National Health (Variation of benefits) (No. 11) Regulations

Legislation au C1974L00053 Regulations Not in force Legislative Instrument

Legislation content

Statutory Rules

1974 No. 53

REGULATIONS UNDER THE NATIONAL HEALTH ACT 1953-1973.*

I, THE GOVERNOR-GENERAL of Australia, acting with the advice of the Executive Council, hereby make the following Regulations under the National Health Act 1953-1973.

Dated this tenth day of April, 1974.

PALL HASLUCK

Governor-General.

By His Excellency’s Command,

BILL HAYDEN

Minister of State for Social Security.

_____________

NATIONAL HEALTH (VARIATION OF BENEFITS) (No. 11) REGULATIONS

Citation.

1. These Regulations may be cited as the National Health (Variation of Benefits) (No. 11) Regulations,

Definition.

2. In these Regulations the Actmeans the National Health Act 1953-1973.

Variation of the rules of interpretation in the First Schedule of the Act.

3. The Act shall have effect as if the Act were varied—

(a) by omitting the rules of interpretation numbered 2 and 3 in the First Schedule;

(b) by inserting the following rules of interpretation in the First Schedule:—

“2. Where an item in Part 1, in Division 3 of Part 3 or in Part 4 of the table in this Schedule includes the symbol ‘ (S) ’, the item shall be taken to relate to the service specified in the item when rendered by a specialist in the practice of his specialty.

“3. Where an item in Part 1, in Division 3 of Part 3 or in Part 4 of the table in this Schedule includes the symbol ‘ (G) ’, the item shall be taken to relate to the service specified in the item when

________________________________________________________________________________________

* Notified in the Australian Government Gazette on 11 April 1974.


rendered otherwise than by a specialist in the practice of his specialty.”; and

(c) by inserting the following rules of interpretation in the First Schedule:—

8. A reference in an item in Division 1 of Part 3 of the table in this Schedule to the administration of an anaesthetic shall be read as a reference to the administration of an anaesthetic by a medical practitioner other than a specialist anaesthetist.

“9. A reference in an item in Division 2 of Part 3 of the table in this Schedule to the administration of an anaesthetic shall be read as a reference to the administration of an anaesthetic by a specialist anaesthetist.

“10. A reference in an item in Division 3 of Part 3 of the table in this Schedule to the administration of an anaesthetic shall be read as a reference to the administration of an anaesthetic in connexion with a dental service other than a service that is a prescribed medical service for the purposes of paragraph (b) of the definition of ‘professional service’ in sub-section 13 (1).”.

Variation of Act in relation, to table of Commonwealth medical benefits.

4. The table of Commonwealth medical benefits in Schedule 1 is prescribed for the purposes of paragraph 13A (1A) (a) of the Act.

Variation of Act in relation to tables of fund medical benefits.

5. (1) The tables of fund medical benefits in Schedules 2, 3, 4, 5, 6 and 7 are prescribed for the purposes of paragraph 13A (1A) (b) of the Act.

(2) A table of fund medical benefits referred to in sub-regulation (1) is the table of fund medical benefits in respect of the State the name of which is specified in the heading to that table.

Commencement.

6. These Regulations shall come into operation on 22 April 1974.

_________________

SCHEDULE 1    Regulation 4

TABLE OF COMMONWEALTH MEDICAL BENEFITS

Item No.

Medical Service

Basic Commonwealth

benefit.

 

Part 1 —Professional attendances not covered by an item in any other Part of this Schedule

$

1

Professional attendance at consulting rooms of not more than 5 minutes duration (not being an attendance covered by any other item in this Part) at a time other than a time covered by item 2—each attendance             

1.10

2

Professional attendance at consulting rooms of not more than 5 minutes duration (not being an attendance covered by any other item in this Part)—each attendance on a public holiday, on a Sunday, before 8 a.m. or after 1 p.m. on a Saturday or at any time other than between 8 a.m. and 8 p.m. on a day not being a Saturday, Sunday or public holiday             

2.00

10

Professional attendance at consulting rooms of more than 5 minutes duration but not more than 25 minutes duration (not being an attendance covered by any other item in this Part) at a time other than a time covered by item 12—each attendance             

1.55


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 1—continued

$

12

Professional attendance at consulting rooms of more than 5 minutes duration but not more than 25 minutes duration (not being an attendance covered by any other item in this Part)—each attendance on a public holiday, on a Sunday, before 8 a.m. or after 1 p.m. on a Saturday or at any time other than between 8 a.m. and 8 p.m. on a day not being a Saturday, Sunday or public holiday             

2.40

21

Professional attendance at consulting rooms of more than 25 minutes duration but not. more than 45 minutes duration (not being an attendance covered by any other item in this Part) at a time other than a time covered by item 24—each attendance             

3.00

24

Professional attendance at consulting rooms of more than 25 minutes duration but not more than 45 minutes duration (not being an attendance covered by any other item in this Part)—each attendance on a public holiday, on a Sunday, before 8 a.m. or after 1 p.m. on a Saturday or at any time other than between 8 a.m. and 8 p.m. on a day not being a Saturday. Sunday or public holiday             

3.80

29

Professional attendance at consulting rooms of more than 45 minutes duration (not being an attendance covered by any other item in this Part) at a time other than a time covered by item 31—each attendance             

4.50

31

Professional attendance at consulting rooms of more than 45 minutes duration (not being an attendance covered by any other item in this Part)—each attendance on a public holiday, on a Sunday, before 8 a.m. or after 1 p.m. on a Saturday or at any time other than between 8 a.m. and 8 p.m. on a day not being a Saturday, Sunday or public holiday             

5.30

36

Professional attendance at a place other than consulting rooms, hospital or nursing home of not more than 5 minutes duration (not being an attendance covered by any other item in this Part) at a time other than a time covered by item 41—each attendance             

1.70

41

Professional attendance at a place other than consulting rooms, hospital or nursing home of not more than 5 minutes duration (not being an attendance covered by any other item in this Part)— each attendance on a public holiday, on a Sunday, before 8 a.m. or after 1 p.m. on a Saturday or at any time other than between 8 a.m. and 8 p.m. on a day not being a Saturday, Sunday or public holiday             

2.55

47

Professional attendance at a place other than consulting rooms, hospital or nursing home of more than 5 minutes duration but not more than 25 minutes duration (not being an attendance covered by any other item in this Part) at a time other than a time covered by item 49—each attendance             

2.30

49

Professional attendance at a place other than consulting rooms, hospital or nursing home of more than 5 minutes duration but not more than 25 minutes duration (not being an attendance covered by any other item in this Part)—each attendance on a public holiday, on a Sunday, before 8 a.m. or after 1 p.m. on a Saturday or at any time other than between 8 a.m. and 8 p.m. on a day not being a Saturday, Sunday or public holiday             

3.15

55

Professional attendance at a place other than consulting rooms, hospital or nursing home of more than 25 minutes duration but not more than 45 minutes duration (not being an attendance covered by any other item in this Part) at a time other than a time covered by item 56—each, attendance             

3.75


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth

benefit

 

Part 1—continued

$

56

Professional attendance at a place other than consulting rooms, hospital or nursing home of more than 25 minutes duration but not more than 45 minutes duration (not being an attendance covered by any other item in this Part)—each attendance on a public holiday, on a Sunday, before 8 a.m, or after 1 p.m. on a Saturday or at any time other than between 8 a.m. and 8 p.m. on a day not being a Saturday, Sunday or public holiday             

4.60

61

Professional attendance at a place other than consulting rooms, hospital or nursing home of more than 45 minutes duration (not being an attendance covered by any other item in this Part) at a time other than a time covered by item 62—each attendance             

5.25

62

Professional attendance at a place other than consulting rooms, hospital or nursing home of more than 45 minutes duration (not being an attendance covered by any other item in this Part)—each attendance on a public holiday, on a Sunday, before 8 a.m. or after 1 p.m. on a Saturday or at any time other than between 8 a.m. and 8 p.m. on a day not being a Saturday, Sunday or public holiday             

6.10

63

Professional attendance at a hospital or nursing home (not being an attendance covered by any other item in this Part) at a time other than a time covered by item 64—each attendance when only one patient is seen             

2.30

64

Professional attendance at a hospital or nursing home (not being an attendance covered by any other item in this Part)—each attendance on a public holiday, on a Sunday, before 8 a.m. or after 1 p.m. on a Saturday or at any time other than between 8 a.m. and 8 p.m. on a day not being a Saturday, Sunday or public holiday, when only one patient is seen             

3.15

67

Professional attendance at a hospital (not being an attendance covered by any other item in this Part) at a time other than a time covered by item 68 each attendance on two or more patients in the one hospital on the one occasion- each patient             

1.55

68

Professional attendance at a nursing home (not being an attendance covered by any other item in this Part)—each attendance on two or more patients in the one nursing home on the one occasion— each patient             

1.10

74

Pre-operative examination of a patient in preparation for the administration of an anaesthetic, being an examination carried out at an attendance other than that at which the anaesthetic is administered (G)             

1.55

76

Pre-operative examination of a patient in preparation for the administration of an anaesthetic, being an examination carried out at an attendance other than that at which the anaesthetic is administered (S)             

1.50

80

Professional attendance by a specialist in the practice of his specialty where the patient is referred to him—an attendance (other than a second or subsequent attendance in a single course of treatment) where that attendance is at consulting rooms, hospital or nursing home             

4.10

83

Professional attendance by a specialist in the practice of his specialty where the patient is referred to him—each attendance subsequent to the first in a single course of treatment where that attendance is at consulting rooms, hospital or nursing home             

2.00

86

Professional attendance by a specialist in the practice of his specialty where the patient is referred to him—an attendance (other than a second or subsequent attendance in a single course of treatment) where that attendance is at a place other than consulting rooms, hospital or nursing home             

6.10

89

Professional attendance by a specialist in the practice of his specialty where the patient is referred to him—each attendance subsequent to the first in a single course of treatment where that attendance is at a place other than consulting rooms, hospital or nursing home             

3.80


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth

benefit

 

Part 1—continued

$

92

Professional attendance by a consultant physician in the practice of his specialty where the patient is referred to him by a medical practitioner—an attendance of not more than 15 minutes duration where that attendance is at consulting rooms, hospital or nursing home             

2.00

95

Professional attendance by a consultant physician in the practice of his specialty where the patient is referred to him by a medical practitioner—an attendance of more than 15 minutes duration but not more than 30 minutes duration where that attendance is at consulting rooms, hospital or nursing home             

4.10

98

Professional attendance by a consultant physician in the practice of the specialty where the patient is referred to him by a medical practitioner—an attendance of more than 30 minutes duration but not more than 45 minutes duration where that attendance is at consulting rooms, hospital or nursing home             

6.50

101

Professional attendance by a consultant physician In the practice of his specialty where the patient is referred to him by a medical practitioner—an attendance of more than 45 minutes duration but not more than 60 minutes duration where that attendance is at consulting rooms, hospital or nursing home             

9.00

104

Professional attendance by a consultant physician in the practice of his specialty where the patient is referred to him by a medical practitioner—an attendance of more than 60 minutes duration where that attendance is at consulting rooms, hospital or nursing home             

11.00

109

Professional attendance by a consultant physician in the practice of his specialty where the patient is referred to him by a medical practitioner—an attendance of not more than 15 minutes duration where that attendance is at a place other than consulting rooms, hospital or nursing home             

3.80

112

Professional attendance by a consultant physician in. the practice of his specialty where the patient is referred to him by a medical practitioner—an attendance of more than 15 minutes duration but not more than 30 minutes duration where that attendance is at a place other than consulting rooms, hospita1 or nursing home             

6.10

115

Professional attendance by a consultant physician in the practice of his specialty where the patient is referred to him by a medical practitioner—an attendance of more than 30 minutes duration but not more than 45 minutes duration where that attendance is at a place other than consulting rooms, hospital or nursing home             

8.60

118

Professional attendance by a consultant physician in the practice of his specialty where the patient is referred to him by a medical practitioner—an attendance of more than 45 minutes duration but not more than 60 minutes duration where that attendance is at a place other than consulting rooms, hospital or nursing home             

11.00

121

Professional attendance by a consultant physician in the practice of his specialty where the patient is referred to him by a medical practitioner an attendance of more than 60 minutes duration where that attendance is at a place other than consulting rooms, hospital or nursing home             

13.00

124

Professional attendance for a period of not less than one hour but less than two hours on a patient in a critical condition that requites attention to the exclusion of ail other patients             

5.90

127

Professional attendance for a period of not less than two hours but less than three hours on a patient in a critical condition that requires constant attention to the exclusion of ail other patients             

9.90

129

Professional attendance for a period of not less than three hours but less than four hours on a patient in a critical condition that requires constant attention to the exclusion of all other patients             

14.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth

benefit

 

Part 1continued

$

131

Professional attendance for a period of not less than four hours but less than five hours on a patient in a critical condition that requires constant attention to the exclusion of ail other patients             

18.00

133

Professional attendance for a period of five hours or more on a patient in a critical condition that requires constant attention to the exclusion of all other patients             

23.00

Part 2—Obstetrics

Division 1—General

203

Antenatal care (not including any service or services covered by item 223, 224, 245, 248, 253, 254, 257, 262, 274, 277, 280, 282 or 292), where attendances do not exceed ten—each attendance             

1.55

206

Antenatal care (not including any service or services covered by item 223, 224, 245, 248, 253, 254, 257, 262, 274, 277, 280, 282 or 292), where attendances exceed ten             

17.50

208

Confinement and postnatal care for nine days (not including any service or services covered by item 223, 224, 245, 248, 274, 282, 285, 289, 292, 294 or 296), where the medical practitioner has not given the antenatal care (G)             

17.00

212

Confinement and postnatal care for nine days (not including any service or services covered by item 223, 224, 245, 248, 274, 282, 285, 289, 292, 294 or 296), where the medical practitioner has not given the antenatal care (S)             

25.00

218

Confinement, as an independent procedure where a separate account is not rendered for the procedure under item 80 (S) 

17.00

223

Antenatal care, confinement and postnatal care for nine days (not including services covered by Division. 2) (G) 

29.00

224

Antenatal care, confinement and postnatal care for nine days (not including services covered by Division 2) (S) 

40.00

 

Division 2—Special Services

226

Antenatal care, confinement and postnatal care for nine days with surgical induction of labour (G) 

34.00

227

Antenatal care, confinement and postnatal care for nine days with surgical induction of labour (S) 

45.00

237

Antenatal care, confinement and postnatal care for nine days with surgical induction of labour; requiring major regional or field, block (G)             

42.00

238

Antenatal care, confinement and postnatal care for nine days with surgical induction of labour; requiring major regional or field block (S)             

52.00

239

Caesarean section and postnatal care for nine days (G) (AU 1O)......

38.00

240

Caesarean section and postnatal care for nine days (S) (AU 10).......

50.00

245

Treatment of habitual miscarriage by injection of hormones—each injection up to a maximum of twelve injections 

1.10

248

Threatened abortion, threatened miscarriage or hyperemesis gravidarum, requiring admission to hospital, treatment of—each attendance             

1.10

253

Cervix, purse string ligation of, for threatened miscarriage (G) (AU 6)..

11.00

254

Cervix, purse string ligation of, for threatened miscarriage (S) (AU 6)..

14.50


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 2—Division 2—continued

$

257

Cervix, removal of purse string ligature of, under general anaesthesia (AU 5) 

3.80

262

Pre-eclampsia, eclampsia or antepartum haemorrhage, treatment of— each attendance 

1.10

269

Amnioscopy........................................

3.40

272

Amnioscopy with surgical induction of labour..................

5.50

274

Amniocentesis.......................................

3.80

277

Version, external, under general aneasthesia (AU 6)..............

3.80

280

Version, internal, under general anaesthesia (AU 6)..............

7.60

282

Surgical induction of labour (AU 5).........................

3.80

285

Decapitation, craniotomy, cleidotomy or evisceration of foetus or any two or more of those services (AU 8) 

17.00

289

Evacuation by intrauterine manual removal of the products of conception such as retained foetus, placenta, membranes or mole (AU 7)             

5.70

292

Manipulative correction of acute inversion of uterus, with or without incision of cervix (AU 8) 

19.00

294

Postpartum haemorrhage requiring special procedures such as packing, treatment of (AU 8) 

3.80

296

Third degree tear, repair of, involving anal sphincter muscles (AU 7)...

8.40

Part 3—Anaesthetics

Division 1—Anaesthetics administered by a medical practitioner other than a specialist anaesthetist.

300

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 1)             

1.00

303

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 2)             

2.00

304

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 3)             

3.40

307

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 4)             

4.30

308

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 5)             

5.70

311

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 6)             

6.80

312

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 7)             

8.10

314

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 8)             

9.70

315

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 9)             

11.00

316

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 10)             

12.50

318

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 11)             

14.00

319

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 12)             

14.50

320

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 13)             

16.00

322

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 14)             

17.50


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth

benefit

 

Part 3—Division 1—continued

$

324

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 15)             

19.00

325

Administration of an anaesthetic in connexion with a medical service being a medical service which contains the reference (AU 16)             

20.00

326

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 17)             

21.00

327

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 18)             

23.00

328

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 19)             

24.00

329

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 20)             

25.00

330

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 21)             

27.00

331

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 22)             

28.00

332

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 23)             

30.00

333

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 24)             

31.00

334

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 25)             

32.00

335

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 26)             

34.00

336

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 27)             

35.00

337

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 28)             

37.00

338

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 29)             

38.00

339

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 30)             

39.00

343

Administration of an anaesthetic in connection with a medical service being a medical, service which contains the reference (AU 32)             

42.00

346

Administration of an anaesthetic in connection with a medical service being a medical, service which contains the reference (AU 36)             

48.00

349

Administration of an anaesthetic in connection with a medical service being a. medical service which contains the reference (AU 38)             

51.00

350

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 39)             

51.00

353

Administration of an anaesthetic in connection with electroconvulsive therapy 

2.70

356

Administration of an anaesthetic in connection with radio-therapy

6.80

359

Administration of an anaesthetic in connection with the treatment of a dislocation requiring open operation being a dislocation referred to in items 6540 to 6653             

 

 

The amount fixed for the administration of an anaesthetic in the item relating to the dislocation in items 6540 to 6653, plus one-half of that amount


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 3—Division 1—continued

$

363

Administration of an anaesthetic in connection with the treatment of a simple and uncomplicated fracture requiring open operation, being a fracture referred to in items 6675 to 6897             

 

 

The amount fixed for the administration of an anaesthetic in the item relating to the fracture in items 6675 to 6897 plus one-third of that amount

366

Administration of an anaesthetic in connection with the treatment of a simple and uncomplicated fracture requiring internal fixation or in connection with the treatment of a compound fracture requiring open operation, being in either case a fracture referred to in items 6675 to 6897             

 

 

 

 

The amount fixed for the administration of an anaesthetic in the item relating to the fracture in items 6675 to 6897 plus one-half of that amount

369

Administration of an anaesthetic in connection with the treatment of a complicated fracture involving viscera, blood vessels or nerves and requiring open operation, being a fracture referred to in items 6675 to 6897             

 

 

 

The amount fixed for the administration of an anaesthetic in the item relating to the fracture in items 6675 to 6897 plus three-quarters of that amount

373

Administration of an anaesthetic in connection with each redaction in a series of two or more reductions of a fracture which is a fracture referred to in items 6675 to 6926             

 

 

The amount fixed for the administration of an anaesthetic in the item relating to the treatment of the fracture in items 6675 to 6926


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth

benefit

 

Part 3—Division I—continued

$

377

Administration of an anaesthetic in connection with the treatment of avulsion of an epiphysis of any part referred to in items 6675 to 6897

The amount fixed for the administration of an anaesthetic in the item relating to the treatment of that part in items 6675 to 6897

 

Division 2—Anaesthetics administered by a specialist anaesthetist

 

410

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 1)             

1.30

411

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 2)             

2.60

412

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 3)             

4.30

413

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 4)             

5.40

414

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 5)             

7.00

415

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 6)             

8.60

416

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 7)             

10.50

417

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 8)             

12.00

418

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 9)             

13.50

419

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 10)             

15.00

420

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 11)             

16.50

421

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 12)             

18.50

422

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 13)             

19.50

423

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference {AU 14)             

21.00

424

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 15)             

23.00

425

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 16)             

24.00

426

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 17)             

26.00

427

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 18)             

28.00

428

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference ( AU 19)             

30.00

429

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 20)             

31.00

431

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 21)             

33.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 3—Division 2—continued

$

432

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 22)             

35.00

433

Administration of‘ an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 23)             

36.00

434

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 24)             

38.00

437

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 25)             

40.00

438

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 26)             

42.00

439

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 27)             

43.00

440

Administration of fin. anaesthetic in connection with a medical service being a medical service which contains the reference (AU 28)             

45.00

441

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 29)             

46.00

442

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 30)             

49.00

444

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 32)             

51.00

445

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 36)             

59.00

446

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 38)             

62.00

447

Administration of an anaesthetic in connection with a medical service being a medical service which contains the reference (AU 39)             

65.00

448

Administration of an anaesthetic in connection with electroconvulsive therapy 

3.50

449

Administration of an anaesthetic in connection with radio-therapy..

8.60

453

Administration of an anaesthetic in connection with the treatment of a dislocation requiring open operation, being a dislocation referred to in items 6540 to 6653             

 

 

The amount fixed for the administration of an anaesthetic in the item relating to the dislocation in items 6540 to 6653 plus one-half of that amount

457

Administration of an anaesthetic in connection with the treatment of a simple and uncomplicated fracture requiring open operation, being a fracture referred to in items 6675 to 6897             

 

 

The amount fixed for the administration of an anaesthetic in the item relating to the fracture in items 6675 to 6897 plus one-third of that amount


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 3—Division 2—continued

$

459

Administration of an anaesthetic in connection with the treatment of a simple and uncomplicated fracture requiring internal fixation or in connection with the treatment of a compound fracture requiring open operation, being in either case a fracture referred to in items 6675 to 6897             

 

 

 

 

The amount fixed for the administration of an anaesthetic in the item relating to the fracture in items 6675 to 6897 plus one-half of that amount

463

Administration of an anaesthetic in connection with the treatment of a complicated fracture involving viscera, blood vessels or nerves and requiring open operation, being a fracture referred to in items 6675 to 6897             

 

 

 

The amount fixed for the administration of an anaesthetic in the item relating to the fracture n items 6675 to 6897 plus three-quarters of that amount

466

Administration of an anaesthetic in connection with each reduction in a series of two or more reductions of a fracture which is a fracture referred to in items 6675 to 6926             

 

 

The amount fixed for the administration of an anaesthetic in the item relating to the treatment of the fracture in items 6675 to 6926

469

Administration of an anaesthetic in connection with the treatment of avulsion of an epiphysis of any part referred to in items 6675 to 6897             

 

The amount fixed for the administration of an anaesthetic in the item relating to the treatment of that part in items 6675 to 6897

 

Division 3—Dental Anaesthetics

 

503

Administration by a medical practitioner of an anaesthetic, other than an endotracheal anaesthetic, in connection with a dental operation (G)…             

4.30

504

Administration by a medical practitioner of an anaesthetic, other than an endotracheal anaesthetic, in connection with a dental operation (S)              .

5.40


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 3—Division 3—continued

$

507

Administration by a medical practitioner of an endotracheal anaesthetic for extraction of a tooth or teeth not being an extraction covered by items 511 and 512 (G)             

5.70

508

Administration by a medical practitioner of an endotracheal anaesthetic for extraction of a tooth or teeth not being an extraction covered by items 511 and 512 (S)             

7.00

511

Administration by a medical practitioner of an endotracheal anaesthetic for removal of a tooth or teeth requiring incision of soft tissue and removal of bone (G)             

9.70

512

Administration by a medical practitioner of an endotracheal anaesthetic for removal of a tooth or teeth requiring incision of soft tissue and removal of bone (S)             

12.00

515

Administration by a medical practitioner of an endotracheal anaesthetic for restorative dental work where the procedure is of not more than 30.onrmtes duration (G)             

6.80

516

Administration by a medical practitioner of an endotracheal anaesthetic for restorative dental work where the procedure is of not more than 30 minutes duration (S)             

8.60

519

Administration by a medical practitioner of an endotracheal anaesthetic for restorative dental work where the procedure is of more than 30 minutes duration (G)             

12.50

520

Administration by a medical practitioner of an endotracheal anaesthetic for restorative dental work where the procedure is of more than 30 minutes duration (S)             

15.00

 

Part 4—Regional Nerve or Field Block

 

530

Initial major regional or field block, including abdominal; brachial plexus; caudal; cervical plexus; epidural (peridural); paravertebral (thoracic or lumbar); pudendal; sacral; spinal             

7.80

532

Subsequent major regional or field block, including abdominal; brachial plexus; caudal; cervical plexus; epidural (peridural); paravertebral (thoracic or lumbar); pudendal; sacral; spinal             

5.40

534

Intravenous regional anaesthesia of limb by retrograde perfusion G).

5.70

536

Intravenous regional anaesthesia of limb by retrograde perfusion (S) 

7.00

 

Part 5—Assistance in Administration of an Anaesthetic

 

555

Assistance in the administration of an anaesthetic for which the sum of the basic Commonwealth benefit, the fund benefit and the specified excess is not less than $65.00             

12.00

 

Part 6Miscellaneous Procedures

 

 

Division 1

 

603

Blood pressure recording by intravascular cannula (AU 4).......

3.60

605

Hyperbaric oxygen therapy where the medical practitioner is not in the chamber 

7.90

607

Hyperbaric oxygen therapy where the medical practitioner is confined in the chamber 

12.50

609

Topical application of oxygen in hyperbaric chamber—as an independent procedure 

4.30

612

Administration of a general anaesthetic (including the administration of oxygen) during hyperbaric therapy where the medical practitioner is not confined in the chamber             

11.00

615

Administration of a general anaesthetic (including the administration of oxygen)during hyperbaric therapy where the medical practitioner is confined in the chamber             

16.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

 

$

 

Part 6—continued

 

 

Division 2

 

620

Echoencephalography or echography.....................

4.30

622

Ultrasonic cross-sectional echography, tridimensional..........

10.50

624

Electroencephalography, not covered by item 620, 622, 628 or 633 (AU 6) 

7.60

628

Electroencephalography, temporosphenoidal................

9.40

633

Electrocorticography................................

12.50

635

Electromyography—involving estimation of nerve conduction times or stimulating response recording 

5.40

637

Electromyography—involving sampling of muscle activity—each attendance at which procedure is performed 

4.30

 

Division 3

 

650

Haemodialysis in hospital (where prolonged and constant medical supervision for the duration of the dialysis is required) 

23.00

653

Haemodialysis in hospital (where intermittent medical supervision of the dialysis is required) 

11.00

655

Haemodialysis in hospital (stabilised maintenance dialysis for chronic renal failure where a separate account for an attendance is not rendered under Part 1)             

3.20

658

Haemodialysis in the patient’s home, using a Kiil or similar dialyser, including necessary attendances and provision of disposable equipment—each week of treatment             

17.00

663

Haemodialysis in the patient’s home, using a hollow fibre dialyser, including necessary attendances and provision of disposable equipment—each week of treatment             

31.00

666

Indwelling peritoneal catheter (Tenckhoff or similar) for dialysis— insertion and fixation of 

12.50

669

Dialysis, peritoneal.................................

7.60

671

Bladder washout test for localisation of urinary infection not including bacterial counts for organisms in specimens 

4.00

 

Division 4

 

675

Tonography—in the investigation or management of glaucoma....

3.60

678

Provocative test or tests for glaucoma, including water drinking...

2.20

683

Electroretinography................................

6.10

686

Optic Fundi, examination of following intravenous dye injection...

3.80

690

Retinal photography, multiple exposures, with intravenous dye injection 

7.90

 

Division 5

 

700

Audiogram, air conduction............................

1.40

706

Audiogram, air and bone conduction.....................

2.00

718

Audiogram, air and bone conduction and speech..............

2.80

722

Audiogram, air and bone conduction and speech, with other cochlear tests 

3.20

726

Caloric test of labyrinth or labyrinths.....................

2.30

732

Electronystagmography..............................

2.30


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 6continued

$

 

Division 6

 

735

Electroconvulsive therapy—each attendance at which treatment is given 

2.70

740

Group psychotherapy (including associated consultations) of not less than one hours duration given under the continuous direct supervision. of a consultant physician psychiatrist in the practice of his specialty, a group of 2–9 patients each of whom is referred to the consultant psychiatrist by a medical practitioner—each patient             

2.70

743

Professional attendance by a consultant physician psychiatrist in the practice of his specialty where the patient is referred to him by a medical practitioner involving an interview of a person other than the patient of not less than 20 minutes duration in the course of initial diagnostic evaluation of the patient where that interview is at consulting rooms, hospital or nursing home             

2.90

745

Professional attendance by a consultant physician psychiatrist in the practice of his specialty where the patient is referred to hint by a medical practitioner involving an interview of a person other than the patient of not less than 45 minutes duration in the course of initial diagnostic evaluation of the patient where that interview is at consulting rooms, hospital or nursing home             

6.50

 

Division 7

 

750

Umbilical vein catheterisation with or without infusion.........

2.70

758

Umbilical artery catheterisation with or without infusion........

4.30

762

Scalp vein catheterisation with or without infusion

2.70

765

Blood transfusion with venesection and complete replacement of blood, including collection from donor 

20.00

768

Blood transfusion with venesection and complete replacement of blood, using blood already collected 

16.00

773

Blood for pathology test, collection of, by femora! or external jugular vein puncture in infants 

1.30

 

Division 8

 

775

Electrocardiography, phonocardiography, stethography or ballisto-cardiography 

2.70

778

Restoration of cardiac rhythm by electrical stimulation, other than in the course of cardiac surgery (AU 4) 

4.30

785

Bronchospirometry, including gas analysis.................

9.50

788

Estimation of respiratory function by spirometer or other simple techniques—each attendance at which one or more tests are performed             

2.20

792

Estimation of respiratory function requiring complicated techniques— each attendance at which one or more tests are performed 

7.90

795

Perfusion of limb or organ using heart-lung machine or equivalent..

27.00

798

Whole body perfusion, cardiac by-pass, using heart-lung machine or equivalent 

40.00

802

Induced controlled hypothermia—total body................

6.10

805

Fluids, intravenous infusion of—percutaneous...............

1.80

808

Fluids, intravenous infusion of—by open exposure............

3.10

811

Intravenous infusion or injection of a substance incorporating a cytotoxic agent 

3.10


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth

benefit

 

Part 6—Division 8—continued

$

813

Intraarterial infusion or injection of a substance incorporating a cytotoxic agent, preparation for 

4.50

817

Intralymphatic infusion or injection of a fluid containing a cytotoxic agent, with or without the incorporation of an opaque medium             

7.60

820

Intralymphatic insertion of needle or cannula for the introduction of radio-active material 

7.60

823

Blood transfusion, including collection from donor............

6.80

826

Blood transfusion, using blood already collected..............

4.30

830

Intrauterine foetal blood transfusion using blood already collected, including necessary amniocentesis 

13.50

834

Blood for purposes of transfusion, collection of..............

2.70

837

Blood dye—dilution indicator test.......................

6.50

842

Venesection, not covered by item 765 or 768—each attendance at which venesection is performed 

0.90

848

Blood for pathology test, collection of, by arterial puncture.......

1.10

852

Collection of specimen of sweat by iontophoresis.............

1.80

855

Hormone or living tissue implantation—by incision...........

2.80

858

Hormone or living tissue implantation—by cannula...........

1.70

862

Oesophageal motility test, manometric....................

5.20

869

Gastric hypothermia by closed circuit circulation of refrigerant in the absence of gastrointestinal haemorrhage 

10.50

873

Gastric hypothermia by closed circuit circulation of refrigerant for upper gastrointestinal haemorrhage 

22.00

876

Gastric lavage in the treatment of ingested poison.............

3.10

 

Part 7—Pathology Services

 

 

Division 1—Blood Haematology—Erythrocytes

 

1000

Blood film, examination of............................

1.00

1002

Blood film, examination by special stains to demonstrate; basophilic stippling, foetai haemoglobin, haemoglobin H, Heinz bodies, reticulocytes, siderocytes or similar             

1.00

1004

Malarial or other parasites, examination of blood for...........

1.50

1006

Sickling, examination of blood for.......................

1.30

1008

Haemoglobin estimation (where patient is referred by another medical practitioner for this service) 

1.00

1010

Haemoglobin estimation and examination of blood film.........

2.10

1012

Haemoglobin estimation and examination of blood film and blood grouping A, B, O and Rh 

4.50

1014

Haemoglobin estimation, leucocyte count, and differential leucocyte count 

3.60

1016

Haemoglobin estimation, haematocrit (packed cell volume) estimation, leucocyte count and differential leucocyte count 

3.90

1018

Haemoglobin estimation, haematocrit (packed cell volume) estimation, leucocyte count and differential leucocyte count, and erythrocyte sedimentation rate             

5.70

1019

Haemoglobin estimation, erythrocyte count, haematocrit (packed cell volume) estimation, leucocyte count; one or more of these estimations or counts, when performed on a single specimen of blood simultaneously or consecutively on an automated haematology system             

1.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth

benefit

 

Part 7—Division 1—continued

$

1020

Haemogoblin estimation, blood grouping, A, B, O and Rh, indirect Coombs’ test, total bilirubin and compatability testing 

12.30

1022

Erythrocyte count..................................

1.00

1024

Erythrocyte sedimentation rate (where patient is referred by another medical practitioner for this service) 

1.00

1026

Haematocrit (packed cell volume) estimation................

1.00

1028

Erythrocyte fragility test, to hypotonic saline................

3.80

1030

Erythrocyte fragility test, mechanical fragility...............

3.90

1032

Erythrocyte, autohaemolysis test........................

3.80

1034

Erythrocytes, estimation of mean cell diameter...............

2.10

1036

Erythrocytes, tests for enzymes, acid phosphatase or similar, each enzyme

3.30

1038

Erythrocytes, estimation of glutathione....................

3.90

1040

Erythrocytes, glutathione stability test....................

3.90

1042

Erythrocytes, glucose-6-phosphate dehydrogenase, pyruvate kinase deficiency, or similar, screening test 

3.30

1044

Erythrocytes, glucose-6-phosphate dehydrogenase, pyruvate kinase deficiency, or similar, quantitative estimation 

4.50

1046

Erythrocytes, test for paroxysmal nocturnal haemoglobinuria— screening test (sucrose water test)

1.80

1048

Erythrocytes, test for paroxysmal nocturnal haemoglobinuria—acid haemolysin test 

6.90

1050

Erythrocytes, folate estimation of.......................

4.50

1054

Erythrocytes, direct Coombs’ test.......................

1.50

 

Haematology—Leucocytes

 

1060

Leucocyte count...................................

1.00

1062

Leucocyte count and differentia count....................

2.10

1063

Differential leucocyte count...........................

0.80

1064

Eosinophil count, wet...............................

1.00

1066

Leucocyte agglutinins, detection of......................

2.70

1068

Lupus erythematosus cells, examination of blood film for........

3.00

1070

Cytological sex determination from blood film...............

2.70

1072

Leucocyte (neutrophil) alkaline phosphatase determination.......

3.30

1074

Leucocyte tests for phagocytic activity....................

11.40

1076

Blood film examination using special stains (PA-S., Sudan black or similar) for leucocytes 

1.30

 

Haematology—Platelets

 

1080

Platelet count.....................................

1.00

1082

Platelet agglutinin test...............................

2.70

1084

Platelet survival or life—radio-active technique..............

13.20

 

Haematology—Blood transfusion procedures

 

1090

Blood grouping, A, B, O and Rh (D antigen)................

2.10

1091

Blood grouping, Rh phenotyping, examination for C, D, E, c, e and other Rh phenotypes (five or more antigens) 

3.50

1092

Blood grouping, M, N or other, each system, not covered by item 1090 or 1091 

2.10


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 7—Division 1continued

$

1094

Compatability testing—for each bottle tested up to five bottles....

2.10

1096

Compatability testing—for each subsequent bottle tested in excess of five 

1.80

1098

Examination of serum for Rh or other blood group antibodies—screening test 

2.40

1100

Examination of serum for Rh or other blood group antibodies— quantitative estimation 

3.00

1102

Examination of serum for Rh or other blood group antibodies—screening and quantitative estimation 

4.50

1104

Coombs’ test-direct.................................

1.50

1106

Coombs’ test—indirect (if not part of Items 1094, 1096, 1098, 1100 or 1102) 

2.10

1108

Examination of serum for blood group haemolysins...........

3.00

 

Haematology—Haemostasis

 

1110

Antihaemophilic globulin, assay of, or other blood coagulation factor—quantitative 

7.20

1112

Bleeding time....................................

1.00

1114

Coagulation time (including qualitative clot retraction).........

1.00

1116

Bleeding time, coagulation time (including qualitative clot retraction), prothrombin estimation and platelet count 

6.90

1118

Clot retraction, quantitative...........................

2.10

1120

Euglobulin lysis time, or similar........................

5.70

1122

Fibrinogen estimation...............................

3.30

1124

Fibrinogen titre, determination of.......................

2.10

1126

Kaolin clotting time................................

2.70

1128

Platelet count.....................................

1.00

1130

Platelet adhesion test................................

3.90

1132

Platelet aggregation test, qualitative......................

2.10

1134

Platelet aggregation test, quantitative.....................

3.90

1136

Platelet factor III availability..........................

5.70

1138

Prothrombin estimation..............................

2.10

1140

Prothrombin estimation—two stage......................

3.30

1142

Prothrombin consumption test..........................

3.60

1144

Recalcified plasma clotting time........................

2.10

1146

Thrombin clotting time..............................

2.10

1148

Thromboplastin generation screening test..................

3.30

1150

Thromboplastin generation test (full).....................

5.70

1152

Thrombin time; determination of (including test for presence of an inhibitor) 

3.30

1154

Thrombin time serial test for fibrinogenolysis...............

2.70

1156

Thromboplastin time (partial) with or without kaolin...........

2.70

 

Haematology—Miscellaneous procedures

 

1160

Blood culture.....................................

3.30

1162

Blood volume (dye method)...........................

3.90

1166

Vitamin B12, estimation of, in serum or plasma..............

4.50

1168

Marrow, examination of films made from aspirate............

4.50



Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 7—Division 1—continued

$

1170

Marrow examination—histopathological examination of aspirate or trephine 

5.10

1172

Marrow, examination or films or by special staining, e.g. iron, P.A.S., peroxidase, Sudan black or similar 

1.30

1174

Spectroscopic examination of blood......................

2.10

1178

Assay of concentration of antibiotic or chemotherapeutic agents in serum or plasma 

2.70

 

HaematologySerology

 

1180

Agglutination tests, including agglutination tests for enteric fever, Brucella infection, one antigen 

2.10

1182

Agglutination tests, including agglutination tests for enteric fever, Brucella infection, more than one antigen, each additional antigen             

1.00

1184

Antistreptolysin titre, determination of....................

3.30

1186

Cold agglutinins, qualitative test........................

1.00

1188

Cold agglutinins, quantitative test.......................

2.10

1190

Complement, estimation of, in serum.....................

3.30

1192

Complement fixation tests for the diagnosis of gonorrhoea, hydatid infestation, or similar, each antigen 

3.30

1194

Complement fixation tests for the diagnosis of toxoplasmosis.....

3.30

1196

Complement fixation tests to detect antibodies to other bacterial, viral, fungal or parasitic infection not covered by any other item in this Part             

3.30

1198

Haemagglutination or haemagglutination-inhibition test for the diagnosis of a virus infection 

3.30

1200

Latex flocculation test, or similar test, for rheumatoid arthritis or other conditions—each test 

1.50

1202

Methylene blue dye test for toxoplasmosis..................

3.60

1204

Paul Bunnell test—screening..........................

2.10

1206

Paul Bunnell test—titre with absorptions...................

3.90

1208

Rose Waaler test..................................

3.30

1210

Syphilis, complement fixation tests for the diagnosis of, one antigen 

3.30

1212

Syphilis, complement fixation tests for the diagnosis of, two antigens 

4.50

1214

Syphilis, flocculation test for, Kahn, Kline, VDRL or similar, one antigen 

1.00

1216

Syphilis, flocculation test for, Kahn, Kline, VDRL or similar, two antigens 

2.40

1218

Syphilis, fluorescent antibody test for.....................

4.50

 

HaematologyChemistry

 

1220

Alcohol, estimation of...............................

6.00

1222

Amino acids, total estimation of........................

6.00

1224

Amino acid pattern, qualitative (chromatography or high voltage electrophoresis), estimation of 

10.20

1226

Amino acid pattern, quantitative (ion exchange, gas liquid chromatography), estimation of 

13.20

1228

Ammonia, estimation of..............................

4.50

1230

Barbiturates, quantitative estimation of....................

6.00

1232

Bicarbonate (CO2 combining power, alkali-reserve), estimation of..

3.30

1240

Carboxyhaemoglobin (carbon monoxide), qualitative estimation of.

2.10

1242

Carboxyhaemoglobin (carbon monoxide), quantitative estimation of 

3.90

1246

Cortisol, corticosteroids or similar, estimation of.............

6.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 7—Division 1continued

$

1248

Cryoglobulins—qualitative estimation of..................

1.50

1250

Electrolytes—estimation of one substance..................

3.30

1252

Electrolytes—estimation of two substances.................

5.70

1254

Electrolytes—estimation of three substances................

7.80

1256

Electrolytes—estimation of four substances.................

10.20

1258

Electrolytes—estimation of five substances.................

12.60

1260

Electrophoretic determination of serum or plasma for lipoprotein, protein, abnormal haemoglobin, haptoglobin, or other unspecified fractions, qualitative, each determination             

3.30

1262

Electrophoretic determination of serum or plasma for lipoprotein, protein, abnormal haemoglobin, haptoglobin, or other unspecified fractions, quantitative, each determination             

5.10

1264

Enzymes (whole blood, serum or plasma), one estimation.......

3.30

1266

Enzymes (whole blood, serum or plasma), two estimations.......

5.70

1268

Enzymes (whole blood, serum or plasma), three estimations......

7.80

1270

Enzymes (whole blood, serum or plasma), four or more estimations.

10.20

1272

Folic acid, estimation of..............................

4.50

1274

Gas analysis including oxygen capacity, oxygen saturation and partial carbon dioxide (PCO2) 

13.20

1277

Chemical analysis of blood or serum, one or more tests performed simultaneously or consecutively on a single specimen on one or more multi-channel analyser systems             

2.10

1278

Chemical tests, quantitative, of albumin, bromide, cholesterol, creatinine, globulin, glucose, phosphorus, salicylates, sulphonamides, total protein, urea, urea nitrogen, uric acid or similar substance, not covered by any other item, estimation of one substance, other than by reagent stick, strip, tablet or similar             

3.30

1280

Two estimations of any substance or substances referred to in the last preceding item 

5.70

1282

Three estimations of any substance or substances referred to in Item 1278 

7.80

1284

Four estimations of any substance or substances referred to in Item 1278 

10.20

1286

Five or more estimations of any substance or substances referred to in Item 3278 

12.60

1288

Hydrogen ion concentration (pH), estimation of..............

4.50

1290

Insulin tolerance test................................

6.90

1294

Iron, estimation of.................................

3.30

1296

Iron-binding capacity, estimation of......................

2.10

1298

Iron and iron-binding capacity, estimation of................

5.70

1301

Liver function test (bilirubin, total; bilirubin, direct and indirect; enzymes; alkaline phosphatase, transaminase or similar; turbidity; or other liver function test not covered by any other item), any one test             

3.30

1302

Two of any test or tests referred to in the last preceding item......

5.70

1304

Three of any test or tests referred to in item 1301.............

7.80

1305

Four of any test or tests referred to in Item 1301..............

10.20

1307

Five or more of any test or tests referred to in Item 1301........

12.60

1310

Other unspecified liver function test not covered by any other item.

3.30

1313

Methaemalbumin, qualitative test for.....................

2.10


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 7—Division. 1—continued

$

1314

Phenylketonuria, bacterial inhibition assay for (Guthrie test), when performed as an isolated procedure on specimens from one patient only             

0.70

1317

Phenylketonuria, bacterial inhibition assay for (Guthrie test), when performed simultaneously on specimens from more than one patient —test for each patient             

0.30

1319

Protein bound iodine, estimation of......................

5.40

1322

Proteins, chemical estimation of, total (copper sulphate method)...

1.50

1325

Protamine sulphate titration...........................

1.30

1328

Spectroscopic examination for pigments...................

2.10

1331

Thyroxine, estimation of.............................

6.00

1334

Triglycerides, phospholipids, total lipids, estimation of each substance 

3.90

1337

Estimation of any two substances referred to in the last preceding item 

6.30

1340

Estimation of any three or more substances referred to in Item 1334.

9.00

1343

Triglycerides, phospholipids, total lipids, estimation of one substance and estimation of cholesterol 

6.30

1346

Thyroxine, tri-iodothyronine or digoxin, free plasma estimation of..

10.20

1349

Trace elements (copper, lead, mercury, zinc or other unspecified trace elements), estimation of 

4.20

1352

Vitamin A or carotenoids, estimation of...................

4.50

J355

Vitamin B12, estimation of............................

4.50

1358

Assay of concentration of antibiotic or chemotherapeutic agent....

2.70

 

Division 2—Urine

 

 

Urine—Bacteriology

 

1380

Microscopical examination of urine concentrate (where patient is referred by another medical practitioner for this service) 

1.00

1382

Microscopical examination of urine concentrate and general examination for three or more of: reaction, specific gravity, blood, albumin, urobilinogen, sugar, acetone, bile pigments (where patient is referred by another medical practitioner for this service)             

1.50

1385

Microscopical examination of urine concentrate and general examination for three or more of: reaction, specific gravity, blood, albumin, urobilinogen, sugar, acetone, bile pigments; and cultural examination of urine specimen for isolation and identification of organisms             

3.30

1388

Microscopical examination of urine concentrate and general examination for three or more of: reaction, specific gravity, blood, albumin  urobilinogen, sugar, acetone, bile pigments; cultural examination of urine specimen; and antibiotic sensitivity testing of urine organisms, up to eight antibiotics             

5.70

1389

Microscopical examination, of urine concentrate and general examination for three or more of: reaction, specific gravity, blood, albumin, urobilinogen, sugar, acetone, bile pigments; cultural examination of urine specimen; and antibiotic sensitivity test of urine organism (each organism), for nine or more antibiotics             

7.20

1391

Microscopical examination of urine concentrate and general examination for three or more of: reaction, specific gravity, blood, albumin, urobilinogen, sugar, acetone, bile pigments; bacterial count for organisms in urine (colony count), simplified technique; and cultural examination of urine specimen for isolation and identification of organisms             

4.50


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 7—Division 2continued

$

1392

Microscopical examination of urine concentrate and general examination for three or more of: reaction, specific gravity, blood, albumin, urobilinogen, sugar, acetone, bile pigments; bacterial count for organisms in urine (colony count), simplified technique; cultural examination of urine specimen; and antibiotic sensitivity test of urine organisms, up to eight antibiotics             

7.20

1394

Microscopical examination of urine concentrate and general examination for three or more of; reaction, specific gravity, blood, albumin, urobilinogen, sugar, acetone, bile pigments; bacterial count for organisms in urine (colony count), simplified technique; cultural examination of urine specimen; and antibiotic sensitivity test of urine organisms, for nine or more antibiotics             

9.00

1395

Microscopical examination of urine concentrate by special stain—Ziehl Neelsen or similar 

1.30

1397

Microscopical examination of urine concentrate by special stain—Ziehl Neelsen or similar, and cultural, examination of urine specimen for special pathogens, such as M. tuberculosis             

3.30

1399

Bacterial count for organisms in urine (colony count), simplified technique 

1.00

1401

Bacterial count for organisms in urine (colony count), poured plate technique 

2.10

1404

Cultural examination of urine specimen, for isolation and identification of organisms 

1.50

1407

Microscopical examination of urine concentrate and cultural examination of urine specimen, for isolation and identification of organisms             

3.30

1410

Cultural examination of urine specimen for special pathogens, such as M. tuberculosis 

2.10

1413

Antibiotic sensitivity of urine organism (each organism) up to eight antibiotics 

2.10

1416

Antibiotic sensitivity of urine organism (each organism) nine or more antibiotics 

3.90

1419

Sensitivity testing of mycobacteria, each antibiotic............

2.10

1423

Sensitivity testing—tube dilution, each antibiotic.............

2.70

1423

Assay of concentration of antibiotic or chemotherapeutic agents in urine 

2.70

1425

Examination by animal inoculation......................

4.50

1428

Addis count or quantitative estimation of sediments...........

2.70

 

Urine—Chemistry

 

1430

Alcohol, quantitative estimations of......................

6.00

1432

Aldosterone, estimation of............................

13.20

1434

Amino acid, total estimation of.........................

3.30

1436

Amino acids, identification of, screening tests, by chromatography.

3.90

1438

Amino acids, identification of, qualitative pattern (high voltage electrophoresis or chromatography) 

13.20

1441

Amino-levulinic acid, estimation of......................

4.30

1444

Ascorbic acid, estimation of...........................

3.30

1447

Barbiturates, estimation of, quantitative...................

6.00

1450

Catecholamines or similar, estimation of...................

5.10

1453

Chromatography of urine for separation and identification of sugars and other substances of diagnostic significance other than amino acids             

3.30


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 7—Division 2continued

$

1456

Electrophoresis of urinary protein, qualitative...............

4.50

1459

Chemical tests, quantitative, not covered by any other item (calcium, phosphorus, protein, sugar, urea, enzymes, uric acid or similar substance), one estimation, other than by reagent stick, strip, tablet or similar             

3.30

1461

Two estimations of any substance or substances referred to in the last preceding item 

5.70

1463

Three estimations of any substance or substances referred to in Item 3459 

7.80

1466

Four or more estimations of any substance or substances referred to in Item 1459 

10.20

1468

Chorionic gonadotrophins (for diagnosis of pregnancy) using immunochemical methods 

1.50

1470

Chorionic gonadotrophins (for diagnosis of pregnancy) using animals

3.30

1472

Chorionic gonadotrophins, quantitative estimation of...........

4.50

1474

Pituitary gonadotrophins, quantitative estimation of...........

13.20

1475

Quantitative estimation of luteinizing hormone using immunochemical methods 

10.00

1476

Hydroxycorticosteroids, estimation of....................

4.8U

1478

Hydroxyindole-acetic acid, quantitative estimation of..........

4.20

1481

Lead, thallium, mercury or arsenic, estimation of.............

4.20

1484

Oestrogens, total, estimation of.........................

10.20

1487

Oxosteroids, estimation of............................

4.80

1490

Oxogenic steroids, estimation of........................

4.80

1491

Porphyrins, qualitative examination, other than by reagent stick, strip, tablet or similar 

1.50

1493

Porphyrins, quantitative examination, each substance..........

10.20

1494

Quantitative estimation of pregnanediol, pregnanetriol or similar substances 

13.20

1495

Qualitative estimation of substances in urine (Bence-Jones protein, hydroxyindole-acetic acid, indican, melanogen, porphobilinogen or other similar substances not covered by any other item), each substance, other than by reagent stick, strip, tablet or similar (where patient is referred by another medical practitioner for this service)             

1.30

1496

Spectroscopic examination for pigments...................

2.10

1497

Vanilmandelic acid, estimation of.......................

5.10

 

Urine—Cytology

 

1499

Cytotogical examination for malignancy...................

4.50

 

Division 3—Body fluids.............................

 

Exudates including pus, sputum, sweat and amniotic, ascitic, cerebrospinal, pleural, prostatic, seminal, synovial and vaginal fluids. Body fluids—Bacteriology and parasitology

1500

Microscopical examination—wet film....................

1.00

1502

Microscopical examination—gram stain or similar............

1.00

1504

Microscopical examination, by special stains, e.g. Ziehl Neelsen or similar 

1.00

1506

Microscopical examination by dark ground illumination or phase contrast 

2.70


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 7—Division 3—continued

$

1508

Cultural examination for, and identification of aerobic micro-organisms 

2.00

1511

Cultural examination for, and identification of anaerobic micro-organisms 

2.10

1513

Cultural examination for special pathogens, such as M. tuberculosis, fungi, etc. 

2.10

1515

Microscopical examination, gram stain or similar and cultural examination for and identification of aerobic micro-organisms 

3.60

1517

Microscopical examination, gram stain or similar; and cultural examination for and identification of aerobic micro-organisms; and microscopical examination, by special stains, e.g. Ziehl Neelsen or similar             

4.80

1519

Microscopical examination, gram stain or similar; cultural examination for and identification of aerobic micro-organisms; and sensitivity testing of up to eight antibiotics             

6.00

1521

Microscopical examination, gram stain or similar; cultural examination for and identification of aerobic micro-organisms; sensitivity testing of up to eight antibiotics; and microscopical examination, by special stains, e.g. Ziehl Neelsen or similar             

7.50

1523

Microscopical examination, gram stain or similar; cultural examination for and identification of aerobic micro-organisms; and sensitivity testing of nine or more antibiotics             

7.50

1525

Microscopical examination by special stains, e.g. Ziehl Neelsen or similar; and cultural examination for special pathogens, such as M. tuberculosis, fungi, etc.             

3.60

1527

Examination by animal inoculation......................

4.50

1529

Autogenous vaccines, preparation of, for a single organism......

2.70

1531

Autogenous vaccines, preparation of, for multiple organisms.....

5.10

1534

Sensitivity testing—up to eight antibiotics..................

2.10

1537

Sensitivity testing—nine or more antibiotics................

3.90

1539

Sensitivity testing—tube dilution, each antibiotic.............

2.70

1541

Sensitivity testing of mycobacteria, each antibiotic............

2.10

1543

Assay of concentration of antibiotic or chemotherapeutic agents in body fluids 

2.70

 

Body fluidsVaginal and prostatic fluids

 

1545

Microscopical examination—wet film....................

1.00

1546

Microscopical examination, wet film; microscopical examination gram stain or similar; cultural examination for and identification of aerobic micro-organisms             

4.50

1548

Microscopical examination, wet film; microscopical examination gram stain or similar; cultural examination for and identification of aerobic micro-organisms; and sensitivity testing of up to eight antibiotics             

7.20

 

Body fluidsCerebrospinal fluid

 

1551

Cell count and differential; and quantitative chemical estimation of one substance 

4.50

1554

Cell count and differential; quantitative chemical estimation of one substance; and Lange colloidal gold reaction 

8.10

1557

Cell count and differential; quantitative chemical estimation of one substance; Lange colloidal gold reaction; and complement fixation test for syphilis             

12.00

1560

Cell count and differential; quantitative chemical estimation of one substance; and complement fixation test for syphilis 

8.10


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 7—Division 3—continued

$

1562

Cell count and differential; and quantitative chemical estimation of two substances 

7.20

1564

Cell count and differential; quantitative chemical estimation of two substances; and Lange colloidal gold reaction 

11.10

1566

Cell count and differential; and quantitative chemical estimation of three substances 

9.60

1568

Cell count and differential; quantitative chemical estimation of three substances; and Lange colloidal gold reaction 

13.50

 

Body fluidsSeminal fluid

 

1571

Cell count; microscopical examination, wet film; and microscopical examination, gram stain or similar 

4.20

 

Body fluidsSerological examination

 

1580

Serological procedures, not covered by any other item, to identify organisms 

2.10

1582

Rh or similar blood group antibodies, qualitative examination for..

2.40

1584

Rh or similar blood group antibodies, screening and quantitative examination for 

4.50

1586

Flocculation tests for syphilis, rheumatoid factor or similar.......

1.50

1588

Syphilis, complement fixation tests for....................

3.30

1590

Complement, estimation of............................

3.30

 

Body fluidsChemistry

 

1601

Quantitative chemical estimation of one substance............

3.30

1604

Quantitative chemical estimation of two substances............

5.70

1607

Quantitative chemical estimation of three substances...........

7.80

1609

Quantitative chemical estimation of four or more substances......

10.20

1611

Lange colloidal gold reaction..........................

3.00

1613

Amniotic fluid, spectroscopic examination of................

4.20

1615

Electrophoresis of protein or enzyme, qualitative.............

4.50

 

Body fluidsCytology

 

1616

Cytological examination for malignancy...................

4.50

 

Body fluidsMiscellaneous

 

1621

Cell count and differential............................

1.30

1622

Microscopical examination of wet film....................

1.00

1623

Assay of concentration of antibiotic or chemotherapeutic agent....

2.70

1625

Sweat plate test...................................

1.60

1627

Huhner’s test.....................................

3.30

1629

Milk, human, chemical analysis of.......................

2.70

1631

Calculi (gall stones, urinary calculi and other body concretions) chemical examination of 

2.10


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 7—continued

$

 

Division 4—Immunology

 

1640

Immunoelectrophoresis of serum, cerebrospinal fluid, urine or other body fluids—qualitative 

6.90

1643

Immunodiffusion for the detection of proteins in serum, cerebrospinal fluid, urine or other body fluids—quantitative—each protein             

3.60

1645

Radio-immunodifusion determination of protein in serum, cerebrospinal fluid, urine or other body fluids—quantitative—each protein             

3.60

1647

Radio immune precipitation of globulins...................

13.20

1649

Lymphocyte (function studies) response to phytohaemagglutinin or antigen, visual transformation 

9.00

1651

Lymphocyte (function studies) response to phytohaemagglutinin or antigen—using radio-active techniques, estimation of 

13.20

1653

Skin sensitivity—induction and detection of sensitivity to chemical antigens 

4.50

 

Immunology—Tissue antibody detection

 

1661

Flocculation tests, e.g. latex—each antibody................

1.50

1664

Agglutination immobilisation test.......................

7.20

1667

Tanned erythrocyte haemagglutination technique—each antibody..

3.30

1670

Complement fixation tests involving human tissue antibody—each antibody 

3.30

1673

Imunofluorescent detection of tissue antibody—each antibody....

4.50

 

Division 5—Faeces

 

 

Faeces—Bacteriology and parasitology

 

1680

Microscopical examination of wet preparation...............

1.00

1682

Microscopical examination with simple staining..............

1.00

1684

Microscopical examination with special staining (iron haematoxylin, trichrome or similar) 

1.30

1686

Microscopical examination for parasites or ova after concentration techniques 

1.60

1688

Identification of helminths............................

2.10

1691

Cultural examination for parasites.......................

2.10

1694

Cultural examination for isolation of micro-organisms, using selective media 

2.70

1697

Microscopical examination of wet preparation; and cultural examination for isolation of micro-organisms, using selective media 

4.20

1698

Microscopical examination of wet preparation; microscopical examination for parasites or ova after concentration techniques; and cultural examination for isolation of micro-organisms, using selective media             

5.70

1700

Special cultural examination, for identification of intestinal pathogenic micro-organisms, using biochemical reactions 

2.10

1701

Microscopical examination of wet preparation; microscopical examination for parasites or ova after concentration techniques; cultural examination for isolation of micro-organisms using selective media; and special cultural examination for identification of intestinal pathogenic micro-organisms using biochemical reactions             

8.40

1703

Identification of intestinal pathogenic micro-organisms by specific serological techniques 

2.10

1706

Sensitivity testing (each organism) using up to eight antibiotics....

2.10

1707

Sensitivity testing (each organism) using nine or more antibiotics..

3.90


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 7—Division 5—continued

$

 

FaecesChemistry

 

1710

Bilirubin, qualitative test other than by reagent stick, strip, tablet or similar 

1.00

1712

Chloride, estimation of..............................

3.30

1714

Calcium, estimation of...............................

3.30

1736

Enzyme assay for amylase, trypsin, mucinase or similar enzyme, qualitative, each substance 

1.30

1718

Fat, total, quantitative estimation of, one estimation...........

4.50

1720

Fat, total, quantitative estimation of, two estimations...........

9.00

1722

Fat, total, quantitative estimation of, three or more estimations....

14.40

1724

Fat, differential, quantitative estimation of, one estimation.......

2.10

1726

Fat, differential, quantitative estimation of, two estimations......

4.50

1728

Fat, differential, quantitative estimation of, three or more estimations

7.20

1730

Nitrogen, total, estimation of..........................

4.50

1732

Occult blood, chemical tests for, other than by reagent stick, strip, tablet Of similar 

1.00

1734

Porphyrins, qualitative estimation of, other than by reagent stick, strip, tablet or similar 

1.50

1736

Porphyrins, quantitative estimation of (each substance).........

10.20

1738

Reducing substances, qualitative test other than by reagent stick, strip, tablet or similar 

1.30

1741

Phosphorus, estimation of............................

3.30

1744

Urobilin, urobilinogen, qualitative estimation of, other than by reagent stick, strip, tablet or similar 

1.30

1746

Urobilinogen, quantitative estimation of, other than by reagent stick, strip, tablet or similar 

3.30

1748

Chemical estimation, quantitative, of any one substance not specified elsewhere, other than by reagent stick, strip, tablet or similar 

3.30

 

Division 6—Skin, Hair, Nails

 

1761

Microscopical examination for fungi.....................

1.80

1764

Microscopical and cultural examination for fungi.............

3.30

1767

Chemical examination (qualitative)—each substance...........

1.30

1770

Chemical examination (quantitative)—each substance..........

3.30

1773

Skin sensitivity testing for allergens, using one to twenty allergens..

3.90

1776

Skin sensitivity testing for allergens, using more than twenty allergens 

5.70

1779

Skin sensitivity testing for hydatid disease (Casoni test).........

1.50

1782

Skin sensitivity testing for myco-bacterial infection (Mantoux, Von Pirquet, Vollmer or similar test) 

1.50

1785

Skin sensitivity testing for diagnosis of disease not otherwise listed (Schick test, Frei test, Schultz-Charlton test, etc.) 

1.50

 

Division 7—Gastric and Duodenal Contents

 

 

Gastric and Duodenal Contents—Bacteriology

 

1790

Microscopical examination for myco-bacteria including collection of gastric contents 

2.10

1792

Cultural examination for mycobacteria....................

2.10

1794

Microscopical examination for mycobacteria including collection of gastric contents and cultural examination for mycobacteria 

4.50

1796

Animal inoculation.................................

4.50

1798

Sensitivity testing for mycobacteria—each antibiotic...........

2.10


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 7—Division 7—continued

$

 

Gastric and duodenal contents—Chemistry

 

1800

Qualitative tests for barbiturate, blood, alcohol, metallic poison or similar substances—each substance 

1.60

1802

Quantitative determination of acidity, single or multiple specimens, including collection (fractional test meal) 

4.80

1804

Collection of gastric juice specimens after stimulation by histamine, synthetic gastrin, alcohol or similar substance and quantitative determination of acidity             

7.20

1806

Quantitative determination of bicarbonate—single determination...

3.30

1808

Quantitative determination of bicarbonate—more than one determination 

7.20

1810

Quantitative determination of other substances—each substance...

3.30

1812

Stomach acid secretion test by ingestion of dye..............

3.30

 

Division 8—Morbid anatomy

 

1820

Histopathological examination of biopsy material when one or two pieces of tissue are separately identified, processed and examined             

5.70

1822

Histopathological examination of biopsy material when three or four pieces of tissue are separately identified, processed and examined             

9.00

1824

Histopathological examination of biopsy material when five or more pieces of tissue are separately identified, processed and examined             

12.60

1826

Immediate frozen section diagnosis and histopathological examination of biopsy material when one or two pieces of tissue are separately identified, processed and examined             

12.60

1828

Immediate frozen section diagnosis and histopathological examination of biopsy material when three or more pieces of tissue are separately identified, processed and examined             

15.60

 

Division 9–Special investigations (includes collection of specimens, administration of drugs and all relevant chemical determinations)             

 

1840

ACTH stimulation procedure (including synacthen) using multiple plasma steroid estimation 

18.60

1841

ACTH stimulation procedure (including synacthen) using multiple urine steroid estimation 

24.00

1843

Adrenaline tolerance test.............................

6.90

1846

Arginine infusion test...............................

4.50

1849

Basal metabolic rate estimation.........................

4.50

1850

Bromsulphthalein retention test.........................

5.70

1852

Carbohydrate tolerance test (e.g. glucose, fructose, galactose, lactose, sucrose, or similar) not exceeding 2 hours 

5.70

1853

Bromsulphthalein infusion test of liver function..............

10.00

1855

Carbohydrate tolerance test (e.g. glucose, fructose, galactose, lactose, sucrose, or similar) exceeding 2 hours but not exceeding 3 hours             

7.20

1858

Carbohydrate tolerance test (e.g. glucose, fructose, galactose, lactose, sucrose, or similar) exceeding 3 hours 

9.00

1861

Congo red test....................................

6.30

1863

Creatinine clearance test.............................

7.20

1865

Dexamethazone suppression test........................

21.00

1867

Glucagon tolerance test..............................

6.90

1869

Histidine-loaded figlu test............................

5.70


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 7—Division 9continued

$

1871

Insulin clearance test................................

10.20

1873

Metyropone suppression test...........................

21.00

1875

Para amino hippuric clearance test.......................

7.20

1877

Phenolsulphonphthalein excretion test....................

7.20

1879

Tolbutamide tolerance test............................

6.90

1881

Urea clearance test.................................

5.40

1884

Urea concentration test..............................

4.50

1887

Urine acidification test (ammonium chloride or similar).........

4.50

1889

Vasopressin stimulation test...........................

18.60

1891

Water elimination or Mosenthal kidney function test...........

2.10

1893

Xylose absorption test...............................

5.10

1895

Maximum urine concentration test (osmolality)—not less than three estimates; free water clearance test; urate clearance test; acid load test; each test             

7.20

 

Division 10—Cytology

 

1896

Cytological examination of smears from cervix and vagina, skin or mucous membrane for pathological change 

3.30

1897

Examination of sputum, urine or body fluids including bronchial, cerebrospinal, pericardial, peritoneal, or similar for malignant cells             

4.50

1898

Examination of colonic or duodenal washings for malignant cells..

4.50

1899

Examination of blood for circulating malignant cells...........

7.20

1900

Oesophageal cytology including collection of specimen.........

6.00

1902

Gastric cytology including collection of specimen.............

9.00

1904

Hormonal assessment by cytological examination of vaginal epithelium 

2.70

1906

Cytological sex chromatin studies other than from blood film.....

3.00

 

Division 11—Chromosome studies

 

1908

Chromosome studies—including preparation, count and karyotyping of blood 

9.00

1910

Chromosome studies—including preparation, count and karyotyping of marrow or other tissue 

10.80

1912

Chromosome studies—including preparation, count and karyotyping of skin 

12.60

 

Division 12—Radioisotope studies

 

1914

Erythrocyte radioactive uptake survival time................

13.20

1916

Blood volume Cr51................................

4.50

1917

Radioiodine thyroid uptake............................

4.50

1918

Radioactive T3 test.................................

5.10

1919

Gastrointestinal blood loss estimation with radioactive chromium involving serial examinations of stool specimens 

10.00

1920

Radioiodine, urinary estimation.........................

3.30

1922

Protein bound radioactive iodine test.....................

4.50

1924

Hormonal immunoassay by radioactive techniques, each estimation.

4.50

1926

Radioactive B12 absorption test (Schilling test)..............

5.10

1927

Brain scan.......................................

15.50


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth

benefit

 

Part 7—Division 12continued

$

1929

Cisternal scan....................................

25.00

1931

Spinal cord scan...................................

10.00

1933

Parathyroid scan...................................

8.40

1935

Thyroid scan.....................................

6.30

1937

Mediastinal scan..................................

7.80

1939

Scan of lung or lungs...............................

16.00

1942

Scan of heart and liver...............................

15.50

1946

Heart scan.......................................

7.80

1952

Scan of liver and lungs..............................

29.00

1954

Liver scan.......................................

12.50

1960

Pancreas scan....................................

15.50

1962

Spleen scan......................................

8.40

1964

Renal scan......................................

10.00

!982

Scan of liver and spleen..............................

15.00

1984

Differential renal scan...............................

4.50

1986

Renal scan and differential renal scan.....................

15.00

1987

Placental scan....................................

14.00

1989

Scan of skull.....................................

9.00

1991

Scan of vertebral column and sacrum.....................

14.00

1993

Scan of pelvis....................................

14.00

1995

Scan of joint or long bone............................

9.00

1997

Scan of bone or bones not covered by any other item in this Division 

9.00

1998

Scan of region or organ not covered by any other item in this Division 

7.20

 

Part 8—Radiological services

 

 

Division 1—Radiographic examination of extremities and report (with or without fluoroscopy)

 

2002

Digits or phalanges—all or any of either hand or either foot (when the service is rendered otherwise than by a specialist in the practice of his specialty)             

4.10

2004

Digits or phalanges—all or any of either hand or either foot (when the service is rendered by a specialist in the practice of his specialty)             

4.40

2007

Hand, wrist, forearm, elbow or arm (elbow to shoulder) (when the service is rendered otherwise than by a specialist in the practice of his specialty)             

4.10

2009

Hand, wrist, forearm, elbow or arm (elbow to shoulder) (when the service is rendered by a specialist in the practice of his specialty)             

4.40

2025

Hand, wrist and lower forearm; upper forearm and elbow; or elbow and arm (elbow to shoulder) (when the service is rendered otherwise than by a specialist in the practice of his specialty)             

5.50

2029

Hand, wrist and lower forearm; upper forearm and elbow; or elbow and arm (elbow to shoulder) (when the service is rendered by a specialist in the practice of his specialty)             

6.50

2031

Foot, ankle, lower leg, upper leg, knee or thigh (femur) (when the service is rendered otherwise than by a specialist in the practice of his specialty)

4.10

2033

Foot, ankle, lower leg, upper leg, knee or thigh (femur) (when the service is rendered by a specialist in the practice of his specialty)             

4.90


Schedule 1—continued

Item No

Medical Service

Basic Commonwealth benefit

Part 8—Division 1—continued

$

2035

Foot, ankle and lower leg; or upper leg and knee (when the service is rendered otherwise than by a specialist in the practice of his specialty)             

6.00

2037

Foot, ankle and lower leg; or upper leg and knee (when the service is rendered by a specialist in the practice of his specialty) 

8.00

Division 2—Radiographic examination of shoulder or hip joint and report

2039

Shoulder region, including clavicle and scapula (when the service is rendered otherwise than by a specialist in the practice of his specialty)             

5.50

2046

Shoulder region, including clavicle and scapula (when the service is rendered by a specialist in the practice of his specialty) 

6.50

2050

Hip joint...........................................

5.50

2053

Pelvic girdle........................................

7.00

2056

Sacro-iliac joints.....................................

7.00

2058

Smith-Petersen nail—insertion or similar procedure..............

12.50

Division 3—Radiographic examination of head and report

2062

Skull (calvarium).....................................

7.00

2067

Sinuses............................................

5.50

2070

Mastoids...........................................

7.00

2074

Petrous temporal bones.................................

7.00

2077

Facial bones—orbit, maxilla or malar—any or all................

5.50

2079

Mandible..........................................

5.50

2082

Salivary calculus.....................................

5.50

2084

Nose.............................................

4.40

2086

Eye..............................................

4.40

2088

Temporo-mandibular joints..............................

6.00

2091

Teeth—single area....................................

3.90

2096

Teeth—full mouth....................................

10.00

2100

Palato-pharyngeal studies with fluoroscopic screening.............

7.50

2103

Palato-pharyngeal studies without fluoroscopic screening...........

6.00

2105

Larynx............................................

4.90

Division 4—Radiographic examination of spine and report

2107

Spine—cervical......................................

7.50

2109

Spine—thoracic......................................

6.50

2114

Spine—lumbo-sacral...................................

9.50

2117

Spine—sacro-coccygeal................................

5.50

2120

Spine— two regions...................................

12.00

2122

Spine—three or more regions.............................

16.50

2124

Spine—functional views of one area........................

2.10

Division 5—Bone age study and skeletal surveys

2126

Bone age study, wrist and knee............................

5.50

2129

Skeletal survey involving four or more regions..................

11.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 8—continued

$

Division 6—Radiographic examination of thoracic region and report

2131

Chest (lung fields) by direct radiography (when the service is rendered otherwise than by a specialist in the practice of his specialty)             

4.10

2134

Chest (lung fields) by direct radiography (when the service is rendered by a specialist in the practice of his specialty) 

4.90

2136

Chest (lung fields) by direct radiography with fluoroscopic screening

7.00

2143

Thoracic inlet or trachea................................

4.40

2147

Chest by miniature radiography...........................

2.30

2149

Cardiac examination (including barium, swallow) (whets the service is rendered otherwise than by a specialist in the practice of his specialty)             

6.00

2151

Cardiac examination (including barium swallow) (when the service is. rendered by a specialist in the practice of his specialty) 

7.00

2153

Sternum or one or more ribs of any one side (when the service is rendered otherwise than by a specialist in the practice of his specialty)              

4.10

2155

Sternum or one or more ribs of any one side (when the service is rendered by a specialist in the practice of his specialty) 

4.90

2157

One or more ribs of both sides (when the service is rendered otherwise than by a specialist in the practice of his specialty) 

5.50

2159

One or more ribs of both sides (when the service is rendered by a specialist in the practice of his specialty) 

6.50

Division 7—Radiographic examination of urinary tract and report

2162

Plain renal only......................................

4.90

2165

Drip-infusion pyelography ..............................

16.50

2167

Intravenous pyelography, including preliminary plain film..........

15.00

2171

Intravenous pyelography, including preliminary plain film with delayed examination for the cysto-ureteric reflex 

19.00

 

2175

Retrograde pyelography, including preliminary plain film..........

12. 00

2178

Retrograde cystography or retrograde urethrography..............

8.00

2182

Retrograde micturating cysto-urethrography...................

10.00

2586

Retro-peritoneal pneumogram............................

5.50

Division 8—Radiograph reexamination of alimentary tract and bilary system (with or without fluoroscopy) and report

2201

Plain abdominal only (when the service is rendered otherwise than by a specialist in the practice of his specialty) 

4.10

2206

Plain abdominal only (when the service is rendered by a specialist in the practice of his specialty) 

4. 50

2210

Pneumoperitoneum...................................

4.90

2212

Oesophagus, with or without examination for foreign body or barium swallow 

 

 

8.00

2216

Barium or other opaque meal of oesophagus, stomach and duodenum, with or without screening of chest 

11.00

2220

Barium or other opaque meal of oesophagus, stomach, duodenum and follow through to colon, with or without screening of chest 

13.50

2223

Barium or other opaque meal, small bowel series only............

10.00

2225

Opaque enema......................................

11.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 8—Division 8—continued

$

2228

Opaque enema, including air contrast study (two stages).........

13.50

2232

Graham’s test (cholecystography)........................

8.50

2236

Cholegraphy direct—operative or post-operative..............

8.50

2239

Cholegraphy—intravenous............................

13.50

2241

Cholegraphy—percutaneous transhepatic ..................

9.50

2243

Cholegraphy—drip infusion...........................

16.00

Division 9—Radiographic examination for localisation of foreign bodies and report

2245

Foreign body in eye (special method, Sweet’s or other)..........

8.00

2249

Foreign body, localisation of and report, not covered by any other item in this Part—the amount of Commonwealth benefit for radiographic               examination of the area and report, plus             

2.10

Division 10—Radiographic examination of breasts and report

2255

Radiographic examination of both breasts and report...........

10.00

2257

Radiographic examination of one breast and report............

5.50

Division 10—Radiographic examination in connection with pregnancy and report

2265

Pregnant uterus....................................

4.90

2267

Pelvimetry or placentography ,,.........................

11.00

2269

Control X-rays associated with intrauterine foetal blood transfusion.

8.00

Division 12—Radiographic examination with opaque or contrast media, and report

2272

Serial angiocardiography (rapid cassette changing) (AU 8).......

10.00

2275

Serial angiocardiography (single plane—direct roll-film method) (AU  8) 

13.50

2277

Serial angiocardiography (bi-plane—direct roll-film method) (AU 8) 

13.50

2279

Serial angiocardiography (indirect roll-film method) (AU 8}......

13.50

2281

Discography—one disc ..............................

8.00

2283

Dacryocystography—one side..........................

5.50

2285

Encephalography...................................

13.00

2287

Cerebral angiography—one side.........................

10.00

2289

Cerebral ventriculography.............................

11.00

2296

Hysterosalpingography...............................

8.00

2299

Bronchography—one side.............................

12.50

2302

Arteriography, peripheral—one side......................

12.50

2304

Phlebography—one side .............................

12.50

2306

Aortography......................................

12.50

2308

Splenography.....................................

12.50

2312

Myelography .....................................

15.00

2316

Selective arteriography per injection and film run.............

12.50

2319

Sialography—one side...............................

8.00

2323

Vasoepididymography—one side........................

8.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 8—Division 12—continued

$

2327

Sinuses and fistulae—the amount of Commonwealth benefit for radiographic examination of the area and report, plus 

2.30

1331

Laryngography with contrast media.........................

6.00

2335

Pneumarthrography...................................

4.60

2339

Arthrography—contrast ................................

6.00

2343

Arthrography—double contrast............................

10.50

2348

Lymphangiography, including follow up radiography.............

8.00

2352

Pneumomediastinum..................................

7.00

Division 13—Tomography and report

2365

Tomography, any part and report ..........................

7.00

Division 14—Stereoscopic examination and report

2400

Stereoscopic examination and report—the amount of Commonwealth benefit for radiographic examination of the area and report plus             

1.40

Division 15—Fluoroscopic examination and report

2425

Examination with general anaesthesia (AU 7)..................

4.90

2428

Examination without general anaesthesia.....................

3.40

Division 16—Radiotherapy

2450

Radiotherapy, superficial—each attendance in a course of treatment where the course involves three or more radiotherapy treatments per week at which fractionated treatment is given to one field only             

2.80

2453

Radiotherapy, superficial—each attendance in a course of treatment where the course involves three or more radiotherapy treatments per week at which fractionated treatment is given separately to each of two or more fields—the amount of the Commonwealth benefit under item 2450 plus an additional amount for each field separately treated in excess of one (up to a maximum of five additional fields) of             

0.30

2456

Radiotherapy, superficial—each attendance in a course of treatment where the course involves not more than two radiotherapy treatments per week at which fractionated treatment is given to one field only             

3.60

2461

Radiotherapy, superficial—each attendance in a course of treatment where the course involves not more than two radiotherapy treatments per week at which fractionated treatment is given separately to each of two or more fields—the amount of the Commonwealth benefit under item 2456 plus an additional amount for each field separately treated in excess of one (up to a maximum of five additional fields) of             

0.50

2466

Radiotherapy, superficial—attendance in relation to a condition for the treatment of which a single dose to one field only is given. 

7.50

2469

Radiotherapy, superficial—attendance in relation to a condition for the treatment of which only a single dose is given separately to each of two or more fields—the amount of the Commonwealth benefit under item 2466 plus an additional amount for each field separately treated in excess of one (up to a maximum of five additional fields) of              

1.40


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 8—Division 16—continued

$

2472

Radiotherapy, superficial—each attendance at which treatment is given to an eye  

4.10

2475

Radiotherapy, deep or orthovoltage—each attendance in a course of treatment where the course involves three or more radiotherapy treatments per week at which fractionated treatment is given to one field only             

3.60

2478

Radiotherapy, deep or orthovoltage—each attendance in a course of treatment where the course involves three or more radiotherapy treatments per week at which fractionated treatment is given separately to each of two or more fields—the amount of Commonwealth benefit under item 2475 plus an additional amount for each field separately treated in excess of one (up to a maximum of five additional fields) of             

0.50

2482

Radiotherapy, deep or orthovoltage—each attendance in a course of treatment where the course involves not more than two radiotherapy treatments per week at which fractionated treatment is given to one field only              

3.90

2485

Radiotherapy, deep or orthovoltage—each attendance in a course of treatment where the course involves not more than two radiotherapy treatments per week at which fractionated treatment is given separately to each of two or more fields—the amount of the commonwealth benefit under item 2482 plus art additional amount for each field separately treated m excess of one (up to a maximum of five additional fields) of             

0.70

2488

Radiotherapy, deep or orthovoltage—attendance in relation to a condition for the treatment of which a single dose to one field only is given, (not being an attendance covered by any other item in this Part)             

10.00

2490

Radiotherapy, deep or orthovoltage—attendance in relation to a condition for the treatment of which only a single dose is separately given to each of two or more fields (not being an attendance covered by any other item in this Part)—the amount of the Commonwealth benefit under item 2488 plus an additional amount for each field separately treated in excess of one (up to a maximum of five additional fields) of             

1.80

2492

Radiotherapy, megavoltage or teletherapy—each attendance in a course of treatment where the course involves three or mere radiotherapy  treatments per week at which fractionated treatment is given to one field only             

5.50

2494

Radiotherapy, megavoltage or teletherapy—each attendance in a course of treatment where the course involves three or mere radiotherapy treatments per week at which fractionated treatment is given separately to each of two or more fields— the amount of the Commonwealth benefit under item 2492 plus an additional amount for each field separately treated in excess of one (up to a maximum of five additional fields) of             

1.00

2497

Radiotherapy, megavoltage or teletherapy—each attendance in a course of treatment where the course invokes not more than two radiotherapy treatments per week at which fractionated treatment is given to one field only             

7.50

2501

Radiotherapy, megavoltage or teletherapy—each attendance in a course of treatment where the course involves not more than two radiotherapy treatments per week at which fractionated treatment is given separately to each of two or more fields—the amount of the Commonwealth benefit under item 2497 plus an additional amount for each field separately treated in excess of one (up to a maximum of five additional fields) of             

1.40

2504

Radiotherapy, megavoltage or teletherapy (not covered by any other item in this Part)—attendance in relation to a condition for the treatment of which a single dose to one field only is given             

13.50


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 8—Division 16—continued

$

2507

Radiotherapy, megavoltage or teletherapy (not covered by any other item in this Part)-—attendance in relation to a condition for the treatment of which only a single dose is given separately to each of two or more fields—the amount of the Commonwealth benefit under item 2504 plus an additional amount for each field separately treated in excess of one (up to a maximum of five additional fields) of             

2.30

Sealed radioactive sources

2511

Intrauterine insertion alone (AU 5).......................

23.00

2515

Intravaginal insertion alone (AU 4).......................

16.00

2519

Combined intrauterine and intravaginal insertion (AU 5).........

34.00

2523

Implantation of a region necessitating a major anaesthetic and surgical exposure (including implantation in an eye or in an intra-abdominal organ, bladder or prostate) (AU 7)             

55.00

2527

Complex implantation of a site not requiring separate surgical exposure but necessitating a major anaesthetic (including implantation in the mouth, in the tongue, in a salivary gland, in the neck, in the axilla, in the groin or in any subcutaneous region) (AU 6)             

39.00

2531

Simple implantation of a site not requiring separate surgical exposure, but necessitating a major anaesthetic (AU 5) 

23.00

2536

Implantation of a site not requiring separate surgical exposure or a major anaesthetic (including implantation in skin and implantation in a lip) (AU 4)             

9.50

2540

Preparation of a patient to receive sources for gynaecological irradiation and supervision of the patient during the subsequent irradiation (but not including insertion of the radiation source)             

14.50

2544

Removal of sealed radioactive sources under a major anaesthetic (AU 4) 

6.00

2547

Removal of sealed radioactive sources without major anaesthetic...

4.10

2S50

Construction and first application of a radioactive mould to an intracavitary, an intraoral or an intranasal site 

13.50

2553

Attendance upon a patient to apply a radioactive mould constructed for application to an intracavitary, intraoral or intranasal site other than an attendance which is the first attendance to apply the mould— each attendance             

4.10

2S56

Construction and first application of a radioactive mould not exceeding 5 cm diameter to an external surface 

9.50

2559

Construction and first application of a radioactive mould 5 cm or more in diameter to an eternal surface 

11.50

2562

Attendance upon a patient to apply a radioactive mould constructed for application to an external, surface of the patient other than an attendance which is the first attendance to apply the mould—each attendance              

2.80

Unsealed radioactive sources

2565

Oral administration of a therapeutic dose of a radioisotope.......

3.10

2568

Intravenous administration of a therapeutic dose of a radioisotope...

5.50

2571

Intracavitary administration of a therapeutic dose of a radioisotope (not including preliminary paracentesis) 

5.50

 

Division 17—Preparation for radiological procedure, being the injection of opaque or contrast media or the removal of fluid and its replacement by air, oxygen or other contrast media or other similar preparation             

 

2600

Encephalography (AU 10) ............................

18.00

2603

Cerebral angiography—percutaneous, one side (AU 9)..........

15.00

2606

Cerebral angiography—catheter or open exposure, one side (AU 10).

15.00

2613

Cerebral ventriculography (AU 10).......................

21.00

2616

Dacryocystography—one side..........................

4.40


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 8—Division 17—continued

$

2619

Bronchography—one or both sides (AU 8)..................

7.00

2623

Aortography (AU 8).................................

7.00

2631

Arteriography—peripheral, one artery (AU 6)................

5.50

2635

Phlebography—one vein (AU 6).........................

5.50

2639

Splenography (AU 6)................................

4.10

2643

Retroperitoneal pneumogram...........................

5.50

2647

Selective phlebogram (AU 5)...........................

4.10

2651

Selective arteriogram (AU 6)...........................

4.10

2655

Renal cyst or cysts, aspiration with injection of radio-opaque material 

7.00

2658

Pneumarthrography.................................

6.00

2663

Pneumoperitoneum..................................

6.00

2667

Drip-infusion pyelography or drip-infusion cholegraphy.........

3.60

2669

Hysterosalpingography (AU 6)..........................

7.00

2673

Discography—one disc (AU 5)..........................

4.40

2677

Intraosseous venography..............................

4.40

2680

Myelography......................................

15.00

2685

Cisternal puncture..................................

10.00

2689

Sinus or fistula injection into...........................

2.10

2693

Lymphangiography—one side..........................

15.00

2701

Intracavitary administration of radioactive substance (AU 5)......

6.50

2704

Laryngography....................................

7.00

2708

Pneumomediastinum................................

10.00

2712

Cholegram, percutaneous transhepatic .....................

15.00

 

Part 9—Assistance at operations

 

2920

Assistance at any operation or series or combination of operations for which the aggregate of the basic Commonwealth benefit, the fund benefit and the specified excess does not exceed $80.00             

8.00

2929

Assistance at any operation or series or combination of operations for which the aggregate of the basic Commonwealth benefit, the fund benefit and the specified excess exceeds $80.00             

One-fifth of the basic Commonwealth benefit for the operation or operations

 

Part 10—Operations

 

 

Division 1—General surgical

 

3003

Dressing of localised bums (not involving grafting)—each attendance at which the procedure is performed 

1.55

3007

Dressing of burns, extensive, without anaesthesia (not involving grafting)—each attendance at which the procedure is performed 

3.70

3010

Dressing of localised burns under general anaesthesia (not involving grafting)—each attendant at which the procedure is performed (G) (AU 7)             

4.80

3014

Dressing of localised bums under general anaesthesia (not involving grafting)—each attendance at which the procedure is performed(S) (AU 7)              

6.10

3018

Dressing of burns, extensive, under general anaesthesia (not involving grafting)—each attendance at which the procedure is performed (G) (AU 10)              

11.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division I—continued

$

3020

Dressing of burns, extensive, under general anaesthesia (not involving grafting)—each attendance at which the procedure is performed (S) (AU 10)               

14.00

3023

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, other than on face or neck, small (not more than 7 centimetres long), superficial, not covered by any item in Part 2 (AU 5)             

4.00

3026

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, other than on face or neck, small (not more than 7 centimetres long), involving deeper tissue, not covered by any item in Part 2 (AU 6)              

7.20

3028

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, small (not more than 7 centimetres long), superficial (AU 7)             

6.40

3032

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face nr neck, small (not more than 7 centimetres long), superficial (D) (AU 7)             

6.40

3035

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, small (not more than 7 centimetres long), involving deeper tissue (AU 7)             

10.00

3040

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, small (not more than 7 centimetres long), involving deeper tissue (D) (AU 7)             

10.00

3042

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, other than on face or neck, large (more than 7 centimetres long), superficial, not covered by any stem in Part 2 (AU 6)             

7.20

3044

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, other than on face or neck, large (more than 7 centimetres long), involving deeper tissue, not covered by any item in Part 2 (G) (AU 7) .             

12.50

3048

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, other than on face or neck, large (more than 7 centimetres long), involving deeper tissue, not covered by any item in Part 2 (S) (AU 7)             

16.00

3053

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, large (more than 7 centimetres long), superficial (AU 7)              

10.00

3054

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, large (more than 7 centimetres long), superficial (D) (AU 7)             

10.00

3060

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, large (more than 7 centimetres long), involving deeper tissue (G) (AU 8)             

13.50

3066

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, large (more than 7 centimetres long), involving deeper tissue (S) (AU 8)             

16.50

3072

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, large (more than 7 centimetres long), involving deeper tissue (D) (AU 8)             

16.50

3076

Superficial foreign body, removal of, not covered by any other item in this Part (AU 3) 

1.80

3079

Superficial foreign body, removal of, not covered by any other item in this Part (D) (AU 5) 

3.80

3083

Subcutaneous foreign body, removal of, not covered by any other item in this Part (AU 6) 

9.00

3086

Subcutaneous foreign body, removal of, not covered by any other item in this Part (D) (AU 6) 

9.00

3088

Foreign body in muscle, tendon or other deep tissue, removal of, not covered by any other item in this Part (G) (AU 7) 

19.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 1—continued

$

3091

Foreign body in muscle, tendon or other deep tissue, removal of, not covered by any other item in this Part (S) (AU 7) 

24.00

3096

Foreign body in muscle, tendon or other deep tissue, removal of, not covered by any other item in. this Part (D) (AU 7)  

24.00

3100

Biopsy of skin or mucous membrane, as an independent procedure (AU 5) 

4.00

3102

Biopsy of skin or mucous membrane, as an independent procedure (D) (AU 5)  

4.00

3107

Biopsy of lymph gland, muscle or other deep tissue or organ, as an independent procedure (G) (AU 6) 

10.00

3111

Biopsy of lymph gland, muscle or other deep tissue or organ, as an independent procedure (S) (AU 6) 

13.50

3118

Biopsy of lymph grand, muscle or other deep tissue or organ, as an independent procedure (D) (AU 6) 

13.50

3122

Aspiration biopsy of lymph gland, deep tissue or organ, as an independent procedure (AU 5) 

4.00

3127

Biopsy of bone marrow by trephine or burr-hole (AU 5).........

9.00

3129

Biopsy of bone marrow by aspiration (AU 5)................

2.10

3133

Punch biopsy of synovial membrane or pleura................

2.10

3136

Scalene node biopsy (AU 5)...........................

16.00

3141

Sinus, excision of, involving superficial tissues only (AU 6)......

7.20

3145

Sinus, excision of, involving superficial tissues only (D) (AU 6)....

7.20

3151

Sinus, excision of, involving muscle and deep tissue (G) (AU 7)....

13.50

3154

Sinus, excision of, involving muscle and deep tissue (S) (AU 7)....

16.00

3158

Sinus, excision of, involving muscle and deep tissue (D) (AU 7)....

16.00

3164

Bursa, incision of (AU 5).............................

2.70

3167

Ganglion or small bursa, excision of (G) (AU 6)..............

14.00

3169

Ganglion or small bursa, excision of (S) (AU 6)..............

18.50

3172

Bursa (large), including olecranon, calcaneum or patella, excision of (G) (AU 6) 

25.00

3176

Bursa (large), including olecranon, calcaneum or patella, excision of (S) (AU 6)  

34.00

3182

Bursa, semimembranosus (Baker’s cyst), excision of (AU 7)......

34.00

3186

Tumour, cyst or scar, removal of cutaneous, subcutaneous or in mucous membrane, up to 3 centimetres in diameter (G) (AU 6) 

8.20

3188

Tumour, cyst or scar, removal of cutaneous, subcutaneous or in mucous membrane, up to 3 centimetres in diameter (S) (AU 6) 

11.50

3192

Tumour, cyst or scar, removal of cutaneous, subcutaneous or in mucous membrane, up to 3 centimetres in diameter (D) (AU 6) 

11.50

3198

Tumour, cyst or scar, removal of cutaneous, subcutaneous or in mucous membrane, more than 3 centimetres in diameter (G) (AU 6)             

12.00

3200

Tumour, cyst or scar, removal of cutaneous, subcutaneous or in mucous membrane, more than 3 centimetres in diameter (S) (AU 6)             

15.00

3205

Tumour, cyst or scar, removal of cutaneous, subcutaneous or in mucous membrane, more than 3 centimetres in diameter (D) (AU 6)             

15.00

3209

Tumour, cyst or scar, removal of, not covered by any other Item in this Part, involving muscle, bone or other deep tissue (G) (AU 8)             

17.50

3212

Tumour, cyst or scar, removal of, not covered by any other item in this Part, involving muscle, bone or other deep tissue (S) (AU 8)             

22.00

3214

Tumour, cyst or scar, removal of, not covered by any other item in this Part, involving muscle, bone or other deep tissue (D) (AU 8)             

22.00

3223

Tumour or deep cyst, removal of, not covered by any other item in this Part, requiring wide excision (G) (AU 8) 

24.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 1—continued

$

3227

Tumour or deep cyst, removal of, not covered by any other item in this Part, requiring wide excision (S) (AU 8) 

29.00

3231

Malignant tumour, removal of from skin, requiring wide and deep excision (AU 8) 

37.00

3234

Malignant tumour, removal of from skin, requiring wide and deep excision with immediate block dissection of lymph glands (AU 13)             

80.00

3239

Tumour, removal of from soft tissue (including muscle, fascia and connective tissue), extensive excision of without skin graft (AU 8)             

47.00

3240

Tumour, removal of from soft tissue (including muscle, fascia and connective tissue) extensive excision of, without skin graft (D) (AU 8)             

47.00

3241

Tumour, removal of from soft tissue (including muscle, fascia and connective tissue), extensive excision of with skin graft (AU 10)             

56.00

3243

Tumour, removal of from soft tissue (including muscle, fascia and connective tissue), extensive excision of with skin graft (D) (AU 10)                           

56.00

3246

Malignant tumour, removal of from any region involving a radical operation (not being an operation covered by any other item in this Part) (AU 13)             

80.00

3249

Malignant tumour, removal of from any region involving a limited operation (not being an operation covered by any other item in this Part) (AU 8)             

37.00

3257

Lipectomy for abdominal apron or similar condition (AU 12)......

64.00

3260

Axillary hyperidrosis, wedge excision for (AU 7).............

11.50

3264

Plantar wart, simple removal of (AU 5)....................

3.90

3266

Keratoses, warts or similar lesions, electrosurgical destruction or chemotherapy of—each attendance at which the procedure is performed on not more than five lesions (AU 4)              

4.00

3270

Keratoses, warts or similar lesions, electrosurgical destruction or chemotherapy of—each attendance at which the procedure is performed on slot more than five lesions (D) (AU 4)             

4.00

3275

Keratoses, warts or similar lesions, electrosurgical destruction or chemotherapy of—each attendance at which the procedure is performed on more than five but not more than ten lesions (AU 5)                           

5.60

3273

Keratoses, warts or similar lesions, electrosurgical destruction or chemotherapy of—each attendance at which the procedure is performed on more than ten but not more than fifteen lesions (AU 6)             

6.90

3283

Keratoses, warts or similar lesions, electrosurgical destruction or chemotherapy of—each attendance at which the procedure is performed on. more than fifteen but not more than twenty lesions (AU 7)              

7.70

3287

Keratoses, warts or similar lesions, electrosurgical destruction or chemotherapy of—each attendance at which the procedure is performed on more than twenty lesions (AU 8)             

9.00

3293

Skin lesions, multiple injections with hydrocortisone or similar preparations 

3.40

3296

Keloid, extensive, multiple injections of hydrocortisone or similar preparation under general anaesthesia (AU 5) 

14.00

3302

Haematoma, aspiration of (AU 4)........................

1.80

3307

Haematoma, furuncle, small abscess or similar lesion not requiring a general anaesthetic, incision with drainage of (excluding after-care)             

1.80

3310

Large haematoma, abscess, carbuncle, cellulitis or similar lesion requiring a general anaesthetic, incision with drainage of (excluding after-care) (G) (AU 5)              

10.00

3312

Large haematoma, abscess, carbuncle, cellulitis or similar lesion requiring a general anaesthetic, incision with drainage of (excluding after-care) (S) (AU 5)             

14.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

Part 10—Division 1—continued

$

3317

Large haematoma, abscess, carbuncle, cellulitis or similar lesion requiring a general anaesthetic, incision with drainage of (excluding after-care) (D) (AU 5)             

14.00

3322

Muscle, excision of (limited) (G) (AU 6)...................

10.50

3327

Muscle, excision of (limited) (S) (AU 6)...................

13.50

3333

Muscle, excision of (extensive) (G) (AU 7).................

18.50

3337

Muscle, excision of (extensive) (S) (AU 7)..................

24.00

3341

Muscle, raptured, repair of (limited), not associated with external wound (G) (AU 7) 

15.50

3343

Muscle, ruptured, repair of (limited), not associated with external wound (S) (AU 7) 

19.00

3347

Muscle, raptured, repair of (extensive), not associated with external wound (AU 7) 

27.00

3352

Fascia, deep, repair of, for herniated muscle (G) (AU 7).........

10.30

3355

Fascia, deep, repair of, for herniated muscle (S) (AU 7).........

13.50

3358

Bone tumour, innocent, excision of, not covered by any other item in this Part (AU 7) 

32.00

3360

Bone tumour, innocent, excision of, not covered by any other item in this Part (D) (AU 7) 

32.00

3365

Styloid process of temporal hone, removal of (AU 7)...........

32.00

3370

Parotid gland, total extirpation of (AU 15)..................

72.00

3374

Parotid gland, total extirpation of with preservation of facial nerve (AU 18) 

120.00

3376

Parotid gland, superficial lobectomy or removal of tumour from, with exposure of facial nerve (AU 14) 

80.00

3380

Submandibular gland, extirpation of (AU 8).................

32.00

3382

Submandibular gland, extirpation of (D) (AU 8)..............

32.00

3385

Sublingual gland, extirpation of (AU 7)....................

17.50

3388

Sublingual gland, extirpation of (D) (AU 7).................

17.50

3410

Salivary gland, dilatation or diathermy of duct (AU 6)..........

4.50

3413

Salivary gland, dilatation or diathermy of duct (D) (AU 6)........

4.50

3416

Salivary gland, removal of calculus from duct (G) (AU 7)........

10.00

3420

Salivary gland, removal of calculus from duct (S) (AU 7)........

13.50

3422

Salivary gland, removal of calculus from duct (D) (AU 7)........

13.50

3426

Salivary gland, repair of cutaneous fistula of (AU 7)............

13.50

3429

Tongue, partial excision of (AU 7).......................

27.00

3432

Tongue, partial excision of (D) (AU 7)....................

27.00

3435

Tongue, total excision of (AU 14)........................

66.00

3438

Tongue, total excision of (D) (AU 14).....................

66.00

3441

Radical excision of intra-oral tumour involving resection of mandible and lymph glands of neck (commando-type operation) (AU 18]             

170.00

3449

Tongue tie, repair of (AU 6) ...........................

3.70

345!

Tongue tie, repair of (D) (AU 6).........................

3.70

3457

Ranula, removal of (G) (AU 9)..........................

14.00

3461

Ranula, removal of (S) (AU 9)..........................

18.50

3463

Ranula, removal of (D) (AU 9)..........................

18.50

3467

Thymectomy (AU 16)...............................

120.00

3471

Branchial cyst, removal of (AU 9).......................

37.00

3474

Branchial fistula, removal of (AU 9)......................

47.00

3476

Cystic hygroma, removal of (AU 11)......................

56.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 1—continued

$

3481

Thyroidectomy, total (AU 14)..........................

95.00

3485

Parathyroid tumour, removal of (AU 13)...................

105.00

3489

Parathyroid glands, removal of, other than for tumour (AU 16).....

120.00

3494

Thyroidectomy, sub-total (AU 52).......................

66.00

3499

Hemithyroidectomy and exposure of recurrent laryngeal nerve (AU 11) 

69.00

3504

Thyroid, excision of localised tumour of (AU 10).............

47.00

3512

Thyroglossal cyst, removal of (AU 10) .....................

36.00

3515

Thyroglossal fistula, removal of (AU 10)...................

47.00

3518

Cervical oesophagostomy (AU 13).......................

41.00

3520

Cervical oesophagostomy, closure or plastic repair of (AU 10).....

31.00

3522

Cervical oesophagectomy with tracheostomy and oesophagostomy, with or without plastic reconstruction; op laryngopharyngectomy with tracheostomy and plastic reconstruction (AU 22)             

170.00

3538

Lymph glands of neck, limited excision of (AU 9).............

34.00

3540

Lymph glands of neck, radical excision of (AU 20)............

95.00

3543

Lymph glands of groin or axilla, limited excision of (AU 9).......

22.00

3546

Lymph glands of groin or axilla, radical excision of (AU 13)......

69.00

3549

Operation for lymphoedema by extended indwelling subcutaneous tube or tubes (AU 10) 

18.00

 

3552

Simple mastectomy with or without frozen section biopsy (G) (AU 9) 

29.00

3557

Simple mastectomy with or without frozen section biopsy (S) (AU 9) 

40.00

3558

Breast, excision of cyst, fibro adenoma or other local lesion or segmental

 

 

resection for any other reason (G) (AU 7)...................

17.50

3562

Breast, excision of cyst, fibro adenoma or other local lesion or segmental resection for any other reason (S) (AU 7) 

24.00

 

3564

Breast, excision of cyst, fibro adenoma or other local lesion or segmental resection for any other reason, where frozen section is performed (G) (AU 8)              

23.00

3568

Breast, excision of cyst, fibro adenoma or other local lesion or segmental resection for any other reason, where frozen section is performed (S) (AU 8)              

29.00

3570

Partial mastectomy involving more than one quarter of the breast tissue with or without frozen section biopsy (G) (AU 8) 

23.00

3574

Partial mastectomy involving more than one quarter of the breast tissue with or without frozen section biopsy (S) (AU 8) 

29.00

3579

Breast, extended simple mastectomy with or without frozen section biopsy (AU 12)  

56.00

3584

Breast, radical or modified radical mastectomy with or without frozen section biopsy (AU 16) 

82.00

3586

Nipple, inverted, surgical aversion of (AU 7) ................

13.50

3590

Laparotomy (exploratory) where no other procedure is performed (G) (AU 9) 

32.00

3592

Laparotomy (exploratory) where no other procedure is performed (S) (AU 9) 

41.00

3596

Laparotomy, exploratory, followed by enterostomy or colostomy (G) (AU 12) 

41.00

3600

Laparotomy, exploratory, followed by enterostomy or colostomy (S) (AU 12) 

56.00

3606

Operation on abdominal viscera involving laparotomy, not covered by any other item in this Part (G) (AU 12) 

48.00

3611

Operation on abdominal viscera involving laparotomy, not covered by any other item in this Part (S) (AU 12) 

61.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 1—continued

$

3613

Subphrenic abscess, drainage of (AU 10)...................

50.00

3621

Liver tumour, removal of other than by biopsy (AU 13).........

56.00

3625

Liver, massive resection of, or lobectomy (AU 18) ............

145.00

3628

Liver abscess, abdominal drainage of (AU 11)...............

50.00

3631

Liver abscess, transpleural drainage of (AU 13) ..............

56.00

3635

Hydatid cyst of liver, peritoneum or viscus, drainage procedure for (AU 11) 

56.00

3639

Operative cholegram or pancreatogram, or choledochoscopy (AU 2).

10.50

3642

Cholecystectomy (G) (AU 11)..........................

56.00

3644

Cholecystectomy (S) (AU 11) ..........................

72.00

3648

Cholecystostomy (G) (AU 10)..........................

41.00

3650

Cholecystostomy (S) (AU 10)..........................

50.00

3653

Choledochotomy after previous cholecystectomy (AU 14)........

85.00

3659

Choledochotomy (with or without cholecystectomy) not covered by item. 3653 (AU 13) 

82.00

3663

Sphincter of oddi-direct operation on: including dilatation, removal of calculus, sphincterotomy and plastic repair (AU 15) 

58.00

3666

Operations on the biliary system not covered by any other item in this Part including cholecystoduodenostomy, cholecystogastrostomy or cholecystoenterostomy (AU 15)             

93.00

3669

Operation on (including operations for the reconstruction of) hepatic duct or common bile duct with or without anastomosis to gallbladder, stomach or intestine (AU 19)             

145.00

3672

Gallbladder, radical excision and reconstruction for carcinoma, including excision and reconstruction of bile ducts where necessary or radical excision and reconstruction of the bile ducts alone for carcinoma (AU 19)             

145.00

3674

Gastroscopy (AU 6).................................

16.50

3677

Gastroscopy with biopsy (AU 6).........................

18.50

3679

Gastrostomy, not covered by item 2685 (AU 9)...............

50.00

3685

Gastrostomy—for fixation of indwelling oesophageal tube, for removal of foreign body or for excision of benign lesion (AU 10) 

53.00

3694

Vagotomy—trunkal (AU 12)...........................

56.00

3697

Vagotomy—selective (AU 12)..........................

66.00

3701

Vagotomy, including pyloroplasty or gastro-enterostomy (AU 11)..

80.00

3703

Gastro-enterostomy (including gastro-duodenostomy) or entero- colosiomy or entero-enterostomy (G) (AU 13) 

50.00

3705

Gastro-enterostomy (including gastro-duodenostomy) or entero- colostomy or entero-enterostomy (S) (AU 13) 

66.00

3712

Pancreatic cyst—anastomosis to stomach or duodenum (AU 13)....

66.00

3717

Perforated peptic ulcer, suture of (G) (AU 10)................

41.00

3719

Perforated peptic ulcer, suture of (S) (AU 10)................

50.00

3723

Partial gastrectomy, with, or without gastro-jejunostomy (AU 15)...

95.00

3730

Gastrectomy, total, for benign disease (AU 19)...............

120.00

3734

Gastrectomy, total radical, for carcinoma (AU 21).............

145.00

3738

Pyloroplasty, adult (AU 11)............................

50.00

3740

Pyloroplasty, infant, or pyloromyotomy (Ramstedt’s operation) (AU 9) 

41.00

3744

Laparotomy and division of peritoneal adhesions where no other listed intra-abdominal procedure is performed (G) (AU 11) 

41.00

3748

Laparotomy and division of peritoneal adhesions where ho other listed intra-abdominal procedure is performed (S) (AU 11) 

50.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth

benefit

 

Part 10—Division 1 —continued

 

3752

Laparotomy and division of extensive peritoneal adhesions with or without intestinal plication (Noble operation or similar procedure) (AU 11)             

66.00

3757

Enterostomy or colostomy, as an independent procedure (G) (AU 11).

41.00

3762

Enterostomy or colostomy, as an independent procedure (S) (AU 11)..

50.00

3775

Enterostomy or colostomy, extra-peritoneal closure of (G) (AU 11)...

28.00

3781

Enterostomy or colostomy, extra-peritoneal closure of (S) (AU 11)...

35.00

3785

Enterostomy or colostomy, intra-peritoneal closure, not involving resection (AU 11) 

50.00

3787

Enterotomy or colotomy (AU 12).........................

50.00

3791

Caecostomy (G) (AU 12)...............................

33.00

3794

Caecostomy (S) (AU 12) ...............................

41.00

3799

Intussusception, reduction of, by fluid......................

21.00

3804

Intussusception, laparotomy and reduction of (AU 11)............

47.00

3813

Intussusception, laparotomy and resection of (AU 14)............

82.00

3818

Transverse or sigmoid colectomy with or without anastomosis (AU 15) 

85.00

3819

Laparotomy with reduction of volvulus (G) (AU 1J) .............

41.00

3822

Laparotomy with reduction of volvulus (S) (AU H).............

50.00

3828

Meckel’s diverticulum, removal of (G) (AU 10)................

41.00

3830

Meckel’s diverticulum, removal of (S) (AU 10)................

50.00

3835

Bowel, segmental resection of, with or without anastomosis, not covered by any other item in this Part (G) (AU 15) 

64.00

3839

Bowel, segmental resection of, with or without anastomosis, not covered by any other item in this Part (S) (AU 15) 

82.00

3840

Hemicolectomy, right or left (AU 15).......................

95.00

3845

Total colectomy with ileo-rectal anastomosis or ileostomy (AU 20)...

120.00

3847

Total colectomy with excision of rectum and ileostomy—one surgeon (AU 20) 

145.00

3851

Total colectomy with excision of rectum and ileostomy, combined synchronous operation; abdominal resection (including after care) (AU 11)             

110.00

3852

Total colectomy with excision of rectum and ileostomy, combined synchronous operation; perineal resection 

33.00

3858

Rectum, restorative anterior resection of, with rectosigmoidectomy (AU 1.6) 

120.00

3861

Appendicectomy, not covered by item 3866 (G) (AU 8)...........

32.00

3862

Appendicectomy, not covered by item 3866 (S) (AU 8)...........

37.00

3866

Appendicectomy, when performed in conjection with any other intrabdominal procedure (other than that covered by items 3791 and 3794) and through the same incision (AU 4)             

10.50

3868

Drainage of appendiceal abscess, or for ruptured appendix or for peritonitis with or without appendicectomy (G) (AU 10) 

37.00

3871

Drainage of appendiceal abscess, or for ruptured appendix or for peritonitis with or without appendicectomy (S) (AU 10) 

46.00

3873

Small bowel intubation with biopsy .......................

15.50

3876

Small bowel intubation—as an independent procedure...........

7.20

3877

Pancreatectomy, partial (AU 15)..........................

115.00

3881

Pancreatico-duodenectomy, Whipple’s operation (AU 30).........

170.00

3885

Pancreatectomy, total, including surrounding viscera (AU 32).......

190.00

3887

Pancreas, drainage of (G) (AU 11).........................

38.00

3890

Pancreas, drainage of (S) (AU 11).........................

48.00

3891

Anastomosis of pancreatic duct to bowel (AU 18)...............

120.00



Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 1—continued

$

3893

Splenectomy for trauma (G) (AU 13) .....................

50.00

3895

Splenectomy for trauma (S) (AU 13) .....................

66.00

3897

Splenectomy, other than for trauma {AU 13)................

72.00

3942

Ruptured viscus (including liver, kidney or hollow viscus), simple repair of (G) (AU 14) 

44.00

3944

Ruptured viscus (including liver, kidney or hollow viscus), simple repair of (S) (AU 14) 

56.00

3947

Multiple ruptured viscera (including liver, kidney, spleen or hollow viscus) major repair or removal of (AU 18) 

105.00

3950

Retroperitoneal tumour, removal of (AU 15).................

82.00

3953

Sacrococcygeal and presacral tumour—excision of (AU 13)......

82.00

3956

Retroperitoneal abscess, drainage of, not involving laparotomy (AU 9)  

47.00

3960

Peritoneoscopy (AU 6) ..............................

13.50

3966

Paracentesis abdominis ..............................

4.00

3972

Rectum and anus, abdomino-perineal resection of—one surgeon (AU 17)  

120.00

3974

Rectum and anus, abdomino-perineal resection of, combined synchronous operation—abdominal resection (AU 16) 

98.00

3977

Rectum and anus, abdomino-perineal resection of, combined synchronous operation—perineal resection  

40.00

3980

Rectum and anus-perineal excision of (AU 13)...............

58.00

3982

Inguinal hernia, repair of in a person under 10 years of age or repair of a hydrocele in a person under 10 years of age or repair of both an inguinal hernia and a hydrocele in a person under 10 years of age (AU 8)              

32.00

3985

Femoral or inguinal hernia, repair of not covered by items 3992, 4014 or 4016 (G) (AU 8) 

32.00

3988

Femoral or inguinal hernia, repair of not covered by items 3592, 4014 or 4016 (S) (AU 8) 

40.00

3992

Strangulated, incarcerated or obstructed hernia, repair of, without bowel resection (AU 10) 

50.00

3994

Diaphragmatic hernia, traumatic, repair of (AU 17)............

74.00

3997

Diaphragmatic hernia, other than traumatic, repair of (abdominal approach) (AU 14) 

93.00

400!

Umbilical hernia, repair of, in person under ten years of age (G) (AU 8) 

23.00

4005

Umbilical hernia, repair of, in person under ten years of age (S) (AU 8) 

32.00

4006

Umbilical hernia, repair of, in person ten years of age or over (G) (AU S)  

27.00

4010

Umbilical hernia, repair of, in person ten years of age or over (S) (AU 8)  

37.00

4014

Ventral, incisional, lumbar or recurrent hernia, repair of (G) (AU 10) 

41.00

4016

Ventral, incisional, lumbar or recurrent hernia, repair of (S) (AU 10).

50.00

4019

Hydrocele, tapping of................................

2.70

4023

Hydrocele, removal of (G) (AU 7).......................

18.50

4025

Hydrocele, removal of (S) (AU 7)........................

24.00

4028

Hydrocele, operation for, by inguinal approach with removal of patent processus vaginalis (G) (AU 7) 

32.00

4030

Hydrocele, operation for, by inguinal approach with removal of patent processus vaginalis (S) (AU 7) 

37.00

4036

Varicocele, removal of (G) (AU 7).......................

21.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 1—continued

$

4038

Varicocele, removal of (S) (A U 7)........................

27.00

4058

Orchidectomy (simple) (G) (AU 7)........................

27.00

4063

Orchidectomy (simple) (S) (AU 7) ........................

37.00

4067

Orchidectomy and complete excision of spermatic cord (AU 8)......

50.00

4069

Orchidectomy and radical dissection of iliac lymph glands (AU 13)...

80.00

4073

Undescended testis, transplantation of, with or without associated hernial repair (AU 8) 

50.00

4077

Secondary detachment of testis from thigh (AU 6)..............

9.50

4079

Circumcision of person under four weeks of age (AU 5)..........

3.70

4081

Circumcision of person under ten years of age but not less than four weeks of age (AU 6) 

9.00

4083

Circumcision of person ten years of age or over (G) (AU 6)........

13.50

4085

Circumcision of person ten years of age or over (S) (AU 6)........

16.50

4088

Paraphimosis, reduction of, under anaesthesia, with or without dorsal incision (AU 5) 

3.90

4092

Sigmoidoscopic examination (AU 5).......................

4.00

4098

Sigmoidoscopy with diathermy or resection of rectal tumour or tumours (AU 7) 

17.50

4103

Sigmoidoscopic examination followed by removal, ligation or cauterisation of haemorrhoids (G) (AU 8)  

29.00

4105

Sigmoidoscopic examination followed by removal, ligation or cauterisation of haemorrhoids (S) (AU 8) 

37.00

4110

Full thickness rectal biopsy (AU 6)........................

10.00

4111

Colonic fibreoscopy (AU 7).............................

16.50

4116

Colonic fibreoscopy with biopsy (AU 7).....................

18.50

4121

Rectum, radical operation for prolapse of, perineal approach including recto-sigmoidectomy (AU 9) 

56.00

4123

Rectum, radical operation for prolapse of, involving laparotomy (AU 13) 

90.00

4128

Rectum, prolapse, injection into ..........................

2.70

4129

Rectal polyp, removal of (G) (AU 7).......................

12.50

4131

Rectal polyp, removal of (S) (AU 7)........................

16.50

4134

Anus, dilatation of, as an independent procedure (AU 4)..........

2.90

4135

Anus, massive dilatation of, under anaesthesia (Lord’s procedure) with or without modified haemorrhoidectomy (AU 5) 

13.50

4137

Anal prolapse—circum anal suture (AU 6)...................

10.00

4139

Anal prolapse, submucosal injection for, under general anaesthesia (AU 5) 

6.60

4142

Anal stricture, repair of (AU 7) ...........................

35.00

4145

Anal sphincterotomy as an independent procedure (AU 6).........

11.50

4147

Haemorrhoids, injection into—each attendance at which the procedure is performed  

3.90

4152

Haemorrhoids, incision of (AU 5).........................

4.50

4154

Haemorrhoids, rubber band ligation of......................

4.00

4159

Haemorrhoidectomy, radical (G) (AU 7).....................

27.00

4160

Haemorrhoidectomy, radical (S) (AU 7).....................

34.00

4164

Haemorrhoids, external, or anal tags, one or more, removal of under general anaesthetic (AU 5)  

8.50

4168

Fissure in ano, excision of (G) (AU 6)......................

19.00

4170

Fissure in ano, excision of (S) (AU 6).......................

24.00



Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 1—continued

$

4174

Fistula in ano, subcutaneous, excision of (G) ({AU 7)...........

9.50

4178

Fistula in ano, subcutaneous, excision of (S) (AU 7)............

27.00

4180

Fistula in ano, excision of (involving incision of external sphincter) (G) (AU 7)  

29.00

4184

Fistula in ano, excision of (involving incision of external sphincter) (S) (AU7)  

37.00

4186

Ischio-rectal abscess, incision of (excluding after-care) (G) (AU 6)...

10.00

4187

Ischio-rectal abscess, incision of (excluding after-care) (S) (AU 6)...

13.50

4192

Faecal fistula, repair of (AU 12)..........................

56.00

4196

Pubo-rectalis muscle, division of (AU 6) ....................

29.00

4198

Disimpaction of faeces under anaesthesia (AU 7)..............

5.60

4203

Coccyx, excision of (AU 8).............................

52.00

4204

Pilonidal cyst or sinus, excision of (G) {AU 8)................

27.00

4205

Pilonidal cyst or sinus, excision of (S) (AU 8).................

35.00

4210

Pilonidal sinus, injection of sclerosant fluid under anaesthesia (AU 6).

8.00

Vascular surgery

4226

Varicose veins, injection into—each attendance at which one or more injections are made 

2.70

4228

Varicose veins, multiple simultaneous injections by continuous compression techniques (excluding after-care) 

8.50

4232

Varicose veins multiple ligations, with or without local stripping or excision not covered by any other item in this Part (AU 8) 

17.50

4234

Varicose veins, high ligation and complete stripping or excision of long saphenous vein (AU 7) 

46.00

4237

Varicose veins, high ligation and complete stripping or excision of short saphenous vein (AU 7) 

33.00

4239

Varicose veins, high ligation and complete stripping or excision of both long and short saphenous systems (AU 10) 

64.00

4242

Varicose veins, high ligation of long saphenous vein at saphenous femoral junction (AU 6) 

29.00

4244

Varicose veins, high ligation of short saphenous vein at saphenous popliteal junction (AU 6) 

22.00

4245

Varicose veins, sub-fascia! ligation of single deep perforation (AU 6).

IS.00

4248

Varicose veins, sub-fascial ligation of multiple deep perforating veins (Cocketts’ operation) (AU 7) 

47.00

4250

Cross-leg by-pass graft—saphenous to femoral vein (AU 11)......

77.00

4252

Intra-arterial oxygen injection ...........................

4.20

4255

Ligation of medium artery, medium vein or medium artery and medium vein by elective operation (AU 6) 

22.00

4257

Ligation of large artery, large vein or large artery and large vein by elective operation (AU 7) 

31.00

4259

Great artery or great vein {including jugular, sub-clavian, axillary, iliac, femoral or popliteal) ligation of (AU 8) 

47.00

4263

Major artery of neck or extremity, repair of wound of, with restoration of continuity (AU 13) 

69.00

4264

Major artery or vein of abdomen including aorta and vena cava, repair of wound of, with restoration of continuity (AU 16) 

95.00

4266

Areterio venous fistula, dissection and repair of, with restoration of continuity (AU 10) 

15.00

4268

Arterio-venous fistula, dissection and ligation of (AU 10).........

69.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 1—continued

$

4270

Innominate, subclavian, or any intra-abdominal artery, endarterectomy of (AU 19) 

115.00

4272

Artery of neck or extremities, endarterectomy of (AU 15)..........

105.00

4274

Great artery or great vein (including carotid, jugular, sub-clavian, axillary, iliac, femoral or popliteal) ligation of involving gradual occlusion by mechanical device (AU 10)             

50.00

4278

Inferior vena cava, plication or ligation of (AU 12)..............

66.00

4280

Internal carotid artery, repositioning of (AU 13)................

56.00

4283

Arterial patch graft (AU 12)..............................

69-00

4286

Aorto-iliac or aorto-femoral bifurcate graft (AU 19)..............

130.00

4289

Axillary-femoral by-pass graft of subclavian-femoral by-pass graft (AU 16)  

125.00

4290

Arterial or venous graft or by-pass not included in any other item (AU 20) 

130-00

4292

Arterial anastomosis (AU 16).............................

115.00

4295

Portal hypertension, lienorenal anastomosis for (AU 20)...........

115.00

4298

Portal vein anastomosis (AU 21)..........................

115.00

4301

Embolus, removal of, from artery of neck or extremities (AU 12).....

66.00

4306

Embolus, removal of, from artery of trunk (AU 15)..............

85.00

4308

Thrombus, removal of, from femoral, iliac or other similar large vein (AU 12) 

61.00

4312

Abdominal aortic aneurysm, excision of and insertion of graft (AU 26).

145.00

4314

Ruptured abdominal aortic aneurysm, excision of and insertion of graft (AU 26) 

170.00

4323

Aneurysm of major artery, excision of and insertion of graft (AU 18)..

120.00

437.9

Transluminal angioplasty including associated radiological services and preparation (AU 12) 

40.00

4335

Carotid body or carotid body tumour, removal of, without arterial anastomosis (AU 14) 

82.00

4341

Arteriovenous shunt, external, insertion of (AU 9)...............

21.00

4344

Arteriovenous shunt, external, removal of (AU 5)...............

16.50

4347

Arteriovenous anastomosis, direct, of upper or lower limb (AU 14)....

95.00

4349

Intra-arterial infusion of arteries of neck, thorax or abdomen, including initial operation and all post-operative management (AU 13)             

50.00

Operations for acute osteomyelitis

4353

Operation on terminal phalanx of finger or toe (AU 7)............

4.50

4357

Operation on phalanx other than terminal, metacarpus or metatarsus— One bone (AU 7) 

10.50

4361

Operation on sternum, clavicle, rib, ulna, radius, carpus, tibia, fibula, tarsus, mandible or maxilla (other than alveolar margins)—one bone (AU 10)             

10.50

4363

Operation on mandible or maxilla (other than alveolar margins)—one bone (D) (AU 10) 

18.50

4367

Operation on humerus or femur—one bone (AU 10)..............

32.00

4369

Operation on skull (AU 12)..............................

27.00

4371

Operation on spine or pelvic bones—one bone (AU 13)...........

32.00

Operations for chronic osteomyelitis

4374

Operation on nasal bones (AU 12) .........................

10.50

4377

Operation on scapula, sternum, clavicle, rib, ulna, radius, metacarpus, carpus, phalanx, tibia, fibula, metatarsus, tarasus, mandible or maxill (other than alveolar margins)—one bone (AU 12)              

32.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 1—continued

$

4382

Operation on mandible or maxilla, or mandible and maxilla (other than alevolar margins) (D) (AU 12) 

32.00

4386

Operation on humerus or femur—one bone (AU 11)............

32.00

4388

Operation on spine or pelvic bones—one bone (AU 12)..........

56.00

4392

Operation on skull (AU 12).............................

42.00

4396

Operation on any combination of bones referred to in item 4377 (AU 12) 

32.00

4398

Operation on any combination of bones where one or more of the bones operated upon is not a bone referred to in item 4396 (AU 12)             

56.00

Division 2—Amputation or disarticulation of limb

4405

One digit of hand (G) (AU 6) ...........................

14.00

4406

One digit of hand (S) (AU 6) ...........................

17.00

4410

Two digits of one hand (G) (AU 7)........................

20.00

4411

Two digits of one hand (S) (AU 7)........................

26.00

4415

Three digits of one hand (G) (AU 8).......................

24.00

4417

Three digits of one hand (S) (AU 8).......................

31.00

4423

Four digits of one hand (G) (AU 9)........................

28.00

4425

Four digits of one hand (S) (AU 9)........................

36.00

4431

Five digits of one hand (G) (AU 10).......................

32.00

4433

Five digits of one hand (S) (AU 10).......................

40.00

4438

Finger or thumb, including metacarpal or part of metacarpal—each digit (G) (AU 6) 

16.00

4439

Finger or thumb, including metacarpal or part of metacarpal—each digit (S) (AU 6)  

19.50

4446

Hand, midcarpal or transmetacarpal (G) (AU 7)...............

19.50

4451

Hand, midcarpal or transmetacarpal (S) (AU 7)................

27.00

4457

Hand, forearm or through arm (AU 8)......................

32.00

4459

At shoulder (AU 12) .................................

56.00

4462

Interscapulothoracic (AU 15)............................

115.00

4465

One digit of foot (G) (AU 6)............................

10.00

4466

One digit of foot (S) (AU 6) ............................

12.50

4470

Two digits of one foot (G) (AU 7)........................

15.50

4471

Two digits of one foot (S) (AU 7).........................

19.00

4475

Three digits of one foot (G) (AU 8)........................

18.50

4477

Three digits of one foot (S) (AU 8)........................

22.00

4479

Four digits of one foot (G) (AU 9) ........................

21.00

4481

Four digits of one foot (S) (AU 9).........................

26.00

4486

Five digits of one foot (G) (AU 10)........................

24.00

4487

Five digits of one foot (S) (AU 10)........................

30.00

4491

Toe, including metatarsal or part of metatarsal—each toe (G) (AU 7).

12.50

4493

Toe, including metatarsal or part of metatarsal—each toe (S) (AU 7)..

16.00

4500

Foot at ankle (Syme, Pirogoff types) (AU 8)..................

32.00

4506

Foot, midtarsal or transmetatarsal (AU 7) ...................

27.00

4510

Through thigh or at knee (AU 8).........................

42.00

4512

Through thigh (AU 10)................................

61.00

4515

At hip (AU 14) ....................................

69.00

4518

Hindquarter (AU 17).................................

145.00


 

Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—continued

$

 

Division 3—Ear, nose and throat

 

4530

Ear, removal of foreign body in, otherwise than by simple syringing (AU 4) 

6.40

4532

Ear, removal of foreign body in, involving incision of external auditory canal (AU 6)  

21.00

4535

Aural polyp, removal of (AU 4)..........................

12.50

4539

External auditory meatus, surgical removal of keratosis obturans from, not covered by any other item in this Part (AU 9) 

14.00

4543

External auditory meatus, removal of exostoses in (AU 12)........

90.00

4546

Myringoplasty, trans-canal approach (Rosen incision) (AU 11)......

56.00

4550

Myringoplasty, post-aural or endaural approach with or without mastoid inspection (AU 12) 

93.00

4554

Ossicular chain reconstruction (AU 12).....................

105.00

4556

Ossicular chain reconstruction and myringoplasty {AU 13)........

135.00

4558

Mastoidectomy (cortical) (AU 12) ........................

50.00

4566

Obliteration of the mastoid cavity (AU 10)...................

64.00

4569

Mastoidectomy (radical or modified radical) (AU 13)............

105.00

4572

Mastoidectomy (radical or modified radical) and myringoplasty (AU 13) 

150.00

4574

Mastoidectomy (radical or modified radical), myringoplasty and ossicular chain reconstruction (AU 14) 

170.00

4577

Decompression of facial nerve in its mastoid portion (AU 13).......

115.00

4581

Decompression of facial nerve in its intracranial portion by intracranial or intrapetrous approach (AU 18) 

130.00

4584

Labyrinthotomy or destruction of labyrinth (AU 12).............

100.00

4588

Cerebello-pontine angle tumour, removal of by two surgeons operating conjointly, by transmastoid, translabyrinthine approach— transmastoid, translabyrinthine procedure (including after-care) (AU 39)             

235.00

4589

Cerebello-pontine angle tumour, removal of by two surgeons operating conjointly, by transmastoid, translabyrinthine approach— intracranial procedure (including after-care)             

235.00

4593

Endolymphatic sac, transmastoid decompression with or without drainage of (AU 12) 

115.00

4597

Internal auditory meatus, exploration of, by middle cranial fossa approach with or without removal of tumour (AU 21) 

145.00

4601

Fenestration operation—each ear (AU 11)....................

115.00

4607

Venous graft to fenestration cavity (AU ) 2)..................

56.00

4609

Stapedectomy (AU 11)................................

105.00

4613

Stapes mobilisation (AU 10) ............................

66.00

4615

Glomus tumour, transtympanic removal of (AU 12).............

77.00-

4619

Glomus tumour, transmastoid removal of, including mastoidectomy (AU 13) 

115.00

4621

Abscess or inflammation of middle ear, operation for (excluding after-care) (AU 7) 

8.20

4623

Middle ear, exploration of (AU 9).........................

40.00

4627

Middle ear, insertion of tube for drainage of (AU 6).............

21.00

4632

Perforation of tympanum, cauterisation or diathermy of (AU 6)......

3.90

4634

Cholesteatoma, removal of, by suction ear toilet (AU 7)...........

9.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 3—continued

$

4636

Tympanic membrane, micro-inspection of, with or without suction removal of cholesteatoma (AU 7) 

9.00

4638

Examination of nasal cavity or post-nasal space, or nasal cavity and post-nasal space, under general anaesthesia, as an independent procedure (AU 6)             

5.80

4642

Nasal haemorrhage, posterior, arrest of, with posterior nasal packing with or without cauterisation and with or without anterior jack (excluding after-care) (AU 8)             

10.50

4644

Nose, removal of foreign body in, other than by simple probing (AU 6) 

6.40

4646

Nasal polyp or polypi (simple), removal of...................

6.40

4647

Nasal polyp or polypi (requiring admission to hospital), removal of (G) (AU 7)  

15.00

4648

Nasal polyp or polypi (requiring admission to hospital), removal of (S) (AU 7)  

18.50

4652

Nasal septum, septoplasty or submucous resection of (AU 9) ......

40.00

4654

Nasal septum, septoplasty or submucous resection of, with cauterisation or diathermy of any one or more of septum or turbinates or pharynx (AU 10)             

45.00

4656

Nasal septum, septoplasty or submucous resection of, with turbin- ectomy or dislocation of turbinate (AU 9) 

46.00

4659

Cauterisation or diathermy of septum or turbinates or pharynx—any one or more—each attendance at which the procedure is perfomed (AU 6)             

8.20

466!

Cryotherapy to nose in the treatment of nasal haemorrhage (AU 7)...

14.00

4664

Turbinectomy or dislocation of turbinate (AU 6)...............

11.50

4666

Turbinates, submucous resection of (AU 8)..................

15.50

4668

Maxillary antrum, proof puncture and lavage of (AU 6)..........

2.40

4669

Maxillary antrum, proof puncture and lavage of (D) (AU 6)........

2.40

4671

Maxillary antrum, proof puncture and lavage of under general anaesthesia (requiring admission to hospital) (AU 6) 

7.40

4672

Maxillary antrum, proof puncture and lavage of under general anaesthesia (D) (AU 6)  

7.40

4673

Maxillary antrum, lavage of—each attendance (AU 6) ...........

1.90

4675

Maxiliery artery, transantral ligation of (AU 9)................

40.00

4679

Antrostomy (radical) (AU 9)............................

40.00

4680

Antrostomy (radical) (D) (AU 9).........................

40.00

4682

Antrostomy (radical) with transantral ethmoidectomy (AU 10)......

61.00

4683

Antrum, intranasal operation on, or removal of foreign body from (AU 8)  

24.00

4684

Antrum, intranasal operation on, or removal of foreign body from (D).(AU 8)  

24.00

4685

Antrum, drainage of, through tooth socket (AU 7)..............

10.00

4686

Antrum, drainage of, through tooth socket (D) (AU 7)...........

10.00

4687

Oro-antral fistula, plastic closure of (AU 11).................

56.00

4688

Oro-antral fistula, plastic closure of (D) (AU 11)...............

56.00

4689

Fronto-nasal ethmoidectomy with or without sphenoidectomy (AU 9).

74.00

4692

Radical fronto-ethmoidectomy with osteoplastic flap (AU 13)......

98.00

4695

Frontal sinus or ethmoidal sinuses, intranasal operation on (AU 9)...

34.00

4698

Frontal sinus, catheterisation of (AU 6).....................

4.50

4700

Frontal sinus, trephine of (AU 6).........................

31.00

4703

Frontal sinus, radical obliteration of (AU 10).................

74.00


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 3—continued

$

4706

Ethmoidal sinuses, external operation on (AU 10)..............

58.00

4708

Sphenoidal sinus, proof puncture of (AU 6) ..................

4.50

4711

Sphenoidal sinus, intranasal operation on (AU 10)..............

27.00

4716

Transantral vidian neurectomy (AU 12).....................

56.00

4717

Trans-sphenoidal hypophysectomy (AU 14)..................

77.00

4720

Trans-sphenoidal hypophysectomy including submucous resection of nasal septum and grafting to obliterate the pituitary fossa (including obtaining of graft) (AU 15)             

105.00

4722

Eustachian tube, catheterisation of (AU 6)...................

3.20

4731

Division of pharyngeal adhesions (AU 7)....................

10.00

4734

Post-nasal space, direct examination of, with biopsy (AU 7)........

10.50

4737

Nasopharyngeal tumour, operation for removal of, involving hard palate (AU 14) 

93.00

4742

Pharyngeal, pouch, removal of (AU 16).....................

66. 00

4745

Pharyngeal pouch, endoscopic resection of (Dohlman’s operation) (AU 14) 

56.00

4748

Pharyngotomy (lateral) (AU 6)...........................

66.00

4750

Tonsils or tonsils and adenoids, removal of, in a person aged less than twelve years (G) (AU 7) 

18.50

47S3

Tonsils or tonsils and adenoids, removal of, in a person aged less than twelve years (S) (AU 7)  

27.00

4756

Tonsils or tonsils and adenoids in a person aged less than twelve years, removal of with operation for abscess or inflammation of middle ear (G) (AU 8)              

23.00

4757

Tonsils or tonsils and adenoids in a person aged less than twelve years, removal of with operation for abscess or inflammation of middle ear (S) (AU 8)             

31.00

4760

Tonsils or tonsils and adenoids in a person aged less than twelve years, removal of with cauterisation and diathermy of any one or more of septum or turbinates or pharynx (G) (AU 9)             

23.00

4761

Tonsils or tonsils and adenoids in a person aged less than twelve years, removal of with cauterisation and diathermy of any one or more of septum or turbinates or pharynx (S) (AU 9)             

31.00

4769

Tonsils or tonsils and adenoids, removal of, in a person twelve years of age or over (G) (A U 8)  

24.00

4770

Tonsils or tonsils and adenoids, removal of, in a person twelve years of age or over (S) (AU 8)  

34.00

4776

Tonsils or tonsils and adenoids, arrest of haemorrhage requiring general anaesthesia, following removal of (G) (AU 9) 

9.50

4777

Tonsils or tonsils and adenoids, arrest of haemorrhage requiring general anaesthesia, following removal of (S) (AU 9) 

12.50

4781

Adenoids, removal of (G) (AU 6).........................

10.00

47S2

Adenoids, removal of (S) (AU 6).........................

14.00

4786

Adenoids, removal of. with operation for abscess or inflammation of middle ear (G) (AU 7) 

14.50

4788

Adenoids, removal of, with operation for abscess or inflammation of middle ear (S) (A.U 7)  

18.50

4793

Lingual tonsil or lateral pharyngeal bands, removal of (AU 7)......

7.20

4795

Peritonsillar abscess (quinsy), incision of (AU 7)...............

5.60

4797

Uvulatomy (AU 6)...................................

2.70

4799

Vallecular or pharyngeal cysts, removal of (AU 8)..............

32.00

4803

Oesophagoscopy (AU 6)...............................

16.50


Schedule 1—continued

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 3—continued

$

4805

Oesophagoscopy, initial, with dilatation or insertion of prosthesis (AU 7)...

33.00

4807

Oesophagoscopy with dilatation or insertion of prosthesis—subsequent procedures in a single course of treatment (AU 7) 

15.50

4809

Oesophagoscopy with biopsy (AU 7)..........................

18.50

4813

Oesophagus, removal of foreign body in (AU 7)...................

32.00

4816

Oesophageal stricture, dilatation of, without oesophagoscopy (AU 6)

4.00

4821

Laryngectomy (total) (AU 20)...............................

125.00

4824

Laryngopharyngectomy (AU 20).............................

130.00

4826

Primary restoration of alimentary continuity after laryngopharyngectomy using stomach or bowel (AU 20) 

130.00

4829

Larynx, direct examination of, as an independent procedure (AU 8)

16.50

4833

Larynx, direct examination of, with biopsy (AU 8)..................

18.50

4840

Larynx, direct examination of, with removal of tumour (AU 9).........

21.00

4842

Microlaryngoscopy (AU 8).................................

26.00

4846

Microlaryngoscopy with removal of tumour (AU 9).................

37.00

4849

Larynx, fractured, operation for (AU 15)........................

56.00

4852

Larynx, external operation on, or laryngofissure (AU 13).............

56.00

4857

Arytenoid cartilage, fixation of (AU 13)........................

93.00

4859

Arytenoid cartilage, removal of (AU 11)........................

80.00

4861

Tracheostomy (G) (AU 10).................................

16.00

4863

Tracheostomy (S) (AU 10).................................

21.00

4865

Trachea, removal of foreign body in (AU 7)......................

15.50

4869

Bronchoscopy, as an independent procedure (AU 7).................

15.50

4871

Bronchoscopy with biopsy or other diagnostic or therapeutic procedure (AU 8) 

21.00

4873

Bronchus, removal of foreign body in (AU 9).....................

33.00

4875

Bronchoscopy with dilatation of tracheal stricture—initial (AU 7).......

22.00

4878

Bronchoscopy with dilatation of tracheal stricture—subsequent dilatation in a single course of treatment (AU 7) 

10.50

 

Division 4—Urological

 

4890

Adrenal gland, biopsy of (AU 9).............................

74.00

4892

Adrenal gland, removal of (AU 12)............................

82.00

4894

Renal transplant (AU 24)..................................

145.00

4896

Donor nephrectomy (cadaver)...............................

77.00

4898

Nephrectomy, complicated by previous surgery on same kidney (AU 13)...

105.00

4903

Nephrectomy, complete (G) (AU 13)..........................

74.00

4904

Nephrectomy, complete (S) (AU 13)...........................

93.00

4908

Nephrectomy, partial (AU 11)...............................

105.00

4913

Nephro-ureterectomy (AU 13)...............................

105.00

4914

Nephro-ureterectomy, complete, with bladder repair (AU 17)..........

115.00

4920

Kidney, fused, symphysiotomy for (AU 14)......................

105.00

4923

Kidney, exploration of, with any procedure, not covered by any other item (AU 10)

72.00

4928

Nephrolithotomy or pyelolithotomy (AU 12).....................

93.00

4929

Nephrolithotomy or pyelolithotomy complicated by previous surgery on same kidney (AU 12) 

105.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 4—continued

$

4932

Nephrolithotomy or pyelolithotomy—large staghorn calculus filling renal pelvis and calyces (AU 12) 

105.00

4936

Ureterolithotomy (AU 11).................................

82.00

4938

Nephrostomy, nephrotomy or pyelostomy with drainage (A.U 11).......

74.00

4941

Nephropexy, as an independent procedure (AU 9)

56.00

4945

Renal cyst or cysts, excision or unroofing of (AU 11)...............

64.00

4947

Renal biopsy (closed) (AU 6)...............................

15.00

4951

Pyonephrosis, drainage of (AU 11)...........................

32.00

4953

Perinephric abscess, drainage of (AU 9)........................

45.00

4956

Pyeloplasty (AU 14).....................................

93.00

4958

Pyeloplasty, complicated by previous surgery on same kidney, or by congenital kidney abnormality or by the operation being on a solitary kidney (AU 14)             

105.00

4960

Divided ureter, repair of (AU 13)............................

93.00

4962

Repair of kidney, wound or injury (AU 13)......................

93.00

4964

Ureterectomy, complete, with bladder repair, as an independent procedure (AU 12) 

74.00

4966

Replacement of ureter by bowel—unilateral (AU 12)...............

130.00

4968

Replacement of ureter by bowel—bilateral (AU 17)................

170.00

4971

Ureter (unilateral), transplantation of into skin (AU 10)..............

74.00

4973

Ureters (bilateral), transplantation of, into skin (AU 12)..............

93.00

4975

Ureter (unilateral), transplantation of, into bladder (AU 12)...........

82.00

4977

Ureters (bilateral), transplantation of, into bladder (AU 14)...........

105.00

4980

Ureter, transplantation of, into bladder with bladder plastic procedure (Boari flap) (AU 12) 

93.00

4982

Ureter (unilateral), transplantation of, into intestine (AU 12)..........

93.00

4984

Ureters (bilateral), transplantation of, into intestine (AU 14)...........

110.00

4986

Ureter, transplantation of, into other ureter (AU 12)................

93.00

4988

Ureter (unilateral), transplantation of, into isolated intestinal loop (AU 14).

110.00

4992

Ureter (bilateral), transplantation of, into isolated intestinal loop (AU 16)..

130.00

5000

Ureterotomy with exploration or drainage as an independent procedure where the procedure is not covered by item 5003 (AU 11)             

64.00

5003

Ureterotomy with exploration or drainage for tumour, as an independent procedure (AU 11) 

74.00

5005

Ureterolysis, with or without repositioning of ureter, for retroperitoneal fibrosis, ovarian vein syndrome, or similar condition—unilateral (AU 11)             

74.00

5008

Ureterolysis, with or without repositioning of ureter, for retroperitoneal fibrosis, ovarian vein syndrome, or similar condition— bilateral (AU 13)             

93.00

 

Operation on the Bladder (Closed)

 

5011

Bladder, catheterisation of—where no other surgical procedure is performed (AU 4) 

2.10

5013

Cystoscopy, with or without urethral dilatation not being a procedure covered by item 5017 (AU 5) 

13.00

5017

Cystoscopy, with dilatation of urethral stricture (AU 5)..............

16.00

5020

Cystoscopy, with ureteric catheterisation, with or without introduction of opaque medium (AU 5) 

17.00

5022

Cystoscopy, with controlled, hydro-dilatation of the bladder (AU 5).....

21.00

5025

Cystometrography (AU 5).................................

8.00

5027

Ascending cysto-urethrography (AU 5)........................

8.00

5030

Cystoscopic removal of foreign body (AU 6).....................

26.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 4—continued

$

5033

Cystoscopy, with biopsy of bladder tumours (AU 6)................

21.00

5035

Cystoscopy, with diathermy or resection of superficial bladder tumours or with other diathermy of bladder or prostate (AU 5) 

31.00

5039

Cystoscopy with diathermy or resection of invasive bladder tumours or solitary tumour over 2 cm in diameter (AU 6) 

69.00

5042

Cystoscopy, with ureteric meatotomy or with resection of ureterocoele (AU 5) 

24.00

5044

Cystoscopy, with endoscopic bladder neck resection (AU 7)...........

45.00

5046

Cystoscopy, with endoscopic removal or manipulation of ureteric calculus (AU 6) 

32.00

5049

Litholapaxy, with or without cystoscopy (AU 7)..................

45.00

 

Operations on the bladder (open)

 

5053

Bladder, repair of rupture of, or partial excision of, or plastic repair of (G) (AU 13) 

56.00

5054

Bladder, repair of rupture of, or partial excision of, or plastic repair of (S) (AU 13)  

69.00

5057

Cystostomy or cystotomy, suprapubic (G) (AU S).................

32.00

5058

Cystostomy or cystotomy, suprapubic (S) (AU 8)..................

40.00

5061

Bladder, total excision of (AU 29)............................

105.00

5063

Bladder neck contracture, operation for (AU 9)...................

69.00

5065

Bladder tumours, suprapubic diathermy of (AU 10)................

69.00

5069

Diverticulum of bladder, excision or obliteration of (AU 10)..........

74.00

5071

Vesical fistula, cutaneous, operation for (AU 12)..................

40.00

5074

Vesico-vaginal fistula, closure of by abdominal approach (AU 12)......

82.00

5076

Vesico-colic fistula, closure of, excluding bowel resection (AU 11)......

64.00

5080

Vesico-rectal fistula, closure of (AU 13)........................

74.00

5082

Bladder aspiration, by needle...............................

4.00

5084

Cystotomy with removal of calculus as an independent procedure (AU 8)..

45.00

5088

Urethral valves transvesical removal (AU 9).....................

45.00

5090

Urethropexy (Marshall-Marchetti operation) (AU 9)................

74.00

5092

Bladder enlargement, using intestine (AU 23)....................

170.00

5094

Correction of vesico-ureteric reflux—operation for—unilateral (AU 10)...

93.00

5096

Correction of vesico-ureteric reflux—operation for—bilateral (AU 12)....

110.00

 

Operations on the prostate

 

5111

Prostatectomy (suprapubic, perineal or retropubic) (AU 13)...........

105.00

5115

Prostatectomy (endoscopic), with or without cystoscopy (AU 10).......

98.00

5117

Median bar, endoscopic resection of, with or without cystoscopy (AU 9)

45.00

5121

Prostate, total excision of (AU 13)............................

115.00

5123

Prostate, open perineal biopsy of (AU 6).......................

27.00

5126

Prostate, biopsy of, endoscopic, with or without cystoscopy (AU 6)......

40.00

5129

Prostate, needle biopsy of, or injection into (AU 5).................

12.50

5134

Prostatic abscess, retropubic or endoscopic drainage of (AU 7).........

45.00

 

Operations on urethra, penis or scrotum

 

5137

Urethral sounds, passage of, as an independent procedure (AU 5).......

4.00

5139

Urethral stricture, dilatation of (AU 5).........................

6.40

5142

Urethra, repair of rupture of (AU 10)..........................

93.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 4—continued

$

5146

Urethral fistula, closure of (AU 8)............................

26.00

5148

Urethroscopy, as an independent procedure (AU 5)................

13.00

5151

Urethroscopy, with diathermy of tumour (AU 7)..................

31.00

5154

Urethroscopy with removal of stone or foreign body (AU 5)...........

21.00

5156

Urethra, examination of, involving the use of urethroscope, with cystoscopy (AU 4) 

15.50

5159

Urethral meatotomy, external (AU 4)..........................

8.00

5164

Urethrotomy (external) (AU 7)..............................

21.00

5168

Urethrotomy (internal) (AU 5)..............................

21.00

5177

Urethrectomy, partial or complete, for removal of tumour (AU 9).......

64.00

5180

Urethro-vaginal fistula, closure of (AU 9).......................

56.00

5183

Urethro-rectal fistula, closure of (ALT 10)......................

74.00

5187

Urethroplasty—single stage operation (AU 10)...................

74.00

5189

Urethroplasty—two stage operation—first stage (AU 9).............

69.00

5195

Urethroplasty—two stage operation—second stage (AU 9)...........

69.00

5197

Urethroplasty, not covered by any other item in this Part (AU 9)........

26.00

5200

Hypospadias, correction of chordee (AU 10).....................

36.00

5203

Hypospadias, correction of chordee with transplantation of prepuce (AU 10) 

45.00

5207

Hypospadias, urethral reconstruction for (AU 10)..................

69.00

5209

Hypospadias, urethral reconstruction with perineal urethrostomy (AU 11)..

72.00

5211

Hypospadias, urethral reconstruction and correction of chordee, complete, one stage including urinary diversion (AU 13) 

82.00

5213

Hypospadias, secondary correction of (AU 9)....................

25.00

5215

Epispadias, repair of, not involving sphincter (AU 9)...............

56.00

5219

Epispadias, repair of, including bladder neck closure (AU 10).........

93.00

5226

Urethra, diathermy of (AU 4)...............................

17.00

5231

Urethra, excision of prolapse of (AU 7)........................

17.00

5234

Urethra, excision of diverticulum of (AU 8).....................

45.00

5238

Urethra, operation for correction of male urinary incontinence (AU 9)

74.00

5242

Priapism, decompression operation for, under general anaesthesia (AU 7)..

6.40

5247

Priapism, decompression shunt operation for (AU 10)...............

74.00

5250

Urethral abscess, drainage of (AU 5)..........................

10.00

5253

Urethral valves, endoscopic resection of (AU 7)...................

36.00

5255

Penis, partial amputation of (AU 8)...........................

45.00

5258

Penis, complete or radical amputation of (AU 12)..................

93.00

5263

Penis, repair of laceration or fracture involving cavernous tissue (AU 8)

45.00

5265

Penis, repair of avulsion (AU 12)............................

93.00

5267

Penis, Peyronies’disease, injection procedure for..................

4.00

5271

Penis, Peyronies’ disease, operation for (AU 8)...................

45.00

5273

Penis, plastic implantation of (AU 8)..........................

85.00

5275

Scrotum, partial excision of (AU 7)...........................

27.00

5279

Scrotum, drainage of abscess of (AU 4)........................

17.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 4—continued

$

 

Operations on testes, vasa or seminal vesicles

 

5290

Testicular biopsy (AU 6)..................................

17.00

5292

Spermatocele, or epididymal cysts, excision of (G) (AD 6)............

20.00

5293

Spermatocele or epididymal cysts, excision of (S) (AU 6)............

26.00

5297

Exploration of the testis, with or without fixation for torsion (AU 5)

26.00

5299

Orchidectomy, with excision of retroperitoneal glands or seminal vesicles (AU 12) 

93.00

5302

Orchidoplasty (AU 8)....................................

32.00

5304

Epididymectomy (AU 8)..................................

29.00

5307

Vasoepididymostomy—unilateral (AU 9).......................

56.00

5309

Vasoepididymostomy—bilateral (AU 12).......................

64.00

5315

Vas deferens, reanastomosis of (AU 9).........................

50.00

5321

Vasoepididymography and vasovesiculography as an independent operative procedure, preparation for, by open operation (AD 5)             

17.00

5326

Vasotomy or vasectomy (unilateral or bilateral) (G) (AU 5)...........

17.00

5331

Vasotomy or vasectomy (unilateral or bilateral) (S) (AU 5)...........

21.00

 

Division 5—Gynaecological

 

5365

Gynaecological examination under anaesthesia not performed in association with any service covered by any other item in this Part (AU 5)             

6.40

5368

Intra-uterine contraceptive device, introduction or removal of as an independent procedure (AU 5) 

4.00

5373

Simple tumour of vagina or vulva, removal of (AU 7)...............

7.20

5377

Hymenectomy (AU 5)...................................

7.20

5379

Bartholin’s cyst, excision of (G) (AU 7)........................

13.50

5381

Bartholin’s cyst, excision of (S) (AU 7)........................

16.50

5384

Bartholin’s cyst or gland, marsupialisation or cautery destruction of (G) (AU 6) 

10.00

5386

Bartholin’s cyst or gland, marsupialisation or cautery destruction of (S) (AU 6) 

13.00

5391

Bartholin’s abscess, incision of (AU 5).........................

4.50

5395

Skene’s duct, incision of. or removal of calculus from (AU 6).........

7.20

5400

Urethra or urethral caruncle, cauterisation of (AU 4)................

4.50

5405

Urethral caruncle, excision of (G) (AU 6).......................

10.00

5406

Urethral caruncle, excision of (S) (AU 6).......................

13.00

5412

Clitoris, amputation of (AU 7)..............................

24.00

5417

Vulvectomy (simple) (AU 9)...............................

32.00

5421

Vulvectomy (radical) (AU 16)..............................

115.00

5430

Pelvic lymph glands, excision of (radical) (AU 15).................

66.00

5432

Vagina, dilatation of, as an independent procedure—each attendance at which dilatation is performed. (AU 4) 

3.60

5435

Vagina, complete removal of (AU 13).........................

66.00

5440

Vaginal reconstruction in congenital absence or gynatresia (AU IS)......

66.00

5446

Vaginal septum, excision of, for correction of double vagina (AU 12)

37.00

5450

Plastic repair to enlarge vaginal orifice (AU 9)...................

14.00

5465

Colpotomy or colporrhaphy, not covered by any other item in this Part (AU 6)

10.50

5468

Cystocele or rectocele, repair of not covered by item 5478, 5479, 5484 or 5485 (G) (AU 10) 

31.00

5469

Cystocele or rectocele, repair of not covered by item 5478, 5479, 5484 or 5485 (S) (AU 10) 

39.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 5—continued

$

5478

Cystocele and rectocele, repair of, not covered by item 5484 or 5485 (G) (AU 10)

39.00

5479

Cystocele and rectocele, repair of, not covered by item 5484 or 5485 (S) (AU 10)

50.00

5484

Colpoplasty, Donald-Fothergill or Manchester operation (operation for genital prolapse) (G) (AU 10) 

50.00

5485

Colpoplasty, Donald-Fothergill or Manchester operation (operation for genital prolapse) (S) (AU 10) 

61.00

5496

Colpoplasty, Donald-Fothergill or Manchester operation (operation for genital prolapse) and curettage of uterus; with, or without dilatation (G) (AU 11)             

56.00

5497

Colpoplasty, Donald-Fothergill or Manchester operation (operation for genital prolapse) and curettage of uterus, with or without dilatation (S) (AU 11)             

69.00

3502

Urethrocele, operation for (AU 9)............................

15.50

5506

Operation involving abdominal approach for repair of enterocoele or suspension of vaginal vault or enterocoele and suspension of vaginal vault (AU 9)             

50.00

5514

Fistula between genital and urinary or alimentary tracts, repair of not covered by items 5074, 5180 or 5183 (AU 13) 

66.00

5521

Stress incontinence, sling operation for, as an independent procedure (AU 12) 

64.00

5526

Cervix, cauterisation, ionisation or diathermy of (AU 5).............

5.00

5528

Cervix, removal of polyp from (AU 5).........................

5.00

5532

Examination of the uterine cervix by a magnifying colposcope of the Hinselmann type or similar instrument (AU 5) 

5.60

5536

Cervix, cone biopsy of (G) (AU 7)...........................

15.00

5538

Cervix, cone biopsy of (S) (AU 7)............................

18.50

5544

Cervix, cone biopsy of and curettage of uterus with or without dilatation (G) (AU 7) 

21.00

5546

Cervix, cone biopsy of and curettage of uterus with or without dilatation (S) (AU 7)

27.00

5549

Cervix, amputation or repair of, not covered by item 5484 or 5485 (G) (AU 7) 

12.50

5550

Cervix, amputation or repair of, not covered by item 5484 or 5485 (S) (AU 7) 

15.50

5555

Cervix, dilatation of, not covered by item 5563 or 5564 in this Schedule (AU 5) 

5.40

5558

Culdoscopy (AU 5).....................................

9.00

5563

Uterus, curettage of, with or without dilatation (G) (AU 5)............

11.50

5564

Uterus, curettage of, with or without dilatation (S) (AU 5)............

15.00

5570

Evacuation of the contents of the gravid uterus by curettage or suction curettage not covered by item 5563 or 5564 (AU 5) 

19.00

5581

Uterus, curettage of, with or without dilatation; and cauterisation, ionisation or diathermy of cervix (G) (AU 6) 

14.50

5582

Uterus, curettage of, with or without dilatation; and cauterisation, ionisation or diathermy of cervix (S) (AU 6) 

18.00

5587

Uterus, curettage of, with or without dilatation and removal of polyp from cervix (G) (AU 6) 

14.50

5590

Uterus, curettage of, with or without dilatation and removal of polyp from cervix (S) (AU 6) 

18.00

5591

Uterus, curettage of, with or without dilatation, with removal of polyp from cervix and cauterisation, ionisation or diathermy of cervix (G) (AU 6)             

16.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 5—continued

$

5592

Uterus, curettage of, with or without dilatation, with removal of polyp from cervix and cauterisation, ionisation or diathermy of cervix (S) (AU 6)             

19.00

5599

Hysterotomy (AU 10)....................................

50.00

5603

Hysterectomy (other than vaginal)—subtotal (G) (AU 10)............

50.00

5604

Hysterectomy (other than vaginal)—subtotal (S) (AU 10)............

64.00

5608

Hysterectomy (other than vaginal)—total (G) (AU 11)..............

50.00

5609

Hysterectomy (other than vaginal)—total (S) (AU 11)...............

64.00

5615

Hysterectomy (other than vaginal)—total, with curettage of uterus, with or without dilatation (G) (AU 11) 

57.00

5617

Hysterectomy (other than vaginal)—total, with curettage of uterus, with or without dilatation (S) (AU 11) 

72.00

5621

Hysterectomy (total) with abdominal urethroplexy (AU 12)...........

72.00

5623

Hysterectomy and dissection of pelvic glands (AU 17)..............

110.00

5629

Radical hysterectomy without gland dissection (AU 12).............

77.00

5633

Colpoplasty with vaginal hysterectomy (AU 12)..................

77.00

5638

Ectopic gestation, removal of (G) (AU 9).......................

39.00

5639

Ectopic gestation, removal of (S) (AU 9).......................

50.00

5643

Myomectomy (G) (AU 10)................................

39.00

5645

Myomectomy (S) (AU 10).................................

50.00

5650

Bicornuate uterus, plastic reconstruction for (AU 14)...............

56.00

5657

Uterus, suspension or fixation of—as an independent procedure (G) (AU 8) 

32.00

5660

Uterus, suspension or fixation of—as an independent procedure (S) (AU 8).

40.00

5664

Rubin test for patency (AU 5)...............................

5.30

5670

Laparoscopy, diagnostic, as a diagnostic procedure performed in gynaecology (AU 7)

18.50

5672

Laparoscopy with transection or resection of Fallopian tubes by diathermy or any other method, or laparoscopy and ovarian biopsy (AU 7)             

32.00

5676

Fallopian tube or tubes, implantation of, into uterus (AU 12)..........

61.00

5682

Fallopian tubes, hydrotubation of, as an isolated procedure (AU 7)

5.00

5684

Fallopian tubes, hydrotubation of, as a repetitive post-operative procedure (AU 7) 

3.40

5688

Oophorectomy, salpingectomy, salpingo-oophorectomy or ligation of Fallopian tubes, not associated with hysterectomy (G) (AU 9)             

33.00

5690

Oophorectomy, salpingectomy, salpingo-oophorectomy or ligation of Fallopian tubes, not associated with hysterectomy (S) (AU 9)             

42.00

5695

Oophorectomy, salpingectomy, salpingo-oophorectomy or ligation of Fallopian tubes, not associated with hysterectomy in addition to curettage of uterus, with or without dilatation (G) (AU 10)             

40.00

5696

Oophorectomy, salpingectomy, salpingo-oophorectomy or ligation of Fallopian tubes, not associated with, hysterectomy in addition to curettage of uterus, with or without dilatation (S) (AU 10)             

51.00

5700

Salpingostomy or salpingolysis, or both (AU 11)..................

61.00

5707

Ovarian, parovarian, fimbrial or broad ligament cyst, excision of, not covered by any other item in this Part (G) (AU 9) 

39.00

5709

Ovarian, parovarian, fimbrial or broad ligament cyst, excision of, not covered by any other item in this Part (S) (AU 9) 

50.00

5716

Pelvic abscess, suprapubic drainage of (G) (AU 8).................

33.00

5717

Pelvic abscess, suprapubic drainage of (S) (AU 8).................

42.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—continued

$

 

Division 6—Ophthalmological

 

5740

Ophthalmological examination under general anaesthesia as an independent procedure (AU 5) 

8.70

5752

Eye, enucleation of, with or without sphere implant (AU 8)...........

45.00

5755

Eye, enucleation of, with insertion of integrated implant (AU 9)........

58.00

5759

Globe, evisceration of (AU 8)...............................

45.00

5761

Globe, evisceration of, and insertion of intrascleral ball or cartilage (AU 9).

58.00

5765

Anophthalmic orbit, insertion of cartilage or artificial implant as a delayed procedure (AU 9) 

32.00

5768

Orbit, skin graft to, as a delayed procedure (AU 7).................

18.50

5771

Contracted socket, reconstruction including mucous membrane grafting and stent mould (AU 11) 

39.00

5776

Orbit, exploration with or without biopsy, requiring removal of bone (AU 9) 

61.00

5781

Orbit, exploration of, with drainage or biopsy not requiring removal of bone (AU 8) 

37.00

5784

Orbit, exenteration of (AU 8)...............................

64.00

5787

Orbit, exenteration of, with skin graft (AU 10)....................

80.00

5789

Orbit exenteration of, including skin grafting, with temporalis muscle transplant (AU 11) 

87.00

5797

Orbit, exploration of, with removal of tumour or foreign body, requiring removal of bone (AU 12) 

100.00

5801

Orbit, exploration of, with removal of tumour or of foreign body (AU 10)..

47.00

5805

Eyeball, perforating wound of, not involving intraocular structures— repair (AU 10) 

61.00

5808

Eyeball, perforating wound of, with incarceration or prolapse of uveal tissue—repair (AU 12) 

72.00

5811

Eyeball, perforating wound of, with incarceration of lens or vitreous—repair (AU 12) 

100.00

5815

Intraocular foreign body, magnetic removal from anterior segment (AU 10) 

39.00

5817

Intraocular foreign body, non-magnetic removal from anterior segment (AU 11)

50.00

5820

Intraocular foreign body, magnetic removal from posterior segment (AU 10) 

72.00

5823

Intraocular foreign body, non-magnetic removal from posterior segment (AU 12) 

100.00

5825

Abscess (intraorbital), drainage of (AU 6).......................

10.00

5829

Tarsal cyst, extirpation of (AU 6)............................

6.60

5832

Tarsal cartilage, excision of (AU 8)...........................

42.00

5835

Ectropion, tarsal cauterisation for............................

10.00

5839

Tarsorrhaphy (AU 8)....................................

24.00

5841

Canthoplasty, medial or lateral (AU 9).........................

31.00

5844

Lacrimal gland, excision of palpebral lobe (AU 8).................

18.50

5860

Lacrimal sac, excision of, or operation on (AU 8)..................

47.00

5863

Dacryocystorhinostomy (AU 11)............................

66.00

5865

Conjunctivorhinostomy (AU 11).............................

56.00

5867

Conjunctivorhinostomy including dacryocystorhinostomy and fashioning of conjunctival flaps (AU 12) 

72.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 6—continued

$

5870

Parotid duct, transplantation of into conjunctival sac (AU 11)..........

72.00

5872

Lacrimal canalicular system, reconstruction of (AU 8)..............

61.00

5874

Lacrimal canaliculus, immediate repair of (AU 8).................

42.00

5877

Naso-lacrimal duct, probing for obstruction one or both ducts (AU 4)

12.50

5880

Lacrimal passages, lavage of (excluding after-care) (AU 4)...........

3.90

5882

Punctum snip operation (AU 4).............................

11.50

5884

Conjunctival peritomy (AU 7)..............................

10.00

5886

Conjunctival graft over cornea (AU 7)

35.00

5890

Trachoma, crushing operation for (AU 6).......................

10.50

5893

Cornea or sclera, removal of superficial foreign body from (excluding after-care) (AU 6) 

1.55

5895

Cornea or sclera, removal of imbedded foreign body from (excluding after-care) (AU 8) 

5.80

5898

Corneal scars, removal of, by partial keratectomy (AU 8)............

18.50

5900

Cornea, tattooing of (AU 9)................................

21.00

5902

Cornea, epithelial debridement for dendritic ulcer (excluding after-care) (AU 8) 

5.80

5904

Cornea, transplantation of, full thickness, including collection of implant (AU 13) 

130.00

5907

Cornea, transplantation of, superficial or lamellar, including collection of transplant (AU 11) 

85.00

5913

Conjunctiva, cautery of, including treatment of pannus—each attendance at which treatment is given (AU 4) 

4.80

5914

Pterygium, removal of (AU 6)..............................

22.00

5917

Pinguecula, removal of (AU 6)..............................

10.00

5921

Limbic tumour, removal of (AU 7)...........................

24.00

5923

Lens extraction (AU 11)..................................

115.00

5925

Artificial lens, insertion of (AU 11)...........................

61.00

5932

Artificial lens, removal of (AU 9)............................

42.00

5934

Cataract, juvenile, removal of, including subsequent needlings (AU 11)

115.00

5939

Capsulectomy (AU 9)....................................

49.00

5942

Capsulotomy or needling (AU 7)............................

29.00

5944

Paracentesis in relation to eye, for diagnosis or relief of tension (AU 6)

27.00

5950

Anterior chamber, irrigation of blood from, as an independent procedure (AU 7) 

61.00

5952

Glaucoma, filtering and allied operations in the treatment of (AU 10)

93.00

5955

Goniotomy (AU 10).....................................

66.00

5957

Iridectomy or iridotomy, as an independent procedure (AU 10).........

50.00

5961

Iris, light coagulation of.(AU 6).............................

32.00

5965

Tumour of iris, excision of (AU 10)...........................

50.00

5970

Tumour, involving ciliary body or ciliary body and iris, excision of (AU 12) 

105.00

5974

Cyclodiathermy or cyclocryotherapy (AU 8).....................

27.00

5978

Detached retina, diathermy operation for (AU 11).................

85.00

5982

Detached retina, resection of, or buckling operation for, or revision operation for (AU 12) 

112.00

5987

Photocoagulation, each attendance at which treatment is given (AU 10)

32.00

5991

Detached retina, removal of encircling silicone band from (AU 8).......

14.50


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 6—continued

$

5995

Retina, cryotherapy to, as an independent procedure (AU 13)..........

56.00

5999

Cryopexy, with scleral resection or scleral infolding, for treatment of detached retina or pre-detachment disease of retina (AU 12)             

85.00

6004

Retrobulbar  transillumination, as an independent procedure (AU 5)

7.20

6006

Retrobulbar injection of alcohol or other drug as an independent procedure.

5.60

6009

Squint, operation for, on one or both eyes, the operation involving a total of one or two muscles (AU 8) 

56.00

6011

Squint, operation for, on one or both eyes, the operation involving a total of three or four muscles (AU 9) 

66.00

6014

Squint, operation for, on one or both eyes, the operation involving a total of more than four muscles (AU 10) 

72.00

6018

Squint, muscle transplant for (Hummelsheim type, etc.) (AU 9)........

66.00

6020

Re-attachment of ruptured medial palpebral ligament (AU 9)..........

37.00

6026

Torn extra-ocular muscle, repair of (AU 9)......................

37.00

6031

Resuturing of wound following intra-ocular procedures with or without excision of prolapsed iris (AU 9) 

37.00

 

Division 7—Thoracic

 

6051

Thoracic cavity, aspiration or paracentesis of, or both (excluding after-care) 

5.30

6055

Pericardium, paracentesis of (excluding after-care) (AU 6)............

9.30

6059

Artificial pneumothorax—induction..........................

7.20

6063

Artificial pneumothorax—each filling subsequent to induction.........

3.70

6067

Intercostal drain, insertion of, not involving resection of rib (excluding after-care) (AU 7) 

9.30

6071

Empyema, radical operation for, involving resection of rib (AU 13)

43.00

6074

Thoracotomy, exploratory, with or without biopsy (AU 11)...........

87.00

6076

Thoracotomy with pulmonary decortication (AU 17)...............

135.00

6080

Thoracotomy with pleurectomy or pleurodesis (AU 16)..............

95.00

6082

Thoracoplasty (complete) (AU 21)...........................

135.00

6085

Thoracoplasty (in stages)—each stage (AU 14)...................

68.00

6087

Pectus excavatum or pectus carinatum, limited correction of (AU 13)

38.00

6091

Pectus excavatum or pectus carinatum, radical correction of (AU 16)

115.00

6093

Thoracoscopy, with or without division of pleural adhesions (AU 7)

25.00

6096

Thoracic duct cannulisation (AU 8)...........................

7.40

6103

Phrenic avulsion or crush (AU 5)............................

16.00

6106

Pneumonectomy or lobectomy (AU 18)........................

135.00

6111

Hydatid cysts of lungs, enucleation of (AU 16)...................

95.00

6117

Oesophagus, correction of atresia of (AU 23)....................

135.00

6121

Oesophagectomy with direct anastomosis or with stomach transposition (AU 23) 

135.00

6125

Oesophagectomy with interposition of small or large bowel (AU 27).....

160.00

6129

Mediastinal abscess, drainage of (AU 14).......................

57.00

6134

Mediastinum, cervical exploration of, with or without biopsy (AU 10)

38.00

6139

Left ventricular puncture..................................

27.00

6145

Pericardium, transthoracic drainage of (other than for treatment of constrictive pericarditis) (AU 14) 

95.00

6150

Bronchoscopy with left atrial puncture (AU 6)....................

43.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 7—continued

$

6153

Hernia, hiatus or other diaphragmatic, transthoracic repair of (AU 15)

95.00

6156

Intrathoracic operation on heart, lungs, great vessels, bronchial tree, oesophagus or mediastinum, or on more than one of those organs, not covered by any other item in this Part (Au 28)

135.00

6161

Cardiac catheterisation with or without fluoroscopy (Au 12)

16.00

6168

Cardiac catheterisation with oximetry (AU 12)...................

23.00

6171

Atrial balloon septostomy including preliminary cardiac catheterisation with oximetry (AU 15) 

55.00

6174

Permanent internal pacemaker and myocardial electrodes, insertion or replacement of by thoracotomy (AU 11) 

115.00

6178

Permanent transvenous electrode and pacemaker, insertion or replacement of (AU 14) 

95.00

6183

Permanent transvenous electrode, insertion or replacement of (A1J 12)

57.00

6188

Permanent pacemaker, insertion or replacement of (AU 12)...........

36.00

6193

Open heart surgery, single valve replacement (AU 32)..............

190.00

6200

Open heart surgery for congenital heart disease (AU 32).............

190.00

6206

Open heart surgery on more than one valve or involving more than one chamber (AU 38) 

270.00

6210

Open heart surgery not covered by any other item in this Part (AU 32)

190.00

6213

Coronary artery or arteries, direct surgery to, employing cardiopulmonary by-pass (AU 36) 

215.00

 

Division 8—Neuro-surgical

 

6250

Local infiltration around nerve or in muscle with alcohol, novocaine or similar preparation—each attendance at which an injection is given             

1.55

6254

Nerve blocking with alcohol or other agent following localisation by electrical stimulator 

4.80

6257

Local anaesthetic infiltration of cranial nerve or sympathetic plexus......

6.30

6260

Injection into trigeminal ganglion or primary branch of trigeminal nerve with alcohol 

24.00

6264

Intrathecal injection of alcohol or phenol.......................

25.00

6266

Lumbar puncture.......................................

5.80

6268

Cisternal puncture......................................

6.90

6270

Spinal or epidural injection for neurological diagnosis or for therapeutic reason 

6.40

6273

Ventricular puncture (not including burr-hole)....................

17.00

6275

Cutaneous or digital nerve, primary suture of (G) (AU 8).............

11.00

6276

Cutaneous or digital nerve, primary suture of (S) (AU 8).............

14.00

6281

Repair of divided digital nerve to thumb or finger (G) (AU 8)..........

18.00

6282

Repair of divided digital nerve to thumb or finger (S) (AU 8)..........

23.00

6287

Nerve trunk, primary suture of (AU 8).........................

40.00

6288

Nerve trunk, primary suture of (D) (AU 8)......................

40.00

6293

Nerve trunk, secondary suture of (AU 9).......................

46.00

6294

Nerve trunk, secondary suture of (D) (AU 9).....................

46.00

6298

Nerve graft performed with magnification (AU 9).................

82.00

6301

Nerve, transposition of (AU 8)..............................

40.00

6304

Neurectomy, neurotomy, or removal of tumour from superficial peripheral nerve (G) (AU 8) 

 

 

16.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Divisions—continued

$

6305

Neurectomy, neurotomy, or removal of tumour from superficial peripheral nerve (S) (AU 8) 

20.00

6312

Neurectomy, neurotomy, or removal of tumour from deep peripheral nerve (AU 10) 

40.00

6317

Neurectomy, periarterial (AU 9).............................

69.00

6319

Neurectomy, intracranial or radical as in tic douloureux (AU 16)........

110.00

6323

Exploration of brachial plexus not covered by any other item in this Part (AU 11) 

34.00

6329

Neurolysis by open operation, without transposition (G) (AU 7)........

23.00

6330

Neurolysis by open operation, without transposition (S) (AU 7)........

29.00

6334

Burr-hole, single preparatory to ventricular puncture or for inspection purpose—not included in. any other items (AU 11) 

21.00

6339

Intracranial tumour, biopsy of, or intracranial cyst, drainage of via burr-hole—including burr-hole (AU SO) 

43.00

6341

Intracranial tumour, biopsy or decompression of via osteoplastic llap or biopsy and decompression of via osteoplastic flap (AU IK)             

95.00

6346

Intracerebral tumour, craniotomy and removal (AU 25)..............

140.00

6351

Intracranial extracerebral tumour, craniotomy and removal (AU 25)

235.00

6356

Intracranial haemorrhage, burr-hole craniotomy for—including burr- hole (G) (AU 11) 

34.00

6357

Intracranial haemorrhage, osteoplastic, craniotomy for—including burr- hole (S) (AU 11) 

43.00

6362

Intracranial haemorrhage, osteoplastic craniotomy or extensive craniectomy and removal of haematoma (AU 18) 

105.00

6369

Fracture of skull, depressed or comminuted, operation for (G)(AU 12)

55.00

6370

Fracture of skull, depressed or comminuted, operation for (S) (AU 12)

69.00

6375

Fractured skull, compound, without dural penetration, operation for (G) (AU 12) 

72.00

6376

Fractured skull, compound, without dural penetration, operation for IS) (AU 12) 

90.00

6380

Fractured skull, compound or complicated, with dural penetration and brain damage, operation for (AU 14) 

105.00

6385

Fractured skull with rhinorrhoea or otorrhea, cranioplasty and repair of (AU 16) 

105.00

6390

Reconstructive cranioplasty (AU 16)..........................

85.00

6394

Craniotomy involving osteoplastic flap (AU 18)..................

75.00

6395

Aneurysm or arteriovenous malformation, capping or reinforcement of sac (AU 28) 

235.00

6399

Aneurysm, or arteriovenous malformation, intracranial proximal artery clipping (AU 24) 

125.00

6405

Aneurysm, or arteriovenous fistula, cervical carotid ligation for (AU 10)

61.00

6408

Craniotomy involving osteoplastic flap, for re-opening post-operatively for haemorrhage, swelling, etc. (AU 16) 

69.00

6411

Intracranial abscess, excision of (AU 17).......................

140.00

6421

Intracranial infection, drainage of, via burr-hole—including burr-hole (AU 10) 

43.00

6429

Craniectomy for osteomyelitis of skull (AU 10)...................

69.00

6433

Leucotomy or lobotomy for psychiatric causes (AU 15)..............

85.00

6440

Hemispherectomy (AU 23)................................

235.00

6444

Temporal lobectomy (AU 24)...............................

140.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 8—continued

$

6450

Chemopallidectomy, or other stereotactic procedure including burr-hole and air studies (AU 17) 

105.00

6457

Laminectomy for exploration or removal of intervertebral disc or discs (AU 12) 

93.00

6461

Laminectomy for recurrent disc lesion or spinal stenosis (AU 13).......

93.00

6466

Laminectomy for extradural tumour or abscess (AU 12).............

93.00

6474

Laminectomy for intradural lesion or open cordotomy (AU 13).........

95.00

6479

Laminectomy and radical excision of intra-medullary tumour or arteriovenous malformation (AU 14) 

115.00

6484

Laminectomy followed by posterior fusion—not covered by items 6490 and 6492 (AU 18) 

105.00

6490

Laminectomy followed by posterior fusion performed by neurosurgeon and orthopaedic surgeon operating together—laminectomy including after-care (AU 18)             

53.00

6492

Laminectomy followed by posterior fusion performed by neurosurgeon and orthopaedic surgeon operating together—posterior fusion including after-care             

53.00

6500

Spinal rhizolysis involving exposure of spinal nerve roots, with or without laminectomy (AU 16) 

91.00

6504

Sympathectomy (cervical, lumbar, thoracic, sacral or presacral) (AU 10)..

68.00

6511

Percutaneous cordotomy (AU 9).............................

61.00

 

Division 9—Treatment of dislocations

 

 

Dislocations not requiring open operation

 

6540

Mandible—first or second dislocation (AU 4)....................

3.90

6541

Mandible—first or second dislocation (D) (AU 4).................

3.90

6547

Mandible—third or subsequent dislocation (AU 4).................

2.20

6548

Mandible—third or subsequent dislocation (D) (AU 4)..............

2.20

6556

Clavicle (AU 4)........................................

6.10

6560

Shoulder—first or second dislocation (AU 4)....................

7.20

6565

Shoulder—third or subsequent dislocation—requiring anaesthesia (AU 4).

6.10

6571

Shoulder—third or subsequent dislocation—not requiring anaesthesia

4.50

6579

Elbow (AU 4).........................................

9.00

6583

Carpus (AU 4).........................................

5.60

6588

Carpus on radius and ulna (G) (AU 4).........................

12.00

6589

Carpus on radius and ulna (S) (AU 4).........................

15.50

6597

Finger (AU 4).........................................

2.20

6603

Metacarpo-phalangeal joint of thumb (AU 4).....................

7.20

6608

Hip (G) (AU 5)........................................

19.50

6609

Hip (S) (AU 5)........................................

27.00

6616

Knee (G) (AU 4).......................................

14.50

6617

Knee (S) (AU 4).......................................

18.50

6630

Patella (AU 4).........................................

5.60

6635

Ankle (AU 5).........................................

10.00

6640

Toe (AU 4)...........................................

2.70

6644

Tarsus (AU 4).........................................

7.20

6649

Spine (cervical), without fracture (AU 7).......................

24.00

6653

Spine (lumbar), without fracture (AU 7)........................

24.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 9—continued

$

 

Dislocations requiring open operation

 

6657

Treatment of a dislocation requiring open operation, being a dislocation referred to in an item (other than an item that includes the symbol ‘(D)’) under the last preceding beading             

 

 

The amount shown in this column in tie item (other than an item that includes the symbol ‘(D)') in which the dislocation concerned is referred to, plus one-half of ih.at amount

6658

Treatment of a dislocation requiring open operation, being a dislocation referred to in item 6541 or 6548 (D) 

 

The amount shown in this column in the item (being an item that includes the symbol ‘(D)’) in which the dislocation concerned is referred to, plus one-half of that amount

 

Division 10—Treatment of fractures

 

 

Simple and uncomplicated fractures not requiring open operation

 

6675

Terminal phalanx of finger or thumb (AU 4)..................

3.40

6678

Proximal phalanx of finger or thumb (G) (AU 4)...............

7.40

6679

Proximal phalanx of finger or thumb (S) (AU 4)................

11.50

6682

Middle phalanx of finger (AU 4)..........................

4.80

6684

One or more metacarpals, not involving base of first carpometacarpal joint (G) (AU 4) 

11.50

6685

One or more metacarpals, not involving base of first carpometacarpal joint (S) (AU 4) 

16.50

6689

First metacarpal involving carpometacarpal joint (Bennett’s fracture) (G) (AU 4) 

14.00

6690

First metacarpal involving carpometacarpal joint (Bennett’s fracture) (S) (AU 4) 

18.50

6693

Carpus (excluding navicular) (AU 5).......................

5.60

6695

Navicular or carpal scaphoid (G)(AU 5).....................

11.50

6696

Navicular or carpal scaphoid (S) (AU 5).....................

14.00

6710

Colles’ fracture of wrist <G) (AU 5)........................

15.00

6711

Colles’ fracture of wrist <S) (AU 5)........................

21.00

6716

Distal end of radius or ulna, involving wrist (AU 5)..............

11.50

6720

Radius (G) (AU 5)...................................

12.50

6721

Radius (S) (AU 5)...................................

16.50

6725

Ulna (G) (AU 5).....................................

12.00

6726

Ulna (S) (AU 5).....................................

15.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 10—continued

$

6731

Both shafts of forearm (G) (AU 6).........................

18.50

6732

Both shafts of forearm (S) (AU 6).........................

29.00

6733

Humerus (G) (AU 5)..................................

18.50

6734

Humerus (S) (AU 5)..................................

29.00

6737

Clavicle or sternum (G) (AU 6)...........................

8.00

6738

Clavicle or sternum (S) (AU 6)...........................

11.50

6745

Scapula (AU 6).....................................

10.00

6749

One or more ribs—each attendance (G) (AU 7)................

1.55

6750

One or more ribs—each attendance (S) (AU 7).................

2.30

6755

Pelvis (excluding symphysis pubis) or sacrum (G) (AU 8).........

15.50

6756

Pelvis (excluding symphysis pubis) or sacrum (S) (AU 8)..........

21.00

6759

Symphysis pubis (G) (AU 7)

11.50

6760

Symphysis pubis (S) (AU 7).............................

15.50

6763

Femur (G) (AU 8)...................................

37.00

6764

Femur (S) (AU 8)....................................

50.00

6769

Fibula or tarsus (excepting os calcis or os talus) (G) (AU 6)........

8.70

6770

Fibula or tarsus (excepting os calcis or os talus) (S) (AU 6)........

12.50

6775

Tibia or patella (G) (AU 6)..............................

14.00

6776

Tibia or patella (S) (AU 6)..............................

18.50

6779

Both shafts of leg (G) (AU 7)............................

23.00

6780

Both shafts of leg (S) (AU 7)............................

32.00

6783

Ankle (Pott’s fracture), with or without dislocation of ankle (G) (AU 7) 

23.00

6784

Ankle (Pott's fracture), with or without dislocation of ankle (S) (AU 7).

32.00

6787

Os calcis (calcaneus) or os talus (G) (AU 5)...................

23.00

6788

Os calcis (calcaneus) or os talus (S) (AU 5)...................

32.00

6793

Metatarsals—one or more (G) (AU 5)......................

7.70

6794

Metatarsals—one or more (S) (AU 5).......................

11.50

6797

Phalanx of toe (other than great toe) (AU 4)...................

2.90

6801

More than one phalanx of toe (other than great toe) (AU 4).........

4.50

6803

Distal phalanx of great toe (AU 4).........................

7.40

6808

Proximal phalanx of great toe (AU 4).......................

7.40

6812

Skull, not requiring operation—each attendance (G).............

1.55

6813

Skull, not requiring operation—each attendance (S).............

2.30

6825

Nasal bones, not requiring reduction—each attendance (G).........

1.55

6826

Nasal bones, not requiring reduction—each attendance (S).........

2.30

6829

Nasal bones, requiring reduction (G) (AU 6)..................

15.00

6830

Nasal bones, requiring reduction (S) (AU 6)..................

21.00

6834

Nasal bones, requiring reduction and involving osteotomies (AU 8)

45.00

6838

Maxilla—not requiring splinting (G).......................

9.30

6839

Maxilla—not requiring splinting (S)........................

13.00

6840

Maxilla—not requiring splinting (D).......................

13.00

6844

Maxilla—with wiring of teeth or internal fixation (AU 11).........

29.00

6845

Maxilla—with wiring of teeth or internal fixation (D) (AU 11)......

29.00

6850

Maxilla—with external fixation (AU 11).....................

32.00

6851

Maxilla—with external fixation (D) (AU 11)..................

32.00

6854

Mandible—not requiring splinting (G)......................

11.50

6855

Mandible—not requiring splinting (S)......................

15.50

6856

Mandible—not requiring splinting (D)......................

15.50


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 10—continued

$

6862

Mandible—with wiring of teeth or internal fixation (AU 12)........

40.00

6863

Mandible—with wiring of teeth or internal fixation (D) (AU 12).....

40.00

6866

Mandible—skeletal pinning with external fixation (AU 12)........

42.00

6867

Mandible—skeletal pinning with external fixation (D) (AU 12)......

42.00

6875

Zygoma (G) (AU 7)..................................

10.50

6876

Zygoma (S) (AU 7)...................................

14.00

6877

Zygoma (D) (AU 7)..................................

14.00

6882

Spine (excluding sacrum), transverse process or bone other than vertebral body, not requiring immobilisation in plaster—each attendance (G)             

1.55

6883

Spine (excluding sacrum), transverse process or bone other than vertebral body, not requiring immobilisation in plaster—each attendance (S)             

2.30

6887

Spine (excluding sacrum), vertebral body, without involvement of cord, not requiring immobilisation in piaster—each attendance (G)             

1.55

6888

Spine (excluding sacrum), vertebral body, without involvement of cord, not requiring immobilisation in plaster—each attendance (S)

2.30

6893

Spine (excluding sacrum), transverse process or bone other than vertebral body requiring immobilisation in plaster or traction by skull calipers (AU 9)             

18.50

6895

Spine (excluding sacrum), vertebral body, without involvement of cord, requiring immobilisation in plaster or fraction by skull calipers (AU 9)             

32.00

6897

Spine (excluding sacrum), vertebral body, with involvement of cord (AU 9) 

85.00

 

Simple and uncomplicated fractures requiring open operation

 

6910

Treatment of a simple and uncomplicated fracture requiring open operation, being a fracture referred to in an item (other than an item that includes the symbol ‘(D)’) in items 6675 to 6897             

 

 

The amount shown in this column in [he item (other than an item that includes the symbol ‘(D)’) in which tie fracture concerned s referred to, plus one-third of that amount

6911

Treatment of a simple and uncomplicated fracture requiring open operation, being a fracture referred to in item 6840, 6845, 6851, 6856, 6863, 6867 or 6877 (D)             

 

 

The amount shown in this column in the item (being an item that includes the symbol ‘(D)’) in which the fracture concerned is referred to, plus one-third of that amount


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 10—continued

$

6915

Treatment of a simple and uncomplicated fracture requiring internal fixation, being a fracture referred to in an item (other than an item that includes the symbol ‘(D)’) in items 6675 to 6897             

The amount shown in this column in the item (other than an item that includes the symbol ‘(D)’) in which the fracture concerned is referred to, plus one-half of that amount

6916

Treatment of a simple and uncomplicated fracture requiring internal fixation, being a fracture referred to in item 6845, 6863 or 6877 (D)

The amount shown in this column in the item (being an item that includes the symbol ‘(D)’) in which the fracture concerned is referred to, plus one-half of that amount

 

Compound fractures requiring open operation

 

6919

Treatment of a compound fracture requiring open operation, being a fracture referred to in an item (other than an item that includes the symbol‘(D)’) in items 6675 to 6897……………………………….

 

 

The amount shown in this column in the item (other than an item that includes the symbol ‘(D)’) in which the fracture concerned is referred to, plus one-half of that amount

6920

Treatment of a compound fracture requiring open operation, being a fracture referred to in item 6840, 6845, 6851, 6856, 6863, 6867 or 6877 (D)             

 

 

The amount shown in this column in the item (being an item that includes the symbol ‘(D)’) in which the fracture concerned is referred to, plus one-half of that amount


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 10—continued

$

 

Complicated fractures requiring open operation

 

6925

Treatment of a complicated fracture involving viscera, blood vessels or nerves and requiring open operation, being a fracture referred to in an item (other than an item that includes the symbol ‘(D)’) in items 6675 to 6897             

The amount shown in this column in the item (other than an item that includes the symbol ‘(D)’) in which the fracture concerned is referred to, plus three-quarters of that amount

6926

Treatment of a complicated fracture involving viscera, blood vessels or nerves and requiring open operation, being a fracture referred to in item 6840, 6845, 6851, 6856, 6863, 6867 or 6877(D)             

The amount shown in this column in the item (being an item that includes the symbol ‘(D)’) in which the fracture concerned is referred to, plus three-quarters of that amount

 

General

 

6935

Initial reduction (without full post-operative treatment) in a series of two or more reductions of a fracture, being a reduction that would, but for this item, be covered by an item {other than an item that includes the symbol '(D)’) in items 6675 to 6897             

One-half of the amount shown in this column in the item that would, but for this item, apply to the reduction concerned

6936

Initial reduction (without full post-operative treatment) in a series of two or more reductions of a fracture, being a reduction that would, but for this item, be covered by item 6840, 6845, 6851, 6856, 6863, 6867 or 6877 (D)             

One-half of the amount shown in this column in the item that would, but for this item, apply to the reduction concerned


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 10—continued

$

6943

Each subsequent reduction (without full post-operative treatment! in a series (other than the final reduction), being a redaction that would, but for this item, be covered by an item (other than an item that includes the symbol ‘(D)’) in items 6675 to 6897…………………………………..

One-half of the amount shown in this column in the item that would, but for this item, apply to the reduction concerned

6944

Each subsequent reduction (without full post-operative treatment) in a series (other than the final reduction), being a reduction that would, but Tor this item, be covered by item 6840, 6843, 6851, 6856, 6863, 6867 or 6877 (D)             

One-half of the amount shown in this column in the item that would, but for this item, apply to the reduction concerned

6950

Final reduction (including full post-operative treatment) in a series, being a reduction that would, but for this item, be covered by an item (other than an item that includes the symbol ‘(D)’) in items 6675 to 6897             

The amount shown in this column in the item that would, but for this item, apply to the reduction concerned

6951

Final reduction (including full post-operative treatment) in a series, being a reduction that would, but for this item, be covered by item 6840, 6845, 6851, 6856, 6863, 6867 or 6877 (D)             

The amount shown in this column in the item that would, but for this item, apply to the reduction concerned

6956

Treatment of avulsion of epiphysis of any part referred to in an item in items 6675 to 6897 

The amount shown in this column in the item that would apply in the case of a simple and uncomplicated fracture of the part concerned


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 10—continued

$

6960

Treatment of a closed fracture, involving a joint surface, being a fracture referred to in an item (other than an item that includes the symbol ‘(D)’) in items 6675 to 6897             

The amount shown in this column in the item (other than an item that includes the symbol ‘(D)’) in which the fracture concerned is referred to, plus one-fifth of that amount

6961

Treatment of a closed fracture, involving a joint surface, being a fracture referred to in item 6840, 6845, 6851, 6856, 6863, 6867 or 6877 (D)             

The amount shown in this column in the item (being an item that includes the symbol ‘(D)’) in which the fracture concerned is referred to, plus one-fifth of that amount

 

Division 11—Orthopaedic

 

7000

Accessory or sesamoid bone, removal of (AU 6)................

25.00

7004

Epicondylitis, open operation for (AU 6).....................

25.00

7007

Digital nail, removal of (AU 5)............................

2.70

7009

Incision of pulp space, paronychia or other acute infection of hands or feet, not covered by any other item in this Part (excluding aftercare) (AU 5)             

2.20

7012

Middle palmar, thenar or hypothenar spaces, drainage of (AU 6)......

5.80

7017

Ingrowing toenail, excision of nail bed (G) (AU 6)...............

14.50

7018

Ingrowing toenail, excision of nail bed (S) (AU 6)...............

18.50

7024

Insertion of orthopaedic pin or wire where no other surgical procedure is performed (AU 5) 

10.50

7026

Insertion of orthopaedic pin or wire where no other surgical procedure is performed (D) (AU 5) 

10.50

7030

Osteosynthesis by Smith-Petersen nail (AU 11).................

95.00

7034

Temporo-mandibular meniscectomy (AU 9)...................

33.00

7036

Temporo-mandibular meniscectomy (D) (AU 9)................

33.00

7039

Joint (other than spine), manipulation of, under general anaesthesia (G) (AU 4) 

9.50

7040

Joint (other than spine), manipulation of, under general anaesthesia . (S) (AU 4) 

12.00

7049

Spine, manipulation of, under general anaesthesia (G) (AU 4).......

12.50

7053

Spine, manipulation of, under general anaesthesia (S) (AU 4)........

16.50


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 11—continued

$

7059

Spine, application of plaster jacket (AU 6)....................

16.00

7064

Risser jacket, localiser or turn-buckle jacket, application of, body only..

28.00

7071

Risser jacket, localiser or turn-buckle jacket, application of, body and head 

28.00

7077

Scoliosis, spinal fusion for (AU 23).........................

150.00

7083

Scoliosis, re-exploration for adjustment or removal of Harrington rods or similar devices (AU 12) 

47.00

7086

Application of halo for spinal fusion in the treatment of scoliosis, as an independent procedure (AU 8) 

31.00

7090

Bone graft to spine, posterior, not covered by item 7094, 7123 or7127 in this Schedule (AU 14) 

69.00

7094

Bone graft to spine, postero-lateral for spondylolisthesis (AU 14).....

120.00

7102

Anterior interbody spinal fusion to cervical spine—one level (AU 14)..

105.00

7110

Anterior interbody spinal fusion to cervical spine—more than one level (AU 15) 

135.00

7115

Anterior interbody spinal fusion to lumbar or thoracic spine—one level (AU 15) 

120.00

7119

Anterior interbody spinal fusion to lumbar or thoracic spine—more than one level (AU 15) 

165.00

7123

Bone graft to spine with laminectomy and posterior interbody fusion—one level (AU 15) 

120.00

7127

Bone graft to spine with laminectomy and posterior interbody fusion— more than one level (AU 18) 

165.00

7131

Bone graft to femur (AU 11).............................

82.00

7137

Bone graft to tibia (AU 10)..............................

64.00

7142

Bone graft to humerus (AU 10)............................

82.00

7144

Bone graft to radius and ulna (AU 10).......................

82.00

7147

Bone graft to radius or ulna (AU 8).........................

58.00

7150

Bone graft to scaphoid (AU 9)............................

53.00

7168

Bone graft to other bones—not covered by any other item in this Part (AU 8) 

47.00

7169

Bone graft not covered by any other item in this Part (D) (AU 81).....

50.00

7174

Shoulder—removal of calcium deposit from cuff (AU 8)...........

25.00

7179

Shoulder—arthrotomy (AU 7)............................

28.00

7183

Shoulder—arthroplasty or plastic reconstruction (AU 11)..........

74.00

7187

Shoulder—arthrodesis or arthrectomy (AU 11).................

87.00

7191

Finger or other small joint—arthrodesis, arthrectomy, or arthroplasty (AU 5) 

30.00

7196

Small joint—arthrotomy (AU 5)...........................

7.40

7201

Zygapophyseal joints, arthrectomy (AU 8)....................

44.00

7207

Sacro-iliac joint—arthrodesis (AU 12).......................

49.00

7211

Other large joint—arthrodesis, arthrectomy, arthroplasty or total synovectomy of (AU 10) 

44.00

7215

Other large joint—arthrotomy (AU 8).......................

31.00

7219

Hip—arthrodesis (AU 15)...............................

115.00

7229

Hip—arthrectomy (AU 15)..............................

80.00

7235

Hip—arthroplasty (Austin Moore, Girdlestone or similar procedure) (AU 10) 

80.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 11—continued

$

7239

Hip—arthroplasty, cup or mould (Smith-Petersen or similar procedure) (AU 10) 

100.00

7243

Hip—arthroplasty, total replacement (McKee-Farrer, Charnley or similar procedure) (AU 17) 

150.00

7247

Hip—arthrotomy (AU 9)................................

58.00

7254

Knee—arthrodesis, arthrectomy, arthroplasty or total synovectomy of (AU 9) 

80.00

7258

Knee—arthrotomy (AU 6)...............................

39.00

7264

Knee—arthroscopy of, not associated with any other operative procedure on that knee (AU 5)

19.00

7267

Knee—operation for internal derangement (AU 7)...............

43.00

7269

Knee—reconstruction of cruciate ligaments (AU 9)..............

58.00

7272

Knee—reconstruction of capsular ligaments (AU 9)..............

44.00

7276

Knee—excision of patella (G) (AU 7).......................

42.00

7277

Knee—excision of patella (S) (AU 7).......................

53.00

7281

Knee—operation for recurrent dislocation of patella (AU 9).........

64.00

7286

Joint, aspiration of, or intra-articular injection into, or both of these services (AU 5)

2.40

7288

Synovial cavity, aspiration of, or intra-synovia! injection into, or both of these services (AU 5) 

2.60

7294

Joint, repair of capsule or ligament of (AU 7)..................

38.00

7296

Foot or ankle region—triple arthrodesis (AU 9).................

58.00

7299

Calcanean spur, removal of (AU 6).........................

33.00

7302

Hallux valgus, correction of (G) (AU 7)......................

28.00

7303

Hallux valgus, correction of (S) (AU 7)......................

36.00

7308

Hallux valgus, correction of, with osteotomy or osteectomy of phalanx or metatarsal (AU 7) 

53.00

7311

Hallux valgus, correction of, with osteotomy or osteectomy of phalanx or metatarsal and transplantation of adductor hallucis tendon (AU 8)             

64.00

7317

Hallux valgus and hammer toe, correction of, with subcutaneous tenotomy, one or more tendons (G) (AU 7) 

42.00

7320

Hallux valgus and hammer toe, correction of, with subcutaneous tenotomy, one or more tendons (S) (AU 7) 

52.00

7322

Hallux rigidus, correction of (AU 6)........................

49.00

7327

Hammer toe, correction of (G) (AU 6).......................

19.00

7330

Hammer toe, correction of (S) (AU 6).......................

24.00

7335

Cervical rib, removal of (AU 11)..........................

58.00

7337

Scalenotomy .......................................

45.00

7345

Acromion or coraco-acromion ligament, removal of (AU 7).........

33.00

7347

Excision of exostosis of small bone (G) (AU 6).................

19.00

7349

Excision of exostosis of small bone (S) (AU 6).................

24.00

7350

Excision of exostosis of small bone (D) (AU 6).................

24.00

7357

Excision of exostosis of large bone (G) (AU 6).................

24.00

7358

Excision of exostosis of large bone (S) (AU 6)..................

31.00

7362

Osteotomy or osteectomy of phalanx, metacarpal or metatarsal (AU 6)

25.00

7366

Osteotomy of phalanx, metacarpal or metatarsal, with internal fixation (AU 6) 

28.00

7369

Osteotomy or osteectomy of fibula, radius, ulna, clavicle, scapula (other than acromion), rib, tarsus or carpus (AU 7) 

28.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 11—continued

$

7371

Osteotomy of fibula, radius, ulna, clavicle, scapula (other than acromion), rib, tarsus or carpus, with internal fixation (AU 7) 

33.00

7375

Osteotomy or osteectomy of tibia or humerus (AU 7)............

39.00

7379

Osteotomy or osteectomy of femur or pelvic bone (AU 8).........

64.00

7383

Osteotomy of tibia, humerus, femur or pelvic bone, with internal fixation (AU 11) 

95.00

7385

Osteotomy, bilateral iliac, preliminary to repair of ectopic bladder (AU 14) 

53.00

7388

Osteotomy of femur—sub-trochanteric (AU 11)................

64.00

7393

Osteectomy of vertebral bodies (AU 10).....................

61.00

7398

Osteotomy and distraction for lengthening of limb (AU 8).........

64.00

7403

Removal of distracting apparatus from limb, without internal (ration (AU 6) 

14.50

7405

Removal of distracting apparatus from limb, with internal fixation (AU 7) 

31.00

7414

Flexor tendon of hand, primary suture of (G) (AU 8).............

26.00

7415

Flexor tendon of hand, primary suture of (S) (AU 8).............

33.00

7418

Flexor tendon of hand, secondary suture of (AU 9)..............

38.00

7421

Extensor of hand, primary suture of (G) (AU 8)................

13.50

7422

Extensor tendon of hand, primary suture of (S) (AU 8)...........

16.00

7425

Extensor tendon of hand, secondary suture of (AU 9)............

25.00

7428

Achilles tendon or other large tendon, suture of (G) (AU 9)........

33.00

7429

Achilles tendon or other large tendon, suture of (S) (AU 9).........

41.00

7433

Tendon of foot, primary suture of (AU 8)....................

10.50

7437

Tendon of foot, secondary suture of (AU 8)...................

16.00

7439

Tenotomy, subcutaneous, one or more tendons (AU 4)............

9.50

7441

Tenotomy, open, with or without tenoplasty (AU 7).............

24.00

7445

Tendon or ligament transplantation not covered by any other item (AU 8) 

47.00

7447

Iliopsoas tendon, transplantation of, to greater trochanter (AU 19)....

130.00

7449

Tendon graft (AU 8)..................................

64.00

7452

Achilles tendon or other large tendon—operation for lengthening (AU 9) 

28.00

7455

Tendon sheath, incision of (G) (AU 5)......................

15.50

7456

Tendon sheath, incision of (S) (AU J).......................

19.00

7460

Stenosing tendovaginitis, open operation for (AU 6).............

19.00

7465

Tendon sheath of finger or thumb, synovectomy of (AU 8).........

22.00

7469

Cicatricial flexion contracture of joint, correction of, involving tissues deeper than skin and subcutaneous tissue (AU 9) 

33.00

7475

Dupuytren’s contracture, subcutaneous fasciotomy (AU 8).........

16.00

7479

Dupuytren’s contracture, radical operation for (AU 9)............

41.00

7481

Volkmann’s contracture, operation for (AU 10)................

39.00

7484

Fragmentation and rodding in fragilitas ossium—humerus, radius or ulna (AU 11) 

64.00

7487

Fragmentation and rodding in fragilitas ossium—tibia (AU 10)......

80.00

7491

Fragmentation and rodding in fragilitas ossium—femur (AU 12).....

105.00

7493

Scapulopexy (AU 9)..................................

80.00

7496

Epiphyseodesis—femur (AU 7)...........................

38.00

7500

Epiphyseodesis—tibia and fibula (AU 7).....................

38.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 11—continued

$

7501

Epiphyseodesis—femur, tibia and fibula (AU 10)...............

53.00

7504

Staple arrest of hemi-epiphysis (AU 7)......................

53.00

7507

Stripping of ilium (Soutter’s operation) (AU 8)................

49.00

7511

Radical plantar fasciotomy (Steindler's operation) (AU 7)..........

49.00

7515

Talipes equinovarus—posterior release procedure (AU 7)..........

47.00

7518

Talipes equinovarus—medial release procedure (AU 7)...........

53.00

7522

Subtalar arthrodesis (extra-articular) (AU 10)..................

53.00

7525

Calcaneal osteotomy (AU 8).............................

38.00

7526

Calcaneal osteotomy with bone graft (AU 10).................

53.00

 

Division 12—Paediatric

 

 

Manipulations and plaster work for correction of congenital abnormalities

 

7555

Congenital dislocation of hip—manipulation and plaster (one hip) (AU 6) 

17.50

7558

Talipes equinovarus—manipulation under general anaesthesia (AU 5)

4.00

7562

Talipes equinovarus—manipulation and plaster under general anaesthesia (AU 6) 

4.20

7564

Calcaneus valgus—manipulation under general anaesthesia (AU 5)...

4.00

7568

Calcaneus valgus—manipulation and plaster under general anaesthesia (AU 6) 

4.80

7571

Pes planus—manipulation under general anaesthesia (AU 5)........

4.00

7574

Pes planus—manipulation and plaster under general anaesthesia (AU 6) 

6.10

7576

Genu varum or genu valgum—manipulation under general anaesthesia (AU 5) 

4.00

7579

Genu varum or genu valgum—manipulation and plaster under general anaesthesia (AU 5) 

7.40

7583

Genu varum or genu valgum—manipulation and plaster with osteoclasis (AU 5) 

22.00

7587

Contractures, manipulation under general anaesthesia, not covered by any other item in this Pan (AU 5) 

4.00

7589

Contractures, manipulation and plaster under general anaesthesia, not covered by any other item in this Part (AU 5) 

6.10

7592

Spastic paralysis—manipulation and plaster (one limb) (AU 5)......

6.10

 

Operations for correction of congenital abnormalities

 

7595

Subdural haemorrhage, tap for, each tap (AU 6)................

6.40

7600

Subdural haemorrhage, osteoplastic flap and excision, of (AU 16)....

77.00

7604

Ventriculo-cisternostomy (Torkildsen’s operation) (AU 15)........

87.00

7612

Ventriculo-jugular shunt (AU 13).........................

87.00

7614

Ventriculo-atrial shunt for hydrocephalus or other lesion (AU 14)....

87.00

7617

Ventriculo-atrial shunt, revision or removal of (AU 12)...........

45.00

7621

Hydrocephalus, spino-ureteral, spino-peritoneal or spino-pleural anastomosis of, or ventricular spino-peritoneal or similar spinal shunt (AU 13)             

69.00

7623

Craniostenosis, operation for—single suture (AU 17)............

69.00

7628

Craniostenosis, operation for—more than one suture (AU 20).......

98.00

7633

Arachnoidal cyst, operation for (AU 15).....................

87.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 12—continued

$

7636

Hypertelorism, correction of (AU 14).......................

87.00

7639

Choanal atresia, plastic repair of (AU 16)....................

85.00

7645

Choanal atresia, repair of by puncture and dilatation (AU 11).......

19.00

7648

Macrocheilia, macroglossia or macrostomia, operation for (AL 13)...

45.00

7651

Torticollis, operation for (AU 7)..........................

33.00

7656

Oesophagus, radical correction of congenital stenosis of (AU 21).....

105.00

7660

Tracheo-oesophageal fistula, correction of (AU 20)..............

105.00

7663

Duodenal obstruction (congenital)—anastomosis or resection of (AU 14) 

69.00

7669

Congenital volvulus of the small intestine, correction of (AU 12).....

58.00

7675

Intestinal atresia or stenosis—excision or anatomosis (or both) (AU 15) 

69.00

7679

Hirschsprung’s disease, rectosigmoidectomy for (AU 22)..........

87.00

7686

Exomphalos, operation for (AU 13)........................

45.00

7689

Exomphalos, operation for, by plastic flap (AU 14)..............

58.00

7692

Imperforate anus, abdomino-perineal, correction of (AU 18)........

87.00

7695

Imperforate anus, correction of (other than abdomino-perineal) (AU 10) 

33.00

7699

Contracted bladder neck (congenital), wedge excision or perurethral resection of (AU 11) 

58.00

7702

Urachal fistula, operation for (AU 11)......................

33.00

7705

Ectopic bladder—'turning-in’ operation (AU 12)...............

87.00

7710

Pinhole urinary meatus—meatotomy (AU 5)..................

10.50

7713

Urethral valves, open removal of (AU 12)....................

69.00

7716

Incontinence of urine (congenital)—plastic operation to sphincter (AU 12) 

50.00

7719

Lymphangiectasis of limb (Milroy’s disease)—excision of (AU 14)...

48.00

 

Operations for excision of congenital abnormalities

 

7722

Abnormal limb, amputation of (AU 7)......................

28.00

7725

Extra digit, amputation of (AU 6).........................

10.50

7728

Dermoid, periorbital, excision of (G) (AU 8)..................

15.50

7729

Dermoid, periorbital, excision of (S) (AU 8)..................

19.50

7733

Dermoid, orbital, excision of (AU 8).......................

45.00

7736

Dermoid of nose, superficial, excision of (AU 7)...............

10.50

7740

Dermoid of nose, excision of, with intranasal extension (AU 8)......

53.00

7742

Sacrococcygeal dermoid or teratoma other than pilonidal sinus, excision of (AU 12)

50.00

7746

Myelomeningocele—excision of sac (AU 13).................

64.00

7748

Myelomeningocele extensive, requiring formal repair with skin flaps or Z plasty (AU 15) 

98.00

 

Operations for acquired conditions

 

7752

Megacolon, colectomy (AU 15)...........................

69.00

7755

Epiphysitis (Perthes’, Caive’s or Scheuermann’s) plaster for (AU 5)...

8.20

7759

Epiphysitis (Sever’s, Kohler’s, Kienboch’s or Schlatter's) plaster for (AU 5) 

4.80



Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—continued

$

 

Division 13—Plastic and Reconstructive

Meticulous plastic repair designed to obtain maximal functional or cosmetic results including the preparation of the defect requiring repair.

 

7780

Derma-fat fascia graft (including transplant or muscle flap) (AU 12)...

43.00

7784

Abrasive therapy, limited area (AU 6).......................

15.50

7786

Abrasive therapy, extensive area (AU 7)......................

37.00

7790

Electrolysis epilation, each treatment (AU 6)...................

4.00

7794

Angioma, cauterisation of or injection into, under general anaesthesia (AU 7) 

3.90

7796

Angioma, cauterisation of or injection into, under general anaesthesia (D) (AU 7) 

3.90

7800

Angioma of skin, and subcutaneous tissue or mucous surface, small, excision and repair of (AU 7) 

11.50

7801

Angioma of skin and subcutaneous tissue or mucous surface, small, excision and repair of (D) (AU 7) 

11.50

7805

Angioma of skin and subcutaneous tissue or mucous surface, large, excision and repair of (AU 9) 

14.00

7806

Angioma of skin and subcutaneous tissue or mucous surface, large, excision and repair of (D) (AU 9) 

14.00

7811

Angioma, involving deeper tissue, small, excision and repair of (AU 9)

18.50

7813

Angioma involving deeper tissue, large, excision and repair of (AU 10)

29.00

7816

Haemangioma of neck, deep-seated, excision of (AU 10)...........

53.00

7819

Major excision and grafting for lymphoedema (AU 15)............

74.00

7822

Foreign implants for contour reconstruction (AU 10).............

43.00

 

Skin flap surgery

 

7825

Single stage local flap repair, simple, small (A.U 7)..............

25.00

7826

Single stage local flap repair, simple, small (D) (AU 7)............

25.00

7829

Single stage local flap repair, complicated or large (AU 10).........

39.00

7833

Direct flap repair (cross leg or similar), first stage (AU 11).........

43.00

7837

Direct flap repair (cross leg or similar), second stage (AU 9)........

20.00

7842

Direct flap repair, small, first stage (AU 7)....................

23.00

7846

Direct flap repair, small, second stage (AU 7)..................

10.00

7851

Indirect flap or tubed pedicle, formation of (AU 10)..............

41.00

7856

Indirect flap or tubed pedicle, delay, intermediate transfer or detachment of (AU 8)

20.00

7859

Indirect flap or tubed pedicle, preparation of site and attachment to site (AU 10) 

43.00

7865

Indirect flap or tubed pedicle, spreading of pedicle, as a separate procedure (AU 8)

34.00

7871

Direct, indirect-or local flap repair, revision of graft (AU 7).........

23.00

 

Free grafts

 

7875

Free grafts (split skin or pinch grafts) on granulating areas, small (AU 7) 

18.50

7876

Free grafts (split skin or pinch grafts) on granulating areas, small (D) (AU 7) 

18.50

7879

Free grafts (split skin) on granulating areas, extensive (AU 11).......

39.00

7882

Free grafts (split skin) to extensive bums (AU 11)...............

66.00

7886

Free grafts (split skin) including elective dissection, small (AU 8).....

25.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 13—continued

$

7887

Free grafts (split skin) including elective dissection, small (D) (AU 8)

25.00

7890

Free grafts (split skin) including elective dissection, extensive (AU 11)

56.00

7894

Free full thickness grafts (AU 9)...........................

43.00

7895

Free full thickness grafts (D) (AU 9)........................

43.00

 

Other grafts and miscellaneous procedures

 

7899

Cineplasty for amputation stump (AU 8).....................

72.00

7903

Mammaplasty, reduction or repositioning (unilateral) (AU 10).......

85.00

7906

Mammaplasty, augmentation, prosthetic (unilateral) (AU 10)........

72.00

7910

Mammaplasty, derma-fat fascia (unilateral) (AU 11)..............

85.00

7914

Hair transplants, multiple punch or similar technique, involving not more than 40 punch grafts (AU 7) 

9.00

7918

Hair transplants, multiple punch or similar techniques, involving more than 40 but not more than 100 punch grafts (AU 8) 

18.50

7922

Hair transplants, multiple punch or similar technique, involving more than 100 punch grafts (AU 10) 

45.00

7930

Digit, transplantation of—complete procedure (AU 16)............

87.00

7935

Macrodactyly, plastic reduction of, each finger (AU 8)............

30.00

7939

Facial nerve paralysis, free fascia graft for (AU 12)..............

69.00

7944

Facial nerve paralysis, muscle transfer or graft for (AU 13).........

80.00

7948

Melonoplasty (AU 17).................................

130.00

7955

Orbital cavity, reconstruction of floor or roof of (AU 12)...........

45.00

7959

Maxilla, resection of (AU 17).............................

85.00

7963

Mandible, resection of (AU 15)...........................

66.00

7964

Mandible, resection of (D) (AU 15).........................

66.00

7971

Mandible, segmental resection of, for tumours (AU 13)............

56.00

7972

Mandible, segmental resection of, for tumours (D) (AU 13).........

56.00

7979

Mandible, section-fixation for prognathism or retrognathism (AU 14)

56.00

7980

Mandible, section-fixation for prognathism or retrognathism (D) (AU 14) 

56.00

7991

Mandible, hemi-mandibular reconstruction with bone graft, not associated with item 7963 (AU 15) 

77.00

7995

Mandible, condylectomy (AU 11)..........................

43.00

7996

Mandible, condylectomy (D) (AU 11).......................

43.00

8004

Osteotomy or osteectomy of mandible (other than alveolar margins) for congenital or post-traumatic malformation not covered by any other item in this Part (AU 11)

48.00

8005

Osteotomy or osteectomy of mandible (other than alveolar margins) for congenital or post-traumatic malformation not covered by any other item in this Part (D) (AU 11)             

48.00

8012

Osteotomy or osteectomy of maxilla (other than alveolar margins) for congenital or post-traumatic malformation not covered by another item in this Part (AU 11)             

56.00

8013

Osteotomy or osteectomy of maxilla (other than alveolar margins) for congenital or post-traumatic malformation not covered by another item in this Part (D) (AU 11)

56.00

8025

Whole thickness repair of eyelid (AU 10).....................

56.00

8030

Partial reconstruction of eyelid or socket (AU 12)...............

25.00

8034

Correction of ptosis (unilateral) (AU 12).....................

74.00

8039

Ectropion or entropion, correction of (unilateral) (AU 9)...........

29.00


Schedule 1—continued

 

Item No.

Medical Service

Basic Commonwealth benefit

 

Part 10—Division 13—continued

$

8043

Reduction of eyelid or eyelids of one eye (AU 9)...............

29.00

8047

Symblepharon, grafting for (AU 8)........................

43.00

8052

Rhinoplasty, correction of lateral and/or alar cartilages (AU 10).....

48.00

8056

Rhinoplasty, correction of bony vault only (AU 10)..............

56.00

8064

Rhinoplasty, correction of bony vault and lateral and alar cartilages (AU 12) 

81.00

8068

Rhinoplasty, autogenous bone or costal cartilage graft (AU 13)......

120.00

8073

Rhinoplasty, secondary revision of (AU 10)...................

13.00

8078

Rhinophyma, correction of (AU 9).........................

32.00

8082

Composite graft to nose or ear (AU 11)......................

32.00

8086

Lop ear, bat ear or similar deformity, correction of (AU 8).........

50.00

8090

Pinna, amputation of, complete (AU 9)......................

17.00

8094

Congenital atresia, reconstruction of external auditory canal (AU 11)

66.00

8098

Lip or eyelid reconstruction using full thickness flap, first stage (AU 11)

50.00

8102

Lip or eyelid reconstruction using full thickness flap, second stage (AU 4) 

14.00

8107

Cleft lip, complete primary repair, unilateral (AU 12)............

61.00

8112

Cleft lip, complete primary repair, one stage, bilateral (AU 14)......

82.00

8117

Cleft lip, incomplete primary repair, unilateral (AU 11)...........

32.00

8121

Cleft tip, secondary correction, partial or incomplete (AU 10).......

24.00

8125

Cleft lip, secondary correction, complete revision (AU 12).........

48.00

8129

Cleft lip, secondary correction, Abbe flap (AU 12)..............

115.00

8133

Cleft lip, secondary correction of nostril or nasal tip (AU 10).......

32.00

8137

Cleft palate, primary repair, partial cleft (AU 13)...............

61.00

8138

Cleft palate, primary repair, partial cleft (D) (AU 13)............

61.00

8146

Cleft palate, primary repair, complete cleft or cleft requiring major repair (AU 14)

77.00

8147

Cleft palate, primary repair, complete cleft or cleft requiring major repair (D) (AU 14) 

77.00

8155

Cleft palate, secondary repair, closure of fistula (AU 13)..........

39.00

8156

Cleft palate, secondary repair, closure of fistula (D) (AU 13).......

39.00

8164

Cleft palate, secondary repair, lengthening procedure (AU 12)......

56.00

8165

Cleft palate, secondary repair, lengthening procedure (D) (AU 12)....

56.00

8171

Cleft palate, partial repair, complex cleft (AU 13)...............

56.00

8172

Cleft palate, partial repair, complex cleft (D) (AU 13)............

56.00

8177

Pharyngeal flap or pharyngoplasty (AU 15)...................

72.00


SCHEDULE 2

Regulation 2

TABLE OF FUND MEDICAL BENEFITS IN RESPECT OF NEW SOUTH WALES

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

1

..

1.60

.80

274

..

5.20

2.50

2

..

2.80

1.20

277

..

5.20

2.50

10

..

2.35

.80

280

..

10.40

3.00

12

..

3.40

1.40

282

..

5.20

2.50

21

..

4.20

1.80

285

..

23.00

5.00

24

..

5.40

2.30

289

..

7.80

3.00

29

..

6.30

2.70

292

..

26.00

5.00

31

..

7.50

3.20

294

..

5.20

2.50

36

..

2.35

1.20

296

..

11.60

3.00

41

..

3.70

1.50

300

..

.80

.80

47

..

3.50

1.20

303

..

1.70

1.50

49

..

4.45

1.90

304

..

2.90

1.50

55

..

5.40

2.20

307

..

3.70

2.50

56

..

6.55

2.70

308

..

4.80

2.50

61

..

7.50

3.10

311

..

5.70

3.00

62

..

8.65

3.60

312

..

6.90

3.00

63

..

3.50

1.20

314

..

8.30

3.00

64

..

4.45

1.90

315

..

9.00

3.00

67

..

2.35

.80

316

..

10.50

3.00

68

..

1.60

.80

318

..

12.00

3.00

74

..

2.35

.80

319

..

12.50

4.00

76

..

2.80

1.50

320

..

14.00

4.00

80

..

7.40

2.50

322

..

14.50

4.00

83

..

3.50

1.50

324

..

16.00

4.00

86

..

10.90

3.00

325

..

17.00

5.00

89

..

6.70

2.50

326

..

18 00

5.00

92

..

3.50

1.50

327

..

19.00

5.00

95

..

7.40

2.50

328

..

20.00

5.00

98

..

11.50

3.00

329

..

22.00

5.00

101

..

16.00

3.00

330

..

23 00

5.00

104

..

20.00

4.00

331

..

24.00

5.00

109

..

6.70

2.50

332

..

25.00

5.00

112

..

10 90

3.00

333

..

26.00

5.00

115

..

15.40

3.00

334

..

28.00

5.00

118

..

19.00

4.00

335

..

29.00

5.00

121

..

23.00

5.00

336

..

30.00

5.00

124

..

10.60

3.00

337

..

31.00

5.00

127

..

17.60

4.00

338

..

32.00

5.00

129

..

24.50

5.00

339

..

34 00

5.00

131

..

32.50

5.00

343

..

36 00

5.00

133

..

39.50

5.00

346

..

41 00

5 00

203

..

2.35

.80

349

..

43 00

5.00

206

..

24.50

5.00

350

..

44.00

5.00

208

..

23 00

5.00

353

..

2.33

1.50

212

..

35.00

5.00

356

..

5.70

3.00

218

..

23.00

5.00

359

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

223

..

41.00

5.00

 

 

224

..

55.00

5.00

 

 

226

..

47.50

5.00

 

 

227

..

61.00

5.00

 

 

237

..

57.00

5.00

 

 

238

..

72.00

5.00

 

 

239

..

52.00

5.00

 

 

240

..

70.00

5.00

 

 

245

..

1 60

.80

 

 

248

..

1.60

.80

 

 

253

..

15.00

4.00

 

 

254

..

20.50

5.00

 

 

257

..

5.20

2.50

 

 

262

..

1.60

.80

 

 

269

..

4.60

2.50

 

 

272

..

7.50

3.00

 

 


SCHEDULE 2—continued

Number of Item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

 

$

$

363

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-third of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-third of that amount

administration of an anaesthetic in connection with the treatment of the part concerned

administration of an anaesthetic in connection with Ae treatment of the part concerned

410

..

1.10

.80

411

..

2.20

1.50

412

..

3.70

1.50

413

..

4.60

2.50

114

..

6.00

3.00

415

..

7.40

3.00

416

..

8.50

3.00

366

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-half of that amount

417

..

10.00

3 00

418

..

11.50

3.00

419

..

13.00

4.00

420

..

14.50

4.00

421

..

15.50

4.00

422

..

16.50

5.00

423

..

18.00

5.00

424

..

19.00

5.00

425

..

21.00

5.00

426

..

23.00

5.00

427

..

24 00

5 00

428

..

25.00

5.00

429

..

27.00

5.00

431

..

28.00

5.00

369

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus three-quarters of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus three-quarters of that amount

432

..

29.00

5.00

433

..

31.00

5.00

434

..

33.00

5 00

437

..

34.00

5.00

438

..

35.00

5.00

439

..

37.00

5.00

440

..

38.00

5.00

441

..

40.00

5.00

442

..

41.00

5.00

444

..

44.00

5.00

445

..

51.00

5.00

446

..

53 00

5.00

447

..

55.00

5.00

373

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

448

..

2.90

1.50

449

..

7.40

3.00

453

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

377

..

The amount shown in this column in the item relating to the

The amount shown in this column in the item relating to the

 

 

 

 


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

457

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-third of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-third of that amount

 

 

administration of an anaesthetic in connection with the treatment of the part concerned

administration of an anaesthetic in connection with the treatment of the fracture concerned

503

..

3.70

2.50

504

..

4 60

2.50

507

..

4.80

2.50

508

..

6.00

3.00

511

..

8.30

3.00

512

..

10.00

3.00

515

..

5.70

3.00

459

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned phi' one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-half of that amount

516

..

7.40

3.00

519

..

10.50

3.00

520

..

13.00

4.00

530

..

6.70

3.00

532

..

4.60

2.50

534

..

4.80

2.50

536

..

6.00

3.00

555

..

10.00

3.00

603

..

6.40

2.50

605

..

14.10

3 00

607

..

22.50

5.00

609

..

7.70

3.00

612

..

20.00

4.00

615

..

29.00

5.00

620

..

7.70

3.00

463

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus three-quarters of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus three-quarters of that amount

622

..

18 50

4.00

624

..

13.40

3.00

628

..

16.60

4.00

633

..

22.50

5.00

635

..

9.60

3 00

637

..

7.70

3.00

650

..

42.00

5.00

653

..

20.00

4.00

655

..

5.80

2.50

658

..

30.00

5.00

663

..

54.00

5.00

666

..

22.50

5.00

669

..

13.40

3.00

671

..

7.00

2.50

675

..

6.40

2 50

466

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

The a mount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the part concerned

678

..

3.80

1.50

683

..

10.90

3.00

686

..

6.70

2.50

690

..

14.10

3.00

700

..

2.40

1.00

706

..

3.50

1.50

718

..

4 90

1.50

722

..

5.80

2.50

726

..

4.20

1.50

732

..

4.20

1.50

735

..

4.80

2.50

740

..

4.80

2. 50

743

..

5.10

1.50

745

..

11.50

3.00

469

..

The amount shown in this column in the item relating to the

The amount shown in this column in the item relating to the

750

..

4.80

2.50

758

..

7.70

3.00

762

..

4.80

2.50

765

..

35.00

5.00


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

768

..

29 00

5.00

1070

..

1.80

1.50

773

..

2.20

1.50

1072

..

2.20

1.50

775

..

4.80

1.50

1074

..

7.60

3.00

778

..

7.70

3.00

1076

..

.90

.80

785

..

17.00

4.00

1080

..

1.20

.80

788

..

3.90

1.50

1082

..

1.80

1.50

792

..

14.10

3.00

1084

..

8.80

3.00

795

..

48 00

5.00

1090

..

1.40

1.50

798

..

70.00

5.00

1091

..

2.00

1.50

802

..

10 90

3.00

1092

..

1.40

1.50

805

..

3.30

1.50

1094

..

1.40

1.50

808

..

5 40

2.50

1096

..

1.20

1.00

811

..

5 40

2.50

1098

..

1.60

1.50

813

..

8.00

3.00

1100

..

2.00

1.50

817

..

13.40

3.00

1102

..

3.00

2.50

820

..

13.40

3.00

1104

..

1.50

1.00

823

..

12.20

3.00

1106

..

1.40

1.50

826

..

7.70

3.00

1108

..

2.00

1.50

830

..

23.50

5.00

1110

..

4.80

3 00

834

..

4.80

1.50

1112

..

.70

.80

837

..

11.50

3.00

1114

..

1.20

.80

842

..

1.60

.80

1116

..

4.60

2.50

848

..

1.90

1.00

1118

..

1.40

1.50

852

..

3.10

1.50

1120

..

3.80

2.50

855

..

5.10

1 50

1122

..

2.20

1.50

858

..

3.00

1.50

1124

..

1.40

1.50

862

..

9.30

3.00

1126

..

1.80

1.50

869

..

18.50

4.00

1128

..

1.20

.80

873

..

38.00

5.00

1130

..

2.60

1.50

876

..

5.40

2.50

1132

..

1.40

1.50

1000

..

.70

.80

1134

..

2.60

1.50

1002

..

1.20

.80

1136

..

3.80

2.50

1004

..

1.50

1 00

1138

..

1.40

1.50

1006

..

.90

.80

1140

..

2.20

1.50

1008

..

.70

.80

1142

..

2.40

1.50

1010

..

1.40

1.00

1144

..

1.40

1.50

1012

..

3.00

2.50

1146

..

1.40

1.50

1014

..

2.40

1.50

1148

..

2.20

1.50

1016

..

2.60

1.50

1150

..

3.80

2.50

1018

..

3.80

2.50

1152

..

2.20

1.50

1019

..

70

.80

1154

..

1.80

1.50

1020

..

8.20

3.00

1156

..

1.80

1.50

1022

..

.70

.80

1160

..

2.20

1.50

1024

..

2.00

1 00

1162

..

2.60

1.50

1026

..

1.20

.80

1166

..

3.00

1.50

1028

..

2.70

1.50

1168

..

3.00

2.50

1030

..

2.60

1.50

1170

..

3.40

2.50

1032

..

2.70

1.50

1172

..

.90

.80

1034

..

1.40

1.50

1174

..

1.40

1.50

1036

..

2.20

1.50

1178

..

1.80

1.50

1038

..

2.60

1.50

1180

..

1.40

1.50

1040

..

2.60

1 50

1182

..

2.00

1.00

1042

..

2.20

1.50

1184

..

2.20

1.50

1044

..

3.00

2.50

1186

..

.70

.80

1046

..

1.20

1.00

1188

..

1.40

1.50

1048

..

4.60

2.50

1190

..

2.20

1.50

1050

..

3.00

2.50

1192

..

2.20

1.50

1054

..

1.50

1.00

1194

..

2.20

1.50

1060

..

.70

.80

1196

..

2.20

1.50

1062

..

1.40

1.00

1198

..

2.20

1.50

1063

..

.40

.80

1200

..

2.00

1.00

1064

..

.70

.80

1202

..

2.40

1.50

1066

..

1.80

1.50

1204

..

1.40

1.00

1068

..

2.00

1.50

1206

..

2.60

1.50


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

1208

..

2.20

1.50

1382

..

1.50

1.00

1210

..

2.20

1.50

1385

..

2.20

1.50

1212

..

3.00

1.50

1388

..

3.80

2.50

1214

..

2.00

1.00

1389

..

4.80

3.00

1216

..

1.60

1.50

1391

..

3.00

2.50

1218

..

3.00

1.50

1392

..

4.80

3.00

1220

..

4.00

2.50

1394

..

6.00

3.00

1222

..

4.00

2.50

1395

..

.90

.80

1224

..

6.80

3.00

1397

..

2.40

1.50

1226

..

8.80

3.00

1399

..

.70

.80

1228

..

3.00

1.50

1401

..

1.40

1.50

1230

..

4.00

2.50

1404

..

1.20

.80

1232

..

2.20

1.50

1407

..

2.20

1.50

1240

..

1.40

1.50

1410

..

1.40

1.50

1242

..

2.60

1.50

1413

..

1.40

1.50

1246

..

4.00

2.50

1416

..

2.60

1.50

1248

..

1.20

.80

1419

..

1.40

1.50

1250

..

2.20

1.50

1421

..

1.80

1.50

1252

..

3.80

2.50

1423

..

1.80

1.30

1254

..

5.20

3.00

1425

..

3.00

2.50

1256

..

6.80

3.00

1428

..

1.80

1.50

1258

..

8.40

3.00

1430

..

4.00

2.50

1260

..

2.20

1.50

1432

..

8.80

3.00

1262

..

3.40

2.50

1434

..

2.20

1.50

1264

..

2.20

1.50

1436

..

2.60

1.50

1266

..

3.80

2.50

1438

..

8.80

3.00

1268

..

5.20

3.00

1441

..

2.80

1.50

1270

..

6.80

3.00

1444

..

2.20

1.50

1272

..

3.00

1.50

1447

..

4.00

2.50

1274

..

8.80

3.00

1450

..

3.40

2.50

1277

..

1.40

1.50

1453

..

2.20

1.50

1278

..

2.20

1.50

1456

..

3.00

1.50

1280

..

3.80

2.50

1459

..

2.20

1.50

1282

..

5.20

3.00

1461

..

3.80

2.50

1284

..

6.80

3.00

1463

..

5.20

3.00

1286

..

8.40

3.00

1466

..

6.80

3.00

1288

..

3.00

2.50

1468

..

2.00

1.50

1290

..

4.60

2.50

1470

..

2.20

1.50

1294

..

2.20

1.50

1472

..

3.00

2.50

1296

..

1.40

1.50

1474

..

8.80

3.00

1298

..

3.80

2.50

1475

..

7.00

3.00

1301

..

2.20

1.50

1476

..

3.20

2.50

1302

..

3.80

2.50

1478

..

2.80

1.50

1304

..

5.20

3.00

1481

..

2.80

1.50

1305

..

6.80

3.00

1484

..

6.80

3.00

1307

..

8.40

3.00

1487

..

3.20

2.50

1310

..

2.20

1.50

1490

..

3.20

2.50

1313

..

1.40

1.50

1491

..

2.00

1.50

1314

..

.50

.80

1493

..

6.80

3.00

1317

..

.20

.50

1494

..

8.80

3.00

1319

..

3.60

2.50

1495

..

.90

.80

1322

..

1.50

1.00

1496

..

1.40

1.50

1325

..

.90

.80

1497

..

3.40

2.50

1328

..

1.40

1.50

1499

..

3.00

2.50

1331

..

4.00

2.50

1500

..

.70

.80

1334

..

2.60

1.50

1502

..

1.20

.80

1337

..

4.20

2.50

1504

..

1.20

.80

1340

..

6.00

3.00

1506

..

1.80

1.50

1343

..

4.20

2.50

1508

..

1.50

1.00

1346

..

6.80

3.00

1511

..

1.40

1.50

1349

..

2.80

1.50

1513

..

1.40

1.00

1352

..

3.00

1.50

1515

..

2.40

1.50

1355

..

3.00

1.50

1517

..

3.20

2.50

1358

..

1.80

1.50

1519

..

4.00

2.50

1380

..

1.70

.80

1521

..

5.00

3.00


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

1523

..

5.00

3.00

1701

..

5.60

3.00

1525

..

2.40

1.50

1703

..

1.40

1.50

1527

..

3.00

2.50

1706

..

1.40

1.50

1529

..

1.80

1.50

1707

..

2.60

1.50

1531

..

3.40

2.50

1710

..

.70

.80

1534

..

1.40

1.50

1712

..

2.20

1.50

1537

..

2.60

1.50

1714

..

2.20

1.50

1539

..

1.80

1.50

1716

..

.90

.80

1541

..

1.40

1.50

1718

..

3.00

1.50

1543

..

1.80

1.50

1720

..

6.00

3.00

1545

..

.70

.80

1722

..

9.60

3.00

1546

..

3.00

2.50

1724

..

1.40

1.50

1548

..

4.80

3.00

1726

..

3.00

2.50

1553

..

3.00

2.50

1728

..

4.80

3.00

1554

..

5.40

3.00

1730

..

3.00

2.50

1557

..

8.00

3.00

1732

..

1.20

.80

1560

..

5.40

3.00

1734

..

2.00

1.50

1562

..

4.80

3.00

1736

..

6.80

3.00

1564

..

7.40

3.00

1738

..

.90

.80

1566

..

6.40

3.00

1741

..

2.20

1.50

1568

..

9.00

3.00

1744

..

.90

.80

1571

..

2.80

1.50

1746

..

2.20

1.50

1580

..

1.40

1.50

1748

..

2.20

1.50

1582

..

1.60

1.50

1761

..

1.20

1.00

1584

..

3.00

2.50

1764

..

2.20

1.50

1586

..

2.00

3.00

1767

..

.90

.80

1588

..

2.20

1.50

1770

..

2.20

1.50

1590

..

2.20

1.50

1773

..

2.60

1.50

1601

..

2.20

1.50

1776

..

3.80

2.50

1604

..

3.80

2.50

1779

..

2.00

1.00

1607

..

5.20

3.00

1782

..

2.00

1.00

1609

..

6.80

3.00

1785

..

2.00

1 00

1611

..

2.00

1.50

1790

..

1.40

1.50

1613

..

2.80

1.50

1792

..

1.40

1.50

1615

..

3.00

1.50

1794

..

3.00

2.50

1616

..

3.00

2.50

1796

..

3.00

2.50

1621

..

.90

.80

1798

..

1.40

1.50

1622

..

.70

.80

1800

..

1.10

.80

1623

..

1.80

1.50

1802

..

3.20

2.50

1625

..

1.10

.80

1804

..

4.80

3.00

1627

..

2.20

1.50

1806

..

2.20

1 50

1629

..

1.80

1.50

1808

..

4.80

3.00

1631

..

1.40

1.50

1810

..

2.20

1.50

1640

..

4.60

2.50

1812

..

2.20

1.50

1643

..

2.40

1.50

1820

..

3.80

2.50

1645

..

2.40

1.50

1822

..

6.00

3.00

1647

..

8.80

3.00

1824

..

8.40

3.00

1649

..

6.00

3.00

1826

..

8.40

3.00

1651

..

8.80

3.00

1828

..

10.40

4.00

1653

..

3.00

2.50

1840

..

12.40

4.00

1661

..

2.00

1.00

1841

..

36.00

5.00

1664

..

4.80

3.00

1843

..

4.60

2.50

1667

..

2.20

1.50

1846

..

3.00

2.50

1670

..

2.20

1.50

1849

..

3.00

2.50

1673

..

3.00

1.50

1850

..

3.80

2.50

1680

..

.70

.80

1852

..

3.80

2.50

1682

..

1.20

.80

1853

..

7.00

3.00

1684

..

.90

.80

1855

..

4.80

3.00

1686

..

1.10

.80

1858

..

6.00

3.00

1688

..

1.40

1.50

1861

..

4.20

2.50

1691

..

1.40

1.50

1863

..

4.80

3.00

1694

..

1.80

1.50

1865

..

14.00

5.00

1697

..

2.80

1.50

1867

..

4.60

2.50

1698

..

3.80

2.50

1869

..

3.80

2.50

1700

..

1.40

1.50

1871

..

6.80

3.00


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

 

$

$

 

 

1873

..

14.00

5.00

2039

..

5.00

2.50

1875

..

4.80

3.00

2046

..

5.50

2.50

1877

..

4.80

3.00

2050

..

5.00

2.50

1879

..

4.60

2.50

2053

..

6.50

3.00

1881

..

3.60

2.50

2056

..

6.50

3.00

1884

..

3.00

2.50

2058

..

11.50

3.00

1887

..

3.00

2.50

2062

..

6.50

3.00

1889

..

12.40

4.00

2067

..

5.00

2.50

1891

..

1.40

1.50

2070

..

6.50

3.00

1892

..

3.40

2.50

2074

..

6.50

3.00

1895

..

4.80

3.00

2077

..

5.00

2.50

1896

..

2.20

1.50

2079

..

5.00

2.50

1897

..

3.00

2.50

2082

..

5.00

2.50

1898

..

3.00

2.50

2084

..

4.10

2.50

1899

..

4.80

3.00

2086

..

4.10

2.50

1900

..

4.00

2.50

2088

..

5.50

2.50

1902

..

6.00

3.00

2091

..

3.60

1.50

1904

..

1.80

1.50

2096

..

9.00

3.00

1906

..

2.00

1.50

2100

..

7.00

3.00

1908

..

6.00

3.00

2103

..

5.50

2.50

1910

..

7.20

3.00

2105

..

4.60

2.50

1912

..

8.40

3.00

2107

..

7.00

3.00

1914

..

8.80

3.00

2109

..

5.50

3.00

1916

..

3.00

2.50

2114

..

8.50

3.00

1917

..

3.00

2.50

2117

..

4.50

2.50

1918

..

3.40

2.50

2120

..

11.50

3.00

1919

..

7.00

3.00

2122

..

15.00

4.00

1920

..

2.20

1.50

2124

..

1.90

1.50

1922

..

3.00

2.50

2126

..

5.00

2.50

1924

..

3.00

2.50

2129

..

10.00

3.00

1926

..

3.40

2.50

2131

..

3.90

2.50

1927

..

10.50

4.00

2134

..

4.60

2.50

1929

..

17.00

5.00

2136

..

6 50

3.00

1931

..

7.00

3.00

2143

..

4.10

2.50

1933

..

5.60

3.00

2147

..

2.20

1.50

1935

..

4.20

2.50

2149

..

5.50

2.50

1937

..

5.20

3.00

2151

..

6.50

3.00

1939

..

11.00

4.00

2153

..

3.90

2.50

1942

..

10.50

4.00

2155

..

4.60

2.50

1946

..

5.20

3.00

2157

..

5.00

2.50

1952

..

19.00

5.00

2159

..

6.06

3.00

1954

..

8.50

3.00

2162

..

4.60

2 50

1960

..

10.50

4.00

2165

..

35.50

4.00

1962

..

5.60

3.00

2167

..

14.00

4.00

1964

..

7.00

3.00

2171

..

18.00

5.00

1982

..

12.00

4.00

2175

..

11.50

3.00

1984

..

5.00

2.50

2178

..

7.00

3.00

1986

..

13.00

4.00

2182

..

9.00

3.00

1987

..

12.00

4.00

2186

..

5.00

2.50

1989

..

8.00

3.00

2201

..

3.90

2.50

1991

..

12.00

4.00

2206

..

4.60

2.50

1993

..

12.00

4.00

2210

..

4.60

2.50

1995

..

8.00

3.00

2212

..

7.50

3.00

1997

..

8.00

3.00

2216

..

10.00

3.00

1998

..

6.80

3.00

2220

..

12.50

3.00

2002

..

3.90

1.50

2223

..

9.00

3.00

2004

..

4.10

2.50

2225

..

10.00

3.00

2007

..

3.90

1.50

2228

..

12.50

3.00

2009

..

4.10

2.50

2232

..

7.50

3.00

2025

..

5.00

2.50

2236

..

8.00

3.00

2029

..

5.50

2.50

2239

..

12.50

3.00

2031

..

3.90

1.50

2241

..

8.50

3.00

2033

..

4.60

2.50

2243

..

15.00

4.00

2035

..

5.50

2.50

2245

..

7.00

3.00

2037

..

7.00

3.00

2249

..

1.90

1.50


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

$

$

2255

..

9.00

3.00

2553

..

3.90

2.50

2257

..

5.00

2.50

2556

..

8.50

3.00

2265

..

4.60

2.50

2559

..

10.50

3.00

2267

..

10.00

3.00

2562

..

2.70

1.50

2269

..

7.00

3.00

2565

..

2.90

1.50

2272

..

9.00

3.00

2568

..

4.50

2.50

2275

..

12.50

4.00

2571

..

4.50

2.50

2277

..

12.50

4.00

2600

..

17.00

4.00

2279

..

12.50

4.00

2603

..

14.00

4.00

2281

..

7.00

3.00

2606

..

14.00

4.00

2283

..

5.00

2.50

2613

..

19.00

5.00

2285

..

12.00

3.00

2616

..

4.10

2.50

2287

..

9.00

3.00

2619

..

6.50

3.00

2289

..

10.00

3.00

2623

..

6.50

3.00

2296

..

7.50

3.00

2631

..

5.00

2.50

2299

..

11.50

3 00

2635

..

5.00

2.50

2302

..

11.50

3.00

2639

..

3.90

2.50

2304

..

11.50

3.00

2643

..

5.00

2.50

2306

..

11.50

3.00

2647

..

3.90

2.50

2308

..

11.50

3.00

2651

..

3.90

2.50

2312

..

14.00

4.00

2655

..

6.50

3.00

2316

..

11.50

3.00

2658

..

5.00

2.50

2319

..

7.50

3.00

2663

..

5.00

2.50

2323

..

7.50

3.00

2667

..

3.40

1.50

2327

..

2.20

1.50

2669

..

6.50

3.00

2331

..

5.50

2.50

2673

..

4.10

2.50

2335

..

4.40

2.50

2677

..

4.10

2.50

2339

..

5.50

2.50

2680

..

14.00

4.00

2343

..

9.50

3.00

2685

..

9.00

3.00

2348

..

7.00

3.00

2689

..

1.90

1.50

2352

..

6.50

3.00

2693

..

14.00

4.00

2365

..

6.50

3.00

2701

..

6.00

3.00

2400

..

1.30

.80

2704

..

6.50

3.00

2425

..

4.60

2.50

2708

..

9 00

3.00

2428

..

3.10

1.50

2712

..

14.00

4.00

2450

..

2.70

1.50

2920

..

7.00

1.00

2453

..

.30

.80

2929

..

One-fifth of the amount shown in this column for the operation or operations

One-fifth of the amount shown in this column for the operation or operations

2456

..

3.40

1. 50

 

 

2461

..

.40

.80

 

 

2466

..

6.50

3.00

 

 

2469

..

1.20

.80

 

 

2472

..

3.90

1.50

 

 

2475

..

3.40

1.50

3003

..

2.35

.89

2478

..

.40

.80

3007

..

3.30

1.50

2482

..

3.60

2.50

3010

..

4.20

2.50

2485

..

.50

.80

3014

..

5.40

2.50

2488

..

9.00

3.00

3018

..

10.00

3.00

2490

..

1.60

1.00

3020

..

12.00

3.00

2492

..

5.00

2.50

3023

..

3.50

2.50

2494

..

.80

.80

3026

..

6.30

3.00

2497

..

7.00

3.00

3028

..

5.60

3.00

2501

..

1.30

.80

3032

..

5.60

3.00

2504

..

12.50

4.00

3035

..

9.00

3.00

2507

..

2.20

1.50

3040

..

9.00

3.00

2511

..

22.00

5.00

3042

..

6.30

3.00

2515

..

15.00

4.00

3044

..

11.50

3.00

2519

..

31.00

5.00

3048

..

14.00

4.00

2523

..

45.00

5.00

3053

..

9.00

3.00

2527

..

36.00

5.00

3054

..

9.00

3.00

2531

..

22.00

5.00

3060

..

11.50

3.00

2536

..

8.50

3.00

3066

..

14.50

4.00

2540

..

13.50

4.00

3072

..

14.50

4.00

2544

..

5.50

2.50

3076

..

1.60

1.00

2547

..

3.90

2.50

3079

..

1.60

1.00

2550

..

14.50

4.00

3083

..

8.00

3.00


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

3086

..

8.00

3.00

3341

..

13.50

4.00

3088

..

17.00

5.00

3343

..

17.00

5.00

3091

..

22.00

5.00

3347

..

23.00

5.00

3096

..

22.00

5.00

3352

..

9.50

3.00

3100

..

3.50

2.50

3355

..

11.50

3.00

3102

..

3.50

2.50

3358

..

28.00

5.00

3107

..

9.00

3.00

3360

..

28.00

5.00

3111

..

11.50

3.00

3365

..

28.00

5.00

3118

..

11.50

3.00

3370

..

63.00

5.00

3122

..

3.50

1.50

3374

..

105.00

5.00

3127

..

8.00

3.00

3376

..

70.00

5.00

3129

..

1.90

1.50

3380

..

28.00

5.00

3133

..

1.90

1.50

3382

..

28.00

5.00

3136

..

14.00

4.00

3385

..

15.50

4.00

3141

..

6.30

3.00

3388

..

15.50

4.00

3145

..

6.30

3.00

3410

..

4.00

2.50

3151

..

11.50

3.00

3413

..

4.00

2.50

3154

..

14.00

4.00

3416

..

9.00

3.00

3158

..

14.00

4.00

3420

..

11.50

3.00

3164

..

2.40

1.50

3422

..

11.50

3.00

3167

..

12.00

3.00

3426

..

11.50

3.00

3169

..

16.50

5.00

3429

..

23.00

5.00

3172

..

22.50

5.00

3432

..

23.00

5.00

3176

..

31.00

5.00

3435

..

59.00

5.00

3182

..

30.00

5.00

3438

..

59.00

5.00

3186

..

7.30

3.00

3441

..

150.00

5.00

3188

..

10.50

3.00

3449

..

3.30

1.50

3192

..

10.50

3.00

3451

..

3.30

1.50

3198

..

11.00

3.00

3457

..

12.50

3.00

3200

..

13.00

4.00

3461

..

16.50

4.00

3205

..

13.00

4.00

3463

..

16.50

4.00

3209

..

15.50

4.00

3467

..

105.00

5.00

3212

..

19.00

5.00

3471

..

32.00

5.00

3214

..

19.00

5.00

3474

..

42.00

5.00

3223

..

21.00

5.00

3476

..

49.00

5.00

3227

..

26.00

5.00

3481

..

85.00

5.00

3231

..

32.00

5.00

3485

..

95.00

5.00

3234

..

70.00

5.00

3489

..

105.00

5.00

3239

..

42.00

5.00

3494

..

59.00

5.00

3240

..

42.00

5.00

3499

..

61.00

5.00

3241

..

49.00

5.00

3504

..

42.00

5.00

3243

..

49.00

5.00

3512

..

32.00

5.00

3246

..

70.00

5.00

3515

..

42.00

5.00

3249

..

32.00

5.00

3518

..

36.00

5.00

3257

..

56.00

5.00

3520

..

28.00

5.00

3260

..

10.50

3.00

3522

..

150.00

5.00

3264

..

3.40

1.50

3538

..

30.00

5.00

3266

..

3.50

2.50

3540

..

85.00

5.00

3270

..

3.50

2.50

3543

..

19.00

5.00

3275

..

4.90

2.50

3546

..

61.00

5.00

3278

..

6.10

3.00

3549

..

16.00

4.00

3283

..

6.80

3.00

3552

..

26.00

5.00

3287

..

8.00

3.00

3557

..

35.00

5.00

3293

..

3.10

1.50

3558

..

15.50

4.00

3296

..

12.00

4.00

3562

..

21.00

5.00

3302

..

1.60

1.00

3564

..

20.00

5.00

3307

..

1.60

1.00

3568

..

26.00

5.00

3310

..

9.00

3.00

3570

..

20.00

5.00

3312

..

12.00

4.00

3574

..

26.00

5.00

3317

..

12.00

4.00

3579

..

49.00

5.00

3322

..

9.50

3.00

3584

..

73.00

5.00

3327

..

11.50

3.00

3586

..

11.50

3.00

3333

..

16.50

5.00

3590

..

29.00

5.00

3337

..

21.00

5.00

3592

..

36.00

5.00


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

3596

..

36.50

5.00

3861

..

28.00

5.00

3600

..

49.00

5.00

3862

..

33.00

5.00

3606

..

42.00

5.00

3866

..

9.50

3.00

3611

..

54.00

5.00

3868

..

32.00

5.00

3613

..

45.00

5.00

3871

..

41.00

5.00

3621

..

49.00

5.00

3873

..

13.50

4.00

3625

..

130.00

5.00

3876

..

6.30

3.00

3628

..

45.00

5.00

3877

..

100.00

5.00

3631

..

49.00

5.00

3881

..

150.00

5.00

3635

..

49.00

5.00

3885

..

170.00

5.00

3639

..

9.50

3.00

3887

..

34.00

5.00

3642

..

49.00

5.00

3890

..

42.00

5.00

3644

..

63.00

5.00

3891

..

105.00

5.00

3648

..

36.00

5.00

3893

..

45.00

5.00

3650

..

45.00

5.00

3895

..

59.00

5.00

3653

..

75.00

5.00

3897

..

63.00

5.00

3659

..

73.00

5.00

3942

..

39.00

5.00

3663

..

52.00

5.00

3944

..

49.00

5.00

3666

..

82.00

5.00

3947

..

95.00

3.00

3669

..

125.00

5.00

3950

..

73.00

5.00

3672

..

125.00

5.00

3953

..

73.00

5.00

3674

..

14.50

4.00

3956

..

38.00

5.00

3677

..

16.50

5.00

3960

..

11.50

3.00

3679

..

45.00

5.00

3966

..

3.50

2.50

3685

..

47.00

5.00

3972

..

105.00

5.00

3694

..

49.00

5.00

3974

..

87.00

5.00

3697

..

59.00

5.00

3977

..

35.00

5.00

3701

..

70.00

5.00

3980

..

52.00

5.00

3703

..

45.00

5.00

3982

..

28.00

5.00

3708

..

59.00

5.00

3985

..

28.00

5.00

3712

..

59.00

5.00

3988

..

35.00

5.00

3717

..

36.00

5.00

3992

..

45.00

5.00

3719

..

45.00

5 00

3994

..

66.00

5.00

3723

..

85.00

5.00

3997

..

82.00

5.00

3730

..

105.00

5.00

4001

..

21.00

5.00

3734

..

125.00

5.00

4005

..

28.00

5.00

3738

..

45.00

5.00

4006

..

24.50

5.00

3740

..

36.00

5.00

4010

..

33.00

5.00

3744

..

36.00

5.00

4014

..

36.00

5.00

3748

..

45.00

5.00

4016

..

45.00

5.00

3752

..

59.00

5.00

4019

..

2.40

1.50

3757

..

36.00

5.00

4023

..

16.50

5.00

3762

..

45.00

5.00

4025

..

21.00

5.00

3775

..

24.00

5.00

4028

..

28.00

5.00

3781

..

31.00

5.00

4030

..

33.00

5.00

3785

..

45.00

5.00

4036

..

18.00

5.00

3787

..

45.00

5.00

4038

..

23.00

5.00

3791

..

29.00

5.00

4058

..

24.50

5.00

3794

..

37.00

5.00

4063

..

33.00

5.00

3799

..

18.00

5.00

4067

..

45.00

5.00

3804

..

42.00

5.00

4069

..

70.00

5.00

3813

..

73.00

5.00

4073

..

45.00

5.00

3818

..

75.00

5.00

4077

..

8.50

3.00

3839

..

36.00

5.00

4079

..

3.30

1.50

3822

..

45.00

5.00

4081

..

8.00

3.00

3828

..

36.00

5.00

4083

..

11.50

3.00

3830

..

45.00

5.00

4085

..

14.50

4.00

3835

..

56.00

5.00

4088

..

3.40

1.50

3839

..

73.00

5.00

4092

..

3.50

2.50

3840

..

85.00

5.00

4098

..

15.50

4.00

3845

..

105.00

5.00

4103

..

26.00

5.00

3847

..

125.00

5.00

4105

..

33.00

5.00

3851

..

95.00

5.00

4110

..

9.00

3.00

3852

..

30.00

5.00

4111

..

14.50

4.00

3858

..

105.00

5.00

4116

..

16.50

5.00


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

4121

..

49.00

5.00

4308

..

54.00

5.00

4123

..

80.00

5.00

4312

..

125.00

5.00

4128

..

2.40

1.50

4314

..

150.00

5.00

4129

..

11.00

3.00

4323

..

105.00

5.00

4131

..

14.50

4.00

4329

..

35.00

5.00

4134

..

2.60

1.50

4335

..

73.00

5.00

4135

..

11.50

3.00

4343

..

19.00

5.00

4137

..

9.00

3.00

4344

..

14.50

4.00

4139

..

5.90

3.00

4347

..

85.00

5.00

4142

..

31.00

5.00

4349

..

45.00

5.00

4145

..

10.50

3.00

4353

..

4.00

2.50

4147

..

1.60

1.50

4357

..

9.50

3.00

4152

..

4.00

2.50

4361

..

16.50

4.00

4154

..

3.50

2.50

4363

..

16.50

4.00

4159

..

23.00

5.00

4367

..

28.00

5.00

4160

..

31.00

5.00

4369

..

23.00

5.00

4164

..

7.50

3.00

4371

..

28.00

5.00

4168

..

17.00

5.00

4374

..

9.50

3.00

4170

..

22.00

5.00

4377

..

28.00

3.00

4174

..

17.00

5.00

4382

..

28.00

5.00

4178

..

23.00

5.00

4386

..

28.00

5.00

4180

..

26.00

5.00

4388

..

49.00

5.00

4184

..

32.00

5.00

4392

..

38.00

5.00

4186

..

9.00

3.00

4396

..

28.00

5.00

4187

..

11.50

3.00

4398

..

49.00

5.00

4192

..

59.00

5.00

4405

..

12.00

3.00

4196

..

26.00

5.00

4406

..

15.00

4.00

4198

..

4.90

2.50

4410

..

18.50

5.00

4203

..

28.00

5.00

4411

..

23.00

5.00

4204

..

24.00

5.00

4415

..

21.75

5.00

4205

..

31.00

5.00

4417

..

27.00

5.00

4210

..

7.00

3.00

4423

..

25.00

5.00

4226

..

2.30

1.50

4425

..

31.00

5.00

4228

..

7.50

3.00

4431

..

28.25

5.00

4232

..

15.50

4.00

4433

..

36.00

5.00

4234

..

41.00

5.00

4438

..

14.00

4.00

4237

..

30.00

5.00

4439

..

17.50

5.00

4239

..

57.00

5.00

4446

..

17.00

5.00

4242

..

26.00

5.00

4451

..

23.00

5.00

4244

..

20.00

5.00

4457

..

28.00

5.00

4245

..

16.00

4.00

4459

..

49.00

5.00

4248

..

42.00

5.00

4462

..

100.00

5.00

4250

..

68.00

5.00

4465

..

9.00

3.00

4252

..

3.70

1.50

4466

..

11.50

3.00

4255

..

20.00

5.00

4470

..

13.50

4.00

4257

..

28.00

5.00

4471

..

16.50

5.00

4259

..

42.00

5.00

4475

..

16.00

4.00

4261

..

61.00

5.00

4477

..

20.25

5.00

4264

..

85.00

5.00

4479

..

18.00

5.00

4266

..

100.00

5.00

4481

..

23.00

5.00

4268

..

61.00

5.00

4486

..

20.50

5.00

4270

..

100.00

5.00

4487

..

25.75

5.00

4272

..

90.00

5.00

4491

..

11.50

3.00

4274

..

45.00

5.00

4493

..

14.00

4 00

4278

..

59.00

5.00

4500

..

28 00

5.00

4280

..

49.00

5.00

4506

..

23.00

5.00

4283

..

61.00

5.00

4510

..

38.00

5.00

4286

..

115.00

5.00

4512

..

54.00

5.00

4289

..

110 00

5.00

4515

..

61.00

5.00

4290

..

115.00

5.00

4518

..

125.00

5.00

4292

..

100.00

5.00

4530

..

5.60

3.00

4295

..

100.00

5.00

4532

..

19.00

5.00

4298

..

100.00

5.00

4535

..

11.50

3.00

4301

..

59.00

5.00

4539

..

12.00

4.00

4306

..

75.00

5.00

4543

..

80.00

5.00


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

4546

..

49.00

5.00

4716

..

49.00

5.00

4550

..

82.00

5.00

4717

..

68.00

5.00

4554

..

90.00

5.00

4720

..

90.00

5.00

4556

..

115.00

5.00

4722

..

2.80

1.50

4558

..

45.00

5.00

4731

..

9.00

3.00

4566

..

56.00

5.00

4734

..

9.50

3.00

4569

..

90.00

5.00

4737

..

82.00

5.00

4572

..

135.00

5.00

4742

..

59.00

5.00

4574

..

152.50

5.00

4745

..

49.00

5.09

4577

..

100.00

5.00

4748

..

59.00

5.00

4581

..

115.00

5.00

4750

..

16.50

5.00

4584

..

90.00

5.00

4753

..

23.00

5.09

4588

..

210.00

5.00

4756

..

21.25

5.00

4589

..

210.00

5.00

4757

..

28.25

5.00

4593

..

100.00

5.00

4760

..

21.25

5.00

4597

..

125.00

5.00

4761

..

28.25

5.00

4601

..

100.00

5.00

4769

..

22.00

5.00

4607

..

49.00

5.00

4770

..

31.00

5.00

4609

..

90.00

5.00

4776

..

8.50

3.00

4613

..

59.00

5.00

4777

..

11.50

3.00

4615

..

68.00

5.00

4781

..

9.00

3.00

4619

..

100.00

5.00

4782

..

12.00

4.00

4621

..

7.30

3.00

4786

..

12.75

4.00

4623

..

35.00

5.00

4788

..

16.75

4.00

4627

..

19.00

5.00

4793

..

6.30

3.00

4632

..

3.40

1.50

4795

..

4.90

2.50

4634

..

8.00

3.00

4797

..

2.40

1.50

4636

..

8.00

3.00

4799

..

28.00

5.00

4638

..

5.20

2.50

4803

..

14.50

4.00

4642

..

9.50

3.00

4805

..

29.00

5.00

4644

..

5.60

2.50

4807

..

13.50

4.00

4646

..

5.60

3.00

4809

..

16.50

5.00

4647

..

13.00

4.00

4813

..

28.00

5.00

4648

..

16.50

5.00

4816

..

3.50

2.50

4652

..

35.00

5.00

4821

..

110.00

5.00

4654

..

39.25

5.00

4824

..

115.00

5.00

4656

..

41.50

5.00

4826

..

115.00

5.00

4659

..

7.30

3.00

4829

..

14.50

4.00

4661

..

12.00

4.00

4833

..

16.50

5.00

4664

..

10.50

3.00

4840

..

19.00

5.00

4666

..

13.50

4.00

4842

..

23.00

5.00

4668

..

2.10

1.50

4846

..

33.00

5.00

4669

..

2.10

1.50

4849

..

49.00

5.00

4671

..

6.60

3.00

4852

..

49.00

5.00

4672

..

6.60

3.00

4857

..

82.00

5.00

4673

..

1.60

1.50

4859

..

70.00

5.00

4675

..

35.00

5.00

4861

..

14.00

4.00

4679

..

35.00

5.00

4863

..

19.00

5.00

4680

..

35.00

5.00

4865

..

13.50

4.00

4682

..

54.00

5.00

4869

..

13.50

4.00

4683

..

21.00

5.00

4871

..

18.00

5.00

4684

..

21.00

5.00

4873

..

30.00

5.00

4685

..

9.08

3.00

4875

..

19.00

5.00

4686

..

9.00

3.00

4878

..

9.50

3.00

4687

..

49.00

5.00

4890

..

66.00

5.00

4688

..

49.00

5.00

4892

..

73.00

5.00

4689

..

66.00

5.00

4894

..

125.00

5.00

4692

..

87.00

5.00

4896

..

68.00

5.00

4695

..

31.00

5.00

4898

..

90.00

5.00

4698

..

4.00

2.50

4903

..

66.00

5.00

4700

..

27.00

5.00

4904

..

82.00

5.00

4703

..

66.00

5.00

4908

..

90.00

5.00

4706

..

52.00

5.00

4913

..

90.00

5.00

4708

..

4.00

2.50

4914

..

105.00

5.00

4711

..

23.09

5.00

4920

..

90.00

5.00


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

4923

..

63.00

5.00

5096

..

100.00

5.00

4928

..

82.00

5.00

5111

..

90.00

5.00

4929

..

90.00

5.00

5115

..

87.00

5.00

4932

..

95.00

5.00

5117

..

40.00

5.00

4936

..

73.00

5.00

5121

..

100.00

5.00

4938

..

66.00

5.00

5123

..

23.00

5.00

4941

..

49.00

5.00

5126

..

35.00

5.00

4945

..

56.00

5.00

5129

..

11.50

3.00

4947

..

13.00

4.00

5134

..

40.00

5.00

4951

..

28.00

5.00

5137

..

3.50

3.50

4953

..

40.00

5.00

5139

..

5.60

3.00

4956

..

82.00

5.00

5142

..

82.00

5.00

4958

..

90.00

5.00

5146

..

23.00

5.00

4960

..

82.00

5.00

5148

..

11.50

3.00

4962

..

82.00

5.00

5151

..

27.00

5.00

4964

..

66.00

5.00

5154

..

19.00

5.00

4966

..

115.00

5.00

5156

..

13.50

4.00

4968

..

150.00

5.00

5159

..

7.00

3.00

4971

..

66.00

5.00

5164

..

19.00

5.00

4973

..

82.00

5.00

5168

..

39.00

5.00

4975

..

73.00

5.00

5377

..

56.00

5.00

4977

..

90.00

5.00

5180

..

49.00

5.00

4980

..

82.00

5.00

5183

..

66.00

5.00

4982

..

82.00

5.00

5187

..

66.00

5.00

4984

..

100.00

5.00

5189

..

61.00

5.00

4986

..

82.00

5.00

5195

..

61.00

5.00

4988

..

100.00

5.00

5197

..

23.00

5.00

4992

..

115.00

5.00

5200

..

31.00

5.00

5000

..

56.00

5.00

5203

..

40.00

5.00

5003

..

66.00

5.00

5207

..

61.00

5.00

5005

..

66.00

5.00

5209

..

63.00

5.00

5008

..

82.00

5.00

5211

..

73.00

5.00

5011

..

1.90

1.50

5213

..

23.00

5.00

5013

..

11.50

3.00

5215

..

49.00

5.00

5017

..

14.00

4.00

5219

..

82.00

5.00

5020

..

15.00

4.00

5226

..

15.00

4.00

5022

..

19.00

5.00

5231

..

15.00

4.00

5025

..

7.00

3.00

5234

..

40.00

5.00

5027

..

7.00

3.00

5238

..

66.00

5.00

5030

..

23.00

5.00

5242

..

5.60

3.00

5033

..

19.00

5.00

5247

..

66.00

5.00

5035

..

27.00

5.00

5250

..

9.00

3.00

5039

..

61.00

5.00

5253

..

31.00

5.00

5042

..

21.00

5.00

5255

..

40.00

5.00

5044

..

40.00

5.00

5258

..

82.00

5.00

5046

..

28.00

5.00

5263

..

40.00

5.00

5049

..

40.00

5.00

5265

..

82.00

5.00

5053

..

49.00

5.00

5267

..

3.50

1.50

5054

..

61.00

5.00

5271

..

40.00

5.00

5057

..

28.00

5.00

5273

..

75.00

5.00

5058

..

36.00

5.00

5275

..

23.00

5.00

5061

..

90.00

5.00

5279

..

15.00

4.00

5063

..

61.00

5.00

5290

..

15.00

4.00

5065

..

61.00

5.00

5292

..

18.00

5.00

5069

..

66.00

5.00

5293

..

23.00

5.00

5071

..

36.00

5.00

5297

..

23.00

5.00

5074

..

73.00

5.00

5299

..

82.00

5.00

5076

..

56.00

5.00

5302

..

28.00

5.00

5080

..

66.00

5.00

5304

..

26.00

5.00

5082

..

3.50

1.50

5307

..

49.00

5.00

5084

..

40.00

5.00

5309

..

56.00

5.00

5088

..

40.00

5.00

5315

..

44.00

5.00

5090

..

66.00

5.00

5321

..

15.00

4.00

5092

..

150.00

5.00

5326

..

15.00

4.00

5094

..

82.00

5.00

5331

..

19.00

5.00


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

5365

..

5.60

3.00

5633

..

68.00

5.00

5368

..

3.50

2.50

5638

..

35.00

5.00

5373

..

6.30

3.00

5639

..

45.00

5.00

5377

..

6.30

3.00

5643

..

35.00

5.00

5379

..

11.50

3.00

5645

..

45.00

5.00

5381

..

14.50

4.00

5650

..

49.00

5.00

5384

..

9.00

3.00

5657

..

28.00

5.00

5386

..

11.50

3.00

5660

..

35.00

5.00

5391

..

4.00

2.50

5664

..

4.70

2.50

5395

..

6.30

3.00

5670

..

16.50

5.00

5400

..

4.00

2.50

5672

..

28.00

5.00

5405

..

9.00

3.00

5676

..

54.00

5.00

5406

..

11.50

3.00

5682

..

4.50

2.50

5412

..

21.00

5.00

5684

..

3.10

1.50

5417

..

28.00

5.00

5688

..

30.00

5.00

5421

..

105.00

5.00

5690

..

38.00

5.00

5430

..

59.00

5.00

5695

..

35.50

5.00

5432

..

3.10

1.50

5696

..

45.00

5.00

5435

..

59.00

5.00

5700

..

54.00

5.00

5400

..

59.00

5.00

5707

..

35.00

5.00

5446

..

33.00

5.00

5709

..

45.00

5.00

5450

..

12.00

4.00

5716

..

30.00

5.00

5465

..

9.50

3.00

5717

..

38.00

5.00

5468

..

28.00

5.00

5740

..

7.80

3.00

5469

..

35.00

5.00

5752

..

39.00

5.00

5478

..

35.00

5.00

5755

..

52.00

5.00

5479

..

45.00

5.00

5759

..

39.00

5.00

5484

..

44.00

5.00

5761

..

52.00

5.00

5485

..

54.00

5.00

5765

..

28.00

5.00

5496

..

50.50

5.00

5768

..

16.50

4.00

5497

..

62.00

5.00

5771

..

34 00

5.00

5502

..

13.50

4.00

5776

..

54.00

5.00

5506

..

45.00

5.00

5781

..

33.00

5.00

5514

..

59.00

5.00

5784

..

56.00

5.00

5521

..

56.00

5.00

5787

..

70.00

5.00

5526

..

4.50

2.50

5789

..

78.00

5.00

5528

..

4.50

2.50

5797

..

90.00

5.00

5532

..

4.90

2.50

5801

..

42.00

5.00

5536

..

13.00

4.00

5805

..

54.00

5.00

5538

..

16.50

5.00

5808

..

63 00

5.00

5544

..

18.50

5.00

5811

..

90.00

5.00

5546

..

24.00

5.00

5815

..

34.00

5.00

5549

..

11.50

3.00

5817

..

45.00

5.00

5550

..

13.50

4.00

5820

..

63.00

5.00

5555

..

5.60

3.00

5823

..

90.00

5.00

5558

..

8.00

3.00

5825

..

9.00

3.00

5563

..

10.50

3.00

5829

..

5.90

3.00

5564

..

13.00

4.00

5832

..

38.00

5.00

5570

..

17.00

5.00

5835

..

9.00

3.00

5581

..

12.50

4.00

5839

..

22.00

5.00

5582

..

36.00

4.00

5841

..

27.00

5.00

5587

..

12.50

4.00

5844

..

16.50

4.00

5590

..

16.00

4.00

5860

..

42.00

5.00

5591

..

14.00

4.00

5863

..

59.00

5.00

5592

..

17.00

5.00

5865

..

49.00

5.00

5599

..

45.00

5.00

5867

..

63.00

5.00

5603

..

45.00

5.00

5870

..

63.00

5.00

5604

..

56.00

5.00

5872

..

54.00

5.00

5608

..

45.00

5.00

5874

..

38.00

5.00

5609

..

56.00

5.00

5877

..

11.50

3.00

5615

..

50.50

5.00

5880

..

3.50

1.50

5617

..

64.00

5.00

5882

..

10.50

3.00

5621

..

63.00

5.00

5884

..

9.00

3.00

5623

..

95.00

5.00

5886

..

31.00

5.00

5629

..

68.00

5.00

5890

..

9.50

3.00


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

5893

..

2.35

.80

6145

..

85.00

5.00

5895

..

5.20

2.50

6150

..

39.00

5.00

5898

..

16.50

4.00

6153

..

85.00

5.00

5900

..

18.00

5.00

6156

..

115.00

5.00

5902

..

5.20

2.50

6161

..

14.00

4.00

5904

..

115.00

5.00

6168

..

20.00

5.00

5907

..

75.00

5.00

6171

..

48.00

5.00

5913

..

4.20

2.50

6174

..

105.00

5.00

5914

..

20.00

5.00

6178

..

85.00

5.00

5917

..

9.00

3.00

6183

..

51.00

5.00

5921

..

22.00

5.00

6188

..

31.00

5.00

5923

..

100.00

5.00

6193

..

165.00

5.00

5925

..

54.00

5.00

6200

..

165.00

5.00

5932

..

38.00

5.00

6206

..

240.00

5.00

5934

..

100.0

5.00

6210

..

165.00

5.00

5939

..

44.00

5.00

6213

..

190.00

5.00

5942

..

25.00

5.00

6250

..

2.35

.80

5944

..

23.00

5.00

6254

..

3.70

2.50

5950

..

54.00

5.00

6257

..

4.70

2.50

5952

..

82.00

5.00

6260

..

21.00

5.00

5955

..

59.00

5.00

6264

..

23.00

5.00

5957

..

45.00

5.00

6266

..

5.20

2.50

5961

..

28.00

5.00

6268

..

6.10

3.00

5965

..

45.00

5.00

6270

..

5.60

2.50

5970

..

90.00

5.00

6273

..

15.00

4.00

5974

..

23.00

5.00

6275

..

9.50

3.00

5978

..

75.00

5.00

6276

..

12.00

3.00

5982

..

100.00

5.00

6281

..

16.00

4.00

5987

..

28.00

5.00

6282

..

19.50

5.00

5991

..

12.50

4.00

6287

..

36.00

5.00

5995

..

49.00

5.00

6288

..

36.00

5.00

5999

..

75.00

5.00

6293

..

40 00

5.00

6004

..

6.30

3.00

6294

..

40.00

5.00

6006

..

4.90

2.50

6298

..

73 00

5.00

6009

..

49.00

5.00

6301

..

35.00

5.00

6011

..

59.00

5.00

6304

..

14.50

4.00

6014

..

63.00

5.00

6305

..

18.00

5.00

6018

..

59.00

5.00

6312

..

35.00

5.00

6020

..

33.06

5.00

6317

..

61.00

5.00

6026

..

32.00

5.00

6319

..

100.00

5.00

6031

..

33.00

5.00

6323

..

31.00

5.00

6051

..

4.70

2.50

6329

..

20.00

5.00

6055

..

8.20

3.00

6330

..

26.00

5.00

6059

..

6.30

3.00

6334

..

18.00

5.00

6063

..

3.20

1.50

6339

..

38.00

5.00

6067

..

8.20

3.00

6341

..

85.00

5.00

6071

..

39.00

5.00

6346

..

120.00

5.00

6074

..

78.00

5.00

6351

..

210.00

5.00

6076

..

115.00

5.00

6356

..

31.00

5.00

6080

..

85.00

5.00

6357

..

39.00

5.00

6082

..

115.00

5.00

6362

..

90.00

5.00

6085

..

60.00

5.00

6369

..

48.00

5.00

6087

..

34.00

5.00

6370

..

61.00

5.00

6091

..

105.00

5.00

6375

..

63.00

5.00

6093

..

22.00

5.00

6376

..

80.00

5.00

6096

..

6.69

3.00

6380

..

90.00

5.00

6103

..

14.00

4.00

6385

..

90.00

5.00

6106

..

115.00

5.00

6390

..

75.00

5.00

6111

..

85.00

5.00

6394

..

67.00

5.00

6117

..

115.00

5.00

6395

..

210.00

5.00

6121

..

115.00

5.00

6399

..

110.00

5.00

6125

..

145.00

5.00

6405

..

54.00

5.00

6129

..

51.00

5.00

6408

..

61.00

5.00

6134

..

34.00

5.00

6411

..

120.00

5.00

6139

..

24.00

5.00

6421

..

39.00

5.00


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

6429

..

61.00

5.00

 

 

an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the dislocation concerned, plus one-half of that amount

an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the dislocation concerned, plus one-half of that amount

6433

..

75.00

5.00

 

 

6440

..

210.00

5.00

 

 

6444

..

120.00

5.00

 

 

6450

..

90.00

5.00

 

 

6457

..

82.00

5.00

 

 

6461

..

82.00

5.00

 

 

6466

..

82.00

5.00

 

 

6474

..

85.00

5.00

 

 

6479

..

105.00

5.00

 

 

6484

..

90.00

5.00

 

 

6490

..

47.00

5.00

 

 

6492

..

47.00

5.00

 

 

6500

..

81.00

5.00

 

 

6504

..

60.00

5.00

 

 

6511

..

54.00

5.00

 

 

6540

..

3.40

5.00

6675

..

3.10

1.50

6541

..

3.40

1.50

6678

..

6.60

3.00

6547

..

1.90

1.50

6679

..

10.50

3.00

6548

..

1.90

1.50

6682

..

4.20

2.50

6556

..

5.40

2.50

6684

..

10.50

3.00

6560

..

6.30

3.00

6685

..

14.50

4.00

6565

..

5.40

2.50

6689

..

12.00

3.00

6571

..

4.00

2.50

6690

..

16.50

5.00

6579

..

8.00

3.00

6693

..

4.90

2.50

6583

..

4.90

2.50

6695

..

10.50

3.00

6588

..

11.00

3.00

6696

..

12.00

4.00

6589

..

13.50

4.00

6710

..

13.00

4.00

6597

..

1.90

1.50

6731

..

19.00

5.00

6603

..

6.30

3.00

6716

..

10.50

3.00

6608

..

17.00

5.00

6720

..

11.50

3.00

6609

..

23.00

5.00

6721

..

14.50

4.00

6616

..

12.50

4.00

6725

..

11.00

3.00

6617

..

16.50

4.00

6726

..

13.00

4.00

6630

..

4.90

2.50

6731

..

16.50

5.00

6635

..

9 00

3.00

6732

..

26.00

5.00

6640

..

2.40

1.50

6733

..

16.50

5.00

6644

..

6.30

3.00

6734

..

26.00

5.00

6649

..

21.00

5.00

6737

..

7.00

3.00

6653

..

21.00

5.00

6738

..

10.50

3.00

6657

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the dislocation concerned, plus one-half of that amount

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(CD)’) relating to the dislocation concerned, plus one-half of that amount

6745

..

9 00

3 00

 

 

6749

..

2.35

.80

 

 

6750

..

2.10

1.50

 

 

6755

..

13.50

4.00

 

 

6756

..

18.00

5.00

 

 

6759

..

10.50

3.00

 

 

6760

..

13.50

4.00

 

 

6763

..

33.00

5.00

 

 

6764

..

45.00

5.00

 

 

6769

..

7.80

3.00

 

 

6770

..

11.00

3.00

 

 

6775

..

12.00

3.00

 

 

6776

..

16.50

5.00

 

 

6779

..

21.00

5.00

 

 

6780

..

28.00

5.00

 

 

6783

..

21.00

5.00

 

 

6784

..

28.00

5.00

 

 

6787

..

21.00

5.00

 

 

6788

..

28.00

5.00

 

 

6793

..

6.80

3.00

 

 

6794

..

10.50

3.00

6658

..

The amount shown in this column in the item (being

The amount shown in this column in the item (being

6797

..

2.60

1.50

 

 

6801

..

4.00

2.50

 

 

6803

..

6.60

3.00

 

 

6808

..

6.60

3.00


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

6812

..

2.35

.80

 

 

to an item in the table of Commonwealth, medical benefits the includes the symbol ‘(D)’) relating to the fracture concerned, plus one-third of that amount

to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-third of that amount

6813

..

2.10

1.50

 

 

6825

..

2.35

80

 

 

6826

..

2.10

1.50

 

 

6829

..

13.00

4.00

 

 

6830

..

19.00

5.00

 

 

6834

..

40.00

5.00

 

 

6838

..

8.20

3.00

 

 

6839

..

11.50

3.00

 

 

6840

..

11.50

3.00

 

 

6844

..

26.00

5.00

 

 

6845

..

26.00

5.00

6915

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)') relating to the fracture concerned, plus one-half of that amount

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

6850

..

28.00

5.00

 

 

6851

..

28.00

5.00

 

 

6854

..

10.50

3.00

 

 

6855

..

13.50

4.00

 

 

6856

..

13.50

4.00

 

 

6862

..

35.00

5.00

 

 

6863

..

35.00

5.00

 

 

6866

..

38.00

5.00

 

 

6867

..

38.00

5.00

 

 

6875

..

9.00

3.00

 

 

6876

..

12.00

4.00

 

 

6877

..

12.00

4.00

 

 

6882

..

2.35

.80

 

 

6883

..

2.10

1.50

 

 

6887

..

2.35

.80

 

 

6888

..

2.10

1.50

 

 

6893

..

16.50

4.00

6916

..

The amount shown in this column in the item (being an Item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘ID)’) relating to the fracture concerned, plus one-half of that amount

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

6895

..

28.00

5.00

 

 

6897

..

75.00

5.00

 

 

6910

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-third of that amount

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-third of that amount

 

 

 

 

 

 

6919

..

The amount shown in this column in tie item (other than an item relating to an item in the table of

The amount shown in this column in the item relating to the fracture concerned, plus one-half of that amount

6911

..

The amount shown in this column in the item (being an item relating

The amount shown in this column in the item (being an item relating

 

 


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

 

 

Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

 

 

 

Commonwealth medical benefits that includes the symbol ‘(D)') relating to the fracture concerned, plus three-quarters of that amount

Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6920

..

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

6935

..

One-half of the amount shown in this column in the item (other than an. item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item in the table of Commonwealth medical benefits apply to the reduction concerned

One-halt of the amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6935 in the table of Commonwealth medical benefits apply to the reduction concerned

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6925

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

The amount shown in this column in the item, (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

 

 

 

 

6936

..

One-half of the amount shown in this column in the item that would, but for item in the table of Commonwealth medical benefits apply to the reduction concerned

One-half of the amount shown in this column in the item that would, but for item 6936 in the table of Commonwealth medical benefits apply to the reduction concerned

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6926

..

The amount shown in this column in the item (being an item relating to an item in the table of

The amount shown in this column in the item (being an item relating to an item in the table of

 

 

 

 

6943

..

One-half of the amount shown in this column in the item (ether than an item relating to an item

One-half of the amount shown in this column in the item (other than an item relating to an item

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

 

 

in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6943 in the table of Commonwealth medical benefits apply to the reduction concerned

in the table of Commonwealth medical benefits that includes the symbol ‘(D)') that would, but for item 6943 in the table of Commonwealth medical benefits apply to the reduction concerned

 

 

item that would, but for item 6951 in the table of Commonwealth medical benefits apply to the reduction concerned

item that would, but for item 6951 in the table of Commonwealth medical benefits apply to the reduction concerned

6956

..

The amount shown in this column in tie item that would apply in the case of a simple and uncomplicated fracture of the part concerned

The amount shown in this column in the item that would apply in the case of a simple and uncomplicated fracture of the part concerned

6944

..

One-half of the amount shown in this column in the item that would, but for item 6944 in the table of Commonwealth

medical benefits apply to the reduction concerned

One-half of the amount shown art this column in the item that would, but for item 6944 in the table of Commonwealth medical benefits apply to the reduction concerned

6960

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6961

..

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

..

The amount shown in this column in tie item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

 

The amount- shown in this column in tie item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating So the fracture concerned, plus one-fifth of that amount.

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

 

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

6950

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol‘(D)’) that would, but for item 6950 in the table of Commonwealth medical benefits apply to the reduction concerned

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, hut for item 6950 in the table of Commonwealth medical benefits apply to the reduction concerned.

6951

..

The amount shown in this column in the

The amount shown in this column in the


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

7000

..

22.00

5.00

7294

..

34.00

5.00

7004

..

22.00

5.00

7296

..

52.00

5.00

7007

..

2.40

1.50

7299

..

30.00

5.00

7009

..

1.50

1.50

7302

..

25.00

5.00

7012

..

5.20

2.50

7303

..

31.00

5.00

7017

..

12.50

4.00

7308

..

47.00

5.00

7018

..

16.50

5.00

7311

..

56.00

5.00

7024

..

9.50

3.00

7317

..

36.75

5.00

7026

..

9.50

3.00

7320

..

45.75

5.00

7030

..

85.00

5.00

7322

..

43.00

5.00

7034

..

30.00

5.00

7327

..

17.00

5.00

7036

..

30.00

S.00

7330

..

22.00

5.00

7039

..

8.50

3.00

7335

..

52.00

5.00

7040

..

11.00

3.00

7337

..

39.00

5.00

7049

..

11.50

3.00

7345

..

30.00

5.00

7053

..

14.50

4.00

7347

..

17.00

5.00

7059

..

14.00

4.00

7349

..

22.00

5.00

7064

..

24.00

5.00

7350

..

22.00

5.00

7071

..

24.00

5.00

7357

..

21.00

5.00

7077

..

130.00

5.00

7358

..

27.00

5.00

7083

..

42.00

5.00

7362

..

22.00

5.00

7086

..

27.00

5.00

7366

..

24.00

5.00

7090

..

61.00

5.00

7369

..

24.00

5.00

7094

..

110.00

5.00

7371

..

30.00

5.00

7102

..

95.00

5.00

7375

..

34.00

5.00

7110

..

120.00

5 00

7379

..

56.00

5.00

7115

..

110.00

5.00

7383

..

85.00

5.00

7119

..

145.00

5.00

7385

..

47.00

5.00

7123

..

105.00

5.00

7388

..

56.00

5.00

7127

..

145.00

5.00

7393

..

54.00

5.00

7131

..

73.00

5.00

7398

..

56.00

5.00

7137

..

56.00

5.00

7403

..

12.50

4.00

7142

..

73.00

5.00

7405

..

27.00

5.00

7144

..

73.00

5.00

7414

..

23.00

5.00

7147

..

52.00

5.00

7415

..

30.00

5.00

7150

..

47.00

5.00

7418

..

34.00

5.00

7168

..

42.00

5.00

7421

..

11.50

3.00

7169

..

45.00

5.00

7422

..

14.00

4.00

7174

..

22.00

5.00

7425

..

22.00

5.00

7179

..

24.00

5.00

7428

..

29 00

5.00

7183

..

66.00

5.00

7429

..

37.00

5.00

7187

..

78.00

5.00

7433

..

9.50

3.00

7191

..

26.00

5.00

7437

..

14.00

4.00

7196

..

6.60

3.00

7439

..

8 50

3.00

7201

..

39.00

5.00

7441

..

22.00

5.00

7207

..

44.00

5.00

7445

..

42.00

5.00

7211

..

39.00

5.00

7447

..

115.00

5 00

7215

..

27.00

5.00

7449

..

56.00

5.00

7219

..

105.00

5.00

7452

..

24.00

5.00

7229

..

70.00

5.00

7455

..

13.50

4.00

7235

..

70.00

5.00

7456

..

17.00

5.00

7239

..

90.00

5.00

7460

..

17.00

5.00

7243

..

130.00

5.00

7465

..

19.00

5.00

7247

..

52.00

5.00

7469

..

30.00

5.00

7254

..

70.00

5.00

7475

..

14.00

4.00

7258

..

34.00

5 00

7479

..

37.00

5.00

7264

..

17.00

5.00

7481

..

34.00

5.00

7267

..

39.00

5.00

7484

..

56.00

5.00

7269

..

52.00

5.00

7487

..

70.00

5.00

7272

..

39.00

5.00

7491

..

95.00

5.00

7276

..

37.00

5.00

7493

..

70.00

5.00

7277

..

47.00

5.00

7496

..

34.00

5.00

7281

..

56.00

5.00

7500

..

34.00

5.00

7286

..

2.10

1.50

7501

..

47.00

5.00

7288

..

2.30

1.50

7504

..

47.00

5.00


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

7507

..

44.00

5.00

7780

..

39.00

5.00

7511

..

44.00

5.00

7784

..

13.50

4.00

7515

..

41.00

5.00

7786

..

32.00

5.00

7518

..

47.00

5.00

7790

..

3.50

2.50

7522

..

47.00

5.00

7794

..

3.40

1.50

7525

..

34.00

5.00

7796

..

3.40

1.50

7526

..

47.00

5.00

7800

..

10.50

3.00

7555

..

15.50

4.00

7801

..

10.50

3.00

7558

..

3.60

1.50

7805

..

12.00

4.00

7562

..

3.80

2.50

7806

..

12.00

4.00

7564

..

3.60

1.50

7811

..

16.50

5.00

7568

..

4.20

2.50

7813

..

26.00

5.00

7571

..

3.60

1.50

7816

..

47.00

5.00

7574

..

5.40

2.50

7819

..

66.00

5.00

7576

..

3.60

1.50

7822

..

39.00

5.00

7579

..

6.60

3.00

7825

..

22.00

5.00

7583

..

19.00

5.00

7826

..

22.00

5.00

7587

..

3.60

1.50

7829

..

34.00

5.00

7589

..

5.40

2.50

7833

..

39.00

5.00

7592

..

5.40

2.50

7837

..

18.00

5.00

7595

..

5.60

3.00

7842

..

20.00

5.00

7600

..

68.00

5.00

7846

..

9.00

3.00

7604

..

78.00

5.00

7851

..

36.00

5.00

7612

..

78.00

5.00

7856

..

18.00

5.00

7614

..

78.00

5.00

7859

..

39.00

5.00

7617

..

39.00

5.00

7865

..

30.00

5.00

7621

..

61.00

5.00

7871

..

20.00

5.00

7623

..

61.00

5.00

7875

..

16.50

4.00

7628

..

87.00

5.00

7876

..

16.50

4.00

7633

..

78.00

5.00

7879

..

34.00

5.00

7636

..

78.00

5.00

7882

..

59.00

5.00

7639

..

75.00

5.00

7886

..

22.00

5.00

7645

..

17.00

5.00

7887

..

22.00

5.00

7648

..

39.00

5.00

7890

..

49.00

5.00

7653

..

30 00

5.00

7894

..

39.00

5.00

7656

..

95.00

5.00

7895

..

39.00

5.00

7660

..

95.00

5.00

7899

..

63 00

5.00

7663

..

61.00

5.00

7903

..

75.00

5.00

7669

..

52.00

5.00

7906

..

63.00

5.00

7675

..

61.00

5.00

7910

..

75.00

5.00

7679

..

78.00

5.00

7914

..

8.00

3.00

7686

..

39.00

5.00

7918

..

16.50

5.00

7689

..

52.00

5.00

7922

..

40.00

5.00

7692

..

78.00

5.00

7930

..

78.00

5.00

7695

..

30.00

5.00

7935

..

26.00

5.00

7699

..

52.00

5.00

7939

..

61.00

5.00

7702

..

30.00

5.00

7944

..

70.00

5.00

7705

..

78.00

5.00

7948

..

115.00

5.00

7710

..

9.50

3.00

7955

..

40.00

5.00

7713

..

61.00

5.00

7959

..

75.00

5.00

7716

..

45.00

5.00

7963

..

59.00

5.00

7739

..

42.00

5.00

7964

..

59.00

5.00

7722

..

24.00

5.00

7971

..

49.00

5.00

7725

..

9.50

3.00

7972

..

49.00

5.00

7728

..

13.50

4.00

7979

..

49.00

5.00

7729

..

17.50

5.00

7980

..

49.00

5.00

7733

..

39.00

5.00

7991

..

68.00

5.00

7736

..

9.50

3.00

7995

..

39.00

5.00

7740

..

47.00

5.00

7996

..

39.00

5.00

7742

..

45.00

5.00

8004

..

42.00

5.00

7746

..

56.00

5.00

8005

..

42.00

5.00

7748

..

87.00

5.00

8012

..

49.00

5.00

7752

..

61.00

5.00

8013

..

49.00

5.00

7755

..

7.30

3.00

8025

..

49.00

5.00

7759

..

4.20

2.50

8030

..

22.00

5.00


SCHEDULE 2—continued

Number of item in  First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

8034

..

66.00

5.00

8112

..

73.00

5.00

8039

..

26.00

5.00

8117

..

28.00

5.00

8043

..

26.00

5.00

8121

..

21.00

5.00

8047

..

39.00

5.00

8325

..

42.00

5.00

8052

..

42.00

5.00

8129

..

100.00

5.00

8056

..

49.00

5.00

8133

..

28.00

5.00

8064

..

71.50

5.00

8137

..

54.00

5.00

8068

..

110.00

5.00

8138

..

54.00

5.00

8073

..

11.50

3.00

8146

..

68.00

5.00

8078

..

28.00

5.00

8147

..

68.00

5.00

8082

..

28.00

5.00

8155

..

34.00

5.00

8086

..

45.00

5.00

8156

..

34.00

5.00

8090

..

15.00

4.00

8164

..

49.00

5.00

8094

..

59.00

5.00

8165

..

49.00

5.00

8098

..

44.00

5.00

8171

..

49 00

5.00

8102

..

12.00

4.00

8172

..

49.00

5.00

8107

..

54.00

5.00

8177

..

63.00

5.00


 

SCHEDULE 3

Regulation 5

TABLE OF FUND MEDICAL BENEFITS IN RESPECT OF VICTORIA

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

1

..

1.30

.80

274

..

6.20

1.50

2

..

2.60

1.10

277

..

6.20

1.50

10

..

1.95

.80

280

..

10.40

3.00

12

..

3.10

1.30

282

..

6.20

1.50

21

..

3.70

1.60

285

..

23.00

5.00

24

..

4.90

2.10

289

..

5.80

1.50

29

..

5.50

2.50

292

..

26.00

5.00

31

..

6.70

3.00

294

..

6.20

1.50

36

..

1.90

1.20

296

..

11.60

3.00

41

..

3.35

1.40

300

..

.80

.80

47

..

2.95

1.20

303

..

2.10

1.00

49

..

4.05

1.80

304

..

3.30

1.00

55

..

5.05

2.20

307

..

4.20

1.50

56

..

6.20

2.70

308

..

5.80

1.50

61

..

7.00

3.00

311

..

6.70

2.00

62

..

8.15

3.50

312

..

7.90

2.00

63

..

2.95

1.20

314

..

7.30

3.00

64

..

4.05

1.80

315

..

9.00

3.00

67

..

1.95

.80

316

..

10.50

3.00

68

..

1.30

.80

318

..

11.00

3.00

74

..

1.95

.80

319

..

12.50

4.00

76

..

2.90

1.00

320

..

13.00

4.00

80

..

7.40

1.50

322

..

14.50

4.00

83

..

3.50

1.00

324

..

15.00

4.00

86

..

10.90

2.00

325

..

16.00

5.00

89

..

7.20

1.50

326

..

17.00

5.00

92

..

3.50

1.00

327

..

18.00

5.00

95

..

7.40

1.50

328

..

19.00

5 00

98

..

11.00

2.00

329

..

21.00

5.00

101

..

14.00

3.00

330

..

22.00

5.00

104

..

17.50

4.00

331

..

23.00

5.00

109

..

7.20

1.50

332

..

24.00

5.00

112

..

10.90

2.00

333

..

25.00

5.00

115

..

13.90

3.00

334

..

27.00

5.00

118

..

17.00

4.00

335

..

27.00

5.00

121

..

21.50

4.00

336

..

29.00

5.00

124

..

11.60

2.00

337

..

29.00

5.00

127

..

57.60

4.00

338

..

31.00

5.00

129

..

24.50

5.00:

339

..

33.00

5.00

131

..

32.50

5.00

343

..

35.00

5.00

133

..

39.50

5.00

346

..

39.00

5.00

203

..

1.95

.80

349

..

41.00

5.00

206

..

20.50

5.00

350

..

43.00

5.00

208

..

18.00

5.00

353

..

2.70

1.00

212

..

20.00

5.00

356

..

6.70

2.00

218

..

18.00

5.00

359

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned, plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned, plus one-half of that amount

223

..

36.00

5.00

 

 

224

..

40.00

5.00

 

 

226

..

42.50

5.00

 

 

227

..

46.50

5.00

 

 

237

..

52.00

5.00

 

 

238

..

57.00

5.00

 

 

239

..

52.00

5.00

 

 

240

..

55.00

5.00

 

 

245

..

1.30

.80

 

 

248

..

1.30

.80

 

 

253

..

15.00

4.00

 

 

254

..

20.50

5.00

 

 

257

..

6.20

1.50

 

 

262

..

1.30

.80

 

 

269

..

5.60

1.50

 

 

272

..

8.50

2.00

 

 


SCHEDULE 2—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

363

..

The amount shown in this column In the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned, plus one-third of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned, plus one-third of that amount

 

 

to the administration of an anaesthetic in connection with the treatment of the part concerned

to the administration of an anaesthetic in connection with the treatment of the part concerned

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

410

..

1.00

.80

 

 

411

..

2.60

1.00

 

 

412

..

4.00

1.00

 

 

413

..

5.60

1.50

 

 

414

..

6.50

2.00

 

 

415

..

7.90

2.00

 

 

416

..

8.50

3.00

366

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned, plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned, plus one-half of that amount

417

..

10.00

3.00

 

 

418

..

11.50

3.00

 

 

419

..

12.00

4.00

 

 

420

..

13.50

4.00

 

 

421

..

14.50

4.00

 

 

422

..

15.50

5.00

 

 

423

..

17.00

5.00

 

 

424

..

19 00

5 00

 

 

425

..

21.00

5.00

 

 

426

..

22.00

5.00

 

 

427

..

23.00

5.00

 

 

428

..

24.00

5.00

 

 

429

..

26.00

5.00

 

 

431

..

27.00

5.00

 

 

432

..

28.00

5.00

 

 

433

..

30.00

5.00

369

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned, phis three-quarters of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned, plus three-quarters of that amount

434

..

31.00

5.00

 

 

437

..

33.00

5.00

 

 

438

..

34.00

5.00

 

 

439

..

36.00

5.00

 

 

440

..

37.00

5.00

 

 

441

..

39.00

5.00

 

 

442

..

39.00

5.00

 

 

444

..

43.00

5.00

 

 

445

..

46.00

5.00

 

 

446

..

53 00

5.00

 

 

447

..

50.00

5.00

 

 

448

..

3.30

1.00

 

 

449

..

7 90

2 00

 

 

453

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned, plus one-half of that amount

 

 

The amount shown in this column in the item relating

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned, plus one-half of that amount

 

 

The amount shown in this column in the item relating

 

 

 

 

 

 

 

 

373

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

377

..

The amount shown in this column in the item relating

The amount shown in this column in the item relating

457

 

..

 

 

 

 

 

 

 

 

 

 

 

 


Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item m First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

$

$

to the administration of an anaesthetic in connection with the treatment of the fracture concerned, plus one-third of that amount

to the administration of an anaesthetic in connection with the treatment of the fracture concerned, plus one-third of that amount

 

anaesthetic in connection with the treatment of the part concerned

anaesthetic in connection with the treatment of the fracture concerned

503

..

4.20

1.50

504

..

5.60

1.50

507

..

5.80

1.50

508

..

6.50

2.00

511

..

7.30

3.00

512

..

10.00

3.00

459

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned, plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned, plus one-half of that amount

515

..

6.70

2.00

516

..

7.90

2.00

519

..

10.50

3.00

520

..

12.00

4.00

530

..

7.70

2.00

532

..

5.60

1.50

534

..

5.80

1.50

536

..

7.00

2.00

555

..

10.00

3.00

603

..

7.40

1.50

605

..

14.10

3.00

607

..

22.50

5.00

609

..

8.70

2.00

612

..

20.00

4.00

615

..

29.00

5.00

620

..

8.70

2.00

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned, plus three-quarters of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned, plus three-quarters of that amount

622

..

18.50

4.00

463

..

624

..

13.40

3.00

628

..

16.60

4.00

633

..

22.50

5.00

635

..

10.60

2.00

637

..

8.70

2.00

650

 

42.00

5.00

653

..

20.00

4 00

655

..

6.80

1.50

658

..

30.00

5.00

663

 

54.00

5.00

666

..

22.50

5.00

669

..

13.40

3.00

671

..

8.00

1.50

675

..

5.40

1.50

678

..

4.30

1.00

683

..

10.90

3.00

466

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of he part concerned

686

..

7.70

1.50

690

..

14.10

3.00

700

..

2.60

.80

706

..

4.00

1.00

718

..

5.40

1.00

722

..

6.80

1.50

726

..

4.70

1..00

732

..

4.70

1.00

735

..

5.80

1.50

740

..

5.30

1.00

743

..

4.90

1.00

745

..

11.00

2.00

750

..

5.80

1.50

469

..

The amount shown in this column in the item relating to the administration of an

The amount shown in this column in the item relating to the administration  of an

758

..

8.70

2.00

762

..

5.80

1.50

765

..

35.00

5.00

768

..

29.00

5.00

773

..

2.70

1.00

775

..

5.30

1.00

778

..

8.70

2.00


Schedule 3—continued

Number of item in First Schedule

Fund Medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

$

 

$

$

785

..

17.00

4.00

1076

..

.90

.80

788

..

4.40

1.00

1080

..

1.20

.80

792

..

14.10

3.00

1082

..

2.30

1.00

795

..

48.00

5.00

1084

..

8.80

3.00

798

..

70.00

5.00

1090

..

1.90

1.00

802

..

10.90

3.00

1091

..

2.50

1.00

805

..

3.80

1.00

1092

..

1.90

1.00

808

..

6.40

1.50

1094

..

1.60

.80

811

..

6.40

1.50

1096

..

.90

.80

813

..

9.00

2.00

1098

..

1.30

.80

817

..

13.40

3.00

1100

..

1.50

1.00

820

..

13.40

3.00

1102

..

3.50

1.00

823

..

12.20

3.00

1104

..

.70

.80

826

..

8.70

2.00

1106

..

.60

.80

830

..

23.50

5.00

1108

..

1.50

1.00

834

..

S.30

1.00

1110

..

5.80

2.00

837

..

11.50

3.00

1112

..

.70

.80

842

..

1.60

.80

1114

..

1.20

.80

848

..

2..10

.80

1116

..

4 60

1.50

852

..

3.60

1.00

1118

..

1.90

1.00

855

..

5.60

1.00

1120

..

4.80

1.50

858

..

3.50

1.00

1122

..

2.70

1.00

862

..

10.30

2.00

1124

..

1.90

1.00

869

..

18.50

4.00

1126

..

2.30

3.00

873

..

38.00

5.00

1128

..

1.40

.80

876

..

6.40

1.50

1130

..

3.10

1.00

1000

..

1.20

.80

1132

..

190

1.00

1002

..

1.20

.80

1134

..

3.10

1.10

1004

..

1.70

.80

1136

..

4.80

1.50

1006

..

.90

.80

1138

..

1.60

. 80

1008

..

.70

.80

1140

..

3.20

1.00

1010

..

1.90

1.00

1142

..

1.40

1.00

1012

..

5.00

1.50

1144

..

l. 90

1.00

1014

..

2.40

1.00

1146

..

1.90

1.00

1016

..

3.60

1.00

1148

..

2.70

1.00

1018

..

5.80

1.50

1150

..

4.80

1.50

1019

..

.70

.80

1152

..

2.70

1.00

3020

..

4.70

3.00

1154

..

2 30

1.00

1022

..

.70

.80

1156

..

2.30

1.00

1024

..

2.20

.80

1160

..

3.70

1.00

1026

..

.70

.80

1162

..

3.10

1.00

1028

..

3.20

1.00

1164

..

4.00

1.50

1030

..

3.10

1.00

1166

..

4.00

1.50

1032

..

3.20

100

1168

..

5.00

1.50

1034

..

1.90

1.00

1170

..

4.40

1.50

1036

..

2.70

1.00

1172

..

.90

.80

1038

..

3.10

1.00

1174

..

2.40

1.00

1040

..

3.10

1.00

1182

..

2.20

.80

1042

..

3.20

1.00

1184

..

3.70

1.00

1044

..

4.00

1.50

1186

..

.70

.80

1046

..

3.40

.80

1188

..

1.90

1.00

1048

..

5.60

1.50

1190

..

2.70

1.00

1050

..

4.00

1.50

1192

..

2.70

1.00

1054

..

.70

.80

1194

..

3.20

1.00

1060

..

1.20

.80

1196

..

2 70

1.00

1062

..

1.60

.80

1198

..

1.70

1.00

1063

..

.40

.80

1200

..

1.20

.80

1064

..

1.20

.80

1202

..

2.90

1.00

1066

..

2.30

1.00

1204

..

.60

.80

1068

..

2.50

1.00

1206

..

3.10

1.00

1070

..

2.30

100

1208

..

3.70

100-

1072

..

2.70

1.00

1210

..

2.70

1.00

1074

..

7.60

3.00

1212

..

3.50

1.00


Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

..

$

$

$

..

$

$

1214

..

2.20

.80

1388

..

4.80

1.50

1216

..

2.10

1.00

1389

..

5.80

2.00

1238

..

3.50

1.00

1391

..

4.00

1.50

1220

..

5.00

1.50

1392

..

6.30

2.00

1222

..

5.00

1.50

1394

..

7.50

2.00

1224

..

6.80

3 00

1395

..

.90

.80

1226

..

8.80

3.00

1397

..

2.90

1.00

1228

..

3.50

1.00

1399

..

.70

.80

1230

..

5.00

1.50

1401

..

1.90

1.00

1232

..

2.70

1.00

1404

..

1.20

.80

1240

..

1.90

1.00

1407

..

2.70

1.00

1242

..

3.10

1.00

1410

..

1.90

1.00

1246

..

5.00

1.50

1413

..

2.40

1.00

1248

..

.20

.80

1416

..

3.60

1.00

1250

..

2.70

l.00

1419

..

190

1.00

1252

..

4.80

1.50

1421

..

2.30

l.00

1254

..

6.20

2.00

1423

..

2.30

1.00

1256

..

6 80

3.00

1425

..

4.00

1.50

1258

..

8.40

3.00

1428

..

2.30

1.00

1260

..

2.70

1.00

1430

..

5.00

1.50

1262

..

4.40

1.50

1432

..

8.80

3.00

1264

..

2.70

1.00

1434

..

2.70

1.00

1266

..

4.80

1.50

1436

..

3.10

1.00

1268

..

6.20

2.00

1438

..

8.80

3.00

1270

..

6.80

3.00

1441

..

3.30

1.00

1272

..

4.00

1.50

1444

..

2.70

1.00

1274

..

8.80

3.00

1447

..

5.00

1.50

1277

..

1.90

1.00

1450

..

4.40

1.50

1278

..

2.70

1.00

1453

..

2.70

1.00

1280

..

4.80

1.50

1456

..

3.50

1.00

1282

..

6.20

2.00

1459

..

2.70

1.00

1284

..

6.80

3.00

1461

..

4.80

1.50

1286

..

8.40

3.00

1463

..

6.20

2.00

1288

..

4.00

1.50

1466

..

6.80

3.00

1290

..

5.60

1.50

1468

..

2.50

1.00

1294

..

2.70

1.00

1470

..

2.20

1.00

1296

..

1.90

1.00

1472

..

4.00

1.50

1298

..

4.80

1.50

1474

..

8.80

3.00

1301

..

2.70

1.00

1475

..

7.00

3.00

1302

..

4.80

1.50

1476

..

1.20

1.50

1304

..

6.20

2.00

1478

..

3.30

1.00

1305

..

6.80

3.00

1481

..

3.30

1.00

1307

..

8.40

3.00

1484

..

6.80

3.00

1310

..

2.70

1.00

1487

..

4.20

1.50

1313

..

1.90

1.00

1490

..

4.20

1.50

1314

..

.50

.80

1491

..

2.50

1.00

1317

..

.20

.50

1493

..

6.80

3.00

1319

..

3.60

1.50

1494

..

8.80

3.00

1322

..

1.70

.80

1495

..

.90

.80

1325

..

.90

.80

1496

..

2.40

1.00

1328

..

2.40

1.00

1497

..

4.40

1.50

1331

..

5.00

1.50

1499

..

4.00

1.50

1334

..

3.10

1.00

1500

..

.70

.80

1337

..

5.20

1.50

1502

..

1.20

.80

1340

..

7.00

2.00

1506

..

2.30

1.00

1343

..

5.20

1.50

1508

..

1.70

.80

1346

..

6.80

3.00

1511

..

1.90

1.00

1349

..

3.30

1.00

1513

..

1.60

.80

1352

..

3.50

1.00

1515

..

2.90

1.00

1355

..

4.00

1.50

1517

..

4.20

1.50

1358

..

2.30

1.00

1519

..

5.00

1.50

1380

..

1.70

.80

1521

..

6.00

2.00

1382

..

1.70

.80

1523

..

6.00

2.00

1385

..

2.70

1.00

1525

..

2.90

1.00


Schedule 3—continued

Number of item First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund Medical benefit

Specified excess

 

 

$

$

$

 

$

$

1527

..

4.00

1.50

1706

..

1.90

1.00

1529

..

2.30

1.00

1707

..

3.10

1.00

1531

..

4.40

1.50

1710

..

.70

.80

1534

..

1.90

1.00

1712

..

2.70

1.00

1537

..

3.10

1.00

1714

..

2.70

1.00

1539

..

2.30

1.00

1716

..

.90

.80

1541

..

1.90

1.00

1718

..

3.50

1.00

1543

..

2.30

1.00

1720

..

7.00

2.00

1545

..

.70

.80

1722

..

9.60

3-00

1546

..

4.00

1.50

1724

..

1.90

1.00

1548

..

5.80

2.00

1726

..

4.00

1.50

1551

..

4.00

1.50

1728

..

5.80

2.00

1554

..

6.40

2.00

1730

..

4.00

1.50

1557

..

8.00

3.00

1732

..

.70

.80

1560

..

6.40

2.00

1734

..

2.50

1.00

1562

..

5.80

2.00

1736

..

6.80

3.00

1564

..

7.46

3.00

1738

..

.90

.80

1566

..

7.40

2.00

1741

..

2.70

1.00

1568

..

9.00

3.00

1744

..

.90

.80

1571

..

3.30

1.00

1746

..

2.70

1.00

1580

..

1.90

1.00

1748

..

2.70

1.00

1582

..

1.60

1.00

1761

..

1.40

.80

1584

..

3.50

1.00

1764

..

2.70

1.00

1586

..

1.70

.80

1767

..

.90

.80

1588

..

2.70

1.00

1770

..

2.70

1.00

1590

..

2.70

1.00

1773

..

3.10

1.00

1601

..

2.70

1.00

1776

..

4.80

1.50

1604

..

4.80

1.50

1779

..

1.70

.80

1607

..

6.20

2.00

1782

..

1.70

.80

1609

..

6.80

3.00

1785

..

1.70

.80

1611

..

2.50

1.00

1790

..

1.90

1.00

1613

..

3.30

1.00

1792

..

1.90

1.00

1615

..

3.50

1.00

1794

..

4.00

1.50

1616

..

4.00

1.50

1796

..

4.00

1.50

1621

..

.90

.80

1798

..

1.90

1.00

1622

..

.70

.80

1800

..

1.10

.80

1623

..

2.30

1.00

1802

..

4.20

1.50

1625

..

1.10

.80

1804

..

5.80

2.00

1627

..

2.70

1.00

1806

..

2.70

1.00

1629

..

2.30

1.00

1808

..

5.80

2.00

1631

..

1.90

1.00

1810

..

2.70

1.00

1640

..

5.60

1.50

1812

..

2.70

1.00

1643

..

2.90

1.00

1820

..

4.80

1.50

1645

..

2.90

1.00

1822

..

7.00

2.00

1647

..

8.80

3.00

1824

..

8.40

3.00

1649

..

7.00

2.00

1826

..

8.40

3.00

1651

..

8.80

3.00

1828

..

10.40

4.00

1653

..

4.00

1.50

1840

..

12.40

4.00

1661

..

1.20

.80

1841

..

16.00

5.00

1664

..

5.80

2.00

1843

..

5.60

1.50

1667

..

2.70

1.00

1846

..

4.00

1.50

1670

..

2.70

1.00

1849

..

4.00

1.50

1673

..

3.50

1.00

1850

..

4.80

1.50

1680

..

1.70

.80

1852

..

4.80

1.50

1682

..

1.20

.80

1853

..

7.00

3.00

1684

..

.90

.80

1855

..

5.80

2.00

1686

..

1.10

.80

1858

..

7.00

2.00

1688

..

1.90

1.00

1861

..

5.20

1.50

1691

..

1.90

1.00

1863

..

5.80

2.00

1694

..

1.30

1.00

1865

..

14.00

5.00

1697

..

3.30

1.00

1867

..

5.60

1.50

1698

..

4.80

1.50

1869

..

4.80

1.50

1700

..

1.90

1.00

1871

..

6.80

3.00

1701

..

6.60

2.00

1873

..

14.00

5.00

1703

..

1.90

1.00

1875

..

5.80

2.00


Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

$

..

$

$

1877

..

5.80

2.00

2046

..

6.50

1.50

1879

..

5.60

1.50

2050

..

6.00

3.50

1881

..

4.60

1.50

2053

..

7.50

2.00

1884

..

4.00

1.50

2056

..

7.50

2.00

1887

..

4.00

1.50

2058

..

11.50

3.00

1889

..

12.40

4.00

2062

..

8.50

2.00

1891

..

1.90

1.00

2067

..

6.00

1.50

1893

..

4.40

1.50

2070

..

8.50

2.00

1895

..

5.80

2.00

2074

..

8.50

2.00

1896

..

2.70

1.00

2077

..

6.00

1.50

1897

..

4.00

1.50

2079

..

6.00

1.50

1898

..

4.00

1.50

2082

..

6.00

1.50

1899

..

5.80

2.00

2084

..

7.10

1.50

1900

..

5.00

1.50

2086

..

7.10

1.50-

1902

..

7.00

2.00

2088

..

6.50

1.50

1904

..

2.30

1.00

2091

..

4.10

1.00

1906

..

2.50

1.00

2096

..

9.00

3.00

1908

..

7.00

2.00

2300

..

8.00

2.00

1910

..

7.20

3.00

2103

..

6.50

1.50

1912

..

8.40

3.00

2105

..

5.60

1.50

1914

..

8.80

3.00

2107

..

8.00

2.00

1916

..

4.00

1.50

2109

..

6.50

2.00

1917

..

4.00

3.50

2114

..

8.50

3.00

1918

..

3.40

1.50

2117

..

5.50

1.50

1919

..

7.00

3.00

2120

..

31.50

3.00

3920

..

2.70

1.00

2122

..

15.00

4.00

1922

..

4.00

1.50

2124

..

2.40

1.00

1924

..

4.00

1.50

2126

..

6.00

1.50

1926

..

4.40

1.50

2129

..

10.00

3.00

1927

..

10.50

4.00

2131

..

5.90

1.50

1929

..

17.00

5.00

2134

..

6.60

1.50

1931

..

7.00

3.00

2136

..

7.50

2.00

3933

..

6.60

2.00

2143

..

5.10

1.50

3935

..

5.20

1.50

2147

..

2.70

1.00

1937

..

6.20

2.00

2149

..

6.50

1.50

1939

..

11 00

4.00

2151

..

7.50

2.00

1942

..

10.50

4.00

2153

..

5.90

1.50

1946

..

6.20

2.00

2155

..

6.60

1.50

1952

..

19.00

5.00

2157

..

7.00

1.50

1954

..

8.50

3.00

2159

..

8.00

2.00

1960

..

10.50

4.00

2162

..

6.60

1.50

1962

..

6.60

2.00

2165

..

15.50

4.00

1964

..

7.00

3.00

2167

..

14.00

4.00

1982

..

12.00

4.00

2171

..

18.00

5.00

1984

..

6.00

1.50

2175

..

13.50

3.00

1986

..

13.00

4.00

2178

..

8.00

2.00

1987

..

32.00

4.00

2182

..

9.00

3.00

19?9

..

8.00

3.00

2186

..

7.00

1.50

1991

..

12.00

4.00

2201

..

5.90

1.50

1993

..

12.00

4.00

2206

..

6.60

1.50

1995

..

8.00

3.00

2210

..

5.60

1.50

1997

..

8.00

3.00

2212

..

8.50

2.00

1998

..

7.80

2.00

2216

..

11.00

3.00

2002

..

4.40

1.00

2220

..

12.50

4.00

2004

..

5.10

1.50

2223

..

9.00

3.00

2007

..

4.40

1.00

2225

..

11.00

3.00

2009

..

5.10

1.50

2228

..

12.50

4.00

2025

..

6.00

1.50

2232

..

10.50

3.00

2029

..

6.50

1.50

2236

..

9.50

3.00

2031

..

4.40

1.00

2239

..

12.50

4.00

2033

..

5.60

1.50

2241

..

11.50

3.00

2035

..

6.50

1.50

2243

..

19.00

5.00

2037

..

8.00

2.00

2245

..

8.00

2.00

2039

..

6.00

1.50

2249

..

2.40

1.00


Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

$

 

$

$

2255

..

9.00

3.00

2550

..

14.50

4.00

2257

..

6.00

1.50

2553

..

4.90

1.50

2265

..

7.10

1.50

2556

..

8.50

3.00

2267

..

10.00

3.00

2559

..

10.50

3.00

2269

..

8.00

2.00

2562

..

3.20

1.00

2272

..

9.00

3.00

2565

..

3.40

1.00

2275

..

12.50

4.00

2568

..

5.50

1.50

2277

..

12.50

4.00

2571

..

5.50

1.50

2279

..

12.50

4.00

2600

..

26.00

5.00

2281

..

9.50

2.00

2603

..

14.00

4.00

2283

..

6.00

1.50

2606

..

14.00

4.00

2285

..

12.00

3.00

2613

..

14.00

5.00

2287

..

9.00

3.00

2616

..

5.10

1.50

2289

..

10.00

3.00

2619

..

7.50

2.00

2296

..

8.50

2.00

2623

..

7.50

2.00

2299

..

11.50

3.00

2631

..

6.00

1.50

2302

..

11.50

3.00

2635

..

6.00

1.50

2304

..

11.50

3.00

2639

..

4.90

1.50

2306

..

11.50

3.00

2643

..

6.00

1.50

2308

..

.50

3.00

2647

..

4.90

1.50

2312

..

14.00

4.00

2651

..

4.90

1.50

2316

..

11.50

3.00

2655

..

7.50

2.00

2319

..

8.50

2.00

2658

..

6.00

1.50

2323

..

8.50

2.00

2663

..

6.00

1.50

2327

..

2.70

1.00

2667

..

3.90

1.00

2331

..

6.50

150

2669

..

7.50

2.00

2335

..

5.40

1.50

2673

..

5.10

1.50

2339

..

6.50

1.50

2677

..

5.10

1.50

2343

..

9.50

3.00

2680

..

14.00

4.00

2348

..

8.00

2.00

2685

..

9.00

3.00

2352

..

7.50

2.00

2689

..

2.40

1.00

2365

..

7.50

2.00

2693

..

14.00

4.00

2400

..

1.30

.80

2701

..

7.00

2.00

2425

..

5.60

1.50

2704

..

7.50

2.00

2428

..

3.60

1.00

2708

..

9.00

3.00

2450

..

3.20

1.00

2712

..

14.00

4.00

2453

..

.30

.80

2920

..

7.00

1.00

2456

..

3.90

1.00

2929

..

One-fifth of the amount shown in this column for the operation of operations

One-fifth of the amount shown in this column for the operation of operations

246!

..

.40

.80

 

 

2466

..

7.50

2.00

 

 

2469

..

1.20

.80

 

 

2472

..

4.40

1.00

 

 

2475

..

3.90

1.00

 

 

2478

..

.40

.80

3003

..

1.95

.80

2482

..

4.60

1.50

3007

..

3.00

1.00

2485

..

.50

.80

3010

..

5.20

1.50

2488

..

9.00

3.00

3014

..

6.40

1.50

2490

..

1.80

.80

3018

..

10.00

3.00

2492

..

6.00

1.50

3020

..

12.00

3.00

2494

..

.80

.80

3023

..

4.50

1.50

2497

..

8.00

2.00

3026

..

5.30

1.50

2501

..

1.30

.80

3028

..

4.10

1.50

2504

..

12.50

4.00

3032

..

4.10

1.50

2507

..

2.70

1.00

3035

..

9.00

3.00

2511

..

22.00

5.00

3040

..

9.00

3.00

2515

..

15.00

4.00

3042

..

5.80

2.00

2519

..

31.00

5.00

3044

..

11.50

3.00

2523

..

45.00

5.00

3048

..

12.00

3.00

2527

..

36.00

5.00

3053

..

9.00

3.00

2531

..

22.00

5.00

3054

..

9.00

3.00

2536

 

 

5.00

3060

 

11.50

3.00

 

..

8.50

3.00

3066

..

14.50

4.00

2540

..

13.50

4.00

3072

..

14.50

4.00

2544

..

6.50

1.50

3076

..

1.40

.80

2547

..

4.90

1.50

3079

..

1.40

.80


Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

..

$

$

 

 

$

$

3083

..

8.00

3.00

3337

..

21.00

5.00

3086

..

8.00

3.00

3341

..

13.50

4.00

3088

..

17.00

5.00

3343

..

17.00

5.00

3091

..

22.00

5.00

3347

..

23.00

5.00

3096

..

22.00

5.00

3352

..

9.50

3.00

3100

..

4.40

1.00

3355

..

11.50

3.00

3102

..

4.40

1.00

3358

..

28.00

5.00

3107

..

8.00

3.00

3360

..

28.00

5.00

3111

..

9.50

3.00

3365

..

28.00

5.00

3118

..

9.50

3.00

3370

..

63.00

5.00

3122

..

4.00

1.00

3374

..

105.00

5.00

3127

..

8.00

3.00

3376

..

70.00

5.00

3129

..

2.40

1.00

3380

..

43.00

5.00

3133

..

2.40

1.00

3382

..

43.00

5.00

3136

..

14.00

4.00

3385

..

15 50

4.00

3141

..

7.30

2.00

3388

..

15.50

4.00

3145

..

7.30

2.00

3410

..

5.00

1.50

3153

..

11.50

3.00

3413

..

5.00

1.50

3154

..

14.00

4.00

3416

..

9.00

3.00

3158

..

14.00

4.00

3420

..

11.50

3.00

3164

..

2.90

1.00

3422

..

11.50

3.00

3167

..

12.00

3.00

3426

..

11.50

3.00

3169

..

16.50

5.00

3429

..

23.00

500

3172

..

11.00

5.00

3432

..

23.00

5.00

3176

..

12.00

5.00

3435

..

59.00

5.00

3182

..

30.00

5.00

3438

..

59.00

5.00

3186

..

8.30

2.00

3441

..

150.00

5.00

3188

..

10.50

3.00

3449

..

3.80

1.00

3192

..

10.50

3.00

3451

..

3.80

1.00

3198

..

11.00

3.00

3457

..

12.50

3.00

3200

..

13.00

4.00

3461

..

16.50

4.00

3205

..

13.00

4.00

3463

..

16.50

4.00

3209

..

15.50

4.00

3467

..

105.00

5.00

3212

..

19.00

5.00

3471

..

32.00

5.00

3214

..

19.00

5.00

3474

..

42.00

5.00

3223

..

31.00

5.00

3476

..

49.00

5.00

3227

..

36.00

5.00

3481

..

85.00

5.00

3231

..

32.00

5.00

3485

..

95.00

5.00

3234

..

70.00

5.00

3489

..

105.00

5.00

3239

..

42.00

5.00

3494

..

69.00

5.00

3240

..

42.00

5.00

3499

..

66.00

5.00

3241

..

49.00

5.00

3504

..

48.00

5.00

3243

..

49 00

5.00

3512

..

32.00

5.00

3246

..

70.00

5.00

3515

..

42.00

5.00

3249

..

32.00

5.00

3518

..

36.00

5.00

3257

..

56.00

5.00

3520

..

28.00

5.00

3260

..

10.50

3.00

3522

..

150.00

5.00

3538

..

30 00

5.00

3264

..

3.10

1.00

3540

..

85.00

5.00

3266

..

6.50

1.50

3543

..

19.00

5.00

3270

..

6.50

1.50

3546

..

61.00

5.00

3275

..

5.90

1.50

3549

..

16.00

4.00

3278

..

6.10

2.00

3552

..

26.00

5.00

 

 

 

 

 

 

 

 

3283

..

6.30

2.00

3557

..

35.00

5.00

3287

..

7.00

2.00

3558

..

17.50

5.00

3293

..

3.60

1.00

3562

..

21.00

5 00

3296

..

12.00

4.00

3564

..

20.00

5.00

3302

..

2.20

1.00

3568

..

26.00

5.00

3307

..

2.20

1.00

3570

..

20.00

5.00

3310

..

9.00

3.00

3574

..

26.00

5.00

3312

..

12.00

4.00

3579

..

49.00

5.00

3317

..

12.00

4.00

3584

..

73.00

5.00

3322

..

9.50

3.00

3586

..

11.50

3.00

3327

..

11.50

3.00

3590

..

29.00

5.00

3333

..

16.50

5.00

3592

..

44.00

5.00


Schedule 3—continued

Number of item in First Schedule.

Fund Medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

..

$

$

 

 

$

S

3596

..

36.50

5.00

3861

..

23.00

5.00

3600

..

49.00

5.00

3862

..

38.00

5.00

3606

..

42.00

5.00

3866

..

9.50

3.00

3611

..

54.00

5.00

3868

..

32.00

5.00

3613

..

45.00

5.00

3871

..

41.00

5.00

3621

..

49.00

5.00

3873

..

13.50

4.00

3625

..

130.00

5.00

3876

..

7.30

2.00

3628

..

45.00

5.00

3877

..

100.00

5.00

3631

..

49.00

5.00

3881

..

150.00

5.00

3635

..

49.00

5.00.

3885

..

170.00

5.00

3639

..

9.50

3.00

3887

..

34.00

5.00

3642

..

44.00

5.00

3890

..

42.00

5.00

3644

..

63.00

5.00

3891

..

105.00

5.00

3648

..

36.00

5.00

3893

..

46.50

5.00

3650

..

45.00

5.00

3895

..

64.00

5.00

3653

..

75.00

5.00

3897

..

63.00

5.00

3659

..

73.00

5.00

3942

..

39.00

5.00

3663

..

52.00

5.00

3944

..

49.00

5.00

3666

..

82.00

5.00

3947

..

95.00

5.00

3669

..

125.00

5.00

3950

..

73.00

5.00

3672

..

125.00

5.00

3953

..

73.00

5.00

3674

..

14.50

4.00

3956

..

38.00

5.00

3677

..

16.50

5.00

3960

..

11.50

3.00

3679

..

45.00

5.00

3966

..

4.50

1.50

3685

..

47.00

5.00

3972

..

105.00

5.00

3694

..

49.00

5.00

3974

..

87.00

5.00

3697

..

59.00

5.00

3977

..

35.00

5.00

3701

..

70.00

5.00

3980

..

52.00

5.00

3703

..

45.00

5.00

3982

..

28.00

5.00

3708

..

59.00

5.00

3985

..

28.00

5.00

3712

..

59.00

5.00

3988

..

35.00

5.00

3717

..

36.00

5.00

3992

..

45.00

5.00

3719

..

45.00

5.00

3994

..

66.00

5.00

3723

..

85.00

5.00

3997

..

67.00

5.00

3730

..

105.00

5.00

4001

..

21.00

5.00

3734

..

125.00

5.00

4005

..

28.00

5.00

3738

..

45.00

5.00

4006

..

24.50

5.00

3740

..

36.00

5.00

4010

..

33.00

5.00

3744

..

36.00

5.00

4014

..

36.00

5.00

3748

..

45.00

5.00

4016

..

45.00

5.00

3752

..

59.00

5.00

4019

..

2.90

1.00

3757

..

36.00

5.00

4023

..

26.50

5.00

3762

..

45.00

5.00

4025

..

31.00

5.00

3775

..

24.00

5.00

4028

..

28.00

5.00

3781

..

31.00

5.00

4030

..

33.00

5.00

3785

..

45.00

5.00

4036

..

18.00

5.00

3787

..

45.00

5.00

4038

..

23.00

5.00

3791

..

29.00

5.00

4058

..

24.50

5.00

3794

..

37.00

5.00

4063

..

33.00

5.00

3799

..

18.00

5.00

4067

..

45.00

5.00

3804

..

42.00

5.00

4069

..

70.00

5.00

3813

..

9300

5.00

4073

..

45.00

5.00

3818

..

75.00

5.00

4077

..

8.50

3.00

3819

..

36.00

5.00

4079

..

3.80

1.00

3822

..

45.00

5.00

4081

..

8.00

3.00

3828

..

36.00

5.00

4083

..

11.50

3.00

3830

..

45.00

5.00

4085

..

14.50

4.00

3835

..

66.00

5.00

4088

..

3.90

1.00

3839

..

93.00

5.00

4092

..

4.50

1.50

3840

..

85.00

5.00

4098

..

15.50

4.00

3845

..

105.00

5.00

4103

..

31.00

5.00

3847

..

125.00

5.00

4105

..

48.00

5.00

3851

..

95.00

5.00

4110

..

9.00

3.00

3852

..

30.00

5.00

4111

..

14.50

4.00

3858

..

105.00

5.00

4116

..

16.50

5.00


Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

..

$

$

 

..

$

$

4121

..

49.00

5.00

4306

..

75.00

5.00

4123

..

80.00

5.00

4308

..

54.00

5.00

4128

..

2.90

1.00

4312

..

125.00

5.00

4129

..

11.00

3.00

4314

..

150.00

5.00

4131

..

14.50

4.00

4323

..

105.00

5.00

4134

..

3.10

1.00

4329

..

35.00

5.00

4135

..

11.50

3.00

4335

..

73.00

5.00

4137

..

9.00

3.00

4341

..

19.00

5.00

4139

..

6.90

2.00

4344

..

14.50

4.00

4142

..

31.00

5.00

4347

..

85.00

5.00

4145

..

10.50

3.00

4349

..

45.00

5.00

4147

..

2.10

1.00

4353

..

5.00

1.50

4152

..

4.00

1.50

4357

..

9.50

3.00

4154

..

4.50

1.50

4361

..

16.50

4.00

4159

..

28.00

5.00

4363

..

16.50

4.00

4160

..

46.00

5.00

4367

..

28.00

5.00

4164

..

8.50

2.00

4369

..

23.00

5.00

4168

..

17.00

5.00

4371

..

28.00

5.00

4170

..

31.00

5.00

4374

..

9.50

3.00

4174

..

17.00

5.00

4377

..

28.00

5.00

4178

..

23.00

5.00

4382

..

28.00

5.00

4180

..

26.00

5.00

4386

..

28.00

5.00

4184

..

32.00

5.00

4388

..

49.00

5.00

4186

..

9.00

3.00

4392

..

38.00

5.00

4187

..

11.50

3.00

4396

..

28.00

5.00

4192

..

59.00

5.00

4398

..

49.00

5.00

4196

..

26.00

5.00

4405

..

12.00

3.00

4198

..

5.90

1.50

4406

..

15.00

4.00

4203

..

43.00

5.00

4410

..

18.50

5.00

4204

..

24.00

5.00

4411

..

23.00

5.00

4205

..

31.00

5.00

4415

..

21.75

5.00

4210

..

7.00

2.00

4417

..

27.00

5.00

4226

..

2.80

1.00

4423

..

25.00

5.00

4228

..

8.50

2.00

4425

..

31.00

5.00

4232

..

15.50

4.00

4431

..

11.50

5.00

4234

..

41.00

5.00

4433

..

28.25

5.00

4237

..

30.00

5.00

4438

..

14.00

4.00

4239

..

57.00

5.00

4439

..

17.50

5.00

4242

..

26.00

5.00

4446

..

17.00

5.00

4244

..

20.00

5.00

4451

..

23.00

5.00

4245

..

16.00

4.00

4457

..

28.00

5.00

4248

..

42.00

5.00

4459

..

49.00

5.00

 

 

 

 

4462

..

100.00

5.00

4250

..

68.00

5.00

4465

..

9.00

3.00

4252

..

4.20

1.00

4466

..

11.50

3.00

4255

..

20.00

5.00

4470

..

13.50

4.00

4257

..

28.00

5.00

4471

..

16.50

5.00

4259

..

42.00

5.00

4475

..

16.00

4.00

4261

..

61.00

5.00

4477

..

20.25

5.00

4264

..

85.00

5.00

4479

..

18.00

5.00

4266

..

100.00

5.00

4481

..

23.00

5.00

4268

..

61.00

5.00

4486

..

11.50

5.00

4270

..

100.00

5.00

4487

..

14.00

5.00

4272

..

90.00

5.00

4491

..

28.00

3.00

4274

..

45.00

5.00

4493

..

23.00

4.00

4278

..

59.00

5.00

4500

..

38.00

5.00

4280

..

49.00

5.00

4506

..

54.00

5.00

4283

..

61.00

5.00

4510

..

11.50

5.00

4286

..

115.00

5.00

4512

..

61.00

5.00

4289

..

110.00

5.00

4515

..

125.00

5.00

4290

..

115.00

5.00

4518

..

6.60

5.00

4292

..

100.00

5.00

4530

..

19.00

2.00

4295

..

100.00

5.00

4532

..

11.50

5.00

4298

..

100.00

5.00

4535

..

12.00

3.00

4301

..

59.00

5.00

4539

..

61.00

4.00


Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

4543

..

80.00

5.00

4708

..

5.00

1.50

4546

..

49.00

5.00

4711

..

23.00

5.00

4550

..

82.00

5.00

4716

..

49.00

5.00

4554

..

90.00

5 00

4717

..

68.00

5.00

4556

..

115.00

5.00

4720

..

90.00

5.00

4558

..

45.00

5.00

4722

..

4.30

1.00

4566

..

56.00

500

4731

..

9.00

3.00

4569

..

90.00

5.00

4734

..

9.50

3.00

4572

..

135.00

5.00

4737

..

82.00

5.00

4574

..

152.50

5.00

4742

..

59.00

5.00

4577

..

100.00

5.00

4745

..

49.00

5.00

4581

..

115.00

5.00

4748

..

59.00

5.00

4584

..

90.00

5.00

4750

..

16.50

5.00

4588

..

210.00

5.00

4753

..

18.00

5.00

4589

..

210.00

5.00

4756

..

25.50

5.00

4593

..

100.00

5.00

4757

..

27.50

5.00

4597

..

125.00

5.00

4760

..

23.50

5.00

4601

..

100.00

5.00

4761

..

25.50

5.00

4607

..

49.00

5.00

4769

..

22.00

5.00

4609

..

90.00

5.00

4770

..

31.00

5.00

4613

..

59.00

5.00

4776

..

8.50

3.00

4615

..

68.00

5 00

4777

..

11.50

3.00

4619

..

100.00

5.00

4781

..

6.00

2.00

4621

..

15.80

3.00

4782

..

8.00

3.00

4623

..

55.00

5.00

4786

..

17.50

4.00

4627

..

14.00

5.00

4788

..

17.00

4.00

4632

..

3.90

1.00

4793

..

7.30

2.00

4634

..

8.00

3.00

4795

..

5.90

1.50

4636

..

8.00

3.00

4797

..

2.90

1.00

4638

..

6.20

1.50

4799

..

28.00

5.00

4642

..

9.50

3.00

4803

..

14.50

4.00

4644

..

6.60

1.50

4805

..

29.00

5.00

4646

..

6.60

2.00

4807

..

13.50

4.00

4647

..

13.00

4.00

4809

..

16.50

5.00

4648

..

16.50

5.00

4813

..

28.00

5.00

4652

..

45.00

5.00

4816

..

4.50

1.50

4654

..

51.50

5.00

4821

..

110.00

5.00

4656

..

51.50

5.00

4824

..

115.00

5.00

4659

..

11.80

3.00

4826

..

115.00

5.00

4661

..

12.00

4.00

4829

..

14.50

4.00

4664

..

10.50

3.00

4833

..

26.50

5.00

4666

..

13.50

4.00

4840

..

29.00

5.00

4668

..

2.60

1.00

4842

..

23.00

5.00

4669

 

2.60

1.00

4846

 

33.00

5.00

4671

..

7.60

2.00

4849

..

49.00

5.00

4672

..

7.60

2.00

4852

..

49.00

5.00

4673

..

2.10

1.00

4857

..

82.00

5.00

4675

..

35.00

5.00

4859

..

70.00

5.00

4679

..

55.00

5.00

4861

..

14.00

4.00

4680

..

55.00

5.00

4863

..

19.00

5.00

4682

..

54.00

5.00

4865

..

13.50

4.00

4683

..

21.00

5.00

4869

..

13.50

4.00

4684

..

21.00

5.00

4871

..

18.00

5.00

4685

..

9.00

3.00

4873

..

30.00

5.00

4686

..

9.00

3.00

4875

..

19.00

5.00

4687

..

49.00

5.00

4878

..

9.50

3.00

4688

..

49.00

5.00

4890

..

66.00

5.00

4689

..

66.00

5.00

4892

..

73.00

5.00

4692

..

87.00

5.00

4894

..

125.00

5.00

4695

..

5100

5.00

4896

..

68.00

5.00

4698

..

5.00

1.50

4898

..

90.00

5.00

4700

..

27.00

5.00

4903

..

66.00

5.00

4703

..

66.00

5.00

4904

..

82.00

5.00

4706

..

52.00

5.00

4908

..

90.00

5.00


Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

4913

..

90.00

5.00

5088

..

40.00

5.00

4914

..

105.00

5.00

5090

..

66.00

5.00

4920

..

90.00

5.00

5092

..

150.00

5.00

4923

..

63.00

5.00

5094

..

82.00

5.00

4928

..

82.00

5.00

5096

..

100.00

5.00

4929

..

90.00

5.00

5111

..

90.00

5.00

4932

..

95.00

5.00

5115

..

107.00

5.00

4936

..

73.00

5.00

5117

..

40.00

5.00

4938

..

66.00

5.00

5121

..

100.00

5.00

4941

..

49.00

5.00

5123

..

23.00

5 00

4945

..

56.00

5.00

5126

..

35.00

5.00

4947

..

13.00

4.00

5129

..

11.50

3.00

4951

..

28.00

5.00

5134

..

40.00

5.00

4953

..

40.00

5.00

5137

..

4.00

1.00

4956

..

82.00

5.00

5139

..

6.60

1.50

4958

..

90.00

5.00

5142

..

82.00

5.00

4960

..

82.00

5.00

5146

..

23.00

5.00

4962

..

82.00

5.00

5148

..

11.50

3.00

4964

..

66.00

5.00

5151

..

27.00

5.00

4966

..

115.00

5.00

5154

..

19.00

5.00

4968

..

150.00

5.00

5156

..

13.50

4.00

4971

..

66.00

5.00

5159

..

8.00

2.00

4973

..

82.00

5.00

5164

..

19.00

5.00

4975

..

73.00

5.00

5168

..

19.00

5.00

4977

..

90.00

5.00

5177

..

56.00

5.00

4980

..

82.00

5.00

5180

..

49.00

5.00

4982

..

82.00

5.00

5183

..

66.00

5.00

4984

..

100.00

5.00

5187

..

66.00

5.00

4986

..

82.00

5.00

5189

..

61.00

5.00

4988

..

100.00

5.00

5195

..

61.00

5.00

4992

..

115.00

5.00

5197

..

23.00

5.00

5000

..

56.00

5.00

5200

..

31.00

5.00

5003

..

66.00

5.00

5203

..

40.00

5.00

5005

..

66.00

5.00

5207

..

61.00

5.00

5008

..

82.00

5.00

5209

..

63.00

5.00

5011

..

2.90

1.00

5211

..

73.00

5.00

5013

..

11.00

3.00

5213

..

23.00

5.00

5017

..

14.00

4.00

5215

..

49.00

5.00

5020

..

18.00

5.00

5219

..

82.00

5.00

5022

..

19.00

5.00

5226

..

15 00

4.00

5025

..

8.00

2.00

5231

..

15.00

4.00

5027

..

8.00

2.00

5234

..

40.00

5.00

5030

..

23.00

5.00

5238

..

66.00

5.00

5033

..

19 00

5.00

5242.

..

6.60

2.00

5035

..

27.00

5.00

5247

..

66.00

5.00

5039

..

61 00

5.00

5250

..

9.00

3.00

5042

..

21.00

5.00

5253

..

31.00

5.00

5044

..

40.00

5.00

5255

..

40.00

5.00

5046

..

43.00

5.00

5258

..

82.00

5.00

5049

..

40.00

5.00

5263

..

40.00

5.00

5053

..

49.00

5.00

5265

..

82.00

5.00

5054

..

61.00

5.00

5267

..

4.00

1.00

5057

..

25.00

5.00

5271

..

40.00

5.00

5058

..

36.00

S.00

5273

..

75.00

5.00

5061

..

90.00

5.00

5275

..

23.00

5.00

5063

..

61.00

5.00

5279

..

15.00

4.00

5065

..

61.00

5.00

5290

..

15.00

4.00

5069

..

66.00

5.00

5292

..

18.00

5.00

5071

..

36.00

5.00

5293

..

23.00

5.00

5074

..

73.00

5.00

5297

..

23.00

5.00

5076

..

56.00

5.00

5299

..

82.00

5.00

5080

..

66.00

5.00

5302

..

28.00

5.00

5082

..

4.00

1.00

5304

..

26.00

5.00

5084

..

40.00

5.00

5307

..

49.00

5.00


Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

5309

..

56.00

5.00

5609

..

56.00

5.00

5315

..

44.00

5.00

5615

..

50.50

5.00

5321

..

15.00

4.00

5617

..

65.50

5.00

5326

..

15.00

4.00

5621

..

63.00

5.00

S331

..

19.00

5.00

5623

..

95.00

5.00

5365

..

6.60

2.00

5629

..

68.00

5.00

5368

..

4.50

1.50

5633

..

58.00

5.00

5373

..

7.30

2.00

5638

..

35.00

5.00

5377

..

7.30

2.00

5639

..

45.00

5.00

5379

..

11.50

3.00

5643

..

35.00

5.00

5381

..

14.50

4.00

5645

..

45.00

5.00

5384

..

9.00.

3.00

5650

..

49.00

5.00

5386

..

11.50

3.00

5657

..

28.00

5.00

5391

..

5.00

1 50

5660

..

45.00

5.00

5395

..

7.30

2.00

5664

..

5.70

1.50

5400

..

5.00

1.50

5670

..

16.50

5.00

5405

..

9.00

3.00

5672

..

25.00

5.00

5406

..

11.50

3.00

5676

..

54.00

5.00

5412

..

21.00

5.00

5682

..

5.50

1.50

5417

..

28.00

5.00

5684

..

3.60

1.00

5421

..

105.00

5.00

5688

..

34.00

5.00

5430

..

59.00

5.00

5690

..

43.00

5.00

5432

..

3.60

1.00

5695

..

39.50

5.00

5435

..

59.00

5.00

5696

..

51.50

5.00

5440

..

59.00

5.00

5700

..

54.00

5.00

5446

..

33.00

5000

5707

..

28.00

5.00

5450

..

12.00

4.00

5709

..

35.00

5.00

5465

..

9.50

3.00

5716

..

30.00

5.00

5468

..

20.00

5.00

5717

..

38.00

5.00

5469

..

26.00

5.00

5740

..

8.80

2.00

5478

..

35.00

5.00

5752

..

39.00

5.00

5479

..

45.00

5.00

5755

..

52.00

5.00

5484

..

44.00

5.00

5759

..

39.00

5.00

5485

..

54.00

5.00

5761

..

52.00

5.00

5496

..

50.00

5.00

5765

..

28.00

5.00

5497

..

63.50

5.00

5768

..

16.50

4.00

5502

..

13.50

 4.00

5771

..

34.00

5.00

5506

..

45.00

5.00

5776

..

5400

5.00

5514

..

59.00

5.00

5781

..

33.00

5.00

5521

..

56.00

5.00

5784

..

56.00

5.00

5526

..

5.50

1.50

5787

..

70.00

5.00

5528

..

5.50

1.50

5789

..

78.00

5.00

5532

..

5.90

1.50

5797

..

90.00

5.00

5535

..

13.00

4.00

5801

..

42.00

5.00

5538

..

16.50

5.00

5S05

..

54.00

5.00

5544

..

18.50

5.00

5808

..

63.00

5.00

5546

..

25.50

5.00

5811

..

90.00

5.00

5549

..

11.50

3.00

5815

..

34.00

5.00

5550

..

13.50

4.00

5817

..

45.00

5.00

5555

..

6.60

2.00

5820

..

63.00

5.00

5558

..

8.00

3.00

5823

..

90.00

5.00

5563

..

10.50

3.00

5825

..

9.00

3.00

5564

..

16.00

4.00

5829

..

6.90

2.00

5570

..

17.00

5.00

5832

..

38.00

5.00

5581

..

12.50

4.00

5835

..

9.00

3.00

5582

..

18.00

5.00

5839

..

22.00

5.00

5587

..

12.50

4.00

5841

..

27.00

5.00

5590

..

18.00

5.00

5844

..

16.50

4.00

5591

..

14.00

4.00

5860

..

42.00

5.00

5592

..

20.00

5.00

5863

..

59.00

5.00

5599

..

45.00

5.00

5865

..

49.00

5.00

5603

..

45.00

5.00

5867

..

63.00

5.00

5604

..

56.00

5.00

5870

..

63.00

5.00

5608

..

45.00

5.00

5872

..

54.00

5.00


 

Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

$

$

5874

..

38.00

5.00

6111

..

85.00

5.00

5877

..

11.50

3.00

6117

..

115.00

5.00

5880

..

4.00

1.00

6121

..

115.00

5.00

5882

..

6.50

3.00

6125

..

145.00

5.00

5884

..

9.00

3.00

6129

..

51.00

5.00

5886

..

31.00

5.00

6134

..

34.00

5.00

5890

..

9.50

3.00

6139

..

24.00

5.00

5893

..

1.95

.80

6145

..

85.00

5.00

5895

..

6.20

1.50

6150

..

39.00

5.00

5898

..

16.50

4.00

6153

..

85.00

5.00

5900

..

18.00

5.00

6156

..

115.00

5.00

5902

..

6.20

1.50

6161

..

14.00

4.00

5904

..

115.00

5.00

6168

..

20.00

5.00

5907

..

75.00

5.00

6171

..

48.00

5.00

5913

..

5.20

1.50

6174

..

105.00

5.00

5914

..

23.00

5.00

6178

..

85.00

5.00

5917

..

9.00

3.00

6183

..

51.00

5.00

5921

..

22.00

5.00

6188

..

31.00

5.00

5923

..

80.00

5.00

6193

..

165.00

5.00

5925

..

54.00

5.00

6200

..

165.00

5.00

5932

..

38.00

5.00

6206

..

240.00

5.00

5934

..

100.60

5.00

6210

..

165.00

5.00

5939

..

44.00

5.00

6213

..

190.00

5.00

5942

..

25.00

5.00

6250

..

1.95

.80

5944

..

23.00

5.00

6254

..

4.70

1.50

5950

..

54.00

5.00

6257

..

5.70

1.50

5952

..

6700

5.00

6260

..

21.00

5.00

5955

..

59.00

5.00

6264

..

23.00

5.00

5957

..

45.00

5.00

6266

..

6.20

1.50

596J

..

28.00

5.00

6268

..

7.10

2.00

5965

..

45.00

5.00

6270

..

6 60

1.50

5970

..

90.00

5.00

6273

..

15.00

4.00

5974

..

23.00

5.00

6275

..

9.50

3.00

5978

..

75.00

5.00

6276

..

12.00

3.00

5982

..

130.00

5 00

6281

..

16.00

4.00

5987

..

28.00

5.00

6282

..

19 50

5.00

5991

..

12.50

4.00

6287

..

36.00

5.00

5995

..

49.00

5.00

6288

..

36.00

5.00

5999

..

75.00

5.00

6293

..

40.00

5.00

6004

..

7.30

2.00

6294

..

40.00

5.00

6006

..

5.90

1.50

6298

..

73.00

5.00

6009

..

49.00

5.00

6301

..

35.00

5.00

6011

..

59.00

5.00

6304

..

14.50

4.00

6014

..

63 00

5.00

6305

..

18.00

5.00

6018

..

59.00

5.00

6312

..

35.00

5.00

6020

..

33.00

5.00

6317

..

61.00

5.00

6026

..

32.00

5.00

6319

..

100.00

5.00

6031

..

33.00

5.00

6323

..

31.00

5.00

6051

..

5.70

1.50

6329

..

20.00

5.00

6055

..

S. 20

3.00

6330

..

26.00

5.00

6059

..

7.30

2.00

6334

..

18.00

5.00

6063

..

3.70

1.00

6339

..

38.00

5.00

6067

..

8.20

3 00

6341

..

85.00

5.00

6071

..

39.00

5.00

6346

..

120.00

5.00

6074

..

78.00

5.00

6351

..

210.00

5.00

6076

..

115.00

5.00

6356

..

31.00

5.00

6080

..

85.00

5.00

6357

..

39.00

5.00

6082

..

115.00

5.00

6362

..

90.00

5.00

6085

..

60.00

5.00

6369

..

48.00

5.00

6087

..

34.00

5.00

6370

..

61.00

5.00

6091

..

105 00

5.00

6375

..

63.00

5.00

6093

..

22.00

5.00

6376

..

80.00

5.00

6096

..

7 60

2.00

6380

..

90.00

5.00

6103

..

14 00

4.00

6385

..

90.00

5.00

6106

..

115.00

5.00

6390

..

75.00

5.00


Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

6394

..

67.00

5.00

 

 

plus one-half of that amount The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the dislocation concerned, pins one-half of that amount

plus one-half of that amount The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the dislocation concerned, plus one-half of that amount

6395

..

210.00

5.00

 

 

6399

..

110.00

5.00

6658

..

6405

..

54.00

5.00

 

 

6408

..

61.00

5.00

 

 

6411

..

120.00

5.00

 

 

6421

..

39.00

5.00

 

 

6429

..

61.00

5.00

 

 

6433

..

75.00

5.00

 

 

6440

..

210.00

500

 

 

6444

..

120.00

5.00

 

 

6450

..

90.00

5.00

 

 

6457

..

82.00

5.00

 

 

6461

..

82.00

5.00

 

 

6466

..

82.00

5.00

 

 

6474

..

85.00

5.00

 

 

6479

..

105.00

5.00

 

 

6484

..

90.00

5.00

 

 

6490

..

47.00

5.00

 

 

6492

..

47.00

5.00

 

 

6500

..

81.00

5.00

 

 

6504

..

60.00

5.00

6675

..

3.60

1.00

6511

..

54.00

5.00

 

 

 

 

6540

..

3.90

1.00

6678

..

7.60

2.00

6541

..

3.90

1.00

6679

..

1 0.50

3.00

6547

..

2.40

100

6682

..

5.20

1.50

6548

..

2.40

1.00

66S4

..

10.50

3.00

6556

..

6.40

1.50

6685

..

14.50

4.00

6560

..

7 30

2.00

6689

..

12.00

3.00

6565

..

6.40

1.50

6690

..

16.50

5.00

6575

..

5.00

1.50

6693

..

5.90

! 50

6579

..

8.00

3.00

6695

..

10.50

3.00

6583

..

5.90

1.50

6696

..

12.00

4.00

6588

..

11.00

3.00

6710

..

13.00

4.00

6589

..

13.50

4.00

6711

..

14.00

500

6597

..

2.40

1.00

6716

..

10.50

3.00

6603

..

7.30

2 00

6720

..

13.50

3.00

6608

..

17.00

5.00

6721

..

18.50

5.00

6609

..

23.00

5.00

6725

..

11.00

3.00

6616

..

12.50

4.00

6726

..

13.00

4.00

6617

..

16 50

4.00

6731

..

14.50

4.00

6630

..

5.90

1.50

6732

..

16.00

5.00

6635

..

9.00

3.00

6733

..

14.50

4.00

6640

..

2.90

1.00

6734

..

 

 

6644

..

7.30

2.00

6737

..

8.00

2.00

 

 

 

 

6738

 

9.50

3.00

6649

..

21.00

5.00

6745

..

9.00

3.00

6653

..

21.00

5.00

6749

..

1.95

.80

6657

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the dislocation concerned,

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the dislocation concerned,

6750

..

2.60

1.00

 

 

6755

..

13.50

4.00

 

 

6756

..

18.00

5.00

 

 

6759

..

10.50

3.00

 

 

6760

..

13.50

4.00

 

 

6763

..

33.00

5.00

 

 

6764

..

45.00

5.00

 

 

6769

..

8.80

2.00

 

 

6770

..

1.2.00

3.00

 

 

6775

..

12.00

4.00

 

 

6776

..

16.50

5.00

 

 

6779

..

21.00

5.00

 

 

6780

..

28.00

5.00

 

 

6783

..

21.00

5.00

 

 

6784

..

28.00

5.00

 

 

6787

 

21.00

5.00

 

 

6788

..

28.00

5.00

 

 

 

 

 

 

 

 

 

Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

6793

..

7.80

2.00

 

 

wealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-third of that amount

wealth medical. benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-third of that amount

6794

..

10.50

3.00

 

 

6797

..

3.10

1.00

 

 

6801

..

5.00

1.50

 

 

6803

..

7.60

2.00

 

 

6808

..

7.60

2.00

 

 

6812

..

1.95

.80

 

 

6813

..

2.60

1.00

 

 

6825

..

1.95

.80

 

 

6826

..

2.60

1.00

 

 

6829

..

13.00

4.00

6915

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

The amount shown in this column in the item (other than an item relating to an item in the table of Common-wealth medical benefits that includes the symbol '(D)’) relating to She- fracture concerned, plus one-half of that amount

6830

..

19.00

5.00

 

 

6834

..

40.00

5.00

 

 

6838

 

8.20

3.00

 

 

6839

..

11.50

3.00

 

 

6840

..

11.50

3.00

 

 

6844

..

26.00

5.00

 

 

6845

..

26.00

5.00

 

 

6850

..

28.00

5.00

 

 

6851

..

28.00

5.00

 

 

6854

..

10.50

3.00

 

 

6855

..

13.50

4.00

 

 

6856

..

13.50

4.00

 

 

6862

..

35.00

5.00

 

 

6863

..

35.00

5.00

 

 

6866

 

38.00

5.00

 

 

6867

..

38.00

5.00

 

 

6875

..

9.00

3.00

 

 

6876

..

12.00

4.00

 

 

6877

..

12.00

4.00

6916

..

The amount shown in this column in the item (being an item relating so an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

6882

..

195

.80

 

 

6883

..

2.60

1.00

 

 

6887

..

1.95

.80

 

 

6888

..

2.60

1.00

 

 

6893

..

16.50

4.00

 

 

6895

..

28.00

5.00

 

 

6897

..

75.00

5.00

 

 

6910

..

The amount, shown in this column in the item (other than an item relating to an item m the table of Common wealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-third of that amount

The amount shown in this column in the item (other than an item relating to an item in the Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-third of that amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6919

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture

The amount shown in this, column in the item relating to the fracture

 

 

6911

..

The amount shown in this column in the item (being an item relating to an item in the table of Common-

The amount shown in this column in the item (being an item relating to an item it’s the table of Common-


Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

concerned, plus one-half of that amount.

concerned, plus one-half of that amount.

6935

..

One-half of the amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6935 in the table of Commonwealth medical benefits apply to the- reduction concerned

One-half of the amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6935 in the table of Commonwealth medical benefits apply to the reduction concerned

6920

..

The amount shown in this column in tins item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount.

The amount shown in this column in the item (being an item relating to an item in the table of Common wealth medical benefits that includes the symbol '(D) ’) relating to the fracture concerned, - plus one-half of that amount.

6925

..

The amount shown in this column in tins item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus three quarters of that amount

The amount shown in this column in the item (being an item relating to an item in the table of Common  wealth medical benefits that includes the symbol '(D) ’) relating to the fracture concerned, , plus three quarters of that amount

6936

..

One-half of the amount shown in this column in the item that would but for item 6396 in the table of Commonwealth medical benefits apply to the reduction concerned

One-half of the amount shown in this column in the item that would but for item 6396 in the table of Commonwealth medical benefits apply to the reduction concerned

6926

..

The amount shown in this column in tins item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount of that amount

The amount shown in this column in the item (being an item relating to an item in the table of Common  wealth medical benefits that includes the symbol '(D) ’) relating to the fracture concerned, plus one-half of that amount of that amount

6943

..

One-half of the amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol '(D)’) that would, but for item 6943 in the table

One-half of the amount shown in this column in the item (other than an item relating to an item in the table of Common wealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6943 in the table of Commonwealth medical benefits

 


Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

 

 

 

6944

 

 

..

apply to the reduction concerned

One-half of the amount shown in this column in the item that would, but for item 6944 in the table of Commonwealth medical benefits apply to the reduction concerned

apply to the reduction concerned

One-half of the amount shown in this column in the item that would, but for item 6944 in the table of Commonwealth medical benefits apply to the reduction concerned

6960   ..

Uncomplicated fracture of the part concerned The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount.

Uncomplicated fracture of the part concerned The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount.

6950

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6950 in the table of Commonwealth medical benefits apply to the reduction concerned

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6950 in the table of Commonwealth medical benefits apply to the reduction concerned

 

 

6961 ..

The amount shown in this column in the item (being an item relating to an item in the table of Common wealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

The amount shown in this column, in the item (being an item: relating to an item in the table of Common wealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7000

22.00

5 00

6951

..

The amount shown in this column in the item that would, but for item 6951 in the table of Common wealth medical benefits apply to the reduction concerned

The amount shown in this column in the item that would, but for item 6951 in the table of Commonwealth medical benefits apply to the reduction concerned

7004

22.00

5.00

7007

2.90

1 00

7009

2.40

1.00

7012

6.20

150

7017

5.50

3.00

7018

7.50

4.00

7024

9.50

3.00

7026

9.50

3.00

7030

85.00

5 00

7034

30.00

5 00

7036

30.00

5.00

7039

8 50

3.00

7040

11.00

3.00

7049

7.50

3.00

6956

..

The amount shown in this column in the item that would apply in the case of a simple and

The amount shown in this column in the item that would apply in the case of a simple and

7053

8.50

3.00

7059

14.00

4.00

7064

24.00

5.00

7071

24.00

5.00

7077

130.00

5.00

7083

42.00

5.00

7086

27.00

5.00

7090

61.00

5.00

 

 

 

 

 

 

 

 

 

Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

..

$

$

7094

..

110.00

5.00

7369

..

24.00

5.00

7102

..

95.00

5.00

7371

..

30.00

5.00

7110

..

120.00

5.00

7375

..

34.00

5.00

7115

..

110.00

5.00

7379

..

56.00

5.00

7119

..

145.00

5.00

7383

..

85.00

5.00

7123

..

105.00

5.00

7385

..

47.00

5.00

7127

..

145.00

5.00

7388

..

56.00

5.00

7131

..

73.00

5.00

7393

..

54.00

5.00

7137

..

56.00

5.00

7398

..

56.00

5.00

7142

..

73.00

5.00

7403

..

12.50

4.00

7144

..

73.00

5.00

7405

..

27.00

5.00

7147

..

52.00

5.00

7414

..

23.00

5.00

7150

..

47.00

5.00

7415

..

30.00

5.00

7168

..

42.00

5.00

7418

..

34.00

5.00

7169

..

45.00

5.00

7421

..

11.50

3.00

7174

..

22.00

5.00

7422

..

14.00

4.00

7179

..

24.00

5.00

7425

..

22.00

5.00

7183

..

66.00

5.00

7428.

..

29.00

5.00

7187

..

78.00

5.00

7429

..

37.00

5.00

7191

..

26.00

5.00

7433

..

9.50

3.00

7196

..

7.60

2.00

7437

..

14.00

4.00

7201

..

39.00

5.00

7439

..

8.50

3.00

7207

..

44.00

5.00

7441

..

22.00

5.00

7211

..

39.00

5.00

7445

..

42.00

5.00

7215

..

27.00

5.00

7447

..

115.00

5.00

7219

..

105.00

5.00

7449

..

56.00

5.00

7229

..

70.00

5.00

7452

..

24.00

5.00

7235

..

70.00

5.00

7455

..

13.50

4.00

7239

..

90.00

5.00

7456

..

17.00

5.00

7243

..

130.00

5.00

7460

..

17.00

5.00

7247

..

52.00

5.00

7465

..

19.00

5.00

7254

..

70.00

5.00

7469

..

30.00

5.00

7258

..

34.00

5.00

7475

..

14.00

4.00

7264

..

17.00

5.00

7479

..

37.00

5.00

7267

..

45.00

5.00

7481

..

34.00

5.00

7269

..

52.00

5.00

7484

..

56.00

5.00

7272

..

39.00

5.00

7487

..

70.00

5.00

7276

..

37.00

5.00

7491

..

95.00

5.00

7277

..

47.00

5.00

7493

..

70.00

5.00

7281

..

56.00

5.00

7496

..

34.00

5.00

7286

..

2.60

1.00

7500

..

34.00

5.00

7288

..

2.80

1.00

7501

..

47.00

5.00

7294

..

34.00

5.00

7504

..

47.00

5.00

7296

..

62.00

5.00

7507

..

44.00

5.00

7299

..

30.00

5.00

7511

..

44.00

5.00

7302

..

25.00

5.00

7515

..

41.00

5.00

7303

..

31.00

5.00

7518

..

47.00

5.00

7308

..

40.00

5.00

7522

..

47.00

5.00

7311

..

51.00

5.00

7525

..

34.00

5.00

7317

..

36.75

5.00

7526

..

47.00

5.00

7320

..

45.75

5.00

7555

..

6.50

3.00

7322

..

43.00

5.00

7558

..

4.10

1.00

7327

..

17.00

5.00

7562

..

4.80

1.50

7564

..

4.10

1.00

7330

..

22 00

5.00

7568

..

5.20

1.50

7335

..

52.00

5.00

7571

..

4.10

1.00

7337

..

39.00

5.00

7574

..

6.40

1.50

7345

..

30.00

5.00

7576

..

4.10

1.00

7347

..

17.00

5.00

7579

..

7.60

2.00

7349

..

22.00

5.00

7583

..

19.00

5.00

7350

..

22.00

5.00

7587

..

4.10

1.00

7357

..

21.00

5.00

7589

..

6.40

1.50

7358

..

27.00

5.00

7592

..

6.40

1.50

7362

..

22.00

5.00

7595

..

6.60

2.00

7366

..

24.00

5.00

7600

..

68.00

5.00


Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

7604

..

78.00

5.00

7846

..

9.00

3.00

7612

..

78.00

5.00

7851

..

36.00

5.00

7614

..

78.00

5.00

7856

..

18.00

5.00

7617

..

39.00

5.00

7859

..

39.00

5.00

7621

..

61.00

5.00

7865

..

30.00

5.00

7623

..

61.00

5.00

7871

..

20.00

5.00

7628

..

87.00

5.00

7875

..

16.50

4.00

7633

..

78.00

5.00

7876

..

16.50

4.00

7636

..

78.00

5.00

7879

..

34.00

5.00

7639

..

75.00

5.00

7882

..

59.00

5.00

7645

..

17.00

5.00

7886

..

22.00

5.00

7648

..

39.00

5.00

7887

..

22.00

5.00

7651

..

30.00

5.00

7890

..

49.00

5.00

7656

..

95.00

5.00

7894

..

39.00

5.00

7660

..

95.00

5.00

7895

..

39.00

5.00

7663

..

61.00

5.00

7899

..

63.00

5.00

7669

..

52.00

5.00

7903

..

75.00

5.00

7675

..

61.00

5.00

7906

..

63.00

5.00

7679

..

78.00

5.00

7910

..

75.00

5.00

7686

..

39.00

5.00

7914

..

8.00

3.00

7689

..

52.00

5.00

7918

..

16.50

5.00

7692

..

78.00

5.00

7922

..

40.00

5.00

7695

..

30.00

5.00

7930

..

78.00

5.00

7699

..

52.00

5.00

7935

..

26.00

5.00

7702

..

30.00

5.00

7939

..

61.00

5.00

7705

..

78.00

5.00

7944

..

70.00

5.00

7710

..

9.50

3.00

7948

..

115.00

5.00

7713

..

61.00

5.00

7955

..

40.00

5.00

7716

..

45.00

5.00

7959

..

75.00

5.00

7719

..

42.00

5.00

7963

..

59.00

5.00

7722

..

24.00

5.00

7964

..

59.00

5.00

7725

..

9.50

3.00

7971

..

49.00

5.00

7728

..

13.50

4.00

7972

..

49.00

5.00

7729

..

17.50

5.00

7979

..

49.00

5.00

7733

..

39.00

5.00

7980

..

49.00

5.00

7736

..

9.50

3.00

7991

..

68.00

5.00

7740

..

47.00

5.00

7995

..

39.00

5.00

7742

..

45.00

5.00

7996

..

39.00

5.00

7746

..

56.00

5.00

8004

..

42.00

5.00

7748

..

87.00

5.00

8005

..

42.00

5.00

7752

..

61.00

5.00

8012

..

49.00

5.00

7755

..

8.30

2.00

8013

..

49.00

5.00

7759

..

5.20

1.50

8025

..

49.00

5.00

7780

..

39.00

5.00

8030

..

22.00

5.00

7784

..

13.50

4.00

8034

..

46.00

5.00

7786

..

32.00

5.00

8039

..

26.00

5.00

7790

..

3.70

1.00

8043

..

26.00

5.00

7794

..

3.90

1.00

8047

..

39.00

5.00

7796

..

3.90

1.00

8052

..

42.00

5.00

7800

..

10.50

3.00

8056

..

49.00

5.00

7801

..

10.50

3.00

8064

..

71.50

5.00

7805

..

12.00

4.00

8068

..

110.00

5.00

7806

..

12.00

4.00

8073

..

1150

3.00

7811

..

16.50

5.00

8078

..

28.00

5.00

7813

..

26.00

5.00

8082

..

28.00

5.00

7816

..

47.00

5.00

8086

..

45.00

5.00

7819

..

66.00

5.00

8090

..

15.00

4.00

7822

..

39.00

5.00

8094

..

59.00

5.00

7825

..

22.00

5.00

8098

..

44.00

5.00

7826

..

22.00

5.00

8102

..

12.00

4.00

7829

..

34.00

5.00

8107

..

54.00

5.00

7833

..

39.00

5.00

8112

..

73.00

5.00

7837

..

18.00

5.00

8117

..

28.00

5.00

7842

..

20.00

5.00

8121

..

21.00

5.00


Schedule 3—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule.

Fund medical benefit

Specified excess-

 

 

$

$

 

 

$

$

8125

..

42.00

5.00

8155

..

34.00

5.00

8129

..

100.00

5.00

8156

..

34.00

5.00

8133

..

28.00

5.00

8164

..

49.00

5.00

8137

..

54.00

5.00

8165

..

49.00

5.00

8138

..

54.00

5.00

8171

..

49.00

5.00

8146

..

68.00

5.00

8172

..

49.00

5.00

8147

..

68.00

5.00

8177

..

63.00

5.00


Schedule 4                  

Regulation 5

TABLE OF FUND MEDICAL BENEFITS IN RESPECT OF QUEENSLAND

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule.

Fund medical benefit

Specified excess-

 

..

$

$

 

..

$

$

1

..

1.25

.80

277

..

6.20

1.50

2

..

2.55

1.10

280

..

10.40

3.00

10

..

1.85

.80

282

..

6.20

1.50

12

..

3.00

1.30

285

..

23.00

5.00

21

..

3.50

1.60

289

..

5.80

1.50

24

..

4.70

2.10

292

..

26.00

5.00

29

..

5.30

2.40

294

..

6.20

1.50

31

..

6.50

2.90

296

..

11.60

3.00

36

..

1.85

1.20

300

..

.80

.80

41

..

3.30

1.40

303

..

2.10

1.00

47

..

2.80

1.20

304

..

3.30

1.00

49

..

3.95

1.70

307

..

4.20

1.50

55

..

4.90

2.10

308

..

5.80

1.50

56

..

6.05

2.60

311

..

6.70

2.00

61

..

6.75

3.00

312

..

7.90

2.00

62

..

7.90

3.50

314

..

7.30

3.00

63

..

2.80

1.20

315

..

9.00

3.00

64

..

3.95

1.70

316

..

10.50

3.00

67

..

1.85

.80

318

..

11.00

3.00

68

..

1.25

.80

319

..

12.50

4.00

74

..

1.85

.80

320

..

13.00

4.00

76

..

2.80

1.00

322

..

14.50

4.00

80

..

7.40

1.50

324

..

15.00

4.00

83

..

3.50

1.00

325

..

16.00

5.00

86

..

10.90

2.00

326

..

17.00

5.00

89

..

7.20

1.50

327

..

18.00

5.00

92

..

3.50

1.00

328

..

19.00

5.00

95

..

7.40

1.50

329

..

21.00

5.00

98

..

11.00

2.00

330

..

22.00

5.00

101

..

14.00

3.00

331

..

23.00

5.00

104

..

17.50

4.00

332

..

24.00

5.00

109

..

7.20

1.50

333

..

25.00

5.00

112

..

10.90

2.00

334

..

27.00

5.00

115

..

13.90

3.00

335

..

27.00

5.00

118

..

17.00

4.00

336

..

29.00

5.00

121

..

21.50

4.00

337

..

29.00

5.00

124

..

11.60

2.00

338

..

31.00

5.00

127

..

17.60

4.00

339

..

33.00

5.00

129

..

24.50

5.00

343

..

35.00

5.00

131

..

32.50

5.00

346

..

39.00

5.00

133

..

39.50

5.00

349

..

41.00

5.00

203

..

1.85

.80

350

..

43.00

5.00

206

..

19.50

5.00

353

..

2.70

1.00

208

..

58.00

5.00

356

..

6.70

2.00

212

..

20.00

5.00

359

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount 

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

218

..

18.00

5.00

 

 

223

..

31.00

5.00

 

 

224

..

30.00

5.00

 

 

226

..

38.00

5.00

 

 

227

..

37.00

5.00

 

 

237

..

48.50

5.00

 

 

238

..

47.00

5.00

 

 

239

..

47.00

5.00

 

 

240

..

55.00

5.00

 

 

245

..

1.25

.80

 

 

248

..

1.25

.80

 

 

253

..

15.00

4.00

 

 

254

..

20.50

5.00

 

 

257

..

6.20

1.50

 

 

The amount shown m this column in the item relating

The amount shown in. this column in the item relating

262

..

1.25

.80

363

..

269

..

5.60

1.50

 

 

272

..

8.50

2.00

 

 

274

..

6.20

1.50

 

 


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule.

Fund medical benefit

Specified excess-

 

$

$

 

$

$

to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-third of that amount

to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-third of that amount

 

with the treatment of the part concerned

with the treatment of the part concerned

 

 

 

410

..

1.00

.80

411

..

2.60

1.00

412

..

4.00

1.00

413

..

5.60

150

414

..

6.50

2.00

415

..

7.90

2.00

416

..

8.50

3.00

366 ..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-half of that amount

417

..

10.00

3.00

418

..

11.50

3.00

419

..

12.00

4.00

420

..

13.50

4.00

421

..

14.50

4.00

422

..

15.50

5.00

423

..

17.00

5.00

424

..

19.00

5.00

425

..

21 00

5.00

426

..

22.00

5.00

427

..

23.00

5.00

428

..

24.00

5.00

429

..

26.00

5.00

431

..

27.00

5.00

432

..

28.00

5.00

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus three-quarters of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus three-quarters of that amount

433

..

30.00

5.00

369 ..

434

..

31.00

5.00

437

..

33.00

5.00

438

..

34.00

5.00

439

..

36.00

5.00

440

..

37.00

5.00

441

..

39.00

5.00

442

..

39.00

5.00

444

..

43.00

5.00

445

..

46.00

5.00

446

..

53.00

5.00

447

..

50.00

5.00

448

..

3.30

1.00

449

..

7.90

2.00

 

The amount shown in this column in the item relating to the administration, of an anaesthetic in connection with the treatment of the dislocation concerned plus. one-half of that amount

453

..

The amount shown in this column it’s the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

373 ..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

377 ..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection

The amount shown in this column in the item relating to the administration of an anaesthetic in connection

457

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection

The amount shown in this column in the item relating to the administration of an anaesthetic in connection

 

 


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule.

Fund medical benefit

Specified excess-

 

$

$

 

 

$

$

with the treatment of the fracture concerned plus one-third of that amount

with the treatment of the fracture concerned plus one-third of that amount

503

..

4.20

1.50

504

..

5.60

1.50

507

..

5.80

1.50

508

..

6.50

2.00

511

..

7.30

3.00

512

..

10.00

3.00

459 ..

The amount shown in this column in the item relating to the administration of an anaesthetic m connection with the treatment of (he fracture concerned pins one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-half of that amount

515

..

6.70

2.00

516

..

7.90

2.00

519

..

10.50

3.00

520

..

12.00

4.00

530

..

7.70

2.00

532

..

5.60

1.50

534

..

5.80

1.50

536

..

7.00

2.00

555

..

10.00

3.00

603

..

7.40

1.50

605

..

14.10

3.00

607

..

22.50

5.00

609

..

8.70

2.00

612

..

20.00

4.00

615

..

29.00

5.00

620

..

8.70

2.00

463 ..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture, concerned plus three-quarters of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus three-quarters of that amount

622

..

18.50

4.00

624

..

13.40

3.00

628

..

16.60

4.00

633

..

22.50

5.00

635

..

10.60

2.00

637

..

8.70

2.00

650

..

42.00

5.00

653

..

20.00

4.00

655

..

6.80

1.50

658

..

30.00

5.00

663

..

54.00

5.00

666

..

22.50

5.00

669

..

13.40

3.00

671

..

8 00

1.50

675

..

7.40

1.50

678

..

4.30

1.00

466 ..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

683

..

10.90

3.00

686

..

7.70

1.50

690

..

14.10

3.00

700

..

2.60

.80

706

..

4.00

1.00

718

..

5.40

1.00

722

..

6.80

1.50

726

..

4.70

1.00

732

..

4.70

1.00

735

..

5.80

1.50

740

..

5.30

1.00

743

..

4.90

1.00

745

..

11.00

2.00

750

..

5.80

1.50

469 ..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the part concerned

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the part concerned

758

..

8.70

2.00

762

..

5.80

1.50

765

..

35.00

5.00

768

..

29.00

5.00

773

..

2.70

1.00

775

..

5.30

1.00

775

..

8.70

2.00

785

..

17.00

4.00

788

..

4.40

1.00

792

..

14.10

3.00

795

..

48.00

5.00

798

..

70.00

5.00


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule.

Fund medical benefit

Specified excess-

 

 

$

$

 

..

$

$

802

..

10.90

3.00

1092

..

1.90

1.00

805

..

3.80

1.00

1094

..

1.90

1.00

808

..

6.40

1.50

1096

..

.90

.80

811

..

6.40

1.50

1098

..

1 30

.80

813

..

9.00

2.00

1100

..

1.50

1.00

817

..

13.40

3.00

1102

..

3.50

1.00

820

..

13 40

3.00

1104

..

.70

80

823

..

12.20

3.00

1106

..

.60

.80

826

..

8.70

2.00

1108

..

1.50

1.00

830

..

23.50

5.00

1110

..

5.80

2.00

834

..

5.30

3.00

1112

..

.70

.80

837

..

11.50

3.00

1114

..

.70

.80

842

..

1.60

.80

1116

..

4.10

1.50

848

..

2.10

.80

1118

..

1.90

1.00

852

..

3.60

1.00

1120

..

4.80

1.50

855

..

5.60

1.00

1122

..

1.20

1.00

858

..

3.50

1.00

1124

..

1.90

1.00

862

..

10.30

2.00

1126

..

2.30

1.00

869

..

18.50

4.00

1128

..

1.20

.80

873

..

38.00

5.00

1130

..

3.10

1.00

876

..

6.40

1.50

1132

..

1.90

1.00

1000

..

.20

.80

1134

..

3.10

1.00

1002

..

1.20

.80

1136

..

4.80

1.50

1004

..

.70

.80

1138

..

1.90

1.00

1006

..

.90

.80

1140

..

2.30

1.00

1008

..

.20

.80

1142

..

1.40

1.00

1010

..

.60

.80

1144

..

1.90

1.00

1012

..

3.50

1.00

1146

..

1.90

1.00

1014

..

.90

1.00

1148

..

2.70

1.00

1016

..

2.60

1.00

1150

..

4.80

1.50

10!8

..

3.30

1.50

1152

..

2.70

1.00

1019

..

.70

.80

1154

..

2.30

1.00

1020

..

5.20

3.00

1156

..

2.30

1.00

1022

..

.20

.80

1160

..

.70

1.00

1024

..

120

.80

1162

..

2.60

1.00

1026

..

1.20

.80

1166

..

3.00

1.00

1028

..

2.70

1.00

1168

..

1.50

1.00

1030

..

2.60

1.00

1170

..

3.40

1.00

1032

..

2.70

1.00

5172

..

.90

.80

1034

..

1.90

1.00

1174

..

1.90

1.00

1036

..

2.70

1.00

1178

..

1.80

1.00

1038

..

3.10

1.00

1180

..

60

.80

1040

..

3.10

1.00

1182

..

.70

.80

1042

..

.70

1.00

1184

..

5.70

1.00

1044

..

4.00

1.50

1186

..

70

.80

1046

..

1.40

.80

1188

..

1.90

1.00

1048

..

5.60

1.50

1190

..

2.70

1.00

1050

..

4.00

1.50

1192

..

.70

1.00

1054

..

.70

.80

1194

..

1.20

1.00

1060

..

.20

.80

1196

..

2.70

1.00

1062

..

.60

.80

1198

..

1.20

1.00

1063

..

.40

.80

1200

..

.70

.80

1064

..

.70

.80

1202

..

.90

1.00

1066

..

2.30

1.00

1204

..

.10

.80

1068

..

2.00

1.00

1206

..

1.10

1:00

1070

..

1.30

1.00

1208

..

1.70

1.00

1072

..

2.70

1.00

1210

..

1.20

1.00

1074

..

7.60

3.00

1212

..

2.00

1.00

1076

..

.90

.80

1214

..

1.20

80

1080

..

1.20

.80

1216

..

1.30

.80

1082

..

2.30

1.00

1218

..

3.50

1.00

1084

..

8.80

3.00

1220

..

5.00

1.50

1090

..

1.90

1.00

1222

..

5.00

1.50

1091

..

2.50

1.00

1224

..

6.80

3.00


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule.

Fund medical benefit

Specified excess-

 

$

$

 

 

$

$

1226

..

8.80

3.00

1397

..

2.90

1.00

1228

..

3.50

1.00

1399

..

.70

.80

1230

..

5.00

1.50

1401

..

1.90

1.00

1232

..

2.70

1.00

1404

..

.50

.80

1240

..

1.90

1.00

1407

..

.70

1.00

1242

..

3.10

1.00

1410

..

1.90

1.00

1246

..

5.00

1.50

1413

..

1.90

1.00

1248

..

.70

.80

1416

..

3.10

1.00

1250

..

1.20

1.00

1419

..

1.90

1.00

1252

..

3.30

1.50

1421

..

2.30

1.00

1254

..

5.20

1.50

1423

..

1.80

1.00

1256

..

6.30

2.00

1425

..

4.00

1.50

1258

..

6.90

3.00

1428

..

1.80

1.00

1260

..

2.70

1.00

1430

..

5.00

1.50

1262

..

4.40

1.50

1432

..

8.80

3.00

1264

..

1.20

1.00

1434

..

2.70

1.00

1266

..

3.30

1.50

1436

..

3.10

1.00

1268

..

5.20

1.50

1438

..

8.80

3.00

1270

..

6.30

2.00

1441

..

3.30

1.00

1272

..

3.00

1.00

1444

..

2.20

1.00

1274

..

8.80

3.00

1447

..

5.00

1.50

1277

..

1.90

1.00

1450

..

3.90

1.50

1278

..

1.20

1.00

1453

..

2.20

1.00

1280

..

3.30

1.50

1456

..

2.50

1.00

1282

..

5.20

1.50

1459

..

1.70

1.00

1284

..

6.30

2.00

1461

..

3.80

1.50

1286

..

6.90

3.00

1463

..

5.20

2.00

1288

..

4.00

1.50

1466

..

6.80

2.00

1290

..

4.10

1.50

1468

..

1.20

.80

1294

..

1.20

1.00

1470

..

1.70

1.00

1296

..

1.90

1.00

1472

..

4.00

1.50

1298

..

3.30

1.50

1474

..

8.80

3.00

1301

..

1.20

1.00

1475

..

7.00

3.00

1302

..

3.30

1.50

1476

..

3.70

1.50

1304

..

5.20

1.50

1478

..

3.30

1.00

1305

..

6.30

2.00

1482

..

3.30

1.00

1307

..

6.90

3.00

1484

..

6.80

3.00

1350

..

1.20

1.00

1487

..

3.70

1.50

1313

..

1.90

1.00

1490

..

3.70

1.50

1314

..

.50

.80

1491

..

.20

.80

1317

..

.20

.50

1493

..

6.80

3.00

1319

..

3.60

1.50

1494

..

8.80

3.00

1322

..

.70

.80

1495

..

.90

.80

1325

..

.70

.80

1496

..

1.90

1.00

1328

..

2.40

1.00

1497

..

3.90

1.50

1331

..

3.00

1.50

1499

..

3.50

1.00

1334

..

1.60

1.00

1500

..

.70

.80

1337

..

3.70

1.50

1502

..

.70

.80

1340

..

5.50

2.00

1504

..

.70

.80

1343

..

2.20

1.50

1506

..

2.30

1.00

1346

..

6.80

3.00

1508

..

1.70

.80

1349

..

3.30

1.00

1511

..

1.90

1.00

1352

..

3.50

1.00

1513

..

1.60

.80

1355

..

3.00

1.00

1515

..

2.40

1.00

1358

..

1.80

1.00

1517

..

3.70

1.00

1380

..

.70

.80

1519

..

4.50

1.50

1382

..

.70

.80

1521

..

5.50

1.50

1385

..

1.20

1.00

1523

..

5.50

2.00

1388

..

3.30

1.50

1525

..

2.40

1.00

1389

..

4.80

1.50

1527

..

4.00

1.50

1391

..

2.50

1.00

1529

..

2.30

1.00

1392

..

4.30

1.50

1531

..

4.40

1.50

1394

..

5.00

2.00

1534

..

1.90

1.00

1395

..

.40

.80

1537

..

3.10

1.00


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

1539

..

2.30

1.00

1714

..

1.70

1.00

1541

..

1.90

1.00

1716

..

.90

.80

1543

..

1.80

1.00

1718

..

2.00

1.00

1545

..

.70

.80

1720

..

4.00

2.00

1546

..

4.00

1.00

1722

..

5.10

3.00

1548

..

5.80

1.50

1724

..

1.90

1.00

1551

..

2.50

1.00

1726

..

4.00

1.50

1554

..

3.90

1.50

1728

..

5.80

2.00

1557

..

4.50

2.00

1730

..

4.00

1.50

1560

..

3.40

1.50

1732

..

.20

.80

1562

..

4.30

1.50

1734

..

.20

.80

1564

..

5.40

2.00

1736

..

6.80

3.00

1566

..

5.40

2.00

1738

..

.90

.80

1568

..

6.00

3.00

1741

..

1.20

1.00

1571

..

2.30

1.00

1744

..

.90

.80

1580

..

1.90

1.00

1746

..

1.20

1.00

1582

..

1.60

1.00

1748

..

1.20

1.00

1584

..

3.50

100

1761

..

1.40

.80

1586

..

.70

.80

1764

..

2.70

1.00

1588

..

1.20

1.00

1767

..

.90

.80

1590

..

2.70

1.00

1770

..

1.70

1.00

1601

..

1.20

1.00

1773

..

3.10

1.00

1604

..

3.30

1.50

1776

..

4.80

1.50

1607

..

5.20

1.50

1779

..

.20

.80

1609

..

6.30

2 00

1782

..

.20

.80

1611

..

1.50

1.00

1785

..

.20

.80

1613

..

3.30

1.00

1790

..

1.90

1 00

1615

..

2.50

100

1792

..

1.90

1.00

1616

..

3.50

100

1794

..

4.00

1.50

1621

..

.40

.80

1796

..

4.00

1.50

1622

..

.70

.80

1798

..

1.90

1.00

1623

..

1.80

1.00

1800

..

1 10

.80

1625

..

 

.50

1802

..

3 70

150

1627

..

2.70

1.00

1804

..

5.80

1.50

1629

..

2.30

1.00

1806

..

2.70

1.00

1631

..

1.60

.80

1808

..

5.80

2.00

1640

..

5.60

1.50

1810

..

2.70

1.00

1643

..

2.90

1.00

1812

..

.70

1.00

1645

..

2.90

1.00

1820

..

2.80

1.50

1647

..

8.80

3.00

1822

..

5.00

2.00

1649

..

7.00

2.00

1824

..

6.40

3.00

1651

..

8.80

3.00

1826

..

4.40

3.00

1653

..

4.00

1.50

1828

..

7.40

3.00

1661

..

.70

.80

1840

..

12.40

4.00

1664

..

5.80

2.00

1841

..

16.00

5.00

1667

..

.70

100

1843

..

4.10

1.50

1670

..

2.70

1.00

1846

..

4.00

1.50

1673

..

3.50

1.00

1849

..

2.50

1.00

1680

..

.70

.80

1850

..

3.80

1.50

1682

..

.70

.80

1852

..

3.80

1.50

1684

..

.40

.80

1853

..

7.00

3.00

1686

..

1.10

.80

1855

..

5.30

1.50

1688

..

1.90

1.00

1858

..

6.00

2.00

1691

..

1.90

1.00

1861

..

4.20

1.50

1694

..

1.00

.80

1863

..

5.80

2.00

1697

..

1.80

1.00

1865

..

14.00

5.00

1698

..

3.30

1.50

1867

..

4.10

1.50

1700

..

1.90

1.00

1869

..

4.80

1.50

1701

..

5.10

2.00

1871

..

6.80

3.00

1703

..

1.90

1.00

1873

..

14.00

5.00

1706

..

1.90

1.00

1875

..

5.80

2.00

1707

..

3.10

1.00

1877

..

5.80

2.00

1710

..

.70

.80

1879

..

4.10

1.50

1712

..

1.70

1.00

1881

..

3.10

1.00


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

1884

..

2.50

1.00

2056

..

3.00

1.50

1887

..

4.00

1.50

2058

..

11.50

3.00

1889

..

12.40

4.00

2062

..

5.50

1.50

1891

..

1.90

1.00

2067

..

4.50

1.50

1893

..

3.90

1.50

2070

..

5.50

1.50

1895

..

5.80

2.00

2074

..

5.50

1.50

1896

..

1.70

1.00

2077

..

4.50

1.50

1897

..

3.50

1.00

2079

..

4.50

1.50

1898

..

3.50

1.00

2082

..

4.50

1.50

1899

..

5.30

1.50

2084

..

4.10

1.50

1900

..

4.00

1.50

2086

..

4.10

1.50

1902

..

6.00

2.00

2988

..

5.00

1.50

1904

..

1.30

1.00

2091

..

3.10

1.00

1906

..

1.50

1.00

2096

..

8.00

3.00

1908

..

7.00

2.00

2100

..

8.00

2.00

1910

..

7.20

3.00

2103

..

6.50

1.50

1912

..

8.40

3.00

2105

..

3.60

1.50

1914

..

8.80

3.00

2107

..

5.50

1.50

1916

..

4.00

1.50

2109

..

4.50

1.50

1917

..

4.00

3.50

2114

..

5.50

2.00

1918

..

3.40

1.50

2117

..

3.50

1.50

1919

..

7.00

3.00

2120

..

7.50

3.00

1920

..

2.70

1.00

2122

..

10.00

3.00

1922

..

4.00

1.50

2124

..

2.40

1.00

1924

..

4.00

1.50

2126

..

6.00

1.50

1926

..

4.40

1.50

2129

..

10.00

3.00

1927

..

10.50

4.00

2131

..

4.40

1.00

1929

..

17.00

5.00

2134

..

4.60

1.50

1931

..

7.00

3.00

2136

..

5.00

1.50

1933

..

6.60

2.00

2143

..

4.10

1.50

1935

..

5.20

1.50

2147

..

2.20

1.00

1937

..

6.20

2.00

2149

..

4.50

1.50

1939

..

11.00

4.00

2151

..

6.00

1.50

1942

..

10.50

4.00

2153

..

4.40

1.00

1946

..

6.20

2.00

2155

..

4.60

1.50

1952

..

19.00

5.00

2157

..

5.00

1.50

1954

..

8.50

3.00

2159

..

6.50

1.50

1960

..

10.50

4.00

2162

..

4.60

1.50

1962

..

6.60

2.00

2165

..

15.50

4.00

1964

..

7.00

3.00

2167

..

12.00

4.00

1982

..

12.00

4.00

2171

..

16.00

4.00

1984

..

6.00

1.50

2175

..

10.50

3.00

1986

..

13.00

4.00

2178

..

7.50

2.00

1987

..

12.00

4.00

2182

..

9.00

3.00

1989

..

8.00

3.00

2186

..

5.00

1.50

1991

..

12.00

4.00

2201

..

4.40

1.00

1993

..

12.00

4.00

2206

..

4.60

1.50

1995

..

8.00

3.00

2210

..

4.60

1.50

1997

..

8.00

3.00

2212

..

6.50

2.00

1998

..

7.80

2.00

2216

..

8.00

3.00

2002

..

2.40

1.00

2220

..

9.50

3.00

2004

..

3.60

1.00

2223

..

9.00

3.00

2007

..

2.40

1.00

2225

..

8.00

3.00

2009

..

3.60

1.00

2228

..

10.50

3.00

2025

..

4.00

1.50

2232

..

7.50

2.00

2029

..

4.50

1.50

2236

..

8.00

2.00

2031

..

3.40

1.00

2239

..

10.50

3.00

2033

..

3.60

1.50

2241

..

8.00

2.00

2035

..

4.50

1.50

2243

..

13.00

4.00

2037

..

4.50

1.50

2245

..

8.00

2.00

2039

..

4.00

1.50

2249

..

2.40

1.00

2046

..

4.50

1.50

2255

..

9.00

3.00

2050

..

4.00

1.50

2257

..

6.00

1.50

2053

..

3 00

1.50

2265

..

4.60

1.50


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

2267

..

5.00

2.00

2559

..

10.50

3.00

2269

..

8 00

2.00

2562

..

3.20

1.00

2272

..

9.00

3.00

2565

..

3.40

1.00

2275

..

12.50

4.00

2568

..

5.50

1.50

2277

..

12.50

4.00

2571

..

5.50

1.50

2279

..

12.50

4.00

2600

..

17.00

4.00

2281

..

6.50

2.00

2603

..

14.00

4.00

2283

..

6.00

1.50

2606

..

14.00

4.00

2285

..

12.00

3.00

2613

..

14.00

5.00

2287

..

9.00

3.00

2616

..

5.10

1.50

2289

..

10.00

3.00

2619

..

7.50

2.00

2296

..

5.00

1.50

2623

..

7.50

2.00

2299

..

6.50

3.00

2631

..

6.00

1.50

2302

..

6.50

3.00

2635

..

6.00

1.50

2304

..

6.50

3.00

2639

..

4.90

1.50

2306

..

6.50

3.00

2643

..

6.00

1.50

2308

..

6.56

3.00

2647

..

4.90

1.50

2312

..

14.00

4.00

2651

..

4.90

1.50

2316

..

6.50

3.00

2655

..

7.50

2.00

2319

..

8.50

2.00

2658

..

6.00

1.50

2323

..

8.50

2.00

2663

..

6.00

1.50

2327

..

2.70

1.00

2667

..

3.90

1.00

2331

..

6.50

1.50

2669

..

7.50

2.00

2335

..

5.40

1.50

2673

..

5.10

1.50

2339

..

6.50

1.50

2677

..

5.10

1.50

2343

..

9.50

3.00

2680

..

14.00

4.00

2348

..

8.00

2.00

2685

..

9.00

3.00

2352

..

6.00

2.00

2689

..

2.40

1.00

2365

..

7.58

2.00

2693

..

14.00

4.00

2400

..

1.30

.80

2701

..

7.00

2.00

2425

..

5.60

1.50

2704

..

7.50

2.00

2428

..

3.60

1.00

2708

..

9.00

3.00

2450

..

3.20

1.00

2712

..

14.00

4.00

2453

..

.30

.80

2920

..

7.00

1.00

2456

..

3.90

1.00

2929

..

One-fifth of the amount shown in this column for the operation or operations

One-fifth of the amount shown m this column for the operation or operations

2461

..

.40

.80

2466

..

7.50

2.00

2469

..

1.20

.80

2472

..

4.40

1.00

2475

..

3.90

1.00

2478

..

.40

.80

2482

..

4.60

1.50

3003

..

1.85

.80

2485

..

.50

.80

3007

..

3.80

1.00

2488

..

9.00

3.00

3010

..

5.20

1.50

2490

..

1.80

.80

3014

..

6.40

1.50

2492

..

6.00

1.50

3018

..

10.00

3.00

2494

..

.80

.80

3020

..

12.00

3.00

2497

..

8.00

2.00

3023

..

4.50

1.50

2501

..

1.30

.80

3026

..

5.80

1.50

2504

..

12.50

4.00

3028

..

4.10

1.50

2507

..

2.70

1.00

3032

..

4.10

1.50

2511

..

22.00

5.00

3035

..

9.00

3.00

2515

..

55.00

4.00

3040

..

9.00

3.00

2519

..

31.00

5.00

3042

..

5.30

1.50

2523

..

45.00

5.00

3044

..

11.50

3.00

2527

..

36.00

5.00

3048

..

14.00

4.00

2531

..

22.00

5.00

3053

..

9.00

3.00

2536

..

8.50

3.00

3054

..

9.00

3.00

2540

..

13.50

4.00

3060

..

11.50

3.00

2544

..

6.50

1.50

3066

..

14.50

4.00

2547

..

4.90

1.50

3072

..

14.50

4.00

2550

..

14.50

4.00

3076

..

1.10

.80

2553

..

4.90

1.50

3079

..

1.10

.80

2556

..

8.50

3.00

3083

..

8.00

3.00

 

 

 

 

Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

3086

..

8.00

3.00

3341

..

13.50

4.00

3088

..

17.00

5.00

3343

..

17.00

5.00

3091

..

22.00

5.00

3347

..

23.00

5.00

3096

..

22.00

5.00

3352

..

9.50

3.00

3100

..

4.50

1.50

3355

..

11.50

3.00

3102

..

4.50

1.50

3358

..

28.00

5.00

3107

..

8.00

3.00

3360

..

28.00

5.00

3111

..

9.50

3.00

3365

..

28.00

5.00

3118

..

9.50

3.00

3370

..

63.00

5.00

3122

..

4.00

1.00

3374

..

105.00

5.00

3127

..

8.00

3.00

3376

..

70.00

5.00

3129

..

2.40

1.00

3380

..

28.00

5.00

3133

..

2.40

1.00

3382

..

28.00

5.00

3136

..

14.00

4.00

3385

..

15.50

4.00

3141

..

7.30

2.00

3388

..

15.50

4.00

3145

..

7.30

2.00

3410

..

5.00

1.50

3151

..

11.50

3.00

3413

..

5.00

1.50

3154

..

14.00

4.00

3416

..

9.00

3.00

3158

..

14.00

4.00

3420

..

11.50

3.00

3164

..

2.90

1.00

3422

..

11.50

3.00

3167

..

12.00

3.00

3426

..

11.50

3.00

3169

..

11.50

4.00

3429

..

23.00

5.00

3172

..

11.00

5.00

3432

..

23.00

5.00

3176

..

12.00

5.00

3435

..

59.00

5.00

3182

..

30.00

5.00

3438

..

59.00

5.00

3186

..

6.80

2.00

3441

..

150.00

5.00

3188

..

5.50

3.00

3449

..

3.80

1.00

3192

..

5.50

3.00

3451

..

3.80

1.00

3198

..

9.00

3.00

3457

..

12.50

3.00

3200

..

11.00

3.00

3461

..

16.50

4.00

3205

..

11.00

3.00

3463

..

16.50

4.00

3209

..

11.50

4.00

3467

..

105.00

5.00

3212

..

15.00

5.00

3471

..

32.00

5.00

3214

..

15.00

5.00

3474

..

42.00

5.00

3223

..

21.00

5.00

3476

..

49.00

5.00

3227

..

26.00

5.00

3481

..

85.00

5.00

3231

..

32.00

5.00

3485

..

95.00

5.00

3234

..

70.00

5.00

3489

..

105.00

5.00

3239

..

42 00

5.00

3494

..

59.00

5.00

3240

..

42.00

5.00

3499

..

61.00

5.00

3241

..

49.00

5.00

3504

..

42.00

5.00

3243

..

49.00

5.00

3512

..

32.00

5.00

3246

..

70 00

5.00

3515

..

42.00

5.00

3249

..

32.00

5.00

3518

..

36.00

5.00

3257

..

56.00

5.00

3520

..

28.00

5.00

3260

..

10.50

3.00

3522

..

150.00

5.00

3264

..

3.10

1.00

3538

..

30.00

5.00

3266

..

4.00

1.00

3540

..

85.00

5.00

3270

..

4.00

1.00

3543

..

19.00

5.00

3275

..

2.90

1.50

3546

..

61.00

5.00

3278

..

6.10

2.00

3549

..

16.00

4.00

3283

..

6.30

2.00

3552

..

26.00

5.00

3287

..

7.00

2.00

3557

..

35.00

5.00

3293

..

3.60

1.00

3558

..

10.50

4.00

3296

..

12.00

4.00

3562

..

16.00

5.00

3302

..

.90

.80

3564

..

20.00

5.00

3307

..

1.70

.80

3568

..

26.00

5.00

3310

..

6.50

2.00

3570

..

20.00

5.00

3312

..

8.00

3.00

3574

..

26.00

5.00

3317

..

8.00

3.00

3579

..

49.00

5.00

3322

..

9.50

3.00

3584

..

73.00

5.00

3327

..

11.50

3.00

3586

..

11.50

3.00

3333

..

16.50

5.00

3590

..

29.00

5.00

3337

..

21.00

5.00

3592

..

36.00

5.00


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

3596

..

36.50

5.00

3858

..

105.00

5.00

3600

..

49.00

5.00

3861

..

23.00

5.00

3606

..

42.00

5.00

3862

..

38.00

5.00

3611

..

54.00

5.00

3866

..

9.50

3.00

3613

..

45.00

5.00

3868

..

32.00

5.00

3621

..

49.00

5.00

3871

..

41.00

5.00

3625

..

130.00

5.00

3873

..

13.50

4.00

3628

..

45.00

5.00

3876

..

7.30

2.00

3631

..

49.00

5.00

3877

..

100.00

5.00

3635

..

49.00

5.00

3881

..

150.00

5.00

3639

..

9.50

3.00

3885

..

170.00

5.00

3642

..

44.00

5.00

3887

..

34.00

5.00

3644

..

63.00

5.00

3890

..

42.00

5.00

3648

..

36.00

5.00

3891

..

105.00

5.00

3650

..

45.00

5.00

3893

..

45.00

5.00

3653

..

75.00

5.00

3895

..

59.00

5.00

3659

..

73.00

5.00

3897

..

63.00

5.00

3663

..

52.00

5.00

3942

..

39.00

5.00

3666

..

82.00

5.00

3944

..

49.00

5.00

3669

..

125.00

5.00

3947

..

95.00

5.00

3672

..

125.00

5.00

3950

..

73.00

5.00

3674

..

14.50

4.00

3953

..

73.00

5.00

3677

..

16 50

5.00

3956

..

38.00

5.00

3679

..

45.00

5.00

3960

..

11.50

3.00

3685

..

47.00

5.00

3966

..

4.50

11.50

3694

..

49..00

5.00

3972

..

105.00

5.00

3697

..

59.00

5.00

3974

..

87.00

5.00

3701

..

70.00

5.00

3977

..

35.00

5.00

3703

..

45.00

5.00

3980

..

52.00

5.00

3708

..

59.00

5.00

3982

..

28.00

5.00

3712

..

59.00

5.00

3985

..

26.00

5.00

3717

..

36.00

5.00

3988

..

35.00

5.00

3719

..

45.00

5.00

3992

..

45.00

5.00

3723

..

85.00

5.00

3994

..

66.00

5.00

3730

..

105.00

5.00

3997

..

67.00

5.00

3734

..

125.00

5.00

4001

..

21.00

5.00

3738

..

45.00

5.00

4005

..

28.00

5.00

3740

..

36.00

5.00

4006

..

24.50

5.00

3744

..

36.00

5.00

4010

..

33.00

5.00

3748

..

45.00

5.00

4014

..

36.00

5.00

3752

..

59.00

5.00

4016

..

45.00

5.00

3757

..

36.00

5.00

4019

..

2.90

1.00

3762

..

45.00

5.00

4023

..

21.50

5.00

3775

..

24.00

5.00

4025

..

31.00

5.00

3781

..

31.00

5.00

4028

..

28.00

5.00

3785

..

45.00

5.00

4030

..

33.00

5.00

3787

..

45.00

5.00

4036

..

18.00

5.00

3791

..

29.00

5.00

4038

..

23.00

5.00

3794

..

37.00

5.00

4058

..

24.50

5.00

3799

..

18.00

5.00

4063

..

33.00

5.00

3804

..

42.00

5.00

4067

..

45.00

5.00

3813

..

73.00

5.00

4069

..

70.00

5.00

3818

..

75.00

5.00

4073

..

39.00

5.00

3819

..

36.00

5.00

4077

..

8.50

3.00

3822

..

45.00

5.00

4079

..

3.80

1.00

3828

..

36.00

5.00

4081

..

7.50

2.00

3839

..

45.00

5.00

4083

..

11.50

3.00

3835

..

56.00

5.00

4085

..

14.50

4.00

3839

..

73.00

5.00

4088

..

3.90

1.00

3840

..

85.00

5.00

4092

..

4.50

1.50

3845

..

305.00

5.00

4098

..

15.50

4.00

3847

..

125.00

5.00

4103

..

21.00

5.00

3851

..

95.00

5.00

4105

..

23.00

5.00

3852

..

30.00

5.00

4110

..

9.00

3.00


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

 

4111

..

14.50

4.00

4298

..

100.00

5.00

4116

..

16.50

5.00

4301

..

59.00

5.00

4121

..

49.00

5.00

4306

..

75.00

5.00

4123

..

80.00

5.00

4308

..

54.00

5.00

4128

..

2.90

1.00

4312

..

125.00

5.00

4129

..

14.00

3.00

4314

..

150.00

5.00

4131

..

14.50

4.00

4323

..

105.00

5.00

4134

..

3.10

1.00

4329

..

35.00

5.00

4135

..

31.50

3.00

4335

..

73.00

5.00

4137

..

9.00

3.00

4341

..

19.00

5.00

4139

..

6.90

2.00

4344

..

14.50

4.00

4142

..

31.00

5.00

4347

..

85.00

5.00

4145

..

10.50

3.00

4349

..

45.00

5.00

4147

..

1.30

.80

4353

..

5.00

1.50

4152

..

4.50

1.50

4357

..

9.50

3.00

4154

..

4.50

1.50

4361

..

16.50

4.00

4159

..

18.00

5.00

4363

..

16.50

4.00

4160

..

21.00

5.00

4367

..

28.00

5.00

4164

..

8.50

2.00

4369

..

23.00

5.00

4168

..

17.00

5.00

4371

..

28.00

5.00

4170

..

22.00

5.00

4374

..

9.50

3.00

4174

..

17.00

5.00

4377

..

28.00

5.00

4178

..

23.00

5.00

4382

..

28.00

5.00

4180

..

26.00

5.00

4336

..

28.00

5.00

4184

..

32.00

5.00

4388

..

49.00

5.00

4186

..

9.00

3.00

4392

..

38.00

5.00

4187

..

11.50

3.00

4396

..

28.00

5.00

4192

..

59.00

5.00

4398

..

49.00

5.00

4196

..

26.00

5.00

4405

..

12.00

3.00

4198

..

5.90

1.50

4406

..

15.00

4.00

4203

..

28.00

5.00

4410

..

18.50

5.00

4204

..

21.00

5.00

4411

..

23.00

5.00

4205

..

26.00

5.00

4415

..

21.75

5.00

4210

..

7.00

2.00

4417

..

27.00

5.00

4226

..

2.80

l.00

4423

..

25.00

5.00

4228

..

8.50

2.00

4425

..

31.00

5.00

4232

..

15.50

4.00

4431

..

28.25

5.00

4234

..

41.00

5.00

4433

..

36.00

5.00

4237

..

30.00

5.00

4438

..

14.00

4.00

4239

..

57.00

5.00

4439

..

17.50

5.00

4242

..

26.00

5.00

4446

..

37.00

5.00

4244

..

20.00

5.00

4451

..

23.00

5.00

4245

..

16.00

4.00

4457

..

28.00

5.00

4248

..

42.00

5.00

4459

..

49.00

5.00

4250

..

68.00

5.00

4462

..

100.00

5.00

4252

..

4.20

1.00

4465

..

9.00

3.00

4255

..

20.00

5.00

4466

..

11.50

3.00

4257

..

28.00

5.00

4470

..

13.50

4.00

4259

..

42.00

5.00

4471

..

16.50

5.00

4261

..

61.00

5.00

4475

..

16.00

4.00

4264

..

85.00

5.00

4477

..

20.25

5.00

4266

..

100.00

5.00

4479

..

18.00

5 00

4268

..

61.00

5.00

4481

..

23.00

5.00

4270

..

100.00

5.00

4486

..

20.50

5.00

4272

..

90.00

5.00

4487

..

25.75

5.00

4274

..

45.00

5.00

4491

..

11.50

3.00

4278

..

59.00

5.00

4493

..

14.00

4.00

4280

..

49.00

5.00

4500

..

28.00

5.00

4283

..

61.00

5.00

4506

..

23.00

5.00.

4286

..

115.00

5.00

4510

..

38.00

5 00

4289

..

110.00

5.00

4512

..

54.00

5.00

4290

..

115.00

5.00

4515

..

61.00

5.00

4292

..

100.00

5.00

4518

..

125.00

5.00

4295

..

100.00

5.00

4530

..

6.60

2.00


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund benefit

Specified excess

 

 

$

$

 

 

$

$

4532

..

19.00

5.00

4700

..

27.00

5.00

4535

..

11.50

5.00

4703

..

66.00

5.00

4539

..

12.00

5.00

4706

..

52.00

5.00

4543

..

80.00

5.00

4708

..

5.00

1.50

4546

..

49.00

5.00

4711

..

23.00

5.00

4550

..

82.00

5.00

4716

..

49.00

5.00

4554

..

90.00

5.00

4717

..

68.00

5.00

4556

..

115.00

5.00

4720

..

90.00

5.00

4558

..

45.00

5.00

4722

..

2.80

1.00

4566

..

56.00

5.00

4731

..

9.00

3.00

4569

..

90.00

5.00

4734

..

9.50

3.00

4572

..

135.00

5.00

4737

..

82.00

5.00

4574

..

152.50

5.00

4742

..

59.00

5.00

4577

..

100.00

5.00

4745

..

49.00

5.00

4581

..

115.00

5.00

4748

..

59.00

5.00

4584

..

90.00

5.00

4750

..

12.50

4.00

4588

..

210.00

5.00

4753

..

12.00

5.00

4589

..

210.00

5.00

4756

..

16.25

5.00

4593

..

100.00

5.00

4757

..

17.25

5.00

4597

..

125.00

5.00

4760

..

18.50

5.00

4601

..

100.00

5.00

4761

..

19.50

5.00

4607

..

49.00

5.00

4769

..

14.00

5.00

4609

..

90.00

5.00

4770

..

14.00

5.00

4613

..

59.00

5.00

4776

..

8.50

3.00

4615

..

68.00

5.00

4777

..

14.50

3.00

4619

..

100.00

5.00

4781

..

6.00

2.00

4621.

..

8.30

2.00

4782

..

8.00

3.00

4623

..

35.00

5.00

4786

..

10.00

3.00

4627

..

7.00

4.00

4788

..

11.75

4.00

4632

..

3.90

1.00

4793

..

7.30

2.00

4634

..

8.00

3.00

4795

..

5.90

1.50

4636

..

8.00

3.00

4797

..

2.90

1.00

4638

..

6.20

1.50

4799

..

28.00

5.00

4642

..

9.50

3.00

4803

..

14.50

4.00

4644

..

6.60

1.50

4805

..

29.00

5.00

4646

..

6.60

2.00

4807

..

13.50

4.00

4647

..

8.00

3.00

4809

..

16.50

5.00

4648

..

9.50

4.00

4813

..

28.00

5.00

4652

..

15.00

5.00

4816

..

4.50

1.50

4654

..

21.50

5.00

4821

..

10.00

5.00

4656

..

21.50

5.00

4824

..

115.00

5.00

4659

..

11.80

3.00

4826

..

115.00

5.00

4661

..

12.00

4.00

4829

..

14.50

4.00

4664

..

10.50

3.00

4833

..

36.50

5.00

4666

..

13.50

4.00

4840

..

19.00

5.00

4668

..

2.60

1.00

4842

..

23.00

5.00

4669

..

2.60

1.00

4846

..

33.00

5.00

4671

..

7.60

2.00

4849

..

49.00

5.00

4672

..

7.60

2.00

4852

..

49.00

5.00

4673

..

2.10

1.00

4857

..

82.00

5.00

4675

..

35.00

5.00

4859

..

70.00

5.00

4679

..

35.00

5.00

4861

..

34.00

4.00

4680

..

35.00

5.00

4863

..

19.00

5.00

4682

..

54.00

5.00

4865

..

13.50

4.00

4683

..

26.00

5.00

4869

..

13.50.

4.00

4684

..

26.00

5.00

4871

..

18.00

5.00

4685

..

9.00

3.00

4873

..

30.00

5.00

4686

..

9.00

3.00

4875

..

19.00

5.00

4687

..

49.00

5.00

4878

..

9.50

3.00

4688

..

49.00

5.00

4890

..

66.00

5.00

4689

..

66.00

5.00

4892

..

73.00

5.00

4692

..

87.00

5.00

4894

..

125.00

5.00

4695

..

31.00

5.00

4896

..

68.00

5.00

4698

..

5.00

1.50

4898

..

90.00

5.00


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

4903

..

66.00

5.00

5080

..

66.00

5.00

4904

..

82.00

5.00

5082

..

4.00

1.00

4908

..

90.00

5.00

5084

..

40.00

5.00

4913

..

90.00

5.00

5088

..

40.00

5.00

4914

..

105.00

5.00

5090

..

66.00

5.00

4920

..

90.00

5.00

5092

..

150.00

5.00

4923

..

63.00

5.00

5094

..

82.00

5.00

4928

..

82.00

5.00

5096

..

100.00

5.00

4929

..

90.00

5.00

5111

..

80.00

5.00

4932

..

95.00

5.00

5115

..

87.00

5.00

4936

..

73.00

5.00

5117

..

40.00

5.00

4938

..

66.00

5.00

5121

..

100.00

5.00

4941

..

49.00

5.00

5123

..

23.00

5.00

4945

..

56.00

5.00

5126

..

35.00

5.00

4947

..

13.00

4.00

5129

..

11.50

3.00

4951

..

28.00

5.00

5134

..

40.00

5.00

4953

..

40.00

5.00

5137

..

4.00

1.00

4956

..

82.00

5.00

5139

..

6.60

2.00

4958

..

90.00

5.00

5142

..

82.00

5.00

4960

..

82.00

5.00

5146

..

23.00

5.00

4962

..

82.00

5.00

5148

..

11.50

3.00

4964

..

66.00

5.00

5151

..

27.00

5.00

4966

..

115.00

5.00

5154

..

19.00

5.00

4968

..

150.00

5.00

5156

..

13.50

4.00

4971

..

66.00

5 00

5159

..

8.00

2.00

4973

..

82.00

5.00

5164

..

19.00

5.00

4975

..

73.00

5.00

5168

..

19.00

5.00

4977

..

90.00

5.00

5177

..

56.00

5.00

4980

..

82.00

5.00

5180

..

49.00

5.00

4982

..

82.00

5.00

5183

..

66.00

5.00

4984

..

100.00

5.00

5187

..

66.00

5.00

4986

..

82.00

5.00

5189

..

61.00

5.00

4988

..

100.00

5.00

5195

..

61.00

5.00

4992

..

115.00

5.00

5197

..

23.00

5.00

5000

..

56.00

5.00

5200

..

31.00

5.00

5003

..

66.00

5.00

5203

..

40.00

5.00

5005

..

66.00

5.00

5207

..

61.00

5.00

5008

..

82.00

5.00

5209

..

63.00

5.00

5011

..

2.40

1.00

5211

..

73.00

5.00

5013

..

11.00

3.00

5213

..

23.00

5.00

5017

..

14.00

4.00

5215

..

49.00

5.00

5020

..

15.00

4.00

5219

..

82.00

5.00

5022

..

19.00

5.00

5226

..

15.00

4.00

5025

..

8.00

2.00

5231

..

15.00

4.00

5027

..

8.00

2.00

5234

..

40.00

5.00

5030

..

23.00

5.00

5238

..

66.00

5.00

5033

..

19.00

5.00

5242

..

6.60

2.00

5035

..

27.00

5.00

5247

..

66.00

5.00

5039

..

61.00

5.00

5250

..

9.00

3.00

5042

..

21.00

5.00

5253

..

31.00

5.00

5044

..

40.00

5.00

5255

..

40.00

5.00

5046

..

28.00

5.00

5255

..

82.00

5.00

5049

..

40.00

5.00

5263

..

40.00

5.00

5053

..

49.00

5.00

5265

..

82.00

5.00

5054

..

61.00

5.00

5267

..

4.00

1.00

5057

..

28.00

5.00

5271

..

40.00

5.00

5058

..

36.00

5.00

5273

..

75.00

5.00

5061

..

90.00

5.00

5275

..

23.00

5.00

5063

..

61.00

5.00

5279

..

15.00

4.00

5065

..

61.00

5.00

5290

..

15.00

4.00

5069

..

66.00

5.00

5292

..

18.00

5.00

5071

..

36.00

5.00

5293

..

23.00

5.00

5074

..

73.00

5.00

5297

..

23.00

5.00

5076

..

56.00

5 00

5299

..

82.00

5.00


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

5302

..

28.00

5.00

5604

..

56.00

5.00

5304

..

26.00

5.00

5608

..

45.00

5.00

5307

..

49.00

5.00

5609

..

56.00

5.00

5309

..

56.00

5.00

5615

..

50.50

5.00

5315

..

44.00

5.00

5617

..

64.00

5.00

5321

..

15.00

4.00

5621

..

63.00

5.00

5326

..

15.00

4.00

5623

..

95.00

5.00

5331

..

19.00

5.00

5629

..

68.00

5.00

5365

..

6.60

2.00

5633

..

58.00

5.00

5368

..

4.50

1.50

5638

..

35.00

5.00

5373

..

7.30

1.50

5639

..

45.00

5.00

5377

..

7.30

2.00

5643

..

35.00

5.00

5379

..

11.50

3.00

5645

..

45.00

5.00

5381

..

14.50

4.00

5650

..

49.00

5.00

5384

..

9.00

3.00

5657

..

23.00

5.00

5386

..

11.50

3.00

5660

..

35.00

5.00

5391

..

5.00

1.50

5664

..

5.70

1.50

5395

..

7.30

2.00

5670

..

16.50

5.00

5400

..

5.00

1.50

5672

..

28.00

5.00

5405

..

9.00

3.00

5676

..

54.00

5.00

5406

..

11.50

3.00

5682

..

5.50

1.50

5412

..

21.00

5.00

5684

..

3.60

1.00

5417

..

28.00

5.00

5688

..

30.00

5.00

5421

..

105.00

5.00

5690

..

38.00

5.00

5430

..

59.00

5.00

5695

..

35.50

5.00

5432

..

3.60

1.00

5696

..

45.00

5.00

5435

..

59.00

5.00

5700

..

54.00

5.00

5440

..

59.00

5.00

5707

..

28.00

5.00

5446

..

33.00

5.00

5709

..

35.00

5.00

5450

..

12.00

4.00

5716

..

30.00

5.00

5465

..

9.50

3.00

5468

..

20.00

5.00

5717

..

38.00

5.00

5469

..

26.00

5.00

5740

..

8.80

2.00

5478

..

35.00

5 00

5752

..

39.00

5.00

5479

..

45.00

5.00

5755

..

52.00

5.00

5484

..

44.00

5.00

5759

..

39.00

5.00

5485

..

54.00

5.00

5761

..

52.00

5.00

5496

..

50.50

5.00

5765

..

28.00

5.00

5497

..

62.00

5.00

5768

..

16.50

4.00

5502

..

13.50

4.00

5771

..

34.00

5.00

5506

..

45.00

5.00

5776

..

54.00

5.00

5514

..

59.00

5.00

5781

..

33.00

5.00

5521

..

56.00

5.00

5784

..

56.00

5.00

5526

..

5.50

1.50

5787

..

70.00

5.00

5528

..

5.50

1.50

5789

..

78.00

5.00

5532

..

5.90

1.50

5797

..

90.00

5.00

5536

..

13.00

4.00

5801

..

42.00

5.00

5538

..

16.50

5.00

5805

..

54.00

5.00

5544

..

18.50

5.00

5808

..

63.00

5.00

5546

..

24.00

5.00

5811

..

90.00

5.00

5549

..

11.50

3.00

5815

..

34.00

5.00

5550

..

13.50

4.00

5817

..

45.00

5.00

5555

..

6.60

2.00

5820

..

63.00

5.00

5558

..

8.00

3.00

5823

..

90.00

5.00

5563

..

10.50

3.00

5825

..

9.00

3.00

5564

..

13.00

4.00

5829

..

6.90

2.00

5570

..

17.00

5.00

5832

..

38.00

5.00

5581

..

12.50

4.00

5835

..

9.00

3.00

5582

..

16.00

4.00

5839

..

22.00

5.00

5587

..

12.50

4.00

5841

..

27.00

5.00

5590

..

16.00

4.00

5844

..

16.50

4.00

5591

..

14.00

4.00

5860

..

42.00

5.00

5592

..

17.00

5.00

5863

..

59.00

5.00

5599

..

45.00

5.00

5865

..

49.00

5.00

5603

..

45.00

5.00

5867

..

63.00

5.00


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

5870

..

63.00

5.00

6096

..

7.60

2.00

5872

..

54.00

5.00

6103

..

14.00

4.00

5874

..

38.00

5.00

6106

..

115.00

5.00

5877

..

4.00

2.00

6111

..

85.00

5.00

5880

..

4.00

1.00

6117

..

115.00

5.00

5882

..

1.50

2.00

6121

..

115.00

5.00

5884

..

9.00

3.00

6125

..

145.00

5.00

5886

..

31.00

5.00

6129

..

51.00

5.00

5890

..

9.50

3.00

6134

..

34.00

5.00

5893

..

1.85

.80

6139

..

24.00

5.00

5895

..

6.20

1.50

6145

..

85.00

5.00

5898

..

16.50

4.00

6150

..

39.00

5.00

5900

..

18.00

5.00

6153

..

85.00

5.00

5902

..

5.20

1.50

6156

..

115.00

5.00

5904

..

115.00

5.00

6161

..

14.00

4.00

5907

..

75.00

5.00

6168

..

20.00

5.00

5913

..

5.20

1.50

6171

..

48.00

5.00

5914

..

16.00

5.00

6174

..

105.00

5.00

5917

..

9.00

3.00

6178

..

85.00

5.00

5921

..

22.00

5.00

6183

..

51.00

5.00

5923

..

65.00

5.00

6188

..

31.00

5.00

5925

..

54.00

5.00

6193

..

165.00

5.00

5932

..

38.00

5.00

6200

..

165.00

5.00

5934

..

100.00

5.00

6206

..

240.00

5.00

5939

..

44.00

5.00

6210

..

165.00

5.00

5942

..

25.00

5.00

6213

..

190.00

5.00

5944

..

23.00

5.00

6250

..

1.85

.80

5950

..

54.00

5.00

6254

..

4.70

1.50

5952

..

67.00

5.00

6257

..

5.70

1.50

5955

..

59.00

5.00

6260

..

21.00

5.00

5957

..

45.00

5.00

6264

..

23.00

5.00

5961

..

28.00

5.00

6266

..

6.20

1.50

5965

..

45.00

5.00

6268

..

7.10

2.00

5970

..

90.00

5.00

6270

..

6.60

1.50

5974

..

23.00

5.00

6273

..

15.00

4.00

5978

..

75.00

5.00

6275

 

9.50

3.00

6276

..

12.00

3.00

5982

..

100.00

5.00

6281

..

16.00

4.00

5987

..

28.00

5.00

6282

..

19.50

5.00

5991

..

12. 50

4.00

6287

..

36.00

5.00

5395

..

49.00

5.00

6288

..

36.00

5.00

5999

..

75.00

5.00

6293

..

40.00

5.00

6004

..

7.30

2.00

6294

..

40.00

5.00

6006

..

5.90

1.50

6298

..

73.00

5.00

6009

..

37.00

5.00

6301

..

35.00

5.00

6011

..

44.00

5.00

6304

..

14.50

4.00

6014

..

53.00

5.00

6305

..

18.00

5.00

6018

..

39.00

5.00

6312

..

35.00

5.00

6020

..

33.00

5.00

6317

..

61.00

5.00

6026

..

32.00

5.00

6319

..

100.00

5.00

6031

..

33.00

5.00

6323

..

31.00

5.00

6051

..

5.70

1.50

6329.

..

12.00

5.00

6055

..

8.20

3.00

6330

..

16.00

5.00

6059

..

7.30

2.00

6334

..

18.00

5.00

6063

..

3.70

1.00

6339

..

38.00

5.00

6067

..

8.20

3.00

6341

..

85.00

5.00

6071

..

39.00

5.00

6346

..

120.00

5.00

6074

..

78.00

5.00

6351

..

210.00

5.00

6076

..

115.00

5.00

6356

..

31.00

5.00

6080

..

85.00

5.00

6357

..

39.00

5.00

6082

..

115.00

5.00

6362

..

90.00

5.00

6085

..

60.00

5.00

6369

..

48.00

5.00

6087

..

34 00

5.00

6370

..

61.00

5.00

6091

..

105.00

5.00

6375

..

63.00

5.00

6093

..

22.00

5.00

6376

..

80.00

5.00


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

6380

..

90.00

5.00

 

 

dislocation concerned, plus one-half of that amount

dislocation concerned, plus one-half of that amount

6385

..

90.00

5.00

 

 

6390

..

75.00

5.00

 

 

6394

..

67.00

5.00

 

 

6395

..

210.00

5.00

6658

..

The amount shown in this column in the item (being an item relating to an item it the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the dislocation concerned, plus one-half of that amount

The amount shown in this column in the item (being an. item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the dislocation concerned, plus one-half of that amount

6399

..

110.00

5.00

 

 

6405

..

54.00

5.00

 

 

6408

..

61.00

5.00

 

 

6411

..

120.00

5.00

 

 

6421

..

39.00

5.00

 

 

6429

..

61.00

5.00

 

 

6433

..

75.00

5.00

 

 

6440

..

210.00

5.00

 

 

6444

..

120.00

5.00

 

 

6450

..

90.00

5.00

 

 

6457

..

82.00

5.00

 

 

6461

..

82.00

5.00

 

 

6466

..

82.00

5.00

 

 

6474

..

85.00

5.00

 

 

6479

..

105.00

5.00

 

 

6454

..

90.00

5.00

 

 

6490

..

47.00

5.00

 

 

 

 

6492

..

47.00

5.00

6675

..

3.60

1.00

6500

..

81.00

5.00

6678

..

7.60

2.00

6504

..

60.00

5.00

6679

..

10.50

3.00

6511

..

54 00

5.00

6682

..

5.20

1.50

6540

..

3.90

1.00

6684

..

10.50

3.00

6541

..

3.90

1.00

6685

..

14.50

4.00

6547

..

2.40

1.00

6689

..

12.00

3.00

6548

..

2.40

1.00

6690

..

16.50

5.00

6556

..

6.40

1.50

6693

..

5.90

1.50

6560

..

7.30

2.00

6695

..

10.50

3.00

6565

..

6.40

1.50

6696

..

12.00

4.00

6571

..

5.00

1.50

6710

..

15.00

4.00

6579

..

8.00

3.00

6711

..

24.00

5.00

6583

..

5.90

1.50

6716

..

10.50

3.00

6588

..

11.00

3.00

6720

..

11.50

3.00

6589

..

13.50

4.00

6721

..

11.50

4.00

6597

..

2.40

1.00

6725

..

11.00

3.00

6603

..

7.30

2 00

6726

..

13.00

4.00

6608

..

17.00

5.00

6731

..

14.50

4.00

6609

..

23.00

5.00

6732

..

16.00

5.00

6616

..

12.50

4.00

6733

..

14.50

4.00

6617

..

16.50

4.00

6734

..

16.00

5.00

6630

..

5.90

1.50

6737

..

8.00

2.00

6635

..

9.00

3.00

6738

..

10.50

3.00

6640

..

2.90

1.00

6745

..

9.00

3.00

6644

..

7.30

2.00

6749

..

1.85

.80

6649

..

21.00

5.00

6750

..

2.60

1.00

6653

..

21.00

5.00

6755

..

13.50

4.00

6657

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the

The amount shown in this column in the item (other than an stem relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the

6756

..

18.00

5.00

 

6759

..

10.50

3.00

 

6760

..

13.50

4.00

 

6763

..

33.00

5.00

 

6764

..

45.00

5.00

 

6769

..

8.80

2.00

 

6770

..

8.50

3.00

 

6775

..

9.50

3.00

 

6776

..

12.50

4,00

 

6779

..

21.00

5.00

 

6780

..

28.00

5.00

 

6783

..

21.00

5.00

 

6784

..

28.00

5.00

 

6787

..

21.00

5.00

 

6788

..

28.00

5.00


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

 

$

$

6793

..

7.80

2.00

 

 

Medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-third of that amount

medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one- third of that amount

6794

..

10.50

3.00

 

 

6797

..

3.10

1.00

 

 

6801

..

5.00

1.50

 

 

6803

..

7.60

2.00

 

 

6808

..

7.60

2.00

 

 

6812

..

1.85

.80

 

 

6813

..

2.60

1.00

 

 

6825

..

1.85

.80

 

 

6826

..

2.60

1.00

6915

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the  symbol ‘(D)’) relating to the fracture concerned, plus one-half of the amount

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

6829

..

13.00

4.00

 

 

6830

..

14.00

5.00

 

 

6834

..

40.00

5.00

 

 

6838

..

8.20

3.00

 

 

6839

..

11.50

3.00

 

 

6840

..

11.50

3.00

 

 

6844

..

26.00

5.00

 

 

6845

..

26.00

5.00

 

 

6850

..

28.00

5.00

 

 

6851

..

28.00

5.00

 

 

6854

..

10.50

3.00

 

 

6855

..

13.50

4.00

 

 

6856

..

13.50

4.00

 

 

6862

..

35.00

5.00

 

 

6863

..

35.00

5.00

 

 

6866

..

38.00

5.00

 

 

6867

..

38.00

5.00

 

 

6875

..

9.00

3.00

 

 

 

 

6876

..

12.00

4.00

6916

..

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that schedules the symbol ‘(D)’) relating to the fracture concerned, plus one-half of the amount

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

6877

..

12.00

4.00

 

 

6882

..

1.85

80

6883

..

2.60

1.00

6887

..

1.85

.80

6888

..

2 60

1.00

6893

..

16.50

4.00

6895

..

28.00

5.00

6897

..

75.00

5.00

6910

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)‘) relating to the

 

 

concerned, plus one-third of that amount

fracture concerned, plus one-third of that amount

6919

..

The amount shown in this column in the item (other than an item  relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

The amount shown in this column in the item relating to the fracture concerned, plus one-half of that amount

6911

..

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth

 


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

 

$

$

6920

..

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

 

 

relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6935 in the table of Commonwealth medical benefits apply to the reduction concerned

relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’ that would, but for item 6935 in the table of Commonwealth medical benefits apply to the reduction concerned

6925

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical, benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

The amount shown in this column in the item (other than an item relating to on item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

6936

 

One-half of the amount shown in this column in the item that would, but for item 6936 in the table of Commonwealth medical benefits apply to the  reduction concerned

One-half of the amount shown in this column in the item that would, but for item 6396 in the table of Commonwealth medical benefits apply to the  reduction concerned

6943

..

One-half of the amount shown in this column in the item (other than an item, relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6943 in the table of Commonwealth medical benefits apply to the reduction concerned

One-half of the amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6943 in the table of Commonwealth medical benefits apply to the reduction concerned

6926

..

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

6935

..

One-half of the amount shown in this column  in the item (other than an item

One-half of the amount shown  in this column in the item (other than an item

6944

..

One-half of the amount shown in this column in the

One-half of the amount shown in this column in the


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

 

item that would, but for item 6944 in the table of Commonwealth medical benefits apply to the reduction concerned

item that would, but for item 6944 in the table of Commonwealth medical benefits apply to the reduction concerned

 

relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

relating to an item in the table of Commonwealth medical benefits that includes the symbol (‘(D)‘) relating to the fracture concerned, plus one-fifth of that amount

6950             ..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6950 in the table of Commonwealth medical benefits apply to the reduction concerned

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6950 in the table of Commonwealth medical benefits apply to the reduction concerned

6961

..

The amount shown in this column in the item (being an item relating to an stem in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

The amount shown in this column in the item (being an item relating to an. item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

7000

..

22.00

5.00

7004

..

2.00

5.00

7007

..

1.50

1.00

7009

..

2.40

1.00

6951           ..

The amount shown in this column in the item that would, but for item 6951 in the table of Commonwealth medical benefits apply to the reduction concerned

The amount shown in this column in the item that would, but for item 6951 in the table of Commonwealth medical benefits apply to the reduction concerned

7012

..

6.20

1.50

7017

..

5.50

3.00

7018

..

7.50

4.00

7024

..

9.50

3.00

7026

..

9.50

3.00

7030

..

85.00

5.00

7034

..

30.00

5.00

7036

..

30.00

5.00

7039

..

8.50

3.00

7040

..

11.00

3.00

7049

..

7.50

3.00

7053

..

8.50

3.00

7059

..

14.00

4.00

7064

..

24.00

5.00

6956           ..

The amount shown in this column in the item that would apply in the case of a simple and uncomplicated fracture of the part concerned

The amount shown in this column in the item that would apply in the case of a simple and uncomplicated fracture of the part concerned

7071

..

24.00

5.00

7077

..

130.00

5.00

7083

..

42.00

5.00

7086

..

27.00

5.00

7090

..

61.00

5.00

7094

..

110.00

5.00

7102

..

95.00

5.00

7110

..

120 00

5.00

7115

..

110.00

5.00

7119

..

145.00

5.00

7123

..

105.00

5.00

6960           ..

The amount shown in this column in the item (other than an item

The amount shown in this column in the item (other than an item

7127

..

145.00

5.00

7131

..

73.00

5.00

7137

..

56.00

5.00

7142

..

73.00.

5.00

7144

..

73.00

5.00

7147

..

52.00

5.00


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

$

$

$

7150

47.00

5.00

7421

11.50

3.00

7168

42.00

5.00

7422

14.00

4.00

7169

45.00

5.00

7425

22.00

5.00

7174

22.00

5.00

7428

29.00

5.00

7179

24.00

5.00

7429

37.00

5.00

7183

66.00

5.00

7433

9.50

3.00

7187

78.00

5.00

7437

14.00

4.00

7191

16.00

5.00

7439

8.50

3.00

7196

7.60

2.00

7441

22.00

5.00

7201

39.00

5.00

7445

42.00

5.00

7207

44.00

5.00

7447

115.00

5.00

7211

39.00

5.00

7449

56.00

5.00

7255

27.00

5.00

7452

24.00

5.00

7219

105.00

5.00

7455

13.50

4.00

7229

70.00

5.00

7456

17.00

5.00

7235

70.00

5.00

7460

17.00

5.00

7239

90.00

5.00

7465

19.00

5.00

7243

130.00

5.00

7469

30.00

5.00

7247

52.00

5.00

7475

14.00

4.00

7254

70.00

5.00

7479

37.00

5.00

7258

34.00

5.00

7481

34.00

5.00

7264

17.00

5.00

7484

56.00

5.00

7267

39.00

5.00

7487

70.00

5.00

7269

52.00

5.00

7491

95.00

5.00

7272

39.00

5.00

7493

70.00

5.00

7276

37.00

5.00

7496

34.00

5.00

7277

47.00

5.00

7500

34.00

5.00

7281

56.00

5.00

7501

47.00

5.00

7286

2.60

1.00

7504

47.00

5.00

7288

2.80

1.00

7507

44.00

5.00

7294

34.00

5.00

7511

44.00

5.00

7296

52.00

5.00

7515

41.00

5.00

7299

30.00

5.00

7518

47.00

5.00

7302

17.00

5.00

7522

47.00

5.00

7303

22.00

5.00

7525

34.00

5.00

7308

29.00

5.00

7526

47.00

5.00

7311

41.00

5.00

7555

6.50

3.00

7317

28.75

5.00

7558

4.10

1.00

7320

36.75

5.00

7562

4.80

1.50

7322

43.00

5.00

7564

4.10

1.00

7327

17.00

5.00

7568

5.20

1.50

7330

22.00

5.00

7571

4.10

1.00

7335

52.00

5.00

7574

6.40

1.50

7337

39.00

5.00

7576

4.10

1.00

7345

30.00

5.00

7579

7.60

2.00

7347

17.00

5.00

7583

19.00

5.00

7349

22.00

5.00

7587

4.10

1.00

7350

22.00

5.00

7589

6.40

1.50

7357

21.00

5.00

7592

6.40

1.50

7358

27.00

5.00

7595

6.60

2.00

7362

18.00

5.00

7600

68.00

5.00

7366

24.00

5.00

7604

78.00

5.00

7369

24.00

5.00

7612

78.00

5.00

7371

30.00

5.00

7614

78.00

5.00

7375

34.00

5.00

7617

39.00

5.00

7379

56.00

5.00

7621

61.00

5.00

7383

85.00

5.00

7623

61.00

5.00

7385

47.00

5.00

7628

87.00

5.00

7388

56.00

5.00

7633

78.00

5.00

7393

54.00

5.00

7636

78.00

5.00

7398

56.00

5.00

7639

75.00

5.00

7403

12.50

4.00

7645

17.00

5.00

7405

27.00

5.00

7648

39.00

5.00

7414

23.00

5.00

7651

30.00

5.00

7415

30.00

5.00

7656

95.00

5.00

7418

34.00

5.00

7660

95.00

5.00


Schedule 4—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

$

$

7663

..

61.00

5.00

7899

..

63.00

5.00

7669

..

52.00

5.00

7903

..

75.00

5.00

7675

..

61.00

5.00

7906

..

63.00

5.00

7679

..

78.00

5.00

7910

..

75.00

5.00

7686

..

39.00

5.00

7914

..

8.00

3.00

7689

..

52.00

5.00

7918

..

16.50

5.00

7692

..

78.00

5.00

7922

..

40.00

5.00

7695

..

30.00

5.00

7930

..

78.00

5.00

7699

..

52.00

5.00

7935

..

26.00

5.00

7702

..

30.00

5.00

7939

..

61.00

5.00

7705

..

78.00

5.00

7944

..

70.00

5.00

7710

..

9.50

3.00

7948

..

115.00

5.00

7713

..

61.00

5.00

7955

..

40.00

5.00

7716

..

45.00

5.00

7959

..

75.00

5.00

7719

..

42.00

5.00

7963

..

59.00

5.00

7722

..

24.00

5.00

7964

..

59.00

5.00

7725

..

9.50

3.00

7971

..

49.00

5.00

7728

..

13.50

4.00

7972

..

49.00

5.00

7729

..

17.50

5.00

7979

..

49.00

5.00

7733

..

39.00

5.00

7980

..

49.00

5.00

7736

..

9.50

3.00

7991

..

68.00

5.00

7740

..

47.00

5.00

7995

..

39.00

5.00

7742

..

45.00

5.00

7996

..

39.00

5.00

7746

..

56.00

5.00

8004

..

42.00

5.00

7748

..

87.00

5.00

8005

..

42.00

5.00

7752

..

61.00

5.00

8012

..

49.00

5.00

7755

..

8.30

2.00

8013

..

49 00

5.00

7759

..

5.20

1.50

8025

..

49.00

5.00

7780

..

39.00

5.00

8030

..

22.00

5.00

7784

..

13.50

4.00

8034

..

46.00

5.00

7786

..

32.00

5.00

8039

..

26.00

5.00

7790

..

3.70

1.00

8043

..

26.00

5.00

7794

..

3.90

1.00

8047

..

39.00

5.00

7796

..

3 90

1.00

8052

..

42.00

5.00

7800

..

5.50

3.00

8056

..

49.00

5.00

7801

..

5.50

3.00

8064

..

71.50

5.00

7805

..

12.00

4.00

8068

..

110.00

5.00

7806

..

12.00

4.00

8073

..

11.50

3.00

7811

..

16 50

5.00

8078

..

28.00

5.00

7813

..

26.00

5.00

8082

..

28.00

5.00

7816

..

47.00

5.00

8086

..

45.00

5.00

7819

..

66.00

5.00

8090

..

15.00

4.00

7822

..

39.00

5.00

8094

..

59.00

5.00

7825

..

22.00

5.00

8098

..

44.00

5.00

7826

..

22.00

5.00

8102

..

12.00

4.00

7829

..

34.00

5.00

8107

..

54.00

5.00

7833

..

39.00

5.00

8112

..

73.00

5.00

7837

..

18.00

5.00

8117

..

28 00

5.00

7842

..

20.00

5.00

8121

..

21.00

5.00

7846

..

9.00

3.00

8125

..

42.00

5.00

7851

..

36.00

5.00

8129

..

100.00

5.00

7856

..

18.00

5.00

8133

..

28.00

5.00

7859

..

39.00

5.00

8137

..

54.00

5.00

7865

..

30.00

5.00

8138

..

54.00

5.00

7871

..

20.00

5.00

8146

..

68.00

5.00

7875

..

16.50

4.00

8147

..

68.00

5.00

7876

..

16.50

4.00

8155

..

34.00

5.00

7879

..

34.00

5.00

8156

..

34.00

5.00

7882

..

59.00

5.00

8164

..

49.00

5.00

7886

..

22.00

5.00

7887

..

22.00

5.00

8165

..

49.00

5.00

7890

..

49.00

5.00

8171

..

49.00

5.00

7894

..

39.00

5.00

8172

..

49.00

5.00

7895

..

39.00

5.00

8177

..

63.00

5.00


 

SCHEDULE 5

Regulation 5

TABLE OF FUND MEDICAL BENEFITS IN RESPECT OF SOUTH AUSTRALIA

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

1

..

1.25

.80

274

..

6.20

1.50

2

..

2.55

1.10

277

..

6.20

1.50

10

..

1.85

.80

280

..

10.40

3.00

12

..

3.00

1.30

282

..

6.20

1.50

21

..

3.50

1.60

285

..

23.00

5.00

24

..

4.70

2.10

289

..

5.80

1.50

29

..

5.30

2.40

292

..

26.00

5.00

31

..

6.50

2.90

294

..

6.20

1.50

36

..

1.85

1.20

296

..

11.60

3.00

41

..

3.30

1.40

300

..

.70

.80

47

..

2.80

1.20

303

..

2.00

1.00

49

..

3.95

1.70

304

..

3.10

1.00

55

..

4.90

2.10

307

..

4.20

1.50

56

..

6.05

2.60

308

..

5.30

1.50

61

..

6.75

3.00

311

..

6.20

2.00

62

..

7.90

3.50

312

..

7.40

2.00

63

..

2.80

1.20

314

..

7.30

3.00

64

..

3.95

1.70

315

..

9.00

3.00

67

..

1.85

.80

316

..

9.50

3.00

68

..

1.25

.80

318

..

11.00

3.00

74

..

1.85

.80

319

..

11.50

4.00

76

..

2.80

1.00

320

..

13.00

4.00

80

..

7.40

1.50

322

..

13.50

4.00

83

..

3.50

1.00

324

..

15.00

4.00

86

..

10.90

2.00

325

..

15.00

5.00

89

..

7.20

1.50

326

..

17.00

5.00

92

..

3.50

1.00

327

..

17.00

5.00

95

..

7.40

1.50

328

..

19.00

5.00

98

..

11.00

2.00

329

..

20.00

5.00

101

..

14.00

3.00

330

..

21.00

5.00

104

..

17.50

4.00

331

..

22.00

5.00

109

..

7.20

1.50

332

..

23.00

5.00

112

..

10.90

2.00

333

..

24.00

5.00

115

..

13.90

3.00

334

..

26.00

5.00

118

..

17.00

4.00

335

..

26.00

5.00

121

..

24.50

4.00

336

..

28.00

5.00

124

..

11.60

2.00

337

..

28.00

5.00

127

..

17.60

4.00

338

..

30.00

5.00

129

..

24.50

5.00

339

..

31.00

5.00

131

..

32.50

5.00

343

..

33.00

5.00

133

..

39.50

5.00

346

..

37.00

5.00

203

..

1.85

.80

349

..

39.00

5.00

206

..

19.50

5.00

350

..

42.00

5.00

208

..

14.00

4.00

353

..

2.60

1.00

212

..

15.00

5.00

356

..

6.20

2.00

218

..

18.00

5.00

359

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

223

..

26.00

5.00

 

224

..

40.00

5.00

226

..

32.50

5.00

227

..

46.50

5.00

237

..

42.00

5.00

238

..

57.00

5.00

239

..

47.00

5.00

240

..

55.00

5.00

245

..

1.25

.80

248

..

1.25

.80

253

..

15.00

4.00

254

..

20.50

5.00

257

..

6.20

1.50

262

..

1.25

.80

269

..

5.60

1.50

272

..

8.50

2.00


Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

363

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-third of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-third of that amount

377

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the part concerned

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the part concerned

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

410

..

1.00

.80

411

..

2.50

1.00

412

..

3.90

1.00

413

..

5.10

1.50

414

..

6.50

2.00

366

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-half of that amount

415

..

7.90

2.00

 

 

416

..

7.50

3.00

 

 

417

..

9.00

3.00

 

 

418

..

10.50

3.00

 

 

419

..

12.00

4.00

 

 

420

..

13.50

4.00

 

 

421

..

14.50

4.00

 

 

422

..

15.50

5.00

 

 

423

..

17.00

5.00

 

 

424

..

18.00

5.00

 

 

425

..

20.00

5.00

 

 

426

..

21.00

5.00

 

 

427

..

22.00

5.00

 

 

428

..

23.00

5.00

 

 

429

..

25.00

5.00

 

 

431

..

26.00

5.00

 

 

432

..

27.00

5.00

369

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus three- quarters of that amount

The amount shown in this column in the item relating to the; administration: of an anaesthetic in; connection with the treatment of i the fracture concerned plus three- quarters of that amount

433

..

29.00

5.00

 

 

434

..

30.00

5.00

 

 

437

..

31.00

5.00

 

 

438

..

32.00

5.00

 

 

439

..

34.00

5.00

 

 

440

..

35.00

5.00

 

 

441

..

37.00

5.00

 

 

442

..

38.00

5.00

 

 

444

..

42.00

5.00

 

 

445

..

46.00

5.00

 

 

446

..

53.00

5.00

 

 

447

..

50.00

5.00

 

 

448

..

3.10

1.00

 

 

449

..

7.90

2.00

 

 

453

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

 

 

 

 

 

 

373

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

The amount shown in this : column in the item relating to the administration : of an anaesthetic in connection with the treatment of the fracture concerned

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

457

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-third of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-third of that amount

 

administration of an anaesthetic in connection with the treatment of the part concerned

administration of an anaesthetic in connection with the treatment of the part concerned

503

..

4.20

1.50

504

..

5.10

1.50

507

..

5.30

1.50

508

..

6.50

2.00

511

..

7.30

3.00

512

..

9.00

3.00

515

..

6.20

2.00

459

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-half of that amount

516

..

7.90

2.00

519

..

9.50

3.00

520

..

12.00

4.00

530

..

7.70

2.00

532

..

5.60

1.50

534

..

5.80

1.50

536

..

7.00

2.00

555

..

10.00

3.00

603

..

6.90

1.50

605

..

14.10

3.00

607

..

22.50

5.00

609

..

8.70

2.00

612

..

20.00

4.00

615

..

29.00

5.00

620

..

8.70

2.00

463

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment, of the fracture concerned plus three- quarters of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus three- quarters of that amount

622

..

18.50

4.00

624

..

13.40

3.00

628

..

16.60

4.00

633

..

22.50

5.00

635

..

10.60

2.00

637

..

8.70

2.00

650

..

42.00

5.00

653

..

20.00

4.00

655

..

6.80

1.50

658

..

30.00

3.00

663

..

54 00

5.00

666

..

22.50

5.00

669

..

13.40

3.00

671

..

8.00

1.50

675

..

7.40

1.50

678

..

4.30

1.00

466

..

The amount shown in this column in the item relating to the administration of an anaesthetic m connection with the treatment of the fracture concerned

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

683

..

10.90

3.00

686

..

7.70

1.50

690

..

14.10

3.00

700

..

2.60

.80

706

..

4.00

1.00

718

..

5.40

1.00

722

..

6.80

1.50

726

..

4.70

1.00

732

..

4.70

1.00

735

..

5.80

1.50

740

..

5.30

1.00

743

..

4.90

1.00

745

..

11.00

2.00

750

..

5.80

1.50

469

..

The amount shown in this column in the item relating to the

The amount shown in this column in the item relating to the

758

..

8.70

2.00

762

..

5.80

1.50

765

..

35.00

5.00

768

..

29.00

5.00

773

..

2.70

1.00


Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

775

..

5.30

1.00

1076

..

.90

.80

778

..

8.70

2.00

1080

..

.20

.80

785

..

17.00

4.00

1082

..

2.30

1.00

788

..

4.40

1.00

1084

..

8.80

3.00

792

..

14.10

3.00

1090

..

1.60

.80

795

..

48.00

5.00

1091

..

2.50

1.00

798

..

70.00

5.00

1092

..

1.90

1.00

802

..

10.90

3.00

1094

..

1.60

.80

80S

..

3.80

1.00

1096

..

.90

.80

808

..

6.40

1.50

1098

..

1.30

.80

811

..

6.40

1.50

1100

..

1.50

1.00

813

..

9.00

2.00

1102

..

3.50

1.00

817

..

13.40

3.00

1104

..

.20

.80

820

..

13.40

3.00

1106

..

.60

.80

823

..

12.20

3.00

1108

..

1.50

1.00

826

..

8.70

2.00

1110

..

3.30

1.50

830

..

23.50

5.00

1112

..

.20

.80

834

..

5.30

1.00

1114

..

.20

.80

837

..

11.50

3.00

1116

..

1.60

1.50

842

..

1.60

.80

1118

..

.60

.80

848

..

2.10

.80

1120

..

4.80

1.50

852

..

3.60

1.00

1122

..

.70

1.00

855

..

5.60

1.00

1124

..

1.90

1.00

858

..

3.50

1.00

1126

..

2.30

1.00

862

..

10.30

2.00

1128

..

.20

.80

869

..

18.50

4.00

1130

..

3.10

1.00

873

..

38.00

5.00

1132

..

1.90

1.00

876

..

6.40

1.50

1134

..

3.10

1.00

1000

..

.20

.80

1136

..

4.80

1.50

1002

..

.20

.80

1138

..

1.10

.80

1004

..

.20

.80

1140

..

1.70

1.00

1006

..

.90

.80

1142

..

1.40

1.00

1008

..

.20

.80

1144

..

1.90

1.00

1010

..

.60

.80

1146

..

1.90

1.00

1012

..

3.00

1.00

1148

..

1.70

1.00

1014

..

.40

1.00

1150

..

2 80

1.50

1016

..

2.10

1.00

1152

..

2.70

1.00

1018

..

2.30

1.00

1154

..

2.30

1.00

1019

..

.70

.80

1156

..

2.30

1.00

1020

..

4.70

2.00

1160

..

.70

1.00

1022

..

.20

.80

1162

..

1.10

1.00

1024

..

.20

.80

1166

..

3.00

1.00

1026

..

.20

.80

1168

..

3.50

1.00

1028

..

.20

1.00

1170

..

3.40

1.50

1030

..

.10

1.00

1172

..

.90

.80

1032

..

.20

1.00

1174

..

1.90

1.00

1034

..

1.90

1.00

1178

..

1.30

1.00

1036

..

2.70

1.00

1180

..

.10

.80

1038

..

3.10

1.00

1182

..

.20

.80

1040

..

3.10

1.00

1184

..

1.70

1.00

1042

..

.70

1.00

1186

..

.70

.80

1044

..

4.00

1.50

1188

..

1.90

.1.00

1046

..

1.40

.80

1190

..

2.70

1.00

1048

..

5.60

1.50

1192

..

.70

1.00

1050

..

2.00

1.00

1194

..

.70

1.00

1054

..

.20

.80

1196

..

2.70

100

1060

..

.20

.80

1198

..

.70

1.00

1062

..

.10

.80

1200

..

.20

.80

1063

..

.40

.80

1202

..

.40

1.00

1064

..

.70

.80

1204

..

.60

.80

1066

..

2.30

1.00

1206

..

2.10

1.00

1068

..

1.00

1.00

1208

..

1.70

1.00

1070

..

1.30

1.00

1210

..

.70

1.00

1072

..

2.70

1.00

1212

..

1.50

1.00

1074

..

7.60

3.00

1214

..

.70

.80


Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item  in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

1216

..

.80

.80

1391

..

2.00

1.00

1218

..

3.50

1.00

1392

..

3.30

1.50

1220

..

5.00

1.50

1394

..

4.00

2.00

1222

..

5.00

1.50

1395

..

.40

.80

1224

..

6.80

3.00

1397

..

1.90

100

1226

..

8.80

3.00

1399

..

.70

.80

1228

..

3.50

1.00

1401

..

1.90

1.00

1230

..

5.00

1.50

1404

..

.20

.80

1232

..

.70

1.00

1407

..

.40

.80

1240

..

1.90

1.00

1410

..

1.60

.80

1242

..

3.10

1.00

1413

..

1.60

.80

1246

..

5.00

1.50

1416

..

2.60

1.00

1248

..

.20

.80

1419

..

1.90

1.00

1250

..

.70

1.00

1421

..

2.30

1.00

1252

..

2.80

1.50

1423

..

1.30

1.00

1254

..

4.70

1.50

1425

..

4.00

1.50

1256

..

5.80

2.00

1428

..

1.30

1.00

1258

..

6.40

3.00

1430

..

5.00

1.50

1260

..

2.70

1.00

1432

..

8.80

3.00

1262

..

4.40

1.50

1434

..

2.70

1.00

1264

..

.70

1.00

1436

..

3.10

1.00

1266

..

2.80

1.50

1438

..

8.80

3.00

1268

..

4.70

1.50

1441

..

3.30

1.00

1270

..

5.80

2.00

1444

..

.70

1.00

1272

..

3.00

1.00

1447

..

5.00

1.50

1274

..

8.80

3.00

1450

..

340

1.50

1277

..

1.90

1.00

1453

..

1.20

1.00

1278

..

.70

1.00

1456

..

2.50

1.00

1280

..

2.80

1.50

1459

..

.70

1.00

1282

..

4.70

1.50

1461

..

2.80

1.50

1284

..

5.80

2.00

1463

..

4.70

1.50

1286

..

6.40

3.00

1466

..

5.80

2.00

1288

..

4.00

1.50

1468

..

.20

.80

1290

..

3.10

1.50

1470

..

1.70

1.00

1294

..

.70

1.00

1472

..

4.00

1.50

1296

..

1.90

1.00

1474

..

8.80

3.00

1298

..

2.80

1.50

1475

..

7.00

3.00

1301

..

.70

1.00

1476

..

1.70

1.00

1302

..

2.80

1.50

1478

..

2.30

100

1304

..

4.70

1.50

1481

..

3.30

1.00

1305

..

5.80

2.00

1484

..

6.80

3.00

1307

..

6.40

3.00

1487

..

1.70

1.00

1310

..

.70

1.00

1490

..

1.70

1.00

1313

..

1.90

1.00

1491

..

.20

.80

1314

..

.50

.80

1493

..

6.80

3.00

1317

..

.20

.50

1494

..

8.80

3.00

1319

..

3.10

1.50

1495

..

.90

.80

1322

..

.20

.80

1496

..

1.90

1.00

1325

..

.40

.80

1497

..

3.40

1.50

1328

..

1.90

1.00

1499

..

3.50

1.00

1331

..

2.50

1.50

1500

..

.20

.80

1334

..

1.10

1.00

1502

..

.20

.80

1337

..

3.20

1.50

1504

..

.20

.80

1340

..

5.00

2.00

1506

..

1.30

1.00

1343

..

1.70

1.00

1508

..

.20

.80

1346

..

6.80

3.00

1511

..

1.90

1.00

1349

..

3.30

1.00

1513

..

1.60

.80

1352

..

3.50

1.00

1515

..

.40

1.00

1355

..

3.00

1.00

1517

..

1.20

1.00

1358

..

1.30

1.00

1519

..

2.50

1.00

1380

..

.20

.80

1521

..

2.50

1.50

1382

..

.20

.80

1523

..

3.50

1.50

1385

..

.70

1.00

1525

..

1.90

1.00

1388

..

2.80

1.50

1527

..

4.00

1.50

1389

..

4.30

1.50

1529

..

2.30

1.00


Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

$

$

1531

..

4.40

1.50

1710

..

.70

.80

1534

..

1.60

.80

1712

..

.70

1.00

1537

..

2.60

1.00

1714

..

.70

1.00

1539

..

2.30

1.00

1716

..

.90

.80

1541

..

1.90

1.00

1718

..

2.00

1.00

1543

..

1.30

1.00

1720

..

4.00

2.00

1545

..

.20

.80

1722

..

5.10

3.00

1546

..

1.50

1.00

1724

..

1.90

1.00

1548

..

2.80

1.50

1726

..

4.00

1.50

1551

..

2.00

1.00

1728

..

5.80

2.00

1554

..

2.90

1.50

1730

..

4.00

1.50

1557

..

3.50

2.00

1732

..

.20

.80

1560

..

2.90

1.50

1734

..

.20

.80

1562

..

3.80

1.50

1736

..

6.80

3.00

1564

..

4.40

2.00

1738

..

.90

.80

1566

..

4.90

2.00

1741

..

.70

1.00

1568

..

5.00

3.00

1744

..

.90

.80

1571

..

1.30

1.00

1746

..

.70

1.00

1580

..

1.90

1.00

1748

..

.70

1.00

1582

..

1.30

.80

1761

..

.90

.80

1584

..

3.50

1.00

1764

..

1.70

1.00

1586

..

.20

.80

1767

..

.90

.80

1588

..

.70

1.00

1770

..

.70

1.00

1590

..

2.70

1.00

1773

..

3.10

1.00

1601

..

.70

1.00

1776

..

4.80

1.50

1604

..

2.80

1.50

1779

..

.20

.80

1607

..

4.70

1.50

1782

..

.20

.80

1609

..

5.80

2.00

1785

..

.20

.80

1611

..

1.00

1.00

1790

..

1.90

1.00

1613

..

3.30

1.00

1792

..

1.60

.80

1615

..

2.50

1.00

1794

..

4.00

1.00

1616

..

3.50

1.00

1796

..

4.00

1.50

1621

..

.40

.80

1798

..

1.90

1.00

1622

..

.20

.80

1800

..

1.10

.80

1623

..

1.30

1.00

1802

..

2.20

1.00

1625

..

1.10

.80

1804

..

3.80

1.50

1627

..

2.70

1.00

1806

..

.70

1.00

1629

..

2.30

1.00

1808

..

2.30

1.50

1631

..

1.60

.80

1810

..

.70

1.00

1640

..

5.60

1.50

1812

..

.40

.80

1643

..

2.90

1.00

1820

..

2.80

1.50

1645

..

2.90

1.00

1822

..

5.00

2.00

1647

..

8.80

3.00

1824

..

6.40

3.00

1649

..

7.00

2.00

1826

..

4.40

3.00

1651

..

8.80

3.00

1828

..

7.40

3.00

1653

..

4.00

1.50

1840

..

12.40

4.00

1661

..

.20

.80

1841.

..

16.00

5.00

1664

..

5.80

2.00

1843

..

3.10

1.50

1667

..

.70

1.00

1846

..

4.00

1.50

1670

..

2.70

1.00

1849

..

2.50

1.00

1673

..

3.50

1.00

1850

..

2.80

1.50

1680

..

.20

.80

1852

..

2.80

1.50

1682

..

.20

.80

1853

..

7.00

3.00

1684

..

.40

.80

1855

..

4.30

1.50

1686

..

1.10

.80

1858

..

5.00

2.00

1688

..

1.90

1.00

1861

..

3.20

1.50

1691

..

1.90

1.00

1863

..

5.80

2.00

1694

..

1.00

.80

1865

..

14.00

5.00

1697

..

1.30

1.00

1867

..

3.10

1.50

1698

..

2.80

1.50

1869

..

4.80

1.50

1700

..

1.90

1.00

1871

..

6.80

3.00

1701

..

4.60

2.00

1873

..

14.00

5.00

1703

..

1.90

1.00

1875

..

5.80

2.00

1706

..

1.60

.80

1877

..

5.80

2.00

1707

..

2.60

1.00

1879

..

3.10

1.50


Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

1881

..

2.10

1.00

2056

..

3.00

1.50

1884

..

1.50

1.00

2058

..

11.50

3.00

1887

..

4.00

1.50

2082

..

5.50

1.50

1889

..

12.40

4.00

2067

..

4.50

1.50

1891

..

1.60

.80

2070

..

5.50

1.50

1893

..

3.40

1.50

2074

..

5.50

1.50

1895

..

5.80

2.00

2077

..

4.50

1.50

1896

..

1.70

1.00

2079

..

6.00

1.50

1897

..

3.50

1.00

2082

..

6.00

1.50

1898

..

3.50

1.00

2084

..

4.10

1.50

1899

..

5.30

1.50

2086

..

4.10

1.50

1900

..

4.00

1.50

2088

..

6.50

1.50

1902

..

6.00

2.00

2091

..

4.10

1.00

1904

..

1.30

1.00

2096

..

9.00

3.00

1906

..

1.50

1.00

2100

..

8.00

2.00

1908

..

7.00

2.00

2103

..

6.50

1.50

1910

..

7.20

3.00

2105

..

3.60

1.50

1912

..

8.40

3.00

2107

..

5.50

1.50

1914

..

8.80

3.00

2109

..

4.50

1.50

1916

..

4.00

1.50

2114

..

5.50

2.00

1917

..

4.00

1.50

2117

..

3.50

1.50

1918

..

3.40

1.50

2120

..

7.50

3.00

1919

..

7.00

3.00

2122

..

10.00

3.00

1920

..

2.70

1.00

2124

..

2.40

1.00

1922

..

4.00

1.50

2126

..

6.00

1.50

1924

..

4.00

1.50

2129

..

10.00

3.00

1926

..

4.40

1.50

2131

..

4.40

1.00

1927

..

10.50

4.00

2134

..

4.60

1.50

1929

..

17.00

5.00

2136

..

5.00

1.50

1931

..

7.00

3.00

2143

..

5.10

1.50

1933

..

6.60

2.00

2147

..

2.20

1.00

1935

..

5.20

1.50

2149

..

4.50

1.50

1937

..

6.20

2.00

2151

..

6.00

1.50

1939

..

11.00

4.00

2153

..

4.40

1.00

1942

..

10.50

4.00

2155

..

4.60

1.50

1946

..

6.20

2.00

2157

..

5.00

1.50

1952

..

19.00

5.00

2159

..

6.50

1.50

1954

..

8.50

3.00

2162

..

4.60

1.50

1960

..

10.50

4.00

2165

..

15.50

4.00

1962

..

6.60

2.00

2167

..

12.00

4.00

1964

..

7.00

3.00

2171

..

16.00

4.00

1982

..

12.00

4.00

2175

..

10.50

3.00

1984

..

6.00

1.50

2178

..

7.50

2.00

1986

..

13.00

4.00

2182

..

9.00

3.00

1987

..

12.00

4.00

2186

..

5.00

1.50

1989

..

8.00

3.00

2201

..

4.40

1.00

1991

..

12.00

4.00

2206

..

4.60

1.50

1993

..

12.00

4.00

2210

..

4.60

1.50

1995

..

8.00

3.00

2212

..

6.50

2.00

1997

..

8.00

3.00

2216

..

8.00

3.00

1998

..

7.80

2.00

2220

..

9.50

3.00

2002

..

2.40

1.00

2223

..

9.00

3.00

2004

..

3.60

1.00

2225

..

8.00

3.00

2007

..

2.40

1.00

2228

..

10.50

3.00

2009

..

3.60

1.00

2232

..

7.50

2.00

2025

..

4.00

1.50

2236

..

8.00

2.00

2029

..

4.50

1.50

2239

..

10.50

3.00

2031

..

3.40

1.00

2241

..

8.00

2.00

2033

..

3.60

1.50

2243

..

13.00

4.00

2035

..

4.50

1.50

2245

..

8.00

2.00

2037

..

4.50

1.50

2249

..

2.40

1.00

2039

..

4.00

1.50

2255

..

9.00

3.00

2046

..

4.50

1.50

2257

..

6.00

1.50

2050

..

4.00

1.50

2265

..

4.60

1.50

2053

..

3.00

1.50

2267

..

5.00

2.00


Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

$

$

2269

..

8.00

2.00

2565

..

3.40

1.00

2272

..

9.00

3.00

2568

..

5.50

1.50

2275

..

12.50

4.00

2571

..

5.50

1.50

2277

..

12.50

4.00

2600

..

17.00

4.00

2279

..

12.50

4.00

2603

..

14.00

4.00

2281

..

6.50

2.00

2606

..

14.00

4.00

2283

..

6.00

1.50

2613

..

14.00

5.00

2285

..

12.00

3.00

2616

..

5.10

1.50

2287

..

9.00

3.00

2619

..

7.50

2.00

2289

..

10.00

3.00

2623

..

7.50

2.00

2296

..

6.50

2.00

2631

..

6.00

1.50

2299

..

6.50

3.00

2635

..

6.00

1.50

2302

..

6.50

3.00

2639

..

4.90

1.50

2304

..

6.50

3.00

2643

..

6.00

1.50

2306

..

6.50

3.00

2647

..

4.90

1.50

2308

..

6.50

3.00

2651

..

4.90

1.50

2312

..

14.00

4.00

2655

..

7.50

2.00

2316

..

6.50

3.00

2658

..

6.00

1.50

2319

..

8.50

2.00

2663

..

6.00

1.50

2323

..

8.50

2.00

2667

..

3.90

1.00

2327

..

2.70

1.00

2669

..

7.50

2.00

2331

..

6.50

1.50

2673

..

5.10

1.50

2335

..

5.40

1.50

2677

..

5.10

1.50

2339

..

6.50

1.50

2680

..

14.00

4.00

2343

..

9.50

3.00

2685

..

9.00

3.00

2348

..

8.00

2.00

2689

..

2.40

1.00

2352

..

6.00

2.00

2693

..

14.00

4.00

2365

..

7.50

2.00

2701

..

7.00

2.00

2400

..

1.30

.80

2704

..

7.50

2.00

2425

..

5.60

1.50

2708

..

9.00

3.00

2428

..

3.60

1.00

2712

..

14.00

4.00

2450

..

3.20

1.00

2920

..

7.00

1.00

2453

..

.30

.80

2929

..

One-fifth of the amount shown in this column for the operation or operations

One-fifth of the amount shown in this column for the operation or operations

2456

..

3.90

1.00

 

2461

..

.40

.80

 

2466

..

7.50

2.00

 

2469

..

1.20

.80

 

2472

..

4.40

1.00

 

2475

..

3.90

1.00

3003

..

1.85

.80

2478

..

.40

.80

3007

..

3.80

1.00

2482

..

4.60

1.50

3010

..

5.20

1.50

2485

..

.50

.80

3014

..

6.40

1.50

2488

..

9.00

3.00

3018

..

10.00

3.00

2490

..

1.80

.80

3020

..

12.00

3.00

2492

..

6.00

1.50

3023

..

4.50

1.50

2494

..

.80

.80

3026

..

5.30

1.50

2497

..

8.00

2.00

3028

..

4.10

1.50

2501

..

1.30

.80

3032

..

4.10

1.50

2504

..

12.50

4.00

3035

..

9.00

3.00

2507

..

2.70

1.00

3040

..

9.00

3.00

2511

..

22.00

5.00

3042

..

5.30

1.50

2515

..

15.00

4.00

3044

..

11.50

3.00

2519

..

31.00

5.00

3048

..

14.00

4.00

2523

..

45.00

5.00

3053

..

9.00

3.00

2527

..

36.00

5.00

3054

..

9.00

3.00

2531

..

22.00

5.00

3060

..

11.50

3.00

2536

..

8.50

3.00

3066

..

14.50

4.00

2540

..

13.50

4.00

3072

..

14.50

4.00

2544

..

6.50

1.50

3076

..

1.10

.80

2547

..

4.90

1.50

3079

..

1.10

.80

2550

..

14.50

4.00

3083

..

8.00

3.00

2553

..

4.90

1.50

3086

..

8.00

3.00

2556

..

8.50

3.00

3088

..

14.00

4.00

2559

..

10.50

3.00

3091

..

18.00

5.00

2562

..

3.20

1.00

3096

..

18.00

5.00


Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

3100

..

4.40

1.00

3358

..

28.00

5.00

3102

..

4.40

1.00

3360

..

28.00

5.00

3107

..

8.00

3.00

3365

..

28.00

5.00

3111

..

9.50

3.00

3370

..

63.00

5.00

3118

..

9.50

3.00

3374

..

105.00

5.00

3322

..

4.00

1.00

3376

..

70.00

5.00

3127

..

8.00

3.00

3380

..

28.00

5.00

3129

..

2.40

1.00

3382

..

28.00

5 00

3133

..

2.40

1.00

3385

..

15.50

4.00

3136

..

14.00

4.00

3388

..

15.50

4.00

3141

..

7.30

2.00

3410

..

5.00

1.50

3145

..

7.30

2.00

3413

..

5.00

1.50

3151

..

11.50

3.00

3416

..

9.00

3.00

3154

..

14.00

4.00

3420

..

11.50

3.00

3158

..

14.00

4.00

3422

..

11.50

3.00

3164

..

2.90

1.00

3426

..

11.50

3.00

3167

..

12.00

3.00

3429

..

23.00

5.00

3169

..

11.50

4.00

3432

..

23.00

5 00

3172

..

11.00

5.00

3435

..

59.00

5.00

3176

..

12.00

5.00

3438

..

59.00

5.00

3182

..

30.00

5.00

3441

..

150.00

5.00

3186

..

6.80

2.00

3449

..

3.80

1.00

3188

..

5.50

3.00

3451

..

3.80

1.00

3192

..

5.50

3.00

3457

..

12.50

3.00

3198

..

9.00

3.00

3461

..

16.50

4.00

3200

..

11.00

3.00

3463

..

16.50

4.00

3205

..

11.00

3.00

3467

..

105.00

5.00

3209

..

11.50

4.00

3471

..

32.00

5.00

3212

..

15.00

5.00

3474

..

42.00

5.00

3214

..

15.00

5.00

3476

..

49.00

5.00

3223

..

21.00

5.00

3481

..

85.00

5.00

3227

..

26.00

5.00

3485

..

95.00

5.00

3231

..

32.00

5.00

3489

..

105.00

5.00

3234

..

70.00

5.00

3494

..

59.00

5.00

3239

..

42.00

5.00

3499

..

61.00

5.00

3240

..

42.00

5.00

3504

..

42.00

5.00

3241

..

49.00

5.00

3512

..

32.00

5.00

3243

..

49.00

5.00

3515

..

42.00

5.00

3246

..

70.00

5.00

3518

..

36.00

5.00

3249

..

32.00

5.00

3520

..

28.00

5.00

3257

..

56.00

5.00

3522

..

150.00

5.00

3260

..

10.50

3.00

3538

..

30.00

5.00

3264

..

3.10

1.00

3540

..

85.00

5.00

3266

..

4.00

1.00

3543

..

19.00

5.00

3270

..

4.00

1.00

3546

..

61.00

5.00

3275

..

2.90

1.50

3549

..

16.00

4.00

3278

..

6.10

2.00

3552

..

26.00

5.00

3283

..

6.30

2.00

3557

..

35.00

5.00

3287

..

7.00

2.00

3558

..

9.50

4.00

3293

..

3.60

1.00

3562

..

10.00

4.00

3296

..

12.00

4.00

3564

..

20.00

5.00

3302

..

.90

.80

3568

..

26.00

5.00

3307

..

1.70

.80

3570

..

20.00

5.00

3310

..

6.50

2.00

3574

..

26.00

5.00

3312

..

6.00

3.00

3579

..

49.00

5.00

3317

..

6.00

3.00

3584

..

73.00

5.00

3322

..

9.50

3.00

3586

..

11.50

3.00

3327

..

11.50

3.00

3590

..

29.00

5.00

3333

..

16.50

5.00

3592

..

36.00

5.00

3337

..

21.00

5.00

3596

..

36.50

5.00

3341

..

13.50

4.00

3600

..

49.00

5.00

3343

..

17.00

5.00

3606

..

42.00

5.00

3347

..

23.00

5.00

3611

..

54.00

5.00

3352

..

9.50

3.00

3613

..

45.00

5.00

3355

..

11.50

3.00

3621

..

49.00

5.00


Schedule 5—continued

Number of item m First Schedule

Fund medical benefit

Specified recess

Number of : item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

3625

..

130.00

5.00

3876   ..    

7.30

..

2.00

3628

..

45.00

5.00

3877   ..

100.00

..

5.00

3631

..

49.00

5.00

3881   ..

150.00

..

5.00

3635

..

49.00

5.00

3885   ..

170.00

..

5.00

3639

..

9.50

3.00

3887   ..

34.00

..

5.00

3642

..

39.00

5.00

3890   ..

42.00

..

5.00

3644

..

43.00

5.00

3891   ..

105.00

..

5.00

3648

..

36.00

5 00

3893   ..

45.00

..

5.00

3650

..

45.00

5.00

3895   ..

59.00

..

5.00

3653

..

75.00

5.00

3897   ..

63.00

..

5.00

3659

..

63.00

5.00

3942   ..

39.00

..

5.00

3663

..

52.00

5.00

3944   ..

49.00

..

5.00

3666

..

82.00

5.00

3947   ..

95.00

..

5.00

3669

..

125.00

5.00

3950   ..

73.00

..

5.00

3672

..

125.00

5.00

3953   ..

73.00

..

5.00

3674

..

14.50

4.00

3956   ..

38.00

..

5.00

3677

..

16.50

5.00

3960   ..

11.50

..

3.00

3679

..

45.00

5.00

3966   ..

4.50

..

1.50

3685

..

47.00

5.00

3972   ..

   .. 105.00

..

5.00

3694

..

49.00

5.00

3974   ..

87.00

..

5.00

3697

..

59.00

5.00

3977   ..

35.00

..

5.00

3701

..

70.00

5.00

3980   ..

52.00

..

5.00

3703

..

45.00

5.00

3982   ..

28.00

..

5.00

3708

..

59.00

5.00

3985   ..

26.00

..

5.00

3712

..

59.00

5.00

3988   ..

33.00

..

5.00

3717

..

36.00

5.00

3992   ..

45.00

..

5.00

3719

..

45.00

5.00

3994   ..

66.00

..

5 00

3723

..

85.00

5.00

3997   ..

67.00

..

5.00

3730

..

105.00

5.00

4001   ..

21.00

..

5.00

3734

..

125.00

5.00

4005   ..

28.00

..

5.00

3738

..

45.00

5.00

4006   ..

24.50

..

5.00

3740

..

36.00

5.00

4010   ..

33.00

..

5.00

3744

..

36.00

5.00

4014   ..

36.00

..

5.00

3748

..

45.00

5.00

4016   ..

45.00

..

5.00

3752

..

59.00

5.00

4019   ..

2.90

..

1.00

3757

..

36.00

5.00

4023   ..

16.50

..

5.00

3762

..

45.00

5.00

4025   ..

21.00

..

5.00

3775

..

24.00

5.00

4028   ..

28.00

..

5.00

3781

..

31.00

5.00

4030   ..

33.00

..

5.00

3785

..

45.00

5.00

4036   ..

18.00

..

5.00

3787

..

45.00

5.00

4038   ..

23.00

..

5 00

3791

..

29.00

5.00

4058   ..

24.50

..

5.00

3794

..

37.00

5.00

4063   ..

33.00

..

5.00

3799

..

18.00

5.00

4067   ..

45.00

..

5.00

3804

..

42.00

5.00

4069   ..

70.00

..

5.00

3813

..

73.00

5.00

4073   ..

39.00

..

5.00

3818

..

75.00

5 00

4077   ..

8.50

..

3.00

3819

..

36.00

5.00

4079   ..

3.80

..

1.00

3822

..

45.00

5.00

4081   ..

7.50

..

2.00

3828

..

36.00

5.00

4083   ..

11.50

..

3.00

3830

..

45.00

5.00

4085   ..

14.50

..

4.00

3835

..

56.00

5.00

4088   ..

3.90

..

1 00

3839

..

73.00

5.00

4092   ..

4.50

..

1.50

3840

..

85.00

5.00

4098   ..

15.50

..

4.00

3845

..

105.00

5.00

4103   ..

12.00

..

5.00

3847

..

125.00

5.00

4105   ..

14.00

..

5.00

3851

..

95.00

5.00

4110   ..

9.00

..

3.00

3852

..

30.00

5.00

4111   ..

14.50

..

4.00

3858

..

105.00

5.00

4116   ..

16.50

..

5.00

3861

..

23.00

5.00

4121   ..

49.00

..

5.00

3862

..

28.00

5.00

4123   ..

80.00

..

5 00

3866

..

9.50

3.00

4128   ..

2.90

..

1.00

3868

..

32.00

5.00

4129   ..

11.00

..

3.00

3871

..

41.00

5.00

4131   ..

14.50

..

4.00

3873

..

13.50

4.00

4134   ..

3.10

..

1.00


 

Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of Item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

4135

..

11.50

3.00

4341

..

19.00

5.00

4137

..

9.00

3.00

4344

..

14.50

4.00

4139

..

6.90

2.00

4347

..

85.00

5.00

4142

..

31.00

5.00

4349

..

45.00

5.00

4145

..

10.50

3.00

4353

..

5.00

1.50

4147

..

1.30

.80

4357

..

9.50

3.00

4152

..

4.00

1.50

4361

..

16.50

4.00

4154

..

4.50

1.50

4363

..

16.50

4.00

4159

..

9.00

5.00

4367

..

28.00

5.00

4160

..

12.00

5.00

4369

..

23.00

5.00

4164

..

8.50

2.00

4371

..

28.00

5.00

4168

..

11.00

4.00

4374

..

9.50

3.00

4170

..

14.0.0

5.00

4377

..

28.00

5.00

4174

..

17.00

5.00

4382

..

28.00

5.00

4178

..

23.00

5.00

4386

..

28.00

5.00

4180

..

26.00

5.00

4388

..

49.00

5.00

4184

..

32.00

5.00

4392

..

38.00

5.00

4186

..

9.00

3.00

4396

..

28.00

5.00

4187

..

11.50

3.00

4398

..

49.00

5.00

4192

..

59.00

5.00

4405

..

12.00

3.00

4196

..

26.00

5.00

4406

..

15.00

4.00

4198

..

5.90

1.50

4410

..

18.50

5.00

4203

..

28.00

5.00

4411

..

23.00

5.00

4204

..

21.00

5.00

4415

..

21.75

5.00

4205

..

26.00

5.00

4417

..

27.00

5.00

4210

..

7.00

2.00

4423

..

25.00

5.00

4226

..

2.80

1.00

4425

..

31.00

5.00

4228

..

8.50

2.00

4431

..

28.25

5.00

4232

..

15.50

4.00

4433

..

36.00

5.00

4234

..

41.00

5.00

4438

..

14.00

4.00

4237

..

30.00

5.00

4439

..

17.50

5.00

4239

..

57.00

5.00

4446

..

17.00

5.00

4242

..

26.00

5.00

4451

..

23.00

5.00

4244

..

20.00

5.00

4457

..

28.00

5.00

4245

..

16.00

4.00

4459

..

49.00

5.00

4248

..

42.00

5.00

4462

..

300.00

5.00

4250

..

68.00

5.00

4465

..

9.00

3.00

4252

..

4.20

1.00

4466

..

11.50

3.00

4255

..

20.00

5.00

4470

..

13.50

4.00

4257

..

28.00

5.00

4471

..

16.50

5.00

4259

..

42.00

5.00

4475

..

16.00

4.00

4261

..

61.00

5.00

4477

..

20.25

5.00

4264

..

85.00

5.00

4479

..

18.00

5.00

4266

..

100.00

5.00

4481

..

23.00

5.00

4268

..

61.00

5.00

4486

..

20.50

5.00

4270

..

100.00

5.00

4487

..

25.75

5.00

4272

..

90.00

5.00

4491

..

11.50

3.00

4274

..

45.00

5.00

4493

..

14.00

4.00

4278

..

59.00

5.00

4500

..

28.00

5.00

4280

..

49.00

5.00

4506

..

23.00

5.00

4283

..

61.00

5.00

4510

..

38.00

5.00

4286

..

115.00

5.00

4512

..

54.00

5.00

4289

..

110.00

5.00

4515

..

61.00

5.00

4290

..

115.00

5.00

4518

..

125.00

5.00

4292

..

100.00

5.00

4530

..

6.60

2.00

4295

..

100.00

5.00

4532

..

19.00

5.00

4298

..

100.00

5.00

4535

..

11.50

3.00

4301

..

59.00

5.00

4539

..

12.00

4.00

4306

..

75.00

5.00

4543

..

80.00

5.00

4308

..

54.00

5.00

4546

..

49.00

5.00

4312

..

125.00

5.00

4550

..

82.00

5 00

4314

..

150.00

5.00

4554

..

90.00

5.00

4323

..

105.00

5.00

4556

..

115.00

5.00

4329

..

35.00

5.00

4558

..

45.00

5.00

4335

..

73.00

5.00

4566

..

56.00

5.00

 

 

 

Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

$

$

$

4569

..

90.00

5.00

4737

..

82.00

5.00

4572

..

135.00

5.00

4742

..

59.00

5.00

4574

..

152.50

5.00

4745

..

49.00

5.00

4577

..

100.00

5.00

4748

..

59.00

5.00

4581

..

115.00

5.00

4750

..

12.50

4.00

4584

..

90.00

5.00

4753

..

12.00

5.00

4588

..

210.00

5.00

4756

..

16.25

5.00

4589

..

210.00

5 00

4757

..

17.25

5.00

4593

..

100.00

5.00

4760

..

16.25

5.00

4597

..

125.00

5.00

4761

..

17.25

5.00

4601

..

100.00

5.00

4769

..

14.00

5.00

4607

..

49.00

5.00

4770

..

14.00

5.00

4609

..

90.00

5.00

4776

..

8.50

3.00

4613

..

59.00

5.00

4777

..

11.50

3.00

4615

..

68.00

5.00

4781

..

6.00

2.00

4619

..

100.00

5.00

4782

..

8.00

3.00

4621

..

8.30

2.00

4786

..

10.00

3.00

4623

..

35.00

5.00

4788

..

11.75

4.00

4627

..

7.00

4.00

4793

..

7.30

2.00

4632

..

3.90

1.00

4795

..

5.90

1.50

4634

..

8.00

3.00

4797

..

2.90

1.00

4636

..

8.00

3.00

4799

..

28.00

5.00

4638

..

6.20

1.50

4803

..

14.50

4.00

4642

..

9.50

3.00

4805

..

29.00

5.00

4644

..

6.60

1.50

4807

..

13.50

4.00

4646

..

6.60

2.00

4809

..

16.50

5.00

4647

..

8.00

3.00

4813

..

28.00

5.00

4648

..

9.50

4.00

4816

..

4.50

1.50

4652

..

15.00

5.00

4821

..

110.00

5.00

4654

..

19.25

5.00

4824

..

115.00

5.00

4656

..

21.50

5.00

4826

..

115.00

5.00

4659

..

8.30

2.00

4829

..

14.50

4.00

4661

..

12.00

4.00

4833

..

16.50

5.00

4664

..

30.50

3.00

4840

..

19.00

5.00

4666

..

13.50

4.00

4842

..

23.00

5.00

4668

..

2.60

1.00

4846

..

33.00

5.00

4669

..

2.60

1.00

4849

..

49.00

5.00

4671

..

7.60

2.00

4852

..

49.00

5.00

4672

..

7.60

2.00

4857

..

82.00

5.00

4673

..

2.10

1.00

4859

..

70.00

5.00

4675

..

35.00

5.00

4861

..

14.00

4.00

4679

..

35.00

5.00

4863

..

19.00

5.00

4680

..

35.00

5.00

4865

..

13.50

4.00

4682

..

54.00

5.00

4869

..

13.50

4.00

4683

..

11.00

5.00

4871

..

18.00

5.00

4684

..

11.00

5.00

4873

..

30.00

5.00

4685

..

9.00

3.00

4875

..

19.00

5.00

4686

..

9.00

3.00

4878

..

9.50

3.00

4687

..

49.00

5.00

4890

..

66.00

5.00

4688

..

49.00

5.00

4892

..

73.00

5.00

4689

..

66.00

5.00

4894

..

125.00

5.00

4692

..

87.00

5.00

4896

..

68.00

5.00

4695

..

31.00

5.00

4898

..

90.00

5.00

4698

..

5.00

1.50

4903

..

66.00

5.00

4700

..

27.00

5.00

4904

..

82.00

5.00

4703

..

66.00

5.00

4908

..

90.00

5.00

4706

..

52.00

5.00

4913

..

90.00

5.00

4708

..

5.00

1.50

4914

..

105.00

5.00

4711

..

23.00

5.00

4920

..

90.00

5.00

4716

..

49.00

5.00

4923

..

63.00

5.00

4717

..

68.00

5.00

4928

..

82.00

5.00

4720

..

90.00

5.00

4929

..

90.00

5.00

4722

..

2.40

1.00

4932

..

95.00

5.00

4731

..

9.00

3.00

4936

..

73.00

5.00

4734

..

9.50

3.00

4938

..

66.00

5.00

 

 

 

 

Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

4941

..

49.00

5.00

5126

..

35.00

5.00

4945

..

56.00

5.00

5129

..

11.50

3.00

4947

..

13.00

4.00

5134

..

40.00

5.00

4951

..

28.00

5.00

5137

..

4.00

1 00

4953

..

40.00

5.00

5139

..

6.60

2.00

4956

..

82.00

5.00

5142

..

82.00

5.00

4958

..

90.00

5.00

5146

..

23.00

5.00

4960

..

82.00

5.00

5148

..

11.50

3.00

4962

..

82.00

5.00

5151

..

27.00

5.00

4964

..

66.00

5.00

5154

..

19.00

5 00

4966

..

115.00

5.00

5156

..

13.50

4.00

4968

..

150.00

5.00

5159

..

8.00

2.00

4971

..

66.00

5.00

5164

..

19.00

5.00

4973

..

82.00

5.00

5168

..

19.00

5.00

4975

..

73.00

5.00

5177

..

56.00

5.00

4977

..

90.00

5.00

5180

..

49.00

5.00

4980

..

82.00

5.00

5183

..

66.00

5.00

4982

..

82.00

5.00

5187

..

66.00

5.00

4984

..

100.00

5.00

5189

..

61.00

5.00

4986

..

82.00

5.00

5195

..

61.00

5.00

4988

..

100.00

5.00

5197

..

23.00

5.00

4992

..

115.00

5.00

5200

..

31.00

5.00

5000

..

56.00

5.00

5203

..

40.00

5.00

5003

..

66.00

5.00

5207

..

61.00

5.00

5005

..

66.00

5.00

5209

..

63.00

5.00

5008

..

82.00

5.00

5211

..

73.00

5.00

5011

..

2.40

1.00

5213

..

23.00

5.00

5013

..

11.00

3.00

5215

..

49.00

5.00

5017

..

14.00

4.00

5219

..

82.00

5.00

5020

..

15.00

4.00

5226

..

15.00

4.00

5022

..

19.00

5.00

5231

..

15.00

4.00

5025

..

8.00

2.00

5234

..

40.00

5.00

5027

..

8.00

2.00

5238

..

66.00

5.00

5030

..

23.00

5.00

5242

..

6.60

2.00

5033

..

19.00

5.00

5247

..

66.00

5.00

5035

..

27.00

5.00

5250

..

9.00

3.00

5039

..

61.00

5.00

5253

..

31.00

5.00

5042

..

21.00

5.00

5255

..

40.00

5.00

5044

..

40.00

5.00

5258

..

82.00

5.00

5046

..

28.00

5.00

5263

..

40.00

5.00

5049

..

40.00

5.00

5265

..

82.00

5 00

5053

..

49.00

5.00

5267

..

4.00

1.00

5054

..

61.00

5.00

5271

..

40.00

5.00

5057

..

28.00

5.00

5273

..

75.00

5.00

5058

..

36.00

5.00

5275

..

23.00

5.00

5061

..

90.00

5.00

5279

..

15.00

4.00

5063

..

61.00

5.00

5290

..

15.00

4.00

5065

..

61.00

5.00

5292

..

18.00

5.00

5069

..

66.00

5.00

5293

..

23.00

5.00

5071

..

36.00

5.00

5297

..

23.00

5.00

5074

..

73.00

5.00

5299

..

82.00

5.00

5076

..

56.00

5.00

5302

..

28.00

5.00

5080

..

66.00

5.00

S304

..

26.00

5.00

5082

..

4.00

1.00

5307

..

49.00

5.00

5084

..

40.00

5.00

5309

..

56.00

5.00

5088

..

40.00

5.00

5315

..

44.00

5.00

5090

..

66.00

5.00

5321

..

15.00

4.00

5092

..

150.00

5.00

5326

..

15.00

4.00

5094

..

82.00

5.00

5331

..

19.00

5.00

5096

..

100.00

5.00

5365

..

6.60

2.00

5111

..

80.00

5.00

5368

..

4.50

1.50

5115

..

87.00

5.00

5373

..

7.30

2.00

5117

..

40.00

5.00

5377

..

7.30

2.00

5121

..

100.00

5 00

5379

..

11.50

3.00

5123

..

23.00

5.00

5381

..

14.50

4.00


Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

5384

..

9.00

3.00

5657

..

28.00

5.00

5386

..

11.50

3.00

5660

..

35.00

5.00

5391

..

5.00

1.50

5664

..

5.70

1.50

5395

..

7.30

2.00

5670

..

16.50

5.00

5400

..

5.00

1.50

5672

..

28.00

5.00

5405

..

9.00

3.00

5676

..

54.00

5.00

5406

..

11.50

3.00

5682

..

5.50

1.50

5412

..

21.00

5.00

5684

..

3.60

1.00

5417

..

28.00

5.00

5688

..

30.00

5.00

5421

..

105.00

5.00

5690

..

38.00

5.00

5430

..

59.00

5.00

5695

..

35.50

5.00

5432

..

3.60

1.00

5696

..

45.00

5.00

5435

..

59.00

5.00

5700

..

54.00

5.00

5440

..

59.00

5.00

5707

..

28.00

5.00

5446

..

33.00

5.00

5709

..

35.00

5.00

5450

..

12.00

4.00

5716

..

30.00

5.00

5465

..

9.50

3.00

5717

..

38.00

5.00

5458

..

20.00

5.00

5740

..

8.80

2.00

5469

..

26.00

5.00

5752

..

39.00

5.00

5478

..

35.00

5.00

5755

..

52.00

5.00

5479

..

45.00

5.00

5759

..

39.00

5.00

5484

..

44.00

5.00

5761

..

52.00

5 00

5485

..

54.00

5.00

5765

..

28.00

5 00

5496

..

50.50

5 00

5768

..

16.50

4.00

5497

..

62.00

5.00

5771

..

34.00

5.00

5502

..

13.50

4.00

5776

..

54.00

5.00

5506

..

45.00

500

5781

..

33.00

5.00

5514

..

59.00

5.00

5784

..

56.00

5.00

5521

..

56.00

5.00

5787

..

70.00

5 00

5526

..

5.50

1.50

5789

..

78.00

5.00

5528

..

5.50

1.50

5797

..

90.00

5.00

5532

..

3.40

1 50

5805

..

42.00

5.00

5536

..

13.00

4.00

5805

..

54.00

5.00

5538

..

16.50

5.00

5808

..

63.00

5.00

5544

..

38.50

5.00

5811

..

90.00

5.00

5546

..

24.00

5.00

5815

..

34.00

5.00

5549

..

11.50

3.00

5817

..

45.00

5.00

5550

..

13.50

4.00

5820

..

63.00

5.00

5555

..

6.60

2.00

5823

..

90.00

5.00

5558

..

8.00

3.00

5825

..

9.00

3.00

5563

..

10.50

3.00

5829

..

6.90

2.00

5564

..

13.00

4.00

5832

..

38.00

5.00

5570

..

17.00

5.00

5835

..

9.00

3.00

5581

..

12.50

4.00

5839

..

22.00

5.00

5582

..

16.00

4.00

5841

..

27.00

5.00

5587

..

12.50

4.00

5844

..

16.50

4.00

5590

..

16.00

4.00

5860

..

42.00

5.00

5591

..

14.00

4.00

5863

..

59.00

5.00

5592

..

17.00

5.00

5865

..

49 00

5.00

5599

..

45.00

5.00

5867

..

63.00

5.00

5603

..

45.00

5.00

5870

..

63.00

5.00

5604

..

56.00

5.00

5872

..

54.00

5.00

5608

..

45.00

5.00

5874

..

38.00

5.00

5609

..

56.00

5.00

5877

..

4.00

2.00

5615

..

50.50

5.00

5880

..

4.00

1.00

5617

..

64.00

5.00

5882

..

1.50

2.00

5621

..

63.00

5.00

5884

..

9.00

3.00

5623

..

95.00

5.00

5886

..

31.00

5.00

5629

..

68.00

5.00

5890

..

9.50

3.00

5633

..

68.00

5.00

5893

..

1.85

.80

5638

..

35.00

5.00

5895

..

6.20

1.50

5639

..

45.00

5.00

5898

..

16.50

4.00

5643

..

35.00

5.00

5900

..

18.00

5.00

5645

..

45.00

5.00

5902

..

6.20

1.50

5650

..

49.00

5.00

5904

..

115.00

5.00


Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

5907

..

75.00

5.00

6171

..

48.00

5.00

5913

..

5.20

1.50

6174

..

105.00

5.00

5914

..

16.00

5.00

6178

..

85.00

5.00

5917

..

9.00

3.00

6183

..

51.00

5.00

5921

..

22.00

5.00

6188

..

31.00

5.00

5923

..

60.00

5 00

6193

..

165.00

5.00

5925

..

54.00

5.00

6200

..

165.00

5.00

5932

..

38.00

5.00

6206

..

240.00

5.00

5934

..

100.00

5.00

6210

..

165.00

5.00

5939

..

44.00

5.00

6213

..

190.00

5.00

5942

..

25.00

5.00

6250

..

1.85

.80

5944

..

23.00

5.00

6254

..

4.70

1.50

5950

..

54.00

5.00

6257

..

5.70

1.50

5952

..

67.00

5.00

6260

..

21.00

5.00

5955

..

59.00

5.00

6264

..

23.00

5.00

5957

..

45.00

5.00

6266

..

6.20

1.50

5961

..

28.00

5.00

6268

..

7.10

2.00

5965

..

45.00

5.00

6270

..

6.60

1.50

5970

..

90.00

5.00

6273

..

15.00

4.00

5974

..

23.00

5.00

6275

..

9.50

3.00

5978

..

75.00

5.00

6276

..

12.00

3.00

5982

..

100.00

5.00

6281

..

16.00

4.00

5987

..

28.00

5 00

6282

..

19.50

5.00

5991

..

12.50

4.00

6287

..

36.00

5.00

5995

..

49.00

5.00

6288

..

36.00

5.00

5999

..

75.00

5 00

6293

..

40.00

5.00

6004

..

7.30

2.00

6294

..

40.00

5.00

6006

..

5.90

1.50

6298

..

73.00

5.00

6009

..

37.00

5.00

6301

..

35.00

5.00

6011

..

44.00

5.00

6304

..

14.50

4.00

6014

..

53.00

5.00

6305

..

18.00

5.00

6018

..

29.00

5.00

6312

..

35.00

5.00

6020

..

33.00

5 00

6317

..

61.00

5.00

6026

..

32.00

5.00

6319

..

100.00

5.00

6031

..

33.00

5.00

6323

..

31.00

5.00

6051

..

5.70

1.50

6329

..

12.00

5.00

6055

..

8.20

3.00

6330

..

16.00

5.00

6059

..

7.30

2 00

6334

..

18.00

5.00

6063

..

3.70

1.00

6339

..

38.00

5.00

6067

..

8.20

3.00

6341

..

85.00

5.00

6071

..

39.00

5.00

6346

..

120.00

5.00

6074

..

78.00

5.00

6351

..

210.00

5.00

6076

..

115.00

5.00

6356

..

31.00

5.00

6080

..

85.00

5.00

6357

..

39.00

5.00

6082

..

115.00

5.00

6362

..

90.00

5.00

6085

..

60.00

5.00

6369

..

48.00

5.00

6087

..

34.00

5.00

6370

..

61.00

5.00

6091

..

105.00

5.00

6375

..

63.00

5.00

6093

..

22.00

5.00

6376

..

80.00

5.00

6096

..

7.60

2.00

6380

..

90.00

5.00

6103

..

14.00

4.00

6185

..

90.00

5.00

6106

..

115.00

5.00

6390

..

75.00

5.00

6111

..

85.00

5.00

6394

..

67.00

5.00

6117

..

115.00

5.00

6395

..

210.00

5.00

6121

..

115.00

5.00

6399

..

110.06

5.00

6125

..

145 00

5.00

6405

..

54.0.0

5.00

6129

..

51.00

5.00

6408

..

61.00

5.00

6134

..

34.00

5.00

6411

..

120.00

5.00

6139

..

24.00

5.00

6421

..

39.00

5.00

6145

..

85.00

5.00

6429

..

61.00

5.00

6150

..

39.00

5.00

6433

..

75.00

5.00

6153

..

85.00

5.00

6440

..

210.00

5.00

6156

..

115.00

5.00

6444

..

120.00

5.00

6161

..

34.00

4.00

6450

..

90.00

5.00

6168

..

20.00

5.00

6457

..

82.00

5.00


Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

 

Fund medical benefit

Specified excess

 

$

$

 

 

$

$

6461

..

82.00

5.00

 

..

dislocation concerned, plus one-half of that amount

dislocation concerned, plus one-half of that amount

6466

..

82.00

5.00

 

..

6474

..

85.00

5.00

 

..

6479

..

105.00

5.00

 

..

6484

..

90.00

5.00

6675

..

3.60

1.00

6490

..

47.00

5.00

6678

..

7.60

2.00

6492

..

47.00

5.00

6679

..

10.50

3.00

6500

..

81.00

5.00

6682

..

5.20

1.50

6504

..

60.00

5.00

6684

..

10.50

3.00

6511

..

54.00

5.00

6685

..

14.50

4.00

6540

..

3.90

1.00

6689

..

12.00

3.00

6541

..

3.90

1.00

6690

..

16.50

5.00

6547

..

2.40

1.00

6693

..

5.90

1.50

6548

..

2.40

1.00

6695

..

10.50

3.00

6556

..

6.40

1.50

6696

..

12.00

4.00

6560

..

7.30

2.00

6710

..

13.00

4.00

6565

..

6.40

1.50

6711

..

19.00

5.00

6573

..

S.00

1.50

6716

..

10.50

3.00

6579

..

8.00

3.00

6720

..

11.50

3.00

6583

..

5.90

1.50

6721

..

11.50

4.00

6588

..

11.00

3.00

6725

..

11.00

3.00

6589

..

13.50

4.00

6726

..

13.00

4.00

6597

..

2.40

1.00

6731

..

14.50

4.00

6603

..

7.30

2.00

6732

..

16.00

5.00

6608

..

17.00

5.00

6733

..

14.50

4.00

6609

..

23.00

5.00

6734

..

16.00

5.00

6616

..

12.50

4.00

6737

..

8.00

2.00

6617

..

16.50

4.00

6738

..

7.50

3.00

6630

..

5.90

1.50

6745

..

9.00

3.00

6635

..

9.00

3.00

6749

..

1.85

.80

6640

..

2.90

1.00

6750

..

2.60

1.00

6644

..

7.30

2.00

6755

..

13.50

4.00

6649

..

21.00

5.00

6756

..

18.00

5.00

6653

..

21.00

5.00

6759

..

10.50

3.00

6657

..

The amount shown in this column in the item other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the dislocation concerned, plus one-half of that amount

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the dislocation concerned, plus one-half of that amount

6760

..

13.50

4.00

 

 

6763

..

33.00

5.00

6764

..

45.00

5.00

6769

..

8.80

2.00

6770

..

9.50

3.00

6775

..

8.00

3.00

6776

..

12.50

4.00

6779

..

21.00

5.00

6780

..

28.00

5.00

6783

..

21.00

5.00

6784

..

28.00

5.00

6787

..

21.00

5.00

6788

..

28.00

5.00

6793

..

7.80

2.00

6794

..

10.50

3.00

6797

..

3.10

1.00

6801

..

5.00

1.50

6803

..

7.60

2.00

6658

..

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the

6808

..

7.60

2.00

 

 

6812

..

1.85

.80

6813

..

2.60

1.00

6825

..

1.85

.80

6826

..

2.60

1.00

6829

..

7.00

3.00

6830

..

7.00

4.00

6834

..

40.00

5.00

6838

..

8.20

3.00

6839

..

11.50

3.00

6840

..

11.50

3 00

6844

..

26.00

5.00

6845

..

26.00

5.00


Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

6850

..

28.00

5.00

 

 

Benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

6851

..

28.00

5.00

6854

..

10.50

3.00

6855

..

13.50

4.00

6856

..

13.50

4.00

6862

..

35.00

5.00

6863

..

35.00

5.00

6866

..

33.00

5.00

6867

..

38.00

5.00

6916

..

The amount shown m this column in the item (being an item relating to an item in the table of Common

The amount shown in this column in the item being an item relating to an item in the table of Common

6875

..

9.00

3.00

 

 

6876

..

.12.00

4.00

6877

..

12.00

4.00

6382

..

1.85

.80

6883

..

2.60

1.00

6887

..

1.85

.80

6888

..

2.60

1.00

6893

..

16.50

4.00

wealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

wealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

6895

..

28.00

5.00

6897

..

75.00

5.00

6910

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-third of (hat amount

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-third of that amount

 

 

 

..

6919

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

The amount shown in this column in the item relating to the fracture concerned, plus one-half of that amount

 

 

 

6911

..

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned1, plus one-third of that amount

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-third of that amount

 

 

 

..

6920

..

The amount shown in this column in the item (being an item relating to an item in. the table of Commonwealth medical benefits that includes the symbol ‘(D)') relating to the fracture concerned, plus one-half of that amount

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that induces the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

 

 

6915

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical

 

..

6925

..

The amount shown in this column in the item (other

The amount shown in this column in the item (other

 

 


Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

table of Commonwealth medical benefits apply to the reduction concerned

Commonwealth medical benefits apply to the reduction concerned

6943

..

One-half of the amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth: medical benefits that includes the symbol ‘(D)’) that would, but for item 6943 in the table of Commonwealth medical benefits apply to the reduction concerned

One-half of the amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6943 in the table of Commonwealth medical benefits apply to the reduction concerned

 

 

6926

..

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

The amount shown in this column, in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

 

 

6944

..

One-half of the amount shown in this column in the item that would, but for item 6944 in the table of Commonwealth medical benefits apply to the reduction concerned

One-half of the amount shown in this column in the item that would, but for item 6944 in the fable of Commonwealth medical benefits apply to the reduction concerned

 

 

6935

..

One-half of the amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6935 in the table of Commonwealth medical benefits apply to the reduction concerned

One-half of the amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)") that would, but for item 6935 in the table of Commonwealth medical benefits apply to the reduction concerned

 

 

6950

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6950 in the table of Commonwealth medical

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol‘(D)') that would, but for item 6950 in the table of Commonwealth medical benefits apply

 

 

5936

..

One-half of the amount shown in this column in the item that would but for item 6936 m the

One-half of the amount shown in this column in the item that would, but for item 6936 in the table of

 

 


 

Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

$

$

 

 

benefits apply to the reduction concerned

to the reduction concerned

7000

..

22.00

5.00

7004

..

22.00

5.00

7007

..

1.50

1.00

7009

..

2.40

1.00

7012

..

6.20

1.50

6951

..

The amount shown in this column in the item that would, but for item 6951 in the table of Commonwealth medical benefits apply to the reduction concerned

The amount shown in this column in the item that would, but for item 6951 in the table of Commonwealth medical benefits apply to the reduction concerned

7017

..

5.50

3.00

 

 

7058

..

7.50

3.00

7024

..

9.50

3.00

7026

..

9.50

3.00

7030

..

85.00

5.00

7034

..

30.00

5.00

7036

..

30.00

5.00

7039

..

8.50

3.00

7040

..

11.00

3.00

7049

..

7.50

3.00

7053

..

8.50

3.00

7059

..

14.00

4.00

7064

..

24.00

5.00

6956

..

The amount shown in this column in the item that would apply in the case of a simple and uncomplicated fracture of the part concerned

The amount shown in this column in the item that would apply in the case of a simple and uncomplicated fracture of the part concerned

7071

..

24.00

5.00

7077

..

130.00

5 00

 

 

7083

..

42.00

500

7086

..

27.00

5.00

7090

..

61.00

5.00

7094

..

110.00

5 00

7102

..

95.00

5.00

7110

..

120.00

5.00

7115

..

110.00

5.00

7119

..

145.00

5.00

7123

..

105.00

5.00

6960

..

The amount shown in this column in the item (other than an item relating to an. item in the table of Commonwealth, medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

7127

..

145.00

5.00

 

 

7131

..

73.00

5.00

7137

..

56.00

5.00

7142

..

73.00

5.00

7144

..

73.00

5.00

7147

..

52.00

5.00

7150

..

47.00

5.00

7168

..

42.00

5.00

7169

..

45.00

5.00

7174

..

22.00

5.00

7179

..

24.00

5.00

7183

..

66.00

5.00

7187

..

78.00

5.00

7191

..

11.00

5.00

7196

..

7.60

2.00

7201

..

39.00

5.00

7207

..

44.00

5.00

7211

..

39.00

5.00

7215

..

27.00

5.00

6961

..

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

7219

..

105.00

5.00

 

 

7229

..

70.00

5.00

7235

..

70.00

5.00

7239

..

90.00

5.00

7243

..

130.00

5.00

7247

..

52.00

5.00

7254

..

70.00

5.00

7258

..

34.00

5.00

7264

..

17.00

5.00

7267

..

52.00

5.00

7269

..

52.00

5.00

7272

..

39.00

5.50

7276

..

37.00

5.00

7277

..

47.00

5.00

7281

..

56.00

5.00

7286

..

2.60

1.00

7288

..

2.80

1.00


Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

7294

..

34.00

5.00

7507

..

44.00

5.00

7296

..

52.00

5.00

7511

..

44.00

5.00

7299

..

30.00

5.00

7515

..

41.00

5.00

7302

..

17.00

5.00

7518

..

47.00

5.00

7303

..

22.00

5.00

7522

..

47.00

5.00

7308

..

29.00

5.00

7525

..

34.00

5.00

7311

..

41.00

5.00

7526

..

47.00

5.00

7317

..

28.75

5.00

7555

..

6.50

3.00

7320

..

36.75

5.00

7558

..

4.10

1.00

7322

..

43.00

5.00

7562

..

4.80

1.50

7327

..

17.00

5.00

7564

..

4.10

1.00

7330

..

22.00

5.00

7568

..

5.20

1.50

7335

..

52.00

5.00

7571

..

4.10

1.00

7337

..

39.00

5.00

7574

..

6.40

1.50

7345

..

30.00

5.00

7576

..

4.10

1.00

7347

..

17.00

5.00

7579

..

7.60

2.00

7349

..

22.00

5.00

7583

..

19.00

5.00

7350

..

22.00

5.00

7587

..

4.10

1.00

7357

..

21.00

5.00

7589

..

6.40

1.50

7358

..

27.00

5.00

7592

..

6.40

1.50

7362

..

18.00

5.00

7595

..

6.60

2.00

7366

..

24.00

5.00

7600

..

68.00

5.00

7369

..

24.00

5.00

7604

..

78.00

5.00

7371

..

30.00

5.00

7612

..

78.00

5.00

7375

..

34.00

5.00

7614

..

78.00

5.00

7379

..

56.00

5.00

7617

..

39.00

5.00

7383

..

85.00

5.00

7621

..

61.00

5.00

7385

..

47.00

5.00

7623

..

61.00

5.00

7388

..

56.00

5.00

7628

..

87.00

5.00

7393

..

54.00

5.00

7633

..

78.00

5.00

7398

..

56.00

5.00

7636

..

78.00

5.00

7403

..

12.50

4.00

7639

..

75.00

5.00

7405

..

27.00

5.00

7645

..

17.00

5 00

7414

..

23.00

5.00

7648

..

39.00

5.00

7415

..

30.00

5.00

7651

..

30.00

5.00

7418

..

34.00

5.00

7656

..

95.00

5.00

7421

..

11.50

3.00

7660

..

95.00

5.00

7422

..

14.00

4.00

7663

..

61.00

5.00

7425

..

22.00

5.00

7669

..

52.00

5.00

7428

..

29.00

5.00

7675

..

61.00

5.00

7429

..

37.00

5.00

7679

..

78.00

5.00

7433

..

9.50

3.00

7686

..

39.00

5.00

7437

..

14.00

4.00

7689

..

52.00

5 00

7439

..

8.50

3.00

7692

..

78.00

5.00

7441

..

22.00

5.00

7695

..

30.00

5.00

7445

..

42.00

5.00

7699

..

52.00

5.00

7447

..

115.00

5.00

7702

..

30.00

5.00

7449

..

56.00

5.00

7705

..

78.00

5.00

7452

..

24.00

5.00

7710

..

9.50

3.00

7455

..

13.50

4.00

7713

..

61.00

5 00

7456

..

17.00

5.00

7716

..

45.00

5.00

7460

..

17.00

5.00

7719

..

42.00

5.00

7465

..

19.00

5.00

7722

..

24.00

5.00

7469

..

30.00

5.00

7725

..

9.50

3.00

7475

..

14.00

4.00

7728

..

13.50

4.00

7479

..

37.00

5.00

7729

..

17.50

5.00

7481

..

34.00

5.00

7733

..

39.00

5.00

7484

..

56.00

5.00

7736

..

9.50

3.00

7487

..

70.00

5.00

7740

..

47.00

5.00

7491

..

95.00

5.00

7742

..

45.00

5 00

7493

..

70.00

5.00

7746

..

56.00

5.00

7496

..

34.00

5.00

7748

..

87.00

5 00

7500

..

34.00

5.00

7752

..

61.00

5 00

7501

..

47.00

5.00

7755

..

8.30

2.00

7504

..

47.00

5.00

7759

..

5.20

1.50


Schedule 5—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

7780

..

39.00

5.00

7963

..

59.00

5.00

7784

..

13.50

4.00

7964

..

59.00

5.00

7786

..

32.00

5.00

7971

..

49.00

5.00

7790

..

3.70

1 00

7972

..

49.00

5.00

7794

..

3.90

1.00

7979

..

49.00

5.00

7796

..

3.90

1.00

7980

..

49.00

5.00

7800

..

5.50

3.00

7991

..

68.00

5.00

7801

..

5.50

3.00

7995

..

39.00

5.00

7805

..

12.00

4.00

7996

..

39.00

5.00

7806

..

12.00

4.00

8004

..

42.00

5.00

7811

..

16.50

5.00

8005

..

42.00

5.00

7813

..

26 00

5.00

8012

..

49.00

5.00

7816

..

47.00

5.00

8013

..

49.00

5.00

7819

..

66.00

5.00

8025

..

49.00

5.00

7822

..

39.00

5.00

8030

..

22.00

5.00

7825

..

22.00

5.00

8034

..

46.00

5.00

7826

..

22.00

5.00

8039

..

26.00

5.00

7829

..

34.00

5.00

8043

..

26.00

5.00

7833

..

39.00

5.00

8047

..

39.00

5.00

7837

..

18.00

5.00

8052

..

42.00

5.00

7842

..

20.00

5.00

8056

..

49.00

5.00

7846

..

9.00

3.00

8064

..

71.50

5.00

7851

..

36.00

5.00

8068

..

110.00

5.00

7856

..

18.00

5.00

8073

..

11.50

3.00

7859

..

39.00

5.00

8078

..

28.00

5.00

7865

..

30.00

5.00

8082

..

28.00

5.00

7871

..

20.00

5.00

8086

..

45.00

5.00

7875

..

16.50

4.00

8090

..

15.00

4.00

7876

..

16.50

4.00

8094

..

59.00

5.00

7879

..

34.00

5.00

8098

..

44.00

5.00

7882

..

59.00

5.00

8102

..

12.00

4.00

7886

..

22.00

5.00

8107

..

54.00

5.00

7887

..

22.00

5.00

8112

..

73.00

5.00

7890

..

49.00

5.00

8117

..

28.00

5.00

7894

..

39.00

5.00

8121

..

21.00

5.00

7895

..

39.00

5.00

8125

..

42.00

5.00

7899

..

63.00

5.00

8129

..

100.00

5.00

7903

..

75.00

5.00

8133

..

28.00

5.00

7906

..

63.00

5.00

8137

..

54.00

5.00

7910

..

75.00

5.00

8138

..

54.00

5.00

7914

..

8.00

3.00

8146

..

68.00

5.00

7918

..

16.50

5 00

8147

..

68.00

5.00

7922

..

40.00

5.00

8155

..

34.00

5.00

7930

..

78.00

5.00

8156

..

34.00

5.00

7935

..

26.00

5.00

8164

..

49.00

5.00

7939

..

61.00

5.00

8165

..

49.00

5.00

7944

..

70.00

5.00

8171

..

49.00

5.00

7948

..

115.00

5.00

8172

..

49.00

5.00

7955

..

40.00

5.00

8177

..

63.00

5.00

7959

..

75.00

5.00

 

 

 

 


Schedule 6

Regulation 5

TABLE OF FUND MEDICAL BENEFITS IN RESPECT OF WESTERN AUSTRALIA

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

1

..

1.25

.80

274

 

6.20

1.50

2

..

2.55

1.10

277

..

6.20

1.50

10

..

1.85

.80

280

..

10.40

3.00

12

..

3.00

1.30

282

..

6

1.50

21

..

3.50

1.60

285

..

23.00

5.00

24

..

4.70

2.10

285

..

5.80

1.50

29

..

5.30

2.40

292

..

26.00

5.00

31

..

6.50

2.90

294

..

6.20

1.50

36

..

1.85

1.20

296

..

11.60

3.00

41

..

3.30

1.40

300

..

.70

.80

47

..

2.80

1.20

303

..

2.00

1.00

49

..

3.95

1.70

304

..

3.10

1.00

55

..

4.90

2.10

307

..

4.20

1.50

56

..

6.05

2.60

308

..

5.30

1.50

61

..

6.75

3.00

311

..

6 20

1.50

62

..

7.90

3.00

312

..

7.40

1.50

63

..

2.80

1.20

314

..

7 30

2.00

64

..

3.95

1.70

315

..

9.00

3.00

67

..

1.85

.80

316

..

9.50

3.00

68

..

1.25

.80

318

..

11.00

3.00

74

..

1.85

.80

319

..

11.50

4.00

76

..

2.80

1.00

320

..

13.00

4.00

80

..

7.40

1 50

324

..

15.00

4.00

83

..

3.50

1.00

325

..

15.00

5.00

86

..

30.90

2.00

 

..

 

 

89

..

7.20

1.50

326

..

17.00

5.00

92

..

3.50

1 00

327

..

17.00

5.00

95

..

7.40

1.50

328

..

19.00

5.00

98

..

11.00

2.00

329

..

20.00

5.00

101

..

14.00

3.00

330

..

21.00

5.00

104

..

17.50

4.00

331

..

22.00

5.00

109

..

7.20

1.50

332

..

23.00

5 00

112

..

10.90

2.00

333

..

24.00

5.00

115

..

13.90

3.00

334

..

26.00

5.00

118

..

17.00

4.00

335

..

26.00

5.00

121

..

21.50

4.00

336

..

28.00

5.00

124

..

11.60

2.00

337

..

28.00

5.00

127

..

17.60

4.00

338

..

30.00

5.00

129

..

24 50

4.00

339

..

31 00

5.00

131

..

32.50

5.00

343

..

33.00

5.00

133

..

39.50

5.00

346

..

37.00

5.00

203

..

1.85

.80

349

..

39.00

5.00

206

..

19.50

5.00

350

..

42.00

5.00

208

..

14.00

4.00

353

..

2.60

1.00

212

..

15.00

5.00

356

..

6.20

2.00

218

223

224

226

227

237

238

239

240

245

248

253

254

257

262

269

272

..

..

..

..

..

..

..

..

..
..
..
..

..
..
..
..
..

18.00

26.00

30.00

32.50

37.00

42.00

47 00

47 00

55.00

1.25

1.25

15.00

20.50

6.20

1.25

5.60

8.50

5 00

5.00

5 00

5.00

5.00

5.00

5.00

5.00

5.00

.80

.80

4.00

5.00

1.50

.80

1.50

2.00

359

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned, plus one-half of that amount

 

 

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned, plus one-half of that amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

363

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-third of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-third of that amount

 

item relating to the administration of an anaesthetic in connection with the treatment of the part concerned

item relating to the administration of an anaesthetic in connection with the treatment of the part concerned

 

 

410

..

1.00

.80

411

..

2.50

1.00

412

..

3.90

1.00

413

..

5.10

1.50

414

..

6.50

2.00

366

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned pins one-half of that amount

The amount shown i3i this column in the item relating to the administration of an anaesthetic in connection with the treatment of she fracture concerned pins one-half of that amount

455

..

7.90

2.00

416

..

7.50

3.00

 

 

417

..

9.00

3.00

418

..

10.50

3.00

419

..

12.00

4.00

420

..

13.50

4.00

421

..

14.50

4.00

422

..

15.50

5.00

423

..

17.00

5.00

424

..

18.00

5.00

425

..

20.00

5.00

426

..

21.00

5.00

427

..

22.00

5.00

423

..

23.00

5.00

429

..

25.00

5.00

431

..

26.00

5.00

432

..

27.00

5.00

369

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus three-quarters of that amount

The amount shown in this column in the item relating to the administration. of an anaesthetic in connection with the treatment of the fracture concerned plus three-quarters of that amount

433

..

29.00

5.00

 

 

434

..

30.00

5.00

437

..

31.00

5.00

438

..

32.00

5.00

439

..

34.00

5.00

440

..

35.00

5.00

441

..

37.00

5.00

442

..

38.00

5.00

444

..

42.00

5.00

445

..

46 00

5.00

446

..

53.00

5.00

447

..

50.00

5.00

448

..

3.30

1.00

449

..

7.90

2.00

373

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

453

 

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

 

 

377

..

The amount shown in this column in the

The amount shown in this column in the

 


Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

457

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with, the treatment of the fracture concerned plus one-third of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-third of that amount

 

item relating to the administration of an anaesthetic in connection with the treatment of the part concerned

item relating to the administration of an anaesthetic in connection with the treatment of the part concerned

 

 

503

..

4.20

1.50

504

..

5.10

1.50

507

..

5.30

1.50

505

..

6.50

2.00

511

..

7.30

3.00

512

..

9.00

3.00

459

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-half of that amount

515

..

6.20

2.00

 

 

516

..

7.90

2.00

519

..

9.50

3.00

520

..

12.00

4.00

530

..

7.70

2.00

532

..

5.60

1.50

534

..

5.80

1.50

536

..

7.00

2.00

555

..

10.00

3.00

503

..

6.90

1.50

605

..

14.10

3.00

607

..

22.50

5.00

609

..

8.70

2.00

612

..

20.00

4.00

615

..

29.00

5.00

620

..

8.70

2.00

463

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus three- quarters of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus three- quarters of that amount

622

..

18.50

4.00

624

..

13.40

3.00

 

 

628

..

16.60

4.00

633

..

22.50

5.00

635

..

10.60

2.00

637

..

8.70

2.00

650

..

42.00

5.00

653

..

20.00

4.00

655

..

6. 80

1.50

658

..

30.00

5.00

663

..

54.00

5.00

666

..

22.50

5.00

669

..

13.40

3.00

671

..

8.00

1.50

675

..

5.40

1.50

678

..

4.30

1.00

683

..

10 90

3.00

466

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

The amount shown in the column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

686

..

7.70

1.50

 

 

690

..

14.10

3.00

700

..

2.60

.80

706

..

4.00

1.00

718

..

5.40

1.00

722

..

6.80

1.50

726

..

4.70

1.00

732

..

4.70

1.00

735

..

5.80

1.50

740

..

5.30

1.00

743

..

4.90

1.00

745

..

11.00

2 00

750

..

5.80

1.50

469

..

The amount shown in this column in the

The amount shown in this column in the

758

..

8.70

2.00

762

..

5.80

1.50

765

..

35.00

5.00



Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

768

..

29.00

5.00

1072

..

2.70

1.00

773

..

2.70

1.00

1074

..

7.60

3.00

775

..

5.30

1.00

1076

..

.90

.80

775

..

8.70

2.00

1080

..

.70

.80

785

..

17.00

4.00

1082

..

2.30

1.00

788

..

4.40

1.00

1084

..

3.80

3.00

792

..

14.10

3.00

1090

..

1.60

.80

795

..

48.00

5.00

1091

..

2.50

1.00

798

..

70.00

5.00

1092

..

1.90

1.00

802

..

10.90

3.00

1094

..

1.90

1.00

805

..

3.80

1.00

1096

..

.90

.80

808

..

6.40

1.50

1098

..

1.30

.80

811

..

6.40

1.50

1100

..

1.50

1.00

813

..

9.00

2.00

1102

..

3.50

1.00

817

..

13.40

3.00

1104

..

.20

.80

820

..

13.40

3.00

1106

..

1.60

.80

823

..

12.20

3.00

1108

..

1.50

1.00

826

..

8.70

2.00

1110

..

3.30

1.50

830

..

23.50

5.00

1112

..

.20

.80

834

..

5.30

1.00

1114

..

.20

.80

837

..

11.50

3.00

1116

..

2.60

1.50

842

..

1.60

.80

1118

..

1.10

.80

848

..

2.10

.80

1120

..

4.80

1.50

852

..

3.60

1.00

1122

..

.40

.80

8S5

..

5.60

1.00

1124

..

1.90

1.00

858

..

3.50

1.00

1126

..

2.30

1.00

862

..

10.30

2.00

1128

..

.70

.80

869

..

18.50

4.00

1130

..

3.10

1.00

873

..

38.00

5.00

1132

..

1.90

1.00

876

..

6.40

1.50

1134

..

3.10

1.00

1000

..

.20

.80

1136

..

4.80

1.50

1002

..

.70

.80

1138

..

1.60

.80

1004

..

.20

.80

1140

..

1.70

1.00

1006

..

.90

.80

1142

..

1.40

1.00

1008

..

.20

.80

1144

..

1.10

.80

1010

..

.60

.80

1146

..

1.10

.80

1012

..

3.00

1.00

1148

..

1.70

1.00

1014

..

1.40

1.00

1150

..

2.80

1.50

1016

..

3.60

1.00

1152

..

2.70

1.00

1018

..

3.80

1.50

1154

..

2.30

1.00

1019

..

.70

.80

1156

..

2.30

1.00

1020

..

5.70

3.00

1160

..

.70

1.00

1022

..

.20

.80

1162

..

.60

1.00

1024

..

.70

.80

1166

..

2.00

1.00

1026

..

.70

.80

1168

..

.50

1.00

1028

..

1.70

1.00

1170

..

3.40

1.50

1030

..

1.60

1.00

1172

..

.90

.80

1032

..

1.70

1 00

1174

..

1.60

.80

1034

..

1.90

1.00

1178

..

1.00

.80

1036

..

2.70

1.00

1180

..

.10

.80

1038

..

3.10

1.00

1182

..

.20

.80

3040

..

3.10

1.00

1184

..

1.70

1.00

1042

..

.40

.80

1186

..

.70

.80

1044

..

4.00

1.50

1188

..

1.90

1.00

1046

..

1.40

.80

1190

..

2.70

1.00

1048

..

5.60

1.50

1192

..

.70

1.00

1050

..

1.00

5.00

1194

..

.70

1.00

1054

..

.20

.80

1196

..

2.70

1.00

1060

..

.20

.80

1198

..

.70

1.00

1062

..

1.10

.80

1200

..

.20

.80

1063

..

.40

.80

1202

..

.40

1.00

1064

..

.70

.80

1204

..

.60

.80

1066

..

2.30

1.00

1206

..

2.10

1.00

1968

..

1.00

1.00

1208

..

1.70

1.00

1070

..

1.30

1.00

1210

..

.70

1.00


Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

 

$

$

1212

..

1.50

1.00

1388

..

2.80

1.50

1214

..

.20

.80

1389

..

4.30

1.50

1216

..

.30

.80

1391

..

2.00

1.00

1218

..

3.50

1.00

1392

..

3.30

1.50

1220

..

5.00

1.50

1394

..

4.00

2.00

1222

..

5.00

1.50

1395

..

.40

.80

1224

..

6.80

3.00

1397

..

1.90

1.00

1226

..

8.80

3.00

1399

..

.70

.80

1228

..

3.50

1.00

1401

..

1.90

1.00

1230

..

5.00

1.50

1404

..

.20

.80

1232

..

.40

.80

1407

..

.40

.80

1240

..

1 90

1.00

1410

..

1.60

.80

1242

..

3.10

1.00

1413

..

1.60

.80

1246

..

5.00

1.50

1416

..

2.60

1.00

1248

..

.20

.80

1419

..

1.90

1.00

1250

..

.70

1.00

1421

..

2.30

1.00

1252

..

2.80

1.50

1423

..

1.00

.80

1254

..

4.70

1.50

1425

..

4.00

1.50

1256

..

5.80

2.00

1428

..

1.30

1.00

1258

..

6.40

3.00

1430

..

5.00

1.50

1260

..

2.70

1.00

1432

..

8.80

3.00

1262

..

4.40

1.50

1434

..

2.70

1.00

1264

..

.70

1.00

1436

..

3.10

1.00

1266

..

2.80

1.50

1438

..

8.80

3.00

1268

..

4.70

1.50

1441

..

3.30

1.00

1270

..

5.80

2.00

1444

..

.40

.80

1272

..

2.00

1.00

1447

..

5.00

1.50

1274

..

8.80

3.00

1450

..

3.40

1.50

1277

..

1.90

1.00

1453

..

.40

.80

1278

..

.70

1.00

1456

..

2.50

1.00

1280

..

2.80

1.50

1459

..

.70

1.00

1282

..

4.70

1.50

1461

..

2.80

1.50

1284

..

5 80

2.00

1463

..

4.70

1.50

1286

..

6.40

3.00

1466

..

5.80

2.00

1288

..

4.00

1.50

1468

..

.20

80

1290

..

3.10

1.50

1470

..

1.70

1.00

1294

..

.70

1.00

1472

..

4.00

1.50

1296

..

1.60

.80

1474

..

8.80

3.00

1298

..

2.80

1.00

1475

..

7.00

3.00

1301

..

.70

1.00

1476

..

1.70

1.00

1302

..

2.80

1.50

1478

..

2.30

1.00

1304

..

4.70

1.50

1481

..

3.30

1.00

1305

..

5.80

2.00

1484

..

6.80

3.00

1307

..

6.40

3.00

1487

..

1.70

1.00

1310

..

.70

1.00

1490

..

1.70

1.00

1313

..

1.90

1.00

1491

..

.20

.80

1314

..

.50

.80

1493

..

6.80

3.00

1317

..

.20

.50

1494

..

8.80

3.00

1319

..

3.10

1.50

1495

..

.90

.80

1322

..

.20

.80

1496

..

1.60

.80

1325

..

.40

80

1497

..

3.40

1.50

1328

..

1.60

.80

1499

..

3.50

1.00

1331

..

2.50

1.00

1500

..

.20

.80

1334

..

1.10

1.00

1502

..

.20

.80

1337

..

3.20

1.50

1504

..

.20

.80

1340

..

5.00

2.00

1506

..

1.30

1.00

1343

..

1.70

1.00

1508

..

.20

.80

1346

..

6.80

3.00

1511

..

1.90

1.00

1349

..

3.30

1.00

1513

..

1.60

.80

1352

..

3.50

1.00

1515

..

.40

1.00

1355

..

2.00

1.00

1517

..

1.20

1.00'

1358

..

1.00

.80

1519

..

2.50

1.00

1380

..

.20

.80

1521

..

2.50

1.50

1382

..

.20

.80

1523

..

3.50

1.50

1385

..

.70

1.00

1525

..

1.90

1.00


Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

1527

..

4.00

1.50

1706

..

1.60

.80

1529

..

2.30

1.00

1707

..

2.60

1.00

1531

..

4.40

1.50

1710

..

.70

.80

1534

..

1.60

.80

1712

..

.40

.80

1537

..

2.60

1. 00

17!4

..

.40

.80

1539

..

2.30

1.00

1716

..

.90

80

1541

..

1.90

1.00

1718

..

2.00

1.00

1543

..

1.00

.80

1720

..

4.00

2.00

1545

..

.20

.80

1722

..

5.10

3.00

1546

..

1.50

3 00

1724

..

1.90

1.00

1548

..

2.80

1.50

1726

..

4.00

1.50

1551

..

2.00

1.00

1728

..

5.80

2.00

1554

..

2.90

1.50

1730

..

4.00

1.50

1557

..

3.50

2.00

1732

..

.20

.80

1560

..

2.90

1.50

1734

..

.20

.80

1562

..

3.80

1.50

1736

..

6.80

3.00

1564

..

4.40

2.00

1738

..

90

.80

1566

..

4.90

2.00

1741

..

.70

1.00

1568

..

5.00

3.00

1744

..

.90

.80

1571

..

1.30

1.00

1746

..

.70

1.00

1580

..

1.90

1.00

1743

..

.70

1.00

1582

..

1.30

.80

1761

..

.90

.80

1584

..

3.50

1.00

1764

..

1.70

1.00

1586

..

.20

.80

1767

..

.90

.80

1588

..

.70

1.00

1770

..

.70

1.00

1590

..

2.70

1.00

1773

..

3.10

1.00

1601

..

.70

1.00

1776

..

4.80

1.50

1604

..

2.80

1.50

1719

..

.20

80

1607

..

4.70

1.50

1782

..

.20

.80

1609

..

5.80

2.00

1785

..

.20

.80

1611

..

1.00

1 00

1790

..

1.90

1.00

1613

..

3.30

1.00

1792

..

1.60

.80

1615

..

2.50

1.00

1794

..

4.00

1.00

1616

..

3.50

1.00

1621

..

.40

.80

1796

..

4.00

1.50

1622

..

.20

.80

1798

..

1.90

1.00

1623

..

1.00

.80

1800

..

1.10

.80

1625

..

1.10

.80

1802

..

3.20

1.00

1627

..

2.70

1.00

1804

..

4.80

1.50

1629

..

2.30

1.00

1806

..

.40

.80

1633

..

1.60

.80

1808

..

1.30

1.50

1640

..

5.60

1.50

1810

..

.40

.80

1643

..

2.90

1.00

1812

..

.40

.80

1645

..

2.90

1.00

1820

..

2.80

1.50

1647

..

8.80

3.00

1822

..

5.00

2.00

1649

..

7.00

2.00

1824

..

6.40

3.00

1651

..

8.80

3.00

1826

..

4 40

3.00

1653

..

4.00

1.50

1828

..

7.40

3.00

1661

..

.20

.80

1840

..

12.40

4.00

1664

..

5.80

2.00

1841

..

16.00

5.00

1667

..

.70

1.00

1843

..

3.10

1.50

1670

..

2.70

1.00

1846

..

4.00

1.50

1673

..

3.50

1.00

1849

..

2.50

1.00

1680

..

.20

.80

1850

..

2.80

1.50

1682

..

.20

.80

1852

..

2.80

1.50

1684

..

.40

.80

1853

..

7.00

3.00

1686

..

1.10

.80

1855

..

4.30

1.50

1688

..

1.90

1.00

1858

..

5.00

2.00

1691

..

1.90

1.00

1861

..

2.20

1.50

1694

..

1.30

1.00

1863

..

5.80

2.00

1697

..

1.80

1.00

1865

..

14.00

5.00

1698

..

3.30

1.50

1867

..

3.10

1.50

1700

..

3.90

1.00

1869

..

4.80

1.50

1701

..

5.10

2.00

1871

..

6.80

3.00

1703

..

1.90

1.00

1873

..

14.00

5.00


Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

1875

..

5.80

2.00

2039

..

4.00

1.50

1877

..

5.80

2.00

2046

..

4.50

1.50

1879

..

3.10

1.50

2050

..

4.00

1.50

1881

..

2.10

1.00

2053

..

3.00

1.50

1884

..

1.50

1.00

2056

..

3.00

1.50

1887

..

4.00

1.50

2058

..

11.50

3.00

1889

..

12.40

4.00

2062

..

5.50

1.50

1891

..

1.60

.80

2067

..

4.50

1.50

1893

..

3.40

1.50

2070

..

5.50

1.50

1895

..

5.80

2.00

2074

..

5.50

1.50

1896

..

1.70

1.00

2077

..

4.50

1.50

1897

..

3.56

1.00

2079

..

4.50

1.50

1898

..

3.50

1.00

2082

..

4.50

1.50

1899

..

5.30

1.50

2084

..

4.10

1.50

1900

..

4.00

1.50

2086

..

4.10

1.50

1902

..

6.00

2.00

2088

..

5.00

1.50

1904

..

1.30

1.00

2091

..

3.10

1.00

1906

..

1.50

1.00

2096

..

8.00

3.00

1908

..

7.00

2.00

2100

..

8.00

2.00

1910

..

7.20

3.00

2103

..

6.50

1.50

1912

..

8.40

3.00

2105

..

4.10

1.50

1914

..

8.80

3.00

2107

..

5.50

1.50

1916

..

3.50

1.00

2109

..

4.50

1.50

1917

..

3.50

1.00

2111

..

5.50

2.00

1918

..

3.40

1.50

2117

..

3.50

1.50

1919

..

7.00

3.00

2120

..

7.50

3.00

1920

..

2.70

1.00

2122

..

10.00

3.00

1922

..

4.00

1.50

2124

..

2.40

1.00

1924

..

4.00

1.50

2126

..

6.00

1.50

1926

..

4.40

1.50

2129

..

10.00

3.00

1927

..

10.50

4.00

2131

..

4.40

1.00

1929

..

17.00

5.00

2134

..

4.60

1.50

1931

..

7.00

3.00

2136

..

5.00

1.50

1933

..

6.60

2.00

2143

..

5.10

1.50

1935

..

5.20

1.50

2147

..

2.20

1.00

1937

..

6.20

2.00

2149

..

4.50

1.50

1939

..

11.00

4.00

2151

..

6.00

1.50

1942

..

10.50

4.00

2153

..

4.40

1.00

1946

..

6.20

2.00

2155

..

4.60

1.50

1952

..

19.00

5.00

2157

..

5.00

1.50

1954

..

8.50

3.00

2159

..

6.50

1.50

1960

..

10.50

4.00

2162

..

4.60

1.50

1962

..

6.60

2.00

2165

..

15.50

4.00

1964

..

7.00

3.00

2167

..

12.00

4.00

1982

..

12.00

4.00

2171

..

16.00

4.00

1984

..

6.00

1.50

2175

..

10.50

3.00

1986

..

13.00

4.00

2178

..

7.50

2.00

1987

..

12.00

4.00

2182

..

9.00

3.00

1989

..

8.00

3.00

2186

..

5.00

1.50

1991

..

12.00

4.00

2201

..

4.40

1.00

1993

..

12.00

4.00

2206

..

4.60

1.50

1995

..

8.00

3.00

2210

..

4.60

1.50

1997

..

8.00

3.00

2212

..

6.50

2.00

1998

..

7.80

2.00

2216

..

8.00

3.00

2002

..

2.40

1.00

2220

..

9.50

3.00

2004

..

3.60

1.00

2223

..

9.00

3.00

2007

..

2.40

1.00

2225

..

8.00

3.00

2009

..

3.60

1.00

2228

..

10.50

3.00

2025

..

4.00

1.50

2232

..

7.50

2.00

2029

..

4.50

1.50

2236

..

7.00

2.00

2031

..

3.40

1.00

2239

..

10.50

3.00

2033

..

3.60

1.50

2241

..

8.00

2.00

2035

..

4.50

1.50

2243

..

13.00

4.00

2037

..

4.50

1.50

2245

..

8.00

2.00


Schedule 6—continued

Number of item in First Schedule

 

Fund medical benefit

Specified excess

Number of item in First Schedule

 

Fund medical benefit

Specified excess

 

 

$

$

 

 

$

$

2249

..

2.40

1.00

2550

..

14.50

4.00

2255

..

9.00

3.00

2553

..

4.90

1.50

2257

..

6.00

1.50

2556

..

8.50

3.00

2265

..

4.60

1.50

2559

..

10.50

3.00

2267

..

5.00

2.00

2562

..

3.20

1.00

2269

..

8.00

2.00

2565

..

3.40

1.00

2272

..

9.00

3.00

2568

..

5.50

1.50

2275

..

12.50

4.00

2571

..

5.50

1.50

2277

..

12.50

4.00

2600

..

17.00

4.00

2279

..

12.50

4.00

2603

..

14.00

4.00

2281

..

9.50

2.00

2606

..

14.00

4.00

2283

..

6.00

1.50

2613

..

14.00

5.00

2285

..

12.00

3.00

2616

..

5.10

1.50

2287

..

9.00

3.00

2619

..

7.50

2.00

2289

..

10.00

3.00

2623

..

7.50

2.00

2296

..

5.00

1.50

2631

..

6.00

1.50

2299

..

6.50

3.00

2635

..

6.00

1.50

2302

..

6.50

3.00

2639

..

4.90

1 50

2304

..

6.50

3.00

2643

..

6.00

1.50

2306

..

6.50

3.00

2647

..

4.90

1.50

2308

..

6.50

3.00

2651

..

4.90

1.50

2312

..

14.00

4.00

2655

..

7.50

2.00

2316

..

6.50

3.00

2658

..

6.00

1.50

2319

..

8.50

2.00

2663

..

6.00

1.50

2323

..

8.50

2.00

2667

..

3.90

1.00

2327

..

2.70

1.00

2669

..

7.50

2.00

2331

..

6.50

1.50

2673

..

5.10

1.50

2335

..

5.40

1.50

2677

..

5.10

1.50

2339

..

6.50

1.50

2680

..

14.00

4.00

2343

..

9.50

3.00

2685

..

9.00

3.00

2348

..

8.00

2.00

2689

..

2.40

1.00

2352

..

6.00

2.00

2693

..

14.00

4.00

2365

..

7.50

2.00

2701

..

7.00

2.00

2400

..

1.30

2.00

2704

..

7.50

2.00

2425

..

5.60

1.50

2708

..

9.00

3.00

2428

..

3.60

1.00

2712

..

14.00

4.00

2450

..

3.20

1.00

2920

..

7 00

1.00

2453

..

.30

.80

 

 

One-fifth of the amount shown in this column for the operation or operations

One-fifth of the amount shown in this column for the operation or operations

2456

..

3.90

1.00

2929

..

2461

..

.40

.80

 

 

2466

..

7.50

2.00

 

 

2469

..

1.20

.80

 

 

2472

..

4.40

1.00

 

 

2475

 

3.90

1.00

 

 

2478

 

.40

.80

3003

..

1.85

.80

2482

 

4.60

1.50

3007

..

3.80

1.00

2485

 

.50

.80

3010

..

5.20

1.50

2488

 

9.00

3.00

3014

..

6.40

1.50

2490

 

1.80

.80

3018

..

10.00

3.00

2492

 

6.00

1.50

3020

..

12.00

3.00

2494

 

.80

.80

3023

..

4.50

1.50

2497

 

8.00

2.00

3026

..

5.30

1.50

2501

 

1.30

.80

3028

..

4.10

1.50

2504

 

12.50

4.00

3032

..

4.10

1.50

2507

 

2.70

1 00

3035

..

9.00

3.00

2511

 

22.00

5.00

3040

..

9.00

3.00

2515

 

15.00

4.00

3042

..

5.30

1.50

2519

 

31.00

5.00

3044

..

11.50

3.00

2523

 

45.00

5.00

3048

..

14.00

4.00

2527

 

36.00

5.00

3053

..

9.00

3.00

2531

 

22.00

5.00

3054

..

9.00

3.00

2536

 

8.50

3.00

3060

..

11.50

3.00

2540

 

13.50

4.00

3066

..

14.50

4.00

2544

 

6.50

1.50

3072

..

14.50

4.00

2547

 

4 90

1.50

3076

..

1.10

.80


Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

 

 

 

 

 

3079

..

1.10

.80

3337

..

21.00

5.00

3083

..

8.00

3.00

3341

..

13.50

4.00

3086

..

8.00

3.00

3343

..

17.00

5.00

3088

..

14.00

4.00

3347

..

23.00

5.00

3091

..

18.00

5.00

3352

..

9.50

3.00

3096

..

18.00

5.00

3355

..

11.50

3.00

3100

..

4.40

1.00

3358

..

28.00

5.00

3102

..

4.40

1.00

3360

..

28.00

5.00

3107

..

8.00

3.00

3365

..

28.00

5.00

3111

..

9.50

3.00

3370

..

63.00

5.00

3118

..

9.50

3.00

3374

..

105.00

5.00

3122

..

4.00

1.00

3376

..

70.00

5.00

3127

..

8.00

3.00

3380

..

28.00

5.00

3129

..

2.40

1.00

3382

..

28.00

5.00

3133

..

2.40

1.00

3385

..

15.50

4.00

3136

..

14.00

4.00

3388

..

15.50

4.00

3141

..

7.30

2.00

3410

..

5.00

1.50

3145

..

7.30

2.00

3413

..

5.00

1.50

3151

..

11.50

3.00

3416

..

9.00

3.00

3154

..

14.00

4.00

3420

..

11.50

3.00

3158

..

14.00

4.00

3422

..

11.50

3.00

3164

..

2.90

1.00

3426

..

11.50

3.00

3167

..

6.00

3.00

3429

..

23.00

5.00

3169

..

7.50

4.00

3432

..

23.00

5.00

3172

..

11.00

5.00

3435

..

59.00

5.00

3176

..

12.00

5.00

3438

..

59.00

5.00

3182

..

30.00

5.00

3441

..

150.00

5.00

3186

..

6.00

2.00

3449

..

3.80

1.00

3188

..

5.50

3.00

3451

..

3.80

1.00

3192

..

5.50

3.00

3457

..

12.50

3.00

3198

..

9.00

3.00

3461

..

16.50

4.00

3200

..

11.00

3.00

3463

..

16.50

4.00

3205

..

11. 00

3.00

3467

..

105.00

5.00

3209

..

11.50

4.00

3471

..

32.00

5.00

3212

..

15.00

5.00

3474

..

42.00

5.00

3214

..

55.00

5.00

3476

..

49.00

5.00

3223

..

21.00

5.00

3481

..

85.00

5.00

3227

..

26.00

5.00

3485

..

95.00

5.00

3231

..

32.00

5.00

3489

..

105.00

5.00

3234

..

70.00

5.00

3494

..

59.00

5.00

3239

..

42.00

5.00

3499

..

61.00

5.00

3240

..

42.00

5.00

3504

..

42.00

5.00

3241

..

49.00

5.00

3512

..

32.00

5.00

3243

..

49.00

5.00

3515

..

42.00

5.00

3246

..

70.00

5.00

3518

..

36.00

5.00

3249

..

32.00

5.00

3520

..

28.00

5.00

3257

..

56.00

5.00

3522

..

150.00

5.00

3260

..

10.50

3.00

3538

..

30.00

5.00

3264

..

3.10

1.00

3540

..

85.00

5.00

3266

..

4.00

1.00

3543

..

19.00

5.00

3270

..

4.00

1.00

3546

..

61.00

5.00

3275

..

2.90

1.50

3549

..

16.00

4.00

3278

..

6.10

2.00

3552

..

26.00

5.00

3283

..

6.30

2.00

3557

..

35.00

5.00

3287

..

7.00

2.00

3558

..

9.50

4.00

3293

..

3.60

1.00

3562

..

10.00

4.00

3296

..

12.00

4.00

3564

..

20.00

5.00

3302

..

.80

.80

3568

..

26.00

5.00

3307

..

1.70

.80

3570

..

20.00

5.00

3310

..

6.50

2.00

3574

..

26.00

5.00

3312

..

6.00

3.00

3579

..

49.00

5.00

3317

..

6.00

3.00

3584

..

73.00

5.00

3322

..

9.50

3.00

3586

..

11.50

3.00

3327

..

11.50

3.00

3590

..

29.00

5.00

3333

..

16.50

5.00

3592

..

36.00

5.00


Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

 

$

$

3596

..

36.50

5.00

3861

..

23.00

5.00

3600

..

49.00

5.00

3862

..

33.00

5.00

3606

..

42.00

5.00

3866

..

9.50

3.00

3611

..

34.00

5.00

3568

..

32.00

5.00

3613

..

45.00

5.00

3871

..

41.00

5.00

3621

..

49.00

5.00

3873

..

13.50

4.00

3625

..

130.00

5.00

3876

..

7.30

2.00

3628

..

45.00

5.00

3877

..

100.00

5.00

3631

..

49.00

5.00

3881

..

150.00

5.00

3635

..

49.00

5.00

3885

..

170.00

5.00

3639

..

9.50

3.00

3887

..

34.00

5.00

3642

..

34.00

5.00

3890

..

42.00

5.00

3644

..

48.00

5.00

3891

..

105.00

5.00

3648

..

36.00

5.00

3893

..

45.00

5.00

3650

..

45.00

5.00

3895

..

59.00

5.00

3653

..

75.00

5.00

3897

..

63.00

5.00

3659

..

63.00

5.00

3942

..

39.00

5.00

3663

..

52.00

5.00

3944

..

49.00

5.00

3666

..

82.00

5.00

3947

..

95.00

5.00

3669

..

125.00

5.00

3950

..

73.00

5.00

3672

..

125.00

5.00

3953

..

73.00

5.00

3674

..

14.50

4.00

3956

..

38.00

5.00

3677

..

56.50

5.00

3960

..

11.50

3.00

3679

..

45.00

5.00

3966

..

4.50

1.50

3685

..

47.00

5.00

3972

..

105.00

5.00

3694

..

49.00

5.00

3974

..

87.00

5.00

3697

..

59.00

5.00

3977

..

35.00

5.00

3701

..

70.00

5.00

3980

..

52.00

5.00

3703

..

45.00

5.00

3982

..

28.00

5.00

3708

..

59.00

5.00

3985

..

26.00

5.00

3712

..

59.00

5.00

3988

..

40.00

5.00

3717

..

36.00

5.00

3992

..

45.00

5.00

3719

..

45.00

5.00

3994

..

66.00

5.00

3723

..

85.00

5.00

3997

..

67.00

5.00

3730

..

105.00

5.00

4001

..

21.00

5.00

3734

..

125.00

5.00

4005

..

28.00

5.00

3738

..

45.00

5.00

4006

..

24.50

5.00

3740

..

36.00

5.00

4010

..

33.00

5.00

3744

..

36.00

5.00

4014

..

36.00

5.00

3748

..

45.00

5.00

4016

..

45.00

5.00

3752

..

59.00

5.00

4019

..

2.90

1.00

3757

..

36.00

5.00

4023

..

16.50

5.00

3762

..

45.00

5.00

4025

..

21.00

5.00

3775

..

24.00

5.00

4028

..

28.00

5.00

3781

..

31.00

5.00

4030

..

33.00

5.00

3785

..

45.00

5.00

4036

..

18.00

5.00

3787

..

45.00

5.00

4038

..

23.00

5.00

3791

..

29.00

5.00

4058

..

24.50

5.00

3794

..

37.00

5.00

4063

..

33.00

5.00

3799

..

18.00

5.00

4067

..

45.00

5.00

3804

..

42.00

5.00

4069

..

70.00

5.00

3813

..

73.00

5.00

4073

..

39.00

5.00

3818

..

75.00

5.00

4077

..

8.50

3.00

3819

..

36.00

5.00

4079

..

3.80

1.00

3822

..

45.00

5.00

4081

..

7.50

2.00

3828

..

36.00

5.00

4083

..

11.50

3.00

3830

..

45.00

5.00

4085

..

14.50

4.00

3835

..

56.00

5.00

4088

..

3.90

1.00

3839

..

73.00

5.00

4092

..

4.50

1.50

3840

..

85.00

5.00

4098

..

15.50

4.00

3845

..

105.00

5.00

4103

..

12.00

5.00

3847

..

125.00

5.00

4105

..

14.00

5.00

3851

..

95.00

5.00

4110

..

9.00

3.00

3852

..

30.00

5.00

4111

..

14.50

4.00

3858

..

105.00

5.00

4116

..

16.50

5.00


Schedule 6—continued

Number of item in First Schedule

 

Fund medical benefit

Specified excess

Number of item in First Schedule

 

Fund medical benefit

Specified excess

 

          $

$

 

 

 

$

$

4121

..

49.00

5.00

4308

 

..

54.00

5.00

4123

..

80.00

5.00

4312

 

..

125.00

5.00

4128

..

2.90

1.00

4314

 

..

150.00

5.00

4129

..

11.00

3.00

4323

 

..

105.00

5.00

4131

..

14.50

4.00

4329

 

..

35.00

5 00

4134

..

3.10

1.00

4335

 

..

73.00

5.00

4135

..

11.50

3.00

4341

 

..

19.00

5.00

4137

..

9.00

3.00

4344

 

..

14.50

4.00

4139

..

6.90

2.00

4347

 

..

85.00

5.00

4142

..

31.00

5.00

4349

 

..

45.00

5.00

4145

..

10.50

3.00

4353

 

..

5.00

1.50

4147

..

1.00

0.80

4357

 

..

9.50

3.00

4152

..

4.00

1.50

4361

 

..

16.50

4.00

4154

..

4.50

1.50

4363

 

..

16.50

4 00

4159

..

9.00

5.00

4367

 

..

28.00

5.00

4160

..

12.00

5.00

4369

 

..

23 00

5.00

4164

..

8.50

2.00

4371

 

..

28.00

5.00

4168

..

11.00

4.00

4374

 

..

9.50

3.00

4170

..

14.00

5.00

4377

 

..

28.00

5.00

4174

..

17.00

5.00

4382

 

..

28.00

5.00

4178

..

23.00

5.00

4386

 

..

28.00

5.00

4180

..

26 00

5.00

4388

 

..

49.00

5.00

4184

..

32.00

5.00

4392

 

..

38.00

5.00

4186

..

9.00

3.00

4396

 

..

28 00

5 00

4187

..

11.50

3.00

4398

 

..

49.00

5.00

4192

..

59.00

5.00

4405

 

..

12.00

3.00

4196

..

26.00

5.00

4406

 

..

15.00

4.00

4198

..

5.90

1.50

4410

 

..

18.50

5.00

4203

..

28.00

5 00

4411

 

..

23.00

5.00

4204

..

21.00

5.00

4415

 

..

21.75

5.00

4205

..

26.00

5.00

4417

 

..

27.00

5.00

42!0

..

7.00

2.00

4423

 

..

25.00

5 00

4226

..

2.80

1.00

4425

 

..

31.00

5.00

4228

..

8.50

2.00

4431

 

..

28 25

5 00

4232

..

15.50

4.00

4433

 

..

36.00

5.00

4234

..

41.00

5.00

4438

 

..

14 00

4.00

4237

..

30.00

5.00

4439

 

..

17.50

5.00

4239

..

57.00

5 00

4446

 

..

17.00

5.00

4242

..

26 00

5.00

4451

 

..

23.00

5.00

4244

..

20.00

5.00

4457

 

..

28.00

5.00

4245

..

16.00

4.00

4459

 

..

49.00

5.00

4248

..

42 00

5.00

4462

 

..

100 00

5.00

4250

..

68.00

5.00

4465

 

..

9.00

3.00

4252

..

4.20

1.00

4466

 

..

11 50

3.00

4255

..

20.00

5.00

4470

 

..

13.50

4.00

4257

..

28.00

5.00

4471

 

..

16.50

5.00

4259

..

42.00

5.00

4475

 

..

16.00

4.00

4261

..

61 00

5.00

4477

 

..

20.25

5.00

4264

..

85.00

5.00

4479

 

..

18.00

5.00

4266

..

100.00

5 00

4481

 

..

23.00

5.00

4268

..

61.00

5.00

4486

 

..

20.50

5.00

4270

..

100.00

5.00

4487

 

..

25.75

5.00

4272

..

90.00

5.00

4491

 

..

11 50

3.00

4274

..

45.00

5.00

4493

 

..

14 00

4.00

4278

..

59.00

5.00

4500

 

..

28.00

5.00

4280

..

49.00

5.00

4506

 

..

23 00

5.00

4283

..

61.00

5.00

4510

 

..

38.00

5.00

4286

..

115.00

5 00

4512

 

..

54.00

5.00

4289

..

110.00

5.00

4515

 

..

61.00

5.00

4290

..

115.00

5 00

4518

 

..

125.00

5.00

4292

..

100.00

5.00

4530

 

..

6.60

2.00

4295

..

100.00

5.00

4532

 

..

19.00

5.00

4298

..

100.00

5.00

4535

 

..

11.50

3.00

4301

..

59.00

5.00

4539

 

..

12.00

4 00

4306

..

75.00

5.00

4543

 

 

80.00

5.00


Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

4546

..

49.00

5.00

4716

..

49.00

5.00

4550

..

82.00

5.00

4717

..

68.00

5.00

4554

..

90.00

5.00

4720

..

90.00

5.00

4556

..

115.00

5.00

4722

..

2 40

1.00

4558

..

45.00

5.00

4731

..

9.00

3.00

4566

..

56.00

5.00

4734

..

9 00

3.00

4569

..

90.00

5.00

4737

..

82.00

5.00

4572

..

135.00

5.00

4742

..

59.08

5.00

4574

..

152.50

5.00

4745

..

49.00

5.00

4577

..

100.00

5.00

4748

..

59.00

5.00

4581

..

115 00

5.00

4750

..

12.50

4.00

4584

..

90.00

5.00

4753

..

12.00

5.00

4588

..

210.00

5.00

4756

..

16.25

5 00

4589

..

210.00

5.00

4757

..

17.25

5.00

4593

..

100.00

5.00

4760

..

14.00

5.00

4597

..

125.00

5.00

4761

..

15.00

5 00

4601

..

100.00

5.00

4769

..

14.00

5.00

4607

..

49.00

5.00

4770

..

14.00

5.00

4669

..

90.00

5.00

4776

..

8.50

3.00

4613

..

59.00

5.00

4777

..

11.50

3.00

4615

..

68.00

5.00

4781

..

6.00

2.00

4619

..

100.00

5.00

4782

..

8.00

3.00

4621

..

8.30

2.00

4786

..

10.00

3.00

4623

..

35.00

5.00

4788

..

11.75

4 00

4621

..

7.00

4.00

4793

..

7.30

2.00

4632

..

3.90

1.00

4795

..

5.90

1.50

4634

..

8.00

3.00

4797

..

2.90

1.00

4636

..

8.00

3.00

4799

..

28.00

5.00

4638

..

6.20

1.50

4803

..

14.50

4.00

4642

..

9.50

3.00

4805

..

29.00

5.00

4644

..

6.60

1.50

4807

..

13.50

4.00

4646

..

6.60

2.00

4809

..

16.50

5.00

4647

..

13.00

4.00

4813

..

28.00

5.00

4648

..

16.50

5.00

4816

..

4.50

1.50

4652

..

35.00

5.00

4821

..

110.00

5.00

4654

..

37.00

5.00

4824

..

115.00

5.00

4656

..

41.50

5.00

4826

..

115.00

5.00

4659

..

4.30

1.50

4829

..

14.50

4.00

4661

..

12.00

4.00

4833

..

16.50

5.00

4664

..

10.50

3.00

4840

..

19.00

5.00

4666

..

13.50

4.00

4842

..

23.00

5.00

4668

..

2.60

1.00

4846

..

33.00

5 00

4669

..

2.60

1.00

4849

..

49.00

5.00

4671

..

7.60

2.00

4852

..

49.00

5 00

4672

..

7.60

2.00

4857

..

82.00

5.00

4673

..

2.10

1.00

4859

..

70.00

5.00

4675

..

35.00

5.00

4861

..

14.00

4.00

4679

..

35.00

5.00

4863

..

19.00

5.00

4680

..

35 00

5.00

4865

..

13.50

4.00

4682

..

54.00

5.00

4869

..

13.50

4.00

4683

..

11.00

5.00

4871

..

18.00

5.00

4684

..

11.00

5.00

4873

..

30.00

5.00

4685

..

9.00

3.00

4875

..

19.00

5.00

4686

..

9.00

3.00

4878

..

9.50

3.00

4687

..

49.00

5.00

4890

..

66.00

5.00

4688

..

49.00

5.00

4892

..

73.00

500

4689

..

66.00

5.00

4894

..

125.00

5.00

4692

..

87.00

5.00

4896

..

68.00

5.00

4695

..

31.00

5.00

4898

..

90.00

5.00

4698

..

5.00

1.50

4903

..

66.00

5.00

4700

..

27.00

5.00

4904

..

82.00

5.00

4703

..

66.00

5.00

4908

..

90.00

5.00

4706

..

52.00

5.00

4913

..

90.00

5.00

4708

..

5.00

1.50

4914

..

105.00

5.00

4711

..

23.00

5.00

4920

..

90.00

5.00


Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

$

$

$

4923

..

63.00

5.00

5096

..

100.00

5.00

4928

..

82.00

5.00

5111

..

80.00

5.00

4929

..

90.00

5.00

5115

..

87.00

5.00

4932

..

95.00

5.00

5117

..

40.00

5.00

4936

..

73.00

5.00

5121

..

100.00

5.00

4938

..

66.00

5.00

5123

..

23.00

5.00

4941

..

49.00

5.00

5126

..

35.00

5.00

4945

..

56.00

5.00

5129

..

11.50

3.00

4947

..

13.00

4.00

5134

..

40.00

5.00

4951

..

28.00

5.00

5137

..

4.00

1.00

4953

..

40.00

5.00

5139

..

6.60

2.00

4956

..

82.00

5.00

5142

..

82.00

5.00

4958

..

90.00.

5.00

5146

..

23.00

5.00

4960

..

82.00

5.00

5148

..

11.50

3.00

4962

..

82.00

5.00

5151

..

27.00

5.00

4964

..

66.00

5.00

5154

..

19.00

5.00

4966

..

115.00

5.00

5156

..

13.50

4.00

4968

..

150.00

5.00

5159

..

8.00

2.00

4971

..

66.00

5.00

5164

..

19.00

5.00

4973

..

82.00

5.00

5168

..

19.00

5.00

4975

..

73.00

5.00

5177

..

56.00

5.00

4977

..

90.00

5.00

5180

..

49.00

5.00

4980

..

82.00

5.00

5183

..

66.00

5.00

4982

..

82.00

5.00

5187

..

66.00

5.00

4984

..

100.00

5.00

5189

..

61.00

5.00

4986

..

82.00

5.00

5195

..

61.00

5.00

4988

..

100.00

5.00

5197

..

23.00

5.00

4992

..

115.00

5.00

5200

..

31.00

5.00

5000

..

56.00

5.00

5203

..

40.00

5.00

5003

..

66.00

5.00

5207

..

61.00

5.00

5005

..

66.00

5.00

5209

..

63.00

5.00

5008

..

82.00

5.00

5211

..

73.00

5.00

5011

..

2.90

1.00

5213

..

23.00

5.00

5013

..

11.00

3.00

5215

..

49.00

5.00

5017

..

14.00

4.00

5219

..

82.00

5.00

5020

..

15.00

4.00

5226

..

15.00

4.00

5022

..

19.00

5.00

5231

..

15.00

4.00

5025

..

8.00

2.00

5234

..

40.00

5.00

5027

..

8.00

2.00

5238

..

66.00

5.00

5030

..

23.00

5.00

5242

..

6.60

2.00

5033

..

19.00

5.00

5247

..

66.00

5.00

5035

..

27.00

5.00

5250

..

9.00

3.00

5039

..

61.00

5.00

5253

..

31.00

5.00

5042

..

21.00

5.00

5255

..

40.00

5.00

5044

..

40.00

5.00

5258

..

82.00

5.00

5046

..

28.00

5.00

5263

..

40.00

5.00

5049

..

40.00

5.00

5265

..

82.00

5.00

5053

..

49.00

5.00

5267

..

4.00

1.00

5054

..

61.00

5.00

5271

..

40.00

5.00

5057

..

28.00

5.00

5273

..

75.00

5.00

5058

..

36.00

5.00

5275

..

23.00

5.00

5061

..

90.00

5.00

5279

..

15.00

4.00

5063

..

61.00

5.00

5290

..

15.00

4.00

5065

..

61.00

5.00

5292

..

18.00

5.00

5069

..

66.00

5.00

5293

..

23.00

5.00

5071

..

36.00

5.00

5297

..

23.00

5.00

5074

..

73.00

5.00

5299

..

82.00

5.00

5076

..

56.00

5.00

5302

..

28.00

5.00

5080

..

66.00

5.00

5304

..

26.00

5.00

5082

..

4.00

1.00

5307

..

49.00

5.00

5084

..

40.00

5.00

5309

..

56.00

5.00

5088

..

40.00

5.00

5315

..

44.00

5.00

5090

..

66.00

5.00

5321

..

15.00

4.00

5092

..

150.00

5.00

5326

..

15.00

4.00

5094

..

82.00

5.00

5331

..

19.00

5.00


Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

5365

..

6.60

2.00

5633

..

58.00

5.00

5368

..

4.50

1.50

5638

..

35.00

5.00

5373

..

7.30

2.00

5639

..

45.00

5.00

5377

..

7.30

2.00

5643

..

35.00

5.00

5379

..

11.50

3.00

564S

..

45.00

5.00

5381

..

14.50

4.00

5650

..

49.00

5.00

5384

..

9.00

3.00

5657

..

23.00

S.00

5386

..

11.50

3.00

5660

..

35.00

5.00

5391

..

5.00

3.00

5664

..

5.70

1.50

5395

..

7.30

2.00

5670

..

16.50

5.00

5400

..

5.00

1.50

5672

..

28.00

5.00

5405

..

9.00

3.00

5676

..

54.00

5.00

5406

..

11.50

3.00

5682

..

5.50

1.50

5412

..

21.00

5.00

5684

..

3.60

1.00

5417

..

28.00

5.00

5688

..

30.00

5.00

5421

..

105.00

5.00

5690

..

38.00

5.00

5430

..

59.00

5.00

5695

..

35.50

5.00

5432

..

3.60

1.00

5696

..

45.00

5.00

5435

..

59.00

5.00

5700

..

54.00

5.00

5440

..

59.00

5.00

5707

..

28.00

5.00

5446

..

33.00

5.00

5709

..

35.00

5.00

5450

..

12.00

4.00

5716

..

30.00

5.00

5465

..

9.50

3.00

5717

..

38.00

5.00

5465

..

20.00

5.00

5740

..

8.80

2.00

5469

..

26.00

5.00

5752

..

39.00

5.00

5478

..

35.00

5.00

5755

..

52.00

5.00

5479

..

45.00

5.00

5759

..

39.00

5.00

5484

..

44.00

5.00

5761

..

52.00

5.00

5485

..

59.00

5.00

5765

..

28.00

5.00

5496

..

50.50

5.00

5768

..

16.50

4.00

5497

..

67.00

5.00

5771

..

34.00

5.00

5502

..

13.50

4.00

5776

..

54.00

5.00

5506

..

45.00

5.00

5781

..

33.00

5.00

5514

..

59.00

5.00

5784

..

56.00

5.00

5521

..

56.00

5.00

5787

..

70.00

5.00

5526

..

5.50

1.50

5789

..

78.00

5.00

5528

..

5.50

1.50

5797

..

90.00

5.00

5532

..

3.40

1.50

5801

..

42.00

5.00

5536

..

13.00

4.00

5805

..

54.00

5.00

5538

..

16.50

5.00

5808

..

63.00

5.00

5544

..

18.50

5.00

5811

..

90.00

5.00

5546

..

24.00

5.00

5815

..

34.00

5.00

5549

..

11.50

3.00

5817

..

45.00

5.00

5550

..

13.50

4.00

5820

..

63.00

S.00

5555

..

6.60

2.00

5823

..

90.00

5.00

5558

..

8.00

3.00

5825

..

9.00

3.00

5563

..

10.50

3.00

5829

..

6.90

2.00

5564

..

13.00

4.00

5832

..

38.00

5.00

5570

..

17.00

5.00

5835

..

9.00

3.00

5581

..

12.50

4.00

5839

..

22.00

5.00

5582

..

16.00

4.00

5841

..

27.00

5.00

5587

..

12.50

4.00

5844

..

16.50

4.00

5590

..

16.00

4.00

5860

..

42.00

5.00

5591

..

14.00

4.00

5863

..

59.00

5.00

5592

..

17.00

5.00

5865

..

49.00

5.00

5599

..

45.00

5.00

5867

..

63.00

5.00

5603

..

48.00

5.00

5870

..

63.00

5.00

5604

..

56.00

5.00

5872

..

54.00

5.00

5608

..

45.00

5.00

5874

..

38.00

5.00

5609

..

56.00

5.00

5877

..

4.00

2.00

5615

..

50.50

5.00

5880

..

4.00

1.00

5617

..

64.00

5.00

5882

..

1.50

2.00

5621

..

63.00

5.00

5884

..

9.00

3.00

5623

..

95.00

5.00

5886

..

31.00

5.00

5629

..

68.00

5.00

5890

..

9.50

3.00


Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

5893

..

1.85

.80

6145

..

85.00

5.00

5895

..

6.20

1.50

6150

..

39.00

5.00

5898

..

16.50

4.00

6153

..

85.00

5.00

5900

..

18.00

5.00

6156

..

115.00

5.00

5902

..

6.20

1.50

6161

..

14.00

4.00

5904

..

115.00

5.00

6168

..

20.00

5.00

5907

..

75.00

5.00

6171

..

48.00

5.00

5913

..

5.20

1.50

6174

..

105.00

5.00

5914

..

16.00

5.00

6178

..

85.00

5.00

5917

..

9.00

3.00

6183

..

51.00

5.00

5921

..

22.00

5.00

6188

..

31.00

5.00

5923

..

60.00

5.00

6193

..

165.00

5.00

5925

..

54.00

5.00

6200

..

165.00

5.00

5932

..

38.00

5.00

6206

..

240.00

5.00

5934

..

100.00

5.00

6210

..

165.00

5.00

5939

..

44.00

5.00

6213

..

190.00

5.00

5942

..

25.00

5.00

6250

..

1.85

.80

5944

..

23.00

5.00

6254

..

4.70

1.50

5950

..

54.00

5.00

6257

..

5.70

1.50

5952

..

67.00

5.00

6260

..

21.00

5.00

5955

..

59.00

5.00

6264

..

23.00

5.00

5957

..

45.00

5.00

6266

..

6.20

1.50

5961

..

28.00

5.00

6268

..

7.10

2.00

5965

..

45.00

5.00

6270

..

6.60

1.50

5970

..

90.00

5.00

6273

..

15.00

4.00

5974

..

23.00

5.00

6275

..

9.50

3.00

5978

..

75.00

5.00

6276

..

12.00

3.00

5982

..

100.00

5.00

6281

..

16.00

4.00

5987

..

28.00

5.00

6282

..

19.50

5.00

5991

..

12.50

4.00

6287

..

36.00

5.00

5995

..

49.00

5.00

6288

..

36.00

5.00

5999

..

75.00

5.00

6293

..

40.00

5.00

6004

..

7.30

2.00

6294

..

40.00

5.00

6006

..

5.90

1.50

6298

..

73.00

5.00

6009

..

37.00

5.00

6301

..

35.00

5.00

6011

..

44.00

5.00

6304

..

14.50

4.00

6014

..

53.00

5.00

6305

..

18.00

5.00

6018

..

44.00

5.00

6312

..

35.00

5.00

6020

..

33.00

5.00

6317

..

61.00

5.00

6026

..

32.00

5.00

6319

..

100.00

5.00

6031

..

33.00

5.00

6323

..

31.00

5.00

6051

..

5.70

1.50

6329

..

12.00

5.00

6055

..

8.20

3.00

6330

..

16.00

5.00

6059

..

7.30

2.00

6334

..

18.0.0

5.00

6063

..

3.70

1.00

6339

..

38.00

5.00

6067

..

8.20

3.00

6341

..

85.00

5.00

6071

..

39.00

5.00

6346

..

120.00

5.00

6074

..

78.00

5.00

6351

..

210.00

5.00

6076

..

115.00

5.00

6356

..

31.00

5.00

6080

..

85.00

5.00

6357

..

39.00

5.00

6082

..

115.00

5.00

6362

..

90.00

5.00

6085

..

60.00

5.00

6369

..

48.00

5.00

6087

..

34.00

5.00

6370

..

61.00

5.00

6091

..

105.00

5.00

6375

..

63:00

5.00

6093

..

22.00

5.00

6376

..

80.00

5.00

6096

..

7.60

2.00

6380

..

90.00

5.00

6103

..

14.00

4.00

6385

..

90.00

5.00

6106

..

115.00

5.00

6390

..

75.00

5.00

6111

..

85.00

5.00

6394

..

67.00

5.00

6117

..

115.00

5.00

6395

..

210.00

5.00

6121

..

115.00

5.00

6399

..

110.00

5.00

6125

..

145.00

5.00

6405

..

54.00

5.00

6129

..

51.00

5.00

6408

..

61.00

5.00

6134

..

34.00

5.00

6411

..

120.00

5.00

6139

..

24.00

5.00

6421

..

39.00

5.00


Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

6429

..

61.00

5.00

 

an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the dislocation concerned, plus one-half of that amount

an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the dislocation concerned, plus one-half of that amount

6433

..

75.00

5.00

 

6440

..

210.00

5.00

 

6444

..

120.00

5.00

 

6450

..

90.00

5.00

 

6457

..

82.00

5.00

 

6461

..

82.00

5.00

 

6466

..

82.00

5.00

 

6474

..

85.00

5.00

 

6479

..

105.00

5.00

 

6484

..

90.00

5.00

 

6490

..

47.00

5.00

 

6492

..

47.00

5.00

 

6500

..

81.00

5.00

 

6504

..

60.00

5.00

 

6511

..

54.00

5.00

6675

..

3.60

1.00

6540

..

3.90

1.00

6678

..

7.60

2.00

6541

..

3.90

1.00

6679

..

10.50

3.00

6547

..

2.40

1.00

6682

..

5.20

1.50

6548

..

2.40

1.00

6684

..

10.50

3.00

6556

..

6.40

1.50

6685

..

14.50

4.00

6560

..

7.30

2.00

6689

..

12.00

3.00

6565

..

6.40

1.50

6690

..

16.50

5.00

6571

..

5.00

1.50

6693

..

5.90

1.50

6579

..

8.00

3.00

6695

..

10.50

3.00

6583

..

5.90

1.50

6696

..

12.00

4.00

6588

..

11.00

3.00

6710

..

13.00

4.00

6589

..

13.50

4.00

6711

..

19.00

5.00

6597

..

2.40

1.00

6736

..

10.50

3.00

6603

..

7.30

2.00

6720

..

13.50

3.00

6608

..

17.00

5.00

6721

..

18.50

5.00

6609

..

23.00

5.00

6725

..

11.00

3.00

6616

..

12.50

4.00

6726

..

13.00

4.00

6617

..

16.50

4.00

6731

..

14.50

4.00

6630

..

5.90

1.50

6732

..

11.00

5.00

6635

..

9.00

3.00

6733

..

14.50

4.00

6640

..

2.90

1.00

6734

..

31.00

5.00

6644

..

7.30

2.00

6737

..

8.00

2.00

6649

..

21.00

5.00

6738

..

7.50

3.00

6653

..

21.00

5.00

6745

..

9.00

3.00

6657

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the dislocation concerned, plus one-half of that amount

 

 

 

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)1) relating to the dislocation concerned, plus one-half of that amount

 

 

 

6749

..

1.85

.80

6750

..

2.60

1.00

 

 

6755

..

13.50

4.00

6756

..

18.00

5.00

6759

..

10.50

3.00

6760

..

13.50

4.00

6763

..

33.00

5.00

6764

..

45.00

5.00

6769

..

8.80

2.00

6770

..

9.50

3.00

6775

..

11.00

3.00

6776

..

12.50

4.00

6779

..

21.00

5.00

6780

..

28.00

5.00

6783

..

21.00

5.00

6784

..

28.00

5.00

6787

..

21.00

5.00

6788

..

28.00

5.00

6793

..

7.80

2.00

6794

..

10.50

3.00

6797

..

3.10

1.00

6658

..

The amount shown in this column in the item (being

The amount shown in this column in the item (being

6801

..

5.00

1.50

 

 

6803

..

7.60

2.00

6808

..

7.60

2.00

6812

..

1.85

.80


Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

6813

..

2.60

1.00

 

 

the fracture concerned, plus one-third of that amount

the fracture concerned, plus one-third of that amount

6825

..

1.85

.80

6826

..

2.60

1.00

6829

..

7.00

3.00

6830

..

7.00

4.00

 

 

6834

..

40.00

5.00

The amount shows in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

 

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

6838

..

8.20

3.00

6915

 

 

 

 

 

 

 

 

 

 

 

 

 

 

..

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6839

..

11.50

3.00

6840

..

11.50

3.00

6844

..

26.00

5.00

6845

..

26.00

5.00

6850

..

28.00

5.00

6851

..

28.00

5.00

6854

..

10.50

3.00

6855

..

13.50

4.00

6856

..

13.50

4.00

6862

..

35.00

5.00

6863

..

35.00

5.00

6866

..

38.00

5.00

6867

..

38.00

5.00

6875

..

9.00

3.00

6876

..

12.00

4.00

6877

..

12.00

4.00

6882

..

1.85

.80

6883

..

2.60

1.00

6916

..

The amount shown in this column in the item (being an item, relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

 

 

 

 

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

6887

..

1.85

.80

 

 

6888

..

2.60

1.00

6893

..

16.50

4.00

6895

..

28.00

5.00

6897

..

75.00

5.00

6910

 

 

 

 

 

..

 

 

 

 

 

 

The amount shown m this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits this at includes the symbol ‘(D)’) relating to the fracture concerned, plus one-third of that amount

 

 

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)') relating to the fracture concerned, plus one-third of that amount

 

 

6919

 

 

 

 

 

..

 

 

 

 

 

 

The amount shown in this column in the item (other than, an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

The amount shown in this column in the item relating to the fracture concerned, plus one-half of that amount

 

 

 

 

 

 

6911

..

He amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to

 

 

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to

 

 

 

 

 

 

6920

..

The amount shown in this column in the

The amount shown in this column in the

 

 

 

 


Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

 

 

item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol '(D)’) relating to the fracture concerned, plus one-half of that amount

item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus erne-half of that amount

 

 

Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6935 in the table of Commonwealth medical benefits apply to the reduction concerned

Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6935 in the table of Commonwealth medical benefits apply to the reduction concerned

6925

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

6936

..

 

 

 One-half of the amount shown in this column in the item that would, but for item 6936 in the table of Commonwealth medical benefits apply to the reduction concerned

One-half of the amount shown in this column in the item that would, but for item 6936 in the table of Commonwealth medical benefits apply to the reduction concerned

 

 

6943

..

One-half of the amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6943 in the table of Commonwealth medical benefits apply to the reduction concerned

One-half of the amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, bet for item 6943 in the table of Commonwealth medical benefits apply to the reduction concerned

6926

..

 The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)') relating to the fracture concerned, plus three-quarters of that amount

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the

 

 

 

 

 

 

 

fracture concerned, plus three-quarters of that amount

 

 

 

 

6935

..

 One-half of the amount shown in this  column in the item (other than an item relating to an item in the table of

One-half of the amount shown in this column in the item (other than an item relating to an item in the table of

 

 

 

6944

 

 

 

..

 One-half of the amount shown in this column in the item that would, but.

 

 

 

One-half of the amount shown in this column in the items that would, but


Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

 

for item 6944 in the table of Commonwealth medical benefits apply to the reduction concerned

for item 6944 in the table of Commonwealth medical benefits apply to the reduction concerned

 

item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

6950  ..

The amount shown in this column in the item (other than an item relating to an item m the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6950 in the table of Commonwealth medical benefits apply to the reduction concerned

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefit that includes the symbol ‘(D)’) that would, but for item 6950 in the table of Commonwealth medical benefits apply to the reduction concerned

 

6961  ..

The amount shown in this column in the item (being an item relating to an item the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

 

6951  ..

The amount shown in this column in fee item that would, but for item 6951 in the table of Commonwealth medical benefits apply to the reduction concerned

The amount shown in this column in the item that would, but for item 6951 in the table of Commonwealth medical benefits apply to the reduction concerned

7000  ..

22.00

5.00

 

7004  ..

22.00

5.00

7007  ..

1.50

1.00

7009  ..

2.40

1.00

7012  ..

6.20

1.50

7017  ..

5.50

3.00

7018  ..

7.50

4.00

7024  ..

9.50

3.00

7026  ..

9.50

3.00

7030  ..

85.00

5.00

7034   ..

30.00

5.00

7036   ..

30.00

5.00

7039  ..

8.50

3.00

7040  ..

11.00

3.00

7049  ..

7.50

3.00

6956  ..

 The amount shown in this column in the item that would apply in the case of a simple and uncomplicated fracture of the part concerned

The amount shown in this column in the item that would apply in the case of a simple and uncomplicated fracture of the part concerned

7053  ..

8.50

3.00

7059  ..

14.00

4.00

 

7064  ..

24.00

5.00

7071  ..

24.00

5.00

7077  ..

130.00

5.00

7083  ..

42.00

5.00

7086  ..

27.00

5.00

7090  ..

61.00

5.00

7094  ..

110.00

5.00

7102  ..

95.00

5.00

7110  ..

120.00

5.00

7115  ..

110.00

5.00

7119  ..

145.00

5.00

6960   ..

 The amount shows in this column in the

The amount shown in this column in the

7123  ..

105.00

5.00

7127  ..

145.00

5.00

7131  ..

73.00

5.00



Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

7137

..

56.00

5.00

7405

..

27.00

5.00

7142

..

73.00

5.00

7414

..

23.00

5.00

7144

..

73.00

5.00

7415

..

30.00

5.00

7147

..

52.00

5.00

7418

..

34.00

5.00

7150

..

47.00

5.00

7421

..

11.50

3.00

7168

..

42.00

5.00

7422

..

14.00

4.00

7169

..

45.00

5.00

7425

..

22.00

5.00

7174

..

22.00

5.00

7428

..

29.00

5.00

7179

..

24.00

5.00

7429

..

37.00

5.00

7183

..

66.00

5.00

7433

..

9.50

3.00

7187

..

78.00

5.00

7437

..

14.00

4.00

7191

..

11.00

5.00

7439

..

8.50

3.00

7196

..

7.60

2.00

7441

..

22.00

5.00

7201

..

39.00

5.00

7445

..

42.00

5.00

7207

..

44.00

5.00

7447

..

115.00

5.00

7211

..

39.00

5.00

7449

..

56.00

5.00

7215

..

27.00

5.00

7452

..

24.00

5.00

7219

..

105.00

5.00

7455

..

13.50

4.00

7229

..

70.00

5.00

7456

..

17.00

5.00

7235

..

70.00

5.00

7460

..

17. 00

5.00

7239

..

90.00

5.00

7465

..

19.00

5.00

7243

..

130.00

5.00

7469

..

30.00

5.00

7247

..

52.00

5.00

7475

..

14.00

4.00

7254

..

70.00

5.00

7479

..

37.00

5.00

7258

..

34.00

5.00

7481

..

34.00

5.00

7264

..

17.00

5.00

7484

..

56.00

5.00

7267

..

39.00

5.00

7487

..

70.00

5.00

7269

..

52 00

5.00

7491

..

95.00

5.00

7272

..

39.00

5.00

7493

..

70.00

5.00

7276

..

37.00

5.00

7496

..

34.00

5.00

7277

..

47.00

5.00

7500

..

34.00

5.00

7281

..

56.00

5.00

7501

..

47.00

5.00

7286

..

2.60

1.00

7504

..

47.00

5.00

7288

..

2.80

1.00

7507

..

44.00

5.00

7294

..

34.00

5.00

7511

..

44.00

5.00

7296

..

52.00

5.00

7515

..

41.00

5.00

7299

..

30.00

5.00

7518

..

47.00

5.00

7302

..

17.00

5.00

7522

..

47.00

5.00

7303

..

22.00

5.00

7525

..

34.00

5.00

7308

..

31.00

5.00

7526

..

47.00

5.00

7311

..

41.00

5.00

7555

..

6.50

3.00

7317

..

28.75

5.00

7558

..

4.10

1.00

7320

..

36.75

5.00

7562

..

4.80

1.50

7322

..

43.00

5.00

7564

..

4.10

1.00

7327

..

17.00

5.00

7568

..

5.20

1.50

7330

..

22.00

5.00

7571

..

4.10

1.00

7335

..

52.00

5.00

7574

..

6.40

1.50

7337

..

39.00

5.00

7576

..

4.10

1.00

7345

..

30.00

5.00

7579

..

7.60

2.00

7347

..

17.00

5.00

7583

..

19.00

5.00

7349

..

22.00

5.00

7587

..

4.10

1.00

7350

..

22.00

5.00

7589

..

6.40

1.50

7357

..

21.00

5.00

7592

..

6.40

1.50

7358

..

27.00

5.00

7595

..

6.60

2.00

7362

..

22.00

5.00

7600

..

68.00

5.00

7366

..

24.00

5.00

7604

..

78.00

5.00

7369

..

24.00

5.00

7612

..

78.00

5.00

7371

..

30.00

5.00

7614

..

78.00

5.00

7375

..

34.00

5.00

7617

..

39.00

5.00

7379

..

56.00

5.00

7621

..

61.00

5.00

7383

..

85.00

5.00

7623

..

61.00

5.00

7385

..

47.00

5.00

7628

..

87.00

5.00

7388

..

56.00

5.00

7633

..

78.00

5.00

7393

..

54.00

5.00

7636

..

78.00

5.00

7398

..

56.00

5.00

7639

..

75.00

5.00

7403

..

12.50

4.00

7645

..

17.00

5.00


Schedule 6—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

7648

..

39.00

5.00

7894

..

39.00

5.00

7651

..

30.00

5.00

7895

..

39.00

5.00

7656

..

95.00

5.00

7899

..

63.00

5.00

7660

..

95.00

5.00

7903

..

75.00

5.00

7663

..

61.00

5.00

7906

..

63.00

5.00

7669

..

52.00

5.00

7910

..

75.00

5.00

7675

..

61.00

5.00

7914

..

8.00

3.00

7679

..

78.00

5.00

7918

..

16.50

5.00

7686

..

39.00

5.00

7922

..

40.00

5.00

7689

..

52.00

5.00

7930

..

78.00

5.00

7692

..

78.00

5.00

7935

..

26.00

5.00

7695

..

30.00

5.00

7939

..

61.00

5.00

7699

..

52.00

5.00

7944

..

70.00

5.00

7702

..

30.00

5.00

7948

..

115.00

5.00

7705

..

78.00

5.00

7955

..

40.00

5.00

7710

..

9.50

3.00

7959

..

75.00

5.00

7713

..

61.00

5.00

7963

..

59.00

5.00

7716

..

45.00

5.00

7964

..

59.00

5.00

7719

..

42.00

5.00

7971

..

49.00

5.00

7722

..

24.00

5.00

7972

..

49.00

5.00

7725

..

9.50

3.00

7979

..

49.00

5.00

7728

..

13.50

4.00

7980

..

49.00

5.00

7729

..

17.50

5.00

7991

..

68.00

5.00

7733

..

39.00

5.00

7995

..

39.00

5.00

7736

..

9.50

3.00

7996

..

39.00

5.00

7740

..

47.00

5.00

8004

..

42.00

5.00

7742

..

45.00

5.00

8005

..

42.00

5.00

7746

..

56.00

5.00

8012

..

49.00

5.00

7748

..

87.00

5.00

8013

..

49.00

5.00

7752

..

61.00

5.00

8025

..

49.00

5.00

7755

..

8.30

2.00

8030

..

22.00

5.00

7759

..

5.20

1.50

8034

..

46.00

5.00

7780

..

39.00

5.00

8039

..

26.00

5.00

7784

..

13.50

4.00

8043

..

26.00

5.00

7786

..

32.00

5.00

8047

..

39.00

5.00

7790

..

3.70

1.00

8052

..

42.00

5.00

7794

..

3.90

1.00

8056

..

49.00

5.00

7796

..

3.90

1.00

8064

..

71.50

5.00

7800

..

5.50

3.00

8068

..

110.00

5.00

7801

..

5.50

3.00

8073

..

11.50

3.00

7805

..

12.00

4.00

8078

..

28.00

5.00

7806

..

12.00

4.00

8082

..

28.00

5.00

7811

..

16.50

5.00

8086

..

45.00

5.00

7813

..

26.00

5.00

8090

..

15.00

4.00

7816

..

47.00

5.00

8094

..

59.00

5.00

7819

..

66.00

5.00

8098

..

44.00

5.00

7822

..

39.00

5.00

8102

..

12.00

4.00

7825

..

22.00

5.00

8107

..

54.00

5.00

7826

..

22.00

5.00

8112

..

73.00

5.00

7829

..

34.00

5.00

8117

..

28.00

5.00

7833

..

39.00

5.00

8121

..

21.00

5.00

7837

..

18.00

5.00

8125

..

42.00

5.00

7842

..

20.00

5.00

7846

..

9.00

3.00

8129

..

100.00

5.00

7851

..

36.00

5.00

8133

..

28.00

5.00

7856

..

18.00

5.00

8137

..

54.00

5.00

7859

..

39.00

5.00

8138

..

54.00

5.00

7865

..

30.00

5.00

8146

..

68.00

5.00

7871

..

20.00

5.00

8147

..

68.00

5.00

7875

..

16.50

4.00

8155

..

34.00

5.00

7876

..

16.50

4.00

8156

..

34.00

5.00

7879

..

34.00

5.00

8164

..

49.00

5.00

7882

..

59.00

5.00

8165

..

49.00

5.00

7886

..

22.00

5.00

8171

..

49.00

5.00

7887

..

22.00

5.00

8172

..

49.00

5.00

7890

..

49.00

5.00

8177

..

63.00

5.00


Schedule 7

Regulations 5

TABLE OF FUND MEDICAL BENEFITS IN RESPECT OF TASMANIA

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

1

..

1.30

.80

274

..

6.20

1.50

2

..

2.60

1.10

277

..

6.20

1.50

10

..

1.95

.80

280

..

10.40

3.00

12

..

3.10

1.30

282

..

6.20

1.50

21

..

3.70

1.60

285

..

23.00

5.00

24

..

4.90

2.10

289

..

5.80

1.50

29

..

5.50

2.50

292

..

26.00

5.00

31

..

6.70

3.00

294

..

6.20

1.50

36

..

1.90

1.20

296

..

11.60

3.00

41

..

3.35

1.40

300

..

.40

.80

47

..

2.95

1.20

303

..

1.60

.80

49

..

4.05

1.80

304

..

2.20

1.00

55

..

5.05

2.20

307

..

3.50

1.00

56

..

6.20

2.70

308

..

3.80

1.50

61

..

7.00

3.00

311

..

4.70

1.50

62

..

8.15

3.50

312

..

5.40

2.00

63

..

2.95

1.20

314

..

5.80

2.00

64

..

4.05

1.80

315

..

6.00

3.00

67

..

1.95

.80

316

..

6.50

3.00

68

..

1.30

.80

318

..

7.00

3.00

74

..

1.95

.80

319

..

8.50

3.00

76

..

2.90

1.00

320

..

10.00

3.00

80

..

5.90

1.50

322

..

9.50

4.00

83

..

2.75

1.00

324

..

10.00

4.00

86

..

9.40

2.00

325

..

11.00

4.00

89

..

6.45

1.50

326

..

12.00

4.00

92

..

2.75

1.00

327

..

12.00

5.00

95

..

5.90

1.50

328

..

13.00

5.00

98

..

8.75

2.00

329

..

14.00

5.00

101

..

11.00

3.00

330

..

14.00

5.00

104

..

14.75

3.00

331

..

15.00

5.00

109

..

6.45

.80

332

..

16.00

5.00

112

..

9.40

2.00

333

..

17.00

5.00

115

..

11.65

3.00

334

..

18.00

5.00

118

..

15.00

3.00

335

..

18.00

5.00

121

..

17.75

4.00

336

..

20.00

5.00

124

..

11.60

2.00

127

..

17.60

4.00

337

..

20.00

5.00

129

..

24.50

5.00

338

..

21.00

5.00

131

..

32.50

5.00

339

..

22.00

5.00

133

..

39.50

5.00

343

..

23.00

5.00

203

..

1.95

.80

346

..

26.00

5.00

206

..

20.50

5.00

349

..

28.00

5.00

208

..

14.00

4.00

350

..

30.00

5.00

212

..

15.00

5.00

353

..

1.80

1.00

218

..

18.00

5.00

356

..

4.70

1.50

223

..

26.00

5.00

359

..

The amount shown in this column in the item relating to the administration an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

 

 

 

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

 

 

 

224

..

25.00

5.00

 

 

226

..

32.50

5.00

 

 

227

..

31.50

5.00

237

..

42.00

5.00

238

..

42.00

5.00

239

..

42.00

5.00

240

..

45.00

5.00

245

..

1.30

.80

248

..

1.30

.80

253

..

15.00

4.00

254

..

20.50

5.00

257

..

6.20

1.50

262

..

1.30

.80

269

..

5.60

1.50

272

..

8.50

2.00


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

363

..

The amount shown in this column in the item relating to the administrator of an anaesthetic in connection with the treatment of the fracture concerned pin one-third of that amount

The amount shown in this e column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture s concerned plus one-third of that amount

 

administration of an anaesthetic in connection with the treatment of the part concerned

administration of an anaesthetic in connection with the treatment of the part concerned

410

..

.70

.80

411

..

1.90

1.00

412

..

3.00

1.00

413

..

4.10

1.50

414

..

5.50

1.50

415

..

5.90

2.00

416

..

6.50

2.00

366

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-half of that amount

The amount shown in this e column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-half of that amount

417

..

7.00

3.00

 

 

418

..

8.50

3.00

419

..

10.00

3.00

420

..

9.50

4.00

421

..

10.50

4.00

422

..

12.50

4.00

423

..

14.00

4.00

424

..

13.00

5.00

425

..

15.00

5.00

426

..

16.00

5.00

427

..

17.00

5.00

425

..

17.00

5.00

421

..

19.00

5.00

431

..

20.00

5.00

432

..

21.00

5.00

369

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus three-quarters of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus three-quarters of that amount

433

..

22.00

5.00

434

..

23.00

5.00

 

 

437

..

24.00

5.00

438

..

25.00

5.00

439

..

26.00

5.00

440

..

27.00

5.00

441

..

29.00

5.00

442

..

29.00

5.00

444

..

32.00

5.00

445

..

35.00

5.00

446

..

38.00

5.00

447

..

35.00

5.00

448

..

2.40

1.00

449

..

5.90

2.00

453

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the dislocation concerned plus one-half of that amount

373

..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

 

 

 

 

377

..

The amount shown in this column in the item relating to the

The amount shown in this column in the item relating to the

457

..

The amount shown in this column in the item relating to the

The amount shown in this column in the item relating to the

 

 

 

 


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-third of that amount

administration of an anaesthetic in connection with the treatment of the fracture concerned phis one-third of that amount

 

treatment of the part concerned

treatment of the fracture concerned

503

..

3.50

1.00

504

..

4.10

1.50

507

..

3.80

1.50

508

..

5.50

1.50

511

..

5.80

2.00

512

..

7.00

3.00

515

..

4.70

1.50

459   ..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-half of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus one-half of that amount

516

..

5.90

2.00

519

..

6.50

3.00

520

..

10.00

3.00

530

..

7.70

2.00

532

..

5.60

1.50

534

..

5.80

1.50

536

..

7.00

2.00

555

..

10.00

3.00

603

..

5.90

1.50

605

..

14.10

3.00

607

..

22.50

5.00

609

..

8.70

2.00

612

..

20.00

4.00

615

..

29.00

5.00

620

..

8.70

2.00

463   ..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned pins three-quarters of that amount

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned plus three-quarters of that amount

622

..

18.50

4.00

624

..

13.40

3.00

 

628

..

16.60

4.00

633

..

22.50

5.00

635

..

10.60

2.00

637

..

8.70

2.00

650

..

42.00

5.00

653

..

20.00

4.00

655

..

6.80

1.50

658

..

30.00

5.00

663

..

54.00

5.00

666

..

22.50

5.00

669

..

13.40

3.00

671

..

8.00

1.50

675

..

5.40

l.50

673

..

4.30

1.00

466   ..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the fracture concerned

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the treatment of the part concerned

683

..

10.90

3.00

 

686

..

7.70

1.50

690

..

14.10

3.00

700

..

2.60

.80

706

..

4.00

1.00

718

..

5.40

1.00

722

..

6.80

1.50

726

..

4.70

1.00

732

..

4.70

1.00

735

..

5.80

1.50

740

..

5.30

1.00

743

..

3.90

1.00

745

..

8.75

2.00

469   ..

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the

The amount shown in this column in the item relating to the administration of an anaesthetic in connection with the

750

..

5.80

1.50

 

758

..

8.70

2.00

762

..

5.80

1.50

765

..

35.00

5.00

768

..

29.00

5.00

773

..

2.70

1.00

775

..

5.30

1.00

778

..

8.70

2.00

785

..

17.00

4.00

788

..

4.40

1.00


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

 

$

$

792

..

14.10

3.00

1084

..

3.80

3.00

795

..

48.00

5.00

1090

..

1.60

.80

798

..

70.00

5.00

1091

..

2.50

1.00

802

..

10.90

3.00

1092

..

1.90

1.00

805

..

3.80

1.00

1094

..

1.90

1.00

808

..

6.40

1.50

1096

..

.90

.80

811

..

6.40

1.50

1098

..

1.30

.80

813

..

9.00

2.00

1101

..

1.50

1.00

817

..

13.40

3.00

1102

..

3.50

1.00

820

..

13.40

3.00

1104

..

.20

.80

823

..

12.20

3.00

1106

..

1.10

.80

826

..

8.70

2.00

1108

..

1.50

1.00

830

..

23.50

5.00

1110

..

3.30

1.50

834

..

5.30

1.00

1112

..

.20

.80

837

..

11.50

3.00

1114

..

.20

.80

842

..

1.60

.80

1116

..

2.60

1.50

848

..

2.10

.80

1118

..

1.10

.80

852

..

3.60

1.00

1120

..

4.80

1.50

855

..

5.60

1.00

1122

..

.70

1.00

858

..

3.50

1.00

1124

..

1.90

1.00

862

..

10.30

2.00

1126

..

2.30

1.00

869

..

18.50

4.00

1128

..

.70

.80

873

..

38.00

5.00

1130

..

3.10

1.00

876

..

6.40

1.50

1132

..

1.90

1.00

1018

..

.20

.80

1134

..

3.10

1.00

1002

..

.70

.80

1136

..

4.80

1.50

1004

..

.20

.80

1138

..

1.60

.80

1006

..

.90

.80

1140

..

1.70

1.00

1008

..

.20

.80

1142

..

1.40

1.00

1010

..

.60

.80

1144

..

1.60

.80

1012

..

3.00

1.00

1146

..

1.60

.80

1014

..

.90

1.00

1148

..

1.70

1.00

1016

..

3.10

1.00

1150

..

2.80

1.50

10J8

..

3.80

1.50

1152

..

2.70

1.00

1019

..

.70

.80

1154

..

2.30

1.00

1020

..

5.70

3.00

1156

..

2.30

1.00

1022

..

.20

.80

1160

..

.70

1.00

1024

..

.70

.80

1162

..

1.10

1.00

1026

..

.70

.80

1166

..

2.50

1.00

1028

..

1.20

1.00

1168

..

2.50

1.00

1030

..

1.10

1.00

1170

..

2.90

1.00

1032

..

1.20

1.00

1172

..

.90

.80

1034

..

1.90

1.00

1174

..

1.60

.80

1036

..

2.70

1.00

1178

..

1.00

.80

1038

..

3.10

1.00

1180

..

.10

.80

1040

..

3.10

1.00

1182

..

.20

.80

1042

..

.40

.80

1184

..

1.70

1.00

1044

..

4.00

1.50

1186

..

.70

.80

1046

..

1.40

.80

1188

..

1.90

1.00

1048

..

5.60

1.50

1190

..

2.70

1.00

1050

..

1.50

1.00

1192

..

.70

1.00

1054

..

.20

.80

1194

..

.70

1.00

1060

..

.20

.80

1196

..

2.70

1.00

1062

..

.60

.80

1198

..

.70

1.00

1063

..

.40

.80

1200

..

.20

.80

1064

..

.70

.80

1202

..

.40

1.00

1066

..

2.30

1.00

1204

..

.60

.80

1068

..

1.00

1.00

1206

..

2.10

1.00

1070

..

1.30

1.00

1208

..

1.70

1.00

1072

..

2.70

1.00

1210

..

.70

1.00

1074

..

7.60

3.00

1076

..

.90

.80

1212

..

1.50

1.00

1080

..

.70

.80

1214

..

.70

.80

1082

..

2.30

1.00

1216

..

.80

.80


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

1218

..

3.50

1.00

1391

..

2.00

1.00

1220

..

5.00

1.50

1392

..

3.30

1.50

1222

..

5.00

1.50

1394

..

4.00

2.00

1224

..

6.80

3.00

1395

..

.40

.80

1226

..

8.80

3.00

1397

..

1.90

1.00

1228

..

3.50

1.00

1399

..

.70

.80

1230

..

5.00

1.50

1401

..

1.90

1.00

1232

..

.40

.80

1404

..

.20

.80

1240

..

1.90

1.00

1407

..

.70

1.00

1242

..

3.10

1.00

1410

..

1.60

.80

1246

..

5.00

1.50

1413

..

1.60

.80

1248

..

.20

.80

1416

..

2.60

1.00

1250

..

.70

1.00

1419

..

2.90

5.00

1252

..

2. 50

1.50

1421

..

2.30

1.00

1254

..

4.70

1.50

1423

..

1.00

.80

1256

..

5.80

2.00

1425

..

4.00

1.50

1258

..

6.40

3.00

1428

..

130

1.00

1260

..

2.70

1.00

1430

..

5.00

1.50

1262

..

4.40

1.50

1432

..

8.80

3.00

1264

..

.70

1.00

1434

..

2.70

1.00

1266

..

2.80

1.50

1436

..

3.10

1.00

1268

..

4.70

1.50

1438

..

8.80

3.00

1270

..

5.80

2.00

1441

..

3.30

3.00

1272

..

2.50

1.00

1444

..

.40

.80

1274

..

8.80

3.00

1447

..

5.00

1.50

1277

..

1.90

1.00

3450

..

3.40

1.50

1278

..

.70

1.00

1453

..

1.20

1.00

1280

..

2.80

1.50

1456

..

2.50

1.00

1282

..

4.70

1.50

1459

..

.70

1.00

1284

..

5.80

2.00

1463

..

2.80

1.50

1286

..

6.40

3.00

1463

..

4.70

1.50

1288

..

4.00

1.50

1466

..

5.80

2.00

1290

..

3.10

1.50

1468

..

.20

.80

1294

..

.70

1.00

1470

..

1.70

1.00

1296

..

1.60

.80

1472

..

4.00

1.50

1298

..

2.80

1.00

1474

..

8.80

3.00

1301

..

.70

1.00

1475

..

7.00

3.00

1302

..

2.80

1.50

1476

..

1.70

1.00

1304

..

4.70

1.50

1478

..

2.30

1.00

1305

..

5.80

2.00

1481

..

3.30

1.00

1307

..

6.40

3.00

1484

..

6.80

3.00

1310

..

.70

1.00

1487

..

1.70

1.00

1313

..

1.90

1.00

1490

..

1.70

1.00

1314

..

.50

.80

1491

..

.20

.80

1317

..

.20

.50

1493

..

6.80

3.00

1319

..

3.10

1.50

1494

..

8.80

3.00

1322

..

.20

.80

3495

..

.90

.80

1325

..

.40

.80

1496

..

1.60

.80

1328

..

1.90

1.00

1497

..

3.40

1.50

1331

..

3.00

.50

1499

..

3.50

1.00

1334

..

1.10

1.00

1500

..

.20

.80

1337

..

3.20

1.50

1502

..

.20

.80

1340

..

5.00

2.00

1504

..

.20

.80

1343

..

1.70

3.00

1506

..

1.30

1.00

1346

..

6.80

3.00

1508

..

.20

.80

1349

..

3.30

1.00

1511

..

1.90

1.00

1352

..

3.50

1.00

1513

..

1.60

.80

1355

..

2.50

.00

1515

..

.40

1.00

1358

..

1.00

.80

1517

..

1.20

1.00

1380

..

.70

.80

1519

..

2.50

1.00

1382

..

.70

.80

1521

..

2.50

1.50

1385

..

.70

1.00

1523

..

3.50

1.50

1388

..

2.80

1.50

1525

..

1.90

1.00

1389

..

4.30

1.50

1527

..

4.00

1.50


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

1529

..

2.30

1.00

1707

..

2.60

1.00

1531

..

4.40

1.50

1710

..

.70

.80

1534

..

1.60

.80

1712

..

.70

1.00

1537

..

2.60

1.00

1714

..

.70

1.00

1539

..

2.30

1.00

1716

..

.90

.80

1541

..

1.90

1.00

1718

..

2.00

1.00

1543

..

1.00

.80

1720

..

4.00

2.00

1545

..

.20

.80

1722

..

5.10

3.00

1546

..

1.50

1.00

1724

..

1.90

1.00

1545

..

2.80

1.50

1726

..

4.00

1.50

1551

..

2.00

1.00

1728

..

5.80

2.00

1554

..

2.90

1.50

1730

..

4.00

1.50

1557

..

3.50

2.00

1732

..

.20

.80

1560

..

2.90

1.50

1734

..

.20

.80

1562

..

3.80

1.50

1736

..

6.80

3.00

1564

..

4.40

2.00

1738

..

.90

.80

1566

..

4.90

2.00

1741

..

.70

1.00

1568

..

5.00

3.00

1744

..

.90

.80

1571

..

1.30

1.00

1746

..

.70

1.00

1580

..

1.90

1.00

1748

..

.70

1.00

1582

..

1.30

.80

1761

..

.90

.80

1584

..

3.50

1.00

1764

..

1.70

1.00

1586

..

.20

.80

1767

..

.90

.80

1588

..

.70

1.00

1770

..

.70

1.00

1590

..

2.70

1.00

1773

..

3.10

1.00

1601

..

.70

1.00

1776

..

4.80

1.50

1604

..

2.80

1.50

1779

..

.20

.80

1607

..

4.70

1.50

1782

..

.20

.80

1609

..

5.80

2.00

1785

..

.20

.80

1611

..

1.00

1.00

1790

..

1.90

1.00

1613

..

3.30

1.00

1792

..

1.60

.80

1615

..

2.50

1.00

1794

..

4.00

1.00

1616

..

3.50

1.00

1796

..

4.00

1.50

1621

..

.40

.80

1798

..

1.90

1.00

1622

..

.20

.80

1800

..

1.10

.80

1623

..

1.00

.80

1802

..

2.20

1.00

1S25

..

1.10

.80

1804

..

3.80

1.50

1627

..

2.70

1.00

1806

..

.40

.80

1629

..

2.30

1.00

1808

..

1.30

1.50

1631

..

1.60

.80

1810

..

.40

.80

1640

..

5.60

1.50

1812

..

.40

.80

1643

..

2.90

1.00

1820

..

2.80

1.50

1645

..

2.90

1.00

1822

..

5.00

2.00

1647

..

8.80

3.00

1824

..

6.40

3.00

1649

..

7.00

2.00

1826

..

4.40

3.00

1651

..

8.50

3.00

1828

..

7.40

3.00

1653

..

4.00

1.50

1840

..

12.40

4.00

1661

..

.20

.80

1841

..

16.00

5.00

1564

..

5.80

2.00

1843

..

3.10

1.50

1667

..

.70

1.00

1846

..

4.00

1.50

1670

..

2.70

1.00

1849

..

2.50

1.00

1673

..

3.50

1.00

1850

..

2.80

1.50

1680

..

.20

.80

1852

..

2.80

1.50

1682

..

.20

.80

1853

..

7.00

3.00

1684

..

.40

.80

1855

..

4.30

1.50

1686

..

1.10

.80

1858

..

5.00

2.00

1683

..

1.90

1.00

1861

..

2.70

1.50

1691

..

1.90

1.00

1863

..

5.80

2.00

1694

..

1.30

1.00

1865

..

14.00

5.00

1697

..

1.80

1.00

1867

..

3.10

1.50

1698

..

3.30

1.50

1869

..

4.80

1.50

1700

..

1.90

1.00

1871

..

6.80

3.00

1701

..

5.10

2.00

1703

..

1.90

1.00

1873

..

14.00

5.00

1706

..

1.60

.80

1875

..

5.80

2.00


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

1877

..

5.80

2.00

2046

..

4.50

1.50

1879

..

3.10

1.50

2050

..

4.00

1.50

1881

..

2.10

1.00

2053

..

3.00

1.50

1884

..

1.50

1.00

2055

..

3.00

1.50

1887

..

4.00

1.50

2058

..

11.50

3.00

1889

..

12.40

4.00

2062

..

5.50

1.50

1891

..

1.60

.80

2067

..

4.50

1.50

1893

..

3.40

1.80

2070

..

5.50

1.50

1895

..

1.80

2.00

2074

..

5.50

1.50

1896

..

1.70

1.00

2077

..

4.50

1.50

1897

..

3.50

1.00

2073

..

4.50

1.50

1898

..

3.50

1.00

2032

..

4.50

1.50

1899

..

5.30

1.50

2084

..

4.10

1.50

1900

..

4.00

1.50

2086

..

4.10

1.50

1902

..

6.00

2.00

2088

..

5.00

1.50

1904

..

1.30

1.00

2091

..

3. 10

1.00

1906

..

1.50

1.00

2096

..

8.00

3.00

1908

..

7.00

2.00

2100

..

8.00

2.00

1910

..

7.20

3.00

2103

..

6.50

1.50

1912

..

8.40

3.00

2105

..

3.60

1.50

1914

..

8.80

3.00

2107

..

5.50

1.50

1916

..

4.00

1.00

2109

..

4.50

1.50

1917

..

3.50

1.00

2114

..

5.50

2.00

1918

..

3.40

1.50

2117

..

3.50

1.50

1919

..

7.00

3.00

2120

..

7.50

3.00

1920

..

2.70

1.00

2122

..

10.00

3.00

1922

..

4.00

1.50

2124

..

2.40

1.00

1924

..

4.00

1.50

2126

..

6.00

1.50

1926

..

4.40

1.50

2129

..

10.00

3.00

1927

..

10.50

4.00

2131

..

4.40

1.00

1929

..

17.00

5.00

2134

..

4.60

1.50

1931

..

7.00

3.50

2136

..

5.00

1.50

1933

..

6.60

2.00

2143

..

4. 60

1.50

1936

..

5.20

1.50

2147

..

2.20

1.00

1937

..

6.20

2.00

2149

..

4.50

1.50

1939

..

11.00

4.00

2151

..

6.00

1.50

1942

..

10.50

4.00

2153

..

4.40

1.00

1946

..

6.20

2.00

2155

..

4.00

1.50

1952

..

19.00

5.00

2157

..

5.00

1.00

1954

..

8.50

3.00

2159

..

5.50

1.50

1960

..

10.50

4.00

2162

..

4.60

1.50

1962

..

6.60

2.00

2165

..

15.50

4.00

1964

..

7.00

3.00

2167

..

12.00

4.00

1982

..

12.00

4.00

2171

..

16.00

4.00

1984

..

6.00

1.00

2175

..

10.50

3.00

1986

..

13.00

4.00

2178

..

7.50

2.00

1987

..

12.00

4.00

2182

..

9.00

3.00

1989

..

8.00

3.00

2186

..

4.50

1.50

1991

..

12.00

4.00

2201

..

4.40

1.00

1993

..

12.00

4.00

2206

..

4.60

1.50

1995

..

8.00

3.00

2210

..

3.50

1.50

1997

..

10.50

3.00

2212

..

6.50

2.00

1998

..

7.80

2.00

2256

..

5.00

3.00

2002

..

2.40

1.00

2220

..

9.50

3.00

2004

..

3.60

1.00

2223

..

9.00

3.00

2007

..

2.40

1.00

2225

..

8.00

3.00

2009

..

3.60

1.00

2228

..

10.50

3.00

2025

..

4.00

1.50

2232

..

7.50

2.00

2029

..

4.50

3.50

2236

..

7.00

2.00

2031

..

3.40

1.00

2239

..

10.50

3.00

2033

..

3.60

1.50

2241

..

8.00

2.00

2035

..

4.50

1.50

2243

..

13.00

4.00

2037

..

4. 50

1.50

2245

..

8.00

2.00

2039

..

4.00

1.50

2249

..

2.40

1.00


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

 

$

$

2255

..

9.00

3.00

2550

..

14.50

4.00

2257

..

6.00

1.50

2553

..

4.90

1.50

2265

..

4.60

1.50

2556

..

8.50

3.00

2267

..

5.00

2.00

2559

..

10.50

3.00

2269

..

8.00

2.00

2562

..

3.20

1.00

2272

..

9.00

3.00

2565

..

3.40

1.00

2275

..

12.50

4.00

2568

..

5.50

1.50

2277

..

12.50

4.00

2571

..

5.50

1.50

2279

..

12.50

4.00

2600

..

17.00

4.00

2281

..

8.00

2.00

2603

..

14.00

4.00

2283

..

6.00

1.50

2606

..

14.00

4.00

2285

..

52.00

3.00

2613

..

14.00

5.00

2287

..

9.00

3.00

2616

..

5.10

1.50

2289

..

10.00

3.00

2619

..

7.50

2.00

2296

..

5.00

1.50

2623

..

7.50

2.00

2299

..

6.50

3.00

2631

..

6.00

1.50

2302

..

6.50

3.00

2635

..

6.00

1.50

2304

..

6.50

3.00

2639

..

4.90

1.50

2306

..

6.50

3.00

2643

..

6.00

1.50

2308

..

6.50

3.00

2647

..

4.90

1.50

2312

..

14.00

4.00

2651

..

4.90

1.50

2316

..

6.50

3.00

2655

..

7.50

2.00

2319

..

8.50

2.00

2658

..

6.00

1.50

2323

..

8.50

2.00

2663

..

6.00

1.50

2327

..

2.70

1.00

2667

..

3.90

1.00

2331

..

6.50

1.50

2669

..

7.50

2.00

2335

..

5.40

1.50

2673

..

5.10

1.50

2339

..

6.50

1.50

2677

..

5.10

1.50

2343

..

9.50

3.00

2680

..

14.00

4.00

2348

..

8.00

2.00

2685

..

9.00

3.00

2352

..

6.00

1.50

2689

..

2.40

1.00

2365

..

7.50

2.00

2693

..

14.00

4.00

2400

..

1.30

.80

2701

..

7.00

2.00

2425

..

5.60

1.50

2704

..

7.50

2.00

2428

..

3.60

1.00

2708

..

9.00

3.00

2450

..

3.20

1.00

2712

..

14.00

4.00

2453

..

.30

.80

2920

..

7.00

1.00

2456

..

3.90

1.00

2929

..

One-fifth of the amount shown in this column for the operation or operations

One-fifth of the amount shown in this column for the operation or operations

2461

..

.40

.80

 

 

2466

..

7.50

2.00

2469

..

1.20

.80

2472

..

4.40

1.00

2475

..

3.90

1.00

2478

..

.40

.80

3003

..

1.95

.80

2482

..

4.60

1.50

3007

..

3.80

1.00

2485

..

.50

.80

3010

..

5.20

1.50

2488

..

9.00

3.00

3014

..

6.40

1.50

2490

..

1.80

.80

3018

..

10.00

3.00

2492

..

6.00

1.50

3020

..

12.00

3.00

2494

..

.80

.80

3023

..

4.50

1.50

2497

..

8.00

2.00

3026

..

4.80

1.50

2501

..

1.30

.80

3028

..

4.10

1.50

2504

..

12.50

4.00

3032

..

4.10

1.50

2507

..

2.70

1.00

3035

..

9.00

3.00

2511

..

22.00

5.00

3040

..

9.00

3.00

2515

..

15.00

4.00

3042

..

5.30

1.50

2519

..

31.00

5.00

3044

..

11.50

3.00

2523

..

45.00

5.00

3048

..

14.00

4.00

2527

..

36.00

5.00

3053

..

9.00

3.00

2531

..

22.00

5.00

3054

..

9.00

3.00

2536

..

8.00

3.00

3060

..

11.50

3.00

2540

..

13.50

4.00

3066

..

14.50

4.00

2544

..

6.50

1.50

3072

..

14.50

4.00

2547

..

4.90

1.50

3076

..

1.10

.80


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

3079

..

1.10

.80

3327

..

11.50

3.00

3083

..

8.00

3.00

3333

..

16.50

5.00

3086

..

8.00

3.00

3337

..

21.00

5.00

3088

..

14.00

4.00

3341

..

13.50

4.00

3091

..

18.00

5.00

3343

..

17.00

5.00

3096

..

18.00

5.00

3347

..

23.00

5.00

3100

..

4.40

1.00

3352

..

9.50

3.00

3102

..

4.40

1.00

3355

..

11.50

3.00

3107

..

8.00

3.00

3358

..

28.00

5.00

3111

..

9.50

3.00

3360

..

28.00

5.00

3118

..

9.50

3.00

3365

..

28.00

5.00

3122

..

4.00

1.00

3370

..

63.00

5.00

3127

..

8.00

3.00

3374

..

105.00

5.00

3129

..

2.40

1.00

3376

..

70.00

5.00

3133

..

2.40

1.00

3380

..

28.00

5.00

3136

..

34.00

4.00

3382

..

28.00

5.00

3141

..

7.30

2.00

3385

..

15.50

4.00

3145

..

7.30

2.00

3388

..

15.50

4.00

3151

..

11.50

3.00

3410

..

5.00

1.50

3154

..

14.00

4.00

3413

..

5.00

1.50

3158

..

14.00

4.00

3416

..

9.00

3.00

3164

..

2.90

1.00

3420

..

11.50

3.00

3167

..

6.00

3.00

3422

..

11.50

3.00

3169

..

7.50

4.00

3426

..

11.50

3.00

3172

..

31.00

5.00

3429

..

23.00

5.00

3176

..

12.00

5.00

3432

..

23.00

5.00

3182

..

30.00

5.00

3435

..

59.00

5.00

3186

..

6.80

2.00

3438

..

59.00

5.00

3188

..

5.00

2.00

3441

..

150.00

5.00

3192

..

5.00

2.00

3449

..

3.80

1.00

3198

..

9.00

3.00

3451

..

3.80

1.00

3200

..

11.00

3.00

3457

..

12.50

3.00

3205

..

31.00

3.00

3461

..

16.50

4.00

3209

..

11.50

4.00

3463

..

16.50

4.00

3212

..

15.00

5.00

3467

..

105.00

5.00

3214

..

15.00

5.00

3471

..

59.00

5.00

3223

..

15.00

5.00

3474

..

42.00

5.00

3227

..

21.00

5.00

3476

..

49.00

5.00

3231

..

32.00

5.00

3481

..

85.00

5.00

3234

..

70.00

5.00

3485

..

95.00

5.00

3239

..

42.00

5.00

3489

..

105.00

5.00

3240

..

42.00

5.00

3499

..

59.00

5.00

3241

..

49.00

5.00

3499

..

61.00

5 00

3243

..

49.00

5.00

3504

..

42.00

5.00

3246

..

70.00

5.00

3512

..

36.00

5.00

3249

..

32 00

5.00

3518

..

28.00

5.00

3257

..

56.00

5.00

3520

..

150.00

5.00

3260

..

10.50

3.00

3522

..

30.00

5.00

3264

..

3.10

1.00

3538

..

85.00

5.00

3266

..

4.00

1.00

3540

..

19.00

5.00

3270

..

4.00

1.00

3543

..

61.00

5.00

3275

..

2.90

1.50

3546

..

16.00

4.00

3278

..

6.10

2.00

3549

..

26.00

5.00

3283

..

6.30

2.00

3552

..

35.00

5.00

3287

..

7.00

2.00

3357

..

9.50

4.00

3293

..

3.60

1.00

3358

..

10.00

4.00

3296

..

12.00

4.00

3562

..

20.00

5.00

3302

..

.90

.80

3564

..

20.00

5.00

3307

..

1.70

.80

3568

..

26.00

5.00

3310

..

6.50

2.00

3570

..

20.00

5.00

3312

..

6.00

3.00

3574

..

26.00

5.00

3317

..

6.00

3.00

3579

..

49.00

5.00

3322

..

9.50

3.00

3584

..

73.00

5.00


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

3586

..

11.50

3.00

3851

..

95.00

5.00

3590

..

29.00

5.00

3852

..

30.00

5.00

3592

..

36.00

5.00

3858

..

105.00

5.00

3596

..

36.50

5.00

3861

..

18.00

5.00

3600

..

49.00

5.00

3862

..

23.00

5.00

3606

..

42.00

5.00

3866

..

9.50

3.00

3611

..

54.00

5.00

3868

..

32.00

5.00

3613

..

45.00

5.00

3871

..

41.00

5.00

3621

..

49.00

5.00

3873

..

13.50

4.00

3625

..

130.00

5.00

3376

..

7.30

2.00

3628

..

45.00

5.00

3877

..

100.00

5.00

3631

..

49.00

5.00

3881

..

150.00

5.00

3635

..

49.00

5.00

3835

..

170.00

5.00

3639

..

9.50

3.00

3837

..

34.00

5.00

3642

..

34.00

5.00

3890

..

42.00

5.00

3644

..

43.00

5.00

3891

..

105.00

5.00

3648

..

36.00

5.00

3893

..

45.00

5.00

3650

..

45.00

5.00

3895

..

59.00

5.00

3653

..

75.00

5.00

3897

..

63.00

5.00

3659

..

63.00

5.00

3942

..

39.00

5.00

3663

..

52.00

5.00

3944

..

49.00

5.00

3666

..

82.00

5.00

3947

..

95.00

5.00

3669

..

125.00

5.00

3950

..

73.00

5.00

3672

..

125.00

5.00

3953

..

73.00

5.00

3674

..

14.50

4.00

3956

..

38.00

5.00

3677

..

16.50

5.00

3960

..

11.50

3.00

3679

..

45.00

5.00

3966

..

4.50

1.50

3635

..

47.00

5.00

3972

..

305.00

5.00

3694

..

49.00

5.00

3974

..

87.00

5.00

3697

..

59.00

5.00

3977

..

35.00

5.00

3701

..

70.00

5.00

3980

..

52.00

5.00

3703

..

45.00

5.00

3982

..

28.00

5.00

3708

..

59.00

5.00

3985

..

18.00

5.00

3712

..

59.00

5.00

3988

..

25.00

5.00

3717

..

36.00

5.00

3992

..

45.00

5.00

3719

..

45.00

5.00

3994

..

66.00

5.00

3723

..

85.00

5.00

3997

..

67.00

5.00

3730

..

105.00

5.00

4001

..

21.00

5.00

3734

..

125.00

5.00

4005

..

28.00

5.00

3738

..

45.00

5.00

4006

..

24.50

5.00

3740

..

36.00

5.00

4010

..

33.00

5.00

3744

..

36.00

5.00

4014

..

36.00

5.00

3748

..

45.00

5.00

4016

..

45.00

5.00

3752

..

59.00

5.00

4019

..

2.90

1.00

3757

..

36.00

5.00

4023

..

16.50

5.00

3762

..

45.00

5.00

4025

..

21.00

5.00

3775

..

24.00

5.00

4028

..

28.00

5.00

3731

..

31.00

5.00

4030

..

33.00

5.00

3785

..

45.00

5.00

4036

..

18.00

5.00

3787

..

45.00

5.00

4038

..

23.00

5.00

3771

..

29.00

5.00

4058

..

24.50

5.00

3794

..

37.00

5.00

4063

..

33.00

5.00

3799

..

18.00

5.00

4067

..

45.00

5.00

3804

..

42.00

5.00

4069

..

70.00

5.00

3813

..

73.00

5.00

4073

..

39.00

5.00

3818

..

75.00

5.00

4077

..

8.50

3.00

3819

..

36.00

5.00

4079

..

3.80

1.00

3822

..

45.00

5.00

4081

..

7.50

2.00

3828

..

35.00

5.00

4083

..

11.50

3.00

3830

..

45.00

5.00

4085

..

14.50

4.00

3835

..

56.00

5.00

4088

..

3.90

1.00

3839

..

73.00

5.00

4052

..

4.50

1.50

3840

..

85.00

5.00

4098

..

15.50

4.00

3845

..

105.00

5.00

4103

..

12.00

5.00

3847

..

125.00

5.00

4105

..

14.00

5.00


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

4110

..

9.00

3.00

4292

..

100.00

5.00

4111

..

14.50

4.00

4295

..

100.00

5.00

4116

..

16.50

5.00

4298

..

100.00

5.00

4121

..

49.00

5.00

4301

..

59.00

5.00

4123

..

88.00

5.00

4306

..

75.00

5.00

4128

..

2.90

1.00

4308

..

54.00

5.00

4129

..

11.00

3.00

4312

..

125.00

5.00

4131

..

14.50

4.00

4314

..

150.00

5.00

4134

..

3.10

1.00

4323

..

105.00

5.00

4135

..

11.50

3.00

4329

..

35.00

5.00

4137

..

9.00

3.00

4335

..

73.00

5.00

4139

..

6.90

2.00

4341

..

19.00

5.00

4142

..

31.00

5.00

4344

..

14.50

4.00

4145

..

10.50

3.00

4347

..

85.00

5.00

4147

..

1.30

.80

4349

..

45.00

5.00

4152

..

4.00

1.50

4353

..

5.00

1.50

4154

..

4.50

1.50

4357

..

9.50

3.00

4159

..

9.00

5.00

4361

..

16.50

4.00

4160

..

12.00

5.00

4363

..

16.50

4.00

4164

..

8.50

2.00

4367

..

28.00

5.00

4163

..

11.00

4.00

4369

..

23.00

5.00

4170

..

14.00

5.00

4371

..

28.00

5.00

4174

..

17.00

5.00

4374

..

9.00

5.00

4178

..

23.00

5.00

4377

..

28.00

5.00

4180

..

26.00

5.00

4382

..

28.00

5.00

4184

..

32.00

5.00

4386

..

28.00

5.00

4186

..

9.00

3.00

4388

..

49.00

5.00

4187

..

11.50

3.00

4392

..

38.00

5.00

4192

..

59.00

5.00

4396

..

28.00

5.00

4196

..

26.00

5.00

4398

..

49.00

5.00

4198

..

5.90

1.50

4405

..

12.00

5.00

4203

..

28.00

5.00

4406

..

15.00

4.00

4204

..

21.00

5.00

4410

..

18.50

5.00

4205

..

26.00

5.00

4411

..

23.00

5.00

4210

..

7.00

2.00

4415

..

21.75

5 00

4226

..

2.80

1.00

4417

..

27.00

5.00

4228

..

8.50

2.00

4423

..

25.00

5.00

4232

..

15.50

4.00

4425

..

31.00

5.00

4234

..

41.00

5.00

4431

..

28.25

5.00

4237

..

30.00

5.00

4433

..

36.00

5.00

4239

..

57.00

5.00

4438

..

14.00

5.00

4242

..

26.00

5.00

4439

..

17.50

5.00

4244

..

20.00

5.00

4446

..

17.00

5.00

4245

..

16.00

4.00

4451

..

23.00

5.00

4248

..

42.00

5.00

4459

..

28.00

5.00

4250

..

68.00

5.00

4462

..

49 00

5.00

4252

..

4.20

1.00

4465

..

100.00

3.00

4255

..

20.00

5.00

4466

..

9.00

3.00

4257

..

28.00

5.00

4470

..

13.50

4.00

4259

..

42.00

5.00

4471

..

16.50

5.00

4261

..

61.00

5.00

4475

..

16.60

4.00

4264

..

85.00

5.00

4477

..

20.25

5.00

4266

..

100.00

5.00

4479

..

18.00

5.00

4268

..

61.00

5.00

4481

..

23.00

5.00

4270

..

100.00

5.00

4486

..

20.50

5.00

4272

..

90.00

5.00

4487

..

25.75

5.00

4274

..

45.00

5.00

4491

..

11.50

3.00

4278

..

59.00

5.00

4493

..

14.00

4.00

4280

..

49.00

5.00

4500

..

28.00

5.00

4283

..

61.00

5.00

4506

..

23.00

5.00

4286

..

115.00

5.00

4510

..

38.00

5.00

4289

..

110.00

5.00

4512

..

54.00

5.00

4290

..

115.00

5.00

4515

..

61.00

5.00


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

 

$

$

4518

..

125.00

5.00

4698

..

5.00

1.50

4530

..

6.60

2.00

4700

..

27.00

5.00

4532

..

19.00

5.00

4703

..

66.00

5.00

4535

..

11.50

3.00

4706

..

52.00

5.00

4539

..

12.00

4.00

4708

..

5.00

1.50

4543

..

80.00

5.00

4711

..

23.00

5.00

4546

..

49.00

5.00

4716

..

49.00

5.00

4550

..

82.00

5.00

4717

..

68.00

5.00

4554

..

90.00

5.00

4720

..

90.00

5.00

4556

..

115.00

5.00

4722

..

2.40

1.00

4558

..

45.00

5.00

4731

..

9.00

3.00

4566

..

56.00

5.00

4734

..

9.50

3.00

4569

..

90.00

5.00

4737

..

82.00

5.00

4572

..

135.00

5.00

4742

..

59.00

5.00

4574

..

152.50

5.00

4745

..

49.00

5.00

4577

..

100.00

5.00

4748

..

59.00

5.00

4581

..

115.00

5.00

4750

..

12.50

4.00

4584

..

90.00

5.00

4753

..

12.00

5.00

4588

..

210.00

5.00

4756

..

16.25

5.00

4589

..

210.00

5.00

4757

..

17.25

5.00

4593

..

100.00

5.00

4760

..

14.00

5.00

4597

..

125.00

5.00

4761

..

15.00

5.00

4601

..

100.00

5.00

4769

..

14.00

5.00

4607

..

49.00

5.00

4770

..

14.00

5.00

4609

..

90.00

5.00

4776

..

8.50

3.00

4613

..

59.00

5.00

4777

..

11.50

3.00

4615

..

68.00

5.00

4781

..

6.00

2.00

4619

..

100.00

5.00

4782

..

6.00

3.00

4621

..

8.30

2.00

4786

..

10.00

3.00

4623

..

35.00

5.00

4788

..

7.75

3.00

4627

..

7.00

4.00

4793

..

7.30

2.00

4632

..

3.90

1.00

4795

..

5.90

1.50

4634

..

8.00

3.00

4797

..

2.90

1.00

4636

..

8.00

3.00

4799

..

28.00

5.00

4638

..

6.20

1.50

4803

..

14.50

 4.00

4642

..

9.50

3.00

4805

..

29.00

5.00

4644

..

6.60

1.50

4807

..

13.50

4.00

4646

..

6.60

2.00

4809

..

16.50

5.00

4647

..

8.00

3.00

4813

..

28.00

5.00

4648

..

9.50

4.00

4816

..

4.50

1.50

4652

..

15.00

5.00

4821

..

110.00

5.00

4654

..

17.00

5.00

4824

..

115.00

5.00

4656

..

21.50

5.00

4826

..

115.00

5.00

4659

..

4.30

1.50

4829

..

14.50

4.00

4661

..

12.00

4.00

4833

..

16.50

5.00

4664

..

10.50

3.00

4840

..

19.00

5.00

4666

..

13.50

4.00

4842

..

23.00

 5.00

4668

..

2.60

1.00

4846

..

33.00

5.00

4669

..

2.60

1.00

4849

..

49.00

5.00

4671

..

7.60

2.00

4882

..

49.00

5.00

4672

..

7.60

2.00

4857

..

82.00

5.00

4673

..

2.10

1.00

4859

..

70.00

5.00

4675

..

35.00

5.00

4861

..

14.00

4.00

4679

..

35.00

5.00

4863

..

19.00

5.00

4680

..

35.00

5.00

4865

..

13.50

4.00

4682

..

54.00

5. 00

4869

..

13.50

4.00

4683

..

11.00

5.00

4871

..

18.00

5.00

4684

..

11.00

5.00

4873

..

30.00

5.00

4685

..

9.00

3.00

4875

..

19.00

5.00

4686

..

9.00

3.00

4878

..

9.50

3.00

4687

..

49.00

5.00

4890

..

66.00

5.00

4688

..

49.00

5.00

4892

..

73.00

5.00

4689

..

66.00

5.00

4894

..

125.00

5.00

4692

..

87.00

5.00

4896

..

68.00

5.00

4695

..

31.00

5.00

4898

..

90.00

5.00


Schedule 7—continued

Number of item in  First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

4903

..

66.00

5.00

5080

..

66.00

5.00

4904

..

82.00

5.00

5082

..

4.00

1.00

4908

..

90.00

5.00

5084

..

40.00

5.00

4913

..

90.00

5.00

5088

..

40.00

5.00

4914

..

105.00

5.00

5090

..

66.00

5.00

4920

..

90.00

5.00

5092

..

150.00

5.00

4923

..

63.00

5.00

5094

..

82.00

5.00

4928

..

82.00

5.00

5096

..

100.00

5.00

4929

..

90.00

5.00

5111

..

80.00

5.00

4932

..

95.00

5.00

5115

..

87.00

5.00

4936

..

73.00

5.00

5117

..

40.00

5.00

4938

..

66.00

5.00

5121

..

100.00

5.00

4941

..

49.00

5.00

5123

..

23.00

5.00

4945

..

56.00

5.00

5126

..

35.00

5.00

4947

..

13.00

4.00

5129

..

11.50

3.00

4951

..

28.00

5.00

5134

..

40.00

5.00

4953

..

40.00

5.00

5137

..

4.00

1.00

4956

..

82.00

5.00

5139

..

6.60

2.00

4958

..

90.00

5.00

5142

..

82.00

5.00

4960

..

82.00

5.00

5146

..

23.00

5.00

4962

..

82.00

5.00

5348

..

11.50

3.00

4964

..

66.00

5.00

5151

..

27.00

5.00

4966

..

115.00

5.00

5154

..

19.00

5.00

4968

..

150.00

5.00

5156

..

13.50

4.00

4971

..

66.00

5.00

5159

..

8.00

2.00

4973

..

82.00

5.00

5164

..

19.00

5.00

4975

..

73.00

5.00

5168

..

19.00

5.00

4977

..

90.00

5.00

5177

..

56.00

5.00

4980

..

82.00

5.00

5180

..

49.00

5.00

4982

..

82.00

5.00

5183

..

66.00

5.00

4984

..

100.00

5.00

5187

..

66.00

5.00

4986

..

82.00

5.00

5189

..

61.00

5.00

4988

..

100.00

5.00

5195

..

61.00

5.00

4992

..

115.00

5.00

5197

..

23.00

5.00

5000

..

56.00

5.00

5200

..

31.00

5.00

5003

..

66.00

5.00

5203

..

40.00

5.00

5005

..

66.00

5.00

5207

..

61.00

5.00

5008

..

82.00

5.00

5209

..

63.00

5.00

5011

..

2.30

1.00

5211

..

73.00

5.00

5013

..

11.00

3.00

5213

..

23.00

5.00

5017

..

14.00

4.00

5215

..

49.00

5.00

5020

..

15.00

4.00

5219

..

82.00

5.00

5022

..

19.00

5.00

5226

..

15.00

4.00

5025

..

8.00

2.00

5231

..

15.00

4.00

5027

..

8.00

2.00

5234

..

40.00

5.00

5030

..

23.00

8.00

5238

..

66.00

5.00

5033

..

19.00

5.00

5242

..

6.60

2.00

5035

..

27.00

5.00

5247

..

66.00

5.00

5039

..

61.00

5.00

5250

..

9.00

3.00

5042

..

21.00

5.00

5253

..

31.00

5.00

5044

..

40.00

5.00

5255

..

40.00

5.00

5046

..

28.00

5.00

5258

..

82.00

5.00

5049

..

40.00

5.00

5263

..

40.00

5.00

5053

..

49.00

5.00

5265

..

82.00

5.00

5054

..

61.00

5.00

5267

..

4.00

1.00

5057

..

28.00

5.00

5271

..

40.00

5.00

5058

..

36.00

5.00

5273

..

75.00

5.00

5061

..

90.00

5.00

5275

..

23.00

5.00

5063

..

61.00

5.00

5279

..

15.00

4.00

5065

..

61.00

5.00

5290

..

15.00

4.00

5069

..

66.00

5.00

5292

..

18.00

5.00

5071

..

36.00

5.00

5293

..

23.00

5.00

5074

..

73.00

5.00

5297

..

23.00

5.00

5076

..

56.00

5.00

5299

..

82.00

5.00


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

5302

..

28.00

5.00

5603

..

45.00

5.00

5304

..

26.00

5.00

5604

..

56.00

5.00

5307

..

49.00

5.00

5608

..

45.00

5.00

5309

..

56.00

5.00

5609

..

56.00

5.00

5315

..

44.00

5.00

5615

..

50.50

5.00

5321

..

15.00

4.00

5617

..

64.00

5.00

5326

..

15.00

4.00

5621

..

63.00

5.00

5331

..

19.00

5.00

5623

..

95.00

5.00

5365

..

6.60

2.00

5629

..

68.00

5.00

5368

..

4.50

1.50

5633

..

58.00

5.00

5373

..

7.30

2.00

5638

..

35.00

5.00

5377

..

7.30

2.00

5639

..

45.00

5.00

5379

..

11.50

3.00

5643

..

35.00

5.00

5381

..

14.50

4.00

5645

..

45.00

5.00

5384

..

9.00

3.00

5650

..

49.00

5.00

5386

..

11.50

3.00

5657

..

23.00

5.00

5391

..

5.00

1.50

5660

..

35.00

5.00

5395

..

7.30

2.00

5664

..

5.70

1.50

5400

..

5.00

1.50

5670

..

16.50

5.00

5405

..

9.00

3.00

5672

..

28.00

5.00

5406

..

11.50

3.00

5676

..

54.00

5.00

5412

..

21.00

5.00

5682

..

5.50

1.50

5417

..

28.00

5.00

5684

..

3.60

1.00

5421

..

105.00

5.00

5688

..

30.00

5.00

5430

..

59.00

5.00

5690

..

38.00

5.00

5432

..

3.60

1.00

5695

..

35.50

5.00

5435

..

59.00

5.00

5696

..

45.00

5.00

5440

..

59.00

5.00

5700

..

54.00

5.00

5446

..

33.00

5.00

5707

..

28.00

5.00

5450

..

12.00

4.00

5709

..

35.00

5.00

5465

..

9.50

3.00

5716

..

30.00

5.00

5468

..

20.00

5.00

5717

..

38.00

5.00

5469

..

26.00

5.00

5740

..

8.00

2.00

5478

..

35.00

5.00

5752

..

39.00

5.00

5479

..

45.00

5.00

5755

..

52.00

5.00

5484

..

44.00

5.00

5759

..

39.00

5.00

5485

..

54.00

5.00

5761

..

52.00

5.00

5496

..

50.50

5.00

5765

..

28.00

5.00

5497

..

62.00

5.00

5768

..

16.50

4.00

5502

..

13.50

4.00

5771

..

34.00

5.00

5506

..

45.00

5.00

5776

..

54.00

5.00

5514

..

59.00

5.00

5781

..

33.00

5.00

5521

..

56.00

5.00

5784

..

56.00

5.00

5526

..

5.50

1.50

5787

..

70.00

5.00

5528

..

5.50

1.50

5789

..

78.00

5.00

5532

..

3.40

1.50

5797

..

90.00

5.00

5536

..

13.00

4.00

5801

..

42.00

5.00

5538

..

16.50

5.00

5805

..

54.00

5.00

5544

..

18.50

5.00

5808

..

63.00

5.00

5546

..

24.00

5.00

5811

..

90.00

5.00

5549

..

11.50

3.00

5815

..

34.00

5.00

5550

..

13.50

4.00

5817

..

45.00

5.00

5555

..

6.60

2.00

5820

..

63.00

5.00

5558

..

8.00

3.00

5823

..

90.00

5.00

5563

..

10.50

3.00

5825

..

9.00

3.00

5564

..

13.00

4.00

5829

..

6.90

2.00

5570

..

17.00

5.00

5832

..

38.00

5.00

5581

..

12.50

4.00

5835

..

9.00

3.00

5582

..

16.00

4.00

5839

..

22.00

5.00

5587

..

12.50

4.00

5841

..

27.00

5.00

5590

..

16.00

4.00

5844

..

16.50

4.00

5591

..

14.00

4.00

5860

..

42.00

5.00

5592

..

17.00

5.00

5863

..

59.00

5.00

5599

..

45.00

5.00

5865

..

49.00

5.00


Schedule 7—continued

Number of item in First Schedule

Fond medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

 

$

$

5867

..

63.00

5.00

6093

..

22.00

5.00

5870

..

63.00

5.00

6096

..

7.60

2.00

5872

..

54.00

5.00

6103

..

14.00

4.00

5874

..

38.00

5.00

6106

..

115.00

5.00

5877

..

4.00

2.00

6111

..

85.00

5.00

5880

..

4.00

1.00

6117

..

115.00

5.00

5882

..

1.50

2.00

6121

..

115.00

5.00

5884

..

9.00

3.00

6125

..

145.00

5.00

5886

..

31.00

5.00

6129

..

51.00

5.00

5890

..

9.50

3.00

6134

..

34.00

5.00

5893

..

1.95

.80

6139

..

24.00

5.00

5895

..

6.20

1.50

6145

..

85.00

5.00

5898

..

16.50

4.00

6150

..

39.00

5.00

5900

..

18.00

5.00

6153

..

85.00

5.00

5902

..

6.20

1.50

6156

..

115.00

5.00

5904

..

115.00

5.00

6161

..

14.00

4.00

5907

..

75.00

5.00

6168

..

20.00

5.00

5913

..

5.20

1.50

6171

..

48.00

5.00

5914

..

16.00

5.00

6174

..

105.00

5.00

5917

..

9.00

3.00

6178

..

85.00

5.00

5921

..

22.00

5.00

6183

..

51.00

5.00

5923

..

60.00

5.00

6188

..

31.00

5.00

5925

..

54.00

5.00

6193

..

165.00

5.09

5932

..

38.00

5.00

6200

..

165.00

5.00

5934

..

100.00

5.00

6206

..

240.00

5.00

5939

..

44.00

5.00

6210

..

165.00

5.00

5942

..

25.00

5.00

6213

..

190.00

5.00

5944

..

23.00

5.00

6250

..

1.95

.80

5950

..

54.00

5.00

6254

..

4.70

1.50

5952

..

67.00

5.00

6257

..

5.70

1.50

5955

..

59.00

5.00

6260

..

21.00

5.00

5957

..

45.00

5.00

6264

..

23.00

5.00

5961

..

28.00

5.00

6266

..

6.20

1.50

5965

..

45.00

5.00

6268

..

7.10

2.00

5970

..

90.00

5.00

6270

..

6.60

1.50

5974

..

23.00

5.00

6273

..

15.00

4.00

5978

..

75.00

5.00

6275

..

9.50

3.00

5982

..

100.00

5.00

6276

..

12.00

3.00

5987

..

28.00

5.00

6281

..

16.00

4.00

5991

..

12.50

4.00

6282

..

19.50

5.00

5995

..

49.00

5.00

6287

..

36.00

5.00

5999

..

75.00

5.00

6288

..

36.00

5.00

6004

..

7.30

2.00

6293

..

40.00

5.00

6006

..

5.90

1.50

6294

..

40.00

5.00

6009

..

37.00

5.00

6298

..

73.00

5.00

6011

..

44.00

5.00

6301

..

35.00

5.00

6014

..

53.00

5.00

6304

..

14.50

4.00

6018

..

29.00

5.00

6305

..

18.00

5.00

6020

..

33.00

5.00

6312

..

35.00

5.00

6026

..

32.00

5.00

6317

..

61.00

5.00

6031

..

33.00

5.00

6319

..

100.00

5.00

6051

..

5.70

1.50

6323

..

31.00

5.00

6055

..

8.20

3.00

6329

..

12.00

5.00

6059

..

7.30

2.00

6330

..

16.00

5.00

6063

..

3.70

1.00

6334

..

18.00

5.00

6067

..

8.20

3.00

6339

..

38.00

5.00

6071

..

39.00

5.00

6341

..

85.00

5.00

6074

..

78.00

5.00

6346

..

120.00

5.00

6076

..

115.00

5.00

6351

..

210.00

5.00

6080

..

85.00

5.00

6356

..

31.00

5.00

6082

..

115.00

5.00

6357

..

39.00

5.00

6085

..

60.00

5.00

6362

..

90.00

5.00

6087

..

34.00

5.00

6369

..

48.00

5.00

6091

..

105.00

5.00

6370

..

61.00

5.00


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

6375

..

63.00

5.00

 

includes the symbol ‘(D)’) relating to the dislocation concerned, plus one-half of that amount

includes the symbol ‘(D)’) relating to the dislocation concerned, plus one-half of that amount

6376

..

80.00

5.00

6380

..

90.00

5.00

6385

..

90.00

5.00

6390

..

75.00

5.00

6394

..

67.00

5.00

6395

..

210.00

5.00

6399

..

110.00

5.00

6658   ..

The amount shown in this column in the item (being an stem relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the dislocation concerned, plus one-half of that amount

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the dislocation concerned, plus one-half of that amount

6405

..

54.00

5.00

 

6408

..

61.00

5.03

6411

..

120.00

5.00

6421

..

39.00

5.00

6429

..

61.00

5.00

6433

..

75.00

5.00

6440

..

210.00

5.00

6444

..

120.00

5.00

6450

..

90.00

5.00

6457

..

82.00

5.00

6461

..

82.00

5.00

6466

..

82.00

5.00

6474

..

85.00

5.00

6479

..

105.00

5.00

6484

..

90.00

5.00

6490

..

47.00

5.00

6492

..

47.00

5.00

6500

..

81.00

5.00

6504

..

60.00

5.00

6675

..

3.60

1.00

6511

..

54.00

5.00

6678

..

7.60

2.00

6540

..

3.90

1.00

6679

..

10.50

3.00

6541

..

3.90

1.00

6682

..

5.20

1.50

6547

..

2.40

1.00

6684

..

10.50

3.00

6548

..

2.40

1.00

6685

..

10.50

4.00

6556

..

6.40

1.50

6689

..

12.00

3.00

6560

..

7.30

2.00

6690

..

16.50

5.00

6565

..

6.40

1.50

6693

..

5.90

3.50

6571

..

5.00

1.50

6695

..

10.50

3.00

6579

..

8.00

3.00

6696

..

12.00

4.00

6583

..

5.90

1.50

6710

..

13.00

4.00

6588

..

11.00

3.00

6711

..

14.00

5.00

6589

..

13.50

4.00

6716

..

10.50

3.00

6597

..

2.40

1.00

6720

..

11.50

3.00

6603

..

7.30

2.00

6721

..

11.50

4.00

6608

..

17.00

5.00

6725

..

11.00

3.00

6609

..

23.00

5.00

6616

..

12.50

4.00

6726

..

13.00

4.00

6617

..

16.50

4.00

6731

..

14.50

4.00

6630

..

5.90

1.50

6732

..

11.00

5.00

6635

..

9.00

3.00

6733

..

14.00

4.00

6640

..

2.90

1.00

6734

..

11.00

5.00

6644

..

7.30

2.00

6737

..

8.00

2.00

6738

..

7.50

3.00

6649

..

21.00

5.00

6745

..

9.00

3.00

6653

..

21.00

5.00

6749

..

1.95

.80

6657

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that

The amount shown in this column in the item (other than an item relating to an stem in the table of Commonwealth medical benefits that

6750

..

2.60

1.00

 

6755

..

13.50

4.00

6756

..

18.00

5.00

6759

..

10.50

3.00

6760

..

13.50

4.00

6763

..

33.00

5.00

6764

..

45.00

5.00

6769

..

8.80

2.00

6770

..

9.50

3.00

6775

..

8.00

3.00

6776

..

12.50

4.00

6779

..

21.00

5.00


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

6780

..

28.00

5. 00

6911

..

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-third of that amount

The amount shown in this column in the item (being an item relating to an item in the Sable of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-third of that amount

6783

..

21.00

5.00

 

 

6784

..

28.00

5.00

6787

..

21.00

5.00

6788

..

28.00

5.00

6793

..

7.80

2.00

6794

..

10.50

3.00

6797

..

3.10

1.00

6801

..

5.00

1.50

6803

..

7.60

2.00

6808

..

760

2.00

6812

..

1.95

.80

6813

..

2.60

1.00

6825

..

1.95

.80

6826

..

2.60

1.00

6829

..

7.00

3.00

6830

..

7.00

4.00

6834

..

40.00

5.00

6838

..

8.20

3.00

6839

..

11.50

3.00

6915

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes tile symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

6840

..

11.50

3.00

 

 

6844

..

26.00

5.00

6845

..

26.00

5.00

6850

..

28.00

5.00

6851

..

28.00

5.00

6854

..

10.50

3.00

6855

..

13.50

4.00

6856

..

13.50

4.00

6362

..

35.00

5.00

6863

..

35.00

5.00

6866

..

38.00

5.00

6867

..

38.00

5.00

6875

..

9.00

3.00

6876

..

12.00

4.00

6877

..

12.00

4.00

6882

..

1.95

.80

6883

..

2.60

1.00

6916

..

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

6887

..

1.95

.80

 

 

6888

..

2.60

1.00

6893

..

16.50

4.00

6895

..

28.00

5.00

6897

..

75.00

5.00

6810

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-third of that amount

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture, concerned, plus one-third of that amount

 

6919

..

The amount shown in this column in the item (other than an item relating to an item in the table of Common-

The amount shown in this column in the item relating to the fracture concerned, plus one-half of that amount

 

 


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

 

 

$

$

wealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

 

 

symbol‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

symbol ‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

6935

..

One-half of the amount shown in this column in the item (other than an Item relating to an item in the table of Commonwealth medical benefits that includes the symbol‘(D)’) that would, but for item 6935 in the table of Commonwealth medical benefits apply to the reduction concerned

One-half of the amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6935 in the table of Commonwealth medical benefits apply to the reduction concerned

 

 

6920

..

The amount shown in this column in the item (being as item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-half of that amount

 

 

 

 

6925

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus three-quarters of that amount

 

 

6936

..

One-half of the amount shown in this column in the item that would, but for item 6936 in the table of Commonwealth medical benefits apply to the reduction concerned

One-half of the amount shown in this column in the item that would, but for item 6936 in the table of Commonwealth medical benefits apply to the reduction concerned

 

 

6943

..

One-half of the amount shown In this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol‘(D)’)

One-half of the amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’)

 

6926

..

The amount shown in. this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the

 

 


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

 

that would, but for item 6943 in the table of Commonwealth medical benefits apply to the reduction concerned

that would, but for item 6943 in the table of Commonwealth medical benefits apply to the reduction concerned

 

benefits apply to the reduction concerned

benefits apply to the reduction concerned

6956

..

The amount shown in this column in the item that would apply in the case of a simple and uncomplicated fracture of the part, concerned

The amount shown in this column in the item that would apply in the case of a simple and uncomplicated fracture of the part concerned

 

 

6944

..

One-half of the amount shown in this column in the item that would, but for item 6944 in the table of Commonwealth medical benefits apply to the reduction concerned

One-half of the amount shown in this column in the item that would, but for item 6944 in the table of Commonwealth medical benefits apply to the reduction concerned

 

 

6960

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

 

 

6950

..

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) that would, but for item 6950 in the table of Commonwealth medical benefits apply to the reduction concerned

The amount shown in this column in the item (other than an item relating to an item in the table of Commonwealth medical benefits that includes (he symbol ‘(D)’) that would, but for item 6950 in the table of Commonwealth medical benefits apply to the reduction concerned

 

 

 

 

6961

..

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

The amount shown in this column in the item (being an item relating to an item in the table of Commonwealth medical benefits that includes the symbol ‘(D)’) relating to the fracture concerned, plus one-fifth of that amount

 

6951

..

The amount shown in this column in the item that would, but for item 6951 in the table of Commonwealth medical

The amount shown in this column in the item that would, but for item 6951 in the table of Commonwealth medical

 

 

 

7000

..

22.00

5.00

7004

..

22.00

5.00

7007

..

1.50

1.00

7009

..

2.40

1.00

7012

..

6.20

1.50

7017

..

5.50

3.00

7018

..

7.50

3.00

7024

 

9.50

3.00


 

Schedule 7—continued

 

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

7026

..

9.50

3.00

7320

..

36.75

5.00

7030

..

85.00

5.00

7322

..

43.00

5.00

7034

..

30.00

5.00

7327

..

17.00

5.00

7036

..

30.00

5.00

7330

..

22.00

5.00

7039

..

8.50

3.00

7335

..

52.00

5.00

7040

..

11.00

3.00

7337

..

39.00

5.00

7049

..

7.50

3.00

7345

..

30.00

5.00

7053

..

8.50

3.00

7347

..

17.00

5.00

7059

..

14.00

4.00

7349

..

22.00

5.00

7064

..

24.00

5.00

7350

..

22.00

5.00

7071

..

24.00

5.00

7357

..

21.00

5.00

7077

..

130.00

5.00

7358

..

27.00

5.00

7083

..

42.00

5.00

7362

..

18.00

5.00

7086

..

27.00

5.00

7366

..

24.00

5.00

7090

..

61.00

5.00

7369

..

24.00

5.00

7094

..

110.00

5.00

7371

..

30.00

5.00

7102

..

95.00

5.00

7375

..

34.00

5.00

7110

..

120.00

5.00

7379

..

56.00

5.00

7115

..

110.00

5.00

7383

..

85.00

5.00

7119

..

145.00

5.00

7385

..

47.00

5.00

7123

..

105.00

5.00

7338

..

56.00

5.00

7127

..

145.00

5.00

7393

..

54.00

5.00

7131

..

73.00

5.00

7398

..

56.00

5.00

7137

..

56.00

5.00

7403

..

12.50

4.00

7142

..

73.00

5.00

7405

..

27.00

5.00

7144

..

73.00

5.00

7414

..

23.00

5.00

7147

..

52.00

5.00

7415

..

30.00

5.00

7150

..

47.00

5.00

7418

..

34.00

5.00

7168

..

42.00

5.00

7421

..

11.50

3.00

7169

..

45.00

5.00

7422

..

14.00

4.00

7174

..

22.00

5.00

7425

..

22.00

5.00

7179

..

24.00

5.00

7428

..

29.00

5.00

7183

..

66.00

5.00

7429

..

37.00

5.00

7187

..

78.00

5.00

7433

..

9.50

3.00

7191

..

11.00

5.00

7437

..

14.00

4.00

7196

..

7.60

2.00

7439

..

8.50

3.00

7201

..

39.00

5.00

7441

..

22.00

5.00

7207

..

44.00

5.00

7445

..

42.00

5.00

7211

..

39.00

5.00

7447

..

115.00

5.00

7215

..

27.00

5.00

7449

..

56.00

5.00

7219

..

105.00

5.00

7452

..

24.00

5.00

7229

..

70.00

5.00

7455

..

13.50

4.00

7235

..

70.00

5.00

7456

..

17.00

5.00

7239

..

90.00

5.00

7460

..

17.00

5.00

7243

..

130.00

5.00

7465

..

19.00

5.00

7247

..

52.00

5.00

7469

..

30.00

5.00

7254

..

70.00

5.00

7475

..

14.00

4.00

7258

..

34.00

5.00

7479

..

37.00

5.00

7264

..

17.00

5.00

7481

..

34.00

5.00

7267

..

39.00

5.00

7484

..

56.00

5.00

7269

..

52.00

5.00

7487

..

70.00

5.00

7272

..

39.00

5.00

7491

..

95.00

5.00

7276

..

37.00

5.00

7277

..

47.00

5.00

7493

..

70.00

5.00

7281

..

56.00

5.00

7496

..

34.00

5.00

7286

..

2.60

1.00

7500

..

34.00

5.00

7288

..

2.80

1.00

7501

..

47.00

5.00

7294

..

34.00

5.00

7504

..

47.00

5.00

7296

..

52.00

5.00

7507

..

44.00

5.00

7299

..

30.00

5.00

7511

..

44.00

5.00

7302

..

17.00

5.00

7515

..

41.00

5.00

7303

..

22.00

5.00

7518

..

47.00

5.00

7308

..

29.00

5.00

7522

..

47.00

5.00

7311

..

41.00

5.00

7525

..

34.00

5.00

7317

..

28.75

5.00

7526

..

47.00

5.00


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

$

$

7555

..

6.50

3.00

7796

..

3.90

1.00

7558

..

4.10

1.00

7800

..

4.00

2.00

7562

..

4.80

1.50

7801

..

4.00

2.00

7564

..

4.10

1.00

7805

..

12.00

4.00

7568

..

5.20

1.50

7806

..

12.00

4.00

7571

..

4.10

1.00

7811

..

16.50

5.00

7574

..

6.40

1.50

7813

..

26.00

5.00

7576

..

4.10

1.00

7816

..

47.00

5.00

7579

..

7.60

2.00

7819

..

66.00

5.00

7583

..

19.00

5.00

7822

..

39.00

5.00

7587

..

4.10

1.00

7825

..

22.00

5.00

7589

..

6.40

1.50

7826

..

22.00

5.00

7592

..

6.40

1.50

7829

..

34.00

5.00

7595

..

6.60

2.00

7833

..

39.00

5.00

7600

..

68.00

5.00

7837

..

18.00

5.00

7604

..

78.00

5.00

7842

..

20.00

5.00

7612

..

78.00

5.00

7846

..

9.00

3.00

7614

..

78.00

5.00

7851

..

36.00

5.00

7617

..

39.00

5.00

7856

..

18.00

5.00

7621

..

61.00

5.00

7869

..

39.00

5.00

7623

..

61.00

5.00

7865

..

30.00

5.00

7628

..

87.00

5.00

7871

..

20.00

5.00

7633

..

78.00

5.00

7875

..

16.50

4.00

7636

..

78.00

5.00

7876

..

16.50

4.00

7639

..

75.00

5.00

7879

..

34.00

5.00

7645

..

17.00

5.00

7882

..

59.00

5.00

7648

..

39.00

5.00

7886

..

22.00

5.00

7651

..

30.00

5.00

7887

..

22.00

5.00

7656

..

95.00

5.00

7890

..

49.00

5.00

7660

..

95.00

5.00

7894

..

39.00

5.00

7663

..

61.00

5.00

7895

..

39.00

5.00

7669

..

52.00

5.00

7899

..

63.00

5.00

7675

..

61.00

5.00

7903

..

75.00

5.00

7679

..

78.00

5.00

7906

..

63.00

5.00

7686

..

39.00

5.00

7910

..

75.00

5.00

7689

..

52.00

5.00

7914

..

8.00

3.00

7692

..

78.00

5.00

7918

..

16.50

5.00

7695

..

30.00

5.00

7922

..

40.00

5.00

7699

..

52.00

5.00

7930

..

78.00

5.00

7702

..

30.00

5.00

7935

..

26.00

5.00

7705

..

78.00

5.00

7939

..

61.00

5.00

7710

..

9.50

3.00

7944

..

70.00

5.00

7713

..

61.00

5.00

7948

..

115.00

5.00

7716

..

45.00

5.00

7955

..

40.00

5.00

7719

..

42.00

5.00

7959

..

75.00

5.00

7722

..

24.00

5.00

7963

..

59.00

5.00

7725

..

9.50

3.00

7964

..

59.00

5.00

7971

 

49.00

5.00

7728

..

13.50

4.00

7972

..

49.00

5.00

7729

..

17.50

5.00

7979

..

49.00

5.00

7733

..

39.00

5.00

7980

..

49.00

5.00

7736

..

9.50

3.00

7991

..

68.00

5.00

7740

..

47.00

5.00

7995

..

39.00

5.00

7742

..

45.00

5.00

7996

..

39.00

5.00

7746

..

56.00

5.00

8004

..

42.00

5.00

7748

..

87.00

5.00

8005

..

42.00

5.00

7752

..

61.00

5.00

8012

..

49.00

5.00

7755

..

8.30

2.00

8013

..

49.00

5.00

7759

..

5.20

1.50

8025

..

49.00

5.00

7780

..

39.00

5.00

8030

..

22.00

5.00

7784

..

13.50

4.00

8034

..

46.00

5.00

7786

..

32.00

5.00

8039

..

26.00

5.00

7790

..

3.70

1.00

8043

..

26.00

5.00

7794

..

3.90

1.00

8047

..

39.00

5.00


Schedule 7—continued

Number of item in First Schedule

Fund medical benefit

Specified excess

Number of item in First Schedule

Fund medical benefit

Specified excess

 

$

$

 

 

$

$

8052

..

42.00

5.00

8121

..

21.00

5.00

8056

..

49.00

5.00

8125

..

42.00

5.00

8064

..

71.50

5.00

8129

..

100.00

5.00

8068

..

110.00

5.00

8133

..

28.00

5.00

8073

..

11.50

3.00

8137

..

54.00

5.00

8078

..

28.00

5.00

8138

..

54.00

5.00

8082

..

28.00

5.00

8146

..

68.00

5.00

8086

..

45.00

5.00

8147

..

64.00

5.00

8090

..

15.00

4.00

8155

..

34.00

5.00

8094

..

59.00

5.00

8156

..

34.00

5.00

8098

..

44.00

5.00

8164

..

49.00

5.00

8102

..

12.00

4.00

8165

..

49.00

5.00

8107

..

54.00

5.00

8171

..

49.00

5.00

8112

..

73.00

5.00

8172

..

49.00

5.00

8117

..

28.00

5.00

8177

..

63.00

5.00

 

Interactions

Authorises

All Versions

Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.