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

32560 232.41 79.93

32561 73.20 54.39

32562 65.79 48.97

32601 248.86 248.86

32604 390.30 390.30

32606 373.36 373.36

32607 269.13 269.13

32608 330.47 330.47

32609 228.81 228.81

32650 536.82 536.82

32651 883.79 883.79

32652 1,340.61 1,340.61

32653 854.04 854.04

32654 955.41 955.41

32655 771.28 771.28

32656 646.39 646.39

32658 576.09 576.09

32659 590.54 590.54

32661 645.60 645.60

32662 720.11 720.11

32663 1,130.14 1,130.14

32664 681.14 681.14

32665 995.61 995.61

32666 759.08 759.08

32667 136.53 136.53

32668 137.47 137.47

32669 1,167.89 1,167.89

32670 1,392.92 1,392.92

32671 1,546.64 1,546.64

32672 1,323.32 1,323.32

32673 1,041.63 1,041.63

32674 187.09 187.09

32701 189.54 189.54

32800 762.87 762.87

32810 720.22 720.22

32815 2,250.43 2,250.43

32820 1,137.28 1,137.28

32850 P 444.00 444.00

32851 P 2,663.74 2,663.74

32852 P 2,910.40 2,910.40

32853 P 3,713.76 3,713.76

32854 P 3,942.15 3,942.15

32855 P 340.59 340.59

CODE NOTE NFAC FAC 26 TC

32856 P 401.79 401.79

32900 1,135.19 1,135.19

32905 1,084.49 1,084.49

32906 1,336.12 1,336.12

32940 999.59 999.59

32960 101.38 73.45

32997 269.75 269.75

32998 1,934.25 224.56

32999 REPORT REPORT REPORT REPORT

33010 86.57 86.57

33011 88.65 88.65

33015 412.72 412.72

33020 710.56 710.56

33025 644.50 644.50

33030 1,618.13 1,618.13

33031 1,994.75 1,994.75

33050 805.72 805.72

33120 1,694.95 1,694.95

33130 1,116.68 1,116.68

33140 1,275.33 1,275.33

33141 117.70 117.70

33202 627.39 627.39

33203 650.81 650.81

33206 365.26 365.26

33207 389.44 389.44

33208 422.62 422.62

33210 133.78 133.78

33211 136.81 136.81

33212 259.19 259.19

33213 288.74 288.74

33214 386.65 386.65

33215 251.63 251.63

33216 299.91 299.91

33217 293.91 293.91

33218 315.43 315.43

33220 315.56 315.56

33221 305.11 305.11

33222 272.49 272.49

33223 330.28 330.28

33224 418.61 418.61

33225 381.49 381.49

33226 402.72 402.72

33227 291.24 291.24

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

33228 303.67 303.67

33229 316.11 316.11

33230 328.22 328.22

33231 340.65 340.65

33233 186.23 186.23

33234 392.97 392.97

33235 516.65 516.65

33236 634.14 634.14

33237 676.99 676.99

33238 754.00 754.00

33240 346.92 346.92

33241 174.72 174.72

33243 1,106.56 1,106.56

33244 697.09 697.09

33249 742.77 742.77

33250 1,172.27 1,172.27

33251 1,312.87 1,312.87

33254 1,103.93 1,103.93

33255 1,329.04 1,329.04

33256 1,570.22 1,570.22

33257 470.55 470.55

33258 528.55 528.55

33259 682.65 682.65

33261 1,312.59 1,312.59

33262 316.36 316.36

33263 328.80 328.80

33264 341.22 341.22

33265 1,097.02 1,097.02

33266 1,491.91 1,491.91

33270 561.75 561.75

33271 422.84 422.84

33272 384.10 384.10

33273 339.52 339.52

33282 246.16 246.16

33284 182.22 182.22

33300 1,979.39 1,979.39

33305 3,312.18 3,312.18

33310 952.25 952.25

33315 1,544.38 1,544.38

33320 858.37 858.37

33321 961.28 961.28

33322 1,121.38 1,121.38

33330 1,154.89 1,154.89

CODE NOTE NFAC FAC 26 TC

33335 1,514.91 1,514.91

33340 709.42 709.42

33361 1,148.42 1,148.42

33362 1,256.43 1,256.43

33363 1,300.92 1,300.92

33364 1,384.53 1,384.53

33365 1,519.63 1,519.63

33366 1,604.10 1,604.10

33367 533.33 533.33

33368 646.39 646.39

33369 853.35 853.35

33390 1,688.17 1,688.17

33391 2,000.31 2,000.31

33404 1,417.30 1,417.30

33405 1,832.72 1,832.72

33406 2,325.10 2,325.10

33410 2,054.39 2,054.39

33411 2,710.50 2,710.50

33412 2,563.27 2,563.27

33413 2,603.44 2,603.44

33414 1,746.97 1,746.97

33415 1,641.52 1,641.52

33416 1,640.36 1,640.36

33417 1,354.55 1,354.55

33418 1,494.19 1,566.66

33419 427.94 427.94

33420 1,181.88 1,181.88

33422 1,350.89 1,350.89

33425 2,205.68 2,205.68

33426 1,924.04 1,924.04

33427 1,975.36 1,975.36

33430 2,259.99 2,259.99

33460 1,961.88 1,961.88

33463 2,495.62 2,495.62

33464 1,972.14 1,972.14

33465 2,228.39 2,228.39

33468 1,991.29 1,991.29

33470 1,052.69 1,052.69

33471 1,125.07 1,125.07

33474 1,769.18 1,769.18

33475 1,883.80 1,883.80

33476 1,235.94 1,235.94

33477 1,130.98 1,130.98

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

33478 1,277.12 1,277.12

33496 1,352.85 1,352.85

33500 1,263.37 1,263.37

33501 900.79 900.79

33502 1,036.73 1,036.73

33503 1,077.35 1,077.35

33504 1,190.66 1,190.66

33505 1,676.13 1,676.13

33506 1,669.00 1,669.00

33507 1,400.59 1,400.59

33508 13.06 13.06

33510 1,560.66 1,560.66

33511 1,715.49 1,715.49

33512 1,949.56 1,949.56

33513 2,006.85 2,006.85

33514 2,119.14 2,119.14

33516 2,221.42 2,221.42

33517 151.47 151.47

33518 332.71 332.71

33519 439.98 439.98

33521 527.83 527.83

33522 592.23 592.23

33523 670.97 670.97

33530 425.01 425.01

33533 1,509.27 1,509.27

33534 1,775.88 1,775.88

33535 1,982.18 1,982.18

33536 2,136.19 2,136.19

33542 2,119.64 2,119.64

33545 2,502.79 2,502.79

33548 2,396.32 2,396.32

33572 185.90 185.90

33600 1,395.72 1,395.72

33602 1,354.81 1,354.81

33606 1,444.06 1,444.06

33608 1,461.90 1,461.90

33610 1,442.21 1,442.21

33611 1,586.12 1,586.12

33612 1,628.43 1,628.43

33615 1,622.00 1,622.00

33617 1,757.21 1,757.21

33619 2,214.78 2,214.78

33620 1,450.45 1,450.45

CODE NOTE NFAC FAC 26 TC

33621 768.75 768.75

33622 3,014.24 3,014.24

33641 1,332.63 1,332.63

33645 1,406.41 1,406.41

33647 1,477.30 1,477.30

33660 1,427.47 1,427.47

33665 1,598.26 1,598.26

33670 1,603.87 1,603.87

33675 1,603.11 1,603.11

33676 1,738.34 1,738.34

33677 1,806.04 1,806.04

33681 1,493.92 1,493.92

33684 1,535.49 1,535.49

33688 1,620.89 1,620.89

33690 974.67 974.67

33692 1,684.15 1,684.15

33694 1,586.12 1,586.12

33697 1,670.70 1,670.70

33702 1,255.78 1,255.78

33710 1,667.62 1,667.62

33720 1,256.59 1,256.59

33722 1,320.75 1,320.75

33724 1,251.09 1,251.09

33726 1,652.94 1,652.94

33730 1,629.16 1,629.16

33732 1,338.67 1,338.67

33735 1,052.60 1,052.60

33736 1,142.48 1,142.48

33737 1,054.02 1,054.02

33750 1,075.94 1,075.94

33755 1,117.44 1,117.44

33762 1,092.93 1,092.93

33764 1,069.56 1,069.56

33766 1,137.01 1,137.01

33767 1,155.76 1,155.76

33768 361.21 361.21

33770 1,821.67 1,821.67

33771 1,878.21 1,878.21

33774 1,461.79 1,461.79

33775 1,583.35 1,583.35

33776 1,673.04 1,673.04

33777 1,536.83 1,536.83

33778 1,908.81 1,908.81

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

33779 2,003.50 2,003.50

33780 2,039.30 2,039.30

33781 1,994.10 1,994.10

33782 2,624.39 2,624.39

33783 2,835.58 2,835.58

33786 1,956.45 1,956.45

33788 1,310.59 1,310.59

33800 802.57 802.57

33802 880.69 880.69

33803 934.25 934.25

33813 1,052.89 1,052.89

33814 1,237.36 1,237.36

33820 787.50 787.50

33822 869.10 869.10

33824 957.99 957.99

33840 1,051.75 1,051.75

33845 1,083.48 1,083.48

33851 1,081.05 1,081.05

33852 1,136.44 1,136.44

33853 1,488.94 1,488.94

33860 2,595.61 2,595.61

33863 2,546.21 2,546.21

33864 2,609.28 2,609.28

33870 2,042.84 2,042.84

33875 2,215.83 2,215.83

33877 2,942.45 2,942.45

33880 1,459.11 1,459.11

33881 1,253.63 1,253.63

33883 910.06 910.06

33884 334.60 334.60

33886 783.58 783.58

33889 638.92 638.92

33891 794.55 794.55

33910 2,130.63 2,130.63

33915 1,025.74 1,025.74

33916 3,397.35 3,397.35

33917 1,183.97 1,183.97

33920 1,550.54 1,550.54

33922 1,128.35 1,128.35

33924 232.36 232.36

33925 1,396.43 1,396.43

33926 2,080.65 2,080.65

33930 N.C. N.C.

CODE NOTE NFAC FAC 26 TC

33933 P 404.28 404.28

33935 P 4,021.77 4,021.77

33940 N.C. N.C.

33944 P 385.99 385.99

33945 P 3,930.74 3,930.74

33946 276.14 276.14

33947 300.41 300.41

33948 210.03 210.03

33949 205.00 205.00

33951 343.72 343.72

33952 346.37 346.37

33953 383.99 383.99

33954 387.09 387.09

33955 783.46 780.64

33956 739.44 736.33

33957 186.15 186.15

33958 181.78 181.78

33959 235.82 235.82

33962 237.60 237.60

33963 495.97 493.14

33964 501.16 498.95

33965 186.15 186.15

33966 238.82 238.82

33967 210.34 210.34

33968 27.19 27.19

33969 305.34 302.84

33970 287.56 287.56

33971 574.83 574.83

33973 417.17 417.17

33974 723.20 723.20

33975 1,060.93 1,060.93

33976 1,293.32 1,293.32

33977 913.08 913.08

33978 1,081.78 1,081.78

33979 1,756.56 1,756.56

33980 1,795.70 1,795.70

33981 670.83 670.83

33982 1,586.34 1,586.34

33983 1,876.67 1,876.67

33984 298.28 295.15

33985 563.76 560.94

33986 536.67 533.56

33987 226.86 226.86

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

33988 644.96 641.54

33989 433.37 430.25

33990 345.39 345.39

33991 505.50 505.50

33992 162.47 162.47

33993 141.86 141.86

33999 REPORT REPORT REPORT REPORT

34001 788.60 788.60

34051 722.65 722.65

34101 488.72 488.72

34111 488.36 488.36

34151 1,142.48 1,142.48

34201 840.30 840.30

34203 778.13 778.13

34401 1,186.37 1,186.37

34421 590.78 590.78

34451 1,330.16 1,330.16

34471 885.25 885.25

34490 496.00 496.00

34501 728.77 728.77

34502 1,248.22 1,248.22

34510 973.81 973.81

34520 856.87 856.87

34530 774.24 774.24

34800 919.34 919.34

34802 1,014.81 1,014.81

34803 1,052.33 1,052.33

34804 1,016.82 1,016.82

34805 971.76 971.76

34806 81.08 81.08

34808 169.05 169.05

34812 274.52 274.52

34813 192.16 192.16

34820 398.17 398.17

34825 566.54 566.54

34826 167.11 167.11

34830 1,466.29 1,466.29

34831 1,550.38 1,550.38

34832 1,538.12 1,538.12

34833 494.95 494.95

34834 221.52 221.52

34839 REPORT REPORT REPORT REPORT

34841 1,562.88 1,562.88

CODE NOTE NFAC FAC 26 TC

34842 1,719.55 1,719.55

34843 1,876.21 1,876.21

34844 2,032.88 2,032.88

34845 1,562.88 1,562.88

34846 1,719.55 1,719.55

34847 1,876.21 1,876.21

34848 2,032.88 2,032.88

34900 727.03 727.03

35001 909.07 909.07

35002 931.10 931.10

35005 918.87 918.87

35011 820.58 820.58

35013 1,021.87 1,021.87

35021 1,006.93 1,006.93

35022 1,160.58 1,160.58

35045 805.20 805.20

35081 1,421.46 1,421.46

35082 1,789.70 1,789.70

35091 1,460.05 1,460.05

35092 2,122.38 2,122.38

35102 1,535.83 1,535.83

35103 1,833.98 1,833.98

35111 1,079.49 1,079.49

35112 1,541.65 1,541.65

35121 1,346.29 1,346.29

35122 1,763.25 1,763.25

35131 1,133.09 1,133.09

35132 1,330.24 1,330.24

35141 902.01 902.01

35142 1,079.04 1,079.04

35151 1,012.15 1,012.15

35152 1,131.72 1,131.72

35180 775.19 775.19

35182 1,450.68 1,450.68

35184 915.77 915.77

35188 867.67 867.67

35189 1,294.38 1,294.38

35190 620.41 620.41

35201 768.99 768.99

35206 633.37 633.37

35207 608.01 608.01

35211 1,114.93 1,114.93

35216 1,658.87 1,658.87

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

35221 1,187.08 1,187.08

35226 679.28 679.28

35231 1,000.42 1,000.42

35236 801.02 801.02

35241 1,109.61 1,109.61

35246 1,276.00 1,276.00

35251 1,393.93 1,393.93

35256 830.29 830.29

35261 867.01 867.01

35266 707.01 707.01

35271 1,122.66 1,122.66

35276 1,186.82 1,186.82

35281 1,314.89 1,314.89

35286 760.82 760.82

35301 923.89 923.89

35302 917.18 917.18

35303 1,011.77 1,011.77

35304 1,049.98 1,049.98

35305 1,003.68 1,003.68

35306 361.78 361.78

35311 1,266.20 1,266.20

35321 726.50 726.50

35331 1,183.30 1,183.30

35341 1,117.38 1,117.38

35351 1,042.84 1,042.84

35355 843.22 843.22

35361 1,240.91 1,240.91

35363 1,440.43 1,440.43

35371 668.18 668.18

35372 800.37 800.37

35390 129.99 129.99

35400 121.41 121.41

35500 259.98 259.98

35501 1,221.68 1,221.68

35506 1,039.25 1,039.25

35508 1,089.71 1,089.71

35509 1,149.95 1,149.95

35510 999.85 999.85

35511 994.75 994.75

35512 1,122.18 1,122.18

35515 1,172.00 1,172.00

35516 992.43 992.43

35518 945.40 945.40

CODE NOTE NFAC FAC 26 TC

35521 997.93 997.93

35522 986.78 986.78

35523 1,043.97 1,043.97

35525 936.96 936.96

35526 1,376.01 1,376.01

35531 1,653.46 1,653.46

35533 1,219.26 1,219.26

35535 N.C. N.C.

35536 1,396.43 1,396.43

35537 1,940.81 1,940.81

35538 1,915.47 1,915.47

35539 1,816.33 1,816.33

35540 2,088.16 2,088.16

35556 1,142.87 1,142.87

35558 1,005.55 1,005.55

35560 1,391.45 1,391.45

35563 1,223.73 1,223.73

35565 1,086.79 1,086.79

35566 1,363.55 1,363.55

35570 N.C. N.C.

35571 1,083.49 1,083.49

35572 281.88 281.88

35583 1,181.76 1,181.76

35585 1,369.93 1,369.93

35587 1,117.87 1,117.87

35600 206.41 206.41

35601 1,142.66 1,142.66

35606 958.18 958.18

35612 868.32 868.32

35616 901.45 901.45

35621 897.33 897.33

35623 1,077.26 1,077.26

35626 1,282.98 1,282.98

35631 1,511.87 1,511.87

35632 1,470.50 1,470.50

35633 1,635.41 1,635.41

35634 1,468.08 1,468.08

35636 1,323.61 1,323.61

35637 1,416.79 1,416.79

35638 1,439.95 1,439.95

35642 896.63 896.63

35645 852.08 852.08

35646 1,401.38 1,401.38

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

35647 1,269.12 1,269.12

35650 888.84 888.84

35654 1,119.24 1,119.24

35656 885.34 885.34

35661 887.20 887.20

35663 1,019.87 1,019.87

35665 957.24 957.24

35666 1,033.29 1,033.29

35671 911.13 911.13

35681 65.59 65.59

35682 287.93 287.93

35683 332.35 332.35

35685 161.89 161.89

35686 130.38 130.38

35691 764.82 764.82

35693 679.96 679.96

35694 805.52 805.52

35695 850.09 850.09

35697 120.23 120.23

35700 124.42 124.42

35701 458.25 458.25

35721 373.73 373.73

35741 417.54 417.54

35761 318.06 318.06

35800 580.41 580.41

35820 1,627.74 1,627.74

35840 966.15 966.15

35860 684.18 684.18

35870 1,013.79 1,013.79

35875 486.48 486.48

35876 772.86 772.86

35879 752.46 752.46

35881 832.20 832.20

35883 986.00 986.00

35884 1,009.06 1,009.06

35901 404.09 404.09

35903 459.98 459.98

35905 1,443.19 1,443.19

35907 1,559.37 1,559.37

36000 20.54 7.43

36002 129.47 85.38

36005 265.09 38.65

36010 518.88 93.19

CODE NOTE NFAC FAC 26 TC

36011 792.31 126.03

36012 684.38 139.15

36013 667.55 98.43

36014 662.49 120.90

36015 721.93 136.72

36100 429.52 124.07

36120 350.42 81.38

36140 400.71 77.42

36160 442.72 102.27

36200 531.38 116.43

36215 912.87 187.74

36216 990.58 218.78

36217 1,678.00 260.33

36218 158.97 41.79

36221 1,011.41 184.18

36222 1,251.70 248.84

36223 1,369.44 268.96

36224 1,514.70 297.16

36225 1,359.31 262.89

36226 1,516.38 293.27

36227 216.59 94.21

36228 1,041.05 193.00

36245 1,045.79 193.03

36246 818.87 206.67

36247 1,579.97 246.16

36248 134.56 39.35

36251 1,275.20 239.23

36252 1,398.25 311.53

36253 1,951.72 332.77

36254 2,030.17 358.93

36260 517.00 517.00

36261 261.96 261.96

36262 242.38 242.38

36299 REPORT REPORT REPORT REPORT

36400 21.38 14.25

36405 20.37 12.96

36406 14.84 7.14

36410 13.73 7.43

36415 2.19 2.19

36416 1.50 1.50

36420 43.14 43.14

36425 31.99 31.99

36430 30.57 30.57

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

36440 43.31 43.31

36450 148.93 148.93

36455 102.90 102.90

36456 93.52 93.52

36460 273.91 273.91

36468 P REPORT REPORT REPORT REPORT

36470 118.07 67.05

36471 139.63 80.63

36473 1,321.47 1,321.47

36474 240.46 240.46

36475 1,475.62 253.22

36476 297.82 123.15

36478 1,276.11 255.60

36479 302.87 125.02

36481 1,574.77 268.55

36500 146.57 146.57

36510 85.51 45.07

36511 73.84 73.84

36512 74.66 74.66

36513 77.42 77.42

36514 454.52 74.00

36515 1,710.86 70.40

36516 2,023.07 56.37

36522 1,145.03 81.35

36555 211.96 93.90

36556 193.62 95.51

36557 738.91 253.54

36558 670.08 217.44

36560 931.00 272.20

36561 937.61 273.41

36563 989.81 298.37

36565 794.08 270.12

36566 4,366.86 301.42

36568 250.25 71.12

36569 226.44 72.66

36570 993.67 254.91

36571 1,008.54 249.86

36575 133.30 30.93

36576 276.60 148.59

36578 394.99 163.26

36580 200.06 53.08

36581 612.45 151.58

36582 843.16 234.47

CODE NOTE NFAC FAC 26 TC

36583 1,005.20 262.17

36584 198.12 54.68

36585 875.27 219.90

36589 130.52 110.00

36590 198.92 153.80

36591 19.13 19.13

36592 21.41 21.41

36593 28.28 28.28

36595 513.36 146.22

36596 113.22 35.67

36597 101.04 48.59

36598 92.10 36.46

36600 24.83 12.01 24.83

36620 40.08 40.08

36625 83.32 83.32

36640 90.94 90.94

36660 58.75 58.75

36680 46.56 46.56

36800 117.09 117.09

36810 173.48 173.48

36815 111.21 111.21

36818 566.19 566.19

36819 597.75 597.75

36820 597.41 597.41

36821 541.88 541.88

36823 1,123.33 1,123.33

36825 652.18 652.18

36830 544.88 544.88

36831 503.52 503.52

36832 617.74 617.74

36833 662.89 662.89

36835 399.96 399.96

36838 933.72 933.72

36860 166.43 88.05

36861 110.38 110.38

36901 501.99 501.99

36902 1,070.02 1,070.02

36903 4,926.19 4,926.19

36904 1,559.32 1,559.32

36905 1,995.62 1,995.62

36906 5,969.69 5,969.69

36907 640.36 640.36

36908 2,366.30 2,366.30

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

36909 1,724.99 1,724.99

37140 1,872.40 1,872.40

37145 1,740.97 1,740.97

37160 1,788.70 1,788.70

37180 1,721.29 1,721.29

37181 1,725.43 1,725.43

37182 659.81 659.81

37183 4,680.01 302.50

37184 2,042.85 365.26

37185 672.51 136.55

37186 1,387.09 200.03

37187 1,977.99 317.67

37188 1,704.82 228.96

37191 2,324.25 203.37

37192 1,552.75 314.59

37193 1,481.51 314.38

37195 102.73 102.73

37197 1,371.60 257.45

37200 174.40 174.40

37211 343.53 343.53

37212 303.30 303.30

37213 211.78 211.78

37214 124.70 124.70

37215 810.59 810.59

37216 714.29 714.29

37217 935.54 935.54

37218 706.56 759.62

37220 2,688.71 360.02

37221 3,975.29 437.68

37222 773.43 163.43

37223 2,191.09 185.59

37224 3,231.24 396.47

37225 9,150.99 535.33

37226 7,649.07 437.53

37227 12,360.24 645.20

37228 4,602.12 484.60

37229 9,060.12 626.05

37230 7,113.94 602.55

37231 11,424.49 655.77

37232 1,031.65 174.86

37233 1,258.76 288.13

37234 3,294.53 239.84

37235 3,517.20 340.46

CODE NOTE NFAC FAC 26 TC

37236 3,179.68 377.25

37237 1,944.32 184.27

37238 3,457.89 276.63

37239 1,719.03 122.55

37241 3,823.59 382.36

37242 6,448.75 386.93

37243 8,141.92 488.52

37244 5,691.56 569.16

37246 1,885.28 1,885.28

37247 761.90 761.90

37248 1,304.41 1,304.41

37249 558.44 558.44

37252 1,237.63 81.56

37253 190.55 65.24

37500 525.64 525.64

37501 REPORT REPORT REPORT REPORT

37565 592.43 592.43

37600 573.51 573.51

37605 640.42 640.42

37606 420.72 420.72

37607 305.79 305.79

37609 248.45 167.22

37615 409.20 409.20

37616 891.44 891.44

37617 1,085.21 1,085.21

37618 311.04 311.04

37619 1,411.82 1,411.82

37650 375.60 375.60

37660 1,053.05 1,053.05

37700 202.03 202.03

37718 352.78 352.78

37722 387.70 387.70

37735 474.24 474.24

37760 498.76 498.76

37761 446.55 446.55

37765 523.60 364.29

37766 621.10 444.39

37780 204.24 204.24

37785 286.54 213.29

37788 1,005.79 1,005.79

37790 388.73 388.73

37799 REPORT REPORT REPORT REPORT

38100 932.10 932.10

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

38101 933.02 933.02

38102 212.08 212.08

38115 1,024.29 1,024.29

38120 850.80 850.80

38129 REPORT REPORT REPORT REPORT

38200 107.52 107.52

38204 P 65.00 83.84

38205 P 65.92 65.92

38206 P 65.92 65.92

38207 P 34.19 37.23

38208 P 21.82 23.75

38209 P 9.47 9.91

38210 P 60.89 65.63

38211 P 54.86 59.57

38212 P 36.47 39.45

38213 P 9.47 9.91

38214 P 31.02 33.93

38215 P 36.47 39.45

38220 134.46 49.24

38221 136.13 59.01

38230 196.43 196.43

38232 157.99 157.99

38240 P 177.48 177.48

38241 P 132.67 132.67

38242 P 93.95 93.95

38243 97.80 97.80

38300 217.82 146.28

38305 369.09 369.09

38308 360.14 360.14

38380 449.40 449.40

38381 649.49 649.49

38382 542.29 542.29

38500 266.49 205.22

38505 100.56 56.95

38510 415.82 337.45

38520 373.50 373.50

38525 353.17 353.17

38530 446.59 446.59

38542 415.78 415.78

38550 407.90 407.90

38555 820.56 820.56

38562 567.59 567.59

38564 564.52 564.52

CODE NOTE NFAC FAC 26 TC

38570 404.67 404.67

38571 582.35 582.35

38572 756.48 756.48

38589 REPORT REPORT REPORT REPORT

38700 643.87 643.87

38720 1,075.25 1,075.25

38724 1,160.23 1,160.23

38740 561.09 561.09

38745 708.54 708.54

38746 194.16 194.16

38747 215.76 215.76

38760 679.98 679.98

38765 1,043.53 1,043.53

38770 647.47 647.47

38780 822.94 822.94

38790 66.76 66.76

38792 32.05 32.05

38794 239.53 239.53

38900 113.41 113.41

38999 REPORT REPORT REPORT REPORT

39000 400.75 400.75

39010 635.91 635.91

39200 703.68 703.68

39220 915.39 915.39

39401 276.01 276.01

39402 359.77 359.77

39499 REPORT REPORT REPORT REPORT

39501 684.98 684.98

39503 4,782.77 4,782.77

39540 701.56 701.56

39541 762.63 762.63

39545 715.80 715.80

39560 644.81 644.81

39561 1,004.63 1,004.63

39599 REPORT REPORT REPORT REPORT

40490 103.48 59.02

40500 407.91 293.90

40510 389.83 287.51

40520 394.16 288.98

40525 443.88 443.88

40527 500.64 500.64

40530 431.94 323.64

40650 353.47 240.89

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

40652 396.29 285.71

40654 461.16 344.59

40700 814.20 814.20

40701 964.23 964.23

40702 723.39 723.39

40720 802.83 802.83

40761 777.78 777.78

40799 REPORT REPORT REPORT REPORT

40800 173.97 108.13

40801 256.85 182.18

40804 149.54 93.17

40805 262.36 190.53

40806 85.71 26.99

40808 152.30 88.73

40810 168.35 104.22

40812 235.78 161.68

40814 314.96 249.98

40816 327.95 258.70

40818 293.51 223.40

40819 258.39 196.83

40820 217.41 141.88

40830 218.68 135.74

40831 275.34 184.14

40840 654.02 506.68

40842 662.12 526.75

40843 878.03 692.20

40844 1,038.76 843.81

40845 1,175.04 986.08

40899 REPORT REPORT REPORT REPORT

41000 131.88 91.42

41005 184.90 101.68

41006 315.51 220.60

41007 311.11 213.92

41008 310.48 221.27

41009 329.53 240.32

41010 162.93 87.13

41015 371.27 287.48

41016 359.95 288.12

41017 364.50 290.12

41018 412.77 337.81

41019 374.49 374.49

41100 136.31 87.29

41105 138.86 90.97

CODE NOTE NFAC FAC 26 TC

41108 120.52 73.79

41110 172.32 106.76

41112 273.04 207.20

41113 298.64 229.10

41114 515.31 515.31

41115 199.92 117.55

41116 269.99 179.64

41120 878.43 878.43

41130 1,078.20 1,078.20

41135 1,767.85 1,767.85

41140 1,782.68 1,782.68

41145 2,251.54 2,251.54

41150 1,790.31 1,790.31

41153 1,945.04 1,945.04

41155 2,448.83 2,448.83

41250 217.02 124.39

41251 232.95 147.17

41252 257.07 171.29

41500 367.34 367.34

41510 346.53 346.53

41512 536.96 536.96

41520 287.69 210.73

41530 989.15 305.30

41599 REPORT REPORT REPORT REPORT

41800 225.65 121.06

41805 202.09 140.24

41806 289.15 212.76

41820 49.00 49.00

41821 18.00 18.00

41822 256.87 151.42

41823 374.84 273.95

41825 173.45 99.92

41826 258.54 175.03

41827 361.26 252.68

41828 251.12 175.02

41830 321.61 232.69

41850 26.00 26.00

41870 50.00 50.00

41872 307.54 215.48

41874 310.59 211.13

41899 REPORT REPORT REPORT REPORT

42000 129.66 84.63

42100 121.89 88.83

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

42104 175.32 113.18

42106 223.80 146.28

42107 374.71 281.22

42120 824.63 824.63

42140 204.62 125.09

42145 565.79 565.79

42160 188.48 119.23

42180 196.29 147.54

42182 257.46 205.60

42200 685.05 685.05

42205 732.90 732.90

42210 837.11 837.11

42215 585.98 585.98

42220 425.67 425.67

42225 729.65 729.65

42226 733.45 733.45

42227 697.59 697.59

42235 589.85 589.85

42260 677.27 561.84

42280 133.07 90.04

42281 165.19 121.58

42299 REPORT REPORT REPORT REPORT

42300 168.61 123.00

42305 347.51 347.51

42310 129.75 99.83

42320 199.92 140.35

42330 187.32 132.88

42335 302.05 207.71

42340 375.47 271.44

42400 84.92 44.17

42405 240.30 181.87

42408 365.86 262.96

42409 269.07 179.01

42410 498.44 498.44

42415 844.60 844.60

42420 947.38 947.38

42425 668.72 668.72

42426 1,079.27 1,079.27

42440 333.88 333.88

42450 364.89 288.79

42500 349.99 275.89

42505 446.53 363.88

42507 404.48 404.48

CODE NOTE NFAC FAC 26 TC

42509 677.93 677.93

42510 519.78 519.78

42550 119.63 50.19

42600 379.26 275.51

42650 67.34 47.40

42660 104.57 73.21

42665 255.24 167.74

42699 REPORT REPORT REPORT REPORT

42700 152.76 109.15

42720 363.33 313.73

42725 659.27 659.27

42800 127.73 90.10

42804 157.86 91.17

42806 177.06 106.10

42808 182.62 130.18

42809 161.64 98.07

42810 312.04 232.81

42815 449.56 449.56

42820 231.34 231.34

42821 241.44 241.44

42825 210.41 210.41

42826 201.93 201.93

42830 166.53 166.53

42831 179.98 179.98

42835 146.05 146.05

42836 193.35 193.35

42842 822.97 822.97

42844 1,130.83 1,130.83

42845 1,810.01 1,810.01

42860 151.33 151.33

42870 485.76 485.76

42890 1,164.63 1,164.63

42892 1,536.51 1,536.51

42894 1,928.13 1,928.13

42900 270.90 270.90

42950 666.21 666.21

42953 801.10 801.10

42955 620.21 620.21

42960 136.72 136.72

42961 339.26 339.26

42962 417.46 417.46

42970 328.22 328.22

42971 369.66 369.66

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

42972 409.76 409.76

42999 REPORT REPORT REPORT REPORT

43020 429.43 429.43

43030 415.19 415.19

43045 1,052.03 1,052.03

43100 497.68 497.68

43101 863.25 863.25

43107 2,068.49 2,068.49

43108 3,772.57 3,772.57

43112 2,184.63 2,184.63

43113 3,526.95 3,526.95

43116 4,212.72 4,212.72

43117 1,995.86 1,995.86

43118 3,063.07 3,063.07

43121 2,307.04 2,307.04

43122 2,072.92 2,072.92

43123 3,805.66 3,805.66

43124 3,103.99 3,103.99

43130 630.07 630.07

43135 1,198.13 1,198.13

43180 460.23 508.00

43191 124.04 124.04

43192 136.37 136.37

43193 148.40 148.40

43194 155.37 155.37

43195 148.70 148.70

43196 163.21 163.21

43197 152.99 66.69

43198 170.59 79.66

43200 173.40 76.54

43201 208.86 94.07

43202 246.23 84.05

43204 137.13 137.13

43205 142.58 142.58

43206 N.C. N.C.

43210 374.47 374.47

43211 202.78 202.78

43212 160.14 160.14

43213 1,030.18 226.64

43214 163.21 163.21

43215 288.38 115.37

43216 285.17 109.32

43217 303.77 130.76

CODE NOTE NFAC FAC 26 TC

43220 863.72 95.89

43226 254.09 106.16

43227 503.85 150.90

43229 606.36 169.78

43231 267.31 136.69

43232 320.51 190.75

43233 193.60 193.60

43235 229.40 103.80

43236 285.04 125.96

43237 173.65 173.65

43238 212.76 212.76

43239 273.96 123.20

43240 319.06 319.06

43241 115.99 115.99

43242 265.20 265.20

43243 192.62 192.62

43244 212.82 212.82

43245 442.47 142.92

43246 180.44 180.44

43247 278.99 144.40

43248 279.47 135.82

43249 817.67 125.09

43250 317.56 138.57

43251 351.38 159.28

43252 N.C. N.C.

43253 224.65 224.65

43254 233.30 233.30

43255 532.48 203.27

43257 219.93 219.93

43259 216.98 216.98

43260 261.78 261.78

43261 275.04 275.04

43262 307.74 307.74

43263 303.23 303.23

43264 369.24 369.24

43265 414.62 414.62

43266 204.96 204.96

43270 603.43 205.17

43273 98.38 98.38

43274 399.37 399.37

43275 329.39 329.39

43276 415.39 415.39

43277 331.38 331.38

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

43278 376.70 376.70

43279 1,043.91 1,043.91

43280 874.24 874.24

43281 1,248.73 1,248.73

43282 1,404.47 1,404.47

43283 135.59 135.59

43284 576.20 576.20

43285 582.70 582.70

43289 REPORT REPORT REPORT REPORT

43300 496.71 496.71

43305 873.05 873.05

43310 1,191.99 1,191.99

43312 1,298.64 1,298.64

43313 2,172.21 2,172.21

43314 2,402.63 2,402.63

43320 1,120.42 1,120.42

43325 1,079.94 1,079.94

43327 684.75 684.75

43328 1,006.71 1,006.71

43330 1,080.96 1,080.96

43331 1,081.89 1,081.89

43332 980.12 980.12

43333 1,025.20 1,025.20

43334 1,075.02 1,075.02

43335 1,158.04 1,158.04

43336 1,270.11 1,270.11

43337 1,387.08 1,387.08

43338 112.99 112.99

43340 1,107.09 1,107.09

43341 1,136.31 1,136.31

43351 1,116.01 1,116.01

43352 866.59 866.59

43360 1,911.14 1,911.14

43361 2,083.92 2,083.92

43400 1,193.46 1,193.46

43401 1,181.40 1,181.40

43405 1,237.52 1,237.52

43410 851.35 851.35

43415 2,078.33 2,078.33

43420 814.90 814.90

43425 1,178.70 1,178.70

43450 125.31 64.61

43453 732.47 69.82

CODE NOTE NFAC FAC 26 TC

43460 173.03 173.03

43496 1,588.64 1,588.64

43499 REPORT REPORT REPORT REPORT

43500 635.05 635.05

43501 1,088.58 1,088.58

43502 1,217.00 1,217.00

43510 748.50 748.50

43520 555.14 555.14

43605 679.79 679.79

43610 791.85 791.85

43611 988.48 988.48

43620 1,590.27 1,590.27

43621 1,834.43 1,834.43

43622 1,853.82 1,853.82

43631 1,172.58 1,172.58

43632 1,642.99 1,642.99

43633 1,553.88 1,553.88

43634 1,713.86 1,713.86

43635 91.39 91.39

43640 953.10 953.10

43641 963.94 963.94

43644 P 1,401.18 1,401.18

43645 P 1,492.65 1,492.65

43647 546.30 546.30

43648 400.39 178.85

43651 528.17 528.17

43652 619.10 619.10

43653 463.59 463.59

43659 REPORT REPORT REPORT REPORT

43752 32.39 32.39

43753 17.33 17.33

43754 98.59 28.48

43755 110.49 48.36

43756 184.44 43.01

43757 236.86 62.33

43760 394.94 37.92

43761 92.76 81.93

43770 P 905.86 905.86

43771 1,028.04 1,028.04

43772 765.17 765.17

43773 1,030.65 1,030.65

43774 775.16 775.16

43775 969.41 969.41

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

43800 751.83 751.83

43810 820.02 820.02

43820 1,084.54 1,084.54

43825 1,044.32 1,044.32

43830 564.90 564.90

43831 453.84 453.84

43832 837.57 837.57

43840 1,098.44 1,098.44

43842 P 834.21 952.75

43843 P 1,026.90 1,026.90

43845 1,586.00 1,586.00

43846 P 1,308.71 1,308.71

43847 P 1,433.37 1,433.37

43848 1,554.64 1,554.64

43850 1,304.02 1,304.02

43855 1,343.87 1,343.87

43860 1,321.84 1,321.84

43865 1,368.10 1,368.10

43870 574.48 574.48

43880 1,292.89 1,292.89

43881 520.39 477.07

43882 552.95 506.32

43886 293.41 293.41

43887 264.41 264.41

43888 370.63 370.63

43999 REPORT REPORT REPORT REPORT

44005 885.04 885.04

44010 696.57 696.57

44015 115.31 115.31

44020 786.51 786.51

44021 786.62 786.62

44025 793.78 793.78

44050 755.33 755.33

44055 1,204.46 1,204.46

44100 87.57 87.57

44110 688.39 688.39

44111 791.82 791.82

44120 988.75 988.75

44121 195.95 195.95

44125 953.73 953.73

44126 1,967.04 1,967.04

44127 2,232.37 2,232.37

44128 198.19 198.19

CODE NOTE NFAC FAC 26 TC

44130 1,061.22 1,061.22

44132 P REPORT REPORT REPORT REPORT

44133 P REPORT REPORT REPORT REPORT

44135 P 4,000.00 4,000.00

44136 P REPORT REPORT REPORT REPORT

44137 1,223.69 1,223.69

44139 98.22 98.22

44140 1,084.16 1,084.16

44141 1,477.12 1,477.12

44143 1,346.27 1,346.27

44144 1,430.27 1,430.27

44145 1,338.94 1,338.94

44146 1,714.41 1,714.41

44147 1,569.32 1,569.32

44150 1,511.54 1,511.54

44151 1,725.86 1,725.86

44155 1,683.02 1,683.02

44156 1,834.88 1,834.88

44157 1,743.62 1,743.62

44158 1,808.46 1,808.46

44160 1,003.35 1,003.35

44180 742.78 742.78

44186 526.88 526.88

44187 892.40 892.40

44188 990.35 990.35

44202 1,120.00 1,120.00

44203 194.91 194.91

44204 1,242.33 1,242.33

44205 1,080.34 1,080.34

44206 1,414.96 1,414.96

44207 1,468.20 1,468.20

44208 1,603.69 1,603.69

44210 1,436.42 1,436.42

44211 1,762.07 1,762.07

44212 1,649.91 1,649.91

44213 152.17 152.17

44227 1,346.90 1,346.90

44238 REPORT REPORT REPORT REPORT

44300 680.29 680.29

44310 842.83 842.83

44312 475.87 475.87

44314 808.91 808.91

44316 1,147.19 1,147.19

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

44320 970.87 970.87

44322 807.33 807.33

44340 504.08 504.08

44345 849.66 849.66

44346 955.52 955.52

44360 117.02 117.02

44361 129.14 129.14

44363 156.01 156.01

44364 166.10 166.10

44365 146.30 146.30

44366 195.05 195.05

44369 200.05 200.05

44370 216.91 216.91

44372 195.59 195.59

44373 156.40 156.40

44376 231.01 231.01

44377 243.43 243.43

44378 312.56 312.56

44379 333.27 333.27

44380 134.70 49.51

44381 754.22 69.05

44382 210.10 59.61

44384 123.49 123.49

44385 172.31 76.80

44386 266.98 90.21

44388 245.99 127.25

44389 302.56 139.83

44390 339.74 171.38

44391 554.55 187.16

44392 323.45 161.14

44394 378.39 183.94

44401 2,561.78 197.02

44402 211.44 211.44

44403 246.49 246.49

44404 287.35 139.71

44405 431.56 148.83

44406 186.67 186.67

44407 223.63 223.63

44408 188.30 188.30

44500 18.77 18.77

44602 1,140.75 1,140.75

44603 1,310.09 1,310.09

44604 855.09 855.09

CODE NOTE NFAC FAC 26 TC

44605 1,052.89 1,052.89

44615 867.33 867.33

44620 701.04 701.04

44625 820.31 820.31

44626 1,295.06 1,295.06

44640 1,132.75 1,132.75

44650 1,167.92 1,167.92

44660 1,075.01 1,075.01

44661 1,250.10 1,250.10

44680 862.63 862.63

44700 819.25 819.25

44701 135.96 135.96

44705 N.C. N.C.

44715 P 311.96 311.96

44720 P 244.99 244.99

44721 P 311.60 311.60

44799 REPORT REPORT REPORT REPORT

44800 618.48 618.48

44820 675.54 675.54

44850 605.90 605.90

44899 REPORT REPORT REPORT REPORT

44900 619.27 619.27

44950 518.84 518.84

44955 67.90 67.90

44960 706.72 706.72

44970 485.58 485.58

44979 REPORT REPORT REPORT REPORT

45000 340.86 340.86

45005 221.81 130.61

45020 462.17 462.17

45100 241.43 241.43

45108 294.76 294.76

45110 1,489.52 1,489.52

45111 876.81 876.81

45112 1,510.65 1,510.65

45113 1,555.38 1,555.38

45114 1,459.24 1,459.24

45116 1,305.89 1,305.89

45119 1,566.68 1,566.68

45120 1,283.59 1,283.59

45121 1,333.31 1,333.31

45123 901.51 901.51

45126 2,244.09 2,244.09

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CODE NOTE NFAC FAC 26 TC

45130 875.88 875.88

45135 1,104.94 1,104.94

45136 1,546.47 1,546.47

45150 288.28 288.28

45160 825.91 825.91

45171 485.26 485.26

45172 652.03 652.03

45190 559.75 559.75

45300 99.00 43.71

45303 728.22 70.13

45305 120.76 59.30

45307 138.88 78.69

45308 128.36 68.22

45309 143.50 72.70

45315 148.49 85.39

45317 145.75 90.45

45320 142.85 84.61

45321 82.16 82.16

45327 91.41 91.41

45330 133.94 45.59

45331 205.60 58.53

45332 211.38 85.69

45333 235.36 78.38

45334 442.35 117.88

45335 187.54 65.59

45337 101.94 101.94

45338 234.80 101.39

45340 346.87 81.96

45341 112.18 112.18

45342 170.97 170.97

45346 2,462.58 130.59

45347 125.56 125.56

45349 161.22 161.22

45350 421.48 82.02

45378 298.64 155.38

45379 376.43 194.45

45380 356.70 186.45

45381 347.21 176.04

45382 576.22 237.59

45384 358.24 194.71

45385 400.29 221.04

45386 513.67 190.83

45388 2,585.77 220.16

CODE NOTE NFAC FAC 26 TC

45389 235.79 235.79

45390 269.95 269.95

45391 214.84 214.84

45392 269.79 269.79

45393 205.36 205.36

45395 1,593.69 1,593.69

45397 1,733.21 1,733.21

45398 538.23 190.79

45399 REPORT REPORT REPORT REPORT

45400 917.19 917.19

45402 1,222.91 1,222.91

45499 REPORT REPORT REPORT REPORT

45500 419.19 419.19

45505 477.34 477.34

45520 125.19 32.56

45540 850.46 850.46

45541 761.34 761.34

45550 1,177.21 1,177.21

45560 549.67 549.67

45562 906.94 906.94

45563 1,326.87 1,326.87

45800 968.74 968.74

45805 1,156.08 1,156.08

45820 900.97 900.97

45825 1,147.76 1,147.76

45900 163.24 163.24

45905 135.96 135.96

45910 155.72 155.72

45915 265.95 182.15

45990 86.76 86.76

45999 REPORT REPORT REPORT REPORT

46020 222.14 188.79

46030 111.89 72.84

46040 430.87 334.25

46045 350.74 350.74

46050 162.38 78.58

46060 383.73 383.73

46070 182.22 182.22

46080 199.50 128.53

46083 141.78 85.63

46200 359.34 263.00

46220 165.64 95.52

46221 215.21 153.07

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

46230 219.39 138.74

46250 372.43 253.86

46255 407.23 284.96

46257 339.00 339.00

46258 374.55 374.55

46260 382.97 382.97

46261 419.75 419.75

46262 445.22 445.22

46270 408.80 315.89

46275 432.57 333.11

46280 377.42 377.42

46285 429.90 332.71

46288 442.74 442.74

46320 147.63 89.20

46500 150.92 99.34

46505 228.64 191.87

46600 71.11 32.92

46601 108.35 75.00

46604 502.01 53.68

46606 182.01 61.16

46607 153.22 101.63

46608 189.03 67.61

46610 183.50 65.79

46611 141.71 65.61

46612 200.62 74.08

46614 103.01 52.78

46615 114.75 74.77

46700 525.73 525.73

46705 400.90 400.90

46706 141.16 141.16

46707 379.89 379.89

46710 835.53 835.53

46712 1,693.55 1,693.55

46715 437.85 437.85

46716 886.97 886.97

46730 1,456.92 1,456.92

46735 1,686.65 1,686.65

46740 1,627.48 1,627.48

46742 2,191.69 2,191.69

46744 2,851.29 2,851.29

46746 2,860.76 2,860.76

46748 3,168.46 3,168.46

46750 604.02 604.02

CODE NOTE NFAC FAC 26 TC

46751 476.94 476.94

46753 463.25 463.25

46754 235.33 181.46

46760 887.16 887.16

46761 738.85 738.85

46762 731.12 731.12

46900 194.35 109.99

46910 206.18 107.28

46916 184.59 115.04

46917 366.71 106.21

46922 214.92 108.89

46924 429.30 147.14

46930 165.06 118.03

46940 183.02 117.18

46942 173.11 105.27

46945 248.99 182.58

46946 252.12 181.43

46947 307.87 307.87

46999 REPORT REPORT REPORT REPORT

47000 245.39 73.02

47001 84.42 84.42

47010 974.99 974.99

47015 940.02 940.02

47100 682.57 682.57

47120 1,884.69 1,884.69

47122 2,772.00 2,772.00

47125 2,485.52 2,485.52

47130 2,670.22 2,670.22

47133 N.C. N.C.

47135 P 4,340.47 4,340.47

47140 P 2,678.22 2,678.22

47141 P 3,454.28 3,454.28

47142 P 3,787.40 3,787.40

47143 P 312.82 312.82

47144 P 371.47 371.47

47145 P 351.91 351.91

47146 P 267.29 267.29

47147 P 309.99 309.99

47300 915.60 915.60

47350 1,105.76 1,105.76

47360 1,495.73 1,495.73

47361 2,451.78 2,451.78

47362 1,174.02 1,174.02

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

47370 1,008.90 1,008.90

47371 1,001.49 1,001.49

47379 REPORT REPORT REPORT REPORT

47380 1,162.62 1,162.62

47381 1,106.06 1,106.06

47382 3,885.64 611.34

47383 6,734.62 435.06

47399 REPORT REPORT REPORT REPORT

47400 1,723.83 1,723.83

47420 1,083.70 1,083.70

47425 1,053.48 1,053.48

47460 1,017.19 1,017.19

47480 709.01 709.01

47490 329.49 329.49

47531 326.57 70.41

47532 717.94 187.67

47533 1,173.93 266.48

47534 1,445.50 353.14

47535 971.16 203.17

47536 716.96 128.26

47537 354.17 87.02

47538 3,973.22 234.99

47539 4,339.58 385.79

47540 4,510.00 460.92

47541 1,035.68 267.44

47542 453.90 117.06

47543 575.09 148.15

47544 874.69 160.70

47550 133.98 133.98

47552 246.85 246.85

47553 244.59 244.59

47554 379.43 379.43

47555 290.22 290.22

47556 331.08 331.08

47562 531.59 531.59

47563 577.35 577.35

47564 899.84 899.84

47570 628.10 628.10

47579 REPORT REPORT REPORT REPORT

47600 862.58 862.58

47605 908.13 908.13

47610 1,014.23 1,014.23

47612 1,024.16 1,024.16

CODE NOTE NFAC FAC 26 TC

47620 1,107.11 1,107.11

47700 840.28 840.28

47701 1,377.95 1,377.95

47711 1,258.41 1,258.41

47712 1,612.48 1,612.48

47715 1,072.02 1,072.02

47720 922.65 922.65

47721 1,092.88 1,092.88

47740 1,057.00 1,057.00

47741 1,172.37 1,172.37

47760 1,821.96 1,821.96

47765 2,458.92 2,458.92

47780 2,000.53 2,000.53

47785 2,621.35 2,621.35

47800 1,274.54 1,274.54

47801 802.42 802.42

47802 1,232.99 1,232.99

47900 1,109.62 1,109.62

47999 REPORT REPORT REPORT REPORT

48000 1,507.15 1,507.15

48001 1,871.13 1,871.13

48020 938.08 938.08

48100 719.23 719.23

48102 424.99 192.42

48105 2,302.12 2,302.12

48120 894.65 894.65

48140 1,264.33 1,264.33

48145 1,312.03 1,312.03

48146 1,514.99 1,514.99

48148 1,005.80 1,005.80

48150 2,519.72 2,519.72

48152 2,335.20 2,335.20

48153 2,504.48 2,504.48

48154 2,333.41 2,333.41

48155 1,470.66 1,470.66

48160 P REPORT REPORT REPORT REPORT

48400 86.09 86.09

48500 912.46 912.46

48510 881.14 881.14

48520 882.33 882.33

48540 1,060.50 1,060.50

48545 1,087.76 1,087.76

48547 1,441.69 1,441.69

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

48548 1,339.24 1,339.24

48550 N.C. N.C.

48551 P 311.96 311.96

48552 P 189.58 189.58

48554 P 2,065.67 2,065.67

48556 1,025.74 1,025.74

48999 REPORT REPORT REPORT REPORT

49000 621.87 621.87

49002 844.29 844.29

49010 753.61 753.61

49020 1,285.23 1,285.23

49040 806.60 806.60

49060 886.08 886.08

49062 596.59 596.59

49082 154.43 59.51

49083 266.58 90.53

49084 87.57 87.57

49180 134.08 67.95

49185 877.70 107.17

49203 966.41 966.41

49204 1,237.29 1,237.29

49205 1,421.25 1,421.25

49215 1,790.60 1,790.60

49220 786.16 786.16

49250 475.56 475.56

49255 638.63 638.63

49320 262.28 262.28

49321 278.08 278.08

49322 296.98 296.98

49323 512.78 512.78

49324 314.17 314.17

49325 335.04 335.04

49326 152.85 152.85

49327 109.19 109.19

49329 REPORT REPORT REPORT REPORT

49400 139.03 74.20

49402 691.12 691.12

49405 726.78 174.43

49406 726.48 174.36

49407 612.43 189.85

49411 391.62 151.13

49412 68.19 68.19

49418 1,286.94 193.68

CODE NOTE NFAC FAC 26 TC

49419 358.33 358.33

49421 230.51 230.51

49422 306.78 306.78

49423 461.95 57.24

49424 126.27 30.45

49425 579.48 579.48

49426 492.09 492.09

49427 36.66 36.66

49428 373.39 373.39

49429 371.88 371.88

49435 96.59 96.59

49436 150.86 150.86

49440 863.77 171.46

49441 1,023.77 194.10

49442 834.35 167.10

49446 854.78 121.38

49450 600.97 53.19

49451 635.69 72.13

49452 776.18 110.92

49460 638.50 38.16

49465 132.18 24.66

49491 632.96 632.96

49492 773.97 773.97

49495 302.85 302.85

49496 432.57 432.57

49500 317.43 317.43

49501 489.63 489.63

49505 420.46 420.46

49507 472.57 472.57

49520 510.44 510.44

49521 578.72 578.72

49525 462.75 462.75

49540 543.84 543.84

49550 464.70 464.70

49553 509.35 509.35

49555 482.80 482.80

49557 585.17 585.17

49560 595.78 595.78

49561 751.03 751.03

49565 620.34 620.34

49566 757.66 757.66

49568 216.08 216.08

49570 336.59 336.59

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

49572 416.88 416.88

49580 264.72 264.72

49582 370.81 370.81

49585 359.42 359.42

49587 383.73 383.73

49590 462.52 462.52

49600 524.71 524.71

49605 3,999.51 3,999.51

49606 916.90 916.90

49610 521.77 521.77

49611 448.40 448.40

49650 345.99 345.99

49651 449.67 449.67

49652 600.70 600.70

49653 749.54 749.54

49654 683.20 683.20

49655 833.63 833.63

49656 741.05 741.05

49657 1,067.01 1,067.01

49659 REPORT REPORT REPORT REPORT

49900 657.92 657.92

49904 1,145.66 1,145.66

49905 285.14 285.14

49906 1,535.01 1,535.01

49999 REPORT REPORT REPORT REPORT

50010 593.22 593.22

50020 808.91 808.91

50040 737.66 737.66

50045 749.49 749.49

50060 908.38 908.38

50065 962.55 962.55

50070 989.84 989.84

50075 1,161.71 1,161.71

50080 692.50 692.50

50081 1,016.08 1,016.08

50100 884.47 884.47

50120 769.37 769.37

50125 820.75 820.75

50130 821.79 821.79

50135 893.03 893.03

50200 429.88 106.82

50205 607.97 607.97

50220 835.80 835.80

CODE NOTE NFAC FAC 26 TC

50225 957.91 957.91

50230 1,021.48 1,021.48

50234 1,036.55 1,036.55

50236 1,168.58 1,168.58

50240 1,054.05 1,054.05

50250 962.84 962.84

50280 764.99 764.99

50290 715.56 715.56

50300 P 219.00 219.00

50320 P 1,216.10 1,216.10

50323 P 457.74 457.74

50325 P 209.09 209.09

50327 P 175.25 175.25

50328 P 153.56 153.56

50329 P 144.67 144.67

50340 764.91 764.91

50360 P 1,952.92 1,952.92

50365 P 2,306.31 2,306.31

50370 970.45 970.45

50380 P 1,551.30 1,551.30

50382 1,076.86 212.79

50384 866.23 193.46

50385 1,030.22 178.85

50386 664.76 135.61

50387 512.17 76.88

50389 318.75 43.03

50390 76.42 76.42

50391 96.77 77.64

50395 141.85 141.85

50396 93.31 93.31

50400 922.71 922.71

50405 1,113.36 1,113.36

50430 455.85 144.96

50431 141.34 57.92

50432 740.27 191.29

50433 997.33 236.17

50434 789.83 181.19

50435 414.93 88.09

50500 922.92 922.92

50520 820.18 820.18

50525 1,286.69 1,286.69

50526 1,186.48 1,186.48

50540 906.25 906.25

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

50541 731.65 731.65

50542 928.42 928.42

50543 1,184.47 1,184.47

50544 992.14 992.14

50545 1,066.99 1,066.99

50546 959.19 959.19

50547 1,296.98 1,296.98

50548 1,072.80 1,072.80

50549 REPORT REPORT REPORT REPORT

50551 286.95 234.79

50553 305.67 249.23

50555 328.27 271.84

50557 334.45 276.01

50561 378.29 313.87

50562 462.81 462.81

50570 393.22 393.22

50572 423.80 423.80

50574 450.44 450.44

50575 569.52 569.52

50576 449.35 449.35

50580 484.27 484.27

50590 696.85 452.58

50592 1,226.24 280.19

50593 3,654.98 369.94

50600 750.49 750.49

50605 792.20 792.20

50606 564.64 136.64

50610 771.79 771.79

50620 718.34 718.34

50630 714.96 714.96

50650 824.94 824.94

50660 923.74 923.74

50684 105.84 40.46

50686 117.18 71.58

50688 63.40 63.40

50690 79.56 56.34

50693 929.70 189.47

50694 1,022.26 244.83

50695 1,245.84 309.96

50700 735.49 735.49

50705 1,559.73 175.18

50706 801.67 162.21

50715 981.78 981.78

CODE NOTE NFAC FAC 26 TC

50722 840.30 840.30

50725 899.30 899.30

50727 406.77 406.77

50728 556.38 556.38

50740 979.47 979.47

50750 912.52 912.52

50760 899.25 899.25

50770 937.39 937.39

50780 884.06 884.06

50782 962.20 962.20

50783 902.45 902.45

50785 966.41 966.41

50800 736.00 736.00

50810 1,100.62 1,100.62

50815 976.57 976.57

50820 1,047.89 1,047.89

50825 1,321.52 1,321.52

50830 1,449.39 1,449.39

50840 980.59 980.59

50845 996.10 996.10

50860 759.40 759.40

50900 686.14 686.14

50920 731.24 731.24

50930 877.42 877.42

50940 702.56 702.56

50945 778.13 778.13

50947 1,105.39 1,105.39

50948 1,016.35 1,016.35

50949 REPORT REPORT REPORT REPORT

50951 299.72 244.42

50953 316.45 259.45

50955 353.07 280.93

50957 342.18 282.89

50961 308.55 252.97

50970 295.17 295.17

50972 285.27 285.27

50974 376.81 376.81

50976 371.57 371.57

50980 283.64 283.64

51020 374.49 374.49

51030 375.11 375.11

51040 231.34 231.34

51045 391.22 391.22

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

51050 376.31 376.31

51060 461.21 461.21

51065 461.47 461.47

51080 327.53 327.53

51100 49.01 31.06

51101 99.95 41.22

51102 248.27 142.94

51500 508.92 508.92

51520 475.13 475.13

51525 684.59 684.59

51530 637.39 637.39

51535 622.08 622.08

51550 770.26 770.26

51555 1,010.49 1,010.49

51565 1,036.66 1,036.66

51570 1,177.80 1,177.80

51575 1,450.11 1,450.11

51580 1,533.46 1,533.46

51585 1,684.48 1,684.48

51590 1,539.62 1,539.62

51595 1,741.55 1,741.55

51596 1,873.53 1,873.53

51597 1,825.17 1,825.17

51600 161.56 35.11

51605 30.68 30.68

51610 90.44 51.39

51700 69.55 33.98

51701 46.89 20.91

51702 67.43 23.09

51703 113.63 61.88

51705 91.65 51.41

51710 130.53 72.05

51715 231.31 158.93

51720 91.17 62.29

51725 188.20 188.20 76.04 112.16

51726 265.31 265.31 84.80 180.51

51727 248.97 248.97 84.73 164.24

51728 251.78 251.78 82.70 169.08

51729 271.70 271.70 100.04 171.66

51736 15.26 15.26 8.14 7.12

51741 15.62 15.62 8.14 7.48

51784 68.29 68.29 36.74 31.55

51785 212.97 212.97 71.82 141.15

CODE NOTE NFAC FAC 26 TC

51792 197.34 197.34 50.68 146.66

51797 111.01 111.01 39.50 71.51

51798 16.24 16.24

51800 833.22 833.22

51820 943.38 943.38

51840 522.84 522.84

51841 623.98 623.98

51845 464.90 464.90

51860 596.98 596.98

51865 714.98 714.98

51880 373.56 373.56

51900 669.33 669.33

51920 625.91 625.91

51925 H 824.28 824.28

51940 1,317.69 1,317.69

51960 1,103.71 1,103.71

51980 568.25 568.25

51990 598.59 598.59

51992 668.97 668.97

51999 REPORT REPORT REPORT REPORT

52000 162.82 93.59

52001 296.68 229.06

52005 231.95 106.52

52007 485.56 132.33

52010 361.40 132.33

52204 366.93 113.01

52214 617.21 152.39

52224 688.49 162.42

52234 196.37 196.37

52235 230.20 230.20

52240 374.19 374.19

52250 190.84 190.84

52260 167.77 167.77

52265 389.49 129.59

52270 359.10 145.19

52275 495.85 198.23

52276 211.20 211.20

52277 257.59 257.59

52281 259.58 121.62

52282 268.46 268.46

52283 220.49 160.64

52285 222.69 156.28

52287 264.63 139.72

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

52290 194.41 194.41

52300 223.55 223.55

52301 231.23 231.23

52305 222.44 222.44

52310 204.79 120.97

52315 367.32 218.86

52317 865.30 276.72

52318 377.06 377.06

52320 196.84 196.84

52325 255.94 255.94

52327 285.05 208.63

52330 489.50 210.27

52332 392.57 124.37

52334 203.71 203.71

52341 242.08 242.08

52342 260.38 260.38

52343 286.42 286.42

52344 309.18 309.18

52345 327.79 327.79

52346 366.14 366.14

52351 241.41 241.41

52352 282.06 282.06

52353 314.31 314.31

52354 332.36 332.36

52355 372.52 372.52

52356 337.38 337.38

52400 404.68 404.68

52402 212.49 212.49

52441 1,089.41 202.74

52442 851.58 59.72

52450 374.89 374.89

52500 400.39 400.39

52601 673.56 673.56

52630 336.54 336.54

52640 294.21 294.21

52647 1,773.55 515.86

52648 1,823.99 549.63

52649 734.72 734.72

52700 352.49 352.49

53000 117.95 117.95

53010 235.66 235.66

53020 77.47 77.47

53025 57.41 57.41

CODE NOTE NFAC FAC 26 TC

53040 313.14 313.14

53060 146.30 131.19

53080 346.64 346.64

53085 526.26 526.26

53200 124.20 113.65

53210 620.55 620.55

53215 739.69 739.69

53220 365.45 365.45

53230 482.99 482.99

53235 505.65 505.65

53240 338.87 338.87

53250 326.74 326.74

53260 159.99 143.18

53265 173.45 148.08

53270 164.10 146.71

53275 209.86 209.86

53400 637.60 637.60

53405 700.32 700.32

53410 778.55 778.55

53415 899.73 899.73

53420 669.99 669.99

53425 745.82 745.82

53430 770.02 770.02

53431 918.63 918.63

53440 633.57 633.57

53442 623.74 623.74

53444 631.22 631.22

53445 641.16 641.16

53446 511.72 511.72

53447 643.95 643.95

53448 1,020.81 1,020.81

53449 487.32 487.32

53450 325.91 325.91

53460 365.21 365.21

53500 596.45 596.45

53502 387.84 387.84

53505 387.27 387.27

53510 502.96 502.96

53515 628.74 628.74

53520 443.29 443.29

53600 66.64 50.63

53601 65.51 42.72

53605 51.38 51.38

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

53620 98.50 69.70

53621 94.13 57.56

53660 58.17 33.43

53661 57.89 32.27

53665 30.81 30.81

53850 2,068.19 484.03

53852 1,905.41 496.04

53855 627.15 86.57

53860 1,263.01 193.24

53899 REPORT REPORT REPORT REPORT

54000 125.10 86.57

54001 152.10 110.68

54015 245.46 245.46

54050 106.20 85.11

54055 94.84 74.31

54056 113.65 89.13

54057 108.97 76.20

54060 144.46 104.26

54065 174.66 138.46

54100 158.64 101.06

54105 217.12 170.04

54110 498.87 498.87

54111 642.97 642.97

54112 746.81 746.81

54115 362.77 341.11

54120 503.76 503.76

54125 648.84 648.84

54130 950.17 950.17

54135 1,203.52 1,203.52

54150 144.79 77.90

54160 185.57 114.80

54161 156.99 156.99

54162 216.03 158.38

54163 174.95 174.95

54164 155.19 155.19

54200 85.91 67.03

54205 424.41 424.41

54220 171.44 107.10

54230 76.96 63.56

54231 111.55 93.02

54235 72.04 58.64

54240 83.34 83.34 55.08 28.26

54250 95.67 95.67 86.80 8.87

CODE NOTE NFAC FAC 26 TC

54300 512.34 512.34

54304 595.98 595.98

54308 569.73 569.73

54312 684.28 684.28

54316 833.81 833.81

54318 566.59 566.59

54322 615.60 615.60

54324 770.00 770.00

54326 753.29 753.29

54328 761.59 761.59

54332 844.70 844.70

54336 947.05 947.05

54340 450.82 450.82

54344 755.25 755.25

54348 807.81 807.81

54352 1,127.92 1,127.92

54360 574.38 574.38

54380 636.97 636.97

54385 775.38 775.38

54390 987.82 987.82

54400 P 421.83 421.83

54401 P 523.10 523.10

54405 P 643.85 643.85

54406 582.19 582.19

54408 P 630.00 630.00

54410 P 684.79 684.79

54411 P 817.44 817.44

54415 P 421.77 421.77

54416 P 566.54 566.54

54417 P 715.90 715.90

54420 560.65 560.65

54430 509.68 509.68

54435 333.00 333.00

54437 591.34 591.34

54438 1,191.32 1,191.32

54440 553.07 553.07

54450 56.97 45.95

54500 59.59 59.59

54505 167.51 167.51

54512 431.01 431.01

54520 260.86 260.86

54522 471.80 471.80

54530 403.08 403.08

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

54535 599.53 599.53

54550 395.79 395.79

54560 574.49 574.49

54600 363.26 363.26

54620 239.07 239.07

54640 382.08 382.08

54650 580.90 580.90

54660 P 290.80 290.80

54670 327.35 327.35

54680 640.31 640.31

54690 526.65 526.65

54692 640.25 640.25

54699 REPORT REPORT REPORT REPORT

54700 170.89 170.89

54800 106.49 106.49

54830 297.81 297.81

54840 256.39 256.39

54860 334.23 334.23

54861 450.93 450.93

54865 286.69 286.69

54900 669.33 669.33

54901 840.79 840.79

55000 96.98 68.03

55040 270.23 270.23

55041 407.27 407.27

55060 304.22 304.22

55100 172.06 132.73

55110 309.97 309.97

55120 287.85 287.85

55150 392.85 392.85

55175 290.92 290.92

55180 548.73 548.73

55200 423.76 218.37

55250 S 376.71 182.58

55300 149.56 149.56

55400 N.C. N.C.

55450 S 302.49 208.88

55500 317.08 317.08

55520 365.69 365.69

55530 280.81 280.81

55535 343.22 343.22

55540 445.87 445.87

55550 341.81 341.81

CODE NOTE NFAC FAC 26 TC

55559 REPORT REPORT REPORT REPORT

55600 336.40 336.40

55605 436.95 436.95

55650 572.99 572.99

55680 292.18 292.18

55700 197.51 104.31

55705 212.34 212.34

55706 297.83 297.83

55720 360.41 360.41

55725 526.85 526.85

55801 874.01 874.01

55810 1,043.13 1,043.13

55812 1,321.98 1,321.98

55815 1,408.73 1,408.73

55821 695.92 695.92

55831 752.48 752.48

55840 979.19 979.19

55842 1,048.75 1,048.75

55845 1,198.70 1,198.70

55860 696.86 696.86

55862 894.49 894.49

55865 1,062.10 1,062.10

55866 1,273.47 1,273.47

55870 N.C. N.C.

55873 5,694.86 756.15

55875 607.50 607.50

55876 112.38 81.99

55899 REPORT REPORT REPORT REPORT

55920 355.27 355.27

55970 N.C. N.C.

55980 P N.C. N.C.

56405 106.46 103.09

56420 122.92 90.14

56440 176.58 176.58

56441 146.80 135.39

56442 46.97 46.97

56501 127.67 109.43

56515 216.17 188.09

56605 82.22 58.67

56606 38.07 28.93

56620 484.22 484.22

56625 569.41 569.41

56630 822.40 822.40

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

56631 1,051.62 1,051.62

56632 1,208.56 1,208.56

56633 1,071.06 1,071.06

56634 1,137.12 1,137.12

56637 1,349.38 1,349.38

56640 1,344.12 1,344.12

56700 179.65 179.65

56740 285.11 285.11

56800 233.82 233.82

56805 1,101.10 1,101.10

56810 251.74 251.74

56820 108.70 81.82

56821 145.99 111.96

57000 183.73 183.73

57010 410.98 410.98

57020 92.82 78.97

57022 161.18 161.18

57023 297.10 297.10

57061 111.32 94.54

57065 188.57 165.70

57100 87.02 63.34

57105 133.15 121.67

57106 449.69 449.69

57107 1,331.09 1,331.09

57109 1,520.53 1,520.53

57110 862.83 862.83

57111 1,550.75 1,550.75

57112 1,591.46 1,591.46

57120 490.90 490.90

57130 177.81 155.09

57135 190.40 167.65

57150 49.21 28.52

57155 348.98 219.37

57156 158.63 115.62

57160 75.85 46.13

57170 66.22 46.87

57180 139.80 105.12

57200 284.64 284.64

57210 351.42 351.42

57220 306.09 306.09

57230 375.31 375.31

57240 600.93 600.93

57250 588.24 588.24

CODE NOTE NFAC FAC 26 TC

57260 742.31 742.31

57265 840.86 840.86

57267 261.20 261.20

57268 457.46 457.46

57270 761.14 761.14

57280 920.84 920.84

57282 488.41 488.41

57283 657.13 657.13

57284 805.47 805.47

57285 625.16 625.16

57287 665.72 665.72

57288 726.23 726.23

57289 736.44 736.44

57291 525.54 525.54

57292 794.33 794.33

57295 471.32 471.32

57296 894.70 894.70

57300 502.38 502.38

57305 837.46 837.46

57307 938.45 938.45

57308 604.41 604.41

57310 457.46 457.46

57311 519.95 519.95

57320 520.73 520.73

57330 748.59 748.59

57335 1,091.61 1,091.61

57400 129.84 129.84

57410 102.93 102.93

57415 151.55 151.55

57420 114.18 86.49

57421 154.54 119.37

57423 872.02 872.02

57425 918.04 918.04

57426 879.47 879.47

57452 107.88 88.34

57454 151.67 132.54

57455 141.89 107.62

57456 134.09 100.59

57460 294.64 159.14

57461 330.34 183.47

57500 130.08 71.53

57505 99.67 88.67

57510 130.97 112.71

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

57511 142.75 127.73

57513 140.76 128.56

57520 302.33 266.35

57522 258.36 234.41

57530 330.37 330.37

57531 1,628.89 1,628.89

57540 742.97 742.97

57545 786.15 786.15

57550 388.84 388.84

57555 576.42 576.42

57556 542.11 542.11

57558 H 122.53 109.51

57700 289.04 289.04

57720 295.60 295.60

57800 59.46 47.59

58100 108.64 85.42

58110 48.40 40.26

58120 237.05 207.32

58140 873.04 873.04

58145 520.04 520.04

58146 1,109.53 1,109.53

58150 H 941.31 941.31

58152 H 1,197.53 1,197.53

58180 H 903.66 903.66

58200 H 1,247.90 1,247.90

58210 H 1,661.13 1,661.13

58240 H 2,544.47 2,544.47

58260 H 790.48 790.48

58262 H 883.04 883.04

58263 H 951.08 951.08

58267 H 1,010.54 1,010.54

58270 H 847.69 847.69

58275 H 940.13 940.13

58280 H 1,006.92 1,006.92

58285 H 1,259.16 1,259.16

58290 H 1,108.51 1,108.51

58291 H 1,203.09 1,203.09

58292 H 1,270.33 1,270.33

58293 H 1,320.31 1,320.31

58294 H 1,167.72 1,167.72

58300 76.00 51.54

58301 94.93 65.63

58321 N.C. N.C.

CODE NOTE NFAC FAC 26 TC

58322 N.C. N.C.

58323 N.C. N.C.

58340 126.76 57.98

58345 266.61 266.61

58346 431.49 431.49

58350 94.90 76.33

58353 1,110.24 214.13

58356 2,069.35 339.99

58400 427.38 427.38

58410 764.50 764.50

58520 745.12 745.12

58540 865.52 865.52

58541 H 776.43 776.43

58542 H 886.97 886.97

58543 H 894.72 894.72

58544 H 977.50 977.50

58545 858.52 858.52

58546 1,087.54 1,087.54

58548 H 1,710.41 1,710.41

58550 H 847.76 847.76

58552 H 933.04 933.04

58553 H 1,092.19 1,092.19

58554 H 1,247.30 1,247.30

58555 229.29 167.76

58558 1,091.60 256.05

58559 315.32 315.32

58560 345.11 345.11

58561 479.15 479.15

58562 320.47 253.20

58563 1,759.84 298.58

58565 S 1,958.43 433.60

58570 H 846.09 846.09

58571 H 948.49 948.49

58572 H 1,075.90 1,075.90

58573 H 1,210.66 1,210.66

58578 REPORT REPORT REPORT REPORT

58579 REPORT REPORT REPORT REPORT

58600 S 351.71 351.71

58605 S 319.25 319.25

58611 S 75.80 75.80

58615 S 244.99 244.99

58660 644.15 644.15

58661 620.31 620.31

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

58662 679.69 679.69

58670 S 351.28 351.28

58671 S 351.67 351.67

58672 721.76 721.76

58673 778.44 778.44

58674 703.73 703.73

58679 REPORT REPORT REPORT REPORT

58700 S 727.72 727.72

58720 684.66 684.66

58740 836.32 836.32

58750 N.C. N.C.

58752 N.C. N.C.

58760 789.88 789.88

58770 823.42 823.42

58800 310.37 284.73

58805 384.12 384.12

58820 303.09 303.09

58822 653.32 653.32

58825 664.39 664.39

58900 392.35 392.35

58920 673.99 673.99

58925 695.54 695.54

58940 476.31 476.31

58943 1,066.94 1,066.94

58950 1,016.27 1,016.27

58951 H 1,308.99 1,308.99

58952 1,477.46 1,477.46

58953 H 1,833.53 1,833.53

58954 H 1,990.69 1,990.69

58956 H 1,307.97 1,307.97

58957 1,387.71 1,387.71

58958 1,534.71 1,534.71

58960 878.40 878.40

58970 N.C. N.C.

58974 N.C. N.C.

58976 N.C. N.C.

58999 REPORT REPORT REPORT REPORT

59000 129.36 80.69

59001 179.56 179.56

59012 202.89 202.89

59015 155.04 132.23

59020 69.81 69.81 36.37 33.44

59025 45.87 45.87 28.31 17.56

CODE NOTE NFAC FAC 26 TC

59030 103.78 103.78

59050 50.76 50.76

59051 41.77 41.77

59070 382.67 271.50

59072 423.80 423.80

59074 354.98 266.63

59076 423.80 423.80

59100 807.96 807.96

59120 768.28 768.28

59121 774.10 774.10

59130 872.46 872.46

59135 H 872.40 872.40

59136 835.97 835.97

59140 360.88 360.88

59150 749.31 749.31

59151 735.50 735.50

59160 213.92 180.38

59200 74.40 44.88

59300 192.40 143.53

59320 152.32 152.32

59325 228.47 228.47

59350 275.38 275.38

59400 N.C. N.C.

59409 860.00 860.00

59410 941.93 941.93

59412 102.16 102.16

59414 89.77 89.77

59425 N.C. N.C.

59426 N.C. N.C.

59430 148.76 125.08

59510 N.C. N.C.

59514 993.44 993.44

59515 1,124.12 1,124.12

59525 H 477.67 477.67

59610 N.C. N.C.

59612 857.29 857.29

59614 957.87 957.87

59618 N.C. N.C.

59620 934.28 934.28

59622 1,154.13 1,154.13

59812 300.53 285.47

59820 367.76 338.27

59821 375.03 344.77

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

59830 427.30 427.30

59840 A 213.33 208.85

59841 A 370.93 348.93

59850 A 364.99 364.99

59851 A 392.96 392.96

59852 A 529.28 529.28

59855 A 407.16 407.16

59856 A 481.97 481.97

59857 A 546.13 546.13

59866 A 225.68 225.68

59870 452.38 452.38

59871 133.23 133.23

59897 REPORT REPORT REPORT REPORT

59898 REPORT REPORT REPORT REPORT

59899 REPORT REPORT REPORT REPORT

60000 126.78 113.95

60100 89.36 62.58

60200 529.45 529.45

60210 567.34 567.34

60212 809.24 809.24

60220 565.48 565.48

60225 746.21 746.21

60240 737.02 737.02

60252 1,059.32 1,059.32

60254 1,334.26 1,334.26

60260 875.32 875.32

60270 1,098.38 1,098.38

60271 847.38 847.38

60280 353.50 353.50

60281 472.33 472.33

60300 94.33 39.61

60500 775.43 775.43

60502 1,034.75 1,034.75

60505 1,109.87 1,109.87

60512 195.26 195.26

60520 840.90 840.90

60521 904.49 904.49

60522 1,099.03 1,099.03

60540 855.84 855.84

60545 979.22 979.22

60600 P 1,117.45 1,117.45

60605 1,552.88 1,552.88

60650 959.65 959.65

CODE NOTE NFAC FAC 26 TC

60659 REPORT REPORT REPORT REPORT

60699 REPORT REPORT REPORT REPORT

61000 102.96 102.96

61001 92.15 92.15

61020 113.78 113.78

61026 115.79 115.79

61050 94.41 94.41

61055 133.63 133.63

61070 63.78 63.78

61105 414.21 414.21

61107 307.59 307.59

61108 807.93 807.93

61120 663.95 663.95

61140 1,152.22 1,152.22

61150 1,233.20 1,233.20

61151 902.01 902.01

61154 1,149.92 1,149.92

61156 1,150.64 1,150.64

61210 358.44 358.44

61215 436.45 436.45

61250 783.81 783.81

61253 865.83 865.83

61304 1,524.56 1,524.56

61305 1,818.54 1,818.54

61312 1,881.73 1,881.73

61313 1,810.69 1,810.69

61314 1,669.87 1,669.87

61315 1,919.65 1,919.65

61316 83.29 83.29

61320 1,772.39 1,772.39

61321 1,962.00 1,962.00

61322 2,125.27 2,125.27

61323 2,174.45 2,174.45

61330 1,457.61 1,457.61

61332 1,734.67 1,734.67

61333 1,720.77 1,720.77

61340 1,329.48 1,329.48

61343 2,037.32 2,037.32

61345 1,874.72 1,874.72

61450 1,736.69 1,736.69

61458 1,863.69 1,863.69

61460 1,885.23 1,885.23

61480 1,620.65 1,620.65

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CODE NOTE NFAC FAC 26 TC

61500 1,242.56 1,242.56

61501 1,054.15 1,054.15

61510 2,007.51 2,007.51

61512 2,381.51 2,381.51

61514 1,758.76 1,758.76

61516 1,718.49 1,718.49

61517 84.10 84.10

61518 2,561.54 2,561.54

61519 2,759.71 2,759.71

61520 3,508.41 3,508.41

61521 2,972.27 2,972.27

61522 2,014.76 2,014.76

61524 1,924.49 1,924.49

61526 3,160.67 3,160.67

61530 2,685.85 2,685.85

61531 1,097.52 1,097.52

61533 1,396.71 1,396.71

61534 1,499.34 1,499.34

61535 890.06 890.06

61536 2,410.60 2,410.60

61537 2,147.72 2,147.72

61538 2,288.16 2,288.16

61539 2,183.44 2,183.44

61540 2,065.52 2,065.52

61541 1,957.14 1,957.14

61543 1,965.25 1,965.25

61544 1,678.27 1,678.27

61545 2,936.07 2,936.07

61546 2,122.59 2,122.59

61548 1,418.44 1,418.44

61550 987.17 987.17

61552 1,161.99 1,161.99

61556 1,495.33 1,495.33

61557 1,563.97 1,563.97

61558 1,567.08 1,567.08

61559 2,167.47 2,167.47

61563 1,738.26 1,738.26

61564 2,248.74 2,248.74

61566 2,064.64 2,064.64

61567 2,311.36 2,311.36

61570 1,690.36 1,690.36

61571 1,827.58 1,827.58

61575 2,169.49 2,169.49

CODE NOTE NFAC FAC 26 TC

61576 3,364.46 3,364.46

61580 2,281.33 2,281.33

61581 2,514.88 2,514.88

61582 2,639.63 2,639.63

61583 2,696.49 2,696.49

61584 2,620.93 2,620.93

61585 2,762.85 2,762.85

61586 2,014.33 2,014.33

61590 2,883.29 2,883.29

61591 2,910.60 2,910.60

61592 2,931.73 2,931.73

61595 2,178.02 2,178.02

61596 2,389.42 2,389.42

61597 2,664.78 2,664.78

61598 2,379.22 2,379.22

61600 1,963.67 1,963.67

61601 2,181.38 2,181.38

61605 2,053.29 2,053.29

61606 2,764.78 2,764.78

61607 2,563.10 2,563.10

61608 3,033.38 3,033.38

61610 1,794.11 1,794.11

61611 407.56 407.56

61612 1,301.39 1,301.39

61613 2,942.22 2,942.22

61615 2,288.01 2,288.01

61616 3,037.98 3,037.98

61618 1,198.75 1,198.75

61619 1,385.88 1,385.88

61623 536.83 536.83

61624 1,047.07 1,047.07

61626 845.33 845.33

61630 1,212.19 1,212.19

61635 1,326.41 1,326.41

61640 527.40 527.40

61641 185.19 185.19

61642 370.37 370.37

61645 857.36 857.36

61650 588.22 588.22

61651 250.63 250.63

61680 2,101.30 2,101.30

61682 3,977.44 3,977.44

61684 2,667.75 2,667.75

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CODE NOTE NFAC FAC 26 TC

61686 4,255.41 4,255.41

61690 2,002.48 2,002.48

61692 3,419.37 3,419.37

61697 3,793.52 3,793.52

61698 4,006.23 4,006.23

61700 3,268.31 3,268.31

61702 3,537.07 3,537.07

61703 1,209.14 1,209.14

61705 2,395.16 2,395.16

61708 1,966.17 1,966.17

61710 1,791.29 1,791.29

61711 2,437.66 2,437.66

61720 1,065.64 1,065.64

61735 1,326.66 1,326.66

61750 1,290.39 1,290.39

61751 1,259.86 1,259.86

61760 1,386.22 1,386.22

61770 1,371.28 1,371.28

61781 256.99 256.99

61782 193.59 193.59

61783 256.99 256.99

61790 776.20 776.20

61791 999.29 999.29

61796 844.69 844.69

61797 206.30 206.30

61798 1,148.93 1,148.93

61799 285.26 285.26

61800 146.77 146.77

61850 890.82 890.82

61860 1,424.07 1,424.07

61863 1,399.56 1,399.56

61864 306.96 306.96

61867 2,025.03 2,025.03

61868 540.70 540.70

61870 1,094.99 1,094.99

61880 495.33 495.33

61885 563.34 563.34

61886 709.02 709.02

61888 373.05 373.05

62000 789.41 789.41

62005 1,118.57 1,118.57

62010 1,399.62 1,399.62

62100 1,487.07 1,487.07

CODE NOTE NFAC FAC 26 TC

62115 1,282.45 1,282.45

62117 1,706.07 1,706.07

62120 1,672.54 1,672.54

62121 1,543.23 1,543.23

62140 969.03 969.03

62141 1,060.74 1,060.74

62142 804.06 804.06

62143 948.03 948.03

62145 1,282.25 1,282.25

62146 1,112.47 1,112.47

62147 1,318.19 1,318.19

62148 118.87 118.87

62160 185.12 185.12

62161 1,409.67 1,409.67

62162 1,733.29 1,733.29

62163 1,101.29 1,101.29

62164 1,829.26 1,829.26

62165 1,411.97 1,411.97

62180 1,455.60 1,455.60

62190 801.84 801.84

62192 884.37 884.37

62194 364.29 364.29

62200 1,268.77 1,268.77

62201 1,083.87 1,083.87

62220 942.05 942.05

62223 950.86 950.86

62225 455.86 455.86

62230 768.20 768.20

62252 96.30 96.30 53.38 42.92

62256 529.79 529.79

62258 1,037.99 1,037.99

62263 621.33 354.75

62264 379.67 214.48

62267 247.36 162.34

62268 283.98 257.88

62269 293.44 254.62

62270 149.59 72.93

62272 177.93 79.68

62273 158.29 103.92

62280 296.07 144.96

62281 264.94 136.60

62282 283.08 127.07

62284 206.19 85.93

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CODE NOTE NFAC FAC 26 TC

62287 524.45 524.45

62290 314.84 161.89

62291 295.19 155.48

62292 475.13 475.13

62294 788.94 788.94

62302 264.29 132.73

62303 274.74 134.67

62304 260.47 130.47

62305 284.55 136.10

62320 164.92 164.92

62321 246.43 246.43

62322 154.00 154.00

62323 242.00 242.00

62324 143.56 143.56

62325 217.70 217.70

62326 151.11 151.11

62327 222.44 222.44

62350 376.75 376.75

62351 779.04 779.04

62355 282.35 282.35

62360 257.26 257.26

62361 372.97 372.97

62362 397.80 397.80

62365 313.66 313.66

62367 36.99 21.82

62368 52.98 34.67

62369 130.76 37.01

62370 137.69 49.61

62380 REPORT REPORT REPORT REPORT

63001 1,131.87 1,131.87

63003 1,141.08 1,141.08

63005 1,083.04 1,083.04

63011 1,017.56 1,017.56

63012 1,106.74 1,106.74

63015 1,368.64 1,368.64

63016 1,397.26 1,397.26

63017 1,145.41 1,145.41

63020 1,085.92 1,085.92

63030 904.37 904.37

63035 193.75 193.75

63040 1,323.82 1,323.82

63042 1,242.25 1,242.25

63043 475.05 475.05

CODE NOTE NFAC FAC 26 TC

63044 393.94 393.94

63045 1,179.64 1,179.64

63046 1,124.93 1,124.93

63047 1,032.80 1,032.80

63048 206.31 206.31

63050 1,404.05 1,404.05

63051 1,581.80 1,581.80

63055 1,519.43 1,519.43

63056 1,408.61 1,408.61

63057 319.06 319.06

63064 1,667.69 1,667.69

63066 195.39 195.39

63075 1,309.39 1,309.39

63076 247.03 247.03

63077 1,411.66 1,411.66

63078 195.00 195.00

63081 1,661.73 1,661.73

63082 266.23 266.23

63085 1,759.47 1,759.47

63086 187.19 187.19

63087 2,243.45 2,243.45

63088 254.56 254.56

63090 1,826.56 1,826.56

63091 174.31 174.31

63101 2,110.35 2,110.35

63102 2,106.28 2,106.28

63103 276.29 276.29

63170 1,390.61 1,390.61

63172 1,282.08 1,282.08

63173 1,576.90 1,576.90

63180 1,291.23 1,291.23

63182 1,361.24 1,361.24

63185 1,027.53 1,027.53

63190 1,163.63 1,163.63

63191 1,179.37 1,179.37

63194 1,338.21 1,338.21

63195 1,389.98 1,389.98

63196 1,505.97 1,505.97

63197 1,420.49 1,420.49

63198 1,611.38 1,611.38

63199 1,611.99 1,611.99

63200 1,391.02 1,391.02

63250 2,663.48 2,663.48

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CODE NOTE NFAC FAC 26 TC

63251 2,810.34 2,810.34

63252 2,798.04 2,798.04

63265 1,538.09 1,538.09

63266 1,583.83 1,583.83

63267 1,276.06 1,276.06

63268 1,257.75 1,257.75

63270 1,897.69 1,897.69

63271 1,906.25 1,906.25

63272 1,757.37 1,757.37

63273 1,694.36 1,694.36

63275 1,657.53 1,657.53

63276 1,646.39 1,646.39

63277 1,450.57 1,450.57

63278 1,416.72 1,416.72

63280 1,958.90 1,958.90

63281 1,941.78 1,941.78

63282 1,828.95 1,828.95

63283 1,741.95 1,741.95

63285 2,414.90 2,414.90

63286 2,413.60 2,413.60

63287 2,532.69 2,532.69

63290 2,540.25 2,540.25

63295 301.16 301.16

63300 1,707.87 1,707.87

63301 1,880.46 1,880.46

63302 1,869.15 1,869.15

63303 1,964.58 1,964.58

63304 2,101.00 2,101.00

63305 2,158.68 2,158.68

63306 2,223.74 2,223.74

63307 1,997.44 1,997.44

63308 320.14 320.14

63600 760.58 760.58

63610 491.57 405.13

63615 1,056.32 1,056.32

63620 930.71 930.71

63621 237.22 237.22

63650 1,050.33 389.62

63655 777.59 777.59

63661 557.02 307.59

63662 709.11 709.11

63663 825.43 476.03

63664 738.46 738.46

CODE NOTE NFAC FAC 26 TC

63685 382.88 382.88

63688 342.75 342.75

63700 1,136.03 1,136.03

63702 1,240.49 1,240.49

63704 1,431.26 1,431.26

63706 1,661.74 1,661.74

63707 838.44 838.44

63709 1,020.32 1,020.32

63710 1,020.91 1,020.91

63740 855.45 855.45

63741 566.96 566.96

63744 598.07 598.07

63746 498.90 498.90

64400 102.20 58.38

64402 107.29 68.25

64405 98.20 67.33

64408 113.12 83.40

64410 132.35 72.79

64413 109.13 70.44

64415 124.26 69.04

64416 84.33 84.33

64417 125.87 69.47

64418 127.93 66.95

64420 121.37 60.68

64421 163.48 82.46

64425 122.34 85.94

64430 149.84 80.45

64435 139.63 80.73

64445 129.22 74.31

64446 84.87 84.87

64447 93.93 66.55

64448 76.21 76.21

64449 87.27 87.27

64450 87.68 49.53

64455 50.72 37.67

64461 161.88 94.10

64462 91.69 59.09

64463 179.95 91.92

64479 256.59 114.00

64480 122.94 69.06

64483 238.48 100.76

64484 95.34 55.42

64486 133.09 67.79

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

64487 146.99 73.04

64488 152.34 79.96

64489 195.03 84.89

64490 189.42 110.85

64491 95.09 63.43

64492 96.23 64.58

64493 169.63 94.14

64494 86.56 54.14

64495 87.70 55.28

64505 97.02 78.60

64508 65.09 66.88

64510 134.95 63.08

64517 161.23 110.77

64520 177.07 70.53

64530 182.82 83.90

64550 14.97 8.59

64553 193.50 151.57

64555 204.87 139.72

64561 910.11 332.69

64565 162.32 113.90

64566 138.74 31.19

64568 678.53 678.53

64569 669.36 669.36

64570 591.66 591.66

64575 268.35 268.35

64580 280.72 280.72

64581 728.18 728.18

64585 270.35 155.43

64590 292.53 173.16

64595 271.85 137.65

64600 385.11 197.41

64605 544.86 311.99

64610 670.50 449.30

64611 107.00 96.69

64612 144.50 125.46

64615 127.80 114.93

64616 127.56 112.25

64617 197.65 118.59

64620 221.79 154.50

64630 222.92 176.93

64632 81.97 69.77

64633 458.41 246.01

64634 206.36 74.20

CODE NOTE NFAC FAC 26 TC

64635 453.41 242.58

64636 187.80 64.68

64640 144.79 101.92

64642 144.41 111.20

64643 94.77 73.92

64644 164.96 122.07

64645 116.14 84.78

64646 155.30 119.58

64647 179.72 138.38

64650 62.14 35.57

64653 75.85 44.56

64680 292.50 149.67

64681 422.20 220.13

64702 414.89 414.89

64704 314.31 314.31

64708 432.59 432.59

64712 497.65 497.65

64713 696.19 696.19

64714 574.66 574.66

64716 489.93 489.93

64718 528.50 528.50

64719 372.04 372.04

64721 392.81 391.28

64722 302.15 302.15

64726 277.77 277.77

64727 178.25 178.25

64732 346.88 346.88

64734 412.90 412.90

64736 351.79 351.79

64738 440.81 440.81

64740 434.91 434.91

64742 439.84 439.84

64744 401.78 401.78

64746 421.05 421.05

64755 805.57 805.57

64760 432.94 432.94

64763 474.65 474.65

64766 560.78 560.78

64771 547.44 547.44

64772 521.11 521.11

64774 381.97 381.97

64776 367.21 367.21

64778 153.80 153.80

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CODE NOTE NFAC FAC 26 TC

64782 425.28 425.28

64783 210.80 210.80

64784 673.88 673.88

64786 1,019.86 1,019.86

64787 244.55 244.55

64788 355.77 355.77

64790 776.09 776.09

64792 977.78 977.78

64795 182.81 182.81

64802 573.18 573.18

64804 850.78 850.78

64809 814.34 814.34

64818 622.04 622.04

64820 704.70 704.70

64821 642.08 642.08

64822 639.91 639.91

64823 724.17 724.17

64831 645.24 645.24

64832 331.32 331.32

64834 698.35 698.35

64835 757.69 757.69

64836 758.23 758.23

64837 367.38 367.38

64840 844.57 844.57

64856 949.10 949.10

64857 992.66 992.66

64858 1,143.07 1,143.07

64859 250.14 250.14

64861 1,304.53 1,304.53

64862 1,309.77 1,309.77

64864 830.81 830.81

64865 1,101.80 1,101.80

64866 1,140.12 1,140.12

64868 989.22 989.22

64872 116.47 116.47

64874 173.74 173.74

64876 190.59 190.59

64885 1,075.22 1,075.22

64886 1,270.78 1,270.78

64890 1,021.80 1,021.80

64891 997.99 997.99

64892 991.82 991.82

64893 1,065.90 1,065.90

CODE NOTE NFAC FAC 26 TC

64895 1,208.27 1,208.27

64896 1,323.68 1,323.68

64897 1,182.99 1,182.99

64898 1,286.97 1,286.97

64901 580.01 580.01

64902 676.68 676.68

64905 901.26 901.26

64907 1,181.58 1,181.58

64910 659.82 659.82

64911 815.99 815.99

64999 REPORT REPORT REPORT REPORT

65091 501.27 501.27

65093 495.35 495.35

65101 582.25 582.25

65103 606.95 606.95

65105 668.41 668.41

65110 963.57 963.57

65112 1,118.62 1,118.62

65114 1,163.98 1,163.98

65125 358.87 228.33

65130 575.96 575.96

65135 584.82 584.82

65140 635.24 635.24

65150 456.17 456.17

65155 665.07 665.07

65175 518.39 518.39

65205 44.11 34.43

65210 53.88 41.63

65220 45.98 33.43

65222 52.46 40.77

65235 558.54 558.54

65260 755.33 755.33

65265 849.86 849.86

65270 210.58 110.25

65272 397.20 276.07

65273 299.82 299.82

65275 455.43 362.81

65280 527.83 527.83

65285 870.74 870.74

65286 556.36 389.63

65290 387.12 387.12

65400 535.88 475.17

65410 112.76 82.26

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

65420 408.74 297.87

65426 515.42 376.90

65430 89.64 81.37

65435 62.89 54.91

65436 304.80 292.55

65450 256.55 253.99

65600 311.21 271.31

65710 869.36 869.36

65730 964.60 964.60

65750 969.12 969.12

65755 964.16 964.16

65756 929.90 929.90

65757 229.26 229.26

65760 603.00 603.00

65765 603.00 603.00

65767 625.00 625.00

65770 1,100.38 1,100.38

65771 N.C. N.C.

65772 355.67 320.04

65775 433.92 433.92

65778 1,142.09 55.62

65779 964.11 147.86

65780 557.32 557.32

65781 1,047.76 1,047.76

65782 904.53 904.53

65785 1,863.32 335.77

65800 97.54 82.64

65810 366.44 366.44

65815 503.83 376.15

65820 589.43 589.43

65850 659.45 659.45

65855 227.20 194.96

65860 242.97 199.07

65865 372.52 372.52

65870 465.37 465.37

65875 496.31 496.31

65880 522.21 522.21

65900 757.66 757.66

65920 620.13 620.13

65930 501.06 501.06

66020 147.54 103.36

66030 131.54 87.36

66130 548.72 447.54

CODE NOTE NFAC FAC 26 TC

66150 690.51 690.51

66155 689.96 689.96

66160 777.23 777.23

66170 861.09 861.09

66172 937.42 937.42

66174 817.71 817.71

66175 932.72 932.72

66179 847.59 927.53

66180 894.11 894.11

66183 882.71 882.71

66184 618.24 677.56

66185 664.47 664.47

66220 558.99 558.99

66225 732.39 732.39

66250 591.82 438.77

66500 279.63 279.63

66505 308.54 308.54

66600 655.55 655.55

66605 830.14 830.14

66625 337.95 337.95

66630 448.15 448.15

66635 452.01 452.01

66680 408.01 408.01

66682 502.78 502.78

66700 354.71 309.40

66710 346.16 309.11

66711 506.34 506.34

66720 363.37 322.89

66740 343.89 309.11

66761 284.67 253.13

66762 374.28 335.81

66770 415.83 381.07

66820 311.53 311.53

66821 260.35 245.53

66825 598.69 598.69

66830 560.83 560.83

66840 547.67 547.67

66850 623.21 623.21

66852 663.41 663.41

66920 592.82 592.82

66930 671.90 671.90

66940 614.92 614.92

66982 677.60 677.60

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

66983 581.59 581.59

66984 503.10 503.10

66985 605.58 605.58

66986 714.17 714.17

66990 70.79 70.79

66999 REPORT REPORT REPORT REPORT

67005 372.04 372.04

67010 426.83 426.83

67015 456.93 456.93

67025 572.20 497.81

67027 669.64 669.64

67028 99.41 98.00

67030 419.86 419.86

67031 306.25 280.88

67036 708.12 708.12

67039 767.42 767.42

67040 883.52 883.52

67041 904.21 904.21

67042 919.72 919.72

67043 966.45 966.45

67101 321.41 278.58

67105 290.52 269.28

67107 889.37 889.37

67108 994.22 994.22

67110 690.68 639.94

67113 1,061.99 1,061.99

67115 393.97 393.97

67120 518.57 439.33

67121 713.90 713.90

67141 412.38 384.16

67145 414.66 392.14

67208 471.50 454.97

67210 430.19 412.94

67218 1,085.46 1,085.46

67220 522.37 489.45

67221 225.81 167.38

67225 23.16 22.02

67227 283.54 250.97

67228 332.73 299.81

67229 915.67 915.67

67250 614.47 614.47

67255 538.41 538.41

67299 REPORT REPORT REPORT REPORT

CODE NOTE NFAC FAC 26 TC

67311 470.17 470.17

67312 559.09 559.09

67314 528.91 528.91

67316 629.72 629.72

67318 555.15 555.15

67320 252.58 252.58

67331 239.92 239.92

67332 260.30 260.30

67334 236.32 236.32

67335 116.50 116.50

67340 280.95 280.95

67343 514.70 514.70

67345 191.53 172.43

67346 152.37 152.37

67399 REPORT REPORT REPORT REPORT

67400 732.28 732.28

67405 624.74 624.74

67412 669.93 669.93

67413 672.89 672.89

67414 1,042.76 1,042.76

67415 82.36 82.36

67420 1,273.04 1,273.04

67430 973.64 973.64

67440 948.82 948.82

67445 1,101.93 1,101.93

67450 984.27 984.27

67500 60.95 55.82

67505 69.46 63.47

67515 76.09 70.11

67550 759.39 759.39

67560 777.79 777.79

67570 921.90 921.90

67599 REPORT REPORT REPORT REPORT

67700 213.22 91.81

67710 177.54 76.64

67715 190.45 85.57

67800 99.73 81.49

67801 127.43 104.62

67805 158.49 129.42

67808 290.19 290.19

67810 146.72 61.01

67820 39.27 41.84

67825 101.12 95.70

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

67830 210.63 108.60

67835 345.58 345.58

67840 217.79 124.59

67850 170.69 107.70

67875 135.79 76.79

67880 361.66 290.40

67882 444.55 371.86

67900 505.43 401.68

67901 597.49 454.41

67902 568.91 568.91

67903 467.78 380.85

67904 577.46 470.58

67906 399.68 399.68

67908 388.69 334.25

67909 423.21 345.97

67911 442.79 442.79

67912 698.55 386.75

67914 371.92 258.77

67915 237.63 162.30

67916 468.05 340.08

67917 475.82 360.96

67921 364.32 245.18

67922 230.97 157.80

67923 467.08 339.40

67924 497.73 360.92

67930 287.71 188.81

67935 469.14 348.29

67938 193.52 91.77

67950 451.91 365.55

67961 453.40 358.49

67966 604.90 517.39

67971 568.94 568.94

67973 731.77 731.77

67974 729.77 729.77

67975 538.41 538.41

67999 REPORT REPORT REPORT REPORT

68020 94.01 86.88

68040 48.45 39.33

68100 134.33 76.76

68110 178.30 117.02

68115 246.34 144.87

68130 425.19 324.58

68135 123.19 118.91

CODE NOTE NFAC FAC 26 TC

68200 32.56 27.43

68320 572.38 425.03

68325 518.46 518.46

68326 508.49 508.49

68328 557.96 557.96

68330 477.13 363.42

68335 510.41 510.41

68340 430.25 314.53

68360 420.04 324.85

68362 516.68 516.68

68371 325.45 325.45

68399 REPORT REPORT REPORT REPORT

68400 225.19 103.77

68420 254.18 132.48

68440 80.47 78.18

68500 770.12 770.12

68505 762.71 762.71

68510 350.54 228.84

68520 540.77 540.77

68525 207.19 207.19

68530 337.74 202.64

68540 730.85 730.85

68550 876.11 876.11

68700 475.47 475.47

68705 186.98 131.11

68720 595.54 595.54

68745 597.75 597.75

68750 619.25 619.25

68760 158.99 115.10

68761 116.51 93.71

68770 495.63 495.63

68801 80.76 68.54

68810 154.40 125.03

68811 130.45 130.45

68815 315.15 174.93

68816 515.33 153.67

68840 100.76 91.92

68850 48.62 44.63

68899 REPORT REPORT REPORT REPORT

69000 159.72 101.73

69005 185.71 139.10

69020 204.75 126.68

69090 N.C. N.C.

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

69100 94.00 41.32

69105 123.77 57.45

69110 395.64 289.53

69120 361.06 361.06

69140 779.42 779.42

69145 326.36 217.68

69150 941.32 941.32

69155 1,490.49 1,490.49

69200 81.84 48.52

69205 90.87 90.87

69209 11.27 11.27

69210 43.91 28.75

69220 89.22 55.22

69222 197.32 124.17

69300 P 472.35 415.20

69310 975.60 975.60

69320 1,381.50 1,381.50

69399 REPORT REPORT REPORT REPORT

69420 169.42 106.12

69421 136.79 136.79

69424 115.06 55.18

69433 175.09 114.84

69436 148.82 148.82

69440 601.75 601.75

69450 471.12 471.12

69501 649.22 649.22

69502 857.63 857.63

69505 1,081.92 1,081.92

69511 1,108.93 1,108.93

69530 1,477.39 1,477.39

69535 2,395.74 2,395.74

69540 186.73 114.73

69550 933.10 933.10

69552 1,415.73 1,415.73

69554 2,262.86 2,262.86

69601 925.28 925.28

69602 964.04 964.04

69603 1,145.46 1,145.46

69604 987.42 987.42

69605 1,402.77 1,402.77

69610 351.74 264.19

69620 622.43 434.83

69631 773.08 773.08

CODE NOTE NFAC FAC 26 TC

69632 949.73 949.73

69633 915.36 915.36

69635 1,088.07 1,088.07

69636 1,237.86 1,237.86

69637 1,231.24 1,231.24

69641 919.49 919.49

69642 1,186.19 1,186.19

69643 1,082.16 1,082.16

69644 1,330.99 1,330.99

69645 1,303.20 1,303.20

69646 1,384.12 1,384.12

69650 703.39 703.39

69660 822.59 822.59

69661 1,078.46 1,078.46

69662 1,031.68 1,031.68

69666 712.69 712.69

69667 714.18 714.18

69670 835.36 835.36

69676 736.90 736.90

69700 625.45 625.45

69710 P REPORT REPORT REPORT REPORT

69711 P 763.65 763.65

69714 955.97 955.97

69715 1,184.84 1,184.84

69717 1,016.10 1,016.10

69718 1,261.48 1,261.48

69720 1,042.98 1,042.98

69725 1,677.92 1,677.92

69740 1,030.78 1,030.78

69745 1,047.19 1,047.19

69799 REPORT REPORT REPORT REPORT

69801 214.80 124.67

69805 931.32 931.32

69806 837.76 837.76

69820 767.85 767.85

69840 819.77 819.77

69905 808.96 808.96

69910 906.60 906.60

69915 1,369.66 1,369.66

69930 1,133.05 1,133.05

69949 REPORT REPORT REPORT REPORT

69950 1,626.72 1,626.72

69955 1,785.32 1,785.32

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

69960 1,720.79 1,720.79

69970 1,915.44 1,915.44

69979 REPORT REPORT REPORT REPORT

69990 199.26 199.26

70010 65.23 65.23 18.73 46.50

70015 123.70 123.70 49.27 74.43

70030 21.98 21.98 6.56 15.42

70100 26.24 26.24 7.11 19.13

70110 30.09 30.09 9.82 20.27

70120 26.81 26.81 7.11 19.70

70130 43.36 43.36 13.39 29.97

70134 41.04 41.04 13.64 27.40

70140 24.67 24.67 8.58 16.09

70150 33.48 33.48 10.55 22.93

70160 25.97 25.97 6.84 19.13

70170 44.76 44.76 11.76 33.00

70190 28.18 28.18 8.76 19.42

70200 34.64 34.64 11.29 23.35

70210 24.09 24.09 6.95 17.14

70220 31.71 31.71 10.45 21.26

70240 23.94 23.94 7.66 16.28

70250 28.69 28.69 9.84 18.85

70260 38.70 38.70 14.61 24.09

70300 11.85 11.85 4.69 7.16

70310 28.84 28.84 6.29 22.55

70320 42.45 42.45 9.63 32.82

70328 24.25 24.25 7.11 17.14

70330 38.38 38.38 9.84 28.54

70332 73.45 73.45 27.94 45.51

70336 296.13 296.13 71.74 224.39

70350 16.67 16.67 8.48 8.19

70355 20.48 20.48 10.90 9.58

70360 22.27 22.27 6.56 15.71

70370 61.35 61.35 12.58 48.77

70371 82.84 82.84 37.89 44.95

70380 28.86 28.86 7.20 21.66

70390 76.39 76.39 15.09 61.30

70450 114.38 114.38 41.42 72.96

70460 159.80 159.80 54.60 105.20

70470 189.24 189.24 61.76 127.48

70480 173.29 173.29 62.08 111.21

70481 266.69 266.69 65.41 201.28

70482 306.40 306.40 71.94 234.46

CODE NOTE NFAC FAC 26 TC

70486 137.39 137.39 41.42 95.97

70487 165.11 165.11 54.60 110.51

70488 201.64 201.64 61.40 140.24

70490 173.29 173.29 62.08 111.21

70491 255.34 255.34 73.78 181.56

70492 274.54 274.54 70.23 204.31

70496 319.95 319.95 93.74 226.21

70498 320.24 320.24 94.06 226.18

70540 316.79 316.79 71.70 245.09

70542 368.69 368.69 86.43 282.26

70543 411.89 411.89 103.81 308.08

70544 311.47 311.47 64.69 246.78

70545 353.06 353.06 64.07 288.99

70546 475.29 475.29 81.60 393.69

70547 311.17 311.17 64.63 246.54

70548 353.37 353.37 64.54 288.83

70549 475.29 475.29 81.60 393.69

70551 227.74 227.74 71.58 156.16

70552 316.38 316.38 86.54 229.84

70553 372.66 372.66 110.96 261.70

70554 444.90 444.90 102.84 342.06

70555 13.34 13.34 13.34

70557 205.36 205.36 57.50 147.86

70558 227.07 227.07 63.58 163.49

70559 228.04 228.04 63.85 164.19

71010 19.65 19.65 7.77 11.88

71015 23.19 23.19 8.97 14.22

71020 25.53 25.53 9.74 15.79

71021 31.38 31.38 12.40 18.98

71022 34.90 34.90 13.66 21.24

71023 50.41 50.41 14.75 35.66

71030 36.11 36.11 13.41 22.70

71034 69.45 69.45 19.08 50.37

71035 25.96 25.96 7.11 18.85

71100 26.17 26.17 8.74 17.43

71101 30.81 30.81 11.36 19.45

71110 32.87 32.87 11.74 21.13

71111 40.53 40.53 13.62 26.91

71120 26.73 26.73 9.06 17.67

71130 29.40 29.40 9.03 20.37

71250 160.76 160.76 49.55 111.21

71260 226.84 226.84 60.41 166.43

71270 271.87 271.87 66.85 205.02

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

71275 326.65 326.65 97.19 229.46

71550 320.76 320.76 77.17 243.59

71551 372.39 372.39 68.19 304.20

71552 511.92 511.92 105.81 406.11

71555 375.66 375.66 82.37 293.29

72020 18.61 18.61 6.42 12.19

72040 28.20 28.20 9.42 18.78

72050 40.25 40.25 13.76 26.49

72052 50.58 50.58 16.16 34.42

72070 27.02 27.02 8.74 18.28

72072 30.27 30.27 9.38 20.89

72074 35.91 35.91 9.79 26.12

72080 27.91 27.91 9.77 18.14

72081 33.58 33.58 11.29 22.29

72082 54.10 54.10 13.71 40.39

72083 58.70 58.70 14.88 43.82

72084 69.82 69.82 17.26 52.56

72100 29.69 29.69 9.31 20.38

72110 41.44 41.44 13.13 28.31

72114 53.86 53.86 14.03 39.83

72120 37.40 37.40 10.17 27.23

72125 163.12 163.12 51.91 111.21

72126 225.83 225.83 59.04 166.79

72127 267.13 267.13 61.40 205.73

72128 159.74 159.74 48.54 111.20

72129 226.89 226.89 59.40 167.49

72130 268.19 268.19 61.40 206.79

72131 159.74 159.74 48.54 111.20

72132 225.47 225.47 59.04 166.43

72133 266.77 266.77 61.40 205.37

72141 221.41 221.41 71.97 149.44

72142 321.33 321.33 86.54 234.79

72146 221.76 221.76 71.97 149.79

72147 319.20 319.20 86.53 232.67

72148 220.70 220.70 72.32 148.38

72149 317.84 317.84 86.93 230.91

72156 375.14 375.14 110.96 264.18

72157 375.85 375.85 110.96 264.89

72158 373.73 373.73 111.31 262.42

72159 412.26 412.26 87.55 324.71

72170 25.40 25.40 6.84 18.56

72190 30.17 30.17 8.47 21.70

72191 322.64 322.64 93.50 229.14

CODE NOTE NFAC FAC 26 TC

72192 143.96 143.96 52.93 91.03

72193 223.49 223.49 56.35 167.14

72194 257.33 257.33 59.04 198.29

72195 320.73 320.73 77.46 243.27

72196 372.64 372.64 77.12 295.52

72197 511.60 511.60 112.04 399.56

72198 375.06 375.06 81.63 293.43

72200 22.64 22.64 6.87 15.77

72202 27.33 27.33 7.68 19.65

72220 23.80 23.80 7.31 16.49

72240 96.54 96.54 43.75 52.79

72255 96.94 96.94 45.22 51.72

72265 90.71 90.71 40.04 50.67

72270 124.72 124.72 64.84 59.88

72275 91.65 91.65 30.34 61.31

72285 110.56 110.56 58.48 52.08

72295 96.07 96.07 41.86 54.21

73000 22.00 22.00 6.57 15.43

73010 23.98 23.98 7.12 16.86

73020 18.80 18.80 6.47 12.33

73030 23.78 23.78 7.61 16.17

73040 85.06 85.06 22.81 62.25

73050 28.22 28.22 8.22 20.00

73060 23.50 23.50 6.67 16.83

73070 21.74 21.74 6.30 15.44

73080 26.19 26.19 7.21 18.98

73085 79.12 79.12 23.38 55.74

73090 21.47 21.47 6.86 14.61

73092 22.00 22.00 6.29 15.71

73100 23.14 23.14 6.57 16.57

73110 28.25 28.25 6.84 21.41

73115 84.66 84.66 22.21 62.45

73120 21.17 21.17 6.67 14.50

73130 24.55 24.55 6.84 17.71

73140 25.19 25.19 5.49 19.70

73200 159.74 159.74 48.54 111.20

73201 219.95 219.95 56.35 163.60

73202 297.79 297.79 64.09 233.70

73206 322.61 322.61 86.32 236.29

73218 316.79 316.79 72.20 244.59

73219 368.69 368.69 72.90 295.79

73220 487.61 487.61 102.59 385.02

73221 234.46 234.46 66.21 168.25

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CODE NOTE NFAC FAC 26 TC

73222 368.66 368.66 77.51 291.15

73223 507.48 507.48 113.98 393.50

73225 404.99 404.99 83.11 321.88

73501 25.92 25.92 8.09 17.83

73502 35.83 35.83 9.49 26.34

73503 44.81 44.81 12.23 32.58

73521 34.58 34.58 9.88 24.70

73522 42.27 42.27 12.81 29.46

73523 49.10 49.10 13.70 35.40

73525 80.96 80.96 22.49 58.47

73551 24.08 24.08 7.10 16.98

73552 28.10 28.10 8.00 20.10

73560 24.56 24.56 6.57 17.99

73562 28.52 28.52 7.39 21.13

73564 31.58 31.58 8.74 22.84

73565 28.56 28.56 6.86 21.70

73580 98.12 98.12 23.73 74.39

73590 22.85 22.85 6.57 16.28

73592 22.00 22.00 6.29 15.71

73600 23.71 23.71 6.57 17.14

73610 25.11 25.11 6.84 18.27

73615 83.77 83.77 22.17 61.60

73620 20.87 20.87 6.09 14.78

73630 23.84 23.84 6.76 17.08

73650 21.43 21.43 6.29 15.14

73660 22.35 22.35 5.20 17.15

73700 159.74 159.74 48.54 111.20

73701 223.49 223.49 56.35 167.14

73702 298.09 298.09 64.91 233.18

73706 326.08 326.08 84.96 241.12

73718 316.79 316.79 71.90 244.89

73719 368.69 368.69 85.35 283.34

73720 487.32 487.32 102.01 385.31

73721 234.11 234.11 65.86 168.25

73722 368.66 368.66 76.86 291.80

73723 507.79 507.79 113.57 394.22

73725 375.65 375.65 82.39 293.26

74000 20.84 20.84 7.87 12.97

74010 28.49 28.49 9.21 19.28

74020 30.81 30.81 11.03 19.78

74022 36.68 36.68 13.03 23.65

74150 147.30 147.30 57.70 89.60

74160 228.19 228.19 61.76 166.43

CODE NOTE NFAC FAC 26 TC

74170 259.43 259.43 67.87 191.56

74174 367.56 367.56 106.21 261.35

74175 325.51 325.51 93.94 231.57

74176 181.41 181.41 77.63 103.78

74177 286.56 286.56 82.23 204.33

74178 363.20 363.20 101.28 261.92

74181 320.98 320.98 77.21 243.77

74182 372.68 372.68 69.61 303.07

74183 511.60 511.60 111.80 399.80

74185 375.06 375.06 81.27 293.79

74190 65.00 65.00 20.13 44.87

74210 61.84 61.84 14.21 47.63

74220 70.24 70.24 18.05 52.19

74230 102.03 102.03 20.77 81.26

74235 51.00 51.00 21.42 29.58

74240 89.51 89.51 27.06 62.45

74241 93.50 93.50 27.06 66.44

74245 136.15 136.15 35.50 100.65

74246 100.91 100.91 27.06 73.85

74247 112.60 112.60 27.06 85.54

74249 146.13 146.13 35.51 110.62

74250 82.76 82.76 18.60 64.16

74251 135.88 135.88 31.46 104.42

74260 109.50 109.50 19.68 89.82

74261 234.05 234.05 119.88 114.17

74262 320.87 320.87 101.83 219.04

74263 602.23 602.23 87.99 514.24

74270 116.59 116.59 27.06 89.53

74280 140.97 140.97 42.63 98.34

74283 164.80 164.80 80.40 84.40

74290 55.94 55.94 12.58 43.36

74300 39.25 39.25 14.25 25.00

74301 12.50 12.50 10.17 2.33

74328 135.72 135.72 27.89 107.83

74329 111.50 111.50 35.23 76.27

74330 143.67 143.67 35.53 108.14

74340 100.84 100.84 21.03 79.81

74355 53.37 53.37 22.42 30.95

74360 117.29 117.29 21.96 95.33

74363 108.82 108.82 33.29 75.53

74400 87.86 87.86 19.13 68.73

74410 87.25 87.25 19.25 68.00

74415 108.95 108.95 19.13 89.82

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

74420 103.10 103.10 13.60 89.50

74425 58.37 58.37 13.65 44.72

74430 37.26 37.26 15.62 21.64

74440 64.66 64.66 14.46 50.20

74445 78.36 78.36 41.88 36.48

74450 62.74 62.74 12.84 49.90

74455 69.33 69.33 13.63 55.70

74470 59.54 59.54 20.46 39.08

74485 90.55 90.55 25.01 65.54

74710 37.50 37.50 17.25 20.25

74712 257.09 257.09 145.88 111.21

74713 199.61 199.61 78.34 121.27

74740 59.53 59.53 14.75 44.78

74742 119.28 119.28 23.75 95.53

74775 75.31 75.31 24.34 50.97

75557 315.03 315.03 111.79 203.24

75559 381.75 381.75 145.80 235.95

75561 419.32 419.32 123.63 295.69

75563 528.43 528.43 149.56 378.87

75565 54.32 54.32 11.84 42.48

75571 70.02 70.02 22.38 47.64

75572 225.38 225.38 67.41 157.97

75573 308.66 308.66 98.24 210.42

75574 302.96 302.96 92.22 210.74

75600 196.66 196.66 23.50 173.16

75605 135.88 135.88 54.05 81.83

75625 135.31 135.31 54.20 81.11

75630 166.88 166.88 85.06 81.82

75635 344.49 344.49 105.47 239.02

75658 166.19 166.19 62.38 103.81

75705 243.83 243.83 112.04 131.79

75710 160.14 160.14 54.55 105.59

75716 184.20 184.20 61.94 122.26

75726 147.11 147.11 53.61 93.50

75731 169.42 169.42 55.33 114.09

75733 183.18 183.18 61.26 121.92

75736 157.87 157.87 53.35 104.52

75741 148.13 148.13 61.35 86.78

75743 165.50 165.50 77.66 87.84

75746 150.97 150.97 54.27 96.70

75756 168.01 168.01 55.35 112.66

75774 85.72 85.72 16.99 68.73

75801 70.50 70.50 29.61 40.89

CODE NOTE NFAC FAC 26 TC

75803 50.50 50.50 21.21 29.29

75805 70.50 70.50 29.61 40.89

75807 43.50 43.50 18.27 25.23

75809 78.77 78.77 18.60 60.17

75810 41.50 41.50 17.43 24.07

75820 91.84 91.84 27.11 64.73

75822 108.66 108.66 40.79 67.87

75825 133.54 133.54 54.55 78.99

75827 136.41 136.41 54.59 81.82

75831 138.01 138.01 53.35 84.66

75833 162.37 162.37 70.24 92.13

75840 147.02 147.02 55.65 91.37

75842 176.52 176.52 70.58 105.94

75860 141.50 141.50 54.01 87.49

75870 147.07 147.07 55.69 91.38

75872 153.14 153.14 55.03 98.11

75880 117.07 117.07 27.82 89.25

75885 153.49 153.49 65.65 87.84

75887 155.26 155.26 66.36 88.90

75889 141.41 141.41 52.86 88.55

75891 143.17 143.17 53.92 89.25

75893 117.86 117.86 26.13 91.73

75894 136.50 136.50 53.43 83.07

75898 105.15 105.15 67.79 37.36

75901 141.72 141.72 18.27 123.45

75902 79.06 79.06 20.28 58.78

75952 121.41 121.41 50.99 70.42

75953 50.00 50.00 21.00 29.00

75954 60.14 60.14 25.26 34.88

75956 194.56 194.56 81.72 112.84

75957 166.80 166.80 70.06 96.74

75958 111.06 111.06 46.65 64.41

75959 97.29 97.29 40.86 56.43

75970 420.38 420.38 31.10 389.28

75984 88.40 88.40 28.40 60.00

75989 122.15 122.15 57.95 64.20

76000 47.18 47.18 8.54 38.64

76001 121.81 121.81 28.70 93.11

76010 22.03 22.03 7.52 14.51

76080 50.33 50.33 23.63 26.70

76098 16.40 16.40 7.83 8.57

76100 78.85 78.85 26.74 52.11

76101 122.89 122.89 32.33 90.56

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

76102 153.81 153.81 34.65 119.16

76120 62.66 62.66 15.03 47.63

76125 35.30 35.30 11.28 24.02

76140 10.00 10.00 10.00

76376 22.99 22.99 9.49 13.50

76377 69.92 69.92 38.73 31.19

76380 106.69 106.69 47.53 59.16

76390 364.73 364.73 55.41 309.32

76496 REPORT REPORT REPORT REPORT

76497 REPORT REPORT REPORT REPORT

76498 REPORT REPORT REPORT REPORT

76499 REPORT REPORT REPORT REPORT

76506 94.79 94.79 25.21 69.58

76510 133.98 133.98 68.95 65.03

76511 82.49 82.49 42.38 40.11

76512 77.11 77.11 43.34 33.77

76513 75.49 75.49 27.57 47.92

76514 12.01 12.01 7.70 4.31

76516 62.32 62.32 24.09 38.23

76519 67.17 67.17 24.38 42.79

76529 62.55 62.55 24.89 37.66

76536 93.42 93.42 21.85 71.57

76604 70.64 70.64 21.01 49.63

76641 92.82 92.82 30.75 62.07

76642 76.07 76.07 28.63 47.44

76700 102.56 102.56 32.91 69.65

76705 76.71 76.71 24.06 52.65

76706 82.20 82.20

76770 98.79 98.79 31.28 67.51

76775 57.58 57.58 27.80 29.78

76776 125.86 125.86 29.48 96.38

76800 94.81 94.81 47.18 47.63

76801 101.98 101.98 40.40 61.58

76802 59.63 59.63 38.67 20.96

76805 114.13 114.13 39.42 74.71

76810 76.82 76.82 40.53 36.29

76811 170.09 170.09 89.54 80.55

76812 164.55 164.55 72.74 91.81

76813 100.47 100.47 49.40 51.07

76814 64.61 64.61 40.35 24.26

76815 70.37 70.37 26.63 43.74

76816 93.02 93.02 34.55 58.47

76817 78.03 78.03 29.82 48.21

CODE NOTE NFAC FAC 26 TC

76818 99.02 99.02 42.80 56.22

76819 78.35 78.35 33.55 44.80

76820 49.76 49.76 26.17 23.59

76821 77.68 77.68 29.66 48.02

76825 223.29 223.29 65.60 157.69

76826 131.43 131.43 32.20 99.23

76827 62.98 62.98 23.55 39.43

76828 46.09 46.09 24.06 22.03

76830 98.06 98.06 27.06 71.00

76831 96.05 96.05 28.75 67.30

76856 88.45 88.45 27.08 61.37

76857 47.50 47.50 24.09 23.41

76870 67.40 67.40 31.24 36.16

76872 100.35 100.35 34.23 66.12

76873 135.83 135.83 60.55 75.28

76881 97.11 97.11 25.18 71.93

76882 28.29 28.29 19.13 9.16

76885 76.59 76.59 28.95 47.64

76886 70.79 70.79 23.16 47.63

76930 77.18 77.18 25.83 51.35

76932 74.50 74.50 25.35 49.15

76936 217.79 217.79 76.63 141.16

76937 27.36 27.36 12.31 15.05

76940 145.66 145.66 81.21 64.45

76941 125.00 125.00 61.74 63.26

76942 59.14 59.14 31.12 28.02

76945 80.19 80.19 27.45 52.74

76946 32.21 32.21 19.06 13.15

76948 56.77 56.77 26.24 30.53

76965 88.45 88.45 64.33 24.12

76970 62.63 62.63 14.99 47.64

76975 86.08 86.08 32.88 53.20

76977 7.41 7.41 2.76 4.65

76998 143.82 143.82 50.12 93.70

76999 REPORT REPORT REPORT REPORT

77001 74.34 74.34 16.34 58.00

77002 74.12 74.12 21.93 52.19

77003 74.82 74.82 23.19 51.63

77011 221.64 221.64 60.88 160.76

77012 121.89 121.89 55.29 66.60

77013 23.34 23.34 23.34

77014 116.82 116.82 42.43 74.39

77021 374.14 374.14 67.80 306.34

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

77022 25.33 25.33 25.33

77053 58.05 58.05 17.65 40.40

77054 76.65 76.65 22.09 54.56

77058 499.75 499.75 79.06 420.69

77059 499.75 499.75 79.06 420.69

77061 48.19 48.19 25.68 22.51

77062 48.19 48.19 25.68 22.51

77063 48.18 48.18 25.88 22.30

77065 105.85 105.85 0.28 0.71

77066 134.31 134.31 0.28 0.71

77067 108.47 108.47 0.26 0.73

77071 38.53 38.53 38.53

77072 18.24 18.24 7.37 10.87

77073 31.68 31.68 12.55 19.13

77074 52.24 52.24 18.16 34.08

77075 74.71 74.71 22.70 52.01

77076 76.66 76.66 27.32 49.34

77077 37.56 37.56 16.06 21.50

77078 65.61 65.61 10.94 54.67

77080 40.69 40.69 9.84 30.85

77081 26.40 26.40 10.07 16.33

77084 311.45 311.45 62.85 248.60

77085 48.75 48.75 13.17 35.58

77086 30.91 30.91 7.48 23.43

77261 59.26 59.26 59.26

77262 88.00 88.00 88.00

77263 129.13 129.13 129.13

77280 220.28 220.28 28.14 192.14

77285 351.04 351.04 42.33 308.71

77290 414.59 414.59 62.85 351.74

77293 373.68 373.68 80.61 293.07

77295 483.71 483.71 213.38 270.33

77299 REPORT REPORT REPORT REPORT

77300 61.26 61.26 29.17 32.09

77301 1,567.09 1,567.09 320.41 1,246.68

77306 122.95 122.95 58.40 64.55

77307 239.45 239.45 121.79 117.66

77316 158.57 158.57 59.43 99.14

77317 207.67 207.67 78.01 129.66

77318 298.82 298.82 123.22 175.60

77321 91.45 91.45 47.50 43.95

77331 50.40 50.40 34.97 15.43

77332 64.47 64.47 21.99 42.48

CODE NOTE NFAC FAC 26 TC

77333 76.81 76.81 30.04 46.77

77334 137.36 137.36 61.11 76.25

77336 64.39 64.39 64.39

77338 428.28 428.28 182.50 245.78

77370 106.68 106.68 106.68

77371 982.06 982.06 982.06

77372 868.46 868.46 868.46

77373 1,309.95 1,309.95 1,309.95

77385 REPORT REPORT REPORT REPORT

77386 REPORT REPORT REPORT REPORT

77387 REPORT REPORT REPORT REPORT

77399 REPORT REPORT REPORT REPORT

77401 24.82 24.82 24.82

77402 94.21 94.21 94.21

77407 120.70 120.70 120.70

77412 139.45 139.45 139.45

77417 11.02 11.02 11.02

77422 108.77 108.77 108.77

77423 148.38 148.38 148.38

77424 N.C. N.C.

77425 N.C. N.C.

77427 144.69 144.69 144.69

77431 79.70 79.70 79.70

77432 325.42 325.42 325.42

77435 492.57 492.57 492.57

77469 250.46 250.46

77470 140.46 140.46 101.47 38.99

77499 REPORT REPORT REPORT REPORT

77520 680.62 680.62 680.62

77522 680.62 680.62 680.62

77523 781.49 781.49 781.49

77525 882.35 882.35 882.35

77600 332.81 332.81 54.21 278.60

77605 627.43 627.43 80.06 547.37

77610 693.12 693.12 53.97 639.15

77615 825.10 825.10 73.76 751.34

77620 371.99 371.99 68.29 303.70

77750 292.41 292.41 200.49 91.92

77761 309.94 309.94 153.29 156.65

77762 412.57 412.57 231.37 181.20

77763 580.09 580.09 347.47 232.62

77767 196.08 196.08 46.12 149.96

77768 307.59 307.59 61.16 246.43

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

77770 278.96 278.96 85.08 193.88

77771 519.35 519.35 166.04 353.31

77772 793.10 793.10 234.97 558.13

77778 649.51 649.51 351.26 298.25

77789 94.10 94.10 45.90 48.20

77790 14.91 14.91 8.99 5.92

77799 REPORT REPORT REPORT REPORT

78012 72.10 72.10 7.96 64.14

78013 158.80 158.80 14.19 144.61

78014 210.79 210.79 20.36 190.43

78015 183.96 183.96 25.67 158.29

78016 235.47 235.47 26.41 209.06

78018 259.73 259.73 32.14 227.59

78020 68.88 68.88 21.64 47.24

78070 248.98 248.98 30.55 218.43

78071 313.40 313.40 48.23 265.17

78072 340.81 340.81 59.35 281.46

78075 369.16 369.16 28.67 340.49

78099 REPORT REPORT REPORT REPORT

78102 141.12 141.12 20.73 120.39

78103 181.78 181.78 27.48 154.30

78104 203.10 203.10 29.69 173.41

78110 83.01 83.01 7.66 75.35

78111 81.04 81.04 8.68 72.36

78120 77.81 77.81 9.01 68.80

78121 90.14 90.14 12.82 77.32

78122 98.64 98.64 20.27 78.37

78130 138.43 138.43 23.43 115.00

78135 289.80 289.80 25.15 264.65

78140 127.39 127.39 26.49 100.90

78185 175.56 175.56 15.56 160.00

78190 325.95 325.95 41.93 284.02

78191 171.95 171.95 29.10 142.85

78195 295.12 295.12 45.86 249.26

78199 REPORT REPORT REPORT REPORT

78201 156.68 156.68 16.34 140.34

78202 165.95 165.95 18.20 147.75

78205 197.35 197.35 29.50 167.85

78206 283.81 283.81 36.27 247.54

78215 161.18 161.18 18.85 142.33

78216 116.80 116.80 23.74 93.06

78226 285.26 285.26 29.46 255.80

78227 372.89 372.89 34.67 338.22

CODE NOTE NFAC FAC 26 TC

78230 145.01 145.01 17.78 127.23

78231 109.73 109.73 20.85 88.88

78232 113.67 113.67 20.82 92.85

78258 186.40 186.40 28.67 157.73

78261 203.55 203.55 26.16 177.39

78262 201.00 201.00 25.61 175.39

78264 279.25 279.25 30.28 248.97

78265 330.32 330.32 41.14 289.18

78266 427.93 427.93 46.45 381.48

78267 8.51 8.51 8.51

78268 72.87 72.87 72.87

78270 84.13 84.13 8.21 75.92

78271 74.44 74.44 7.92 66.52

78272 81.15 81.15 10.35 70.80

78278 288.88 288.88 37.93 250.95

78282 25.00 25.00 12.50 12.50

78290 275.75 275.75 26.22 249.53

78291 211.82 211.82 33.29 178.53

78299 REPORT REPORT REPORT REPORT

78300 150.14 150.14 24.34 125.80

78305 191.96 191.96 32.24 159.72

78306 208.11 208.11 32.72 175.39

78315 286.83 286.83 39.00 247.83

78320 209.08 209.08 43.55 165.53

78350 28.11 28.11 9.08 19.03

78351 N.C. N.C.

78399 REPORT REPORT REPORT REPORT

78414 80.61 80.61 17.17 63.44

78428 149.51 149.51 29.13 120.38

78445 150.64 150.64 18.85 131.79

78451 280.49 280.49 52.04 228.45

78452 390.12 390.12 60.99 329.13

78453 251.24 251.24 38.48 212.76

78454 361.58 361.58 51.87 309.71

78456 264.60 264.60 37.87 226.73

78457 144.97 144.97 28.86 116.11

78458 169.03 169.03 35.25 133.78

78459 958.76 958.76 54.66 904.10

78466 161.66 161.66 27.30 134.36

78468 171.84 171.84 32.41 139.43

78469 207.84 207.84 38.64 169.20

78472 210.69 210.69 41.69 169.00

78473 296.13 296.13 68.57 227.56

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

78481 191.68 191.68 49.51 142.17

78483 246.88 246.88 68.67 178.21

78491 1,068.50 1,068.50 55.23 1,013.27

78492 1,118.57 1,118.57 69.39 1,049.18

78494 243.73 243.73 59.41 184.32

78496 43.92 43.92 23.34 20.58

78499 REPORT REPORT REPORT REPORT

78579 154.27 154.27 18.53 135.74

78580 198.08 198.08 28.38 169.70

78582 279.03 279.03 41.48 237.55

78597 170.27 170.27 28.03 142.24

78598 262.17 262.17 33.23 228.94

78599 REPORT REPORT REPORT REPORT

78600 153.86 153.86 17.51 136.35

78601 178.24 178.24 19.38 158.86

78605 166.23 166.23 20.77 145.46

78606 274.08 274.08 24.26 249.82

78607 291.03 291.03 46.06 244.97

78608 1,104.73 1,104.73 55.56 1,049.17

78609 57.72 57.72 57.72

78610 145.54 145.54 11.76 133.78

78630 281.46 281.46 26.22 255.24

78635 284.43 284.43 24.35 260.08

78645 269.65 269.65 21.54 248.11

78647 293.93 293.93 35.56 258.37

78650 275.28 275.28 23.18 252.10

78660 148.85 148.85 20.48 128.37

78699 REPORT REPORT REPORT REPORT

78700 142.12 142.12 17.17 124.95

78701 175.40 175.40 18.24 157.16

78707 192.28 192.28 36.27 156.01

78708 162.52 162.52 51.92 110.60

78709 301.56 301.56 53.16 248.40

78710 195.95 195.95 27.87 168.08

78725 88.10 88.10 14.17 73.93

78730 59.49 59.49 5.80 53.69

78740 181.51 181.51 21.22 160.29

78761 176.76 176.76 27.87 148.89

78799 REPORT REPORT REPORT REPORT

78800 159.54 159.54 26.33 133.21

78801 217.76 217.76 31.25 186.51

78802 268.57 268.57 32.43 236.14

78803 282.99 282.99 40.29 242.70

CODE NOTE NFAC FAC 26 TC

78804 470.40 470.40 40.34 430.06

78805 151.35 151.35 27.83 123.52

78806 276.55 276.55 32.43 244.12

78807 283.56 283.56 40.29 243.27

78808 36.25 36.25 36.25

78811 963.89 963.89 59.79 904.10

78812 1,121.94 1,121.94 72.76 1,049.18

78813 1,124.98 1,124.98 75.81 1,049.17

78814 1,133.51 1,133.51 84.34 1,049.17

78815 1,150.00 1,150.00 93.37 1,056.63

78816 1,350.00 1,350.00 110.73 1,239.27

78999 REPORT REPORT REPORT REPORT

79005 126.64 126.64 79.81 46.83

79101 136.25 136.25 89.54 46.71

79200 138.29 138.29 82.75 55.54

79300 43.85 43.85 21.93 21.93

79403 182.87 182.87 102.56 80.31

79440 132.66 132.66 85.92 46.74

79445 91.38 91.38 45.69 45.69

79999 REPORT REPORT REPORT REPORT

90281 REPORT

90283 REPORT

90284 REPORT

90287 REPORT

90288 REPORT

90291 REPORT

90296 REPORT

90371 111.33 111.33

90375 305.48 305.48

90376 294.59 294.59

90378 REPORT

90384 38.75

90385 25.43

90386 REPORT

90389 114.00

90393 REPORT

90396 110.41

90399 REPORT

90460 N.C.

90461 N.C.

90471 N.C.

90472 N.C.

90473 N.C.

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

90474 N.C.

90476 REPORT

90477 REPORT

90581 REPORT

90585 123.20 123.20

90586 123.20 123.20

90620 160.75

90621 115.75

90625 N.C.

90630 20.34 20.34

90632 50.85 50.85

90633 21.17

90634 23.91

90636 78.16

90644 REPORT

90647 20.37

90648 22.83

90649 130.27

90650 128.75

90651 177.70

90653 37.38 37.38

90654 N.C.

90655 15.45

90656 17.72 17.72

90657 5.68

90658 11.37

90660 22.32

90661 REPORT

90662 42.72 42.72

90664 N.C.

90666 REPORT

90667 REPORT

90668 REPORT

90670 181.06 181.06

90672 26.87 26.87

90673 40.61 40.61

90674 22.93 22.93

90675 272.48 272.48

90676 146.00

90680 63.25

90681 63.25

90685 26.26 26.26

90686 19.03 19.03

CODE NOTE NFAC FAC 26 TC

90687 9.40 9.40

90688 17.83 17.83

90690 7.00

90691 84.03 84.03

90696 48.00

90698 70.72

90700 15.30

90702 30.81

90707 47.00

90710 117.5

90713 28.01

90714 24.18 24.18

90715 31.36 31.36

90716 81.75

90717 59.49

90723 60.06

90732 89.94 89.94

90733 100.43

90734 82.00

90736 REPORT

90738 REPORT

90739 N.C.

90740 122.95 122.95

90743 25.39 25.39

90744 25.39 25.39

90746 61.47 61.47

90747 122.95 122.95

90748 45.32

90749 REPORT

90785 N.C. N.C.

90791 146.63 146.63

90792 154.19 154.19

90832 66.72 66.72

90833 68.89 68.89

90834 88.29 88.29

90836 87.91 87.91

90837 132.66 132.66

90838 115.06 115.06

90839 138.62 138.62

90840 66.00 66.00

90845 62.44 60.90

90846 106.96 104.98

90847 111.49 106.51

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

90849 37.55 33.83 37.55

90853 23.93 23.93

90863 N.C. N.C.

90865 115.98 100.79 115.98

90867 159.53 96.34

90868 146.32 18.54

90869 399.60 95.62

90870 105.39 65.10 105.39

90875 52.15 43.28 52.15

90876 78.65 68.48 78.65

90880 83.23 74.86

90882 N.C. N.C.

90885 N.C. N.C.

90887 N.C. N.C.

90889 N.C. N.C.

90899 20.00 20.00

90901 28.53 14.87 28.53

90911 70.23 33.95 70.23

90935 55.63 55.63

90937 80.32 80.32

90940 15.00 15.00

90945 66.34 66.34

90947 95.52 95.52

90951 728.23 728.23

90952 473.88 473.88

90953 316.07 316.07

90954 629.10 629.10

90955 353.87 353.87

90956 246.02 246.02

90957 497.16 497.16

90958 336.55 336.55

90959 229.01 229.01

90960 219.29 219.29

90961 184.37 184.37

90962 142.32 142.32

90963 420.63 420.63

90964 368.06 368.06

90965 350.24 350.24

90966 183.76 183.76

90967 14.98 14.98

90968 12.04 12.04

90969 11.78 11.78

90970 6.04 6.04

CODE NOTE NFAC FAC 26 TC

90989 N.C. N.C.

90993 N.C. N.C.

90997 69.34 69.34

90999 REPORT REPORT REPORT REPORT

91010 154.68 154.68 57.97 96.71

91013 19.39 19.39 7.74 11.65

91020 185.10 185.10 58.19 126.91

91022 151.42 151.42 66.77 84.65

91030 106.48 106.48 36.32 70.16

91034 167.00 167.00 44.31 122.69

91035 383.65 383.65 65.54 318.11

91037 127.20 127.20 39.38 87.82

91038 358.71 358.71 44.87 313.84

91040 341.50 341.50 39.06 302.44

91065 59.83 59.83 7.92 51.91

91110 732.83 732.83 130.39 602.44

91111 596.28 596.28 40.75 555.53

91112 1,031.58 1,031.58 102.16 929.42

91117 117.58 117.58

91120 340.76 340.76 39.17 301.59

91122 189.84 189.84 74.16 115.68

91132 117.69 117.69 21.04 96.65

91133 137.12 137.12 27.07 110.05

91200 31.28 31.28 10.86 20.42

91299 REPORT REPORT REPORT REPORT

92002 63.71 37.20

92004 116.51 77.46

92012 67.09 41.15

92014 96.99 62.22

92015 19.02 15.03 19.02

92018 113.05 113.05 113.05

92019 56.16 56.16

92020 21.00 16.43 21.00

92025 29.90 29.90 15.61 14.29

92060 51.21 51.21 29.80 21.41

92065 P 42.98 42.98 13.87 29.11

92071 31.59 28.03

92072 104.54 80.01

92081 33.37 33.37 15.62 17.75

92082 49.38 49.38 21.82 27.56

92083 56.74 56.74 24.03 32.71

92100 63.33 34.29 63.33

92132 30.41 30.41 15.91 14.50

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

92133 37.09 37.09 22.01 15.08

92134 37.09 37.09 22.97 14.12

92136 71.45 71.45 24.38 47.07

92145 14.29 14.29 7.70 6.59

92225 20.98 16.70 20.98

92226 19.36 14.80 19.36

92227 11.72 11.72

92228 27.30 27.30 16.43 10.87

92230 48.27 25.48 48.27

92235 84.00 84.00 41.82 42.18

92240 165.90 165.90 36.18 129.72

92242 198.27 198.27

92250 53.55 53.55 17.34 36.21

92260 14.48 8.49 14.48

92265 67.22 67.22 36.12 31.10

92270 72.39 72.39 31.60 40.79

92275 117.90 117.90 42.01 75.89

92283 44.78 44.78 7.41 37.37

92284 51.16 51.16 10.06 41.10

92285 30.13 30.13 4.50 25.63

92286 93.71 93.71 53.15 40.56

92287 109.44 109.44 36.40 73.04

92310 P 75.28 46.21

92311 P 79.33 43.13

92312 P 92.38 49.91

92313 P 75.89 36.56

92314 62.97 27.34 62.97

92315 P 58.79 17.17 58.79

92316 P 73.46 26.27 73.46

92317 60.25 17.78

92325 P 33.95 33.95

92326 P 36.82 36.82

92340 27.88 14.48

92341 31.71 18.60

92342 34.16 20.77

92352 N.C. N.C.

92353 N.C. N.C.

92354 P 61.53 61.53

92355 P 43.11 43.11

92358 N.C. N.C.

92370 24.26 12.58

92371 N.C. N.C.

92499 REPORT REPORT REPORT REPORT

CODE NOTE NFAC FAC 26 TC

92502 87.78 87.78 87.78

92504 26.23 8.75 26.23

92507 63.99 61.27

92508 30.47 30.47 30.47

92511 109.20 36.98 109.20

92512 58.49 24.76 58.49

92516 59.85 20.81

92520 60.04 36.50

92521 91.35 91.35

92522 74.00 74.00

92523 153.97 153.97

92524 77.40 77.40

92526 80.85 66.90 80.85

92531 3.50 3.50 3.50

92532 3.50 3.50 3.50

92533 3.50 3.50 3.50

92534 3.50 3.50 3.50

92537 34.43 34.43 26.90 7.53

92538 17.54 17.54 13.45 4.09

92540 87.06 87.06 67.42 19.64

92541 23.93 23.93 20.34 3.59

92542 26.97 26.97 24.09 2.88

92544 16.44 16.44 13.92 2.52

92545 14.72 14.72 12.55 2.17

92546 82.40 82.40 11.48 70.92

92547 4.97 4.97 4.97

92548 95.38 95.38 24.33 71.05

92550 18.83 18.83

92551 9.72 9.72 9.72

92552 25.40 25.40 25.40

92553 30.25 30.25 30.25

92555 18.85 18.85 18.85

92556 30.53 30.53 30.53

92557 36.60 31.64 36.60

92558 N.C. N.C.

92559 N.C. N.C.

92560 5.50 5.50 5.50

92561 31.14 31.14 31.14

92562 37.37 37.37 37.37

92563 24.83 24.83 24.83

92564 21.98 21.98 21.98

92565 13.22 13.22 13.22

92567 14.09 10.55 14.09

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

92568 16.02 16.02 16.02

92570 31.92 30.03

92571 21.98 21.98

92572 25.44 25.44

92575 47.10 47.10

92576 29.39 29.39

92577 15.26 15.26

92579 35.55 33.46 35.55

92582 53.94 53.94

92583 40.51 40.51 40.51

92584 70.26 70.26 70.26

92585 108.36 108.36 20.79 87.57

92586 69.62 69.62

92587 20.86 20.86 17.63 3.23

92588 32.12 32.12 28.18 3.94

92590 13.00 13.00 13.00

92591 13.00 13.00 13.00

92592 5.50 5.50 5.50

92593 35.00 35.00

92594 11.00 11.00 11.00

92595 13.00 13.00 13.00

92596 33.42 33.42 33.42

92597 69.92 56.29 69.92

92601 138.69 117.22

92602 80.14 63.86

92603 118.62 100.67

92604 70.49 59.17

92605 72.29 68.87

92606 64.61 55.21

92607 121.74 121.74

92608 41.53 41.53

92609 86.26 86.26

92610 81.43 72.41

92611 88.58 88.58

92612 149.99 62.07

92613 29.94 29.94

92614 134.84 62.07

92615 26.03 26.03

92616 186.01 92.02

92617 32.60 32.60

92618 N.C. N.C.

92620 73.76 64.35 73.76

92621 17.33 14.76 17.33

CODE NOTE NFAC FAC 26 TC

92625 55.00 48.74 55.00

92626 70.21 64.22 70.21

92627 17.37 15.45 17.37

92630 N.C. N.C.

92633 N.C. N.C.

92640 86.98 74.44

92700 REPORT REPORT REPORT REPORT

92920 461.79 461.79

92921 N.C. N.C.

92924 549.06 549.06

92925 N.C. N.C.

92928 512.97 512.97

92929 N.C. N.C.

92933 573.62 573.62

92934 N.C. N.C.

92937 512.40 512.40

92938 N.C. N.C.

92941 574.80 574.80

92943 574.80 574.80

92944 N.C. N.C.

92950 239.13 146.22 239.13

92953 1.08 1.08 1.08

92960 154.87 100.82 154.87

92961 201.34 201.34 201.34

92970 147.77 147.77

92971 81.66 81.66

92973 143.29 143.29

92974 131.41 131.41

92975 305.51 305.51 305.51

92977 69.80 69.80 69.80

92978 236.66 236.66 77.15 159.51

92979 61.00 61.00 61.00

92986 1,070.11 1,070.11

92987 1,104.20 1,104.20

92990 881.37 881.37

92992 1,200.57 1,200.57 1,200.57

92993 1,200.57 1,200.57 1,200.57

92997 523.02 523.02 523.02

92998 258.15 258.15

93000 17.58 17.58 17.58

93005 8.54 8.54 8.54

93010 6.56 6.56 6.56

93015 80.32 80.32 80.32

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

93016 17.80 17.80 17.80

93017 39.34 39.34 39.34

93018 11.96 11.96 11.96

93024 91.37 91.37 45.75 45.62

93025 161.26 161.26 35.54 125.72

93040 10.46 10.46 10.46

93041 4.75 4.75 4.75

93042 5.72 5.72 5.72

93050 15.31 15.31 7.48 7.83

93224 90.29 90.29 90.29

93225 26.60 26.60 26.60

93226 37.93 37.93 37.93

93227 20.75 20.75 20.75

93228 20.22 20.22

93229 579.09 579.09

93260 56.07 56.07 37.22 18.85

93261 51.30 51.30 32.56 18.74

93268 217.68 217.68 217.68

93270 9.25 9.25 9.25

93271 N.C. N.C.

93272 20.29 20.29 20.29

93278 29.94 29.94 11.84 18.10

93279 42.51 42.51 27.08 15.43

93280 50.17 50.17 32.61 17.56

93281 58.66 58.66 38.08 20.58

93282 54.27 54.27 36.13 18.14

93283 66.03 66.03 46.24 19.79

93284 77.23 77.23 53.25 23.98

93285 36.81 36.81 22.48 14.33

93286 21.45 21.45 11.73 9.72

93287 28.90 28.90 18.03 10.87

93288 32.99 32.99 18.61 14.38

93289 51.41 51.41 35.42 15.99

93290 24.66 24.66 16.93 7.73

93291 31.61 31.61 18.49 13.12

93292 28.53 28.53 18.61 9.92

93293 46.01 46.01 13.18 32.83

93294 27.70 27.70

93295 52.61 52.61

93296 28.17 28.17

93297 20.50 20.50

93298 22.28 22.28

93299 34.06 34.06

CODE NOTE NFAC FAC 26 TC

93303 188.47 188.47 49.30 139.17

93304 123.85 123.85 28.33 95.52

93306 205.69 205.69 55.83 149.86

93307 127.94 127.94 43.28 84.66

93308 99.71 99.71 19.88 79.83

93312 243.16 243.16 105.82 137.34

93313 11.16 11.16 11.16

93314 210.92 210.92 79.94 130.98

93315 333.24 333.24 99.87 233.37

93316 26.07 26.07 26.07

93317 314.59 314.59 72.99 241.60

93318 56.00 56.00 28.00 28.00

93320 53.32 53.32 17.56 35.76

93321 26.96 26.96 7.13 19.83

93325 25.33 25.33 3.02 22.31

93350 191.29 191.29 54.98 136.31

93351 215.33 215.33 65.87 149.46

93352 29.64 29.64

93355 190.44 190.44 190.44

93451 646.25 646.25 116.96 529.29

93452 715.24 715.24 207.60 507.64

93453 935.91 935.91 280.31 655.60

93454 737.74 737.74 213.88 523.86

93455 860.78 860.78 248.49 612.29

93456 933.94 933.94 278.39 655.55

93457 1,051.49 1,051.49 311.56 739.93

93458 890.17 890.17 264.48 625.69

93459 982.82 982.82 298.49 684.33

93460 1,051.49 1,051.49 331.83 719.66

93461 1,205.26 1,205.26 367.39 837.87

93462 169.63 169.63

93463 89.16 89.16

93464 212.10 212.10 70.97 141.13

93503 100.57 100.57 100.57

93505 560.71 560.71 176.44 384.27

93530 331.00 331.00 109.23 221.77

93531 1,883.34 1,883.34 342.91 1,540.43

93532 855.00 855.00 324.90 530.10

93533 754.00 754.00 366.44 387.56

93561 59.61 59.61 12.65 46.96

93562 16.00 16.00 1.16 14.84

93563 47.12 47.12

93564 49.83 49.83

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

93565 36.58 36.58

93566 142.68 37.55

93567 117.32 42.58

93568 128.76 38.36

93571 231.84 231.84 77.15 154.69

93572 133.35 133.35 61.90 71.45

93580 791.91 791.91

93581 1,088.83 1,088.83

93582 560.13 560.13

93583 623.39 623.39

93590 1,060.35 1,060.35

93591 880.14 880.14

93592 387.74 387.74

93600 158.09 158.09 95.90 62.19

93602 57.84 57.84 28.92 28.92

93603 57.82 57.82 24.28 33.54

93609 149.00 149.00 74.50 74.50

93610 179.51 179.51 132.43 47.08

93612 81.95 81.95 40.98 40.98

93613 322.72 322.72 322.72

93615 25.00 25.00 25.00

93616 45.45 45.45 45.45

93618 303.51 303.51 178.95 124.56

93619 320.00 320.00 320.00

93620 899.47 899.47 507.61 391.86

93621 100.00 100.00 100.00

93622 300.00 300.00 170.28 129.72

93623 77.59 77.59 77.59

93624 265.07 265.07 195.17 69.90

93631 204.79 204.79 204.79

93640 244.83 244.83 144.74 100.09

93641 377.63 377.63 252.52 125.11

93642 276.39 276.39 209.85 66.54

93644 212.16 212.16 154.06 58.10

93650 479.79 479.79 479.79

93653 698.71 698.71

93654 932.50 932.50

93655 349.34 349.34

93656 932.76 932.76

93657 349.66 349.66

93660 129.75 129.75 76.18 53.57

93662 236.31 236.31 111.62 124.69

93668 15.43 15.43

CODE NOTE NFAC FAC 26 TC

93701 24.47 24.47 5.42 19.05

93702 100.25 100.25 100.25

93724 267.68 267.68 239.02 28.66

93740 8.11 8.11 8.11

93745 66.22 66.22 16.51 49.71

93750 N.C. N.C.

93770 6.29 6.29 6.29

93784 53.92 53.92

93786 25.89 25.89

93788 5.36 5.36

93790 14.42 14.42

93797 14.60 7.47 14.60

93798 21.58 11.36 21.58

93799 REPORT REPORT REPORT REPORT

93880 162.13 162.13 31.23 130.90

93882 130.93 130.93 25.12 105.81

93886 216.03 216.03 36.69 179.34

93888 109.86 109.86 20.33 89.53

93890 219.29 219.29 39.93 179.36

93892 136.42 136.42 46.89 89.53

93893 136.06 136.06 46.53 89.53

93895 N.C. N.C.

93922 96.77 96.77 13.45 83.32

93923 148.12 148.12 23.54 124.58

93924 180.45 180.45 25.49 154.96

93925 207.69 207.69 30.62 177.07

93926 108.47 108.47 18.90 89.57

93930 166.72 166.72 31.27 135.45

93931 103.02 103.02 19.19 83.83

93970 158.01 158.01 27.11 130.90

93971 96.20 96.20 17.21 78.99

93975 224.54 224.54 45.19 179.35

93976 161.85 161.85 41.78 120.07

93978 152.80 152.80 31.02 121.78

93979 95.93 95.93 19.51 76.42

93980 119.11 119.11 59.23 59.88

93981 73.18 73.18 21.45 51.73

93982 35.21 35.21

93990 108.86 108.86 19.30 89.56

93998 N.C. N.C.

94002 71.77 71.77

94003 51.96 51.96

94004 38.30 38.30

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

94005 N.C. N.C.

94010 28.53 28.53 6.56 21.97

94011 75.84 75.84

94012 116.54 116.54

94013 19.35 19.35

94014 44.72 44.72 44.72

94015 25.11 25.11 25.11

94016 19.61 19.61 19.61

94060 48.58 48.58 10.07 38.51

94070 47.46 47.46 22.34 25.12

94150 20.18 20.18 3.04 17.14

94200 20.67 20.67 4.39 16.28

94250 21.24 21.24 4.39 16.85

94375 31.40 31.40 11.42 19.98

94400 45.24 45.24 15.28 29.96

94450 55.21 55.21 15.56 39.65

94452 45.94 45.94 11.14 34.80

94453 63.76 63.76 14.70 49.06

94610 46.19 46.19

94620 54.96 54.96 29.43 25.53

94621 128.70 128.70 53.39 75.31

94640 14.85 14.85

94642 24.70 24.70 24.70

94644 35.66 35.66

94645 11.72 11.72

94660 50.08 29.85 50.08

94662 27.32 27.32 27.32

94664 14.00 14.00 14.00

94667 21.45 21.45

94668 N.C. N.C.

94669 29.40 29.40

94680 51.93 51.93 11.20 40.73

94681 53.78 53.78 9.84 43.94

94690 48.36 48.36 3.56 44.80

94726 46.50 46.50 10.53 35.97

94727 36.38 36.38 10.34 26.04

94728 36.38 36.38 11.32 25.06

94729 46.34 46.34 7.53 38.81

94750 63.19 63.19 8.43 54.76

94760 2.60 2.60

94761 4.55 4.55

94762 21.75 21.75

94770 7.13 7.13

CODE NOTE NFAC FAC 26 TC

94772 171.00 171.00

94774 REPORT REPORT REPORT REPORT

94775 REPORT REPORT REPORT REPORT

94776 REPORT REPORT REPORT REPORT

94777 30.00 30.00

94780 47.08 19.66

94781 18.24 6.84

94799 20.00 20.00

95004 5.43 5.43 5.43

95012 15.43 15.43

95017 7.61 3.16

95018 18.75 6.80

95024 6.29 1.08 6.29

95027 4.31 4.31

95028 10.87 10.87 10.87

95044 5.88 5.88 5.88

95052 6.50 6.50 6.50

95056 35.66 35.66 35.66

95060 28.53 28.53 28.53

95065 20.27 20.27 20.27

95070 30.89 30.89

95071 36.56 36.56

95076 99.38 59.93

95079 69.34 55.10

95115 8.89 8.89 8.89

95117 10.31 10.31 10.31

95120 6.50 6.50 6.50

95125 6.50 6.50 6.50

95130 6.50 6.50 6.50

95131 6.50 6.50 6.50

95132 6.50 6.50 6.50

95133 6.50 6.50 6.50

95134 6.50 6.50 6.50

95144 10.47 2.49 10.47

95145 20.16 2.49 20.16

95146 36.98 2.49 36.98

95147 39.25 2.49 39.25

95148 55.50 2.49 55.50

95149 73.46 2.49 73.46

95165 10.47 2.49 10.47

95170 7.62 2.49 7.62

95180 110.50 79.49 110.50

95199 REPORT REPORT REPORT REPORT

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Maryland Medical Assistance FS-91

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

95250 126.98 126.98 126.98

95251 33.91 33.91 33.91

95782 907.45 907.45 108.47 798.98

95783 968.56 968.56 115.87 852.69

95800 173.25 173.25 49.30 123.95

95801 80.78 80.78 43.08 37.70

95803 111.91 111.91 33.78 78.13

95805 420.39 420.39 56.16 364.23

95806 160.52 160.52 56.63 103.89

95807 414.95 414.95 53.72 361.23

95808 512.60 512.60 68.53 444.07

95810 628.08 628.08 119.06 509.02

95811 690.50 690.50 129.64 560.86

95812 259.03 259.03 44.91 214.12

95813 325.97 325.97 67.92 258.05

95816 289.28 289.28 44.91 244.37

95819 332.92 332.92 45.20 287.72

95822 300.40 300.40 45.20 255.20

95824 25.00 25.00

95827 533.55 533.55 44.35 489.20

95829 1,533.12 1,533.12 263.73 1,269.39

95830 173.96 71.64 173.96

95831 24.98 12.44 24.98

95832 24.72 13.32 24.72

95833 29.11 18.20 29.11

95834 41.19 24.38 41.19

95851 14.27 6.26 14.27

95852 12.37 4.47 12.37

95857 42.75 23.37 42.75

95860 96.98 96.98 40.22 56.76

95861 137.67 137.67 64.67 73.00

95863 172.95 172.95 78.01 94.94

95864 194.75 194.75 83.84 110.91

95865 115.70 115.70 66.07 49.63

95866 107.33 107.33 52.86 54.47

95867 76.78 76.78 32.56 44.22

95868 106.65 106.65 49.61 57.04

95869 73.23 73.23 15.62 57.61

95870 74.08 74.08 15.61 58.47

95872 154.24 154.24 120.28 33.96

95873 58.33 58.33 15.58 42.75

95874 58.94 58.94 15.62 43.32

95875 92.79 92.79 46.02 46.77

CODE NOTE NFAC FAC 26 TC

95885 48.08 48.08 15.23 32.85

95886 72.05 72.05 36.14 35.91

95887 66.68 66.68 30.92 35.76

95905 66.20 66.20 2.56 63.64

95907 80.77 80.77 43.95 36.82

95908 99.61 99.61 52.86 46.75

95909 119.38 119.38 63.70 55.68

95910 157.09 157.09 84.70 72.39

95911 185.56 185.56 104.86 80.70

95912 222.43 222.43 134.92 87.51

95913 257.66 257.66 161.16 96.50

95921 67.16 67.16 35.21 31.95

95922 79.02 79.02 37.66 41.36

95923 112.23 112.23 35.81 76.42

95924 125.77 125.77 73.28 52.49

95925 110.89 110.89 21.60 89.29

95926 107.47 107.47 21.32 86.15

95927 110.31 110.31 21.32 88.99

95928 169.64 169.64 62.72 106.92

95929 174.73 174.73 62.97 111.76

95930 103.76 103.76 14.48 89.28

95933 60.87 60.87 24.64 36.23

95937 65.04 65.04 26.81 38.23

95938 274.84 274.84 36.17 238.67

95939 403.32 403.32 93.65 309.67

95940 26.85 26.85

95941 N.C. N.C.

95943 74.79 74.79 37.46 37.33

95950 266.30 266.30 62.41 203.89

95951 450.00 450.00 76.09 373.91

95953 336.95 336.95 128.20 208.75

95954 361.19 361.19 97.94 263.25

95955 170.74 170.74 41.88 128.86

95956 1,307.69 1,307.69 149.25 1,158.44

95957 243.01 243.01 81.87 161.14

95958 461.48 461.48 176.85 284.63

95961 242.83 242.83 127.65 115.18

95962 206.60 206.60 135.88 70.72

95965 705.99 705.99 328.72 377.27

95966 104.33 104.33 104.33

95967 329.98 329.98 144.56 185.42

95970 54.30 18.96 54.30

95971 40.18 31.84 40.18

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

95972 56.89 40.61 56.89

95974 163.57 129.09 163.57

95975 87.68 72.86 87.68

95978 196.48 151.16 196.48

95979 84.94 70.40 84.94

95980 36.73 36.73

95981 25.51 14.12

95982 41.85 28.74

95990 73.08 73.08

95991 94.81 30.97 94.81

95992 33.50 28.93

95999 20.00 20.00

96000 74.26 74.26 74.26

96001 96.15 96.15 96.15

96002 17.01 17.01 17.01

96003 12.84 12.84 12.84

96004 91.47 91.47 91.47

96020 271.88 271.88 124.51 147.37

96040 38.02 38.02

96101 75.59 74.88 75.59

96102 49.04 22.68 49.04

96103 N.C. N.C.

96105 83.58 83.58 83.58

96110 8.86 8.86 8.86

96111 101.32 96.47 101.32

96116 71.54 69.55

96118 84.35 68.31 84.35

96119 N.C. N.C.

96120 N.C. N.C.

96125 N.C. N.C.

96127 4.71 4.71 4.71

96150 20.51 20.15

96151 19.85 19.49

96152 15.16 14.88

96153 N.C. N.C.

96154 N.C. N.C.

96155 N.C. N.C.

96160 4.06 4.06

96161 4.06 4.06

96360 46.99 46.99

96361 14.10 14.10

96365 57.37 57.37

96366 18.15 18.15

CODE NOTE NFAC FAC 26 TC

96367 29.45 29.45

96368 16.97 16.97

96369 143.07 143.07

96370 12.18 12.18

96371 55.67 55.67

96372 20.24 20.24

96373 15.11 15.11

96374 45.98 45.98

96375 19.74 19.74

96376 10.90 10.90

96377 REPORT REPORT REPORT REPORT

96379 REPORT REPORT REPORT REPORT

96401 59.64 59.64 59.64

96402 31.57 31.57 31.57

96405 87.31 23.64 87.31

96406 119.14 36.29 119.14

96409 92.78 92.78 92.78

96411 52.92 52.92 52.92

96413 125.73 125.73 125.73

96415 27.91 27.91 27.91

96416 136.57 136.57 136.57

96417 61.84 61.84 61.84

96420 87.47 87.47 87.47

96422 148.83 148.83 148.83

96423 62.56 62.56 62.56

96425 147.47 147.47 147.47

96440 625.06 100.46 625.06

96446 163.61 23.67

96450 178.55 75.14 178.55

96521 112.44 112.44 112.44

96522 91.67 91.67 91.67

96523 21.36 21.36 21.36

96542 136.18 36.63 136.18

96549 REPORT REPORT REPORT REPORT

96567 108.95 108.95

96570 45.07 45.07

96571 20.48 20.48

96900 16.85 16.85 16.85

96902 16.68 16.11 16.68

96904 56.86 56.86

96910 57.32 57.32 57.32

96912 73.57 73.57 73.57

96913 104.43 104.43 104.43

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

96920 123.73 52.76

96921 136.30 59.64

96922 187.66 95.60

96931 127.46 127.46

96932 22.84 22.84

96933 35.40 35.40

96934 65.13 65.13

96935 27.97 27.97

96936 33.77 33.77

96999 REPORT REPORT REPORT REPORT

97010 4.77 4.77 4.77

97012 12.67 12.67 12.67

97014 12.52 12.52 12.52

97016 15.37 15.37 15.37

97018 8.76 8.76 8.76

97022 18.81 18.81 18.81

97024 5.34 5.34 5.34

97026 4.77 4.77 4.77

97028 5.87 5.87 5.87

97032 14.96 14.96 14.96

97033 17.48 17.48 17.48

97034 14.17 14.17 14.17

97035 9.90 9.90 9.90

97036 26.01 26.01 26.01

97039 9.90 9.90 9.90

97110 29.03 29.03 29.03

97112 26.58 26.58 26.58

97113 33.98 33.98 33.98

97116 22.08 22.08 22.08

97124 20.46 20.46 20.46

97139 13.38 13.38 13.38

97140 23.45 23.45

97150 18.25 18.25 18.25

97161 69.20 69.20

97162 69.20 69.20

97163 69.20 69.20

97164 47.19 47.19

97165 67.01 67.01

97166 67.01 67.01

97167 67.01 67.01

97168 44.34 44.34

97169 N.C. N.C.

97170 N.C. N.C.

CODE NOTE NFAC FAC 26 TC

97171 N.C. N.C.

97172 N.C. N.C.

97530 30.56 30.56 30.56

97532 20.58 17.52

97533 22.86 22.86

97535 27.43 27.43

97537 23.73 23.73

97542 N.C. N.C.

97545 10.50 10.50

97546 N.C. N.C.

97597 59.82 22.26

97598 25.68 10.46

97602 N.C. N.C.

97605 32.38 19.95

97606 38.27 22.02

97607 34.45 21.53

97608 40.99 23.76

97610 96.00 12.20

97750 25.72 25.72 25.72

97755 27.68 27.68

97760 N.C. N.C.

97761 N.C. N.C.

97762 N.C. N.C.

97799 20.00 20.00

97802 30.03 30.03

97803 26.35 26.35

97804 13.55 13.55

97810 28.37 23.80

97811 21.11 19.68

97813 30.27 25.70

97814 23.86 21.59

98925 24.61 18.61 24.61

98926 35.56 27.87 35.56

98927 46.53 36.84 46.53

98928 56.63 46.09 56.63

98929 67.60 55.92 67.60

98940 22.00 17.44 22.00

98941 31.51 26.66 31.51

98942 41.04 36.19 41.04

98943 21.18 18.33 21.18

98960 N.C. N.C.

98961 N.C. N.C.

98962 N.C. N.C.

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Maryland Medical Assistance FS-94

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

98966 N.C. N.C.

98967 N.C. N.C.

98968 N.C. N.C.

98969 N.C. N.C.

99000 N.C. N.C.

99001 N.C. N.C.

99002 15.00 15.00

99024 N.C. N.C.

99026 N.C. N.C.

99027 N.C. N.C.

99050 N.C. N.C.

99051 N.C. N.C.

99053 N.C. N.C.

99056 N.C. N.C.

99058 10.00 10.00

99060 N.C. N.C.

99070 9.99 9.99

99071 N.C. N.C.

99075 N.C. N.C.

99078 N.C. N.C.

99080 N.C. N.C.

99082 REPORT REPORT REPORT REPORT

99090 N.C. N.C.

99091 N.C. N.C.

99100 N.C. N.C.

99116 N.C. N.C.

99135 N.C. N.C.

99140 N.C. N.C.

99151 67.33 67.33

99152 44.90 44.90

99153 9.73 9.73

99155 78.98 78.98

99156 64.40 64.40

99157 48.81 48.81

99170 130.19 68.34

99172 4.50 4.50

99173 2.60 2.60

99174 N.C. N.C.

99175 15.98 15.98 15.98

99177 3.50 3.50

99183 107.33 86.41 107.33

99184 197.50 197.50 197.50

99188 N.C. N.C.

CODE NOTE NFAC FAC 26 TC

99190 REPORT REPORT REPORT REPORT

99191 REPORT REPORT REPORT REPORT

99192 REPORT REPORT REPORT REPORT

99195 80.88 80.88 80.88

99199 REPORT REPORT REPORT REPORT

99201 44.36 26.64

99202 75.44 50.34

99203 109.12 77.00

99204 165.88 130.07

99205 207.81 169.03

99211 20.26 9.18

99212 43.96 25.14

99213 73.47 50.95

99214 108.04 78.15

99215 145.44 110.72

99217 N/A 72.76 72.76

99218 N/A 99.39

99219 N/A 135.07

99220 N/A 184.54

99221 N/A 101.35 101.35

99222 N/A 136.61 136.61

99223 N/A 202.02 202.02

99224 N/A 39.63

99225 N/A 72.48

99226 N/A 104.67

99231 N/A 39.25 39.25

99232 N/A 71.74 71.74

99233 N/A 103.59 103.59

99234 N/A 133.38 133.38

99235 N/A 168.33 168.33

99236 N/A 216.68 216.68

99238 N/A 72.35 72.35

99239 N/A 107.10 107.10

99241 48.00 32.49 48.00

99242 89.93 68.15 89.93

99243 123.01 95.32 123.01

99244 183.50 153.22 183.50

99245 223.47 189.48 223.47

99251 N/A 48.63 48.63

99252 N/A 74.42 74.42

99253 N/A 114.34 114.34

99254 N/A 166.24 166.24

99255 N/A 200.43 200.43

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Maryland Medical Assistance FS-95

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

99281 N/A 21.14 21.14

99282 N/A 41.23 41.23

99283 N/A 61.62 61.62

99284 N/A 116.85 116.85

99285 N/A 172.43 172.43

99288 7.50 7.50 7.50

99291 276.03 222.87 276.03

99292 122.68 111.61 122.68

99304 91.48 91.48

99305 130.07 130.07

99306 165.70 165.70

99307 44.77 44.77

99308 69.33 69.33

99309 91.31 91.31

99310 135.63 135.63

99315 73.09 73.09 73.09

99316 105.66 105.66 105.66

99318 95.74 95.74

99324 55.28 55.28

99325 80.30 80.30

99326 138.66 138.66

99327 185.10 185.10

99328 216.13 216.13

99334 60.30 60.30

99335 94.98 94.98

99336 134.25 134.25

99337 192.24 192.24

99339 N.C. N.C.

99340 N.C. N.C.

99341 54.91 54.91 54.91

99342 78.83 78.83 78.83

99343 129.31 129.31 129.31

99344 181.64 181.64 181.64

99345 220.28 220.28 220.28

99347 55.30 55.30 55.30

99348 83.92 83.92 83.92

99349 127.93 127.93 127.93

99350 177.45 177.45 177.45

99354 100.07 92.69 100.07

99355 97.09 89.71 97.09

99356 N/A 91.68 91.68

99357 N/A 90.94 90.94

99358 N.C. N.C.

CODE NOTE NFAC FAC 26 TC

99359 N.C. N.C.

99360 N.C. N.C.

99363 N.C. N.C.

99364 N.C. N.C.

99366 N.C. N.C.

99367 N.C. N.C.

99368 N.C. N.C.

99374 N.C. N.C.

99375 N.C. N.C.

99377 N.C. N.C.

99378 N.C. N.C.

99379 N.C. N.C.

99380 N.C. N.C.

99381 110.98 76.27 110.98

99382 115.89 81.19 115.89

99383 120.84 86.51 120.84

99384 136.39 101.69 136.39

99385 131.77 97.43 131.77

99386 152.99 118.64 152.99

99387 165.88 127.48 165.88

99391 99.82 69.55 99.82

99392 106.54 76.27 106.54

99393 106.17 76.27 106.17

99394 116.41 86.50 116.41

99395 118.87 88.96 118.87

99396 126.65 96.74 126.65

99397 136.39 101.69 136.39

99401 N.C. N.C.

99402 N.C. N.C.

99403 N.C. N.C.

99404 N.C. N.C.

99406 14.23 12.38

99407 27.66 25.82

99408 N.C. N.C.

99409 N.C. N.C.

99411 N.C. N.C.

99412 N.C. N.C.

99415 9.26 9.26

99416 5.20 5.20

99429 REPORT REPORT REPORT REPORT

99441 N.C. N.C.

99442 N.C. N.C.

99443 N.C. N.C.

99444 N.C. N.C.

99446 N.C. N.C.

99447 N.C. N.C.

99448 N.C. N.C.

99449 N.C. N.C.

99450 N.C. N.C.

99455 N.C. N.C.

99456 N.C. N.C.

99460 N/A 95.98

99461 92.35 62.81

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Maryland Medical Assistance FS-96

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

99462 41.61 41.61

99463 N/A 119.15

99464 71.16 71.16

99465 152.36 152.36

99466 229.01 229.01

99467 115.86 115.86

99468 N/A 939.57

99469 N/A 396.53

99471 N/A 878.71

99472 N/A 408.63

99475 N/A 575.11

99476 N/A 346.14

99477 356.25 356.25

99478 136.18 136.18

99479 124.18 124.18

99480 118.87 118.87

99485 76.27 76.27

99486 66.40 66.40

99487 N.C. N.C.

99489 N.C. N.C.

99490 N.C. N.C.

99495 165.68 109.93

99496 233.30 159.09

99497 N.C. N.C.

99498 N.C. N.C.

99499 REPORT REPORT REPORT REPORT

99500 N.C. N.C.

99501 N.C. N.C.

99502 N.C. N.C.

99503 N.C. N.C.

99504 N.C. N.C.

99505 N.C. N.C.

99506 N.C. N.C.

99507 N.C. N.C.

99509 N.C. N.C.

99510 N.C. N.C.

99511 N.C. N.C.

99512 N.C. N.C.

99600 N.C. N.C.

99601 N.C. N.C.

99602 N.C. N.C.

99605 N.C. N.C.

99606 N.C. N.C.

99607 N.C. N.C.

CODE NOTE NFAC FAC 26 TC

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Maryland Medical Assistance FS-97

Professional Services Fee Schedule January 2017

Professional Services HCPCS Level II Fee Schedule

* Please remember that all providers

must bill J codes at their exact acquisition costs, not at their usual and

customary charges or at the average wholesale price (AWP).

Effective January 1, 2017

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Maryland Medical Assistance FS-98

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

A9569 1482.64

A9572 3030.07

A9575 0.20

A9576 1.61

A9577 2.08

A9578 2.01

A9579 1.84

A9581 13.94

A9583 17.92

A9585 0.38

A9604 6484.39

A9606 REPORT

G0202 108.47 108.47 28.63 79.84

G0204 134.31 134.31 37.66 96.65

G0206 105.85 105.85 30.28 75.57

G0453 26.20 26.20

G0455 112.28 58.19

J0120 15.10

J0129 44.75

J0130 1,136.51

J0131 REPORT

J0132 1.50

J0133 0.07

J0135 861.44

J0153 0.63

J0171 0.13

J0178 980.45

J0180 164.41

J0190 3.00

J0200 16.99

J0202 1,738.36

J0205 41.98

J0207 416.53

J0210 42.40

J0215 30.63

J0220 206.64

J0221 159.38

J0256 4.82

J0257 4.36

J0270 0.63

J0275 24.34

J0278 1.47

J0280 8.83

J0282 0.25

J0285 27.94

J0287 13.41

J0288 14.00

J0289 19.01

J0290 1.31

J0295 3.70

J0300 6.33

J0330 0.18

J0348 0.51

J0350 2268.46

J0360 4.59

J0364 4.24

J0365 2.64

J0380 1.07

J0390 17.27

J0395 160.00

CODE NOTE NFAC FAC 26 TC

J0400 0.74

J0401 4.38

J0456 3.31

J0461 0.04

J0470 39.34

J0475 173.43

J0476 76.96

J0480 3,196.11

J0485 3.84

J0490 42.02

J0500 63.59

J0515 34.42

J0520 4.49

J0558 7.96

J0561 10.31

J0571 1.83

J0572 7.39

J0573 7.39

J0574 7.80

J0575 N.C.

J0583 1.52

J0585 5.93

J0586 7.90

J0587 11.71

J0588 4.91

J0592 3.37

J0594 38.37

J0595 2.42

J0596 N.C.

J0597 46.51

J0598 55.55

J0600 5,594.42

J0610 3.51

J0620 10.03

J0630 2,321.14

J0636 0.49

J0637 12.21

J0638 92.49

J0640 3.09

J0641 0.90

J0670 2.32

J0690 0.95

J0692 2.46

J0694 4.62

J0695 N.C.

J0696 0.50

J0697 2.87

J0698 0.46

J0702 6.03

J0706 0.59

J0710 1.48

J0712 2.48

J0713 2.26

J0714 N.C.

J0715 5.24

J0716 REPORT

J0717 7.06

J0720 40.36

J0725 24.62

J0735 14.31

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Maryland Medical Assistance FS-99

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

J0740 554.48

J0743 7.08

J0744 1.15

J0745 1.55

J0770 11.19

J0775 41.42

J0780 11.93

J0795 8.12

J0800 3,555.35

J0833 73.19

J0834 43.7

J0840 2,670.24

J0850 1,126.55

J0875 15.22

J0878 0.90

J0881 3.93

J0882 3.93

J0885 12.59

J0887 1.47

J0888 1.47

J0890 9.07

J0894 20.83

J0895 8.84

J0897 16.22

J0945 0.79

J1000 16.79

J1020 4.82

J1030 5.22

J1040 9.80

J1050 0.41

J1071 0.02

J1094 0.23

J1100 0.11

J1110 75.49

J1120 21.18

J1160 4.81

J1162 3,039.53

J1165 1.41

J1170 2.14

J1180 8.05

J1190 184.04

J1200 0.62

J1205 86.67

J1212 481.94

J1230 17.14

J1240 6.32

J1245 0.78

J1250 5.27

J1260 6.16

J1265 0.64

J1267 0.77

J1270 0.91

J1290 399.56

J1300 221.11

J1320 2.24

J1322 N.C.

J1324 REPORT

J1325 15.48

J1327 19.00

J1330 4.28

CODE NOTE NFAC FAC 26 TC

J1335 45.17

J1364 59.29

J1380 9.07

J1410 261.39

J1430 404.09

J1435 0.23

J1436 71.40

J1438 330.81

J1439 1.05

J1442 1.00

J1443 N.C.

J1447 0.74

J1450 4.33

J1451 7.64

J1452 212.00

J1453 1.88

J1455 10.37

J1457 2.02

J1458 364.4

J1459 37.89

J1460 36.41

J1556 39.52

J1557 37.03

J1559 9.82

J1560 364.12

J1561 38.58

J1562 7.19

J1566 33.07

J1568 35.98

J1569 39.99

J1570 58.65

J1571 56.05

J1572 36.8

J1573 50.62

J1575 12.74

J1580 1.40

J1595 67.64

J1599 REPORT

J1600 12.53

J1602 24.78

J1610 199.11

J1620 180.29

J1626 0.29

J1630 1.52

J1631 18.04

J1640 22.85

J1642 0.18

J1644 0.212

J1645 15.92

J1650 0.87

J1652 2.23

J1655 2.71

J1670 433.06

J1675 REPORT

J1700 REPORT

J1710 REPORT

J1720 8.53

J1725 REPORT

J1730 111.85

J1740 101.96

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Maryland Medical Assistance FS-100

Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

J1741 REPORT

J1742 186.19

J1743 522.03

J1744 N.C.

J1745 82.87

J1750 12.4

J1756 0.25

J1786 41.93

J1790 2.14

J1800 1.14

J1810 5.58

J1815 0.80

J1817 9.09

J1826 REPORT

J1830 119.30

J1833 N.C.

J1835 42.28

J1840 7.68

J1850 1.15

J1885 0.66

J1890 8.64

J1930 51.3

J1931 30.58

J1940 2.05

J1945 234.37

J1950 1,038.69

J1953 0.14

J1955 19.88

J1956 1.66

J1960 3.23

J1980 27.85

J1990 21.05

J2001 0.01

J2010 12.05

J2020 15.77

J2060 0.80

J2150 1.84

J2170 REPORT

J2175 5.09

J2180 3.78

J2185 1.3

J2210 8.03

J2212 REPORT

J2248 0.96

J2250 0.14

J2260 3.42

J2265 REPORT

J2270 1.23

J2274 9.05

J2278 7.30

J2280 8.48

J2300 2.51

J2310 32.40

J2315 3.23

J2320 3.75

J2323 17.89

J2325 38.37

J2353 168.11

J2354 1.19

CODE NOTE NFAC FAC 26 TC

J2355 467.21

J2357 32.30

J2358 2.91

J2360 3.67

J2370 0.76

J2400 25.95

J2405 0.13

J2407 24.64

J2410 2.88

J2425 17.67

J2426 9.11

J2430 10.41

J2440 0.75

J2460 0.93

J2469 22.88

J2501 3.17

J2502 N.C.

J2503 1,054.70

J2504 319.67

J2505 4,040.69

J2507 1,642.46

J2510 26.76

J2513 12.72

J2515 47.17

J2540 1.029

J2543 2.89

J2545 118.84

J2547 N.C.

J2550 1.63

J2560 29.80

J2562 312.10

J2590 0.58

J2597 14.04

J2650 0.17

J2670 3.44

J2675 1.37

J2680 22.78

J2690 55.60

J2700 1.61

J2704 0.12

J2710 0.09

J2720 1.11

J2724 15.22

J2725 15.75

J2730 91.90

J2760 159.00

J2765 0.89

J2770 413.52

J2778 383.22

J2780 1.09

J2783 254.10

J2785 53.89

J2788 27.01

J2790 81.44

J2791 4.74

J2792 21.32

J2793 REPORT

J2794 7.81

J2795 0.07

J2796 62.13

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CODE NOTE NFAC FAC 26 TC

J2800 38.57

J2805 97.44

J2810 0.29

J2820 36.22

J2850 34.78

J2860 N.C.

J2910 24.50

J2916 2.29

J2920 3.72

J2930 5.12

J2940 42.30

J2941 51.96

J2950 0.38

J2993 2301.90

J2995 79.50

J2997 80.29

J3000 13.34

J3010 0.49

J3030 46.67

J3060 40.46

J3070 140.38

J3090 1.27

J3095 5.01

J3101 102.43

J3105 3.12

J3110 7.55

J3121 0.04

J3145 N.C.

J3230 23.11

J3240 1,571.30

J3243 3.12

J3246 7.38

J3250 25.91

J3260 1.39

J3262 4.10

J3265 2.19

J3280 REPORT

J3285 61.23

J3300 3.70

J3301 1.76

J3302 0.28

J3303 3.61

J3305 149.71

J3310 6.20

J3315 460.85

J3320 30.08

J3350 N.C.

J3355 60.01

J3357 174.57

J3360 9.25

J3364 9.15

J3365 457.72

J3370 2.97

J3380 17.43

J3385 343.34

J3396 10.88

J3400 11.26

J3410 2.39

J3411 3.24

CODE NOTE NFAC FAC 26 TC

J3415 9.52

J3420 4.63

J3430 3.49

J3465 4.63

J3470 14.18

J3471 0.35

J3472 137.80

J3473 0.35

J3475 0.25

J3480 0.12

J3485 1.50

J3486 18.87

J3489 15.66

J3490 REPORT

J3520 N.C.

J3530 N.C.

J3535 N.C.

J3570 N.C.

J3590 REPORT

J7030 1.88

J7040 0.94

J7042 0.79

J7050 0.46

J7060 1.85

J7070 3.61

J7100 19.92

J7110 12.72

J7120 2.14

J7121 N.C.

J7131 REPORT

J7178 REPORT

J7180 8.18

J7181 N.C.

J7182 1.31

J7183 0.97

J7185 1.20

J7186 0.97

J7187 1.04

J7188 N.C.

J7189 1.90

J7190 0.97

J7191 1.72

J7192 1.17

J7193 1.10

J7194 1.28

J7195 1.51

J7196 0.00

J7197 3.43

J7198 1.92

J7199 N.C.

J7200 1.24

J7201 2.81

J7205 1.89

J7297 637.50

J7298 826.72

J7300 739.00

J7301 650.32

J7303 REPORT

J7304 REPORT

J7306 REPORT

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

J7307 595.28

J7308 327.41

J7309 REPORT

J7310 16960.00

J7311 P 20,126.60

J7312 200.93

J7313 490.9

J7315 REPORT

J7316 1,046.75

J7321 87.73

J7323 155.31

J7324 159.27

J7325 12.76

J7326 587.57

J7327 917.76

J7328 N.C.

J7330 25109.56

J7336 2.97

J7340 N.C.

J7342

30.00 J7500 0.33

J7501 217.30

J7502 3.36

J7503 1.23

J7504 1,438.73

J7505 1133.50

J7507 0.75

J7508 0.39

J7509 0.34

J7510 0.10

J7511 690.83

J7512 0.00

J7513 351.10

J7515 0.89

J7516 41.56

J7517 0.94

J7518 2.87

J7520 7.57

J7525 163.77

J7527 7.69

J7599 N.C.

J7604 REPORT

J7605 8.97

J7606 10.66

J7607 N.C.

J7608 4.82

J7609 N.C.

J7610 N.C.

J7611 0.11

J7612 0.20

J7613 0.04

J7614 0.07

J7615 N.C.

J7620 0.17

J7622 N.C.

J7624 N.C.

J7626 3.98

J7628 N.C.

J7629 N.C.

CODE NOTE NFAC FAC 26 TC

J7631 0.88

J7632 REPORT

J7633 N.C.

J7634 N.C.

J7635 0.12

J7636 REPORT

J7637 0.10

J7638 0.12

J7639 42.50

J7641 N.C.

J7642 1.19

J7643 1.19

J7644 0.22

J7645 N.C.

J7648 N.C.

J7649 N.C.

J7650 N.C.

J7657 N.C.

J7658 N.C.

J7659 N.C.

J7660 N.C.

J7665 0.66

J7667 N.C.

J7668 N.C.

J7669 0.25

J7670 N.C.

J7674 0.51

J7676 REPORT

J7680 N.C.

J7681 N.C.

J7682 45.42

J7683 N.C.

J7684 N.C.

J7685 N.C.

J7686 521.87

J7699 N.C.

J7799 N.C.

J7999 N.C.

J8498 REPORT

J8499 7.80

J8501 11.10

J8510 23.69

J8515 1.50

J8520 4.12

J8521 13.77

J8530 3.34

J8540 0.02

J8560 71.60

J8562 63.41

J8565 N.C.

J8597 REPORT

J8600 11.70

J8610 1.00

J8650 N.C.

J8655 461.96

J8700 2.66

J8705 103.85

J8999 N.C.

J9000 2.53

J9015 844.42

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

J9017 64.61

J9019 402.74

J9020 64.56

J9025 2.84

J9027 152.44

J9031 123.19

J9032 33.53

J9033 27.01

J9035 72.31

J9039 N.C.

J9040 28.19

J9041 46.52

J9042 129.08

J9043 154.56

J9045 3.55

J9047 31.94

J9050 3,847.56

J9055 55.63

J9060 2.06

J9065 21.74

J9070 43.97

J9098 595.76

J9100 0.90

J9120 1,276.38

J9130 3.95

J9150 40.02

J9151 56.31

J9155 3.62

J9160 1494.82

J9165 12.89

J9171 2.71

J9175 4.07

J9178 1.16

J9179 106.07

J9181 0.68

J9185 59.77

J9190 1.69

J9200 52.79

J9201 6.30

J9202 327.12

J9206 4.01

J9207 77.87

J9208 28.18

J9209 2.38

J9211 29.75

J9212 4.80

J9213 40.52

J9214 26.85

J9215 8.17

J9216 430.93

J9217 225.01

J9218 17.90

J9219 4819.82

J9225 3,138.03

J9226 P 26,205.50

J9228 142.65

J9230 265.88

J9245 1,871.62

J9250 0.23

CODE NOTE NFAC FAC 26 TC

J9260 2.375

J9261 152.20

J9262 N.C.

J9263 0.39

J9264 10.32

J9266 13,911.22

J9267 0.17

J9268 1,887.77

J9270 78.99

J9271 46.49

J9280 103.16

J9293 36.74

J9299 26.06

J9300 2687.21

J9301 56.20

J9302 51.86

J9303 105.59

J9305 62.77

J9306 10.64

J9307 229.71

J9308 55.93

J9310 792.92

J9315 306.78

J9320 323.60

J9328 8.24

J9330 66.67

J9340 113.52

J9351 3.05

J9354 29.21

J9355 92.09

J9357 1,148.72

J9360 3.54

J9370 4.24

J9371 2,506.48

J9390 10.34

J9395 95.77

J9400 8.44

J9600 2934.28

J9999 REPORT

P9041 11.02

P9045 54.72

P9046 22.48

P9047 53.43

Q0138 0.88

Q0139 0.88

Q0162 1.00

Q0163 0.26

Q0164 0.04

Q0166 0.41

Q0167 2.46

Q0169 0.02

Q0180 94.76

Q2035 16.28

Q2037 16.28

Q2043 P 37763.36

Q2050 435.44

Q3027 45.37

Q4074 123.93

Q4081 1.25

Q4101 31.02

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Professional Services Fee Schedule January 2017

CODE NOTE NFAC FAC 26 TC

Q4102 11.01

Q4104 38.89

Q4105 30.36

Q4106 33.44

Q4107 88.33

Q4108 40.70

Q4110 50.72

Q4111 6.88

Q4112 223.46

Q4113 223.46

Q4115 9.97

Q4116 32.20

Q4123 20.06

Q4131 169.40

Q4172 119.12

Q5101 0.82

Q9950 22.32

Q9956 34.54

Q9957 51.82

Q9958 0.07

Q9960 0.22

Q9961 0.20

Q9963 0.19

Q9965 0.85

Q9966 0.17

Q9967 0.12