Department of Veterans' Affairs Fee Schedules for Medical Services

Department of
Veterans’ Affairs
Fee Schedules
for Medical Services
1 November 2011 – 31 October 2012

© Commonwealth of Australia 2011
This work is copyright. Apart from any use as permitted under the
Copyright Act 1968, no part may be reproduced by any process
without prior written permission from the Commonwealth. Requests
and inquiries concerning reproduction and rights should be addressed
to the publications section, Department of Veterans’ Affairs or emailed
to publications@dva.gov.au.
Published by the Department of Veterans’ Affairs, Canberra, 2011.
DVA P01693 April 2012

DEPARTMENT OF VETERANS’ AFFAIRS MEDICAL FEE SCHEDULES
1 November 2011
REPATRIATION MEDICAL FEE SCHEDULE
CONTENTS
LOCAL MEDICAL OFFICER FEE SCHEDULE 2
DERIVED FEES READY RECKONER LOCAL MEDICAL OFFICERS 6
RELATIVE VALUE GUIDE FEE SCHEDULE 59
DIAGNOSTIC IMAGING FEE SCHEDULE 64
PATHOLOGY FEE SCHEDULE 71
NOTES FOR CLAIMING DVA FEES
• The fee schedules list the fees that will be implemented on the Medicare
Australia payment system from 1 November 2011.
• The fee schedules in this booklet are also available on the DVA website at
www.dva.gov.au/service_providers/Fee_schedules/GPs_LMOs_and_
Specialists/Pages/RMFS.aspx
• All item assessments are based on Medicare assessment rules.
• A “D” in a fee column indicates a derived fee.
1 NOVEMBER 2011 – 31 OCTOBER 2012 1

LOCAL MEDICAL OFFICER FEE SCHEDULE
LOCAL MEDICAL OFFICER FEE SCHEDULE
1 November 2011
The Local Medical Officer Fee Schedule lists fees for medical attendances and consultations
provided by general practitioners participating in DVA’s Local Medical Officer (LMO) Scheme.
LMOs will be paid at 115% of the listed MBS fee plus the relevant Veterans Access Payment (VAP)
or where applicable the Rural Enhancement Initiative (REI) loading.
The VAP can be claimed using the Medicare Bulk Billing Incentive item numbers as follows:
• Items 10990, 64990 and 74990 are to be used when claiming the $6.90 VAP; and
• Items 10991, 10992, 64991 and 74991 when claiming the $10.45 VAP.
Please note that VAP is not payable on items provided to inpatients of a hospital or day surgery,
Coordinated Veterans’ Care Program UP items and Telehealth consultation items. Items 10990,
10991 and 10992 are VAP incentives and are paid at 100% of the MBS fee.
Derived fees are indicated by a “D” in the column of the Schedule. Please refer to the derived fees
section of the booklet for benefit calculation.
The REI loading is available to LMOs who provide services to veterans in designated rural public
hospitals by State or Territory governments. The REI only applies to those In Hospital items indicated
in the Local Medical Officer Fee Schedule. The REI loading is an additional 10% of the LMO fee.
For items not listed in the LMO schedule please refer to the appropriate schedule in this booklet.
• For derived fees for Local Medical Officers, please use the Derived Fees for Local Medical
Officers Fee Schedule.
• For all specialist attendances and consultations, investigative and general medical
procedures claim from the Repatriation Medical Fee Schedule.
• For In Hospital anaesthetic services please use Relative Value Guide Fee Schedule.
• For diagnostic imaging services claim from the Diagnostic Imaging Fee Schedule.
• For pathology services claim from the Pathology Fee Schedule.
2 1 NOVEMBER 2011 – 31 OCTOBER 2012

LOCAL MEDICAL OFFICER FEE SCHEDULE
Item
LMO Fee
REI
Benefit
VAP
10990,
64990,
74990
VAP
10991,
10992,
64991,
74991
3 18.75 Y Y
4 D Y Y Y
20 D Y Y
23 40.95 Y Y
24 D Y Y Y
35 D Y Y
36 79.35 Y Y
37 D Y Y Y
43 D Y Y
44 116.80 Y Y
47 D Y Y Y
51 D Y Y
52 12.65 Y Y
53 24.15 Y Y
54 43.70 Y Y
57 70.15 Y Y
58 D Y Y
59 D Y Y
60 D Y Y
65 D Y Y
92 D Y Y
93 D Y Y
95 D Y Y
96 D Y Y
597 143.65 Y Y
599 169.30 Y Y
701 65.70 Y Y
703 152.65 Y Y
705 210.55 Y Y
707 297.45 Y Y
715 234.85 Y Y
721 159.60 Y Y
723 126.45 Y Y
729 77.90 Y Y
731 77.90 Y Y
732 79.80 Y Y
Item
LMO Fee
REI
Benefit
VAP
10990,
64990,
74990
VAP
10991,
10992,
64991,
74991
735 78.15 Y Y
739 133.90 Y Y
743 223.10 Y Y
747 57.45 Y Y
750 98.45 Y Y
758 164.00 Y Y
900 171.25 Y Y
903 117.25 Y Y
2100 25.40
2122 D
2125 D
2126 55.30
2137 D
2138 D
2143 107.20
2147 D
2179 D
2195 157.70
2199 D
2220 D
2497 18.75 Y Y
2501 40.95 Y Y
2503 D Y Y
2504 79.35 Y Y
2506 D Y Y
2507 116.80 Y Y
2509 D Y Y
2517 40.95 Y Y
2518 D Y Y
2521 79.35 Y Y
2522 D Y Y
2525 116.80 Y Y
2526 D Y Y
2546 40.95 Y Y
2547 D Y Y
2552 79.35 Y Y
1 NOVEMBER 2011 – 31 OCTOBER 2012 3

Item
LMO Fee
REI
Benefit
VAP
10990,
64990,
74990
VAP
10991,
10992,
64991,
74991
2553 D Y Y
2558 116.80 Y Y
2559 D Y Y
2598 12.65 Y Y
2600 24.15 Y Y
2603 43.70 Y Y
2606 70.15 Y Y
2610 D Y Y
2613 D Y Y
2616 D Y Y
2620 24.15 Y Y
2622 43.70 Y Y
2624 70.15 Y Y
2631 D Y Y
2633 D Y Y
2635 D Y Y
2664 24.15 Y Y
2666 43.70 Y Y
2668 70.15 Y Y
2673 D Y Y
2675 D Y Y
2677 D Y Y
2700 79.35 Y Y
2701 116.80 Y Y
2712 79.35 Y Y
2713 79.35 Y Y
2715 100.75 Y Y
2717 148.35 Y Y
2721 102.65 Y Y
2723 D Y Y
2725 146.90 Y Y
2727 D Y Y
4001 84.80 Y Y
5000 32.10 Y Y
5003 D Y Y
5010 D Y Y
Item
LMO Fee
REI
Benefit
VAP
10990,
64990,
74990
VAP
10991,
10992,
64991,
74991
5020 54.25 Y Y
5023 D Y Y
5028 D Y Y
5040 92.90 Y Y
5043 D Y Y
5049 D Y Y
5060 130.30 Y Y
5063 D Y Y
5067 D Y Y
5200 24.15 Y Y
5203 35.65 Y Y
5207 55.20 Y Y
5208 81.65 Y Y
5220 D Y Y
5223 D Y Y
5227 D Y Y
5228 D Y Y
5260 D Y Y
5263 D Y Y
5265 D Y Y
5267 D Y Y
10983 31.80 Y Y
10984 31.80 Y Y
10986 57.10 Y Y
10987 23.55 Y Y
10988 11.80 Y Y
10989 11.80 Y Y
10990 6.90
10991 10.45
10992 10.45
64990 6.90
64991 10.45
74990 6.90
74991 10.45
82100 52.40
82105 31.70
4 1 NOVEMBER 2011 – 31 OCTOBER 2012

LOCAL MEDICAL OFFICER FEE SCHEDULE
Item
LMO Fee
REI
Benefit
VAP
10990,
64990,
74990
VAP
10991,
10992,
64991,
74991
Item
LMO Fee
REI
Benefit
VAP
10990,
64990,
74990
VAP
10991,
10992,
64991,
74991
82110 52.40
82210 39.00
82115 313.05
82215 57.45
82120 739.25
82220 27.75
82125 739.25
82221 52.70
82130 52.40
82222 77.50
82135 77.05
82223 27.75
82140 52.40
82224 52.70
82150 27.75
82225 77.50
82151 52.70
UP01 408.00
82152 77.50
UP02 255.00
82200 9.40
UP03 425.85
82205 20.55
UP04 191.25
1 NOVEMBER 2011 – 31 OCTOBER 2012 5

DERIVED FEES - READY RECKONER FOR LOCAL MEDICAL OFFICERS
DERIVED FEES—READY RECKONER FOR
LOCAL MEDICAL OFFICERS
1 November 2011
Derived fees are indicated by a “D” in the column of the Schedule. Derived Fees Ready Reckoner for
Local Medical Officers is a quick reference table for all derived fees. The derived fees are calculated
at 115% of the listed MBS fee.
LMOs will be paid the relevant Veterans Access Payment (VAP) and where applicable the Rural
Enhancement Initiative (REI) loading.
The VAP can be claimed using the Medicare Bulk Billing Incentive item numbers as follows:
• Items 10990, 64990 and 74990 are to be used when claiming the $6.90 VAP; and
• Items 10991, 10992, 64991 and 74991 when claiming the $10.45 VAP.
Please note that VAP is not payable on items provided to inpatients of a hospital or day surgery,
Coordinated Veterans’ Care Program UP items and Telehealth consultation items. Items 10990,
10991 and 10992 are VAP incentives and are paid at 100% of the MBS fee.
The REI loading is available to LMOs who provide services to veterans in designated rural public
hospitals by State or Territory governments. The REI only applies to those In Hospital items indicated
in the Local Medical Officer Fee Schedule. The REI loading of 10% is added to 100% of the MBS
fee prior to the LMO fee calculation.
For items not listed in the Derived Fees schedule please refer to the appropriate schedule in this
booklet.
• For medical attendances and consultations provided by general practitioners participating
in DVA’s Local Medical Officer Scheme, please use the Local Medical Fee Schedule for the
relevant fees.
• For all specialist attendances and consultations, investigative and general medical
procedures claim from the Repatriation Medical Fee Schedule.
• For In Hospital anaesthetic services please use Relative Value Guide Fee Schedule.
• For diagnostic imaging services claim from the Diagnostic Imaging Fee Schedule.
• For pathology services claim from the Pathology Fee Schedule.
6 1 NOVEMBER 2011 – 31 OCTOBER 2012

DERIVED FEES - READY RECKONER FOR LOCAL MEDICAL OFFICERS
Item Nos. Patients LMO Fee
4 1 $47.50
2 $33.15
3 $28.35
4 $25.95
5 $24.50
6 $23.55
7+ $20.95
Item Nos. Patients LMO Fee
43 1 $131.05
2 $105.20
3 $96.60
4 $92.30
5 $89.70
6 $88.00
7+ $83.05
Item Nos. Patients LMO Fee
60 1 $58.65
2 $49.75
3 $46.75
4 $45.30
5 $44.40
6 $43.85
7 $41.65
20 1 $70.45
2 $44.60
3 $36.00
4 $31.70
5 $29.10
6 $27.40
7+ $22.45
47 1 $145.55
2 $131.20
3 $126.40
4 $124.00
5 $122.55
6 $121.60
7+ $119.00
65 1 $83.95
2 $75.05
3 $72.05
4 $70.60
5 $69.70
6 $69.15
7 $66.95
24 1 $69.70
2 $55.35
3 $50.55
4 $48.15
5 $46.70
6 $45.75
7+ $43.15
51 1 $168.50
2 $142.60
3 $134.05
4 $129.75
5 $127.15
6 $125.45
7+ $120.50
92 1 $41.95
2 $25.85
3 $20.50
4 $17.85
5 $16.25
6 $15.15
7+ $11.25
35 1 $92.65
2 $66.80
3 $58.20
4 $53.90
5 $51.30
6 $49.60
7+ $44.65
58 1 $27.60
2 $18.70
3 $15.70
4 $14.25
5 $13.35
6 $12.80
7+ $10.60
93 1 $54.70
2 $36.55
3 $30.50
4 $27.50
5 $25.65
6 $24.45
7 $19.85
37 1 $108.10
2 $93.75
3 $89.00
4 $86.55
5 $85.10
6 $84.15
7+ $81.55
59 1 $38.55
2 $28.50
3 $25.15
4 $23.45
5 $22.45
6 $21.75
7+ $19.25
95 1 $73.00
2 $56.90
3 $51.55
4 $48.90
5 $47.30
6 $46.20
7 $42.30
1 NOVEMBER 2011 – 31 OCTOBER 2012 7

Item Nos. Patients LMO Fee
96 1 $98.30
2 $82.20
3 $76.85
4 $74.20
5 $72.60
6 $71.50
7+ $67.60
Item Nos. Patients LMO Fee
2147 1 $135.95
2 $121.60
3 $116.80
4 $114.40
5 $112.95
6 $112.00
7+ $109.40
Item Nos. Patients LMO Fee
2506,
2522,
2553
1 $108.10
2 $93.75
3 $89.00
4 $86.55
5 $85.10
6 $84.15
7+ $81.55
2122 1 $54.15
2 $39.75
3 $35.00
2179 1 $158.90
2 $133.00
3 $124.45
2509,
2526,
2559
1 $145.55
2 $131.20
3 $126.40
4 $32.55
4 $120.15
4 $124.00
5 $31.15
5 $117.55
5 $122.55
6 $30.15
6 $115.85
6 $121.60
7+ $27.55
7+ $110.90
7+ $119.00
2125 1 $77.05
2 $51.20
3 $42.65
4 $38.30
5 $35.75
6 $34.00
7+ $29.05
2199 1 $186.45
2 $172.05
3 $167.30
4 $164.90
5 $163.45
6 $162.45
7+ $159.85
2610 1 $38.55
2 $28.50
3 $25.15
4 $23.45
5 $22.45
6 $21.75
7+ $19.25
2137 1 $54.15
2 $39.75
3 $35.00
4 $32.55
5 $31.15
6 $30.15
7+ $27.55
2220 1 $209.40
2 $183.50
3 $174.95
4 $170.65
5 $168.05
6 $166.30
7+ $161.35
2613 1 $58.65
2 $49.75
3 $46.75
4 $45.30
5 $44.40
6 $43.85
7+ $41.65
2138 1 $106.95
2 $81.10
3 $72.55
2503,
2518,
2547
1 $69.70
2 $55.35
3 $50.55
2616 1 83.95
2 75.05
3 72.05
4 $68.20
4 $48.15
4 70.60
5 $65.65
5 $46.70
5 69.70
6 $63.90
6 $45.75
6 69.15
7+ $58.95
7+ $43.15
7+ 66.95
8 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item Nos. Patients LMO Fee
2631 1 $38.55
2 $28.50
3 $25.15
4 $23.45
5 $22.45
6 $21.75
7+ $19.25
Item Nos. Patients LMO Fee
2677 1 $83.95
2 $75.05
3 $72.05
4 $70.60
5 $69.70
6 $69.15
7+ $66.95
Item Nos. Patients LMO Fee
5023 1 $83.00
2 $68.60
3 $63.85
4 $61.45
5 $60.00
6 $59.00
7+ $56.45
2633 1 $58.65
2 $49.75
3 $46.75
4 $45.30
5 $44.40
6 $43.85
7+ $41.65
2723 1 $131.40
2 $117.05
3 $112.25
4 $109.85
5 $108.40
6 $107.45
7+ $104.85
5028 1 $105.95
2 $80.05
3 $71.50
4 $67.20
5 $64.60
6 $62.85
7+ $57.95
2635 1 $83.95
2 $75.05
3 $72.05
4 $70.60
5 $69.70
6 $69.15
7+ $66.95
2727 1 $152.70
2 $140.20
3 $136.05
4 $133.95
5 $132.70
6 $131.85
7+ $129.60
5043 1 $121.65
2 $107.25
3 $102.50
4 $100.05
5 $98.65
6 $97.65
7+ $95.05
2673 1 $38.55
2 $28.50
3 $25.15
4 $23.45
5 $22.45
6 $21.75
7+ $19.25
5003 1 $60.85
2 $46.50
3 $41.70
4 $39.30
5 $37.85
6 $36.90
7+ $34.30
5049 1 $144.60
2 $118.70
3 $110.15
4 $105.80
5 $103.25
6 $101.50
7+ $96.55
2675 1 $58.65
2 $49.75
3 $46.75
4 $45.30
5 $44.40
6 $43.85
7+ $41.65
5010 1 $83.80
2 $57.95
3 $49.35
4 $45.05
5 $42.45
6 $40.75
7+ $35.80
5063 1 $159.05
2 $144.70
3 $139.90
4 $137.50
5 $136.05
6 $135.10
7+ $132.50
1 NOVEMBER 2011 – 31 OCTOBER 2012 9

Item Nos. Patients LMO Fee
5067 1 $182.00
2 $156.15
3 $147.55
4 $143.25
5 $140.65
6 $138.95
7+ $134.00
Item Nos. Patients LMO Fee
5260 1 $53.45
2 $37.35
3 $32.00
4 $29.35
5 $27.75
6 $26.65
7+ $22.75
5220 1 $39.10
2 $30.20
3 $27.20
4 $25.75
5 $24.85
6 $24.30
7+ $22.10
5263 1 $66.20
2 $48.05
3 $42.00
4 $39.00
5 $37.15
6 $35.95
7+ $31.35
5223 1 $50.05
2 $40.00
3 $36.65
4 $34.95
5 $33.95
6 $33.25
7+ $30.75
5265 1 $84.50
2 $68.40
3 $63.05
4 $60.40
5 $58.80
6 $57.70
7+ $53.80
5227 1 $70.15
2 $61.25
3 $58.25
4 $56.80
5 $55.90
6 $55.35
7+ $53.15
5267 1 $109.80
2 $93.70
3 $88.35
4 $85.70
5 $84.10
6 $83.00
7+ $79.10
5228 1 $95.45
2 $86.55
3 $83.55
4 $82.10
5 $81.20
6 $80.65
7+ $78.45
10 1 NOVEMBER 2011 – 31 OCTOBER 2012

REPATRIATION MEDICAL FEE SCHEDULE
REPATRIATION MEDICAL FEE SCHEDULE
1 November 2011
The fees listed in the Repatriation Medical Fee Schedule (RMFS) are for specialist consultations and
procedures.
In Hospital items have been calculated with consideration given to private health industry rates.
Out of Hospital items have been calculated based on the Medicare Benefits Schedule (MBS) at a rate
of 135% of the MBS for consultations and 140% of the MBS for procedures.
All medical practitioners, including LMOs and general practitioners, who have the appropriate
qualifications updated with Medicare Australia, are eligible to claim for services listed in the
RMFS. Items listed on the RMFS do not attract the Veterans Access Payment (VAP) or the Rural
Enhancement Initiative (REI) loading.
When claiming an RMFS item using the DVA treatment service voucher, electronic funds transfer or
your own stationery, please ensure that you have correctly indicated whether you have performed
the service In Hospital or Out of Hospital and claimed at the appropriate rate. Whether a service is
considered In Hospital or Out of Hospital is assessed as per Medicare assessment rules.
For items not listed in the RMFS please refer to the appropriate schedule in this booklet.
• For medical attendances and consultations provided by general practitioners participating
in DVA’s Local Medical Officer Scheme, please use the Local Medical Fee Schedule for the
relevant fees.
• For derived fees for Local Medical Officers, please use the Derived Fees for Local Medical
Officers Fee Schedule.
• For In Hospital anaesthetic services please use Relative Value Guide Fee Schedule.
• For diagnostic imaging services please use the Diagnostic Imaging Fee Schedule.
• For pathology services please use the Pathology Fee Schedule.
1 NOVEMBER 2011 – 31 OCTOBER 2012 11

REPATRIATION MEDICAL FEE SCHEDULE
Item
RMFS In
Hospital %
99 D D
104 115.85 113.35
105 58.25 57.00
106 96.15 94.10
107 166.30
108 105.25
109 260.95 255.45
110 204.25 199.95
112 D
116 102.30 100.05
119 58.25 57.00
122 242.60
128 146.75
131 105.65
132 356.20 349.65
133 178.35 175.05
135 356.20 349.65
137 356.20 349.65
139 172.15
141 610.90 599.70
143 381.90 374.85
145 727.15
147 454.55
149 D
160 293.85 287.70
161 489.60 479.50
162 685.20 671.05
163 881.25 863.15
164 979.30 959.05
170 135.55 152.70
171 142.80 160.90
172 173.80 195.75
173 29.95 29.25
193 48.10
195 D 23.83
197 93.15
199 137.10
288 D
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
289 349.70 349.65
291 599.70
293 374.85
296 344.90
297 352.15
299 412.45
300 57.45
302 114.55
304 176.35
306 243.35
308 282.45
310 28.65
312 57.45
314 88.30
316 121.85
318 141.25
319 243.35
320 58.75
322 117.00
324 180.10
326 248.60
328 288.30
330 105.40
332 165.20
334 240.65
336 291.15
338 330.65
342 66.85 65.35
344 88.70 86.75
346 131.10 128.25
348 171.60 167.95
350 236.90 231.90
352 171.60 167.95
353 67.50 75.85
355 134.60 151.65
356 197.40 222.30
357 272.35 306.70
358 331.80 373.65
RMFS
Out
Hospital %
12 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
RMFS In
Hospital %
359 439.20 431.10
361 404.00 396.50
364 58.75 57.45
366 117.00 114.55
367 171.60 176.35
369 236.90 243.50
370 288.30 282.45
385 115.85 113.35
386 58.25 57.00
387 169.80 166.30
388 107.55 105.25
389 D
410 25.95
411 56.65
412 109.50
413 161.30
RMFS
Out
Hospital %
414 D 37.97 35
415 D 37.75 35
416 D 37.89 35
417 D 37.85 35
501 45.30
503 76.55
507 128.60
511 181.95
515 281.70
519 193.70
520 372.10
530 609.80
532 847.55
534 1,085.50
536 1,204.45
597
598 144.45 141.45
600 171.25 167.75
820 184.30
822 276.50
823 368.50
825 132.40
Item
RMFS In
Hospital %
826 211.10
828 289.80
830 188.25 184.30
832 282.40 276.50
834 376.25 368.50
835 132.40
837 211.10
838 289.80
855 188.25 184.30
857 282.40 276.50
858 376.25 368.50
861 188.25 184.30
864 282.40 276.50
866 376.25 368.50
871 108.70 106.40
872 50.60 49.55
880 65.80
2100 25.40
2122 D
2125 D
2126 55.30
2137 D
2138 D
2143 107.20
2147 D
2179 D
2195 157.70
2199 D
2220 D
2801 204.25 199.95
2806 102.30 100.05
2814 58.25 57.00
2820 D
2824 242.60
2832 146.75
2840 105.65
2946 188.25 184.30
2949 282.40 276.50
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 13

Item
RMFS In
Hospital %
2954 376.25 368.50
2958 135.30 132.40
2972 215.65 211.10
2974 296.05 289.80
2978 188.25
2984 282.40
2988 376.25
2992 132.40
2996 211.10
3000 289.80
3005 204.25 199.95
3010 102.30 100.05
3014 58.25 57.00
3015 D
3018 242.60
3023 146.75
3028 105.65
3032 188.25 184.30
3040 282.40 276.50
3044 376.25 368.50
3051 135.30 132.40
3055 215.65 211.10
3062 296.05 289.80
3069 188.25
3074 282.40
3078 376.25
3083 132.40
3088 211.10
3093 289.80
5906 25.95
5908 56.65
5910 107.50
5912 158.30
6007 175.40 171.75
6009 58.25 57.00
6011 115.85 113.35
6013 160.40 157.05
6015 204.25 199.95
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
6016 D
10801 164.70 161.20
10802 164.70 161.20
10803 164.70 161.20
10804 164.70 161.20
10805 164.70 161.20
10806 164.70 161.20
10807 164.70 161.20
10808 164.70 161.20
10809 164.70 161.20
10816 164.70 161.20
11000 151.60 169.15
11003 386.25 447.55
11004 385.25 447.55
11005 385.25 447.55
11006 197.50 229.50
11009 269.40 312.90
11012 132.70 153.90
11015 177.30 205.95
11018 264.90 307.65
11021 214.20 205.95
11024 134.75 156.45
11027 199.75 232.05
11200 52.55 56.10
11203 89.10 94.75
11204 139.65 148.75
11205 139.65 148.75
11210 153.25 148.75
11211 139.65 148.75
11212 90.65 96.35
11215 180.35 169.00
11218 277.75 208.75
11221 101.55 93.10
11222 87.50 93.10
11224 52.60 56.15
11225 52.60 56.15
11235 158.35 168.65
11237 105.20 111.95
RMFS
Out
Hospital %
14 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
RMFS In
Hospital %
11240 104.05 111.95
11241 133.85 142.40
11242 103.40 110.05
11243 103.40 110.05
11300 248.55 264.40
11303 248.55 264.40
11304 408.95 435.50
11306 28.35 30.10
11309 36.10 36.15
11312 51.30 51.05
11315 71.55 67.65
11318 89.05 83.45
11321 148.90 158.50
11324 43.60 45.15
11327 28.65 27.20
11330 10.20 10.85
11332 75.45 80.45
11333 57.55 61.25
11336 57.55 61.25
11339 57.55 61.25
11500 283.35 229.50
11503 170.45 190.50
11506 24.80 28.25
11509 42.25 49.00
11512 73.05 84.85
11600 95.05 95.20
11602 73.10 79.35
11604 89.20 104.05
11605 89.20 104.05
11610 75.20 87.60
11611 76.40 87.60
11612 132.35 154.45
11614 94.15 104.05
11615 100.50 104.30
11627 295.00 314.20
11700 37.60 42.95
11701 18.65 21.35
11702 19.65 21.35
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
11708 151.40 175.70
11709 198.15 230.10
11710 61.40 71.35
11711 33.55 38.85
11712 179.95 209.05
11713 87.60 95.85
11715 142.55 165.90
11718 41.20 47.75
11721 82.55 95.85
11722 41.20 47.75
11724 199.75 232.05
11727 122.10 130.20
11800 205.55 239.70
11810 205.55 239.70
11820 2,401.40 2,801.70
11823 2,401.40 2,801.70
11830 219.95 256.65
11833 294.30 343.15
11900 33.75 37.90
11903 131.55 152.70
11906 131.55 152.70
11909 195.30 226.90
11912 212.60 226.90
11915 195.30 226.90
11917 511.60 588.50
11919 505.35 588.50
11921 96.70 103.15
12000 55.25 53.50
12003 111.40 80.85
12012 24.55 28.60
12015 73.60 85.85
12018 94.75 110.40
12021 138.85 161.95
12200 43.90 51.10
12201 2,818.10 3,287.65
12203 692.55 807.90
12207 692.55 807.90
12210 826.55 964.25
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 15

Item
RMFS In
Hospital %
12213 744.75 868.70
12215 826.55 964.25
12217 744.75 868.70
12250 394.95 460.70
12306 120.65 140.70
12309 120.65 140.70
12312 120.65 140.70
12315 126.80 140.70
12318 120.65 140.70
12321 127.25 140.70
12323 127.35 140.70
12500 255.20 297.65
12503 500.35 583.60
12506 357.30 416.75
12509 255.20 297.65
12512 123.80 144.35
12515 270.80 315.80
12518 123.80 144.35
12521 149.20 174.05
12524 186.50 217.60
12527 100.15 116.70
12530 149.20 174.05
12533 99.75 116.30
13015 300.10 350.00
13020 304.80 355.60
13025 136.35 159.00
13030 192.55 224.60
13100 191.80 187.75
13103 83.90 97.80
13104 203.30
13106 143.05 166.75
13109 268.20 312.90
13110 269.20 313.95
13112 180.35 187.75
13200 4,179.20 4,273.85
13201 3,909.15 3,997.70
13202 625.50 639.60
13203 661.65 668.75
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
13206 1,150.40 639.60
13209 119.95 116.35
13210 D
13212 458.30 487.00
13215 158.45 152.70
13218 1,109.55 1,090.25
13221 70.20 69.80
13251 569.15 574.25
13290 270.55 280.65
13292 540.95 561.55
13300 67.20 78.30
13303 99.40 116.00
13306 393.50 459.00
13309 335.50 391.40
13312 44.75 39.10
13318 267.90 312.50
13319 267.90 312.50
13400 114.10 133.00
13500 212.40 247.75
13503 424.80 495.55
13506 217.30 253.50
13700 394.20 457.90
13703 141.35 164.15
13706 98.75 114.55
13709 62.85 66.60
13750 161.75 187.75
13755 177.05 187.75
13757 86.30 100.25
13760 901.80 1,047.80
13815 100.80 117.15
13818 134.50 156.25
13830 89.15 103.55
13839 28.55 31.65
13842 82.00 95.20
13847 184.45 214.50
13848 159.55 180.05
13851 583.40 678.25
13854 185.45 157.80
RMFS
Out
Hospital %
16 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
RMFS In
Hospital %
13857 173.20 201.15
13870 426.55 497.50
13873 316.40 369.05
13876 96.25 105.65
13881 172.45 201.15
13882 135.85 158.35
13885 181.05 211.15
13888 90.65 105.65
13915 76.70 89.40
13918 115.35 134.55
13921 130.65 152.25
13924 76.95 89.70
13927 99.40 116.00
13930 138.80 161.85
13933 154.00 179.55
13936 100.40 117.00
13939 115.35 134.55
13942 76.95 89.70
13945 62.00 72.10
13948 76.95 89.70
14050 62.45 72.45
14053 62.45 72.45
14100 212.70 209.55
14106 218.30 209.55
14109 269.50 257.40
14112 291.05 304.65
14115 303.55 352.40
14118 425.80 447.60
14124 180.45 209.55
14200 81.00 82.20
14201 306.15 325.45
14202 154.95 164.75
14203 65.95 70.30
14206 46.05 48.95
14209 114.45 121.90
14212 240.05 254.60
14215 126.35 134.55
14218 126.35 134.55
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
14221 62.05 72.10
14224 87.50 96.70
14227 119.70 134.55
14230 364.40
14233 442.50
14236 806.85
14239 195.00
14242 579.05
14245 119.70 134.55
15000 54.95 58.45
RMFS
Out
Hospital %
15003 D 31.25 D 40
15006 140.00 129.65
15009 D 31.46 D 40
15012 84.15 73.45
15100 61.80 65.55
15103 D D 40
15106 72.75 77.35
15109 D D 40
15112 154.80 165.20
15115 D 31.15 D 40
15211 65.65 75.20
15214 D 22.13 D 40
15215 73.30 82.00
15218 73.30 82.00
15221 100.45 82.00
15224 71.85 82.00
15227 88.60 82.00
15230 D 25.02 D 40
15233 D 25.02 D 40
15236 D 71.28 D 40
15239 D 22.56 D 40
15242 D 51.09 D 40
15245 87.90 82.00
15248 73.30 82.00
15251 82.80 82.00
15254 86.95 82.00
15257 88.10 82.00
15260 D 49.86 D 40
1 NOVEMBER 2011 – 31 OCTOBER 2012 17

Item
RMFS In
Hospital %
RMFS
Out
Hospital %
15263 D 25.02 D 40
15266 D 41.23 D 40
15269 D 48.25 D 40
15272 D 50.14 D 40
15303 422.25 490.50
15304 422.25 490.50
15307 800.45 929.90
15308 800.45 929.90
15311 394.15 457.80
15312 391.35 454.55
15315 773.80 898.90
15316 1,094.05 898.90
15319 480.20 557.90
15320 480.20 557.90
15323 853.75 992.00
15324 853.75 992.00
15327 1,298.70 1,079.15
15328 928.95 1,079.15
15331 885.50 1,024.70
15332 1,100.70 1,024.70
15335 800.45 929.90
15336 800.45 929.90
15338 1,245.05 1,285.45
15339 90.20 104.75
15342 225.15 261.45
15345 625.50 697.70
15348 69.20 80.25
15351 138.00 160.25
15354 167.50 194.40
15357 47.30 55.05
15500 300.05 333.45
15503 381.40 428.05
15506 551.75 639.25
15509 257.45 289.00
15512 331.80 372.50
15513 518.40 421.20
15515 484.30 539.30
15518 97.60 105.80
Item
RMFS In
Hospital %
15521 420.90 467.00
15524 753.85 875.65
15527 101.05 108.50
15530 473.65 483.85
15533 832.70 917.35
15536 356.05 366.70
15539 775.50 861.85
15550 779.45 904.85
15553 840.90 976.25
15556 786.25 912.80
15559 1,025.50 1,190.60
15562 1,326.30 1,539.80
15600 2,004.85 2,338.80
15700 58.55 64.35
15705 97.50 107.25
15710 97.50 107.25
15800 122.65 134.85
15850 349.35 279.30
16003 797.25 893.70
16006 588.80 686.80
16009 401.80 468.75
16012 347.75 405.55
16015 4,811.50 5,613.30
16018 2,876.30 3,355.70
16399 D
16400 37.45
16401 115.85 117.55
16404 58.25 59.10
16406 189.80 184.05
16500 66.85 64.75
16501 188.05 193.15
16502 59.75
16504 55.55 64.75
16505 60.75
16508 56.95
16509 57.50 64.75
16511 355.05 302.20
16512 103.30 87.25
RMFS
Out
Hospital %
18 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
RMFS In
Hospital %
16514 48.20 50.35
16515 920.45 619.15
16518 716.00 619.15
16519 1,790.25 953.40
16520 2,092.20
16522 2,262.30 2,238.55
16525 991.65 528.10
16527 904.15 619.15
16528 2,055.15 1,114.35
16564 293.70 299.55
16567 422.40 438.00
16570 536.80 571.65
16571 411.05 438.00
16573 355.85 356.95
16590 445.30
16591 196.00
16600 114.25 87.25
16603 157.25 167.45
16606 359.50 334.20
16609 639.80 681.45
16612 503.10 536.15
16615 268.10 285.55
16618 268.10 285.55
16621 268.10 285.55
16624 386.00 410.90
16627 785.55 836.65
16633 D D
16636 D D
17609 D
17610 68.15 59.10
17615 135.80 117.55
17620 188.10 162.85
17625 239.50 207.35
17640 68.15 59.10
17645 135.80 117.55
17650 188.10 162.85
17655 239.50 207.35
17680 135.80 117.55
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
17690 54.35
18213 129.15 121.80
18216 296.80 260.90
RMFS
Out
Hospital %
18219 D 59.25 D 40
18222 59.90 51.75
18225 82.00 68.75
18226 457.80 391.30
18227 D 63.77 D 40
18228 93.35 85.90
18230 314.90 327.60
18232 266.30 260.90
18233 262.45 260.90
18234 164.30 171.50
18236 86.05 85.90
18238 67.60 51.75
18240 127.85 128.60
18242 56.65 51.75
18244 157.65 138.50
18246 151.80 138.50
18248 126.90 121.80
18250 94.15 85.90
18252 141.10 138.50
18254 144.65 138.50
18256 81.60 85.90
18258 102.55 85.90
18260 125.65 121.80
18262 88.95 85.90
18264 142.35 138.50
18266 96.80 85.90
18268 152.50 121.80
18270 148.70 121.80
18272 103.15 85.90
18274 132.50 121.80
18276 166.20 171.50
18278 125.85 121.80
18280 195.30 171.50
18282 151.80 138.50
18284 211.65 202.90
1 NOVEMBER 2011 – 31 OCTOBER 2012 19

Item
RMFS In
Hospital %
18286 196.10 202.90
18288 201.55 202.90
18290 376.05 343.15
18292 233.40 171.50
18294 227.85 241.80
18296 242.15 206.85
18298 326.70 241.80
18350 174.70 171.50
18351 174.70 171.50
18352 376.05 343.15
18354 207.20 171.50
18356 213.55 171.50
18358 188.05 171.50
18360 223.40 171.50
18361 223.40 171.50
18362 371.40 338.95
18364 188.05 171.50
18366 192.15 214.90
18368 402.00 366.90
18370 67.90 61.90
18371 60.25 61.90
18372 188.05 171.50
18373 188.05 171.50
RMFS
Out
Hospital %
30001 D D 40
30003 45.55 49.85
30006 61.05 63.95
30009 96.80
30010 96.80
30013 203.55
30014 203.55
30017 430.55 447.95
30020 780.20
30023 426.85 447.95
30024 426.85 447.95
30026 68.35 71.75
30029 117.85 123.65
30032 108.15 113.35
30035 150.05 161.50
Item
RMFS In
Hospital %
30038 147.05 123.65
30041 245.55 197.85
30042 245.55 255.05
30045 154.05 161.50
30048 192.85 205.75
30049 239.10 255.05
30052 332.55 348.95
30055 97.55 101.50
30058 183.75 198.35
30061 32.30 32.30
30062 79.55 83.45
30064 131.25 151.00
30067 375.90 307.25
30068 375.90 380.35
30071 68.35 71.75
30074 201.55 161.50
30075 201.55 205.75
30078 60.55 66.60
30081 135.25 151.00
30084 71.05 80.80
30087 38.65 40.50
30090 156.45 176.65
30093 224.65 235.70
30094 248.00 260.20
30096 274.40 252.65
30097 129.55 133.50
30099 117.85 123.65
30102 224.90 205.75
30103 224.90 252.65
30104 193.50 174.40
30106 290.55 213.50
30107 290.55 302.20
30110 486.45 390.70
30111 486.45 510.40
30114 439.45
30165 802.65 624.90
30168 595.50 624.90
30171 1,268.25 950.40
RMFS
Out
Hospital %
20 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
RMFS In
Hospital %
30174 905.45 950.40
30177 1,290.50
30180 178.70 187.55
30183 322.60 338.70
30185 247.50 250.75
30186 61.55 65.20
30187 353.55 353.05
30189 176.20 202.40
30190 585.25 546.50
30192 51.95 54.35
30195 83.10 87.25
30196 165.35 173.55
30197 720.45 604.60
30202 63.35 66.45
30203 222.95 233.95
30205 165.35 173.55
30207 58.50 61.25
30210 262.30
30213 143.80 150.85
30214 143.80 150.85
30216 35.90 37.60
30219 37.60
30223 197.30
30224 311.20 326.45
30225 338.75 367.75
30226 196.10 205.75
30229 357.45 375.00
30232 292.80 307.25
30235 387.10 406.30
30238 196.10 205.75
30241 486.65 489.60
30244 466.60
30246 995.30
30247 967.80
30250 1,663.85
30251 2,540.25 2,640.30
30253 1,158.25
30255 1,682.70
RMFS
Out
Hospital %
Item
30256 668.55
RMFS In
Hospital %
30259 261.85 272.75
30262 77.15 80.80
30265 213.60 161.50
30266 213.60 205.75
30269 196.10 205.75
30272 390.85 406.30
30275 2,500.85
30278 58.55 63.95
30281 146.05 164.15
30282 296.95 213.50
30283 296.95 281.30
30286 587.70 546.65
30289 611.65
30293 583.15 611.95
30294 3,142.70
30296 1,485.35
30297 1,491.65
30299 834.60
30300 1,001.50
30302 667.60
30303 801.10
30306 1,195.45
30308 1,212.00
30309 1,593.35
30310 582.05
30313 489.40 375.00
30314 681.60
30315 1,736.95
30317 2,013.50
30318 1,188.25
30320 1,747.40
30321 1,188.25
30323 2,047.90
30324 2,056.45
30329 323.30 339.30
30330 964.15
30332 452.85
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 21

Item
30335 1,249.30
30336 1,461.60
30373 594.90
30375 682.40
30376 661.15
30378 685.60
30379 1,215.15
30382 1,751.10
30384 1,437.25
30385 775.90
30387 850.60
30388 1,927.65
30390 288.00
30391 372.40
30392 883.10
30393 685.60
30394 645.15
30396 1,200.75
30397 304.35
30399 418.45
30400 828.05
30402 608.30
30403 682.40
30405 1,172.90
RMFS In
Hospital %
30406 70.35 71.75
30408 577.55
30409 228.60 239.70
30411 116.35
30412 68.50 71.90
30414 903.05
30415 2,009.40
30416 980.60
30417 1,500.75
30418 2,079.95
30419 1,069.90 1,122.60
30421 3,072.85
30422 884.10
30425 1,620.40
RMFS
Out
Hospital %
Item
30427 2,032.65
RMFS In
Hospital %
30428 2,744.15 2,294.40
30430 3,041.60 3,192.00
30431 682.40 716.20
30433 950.65
30434 770.05
30436 855.65
30437 1,064.60
30438 1,460.35 1,581.20
30439 243.20
30440 689.10 723.25
30441 178.35
30442 243.20
30443 967.80
30445 1,062.25
30446 1,051.40
30448 1,374.65
30449 1,529.65
30450 686.40 720.45
30451 350.55 367.75
30452 494.35
30454 1,122.30
30455 1,243.80
30457 1,766.65 1,895.35
30458 1,375.50
30460 1,258.55
30461 1,935.70
30463 3,000.65
30464 4,010.10
30466 1,644.35
30467 2,034.00
30469 2,644.05 2,364.35
30472 1,216.65 1,276.80
30473 232.00 243.35
30475 419.35 440.05
30476 321.50 337.35
30478 321.50 337.35
30479 566.00 654.10
RMFS
Out
Hospital %
22 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
RMFS In
Hospital %
30481 467.45 490.50
30482 332.40 348.75
30483 231.95 243.25
30484 477.80 501.35
30485 715.90 773.95
30487 237.00 248.60
30488 117.85 123.65
30490 623.25 723.25
30491 727.10 763.00
30492 1,030.15
30493 436.40 457.80
30494 550.50
30495 1,030.15
30496 770.05 808.10
30497 918.15
30499 1,092.20
30500 1,169.15 1,227.05
30502 1,290.50
30503 1,444.90 1,516.50
30505 706.25
30506 1,264.40
30508 1,330.90
30509 1,330.90 1,396.65
30511 1,112.25
30512 1,368.75
30514 2,040.50
30515 921.95
30517 1,207.25
30518 1,292.75
30520 884.10
30521 2,033.30
30523 1,975.60
30524 2,258.20
30526 2,921.00
30527 1,210.70
30529 1,711.00
30530 1,026.65
30532 1,178.95
RMFS
Out
Hospital %
Item
30533 1,530.45
30535 2,806.30
30536 2,603.90
30538 1,732.75
30539 1,086.95
30541 2,412.60
30542 1,349.80
30544 947.30
30545 2,405.00
RMFS In
Hospital %
30547 1,586.40 1,735.75
30548 1,782.55 1,296.70
30550 2,699.45
30551 1,863.05
30553 1,300.70 1,446.20
30554 3,003.70
30556 2,072.15
30557 1,530.35
30559 1,115.55 1,167.20
30560 1,348.65
30562 776.20
30563 779.15 817.50
30564 1,011.00
30565 1,140.60
30566 1,267.10
30568 859.25
30569 484.85
30571 593.85
30572 622.75
30574 161.50
30575 657.20
30577 1,436.75
30578 1,417.80
30580 1,281.45
30581 1,047.80
30583 1,563.55
30584 2,456.65
30586 918.15
30587 950.65
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 23

Item
30589 1,637.90
30590 1,911.25
RMFS In
Hospital %
30593 2,522.80 2,593.60
30594 3,028.20
30596 1,174.75
30597 942.95
30599 1,830.70
30600 1,017.60
30601 1,253.20
30602 2,034.00
30603 2,148.35 2,254.45
30605 2,702.20
30606 1,454.30
30609 670.80
30612 589.90
30614 589.90
30615 681.00
30616 444.30
30617 444.30
30620 481.20
30621 481.20
30628 46.75 48.95
30631 304.65 325.15
30634 463.60
30635 463.60
30638 530.90
30641 530.90
30644 777.95
30653 61.05 63.95
30656 141.55 148.65
30659 293.45 205.75
30660 293.45 255.05
30663 222.55 198.35
30666 82.70 65.20
30672 610.90
30675 502.75 411.40
30676 502.75 520.80
30679 115.70 132.30
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
30680 1,382.65 1,607.50
30682 1,382.65 1,607.50
30684 1,701.35 1,978.20
30686 1,701.35 1,978.20
30688 476.40 501.35
30690 735.35 773.95
30692 476.40 501.35
30694 735.35 773.95
30696 735.35 773.95
30710 735.35 773.95
31000 732.15 798.10
31001 1,093.65 997.50
31002 1,153.60 1,197.10
31200 44.60 46.70
31205 124.80 131.15
31210 161.35 169.15
31215 196.90 197.20
31220 289.90 294.80
31225 484.50 523.90
31230 220.00 230.90
31235 188.00 197.20
31240 220.00 230.90
31245 551.30 506.95
31250 615.75 506.95
31255 289.80 304.10
31256 289.75 304.10
31257 289.75 304.10
31258 289.75 304.10
31260 413.35 433.65
31261 413.10 433.65
31262 413.10 433.65
31263 413.10 433.65
31265 241.60 253.50
31266 222.35 253.50
31267 241.45 253.50
31268 241.45 253.50
31270 338.30 354.85
31271 338.05 354.85
RMFS
Out
Hospital %
24 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
RMFS In
Hospital %
31272 338.05 354.85
31273 338.05 354.85
31275 391.80 411.15
31276 391.60 411.15
31277 391.60 411.15
31278 391.60 411.15
31280 204.00 214.15
31281 204.80 214.90
31282 204.80 214.90
31283 204.80 214.90
31285 279.00 292.60
31286 317.05 292.60
31287 278.75 292.60
31288 278.75 292.60
31290 322.10 337.85
31291 308.20 337.85
31292 321.85 337.85
31293 321.85 337.85
31295 409.35 402.40
31300 418.80 439.55
31305 515.20 540.65
31310 364.90 382.85
31315 461.65 484.35
31320 515.20 540.65
31325 354.25 371.70
31330 418.80 439.55
31335 483.10 506.95
31340 D D
31345 287.20 289.80
31346 276.10 289.80
31350 604.00 595.35
31355 922.40 981.65
31400 341.85 358.70
31403 394.45
31406 724.75 689.95
31409 2,582.00
31412 2,918.65
31420 232.85 252.65
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
31423 481.10 551.95
31426 1,052.00
31429 1,847.50
31432 2,237.10
31435 1,279.75
31438 2,077.65
31441 301.60 345.80
31450 582.15
31452 1,048.05
31454 769.45
31456 291.05
31458 385.90
31460 484.90
31462 682.40
31464 1,296.90
31466 1,703.15
31468 2,102.00
31470 970.30
31472 1,382.75
31500 354.30 357.30
31503 450.75 476.45
31506 516.15
31509 443.35 476.45
31512 849.05
31515 551.50
31518 961.55
31521 607.25 595.60
31524 1,358.40
31527 907.05 714.70
31530 777.90 818.40
31533 173.85 189.50
31536 248.00 260.20
31539 497.85
31542 257.15 270.65
31545 759.75 818.40
31548 168.50 189.50
31551 277.50
31554 573.95
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 25

Item
RMFS In
Hospital %
31557 466.30 476.45
31560 458.40 476.45
31563 368.30 356.90
31566 230.30 178.60
32000 1,260.65
32003 1,426.25
32004 1,458.55
32005 1,768.70
32006 1,506.00
32009 1,886.50
32012 2,034.85
32015 2,484.50
32018 1,900.10
32021 827.40
32024 1,944.65
32025 2,510.35
32026 2,668.20
32028 3,036.05
32029 551.55
32030 1,364.05
32033 2,000.20
32036 2,715.40
32039 2,135.75
32042 1,683.85
32045 605.50
32046 993.55
32047 1,140.60
32051 3,142.05
32054 2,507.20
32057 737.35
32060 3,425.20
32063 2,783.50
32066 737.35
32069 2,218.00
32072 60.80 65.75
32075 89.90 103.15
32078 203.40 231.60
32081 297.10 318.05
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
32084 141.00 152.95
32087 259.30 281.30
32090 422.60 459.35
32093 582.25 644.65
32094 698.35
32095 161.85 175.60
32096 445.00
32099 436.30
32102 872.90
32103 921.85
32104 1,284.40
32105 679.50 664.95
32106 1,786.50 1,874.85
32108 1,308.70
32111 855.10
32112 1,036.00
32114 228.60 239.70
32115 166.35
32117 1,308.70
32120 336.45
32123 436.30 457.80
32126 633.75
32129 830.80
32131 698.70
32132 59.20 61.95
32135 88.45 92.75
32138 493.10 505.30
32139 549.65
32142 88.45 92.75
32145 177.05 185.60
32147 59.20 61.95
32150 313.10 353.05
32153 95.75
32156 172.50 181.05
32159 425.10
32162 624.85
32165 830.80 872.00
32166 274.00 283.30
RMFS
Out
Hospital %
26 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
32168 169.80
32171 111.10
RMFS In
Hospital %
32174 116.35 122.05
32175 205.90
32177 208.60
32180 335.90
32183 735.30
32186 735.30
32200 387.10 406.30
32203 831.20
32206 717.80
32209 1,206.95
32210 334.45 351.00
32212 178.35
32213 865.00
32214 437.05
32215 164.10 172.30
32216 776.80
32217 204.65
32218 204.65
32220 1,183.35
32221 1,183.35
32500 163.15 150.85
32501 153.70 150.85
32504 374.10 367.75
32507 753.25 733.15
32508 781.15
32511 1,231.60
32514 1,329.25
32517 1,809.45
32520 745.60 733.15
32522 1,108.35 1,089.90
32700 2,133.75
32703 1,730.60
32708 1,934.90
32710 1,912.25
32711 2,813.10
32712 1,522.10
RMFS
Out
Hospital %
Item
32715 1,602.80
32718 1,660.30
32721 3,095.65
32724 2,994.65
32730 2,269.75
32733 2,591.65
32736 577.85
32739 1,681.95
32742 2,049.60
32745 2,358.65
32748 2,592.95
32751 1,675.50
32754 2,161.20
32757 577.85
32760 567.85
32763 1,544.95
32766 1,102.55
32769 382.40
33050 2,243.60
33055 1,682.35
RMFS In
Hospital %
33070 1,176.70 1,156.85
33075 1,497.00
33080 1,598.75
33100 2,075.50 1,973.30
33103 2,815.65
33109 3,811.70 3,347.50
33112 3,214.05
33115 2,104.20
33116 2,169.20 1,922.10
33118 2,314.70
33119 2,242.45 2,135.80
33121 2,687.05
33124 1,497.20
33127 2,216.90 2,180.05
33130 1,933.40
33133 1,451.05
33136 3,315.10
33139 2,142.15
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 27

Item
RMFS In
Hospital %
33142 2,039.45 2,035.50
33145 3,561.60
33148 4,423.55
33151 5,302.25
33154 3,112.15
33157 3,409.05
33160 3,778.25
33163 3,785.10
33166 2,942.30 2,893.05
33169 2,204.35
33172 1,664.55
33175 1,537.75
33178 2,093.25
33181 3,216.55
33500 1,601.15
33506 1,775.90
33509 1,986.25
33512 2,359.75
33515 2,427.55
33518 1,777.15 1,746.10
33521 1,778.65
33524 2,269.75
33527 2,637.40
33530 2,234.30
33533 2,637.40
33536 1,881.00
33539 1,355.40
33542 2,119.40
33545 382.40
33548 777.85
33551 382.40
33554 380.75
33800 1,556.05 1,622.05
33803 1,576.15
33806 1,134.90 1,115.80
33810 828.00 814.00
33811 3,233.70
RMFS
Out
Hospital %
33812 1,190.25 1,281.10
Item
33815 1,198.10
33818 1,241.45
33821 1,608.00
33824 1,523.40
33827 1,704.90
33830 2,048.95
33833 1,859.85
33836 2,175.25
33839 3,341.55
33842 1,303.50
33845 790.45
33848 843.30
34100 951.00
34103 577.85
RMFS In
Hospital %
34106 407.75 400.75
34109 445.00 464.90
34112 1,373.10
34115 1,268.20
34118 2,074.05 1,901.00
34121 1,544.55
34124 1,691.60
34127 2,216.90
34130 693.75 681.90
34133 968.40
34136 1,455.45
34139 1,156.75
34142 1,484.90
34145 1,340.10
34148 2,199.90
34151 2,656.10
34154 2,864.40 3,213.25
34157 1,660.30
34160 3,110.00
34163 3,993.10
34166 3,757.10
34169 2,405.85
34172 2,291.00
34175 1,492.55
RMFS
Out
Hospital %
28 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
RMFS In
Hospital %
34500 430.95 423.75
34503 577.85
34506 294.30
34509 1,271.30
34512 1,340.90
34515 1,071.70
34518 1,745.95
34521 1,103.85
34524 691.75
34527 703.25 757.85
34528 324.15 374.25
34530 248.30
34533 1,733.70 1,704.50
34538 343.55 374.25
34539 241.95
34800 1,134.90 1,115.80
34803 2,333.15
34806 1,355.40
34809 1,355.40
34812 1,638.95
34815 1,752.00
34818 1,677.35
34821 2,028.15 1,994.20
34824 596.00
34827 840.60
34830 1,168.05 971.35
34833 1,346.00
35000 923.45 971.35
35003 1,370.20
35006 1,607.70
35009 1,690.80
35012 988.20
35100 444.15
35103 327.80
35200 239.80
35202 1,141.85
35300 720.35 708.05
35303 794.20 907.90
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
35306 740.15 838.00
35307 1,566.90
35309 917.90 1,047.45
35312 1,207.55
35315 1,207.55
35317 497.50 488.85
35319 772.55 876.30
35320 1,196.95 1,177.05
35321 1,136.35 1,117.45
35324 426.15
35327 570.95
35330 720.35 708.05
35331 828.00
35360 1,157.00
35361 873.50
35362 827.75
35363 663.15
35404 388.10 476.25
35406 1,107.05
35408 830.45
35410 1,107.05 1,117.45
35412 3,889.50 3,925.95
35500 110.65 111.75
35502 96.70 110.15
35503 65.30 73.60
35506 75.25 73.80
35507 214.10
35508 379.45
35509 114.45 122.95
35512 348.30 246.50
35513 348.30 304.60
35516 207.70 159.90
35517 207.70 200.65
35518 291.45 285.55
35520 90.85 80.10
35523 104.05 80.10
35526 203.80 159.90
35527 203.80 200.65
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 29

Item
35530 332.50
RMFS In
Hospital %
35533 451.05 480.70
35536 515.45 478.75
35539 400.85 375.00
35542 498.20 439.15
35545 237.10 252.30
35548 1,376.20
35551 955.65
35554 59.10 59.80
35557 264.10 294.70
35560 843.20
35561 1,716.80
35562 1,582.65
35564 730.65
35565 861.35
35566 611.85
35568 872.70
35569 193.10 221.00
35570 773.95
35571 773.95
35572 146.35
35573 1,186.70
35577 1,136.75
35578 966.00
35595 1,910.60
35596 955.65
35597 2,173.55
35599 930.90
35602 1,095.25
35605 511.35 502.85
35608 89.40 87.95
35611 89.40 87.95
35612 707.05 695.20
35613 565.85
35614 89.25 87.80
35615 75.25 73.80
35616 647.65
35617 323.80 238.65
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
35618 323.80 299.55
35620 74.60 73.30
35622 843.00
35623 1,136.80
35626 114.30 113.75
35627 149.90
35630 238.35
35633 342.20 299.55
35634 835.90 942.10
35635 440.90
35636 641.55
35637 603.00
35638 1,137.30
35639 255.85
35640 255.85
35641 2,169.60
35643 319.35 299.55
35644 291.85 279.80
35645 441.10 437.85
35646 301.20
35647 308.90 279.80
35648 501.95 437.85
35649 767.50
35653 1,011.10
35657 939.35
35658 581.40
35661 1,354.50
35664 2,321.85
35667 1,818.35
35670 1,489.70
35673 1,064.90
35674 303.55 285.55
35676 783.85
35677 783.85
35678 990.25
35680 865.75 799.70
35683 671.75
35684 671.75
RMFS
Out
Hospital %
30 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
35687 526.00
35688 526.00
35691 222.60
35694 778.60
35697 1,322.25
35700 1,286.05
RMFS In
Hospital %
35703 94.30 92.75
35706 94.30 92.75
35709 60.95 59.80
35710 647.55
35712 559.10
35713 559.10
35716 659.95
35717 659.95
35720 942.65
35723 674.95
35726 674.95
35729 304.40
35750 1,315.45
35753 1,455.75
35754 1,855.20
35756 1,247.60
35759 783.45
36500 1,341.75
36502 878.25
36503 1,772.25
36506 1,341.75
36509 960.05
36516 1,282.80
36519 1,830.10
36522 1,727.70
36525 2,270.75
36526 2,252.20 1,773.90
36527 2,272.85 2,189.20
36528 2,002.25
36529 2,411.40
36531 1,595.55
36532 2,411.85
RMFS
Out
Hospital %
Item
36533 2,969.70
36537 957.80
RMFS In
Hospital %
36540 1,493.85 1,522.25
36543 1,807.90 1,773.90
36546 982.65 949.90
36549 1,208.90
36552 1,157.55
36558 942.95 892.80
36561 204.35 237.05
36564 1,341.00
36567 1,728.60
36570 1,980.75
36573 1,285.85
36576 1,624.50
36579 1,076.00
36585 1,076.00
36588 1,252.00
36591 1,676.30
36594 1,341.75
36597 1,341.75
36600 1,843.60 1,522.25
36603 1,824.70
36604 388.55 367.75
36605 998.85
36606 3,360.35
36607 1,265.50
36608 387.10
36609 914.95
36612 779.85
36615 1,076.00
36618 942.95
36621 690.05
36624 809.85 766.80
36627 914.85
36630 537.55
36633 889.30 1,018.75
36636 580.40
36639 1,238.75
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 31

Item
36642 604.45
36645 1,701.70
36648 1,390.85
RMFS In
Hospital %
36649 388.55 367.75
36650 216.55
36652 826.50
36654 1,109.50
36656 1,553.15
36658 736.15 723.25
36660 357.35 351.00
36662 853.45 838.50
36663 924.45 908.15
36664 830.15 815.50
36665 175.35 172.30
36666 467.05 458.85
36667 218.65 214.80
36668 218.65 214.80
36800 34.80 37.95
36803 622.80 640.75
36806 881.65
36809 1,245.65
36811 429.75 444.30
36812 201.90 229.05
36815 302.95 326.85
36818 401.35 380.05
36821 469.10 444.05
36824 309.40 292.90
36825 705.75
36827 333.65 315.80
36830 295.00
36833 401.35 380.05
36836 291.85 315.80
36840 454.00 444.05
36842 393.90
36845 921.10 949.90
36848 333.65
36851 323.55
36854 676.75
RMFS
Out
Hospital %
Item
36857 549.25
RMFS In
Hospital %
36860 431.65 229.05
36863 745.50
37000 1,076.00
37004 942.95
37008 604.45 572.20
37011 135.45 128.25
37014 1,547.15
37020 1,076.00
37023 604.45
37026 604.45
37029 1,617.10
37038 1,004.00
37041 67.75 64.05
37042 1,321.80
37043 918.20
37044 969.10
37045 2,073.15
37047 1,999.80
37050 1,076.00
37053 1,243.15
37200 1,612.75
37201 1,539.30
37202 603.75 571.65
37203 1,531.45
37206 809.85
37207 1,257.40
37208 603.75
37209 1,873.50
37210 3,010.35
37211 3,465.05
UR372 5,197.50
37212 367.65
37215 491.35 572.20
37217 200.75 190.00
37218 200.75 190.00
37219 428.60 385.85
37220 1,515.30
RMFS
Out
Hospital %
32 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
37221 676.75
37223 299.35
RMFS In
Hospital %
37224 417.90 444.05
37227 803.40 777.45
37230 1,479.55 1,431.80
37233 792.40 766.80
37300 67.75 64.05
37303 107.65 101.75
37306 1,183.80
37309 1,425.60
37315 200.75 190.00
37318 401.35 380.05
37321 135.45 128.25
37324 282.20
37327 390.80
37330 942.95
37333 808.30
37336 1,076.00
37339 300.40 329.60
37340 522.85
37341 1,213.15
37342 1,313.15
37343 2,619.45
37345 1,020.50
37348 1,017.60
37351 401.35
37354 469.10
37369 319.80
37372 665.40
37375 1,680.10
37381 998.60
37384 1,680.10
37387 469.10
37390 1,322.35
37393 288.70 315.80
37396 1,060.30
37402 676.75
37405 1,544.75
RMFS
Out
Hospital %
Item
37408 676.75
RMFS In
Hospital %
37411 1,190.65 1,270.45
37415 67.75 64.05
37417 866.95
37418 1,080.90 1,018.75
37420 531.90
37423 1,242.40
37426 1,414.20
37429 469.10
37432 1,605.40
37435 124.90 128.25
37438 369.00 380.05
37444 1,450.55 1,373.40
37601 372.30 380.05
37604 397.60 380.05
37605 536.90 513.10
37606 797.20 761.90
37607 1,341.75
37610 2,483.50
37613 391.20 380.05
37616 1,200.95
37619 401.35 380.05
37622 338.55 265.45
37623 338.55 315.80
37800 700.55
37803 686.10
37806 793.65 827.40
37809 766.20
37812 671.45
37815 134.60
37818 713.15 675.25
37821 1,072.20
37824 1,737.00
37827 933.90
37830 947.00 949.90
37833 478.95
37836 1,008.55
37839 1,118.15
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 33

Item
37842 2,218.85
37845 1,008.55
37848 1,815.15
37851 1,344.90
37854 445.05
RMFS In
Hospital %
38200 574.80 611.95
38203 962.10 730.35
38206 829.05 882.95
38209 1,064.45 1,133.65
38212 1,770.55 1,885.60
38213 527.25 561.55
38215 572.35 487.65
38218 811.45 731.30
38220 286.25 243.75
38222 572.35 487.65
38225 858.50 731.40
38228 1,093.40 975.35
38231 1,430.85 1,219.00
38234 1,046.60 975.10
38237 1,430.80 1,218.95
38240 1,569.85 1,462.65
38241 575.70 645.35
38243 572.35 609.50
38246 1,349.90 1,218.95
38256 344.85 367.15
38270 1,177.00 1,253.45
38272 1,177.00 1,253.45
38275 384.80 409.75
38285 249.05
38286 224.10
38287 2,544.25 2,883.05
38290 3,446.95
38293 3,432.95 3,940.40
38300 664.95 708.05
38303 852.60 907.90
38306 983.65 1,047.45
38309 1,142.40 1,216.55
RMFS
Out
Hospital %
38312 1,460.90 1,555.75
Item
RMFS In
Hospital %
38315 1,568.55 1,670.50
38318 2,046.55 2,179.45
38350 824.05
38353 329.70
38356 1,080.30
38358 4,068.90
38359 189.55 183.50
38362 496.65 528.85
38365 313.20
38368 1,501.05
38371 352.95 395.50
38384 1,290.40 1,446.20
38387 352.95 395.50
38390 1,358.00 1,446.20
38393 371.40 395.50
38415 566.60 548.70
38418 1,140.85
38421 1,998.95
38424 1,359.90
38427 1,679.00
38430 865.45
38436 354.35
38438 1,971.25
38440 1,627.70
38441 2,381.20
38446 1,679.00
38447 1,907.95
38448 515.10
38449 2,838.60
38450 1,215.55
38452 813.95
38453 2,173.35
38455 3,302.40
38456 1,872.65
38457 1,873.20
38458 995.70
38460 390.95
38462 425.15
RMFS
Out
Hospital %
34 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
38464 470.05
38466 1,295.60
38468 2,015.60
38469 2,044.85
38470 1,359.90
38473 813.95
38475 1,180.25
38477 2,842.30
38478 1,376.85
38480 2,666.80
38481 3,295.95
38483 2,441.50
38485 1,159.30
38487 2,449.85
38488 2,709.20
38489 3,222.00
38490 786.70
38493 2,777.40
38496 885.30
38497 2,569.50
38498 2,878.90
38500 3,130.85
38501 3,110.75
38503 3,406.25
38504 3,475.00
38505 393.50
38506 2,307.25
38507 2,708.70
38508 3,198.75
38509 3,101.75
38512 2,509.20
38515 4,067.45
38518 4,068.95
38550 3,044.95
38553 4,168.75
38556 4,209.70
38559 3,529.85
RMFS In
Hospital %
38562 4,343.90
RMFS
Out
Hospital %
Item
38565 5,030.50
38568 2,226.80
38571 2,910.95
38572 2,819.15
38577 786.70
38588 590.35
38600 1,829.05
38603 1,359.90
38609 679.85
RMFS In
Hospital %
38612 937.25 737.95
38613 956.50
38615 1,992.35
38618 2,709.20
38621 1,081.80
38624 1,127.25
38627 906.40
38637 786.70
38640 1,359.90
38643 1,514.35
38647 3,028.35
38650 2,447.85
38653 2,709.20
38654 1,587.45
38656 1,233.75
38670 2,708.70
38673 3,105.10
38677 2,852.10
38680 3,383.05 3,276.15
38700 1,387.70
38703 2,729.75
38706 2,408.10
38709 3,028.35
38712 3,636.40
38715 2,420.90
38718 3,028.35
38721 2,122.10
38724 2,519.10
38727 2,075.15
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 35

Item
38730 3,028.35
38733 2,063.65
38736 3,028.35
38739 2,729.75
38742 2,729.75
38745 2,554.50
38748 3,028.35
38751 3,028.35
38754 4,113.80
38757 3,028.35
38760 3,028.35
38763 3,028.35
38766 3,028.35
RMFS In
Hospital %
38800 54.75 52.95
38803 109.10 105.65
38806 189.55 183.50
38809 233.60 226.10
38812 296.90 287.35
39000 101.10 103.50
39003 119.85 117.70
39006 301.10 219.05
39009 83.10
39012 332.45
39013 149.45 149.95
39015 526.05
39018 526.05
39100 322.50 326.45
39106 1,587.55
39109 713.45 609.65
39112 2,592.75
39115 90.40 103.50
39118 434.50 409.25
39121 883.80 867.95
39124 2,261.85
39125 440.40
39126 506.40
39127 624.60
39128 913.30
RMFS
Out
Hospital %
Item
39130 900.15
RMFS In
Hospital %
39131 196.65 175.60
39133 223.15
39134 476.55
39135 220.80
39136 223.15
39137 788.40
39138 892.75
39139 1,536.35
39140 414.95 402.40
39300 494.50
39303 750.85
39306 981.65
39309 999.35
39312 520.00
39315 1,565.70
39318 1,100.50
39321 606.75
39323 349.90 380.35
39324 387.10 380.35
39327 663.10
39330 360.35
39331 438.50 380.35
39333 557.55 547.55
39500 1,778.05
39503 1,631.95
39600 683.40
39603 1,553.25
39606 996.75
39609 1,175.10
39612 1,567.60
39615 1,719.75
39640 5,434.85
39642 4,439.35
39646 5,111.25
39650 4,678.00
39653 6,579.40
39654 4,785.05
RMFS
Out
Hospital %
36 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
39656 4,554.80
39658 5,214.20
39660 4,241.20
39662 4,241.20
39700 778.80
39703 726.00
39706 1,556.85
39709 2,458.10
39712 4,446.15
39715 3,379.80
39718 1,220.45
39721 1,020.00
39800 4,112.15
39803 4,098.00
39806 1,760.50
39812 883.80
RMFS In
Hospital %
39815 2,556.30 2,510.50
39818 2,800.05
39821 2,943.15
39900 726.00
39903 2,483.65
39906 1,055.65
40000 1,283.50
40003 1,256.05
40006 936.30
40009 686.80
40012 1,579.85
40015 893.60
40018 192.10 219.05
40100 967.90
40103 1,209.55
40106 1,826.60
40109 1,658.40
40112 1,900.90
40115 1,010.05
40118 1,617.35
40300 1,458.95
40301 1,682.95
RMFS
Out
Hospital %
Item
40303 1,951.90
40306 2,289.90
40309 1,635.40
40312 2,635.80
40315 2,731.05
40316 3,196.70
40318 3,422.55
40321 1,525.35
40324 894.30
40327 894.30
40330 1,336.10
40331 1,336.10
40332 2,609.35
40333 1,115.15
40334 1,584.95
40335 3,007.40
40336 442.15
40339 2,219.75
40342 2,452.50
40345 1,850.60
40348 2,424.55
40351 2,424.55
40600 1,336.10
40700 2,663.65
40703 1,973.65
RMFS In
Hospital %
40706 3,151.15 2,944.45
40709 726.00
40712 1,462.20
40800 784.45 877.45
40801 3,202.50
40803 1,672.70 1,642.80
40850 3,825.70
40851 6,567.80
40852 617.70
40854 958.80
40856 359.15
40858 774.55
40860 3,587.70
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 37

Item
RMFS In
Hospital %
40862 261.05 260.65
40903 775.75
40905 823.30 826.70
41500 126.15 113.35
41503 364.95 328.10
41506 189.85 197.85
41509 268.20 223.90
41512 894.90
41515 587.40
41518 1,304.95
41521 1,428.15
41524 436.35
41527 852.30
41530 1,362.35
41533 1,842.70
41536 1,780.15
41539 1,516.30
41542 1,929.85
41545 796.10
41548 1,056.70
41551 2,451.80
41554 3,255.95
41557 1,664.65
41560 1,832.45
41563 2,258.00
41564 3,201.00
41566 1,428.70
41569 1,644.65
41572 1,577.80
41575 3,720.20
41576 6,061.55
41578 3,720.20
41579 2,982.20
41581 5,006.45
41584 2,829.75
41587 3,439.25
41590 1,689.60
41593 2,377.50
RMFS
Out
Hospital %
Item
41596 2,656.85
41599 2,439.50
RMFS In
Hospital %
41603 649.35 692.25
41604 240.40 256.20
41608 2,017.45
41611 1,071.20
41614 1,768.80 1,497.45
41615 1,400.25 1,497.45
41617 2,830.45
41620 1,195.80
41623 1,746.70
41626 220.00 197.85
41629 622.15
41632 346.55 328.10
41635 1,515.10 1,572.15
41638 2,320.05
41641 72.65 65.20
41644 237.80 196.25
41647 167.95 151.00
41650 142.20 151.00
41653 110.15 98.85
41656 192.70 168.80
41659 97.90 106.55
41662 126.15 113.35
41665 335.85
41668 335.85
41671 787.95
41672 1,011.75
41674 153.60 138.15
41677 137.50 123.65
41680 249.15 223.90
41683 179.00 161.00
41686 110.15 98.85
41689 208.55
41692 272.05
41695 152.60 137.45
41698 49.65 44.75
41701 140.70
RMFS
Out
Hospital %
38 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
RMFS In
Hospital %
41704 55.65 49.85
41707 685.10
41710 872.25
41713 1,109.60
41716 451.70
41719 161.70 161.50
41722 897.70 807.35
41725 685.10
41728 1,392.40
41729 845.60
41731 1,418.65
41734 1,625.65
41737 738.05
41740 89.85
41743 515.50
41746 1,187.00 1,067.65
41749 926.45
41752 451.70
41755 71.10 63.95
41758 179.65 161.50
41761 187.50 168.80
41764 187.50 168.80
41767 1,174.60 1,012.55
41770 1,029.15
41773 856.60
41776 807.35
41779 1,079.05
41782 1,337.30
41785 1,804.15 1,622.85
41786 1,095.25
41787 808.00
41788 554.05 302.20
41789 554.05
41792 612.10
41793 612.10
41796 190.50
41797 190.50
41800 249.15
RMFS
Out
Hospital %
Item
41801 249.15
41804 137.50
RMFS In
Hospital %
41807 95.05 96.35
41810 54.50 48.95
41813 468.45
41816 283.70 255.05
41819 464.25 479.45
41820 596.80 575.35
41822 364.95
41825 559.95
41828 79.85 71.75
41831 477.75 490.50
41832 348.80 313.95
41834 2,318.30
41837 1,800.75
41840 2,521.00
41843 2,041.20
41846 283.70 255.05
41849 409.70
41852 438.70
41855 438.70
41858 733.90
41861 888.10
41864 639.70
41867 879.95
41868 577.45
41870 627.40
41873 897.70 807.35
41876 725.25 807.35
41879 1,555.20
41880 300.55
41881 613.60
41884 126.35
41885 342.50
41886 272.05 244.65
41889 272.05 244.65
41892 359.05 322.95
41895 483.80 505.30
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 39

Item
RMFS In
Hospital %
41898 333.65 353.05
41901 779.65
41904 317.90 338.70
41905 635.30
41907 187.50 168.80
41910 596.15
42503 160.60
42506 763.30 661.25
42509 954.80
42510 965.40
42512 673.00 661.25
42515 884.30
42518 469.10
42521 1,699.25
42524 285.90 281.15
42527 567.35
42530 826.30
42533 586.35
42536 1,161.65
42539 1,978.05
42542 692.05
42543 1,248.40
42545 1,975.65
42548 1,061.25
42551 829.05 867.95
42554 1,008.15
42557 1,342.85
42560 567.35 557.90
42563 725.15 713.05
42566 1,029.70
42569 1,439.50
42572 181.95 161.25
42573 336.60 312.50
42574 716.05 663.95
42575 119.35 113.70
42581 164.15 161.25
42584 386.75 380.35
42587 72.85 71.40
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
42590 424.45 464.90
42593 338.40
42596 704.40 692.25
42599 819.95 867.95
42602 883.10 867.95
42605 651.25 640.40
42608 482.30 413.25
42610 140.05 132.25
42611 195.55 198.35
42614 67.80 66.40
42615 107.20 99.30
42617 191.40 188.20
42620 63.85 72.35
42621 73.75 72.35
42622 115.70 113.70
42623 1,220.75
42626 1,602.80 1,549.80
42629 1,130.50
42632 151.05 161.25
42635 394.20 413.25
42638 540.90 516.60
42641 703.30 671.55
42644 100.85 99.15
42647 255.60 281.15
42650 100.85 99.15
42651 245.50 220.95
42653 2,029.70
42656 2,412.10
42659 1,550.90 1,239.70
42662 1,161.40
42665 817.95 826.65
42667 180.35 195.05
42668 95.85 103.50
42672 1,278.35 1,239.70
42673 630.40 619.80
42676 165.25 159.00
42677 85.20 83.75
42680 420.40 413.25
RMFS
Out
Hospital %
40 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
42683 175.85
RMFS In
Hospital %
42686 382.40 376.00
42689 164.15 161.25
42692 338.25 380.35
42695 617.70 619.80
42698 983.70 817.15
42701 562.30 455.70
42702 1,341.40 1,045.05
42703 800.20 786.00
42704 706.30 640.40
42707 962.60 1,095.15
42710 1,260.95 1,239.70
42713 516.00 516.60
42716 1,477.15 1,642.80
42718 1,412.35 1,309.45
42719 638.80 713.05
42722 793.35
42725 2,036.45
42728 315.50
42731 2,104.65
42734 420.40 413.25
42737 420.40 413.25
42740 420.40 413.25
42741 420.40 413.25
42743 815.25 867.95
42744 419.95 412.95
42746 1,467.45
42749 1,685.20
42752 1,738.15
42755 231.55 227.30
42758 992.85
42761 709.05 713.05
42764 624.15 713.05
42767 1,845.85
42770 383.95 405.05
42771 405.45 398.90
42773 1,260.95 1,239.70
42776 1,870.40
RMFS
Out
Hospital %
Item
42779 2,309.55
RMFS In
Hospital %
42782 699.70 619.80
42783 630.40 619.80
42785 479.55 485.45
42786 493.95 485.45
42788 431.15 485.45
42789 493.95 485.45
42791 450.70 485.45
42792 493.95 485.45
42794 94.60 93.00
42797 94.60 93.00
42801 1,349.60
42802 674.50
42805 819.45 805.80
42806 493.95 485.45
42807 497.25 488.85
42808 564.75 488.85
42809 630.40 619.80
42810 793.45 779.95
42811 630.40 619.80
42812 215.00 227.30
42815 883.10
42818 703.20 805.80
42821 126.20 124.15
42824 97.85 96.05
42833 921.65
42836 1,099.15
42839 1,021.85
42842 1,110.95
42845 250.95 260.20
42848 1,154.35
42851 1,216.50
42854 567.35 557.90
42857 519.60 557.90
42860 1,310.45 1,239.70
42863 1,108.55 1,064.15
42866 1,024.70 1,033.00
42869 766.85 754.25
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 41

Item
RMFS In
Hospital %
42872 438.05 330.70
43021 535.95 625.20
43022 643.30 750.35
43023 102.10 121.60
43500 172.45
43503 242.55
43506 454.00
43509 498.10
43512 487.35
43515 509.15 489.60
43518 724.45
43521 648.90
43524 800.10 807.35
43801 1,212.50
43804 1,369.30
43807 1,316.05
43810 1,646.45
43813 1,986.70
43816 2,003.00
43819 1,308.25
43822 1,306.60
43825 1,704.80
43828 1,509.05
43831 1,208.45
43834 1,429.45
43837 1,641.55
43840 1,582.95
43843 2,591.35
43846 2,676.45
43849 630.00
43852 2,083.05 2,227.85
43855 2,202.15
43858 809.40 827.40
43861 2,111.40
43864 1,573.35
43867 933.85
43870 1,308.25
43873 1,558.55
RMFS
Out
Hospital %
Item
43876 1,479.10
43879 1,743.25
RMFS In
Hospital %
43882 2,241.20 2,291.75
43900 1,493.95
43903 2,490.00
43906 2,178.80
43909 2,178.80
43912 2,155.00
43915 1,549.45 1,591.40
43930 561.35
43933 686.10
43936 1,225.25
43939 939.00
43942 311.35 318.40
43945 1,260.45
43948 212.00 191.10
43951 1,173.60
43954 1,336.95
43957 1,556.45
43960 501.50
43963 2,106.90
43966 2,228.20
43969 3,423.85
43972 2,244.95
43975 2,932.35
43978 2,490.00
43981 684.85
43984 1,743.25
43987 1,930.45
43990 2,123.60
43993 2,552.50 2,609.95
43996 2,553.65 2,928.25
43999 320.30
44102 345.70
44105 60.90 61.95
44108 611.90
44111 726.40 790.90
44114 801.85
RMFS
Out
Hospital %
42 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
RMFS In
Hospital %
44130 570.85 636.55
44133 557.70
44136 214.75 232.90
44325 413.50 406.30
44328 471.05
44331 801.40
44334 1,671.45 1,640.80
44338 189.35 197.85
44342 261.05
44346 375.25
44350 393.20 396.00
44354 449.85
44358 237.25
44359 340.35
44361 569.90
44364 420.95
44367 675.60
44370 982.25
44373 2,016.10 2,031.20
RMFS
Out
Hospital %
44376 D D 40
45000 731.60 743.75
45003 889.75 826.65
45006 1,438.10
45009 529.75
45012 853.40
45015 420.40
45018 661.90 650.75
45019 551.05
45020 554.40
45021 248.00 243.70
45024 556.90 547.55
45025 266.85 243.70
45026 600.90 547.55
45027 168.30
45030 160.85 177.60
45033 354.40 330.70
45035 1,037.85
45036 1,585.35
Item
RMFS In
Hospital %
45039 291.60 330.70
45042 537.50 423.75
45045 430.95 423.75
45048 1,036.20
45051 613.75
45054 343.80
45200 336.45 390.70
45203 577.35 557.90
45206 505.20 527.00
45207 493.20 527.00
45209 646.10 650.90
45212 325.60 322.95
45215 1,417.00
45218 593.10
45221 365.55 359.35
45224 202.30 161.50
45227 623.15 611.95
45230 264.95 306.05
45233 622.50 650.90
45236 517.65
45239 365.55 359.35
45240 336.25 359.35
45400 286.15 281.30
45403 602.95 559.90
45406 592.50 619.80
45409 736.75
45412 1,304.50
45415 1,260.95
45418 1,192.15
45439 397.35 390.70
45442 742.40 805.80
45445 734.35 764.70
45448 472.85 516.60
45451 660.25 650.90
45460 1,750.20
45461 1,247.45
45462 941.45
45464 2,601.30
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 43

Item
RMFS In
Hospital %
45465 1,903.35 1,872.65
45466 1,435.25 1,412.35
45468 2,559.25
45469 1,930.70 1,899.70
45471 3,216.65 3,165.00
45472 2,426.55 2,387.30
45474 3,872.60 3,810.25
45475 2,922.00 2,874.85
45477 4,528.50 4,455.60
45478 3,415.85 3,360.65
45480 5,184.35 5,100.80
45481 3,911.35 3,848.40
45483 5,906.60 5,811.55
45484 4,456.65 4,384.80
45485 986.60
45486 630.40
45487 521.65 557.90
45488 630.40
45489 1,098.80 929.90
45490 1,261.05
45491 1,576.15
45492 1,694.10
45493 479.35
45494 2,289.60 2,251.45
45496 580.95
45497 454.00
45498 365.55
45499 272.45
45500 1,748.25
45501 2,644.85
45502 2,481.35
45503 2,837.15
45504 3,204.10
45505 2,481.35
45506 266.55 302.20
45512 405.30 406.30
45515 261.05 256.20
45518 304.45 310.10
RMFS
Out
Hospital %
Item
45519 599.45
45520 1,258.20
RMFS In
Hospital %
45522 1,142.60 867.95
45524 1,036.45
45527 1,301.20
45528 1,554.15
45530 1,536.30
45533 1,739.50
45536 639.65
45539 1,810.00
45542 943.30
45545 827.75 855.35
45546 276.50 271.85
45548 430.70 380.35
45551 620.00
45552 1,150.40 877.45
45553 827.25 877.45
45554 977.35 961.00
45555 892.60
45556 1,070.10 1,052.45
45557 1,070.10
45558 1,605.30
45559 1,472.25 1,561.85
45560 661.90 650.75
45561 2,479.75
45562 1,536.30 1,510.50
45563 1,632.40 1,510.50
45564 4,003.95
45565 2,623.70
45566 1,501.65
45568 628.35
45569 877.55
45570 1,184.85 1,257.10
45572 407.55 400.75
45575 1,006.40 989.45
45578 1,165.60
45581 386.75 380.35
45584 882.85 867.95
RMFS
Out
Hospital %
44 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
RMFS In
Hospital %
45585 882.85 867.95
45586 882.85
45587 1,244.85 1,223.95
45588 1,802.00
45590 752.05
45593 776.20
45596 1,596.75
45597 1,684.25
45599 1,308.75 1,286.75
45602 977.35
45605 821.25
45608 1,340.70
45611 662.10
45614 793.75 807.35
45617 328.60 322.95
45620 564.05 447.95
45623 1,063.25 993.40
45624 1,386.65 1,287.90
45625 317.60
45626 455.70 447.95
45629 889.85 650.90
45632 879.05 703.40
45635 821.25 807.35
45638 1,417.00 1,393.25
45639 1,788.50 1,393.25
45641 1,523.90 1,487.80
45644 2,216.25 1,757.85
45645 312.65
45646 1,199.05 1,237.15
45647 1,626.15
45650 206.80 203.10
45652 497.85 489.60
45653 645.85 489.60
45656 750.40 690.10
45659 728.40 716.20
45660 4,702.05
45661 2,016.15
45662 980.00
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
45665 445.45 447.95
45668 388.90 447.95
45669 491.30 447.95
45671 1,545.80 1,145.90
45674 353.05 333.30
45675 675.35
45676 804.10
45677 756.60
45680 1,032.15
45683 1,004.70
45686 1,124.75
45689 365.70
45692 367.85 413.25
45695 699.90
45698 641.55
45701 1,328.65
45704 420.40 413.25
45707 1,438.00
45710 682.95
45713 777.85
45714 1,139.40
45716 1,361.05
45720 1,350.85 1,328.25
45723 2,017.90
45726 1,880.05
45729 2,387.30
45731 1,935.20
45732 2,578.60
45735 2,366.10
45738 2,545.20
45741 2,367.70
45744 2,808.20
45747 2,701.65 2,656.50
45752 3,420.55
45753 2,977.75 2,993.20
45754 3,649.15
45755 513.90 505.30
45758 919.65
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 45

Item
45761 1,024.60
RMFS In
Hospital %
45767 3,509.55 3,450.75
45770 2,688.40
45773 2,450.10 2,409.00
45776 2,450.10
45779 2,374.05
45782 1,206.35 1,354.25
45785 2,704.70
45788 2,304.15
45791 1,244.85
45794 939.70
45797 261.05
45799 41.35 40.50
45801 167.85 174.40
45803 456.30 447.95
45805 241.45 237.05
45807 345.00 338.70
45809 547.95 510.40
45811 703.00 690.10
45813 822.50 807.35
45815 513.80 489.60
45817 650.10 638.20
45819 806.35 807.25
45821 532.90 523.20
45823 152.40
45825 458.45 464.90
45827 452.60 444.30
45829 344.85 338.95
45831 392.35 444.30
45833 568.15 557.90
45835 705.20 692.25
45837 1,069.35 805.80
45839 820.75 805.80
45841 663.90 650.75
45843 406.55 399.15
45845 705.20 692.25
45847 261.05 256.20
45849 812.80 798.10
RMFS
Out
Hospital %
Item
45851 200.05
RMFS In
Hospital %
45853 1,246.75 1,223.95
45855 571.85 561.55
45857 914.00 898.25
45859 460.85 452.85
45861 1,220.85 1,198.50
45863 1,353.20 1,328.55
45865 406.55 399.15
45867 437.30 429.10
45869 1,662.80 1,632.50
45871 1,873.15 1,838.90
45873 2,104.80 2,066.40
45875 657.60 646.70
45877 657.60 646.70
45879 437.30 429.10
45882 60.15 59.10
45885 620.60 609.65
45888 578.35 568.20
45891 842.55 827.70
45894 286.35 281.30
45897 1,495.20 1,468.85
45900 337.30 331.35
45939 625.30 614.25
45945 166.20 163.10
45975 180.70 177.55
45978 220.75 216.90
45981 119.80 117.70
45984 862.45 847.25
45987 862.45 847.25
45990 1,177.85 1,157.20
45993 1,177.85 1,157.20
45996 334.05 328.10
46300 436.35
46303 563.85
46306 881.50
46307 866.95
46309 927.15
46312 1,164.70
RMFS
Out
Hospital %
46 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
46315 1,374.70
46318 1,896.25
RMFS In
Hospital %
46321 2,344.30 1,860.15
46324 1,253.70
46325 1,399.20
46327 284.00 279.10
46330 487.30
46333 895.35
46336 366.60 361.80
46339 676.95 640.50
46342 651.55
46345 740.15
46348 375.40 335.90
46351 619.35
46354 835.80
46357 1,003.70
46360 1,015.85
46363 292.15 289.35
46366 178.95 175.70
46369 294.35 289.35
46372 722.90 587.95
46375 886.65 697.55
46378 1,125.90
46381 420.40
46384 420.40
46387 964.50 852.70
46390 1,258.30
46393 1,683.20
46396 418.15 452.85
46399 808.85
46402 729.05
46405 883.05
46408 1,054.95
46411 567.60
46414 735.50 723.25
46417 649.30
46420 285.90 281.15
46423 457.80 449.50
RMFS
Out
Hospital %
Item
46426 472.75
RMFS In
Hospital %
46429 612.40 568.35
46432 635.25
46435 834.10
46438 222.20 186.10
46441 457.20 449.50
46442 430.00
46444 864.40
46447 979.05
46450 315.40
46453 443.10
46456 136.65 134.40
46459 255.00 258.40
46462 385.85 413.30
46464 325.55 310.10
46465 277.95 310.10
46468 551.85
46471 788.30 775.00
46474 1,024.75
46477 1,261.05
46480 570.60 516.75
46483 491.15 413.30
46486 315.40
46489 376.45
46492 504.85
46494 306.40 302.20
46495 284.00 279.10
46498 306.65 302.20
46500 390.45 361.80
46501 475.90 452.30
46502 486.60 416.25
46503 502.65 519.90
46504 1,707.10 1,518.95
46507 1,730.90
46510 509.25
46513 79.35 77.65
46516 164.75
46519 222.55 194.05
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 47

Item
46522 623.90
46525 73.00
RMFS In
Hospital %
46528 232.15 232.90
46531 118.95 117.00
46534 285.55 323.55
47000 102.70 97.10
47003 100.95 116.50
47006 247.20 233.95
47009 252.90 232.90
47012 492.05
47015 100.90 116.50
47018 273.85 271.50
47021 382.60
47024 325.20 271.50
47027 390.70
47030 310.35 271.50
47033 382.60 362.20
47036 105.70 116.50
47039 164.75 155.05
47042 159.95 155.05
47045 218.70 207.15
47048 432.80 446.25
47051 599.00
47054 419.90 446.25
47057 162.75 174.55
47060 245.90 232.90
47063 368.90 349.25
47066 492.05
47069 102.70 97.10
47072 123.10 129.15
47300 123.35 116.50
47303 126.00 135.90
47306 164.75 155.05
47309 212.30 194.05
47312 227.35 174.55
47315 209.20 200.55
47318 245.90 232.90
47321 304.80
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
47324 271.85 232.90
47327 286.90 271.50
47330 398.25 310.55
47333 410.80
47336 305.20 232.90
47339 304.60 271.50
47342 368.40 310.55
47345 444.80
47348 136.60 129.15
47351 417.55 323.55
47354 245.90 232.90
47357 615.10 517.40
47360 191.40 181.20
47363 258.05 271.50
47366 396.20 362.20
47369 220.55 232.90
47372 441.70 387.95
47375 546.20
47378 279.00 232.90
47381 383.85
47384 497.10
47385 479.65
47386 654.45
47387 466.50 375.00
47390 612.85
47393 780.05
47396 273.80 258.60
47399 573.35
47402 409.70 387.95
47405 273.80 258.60
47408 534.55
47411 150.20 155.05
47414 328.00 310.55
47417 381.40 362.20
47420 751.60
47423 313.35 297.45
47426 479.75
47429 628.50
RMFS
Out
Hospital %
48 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
47432 669.70
RMFS In
Hospital %
47435 597.50 569.20
47438 956.55
47441 1,394.05
47444 346.60 310.55
47447 514.30
47450 572.85
47451 776.50
47453 363.30 362.20
47456 618.75
47459 774.30
47462 153.50 155.05
47465 327.25 310.55
47466 164.75 155.05
47467 316.40
47468 628.50 594.90
47471 62.40 59.10
47474 255.10 258.60
47477 318.05 323.55
47480 855.10
47483 792.70
47486 1,274.20
47489 2,049.30
47492 334.60 323.55
47495 745.60 646.70
47498 1,101.60
47501 1,406.15
47504 2,435.00 1,940.20
47507 2,363.65
47510 2,534.35
47513 546.45
47516 578.15 594.90
47519 1,389.50
47522 1,084.20
47525 1,299.95
47528 1,076.30
47531 1,421.20
47534 1,582.50
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
47537 587.50 594.90
47540 314.10 297.45
47543 329.15 310.55
47546 492.05 465.60
47549 597.90
47552 544.80 517.40
47555 927.40
47558 1,251.20
47561 461.00 375.00
47564 638.75 562.70
47565 1,070.85
47566 1,372.30
47567 710.15 653.10
47570 906.35 750.15
47573 1,150.05
47576 134.20 155.05
47579 219.75 219.90
47582 411.10
47585 653.10
47588 2,119.95
47591 2,735.45
47594 288.40 297.45
47597 497.45 446.25
47600 647.95
47603 857.50
47606 303.25 323.55
47609 512.35 485.05
47612 515.00 562.70
47615 678.50 646.70
47618 817.95
47621 756.15 562.70
47624 993.95
47627 232.45 219.90
47630 436.20 465.60
47633 161.50 155.05
47636 269.25 232.90
47639 309.70 310.55
47642 218.70 207.15
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 49

Item
RMFS In
Hospital %
47645 329.85 310.55
47648 419.80
47651 341.65 323.55
47654 512.35 485.05
47657 840.95
47663 204.90 194.05
47666 293.95 323.55
47672 162.20 155.05
47678 245.90 232.90
47681 62.40 59.10
47684 1,091.95 1,034.90
47687 1,912.65
47690 1,381.60
47693 1,580.70
47696 509.95
47699 2,484.10
47702 2,994.45
47703 62.40 59.10
47705 409.70
47708 314.10 297.45
47711 444.40
47714 348.40
47717 615.10
47720 615.10 582.20
47723 615.10 582.20
47726 204.90
47729 341.65
47732 546.45
47735 64.75 59.15
47738 383.20 323.55
47741 718.40
47753 590.25
47756 579.75
47762 445.20 328.10
47765 631.25
47768 637.05
47771 975.00
47774 632.20
RMFS
Out
Hospital %
Item
47777 632.20
47780 696.85
RMFS In
Hospital %
47783 821.80 778.15
47786 1,168.70
47789 1,043.40
47900 234.05 232.90
47903 313.55 323.55
47904 82.30 77.65
47906 133.40
47912 82.30 77.65
47915 232.70 232.90
47916 116.00 117.00
47918 315.85 323.55
47920 552.65
47921 164.75 155.05
47924 54.90 51.75
47927 190.00
47930 319.35
47933 300.65 284.45
47936 368.90
47948 240.65
47951 273.80 258.60
47954 539.80 517.40
47957 409.70
47960 191.40 181.20
47963 314.10 297.45
47966 628.50
47969 382.60
47972 305.60
47975 535.65
47978 364.25
47981 218.30 206.85
47982 490.85
48200 1,093.10
48203 1,378.65
48206 820.60
48209 1,052.10
48212 820.60
RMFS
Out
Hospital %
50 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
48215 1,011.65
48218 963.75
48221 1,384.05
48224 546.45
48227 719.65
48230 688.95
48233 1,108.95
48236 1,158.60
48239 642.10
48242 1,102.65
48400 405.45
48403 725.00
48406 478.35
48409 728.55
48412 791.85
48415 1,157.45
48418 755.35
48421 1,404.95
48424 934.35
48427 1,243.55
48500 467.45
48503 458.80
48506 641.90
48509 296.55
48512 1,633.55
48600 136.60
48603 204.90
48606 2,261.70
48612 4,135.60
48613 5,371.20
48615 578.00
48618 3,527.85
48621 2,322.85
48624 2,869.40
48627 4,292.00
48630 4,508.90
48632 2,121.05
RMFS In
Hospital %
RMFS
Out
Hospital %
48636 1,049.15 1,112.25
Item
48639 1,781.65
48640 5,429.15
48642 1,161.40
48645 1,571.20
48648 1,571.20
48651 2,272.60
48654 1,571.20
48657 2,586.50
48660 1,865.25
48663 1,174.85
48666 763.50
48669 2,117.75
48672 1,295.90
48675 851.90
48678 820.60
48681 1,366.25
48684 1,366.25
48687 1,912.65
48690 2,186.05
RMFS In
Hospital %
48691 2,354.50 2,464.30
48692 1,587.00 1,661.00
48693 767.65 803.35
48900 398.45 387.95
48903 735.10
48906 679.00
48909 1,297.60
48912 478.35 452.85
48915 1,231.30
48918 2,685.10
48921 2,649.90
48924 2,863.10
48927 532.75
48930 1,259.35
48933 1,781.60
48936 1,169.45
48939 1,592.70
48942 2,127.35
48945 396.25
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 51

Item
48948 844.65
48951 1,519.55
48954 1,702.50
48957 1,843.35
48960 1,578.20
49100 478.35
49103 1,228.95
RMFS In
Hospital %
49106 1,421.95 1,293.50
49109 1,208.80
49112 1,011.95
49115 1,815.40
49116 2,088.90
49117 2,506.45
49118 396.25
49121 947.30
49200 1,297.85
49203 960.70
49206 819.75
49209 1,254.15
49210 1,392.80
49211 1,671.35
49212 341.65
49215 1,097.30
49218 430.85
49221 1,081.90
49224 1,140.30
49227 1,263.55
49300 806.15
49303 733.40
49306 1,700.95
49309 1,027.85
49312 1,683.15
49315 1,277.30
49318 2,165.35
49319 4,224.95
49321 2,528.60
49324 2,687.55
49327 3,357.65
RMFS
Out
Hospital %
Item
49330 3,292.20
49333 3,912.85
49336 519.10
49339 4,425.75
49342 4,555.00
49345 4,522.10
49346 1,237.95
49360 472.10
RMFS In
Hospital %
49363 546.35 569.10
49366 956.75
49500 546.45
49503 675.70
49506 1,095.95
49509 1,093.10
49512 1,529.80
49515 1,416.90
49517 2,053.00
49518 2,178.00
49519 3,875.00
49521 2,585.60
49524 2,992.65
49527 2,520.50
49530 2,888.85
49533 3,291.95
49534 716.45
49536 1,508.60
49539 1,678.45
49542 2,297.50
49545 1,093.10
49548 1,354.35
49551 2,253.00
49554 2,436.45
49557 393.75
49558 450.90
49559 666.90
49560 921.80
49561 1,122.40
49562 1,272.90
RMFS
Out
Hospital %
52 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
49563 1,279.25
49564 1,525.10
49566 1,193.20
49569 960.00
49700 396.25
49703 1,010.45
49706 478.35
49709 1,024.70
49712 1,337.30
49715 1,914.30
49716 1,955.80
49717 2,346.95
49718 606.90
RMFS In
Hospital %
49721 341.65 323.55
49724 1,088.95
49727 409.70
49728 740.65
49800 191.40 181.20
49803 220.25 232.90
49806 191.40 181.20
49809 314.10
49812 628.50
49815 1,316.35
49818 380.45
49821 644.20
49824 1,238.55
49827 683.10
49830 1,195.55
49833 786.30
49836 1,460.55
49837 939.40
49838 1,971.35
49839 751.60
49842 1,681.65
49845 715.30
49848 232.45 219.90
49851 300.65
49854 567.60
RMFS
Out
Hospital %
Item
49857 528.15
49860 409.70
49863 615.10
49866 444.05
RMFS In
Hospital %
49878 82.30 77.65
50100 337.75 375.00
50102 991.15
50103 478.35
50104 453.35 429.10
50106 588.75
50109 683.10
50112 436.00
50115 193.55
50118 628.50
50121 1,229.75
50127 1,087.25
50130 453.35
50200 273.30 258.60
50201 477.75
50203 640.85 569.20
50206 1,000.50
50209 1,030.75
50212 2,326.35
50215 2,487.00
50218 4,057.00
50221 3,470.90
50224 4,654.05 3,880.40
50227 4,949.25
50230 2,625.35
50233 3,292.35
50236 2,286.05
50239 1,630.95
50300 1,386.30
50303 2,293.75
50306 3,581.35 3,390.70
50309 372.85
50312 1,046.45
50315 976.60
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 53

Item
50318 1,157.45
50321 1,380.00
50324 2,011.80
50327 2,643.25
50330 292.65
50333 922.00
50336 1,350.55
50339 815.00
50342 1,047.50
50345 443.50
50348 293.00
RMFS In
Hospital %
50349 464.60 439.90
50351 2,316.95
50352 90.80 77.65
50353 539.10
50354 1,901.35 1,800.00
50357 815.00
50360 982.30
50363 724.45
50366 1,284.55
50369 945.65
50372 1,614.80
50375 724.45
50378 1,267.70
50381 945.65
50384 1,775.55
50387 945.65
50390 332.00
50393 1,227.35
50394 4,610.40
50396 745.85
50399 1,338.10
50402 659.80
50405 1,002.30
50408 1,589.70
50411 1,901.35 1,800.00
50414 2,565.20 2,428.55
RMFS
Out
Hospital %
50417 1,901.35 1,800.00
Item
50420 1,569.45
RMFS In
Hospital %
50423 1,448.80 1,371.55
50426 738.65
50450 1,645.30
50451 1,645.30
50455 1,863.15
50456 1,863.15
50460 2,781.65
50461 2,781.65
50465 3,917.95
50466 3,917.95
50470 4,968.90
50471 4,968.90
50475 5,733.65
50476 5,733.65
50500 371.00 380.10
50504 494.95 507.05
50508 530.10 543.10
50512 707.25
50516 477.30 488.90
50520 636.25
50524 547.80
50528 883.70
50532 768.95
50536 1,025.05
50540 707.25
50544 353.55 362.20
50548 707.25
50552 609.90
50556 812.85
50560 636.25
50564 848.50
50568 742.55
50572 989.85
50576 812.85 832.90
50580 848.50
50584 812.85
50588 1,060.45
RMFS
Out
Hospital %
54 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
RMFS In
Hospital %
50600 583.00 597.25
50604 2,474.20
50608 4,595.45
50612 6,536.45
50616 830.60
50620 4,595.45
50624 4,595.45
50628 5,676.55
50632 4,772.00
50636 5,302.25
50640 2,931.10
50644 2,827.95
50650 556.25 569.80
50654 666.15
50658 265.20 271.70
50950 1,186.00 1,122.60
50952 1,186.00 1,122.60
51300 122.40 118.60
51303 D D
51306 199.80 171.30
51309 D D
51312 D D
51315 378.20 374.25
51318 237.10 247.00
51700 111.70 117.55
51703 62.30 59.10
51800 120.75 118.60
51803 D D
51900 406.20 447.95
51902 113.50 101.50
51904 610.20 624.90
51906 968.30 950.40
52000 115.55 113.35
52003 164.55 161.50
52006 164.55 161.50
52009 251.10 255.05
52010 304.00 348.95
52012 32.90 32.30
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
52015 153.95 151.00
52018 348.05 380.35
52021 41.35 40.50
52024 73.15 71.75
52025 257.45 252.65
52027 269.55 205.75
52030 120.90 123.65
52033 253.50 252.65
52034 60.10 59.10
52035 666.30 654.10
52036 167.70 174.40
52039 403.65 447.95
52042 241.45 237.05
52045 301.85 338.70
52048 537.30 510.40
52051 630.20 690.10
52054 1,004.35 807.35
52055 37.60
52056 42.60 37.60
52057 205.90
52058 332.55 326.45
52059 374.60 367.75
52060 242.00 260.20
52061 313.00 307.25
52062 413.95 406.30
52063 502.45 489.60
52064 306.25 232.90
52066 623.45 611.95
52069 370.85 272.75
52072 82.35 80.80
52073 209.65 205.75
52075 206.40 205.75
52078 510.85 406.30
52081 65.20 63.95
52084 159.30 164.15
52087 327.70 281.30
52090 454.70 489.60
52092 650.10 638.20
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 55

Item
RMFS In
Hospital %
52094 789.85 807.25
52095 532.90 523.20
52096 158.10 155.05
52097 275.65 219.90
52098 263.50 258.60
52099 175.15 194.05
52102 197.75
52105 369.00 362.20
52106 204.10
52108 434.20 447.95
52111 472.15 447.95
52114 916.20 807.35
52117 1,132.90 961.00
52120 1,153.90 1,136.60
52122 1,322.60 1,136.60
52123 1,310.70 1,286.75
52126 1,260.15 1,237.15
52129 1,686.80 1,656.10
52130 649.60 607.90
52131 929.90 840.70
52132 334.35 342.05
52133 127.40 125.10
52135 191.85
52138 623.45 616.30
52141 636.20 609.65
52144 578.75 568.20
52147 546.20 536.15
52148 965.35 947.75
52158 1,554.25 1,525.95
52180 321.80 258.60
52182 635.10 569.20
52184 933.30 840.70
52186 1,054.15 1,034.90
52300 345.85 390.70
52303 568.15 557.90
52306 843.20 827.70
52309 286.55 281.30
52312 398.00 390.70
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
52315 616.80 650.90
52318 197.75 194.05
52319 329.10 323.55
52321 665.40 650.90
52324 663.15 650.90
52327 329.10 322.95
52330 1,290.70 1,074.30
52333 1,094.40 1,074.30
52336 657.80 671.55
52337 1,310.40 1,468.85
52339 779.10 764.70
52342 1,484.95 1,328.25
52345 1,525.75 1,498.00
52348 2,057.35 1,692.75
52351 1,936.35 1,901.00
52354 2,077.30 1,927.20
52357 2,962.55 2,169.65
52360 2,254.55 2,213.40
52363 2,536.25 2,490.05
52366 2,480.20 2,434.95
52369 2,788.60 2,737.80
52372 2,705.85 2,656.50
52375 3,030.80 2,975.50
52378 1,234.80 1,028.60
52379 1,715.30 1,757.85
52380 3,048.90 2,993.20
52382 3,654.70 3,588.10
52420 337.60 331.35
52424 662.90 650.75
52430 1,525.75 1,498.00
52440 757.65 743.75
52442 947.30 929.90
52444 1,052.30 1,033.00
52446 1,241.95 1,219.35
52450 421.00 413.25
52452 684.00 671.55
52456 1,157.65 1,136.60
52458 421.00 413.25
RMFS
Out
Hospital %
56 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
RMFS In
Hospital %
52460 1,094.40 1,074.30
52480 703.00 690.10
52482 676.30 663.95
52484 805.10 790.40
52600 480.30 464.90
52603 384.50 444.30
52606 344.85 338.95
52609 452.60 444.30
52612 568.15 557.90
52615 705.20 692.25
52618 757.60 805.80
52621 820.75 805.80
52624 829.70 650.75
52626 406.55 399.15
52627 694.05 692.25
52630 261.05 256.20
52633 705.20 692.25
52636 283.55 256.20
52800 387.20 380.35
52803 637.15 547.55
52806 387.20 380.35
52809 663.15 650.90
52812 988.55 929.90
52815 1,277.40 981.50
52818 786.85 650.90
52821 1,441.70 1,415.40
52824 558.20 609.65
52826 332.55 326.45
52828 494.65 485.45
52830 652.30 640.40
52832 894.55 878.25
53000 45.55 44.75
53003 128.85
53004 47.05 48.95
53006 656.00 716.20
53009 413.95 406.30
53012 164.55 161.50
53015 729.10 807.35
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
53016 676.30 663.95
53017 847.65 828.25
53019 812.80 798.10
53052 171.95 168.80
53054 171.90 168.80
53056 100.75 98.85
53058 171.90 168.80
53060 140.70 138.15
53062 126.00 123.65
53064 228.15 223.90
53068 188.85 187.55
53070 249.20 244.65
53200 99.00 97.10
53203 166.40 163.10
53206 185.50
53209 2,307.75 2,265.70
53212 1,246.75 1,223.95
53215 571.85 561.55
53218 914.00 898.25
53220 460.85 452.85
53221 1,265.15 1,198.50
53224 1,173.70 1,328.55
53225 450.30 399.15
53226 437.30 429.10
53227 1,624.25 1,632.50
53230 1,737.35 1,838.90
53233 2,104.80 2,066.40
53236 657.60 646.70
53239 657.60 646.70
53242 437.30 429.10
53400 180.85 177.55
53403 221.00 216.90
53406 546.95 558.70
53409 479.95 558.70
53410 154.80 117.70
53411 386.40 328.10
53412 610.10 538.75
53413 670.55 660.00
RMFS
Out
Hospital %
1 NOVEMBER 2011 – 31 OCTOBER 2012 57

Item
RMFS In
Hospital %
53414 772.20 758.20
53415 622.10 598.60
53416 609.90 598.60
53418 926.55 778.15
53419 792.65 778.15
53422 1,081.95 987.50
53423 1,178.50 987.50
53424 947.55 847.25
53425 939.35 847.25
53427 1,178.70 1,157.20
53429 1,288.65 1,157.20
53439 334.35 328.10
53453 676.30 663.95
53455 794.45 779.90
53458 60.15 59.15
53459 306.45 323.55
53460 672.20 660.00
53600 58.80 53.50
53700 212.65 171.50
53702 94.10 85.90
53704 56.70 51.75
53706 188.10 171.50
75150 121.45 117.55
75153 61.00 59.10
75156 108.20 104.80
75200 78.00 75.50
75203 116.95 113.30
75206 38.80 37.60
75400 233.90 226.40
75403 268.50 260.00
75406 306.10 296.35
RMFS
Out
Hospital %
Item
RMFS In
Hospital %
75409 346.55 335.60
75412 193.60 187.40
75415 233.90 226.40
75600 329.30 318.80
75603 386.95 374.75
75606 386.95 374.75
75609 577.70 559.40
75612 714.85 692.25
75615 264.65 256.20
75618 328.70 318.25
75621 328.70 318.25
75800 116.95 113.30
75803 467.85 453.05
75806 548.70 531.40
75809 653.20 629.20
75812 721.90 699.10
75815 880.80 853.05
75818 1,039.50 1,006.70
75821 837.30 810.85
75824 967.30 936.75
75827 1,111.70 1,076.85
75830 1,227.30 1,188.55
75833 1,501.45 1,454.05
75836 1,554.55 1,663.85
75839 35.20 37.60
75842 52.40 56.00
75845 261.55 279.80
75848 313.55 335.60
75851 156.85 167.80
75854 156.85 167.80
RMFS
Out
Hospital %
58 1 NOVEMBER 2011 – 31 OCTOBER 2012

RELATIVE VALUE GUIDE
RELATIVE VALUE GUIDE FEE SCHEDULE
1 November 2011
The Relative Value Guide (RVG) lists fees for In Hospital anaesthetic services.
The RVG basic unit cost has been reviewed to $32.05.
In addition all medical practitioners will be paid RVG fees where they have qualifications
updated with Medicare Australia.
For items not listed in the RVG Fee Schedule please refer to the appropriate schedule in
this booklet.
• For medical attendances and consultations provided by general practitioners
participating in DVA’s Local Medical Officer Scheme, please use the Local Medical
Officer Fee Schedule for the relevant fees.
• For derived fees for Local Medical Officers, please use the Derived Fees for Local
Medical Officers Fee Schedule.
• For all specialist attendances and consultations, investigative and general medical
procedures claim from the Repatriation Medical Fee Schedule.
• For diagnostic imaging services claim from the Diagnostic Imaging Fee Schedule.
• For pathology services claim from the Pathology Fee Schedule.
1 NOVEMBER 2011 – 31 OCTOBER 2012 59

RELATIVE VALUE GUIDE
Item
Relative
Value
Guide
Item
Relative
Value
Guide
Item
Relative
Value
Guide
Item
Relative
Value
Guide
20100 160.25
20355 384.60
20690 160.25
20845 320.50
20102 192.30
20400 96.15
20700 96.15
20846 320.50
20104 128.20
20401 128.20
20702 128.20
20847 320.50
20120 160.25
20402 160.25
20703 128.20
20848 320.50
20124 128.20
20403 160.25
20704 320.50
20850 384.60
20140 160.25
20404 192.30
20705 192.30
20855 480.75
20142 192.30
20405 256.40
20706 224.35
20860 192.30
20143 192.30
20406 416.65
20730 160.25
20862 224.35
20144 256.40
20410 160.25
20740 160.25
20863 320.50
20145 256.40
20420 160.25
20745 192.30
20864 320.50
20146 160.25
20440 128.20
20750 128.20
20866 320.50
20147 192.30
20450 160.25
20752 192.30
20867 320.50
20148 128.20
20452 192.30
20754 224.35
20868 320.50
20160 192.30
20470 192.30
20756 288.45
20880 480.75
20162 224.35
20472 320.50
20770 480.75
20882 320.50
20164 128.20
20474 416.65
20790 256.40
20884 160.25
20170 192.30
20475 320.50
20791 320.50
20886 192.30
20172 224.35
20500 480.75
20792 416.65
20900 96.15
20174 288.45
20520 192.30
20793 480.75
20902 128.20
20176 320.50
20522 128.20
20794 384.60
20904 224.35
20190 160.25
20524 128.20
20798 320.50
20905 320.50
20192 320.50
20526 320.50
20799 192.30
20906 128.20
20210 480.75
20528 256.40
20800 96.15
20910 128.20
20212 160.25
20540 416.65
20802 160.25
20911 160.25
20214 288.45
20542 480.75
20803 128.20
20912 160.25
20216 641.00
20546 480.75
20804 320.50
20914 224.35
20220 320.50
20548 480.75
20805 192.30
20916 224.35
20222 192.30
20560 641.00
20806 224.35
20920 128.20
20225 384.60
20600 320.50
20810 128.20
20924 128.20
20230 384.60
20604 416.65
20815 192.30
20926 128.20
20300 160.25
20620 320.50
20820 160.25
20928 192.30
20305 480.75
20622 416.65
20830 128.20
20930 128.20
20320 192.30
20630 256.40
20832 192.30
20932 128.20
20321 320.50
20632 224.35
20840 192.30
20934 192.30
20330 256.40
20634 320.50
20841 256.40
20936 256.40
20350 320.50
20670 416.65
20842 128.20
20938 128.20
20352 160.25
20680 96.15
20844 320.50
20940 128.20
60 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
Relative
Value
Guide
Item
Relative
Value
Guide
Item
Relative
Value
Guide
Item
Relative
Value
Guide
20942 160.25
21270 256.40
21530 480.75
21820 96.15
20943 128.20
21272 128.20
21532 256.40
21830 128.20
20944 192.30
21274 192.30
21535 320.50
21832 224.35
20946 256.40
21275 320.50
21600 96.15
21834 128.20
20948 128.20
21280 480.75
21610 160.25
21840 256.40
20950 160.25
21300 96.15
21620 128.20
21842 192.30
20952 128.20
21321 128.20
21622 160.25
21850 128.20
20953 160.25
21340 128.20
21630 160.25
21860 96.15
20954 320.50
21360 160.25
21632 192.30
21865 320.50
20956 128.20
21380 96.15
21634 288.45
21870 480.75
20958 160.25
21382 128.20
21636 480.75
21872 256.40
20960 224.35
21390 96.15
21638 320.50
21878 96.15
21100 96.15
21392 128.20
21650 256.40
21879 160.25
21110 160.25
21400 128.20
21652 320.50
21880 224.35
21112 128.20
21402 224.35
21654 256.40
21881 288.45
21114 160.25
21403 320.50
21656 320.50
21882 352.55
21116 192.30
21404 160.25
21670 128.20
21883 416.65
21120 192.30
21420 96.15
21680 96.15
21884 480.75
21130 96.15
21430 128.20
21682 128.20
21885 544.85
21140 480.75
21432 160.25
21685 320.50
21886 608.95
21150 320.50
21440 256.40
21700 96.15
21887 673.05
21155 320.50
21445 320.50
21710 128.20
21900 96.15
21160 128.20
21460 96.15
21712 160.25
21906 160.25
21170 256.40
21461 128.20
21714 160.25
21908 192.30
21195 96.15
21462 96.15
21716 160.25
21910 288.45
21199 128.20
21464 128.20
21730 96.15
21912 160.25
21200 128.20
21472 160.25
21732 128.20
21914 192.30
21202 128.20
21474 160.25
21740 160.25
21915 160.25
21210 192.30
21480 128.20
21756 192.30
21916 160.25
21212 320.50
21482 160.25
21760 224.35
21918 160.25
21214 320.50
21484 160.25
21770 256.40
21922 224.35
21216 448.70
21486 224.35
21772 192.30
21925 128.20
21220 128.20
21490 96.15
21780 128.20
21926 160.25
21230 192.30
21500 256.40
21785 320.50
21927 160.25
21232 160.25
21502 192.30
21790 480.75
21930 192.30
21234 256.40
21520 128.20
21800 96.15
21935 160.25
21260 128.20
21522 160.25
21810 128.20
21936 192.30
1 NOVEMBER 2011 – 31 OCTOBER 2012 61

Item
Relative
Value
Guide
Item
Relative
Value
Guide
Item
Relative
Value
Guide
Item
Relative
Value
Guide
21939 96.15
22060 641.00
23118 576.90
23510 1,762.75
21941 224.35
22065 160.25
23119 608.95
23520 1,794.80
21942 320.50
22070 320.50
23121 641.00
23530 1,826.85
21943 160.25
22075 480.75
23170 673.05
23540 1,858.90
21945 160.25
22900 192.30
23180 705.10
23550 1,890.95
21949 160.25
22905 192.30
23190 737.15
23560 1,923.00
21952 320.50
23010 32.05
23200 769.20
23570 1,955.05
21955 160.25
23021 64.10
23210 801.25
23580 1,987.10
21959 160.25
23022 64.10
23220 833.30
23590 2,019.15
21962 160.25
23023 64.10
23230 865.35
23600 2,051.20
21965 160.25
23031 96.15
23240 897.40
23610 2,083.25
21969 256.40
23032 96.15
23250 929.45
23620 2,115.30
21970 480.75
23033 96.15
23260 961.50
23630 2,147.35
21973 160.25
23041 128.20
23270 993.55
23640 2,179.40
21976 160.25
23042 128.20
23280 1,025.60
23650 2,211.45
21980 160.25
23043 128.20
23290 1,057.65
23660 2,243.50
21981 128.20
23051 160.25
23300 1,089.70
23670 2,275.55
21990 96.15
23052 160.25
23310 1,121.75
23680 2,307.60
21992 128.20
23053 160.25
23320 1,153.80
23690 2,339.65
21997 128.20
23061 192.30
23330 1,185.85
23700 2,371.70
22001 96.15
23062 192.30
23340 1,217.90
23710 2,403.75
22002 128.20
23063 192.30
23350 1,249.95
23720 2,435.80
22007 128.20
23071 224.35
23360 1,282.00
23730 2,467.85
22008 128.20
23072 224.35
23370 1,314.05
23740 2,499.90
22012 96.15
23073 224.35
23380 1,346.10
23750 2,531.95
22014 96.15
23081 256.40
23390 1,378.15
23760 2,564.00
22015 192.30
23082 256.40
23400 1,410.20
23770 2,596.05
22018 224.35
23083 256.40
23410 1,442.25
23780 2,628.10
22020 128.20
23091 288.45
23420 1,474.30
23790 2,660.15
22025 128.20
23101 320.50
23430 1,506.35
23800 2,692.20
22031 160.25
23111 352.55
23440 1,538.40
23810 2,724.25
22036 96.15
23112 384.60
23450 1,570.45
23820 2,756.30
22040 64.10
23113 416.65
23460 1,602.50
23830 2,788.35
22045 96.15
23114 448.70
23470 1,634.55
23840 2,820.40
22050 64.10
23115 480.75
23480 1,666.60
23850 2,852.45
22051 288.45
23116 512.80
23490 1,698.65
23860 2,884.50
22055 384.60
23117 544.85
23500 1,730.70
23870 2,916.55
62 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
Relative
Value
Guide
Item
Relative
Value
Guide
Item
Relative
Value
Guide
Item
Relative
Value
Guide
23880 2,948.60
24103 3,429.35
24118 3,910.10
24133 4,390.85
23890 2,980.65
24104 3,461.40
24119 3,942.15
24134 4,422.90
23900 3,012.70
24105 3,493.45
24120 3,974.20
24135 4,454.95
23910 3,044.75
24106 3,525.50
24121 4,006.25
24136 4,487.00
23920 3,076.80
24107 3,557.55
24122 4,038.30
25000 32.05
23930 3,108.85
24108 3,589.60
24123 4,070.35
25005 64.10
23940 3,140.90
24109 3,621.65
24124 4,102.40
25010 96.15
23950 3,172.95
24110 3,653.70
24125 4,134.45
25015 32.05
23960 3,205.00
24111 3,685.75
24126 4,166.50
25020 64.10
23970 3,237.05
24112 3,717.80
24127 4,198.55
25025 D
23980 3,269.10
24113 3,749.85
24128 4,230.60
25030 D
23990 3,301.15
24114 3,781.90
24129 4,262.65
25050 D
24100 3,333.20
24115 3,813.95
24130 4,294.70
25200 D
24101 3,365.25
24116 3,846.00
24131 4,326.75
25205 D
24102 3,397.30
24117 3,878.05
24132 4,358.80
1 NOVEMBER 2011 – 31 OCTOBER 2012 63

DIAGNOSTIC IMAGING SERVICES
DIAGNOSTIC IMAGING FEE SCHEDULE
1 November 2011
All medical practitioners will be paid 100% of the MBS for diagnostic imaging services,
where they have the appropriate qualifications updated with Medicare Australia.
Local Medical Officers claiming from the Diagnostic Imaging Fee Schedule can also claim
the relevant Veterans Access Payment (VAP) on these items.
For items not listed in the Diagnostic Imaging Fee schedule please refer to the appropriate
schedule in this booklet.
• For medical attendances and consultations provided by general practitioners
participating in DVA’s Local Medical Officer Scheme, please use the Local Medical
Fee Schedule for the relevant fees.
• For derived fees for Local Medical Officers, please use the Derived Fees for Local
Medical Officers Fee Schedule.
• For all specialist attendances and consultations, investigative and general medical
procedures claim from the Repatriation Medical Fee Schedule.
• For In Hospital anaesthetic services please use Relative Value Guide Fee Schedule.
• For pathology services please use the Pathology Fee Schedule.
64 1 NOVEMBER 2011 – 31 OCTOBER 2012

DIAGNOSTIC IMAGING SERVICES
Item
100% MBS
Item
100% MBS
Item
100% MBS
Item
100% MBS
55005 54.55
55079 37.85
55276 169.50
55727 20.00
55007 18.95
55084 98.25
55278 169.50
55729 27.25
55008 54.55
55085 34.05
55280 169.50
55730 13.65
55010 18.95
55113 230.65
55282 169.50
55731 98.00
55011 54.55
55114 230.65
55284 169.50
55732 49.00
55013 18.95
55115 230.65
55292 169.50
55733 35.00
55014 55.65
55116 261.65
55294 169.50
55734 17.50
55016 18.95
55117 261.65
55296 111.05
55735 63.50
55017 54.55
55118 275.50
55600 109.10
55736 127.00
55019 18.95
55119 115.35
55601 54.55
55737 28.50
55020 55.65
55120 115.35
55603 109.10
55739 57.00
55022 18.95
55121 115.35
55604 54.55
55759 150.00
55023 54.75
55122 130.85
55700 60.00
55760 75.00
55025 18.95
55123 130.85
55701 30.00
55762 60.00
55026 54.55
55125 137.75
55702 17.50
55763 30.00
55028 109.10
55130 170.00
55703 35.00
55764 160.00
55029 37.85
55131 85.00
55704 70.00
55765 80.00
55030 109.10
55135 353.60
55705 35.00
55766 65.00
55031 37.85
55136 176.80
55706 100.00
55767 32.50
55032 109.10
55220 84.75
55707 70.00
55768 150.00
55033 37.85
55221 84.75
55708 35.00
55769 75.00
55036 111.30
55222 84.75
55709 38.00
55770 60.00
55037 37.85
55223 84.75
55710 35.00
55771 30.00
55038 109.10
55224 84.75
55711 17.50
55772 160.00
55039 37.85
55226 84.75
55712 115.00
55773 80.00
55044 111.30
55227 84.75
55713 50.00
55774 65.00
55045 37.85
55228 84.75
55714 35.00
55775 32.50
55048 109.50
55229 84.75
55715 40.00
55800 109.10
55049 37.85
55230 84.75
55716 17.50
55801 54.55
55054 109.10
55232 84.75
55717 19.00
55802 37.85
55059 49.15
55233 84.75
55718 100.00
55803 18.95
55060 17.05
55235 84.75
55719 57.50
55804 109.10
55061 54.55
55236 55.55
55720 20.00
55805 54.55
55062 18.95
55238 169.50
55721 115.00
55806 37.85
55063 49.15
55244 169.50
55722 50.00
55807 18.95
55064 17.05
55246 169.50
55723 38.00
55808 109.10
55070 98.25
55248 169.50
55724 57.50
55809 54.55
55073 34.05
55252 169.50
55725 40.00
55810 37.85
55076 109.10
55274 169.50
55726 19.00
55811 18.95
1 NOVEMBER 2011 – 31 OCTOBER 2012 65

Item
100% MBS
Item
100% MBS
Item
100% MBS
Item
100% MBS
55812 109.10
55851 76.45
56230 177.45
57007 567.75
55813 54.55
55852 109.10
56231 177.45
57041 233.40
55814 37.85
55853 54.55
56232 177.45
57047 283.90
55815 18.95
55854 37.85
56233 240.00
57201 155.20
55816 109.10
55855 18.95
56234 351.40
57247 77.55
55817 54.55
56001 195.05
56235 122.45
57341 470.00
55818 37.85
56007 250.00
56236 177.45
57345 241.60
55819 18.95
56010 252.10
56237 240.00
57350 510.00
55820 109.10
56013 250.00
56238 351.40
57351 510.00
55821 54.55
56016 290.00
56239 122.45
57355 264.15
55822 37.85
56022 225.00
56240 177.45
57356 264.15
55823 18.95
56025 113.15
56259 164.80
57360 700.00
55824 109.10
56026 56.60
56301 295.00
57361 350.00
55825 54.55
56028 336.80
56307 400.00
57506 29.75
55826 37.85
56030 225.00
56341 149.45
57509 39.75
55827 18.95
56036 336.80
56347 202.00
57512 40.50
55828 109.10
56041 98.75
56401 250.00
57515 54.00
55829 54.55
56047 126.10
56407 360.00
57518 32.50
55830 37.85
56050 128.20
56409 250.00
57521 43.40
55831 18.95
56053 128.20
56412 360.00
57524 49.40
55832 109.10
56056 155.45
56441 126.80
57527 65.75
55833 54.55
56062 113.15
56447 181.50
57529 14.90
55834 37.85
56068 168.40
56449 126.80
57530 19.90
55835 18.95
56070 113.15
56452 181.50
57532 20.25
55836 109.10
56076 168.40
56501 385.00
57533 27.00
55837 54.55
56101 230.00
56507 480.05
57535 16.25
55838 37.85
56107 340.00
56541 193.15
57536 21.70
55839 18.95
56141 116.45
56547 243.75
57538 24.70
55840 109.10
56147 171.60
56552 600.00
57539 32.90
55841 54.55
56219 326.20
56554 600.00
57700 40.50
55842 37.85
56220 240.00
56619 220.00
57702 20.25
55843 18.95
56221 240.00
56625 334.65
57703 54.00
55844 87.35
56223 240.00
56659 112.10
57705 27.00
55845 43.70
56224 351.40
56665 167.40
57706 32.50
55846 37.85
56225 351.40
56801 466.55
57708 16.25
55847 18.95
56226 351.40
56807 560.00
57709 43.40
55848 109.10
56227 122.50
56841 233.35
57711 21.70
55849 54.55
56228 122.50
56847 283.85
57712 47.15
55850 152.85
56229 122.50
57001 466.65
57714 23.60
66 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
100% MBS
Item
100% MBS
Item
100% MBS
Item
100% MBS
57715 60.90
57963 47.40
58527 69.40
59301 44.75
57717 30.45
57965 23.70
58529 34.70
59303 53.95
57721 99.25
57966 47.40
58700 46.05
59304 27.00
57723 49.65
57968 23.70
58702 23.05
59306 100.30
57901 64.50
57969 47.40
58706 157.90
59307 50.15
57902 64.50
58100 67.15
58708 78.95
59309 200.60
57903 47.30
58102 33.60
58715 151.55
59310 100.30
57906 64.50
58103 55.10
58717 75.80
59312 87.00
57909 64.50
58105 27.55
58718 126.10
59313 43.50
57911 32.25
58106 77.00
58720 63.05
59314 52.50
57912 47.15
58108 110.00
58721 138.25
59315 26.25
57914 32.25
58109 47.00
58723 69.15
59318 47.05
57915 47.15
58111 38.50
58900 35.70
59319 23.55
57917 23.65
58112 97.25
58902 17.85
59503 89.40
57918 47.15
58114 55.00
58903 47.60
59504 44.70
57920 32.25
58115 110.00
58905 23.80
59700 96.55
57921 47.15
58117 23.50
58909 89.95
59701 48.30
57923 32.25
58120 110.00
58911 45.00
59703 75.90
57924 47.15
58121 110.00
58912 110.25
59704 37.95
57926 23.60
58123 48.65
58914 55.15
59712 113.70
57927 49.65
58124 55.00
58915 78.95
59713 56.85
57929 23.60
58126 55.00
58916 138.50
59715 143.55
57930 32.90
58127 55.00
58917 39.50
59716 71.80
57932 23.60
58300 40.10
58920 69.25
59718 134.65
57933 78.25
58302 20.05
58921 135.25
59719 67.35
57935 23.60
58306 89.40
58923 67.65
59724 226.45
57938 23.60
58308 44.70
58924 84.05
59725 113.25
57939 64.50
58500 35.35
58926 42.05
59733 107.70
57941 24.85
58502 17.70
58927 76.45
59734 53.85
57942 49.65
58503 47.15
58929 38.25
59736 62.00
57944 16.45
58505 23.60
58933 205.60
59737 31.00
57945 43.40
58506 60.75
58935 102.80
59739 73.75
57947 39.15
58508 30.40
58936 195.95
59740 36.90
57950 32.25
58509 39.75
58938 98.00
59751 139.15
57953 24.85
58511 19.90
58939 139.30
59752 69.60
57956 21.70
58521 43.40
58941 69.65
59754 219.35
57959 23.70
58523 21.70
59103 21.30
59755 109.70
57960 47.40
58524 56.50
59104 10.65
59760 115.15
57962 23.70
58526 28.25
59300 89.50
59761 57.60
1 NOVEMBER 2011 – 31 OCTOBER 2012 67

DIAGNOSTIC IMAGING SERVICES
Item
100% MBS
Item
100% MBS
Item
100% MBS
Item
100% MBS
59763 133.90
60500 43.40
61386 332.50
61495 223.10
59764 66.95
60501 21.70
61387 430.75
61499 253.00
59903 114.55
60503 29.75
61389 370.55
61505 100.00
59912 305.20
60504 14.90
61390 409.95
61506 0.05
59925 362.45
60506 63.75
61393 605.50
61523 953.00
59970 168.30
60507 31.90
61397 246.85
61529 953.00
59971 57.30
60509 98.90
61401 162.30
61538 901.00
59972 152.60
60510 49.45
61402 605.05
61541 953.00
59973 181.25
60918 47.15
61405 346.00
61553 999.00
59974 84.20
60927 38.05
61409 873.50
61559 918.00
60000 564.00
61109 258.90
61413 225.95
61565 953.00
60003 827.10
61110 129.45
61417 118.85
61571 953.00
60006 1,176.10
61302 448.85
61421 479.80
61575 953.00
60009 1,376.30
61303 565.30
61425 600.70
61577 953.00
60012 564.00
61306 709.70
61426 554.80
61598 953.00
60015 827.10
61307 834.90
61429 543.00
61604 953.00
60018 1,176.10
61310 367.30
61430 659.45
61610 953.00
60021 1,376.30
61313 303.35
61433 496.95
61616 953.00
60024 564.00
61314 420.00
61434 615.40
61620 953.00
60027 827.10
61316 381.15
61437 542.75
61622 953.00
60030 1,176.10
61317 492.40
61438 672.95
61628 953.00
60033 1,376.30
61320 228.90
61441 489.70
61632 953.00
60036 564.00
61328 227.65
61442 752.35
61640 999.00
60039 827.10
61340 253.00
61445 286.80
61646 999.00
60042 1,176.10
61348 443.35
61446 333.55
61650 878.70
60045 1,376.30
61352 259.35
61449 456.20
61651 224.45
60048 564.00
61353 386.60
61450 397.55
61652 282.65
60051 827.10
61356 392.80
61453 514.70
61653 354.85
60054 1,176.10
61360 403.35
61454 348.10
61654 417.45
60057 1,376.30
61361 461.40
61457 470.45
61655 183.65
60060 564.00
61364 496.95
61458 396.95
61656 151.70
60063 827.10
61368 223.10
61461 527.85
61657 210.00
60066 1,176.10
61369 2,015.75
61462 129.00
61658 190.60
60069 1,376.30
61372 223.10
61465 265.50
61659 246.20
60072 48.10
61373 489.70
61469 348.10
61660 114.45
60075 96.10
61376 143.35
61473 175.40
61661 113.85
60078 144.25
61381 574.35
61480 386.85
61662 126.50
60100 60.75
61383 624.95
61484 880.85
61663 221.70
60101 30.40
61384 687.70
61485 999.20
61664 129.70
68 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
100% MBS
Item
100% MBS
Item
100% MBS
Item
100% MBS
61665 193.30
61704 198.80
63051 403.20
63131 492.80
61666 196.40
61705 257.35
63052 403.20
63132 492.80
61667 201.70
61706 174.05
63054 403.20
63134 246.40
61668 230.70
61707 235.25
63055 403.20
63135 246.40
61669 248.50
61708 198.50
63057 403.20
63136 246.40
61670 111.55
61709 263.95
63058 403.20
63151 358.40
61671 1,007.90
61710 64.50
63060 403.20
63152 358.40
61672 111.55
61711 132.75
63061 403.20
63154 358.40
61673 244.85
61712 174.05
63063 403.20
63155 358.40
61674 71.70
61713 87.70
63064 403.20
63157 179.20
61675 287.20
61714 193.45
63065 403.20
63158 179.20
61676 312.50
61715 440.45
63067 403.20
63161 358.40
61677 343.85
61716 499.60
63070 403.20
63163 358.40
61678 166.25
61717 111.55
63073 403.20
63164 358.40
61679 215.40
61718 126.50
63074 168.00
63165 358.40
61680 185.30
61719 50.00
63075 179.20
63167 358.40
61681 205.00
61729 439.35
63076 201.60
63168 358.40
61682 302.75
63001 403.20
63077 201.60
63169 358.40
61683 123.45
63002 403.20
63078 201.60
63170 358.40
61684 81.15
63004 403.20
63079 201.60
63171 358.40
61685 302.55
63005 403.20
63080 201.60
63172 358.40
61686 173.00
63007 403.20
63081 201.60
63173 358.40
61687 436.75
63008 403.20
63082 201.60
63174 358.40
61688 113.00
63010 336.00
63083 201.60
63175 358.40
61689 59.45
63011 336.00
63084 201.60
63176 358.40
61690 239.90
63013 201.60
63085 201.60
63177 358.40
61691 300.35
63014 201.60
63101 492.80
63179 358.40
61692 277.40
63016 201.60
63102 492.80
63182 358.40
61693 271.50
63017 168.00
63104 246.40
63185 358.40
61694 329.75
63040 336.00
63111 492.80
63186 179.20
61695 248.50
63041 336.00
63113 492.80
63187 179.20
61696 307.70
63042 358.40
63114 492.80
63188 179.20
61697 271.40
63043 358.40
63116 492.80
63189 179.20
61698 336.50
63044 403.20
63117 246.40
63190 179.20
61699 244.85
63045 403.20
63119 246.40
63191 179.20
61700 376.20
63046 403.20
63125 492.80
63192 179.20
61701 143.40
63047 403.20
63126 492.80
63193 179.20
61702 166.80
63048 403.20
63128 492.80
63194 179.20
61703 228.10
63049 403.20
63129 492.80
63201 448.00
1 NOVEMBER 2011 – 31 OCTOBER 2012 69

Item
100% MBS
Item
100% MBS
Item
100% MBS
Item
100% MBS
63202 448.00
63281 492.80
63386 448.00
63467 690.00
63204 448.00
63282 246.40
63387 448.00
63469 690.00
63205 448.00
63283 246.40
63388 448.00
63470 403.20
63207 224.00
63284 246.40
63389 403.20
63472 403.20
63208 224.00
63285 246.40
63391 403.20
63473 627.20
63219 448.00
63301 380.80
63392 224.00
63475 627.20
63220 448.00
63302 380.80
63393 224.00
63476 403.20
63222 448.00
63304 380.80
63394 201.60
63478 403.20
63223 448.00
63305 380.80
63401 403.20
63479 201.60
63224 448.00
63307 380.80
63402 403.20
63481 313.60
63225 448.00
63308 380.80
63404 403.20
63482 403.20
63226 448.00
63310 190.40
63405 403.20
63483 403.20
63227 448.00
63311 190.40
63407 201.60
63484 201.60
63228 448.00
63313 190.40
63408 201.60
63486 201.60
63229 448.00
63322 403.20
63416 403.20
63491 44.80
63230 448.00
63323 403.20
63417 403.20
63492 44.80
63231 448.00
63324 403.20
63419 201.60
63493 44.80
63232 448.00
63325 403.20
63425 403.20
63494 44.80
63234 448.00
63326 403.20
63426 403.20
63495 156.80
63237 448.00
63327 403.20
63428 403.20
63497 156.80
63240 448.00
63328 403.20
63429 403.20
64990 6.90
63243 448.00
63329 336.00
63432 201.60
64991 10.45
63244 448.00
63330 448.00
63433 201.60
63257 224.00
63331 403.20
63440 403.20
63258 224.00
63332 403.20
63441 403.20
63259 224.00
63334 336.00
63442 403.20
63260 224.00
63337 448.00
63443 403.20
63261 224.00
63340 403.20
63444 403.20
63262 224.00
63341 201.60
63446 403.20
63263 224.00
63342 201.60
63447 201.60
63264 224.00
63343 201.60
63448 201.60
63265 224.00
63345 201.60
63449 201.60
63271 492.80
63346 168.00
63455 179.20
63272 492.80
63347 224.00
63457 345.00
63274 492.80
63348 201.60
63458 345.00
63275 492.80
63361 403.20
63461 358.40
63277 492.80
63363 403.20
63463 358.40
63278 492.80
63364 201.60
63464 690.00
63280 492.80
63385 448.00
63466 690.00
70 1 NOVEMBER 2011 – 31 OCTOBER 2012

PATHOLOGY SERVICES
PATHOLOGY FEE SCHEDULE
1 November 2011
All medical practitioners will be paid 100% of the MBS for pathology services, where they have
the appropriate qualifications updated with Medicare Australia.
Local Medical Officers claiming the Pathology Fee Schedule can also claim the relevant Veterans
Access Payment on these items if they do not receive the bulk billing incentive.
In addition, DVA does not apply the coning or super coning rule to “Out of Hospital” pathology
services.
For items not listed in the Pathology Fee schedule please refer to the appropriate schedule in
this booklet.
• For medical attendances and consultations provided by general practitioners
participating in DVA’s Local Medical Officer Scheme, please use the Local Medical Fee
Schedule for the relevant fees.
• For derived fees for Local Medical Officers, please use the Derived Fees for Local
Medical Officers Fee Schedule.
• For all specialist attendances and consultations, investigative and general medical
procedures claim from the Repatriation Medical Fee Schedule.
• For In Hospital anaesthetic services please use Relative Value Guide Fee Schedule.
• For diagnostic imaging services please use the Diagnostic Imaging Fee Schedule.
1 NOVEMBER 2011 – 31 OCTOBER 2012 71

PATHOLOGY SERVICES
Item
100% MBS
Item
100% MBS
Item
100% MBS
Item
100% MBS
63498 44.80
65153 142.80
66578 69.80
66667 30.80
63499 156.80
65156 214.20
66581 78.80
66671 37.15
63501 500.00
65157 71.40
66584 9.75
66674 40.20
63502 500.00
65158 71.40
66587 47.85
66677 11.25
63504 500.00
65159 71.40
66590 30.80
66680 74.95
63505 500.00
65162 10.50
66593 18.10
66683 74.95
65060 7.90
65165 34.70
66596 32.75
66686 51.00
65066 10.45
65166 34.70
66599 23.75
66695 30.70
65070 17.05
65171 25.50
66602 43.25
66696 30.70
65072 10.25
65175 25.50
66605 30.80
66697 13.30
65075 52.30
65176 49.00
66606 30.80
66698 44.00
65078 90.80
65177 72.45
66607 76.25
66701 57.30
65079 90.80
65178 95.85
66608 42.55
66704 70.60
65081 97.25
65179 119.30
66609 42.55
66707 83.90
65082 97.25
65180 25.50
66610 76.25
66711 30.35
65084 166.95
65181 23.45
66623 41.80
66712 43.35
65087 83.65
66500 9.75
66626 24.25
66714 30.35
65090 11.20
66503 11.75
66629 20.25
66715 12.95
65093 22.15
66506 13.75
66632 20.25
66716 25.20
65096 41.30
66509 15.75
66635 20.25
66719 35.05
65099 109.65
66512 17.80
66638 49.40
66722 38.15
65102 165.70
66517 19.80
66639 29.40
66723 38.15
65105 109.65
66518 20.20
66641 29.40
66724 13.25
65108 165.70
66519 40.40
66642 29.40
66725 51.40
65109 13.00
66536 11.10
66644 20.30
66728 64.65
65110 13.00
66539 30.80
66647 45.40
66731 77.90
65111 23.35
66542 19.10
66650 24.50
66734 91.15
65114 9.15
66545 15.90
66651 24.50
66743 20.25
65117 20.40
66548 20.05
66652 20.45
66749 33.15
65120 13.80
66551 16.90
66653 44.90
66750 40.00
65123 20.50
66554 16.90
66655 20.30
66751 55.60
65126 28.05
66557 9.75
66656 20.30
66752 24.85
65129 35.75
66560 20.25
66659 37.55
66755 39.10
65137 25.50
66563 24.85
66660 37.55
66756 98.95
65142 25.50
66566 33.95
66662 80.50
66757 98.95
65144 56.95
66569 42.90
66663 80.50
66758 24.85
65147 38.15
66572 51.90
66665 30.80
66761 13.25
65150 71.40
66575 60.85
66666 30.80
66764 8.95
72 1 NOVEMBER 2011 – 31 OCTOBER 2012

Item
100% MBS
Item
100% MBS
Item
100% MBS
Item
100% MBS
66767 17.95
69309 48.45
69415 69.55
71075 23.15
66770 26.90
69312 34.00
69418 64.00
71076 106.85
66773 24.80
69316 28.85
69419 64.00
71077 27.25
66776 24.80
69317 36.10
69445 92.80
71079 27.00
66779 40.20
69318 34.00
69451 92.80
71081 40.80
66780 40.20
69319 43.25
69471 35.15
71083 20.30
66782 13.25
69321 48.45
69472 15.75
71085 29.15
66783 13.25
69324 43.30
69474 28.85
71087 37.95
66785 40.20
69325 43.30
69475 15.75
71089 29.35
66788 66.30
69327 85.55
69478 29.45
71090 29.35
66789 40.20
69328 85.55
69481 40.80
71091 53.20
66790 26.05
69330 128.85
69482 153.10
71092 23.85
66791 74.95
69331 128.85
69483 153.10
71093 76.95
66792 74.95
69333 20.70
69484 17.20
71095 40.80
66800 18.25
69336 33.65
69488 181.45
71096 40.80
66803 30.70
69339 19.25
69489 181.45
71097 24.60
66804 18.25
69345 53.25
69491 206.20
71099 26.70
66805 12.45
69354 30.95
69492 206.20
71101 17.50
66806 42.15
69357 61.85
69494 28.85
71103 52.40
66812 35.05
69360 92.80
69495 36.10
71106 11.40
66815 59.95
69363 28.85
69496 43.35
71119 17.45
66816 35.05
69378 181.45
69497 28.85
71121 20.95
66817 24.90
69379 181.45
69498 7.25
71123 24.40
66819 30.80
69380 775.50
69499 92.80
71125 27.85
66820 30.80
69381 181.45
69500 92.80
71127 177.55
66821 21.95
69382 181.45
71057 33.10
71129 219.30
66822 52.80
69383 181.45
71058 50.85
71131 261.10
66825 30.80
69384 15.75
71059 35.90
71133 10.45
66826 30.80
69387 29.20
71060 44.35
71134 104.75
66827 21.95
69390 42.65
71062 44.35
71135 209.35
66828 52.80
69393 56.10
71064 20.90
71137 30.45
66830 58.90
69396 69.55
71066 14.65
71139 104.75
66831 31.15
69400 15.75
71068 14.65
71141 198.70
66832 31.15
69401 13.45
71069 22.90
71143 261.75
66900 78.15
69405 15.75
71071 31.15
71145 427.35
69300 12.60
69408 29.20
71072 14.65
71146 104.75
69303 22.15
69411 42.65
71073 106.85
71147 40.80
69306 34.00
69413 56.10
71074 14.65
71148 40.80
1 NOVEMBER 2011 – 31 OCTOBER 2012 73

PATHOLOGY SERVICES
Item
100% MBS
Item
100% MBS
Item
100% MBS
Item
100% MBS
71149 109.00
72846 60.00
73312 36.70
73833 10.20
71151 119.65
72847 90.00
73314 232.50
73834 6.95
71153 34.80
72848 75.00
73315 232.50
73835 8.70
71154 34.80
72849 105.00
73317 36.70
73836 2.35
71155 47.75
72850 120.00
73318 36.70
73837 6.95
71156 12.95
72851 185.60
73320 40.80
73840 17.10
71157 60.70
72852 247.45
73321 40.80
73844 20.50
71159 73.65
72855 185.60
73323 40.80
73920 2.40
71163 24.90
72856 247.45
73324 41.25
73922 8.25
71164 40.15
72857 288.70
73325 75.00
73923 2.40
71165 34.80
73043 23.00
73326 232.50
73924 14.75
71166 47.75
73045 48.95
73327 52.30
73925 2.40
71167 60.70
73047 95.35
73328 400.00
73926 8.25
71168 73.65
73049 68.60
73330 232.50
73927 2.40
71169 34.80
73051 171.50
73332 317.50
73928 6.00
71170 12.95
73053 19.60
73521 9.75
73929 2.40
71180 34.80
73055 19.60
73523 42.05
73930 6.00
71183 47.75
73057 19.60
73525 28.55
73931 2.40
71186 60.70
73059 43.30
73527 10.05
73932 10.30
71189 15.60
73060 57.75
73529 28.85
73933 2.40
71192 28.55
73061 51.55
73801 6.95
73934 17.70
71195 40.30
73062 89.60
73802 4.60
73935 2.40
71198 40.80
73063 100.00
73803 6.40
73936 6.00
71200 60.00
73064 72.20
73804 8.20
73937 2.40
71203 40.80
73065 86.60
73805 4.60
73938 8.00
72813 72.00
73066 222.95
73806 10.20
73939 2.40
72816 86.95
73067 130.00
73807 6.95
73940 10.30
72817 97.45
73287 397.20
73808 8.70
74990 6.90
72818 107.75
73289 361.35
73809 2.35
74991 10.45
72823 97.80
73290 397.20
73810 6.95
74992 1.60
72824 142.30
73291 232.50
73811 11.30
74993 3.75
72825 181.45
73292 593.85
73818 13.75
74994 3.25
72826 195.90
73293 232.50
73824 20.50
74995 4.00
72827 210.35
73294 232.50
73827 14.05
74996 3.70
72828 224.80
73300 102.00
73828 6.95
74997 3.30
72830 276.00
73305 204.00
73829 4.60
74998 2.00
72836 420.00
73308 36.70
73830 6.40
74999 1.60
72838 470.00
73309 36.70
73831 8.20
72844 30.95
73311 36.70
73832 4.60
74 1 NOVEMBER 2011 – 31 OCTOBER 2012