Contact Information
- Website - Division of Worker's Compensation
- Email - Bureau of Claims Management
75000 - 75996
| CPT Code | Region | Zip Codes | Formula Amount |
|---|---|---|---|
| 75552 | NW | 540\544\546\547\548 | $1,753.72 |
| 75552 | SE | 530\531\532\533\534 | $2,005.17 |
| 75650 | NW | 540\544\546\547\548 | $909.63 |
| 75650 | SE | 530\531\532\533\534 | $554.62 |
| 75650 | SW | 535\537\538\539 | $447.93 |
| 75658 | NW | 540\544\546\547\548 | $360.30 |
| 75658 | SE | 530\531\532\533\534 | $634.16 |
| 75658 | SW | 535\537\538\539 | $421.25 |
| 75660 | NW | 540\544\546\547\548 | $783.76 |
| 75660 | SE | 530\531\532\533\534 | $612.53 |
| 75660 | SW | 535\537\538\539 | $535.87 |
| 75662 | NW | 540\544\546\547\548 | $506.61 |
| 75662 | SE | 530\531\532\533\534 | $557.87 |
| 75662 | SW | 535\537\538\539 | $518.24 |
| 75671 | NW | 540\544\546\547\548 | $663.73 |
| 75671 | SE | 530\531\532\533\534 | $582.10 |
| 75671 | SW | 535\537\538\539 | $611.61 |
| 75676 | NW | 540\544\546\547\548 | $656.88 |
| 75676 | SE | 530\531\532\533\534 | $833.40 |
| 75676 | SW | 535\537\538\539 | $580.91 |
| 75680 | NW | 540\544\546\547\548 | $603.25 |
| 75680 | SE | 530\531\532\533\534 | $580.90 |
| 75680 | SW | 535\537\538\539 | $592.25 |
| 75685 | NW | 540\544\546\547\548 | $503.80 |
| 75685 | SE | 530\531\532\533\534 | $578.77 |
| 75685 | SW | 535\537\538\539 | $621.71 |
| 75705 | NW | 540\544\546\547\548 | $626.64 |
| 75705 | SE | 530\531\532\533\534 | $610.20 |
| 75705 | SW | 535\537\538\539 | $660.50 |
| 75733 | NW | 540\544\546\547\548 | $477.05 |
| 75733 | SE | 530\531\532\533\534 | $611.16 |
| 75733 | SW | 535\537\538\539 | $906.92 |
| 75736 | NW | 540\544\546\547\548 | $994.96 |
| 75736 | SE | 530\531\532\533\534 | $556.27 |
| 75736 | SW | 535\537\538\539 | $134.16 |
| 75743 | NW | 540\544\546\547\548 | $966.82 |
| 75743 | SE | 530\531\532\533\534 | $1,066.18 |
| 75743 | SW | 535\537\538\539 | $164.88 |
| 75746 | SE | 530\531\532\533\534 | $612.15 |
| 75746 | SW | 535\537\538\539 | $403.48 |
| 75774 | NW | 540\544\546\547\548 | $456.22 |
| 75774 | SE | 530\531\532\533\534 | $586.43 |
| 75774 | SW | 535\537\538\539 | $475.57 |
| 75790 | NE | 541\542\543\545\549 | $314.31 |
| 75790 | NW | 540\544\546\547\548 | $375.71 |
| 75790 | SE | 530\531\532\533\534 | $368.55 |
| 75790 | SW | 535\537\538\539 | $224.92 |
| 75805 | SE | 530\531\532\533\534 | $766.36 |
| 75809 | NE | 541\542\543\545\549 | $313.49 |
| 75809 | SE | 530\531\532\533\534 | $138.02 |
| 75809 | SW | 535\537\538\539 | $32.00 |
| 75827 | NW | 540\544\546\547\548 | $851.37 |
| 75827 | SE | 530\531\532\533\534 | $612.03 |
| 75827 | SW | 535\537\538\539 | $1,372.99 |
| 75831 | NW | 540\544\546\547\548 | $800.93 |
| 75831 | SE | 530\531\532\533\534 | $1,012.76 |
| 75831 | SW | 535\537\538\539 | $478.50 |
| 75833 | NW | 540\544\546\547\548 | $562.90 |
| 75833 | SE | 530\531\532\533\534 | $644.90 |
| 75833 | SW | 535\537\538\539 | $496.99 |
| 75840 | NW | 540\544\546\547\548 | $360.29 |
| 75840 | SE | 530\531\532\533\534 | $609.22 |
| 75840 | SW | 535\537\538\539 | $408.32 |
| 75842 | NW | 540\544\546\547\548 | $355.75 |
| 75842 | SE | 530\531\532\533\534 | $610.23 |
| 75842 | SW | 535\537\538\539 | $496.64 |
| 75860 | NW | 540\544\546\547\548 | $529.28 |
| 75860 | SE | 530\531\532\533\534 | $608.91 |
| 75860 | SW | 535\537\538\539 | $540.29 |
| 75872 | NW | 540\544\546\547\548 | $523.28 |
| 75872 | SE | 530\531\532\533\534 | $610.28 |
| 75872 | SW | 535\537\538\539 | $871.08 |
| 75880 | NW | 540\544\546\547\548 | $526.24 |
| 75880 | SE | 530\531\532\533\534 | $609.10 |
| 75887 | SW | 535\537\538\539 | $413.45 |
| 75893 | NW | 540\544\546\547\548 | $591.13 |
| 75893 | SE | 530\531\532\533\534 | $674.46 |
| 75893 | SW | 535\537\538\539 | $408.70 |
| 75894 | NW | 540\544\546\547\548 | $986.60 |
| 75894 | SE | 530\531\532\533\534 | $1,613.56 |
| 75894 | SW | 535\537\538\539 | $552.86 |
| 75896 | NW | 540\544\546\547\548 | $749.02 |
| 75896 | SE | 530\531\532\533\534 | $1,075.05 |
| 75896 | SW | 535\537\538\539 | $517.27 |
| 75898 | NW | 540\544\546\547\548 | $504.24 |
| 75898 | SE | 530\531\532\533\534 | $604.09 |
| 75898 | SW | 535\537\538\539 | $425.78 |
| 75900 | NW | 540\544\546\547\548 | $546.92 |
| 75900 | SE | 530\531\532\533\534 | $613.03 |
| 75900 | SW | 535\537\538\539 | $75.34 |
| 75953 | SE | 530\531\532\533\534 | $537.67 |
| 75960 | NW | 540\544\546\547\548 | $1,367.78 |
| 75960 | SE | 530\531\532\533\534 | $1,659.33 |
| 75960 | SW | 535\537\538\539 | $428.88 |
| 75961 | NW | 540\544\546\547\548 | $768.04 |
| 75961 | SE | 530\531\532\533\534 | $887.43 |
| 75961 | SW | 535\537\538\539 | $630.56 |
| 75982 | NW | 540\544\546\547\548 | $712.32 |
| 75982 | SE | 530\531\532\533\534 | $885.65 |
| 75982 | SW | 535\537\538\539 | $591.72 |
| 75984 | NE | 541\542\543\545\549 | $459.84 |
| 75984 | NW | 540\544\546\547\548 | $467.35 |
| 75984 | SE | 530\531\532\533\534 | $1,140.40 |
| 75984 | SW | 535\537\538\539 | $379.15 |
| 75992 | NW | 540\544\546\547\548 | $124.05 |
| 75992 | SW | 535\537\538\539 | $126.53 |
| 75993 | SW | 535\537\538\539 | $216.15 |
| 75994 | SW | 535\537\538\539 | $290.76 |
| 75995 | SW | 535\537\538\539 | $290.74 |
| 75996 | SW | 535\537\538\539 | $215.64 |